The administration of Republican Gov. Ron DeSantis of Florida is blocking a new Advanced Placement course for high school students on African American studies.

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The year after a midterm election is presidential purgatory. Congressional investigators from the opposing party devote themselves to flaying the incumbent. Stripped of any possibility of grand legislative accomplishments, presidents busy themselves with foreign policy and patiently wait for their domestic foes to overplay their hand.

For Joe Biden, this is all intimately familiar. He experienced this discomfort as Barack Obama’s vice president. And he walked away with a sense of how he might get through it differently himself, how he could profitably survive this awkward year—and leverage it as the basis for reelection.

Back in 2009, Obama anointed Biden “The Sheriff.” Obama charged him with overseeing the implementation of the Recovery Act, the $787 billion economic stimulus, passed in the first days of the new administration. This was a thankless task, because it made Biden responsible for any waste, fraud, and abuse in the program, but it was also a dream assignment. The career politician had a chance to race from ribbon cutting to ribbon cutting. He could bask in selling governmental achievements made of concrete and steel, stuff people could touch.

Biden’s frustration with Obama was that he didn’t sufficiently consider the marketing potential of the stimulus. Obama frankly admitted that he took “perverse pride” in how his technocratic administration constructed policy without regard for political considerations. The 2009 Recovery Act included tax cuts, but intentionally didn’t advertise them. The government quietly withheld less money from paychecks, a dividend that almost nobody noticed. This furtive tax cut was theoretically effective, because consumers were less likely to save money that they didn’t know they possessed. But it was also a political nonfact.

[From the April 2016 issue: The Obama doctrine]

This humility of sorts transgressed a core Biden maxim: Good policy is useless without good politics. The health of the government (not to mention the health of the Democratic Party) depends almost entirely on public appreciation of the government’s deeds.

Now that he’s president, Biden is his own self-anointed Sheriff. In its first two years, his administration passed ambitious, expensive legislation. The Infrastructure Investment and Jobs Act spends $1 trillion. The CHIPS and Science Act devotes more than $250 billion to jump-starting the American semiconductor industry and investing in technological research. The Inflation Reduction Act contains, at least, a $370 billion investment in clean energy. Biden could break his hand signing all the checks that his administration is about to write.

Overseeing these investments will allow Biden to fulfill the two grandest ambitions of his presidency. The first ambition is both lofty and self-interested. He has long argued that democracy will prevail in its struggle against authoritarianism only if it can demonstrate its competence to the world. That means passing legislation. But he believes that non-college-educated voters, the neglected constituents he wants to take back from the Republicans, hardly know about the big bills emanating from Washington with banal names. And they won’t believe in their efficacy in any case, unless they can see the fruits of the legislation with their own eyes.

Biden intends to deluge this group with relentless salesmanship—christening new airports and standing next to local officials as they break ground on new factories and tunnels. When he daydreams in the Oval Office, he imagines omnipresent road signs announcing new government projects in his name. In his mind, there will be Biden Rest Stops as far as the eye can see.

His second ambition is far trickier. He doesn’t just imagine scattered projects. He wants to comprehensively change the economy of entire regions of the country. By geographically concentrating investments—in broadband, airports, semiconductor plants, universities—he can transform depressed remnants of the Rust Belt into the next iteration of North Carolina’s Research Triangle. By seizing the commanding heights of the industries of the future, he can reindustrialize America.

But that vision requires mobilizing sclerotic bureaucracies—and aligning disparate agencies that don’t normally play nice with one another. The word implementation, perhaps the least sexy word in the English language, is his current fixation. He believes that the latent potential of these projects can be realized only if he pays close attention to them.

Large checks to semiconductor manufacturers will bring jobs and protect the supply chain from foreign threats. But that’s only half the mission. With his purse strings comes power. And Biden wants to use his leverage to create high-paying unionized jobs. He intends to pressure CEOs so that they don’t furtively funnel government money into stock buybacks. Even though the public doesn’t have this impression of Biden, he actually gravitates to the weeds. Obsessing over small details allows him to feel a sense of mastery of big processes.

Of course, Biden realizes that these projects will be mere sideshows in the press, as he spars with adversaries, foreign and domestic, bent on provoking apocalypse. But, in his mind, the role of Sheriff is connected to solving congressional crises, perhaps not in the near term but over time. All along, Biden has believed that he can exploit fissures within the Republican Party. That’s why he has always carefully drawn a distinction between the authoritarian MAGA faction and the traditional conservatives, whom he recognizes as his fellow politicians. There’s no dealing with the MAGA set. But the other Republicans have conventional interests, which he can exploit in his search for a deal.

[Read: What Joe Biden has (and hasn’t) accomplished]

He took this approach on January 4, in his appearance with Senate Minority Leader Mitch McConnell at the Brent Spence Bridge, crossing the Ohio River, to celebrate new government investment. That event transpired as Kevin McCarthy flailed in his campaign to become House speaker. Biden knows that McConnell has little regard for McCarthy—and would rather cut a deal on the debt ceiling than crash the U.S. economy. (After all, McConnell cut that deal before, back in 2011.) McConnell could serve as an ally while Biden slowly cultivates relationships with the 18 Republican House members from districts that he won in 2020. If these Republicans have any prayer of winning reelection, they will need to evince some measure of independence from the Trumpists. They, too, will need to show their constitutents that they can govern. Biden is not confident that he will prevail in this quest, but it’s his best play.

In the face of Republican extremism, Biden will continue to periodically sound the alarm about the threat to democracy. But he also knows that his opponents will do most of this work for him—and that the Sheriff can’t just pose as the protector; he also needs to deliver.

In a normal year, the March for Life would begin somewhere along the National Mall. The cavalcade of anti-abortion activists in Washington, D.C., would wind around museums and past monuments, concluding at the foot of the Supreme Court, a physical representation of the movement’s objective: to overturn Roe v. Wade. The march happens in January of each year to coincide with the anniversary of the Roe decision.

But this is not a normal year. Tomorrow’s march will be the first without Roe on the books.

[Read: The anti-abortion movement’s Gen-Z victors]

In recognition of that fact, the march has a new route. It will finish somewhere on First Street, between the Capitol and the Court building, an acknowledgment of the enormous and somewhat nebulous task ahead: banning or restricting abortion in all 50 states. That task will involve not only Congress, the courts, and the president but also 50 individual state legislatures, thousands of lawmakers, and all of the American communities they represent.

At the march, activists and other attendees will be jubilant. Speakers will congratulate their fellow marchers on a job well done. Yet at the same time, a current of uncertainty ripples beneath the surface of the anti-abortion movement. Advocates are technically closer than ever to ending abortion in America, but in some ways, the path forward is more treacherous now than it was before. The movement is not in disarray, exactly, but its energy is newly decentralized, diffused throughout the country.

“There’s a much more choose-your-own-adventure feel” to the movement now, Mary Ziegler, a University of California, Davis School of Law professor who has written about abortion for The Atlantic, told me.

Overturning Roe was only the first step. The next isn’t exactly obvious.

Since the 1980s, rescinding the Supreme Court’s 1973 ruling in Roe, which established a nationwide right to abortion, had been the movement’s top goal, because it was the key that unlocked everything else. There could be no real prohibitions on abortion as long as Roe was in effect. Charging into battle was easier under a single banner, with resources and energy directed toward a single national project: filling the Supreme Court with abortion foes.

Now, though, across all 50 states, different leaders are pressing for abortion restrictions of varying types and degrees: heartbeat bans, gestational limits, restrictions on the abortion pill, or outright bans with few or no exceptions.

America’s anti-abortion movement has always been a rich tapestry. Although its members share an overarching goal—ending abortion—they have disagreed on tactics and approach. Some groups—including Susan B. Anthony Pro-Life America, Americans United for Life (AUL), and the National Right to Life Committee (NRLC)—have prioritized legal and political strategies; others, including many Catholic organizations, have advocated more for funding the country’s 2,700 pregnancy centers or expanding the social safety net. But there was always a power hierarchy among these groups. “If you were wondering where the bills came from, the lawsuits, it was obvious: A handful of national groups dictated everything,” Ziegler said. The NRLC and AUL organized the troops and drafted model legislation. They planned judicial strategy and pushed court cases forward.

In the post-Roe world, those groups are less powerful and less relevant. The central players now are the thousands of state-level politicians, local leaders, and grassroots activists who are writing and passing legislation, often independent of those once-dominant national groups.

[From the May 2022 issue: The future of abortion in a post-Roe America]

The influence of the national groups has been waning since even before the fall of Roe. A Texas pastor and a former state solicitor general, for example, came up with Texas’s 2021 S.B. 8, which banned abortion once a fetal heartbeat was detectable (typically after six weeks) and authorized private citizens to sue abortion providers. The two men did so without much input from any national group, according to the experts I spoke with. Abortion restrictions in Alabama and Georgia, which passed in 2019 and went into effect in 2022, were drafted by different state activists and leaders and contain starkly different language, showing little influence from national groups.

The national anti-abortion movement clearly wasn’t ready for this flurry of activity. But it could have been better prepared, Daniel K. Williams, a history professor at the University of West Georgia, told me. When Amy Coney Barrett was nominated to the Court, or even as soon as Trump was elected president, national organizations could have put forward a single model law for lawmakers, and uniform guidance for health-care providers and hospitals. Instead, America ended up with a chaotic patchwork of abortion restrictions—a mixture of newly written trigger laws and dusty legislation from the late 19th century. Some of these new policies are vague or fail to address health complications such as miscarriage and ectopic pregnancy. They propose varying consequences for abortion providers and different mechanisms for enforcement.

In November, the AUL released its American Life Initiative and its model legislation, the Ready for Life Act, which bans abortion after conception and includes a life-of-the-mother exception, as well as clarifications regarding miscarriage and ectopic pregnancy. But it came five months after the Dobbs v. Jackson Women’s Health Organization decision overturning Roe. That groups were drafting these guidelines “months after Dobbs and not experiencing any uniformity in state legislatures is a sign of how decentralized and swift-moving all of this has been,” Williams said.

Clarke Forsythe, the senior counsel for AUL, defends his organization’s strategy: “We needed time to analyze Dobbs and its impact and implications and needed time to put the package together,” he told me. “It’s a long-term initiative and a long-term vision. There was no need to get it out before the election.”

Abortion opponents insist that a state-level free-for-all could turn out to be helpful for the movement. With more people involved and working toward different initiatives, the argument goes, activists might come up with innovative ideas and policy proposals. Democracy, by nature, is messy. “It’s good for the country and good for our politics to decentralize the issue,” Forsythe told me. “The Court sent it back to the local level, where public policy can be better aligned with public opinion, where the people responsible for it are responsive to people at the local level.” Decentralization is the movement’s strength, Lila Rose, the president of the national anti-abortion group Live Action, told me. “It requires a diverse and multifaceted approach. It’s not strategic conflict so much as strategic differences.”

This particular moment gives anti-abortion activists a chance to think creatively and to forge new alliances, some in the movement argue. Now that Roe is gone, do they need to keep up their ties with the GOP? “I would like to see the movement disentangle itself from particular political parties,” Erika Bachiochi, an anti-abortion writer and a fellow at the Ethics and Public Policy Center, told me. Maybe, she added, there’s room for a return of the “old pro-life Democrat.”

But an unintended consequence of overturning Roe could be that the movement has inadvertently pushed its highest objective—ending legal abortion—further out of reach. “On the one hand, when there’s a free-for-all, ideas that may never have been given the time of day can emerge and work,” Ziegler said. “On the other, you can have bills that are damaging nationally get passed.” Texas’s S.B. 8—the Texas Heartbeat Act—frustrated some movement leaders because it empowered individual citizens to sue, which meant that those individuals would control the narrative, Ziegler said. Others worry about the vocal “abortion abolition” groups, which have been calling for women who obtain abortions to be punished.

These days, Ziegler says, “there’s no single voice in the movement to say, ‘No, that’s not what we stand for.’” A few extremists, in other words, could damage the movement’s reputation—and interfere with its ultimate goal.

Before Dobbs, anti-abortion advocates seemed confident that once a handful of states banned abortion, many more would follow—that they could build a “culture of life” in America that would put the country on a righteous path. In some ways, the opposite has occurred. As a few states put limits on abortion rights, others, such as Vermont, California, and Michigan, have reacted by enshrining those rights into state law. Meanwhile, voters in red states including Kansas, Montana, and Kentucky rejected attempts to restrict abortion. Former President Donald Trump—the man whose nomination of three Supreme Court justices led directly to the overturning of Roe—has gone so far as to blame Republicans’ disappointing midterm performance on the anti-abortion movement. (In response, Rose called his comments “sniveling cowardice.”)

Nationally, the movement’s relationship with the Republican Party is troubled. Last fall, when Senator Lindsey Graham proposed legislation restricting abortions after 15 weeks, only a handful of his Republican colleagues were publicly supportive. "Most of the members of my conference prefer that this be dealt with at the state level," Minority Leader Mitch McConnell told reporters at the time.

[David Frum: Roe is the new prohibition]

Even in the new Congress, where Republicans have a House majority, one of the first pieces of legislation passed in the lower chamber was the so-called Born Alive bill, which would require health-care providers to treat babies in the vanishingly rare cases of failed abortions. Here was a chance for Republicans to pass a bill restricting abortion after 15 weeks or even six, in a show of support to the movement that they purport to champion. But they didn’t. Republicans in Congress are “afraid to do anything on this issue that’s meaningful” for fear of the political consequences, Ziegler says.

Anti-abortion leaders like Rose believe that they’re being unfairly blamed for these recent Republican losses and missed opportunities. They argue that in the midterms the GOP chose candidates who were insufficiently anti-abortion, or simply problematic, such as Mehmet Oz and Herschel Walker. But there was also a communication issue, they say. Candidates weren’t outspoken enough about abortion; they should have talked more about the Democrats’ support for abortion at late gestational ages, and their plan to codify abortion rights into law. “That’s where the real problem was” in the midterms, Marilyn Musgrave, the vice president of government affairs for Susan B. Anthony Pro-Life America, told me. “Republicans weren’t pointing out the extremism on the other side.”

It’s true that some Republicans campaigned successfully on abortion restrictions last year, including GOP Governors Ron DeSantis of Florida, Kay Ivey of Alabama, Brian Kemp of Georgia, and Greg Abbott of Texas, each of whom won reelection by a substantial margin. Still, the recent state referenda and post-Dobbs polling suggest that the anti-abortion movement is too optimistic about the level of support for their goals.

“We’ve clearly lost the narrative,” Charlie Camosy, an ethics professor at Creighton University School of Medicine and a columnist for the Religion News Service, told me. Activists like Camosy hope that the movement’s new emphasis will be a grassroots effort to educate Americans and persuade them to oppose abortion. Camosy isn’t attending the March for Life tomorrow; instead, he’s giving a speech at a Catholic seminar in Freehold, New Jersey, where he lives. “Something is wrong in our ability to communicate what’s at stake,” he said of the broader movement. “Focusing on the national level distracts from getting Michigan or Montana or Kentucky or Kansas right.”

But eventually, Camosy’s movement will have to face the reality of abortion in America: Some states just aren’t going to budge. “Fewer than 50 percent of states are likely to meaningfully curtail abortion,” Williams estimates. Even if the movement gains ground in some states, “that’s likely only to harden the resistance in more strongly pro-choice states.” Which means that, rather than a growing national consensus on abortion, Americans probably can expect more polarization—a cultural standoff.

Tomorrow’s March for Life will be the first time activists have held a major national gathering since Roe was overturned in June. But it will probably be a much smaller event than before. Some activists have wondered whether it should happen at all. More states and cities will be hosting their own rallies, because that’s where the next round of work needs to be done. And many people will be at those local marches instead—to start, or maybe to double down, on their difficult project of creating a “culture of life.”

Three years into the global fight against SARS-CoV-2, the arsenal to combat long COVID remains depressingly bare. Being vaccinated seems to reduce people’s chances of developing the condition, but the only surefire option for avoiding long COVID is to avoid catching the coronavirus at all—a proposition that feels ever more improbable. For anyone who is newly infected, “we don’t have any interventions that are known to work,” says Akiko Iwasaki, an immunologist and long-COVID researcher at Yale.

Some researchers are hopeful that the forecast might shift soon. A pair of recent preprint studies, both now under review for publication in scientific journals, hint that two long-COVID-preventing pills might already be on our pharmacy shelves: the antiviral Paxlovid and metformin, an affordable drug commonly used for treating type 2 diabetes. When taken early in infection, each seems to at least modestly trim the chance of developing long COVID—by 42 percent, in the case of metformin. Neither set of results is a slam dunk. The Paxlovid findings did not come out of a clinical trial, and were focused on patients at high risk of developing severe, acute COVID; the metformin data did come out of a clinical trial, but the study was small. When I called more than half a dozen infectious-disease experts to discuss them, all used hopeful, but guarded, language: The results are “promising,” “intriguing”; they “warrant further investigation.”

At this point, though, any advance at all feels momentous. Long COVID remains the pandemic’s biggest unknown: Researchers still can’t even agree on its prevalence or the features that define it. What is clear is that millions of people in the United States alone, and countless more worldwide, have experienced some form of it, and more are expected to join them. “We’ve already seen early data, and we’ll continue to see data, that that will emphasize the impact that long COVID has on our society, on quality of life, on productivity, on our health system and medical expenditures,” says Susanna Naggie, an infectious-disease physician and COVID-drug researcher at Duke University. “This needs to be a high priority,” she told me. Researchers have to trim long COVID incidence as much as possible, as soon as possible, with whatever safe, effective options they can.

By now, news of the inertia around preventive long-COVID therapies may not come as much of a shock. Interventions that stop disease from developing are, on the whole, a neglected group; big, blinded, placebo-controlled clinical trials—the industry gold standard—usually look to investigate potential treatments, rather than drugs that might keep future illness at bay. It’s a bias that makes research easier and faster; it’s a core part of the American medical culture’s reactive approach to health.

[Read: Long COVID has forced a reckoning for one of medicine’s most neglected diseases]

For long COVID, the terrain is even rougher. Researchers are best able to address prevention when they understand a disease’s triggers, the source of its symptoms, and who’s most at risk. That intel provides a road map, pointing them toward specific bodily systems and interventions. The potential causes of COVID, though, remain murky, says Adrian Hernandez, a cardiologist and clinical researcher at Duke. Years of research have shown that the condition is quite likely to comprise a cluster of diverse syndromes with different triggers and prognoses, more like a category (e.g., “cancer”) than a singular disease. If that’s the case, then a single preventive treatment shouldn’t be expected to cut its rates for everyone. Without a universal way to define and diagnose the condition, researchers can’t easily design trials, either. Endpoints such as hospitalization and death tend to be binary and countable. Long COVID operates in shades of gray.

Still, some scientists might be making headway with vetted antiviral drugs, already known to slash the risk of developing severe COVID-19. A subset of long-COVID cases could be caused by bits of virus that linger in the body, prompting the immune system to wage an extended war; a drug that clears the microbe more quickly might lower the chances that any part of the invader sticks around. Paxlovid, which interferes with SARS-CoV-2’s ability to copy itself inside of our cells, fits that bill. “The idea here is really nipping it in the bud,” says Ziyad Al-Aly, a clinical epidemiologist and long-COVID researcher at Washington University in St. Louis, who led the recent Paxlovid work.

Paxlovid has yet to hit the scientific jackpot: proof from a big clinical trial that shows it can prevent long COVID in newly infected people. But Al-Aly’s study, which pored over the electronic medical records of more than 56,000 high-risk patients, offers some early optimism. People who took the pills, he and his colleagues found, were 26 percent less likely to report lingering symptoms three months after their symptoms began than those who didn’t.

[Read: Inside the mind of an anti-Paxxer]

The pills’ main benefit remains the prevention of severe, acute disease. (In the recent study, Paxlovid-takers were also 30 percent less likely to be hospitalized and 48 percent less likely to die.) Al-Aly expects that the drug’s effectiveness at preventing long COVID—if it’s confirmed in other populations—will be “modest, not huge.” Though the two functions could yet be linked: Some long-COVID cases may result from severe infections that damage tissues so badly that the body struggles to recover. And should Paxlovid’s potential pan out, it could help build the case for testing other SARS-CoV-2 antivirals. Al-Aly and his colleagues are currently working on a similar study into molnupiravir. “The early results are encouraging,” he told me, though “not as robust as Paxlovid.” (Another study, run by other researchers, that followed hospitalized COVID patients found those who took remdesivir were less likely to get long COVID, but a later randomized clinical trial didn’t bear that out.)

A clinical trial testing Paxlovid’s preventive potency against long COVID is still needed. Kit Longley, a spokesperson for Pfizer, told me in an email that the company doesn’t currently have one planned, though it is “continuing to monitor data from our clinical studies and real-world evidence.” (The company is collaborating with a research group at Stanford to study Paxlovid in new clinical contexts, but they’re looking at whether the pills  might treat long COVID that’s already developed. The RECOVER trial, a large NIH-funded study on long COVID, is also focusing its current studies on treatment.) But given the meager uptake rates for Paxlovid even among those in high-risk groups, Al-Aly thinks his new data could already serve a useful purpose: providing people with extra motivation to take the drug.

The case for adding metformin to the anti-COVID tool kit might be a bit muddier. The drug isn’t the most intuitive medication to deploy against a respiratory virus, and despite its widespread use among diabetics, its exact effects on the body remain nebulous, says Stacey Schultz-Cherry, a virologist at St. Jude Children’s Research Hospital. But there are many reasons to believe it might be useful. Some research has shown that metformin can mess with the manufacture of viral proteins inside of human cells, Bramante told me, which may impede the ability of SARS-CoV-2 and other pathogens to reproduce. The drug also appears to rev up the disease-dueling powers of certain immune cells, and to stave off inflammation. Studies have shown that metformin can improve responses to certain vaccinations in humans and rodents, and researchers have found that people taking the drug seem less likely to get seriously sick from influenza. Even the diabetes-coronavirus connection may not be so tenuous: Metabolic disease is a risk factor for severe COVID; infection itself can put blood-sugar levels on the fritz. It’s certainly plausible that having a metabolically altered body, Schultz-Cherry told me, could make infections worse.

[Read: The promising treatment we’re not even trying for long COVID]

But the evidence that metformin helps prevent long COVID remains sparse. Carolyn Bramante, the scientist who led the metformin study, told me that when her team first set out in 2020 to investigate the drug’s effects on SARS-CoV-2 infections in a randomized, clinical trial, long COVID wasn’t really on their radar. Like many others in their field, they were hoping to repurpose established medicines to keep infected people out of the hospital; early studies of metformin—as well as the two other drugs in their trial, the antidepressant fluvoxamine and the antiparasitic ivermectin—hinted that they’d work. Ironically, two years later, their story flipped around. A large analysis, published last summer, showed that none of the three drugs were stellar at preventing severe COVID in the short term—a disappointing result (though Bramante contends that their data still indicate that metformin does some good). Then, when Bramante and her colleagues examined their data again, they found that study participants that had taken metformin for two weeks around the start of their illness were 42 percent less likely to have a long-COVID diagnosis from their doctor nearly a year down the road. David Boulware, an infectious-disease physician who helped lead the work, considers that degree of reduction pretty decent: “Is it 100 percent? No,” he told me. “But it’s better than zero.”

Metformin may well prove to prevent long COVID but not acute, severe COVID (or vice versa). Plenty of people who never spend time in the hospital can still end up developing chronic symptoms. And Iwasaki points out that the demographics of long-haulers and people who get severe COVID don’t really overlap; the latter skew older and male. In the future, early-infection regimens may be multipronged: antivirals, partnered with metabolic drugs, in the hopes of keeping symptoms both mild and short-lived.

But researchers are still a long way off from delivering that reality. It’s not yet clear, for instance, whether the drugs work additively when combined, Boulware told me. Nor is it a given that they’ll work across different demographics—age, vaccination status, risk factors, and more. Bramante and Boulware’s study cast a decently wide net: Although everyone enrolled in the trial was overweight or obese, many were young and healthy; a few were even pregnant. The study was not enormous, though—about 1,000 people. It also relied on patients’ individual doctors to deliver long-COVID diagnoses, likely leading to some inconsistencies, so other studies that follow up in the future could find different results. For now, this isn’t enough to “mean we should run out and use metformin,” Schultz-Cherry, who has been battling long COVID herself, told me.

Other medications could still fill the long-COVID gaps. Hernandez, the Duke cardiologist, is hopeful that one of his ongoing clinical trials, ACTIV-6, might provide answers soon. He and his team are testing whether any of several drugs—including ivermectin, fluvoxamine, the steroid fluticasone, and, as a new addition, the anti-inflammatory montelukast—might cut down on severe, short-term COVID. But Hernandez and his colleagues, Naggie among them, appended a check-in at the 90-day mark, when they’ll be asking their patients whether they’re experiencing a dozen or so symptoms that could hint at a chronic syndrome.

That check-in questionnaire won’t capture the full list of long-COVID symptoms, now more than 200 strong. Still, the three-month benchmark could give them a sense of where to keep looking, and for how long. Hernandez, Naggie, and their colleagues are considering whether to extend their follow-up period to six months, maybe farther. The need for long-COVID prevention, after all, will only grow as the total infection count does. “We’re not going to get rid of long COVID anytime soon,” Iwasaki told me. “The more we can prevent onset, the better off we are.”

“How to Build a Life” is a column by Arthur Brooks, tackling questions of meaning and happiness. Click here to listen to his podcast series on all things happiness, How to Build a Happy Life.

“Ōdī et amō,” the Roman poet Catullus wrote of his lover Lesbia about 2,000 years ago. “I hate and I love. Why I do this, perhaps you ask. I know not, but I feel it happening and I am tortured.”

Maybe you can relate. If you’ve ever had mixed feelings about someone you love, you know the intense discomfort that results. If your feelings were purely positive, of course, the relationship would be bliss. Even purely negative feelings would be better, because the course of action would be clear: Say goodbye. But mixed feelings leave you confused about the right thing to do.

Romance isn’t the only part of life in which mixed feelings can cause pain. Maybe your ambivalence is instead directed toward your employer, and you can’t decide whether to stay and work to make things better, or go someplace else. Or maybe some of your memories are painfully mixed and hard to interpret. Perhaps your childhood was both good and bad, not fitting into a neat frame, and thus feels impossible to explain to others or even yourself.

Mixed emotions drain your emotional batteries, like a phone connecting to multiple networks simultaneously. They are one of the most complex psychological phenomena we are capable of, and bring us a great deal of distress. You might think that purely negative emotions are the most unpleasant ones; in truth, a cocktail of negative and positive can be worse.

The idea of being able to experience truly “mixed” feelings is quite new. Well into the 20th century, many psychologists believed that positive and negative emotions existed on a continuum. If you felt “less bad” as time passed after a loss or trauma, that simply meant you felt “more good.” Researchers didn’t think you could feel good and bad at the same time. Even today, people often talk about happiness and unhappiness in this way—as if the presence of one means the absence of the other.

In the 1960s, new psychological research began to collect evidence that positive and negative emotions were in fact separable, and as further research observed, could be felt simultaneously, and also in rapid succession. Neuroscience added support for this hypothesis when scholars found that positive and negative emotions largely correspond to activity in different hemispheres of the brain (for many people, negative emotions align with activity on the right, positive on the left).

[Read: Sit with negative emotions, don’t push them away]

Today, many emotion researchers believe that mixed emotions happen to just about everyone. Sometimes you feel positively about your romantic relationship in the morning, and negatively in the afternoon, for no clear reason. Or in one moment, you feel good about the overall partnership (I’m glad we’re together!) but bad about certain aspects (she isn’t very affectionate, and that worries me).

You might assume that your net happiness at a given time would be something like your positive emotion minus your negative emotion; if good > bad, then you are “net happy.” But as Catullus suggests, it’s not so simple: Mixed emotions can impose a psychological toll that’s greater than the result of that equation, because they are confusing and conflictive. You might say that the bad and good are at war internally, exhausting you emotionally.

Last year, a researcher found just this when he measured the effects of positive, negative, and mixed emotions on well-being: Positive emotions pushed well-being up, and negative emotions pushed it down; meanwhile, the independent measure of mixed emotions also pushed well-being down, and by more than negative emotions alone. In other words, hating your relationship or your job is emotionally easier than being ambivalent about it.

One seemingly obvious solution to the problem of mixed emotions is to try to eradicate them through more binary thinking. For example, you could attempt to eliminate shades of gray in your romance by simply deciding that it is “good” or “bad,” and then acting accordingly. My wife—a Spaniard—has told me that she thinks a lot of Americans do this: Everything has to be either wonderful or awful. Psychologists call this “dichotomous thinking,” and studies show that it is neither helpful nor healthy; on the contrary, it is associated with a number of personality disorders.

Rather than trying to think more dichotomously, lean into the zone of mixed emotions, which psychologists call “dialectical thinking.” This is the attitude that opposite emotions are normal and compatible. Some cultures are better than others at dialectical thinking—and my wife is right that Americans tend to be especially weak at it. For example, one 2021 experiment on American and Chinese students asked them to read statements that elicited happy memories and sad emotions at the same time, such as “I have been dreading this moment, but it has finally arrived. A chapter in my life is ending, and the future is still uncertain. I’ll miss the neighborhood and the friends I’ve made. I really do not want to leave. It’s a sad and nostalgic time.” The Americans experienced almost 50 percent more discomfort when reading this than their Chinese counterparts, possibly because they did not recognize or focus on the fact that missing one’s neighborhood and friends implies that one has happy memories of them.

[Read: The countries where people are the most emotionally complex]

To become more dialectical in your thinking, start by consciously acknowledging your conflicting feelings, as opposed to letting them battle away in your subconscious. If you’re conflicted about your relationship, try writing down its positive and negative aspects. Consider how you might manage the aspects you dislike, or perhaps accept them if you can’t change them. But decide—if the benefits outweigh the costs—that nothing is unnatural or wrong about having positive and negative feelings about someone you love. I have applied this technique in many areas of my life; it provides real relief and raises my happiness.

Once you are more comfortable with your mixed emotions, start to explore the richness that ambivalence can bring to your understanding of your life. Researchers in 2017 showed that people can find a deeper sense of purpose when contemplating both their happy and sad emotions about a particular occurrence, such as graduating from college. Seeing the true complexity of our relationships and experiences takes us beyond the superficial “great” or “horrible” descriptions that obfuscate more than elucidate our lives.

Note here an apparent contradiction: Mixed emotions may bring unhappiness, but they can also bring meaning to life. On reflection, you will notice that there is no inconsistency. Meaning is not only positive; on the contrary, a truly meaningful life is one filled with all types of experiences and emotions, including those we find disagreeable. This is why some psychotherapy seeks to not only lower emotional pain, but also find deep purpose in it. In a fully examined life, your mixed and negative emotions don’t go to waste.

Catullus’s dilemma has haunted and inspired us for centuries. In 1989, the Rolling Stones offered a particularly direct reckoning in their song “Mixed Emotions,” which proved to be their last Billboard top-10 hit to date. “This coming and going is driving me nuts,” sang the modern-day Catullus, Mick Jagger. “This to-ing and fro-ing is hurting my guts.”

[Read: Measuring your happiness can help improve it]

Life is easier when the path forward is clear, of course, but it rarely is. We are built to experience highs and lows, and almost everything truly meaningful has both. Sometimes, that hurts your guts. But that’s the point. Don’t try to make life uncomplicated, or love it any less because it’s messy. Rather, resolve to be fully awake and alive inside that mess.

Turn your mind for a moment to a friend or family member you cherish but don’t spend as much time with as you would like. This needn’t be your most significant relationship, just someone who makes you feel energized when you’re with them, and whom you’d like to see more regularly.

How often do you see that person? Every day? Once a month? Once a year? Do the math and project how many hours annually you spend with them. Write this number down and hang on to it.

This article is adapted from Waldinger and Schulz’s new book.

For us, Bob and Marc, though we work closely together and meet every week by phone or video call, we see each other in person for only a total of about two days (48 hours) every year.

How does this add up for the coming years? Bob is 71 years old. Marc is 60. Let’s be (very) generous and say we will both be around to celebrate Bob’s 100th birthday. At two days a year for 29 years, that’s 58 days that we have left to spend together in our lifetimes.

Fifty-eight out of 10,585 days.

Of course, this is assuming a lot of good fortune, and the real number is almost certainly going to be lower.

Since 1938, the Harvard Study of Adult Development has been investigating what makes people flourish. After starting with 724 participants—boys from disadvantaged and troubled families in Boston, and Harvard undergraduates—the study incorporated the spouses of the original men and, more recently, more than 1,300 descendants of the initial group. Researchers periodically interview participants, ask them to fill out questionnaires, and collect information about their physical health. As the study’s director (Bob) and associate director (Marc), we’ve been able to watch participants fall in and out of relationships, find success and failure at their jobs, become mothers and fathers. It’s the longest in-depth longitudinal study on human life ever done, and it’s brought us to a simple and profound conclusion: Good relationships lead to health and happiness. The trick is that those relationships must be nurtured.

[Read: The six forces that fuel friendship]

We don’t always put our relationships first. Consider the fact that the average American in 2018 spent 11 hours every day on solitary activities such as watching television and listening to the radio. Spending 58 days over 29 years with a friend is infinitesimal compared with the 4,851 days that Americans will spend interacting with media during that same time period. Distractions are hard to avoid.

Thinking about these numbers can help us put our own relationships in perspective. Try figuring out how much time you spend with a good friend or family member. We don’t have to spend every hour with our friends, and some relationships work because they’re exercised sparingly. But nearly all of us have people in our lives whom we’d like to see more. Are you spending time with the people you most care about? Is there a relationship in your life that would benefit both of you if you could spend more time together? Many of these are untapped resources, waiting for us to put them to use. And, enriching these relationships can in turn nourish our minds and bodies.

You don’t have to examine scientific findings to recognize that relationships affect you physically. All you have to do is notice the invigoration you feel when you believe that someone has really understood you during a good conversation, or the tension and distress you feel after an argument, or how little sleep you get during a period of romantic strife.

In this sense, having healthy, fulfilling relationships is its own kind of fitness—social fitness—and like physical fitness, it takes work to maintain. Unlike stepping on the scale, taking a quick look in the mirror, or getting readouts for blood pressure and cholesterol, assessing our social fitness requires a bit more sustained self-reflection. It requires stepping back from the crush of modern life, taking stock of our relationships, and being honest with ourselves about where we’re devoting our time and whether we are tending to the connections that help us thrive. Finding the time for this type of reflection can be hard, and sometimes it’s uncomfortable. But it can yield enormous benefits.

Many of our Harvard Study participants have told us that filling out questionnaires every two years and being interviewed regularly have given them a welcome perspective on their life and relationships. We ask them to really think about themselves and the people they love, and that process of self-reflection helps some of them.       

[Read: 10 practical ways to improve happiness]

This is a practice that could help anyone. Looking in the mirror and thinking honestly about where your life stands is a first step in trying to live a good life. Noticing where you are can help put into relief where you would like to be. Having some reservations about this kind of self-reflection is understandable. Our study participants were not always keen on filling out our questionnaires, or eager to consider the larger picture of their life. Some would skip difficult questions or leave entire pages blank, and some would just not return certain surveys. Some even wrote comments in the margins of their questionnaires about what they thought of our requests. “What kinds of questions are these!?” is a response we received occasionally, often from participants who preferred not to think about difficulties in their life. The experiences of the people who skipped questions or entire questionnaires were also important, though—they were just as crucial in understanding adult development as the experiences of people eager to share. A lot of useful data and gems of experience were buried in the shadowed corners of their lives. We just had to go through a little extra effort to excavate them.

One of these people was a man we’ll call Sterling Ainsley. (We are using a pseudonym to protect his confidentiality as a study participant.)

Pierre Buttin

Sterling Ainsley was a hopeful guy. He graduated from Harvard in the 1940s and then served in World War II. After he left the service, he got a job as a scientist and retired in his 60s. When asked to describe his philosophy for getting through hard times, he said, “You try not to let life get to you. You remember your victories and take a positive attitude.”

The year was 1986. George Vaillant, the then-director of the study, was on a long interview trek, driving through the Rocky Mountains to visit the study’s participants who lived in Colorado, Utah, Idaho, and Montana. Sterling had not returned the most recent survey, and there was some catching up to do. He met Vaillant at a hotel to give him a ride to the diner where Sterling wanted to do his scheduled interview. When Vaillant buckled himself into the passenger seat of Sterling’s car, the seat belt left a stripe of dust across his chest. “I was left to wonder,” he wrote, “the last time somebody had used it.”

Sterling was technically married, but his wife lived far away, and they hadn’t slept in the same room in years. They spoke only every few months.

[Read: The marriage lesson I learned too late]

When asked why they had not gotten a divorce, he said, “I wouldn’t want to do that to the children,” even though his kids were grown and had children of their own. Sterling was proud of his kids and beamed when he spoke of them, saying they were the most important thing in his life. But he rarely saw them and seemed to prefer to keep his relationships with them thriving mostly in his imagination. Vaillant noted that Sterling seemed to be using optimism to push away some of his fears and avoid challenges in his life. Putting a positive spin on every matter and then pushing it out of his mind made it possible for him to believe that nothing was wrong, he was fine, he was happy, his kids didn’t need him.

He didn’t travel to see his son’s new home abroad, because he didn’t “want to be a burden”—even though he’d been learning a new language to prepare for the trip. He had another child who lived closer, but he hadn’t visited in more than a year. He didn’t have a relationship with his grandchildren, and he wasn’t in contact with any friends.

When asked about his older sister, Sterling seemed startled. “My sister?” he said.

Yes, the sister he had told the study so much about when he was younger.

Sterling thought about it for a long time, and then told Vaillant that it must have been decades since he last spoke with her. A frightened expression came over his face. “Would she still be living?” he said.

Sterling tried not to think about his relationships, and he was even less inclined to talk about them. This is a common experience. We don’t always know why we do things or why we don’t do things, and we may not understand what is holding us at a distance from the people in our life. Taking some time to look in the mirror can help. Sometimes there are needs inside of us that are looking for a voice, a way to get out. They might be things that we have never seen or articulated to ourselves.

This seemed to be the case with Sterling. Asked how he spent his evenings, he said he spent time with an elderly woman who lived in a nearby trailer. Each night he would walk over, and they’d watch TV and talk. Eventually she would fall asleep, and he would help her into bed and wash her dishes and close the shades before walking home. She was the closest thing he had to a confidant.

“I don’t know what I’ll do if she dies,” he said.

Loneliness has a physical effect on the body. It can render people more sensitive to pain, suppress their immune system, diminish brain function, and disrupt sleep, which in turn can make an already lonely person even more tired and irritable. Research has found that, for older adults, loneliness is far more dangerous than obesity. Ongoing loneliness raises a person’s odds of death by 26 percent in any given year. A study in the U.K., the Environmental Risk (E-Risk) Longitudinal Twin Study, recently reported on the connections between loneliness and poorer health and self-care in young adults. This ongoing study includes more than 2,200 people born in England and Wales in 1994 and 1995. When they were 18, the researchers asked them how lonely they were. Those who reported being lonelier had a greater chance of facing mental-health issues, partaking in unsafe physical-health behaviors, and coping with stress in negative ways. Add to this the fact that a tide of loneliness is flooding through modern societies, and we have a serious problem. Recent stats should make us take notice.

In a study conducted online that sampled 55,000 respondents from across the world, one out of every three people of all ages reported that they often feel lonely. Among these, the loneliest group were 16-to-24-year-olds, 40 percent of whom reported feeling lonely “often or very often.” In the U.K., the economic cost of this loneliness—because lonely people are less productive and more prone to employment turnover—is estimated at more than £2.5 billion (about $3.1 billion) annually and helped lead to the establishment of a U.K. Ministry of Loneliness.

[Read: Why do we look down on lonely people?]

In Japan, 32 percent of adults expected to feel lonely most of the time during 2020. In the United States, a 2019 study suggested that three out of four adults felt moderate to high levels of loneliness. As of this writing, the long-term effects of the coronavirus pandemic, which separated us from one another on a massive scale and left many feeling more isolated than ever, are still being studied.

Alleviating this epidemic of loneliness is difficult because what makes one person feel lonely might have no effect on someone else. We can’t rely entirely on easily observed indicators such as whether or not one lives alone, because loneliness is a subjective experience. One person might have a significant other and too many friends to count and yet feel lonely, while another person might live alone and have a few close contacts and yet feel very connected. The objective facts of a person’s life are not enough to explain why someone is lonely. Regardless of your race or class or gender, the feeling resides in the difference between the kind of social contact you want and the social contact you actually have.

Pierre Buttin

It never hurts—especially if you’ve been feeling low—to take a minute to reflect on how your relationships are faring and what you wish could be different about them. If you’re the scheduling type, you could make it a regular thing; perhaps every year on New Year’s Day or the morning of your birthday, take a few moments to draw up your current social universe, and consider what you’re receiving, what you’re giving, and where you would like to be in another year. You could keep your chart or relationships assessment in a special place, so you know where to look the next time you want to peek at it to see how things have changed.

If nothing else, doing this reminds us of what’s most important. Repeatedly, when the participants in our study reached old age, they would make a point to say that what they treasured most were their relationships. Sterling Ainsley himself made that point. He loved his older sister deeply—but he lost touch with her. Some of his fondest memories were of his friends—whom he never contacted. There was nothing he cared more about than his children—whom he rarely saw. From the outside it might look like he didn’t care. That was not the case. Sterling was quite emotional in his recounting of his most cherished relationships, and his reluctance to answer certain study questions was clearly connected to the pain that keeping his distance had caused him over the years. Sterling never sat down to really think about how he might conduct his relationships or what he might do to properly care for the people he loved most.

Sterling’s life reminds us of the fragility of our connections, and it echoes the lessons of science: Relationships keep us happier and healthier throughout our life spans. We neglect our connections with others at our peril. Investing in our social fitness is possible each day, each week of our lives. Even small investments today in our relationships with others can create long-term ripples of well-being.

This article is adapted from Robert Waldinger and Marc Schulz’s new book, The Good Life: Lessons from the World's Longest Scientific Study of Happiness.

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