On March 11, 2020, the World Well being Group formally declared the novel coronavirus a pandemic. The choice would change the world as we all know it — how we dwell, work, work together with one another — and mark the start of a brand new period during which we coexist with COVID-19.The pandemic has since been declared over, however the SARS-CoV-2 virus, which causes COVID-19, continues to flow into, mutate and infect individuals across the globe.Though many individuals who’ve gotten COVID-19 have recovered and gone on with their lives, some have been left with persistent signs and debilitating well being issues for which there isn’t a treatment — which we now know as lengthy COVID.What’s lengthy COVID? Lengthy COVID refers to signs and well being issues that proceed, emerge, or persist 4 or extra weeks after recovering from acute COVID-19 an infection, in accordance with the U.S. Facilities for Illness Management and Prevention.It goes by a number of totally different names, together with post-COVID circumstances (PCC), long-haul COVID, and post-acute sequelae of COVID-19 (PASC).Lengthy COVID is just not one sickness, however moderately an umbrella time period to explain a variety of signs, circumstances and illnesses, which may range from individual to individual.Lengthy COVID signs generally embrace fatigue, mind fog, dizziness, complications, shortness of breath, joint ache, nerve points, gastrointestinal issues and lots of extra. The constellation of long-term well being results can have an effect on each organ system within the physique, Dr. Ziyad Al-Aly, chief of analysis and growth on the VA St. Louis Well being Care System, tells TODAY.com. “Signs are on a spectrum from gentle to extreme and profoundly disabling,” says Al-Aly. The cognitive deficits related to lengthy COVID, similar to decreased consideration and reminiscence, could be particularly debilitating.Some sufferers expertise slower processing speeds and diminished government functioning, which implies they might wrestle to synthesize info or make selections, James Jackson, Psy.D., neuropsychologist at Vanderbilt College and writer of the ebook “Clearing the Fog,” tells TODAY.com. “Government functioning impairment is a giant cause why we see so many individuals with lengthy COVID who’re not within the office,” Jackson provides. A current research within the New England Journal of Drugs discovered that folks with lengthy COVID have IQs which might be six factors decrease on common than individuals who have by no means had COVID. The cognitive deficits can contribute to worsened psychological well being outcomes, and vice versa, says Jackson.How lengthy does lengthy COVID final?Lengthy COVID signs can final “weeks, months or years,” in accordance with the CDC, and should persist or go away and are available again once more.Akiko Iwasaki, Ph.D., director of the Heart for An infection & Immunity on the Yale College of Drugs, tells TODAY.com lengthy COVID signs are inclined to final for 2 months or extra.Is there a protracted COVID check?There are not any laboratory assessments to diagnose lengthy COVID, the specialists be aware. Because of the multitude of signs, there isn’t a universally agreed-upon set of diagnostic standards both, says Al-Aly. “Quite a lot of it’s affected person historical past and a strategy of (elimination) of different attainable causes, so medical doctors would possibly carry out a number of totally different assessments to exclude different illnesses that could possibly be leading to related outcomes,” says Iwasaki. Whereas many individuals with lengthy COVID have proof of their acute an infection, similar to a earlier PCR or antibody check, some might have by no means examined optimistic or not know they have been contaminated, per the CDC.A 2023 research printed within the journal Nature confirmed individuals with lengthy COVID might have sure blood biomarkers, indicators of the situation within the physique, which could possibly be promising for creating diagnostic assessments. Nonetheless, as of now, diagnosing lengthy COVID stays a posh and infrequently difficult course of. “Quite a lot of occasions, individuals are being dismissed, and (advised) it’s of their head or this doesn’t exist. … We all know it exists, we all know it’s a giant deal,” says Al-Aly. How frequent is lengthy COVID?In 2022, almost 7% of adults within the U.S. reported ever having lengthy COVID, in accordance with a report from the CDC. Nonetheless, the true variety of individuals affected could also be increased, the specialists be aware. “We see quantity of variation when it comes to incidence charges. I’ve seen these numbers vary from 5-20% of sufferers,” Dr. Rainu Kaushal, chair of the division of inhabitants well being sciences at Weill Cornell Drugs, tells TODAY.com. “Relying on the way you outline lengthy COVID, it could possibly additionally have an effect on the charges you’re seeing.”There’s an ICD-10 diagnostic code for lengthy COVID (which is used for medical data or loss of life certificates, for instance), however this code is just not uniformly used, Kaushal provides. This may additionally impression statistics.Who will get lengthy COVID?Anybody who will get COVID can develop lengthy COVID — no matter age, race, gender, severity of an infection, vaccination standing or underlying well being circumstances.“Now we have youngsters with lengthy COVID, (and) we have now people who find themselves 100 years previous with lengthy COVID,” says Al-Aly.Many individuals additionally get lengthy COVID even when they did not really feel sick. “The overwhelming majority of individuals develop lengthy COVID after a light an infection,” says Iwasaki. Even if you happen to get well absolutely from the primary an infection, it’s attainable to develop lengthy COVID after every subsequent reinfection.Nonetheless, some information signifies that sure teams could also be at elevated threat.In accordance with CDC information from 2022, adults between the ages of 35 and 49 have been probably to expertise lengthy COVID, and ladies have been extra probably than males to have had or at present have lengthy COVID.Individuals who had a extreme acute an infection, particularly those that wanted to be hospitalized or handled within the intensive care unit may be at increased threat, says Iwasaki, in addition to individuals who have underlying well being circumstances and those that are unvaccinated.Well being inequities may put individuals from sure racial or ethnic minority teams at higher threat, per the CDC.Research have proven that in comparison with white adults, Black and Hispanic adults who had extreme COVID-19 have been extra prone to develop signs related to lengthy COVID, but additionally much less prone to be identified, in accordance with the Nationwide Institutes of Well being.Moreover, sure teams might face higher boundaries to well being care, and a protracted COVID analysis, together with those that are low-income.Vaccination and the antiviral paxlovid can cut back the danger of creating lengthy COVID, says Al-Aly, however the one option to fully stop it’s to not get COVID-19 within the first place. What causes lengthy COVID? Scientists have no idea precisely what causes lengthy COVID, however there are a number of theories. One of many important ones is named viral persistence. “Whether or not the virus is replicating or remnants of viral merchandise are persisting, that may be stimulating the immune responses which leads to these signs,” says Iwasaki.The thought is that some people don’t absolutely clear SARS-CoV-2 after an infection, and the virus or its remnants stay in “reservoirs” within the physique, says Kaushal.A 2023 research printed in Cell confirmed that the gastrointestinal tract could also be a reservoir for the virus, and that these reservoirs might impair serotonin manufacturing within the physique, for instance, which may result in cognition-related signs, Al-Aly explains.One other concept is that the an infection with SARS-CoV-2 triggers a sort of persistent, systemic irritation that takes time to resolve or in some instances doesn’t resolve in any respect, the specialists be aware.Scientists are additionally exploring the hyperlink between lengthy COVID and autoimmune circumstances. “We all know that plenty of various kinds of infections can set off autoimmune illnesses,” says Iwasaki. One instance is the Epstein-Barr virus, which is linked to a number of sclerosis, in accordance with a 2019 evaluation on printed in Viruses.”I feel some individuals are affected by autoimmunity attributable to SARS-CoV-2 an infection,” says Iwasaki. Lastly, some hypothesize that SARS-CoV-2 could also be reactivating different, latent viruses within the physique. “All of us carry a number of latent viruses, notably within the herpes household, similar to Epstein-Barr and the Varicella Zoster virus. The speculation is that these can reactivate after an acute an infection with SARS-CoV-2 and trigger signs related to lengthy COVID,” says Iwasaki.Is there a remedy for lengthy COVID?“We don’t have a treatment,” says Al-Aly. Though this can be a very lively space of analysis, there are nonetheless no particular remedies or FDA- permitted drugs for lengthy COVID, Al-Aly provides. As a substitute, remedy is essentially targeted on managing the totally different signs or circumstances, which can contain varied specialists and therapies. “That actually represents a collective failure to search out remedies for lengthy COVID to this point, going into the fifth 12 months of the pandemic,” says Al-Aly. Nonetheless, there are a variety of lengthy COVID clinics that intention to deal with the wants of sufferers. Medical trials are underway, such because the NIH RECOVER Initiative, to judge remedies and discover solutions about lengthy COVID. Within the meantime, what is recognized is that many individuals are struggling, and lengthy COVID can have an effect on the entire physique. TODAY.com spoke with six sufferers, who shared how their lives have modified months to years later. Learn on for his or her tales and an in-depth take a look at the lengthy COVID signs that they battle each day.Higher row (left to proper): Cynthia Adinig, Sue Miller, Chimére L. Sweeney. Backside row (left to proper): Charlie McCone, Tony Marks, Joel Fram.Courtesy Joel Fram /
Courtesy Sue Miller /
Courtesy Chimére L. Sweeney /
Courtesy Cynthia Adinig /
Courtesy Charlie Charlie McCone, 34, San FranciscoAt the beginning of 2020, Charlie McCone had simply turned 30, began a brand new nonprofit job, and moved in along with his girlfriend in San Francisco. McCone was wholesome and lively, however after getting COVID-19 in March 2020, he developed extreme cardiorespiratory signs, which restricted his bodily exercise. When McCone was reinfected in 2021, he turned house-bound and misplaced his job. McCone now suffers from excessive fatigue, cognitive points, migraines and postural orthostatic tachycardia syndrome (POTS).Chimére L. Sweeney, 42, BaltimoreFour years in the past, Chimére L. Sweeney was a wholesome 37-year-old working as a center faculty trainer in Baltimore. However then Sweeney obtained COVID-19 in March 2020. Within the months that adopted, Sweeney developed debilitating complications, fatigue, spinal ache, dizziness, imaginative and prescient loss, gastrointestinal points, and her psychological well being declined, amongst different issues. Sweeney was repeatedly dismissed and discriminated in opposition to by medical doctors, and now advocates for Black ladies dwelling with lengthy COVID.Cynthia Adinig, 38, VirginiaCynthia Adinig is a mom and advertising and marketing specialist turned long-COVID advocate from Northern Virginia. After a light case of COVID-19 in March 2020, Adinig developed a fast coronary heart fee; intermittent paralysis and weak spot in her legs, which put her in a wheelchair for a number of months; esophageal spasms and tears; extreme reactions to sure meals, and extra. Adinig additionally suffers from Mast Cell Activation Syndrome (MCAS), which causes repeated allergic reactions or signs of anaphylaxis. After being repeatedly denied care, Adinig based the BIPOC Fairness Company.Dr. Sue Miller, 50, South CarolinaDr. Sue Miller, 50, served as medical director of the neonatology intensive care unit (NICU) and chair of pediatrics at a hospital in South Carolina earlier than leaving drugs due to her lengthy COVID. Whereas she prevented getting COVID-19 early on, she caught it for the primary and solely time at a convention in Might 2022. A couple of month later, Miller seen she new signs, together with exhaustion, cognitive impairment, gastrointestinal troubles and ache. Joel Fram, 57, New YorkBroadway conductor Joel Fram was a part of the early wave of New Yorkers who contracted COVID-19 in March 2020. As he was recovering throughout lockdown, he seen he turned exhausted when he tried exercising and infrequently felt so drained he fell asleep in the course of a duties, similar to consuming. He’s had COVID-19 4 occasions however doesn’t consider the reinfections worsened his lengthy COVID signs.Tony Marks, 56, North CarolinaTony Marks has been dwelling with lengthy COVID for over three years. The daddy of two and former software program government was as soon as wholesome, lively and recurrently coached hockey. When Marks first contracted COVID-19 in February 2021, he needed to be hospitalized for per week with pneumonia in each lungs. Marks and his medical doctors have been initially assured that he’d get well, however he by no means did. The worst of his lengthy COVID signs embrace debilitating fatigue, muscle ache and spasms, and neuropathy, or nerve harm that may result in ache, numbness and weak spot, per the Mayo Clinic. Mind Fog”Mind fog” is used to explain the gathering of neurological and cognitive signs related to COVID-19 and lengthy COVID. These embrace points with reminiscence, consideration and government functioning. They will vary from gentle to extreme and impair an individual’s skill to work or socialize. Tony Marks was the director of a software program firm earlier than his mind fog and different lengthy COVID signs, pressured him to resign. “Mid-sentence, throughout a dialog, I will simply cease as a result of I don’t know what I simply advised you or the place I used to be going. … (Generally) I will not recall the dialog in any respect, it is like full amnesia,” Marks tells TODAY.com. TODAY Illustration / Getty ImagesOnce, whereas driving, Marks ended up in a random location with no recollection of how he obtained there. “I obtained within the automotive and my mind simply entered into this mode. … I do not bear in mind going via cease lights or cease indicators. … (One other time) I wound up so far-off from the place I used to be imagined to be, I obtained out and checked my truck for dents and to ensure that I hadn’t hit something,” says Marks. Dr. Sue Miller, a former NICU director, realized quickly after she had COVID-19 she might not multitask. “I don’t wish to name it mind fog as a result of I feel that underestimates what I’ve,” Miller tells TODAY.com. “It’s a mind harm. It’s an infection-caused mind harm.” At work, Miller couldn’t full paperwork with the door open as a result of the hallway noise distracted her an excessive amount of. She forgot nurses’ names. “I used to be having word-finding points,” Miller says. “I converse a lot slower now.” With a lot disappointment, Miller realized she wanted to cease training drugs. “I used to be anxious I’d make a mistake,” Miller says. “I save lives. You’ve to have the ability to suppose quick and never be drained and never make a mistake — as a result of seconds matter.”Research have proven COVID-19 can harm the mind, and individuals who get well from an an infection are inclined to have much less gray matter within the mind — essential for information-processing, per Cleveland Clinic — than those that didn’t get COVID-19.DizzinessDizziness and lightheadedness are among the commonest signs reported amongst lengthy COVID sufferers, per the CDC.TODAY Illustration / Getty ImagesIt was considered one of Chimére L. Sweeney’s early lengthy COVID signs in March 2020. “Once I was standing up, I’d really feel extraordinarily dizzy,” Sweeney tells TODAY.com. It quickly turned troublesome to stroll, and showering was a monumental effort. “I used to be fainting in my rest room and waking up and never understanding the place I used to be,” says Sweeney. Some lengthy COVID sufferers additionally report experiencing a sort of dizziness referred to as vertigo and impairments to the vestibular system, which controls steadiness.Imaginative and prescient disturbancesMiller, the previous NICU doctor, says her ongoing visible disturbances bother her. “It’s referred to as imprinting. What occurs is gentle will keep in my eyes,” she says. “Mine lasts for a extremely very long time.” Sweeney, too, seen her imaginative and prescient began to alter after she obtained COVID. “By mid-April, I misplaced imaginative and prescient in my left eye,” she says. “It had been about six months of going to the hospital making an attempt to hunt care. I used to be despatched house with misplaced imaginative and prescient — they might see my imaginative and prescient was blurry, however no one was telling me why,” says Sweeney. After months of her imaginative and prescient loss being dismissed, medical doctors found Sweeney had dense cataracts. “I had two of them, one in every eye due to the an infection, the irritation,” says Sweeney. It took one other few months for medical doctors to agree she wanted surgical procedure. “Now I’ve these darkish black floaters in my eyes that impair my imaginative and prescient quite a bit,” she provides.Fast coronary heart fee, bother breathingIn the primary few months after creating lengthy COVID signs, Cynthia Adinig would discover her coronary heart racing usually “to the purpose the place I feared I used to be having a coronary heart assault,” she says. Her coronary heart signs have been usually dismissed by medical doctors as anxiousness, she says.Joel Fram says he experiences chest ache, however making an attempt to deal with his fast heartbeat has been irritating. “The heart specialist was like, ‘Nicely your coronary heart fee is kind of excessive. However your ECG is coming again regular. Your ultrasounds are coming again regular,’” Fram, a Broadway conductor, tells TODAY.com. “I used to be like, ‘OK, however one thing’s occurring.” Fram’s coronary heart fee usually skyrockets after bodily exercise, so he is slowly build up his exercise ranges via bodily remedy.TODAY Illustration / Getty ImagesBefore the pandemic, Charlie McCone used to recurrently bike 10 miles to work and again. “I obtained sick in March 2020, and I’ve by no means been the identical,” McCone tells TODAY.com. After his first an infection, he developed extreme shortness of breath, chest ache and a fast heartbeat. “I felt like I couldn’t take a breath. It was agonizing,” says McCone, including that he might stroll at most for 5 or 10 minutes. When he was reinfected a 12 months and a half later, COVID-19 took a toll on his lungs and coronary heart as soon as once more. “I ended up getting pneumonia, and I used to be hospitalized for an evening. … It was a complete nightmare,” says McCone. Though his respiratory signs have improved barely, McCone can solely have interaction in restricted bodily exercise, similar to strolling to a different room.FatigueBefore getting COVID-19, Tony Marks was a wholesome, lively particular person who might “do no matter he needed to do,” he says. The intense fatigue has stripped that away from him. “Now, I go to sleep on a regular basis, for no cause. I’ll be sitting visiting with individuals, on the pool, and I go to sleep, and no one can wake me up,” says Marks. “Subsequent factor I do know I’m waking up within the hospital as a result of I had fallen into such a deep state of sleep (and) it was unattainable to wake me,” Marks provides.After being reinfected with COVID in 2021, Charlie McCone’s fatigue rendered him bed-bound. “I couldn’t even sit at a pc for half-hour,” says McCone. The as soon as athletic, outgoing younger man now not often leaves his house besides to hunt medical care.“I’ve been severely housebound. I misplaced my job, am not in a position to work, and I depend on my accomplice as a full-time caretaker,” says McCone, including that he’s seen little enchancment in three years. “Now I’m solely actually in a position to perform for one to 2 hours a day to do laptop work or stuff round the home,” says McCone.Fram, the Broadway conductor, says the fatigue felt “actually debilitating. … It’s simply not one thing as a human being you actually anticipate. You’re having lunch with somebody and also you’re actually falling asleep on them. That’s actually arduous to battle.” Fram additionally experiences post-exertional malaise (PEM), the worsening of signs 12 to 48 hours after little bodily or psychological exercise, which may final for weeks, per the CDC. Fram is now making an attempt a sort of bodily remedy the place he does a number of small actions adopted by intentional respiratory to attempt to fight his PEM. “You’re retraining your physique,” Fram says. “It’s to remind your physique to decrease your coronary heart fee while you’re completed exercising … however not set off a fatigue assault with an excessive amount of exertion.” Tremors and spasmsShaking, buzzing and irregular actions can be signs of lengthy COVID. Adinig has skilled inner vibrations and tremors that sometimes wake her up at evening. “I’ll be waking up choking on my air, having violent tremors in my sleep, after which as soon as I’m awake, the tremors don’t cease,” she says. Though she now takes a drugs that helps together with her tremors, they nonetheless come and go throughout symptom flare-ups. TODAY Illustration / Getty ImagesMarks says that lengthy COVID has left him with “1000’s of muscle spasms a minute,” largely in his legs and arms. “Most of that’s inner spasms however once they get actually dangerous, I’ve an exterior shake or twitch,” says Marks. “One time, I used to be at work, and out of the blue I had one in my arm. I simply occurred to have the (laptop) mouse in my hand and it goes flying in opposition to the wall as a result of the jerk was so dangerous,” he remembers. Three years later, the spasms and twitching haven’t improved. In a 2023 research of 423 adults with lengthy COVID, which Iwasaki co-authored, about 37% reported having “inner tremors, or buzzing and vibrations.” This cohort additionally reported having a worse high quality of life, extra monetary difficulties, and “increased charges of new-onset mast cell issues and neurologic circumstances,” in contrast with lengthy COVID sufferers with out tremors.Continual ache Paint all through the physique, particularly within the joints and muscle mass, is among the important lengthy COVID signs that stops sufferers from returning to their previous lives.Fram retains a bottle of ibuprofen on the prepared to assist ease his swollen, tender joints, which make his work as a conductor and pianist a lot more durable. TODAY Illustration / Getty Photographs“(It) requires much more apply to play the piano as dexterously and precisely as I used to,” he says. “Once I conduct, I’ve all the time used my arms as an alternative of a baton, however the swelling and stiffness in my joints means I’ve to handle a good quantity of ache.” He has discomfort in his ft and legs, too: “It is vitally just like stressed leg syndrome, the place I get uncomfortable tingling in them, and I can’t preserve my ft nonetheless. My physique retains making an attempt to shake it out.” One in every of Sweeney’s early lengthy COVID signs felt like a searing migraine. “I felt this fiery ache transfer from the bottom of my cranium to the underside of my backbone. It felt like somebody had poured acid, (or) lit a match down my backbone. I knew that one thing was very flawed,” she says.By April, the ache moved to the left facet of her face. “It felt like somebody had hit me with concrete,” she provides. It took months for Sweeney to get a analysis of occipital and trigeminal neuralgia, a sort of surprising or capturing ache that follows the trail of a nerve attributable to irritation or harm, per the Nationwide Library of Drugs. “I’ve by no means felt something just like the ache that I felt in my cranium (with lengthy COVID),” says Sweeney. “Each second of the day, my head is hurting.”Marks describes the ache within the muscle mass of his legs as “feeling like I used to be being beat with a baseball bat. … It may be a boring ache or deep. I’ve woken up at evening feeling like I have been stabbed within the legs.”The neuropathy has additionally triggered extreme weak spot in his legs. “It nearly looks like I am making an attempt to steadiness on jello, the muscle mass in my legs are so weak they usually simply cannot help me,” says Marks. The previous hockey coach usually wakes up questioning whether or not it will likely be the final day he can stroll on his personal.Digestive problemsLong COVID can infiltrate the digestive tract, resulting in signs similar to diarrhea and stomach ache. Lengthy-hauler Chimére L. Sweeney initially had diarrhea throughout her acute COVID-19 an infection, however she now offers with persistent and extreme constipation with no aid. TODAY Illustration / Getty Photographs”I’m nonetheless so constipated that after I had a colonoscopy (just lately), they might not full the method as a result of my physique was not even adhering to the prep, after the laxatives and the fasting,” says Sweeney. “I suffered and nonetheless endure at present.”On Mom’s Day in 2020, Cynthia Adinig suffered a response whereas consuming considered one of her favourite meals, shrimp. “I felt unusual, my jaw felt tight, I couldn’t swallow, my coronary heart raced,” says Adinig. “I went to the ER and assessments confirmed nothing alarming to the medical employees.”Within the following months, Adinig suffered from related reactions to extra meals, in addition to gastric reflux and different gastrointestinal points, however was repeatedly dismissed by medical doctors. By September, Adinig had misplaced 50 kilos and needed to be hospitalized a number of occasions for hunger and dehydration, the place medical doctors found an esophageal tear. “I developed esophageal spasms and I’ve had points with swallowing and choking since, even on small quantities of meals and water,” she says.Though she began to get well in 2021, Adinig depends on antihistamines and might solely eat a handful of bland meals that received’t trigger a response. “Even like a sprinkle of pepper will set off my reflux so badly that it is not value it,” says Adinig.Grief and gaslightingMany individuals with lengthy COVID mourn who they as soon as have been.In 2021, Fram, the Broadway conductor, “went down a horrible psychological spiral,” together with suicidal ideas, he says. “I used to be getting anxious and extremely depressed. I might not handle it alone.”He remembers crying after visiting the Heart for Submit-COVID Care at Mount Sinai in New York Metropolis as a result of he “lastly discovered” well being care suppliers who believed him, and he might see a path ahead.Resulting from her lengthy COVID, Miller says she’s needed to confront “a lack of identification, the lack of my well being, getting previous.”“You begin to suppose you’re dropping your thoughts, like this isn’t actual,” she provides. “I’m not clinically depressed, however … I’m crying as a result of this has taken over my life. … Folks will say it’s anxiousness. No. I’m anxious however as a result of I don’t know what that is going to show into.” A former center faculty trainer, Sweeney, too, “(grieves) over how a lot I misplaced. … I’m now retired attributable to being medically disabled. It has been probably the most disappointing and hurtful issues in my life.”Extreme melancholy and suicidal ideation, which Sweeney manages with remedy and remedy, are frequent for lengthy COVID sufferers, usually as a result of burden of their different signs, Jackson explains.And a part of this wrestle might require convincing well being care suppliers to consider you might have lengthy COVID in any respect.“I skilled nothing in need of humiliation, plenty of sexism and even racial profiling and discrimination,” Sweeney remembers of being hospitalized attributable to her lengthy COVID signs in July 2020.Adinig testified in entrance of Congress in 2022 about being dismissed: She sought emergency medical take care of a dangerously excessive coronary heart fee and low oxygen ranges, and emergency room employees drug examined her with out her consent and threatened to arrest her.When Miller advised her major care physician about her lengthy COVID analysis, all she supplied was a hug, “which isn’t something anybody needs to listen to from a doctor,” Miller remembers. Though the analysis on lengthy COVID has superior quickly, many sufferers really feel that these these scientific leaps have but to translate into tangible steps for remedy.”It is debilitating, devastating and demoralizing … and also you take care of that each single day,” says Marks.