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‘Living Nightmare’: Long COVID Upends Lives and Finances 

A nurse prepares a booster dose of the AstraZeneca coronavirus disease (COVID-19) vaccine, during a mass vaccination for people over 60 years old, in Mexico City, Mexico, January 4, 2022. (Reuters)
A nurse prepares a booster dose of the AstraZeneca coronavirus disease (COVID-19) vaccine, during a mass vaccination for people over 60 years old, in Mexico City, Mexico, January 4, 2022. (Reuters)
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‘Living Nightmare’: Long COVID Upends Lives and Finances 

A nurse prepares a booster dose of the AstraZeneca coronavirus disease (COVID-19) vaccine, during a mass vaccination for people over 60 years old, in Mexico City, Mexico, January 4, 2022. (Reuters)
A nurse prepares a booster dose of the AstraZeneca coronavirus disease (COVID-19) vaccine, during a mass vaccination for people over 60 years old, in Mexico City, Mexico, January 4, 2022. (Reuters)

As COVID-19 raged around the world five years ago, London community nurse Beverly Summers found herself on the frontline of the pandemic, caring for patients in their homes as hospitals rapidly ran out of beds.

Passionate about her job, she did back-to-back shifts for eight weeks, but then caught the virus herself.

She has not worked since.

Summers is among an estimated 2 million people in Britain – and possibly 230 million worldwide – living with long COVID. While some have mild symptoms and recover, others have had to quit work or cut their hours due to a deluge of debilitating conditions that have ravaged their health, lives and finances.

"I doubt I'll ever return to work, and that's devastating because I loved my job," Summers told the Thomson Reuters Foundation. "I'm effectively homeless and in a totally precarious position financially."

Economists say long COVID is costing countries billions of dollars a year in lost productivity and increased health and social welfare spending.

"Governments don't appear to understand how serious this is," said Manuel Gomes, a health economist at University College London (UCL). "They've completely underestimated the impact long COVID has on people's ability to work."

One analysis of eight countries by the Economist media group suggested long COVID could have cut their GDP by between 0.5% and 2.3% last year.

Academics have described it as "a mass disabling event", but a dearth of robust data makes it hard to gauge the economic impact and estimates vary wildly.

Compounding the problem is the lack of an agreed global definition of long COVID.

Patients have reported more than 200 symptoms affecting every part of the body. They include cognitive dysfunction, debilitating fatigue, breathlessness, heart problems and joint pain. The causes are unknown and there is no cure.

NO HOME, NO SAVINGS

Long COVID remains hidden, partly because those worst impacted are so exhausted they cannot advocate for their needs. Unable to work or socialize, many are housebound and isolated.

"I've gone from being someone who never wanted to retire and had a full-on social life to living as a virtual recluse," said Summers, one of a dozen people with long COVID interviewed by the Thomson Reuters Foundation.

Self-employed, Summers could not claim sickness leave and quickly exhausted her savings, shelling out thousands of pounds on tests and treatments.

A year after becoming sick in her mid-50s, she took the painful decision to rent out her home so she could generate a small income. Her medication alone costs about 200 pounds ($246) a month.

Summers has moved 16 times since becoming ill, compromising her recovery. She doubts she will ever live in her own home again, which is a source of grief.

At her sickest, Summers was in "unimaginable pain". Her head and lungs felt like they were on fire and one of her vertebrae shattered from inflammation in her chest.

She has had to learn to walk again and has crushing fatigue, respiratory and cardiac issues, joint pain and brain fog - a condition the American actor Matt McGorry recently described as a euphemism for brain damage when he spoke about his own long COVID.

Gregarious by nature, Summers used to love trips abroad, meals with friends, dancing and pilates. All that is gone.

"I live very frugally," she said. "My life is unrecognizable."

EXPERTISE LOST

Official estimates in Britain indicated 3.3% of the population was affected in early 2024 - with one in five people with long COVID reporting a severe impact on their daily life. It affects women more than men.

Health economists said it was astonishing so little attention was being paid to a condition that had removed so many people from the workforce.

Unlike other chronic diseases, long COVID often takes people out of work at the peak of their productivity.

"I know so many people in their 40s who aren't working because of long COVID. A lot of expertise will ultimately go to waste," said Anna, a doctor who was forced to quit work at 41.

Anna, who asked to use a pseudonym due to ongoing negotiations with her employer, estimated she would lose 2.5 million pounds in salary over her lifetime, and predicted her pension would be less than a third of what it would have been if she had been able to work until retirement.

The mother-of-two has spent 20,000 pounds on medication, private consultations, tests and treatments including oxygen therapy and physiotherapy.

Further expenses include a stair lift, wheelchair and wheelchair accessible van. Her mother-in-law helps with childcare, the school run, laundry and cooking.

One recent study suggested the unpaid care provided by family and friends could be worth 4.8 billion pounds a year.

HEALTH COSTS

Long COVID not only impacts the economy through lost work hours, but also because of the greater burden on health services.

Research is emerging that suggests the cost per patient could be comparable to some common chronic conditions, but experts said support for long COVID patients appeared to be fading.

"Long COVID is unlikely to go away any time soon," UCL's Gomes said. "Governments must prioritize funding for prevention, treatment and research to reduce the massive economic burden."

Most people interviewed said they had been forced to pay for private consultations, tests and therapies because of a lack of expertise in the National Health Service.

Many reported being disbelieved and their symptoms treated as psychosomatic.

"Some people don't seek medical help because there's so much gaslighting," said Pooja Mistry, 44, a doctor who has severe heart problems and damage to multiple organ systems.

"It's an invisible illness. It's decimated my whole body, but even as a doctor I've sometimes been made to feel like an imposter."

The mother-of-two, who used to be the main breadwinner in the family, is often bed-ridden and relies on a wheelchair.

Mistry described long COVID as "a living nightmare". But like many others, she has struggled to navigate Britain's complex social welfare system.

Ironically, she said she was not entitled to a key sickness benefit as she missed the application deadline because she was too ill.

"I think a lot of people are falling through the cracks," Mistry said.

Ondine Sherwood, co-founder of patient advocacy group Long Covid SOS, said many people were turned down for benefits and had to go to tribunals to fight for them.

A government spokesperson said benefits were provided to those who met the criteria, but did not address any of the concerns raised by people with long COVID.

Sherwood, who has given evidence to Britain's ongoing COVID inquiry, called for greater investment in long COVID research, improved multidisciplinary specialist healthcare and better access to financial support.

With Britain no longer testing for COVID, she also warned that many more people will develop long COVID symptoms, but may not get diagnosed.

"Long COVID is significantly impacting the economy - and we don't even know the full extent of it," Sherwood said.

"But the government is still burying its head in the sand."

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Features

Report: Europe’s Options in the Strait of Hormuz Are Few and Risky

A cargo ship in the Gulf, near the Strait of Hormuz, as seen from northern Ras al-Khaimah, near the border with Oman’s Musandam, amid the US-Israeli conflict with Iran, in United Arab Emirates, March 11, 2026. (Reuters file)
A cargo ship in the Gulf, near the Strait of Hormuz, as seen from northern Ras al-Khaimah, near the border with Oman’s Musandam, amid the US-Israeli conflict with Iran, in United Arab Emirates, March 11, 2026. (Reuters file)
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Report: Europe’s Options in the Strait of Hormuz Are Few and Risky

A cargo ship in the Gulf, near the Strait of Hormuz, as seen from northern Ras al-Khaimah, near the border with Oman’s Musandam, amid the US-Israeli conflict with Iran, in United Arab Emirates, March 11, 2026. (Reuters file)
A cargo ship in the Gulf, near the Strait of Hormuz, as seen from northern Ras al-Khaimah, near the border with Oman’s Musandam, amid the US-Israeli conflict with Iran, in United Arab Emirates, March 11, 2026. (Reuters file)

When senior officials from 40 countries met virtually this week to discuss how to bring shipping traffic back to the Strait of Hormuz, Italy’s foreign minister had a proposal. He urged them to establish a “humanitarian corridor” allowing safe passage for fertilizer and other crucial goods headed to impoverished nations.

The plan, described after the meeting by Italian officials, was one of several competing proposals from Europe and beyond that were meant to prevent the Iran war from causing widespread hunger. But it was not endorsed by the envoys on the call, and the meeting ended with no concrete plan to reopen the strait, militarily or otherwise, reported the New York Times.

European leaders are under pressure from US President Donald Trump to commit military assets, immediately, to end Iran’s blockage of the strait and tame a growing global energy and economic crisis. They have refused to meet his demands by sending warships now. Instead, they are hotly debating what to do to help unclog the vital shipping lane once the war ends.

But they are struggling to rally around a plan of action.

That partly reflects the slow gears of diplomacy in Europe and the sheer number of nations, including Gulf states, that are invested in safeguarding the strait once the war ends. Many nations involved in the talks, including Italy and Germany, have insisted that any international effort be blessed by the United Nations, which could slow action further. Military leaders will take up the issue in discussions next week.

More than anything, the struggle reflects how difficult it could be to actually secure the strait under a fragile peace — for Europe or for anyone else. None of the options available to Europe, the Gulf states and other countries look foolproof, even under the assumption that the major fighting will have stopped.

Naval escorts

French officials, including President Emmanuel Macron, have repeatedly raised the possibility that French naval vessels could help escort merchant ships through the strait after the war ends.

American officials have pushed for Europeans and other allies, like Japan, to escort ships sailing under their own countries’ flags.

Naval escorts are expensive. Also, their air defense systems alone might not be sufficient to stop some types of attacks, like drone strikes, should Iran choose to start firing again.

“What does the world expect, what does Donald Trump expect, from let’s say a handful or two handfuls of European frigates there in the Strait of Hormuz,” Defense Minister Boris Pistorius of Germany said last month, “to achieve what the powerful American Navy cannot manage there alone?”

Sweep for mines

German and Belgian officials, among others, say they are prepared to send minesweepers to clear the strait of explosives after the war.

Western military leaders aren’t convinced that Iran has actually mined the strait, in part because some Iranian ships still pass through it. So while minesweepers might be deployed as part of a naval escort, they might not have much to do.

Help from above

Another option is sending fighter jets and drones to intercept any Iranian air assaults on ships. American officials have pushed Europe to do this.

It is quite expensive and still not guaranteed to work. Iran can attack ships with a single soldier in a speedboat, and if just a few attempts succeed, that could be enough to spook insurers and shipowners out of attempting passage.

Diplomacy

Another option are negotiations and economic leverage to pressure Iran to refrain from future attacks, and deploy a variety of military means to enforce that. This effort would go beyond Europe. On Thursday, the German foreign ministry called on China to use its influence with Iran “constructively” to help end the hostilities.

This option is expensive and still not guaranteed. Negotiations seem to have done little to stop the fighting. But this may be Europe’s best bet, for lack of a better one.

What if none of that works?

Iranian officials said this week that they would continue to control traffic through the strait after the war. They have already made plans to make ships pay tolls for passing through the strait, which is supposed to be an unfettered waterway under international law.

A continued blockage risks global economic disaster. Countries around the world rely on shipments through the strait for fuel and fertilizer, among other necessities.

In some regions, shortages loom. In others, like Europe, high oil, gas and fertilizer prices have raised the specter of spiking inflation and cratering economic growth.

“The big threat right now is stagflation,” said Hanns Koenig, a managing director at Aurora Energy Research, a Berlin consultancy. “You’ve got higher prices, and they strangle the tiny growth we would have seen this year.”

*Jim Tankersley for the New York Times

Features

US Military Jets Hit in Iran War Are the First Shot Down by Enemy Fire in Over 20 Years

An F-15E Strike Eagle turns toward the Panamint range over Death Valley National Park, Calif., on Feb. 27, 2017. (AP)
An F-15E Strike Eagle turns toward the Panamint range over Death Valley National Park, Calif., on Feb. 27, 2017. (AP)
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US Military Jets Hit in Iran War Are the First Shot Down by Enemy Fire in Over 20 Years

An F-15E Strike Eagle turns toward the Panamint range over Death Valley National Park, Calif., on Feb. 27, 2017. (AP)
An F-15E Strike Eagle turns toward the Panamint range over Death Valley National Park, Calif., on Feb. 27, 2017. (AP)

Iran shooting down two American military jets marks an exceedingly rare assault for the US that has not happened in more than 20 years and shows Iran’s continued ability to hit back despite President Donald Trump asserting it has been “completely decimated.”

The attacks came five weeks after US and Israeli strikes first pounded Iran, with Trump saying earlier this week that Tehran's “ability to launch missiles and drones is dramatically curtailed."

Iran shot down a US F15-E Strike Eagle fighter jet Friday, with one service member getting rescued and the search still underway for a second, US officials say. Iranian state media also said a US A-10 attack aircraft crashed after being hit by Iranian defense forces.

The last time a US warplane was shot down by enemy fire in combat was an A-10 Thunderbolt II during the 2003 US invasion of Iraq, said retired Air Force Brig. Gen. Houston Cantwell, a former F-16 fighter pilot.

But, he said, that’s because the US had largely been fighting insurgents who didn’t have the same anti-aircraft capabilities. The fact that there have not been more fighter jets lost in Iran, Cantwell said, is a testament to the capabilities of US forces.

"The fact that this hasn’t happened until now is an absolute miracle,” said Cantwell, who served four combat tours and is now a senior resident fellow at the Mitchell Institute for Aerospace Studies. “We’re flying combat missions here, they are being shot at every day.”

Shoulder-fired missile likely used, experts say

US Central Command said in a statement Wednesday that American forces have flown more than 13,000 missions in the Iran war while striking more than 12,300 targets.

After more than a month of punishing US-Israeli airstrikes, a degraded Iranian military nonetheless remains a stubborn foe. Its steady stream of strikes against Israel and Gulf Arab neighbors have been causing regional upheaval and global economic shock.

When it comes to American dominance over Iran's airspace, there’s still a distinction between air superiority and air supremacy, said Behnam Ben Taleblu, Iran program senior director at the Foundation for Defense of Democracies, a hawkish Washington think tank.

“A disabled air defense system is not a destroyed air defense system,” he said. “We shouldn’t be shocked that they’re still fighting.”

American planes have been flying missions at lower altitudes, which makes them more vulnerable to Iran's missiles, Taleblu said. It’s possible that Iran fired at the F-15 with a surface-to-air missile, but it's more likely that a portable, shoulder-fired missile was used, he said. Those are much harder to detect and reflect how Iran is “weak but still lethal.”

“This is a regime that is fighting for its life,” he said.

Mark Cancian, a retired Marine colonel and a senior defense adviser with the Center for Strategic and International Studies, agreed that a shoulder-fired missile was likely used against the fighter jet.

Nonetheless, the American air war against Iran has been a “tremendous success” so far, he said.

To put things in perspective, he said the loss rate for American warplanes flying over Germany during World War II was 3% at one point, which would equal about 350 warplanes in the US war against Iran.

“But then there’s the political side — you have an American public that is accustomed to fighting bloodless wars,” Cancian said. “Then a large part of the country doesn’t support the war. So to them, any loss is unacceptable.”

Pilots are trained on what to do if their plane is hit

The last US jet shot down in combat was struck by an Iraqi surface-to-air missile over Baghdad on April 8, 2003. The pilot safely ejected and was rescued, according to the Air Force.

In high-threat environments like missions over Iran, Cantwell, the retired general, said an aviator's blood pressure goes up and they become highly alert to incoming missiles. Those are typically either infrared- or radar-guided missiles, he said, requiring different evasive tactics.

If they are hit and need to eject from their aircraft, they are trained on what to do next, he said.

Pilots learn to check for wounds after a violent ejection and the shock of a missile explosion and, most crucially, how they are going to communicate their location so rescuers can find them.

At the same time, he said, the enemy is likely working to intercept the communications or even spoof the location.

Helicopters are more at risk than other aircraft

The planes that went down Friday were not the first crewed American aircraft to be lost overall in Iran.

A military helicopter and airplane exploded in 1980 during an aborted mission to rescue several dozen American hostages at the US embassy in Tehran, according to the Air Force Historical Support Division.

After a series of setbacks, including severe dust storms and mechanical failures, the mission was called off. As the aircraft took off, the rotor blades of one of the RH-53 helicopters collided with an EC-130 aircraft full of fuel and both exploded, killing eight.

More US helicopters have been shot down in recent decades, including a MH-47 Army Chinook helicopter that was struck by a rocket-propelled grenade in Afghanistan in 2005, killing 16. Helicopters are more dangerous because “the lower and the slower, the more susceptible you are,” Cantwell said.

That’s why those who went out on this week's rescue missions, likely in helicopters, he said, did “such a brave and honorable act.”

Features

Iran Leaders Join Crowds on Tehran’s Streets to Project Control in Wartime

An Iranian flag is seen on a residential building that was damaged by recent strikes at Vahdat town in Karaj, southwest of Tehran on April 3, 2026. (AFP)
An Iranian flag is seen on a residential building that was damaged by recent strikes at Vahdat town in Karaj, southwest of Tehran on April 3, 2026. (AFP)
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Iran Leaders Join Crowds on Tehran’s Streets to Project Control in Wartime

An Iranian flag is seen on a residential building that was damaged by recent strikes at Vahdat town in Karaj, southwest of Tehran on April 3, 2026. (AFP)
An Iranian flag is seen on a residential building that was damaged by recent strikes at Vahdat town in Karaj, southwest of Tehran on April 3, 2026. (AFP)

After more than a month of being stalked by targeted assassinations, Iran's leadership has adopted a new tactic to show it is still in control - with senior officials walking openly in the streets among small crowds who have gathered in support of the regime.

In recent days, Iran's president and foreign minister have separately mixed with groups of several hundred people in central Tehran. On Tuesday, state television aired footage of the two posing for selfies, talking to members of the public and shaking hands with supporters who had gathered in public areas.

According to insiders and analysts, the appearances are part of a calculated effort by Iran's theocratic leadership to project resilience and authority — not only over the vital Strait of Hormuz but also over the population — despite a sustained US-Israeli campaign aimed at "obliterating" it.

One insider close to the hardline establishment said such public outings are intended to show that the regime is "unshaken by strikes and that it remains in control and vigilant" as the war grinds on.

The US-Israeli war ‌on Iran began on ‌February 28 with the killing of veteran Supreme Leader Ali Khamenei and several senior military ‌commanders ⁠in waves of ⁠strikes that have since continued to target top officials.

Iran's new Supreme Leader, Mojtaba Khamenei, has not been seen in public since taking over on March 8 from his father. Foreign Minister Abbas Araqchi, meanwhile, was removed from Israel's hit list amid mediation efforts last month, including by Pakistan, to bring Tehran and Washington together for talks to end the war.

Talks aimed at ending the war have since appeared to have petered out, as Tehran brands US peace proposals "unrealistic". Against that backdrop, recent public appearances by President Masoud Pezeshkian and Araqchi appear designed to project defiance, if not a convincing display of public support.

A senior Iranian source said officials' public presence demonstrates that "the establishment is not intimidated by Israel's targeted killing of top Iranian ⁠figures".

Asked whether Iran's foreign minister or president were on any sort of kill list, an Israeli ‌military spokesperson, Nadav Shoshani, said on Friday he would not "speak about specific personnel."

NIGHTLY RALLIES TO ‌SHOW RESILIENCE

Despite widespread destruction, Tehran appears emboldened by surviving weeks of intense US-Israeli attacks, firing on Gulf countries hosting US troops and demonstrating its ability ‌to effectively block the Strait of Hormuz.

On Wednesday, US President Donald Trump vowed more aggressive strikes on Iran, without offering a timeline ‌for ending hostilities. Tehran responded by warning the United States and Israel that "more crushing, broader and more destructive" attacks were in store.

Encouraged by clerical rulers, supporters of the regime take to the streets each night, filling public squares to show loyalty even as bombs rain down across the country.

Analysts say the establishment is also seeking to raise the "political and reputational" cost of the strikes at a time when civilian casualties are deeply disturbing for Iranians.

Omid Memarian, ‌a senior Iran analyst at DAWN, a Washington-based think tank, said the decision to send officials into gatherings reflects a layered strategy, including an effort to sustain the morale of core supporters ⁠at a moment of acute pressure.

"The system ⁠relies heavily on this base; if its supporters withdraw from public space, its ability to project control and authority weakens significantly," Memarian said.

Speaking to state television, some in the crowds voice unwavering loyalty to Iran's leadership; others oppose the bombing of their country regardless of politics; and some have a stake in the system, including government employees, students and others whose livelihoods are tied to it.

Hadi Ghaemi, head of the New York-based Center for Human Rights in Iran, said the establishment is using such loyal crowds as human shields to raise the cost of any assassination attempts.

"By being in the middle of large crowds they have protections that would make Israeli-American attacks against them very bloody and generate sympathy worldwide," he said.

POTENTIAL PROTESTERS STAY OFF STREETS AT NIGHT

The Islamic republic emerged from a 1979 revolution backed by millions of Iranians. But decades of rule marked by corruption, repression and mismanagement have thinned that support, alienating many ordinary people.

While there has been little sign so far of anti-government protests that erupted in January and abated after a deadly crackdown, the establishment has adopted harsh measures, such as arrests, executions and large-scale deployment of security forces, to prevent any sparks of dissent.

Rights groups have warned about "rushed executions" during wartime after Iran hanged at least seven political prisoners during the war.

"Many potential protesters are frightened by the continuing presence of armed men and violent crowds in the streets and largely stay at home once darkness falls," Ghaemi said.