Researchers looking for root causes of long COVID work in the autopsy suite inside the Clinical Center at the National Institute of Health in Bethesda, Maryland.
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Valerie Plesch
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Topline:
There's still no validated treatment or diagnostic test specifically for long COVID's often disabling symptoms — although there are many candidates.
Why it matters: Clinicians who treat long COVID are acutely aware of the unsettled nature of the field. "You do sort of feel like you're out in the wilderness," says Dr. Rasika Karnik, medical director of UChicago Medicine's post-COVID clinic.
What we do know: If long COVID were a crime scene, authorities would have no shortage of leads. They've pinpointed a handful of possible reasons why patients suffer from an array of chronic symptoms. The tricky thing is disentangling which mechanisms are bystanders and which are actually doing the damage.
For people suffering from long COVID's often disabling symptoms, including intense fatigue, breathing troubles, cognitive issues and heart palpitations, the list of scientific unknowns may sound defeating. There's still no validated treatment or diagnostic test specifically for the condition, although there are many candidates.
Clinicians who treat long COVID are acutely aware of the unsettled nature of the field. "You do sort of feel like you're out in the wilderness," says Dr. Rasika Karnik, medical director of UChicago Medicine's post-COVID clinic.
Karnik first began seeing long COVID patients in the fall of 2020. There's more information to work with now, she says, but doctors' approach still comes down to treating individual symptoms, rather than the underlying cause of the illness. "It's hard to look a patient in the eyes and say 'we're not quite sure yet' and to keep repeating that," she says.
But researchers are making progress in the field, and they presented their recent findings at one of the first major gatherings dedicated to sharing emerging evidence about the possible root cause of long COVID and implications for treatment.
"I know there's been a lot of frustration that there haven't been faster answers," says Dr. Catherine Blish, a professor of medicine at Stanford University and one of the organizers of the conference, held by the nonprofit Keystone Symposia in Santa Fe, N.M., in late August.
"But in all honesty, we are so much further ahead at this relative point than for any other major disease in my lifetime as an infectious disease specialist," she says.
The meeting underscored that scientists have made headway in developing evidence of a clear biological basis for what patients have been reporting for years.
"I've never doubted it — people are suffering," says Harlan Krumholz, a cardiologist at Yale University who's involved in long COVID research. "But we're now seeing imaging evidence, biopsy evidence, physiologic testing evidence of derangements in people who have long COVID."
Here are some of the new findings and promising lines of research highlighted during the three-day gathering.
Narrowing in on some key suspects behind the disease
If long COVID were a crime scene, authorities would have no shortage of leads.
They've pinpointed a handful of possible reasons why patients suffer from an array of chronic symptoms. The tricky thing is disentangling which mechanisms are bystanders and which are actually doing the damage.
"At this point, we have hints and correlative data," says Blish. "We can say we see this finding in a subset of people, but that doesn't mean it's the cause of their problems."
Take the theory of viral persistence: There's now strong evidence that protein and genetic material from SARS-CoV-2 persist in the blood and tissue of some long COVID patients well after their initial illness. Scientists believe these "viral reservoirs" could be driving many of the problems in long COVID patients, although it isn't yet clear exactly how this is happening — and whether the virus itself is replicating.
Dr. Michael Peluso, an infectious disease specialist at the University of California, San Francisco, told conference attendees that his team is now confident in their data showing pieces of viral antigen in the blood of people anywhere from six months to more than a year after they've had COVID-19.
They compared these blood samples to ones collected years before the pandemic to verify their conclusions. "That's a very, very important finding, showing that this is indeed real," he says.
But the story gets more messy from there because these viral reservoirs may not be the primary culprit.
While they are more likely to find viral persistence in the most symptomatic long COVID patients, not everyone with long COVID has it, Peluso notes, "And then really importantly, we're also seeing this in some people who feel totally fine — and we don't know what that means."
Finding activated T cells where they shouldn't be
Other leads have come from imaging technology that traces the activity of T cells, a type of white blood cell, which are part of the body's main antiviral immune response.
"We saw some very unexpected findings," says Dr. Timothy Henrich, an associate professor of medicine at the University of California, San Francisco.
His lab has found activated T cells in the gut wall, lung tissue, certain lymph nodes, the bone marrow, the spinal cord and the brainstem, long after someone's initial infection.
"You really shouldn't have activated T cells in the spinal cord or the brainstem," he says. "We are seeing evidence of this immune response in areas we don't typically see in the setting of an acute viral infection."
Here too the immunological detective work opens up even more questions: This T cell activity is also present in people who've recovered from an infection and have no long COVID symptoms, although Henrich notes the levels appear to be higher in certain tissues of people with long COVID.
So what does this immune response actually indicate about the underlying cause of the disease?
Henrich says T cell activity could be evidence that the immune system is trying to purge the viral reservoirs, or that the immune response has gone awry, possibly in the form of an autoimmune response, and is "doing damage to people, even if the virus has been cleared or is not replicating in those tissues," he says.
Patients and advocates for people suffering from long COVID and myalgic encephalomyelitis/chronic fatigue syndrome hosted an installation of 300 cots in front of the Washington Monument on the National Mall in Washington, D.C., in May, to represent the millions of people suffering from post-infectious disease.
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Similar questions bedevil researchers pursuing another theory.
Akiko Iwasaki, a professor of immunobiology at Yale University, says it's well known that this herpesvirus can lead to a "long COVID-like syndrome," but whether or not the reactivation is driving long COVID symptoms — or just an indication of a dysregulated immune system — remains to be seen.
All of those involved in research stress that they don't expect just one answer to long COVID. It's likely that many of these theories about its underlying cause are interrelated. And certain mechanisms may only be causing symptoms in some patients and not others.
Microclots could point the way to treatment
Early in the pandemic, it was recognized that COVID-19 can wreak havoc on the vascular system, in particular causing inflammation and damage to the inner lining of blood vessels, known as endothelial cells.
Resia Pretorius, a medical researcher at Stellenbosch University in South Africa, says the clotting and hyperactivation of platelets in long COVID is essentially a "persistent continuation" of what happens during an acute infection within the blood vessels.
Her research has focused on the role of tiny, harmful blood clots she's seeing in the blood of long COVID patients that appear to have "trapped inflammatory molecules that you might expect inside the blood if you have inflamed [or] damaged endothelial layers."
"It's not unique to long COVID, but long COVID has so much more of these inflammatory molecules in circulation," says Pretorius. "And what makes it so interesting is that the spike protein drives these microclots to form."
As the clots accumulate, they may choke off blood flow, preventing oxygen from reaching tissue.
In Santa Fe, Pretorius shared preliminary data from her team showing that so-called "triple therapy" — a combination of three medications — targeting clotting and platelet hyperactivation could benefit some long COVID patients. The preprint showed that this regime resolved symptoms in the majority of the 91 patients who were followed, although the results are not yet peer-reviewed and the study was not a clinical trial.
The approach is not without risk; many patients reported bruising, some had nosebleeds and one reported a gastrointestinal bleed.
Pretorius says microclots are not necessarily the root cause of long COVID, though.
It could be that viral reservoirs are actually helping trigger this vascular mayhem in the first place. These microclots, if left untreated, could also tie into other problems seen in long COVID patients, perhaps leading some to develop autoimmunity, says Pretorius. "That is a problem to solve because we know autoimmune diseases are notorious for being so, so difficult to treat."
Sex differences may play a role in long COVID risk
In general, males tend to do worse during an acute bout of COVID-19, but studies show that long COVID appears to be more prevalent among females. Yale's Iwasaki says this is also the case for other "post-acute infection syndromes."
This background led Iwasaki's lab to look into sex differences in the immune profiles of long COVID patients, in hopes of finding another path to understanding what could be driving the illness. She says they've found that reactivation of Epstein-Barr virus and the activation of T cells are more prevalent among females, whereas males have different "immune signatures."
"We're already starting to see sex differences in long COVID symptoms, as well as potentially the autoimmunity more associated with female patients," she says. "This insight is critical going forward because now we can separate out long COVID into different clusters. And depending on the driver of the disease, we can start targeting it with proper medicine."
Iwasaki's lab has also zeroed in on the role of hormones.
At the conference, she shared evidence of reduced cortisol levels in long COVID patients and shared a separate, unpublished finding that female long COVID patients tend to have reduced testosterone levels and that males have reduced estradiol levels.
Those who had lower testosterone (compared to the controls who don't have long COVID symptoms) also have higher activation of T cells, whether they're males or females, says Julio Silva, a graduate student in Iwasaki's lab who presented the new findings on testosterone. And this was "associated with higher neurological symptoms and overall higher symptom burden," says Silva.
The impetus to look at testosterone was, in part, because of "anecdotes from trans individuals who were informing us that while on testosterone therapy, their symptoms had improved dramatically," says Silva. While the results are preliminary and need to be replicated, he says they at least raise the question "could hormonal therapy help?"
Taken together, Iwasaki says their data strongly suggest there could be problems in the area of the brain that's responsible for regulating these hormones.
Viral persistence offers one possible target for treating long COVID
In the absence of a clear roadmap for treating long COVID, doctors and patients have taken to trying all kinds of therapies — from antivirals to drugs approved for treating addiction.
"All of this research is so critical to understanding the underlying mechanisms of long COVID," says Lisa McCorkell, co-founder of the advocacy group Patient-Led Research Collaborative. "We need to pair that with focusing on clinical trials. We have enough evidence right now to at least try some things."
In Santa Fe, UCSF's Peluso outlined how his team had just launched a small trial using monoclonal antibodies to target the coronavirus spike protein in long COVID patients — one vehicle for testing whether viral persistence is the underlying cause of at least some patients' symptoms. Meanwhile, Iwasaki and Krumholz, both at Yale, have started a clinical trial testing whether a 15-day course of Paxlovid can help alleviate symptoms.
Stanford's Blish points out that as more clinical trials start up, their success will hinge on being deliberate about which patients should be enrolled, since long COVID is a catch-all term for what may be multiple different illnesses.
"We need to understand in detail who's most likely to benefit from those trials, because if we just take everyone, that trial will fail," she says.
Many other trials are in the works, too, but Dr. Jennifer Curtin says those will inevitably take time to produce evidence that trickles down to patient care.
"It's that tough sort of in-between status right now," says Curtin, co-founder of the telehealth clinic RTHM that treats long COVID and other overlapping conditions like myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS for short. "So what do you do for the people who are sick and suffering now until we get that data?"
Curtin, who has lived with ME/CFS herself, says their clinic's approach is to perform intensive workups, draw lots of blood and try to identify which symptoms they can treat.
"Treatment is very much individually tailored," she says. "Right now it's a journey that you take with your patients. You're going through this together. You're both learning on this road and it can be tough."
Always in the backdrop at the Santa Fe gathering was the question of whether there would be enough funding — be it from the U.S. Congress or the pharmaceutical industry — to advance the research agenda toward treatments.
"What we really need here is industry engagement. We need funding for clinical trials. And that, to me, is something that's missing," says McCorkell.
Adolfo Guzman-Lopez
is an arts and general assignment reporter on LAist's Explore LA team.
Published May 19, 2026 5:53 PM
A man casts his ballot during early voting
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Topline:
Write-in candidates in Southern California are no joke. Election officials require them to qualify. While many are already in, Tuesday is the deadline to be considered. The full list will be released to the public Friday.
The rules: The city of L.A. requires write-in candidates to file a form and pay $300 or submit 500 valid signatures, while other cities may not require anything except paperwork. Qualified candidate names are sent to county election officials and will post the information Friday for voters.
Some write-in candidates: As of 3 p.m. Tuesday, the L.A. County Registrar of Voters listed 20 write-in candidates who filed in California for a wide range of races, from state Assembly and state Senate to governor. Of the 20, 11 filed as write-ins for the governor’s race.
Why it matters: Most write-in campaigns are a long shot but some have won: Lisa Murkowski won an Alaska U.S. Senate seat in 2010; Washington, D.C., Mayor Anthony Williams was reelected in 2002.
Who gets counted: Only votes for qualified write-in candidates are counted and certified. Sorry, Mickey Mouse and George Washington.
What's next:Here’s the current list of qualified write-in candidates in L.A. County. Checking the box that says Show only Write In Records will show you write-in candidates. Orange County election officials say they have no write-in candidates.
Matthew Ballinger
is the senior editor for climate and environment coverage at LAist.
Updated May 19, 2026 5:56 PM
Published May 19, 2026 4:02 PM
A fire on Santa Rosa Island has been burning since May 15, 2015. The island is seen here in 1997.
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Carlos Chavez
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Los Angeles Times via Getty Images
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Topline:
Several fires are burning across Southern California, with some destroying structures, threatening homes and charring pristine landscapes.
Where are the fires? A large fire is burning on Santa Rosa Island in Channel Islands National Park. A fire in Simi Valley has destroyed one home and led to multiple evacuation alerts. Two fires are in Riverside County, and a small fire is in the San Gabriel Mountains.
The forecast: Warm weather and Santa Ana wind conditions have hampered firefighting efforts and are expected to continue through Wednesday this week.
Read on ... for details about the Sandy Fire, Santa Rosa Island Fire and others.
Several fires are burning across Southern California, with some destroying structures, threatening homes and charring pristine landscapes.
Warm weather and Santa Ana wind conditions have hampered firefighting efforts and are expected to continue through Wednesday this week. The National Weather Service forecasts cooler weather and "May gray" through the weekend.
Here's a roundup of some of the fires burning now.
(All dates refer to today, Tuesday, May 19, unless otherwise noted)
The fire is burning in Channel Island National Park territory. Firefighters traveled by boat with their equipment to get to the island, according to news reports. The island is home to rare and endangered plants and animals.
CalFire reported about 2:40 p.m. Tuesday that lessening winds allowed "firefighters to take full advantage of improved weather to strengthen containment lines and continue aggressive suppression efforts. Crews remain actively engaged both on the ground and in the air to gain additional containment and keep the fire within its current perimeter."
The fire started Monday in the southern part of Simi Valley. It eventually spread eastward toward L.A. County communities in the San Fernando Valley, but overnight conditions were favorable to firefighters, CalFire said. Several communities were under evacuation orders and warnings, and schools in the area were closed.
The fire was first reported around noon Tuesday, according to CalFire, near Jurupa Valley (east of the 15 Freeway and south of the 60). CBS News Los Angeles reported that four people have been injured.
If you're enjoying this article, you'll love our daily newsletter, The LA Report. Each weekday, catch up on the 5 most pressing stories to start your morning in 3 minutes or less.
Frank Stoltze
is a veteran reporter who covers local politics and examines how democracy is and, at times, is not working.
Published May 19, 2026 3:42 PM
Supervisor Lindsey Horvath sponsored the motion to create an L.A. County Ethics Commission.
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Screenshot via YouTube broadcast of L.A. County Board of Supervisors meeting.
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Topline:
Citing a desire to prevent corruption within county government, the Board of Supervisors on Tuesday established Los Angeles County’s first ethics commission.
The backstory: In 2024, voters approved Measure G, which called for the creation of an Ethics Commission and Office of Ethics Compliance. The measure came amid a series of corruption cases at L.A. City Hall but calls for reform spilled over into the county government.
The details: The motion by Supervisor Lindsey Horvath and approved by the board Tuesday directs county departments to begin establishing the operational, staffing and legal infrastructure necessary to launch the commission in this year. It also directs staff to prepare a charter amendment for voter consideration on the November ballot to enshrine the commission in the charter.
Composition: Supervisors voted for a plan that calls for a seven-member commission. Initially, the chair of the Board of Supervisors, the county assessor and the Governance Reform Task Force would each appoint a commissioner, filling three spots. Those appointees would then select the remaining four members from a pool of applicants.
Opposition: Supervisor Janice Hahn supported the overall motion but opposed the composition of the commission, saying too many members were to be appointed by elected officials — the same people the panel would be charged with watchdogging.
History: The county has had its own campaign, lobbying and ethics laws on the books for years, but they were enforced by ethics officers in various departments. The latest proposal calls for a 54-member ethics office to enforce those laws and for the commission to impose fines if they are violated.
Students walk past a sign for a campus financial aid office Dec. 8, 2017.
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Topline:
After a spike in fraudulent applications to California’s community colleges, school officials say they are getting better at detecting and preventing fraud, though it still happens.
Why it matters: Between January and March 2025, scammers stole nearly $5.6 million in federal student aid and over $900,000 in state aid. By comparison, this spring colleges have reported losing just under $1.5 million in federal student aid and about $330,000 in state aid to fraudsters. Last spring was “really the peak,” Hadsell said. He said he anticipates the end-of-year total in 2026 to be “significantly lower” than last year.
The backstory: Last spring, CalMatters reported that colleges were seeing unprecedented reports of fraud, with scammers stealing millions more dollars of student aid than in any previous period, according to reports submitted by colleges to California’s Community Colleges Chancellor’s Office.
Read on... for more on how community colleges in the state are cracking down on financial aid fraud.
This story was originally published by CalMatters. Sign up for their newsletters.
California’s community colleges have been battling fraudulent students for years, trying to prevent scammers from stealing financial aid money.
Recent data shows the colleges’ efforts finally may be working.
Last spring, CalMatters reported that colleges were seeing unprecedented reports of fraud, with scammers stealing millions more dollars of student aid than in any previous period, according to reports submitted by colleges to California’s Community Colleges Chancellor’s Office.
Now fewer scammers are bypassing colleges’ vetting systems, according to monthly reports, and school administrators say they’re better, though still not perfect, at detecting and preventing fraud.
After CalMatters reported on the rise in fraud last year, Republican U.S. Congress members called for a federal investigation, a Democratic state legislator launched a state audit and later, California’s Community Colleges Chancellor’s Office approved a new ID verification policy for students. Colleges now are more vigilant about policing fraud, said Jory Hadsell, an executive in technology initiatives for the chancellor’s office, who pointed to better filtering practices and new software to detect fraud.
Between January and March 2025, scammers stole nearly $5.6 million in federal student aid and over $900,000 in state aid. By comparison, this spring colleges have reported losing just under $1.5 million in federal student aid and about $330,000 in state aid to fraudsters.
Last spring was “really the peak,” Hadsell said. He said he anticipates the end-of-year total in 2026 to be “significantly lower” than last year.
Even in the worst months, such as last spring, the money distributed to scammers is less than 1% of the total financial aid distributed to community college students in California. Students use the money to help pay for tuition, books and the cost of daily living expenses, such as rent, transportation and food.
But any fraud, however small, is unacceptable, said Chris Ferguson, executive vice chancellor of finance and strategic initiatives. “The ultimate goal for our system is zero.”
Some anti-fraud policies have been slow to take effect. The California Community Colleges Board of Governors voted nearly a year ago to require ID verification for all students, but only about 50% of college students are doing it as of this month. Hadsell said the delays arose in part because of complications verifying information of students under 18 years old, who represent a growing demographic for the community colleges. He said ID verification, which is currently optional, will become mandatory on July 1.
The board also voted to “explore” the option of charging students an application fee of no more than $10, but with the rates of fraud declining and other solutions that seem to work, the chancellor’s office is no longer pursuing that option, Ferguson said.
After blaming California officials, the U.S. Department of Education, which shares responsibility for administering federal aid and detecting fraud, said it would implement a “screening process” for applicants. It was supposed to take effect last fall but didn’t launch until last month, according to press releases from the department and statements from the California Student Aid Commission. CalMatters reached out to the U.S. Education Department five times over the last 12 months, seeking clarification, but the department has refused to respond to questions about delays with the screening process.
When more than a third of college applicants are fake
After classes suddenly moved online during the COVID-19 pandemic, the California Community Colleges Chancellor’s Office saw an increase in financial aid fraud on their application portal, CCCApply, which is used by nearly every student as the first step in applying to community college.
In 2021, the chancellor’s office suspected roughly 20% of applicants were fraudulent.
The estimate was higher in January 2024, around 25%. Last spring, it was 34%, though some schools saw much higher rates.
After they apply through CCCApply, students get filtered locally at their college of choice. In the Los Rios Community College District, which represents Sacramento, college officials suspected 64% of local applications from January to March 2025 were fraudulent. And that was after the state already vetted them through its portal, said Gabe Ross, a spokesperson for the district. The San Diego and Los Angeles community college districts also reported spikes in the number of fraudulent applications around the same time.
CalMatters reached out to the five largest community college districts for an interview. The Rancho Santiago Community College District, which includes parts of Orange County, did not provide sufficient data to draw conclusions about trends in fraud. The State Center Community College District, which represents schools in Fresno and Madera counties, did not respond to CalMatters’ questions.
Monthly data reports to the chancellor’s office show that once detected, most scammers who applied to community colleges were then caught and kicked out before they could apply for financial aid, but some succeeded.
This year, both Sacramento and San Diego community colleges say they’re seeing fewer attempts at fraud and are getting better at stopping those who try. The San Diego Community College District is now manually screening for fraudulent applications twice a week and is finalizing a contract with a company to help improve its detection software.
CCCApply has improved its filtering process, which helped reduce fraud attempts at Sacramento area colleges, said Ross. “When we talked about such a complex dynamic challenge, it's always hard to identify what's the one thing that sort of moved the needle. The truth is that we needed support from the feds, we needed support from the (chancellor’s) office, and we needed to invest in tools locally.”
This spring, he said the district flagged about 12% of college applications as suspect.
Using AI to detect AI
Measuring fraud is, by definition, imprecise. If a scammer is truly successful, colleges have no way to identify that fraud.
For a long time, administrators assumed bots enrolling in online classes were responsible for most fraudulent attempts. Yet teachers, students and financial aid administrators say some of the scams are more sophisticated now and are coming from real people impersonating students. Many fraudulent applications to Los Angeles’ community colleges have real names, dates of birth, and addresses that are likely “leaked or stolen,” said Nicole Albo-Lopez, the deputy chancellor of the Los Angeles Community College District.
In San Diego, Victor DeVore, dean of student services, said the college district only requires ID verification for students flagged as fraudulent. At that point they must prove their identity, either in person or through Zoom. Once, a potentially fraudulent student appeared on Zoom and presented a valid-looking ID that matched their face, but DeVore’s team noticed that the student’s IP address was odd. “One minute they’re logging in from Nairobi, the next minute they'll be logging in from Virginia,” he said, adding that the use of AI, virtual private networks (VPNs) or other technology has made fraud harder to detect.
Students’ personal data is supposed to be private, but school districts and education technology companies are frequently hacked. Last week, Canvas — one of the go-to learning platforms for California’s community colleges, University of California and California State University campuses — went offline temporarily due to a major hack. Its parent company, Instructure, said last week that it reached an agreement with the hackers to relinquish students’ data.
The state has turned to AI to fight fraud. Last summer, the state chancellor’s office negotiated a multimillion dollar contract with N2N Services Inc., enabling any college in the state to access the company’s software at a discounted rate. The software uses AI to detect potentially fraudulent applicants. Colleges are not required to use it, and so far, only about two-thirds do. Some districts, such as the Los Angeles Community College District, use a different fraud detection software, known as Socure.
Colleges and the state chancellor’s office continue to face political pressure and scrutiny of their approach to fraud. Last month, the U.S. Education Department said it had prevented more than $171 million in fraud in California after implementing a new policy regarding ID verification. Hadsell, with the state chancellor’s office, said the federal policy had no impact on California’s colleges. “They issued some interim guidance last year that basically said you should at least have a Zoom call with students and have them show an ID when you're approving their aid. And those were things that were already happening. It was not, you know, some new thing at least for most of our colleges.”
Kiran Kodithala, the CEO of N2N, which collects its own data on fraud at community colleges, said the education department’s claim makes no sense.
“I don’t see how $171 million in fraud in California can occur,” he said. “There’s no basis for those numbers. We’re not seeing anything remotely close.” Kodithala estimates that N2N has prevented over $34 million in fraud since last summer, though his platform is not yet in use by all of California's 116 community colleges.
Collecting more precise data may take months or years. U.S. Representative Young Kim, who represents parts of Orange, Riverside and San Bernardino counties, launched the effort for a federal investigation last spring, but her office could not provide any updates or confirm that an investigation was in fact underway. At the state level, the Legislature last year approved conducting an audit of how California’s community colleges handled fraud but the findings won’t be released until this summer.
