From a New York Times, I'm Michael Barbaro. This is The Daily. Today, even as rapidly expanding vaccinations offer a pathway out of the pandemic, there is a small group of people for whom the virus has lingering effects and never seemed to end. My colleague Pam Belic on a rare and cool case of long covid. It's Monday, March 22nd. Yeah, I'm going to try really hard not to get emotional to talk about this since it happened, but we'll take your time and wherever you want to start it, fine with me.

Yeah. PM, tell me about Ivan.

Ivan Eggerton is 50 years old. He lives on Bainbridge Island outside of Seattle with his wife Emily and their three children. He's a former Marine and he has an incredibly cool job getting into this whole documentary, Natural History World.

He is a photographer and he does a lot of adventure photography and a lot of expeditions, and it doesn't pay as much.

But it's nice because I actually feel like I'm contributing to the betterment of our planet.

And his most recent expedition was last fall. He spent two months in the Red Sea in a submarine. Wow. Doing photography and cinematography of all sorts of natural wonders and things that they were discovering down there.

So he spent two months in a submarine in the middle of the pandemic.

Pretty intense. Yeah. I was taking a bunch of comments, as you know, we quarantine before the expedition started and then in order to get off the ship after the expedition was done, we had to test negative. The team took a lot of very strict covid precautions, lots of testing. He tests negative as the expedition ends and we got to know he has to take two or three flights in Cairo from Saudi Arabia to get back to Seattle. And he gets home a little bit before Thanksgiving.

And then I started going down some common cold symptoms and he goes and gets covid tested.

And then I had a positive test. Turns out that he is positive. So quarantined in my bedroom.

Yeah. Which is kind of nice because I was getting room service for many days and it was it was mild.

He doesn't have a very serious case. I lost my sense of smell, mild respiratory symptoms.

He loses his sense of smell.

So this is all sounding pretty routine and pretty run of the mill as covid infections go.

Right? Right. In fact, it sounds like he's pretty lucky.

I came out of isolation and I was fine. My family tested negative. So then and then just a few days later, I got like this spam phone call.

A few days later, he gets kind of an ordinary spam phone call on his cell phone.

One of the things we pick it up and then they actually hang up and write down like a light, switch it up in this van. That's intense paranoia. I mean. And have any was that for some reason, this triggered sort of a cascade of paranoia and delusions when they steadily got worse, every single car that drove by, I was convinced that they were surveilling.

All of a sudden he is convinced that people were spying on him. And then I started thinking that people are listening to my phone. And so I downloaded a police scanner and I started listening to that. And I was convinced that they were talking about me. I took my dog out for a walk and I was walking and I had this police scanner and I hear someone say, oh, you don't want your dog right now is on his way back.

So I was like, wow. And I didn't tell my wife, hey, I only like 36 hours without sleep. Every night that I heard I would get up out of bed now appear out of the window in our bedroom that looks down the street. And we live at the end of this like little cul de sac area. And, you know, I would hear outside our window what I thought were voices outside the window. And this is like two o'clock in the morning.

So I don't know. And I'm walking her dog on the way. It was just to the point where I couldn't sleep and I was absolutely terrified because I didn't know what was happening to me.

Wow. He's really starting to kind of unravel. Yeah. And so I finally grabbed my wife.

And so after keeping this to himself for about 48 hours, he decides that he really needs to tell his wife what's going on.

I'll never forget the moment that he told me, because it was just so out of character for him. I suddenly have fallen on the dresser and I pulled her into a closet. Wow. Well, he pulled me into our closet in our bedroom because he was trying to find the most private space that he could talk. And I closed the closet door. So here's what's been going on with me in the last 48 hours. I know this is going to sound crazy, but, you know, I I believe people are following me and the you know, just the fear in his eyes.

It was bizarre and it was terrifying. I felt like it was a giant hole within me and not even knowing how to process what was happening.

Emily is just stunned. She's she's shocked.

You don't think you're going to have a mental breakdown, right? It's just it just seems so far fetched. Yes.

This is a man she's married to for 18 years. He is unflappable.

Everybody always goes through in a crisis because he's just so rational. So call me on my way. And so we have this training very calm in a crisis.

And she's just really trying to figure out what to make of this all.

So to have your person great in a crisis like experiencing a crisis, that was I mean, for me, just, you know, total helplessness and fear.

So Emily now is trying to figure out how to help Ivan.

He was so sensitive. Right. And that I didn't want him to feel judged or whatever was happening to him. He really believed it.

So for a day or two, she's trying to help him on her own. And she's doing things like taking him to Costco because she thought, well, if we go to Costco, you know, it'll just be kind of like a normal Sunday afternoon and kind of get him out of this trauma that he's experiencing. But that completely backfires because he becomes convinced that the shoppers are kind of plainclothes agents that are watching him come in torture, which really torture for him.

So finally, she in desperation, you know, she calls a friend of hers who's a nurse who has mental health experience.

I called her and I talked about it and we got maybe seven minutes of the conversation. She's like, you need to get to the emergency department right now. Wow. And so I remember coming up and we need to go to the hospital right now. And she was always like, oh, yeah, OK. I was at this point where I was when she said, we're going to the E.R., please give me some work. I think yeah, no, I totally get it scared.

It scared me so bad. And I and and initially, I wasn't thinking about Kopeck. I was just thinking I'm losing my mind. And if I'm losing my mind or my kid's going to lose their mind when they're older, you know, there's something in it that I didn't know about. And so I was I was concerned about that. That was a fluke. And so when she said, let's go to the hospital, take whatever you want to do, I'm on board.

And so at that point, I just let her take over. So she drives over to their local hospital emergency room and the doctors do a brain scan to rule out a brain tumor, and they can't really quite diagnose it themselves.

You know, when I sort of you know, I'm really worried that this is not everything. Right.

I think you there assuming that it may have something to do with the fact that he hasn't been sleeping well, so they send him home with sleeping pills, those two days that were just dreadful.

Yeah.

Some scary things keep getting worse and worse. So Emily starts realizing, you know, they really need some serious psychiatric help for him. And finally, her nurse friend finds a space for Ivan at a hospital in Seattle.

And they get in the car and they start heading there and we check me in the E.R. And then she had to leave because, of course, because of covid protocols, Emily isn't allowed to stay with him.

So she has to leave.

And so I met with the social worker. I met with a doctor, and they decided that inpatient was definitely something that they should do. And while I was in there, they'd actually taken another swab for comment. OK. One of the first things that they do is they test him for covid, but they finally came back while you tested positive.

And it turns out that he is still covid positive. How long had it been since his first covid positive test? Yeah, it's been probably about three and a half weeks at this point. Is that unusual?

Feels a little unusual that he would still be positive. It's not that unusual. What it means most likely is that not that he's still contagious, but he probably has some bit of virus hanging around still in his body. And there are a number of patients who have that. So this is where the medical team starts to think, well, maybe these symptoms are covered, related at that point, and finally decided to move back to the mental health portion of the hospital.

OK.

They move him into a psych ward and he's there with some very severely psychiatrically ill patients, and they put him in a room and he spends a lot of time looking out the window at a parking structure that's outside the window. And he is convinced that people in a car there are there to get him. And he's also. Crying a lot, he's weeping, what I was experiencing was real in my mind, and there was a part of me that was thinking this issue I had and my career is over, my life is over.

That was probably the lowest point of this whole thing. He knows something is happening to him that's not real, but it feels real. What's interesting is you seem to be describing a highly self-aware version of paranoia, somebody who knows that what's happening to him should not be happening. But it's still happening and it's horrifying. Absolutely.

And that is really very unusual for people who have psychosis, which is really what Ivan ends up being diagnosed with. You know, most people who are patients with psychosis either have some kind of chronic situation like schizophrenia, or sometimes they're elderly people who have it as a part of their dementia. And most of the time, patients are in that kind of psychotic realm and aren't realizing that there's another reality out there. But, Ivan, it was almost like double torture for him, because not only is he having these hallucinations and delusions, but half of him is also saying, I'm having these horrible hallucinations and delusions.

And why is this happening? So Ivan is in the hospital for eight days. He misses Christmas with his wife and three kids and he's treated with an antipsychotic that gradually starts to kind of kick in. And then the other thing that he finds helpful is that he sort of buries himself in books to kind of take him out of what was happening. All that sort of starts to help him improve. Paranoia starts to lift. And he is better enough that shortly before New Year's, he's able to return home.

I still have little twinges, mostly like going to bed, and I had my first conversation with him five days later, but I'm probably 85 percent back to normal and whatever normal is.

And it's clear at that point that Ivan and his medical team believe that whatever has been happening with him is connected to covid. Definitely.

And thank you so much. And yeah, thanks. Take care. Bye bye. We'll be right back. The federal minimum wage has been stuck at seven dollars and 25 cents an hour since 2009. Since then, transportation costs have increased 16 percent. Food and beverage costs up eight percent. Housing costs 23 percent. And medical costs have increased 32 percent. In 2018, Amazon introduced to starting wage of at least 15 dollars an hour for all U.S. employees.

Hear from Amazon employees across the country about what our starting wage means to them at Amazon.com. Forward Slash 15.

Hi, I'm Bianca Giaever. I'm a producer on The Daily.

One of the things I love about audio is that there's an intimate quality to people's voices that you sometimes can't get in print. You can hear people wonder out loud. You can hear when they're questioning something, you can be there with them. And when we hit the milestone of a million lives lost to coronavirus around the world, we made an episode. There was a portrait of the grief people were feeling to put a human face to the news. We talked to people in Kenya, in Israel, in Turkey and China.

I spent many, many hours listening to them laugh and cry about the people they had lost. We wouldn't be able to make emotional episodes like this one or any of the daily without your support. So if you can, please subscribe to The New York Times. Thank you. So, Pam, you have been writing about the long term effects of covid-19 for many, many months now. How common is the kind of story that Ivan has described to you?

Well, Ivan's story is pretty uncommon, but it is not unique. There have been probably at this point, dozens of cases of covid linked psychosis reported around the world and in this country. And if you broaden that out to covid related brain effects and neurological effects, we are talking about a lot of people. Psychosis cases are really sort of an extreme version of a spectrum of different brain related and neurological related symptoms that many, many covid survivors are experiencing.

And what are those brain related symptoms? Describe this.

So there have been a lot of reports of something that people are calling brain fog, which is sort of a collection of symptoms that involve things like forgetting what you went into the room for, you know, not being able to organize things, not being able to do very, very simple tasks. I have written about a man who had gone to Paris just before getting covid and this whirlwind trip with his partner and now cannot remember a single thing about his trip to Paris.

He looks at pictures of him and his partner in front of the Mona Lisa and they're smiling and they're in front of the Eiffel Tower. And he says, gosh, it looks like we were really having a good time, but I can't remember anything about it. Wow. I've written about, you know, nurses who sort of forget what patients have told them the minute they leave the exam room in the operating room nurse who can't remember what a scalpel is called.

So she says, you know, give it that thing that we cut with. That's brain fog.

And that is really just one of the brain related neurological issues that people are experiencing. I mean, you've got people who are having trouble smelling and tasting or having phantom smells. There's a lot of people with muscle pain or muscle weakness or headaches and that kind of thing. And studies are starting to come out now that are finding 20 percent, 30 percent, maybe more of covid survivors are experiencing one or more of these kinds of neurological issues. So it's going to be a problem for a long time.

And what exactly do scientists believe is happening here? What is the virus doing to people to trigger these brain related symptoms of the virus?

So there are a few theories that I would say nobody knows exactly yet. But basically what scientists think is happening is not that the virus is getting into people's brains. Instead, what it seems to be doing is that when you get infected with covid, your body responds to the virus. It tries to fight the virus. Right. So you get an immune system response and that immune system response generates inflammation. And what they think is happening is that the body's inflammatory response is not just inflaming the body, but it can inflame what's going on in the brain as well.

And depending on where in the brain that inflammation is happening, it can affect a particular function or set of functions that the brain is used to doing. So maybe it's your memory, maybe its ability to do kind of multitasking. And in very extreme cases like Ivens, it could have something to do with a psychiatric illness.

Right. And so in that sense, people like Ivan become victims of their body's own natural defenses.

Yeah, I think that's the best theory that doctors have come up with. And that theory is buttressed by not only what they're seeing with covid, but for decades there have been cases like this with other viruses from the 1918 flu pandemic to the SARS pandemic to Meurs to meningitis. There are these cases that they call sort of post viral psychosis, and they're different than typical psychosis. And they affect often people like Ivan who don't seem to have any other mental health history.

Pam, I recognize that this is all very new. So with that caveat, what is the understanding of how long a covid related brain symptom like what Ivan has been dealing with is expected to last?

Do we know this is really unchartered territory? No, we don't know. You know, we've had a smattering of cases so far. Some of them have needed several weeks of treatment and they've tried several different kinds of medications. And then some people have gotten better.

Hey, and then hey, how are you? All right. How are you doing? There have been cases where people have had relapses.

You know, I was looking for a little bit. Yeah, just the screaming back.

So and that unfortunately, is is what happened to Ivan.

So it's it's not a switch off like a light switch. I have no idea. Yeah.

By mid-January, he had told me that he was actually feeling 100 percent better or no paranoia and his psychiatrist said he was doing really well. But in the second week of February, Ivan reached out to me a headline and it just triggered.

To get everything back, well, it was a headline, I think he had seen a headline about a police raid and just triggered everything and he said, apparently I can stand back and I'm sorry.

The paranoia came screaming back. We don't know what else to do.

OK, OK. It's starting to become a little overpowering on the sidewalk, but says in the other direction, so. And the day after I talked to him, he was admitted to the psych ward and the hospital again. That must have been really crushing to he and his wife. It was devastating. This relapse and this whole experience feels like such a powerful reminder that the coronavirus has only been with us for a year and there just seems to be so much that we really don't know about it.

And as a result, it feels like Ivan and anybody who has this kind of an outlier becomes this really horrible real life case study that the rest of us are kind of poking and prodding and studying to try to understand.

Yeah, I mean, there is just so much that we don't know. We don't know. Who gets these long term symptoms and why, you know, it's not just people with pre-existing conditions, it's not just people who are hospitalized. It's not just older people. We don't know how long these things last. We don't know what recovery looks like. And very importantly, we don't know what treatment works for many of these things. And for the brain related issues, it's even more difficult because for people who are having a heart problems or lung issues after covid, those are serious and troublesome.

But there are heart medications and there are long medications and there are a lot of things that we know that can help. But right. There's no pill that you can take to clear your brain fog, you know, and so it's really very complicated. There's been one kind of glimmer of potential hope in this area, which is that there are some people with long covid who are reporting that after they get the Kofod vaccine, their symptoms are improving and in some cases vanishing.

And I've had several people tell me these wonderful stories of having like this terrible brain fog for months and months and they get vaccinated. And then, you know, a few days later, it's like, oh, what a beautiful morning, you know? Wow. One woman told me that it was like she was directing Sweeney Todd for months and now all of a sudden she's directing Oklahoma. So that's a very, very theatrical joke.

But she's gone from deep darkness to something brighter.

Yeah, exactly. And it's wonderful. I think maybe we will find that some subset of people with long covid are helped. So has Ivan gotten his vaccine, is there any hope that that might do something for him? No, not yet, but I'm really happy to report that. Hey, how are you? He's home again.

I'm doing all right. Are you OK?

He's feeling much better. He's not 100 percent, but he's getting there.

I still don't have my sense of smell. So something is still damaged in my brain. And so once I recover my sense of smell, my guess is that that's when this will go away and that my brain will be healthy and back to normal. Now, I don't know that this is the layman's kind of. I guess. Yeah, yeah. You know, I hope that's what kind of looking forward to this. Yeah, yeah, yeah. Yeah.

And he's just, you know, really hopeful that he'll be back to the old Ivan again.

I'm tired of picking up the dog shit so I can't smell it. I have to pick it up now. But you know, there's something to look forward to, I guess what I'm saying. Yeah, it's still there still is that underlying that fog. I mean, how long is it kind of day, you know? Pam, thank you very much. We appreciate it. Thank you. We'll be right back. A new independent study looked at the impact of Amazon raising its starting wage to at least 15 million in 2018.

It found that Amazon's pay raise resulted in a four point seven percent increase in the average hourly wage for non Amazon employees in the same area. The study also found no significant job losses in the community after the wage increase. The investments Amazon made in their hourly employees benefited employees, their families and local businesses. Learn more at Amazon.com forward slash 15. Here's what else you need to know today. Officials in at least 20 states have committed to opening vaccine appointments to all adults in March or April ahead of President Biden's deadline of May 1st.

In Ohio, for example, all adults will be allowed to seek shots starting March 29th. In Connecticut, they can obtain the shots beginning April 5th to states. Alaska and Mississippi have already allowed all adults to book appointments. At the same time, the U.S. Centers for Disease Control and Prevention has relaxed the six foot distancing rule for elementary school students, saying they need only remain three feet apart in classrooms as long as everyone is wearing a mask. The new guidance is designed to make it easier to bring students back to school for in-person learning.

Today's episode was produced by Austin Mitchell and Rachelle Banjar. It was edited by Dave Shaw and Lisa Chow and engineered by Corey Schwebel.

That's it for The Daily, I'm Michael Örvar. See you tomorrow. Since 2009, the federal minimum wage has been stuck at seven dollars and 25 cents, but a lot has changed since then. Transportation costs have increased 16 percent. Food and beverage costs up 18 percent. Housing costs 23 percent. And medical costs have increased 32 percent. Amazon raised their starting wage for all U.S. employees to fifteen dollars in 2018. Their employees, their families and communities have seen the impact of dollars starting wage can make.

Learn more at Amazon.com forward slash 15.