Biden is no sure thing for 2024
The midterms were very good to
President Biden. His party avoided the shellacking that it suffered halfway
through President Obama’s first term and the drubbing that Republicans
experienced after two years of President Trump.
After two years of Biden, voters gave
Democrats a gentle slap on the wrist. That makes him look like a miracle worker
and may well muffle chatter about whether he should run for a second term.
But the noise won’t go away entirely.
There’s the matter of Biden’s age, and there’s the matter of Biden’s energy. He
was already the oldest president in American history when he took office at 78.
He’d be just shy of 82 on Election Day in 2024. It shows. He doesn’t project
anything like the ebullience he once did. His flubs transcend malapropisms.
Last month, he erroneously claimed
that student loan forgiveness--which he decreed by executive action--passed
Congress by a few votes. That was the most glaring misstatement of his own
record but hardly the only one. When Robert Costa of CBS News interviewed Rep.
Jim Clyburn, the South Carolina Democrat, just before the midterm results came
in and asked him whether Biden should seek re-election, Clyburn declined to
answer. He said that the Democrats’ decisions going forward should take into
account “who has what capacity to do what,” according to a tweet of Costa’s on
Tuesday night.
Does Biden have the grip and glow to make
certain that Donald Trump or some other Republican doesn’t win the presidency
in two years? Before the midterms, polling showed that a significant majority
of Democrats craved the chance to pick somebody else. I’m not sure that this
week’s results will change that sentiment much. It’s how I feel. But which
somebody? Here’s an assessment (and rough ranking) of various Democrats who
would be possible contenders in 2024 or who are poised to emerge as party
leaders on the far side of Biden, whenever that is.
Many Democrats cringe at the thought
of Kamala Harris as the party’s 2024 nominee. They regard that as party
suicide, pointing to her persistently low approval ratings and her miserable
2020 presidential campaign, which ended before the Iowa caucuses began. But
Biden chose her as a running mate because she has credentials and appeal, and
her current perch would make her the ipso facto front-runner.
“I think she’s one of the reasons
Biden won, and she never got credit for that,” Doug Sosnik, a veteran
Democratic strategist, told me. “She energized the base. She was good on the
stump, and she handled herself well in the debate.” She also made history--she’s
the first woman and first Black woman in the vice presidency--and she’d be
those same firsts in the presidency, an exhilarating prospect that could
dissuade some would-be competitors. Harris would be in an especially strong
position if Biden dallied before deciding against another presidential run; a
compressed time frame could squash candidacies by politicians who still need to
build name recognition, political networks and donor lists.
“There are only two or three people
who can add water and go,” said Bakari Sellers, a former Democratic lawmaker in
South Carolina, which has a pivotal Democratic primary. He named Harris, Pete
Buttigieg and Amy Klobuchar. He left out Bernie Sanders, later saying that
Sanders, 81, is “probably too old.” Buttigieg, 40, would be the second-youngest
American president on Inauguration Day 2025, only a month and a half older than
Theodore Roosevelt. He represents stark generational change. And most of the
Democratic insiders I spoke with predicted that he’d be a formidable candidate,
based on his breakout success in 202-- he essentially came in third, behind
Biden and Sanders, in the Democratic primaries-- and his experience as
transportation secretary.
A gay man with a husband and two children, he,
like Harris, represents progress toward equality. And he has proved to be one
of the party’s gamest and nimblest messengers, his appearances on Fox News and
MSNBC yielding snippets shared widely on social media. “You have to give credit
to a guy who went from being a mediocre mayor of Indiana’s fourth-largest city
to getting the most delegates in Iowa,” said Ari Rabin-Havt, who was Sanders’s
deputy campaign manager in 2020, referring to Buttigieg’s time in South Bend.
“I think he’s the most potent wine-track candidate who exists.”
Rabin-Havt likes to categorize
Democratic candidates as “wine track” (Buttigieg, Elizabeth Warren and other
Democrats favored by voters with more education and money) or “beer track”
(politicians, like Sanders, who are most ardently backed by a less affluent
group). Biden won the nomination because he was acceptable to both contingents.
Can Buttigieg clear that bar? “He was an intellectual force in the Democratic
primaries,” said Joel Benenson, who was Barack Obama’s chief pollster in 2008
and 2012 and whose firm did polling for Buttigieg in 2020. “He may have been a
little too intellectual.” And he didn’t generate excitement among Black voters,
who are critical to Democrats’ fortunes. “Serious candidates and strategists
know that you must show up early and consistently with Black voters because
they rightly see showing up late as checking a box rather than a serious
commitment,” Benenson told me.
Additionally, Buttigieg wouldn’t be the “new
kid on the block” in the 2024 cycle, one longtime Democratic strategist said.
“He’d be treated differently.”
Gretchen Whitmer, a Democrat who just
won re-election by an impressive margin in the key presidential battleground of
Michigan, is Pabst Blue Ribbon with just the right measure of merlot. She
“thinks like a general, looks like a ’40s film star and talks like she’s ice
fishing for muskie,” Sarah Vowell wrote in The Times in August 2020. Vowell
grouped Whitmer with Biden and several other nationally prominent politicians
who, unlike every president since Jimmy Carter, graduated from public
universities (in Whitmer’s case, Michigan State, both college and law school).
She’s also the subject of an adoring song by the Detroit rapper GmacCash, “Big
Gretch.” The nickname took, and it’s gold. Many prominent Democrats urged Biden
to run with Whitmer in 2020--that’s how potent they felt her pull could be.
There’s no reason to think that it has weakened with more experience. And it’s
arguably the right kind of experience. Governors have an easier time separating
themselves from Washington--and from voters’ cynicism about it--than
politicians who’ve been working in the capital for many years.
There will no doubt be some governor
in any post-Biden mix. I don’t spot another with more potential than Whitmer.
“Big Gretch is going to be very formidable,” Sellers said. Nicole Hemmer, a
political scientist at Vanderbilt University and the author of the recently
published book “Partisans: The Conservative Revolutionaries Who Remade American
Politics in the 1900s,” noted that Whitmer “has been targeted by the far right,
so it fits into the narrative of dangers to democracy.” “On paper,” Hemmer
continued, “it makes a lot of sense. I just don’t know if she has that punch to
break through in terms of national media.”
Indeed, Whitmer, 51, hasn’t spent much
time in the national spotlight, so it’s unclear how commanding she’d be on a
larger stage. In a recent debate against her Republican opponent for governor,
Tudor Dixon, she was solid but unspectacular
Amy Klobuchar lasted much longer in
the 2020 primaries than Harris did, and with each passing week, the Minnesota
senator, now 62, honed her message and voice. She could build from there. And
at least in Minnesota, she has shown the ability to win support among
Democratic progressives and moderates alike. But she’s certainly no progressive
darling, and just as a 2024 Democratic field would almost certainly have a
governor in the foreground, it would have a progressive there, too
If Sanders doesn’t run, does Elizabeth Warren--who,
at 73, is eight years his junior--become their standard bearer? She has
undoubtedly learned from her 2020 campaign, which trailed off after an early
surge but revealed her to be not only thoroughly prepared but also dynamic in
debates and on the stump.
I mentioned governors. Roy Cooper, the
Democrat at the helm of North Carolina, has twice been elected in years (2016,
2020) when Trump won North Carolina and when North Carolina Republicans
prevailed in fiercely contested Senate races, too. That amounts to at least
some promise of crossover appeal in rigidly and toxically partisan times.
Cooper, 65, could be a tonic--affable,
sensible, with no whiff of ideologue in him. I may be biased; he’s my governor,
and I think he has done an admirable, balanced job of alternately stymying and
working with the Republicans who control both chambers of the state
legislature. He praises and models the qualities of competence and pragmatism.
Additionally, his current stint as chair of the Democratic Governors
Association means that he has made or strengthened connections beyond his
state, collecting I.O.U.s.
“There’s a charisma issue,” one
Democratic insider, echoing others, confided in me. But, she added, “I do think
his name will be floated, and he’d be an interesting candidate.”
Although Tim Ryan’s loss to J.D. Vance
in the Senate race in Ohio made that state look redder than ever, its voters
just four years ago awarded Sen. Sherrod Brown, a Democrat, a third term--and
they did so by a margin of almost seven percentage points. That’s a testament
to the breadth of his appeal. “If you ask me who in the Democratic Party has
the trust of the progressive community and the pulse of working-class
Americans, that’s Sherrod Brown,” Sosnik told me. “He bridges the wings of the
party.”
But Brown, 70, passed on the 2020
presidential race despite considerable interest in him. Several Democratic
insiders told me that he’s simply too equivocal about his intentions and
ambition to mount a winning presidential campaign.
Gov. J.B. Pritzker of Illinois has won
fans for his fiery moments of refreshing bluntness. “There’s a kind of strange
internet sparkle around Gov. Pritzker,” Hemmer said. The mix of urban and rural
areas in Illinois provides an instructive lesson for a national campaign. And
several Democratic strategists pointed out that if Biden leaves his would-be
successors with little time to raise the money they need, Pritzker, 57, could
fund his own campaign. One strategist quipped that he’d be an especially
fascinating adversary for Trump, “a real billionaire against a fake
billionaire.”
But is a billionaire the right Democratic fit?
The leap from House member to presidential nominee is a big and unlikely one--just
ask Tim Ryan and Eric Swalwell, who failed to make it in 2020--but that might
not prevent Rep. Ro Khanna, a California Democrat, from trying. A strong
communicator who represents Silicon Valley but talks with passion about the
concerns of workers at a lower economic altitude, Khanna is well regarded by
progressives, especially those interested in a changing of the guard.
“I think there is getting to be a
certain wariness among the Democratic base with having the entire leadership of
their party being people with a 1990s mentality about politics,” Rabin-Havt
said, adding that Khanna, a 46-year-old Indian American, departs from that
mentality.
Hemmer concurred that he’s not part of
the Democratic establishment and, if he played his cards right, could wring
that for extra excitement, a particular buzz, “introducing himself to the
American people as a candidate who has not been defined by others and has a
little more breathing room.”
There’s inevitable curiosity about
Bernie Sanders. He has been the Democratic runner-up twice in a row, and he’s
still in the mix, still in the Senate, still revered by many progressives. But
if Biden essentially ages out, can he be succeeded by someone older who had a
heart attack in 2019? I don’t see it. What, then, about a young progressive
like Alexandria Ocasio-Cortez? Her name gets bandied about. But there’s young,
and then there’s 33 years old. She’d reach the minimum age for the presidency,
35, less than a month before Election Day 2024. And she’d bring just six years
of experience in the House to the job. These are wild days in which old rules
fly out the window, but probably not this fast and far.
The eagerness with which Gavin Newsom, 55, has
stepped forward as a voluble defender of liberal values and pugilistic critic
of Ron DeSantis has predictably fed speculation about a presidential candidacy.
And he has the precious credential of big-state governor. But that state is
California, once a harbinger and now more a partisan Rorschach test. And
there’s a preening quality and slickness to Newsom that give many observers
pause and make others--including the writer Josh Barro, who used his Very
Serious newsletter for a savage delineation of the easy case against Newsom--
cringe. And both specifically and metaphorically, can a Newsom candidacy
survive the widely circulated photo of him and his former wife, Kimberly
Guilfoyle, who is now engaged to Donald Trump Jr., stretched out on an
ostentatious rug in a gilded room?
One way to think about Newsom’s
shortcomings versus those of other Democratic presidential prospects: When he
arguably violated his own Covid counsel against large gatherings in California,
it was for a sumptuous feast at the fabled French Laundry in the Napa Valley.
When Whitmer violated hers in Michigan, it was for dinner at a bar and grill
with mozzarella sticks and chili cheese fries on the menu.
Many Democrats still gush about the 2017
speech that Mitch Landrieu, then the mayor of New Orleans, gave about
Confederate monuments and racial reconciliation. It was sublime. And his
current role as a senior adviser and infrastructure coordinator for the Biden
administration has him crisscrossing the country in advantageous ways. But a
Landrieu candidacy elicits the most discussion and excitement from Democratic
intelligentsia. That’s as much curse as blessing.
The next supposedly sentient
acquaintance of mine who suggests that Michelle Obama would or should run for
president is getting deleted from my contacts. The former First Lady is a
profoundly admirable person who has never signaled a scintilla of amenability
to this idea and whose favorability ratings would plummet the minute she was in
the fray rather than above it.
--Frank Bruni, New York Times
How dining out has changed
Restaurants are crowded again, but
customers complain of high prices and spotty service. Is this a new normal?
Here's everything you need to know:
What's causing the change? The pandemic and its continuing economic
consequences have made eating out a costlier and often less pleasant
experience. COVID was an unprecedented disaster for restaurants: Between 2020
and 2021, the industry laid off or furloughed 8 million workers and lost $280
billion in sales. At least 90,000 eateries shuttered. Those that survived had
to adapt with outdoor dining and a greater reliance on takeout and delivery,
which accounted for 90 percent of all restaurant meals sold in 2020.
Vaccination, a reduction in health
risks, and the lifting of some pandemic restrictions have sent a flood of
diners back — even more than in the pre- 2/5 COVID era, according to data from
reservation platform OpenTable. But though the $898 billion in sales
restaurants projected for this year represents a $34 billion increase over
2019, 85 percent of owners say their business remains less profitable now than
before 2020. In a May survey, 41 percent said they couldn't make rent. The
average price of commercially prepared meals rose 8.5 percent between September
2021 and September 2022. The price of a McDonald's Big Mac broke $6 earlier
this year, and for high-end burgers in major cities such as New York, diners
are paying upwards of $30 (without fries or a drink) before tax and tip.
Diners have also complained about
shorter business hours, longer wait times, and less attentive service.
"The industry is unlikely to ever completely return to its pre-pandemic
state," said Hudson Riehle of the National Restaurant Association.
Why are so many restaurants
struggling? The costs of doing business have soared. Overall food prices have
risen about 11 percent over the past year, and factors such as high energy
prices, drought, the war in Ukraine, and an ongoing outbreak of avian influenza
are pushing the costs of some staples much higher. The USDA estimates the price
of cooking oil, butter, and other fats will rise as much as 24 percent this
year, and egg prices are expected to double.
Availability of supplies and labor has also
grown unpredictable. Supply chain snarls delayed or created shortages of needed
ingredients for 96 percent of restaurant owners last year, forcing 6 in 10
full-service establishments to reduce menu options. And while the nation
regained 1.7 million food service jobs in 2021, 7 in 10 restaurants do not have
enough workers.
Why not? Many frustrated, burned-out employees
have handed in their aprons. The quit rate in the accommodation and food
services sector surpassed 10 percent last December and remains over 6 percent,
Labor Department data show. The restaurant industry is still short about
500,000 workers, including waiters, cooks, and dishwashers. Restaurant work
often entails physically demanding labor for long, irregular hours and low pay
in crowded spaces where COVID can easily spread.
When their co-workers quit, those who
remain face a vicious cycle: heavier workloads, pressure to take on more hours,
and even more irate customers grousing about longer wait times. But workers
also have more leverage to demand a more livable wage, benefits and a more
generous sick leave policy. While those improvements increase costs for
restaurant owners, some acknowledge it has been an overdue industry-wide
reckoning.
"Should we be so surprised that people
are quitting," former Chipotle co-CEO Monty Moran said last year,
"when mostly what we're trying to do is manipulate them?"
How have restaurants coped? Sixty
percent have cut hours of operation, and 93 percent have raised or plan to
raise menu prices. They're offering smaller and fewer dishes, often sticking to
those made with ingredients less likely to be affected by supply chain
interruptions. More than half of restaurant owners have employed cost-cutting
tech, such as automated self-service kiosks and digital kitchen displays that
take the place of physical order tickets. Digital QR code menus, popularized
during the pandemic to reduce touching of
surfaces, are likely here to stay, mostly because they let restaurants
easily change the price of menu options or delete them altogether.
What else can diners expect? Customers who
prefer take-out or delivery from fast-food and budget restaurants may find
themselves increasingly served by "ghost kitchens" without dining areas
or storefronts. High-end restaurants, meanwhile, are seeking new revenue by
charging for reservations and launching subscription services. Dame, a
celebrated New York City seafood restaurant, asks diners to pay $1,000 a year
for the privilege of being able to book a table once a week. Robotics startups
are developing AI chefs, cleaners, and servers, though steep up-front price
tags and worries about scaring off customers have made restaurant owners slow
to embrace them.
Higher prices, reduced portions, and
spottier service appear to be here for the foreseeable future. Diners
"want to get back to the old days," said Pittsburgh-area restaurant
owner Ronald Sofranko. "They want to go out, they want to enjoy
themselves. [But] they're not smiling as much as they were."
American restaurant customers are
becoming more miserly tippers. Nearly one-third in an August LendingTree survey
said that inflation has caused them to tip less when they dine out. In effect,
they are punishing the waitstaff for the increase in meal prices. That's in
sharp contrast to the sympathy diners felt for restaurant workers at the height
of the pandemic, when they were widely seen as "essential workers"
who risked their health to make and deliver meals. The average tip at a quick-service restaurant rose from
19.6 percent to 23.5 percent between March and April 2020. But now tips have
fallen to pre-pandemic levels, and with all but eight states allowing a
"subminimum" wage for tipped workers, they're feeling the pain.
Chicago bartender Stacy Donohue has
made less in tips from two jobs this year than she used to earn in one. If
things don't change by January, she plans to leave the restaurant business.
"I'm not making the money that I was making," she said. "I have
to find another avenue."
--The Week
Americans have ‘tip fatigue’
Tipping 20% at a sit-down restaurant
is still the standard however, consumers are less inclined to give as much for
a carry-out coffee or take-away snack.
“Part of it is tip fatigue,” says Eric
Plam, founder and CEO of Uptip. At the Sweetly Bakery & Cafe in Battle
Ground, Washington, near Portland, Oregon, customers seem to be feeling a
little less generous lately. With inflation near record highs and consumers
increasingly cashstrapped, a gratuity isn’t what it used to be.
“Since everything got more expensive,
we’ve seen a decline in tipping,” said Sweetly’s owner, Irina Sirotkina. Like
many other business, the bakery uses a contactless and digital payment method,
which prompts you to leave a tip when you pay. There are predetermined options
ranging from 15% to 25% for each transaction. “We encourage people to tip but
it’s not mandatory, obviously,” Sirotkina said.
Although the average transaction at Sweetly is
less than $20, which means a gratuity would be a few dollars at most, fewer
people leave anything at all. “Only around 1 in 5 people tip,” Sirotkina
estimated. Even though many Americans said they would tip more than usual once
business activities resumed after the Covid pandemic, consumer habits haven’t
changed much in the end. Tipping 20% at a sit-down restaurant is still the
standard, etiquette experts say. But there’s less consensus when it comes to a
carry-out coffee or take-away snack.
Overall, tipping has remained largely
flat at quick-service restaurants, according to Toast’s most recent restaurant
trends report. Tips average 17%, nearly unchanged from a year ago. But when it
comes to takeout, customers are tipping less--now down to 14.5%, on average,
after climbing earlier in the pandemic, the restaurant software vendor found.
Other payment software providers have also reported that these types of tips
have fallen over the last year.
For example, Toast’s rival, Square,
found that the average tip at quick-service restaurants, which includes cafes
and coffee shops, fell from 17.2% to 15.2% from March 2021 to the end of
February, according to a report from The Wall Street Journal.
“Part of it is tip fatigue,” said Eric
Plam, founder and CEO of San Francisco-based startup Uptip, which aims to
facilitate cashless tipping.
“During Covid, everyone was shell-shocked and
feeling generous,” Plam said. Now, “you are starting to see people pull back a
little bit,” he noted, particularly when it comes to point-of-sale tipping,
which prompts customers to tip even before they’ve received the product or service.
“This point-of-sale tipping is what people resist the most,” he said,
“compelling you to tip right there on the spot.”
However, transactions are increasingly
cashless and workers in the service industry are earning minimum or less than
minimum wage so having a method to tip is critical, Plam added. In fact, the
average wage for fast-food and counter workers is $14.34 an hour for full-time
staff and $12.14 for part-time employees-- including tips--according to the
most recent data from the U.S. Bureau of Labor Statistics.
A landmark bill in California aims to raise
the minimum wage to up to $22 an hour for fast-food and quick-service workers
at chains with more than 100 locations nationally. California’s current wage
floor is $15.50 an hour. President Joe Biden and many Democratic lawmakers have
pushed for a $15 hourly wage floor across the U.S. The current federal minimum
wage is $7.25 an hour and has remained unchanged since 2009.
“We are sympathetic but it doesn’t
feel good,” Plam said of point-of-sale tipping. “Now that the pandemic is
essentially over, its starting to shake out now,” he added. “The good news is
we’re rethinking it.
--Jessica Dickler, CNBC
Brain fog: Most misunderstood Long Covid symptom
On March 25, 2020, Hannah Davis was
texting with two friends when she realized that she couldn’t understand one of
their messages. In hindsight, that was the first sign that she had COVID-19. It
was also her first experience with the phenomenon known as “brain fog,” and the
moment when her old life contracted into her current one.
She once worked in artificial
intelligence and analyzed complex systems without hesitation, but now “runs
into a mental wall” when faced with tasks as simple as filling out forms. Her
memory, once vivid, feels frayed and fleeting. Former mundanities— buying food,
making meals, cleaning up—can be agonizingly difficult. Her inner world —what
she calls “the extras of thinking, like daydreaming, making plans,
imagining”—is gone.
The fog “is so encompassing,” she told me, “it
affects every area of my life.”
For more than 900 days, while other
long-COVID symptoms have waxed and waned, her brain fog has never really
lifted. Of long COVID’s many possible symptoms, brain fog “is by far one of the
most disabling and destructive,” Emma Ladds, a primary-care specialist from the
University of Oxford, told me. It’s also among the most misunderstood. It
wasn’t even included in the list of possible COVID symptoms when the
coronavirus pandemic first began.
But 20 to 30 percent of patients
report brain fog three months after their initial infection, as do 65 to 85
percent of the long-haulers who stay sick for much longer. It can afflict
people who were never ill enough to need a ventilator—or any hospital care. And
it can affect young people in the prime of their mental lives.
Long-haulers with brain fog say that
it’s like none of the things that people—including many medical
professionals—jeeringly compare it to. It is more profound than the clouded
thinking that accompanies hangovers, stress, or fatigue.
For Davis, it has been distinct from
and worse than her experience with ADHD. It is not psychosomatic, and involves
real changes to the structure and chemistry of the brain. It is not a mood disorder:
“If anyone is saying that this is due to depression and anxiety, they have no
basis for that, and data suggest it might be the other direction,” Joanna
Hellmuth, a neurologist at UC San Francisco, told me.
And despite its nebulous name, brain
fog is not an umbrella term for every possible mental problem. At its core,
Hellmuth said, it is almost always a disorder of “executive function”—the set
of mental abilities that includes focusing attention, holding information in
mind, and blocking out distractions. These skills are so foundational that when
they crumble, much of a person’s cognitive edifice collapses. Anything
involving concentration, multitasking, and planning—that is, almost everything
important—becomes absurdly arduous.
“It raises what are unconscious processes for
healthy people to the level of conscious decision making,” Fiona Robertson, a
writer based in Aberdeen, Scotland, told me. For example, Robertson’s brain
often loses focus mid-sentence, leading to what she jokingly calls “so-yeah syndrome”:
“I forget what I’m saying, tail off, and go, ‘So, yeah …’” she said. Brain fog
stopped Kristen Tjaden from driving, because she’d forget her destination en
route. For more than a year, she couldn’t read, either, because making sense of
a series of words had become too difficult. Angela Meriquez Vázquez told me it
once took her two hours to schedule a meeting over email: She’d check her
calendar, but the information would slip in the second it took to bring up her
inbox. At her worst, she couldn’t unload a dishwasher, because identifying an
object, remembering where it should go, and putting it there was too
complicated.
Memory suffers, too, but in a
different way from degenerative conditions like Alzheimer’s. The memories are
there, but with executive function malfunctioning, the brain neither chooses
the important things to store nor retrieves that information efficiently.
Davis, who is part of the Patient-Led
Research Collaborative, can remember facts from scientific papers, but not
events. When she thinks of her loved ones, or her old life, they feel distant.
“Moments that affected me don’t feel like they’re part of me anymore,” she
said. “It feels like I am a void and I’m living in a void.”
Most people with brain fog are not so
severely affected, and gradually improve with time. But even when people
recover enough to work, they can struggle with minds that are less nimble than
before. “We’re used to driving a sports car, and now we are left with a
jalopy,” Vázquez said. In some professions, a jalopy won’t cut it. “I’ve had
surgeons who can’t go back to surgery, because they need their executive
function,” Monica Verduzco-Gutierrez, a rehabilitation specialist at UT Health
San Antonio, told me.
Robertson, meanwhile, was studying
theoretical physics in college when she first got sick, and her fog occluded a
career path that was once brightly lit. “I used to sparkle, like I could pull
these things together and start to see how the universe works,” she told me.
“I’ve never been able to access that sensation again, and I miss it, every day,
like an ache.”
That loss of identity was as
disruptive as the physical aspects of the disease, which “I always thought I
could deal with … if I could just think properly,” Robertson said. “This is the
thing that’s destabilized me most.”
Robertson predicted that the pandemic would
trigger a wave of cognitive impairment in March 2020. Her brain fog began two
decades earlier, likely with a different viral illness, but she developed the
same executive-function impairments that long-haulers experience, which then
worsened when she got COVID last year. That specific constellation of problems
also befalls many people living with HIV, epileptics after seizures, cancer
patients experiencing so-called chemo brain, and people with several complex
chronic illnesses such as fibromyalgia. It’s part of the diagnostic criteria
for myalgic encephalomyelitis, also known as chronic fatigue syndrome, or
ME/CFS—a condition that Davis and many other long-haulers now have.
Brain fog existed well before COVID,
affecting many people whose conditions were stigmatized, dismissed, or
neglected. “For all of those years, people just treated it like it’s not worth
researching,” Robertson told me. “So many of us were told, Oh, it’s just a bit
of a depression.” Several clinicians I spoke with argued that the term brain
fog makes the condition sound like a temporary inconvenience and deprives
patients of the legitimacy that more medicalized language like cognitive
impairment would bestow.
But Aparna Nair, a historian of disability at
the University of Oklahoma, noted that disability communities have used the
term for decades, and there are many other reasons behind brain fog’s dismissal
beyond terminology. (A surfeit of syllables didn’t stop fibromyalgia and
myalgic encephalomyelitis from being trivialized.) For example, Hellmuth noted
that in her field of cognitive neurology, “virtually all the infrastructure and
teaching” centers on degenerative diseases like Alzheimer’s, in which rogue
proteins afflict elderly brains.
Few researchers know that viruses can cause
cognitive disorders in younger people, so few study their effects. “As a
result, no one learns about it in medical school,” Hellmuth said. And because
“there’s not a lot of humility in medicine, people end up blaming patients
instead of looking for answers,” she said. People with brain fog also excel at
hiding it: None of the long-haulers I’ve interviewed sounded cognitively
impaired. But at times when her speech is obviously sluggish, “nobody except my
husband and mother see me,” Robertson said.
The stigma that long-haulers
experience also motivates them to present as normal in social situations or
doctor appointments, which compounds the mistaken sense that they’re less
impaired than they claim—and can be debilitatingly draining. “They’ll do what
is asked of them when you’re testing them, and your results will say they were
normal,” David Putrino, who leads a long-COVID rehabilitation clinic at Mount
Sinai, told me. “It’s only if you check in on them two days later that you’ll
see you’ve wrecked them for a week.”
“We also don’t have the right tools
for measuring brain fog,” Putrino said. Doctors often use the Montreal
Cognitive Assessment, which was designed to uncover extreme mental problems in
elderly people with dementia, and “isn’t validated for anyone under age 55,”
Hellmuth told me. Even a person with severe brain fog can ace it. More
sophisticated tests exist, but they still compare people with the population
average rather than their previous baseline. “A high-functioning person with a
decline in their abilities who falls within the normal range is told they don’t
have a problem,” Hellmuth said. This pattern exists for many long-COVID
symptoms: Doctors order inappropriate or overly simplistic tests, whose
negative results are used to discredit patients’ genuine symptoms.
It doesn’t help that brain fog (and long COVID
more generally) disproportionately affects women, who have a long history of
being labeled as emotional or hysterical by the medical establishment. But
every patient with brain fog “tells me the exact same story of
executive-function symptoms,” Hellmuth said. “If people were making this up,
the clinical narrative wouldn’t be the same.”
--Ed Yong, The Atlantic
