Opinion: How long Covid’s scientific stalemate made it politically erasable

OpinionFirst Opinion How long Covid’s scientific stalemate made it politically erasable Attempting to force the condition into the biomedical paradigm was a mistake Manage alerts for this article Email this article Share this article By Steven PhillipsJune 11, 2026 Phillips is vice president for science and strategy at the COVID Collaborative and a fellow of the American College of Epidemiology. Mitchell Miglis had two months left. The Stanford University neurology professor had spent two years studying what long Covid does to the human nervous system — why patients’ hearts race when they stand, why their blood pressure collapses, why their bodies lose the ability to regulate themselves. His National Institutes of Health RECOVER grant was weeks from completion, data collected, analysis underway. On March 25, 2025, a termination notice arrived. The grant was “incompatible with agency priorities.” No modification could bring it into alignment. “This is not only disappointing and demoralizing from a scientific perspective,” Miglis wrote in the Sick Times, a publication about long Covid, “but in a broader sense, as a clinician who sees these patients every day, a much larger disappointment to the patient community.”Advertisement It was a stunning act of institutional abandonment. But it was not a surprising one. Long Covid’s erasure from federal policy was meticulously planned. On Jan. 20, 2025, President Trump’s second Inauguration Day, long Covid data disappeared from federal websites. Within six days of confirming his Department of Health and Human Services secretary, an executive order disbanded the federal advisory committee on long Covid before it had held a single meeting. The Office of Long Covid Research and Practice was closed, too. Project 2025 — the Heritage Foundation blueprint that shaped much of the new administration’s policy agenda — had pre-identified pandemic-era federal health infrastructure for elimination. Long Covid fit the profile precisely: expensive, inconclusive, and a signature health legacy of the Biden administration’s pandemic response. The newly created Department of Government Efficiency provided the fiscal rationale. Robert F. Kennedy Jr.’s Make America Healthy Again (MAHA) framework added the ideological cover — chronic illness as government mismanagement, not viral consequence. HHS announced it would “no longer waste billions of taxpayer dollars responding to a non-existent pandemic.”Advertisement The human cost was immediate and specific. As of 2024, an estimated 1 in 19 U.S. adults continued to experience disabling symptoms from long Covid. (That study has now been discontinued, so we don’t have more recent numbers.) Yet nationwide, 80% of dedicated post-Covid clinics had closed. The University of North Carolina COVID Recovery Clinic — one of the most comprehensive in the country — was among them, shutting its doors in June 2025 after losing multiple funding sources. According to data obtained by the Sick Times, 43% of its patients had stopped working; 33% had gone into debt. When clinics closed, patients were referred to primary care physicians — doctors who, as one patient put it in the Sick Times, are “almost too afraid to address it.“ Long Covid was easy to erase, because researchers, clinicians, policymakers, patient advocates, and the media tried to make it fit into the biomedical paradigm. The biomedical paradigm is medicine’s most powerful tool for acute infectious disease: It identifies a pathogen, seeks to understand mechanisms, develops a targeted intervention, and confers diagnostic legitimacy through externally verifiable findings — blood tests, imaging, confirmed biomarkers. This paradigm had just delivered vaccines and dramatically reduced Covid-19 mortality at historic speed. Researchers followed their funding infrastructure. Clinicians applied what had just worked brilliantly. Policymakers, in good faith, funded what the biomedical establishment recommended: large-scale research aimed at prevention, treatment, and a possible cure. The assumption that the same framework would resolve long Covid was entirely understandable. It was also the original consequential error — because long Covid is not an acute infection that would yield to a targeted intervention. It is a “contested illness.” And applying the biomedical paradigm to a contested illness produces a particular and predictable kind of failure: a scientific stalemate that leaves the condition politically defenseless when institutional support is withdrawn.Advertisement A contested illness is a condition whose legitimacy is perpetually in negotiation between patients, clinicians, researchers, insurers, and the state. The biology is real, but it does not produce the confirmable external markers medicine requires to establish milestones of progress: abnormalities objectively detectable by testing, imaging, or biopsy. Instead, biology manifests as constellations of phenotypic symptoms across many organ systems — real and disabling, but resistant to standard confirmation. ME/CFS, Gulf War illness, and chronic Lyme share a similar profile: absent objective markers, strong patient communities, and institutionalized resistance from the medical mainstream. When patients began reporting long Covid’s symptom constellation in early 2020, a handful of ME/CFS researchers and patient advocates recognized the pattern and warned that the biomedical approach alone had failed this class of illness before. But the institutional mainstream did not incorporate that recognition. The infrastructure surrounding a contested illness — diagnosis, case surveillance, research funding, disability recognition, media attention — determines what gets counted, treated, and understood at all. Strip that infrastructure away, and the illness doesn’t disappear. It goes underground. More than six years since the onset of long Covid in early 2020, the result of applying the biomedical paradigm to a contested illness is a scientific stalemate. After $1.8 billion investment, RECOVER had not produced a validated diagnostic, a widely effective treatment, or consensus mechanism. The initiative attracted legitimate criticism — for slow enrollment, observational study design, and what clinical epidemiologist Ziyad Al-Aly of Washington University called a lack of “clarity of vision and clarity of purpose.” Those critiques were valid — but they were critiques of execution within the biomedical framework, not of the framework itself. Even a more rigorously designed RECOVER studies would have faced the same structural problem. Research publications peaked in 2022 and declined steadily through 2024. At its core, the stalemate was a product of the wrong paradigm.Advertisement The right one — patient-centered, focused on the relief of suffering, and honest about the limits of what biomedicine alone can deliver — was available from the beginning. That scientific stalemate created the political opening the administration exploited. The upside of walking away was substantial: billions in fiscal savings, ideological consistency with the MAHA narrative, and the political dividend of declaring the pandemic era closed. The downside was negligible. A contested illness without confirmed external markers has no clear victim. Without a proven treatment, the administration could walk away without removing anything patients had been able to rely on. The consequences of this systematic dismantling are visible across every constituency that had organized around long Covid. The research community is in crisis: “Some of us are concerned that our entire labs are going to get wiped out,” P.J. Utz, a Stanford University immunologist running multiple RECOVER-funded studies, told Chemical and Engineering News. The administration has since canceled Covid research more broadly, and while Kennedy convened a September 2025 roundtable promising a sustained national effort against long Covid, it arrived without significant new research funding. The academic clinical community is quietly contracting: Even programs that retained funding operated in suspended uncertainty, cutting services preemptively. The mainstream practitioner community — which had already met these patients with skepticism and dismissal — has said almost nothing. The American Academy of Pediatrics has sued the administration over vaccine policy, and the American Medical Association embraced public advocacy when Kennedy disbanded the vaccine advisory committee. Yet disbanding the long Covid advisory committee generated no comparable response. The patient advocacy community has been the most vocal and the most hobbled: “The reason we’re not doing actions like ACT UP’s,” Sam Pearce of the World ME Alliance told the Sick Times, referring to the advocacy organization that galvanized the HIV/AIDS movement, “is because most of us are just far too ill.” The condition that disables its patients also disables its political movement.Advertisement Measuring the real-world impact of this retreat is itself part of the problem. The metrics we would normally use — incidence, prevalence, disability applications, clinical encounters — are all downstream of the infrastructure that has been withdrawn. When federal websites stop tracking, when clinics close, when grants are cut mid-study, the numbers fall. But falling numbers do not distinguish between a disease genuinely receding and one that has simply been forced underground. For example, ME/CFS prevalence estimates vary by an order of magnitude — not because the biology changes, but because the infrastructure built to identify and track cases changes. Long Covid has entered that same zone — where the measurable footprint and the actual burden diverge, and the divergence itself becomes obscured. But the administration cannot permanently close the book on long Covid. The condition will resurface — contested illnesses always do — and now whatever infrastructure rises to meet it will have to be built from scratch, this time, perhaps, no longer shoehorned into solely an ill-fitting biomedical framework. A better fit was available from the beginning: patient-centered, symptom-focused, and honest about what biomedicine alone can and cannot deliver. What may now look like a disappearance may be seen, in retrospect, as a temporary demolition. Steven Phillips, M.D., M.P.H., is vice president for science and strategy at the COVID Collaborative and a fellow of the American College of Epidemiology. Letter to the editor Have an opinion on this essay? Submit a letter to the editor. chronic disease, Covid-19, patients Submit a correction requestReprints Steven Phillips Newsletter The smartest thinkers in life sciences on what's happening — and what's to come Recommended First Opinion June 11, 2026 We published in Nature Medicine in 2025 for free. In 2026, it cost us $12,850 First Opinion June 10, 2026 Even in abortion-protecting states, teens face unnecessary barriers to care Advertisement First Opinion Podcast June 10, 2026 ‘They all think I’m insane’: What it’s like to start medical residency at 72 First Opinion June 9, 2026 Ending animal testing could set back xenotransplantation just as the field is poised for a breakthrough First Opinion June 9, 2026 Why STAT is sticking with ‘health care’ as two words Subscriber Picks