RSN: FOCUS: Charles Pierce | The Iowa Caucuses Should Be Finished as a Crucial Early Primary Contest

 

 

05 February 22

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FOCUS: Charles Pierce | The Iowa Caucuses Should Be Finished as a Crucial Early Primary Contest
Charles Pierce, Esquire
Pierce writes: "In my career, I have covered only two competitive events that were such gigantic chewy clusters of fck that the people running them didn't have the faintest idea who actually won the damn things."

Combine the 2020 debacle with Iowa's new penchant for electing meatheads, and it should be no contest at all.

In my career, I have covered only two competitive events that were such gigantic chewy clusters of fck that the people running them didn’t have the faintest idea who actually won the damn things. The first was the 1980 Boston Marathon, when Rosie Ruiz was the first woman to cross the finish line. Every other runner in the race, and every reporter covering the race, knew instantly that Ruiz had no more run 26 miles than she had flapped her arms and flown from Hopkinton. The befuddled race organizers didn’t get the whole thing sorted out for days.

The second was the 2020 Iowa presidential caucuses, for which I believe people are still counting votes. From the New York Times:

“I don’t even know if they know what they don’t know,” Mr. Bagniewski said of the state party shortly before 2 a.m. on Tuesday…And so, for nearly 22 hours after the Iowa caucuses had begun — with much fanfare, live cable coverage and deep consequences for the Democratic Party and the country — the state party remained silent.

The bright side of the Ruiz debacle was that the Marathon was professionalized almost overnight. And I suspect that the bright side of the Iowa fiasco is that the importance of the Iowa caucuses will be dropped to somewhere around the level of a cow-pie-tossing competition at a county fair. Because, and I do not mean to seem harsh, but the good people of Iowa have lost all claim on a pride of place in a presidential nominating process, because the good people of Iowa have taken to electing meatheads. Governor Kim Reynolds has flown largely under the wingnut radar, but her performance in office has shown her to be playing station-to-station baseball along the modern Republican base paths. Her pet legislature has come right along with her.

Book-banning? Check.

Voter suppression based on the Big Lie? Check.

But this week, Reynolds and the state government outdid themselves. They adapted the late George Aiken’s advice on Vietnam to the current pandemic. They have declared victory and withdrawn. From the Des Moines Register:

The shift will include pulling the plug on a state website focusing on COVID data, such as the number of Iowans testing positive for the disease, being hospitalized with it or dying from it. However, many of those statistics will continue to be available on other state and federal websites, Kelly Garcia, interim director of the Iowa Department of Public Health, said Thursday.

Reynolds said in her statement Thursday that she will allow the current proclamation to expire on Feb. 15 at 11:59 p.m. She said it's time to reallocate state resources. "We cannot continue to suspend duly enacted laws and treat COVID-19 as a public health emergency indefinitely," Reynolds said in a statement. "After two years, it’s no longer feasible or necessary. The flu and other infectious illnesses are part of our everyday lives, and coronavirus can be managed similarly."

Closing the state’s COVID data website is, of course, the giveaway. By suspending the state of emergency, Reynolds is responding to the know-nothing horse-paste segment of the Republican base. If the pandemic hits Iowa hard as a result, Reynolds would rather not have her government publishing statistics that make her look as though she really doesn’t have a handle on things. The facts will do that quite well on their own.

(I mean, it’s not like her administration misappropriated federal COVID relief funds to pay staff salaries. No, wait, it is exactly like that.)

I suspect we’ll be seeing a lot of this from states with Republican governors and/or legislative majorities. Hey, we’ve done all we can. Suck it up and let’s all get back to work at the grain silo. And the pandemic will burn on and on and on, but it’s OK, because we won’t be tallying the butcher’s bill anymore.

Hey, look. More jobs again. From CNBC:

Nonfarm payrolls surged by 467,000 for the month, while the unemployment rate edged higher to 4%, according to the Bureau of Labor Statistics. The Dow Jones estimate was for payroll growth of 150,000 and a 3.9% unemployment rate. The stunning gain came a week after the White House warned that the numbers could be low due to the pandemic.

This is one of those days on which I could envision replacing every economist on the planet—or at least every economist on cable television—with a ouija board. All week, we heard that Omicron was going to murder the job figures to death. Every estimate was ridiculously low. This is the kind of prognosticating that forces you to jump turnstiles to get back from the track. And then there’s this, which is always my favorite part of any monthly jobs report.

Along with the big upside surprise for January, massive revisions sent previous months considerably higher. December, which initially was reported as a gain of 199,000, went up to 510,000. November surged to 647,000 from the previous reported 249,000. For the two months alone, the initial counts were revised up by 709,000. The revisions came as part of the annual adjustments from the BLS that saw sizeable changes for many of the months in 2021.

That December jobs report was the occasion for much weeping and gnashing of teeth and rending of spreadsheets. Now, it turns out that all the tsuris was at the very least premature. Look, this president is doing a good job repairing a COVID-riddled national economy. There are parts of the job that still need to be done, but I think we can probably put the ouija board back in the attic—and see if there’s room for the hysterics, too.

Weekly WWOZ Pick To Click: “Bad Dream Blues” (Mabel Smith): Yeah, I pretty much still love New Orleans.

Weekly Visit To The Pathe Archives: Here, from 1951, are the citizens of Brighton in England organizing to vaccinate themselves against a terrifying smallpox outbreak. That little girl in the hat at the end is braver than all the camo-wearing, freedom-belching, Fox-watching yahoos making a nuisance of themselves everywhere from New York to Ottawa. History is so cool.

Brian Flores’s epic lawsuit against the NFL and three of its teams has all the potential of Curt Flood’s lawsuit against Major League Baseball, and the prosecution of NHL super crook Alan Eagleson, in terms of shaking up the way a sports-entertainment behemoth does business. Apparently, the NFL will start off by invoking a clause in the standard contract that forces disputes like this one into arbitration. But Flores could take his case into the federal administrative system, which would obviate any required arbitration. And I don’t think any judge is likely to hit the abort switch on this lawsuit shortly after launch. This is a bonanza for the lawyers on both sides, but it’s Flores who’s showing the strength of character that football is supposed to breed in its players. He may be setting fire to his career in doing so. As for the other side, what do they care if they wind up arraigned in history for systemic racism? They’ll probably toast themselves for their cleverness.

Here’s a tasty lagniappe to begin the weekend. From CNN:

Two sources who have reviewed the call records tell CNN that Trump spoke on the phone at the White House residence with [Congressman Jim] Jordan for 10 minutes on the morning of January 6. That afternoon, Jordan took to the House floor to object to the certification of President Joe Biden's Electoral College win, and pro-Trump supporters attacked the US Capitol...When asked on Friday about the White House records, Jordan told CNN that he had multiple calls with Trump on January 6 but could only confirm that he spoke with Trump after he left the House floor and did not remember whether they spoke that morning. "I talked to the President a number of times that day, but I don't remember the times," Jordan said.

I never spoke to a president* on the day of an insurrection he incited, so I don’t know how easy it is to forget the details on something like that. Must be one of those things like paying off burglars, or selling missiles to the Mullahs, that just tend to slip everyone’s minds.

Is it a good day for dinosaur news, BBC? It’s always a good day for dinosaur news!

The trace fossil from the Jurassic era was found by archaeologist Marie Woods on the foreshore near Scarborough. Ms Woods said recent strong storms had caused "dramatic erosion" and it was found in the same area she discovered a larger footprint last year. The claw marks were laid down in muddy, wet conditions up to 175 million years ago in what is now North Yorkshire. Ms Woods said of her discovery of a fossilised therapod - or three-toed dinoasaur: "I feel quite excited when I find something, I'm like a child when I do...I go out along coasts often and onto the beach and then it's a case of trying to get your eye in.”

We don’t get enough dinosaur stories like Marie Woods’ anymore. The lone searcher, wandering amid the storm-scrubbed shore, stumbling on dinosaur footprints the way so many of us collect shells. A lot of paleontology was done this way before the field became so systematized.

Ms Woods' first discovery was actually "a rediscovery", as it had been partially spotted by fossil collector Rob Taylor back in November 2020. Last year's bigger find was "quite significant" and papers on that trace fossil were due to be published soon, she said. Ms Woods, a director of Heritage Adventures, said many other people had also found good fossils on that part of the North Yorkshire coast. She said the area around Scarborough "could be called the Dinosaur Coast”. About £2,000 was needed to properly preserve the trace fossil by getting an expert to carry out conservation similar to a "scientific 3D-jigsaw", Ms Woods added.

They lived then so that, one day, 170 million years later, Marie Woods would be walking the beach and be happy.

The landlord is spending his second week with his left leg stuck in what appears to be a golf bag. Hence, the Last Call newsletter will be dark this week, but will be back next Saturday alight with its usual proportions of wit, wisdom, and completely useless historical knowledge. The dusty chests in the attic of the mind are ever full. See you then.

I’ll be back on Monday with the further misadventures of the world’s oldest republic, now d/b/a The Great American Chuckle Hut. Be well and play nice, ya bastids. Stay above the snake-line, wear the damn mask, and get the damn shots, especially the damn boosters.

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POLITICO NIGHTLY: The Covid lull is coming

BY MYAH WARD Presented by AT&T People walk through Grand Central Terminal in New York City. | Spencer Platt/Getty Images ‘WE’RE NOT SURE JUST WHAT THAT MEANS YET’ — After weeks of skyrocketing Omicron cases and feeling like everyone you know, and their brother, has Covid — a surge that has led deaths to surpass 2,100 a day, the highest since early 2021 — experts are saying that a period of reprieve is in sight. Even Michael Osterholm, an epidemiologist at the University of Minnesota who is known for never celebrating victory against Covid too early and correctly projecting Omicron’s destructive path as a “viral blizzard,” says we may have a moment to breathe in a few weeks once the new variant completes its rapid burn through the country. Nightly talked with Osterholm about what we know about the approaching lull in the pandemic and how it should inform our behavior and public policy. This conversation has been edited. Describe the lull that you and other experts say is in sight. When we talk about a lull, we’re not sure just what that means yet. Maybe case numbers will come back down to baseline and what they were before Omicron showed up, but maybe they’re not going to be. But nonetheless, they’ll still be substantially lower in incidence than we saw in December, early January. We’re following closely what’s happening in countries that experienced Omicron before we did, and it’s notable. If you look at South Africa right now, the number of cases increased dramatically from a baseline, hit the peak and then came down sharply. But if you look today, they still have almost 12 times as many cases a day as they did before Omicron occurred. But what’s even more concerning is what we’ve seen in the United Kingdom. If you look there, and it appears to be tied to school kids and their parents — we saw cases come down 10 days ago, we saw them level off, and go back up again. Over the last two days, they’re going back up, not dropping. And so that could also signal that this tail is going to be more volatile than you might imagine. I think that we could very easily see another variant emerge. I don’t know that to be the case, but I don’t know any scientific evidence would support it wouldn’t. I know you don’t have a crystal ball, but how long do you expect this lull to last before we see another variant?  I actually do have a crystal ball! It’s just coated in 5 inches of mud. But we don’t know. This is where humility has to be the main point we keep reinforcing. I saw some of the talking heads six weeks ago who said, “Well, don’t worry, this surge won’t be that bad because we have vaccines. It’s not going to be like 2020.” Some of them now are the very people saying how bad this is. Anybody who does any model that predicts more than four weeks out, be careful. Because their models are based totally on pixie dust. If in the first week of November, just as Omicron was emerging, someone said, “I’m going to model it for the next 30 days,” you would have never picked up any of this. Is that what we should expect at this point in the pandemic — a period of reprieve and then a new variant? I see people wanting to immediately say we’re heading to the endemic stage. I’m a card-carrying epidemiologist of 46 years. I’ve written a lot about epidemics, and pandemics and endemics, and I can’t tell you for the life of me what the hell endemic means right now. If we go into a four-month period of relatively limited transmission, is that endemic? Well, then what happens if in September, we see a new variant emerge that suddenly causes an Omicron-like situation? We have to be careful about the choice of terms. Is this virus going to go away? The answer is no. Will it cause future challenges? The answer is likely yes. We will not likely see the kind of immunity that will come from either vaccination or from previous infection that will be sustainable. You saw the Israeli data today; they’re recommending a fourth dose for everybody 18 years of age and older. Only a third of people who have had two doses of vaccines — so they’re vaccine friendly — have gotten a booster, which we know has been important in reducing the risk of serious Omicron infection. So do you think we’re going to do better with a fourth dose? We’re going to have to learn to live with this virus. But at the same time, I’m optimistic that if we can really put in place very aggressive and well-described systems for testing and drug deployment, we can surely do a lot to reduce serious illness. Welcome to POLITICO Nightly. We had a couple more questions for Osterholm, including on Omicron-specific vaccines and what life will look like in The Lull. Read on, and reach out with news, tips and ideas at nightly@politico.com. Or contact tonight’s author at mward@politico.com, or on Twitter at @MyahWard.   A message from AT&T: Accessible, affordable broadband helps communities reach their American Dream. That’s why we’re making a $2 billion, 3-year commitment toward helping close the digital divide, so more low-income families have the ability to succeed. Learn more.   Speaking of vaccines — Pfizer announced today it’s starting clinical trials for an Omicron-specific vaccine. Shouldn’t we be more worried about the next variant?  That’s exactly it. First of all, companies should not be deciding what the next vaccine should be. They should be manufacturing the vaccines that the public health and regulatory world determine are important. So I think this is putting the cart before the horse to have companies out there pursuing, and even in a sense promoting, vaccines for specific variants. When the lull comes, what should our behavior look like? Should this period affect vaccine and mask mandates and other public health measures?  I think most mandates are going to go out the window. I think society is going to demand it. I think most of the behaviors — it won’t matter what we say — they will be, in a sense, an attempt to be as normal as they were before Omicron hit, or for that matter, before Covid hit. We might not like the wind, but it’s going to blow. We can’t stop it. And so I think the challenge is going to be: Will we at that time continue to do everything we can to get more people vaccinated, particularly kids, to get people who are at high risk to get their additional booster dose? We’re going to have to continue that. The second thing is we need to do everything we can to continue to expand testing capacity. What I don’t want to see happen is: We may not be using all the tests, so we throw them away. No, at this point, we’ve got to have a surge capacity and be prepared for what happens if we do see an Omicron-like surge in the fall. What will we be doing for the health care workers? Will we have more? I think salaries, and we’re looking at benefits, for health care workers to stay on the job. What kind of support can we provide health care workers, many of them who are suffering from post-traumatic stress syndrome? Then if another surge doesn’t happen, it doesn’t happen. You can say it was wasted. I would rather always be sorry for something I did rather than something I didn’t do.   JOIN NEXT FRIDAY TO HEAR FROM GOVERNORS ACROSS AMERICA : As we head into the third year of the pandemic, state governors are taking varying approaches to public health measures including vaccine and mask mandates. "The Fifty: America's Governors" is a series of live conversations featuring various governors on the unique challenges they face as they take the lead and command the national spotlight in historic ways. Learn what is working and what is not from the governors on the front lines, REGISTER HERE.     WHAT'D I MISS? — Hoyer: Voting rights bill, BBB ‘very much alive’: House Majority Leader Steny Hoyer remains optimistic that Democrats will pass the voting rights legislation and the Build Back Better bill despite roadblocks but offered few details about how that could happen. “I do not buy your characterization of the Voting Rights Act being ‘dead’ in the Senate,” Hoyer told POLITICO Playbook co-author Rachael Bade. “It certainly is not in the shape I’d like it to be in, but we’re not going to forget about that.” — Rep. Jim Cooper retires after Tennessee district dismantled: Democratic Rep. Jim Cooper, a 32-year veteran of Congress, will retire at the end of this year, after Tennessee Republicans shredded his Nashville-based district into three pieces in redistricting. He is the 29th House Democrat to leave the chamber to retire or seek higher office during this Congress. — Judge presses ahead with April trial for several Oath Keepers: A federal judge insisted today that the first criminal trial for Oath Keepers who entered the Capitol on Jan. 6 open in Washington this April, a timeline he said he was committed to despite vocal objections from some defense attorneys who worry they wouldn’t have enough time to wade through a massive — and growing — trove of digital evidence. Judge Amit Mehta set the April 19 date for a subset of the 22 Oath Keepers charged with a sweeping conspiracy to obstruct the transfer of presidential power from Donald Trump to Joe Biden. — Cuellar on FBI raid: I intend to win reelection; the investigation will clear me: A defiant Rep. Henry Cuellar declared that he would seek — and win — reelection, six days after an FBI raid of his home and campaign offices. In a video statement recorded outside of his childhood home, the senior Texas Democrat vowed that his name would be cleared in the probe and thanked supporters. But he offered no explanation for why the FBI searched his property less than six weeks before he faces a tough primary against progressive challenger Jessica Cisneros.   A message from AT&T:     AROUND THE WORLD U.S. Embassy Charge d'Affaires Kristina Kvien and Ukrainian Deputy Defense Minister Rostyslav Zamlynskii speak to the media following the unloading of weapons, including Javelin anti-tank missiles, and other military hardware delivered on a National Airlines plane by the United States military at Boryspil Airport near Kyiv in Boryspil, Ukraine. | Sean Gallup/Getty Images TENSIONS HEADACHES — Biden said he told Russian President Vladimir Putin that the United States would deploy thousands of troops to Eastern Europe if Russia continues its military buildup along Ukraine’s border or mounts a renewed invasion of the country, Quint Forgey writes. But the American president also said he would not send troops into Ukraine, even as the White House warned that Russia was likely to move its forces across the border at any moment. Biden’s remarks came after Defense Secretary Lloyd Austin placed the roughly 8,500 troops “on a heightened preparedness to deploy,” Pentagon spokesperson John Kirby said at a news briefing on Monday, with the “bulk” of those troops intended to bolster the NATO Response Force. NATO has not yet activated that multinational force in response to Russia’s aggression, although the alliance announced on Monday that several of its European member states were deploying additional ships and fighter jets to Eastern Europe and putting new forces on standby. Kremlin spokesperson Dmitry Peskov on Tuesday accused the United States of “escalating tensions” by putting the troops on high alert, telling reporters that Moscow was “watching these U.S. actions with great concern.” NIGHTLY NUMBER 62 percent The decrease in OpenTable restaurant reservations in Washington, D.C., on Jan. 24, 2022 compared with Jan. 24, 2019.   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.     PARTING WORDS FILLING IN THE GRID — The launch of the website Grid earlier this month represented the latest bet that the market for explainer journalism still exists in the digital space. But unlike others in the field, Grid has a unique origin story, one that involves early ties to a global consulting firm best known for its crisis communications management and lobbying work on behalf of foreign governments, most notably the United Arab Emirates, Max Tani and Daniel Lippman write. Months before Grid brought on board any writers or staff, the new digital media organization hired APCO Worldwide to help with its launch. The global marketing and consulting firm, which is headquartered in D.C. but is a registered lobbyist for various clients based in the UAE, confirmed to POLITICO that it “provided consulting services for Grid during the first half of 2021.” A spokesperson said it has no continuing role with the digital news organization, which launched earlier this month. And Laura McGann, Grid’s top editor, said in a statement that APCO did not win a competitive bidding process for a PR contract for the site. The contract, instead, has gone to DKC News, which does public relations work for Grid. But Grid maintains links to APCO, which represents a number of major UAE clients, including the company’s state-owned oil company.   A message from AT&T: Brooke Dryden’s daughter was diagnosed with learning disabilities at an early age. She requires an individualized education plan and weekly therapy with speech specialists. However, rural Colorado does not have the kind of specialists she needs. With the help of accessible and affordable broadband, Brooke is able to ensure that she receives regular virtual therapy and never falls behind. Brooke’s dream is to see her daughter not just survive but thrive in the world. That’s why AT&T is dedicated to helping close the digital divide with a $2 billion, 3-year commitment, so more low-income families like Brooke's can achieve their American Dream. Learn more.     Follow us on Twitter Chris Suellentrop @suellentrop Tyler Weyant @tweyant Renuka Rayasam @renurayasam Myah Ward @myahward   FOLLOW US

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POLITICO NIGHTLY: The Medicare-size hole in Biden’s testing plan

 

 

BY RENUKA RAYASAM

Presented by AT&T

Covid-19 rapid at-home test kits rest on a table at a free distribution event for those who received vaccination shots or booster shots at Union Station in Los Angeles. | Mario Tama/Getty Images

A NEW KIND OF MEDI-GAP — With Covid daily case counts three times higher than the country’s previous peak last January, the Biden administration has made testing a larger part of its pandemic strategy.

The hyped website that offers free tests directly to the door of every American is actually a small part of the administration’s plan, limited to just four tests per household. The bigger part of the testing plan includes new guidance that, starting this week, private insurers must cover the costs of eight over-the-counter rapid tests per person every month — another 32 free tests for a family of four.

But there’s a giant loophole: The at-home tests won’t be reimbursed by Medicare, which covers about 64 million people who are either 65 and older or have long-term disabilities.

About 42 percent of Medicare beneficiaries are in what’s called an Advantage plan — run by private insurers with generally broader coverage that Medicare beneficiaries can buy into — and some of them will be covered. But the Advantage plans aren’t required to cover the tests.

And if you’re one of the 58 percent of Medicare beneficiaries without an Advantage plan? You can get a test through the new website or at a clinic or doctor’s office, but you can’t get reimbursed for buying the rapid, at-home tests over the counter.

These are the Americans who are in the demographic cohort that is most vulnerable to Covid complications. This is the group with the highest Covid risk factors . People 65 and older have made up almost three-quarters of all Covid deaths during the pandemic, according to the CDC.

Medicare, including the part with the Advantage plans, is not designed to cover things that people can get over the counter, without a prescription, said Tricia Neuman, a Medicare expert at the Kaiser Family Foundation, who was recently nominated by Biden to serve on Medicare’s board of trustees. The rules-heavy program bills enrolled providers like hospitals, doctors, labs and pharmacies directly for expenses. It doesn’t reimburse patients the way a flexible spending account or a commercial insurer sometimes does.

“There is not a structure in place that is ready made for reimbursement,” she said.

The Centers for Medicare & Medicaid Services, the agency responsible for running the program, told Nightly that people in the program can get tested for free through their health care provider or one of 20,000 testing sites. Medicare covers Covid tests that are done by a lab. A doctor can order a test, making them free to Medicare patients. Some clinics are also distributing free rapid, at-home tests.

CMS is also encouraging Medicare Advantage plans to voluntarily cover the tests. But it can’t require the plans to pay for them. It’s unclear right now how many of the Advantage plans are planning to reimburse people who buy the at-home tests.

Those measures aren’t enough, some advocates and lawmakers say. Rep. Anna Eshoo (D-Calif.), chair of the Energy and Commerce Health Subcommittee, urged the Biden administration, in a letter sent Wednesday, to expand the coverage of at-home tests to Medicare beneficiaries.

“There is a bigger question about how long it will take to adopt a fix and whether it would require a change of law or whether CMS could do this on its own,” Neuman said.

No one seems to know the answer to Neuman’s question. The agency didn’t get back to Nightly about whether it could fix the issue under the Medicare statute, without new legislation.

Nor has CMS told AARP how or whether it will address the issue, said Andrew Scholnick, AARP’s senior legislative representative in government affairs.

Going to a doctor or pharmacy or another site to get a lab-based test that Medicare will pay for is a huge barrier, Scholnick said. A supply of rapid, at-home tests laying around the house would help seniors more easily figure out whether they can gather with friends and relatives or go to a crowded setting.

“To say that they shouldn’t have the same level of access to at home tests is ridiculous,” he said. “This is unfair and bad policy.”

Welcome to POLITICO Nightly. Reach out with news, tips and ideas at nightly@politico.com. Or contact tonight’s author at rrayasam@politico.com, or on Twitter at @RenuRayasam.

 

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Accessible, affordable broadband helps communities reach their American Dream. That’s why we’re making a $2 billion, 3-year commitment toward helping close the digital divide, so more low-income families have the ability to succeed. Learn more.

 

WHAT'D I MISS?

— Some Democrats not ready to give up on child credit: They’re balking at suggestions by the White House to drop their bid to revive their signature Child Tax Credit plan . One day after President Joe Biden appeared ready to concede it may fall by the wayside, some lawmakers said they are not giving up on the proposal, which is included in a sweeping package stalled in the Senate.

— Georgia DA asks for special grand jury in election probe: The Georgia prosecutor looking into possible attempts to interfere in the 2020 general election by former President Donald Trump and others has asked for a special grand jury to aid the investigation . Fulton County District Attorney Fani Willis sent a letter to Fulton County Superior Court Chief Judge Christopher Brasher asking him to impanel a special grand jury. She wrote in the letter that her office “has received information indicating a reasonable probability that the State of Georgia’s administration of elections in 2020, including the State’s election of the President of the United States, was subject to possible criminal disruptions.”

— Jan. 6 panel will target Ivanka Trump for questioning: Jan. 6 investigators revealed today they’re going after Ivanka Trump, whom senior White House aides viewed as a last-ditch resort to convince Donald Trump to address rioters during the Capitol attack , according to evidence and testimony released today. “He didn’t say yes to Mark Meadows, Kayleigh McEnanay or Keith Kellogg, but he might say yes to his daughter?” a committee investigator asked of Kellogg, a top Trump White House official, during a recent interview, according to a testimony transcript published by the panel.

 

BECOME A GLOBAL INSIDER: The world is more connected than ever. It has never been more essential to identify, unpack and analyze important news, trends and decisions shaping our future — and we’ve got you covered! Every Monday, Wednesday and Friday, Global Insider author Ryan Heath navigates the global news maze and connects you to power players and events changing our world. Don’t miss out on this influential global community. Subscribe now.

  

— U.S. drops case against MIT professor accused of ties to China: The Justice Department dropped its case today against a Massachusetts Institute of Technology professor charged last year with concealing research ties to the Chinese government , saying it could “no longer meet its burden of proof at trial.” The department revealed its decision in the case against Gang Chen in a single-page filing in federal court in Boston.

— SEC blocks Anthony Scaramucci’s Bitcoin fund: The Securities and Exchange Commission rejected Anthony Scaramucci’s proposal to launch a Bitcoin-based investment fund, saying it would be too risky for investors. The proposal by Scaramucci — a financier best known for his 10 days as former President Donald Trump’s communications director in 2017 — would have let investors on the New York Stock Exchange buy shares in a fund backed by the Bitcoin digital currency. It’s just one of several exchange-traded funds being pitched as a way to let individuals speculate on the price of Bitcoin without having to buy it directly.

 

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AROUND THE WORLD

President Joe Biden meets with members of his Infrastructure Implementation Task Force. | Chip Somodevilla/Getty Images

BIDEN CLARIFIES ‘INCURSION’ REMARK — Biden personally sought to clarify his remarks about a potential “minor incursion” by Russian forces into Ukraine , which top Ukrainian government officials condemned as needlessly provocative amid a broader White House effort to clean up the president’s statements.

Speaking ahead of a White House infrastructure meeting, Biden said he has been “absolutely clear” with Russian President Vladimir Putin and that his Kremlin counterpart “has no misunderstanding: Any — any — assembled Russian units move across the Ukrainian border, that is an invasion.”

Such an invasion would be met with a “severe and coordinated economic response” by the United States and its European allies, which has already been “laid out very clearly” for Putin, Biden said.

“Let there be no doubt at all,” Biden added. “If Putin makes this choice, Russia will pay a heavy price.”

Biden’s latest remarks today represented a slight revision of his comments at a White House news conference Wednesday, during which he predicted Putin’s forces will “move in” on Ukraine and outlined his thinking surrounding potential responses to such aggression.

 

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NIGHTLY NUMBER

About 10 days The amount of time between now and when the intelligence community’s expert panel on Havana Syndrome is expected to wrap up its work, according to Sen. Mark Warner (D-Va.). Top senators are downplaying and criticizing a new interim CIA assessment on the mysterious illness known as Havana Syndrome, the latest salvo in a years-long battle for transparency between Capitol Hill and the intelligence agencies.

PARTING WORDS

‘PLEASE DADDY, NO MORE ZOOM SCHOOL’ — The Omicron surge is depleting California teachers and keeping students home in unprecedented numbers, but political leaders aren’t yet willing to broach the alternative: distance learning.

Gov. Gavin Newsom and Democratic leaders who allowed school shutdowns early in the pandemic are holding firm on keeping classrooms open, Alexander Nieves writes. They’ve had support from the California Teachers Association despite some educators on the ground saying that working conditions are untenable due to staff shortages. And school districts are going to extreme lengths to keep students in classrooms, pulling retired teachers off the sidelines and recruiting office staff — at times even superintendents — to teach lessons.

It’s a dramatic turn for a state that once had the nation’s longest pandemic closures.

“I’m very, very sensitive to this, the learning opportunities that are lost because kids are not safely in school, the challenges of going online,” Newsom said when asked this month about distance learning. “My son, we had fits and starts, he’s in and out of school, said, ‘Please, Daddy, no more Zoom school.’”

The Sacramento City Unified School District released a statement Friday calling on local residents to “Sub-in and be a hero” by getting an emergency substitute teacher credential. Palo Alto schools have turned to parent volunteers for food service, office assistance and other on-campus jobs.

 

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RSN: FOCUS: Ed Yong | Hospitals Are in Serious Trouble

 

 

09 January 22

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FOCUS: Ed Yong | Hospitals Are in Serious Trouble
Ed Yong, The Atlantic
Yong writes: "When a health-care system crumbles, this is what it looks like."

Omicron is inundating a health-care system that was already buckling under the cumulative toll of every previous surge.

When a health-care system crumbles, this is what it looks like. Much of what’s wrong happens invisibly. At first, there’s just a lot of waiting. Emergency rooms get so full that “you’ll wait hours and hours, and you may not be able to get surgery when you need it,” Megan Ranney, an emergency physician in Rhode Island, told me. When patients are seen, they might not get the tests they need, because technicians or necessary chemicals are in short supply. Then delay becomes absence. The little acts of compassion that make hospital stays tolerable disappear. Next go the acts of necessity that make stays survivable. Nurses might be so swamped that they can’t check whether a patient has their pain medications or if a ventilator is working correctly. People who would’ve been fine will get sicker. Eventually, people who would have lived will die. This is not conjecture; it is happening now, across the United States. “It’s not a dramatic Armageddon; it happens inch by inch,” Anand Swaminathan, an emergency physician in New Jersey, told me.

In this surge, COVID-19 hospitalizations rose slowly at first, from about 40,000 nationally in early November to 65,000 on Christmas. But with the super-transmissible Delta variant joined by the even-more-transmissible Omicron, the hospitalization count has shot up to 110,000 in the two weeks since then. “The volume of people presenting to our emergency rooms is unlike anything I’ve ever seen before,” Kit Delgado, an emergency physician in Pennsylvania, told me. Health-care workers in 11 different states echoed what he said: Already, this surge is pushing their hospitals to the edge. And this is just the beginning. Hospitalizations always lag behind cases by about two weeks, so we’re only starting to see the effects of daily case counts that have tripled in the past 14 days (and are almost certainly underestimates). By the end of the month, according to the CDC’s forecasts, COVID will be sending at least 24,700 and up to 53,700 Americans to the hospital every single day.

This surge is, in many ways, distinct from the ones before. About 62 percent of Americans are fully vaccinated, and are still mostly protected against the coronavirus’s worst effects. When people do become severely ill, health-care workers have a better sense of what to expect and what to do. Omicron itself seems to be less severe than previous variants, and many of the people now testing positive don’t require hospitalization. But such cases threaten to obscure this surge’s true cost.

Omicron is so contagious that it is still flooding hospitals with sick people. And America’s continued inability to control the coronavirus has deflated its health-care system, which can no longer offer the same number of patients the same level of care. Health-care workers have quit their jobs in droves; of those who have stayed, many now can’t work, because they have Omicron breakthrough infections. “In the last two years, I’ve never known as many colleagues who have COVID as I do now,” Amanda Bettencourt, the president-elect of the American Association of Critical-Care Nurses, told me. “The staffing crisis is the worst it has been through the pandemic.” This is why any comparisons between past and present hospitalization numbers are misleading: January 2021’s numbers would crush January 2022’s system because the workforce has been so diminished. Some institutions are now being overwhelmed by a fraction of their earlier patient loads. “I hope no one you know or love gets COVID or needs an emergency room right now, because there’s no room,” Janelle Thomas, an ICU nurse in Maryland, told me.

Here, then, is the most important difference about this surge: It comes on the back of all the prior ones. COVID’s burden is additive. It isn’t reflected just in the number of occupied hospital beds, but also in the faltering resolve and thinning ranks of the people who attend those beds. “This just feels like one wave too many,” Ranney said. The health-care system will continue to pay these costs long after COVID hospitalizations fall. Health-care workers will know, but most other people will be oblivious—until they need medical care and can’t get it.

The Patients

The patients now entering American hospitals are a little different from those who were hospitalized in prior surges. Studies from South Africa and the United Kingdom have confirmed what many had hoped: Omicron causes less severe disease than Delta, and it is less likely to send its hosts to the hospital. British trends support those conclusions: As the Financial Times’ John Burn-Murdoch has reported, the number of hospitalized COVID patients has risen in step with new cases, but the number needing a ventilator has barely moved. And with vaccines blunting the severity of COVID even further, we should expect the average COVID patient in 2022 to be less sick than the average patient in 2021.

In the U.S., many health-care workers told me that they’re already seeing that effect: COVID patients are being discharged more easily. Fewer are critically ill, and even those who are seem to be doing better. “It’s anecdotal, but we’re getting patients who I don’t think would have survived the original virus or Delta, and now we’re getting them through,” Milad Pooran, a critical-care physician in Maryland, told me. But others said that their experiences haven’t changed, perhaps because they serve communities that are highly unvaccinated or because they’re still dealing with a lot of Delta cases. Milder illness “is not what we’re seeing,” said Howard Jarvis, an emergency physician in Missouri. “We’re still seeing a lot of people sick enough to be in the ICU.” Thomas told me that her hospital had just seven COVID patients a month ago, and is now up to 129, who are taking up almost half of its beds. Every day, about 10 patients are waiting in the ER already hooked up to a ventilator but unable to enter the ICU, which is full.

During this surge, record numbers of children are also being hospitalized with COVID. Sarah Combs, a pediatric emergency physician in Washington, D.C., told me that during the height of Delta’s first surge, her hospital cared for 23 children with COVID; on Tuesday, it had 53. “Many of the patients I’m operating on are COVID-positive, and some days all of them are,” Chethan Sathya, a pediatric surgeon in New York, told me. “That never happened at any point in the pandemic in the past.” Children fare much better against the coronavirus than adults, and even severely ill ones have a good chance of recovery. But the number of such patients is high, and Combs and Sathya both said they worry about long COVID and other long-term complications. “I have two daughters myself, and it’s very hard to take,” Sathya said.

These numbers reflect the wild spread of COVID right now. The youngest patients are not necessarily being hospitalized for the disease—Sathya said that most of the kids he sees come to the hospital for other problems—but many of them are: Combs told me that 94 percent of her patients are hospitalized for respiratory symptoms. Among adults, the picture is even clearer: Every nurse and doctor I asked said that the majority of their COVID patients were admitted because of COVID, not simply with COVID. Many have classic advanced symptoms, such as pneumonia and blood clots. Others, including some vaccinated people, are there because milder COVID symptoms exacerbated their chronic health conditions to a dangerous degree. “We have a lot of chronically ill people in the U.S., and it’s like all of those people are now coming into the hospital at the same time,” said Vineet Arora, a hospitalist in Illinois. “Some of it is for COVID, and some is with COVID, but it’s all COVID. At the end of the day, it doesn’t really matter.” (COVID patients also need to be isolated, which increases the burden on hospitals regardless of the severity of patients’ symptoms.)

Omicron’s main threat is its extreme contagiousness. It is infecting so many people that even if a smaller proportion need hospital care, the absolute numbers are still enough to saturate the system. It might be less of a threat to individual people, but it’s disastrous for the health-care system that those individuals will ultimately need.

Other countries have had easier experiences with Omicron. But with America’s population being older than South Africa’s, and less vaccinated or boosted than the U.K.’s or Denmark’s, “it’s a mistake to think that we’ll see the same degree of decoupling between cases and hospitalizations that they did,” James Lawler, an infectious-disease physician in Nebraska, told me. “I’d have thought we’d have learned that lesson with Delta,” which sent hospitalizations through the roof in the U.S. but not in the U.K. Now, as then, hospitalizations are already spiking, and they will likely continue to do so as Omicron moves from the younger people it first infected into older groups, and from heavily vaccinated coastal cities into poorly vaccinated rural, southern, and midwestern regions. “We have plenty of vulnerable people who will fill up hospital beds pretty quickly,” Lawler said. And just as demand for the health-care system is rising, supply is plummeting.

The Workers

The health-care workforce, which was short-staffed before the pandemic, has been decimated over the past two years. As I reported in November, waves of health-care workers have quit their jobs (or their entire profession) because of moral distress, exhaustion, poor treatment by their hospitals or patients, or some combination of those. These losses leave the remaining health-care workers with fewer trusted colleagues who speak in the same shorthand, less expertise to draw from, and more work. “Before, the sickest ICU patient would get two nurses, and now there’s four patients for every nurse,” Megan Brunson, an ICU nurse in Texas, told me. “It makes it impossible to do everything you need to do.”

Omicron has turned this bad situation into a dire one. Its ability to infect even vaccinated people means that “the numbers of staff who are sick are astronomical compared to previous surges,” Joseph Falise, a nurse manager in Miami, told me. Even though vaccinated health-care workers are mostly protected from severe symptoms, they still can’t work lest they pass the virus to more vulnerable patients. “There are evenings where we have whole sections of beds that are closed because we don’t have staff,” said Ranney, the Rhode Island emergency physician.

Every part of the health-care system has been affected, diminishing the quality of care for all patients. A lack of pharmacists and outpatient clinicians makes it harder for people to get tests, vaccines, and even medications; as a result, more patients are ending up in the hospital with chronic-disease flare-ups. There aren’t enough paramedics, making it more difficult for people to get to the hospital at all. Lab technicians are falling ill, which means that COVID-test results (and medical-test results in general) are taking longer to come back. Respiratory therapists are in short supply, making it harder to ventilate patients who need oxygen. Facilities that provide post-acute care are being hammered, which means that many groups of patients—those who need long-term care, dialysis, or care for addiction or mental-health problems—cannot be discharged from hospitals, because there’s nowhere to send them.

These conditions are deepening the already profound exhaustion that health-care workers are feeling. “We’re still speaking of surges, but for me it’s been a constant riptide, pulling us under,” Brunson said. “Our reserves aren’t there. We feel like we’re tapped out, and that person who is going to come in to help you isn’t going to, because they’re also tapped out … or they’ve tested positive.”

Public support is also faltering. “We once had parades and people hanging up signs; professional sports teams used to do Zooms with us and send us lunches,” Falise told me. “The pandemic hasn’t really become any different, but those things are gone.” Health-care workers now experience indifference at best or antagonism at worst. And more than ever, they are struggling with the jarring disconnect between their jobs and their communities. At work, they see the inescapable reality of the pandemic. Everywhere else—on TV and social media, during commutes and grocery runs—they see people living the fantasy that it is over. The rest of the country seems hell-bent on returning to normal, but their choices mean that health-care workers cannot.

As a result, “there’s an enormous loss of empathy among health-care workers,” Swaminathan said. “People have hit a tipping point,” and the number of colleagues who’ve talked about retiring or switching careers “has grown dramatically in the last couple of months.” Medicine runs on an unspoken social contract in which medical professionals expect themselves to sacrifice their own well-being for their patients. But the pandemic has exposed how fragile that contract is, said Arora, the Illinois hospitalist. “Society has decided to move on with their lives, and it’s hard to blame health-care workers for doing the same,” she said.

The System

In the coming weeks, these problems will show up acutely, as the health-care system scrambles to accommodate a wave of people sick with COVID. But the ensuing stress and strain will linger long after. The danger of COVID, to individual Americans, has gone far past the risk that any one infection might pose, because the coronavirus has now plunged the entire health-care system into a state of chronic decay.

In Maryland, Milad Pooran runs a center that helps small community hospitals find beds for critically ill patients. Normally, it gets a few calls a night, but “now we’re getting two an hour,” he told me. In Swaminathan’s emergency room, “we routinely have 60 to 70 people who are waiting for six to 12 hours to be seen,” he said. Other health-care workers noted that even when they can get people into beds, offering the usual standard of care is simply impossible. “Yes, sure, if you’re the patient who puts us at 130 percent capacity, you still technically get a bed, but the level of care that everyone gets is significantly diminished,” Lawler said. Some doctors are discharging patients who would have been admitted six months ago, because there’s nowhere to put them and they seem temporarily stable enough.

To be clear, these problems are not affecting just COVID patients, but all patients. When Swaminathan’s friends asked what they should be doing about Omicron, he advised them about boosters and masks, but also about wearing a seat belt and avoiding ladders. “You don’t want to be injured now,” he told me. “Any need to go to the emergency department is going to be a problem.” This is the bind that Americans, including vaccinated ones, now face. Even if they’re unconcerned about COVID or at low personal risk from it, they can still spread a variant that could ultimately affect them should they need medical care for anything.

These conditions are contributing to the moral distress that health-care workers feel. “This pandemic is making it almost impossible to provide our best care to patients, and that can become too much for some folks to bear,” Ranney said. A friend recently told her, after seeing a patient who had waited six hours with a life-threatening emergency, “How can I go back tomorrow knowing that there might be another patient in the waiting room who might be about to die and who I don’t know about?”

From outside the system, it can be hard to see these problems. “I don’t think people will realize what’s happening until we fall off that cliff—until you call 911 and no one comes, or you need that emergency surgery and we can’t do it,” Swaminathan said. The system hasn’t yet careened over: “When the trauma patients, the cardiac arrests, or the strokes come in, it’s a mad shuffle, but we still find a way to see them,” said Kit Delgado, the Pennsylvania emergency physician. “I don’t know how sustainable that’s going to be if cases keep rising everywhere.”

Measures that worked to relieve strain in earlier surges are now harder to pull off. Understaffed hospitals can hire travel nurses, but Omicron has spread so quickly that too many facilities “are pulling from the same labor pool—and if that pool is sick, where are the reinforcements?” Syra Madad, an infectious-disease epidemiologist in New York, told me. Hospitals often canceled nonemergency surgeries during past surges, but many of those patients are now even sicker, and their care can’t be deferred any longer. This makes it harder for COVID teams to pull in staff from other parts of a hospital, which are themselves heaving with patients. Brunson works in a cardiac ICU, not a COVID-focused one, but her team is still inundated with people who got COVID in a prior surge and “are now coming in with heart failure” because of their earlier infection, she said. “COVID isn’t done for them, even though they’re testing negative.” Hospitals aren’t facing just Omicron, but also the cumulative consequences of every previous variant in every previous surge.

Newer solutions are limited, too. Joe Biden has promised to bolster hard-hit hospitals with 1,000 more military personnel—a tiny number for the demand. New antiviral drugs such as Pfizer’s Paxlovid could significantly reduce the odds of hospitalization, but supplies are low; the pills must also be taken early on in the disease’s course, which depends on obtaining rapid diagnostic tests, which are also in short supply. For people who get the drugs, “they’ll be great, but at a population scale they’re not going to prevent the system from being overwhelmed,” Lawler said. So, almost unbelievably, the near-term fate of the health-care system once again hinges on flattening the curve—on slowing the spread of the most transmissible variant yet, in a matter of days rather than weeks.

Some experts are hopeful that Omicron will peak quickly, which would help alleviate the pressure on hospitals. But what then? Ranney fears that once hospitalizations start falling, policy makers and the public will assume that the health-care system is safe, and do nothing to address the staffing shortages, burnout, exploitative working conditions, and just-in-time supply chains that pushed said system to the brink. And even if the flood of COVID patients slows, health-care workers will still have to deal with the fallout—cases of long COVID, or people who sat on severe illnesses and didn’t go to hospital during the surge. They’ll do so with even less support than before, without the colleagues who are quitting their jobs right now, or who will do so once the need and the adrenaline subside. “Right now, there’s a sense of purpose, which lets you mask the trauma that everyone is experiencing,” Pooran said. “My fear is that when COVID is done with and everything does quiet down, that sense of purpose will go away and a lot of good people will leave.”

There’s a plausible future in which most of the U.S. enjoys a carefree spring, oblivious to the frayed state of the system they rely on to protect their health, and only realizing what has happened when they knock on its door and get no answer. This is the cost of two years spent prematurely pushing for a return to normal—the lack of a normal to return to.

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