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Health | The Atlantic
Health | The Atlantic
The Way Out of Brain Fog
Debbie Gustafson of Dresher, Pennsylvania, was on the trip of a lifetime, touring the Galápagos with her family last March, when she began to feel the effects of COVID-19. Though her physical symptoms—diarrhea, dry cough, chills—were considered mild by doctors, her fatigue was crushing, and her mind was trapped in a fog. Once an avid reader, she couldn’t get through a page. “My eyes darted everywhere. I had no focus,” she told me. Before COVID-19, she’d held two part-time jobs, but she soon had to give up both of them.The cognitive problems emerging from mild to moderate cases of COVID-19 are so new that researchers have struggled to define them. A just-published study led by Igor Koralnik, the director of the Neuro COVID-19 Clinic at Chicago’s Northwestern Memorial Hospital, analyzed the first 100 “long COVID” sufferers who came to the clinic, either in person or via virtual visits. None had ever been hospitalized for COVID-19, yet 85 percent had four or more neurological complaints, including “brain fog”—persistent trouble with focusing, retaining short-term memories, and managing complex tasks. In February, the National Institutes of Health gave long COVID a clinical name: Post-Acute Sequelae of SARS-CoV-2 infection (PASC). But official recognition doesn’t tell us what percentage ofCOVID-19 sufferers experience lingering neurocognitive problems, or how many long-COVID patients there are. “There’s no numerator or denominator for the group yet,” says Sara Manning, a neurologist at the new Post-COVID Assessment and Recovery Clinic at the University of Pennsylvania, one of dozens of such clinics springing up in the United States and worldwide. That Koralnik’s study, like many of the new clinics, probably does not include many people without the resources or connections to find their way to specialized care only increases the uncertainty. “It’s likely there are many millions of these patients in the U.S., and dozens of millions in the world,” Koralnik told me. Like Gustafson, many of them are struggling with brain fog, and with its profound and often frightening disruptions to their daily lives. Now, in the second year of the pandemic, researchers and therapists are beginning to understand how to help them.While identifying long-COVID patients is challenging, helping them through the uncharted territory of their illness is more difficult still. Benjamin Abramoff, the director of Penn’s post-COVID clinic, is a physiatrist with a specialty in spinal-cord injury. Like most U.S. physicians, he was abruptly introduced to COVID-19 a year ago, when hospitals were inundated with critically ill patients—some of whom suffered brain damage from oxygen loss, blood clots, or strokes. Many of those who survived with the help of ventilators emerged, expectedly, with “post-ICU syndrome,” a series of deficits that include memory, attention, and processing-speed impairments. The sickest patients can experience hallucinations and psychoses. “A pneumonia patient in the ICU can be delirious,” Abramoff says. “It’s not a surprise.”But no one was prepared for the second wave of neurocognitive complaints, which came from people who had never been hospitalized. One man in his early 30s, whose physical COVID-19 symptoms had been limited to shortness of breath, appeared in Abramoff’s clinic in January, concerned about his ability to do his job. His work involved keeping many things in his head at once, and he could no longer manage it. Another man, a physician responsible for complex and nuanced diagnoses of heart patients, could not remember phrases that he used every day at work, such as blood pressure. He said he sometimes felt disembodied—depersonalized, as if he were outside of himself.As these new patients—some 350 to date—arrived at the Penn clinic, Abramoff noticed the patterns now codified by Koralnik and his colleagues. For some people, coordinating Zoom calls and emails was too much to handle. Others could no longer work at all. Some began to get better after a couple of weeks or months, but a worrying minority remained ill. Abramoff had never seen so many people with a single viral illness stay so impaired for so long.At Beth Israel Deaconess Medical Center in Boston, patients with milder COVID-19 began requesting help with mental fatigue and concentration problems late last year. The cognitive neurologist Tamara Fong thought they resembled patients with post-concussive syndrome (PCS), which some neurologists hypothesize results from inflammation of the brain. Like PCS patients, many members of the long-COVID group were brain-fogged and depressed. They often had headaches and trouble sleeping.So far, Fong says, the most effective treatments for long COVID resemble those for physical brain injuries. She starts by restoring good sleep hygiene, limiting daytime naps and screen time before bed. She also wants her patients to reduce stress: Because heavy exercise tends to be too taxing at first, she recommends yoga, meditation, or tai chi. “Mindfulness helps,” she told me. After patients are rested and have learned to relax, she helps them recover their cognitive function through steady, gradual practice. Patients might start by reading newspaper headlines and short articles. “Doing too much too fast is like trying to run a marathon without training,” she said.At Penn, therapists also target particular cognitive deficits through regular mental exercises, aiming to stimulate growth of neurons and strengthen their interconnections in affected areas of the brain. Alexandra Merlino, a speech-language pathologist who conducts post-COVID cognitive rehab at the clinic, might ask patients with word-retrieval problems to listen to a podcast and summarize it—concisely and in concrete terms. “Pronouns are not allowed,” she told me. She encourages patients to practice in everyday life, too, by participating more in discussions with friends.To improve memory, Merlino might have patients remember a short grocery list. Over time, her memory-impaired COVID-19 patients can go from recalling three items to six to a dozen or more, both by strengthening the memory center of their brain and by learning to compensate for their acquired deficits. “We teach them tools like association and categorization to remember items,” she said.Because many people with long COVID are hypersensitive to external stimuli, they must also practice their recall in real-world conditions, such as the noise and bright light of a supermarket. Sunglasses or earplugs can help them reduce disruptive stimuli at first, but Merlino tries to gradually increase their exposure. “Maybe they would bring the earplugs and sunglasses,” she said, “but for a few minutes they may try to grocery shop without them and only put them on when they start to experience symptoms.”People can also offset their cognitive symptoms by entering appointments in reminder apps, recording important details in memory journals, and making lists of the steps required to complete a task. “Many of these people have never had memory or organization problems before,” Merlino said, “but suddenly they need to function in the here and now.”For Debbie Gustafson, the Penn-clinic patient, therapy was staged: She needed to recover physical, emotional, and cognitive skills, in that order. Without physical and emotional reserves, addressing cognitive problems would be especially difficult. She went through a six-week “pulmonary-wellness boot camp” to strengthen breathing muscles that had been weakened by COVID-19. Group therapy led by a psychotherapist helped her realize she wasn’t alone. “One of the most important things in this process was just being heard,” she told me. Only then did she begin making simple plans—such as scheduling breakfast between 8 and 9 a.m.—in order to recover her ability to organize. Gustafson now starts each day with a detailed schedule, arranged in tiny increments so that she doesn’t tire herself. One day she might have half an hour for yard work; another day, half an hour for a walk. Reading for 10 minutes a day helps repair the part of her brain involved in memory and focus.Merlino reports improvements for Gustafson and others at the Penn clinic. The majority of patients have noticeably improved after two months, and still more are improved after four, she told me. At Beth Israel, most of Fong’s patients appear to be better by the six-month mark, and many have resumed their pre-COVID responsibilities. But there are caveats. Some 50- and 60-year-olds are returning to jobs before their younger peers, perhaps because the more active, stressful lives of young parents and early-career employees can be more cognitively demanding. Because of these pressures, younger people may need more time to recuperate and regain their capacities. It’s too early to tell whether patients can recover completely. Merlino has seen a couple of patients with minor cognitive deficits apparently recover all their skills and capabilities. But once patients have recovered enough to use the clinic’s strategies at home, they are discharged, and the clinic can no longer keep track of them. “The brain takes a long time to heal, and there is a limit to what insurance companies will cover,” Merlino said. “A lot of my patients have returned to work, and their functioning has definitely improved. In some cases, it has been over a year and they are still not back to work.”The sooner rehab starts, the better the outcome is likely to be, says the neurologist Michael Zandi, a co-founder of a long-COVID clinic at the National Hospital for Neurology in London. While some people may ignore mild symptoms in hopes that they will go away, or delay treatment for fear that word of their symptoms will get out and jeopardize their jobs, Zandi encourages them to seek help: “People should be aware that if they’ve got numbness or weakness, serious memory problems, this could have something to do with their brain.” As researchers and therapists develop treatments for the neurological symptoms of long COVID, other specialists are working to identify its causes. Many think the symptoms result from cytokines, molecules produced by the immune system in response to infection. While it’s not clear to what extent the virus can enter the brain, cytokines can cross the blood-brain barrier, and they may be provoking an inflammatory response. To test the idea, the Columbia University neuroscientist J. John Mann plans to scan patients’ brains in search of a particular protein that is activated during an inflammatory response. In patients with depression and suicidal ideation, Mann has watched levels of that protein surge; he aims to study whether the same is true for those with long COVID.Researchers at Yale also suspect that inflammation generated by the immune system is the cause of many long-COVID symptoms. Like Koralnik, they point to evidence that people already experiencing depression or an autoimmune disease, both of which are associated with inflammation, appear to be at heightened risk of neurological complications from COVID. They have also observed that long-COVID patients have a higher-than-average incidence of psychosis, which might also be linked to inflammation. Serena Spudich, a clinician at the university’s new neuroCOVID-19 clinic, has found inflammatory proteins and antibodies in patients’ blood samples. More alarming, she and her colleagues have also found autoantibodies—immune molecules that attack the patients’ own tissues instead of the pathogen. Spudich speculates that COVID-19 might cause a subtle injury to the blood-brain barrier that allows the autoantibodies to access and attack brain tissue. If that is so, targeted immune-modulating therapies of the sort used for neurodegenerative or autoimmune diseases could help.All of these puzzles will be easier to solve when researchers can include more, and more diverse, patients in their studies. The NeuroCOVID Project, a collaboration between the NIH and NYU, is assembling a repository of blood, tissue, and spinal-fluid samples from large numbers of patients with neurological complications from COVID-19, along with a data bank informed by their physicians. Researchers currently limited to studying small patient groups at elite clinics hope that the project will provide a much fuller picture of patients’ experiences. “Investigators will be able to access the database and the biobank to answer questions of their own priority,” says Andrea Troxel, the project coordinator and director of the biostatistics division at NYU Langone Health. For instance, a few long-haulers have reported some relief of their COVID-19 symptoms following vaccination; the resources of the NeuroCOVID Project could help researchers investigate these anecdotes.COVID-19 infections may be physically disrupting our brains, but life in the age of the coronavirus is scrambling them, too. “In urban environments, in closed spaces, we’ve had to redefine our roles to balance our lives. We’re teaching kids in one room and Zooming all day in another—constant alternating stressors,” says Leo Shea, a senior psychologist at NYU Langone. Like the virus, these conditions can also affect attention, memory, cognition, decision-making abilities, and emotional balance.Seeing the positive amid the losses of the pandemic could be the biggest challenge of all. “I stopped chasing my pre-COVID capacity, because it was causing me to overlook all the progress I had made,” Gustafson told me. After following the Penn clinic’s therapeutic routines day after day for months, she said she feels “like a switch has flipped. I have enough tools now to move forward without fear I will slip back.” A year after getting COVID-19, she’s been able to return to one of her part-time jobs, managing payroll and benefits for a consulting firm. “I’ve slowly worked my way back into it, but it’s different now,” she said. “If something out of the ordinary happens, I am still completely overwhelmed.” Coming back from COVID-19 “is going to be constant learning,” she said—for patients and therapists alike.The Atlantic’s COVID-19 coverage is supported by a grant from the Chan Zuckerberg Initiative.
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theatlantic.com
Vaccine Passports Are Inevitable
Every day, millions of Americans’ immune systems are reprogrammed by sophisticated strands of frozen nucleic acid. They teach our cells to detect and destroy a virus that was totally unknown to our species 18 months ago. The occasion is commemorated with a scribbled-on piece of paper.The American proof-of-vaccination system is, to put it generously, archaic. It hasn’t been a priority amid the crisis. But now some lawmakers are trying to create a more sustainable system to keep track of shots. For example, last month, New York Governor Andrew Cuomo announced a vaccine passport for residents, consisting of a website and smartphone app. The state bills it as “a free, fast, and secure way to present digital proof of vaccination.” Similar systems are already in place in Israel, China, and the United Kingdom, and are being considered elsewhere.Republican leaders have aligned themselves against any such thing. Governors such as Florida’s Ron DeSantis, Texas’s Greg Abbott, and South Dakota’s Kristi Noem have promised to prohibit vaccine passports. Noem, for example, made a stunning comparison to voter-ID laws, accusing those who oppose Georgia’s new voting-rights restrictions but favor vaccine passports of “‘woke’ left” hypocrisy. An opinion piece this week in The Wall Street Journal warned, “Restaurants in most parts of the U.S. have already reopened, at limited capacity in some places. A vaccine passport would prohibit entry by potential customers who haven’t received their shots.” (Emphasis the authors’.)To be clear: Vaccine passports don’t prohibit people from entering restaurants; cities, states, and restaurants do. And a vaccine passport is not like a voter-ID law; it’s more akin to an ID. No one is suggesting you’d need it in order to vote.Falsely conflating the documentation itself with a vaccine requirement is a pervasive argument, but it’s usually either disingenuous or inane. Putting a system in place to help people document their vaccination status is not the same thing as demanding that everyone get vaccinated. Focusing on the very existence of vaccine passports is a distraction that risks dividing people at a moment when unity is crucial.[Read: The threat that COVID-19 poses now]Vaccine requirements have been the subject of heated arguments for as long as inoculation has existed. There is a genuine, important debate to be had. People who support mandatory vaccination cite the collective nature of infectious diseases: If you forgo vaccination, you put your community at risk. It’s not like forgoing sunscreen and getting skin cancer. But for others—even those who support vaccination generally—strict requirements represent a breach of individual bodily autonomy: For the state to mandate an injection of anything (much less something produced by a multinational corporation profiting from the transaction) is simply unconscionable.The American approach has been, historically, to let people do what they want. Individuals have the right to forgo vaccination, just as they have the right to forgo operating a motor vehicle if they don’t want to get a driver’s license. But if they choose not to get vaccinated, they will face limitations on what they can do.Hospitals, for example, can require employees to get particular vaccines; people who don’t want them are free to refrain from working where they could transmit an infectious disease to patients undergoing chemotherapy. School systems can require children to be vaccinated; parents who don’t want their kids to get shots are free to homeschool. The armed forces require personnel to get certain vaccines in order to attend basic training and prior to deployment, to avoid an outbreak in the ranks and potentially putting everyone they defend in peril. In instances when shots are required, private institutions have traditionally required a signed note from a doctor, and recorded their employees’ vaccination status in a database.[Read: The vaccine line is an illusion]The ongoing, expansive distribution of COVID-19 vaccines has prioritized speed and safety over documentation. Instead of being administered exclusively at pharmacies and primary-care offices, shots have been given by podiatrists in empty stadiums, convention centers, and casinos. There is no single, centralized electronic medical record linking these places, no one cloud in which your vaccination status is noted. Your own doctor (if you have one) may have no way of verifying whether you’ve been vaccinated. So far the paper cards handed out at vaccine sites serve as the only evidence.These cards aren’t meant to last long or be carried around. They’re for personal reference. Some people have laminated them, but I wouldn’t know how to go about getting something laminated. Nor would I want to take a big, laminated card with me everywhere I go. Plus, it’s paper with handwriting on it. As official documents go, forgery wouldn’t exactly require a master. (You can already buy one online.)This disjointed system presents a challenge as the United States reopens. Some places—such as hospitals and schools—will inevitably require staff or students to be vaccinated against COVID-19. Already, Brown University and Rutgers have announced that all students must be vaccinated in order to attend the fall semester in person. The hope is that these sorts of requirements will allow schools to return to the normalcy that everyone so desperately wants. Given the unique circumstances of the moment—a still-acute crisis that continues to kill nearly 1,000 Americans every day—COVID-19 vaccine requirements will likely extend beyond schools and hospitals. In Israel, gyms and hotels already require proof of vaccination for employees and patrons. In the U.K., Prime Minister Boris Johnson has indicated that people will soon need proof of vaccination in order to enter a soccer stadium or pub. Enforcing such rules fairly requires a system for verifying vaccination status.President Joe Biden has not endorsed vaccination requirements. In the U.S., such mandates will exist, but will be determined by individual businesses, industries, institutions, cities, and states. This patchwork approach will make reliable documentation only more necessary. If you travel domestically, you may need to prove your vaccination status to go into, say, a theater in New York City, even if your usual theater in Philadelphia doesn’t have such a rule. The people taking tickets at the door will need a centralized registry to check.[Sonny Bunch: Is it safe to go back to the movie theater?]That registry may take the form of an app, a card, or a website. Ultimately, different areas and entities in the U.S. may end up using all three. While the federal government could offer an app that people might use if they wanted—particularly people who travel often between states—White House Press Secretary Jen Psaki has said that the federal government will not maintain a centralized database of who has been vaccinated.Vaccine passports, in some form, are going to be a basic necessity as the United States begins to crawl its way out of the pandemic. Nevertheless, the idea has staunch opponents. The recent Wall Street Journal op-ed called the idea of issuing vaccine passports “unjust and discriminatory,” and suggested that it would somehow lead young, healthy people to jump the line and snap up limited doses of vaccines so they could go to the movies. Such fraud and abuse may be incentivized in the very near term, but that potential will grow more far-fetched as the vaccines become available to more Americans. If passports are likely to incentivize anything, it’s vaccination. The perks of vaccination—say, free Krispy Kreme donuts for the rest of 2021—might be more appealing if a user-friendly system made them easier to claim each morning.The op-ed makes a broader argument, too, that vaccine passports contribute to “a coercive scheme to encourage vaccination.” This is a common strain in conspiracy theories intended to turn vaccination from a public-health tool to a political wedge. But a tool is not inherently coercive. Could it be misused? Sure. Could records of people’s immune status fall into the hands of a scheming demagogue and be used for authoritarian ends? Well, conceivably. Could they be used to divide societies, disenfranchise people, and exacerbate disparities? Theoretically. Could you go to jail if you run a red light and don’t have a vaccine passport? These things are all hypothetically possible. But they would hinge on a malevolent, unchecked government abusing its authority and passing unconstitutional laws. It’s far more likely that vaccine passports would simply help societies reopen and hasten the end of the pandemic.[Listen: The crime of refusing vaccination]Vaccine documentation has a long historical precedent, dating back to the 18th century, and hasn’t resulted in this sort of nightmare before. If you had not been evidently disfigured by smallpox, or did not have an apparent-enough scar on your arm from the primitive inoculation process of the time, then you needed documentation of your immunity in order to enter the U.S. Various states required such proof in order to work or attend school. Privately owned social clubs and businesses also asked for proof, and cities drew quarantine boundaries that could be crossed only with documentation. But the documentation itself was not what restricted individual autonomy. If anything, having a way to demonstrate proof of vaccination gave people more freedom, not less. To this day, federal and state authorities in the U.S. can and do impose quarantine requirements and issue lockdown orders during emergencies. A document proving vaccination could free people from such restrictions.For those who are genuinely concerned about the existence of passports leading to vaccine-based discrimination, the target of debate should be the requirement for vaccines, not for certification once they’re received. If your favorite restaurant institutes a ban on unvaccinated patrons, you could argue about how it is trampling your liberties. Or you could just not eat there.As divisive as vaccination policy can be, a voluntary system for documenting your own vaccination status should be uncontroversial. We should be debating how best to deploy such a system; instead, a basic tool has been misrepresented to fuel a culture war. We are moving toward a vaccine-stratified society, and we will have to work continuously to prevent and minimize the inequities that can arise in any such scenario. This will require a fair, equitable, widely available system for accessing one’s own documentation. As the bioethicist Arthur Caplan explained to me recently on The Atlantic’s Social Distance podcast, we’re likely entering a world where certain establishments may have signs that say something like No shirt, no shoes, no shot, no service. Many people will feel safer inside as a result. Others will object. When division does arise, it will not be helped by having a faction of people who carry around self-laminated certificates.[Listen: No shirt. No shoes. No shots. No service.]While many Americans will inevitably balk at vaccine mandates and sharing health data with elected officials, as a country, we’ve historically proved willing to share that information in exchange for free stuff. Nudges like free donuts may ultimately be what makes Americans comfortable with the idea of a vaccine passport. It’s not just Krispy Kreme. Instacart is now offering a $25 coupon if you’ve been vaccinated. Employees of Target, Amtrak, and McDonald’s get several hours of additional pay.All these measures would likely be more efficient and more fairly executed with a simple vaccine passport. As more and more people are inconvenienced by trying to prove they’ve been vaccinated, the need for an app will become clear. We’ll wonder why this was ever a debate.The Atlantic’s COVID-19 coverage is supported by a grant from the Chan Zuckerberg Initiative.
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theatlantic.com
It Only Took a Pandemic to Get Americans to Go on Vacation
Here’s a cool trick for blowing any American’s mind. Tell us that in France, so many boulangeries shut down for vacation every summer that it can be tough to snag a baguette. Bakers aren’t the only ones who get time off. In August, up to half of the country’s salaried employees have been known to take at least a full week off from work. Half!Americans are good at lots of different things, but going on vacation is not one of them. Every year in parts of Europe, summer turns into a mini-sabbatical. In Norway, during the tradition of fellesferie, the nation simply shuts down for a few weeks of July fun. In Italy, so many people take the last two weeks of August off that Rome’s transit system runs on a reduced “festivi” schedule. Meanwhile, guess which industrialized country is the only one that doesn’t guarantee time off to its workers? Guess which country left 768 million vacation days on the table in 2018? Guess which country … arghhhhhhhh.The pandemic has not been great for America’s vacation malaise. When there are few new places to go and few new things to do, what’s the point of asking for time off? Yes, many Americans who have made it through without losing their jobs have taken a break to discover nature or their apartment balconies, but largely, we do not seem to be PTO-ing our way through this god-awful year. In February, time-off requests on the HR platform Zenefits were down 26 percent from the year before, a spokesperson told me, in line with what the company has seen since July.But something weird is about to happen. This summer, the stars seem to be aligning for vaxxed-up Americans to go PTO wild. After a year in which everyone was cooped up indoors, domestic-travel bookings are going bonkers as people put in their day-off requests and get pumped for some sort of normalcy. It might have taken a global pandemic, but Americans for once seem poised to summer like the Europeans do—that is, if our bosses will let us.[Read: Workism is a making Americans miserable]The roots of what may bloom this summer have been growing all throughout the pandemic. “The pent-up demand is a fire hose that is trying to burst through,” Glenn Fogel, the CEO of Booking.com, told me when I asked about his expectations for post-pandemic travel. On the flight-finding site Kayak, which Booking.com owns, searches for summer travel have been rising as much as 27 percent every week since early March, a spokesperson told me, even as business flyers remain grounded at home and many international destinations remain out-of-bounds for Americans. We can still fly to Mexico, and on Priceline.com, reservations for trips there are up 230 percent from 2019, according to the company.The same vacation boom—sorry, I mean the vacci-cation boom—has struck lodging. “Some hotels, airlines, and travel agencies are telling me that they are seeing double-digit growth on a day-over-day basis,” Henry Harteveldt, a travel-industry analyst, told me. January broke the record for most new short-term rental bookings, according to AirDNA, an independent analytics firm that tracks Airbnb and its competitor Vrbo. February broke it again. Jamie Lane, AirDNA’s vice president of research, told me that demand for Airbnbs has been so strong that he expects some areas in the United States to be totally booked up for the summer by April or May. Travel trends might continue to creep up, now that the CDC has okayed travel for the vaccinated. (Because the pandemic is very much not over, the CDC still recommends that the unvaccinated avoid all nonessential travel.)All that vacation is possible only because people, intentionally or not, have been hoarding time off for the past year. Generally, Americans don’t have that many days off to begin with—just 10 on average for new workers, compared with a minimum of 20 days in the European Union—and many businesses make those days “use it or lose it,” meaning they expire at the end of the year. But when the pandemic hit, a third of companies made a fateful decision: letting their workers carry more days over than usual. By sitting on so much time off, workers have functionally jerry-rigged their own version of all those late-summer weeks that many Europeans automatically get off. “We’re in for a summer surge of PTO,” Howard Metzger, the president of MBL Benefits Consulting, told me. “People want out.”In fact, so many people might soon request PTO that some offices could just go full Europe and close for a week, John Dooney, an HR adviser at the Society for Human Resource Management, told me. Other offices might need to engage in a bit of black-belt scheduling jiu-jitsu to make room for the rush of Zoomed-out employees aching for hikes in Shenandoah and tasting menus in San Francisco. American cities are not about to shut down, European-style, to let employees do their thing for weeks on end, but a summer of a million shorter, weeklong trips and four-day holidays still might feel different. If you’re stuck working in an office, you might send an email blast only to be met with an avalanche of “OOO” auto-replies. Your boss might wrangle you back to the cubicle life only to realize in horror that the rest of the office is still empty, because so many people have gone on vacation. Across the U.S., vacation bliss maybe, just maybe, will settle in for a few months—a shared sense of relief in merely having to worry about awkward tan lines again.But let’s not get ahead of ourselves. The coming PTO crunch will almost certainly be tempered by managers seeking to stop it from happening. Even bosses in more flexible jobs might not want to deal with the logistical headache of keeping the office running with a hollowed-out staff, summer be damned. And the allure of normalcy won’t entirely rid Americans of one of the reasons we don’t take time off in the first place: fear. “The fear of asking for time off from your boss, the fear that taking time off will impact you economically—that is all very palpable,” says Jamie McCallum, a Middlebury College sociologist and the author of Worked Over: How Round-the-Clock-Work Is Killing the American Dream. If your boss wants you back at your desk rather than in Delray Beach, not even your primal urge for a little post-pandemic junket will get in the way.PTO has always been unequal—and as with everything else in this pandemic, the working class is about to have it a whole lot worse. Low-wage workers have disproportionately gotten sick with COVID-19 and have disproportionately lost their jobs. Now they are disproportionately in a position where they won’t be able to take advantage of the summer vacci-cation boom, whenever it finally hits. Less than 40 percent of low-wage workers in the private sector get any paid time off, and although they work fewer hours than C-suite suits, they work more total weeks, complicating the possibility of taking an extended break.At the same time, some sectors are about to get welcomely busier than before the pandemic. All the activities that the professional class is aching to do again will need workers to make them happen—a rush that can’t come soon enough for some line cooks and hostesses. “You’re going to have a situation where some people are going to say, Thank God I can go on vacation, and others will say, Thank God I can go back to work,” McCallum told me.[Read: Only your boss can cure your burnout]For the chunk of Americans who will get a work rumspringa, big questions are waiting for them on the other side of vacation nirvana, about whether they want to return to the norms of yore. If workers can take PTO this summer, why not again in the fall? And next summer? And whenever else they please? The pandemic has already made all sorts of impossible things possible. Maybe actual, sustained time off from work will be next. It’s not the craziest idea ever: A year in which a third of Americans lost someone to the coronavirus, and everyone was hit with deprivation, might be the thing that brings about a mass reckoning over how work has consumed over our lives.Or, uh, maybe not. A more disturbing possibility is that the pandemic has made Americans even more addicted to our jobs. Now that WFH-ers have emulsified work and leisure into one, a remote-friendly future might fully sever the link between travel and time off. Of all the summer spikes playing out on Priceline, the biggest is a 165 percent bump in bundled flight-and hotel-bookings compared with summer 2019, a trend that the company’s CEO, Brett Keller, says is likely driven by workers hunting for the best deals on extended stays during which they can vacation and work. Many Americans can now log on from anywhere, but they still can’t escape logging on.“There is no separation anymore,” Howard Metzger told me. When we spoke, he reminisced about the summer trips he would take as a kid in the ’80s, during which his parents would totally unplug from work. Metzger took my call from Copper Mountain, a ski resort in Colorado. He was supposed to be on vacation.
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theatlantic.com