patients are an invaluable scientific and
journalistic resource. Khullar could have
made a greater attempt to listen; there is
plenty of signal in the noise.
Rachel Denison
Cambridge, Mass.Khullar’s article purports to lay out a de-
bate between long-COVID patients and
the medical establishment, but his ulti-
mate question seems to be how skepti-
cal doctors should be of patients’ experi-
ences. He focusses on unusual problems
instead of conveying how debilitating the
most common symptoms—including
post-exertional malaise and fatigue—can
be. The main question, as I see it, is not
about the legitimacy of the disease. It is,
rather: what is the U.S. going to do about
the growing group of people who have
been disabled in the prime of their lives—
with no treatment and no social support?
Corinne Zuhlke
Summit, N.J.
1
ON LOVING PUNKWhat a treat it was to read Kelefa San-
neh’s recollections of the fading punk
scene in Boston, where I’ve been a d.j.
for thirty-two years (“Part-Time Punk,”
September 13th). I was at that ’91 Fugazi
show and shopped at those record stores.
Aimee Mann rang me up at Newbury
Comics, where I regularly saw the late
Ric Ocasek reading zines. Punk’s origi-
nal D.I.Y. aspects have been supplanted
by a torrent of upload choices, veneer cat-
egorizations, and hyper-corporatized
music and production methods. Sanneh
really gets what the community used to
look like. As I say on the air: in the face
of so much musical chatter, it’s best for
the genre to stay focussed on what feels
authentic to its history.
James F. Kraus
Boston, Mass.DEBATING LONG COVID
I read with great interest Dhruv Khul-
lar’s detailed account of the complex and
sometimes contentious interactions be-
tween health-care providers and advo-
cates for patients with COVID-19—par-
ticularly those suffering from possibly
related chronic illnesses (“The Damage
Done,” September 27th). Some of the
misunderstandings between doctors and
patients may stem from medicine’s un-
wieldy vocabulary. Khullar describes how
Diana Berrent, the forceful patient ad-
vocate, implies that people with relatively
mild COVID infections can suffer “end-
stage organ failure”—total and irrevocable
loss of function of a vital organ. The state-
ment’s implausibility makes Berrent seem
out of touch with science. But the error
is perhaps only a linguistic one. “End-organ
damage,” a related but very different con-
dition, is characterized by injury to any
organ at the end of the circulatory sup-
ply chain that starts at the heart. Such
damage is distressingly common in pa-
tients infected with COVID. It can certainly
become end-stage organ failure, but such
an occurrence would be vanishingly rare
in patients with mild infections.
David N. Howell
Department of Pathology
Duke University Medical Center
Durham, N.C.
I am a thirty-seven-year-old scientist in
my eighteenth month as a long-COVID
patient. Because of my illness, I am on
medical leave from my job as a professor
at Boston University and need a walker
to get around. I bristled at Khullar’s por-
trayal of long-COVID patient-advocacy
groups as having a “disregard for expertise.”
The article doesn’t mention such orga-
nizations as the Body Politic COVID-
support group, whose Patient-Led Re-
search Collaborative recently published
a study characterizing long COVID in
EClinicalMedicine, a scientific journal
published by The Lancet. Moreover, Khul-
lar devotes too little attention to the sto-
ries and the voices of patients themselves.
In the current medical vacuum—in which
there is an illness but no treatment—we
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