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How many more must die?

Retrospectives on the life of Justice Ruth Bader Ginsburg are everywhere this morning. As are previews of how Democrats might fight confirmation of another Donald Trump-Federalist Society justice before the next inauguration. Those stories have for now pushed the death count from COVID-19 below the fold if not entirely off the front page.

Ginsburg’s death and the fate of the Supreme Court under Trump are distractions from the still-raging pandemic, though hardly a welcome one.

Meanwhile, early voting has begun in several states. North Carolina voters have returned more than 100,000 absentee ballots since they went into the mail on Sept. 4. In Virginia, Trump supporters intent on voting on Election Day as instructed by Dear Leader are arriving at early voting places to show the flag for their candidate. Literally. And perhaps to intimidate non-Trumpers.

A vigil for Ginsburg held here Saturday drew over 200 people on the first, brisk evening of the fall. Masked, socially distanced, of course. It was the first time I had been around a crowd since late February. But one wonders about the 200,000-plus private remembrances for COVID-19 victims in the U.S. alone. Because there will be more.

Even many of the recovered are merely “recovered.” They are the forgotten COVID-“long haulers,” explain staffers at The Week:

It’s a persistent and wide-ranging set of symptoms that follow a coronavirus infection. Nearly 100 kinds of lingering symptoms and physical damage have been catalogued, including scarred lungs, chronic heart damage, severe headaches, kidney failure, bulging veins, hand tremors, debilitating fatigue, fever, nausea, stomach problems, hair loss, sensitivity to light and sound, blurry vision, loss of taste and smell, short-term memory loss, and a brain fog so dense it can be difficult to write even a simple email. New York City resident Deborah Copaken, 54, was diagnosed with COVID-19 in March and still suffers from shortness of breath and the repeated and sudden onset of a rapid heartbeat so severe that she must lie down in order to avoid passing out. “A few weeks ago,” she said, “I stood up to make a smoothie and my heart rate zoomed from lying-in-a-hammock to booming-bass-drum.” David Putrino, a neuroscientist at Mount Sinai Hospital who has treated many long-haulers, says his patients struggle with a bewildering array of maladies. “It’s like every day, you reach your hand into a bucket of symptoms, throw some on the table, and say, ‘This is you for today.'”

These are not elderly patients. They are mostly female and average 44 years-old. Isabela Pauer of Cleveland, 22, worked out four to five times a week before taking ill. She developed COVID symptoms in Barcelona six months ago and today labors to brush her teeth. “My whole body feels, like, very weighted down,” she said. Studies in Italy, Germany and Great Britain find such lingering effects persist in patients weeks or months after onset of the disease: fatigue, shortness of breath, heart abnormalities, mental fogginess. Figures suggest there could be millions of long-haulers.

Many COVID long-haulers complain that they were denied tests early on in the pandemic because of shortages in diagnostic swabs and restrictions placed on who was eligible for scarce tests. Boston resident Lauren Nichols, 32, got sick in March but was denied a test by her doctor, who said at her age she was in no danger. She finally tested positive, and has suffered a debilitating array of symptoms consistent with those experienced by other long-haulers, including nausea, brain fog, insomnia, and shortness of breath. Complicating matters, said neuroscientist David Putrino, two-thirds of the 1,400 patients he studied did not test positive for COVID antibodies. Some, like Nichols, tested negative for antibodies even after testing positive for the virus itself. That can make it difficult for the afflicted to prove they have COVID and get paid time off from work or qualify for disability benefits. “Just because you’re negative for antibodies,” Putrino said, “doesn’t mean you didn’t have COVID-19.”

Indeed, we knew three people in our county of 260,000 sick in March with classic COVID-19 symptoms at a time there were only 40 official cases. (Today there are 2,871 cases and 81 deaths.) Like Nichols, they did not qualify for testing. Their cases were never counted. Nationally and worldwide, who knows how many victims went uncounted.

What happens with Ginsburg’s replacement on the Supreme Court is important. But perhaps more important is replacing the acting president who has mismanaged this pandemic from the start. Tens of thousands, maybe hundreds of thousands more Americans will die or suffer long-term health effects because this country elected a president with no government experience, no competence, no focus, no ability to learn the job, and no care for anyone but himself.

Former Vice President Joe Biden is Trump’s polar opposite. Yes, the fate of our nation may be at stake in this election. But so are the fates of countless of our neighbors. Their lives will be cut short or permanently damaged if this country does not come to its senses and elect a president committed to stopping the spread of this illness with science and sound leadership, not empty bluster, denial, and quack remedies.

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