San Francisco Chronicle - (Sunday)
A chance encounter at a house party led to ‘the most formative relationship of my life’
The delta variant is still killing Americans. When its reign is done, long COVID will be waiting for us.
It was a regular night at a regular house party in Madison, Wisc., when a man we’ll call Travis did something that he has yet to live down more than five years later: He brought home a man dressed as a burrito.
No, it wasn’t Halloween, and no, it wasn’t a costume party. This guy was the only one dressed up. Yet something about this man drew Travis (who asked we not use his real name out of respect for burrito man) to approach him.
Now a 33-year-old writer living in New York, Travis said his friends teased him that night in 2015 as they watched him flirt with the burrito man. And they haven’t stopped poking fun to this day. The jokes, though, didn’t matter: He fell in love. It ended up being, he said, “the most formative relationship of my life.”
How did it all go down? And can making out with a burrito at a house party really lead to meaningful romance? The Chronicle spoke with Travis about the experience, including why the burrito costume prompted him, “kind of in a sick way,” to talk to the man inside in the first place. was amazing. I had a little dream life with a little dream family with this guy who came out of nowhere. It showed me that I did deserve all those things. I loved and respected him so much. And oh, this person loves me too. Isn’t that crazy? Who did I trick into this? He rolled up and changed my life in all these ways.
Q: That’s beautiful. So even though you had this meaningful long-term relationship, your friends still just bring up the burrito?
A: Oh my god, to this day. And he came around a lot! We were all in one group. He wasn’t like “the burrito guy.” They knew his name and his story and where he was from and all that. They just called him that to troll me. And it was funny. It was probably funniest to me.
Q: You guys are no longer together. But you still speak very fondly of him. Were things amicable at the end?
A: I would say yes. I mean, that’s a complicated question. He was like “I love you, you’re the perfect boyfriend, I just don’t think I can give you what you deserve.” I was like, “I don’t think you can decide that.” ... He was just honest, even though I didn’t want to hear it. There’s really not a lot I can say about it.
Q: You sound so mature about this.
A: It messed me up for about a year. But also now, I live in New York. Had that not happened, I probably wouldn’t be out here. I have a great job out here. I have a great life. Not that my life with him wouldn’t be just as great, it would be a different reality. It was such a good thing for me that I can’t really bash it. As much as I would love to. It would probably make it easier for me. And I am, at long last, over it.
Q: Do you have any specific feelings about burrito as a food after all of this?
A: No, I don’t. Surprisingly, I do not derive that back to him. Thank goodness. And there’s a lot that I do [derive]. The fact that [burritos] got out unscathed is sort of surprising, but it is the truth. They don’t call him to mind, and I’m going to let it be that way.
Q: Do you like burritos as a food?
A: It’s not the first thing I would get at a Mexican restaurant, but yeah, I like a burrito. Who doesn’t like a burrito?
Left: Vikram Matange (left), Johnny Menhennet and Frances Choi, who had never been to La Taqueria, wait in line to order. Above: S.F. native Adam Gardi (right) brought friend Andrew Lieblich: “My friend is visiting from New York and this is, like, the place to come,” says Gardi. They opted for tacos over burritos.
Janice Kwan of Toronto, who used to live in S.F., brought her boyfriend, Phil Gene: “I wanted to make sure he saw all the highly contested burrito joints in the city.”
Jose Gonzalez, clockwise from above, makes burrito orders; Eric Dominguez crisps the burritos; Ronald Johnson (left) and Steve Fabus eat their burritos outside the taqueria after a party at El Rio. They have been coming to La Taqueria, respectively, since the 1970s and 1980s.
As the coronavirus delta variant continues its rampage across the United States, questions have begun to arise if the world is doomed to a perpetual state of epidemiological crisis. And, indeed, whether we can permanently stop the spread of the virus remains unclear. One thing that is certain, however, is that even if vaccination and other public health strategies are able to contain the virus, we will not be out of the woods from its impacts.
Barring significant scientific advancements, long COVID — symptoms that persist long after the virus has presumably ceased replicating in the body — will be with us for many years to come.
Since the beginning of the pandemic, my work as a virologist (in collaboration with clinicians) has focused on treating patients with long COVID, many of whom are unable to work and are overwhelmed by routine daily tasks. They experience symptoms ranging from fatigue, shortness of breath, “brain fog,” sleep disorders, fevers, gastrointestinal symptoms, anxiety and depression. Nearly all were initially dismissed by a family practice or other physicians who suggested their symptoms were “all in their head.”
Thankfully, after largely being ignored as the effort to stem the pandemic took precedence, motions to mitigate long COVID's impacts are finally making their way into public policy. The Biden administration recently announced that it would acknowledge long COVID as a disability, providing its sufferers with legal protection under the Americans with Disabilities Act. Earlier this year, the National Institutes of Health announced it is investing $1.15 billion over the next four years in long COVID research. In another important, although perhaps less headline-grabbing development, the World Health Organization assigned long COVID its own ICD-10 code, the system of diagnostic codes that health care practitioners use for reimbursement from medical insurance companies, which are critical to providing patients with access to treatment. Without standard codes, patients have been hit with unexpected bills and left to navigate the bureaucracy of medical insurance reimbursement on their own.
These are all promising developments, which accelerate medical research and grant access to much needed resources and protections for long haulers. Legal protections and access to disability benefits through the Social Security Administration are especially critical, as many long haulers have been unable to work at times and often require accommodations from their employers.
But while the institutional recognition of long COVID is very encouraging — and research is shedding more light on the nature of the problem and treatment pathways — greater awareness among ordinary people, their physicians and the scientific community is needed.
Too long dismissed by physicians, long COVID is now understood to affect about a third of people who recover from initial infection. With more than 35 million Americans having been infected with COVID-19, as many as 10 million or more may now be experiencing long COVID symptoms.
One of the patients I have worked with, April, a 45-year-old nurse supervisor in Southern California, was exposed to the coronavirus early in the pandemic, in March of last year. She went to the emergency room twice and stayed for several hours — but at the time coronavirus testing was very limited. She was given a strep throat test, a flu test, a mono test, even a CAT scan, but not a coronavirus test. She was finally tested for the coronavirus after more than two weeks of waiting. It came back negative, likely because it was given too late or because tests were then unreliable.
April was out of work for 13 weeks, and even after returning, continued to struggle with a long list of symptoms, ranging from phantom smells like smoke, to loss of smell and taste, massive hair loss, shortness of breath, severe fatigue, relentless joint pain, increased heart rate, “COVID tongue,” rashes and “brain fog.” With no official diagnosis, however — and feeling pressure to be back after missing 13 weeks — she returned to work despite feeling sick and had very little energy for anything else, including her three children, an 11-yearold daughter, a 16-year-old son and an 18-year-old son.
After months of this status quo, in January, she took a blood test from one of our partner labs, which showed that she had an immune profile characteristic of long COVID, including the presence of viral spike proteins. By May, her immune profile had significantly improved in a follow-up test.
Just having a test and diagnosis to confirm what she suspected has gone a long way to alleviate the fear and anxiety that naturally comes with an unknown, persisting medical condition.
Scientists and physicians are working hard to characterize long COVID. We're now beginning to understand that it is a unique and distinct medical condition of its own. Research shows that long COVID occurs when spike proteins of SARS-CoV-2, virus that causes COVID-19, remain in a person's body, in reservoirs of the immune system. The spike proteins are not able to reproduce, as they lack the genetic material required, but they do cause inflammation as the body's immune system reacts to them. These spike proteins then spread around the body, especially during exercise, and cross the blood-brain barrier, which likely accounts for the exercise intolerance of many long haulers, as well as the neurological effects.
We are also able to reliably diagnose long COVID patients in a nonsubjective way by analyzing patterns in cytokines, different types of proteins produced by a person's immune system, to identify a long COVID immune system “fingerprint.” With this better understanding, new treatment approaches are emerging that address the underlying causes of the disease, not just the symptoms. Whenever the COVID pandemic is finally brought to heel, we will have another very real, very challenging and very costly public health crisis waiting to take its place. The sooner we acknowledge this crisis, the sooner we can begin properly caring for those afflicted. Organizations like the Long COVID Alliance can help to provide patients and their families with resources and support, but more professional dialogue among doctors and collaboration among researchers is critical to ensuring they have access to the research and medical support they need.
Unfortunately, long COVID is going to be a public health issue for the foreseeable future. We need to come together now to help each other through it.
Bruce Patterson is the CEO of IncellDx, where he is working toward a new paradigm for predicting, identifying and treating long COVID-19. He previously served as medical director of diagnostic virolog y at the Stanford University School of Medicine.