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  • NorCal forecast: Freeze Warning Thursday night as the weather dries out

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    NorCal forecast: Freeze Warning Thursday night as the weather dries out

    A few days of dry weather will give crews in in the mountains some much-needed time to plow and restore power.

    ALL RIGHT. NOW TO KCRA 3 WEATHER. IT IS AN IMPACT DAY. BUT LOOK AT THIS. A LIVE LOOK FROM STOCKTON. WE DO HAVE SOME BLUE SKY OUT THERE, ALTHOUGH WE STILL HAVE THE CLOUDS. LET’S GET OVER TO DIRK WITH OUR FORECAST. YEAH, THE BIGGEST IMPACT TODAY HAS BEEN IN THE MOUNTAINS. WE HAVE HAD SOME SHOWERS, WE’VE HAD SOME HAIL AND SOME PRETTY HEAVY DOWNPOURS. BUT THE SIERRA, THAT’S WHERE WE CONTINUE TO SEE A PRETTY GOOD AMOUNT OF SNOW STILL FALLING. NOW WE ARE SEEING SOME SIGNS OF IT BREAKING A BIT AND THAT’S GOOD. LET’S TAKE A CLOSER LOOK HERE. BETWEEN HIGHWAY 50 AND I-80. THIS IS WHERE WE HAVE SOME OF THE HEAVIEST SNOW FALLING RIGHT NOW IN PLUMAS COUNTY AND EL DORADO COUNTIES, AND I-80, WHERE WE’VE BEEN SEEING A LITTLE BIT OF A BREAK. ACTUALLY, THE SNOW PLOWS HAVE BEEN ABLE TO KIND OF CATCH UP A LITTLE BIT. YOU CAN START SEEING SOME OF THE SURFACE OF THE ROAD HERE FROM THE DONNER SUMMIT SKY CAMERA THAT IS ICE ENCRUSTED WITH SOME OF THOSE SNOWFLAKES. GOT A LITTLE BIT OF A WINDOW TO BE ABLE TO SEE THE ACTUAL I-80 DONNER SUMMIT AREA, BUT TEMPERATURE CURRENTLY 18 DEGREES WITH WIND GUSTS UP TO 16MPH. SO LET’S GO AHEAD AND TALK A LITTLE BIT MORE ABOUT THE RAIN HITTING THESE SPOTS WHERE THERE’S THESE LITTLE HEAVY DOWNPOURS, THESE LITTLE CELLS THAT ARE POPPING UP. THAT’S WHERE WE’RE SEEING HAIL THAT’S BEEN FORMING. AND SO THOSE ARE SPOTS THAT’S BEEN COLD ENOUGH TO WHERE WE’RE SEEING HAIL HAS HAD SEVERAL REPORTS OF HAIL. AND THOSE ARE THE MOST LIKELY SPOTS HERE ALONG HIGHWAY 108. WE’RE SEEING SOME. AND THAT’S GOING TO BE PUSHING IN AND TURNING INTO SOME SNOW AS IT MAKES ITS WAY UP INTO THE FOOTHILLS, UP ABOVE 1500 FEET. ALSO, JUST TO THE SOUTH OF IONE. YOU’RE KIND OF COMING OUT OF THIS AREA OF RAIN AS THIS IS MOVING A LITTLE BIT MORE TO THE SOUTH TOWARDS SAN ANDREAS. IN JACKSON, YOU’VE BEEN SEEING SOME OF THAT RAIN. WE HAVE SOME RAIN NEAR CAMERON PARK CURRENTLY, AND AUBURN, WHICH EARLIER HAD SOME SNOW, IS NOW GETTING SOME LIGHT RAIN. SO SNOW THAT’S LAKE TAHOE SOUTH LAKE TAHOE PICTURE HERE SHOWING THE AREA BLANKETED WITH SOME FRESH SNOW. CURRENT TEMPERATURE AND TRUCKEE IS 25 DEGREES MODESTO 5154 IN STOCKTON AND 51 DEGREES CURRENTLY IN SACRAMENTO. SO ONCE WE GOT RID OF THE RAIN AND THINGS ARE DRYING OUT TEMPERATURES, THEY REBOUNDED A LITTLE BIT. EVEN WITH THAT COLD AIR THAT’S BRINGING OUT THOSE LOW SNOW LEVELS, CURRENT WINDS. WE HAVE WINDS 21MPH IN STOCKTON. THAT’S WHERE WE’RE SEEING SOME OF THE STRONGEST WINDS RIGHT NOW. 17 MILE AN HOUR WINDS IN FAIRFIELD, SAN FRANCISCO BEATS THEM ALL WITH A WIND COMING FROM THE WEST NORTHWEST AT 32MPH. SO WE HAVE THIS POCKET OF COLD AIR. IT’S MOVED IN AND WE’VE SEEN THE LOW SNOW LEVELS. AND THIS IS GOING TO MAKE FOR A COLD NIGHT TONIGHT, ESPECIALLY AREAS WHERE WE SEE THE CLOUD COVER STARTING TO CLEAR OUT. THAT’S JUST OPENING THE DOOR, ALLOWING THAT COLD AIR TO JUST SIT IN PLACE. ALTHOUGH ANY WARMTH IS GOING TO ESCAPE. AND WE’RE LOOKING AT A FREEZE WARNING THAT HAS BEEN ISSUED BY THE NATIONAL WEATHER SERVICE FROM MIDNIGHT TONIGHT UNTIL 9:00 TOMORROW MORNING WITH SUBFREEZING TEMPERATURES. BUT NOT EVERY PLACE IS GOING TO BE THE SAME. WE’RE LOOKING AT THE NORTH END OF THE VALLEY, STRETCHING ALL THE WAY UP INTO SHASTA COUNTY. THIS IS WHERE THE COLDEST AIR IS GOING TO BE. ANYWHERE FROM 23 TO 28 DEGREES. AND THEN YOU GET MORE TOWARDS SACRAMENTO AND ON INTO SAN JOAQUIN VALLEY. AND THAT’S WHERE WE’RE EXPECTING TEMPERATURES TO RANGE MORE 29 TO 34 DEGREES. BUT STILL, THOSE ARE SOME PRETTY COLD TEMPERATURES FOR NORTHERN CALIFORNIA. SO IF YOU HAVE ANY TEMPERATURE SENSITIVE PLANTS OR ANYTHING THAT COULD BE AFFECTED BY THAT KIND OF COLD, TAKE CARE OF IT. TAKE CARE OF THAT BUSINESS SNOW THAT’S GOING TO BE DECREASING OVERNIGHT TONIGHT AND INTO TOMORROW MORNING. WE CAN SEE WE HAVE SOME BREAKS IN THE CLOUD COVER. WE’RE GOING TO SEE WIDESPREAD FROST TOMORROW MORNING BECAUSE OF THE RAIN KIND OF ICY CONDITIONS TO WAKE UP TO IN THE MORNING FRIDAY. AS WE GET INTO THE AFTERNOON, WE WILL SEE A LITTLE BIT OF SUNSHINE THAT WILL BE NICE TO WARM THINGS UP. AND THERE’S ALSO THIS BOUNDARY OUT HERE BRINGING SOME RAIN ALONG THE NORTHERN COAST OF CALIFORNIA. NOW, WHAT’S INTERESTING ABOUT THIS IS IT’S GOING TO HANG OUT. WE’RE LOOKING AT DRY SATURDAY AS WELL. SO DRY ON FRIDAY, DRY ON SATURDAY. BUT ALONG THE COAST WE HAVE THESE SHOWERS THAT ARE PICKING UP. IT’S EXPECTED TO SWING IN A LITTLE BIT ON SUNDAY. WE COULD SEE SOME OF THESE SHOWERS BASICALLY PARALLEL WITH I-80. AND SO WE’LL SEE THAT FROM SACRAMENTO NORTH ON SUNDAY AND MONDAY. AND THEN THE BETTER CHANCE FOR RAIN ROLLS IN ON TUESDAY. BUT FOR TOMORROW, TEMPERATURES STARTING OFF AROUND FREEZING, THEN DAYTIME HIGHS LOOKING AT MOSTLY MID TO LOW 50S SEVEN DAY FORECAST. GETTING A NICE BREAK FRIDAY SATURDAY AND FOR SOME EVEN SUNDAY AND MONDAY. IT’S REALLY GOING TO BE TUESDAY THAT WE HAVE THE BETTER SHOT FOR RAIN AND THIS IS GOING TO BE WARMER SYSTEM WITH TEMPERATURES WARMING UP. WE’RE LOOKING AT SNOW LEVELS AROUND 7000FT. SO THOSE AREAS THAT HA

    NorCal forecast: Freeze Warning Thursday night as the weather dries out

    A few days of dry weather will give crews in in the mountains some much-needed time to plow and restore power.

    Updated: 4:42 PM PST Feb 19, 2026

    Editorial Standards

    The next few days will be dry in the Valley, Foothills and Sierra.

    That will give plow and power crews some much-needed time to clear roads and restore electricity.

    Temperatures will plummet Friday morning with many Valley spots at of below freezing at sunrise. Saturday and Sunday will gradually turn milder.

    A couple showers can’t be ruled out Sunday and Monday, but most places will stay dry both days.

    Rain is likely on Tuesday and the snow level will stay at or even above the Sierra summits.

    Cold Friday morning

    A Freeze Warning is in effect Thursday night into Friday morning across the Valley.

    Temperatures are forecast to drop below freezing in some Valley spots Friday morning. The Foothills may have some icy side streets with temperatures in the 20s. Many Sierra roads will be covered in snow and ice.

    Sierra travel outlook

    Snow will stop Thursday night and dry weather is in the forecast Friday, Saturday and Sunday.

    It will take plow crews a while to remove all of the snow that’s fallen this week, especially on narrow side streets.

    Drivers should expect chain controls and long travel times on Friday and maybe Saturday even with dry weather.

    Friday’s high temperatures

    Friday afternoon will be dry and chilly with a mix of sun and clouds. Temperatures will be running about 10 degrees cooler than normal.

    Weekend forecast

    The weekend will be warmer and mostly dry.

    The only chance for a shower comes on Sunday. Areas east of I-5 including the Foothills and Sierra will stay dry while the west side of the Valley could see a few hundredths of an inch of rain.

    KCRA 3 weather Impact Day Tuesday

    The next round of widespread precipitation is in the forecast for Tuesday. This will be a much warmer storm system and the snow level will likely stay at or even above the Sierra passes.

    The KCRA 3 weather team has issued a weather Impact Day for Tuesday because of how rain will affect travel and any outdoor plans.

    Valley 7-day forecast

    A few showers are possible Sunday and Monday, but Tuesday is more likely to be wet all day.

    Rain will clear for the rest of next week.

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  • Front arrives with showers and a few storms late Saturday. 1.2.26

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    Front arrives with showers and a few storms late Saturday. 1.2.26

    FEBRUARY 6TH. TIME TO GET A CHECK OF YOUR FORECAST NOW. IT’S FELT LIKE WINTER. SOME THIS WEEK, BUT NOW IT DOES NOT. NO, IT DOES NOT. AND I’LL TELL YOU WHAT. IF YOU LIKE THE WARM WEATHER, WE HAVE A LONG STRETCH OF WARM WEATHER COMING OUR WAY. SUNDAY MIGHT BE JUST A ONE LITTLE HICCUP KIND OF A DAY HERE, BUT MOST OF US ARE GOING TO BE PRETTY WARM. LET ME TAKE YOU BACK OUTSIDE RIGHT NOW. AS YOU CAN SEE THIS MORNING IT WAS 37 DEGREES UP THERE IN OCALA. DIDN’T GET ANY FROST PICTURES UP THERE. BUT IF THOSE WINDS WERE LIGHT ENOUGH UP THAT WAY, THERE COULD HAVE EASILY BEEN SOME FROST. LET’S TAKE A LOOK NOW AT WILDWOOD 39 BACK TOWARDS SANFORD 43. DELAND WAS 40 DEGREES EARLY THIS MORNING. THERE ARE FOLKS OUT THERE AT THE BEACH AND I TELL YOU WHAT, IT’S GOING TO BE WARM TOMORROW IF YOU CAN GET THERE BEFORE NOON. YOU MAY HAVE A FEW HOURS THERE TO ENJOY SOME WARM WEATHER. ALTHOUGH, AS WE’VE BEEN MENTIONING TO YOU, SOME SHOWERS AND SOME THUNDERSHOWERS WILL BE ARRIVING LATER ON IN THE DAY, AND THERE’S GOING TO BE A GOOD DEAL OF CLOUD. SO JUST BE CAREFUL AND KNOW THAT 6566 RIGHT NOW, PALM COAST STILL 70, IN SAINT CLOUD, 71 FOR MELBOURNE ON INTO PALM BAY. VERY ACTIVE WEATHER PATTERN. WE GOT THAT POLAR VORTEX LIFTING UP THERE JUST NOW NORTH AND EAST OF HUDSON’S BAY. PRETTY WARM TO THE SOUTH. COUPLE LITTLE FEATURES HERE. THIS ONE RIGHT THERE IS GOING TO BRING US SOME ACTIVE WEATHER COME LATE SATURDAY. AND THEN A HUGE WEST COAST STORM SYSTEM BRINGING MORE SIGNIFICANT SNOWS AND RAIN TO FOLKS OUT WEST. YOU CAN SEE THE FLOW UP AND OVER THAT BIG DOME OF HIGH PRESSURE. THAT’S WHERE THE CLOUDS ARE GOING TO BE COMING FROM OFF OF THE GULF HERE. AND THEY’LL START TO THICKEN UP AS WE GET YOU OUT THE DOOR TOMORROW MORNING. AND THAT WILL LEAD TO SOME RAIN AS WE GET YOU ON INTO THE AFTERNOON AND EVENING HOURS. LOOK AT PALM BAY 69. STEADY THROUGH THE EARLY MORNING HOURS AND THEN RISING SIX, SEVEN, 8:00 IN THE MORNING FROM THE LOW 50S INTO THE LOW 60S. BY THE TIME WE’RE AT NINE, 10:00 IN THE MORNING, LOOK AT PALM COAST 6659 STEADY AS SHE GOES RIGHT THROUGH THE OVERNIGHT TIME FRAME. HERE’S THE WINDS WILL TURN AROUND OUT OF THE SOUTH WINTER GARDEN TONIGHT. 53 WEDGEFIELD WINDS A LITTLE BIT LIGHTER. YOU’LL DROP TO ABOUT 51. WILDWOOD 52 AND PALM BAY RIGHT AROUND THE 50 DEGREE MARK. LET’S PUT THE MAPS INTO MOTION. THERE’S OUR FRONT. IT’S ON THE MOVE. SOME SHOWERS, COUPLE RUMBLES OF THUNDER. ANY SEVERE WEATHER AS OF RIGHT NOW APPEARS TO BE UP NORTH ALONG I-10. BRIEFLY COOLER THERE AS WE GET YOU ON INTO SUNDAY. NOT COLD COOLER. LET’S TAKE A LOOK AT THE RAINFALL DIFFERENCES BETWEEN THE GFS AND THE EURO. NOW OUR LONGER RANGE GLOBAL MODELS ARE NOT AS IMPRESSED WITH THIS STORM SYSTEM AS THE LOCAL FUTURECAST MODEL, SO I WANTED TO PARLAY THAT OUT TO YOU AND SHOW YOU THE DIFFERENCES THERE. LOOK AT SATURDAY 76 SUNDAY COMING IN AT 71. SUNDAY SHOULD BE THE BETTER DAY. NOT PERFECT. IT WILL BE COOLER AND THEY’LL BE CLOUDS AROUND. BUT LET ME SHOW YOU WHAT’S GOING TO BE HAPPENING THERE. THERE’S SATURDAY. HERE COMES THE SHOWERS AND STORMS DROPPING SOUTHWARD AS WE GO. THROUGHOUT THE COURSE OF THE AFTERNOON AND THE EVENING, SOME OF THAT RAIN COULD BE BRIEFLY HEAVY. WE’RE GOING TO MONITOR THE TRENDS ON THAT. I’LL HAVE AN UPDATE ON THIS FOR YOU TONIGHT DURING THE 10:00 AND 11:00 BROADCAST. AS THE HER MODEL A BIT MORE AGGRESSIVE WITH THE HEAVIER AMOUNTS OF RAIN THERE. AND IF YOU’RE HEADED TO THE ATTRACTIONS MOST OF THE DAY LOOKS GOOD. WATCH OUT FOR THE AFTERNOON LIKE FIVE 6:00 AFTERNOON AND EVENING SHOWERS AND MAYBE A RUMBLE OF THUNDER. THEN AS WE GET INTO TUESDAY, WEDNESDAY AND THURSDAY, HIGH PRESSURE BUILDS TO THE EAST. LOOK AT THE SOUTH AND THEN SOUTHWESTERLY FLOW HERE THAT WILL BUILD IN BY THE TIME WE GET INTO THURSDAY, FRIDAY AND SATURDAY. THAT’S GOING TO ALLOW FOR SOME VERY WARM AIR AS WE GET YOU INTO THE MIDDLE OF THE MONTH OF JANUARY. THE FIRST 80 WILL BE ON THE WAY. IN FACT, LET ME SHOW YOU A DAYTONA BEACH COULD EVEN BE 81 WEEK FROM TOMORROW. LET’S PUT IT ALL TOGETHER HERE FOR YOU. CENTRAL FLORIDA’S MOST ACCURATE INLAND SEVEN DAY FORECAST 76 SATURDAY AROUND 80.

    Front arrives with showers and a few storms late Saturday. 1.2.26

    Updated: 5:05 PM EST Jan 2, 2026

    Editorial Standards

    Chief meteorologist Tony Mainolfi has Central Florida’s updated forecast.Front arrives with showers and a few storms late Saturday. 1.2.26 Radar Hurricanes Severe Weather Alerts Map Room

    Chief meteorologist Tony Mainolfi has Central Florida’s updated forecast.

    Front arrives with showers and a few storms late Saturday. 1.2.26

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  • Northern California forecast: Cool with a few regional showers

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    Northern California forecast: Cool with a few regional showers

    NOW, LET’S TAKE THIS LIVE. LOOK OUTSIDE IN SACRAMENTO. WHERE? YEAH, JUST A FEW CLOUDS AROUND EARLY. WE’RE AT 62 DEGREES RIGHT NOW. WINDS SOUTHEAST AT ABOUT FIVE MILES PER HOUR. NOW, WE DO HAVE SOME ACTIVITY ON THE RADAR. SO HERE LOCALLY AROUND SACRAMENTO WE’RE STILL LOOKING AT DRY CONDITIONS, MAINLY CLEAR SKIES. BUT AS WE TAKE A LOOK AT WE’RE HEADING UP TOWARD TEHAMA COUNTY AND RED BLUFF. THAT’S WHERE WE’RE SEEING SOME SHOWER ACTIVITY THIS MORNING. WE’VE SEEN A FEW IN PARTS OF GLENN COUNTY, COLUSA AND LAKE COUNTIES THERE AS WELL, AND THEN HEADING OVER INTO PLUMAS COUNTY, SEEING A FEW SHOWERS HERE JUST TO THE NORTH OF CRESCENT MILLS. THOSE ARE MOVING THEIR WAY NORTHWARD, AND WE DO EXPECT TO SEE MORE ACTIVE WEATHER AS WE HEAD INTO THE AFTERNOON, ESPECIALLY IN THE SIERRA. AND THEN AGAIN IN THAT COASTAL RANGE, LIKELY TO SEE SOME SHOWERS THERE, TOO. TOMORROW AFTERNOON. MORE CHANCES FOR SHOWERS AND THUNDERSTORMS, PRIMARILY IN THE SIERRA, MAYBE A LITTLE BIT INTO THE COASTAL HILLS TOO. AND THEN FRIDAY, JUST A SLIGHT CHANCE IN THE SIERRA DRY CONDITIONS. SUNNY FOR US ON SATURDAY. SUNDAY THOUGH, ANOTHER CENTER OF LOW PRESSURE STARTS MOVING ITS WAY IN THIS, BRINGING WITH IT MORE CLOUDS, MORE CHANCES FOR AT LEAST A FEW SHOWERS ALONG THE COAST AND THEN IN THE SIERRA VALLEY WILL LIKELY STAY DRY. AND THEN AS WE GET INTO NEXT WEEK, ANOTHER RIDGE OF HIGH PRESSURE STARTS MOVING IN. AND THAT IS GOING TO BRING SOME WARMER TEMPERATURES BACK TO OUR FORECAST. THE SEVEN DAY FORECAST FOR TODAY IN THE SIERRA 62 DEGREES CHANCES FOR SHOWERS TOMORROW 65 WARMING UP INTO THE 70S OVER THE WEEKEND FOR THE FOOTHILLS. SLIGHT CHANCE FOR A SPRINKLE OR TWO TODAY. JUST MAINLY, MOSTLY CLOUDY SKIES WITH TEMPERATURES IN THE UPPER 70S AND THEN IN SACRAMENTO. TODAY THAT FORECAST HIGH, TOPPING OUT AT 79 DEGREES. HOW NICE IS THAT GETTING INTO THE UPPER 80S FOR US ON SATURDAY. AND A FEW MORE CLOUD

    Northern California forecast: Cool with a few regional showers

    Updated: 6:42 AM PDT Sep 10, 2025

    Editorial Standards

    Enjoy another fall-like day with some showers, mainly in the higher terrain.A few morning showers have returned in the northern Valley, while the rest of the valley is waking up under a few clouds as a slow-moving area of low pressure prepares to swing through.Valley highs on Wednesday will reach the upper 70s, much cooler than the seasonal normal of 90 degrees. A stray shower is possible, especially in the northern Sacramento Valley. Afternoon temperatures in the foothills will also top out in the upper 70s, with a chance of showers. The Sierra has the greatest chance for a couple of thunderstorms this afternoon, with highs in the low 60s.The low will slowly progress east, carrying the potential for afternoon thunderstorms into Thursday. At the same time, valley temperatures will warm back into the 80s, climbing into the upper 80s on Friday. By then, storm chances will be limited to the Sierra.Saturday is shaping up nicely, as a ridge of high pressure brings more sunshine and warms temperatures back near 90 degrees. Our next impactful weather system arrives Sunday, bringing breezes and a few Sierra storms.| MORE | A 2025 guide for how to prepare for wildfires in California | Northern California wildfire resources by county: Find evacuation info, sign up for alertsCal Fire wildfire incidents: Cal Fire tracks its wildfire incidents here. You can sign up to receive text messages for Cal Fire updates on wildfires happening near your ZIP code here.Wildfires on federal land: Federal wildfire incidents are tracked here.Preparing for power outages: Ready.gov explains how to prepare for a power outage and what to do when returning from one here. Here is how to track and report PG&E power outages.Keeping informed when you’ve lost power and cellphone service: How to find a National Weather Service radio station near you.Be prepared for road closures: Download Caltrans’ QuickMap app or check the latest QuickMap road conditions here.See more coverage of top California stories here | Download our app | Subscribe to our morning newsletter | Find us on YouTube here and subscribe to our channel

    Enjoy another fall-like day with some showers, mainly in the higher terrain.

    A few morning showers have returned in the northern Valley, while the rest of the valley is waking up under a few clouds as a slow-moving area of low pressure prepares to swing through.

    Valley highs on Wednesday will reach the upper 70s, much cooler than the seasonal normal of 90 degrees. A stray shower is possible, especially in the northern Sacramento Valley. Afternoon temperatures in the foothills will also top out in the upper 70s, with a chance of showers. The Sierra has the greatest chance for a couple of thunderstorms this afternoon, with highs in the low 60s.

    The low will slowly progress east, carrying the potential for afternoon thunderstorms into Thursday. At the same time, valley temperatures will warm back into the 80s, climbing into the upper 80s on Friday. By then, storm chances will be limited to the Sierra.

    Saturday is shaping up nicely, as a ridge of high pressure brings more sunshine and warms temperatures back near 90 degrees. Our next impactful weather system arrives Sunday, bringing breezes and a few Sierra storms.

    | MORE | A 2025 guide for how to prepare for wildfires in California | Northern California wildfire resources by county: Find evacuation info, sign up for alerts

    See more coverage of top California stories here | Download our app | Subscribe to our morning newsletter | Find us on YouTube here and subscribe to our channel

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  • Everything Can Be Meat

    Everything Can Be Meat

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    Recently, a photo of rice left me confused. The rice itself looked tasty enough—fluffy, well formed—but its oddly fleshy hue gave me the creeps. According to the scientists who’d developed it, each pink-tinged grain was seeded with muscle and fat cells from a cow, imparting a nutty, umami flavor.

    In one sense, this “beef rice” was just another example of lab-grown meat, touted as a way to eat animals without the ethical and environmental impacts. Though not yet commercially available, the rice was developed by researchers in Korea as a nutrition-dense food that can be produced sustainably, at least more so than beef itself. Although it has a more brittle texture than normal rice, it can be cooked and served in the same way. Yet in another sense, this rice was entirely different. Lab-grown meat aims to replicate conventional meat in every dimension, including taste, nutrition, and appearance. Beef rice doesn’t even try.

    Maybe that’s a good thing. Lab-grown meat, also widely known as cultivated meat, has long been heralded as the future of food. But so far, the goal of perfectly replicating meat as we know it—toothy, sinewy, and sometimes bloody—has proved impractical and expensive. Once-abundant funding has dried up, and this week, Florida moved toward becoming the first state to ban sales of cultivated meat. It seems unlikely that whole cuts of cultivated meat will be showing up on people’s plates anytime soon—but maybe something like beef rice could. The most promising future of lab-grown meat may not look like meat at all, at least as we’ve always known it.

    The promise of cultivated meat is that you can have your steak and eat it too. Unlike the meatless offerings at your grocery store, cultivated meat is meat—just created without killing any animals. But the science just isn’t there yet. Companies have more or less figured out the first step, taking a sample of cells from a live animal or egg and propagating them in a tank filled with a nutrient-rich broth. Though not cheaply: By one estimate, creating a slurry of cultivated cells costs $17 a pound or more to produce.

    The next step has proved prohibitively challenging: coaxing that sludge of cells to mature into different types—fat, muscle, connective tissue—and arranging them in a structure resembling a solid cut of meat. Usually, the cells need a three-dimensional platform to guide their growth, known as a scaffold. “It’s something that is very easy to get wrong and hard to get right,” Claire Bomkamp, a senior scientist at the Good Food Institute, a nonprofit supporting meat alternatives, told me. So far, a few companies have served up proofs of concept: In June, the United States approved the sale of cultivated chicken from Upside Foods and Good Meat. However it is virtually impossible to come by now.

    The basic science of lab-grown meat can be used for more than just succulent chicken breasts and medium-rare steaks. Cells grown in a tank function essentially like ground meat, imparting a meaty flavor and mouthfeel to whatever they are added to, behaving more like an ingredient or a seasoning than a food product. Hybrid meat products, made by mixing a small amount of cultivated-meat cells with other ingredients, are promising because they would be more cost-effective than entire lab-grown steaks or chicken breasts but meatier than purely plant-based meat.

    Already, the start-up SciFi Foods is producing what has been described as a “fatty meat paste” that is intended to be mixed with plant-based ingredients to make burgers. Only small amounts are needed to make the burgers beefy; each costs less than $10 to make, according to the company—still considerably more than a normal beef patty, but the prices should come down over time. Maybe it sounds weird, but that’s not so different from imitation crab—which doesn’t contain much or any crab at all. A similar premise underlies the plant-based bacon laced with cultivated pork fat that I tried last year. Was it meat? I’m not sure. Did it taste like it? Absolutely.

    Meat can be so much more than what we’ve always known. “We don’t have to make meat the same way that it’s always come out of an animal,” Bomkamp said. “We can be a little bit more expansive in what our definition of meat is.” Beef rice, which essentially uses rice as a miniature scaffold to grow cow cells, falls into this category. It isn’t particularly meaty—only 0.5 percent of each grain is cow—but the scientists who developed it say the proportion could change in future iterations. It’s framed as a way to feed people in “underdeveloped countries, during war, and in space.”

    Eventually, cultivated meat could impart a whiff of meatiness to blander foods, creating new, meat-ish products in the process that are more sustainable than regular meat and more nutritious than plants. Beef rice is one option; meat grown on mushroom roots is in development. Even stranger foods are possible. Bomkamp envisions using the technology to make thin sheets of seafood—combining elements of salmon, tuna, and shrimp—to wrap around a rainbow roll of sushi. In this scenario, cultivated meat probably won’t save the planet from climate change and animal suffering. “It wouldn’t serve its original function of being a direct replacement for commercial meat,” Daniel Rosenfeld, who studies perceptions of cultivated meat at UCLA, told me. But at the very least, it could provide another dinner option.

    Of course, it’s in the interest of the cultivated-meat industry to suggest that cultivated meat isn’t just outright doomed. No doubt some vegetarians would cringe at the thought, as would some dedicated carnivores. But considering how much meat Americans eat, it’s not hard to imagine a future in which cultivated cells satisfy people searching for a new kind of meat product. Imagine the salad you could make with chicken cells grown inside arugula, or bread baked with bacon-infused wheat. But should those prove too difficult to produce, I’d happily take a bowl of beef rice, in all its flesh-tinged glory.

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    Yasmin Tayag

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  • Biden Is Still the Democrats’ Best Bet for November

    Biden Is Still the Democrats’ Best Bet for November

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    Let’s start with the obvious. The concerns about Joe Biden are valid: He’s old. He talks slowly. He occasionally bumbles the basics in public appearances.

    Biden’s age is so concerning that many Biden supporters now believe he should step aside and let some other candidate become the Democratic Party’s presidential nominee. The New York Times journalist Ezra Klein made the best-available case for this view recently in a 4,000-word piece that garnered intense attention by arguing that Biden is no longer up to the task of campaign life. “He is not the campaigner he was, even five years ago,” Klein writes. “The way he moves, the energy in his voice. The Democrats denying decline are only fooling themselves.”

    In one sense Klein is correct. As the political strategist Mike Murphy said many moons ago, Biden’s age is like a gigantic pair of antlers he wears on his head, all day every day. Even when he does something exceptional—like visit a war zone in Ukraine, or whip inflation—the people applauding him are thinking, Can’t. Stop. Staring. At. The antlers.

    Biden can’t shed these antlers. He’s going to wear them from now until November 5. If anything, they’ll probably grow.

    That said, there’s another point worth noting up front: Joe Biden is almost certainly the strongest possible candidate Democrats can field against Donald Trump in 2024.

    Biden’s strengths as a candidate are considerable. He has presided over an extraordinarily productive first term in which he’s passed multiple pieces of popular legislation with bipartisan majorities.

    Unemployment is at its lowest low, GDP growth is robust, real wage gains have been led by the bottom quartile, and the American economy has achieved a post-COVID soft landing that makes us the envy of the world. He has no major scandals. His handling of American foreign policy has been stronger and defter than any recent president’s.

    Moreover, he is a known quantity. The recent Michigan primary results underscored that Democratic voters don’t actually have an appetite for leaving Biden. In 2012, 11 percent of Michigan Democrats voted “uncommitted” against Barack Obama when he had no opposition. This week, with two challengers on the ballot and progressive activists whipping votes against Biden, the “uncommitted” vote share was just 13 percent. Biden is fully vetted, his liabilities priced in. Voters are not being asked to take a chance on him.

    This last part is crucial, because 2024 pits a current president against a former president, making both quasi-incumbents. If Biden was replaced, another Democrat would have her or his own strengths—but would be an insurgent. Asking voters to roll the dice on a fresh face against a functionally incumbent President Trump is a bigger ask than you might think.

    But the biggest problem plaguing arguments for Biden’s retirement is: Who then? Pretend you are a Democrat and have been handed a magical monkey’s paw. You believe that Biden is too old to defeat Trump and so you make a wish: I want a younger, more vigorous Democrat. There’s a puff of smoke and Kamala Harris is the nominee.

    Do you feel better about the odds of defeating Trump in nine months?

    You shouldn’t. Harris’s approval rating is slightly lower than Biden’s. People skeptical of her political abilities point to her time as vice president, but that’s not really fair: Very few vice presidents look like plausible successors during their time in office. (George H. W. Bush and Al Gore are the exceptions.)

    What should worry you about Harris is her 2020 campaign, which was somehow both disorganized and insular. She did not exhibit the kind of management skills or political instincts that inspire confidence in her ability to win a national campaign. Worse, she only rarely exhibited top-level-candidate skills.

    Harris had some great moments in 2020. Her announcement speech and first debate performance were riveting. But more often she was flat-footed and awkward. She fell apart at the Michigan debate in 2019 and never got polling traction. (My colleague Sarah Longwell likens Harris to a professional golfer who’s got the yips.)

    Some public polling on this question fills out the picture: Emerson finds Harris losing to Trump by three percentage points (Biden is down one point in the same poll). Fox has Harris losing by five points (it also has Biden down by one point). These are just two polls and the questions were hypothetical, but at best, you can say that Harris is not obviously superior to Biden in terms of electability. At worst, she might give Democrats longer odds.

    So you go back to the monkey’s paw with another wish: a younger, more vigorous Democrat who’s not Kamala Harris, please.

    I’m not sure how it would work logistically—would the Democratic Party turn its back on the sitting vice president?—but this is magic, so just roll with it. There’s a puff of smoke and Gavin Newsom walks onstage.

    Newsom is one of those people who, like Bill Clinton, has been running for president since he was 5 years old. Also like Clinton, Newsom is a good talker with some ideas in his head. But Clinton was a third-way Democrat from the Deep South at a time when the Democratic Party needed southern blue-collar voters. Today, the Democratic Party needs Rust Belt blue-collar voters—and Newsom is a liberal from San Francisco. Not a great starting position.

    Every non-Harris Democrat begins from a place of lower name recognition, meaning that there would be a rush to define them in the minds of voters. Republicans have convinced 45 percent of the country that Scrantonian Joe Biden is a Communist. What do you think they’d do with Newsom? In the Fox poll, he runs even with Vice President Harris at -4 to Trump. In the more recent Emerson poll, Newsom trails Trump by 10 points.

    Then there’s the eyeball test. Look at Newsom’s slicked-back hair, his gleaming smile, and tell me: Does he look like the guy to eat into Trump’s margins among working-class whites in Pennsylvania and Michigan?

    What about Pennsylvania and Michigan? You have only one wish left on the monkey’s paw, and Gretchen Whitmer and Josh Shapiro—popular governors who won big in swing states in 2022—are sitting right there. Maybe you should put one of them on the ticket in place of Biden?

    There’s some polling to back you up: Whitmer would probably beat Trump in Michigan and Shapiro would probably beat Trump in Pennsylvania.

    Nationally, it’s a much different question. I haven’t found anyone who’s polled Shapiro-Trump nationally, but Emerson and Fox both have Whitmer polling worse than Biden. (Emerson has Whitmer 12 points behind Trump.)

    Name recognition accounts for part of this gap, but not all of it. In 2022, Whitmer won her gubernatorial race by 11 points while Shapiro won by 15. But each ran against an underfunded MAGA extremist. In the Michigan poll pitting Whitmer against Trump, she leads by only six points; in the Pennsylvania poll with Shapiro, he leads Trump by 11. So even in states where everyone knows them, these potential saviors are softer against Trump than they were against their 2022 MAGA tomato cans.

    Sure, Whitmer and Shapiro seem like strong candidates at the midsize-state level. But you never know whether a candidate will pop until they hit the national stage. Scott Walker, Ron DeSantis, John Kerry, Mitt Romney, Kamala Harris—all of these politicians looked formidable too. Then the presidential-election MRI for the soul exposed their liabilities. Always remember that Barack Obama’s ascent from promising senator to generational political talent was the exception, not the rule.

    Let’s say that one of these not–Kamala Harris candidates is chosen at the Democratic National Convention in August. In the span of 10 weeks they would have to:

    1. Define themselves to the national audience while simultaneously resisting Trump’s attempts to define them.

    2. Build a national campaign structure and get-out-the-vote operation.

    3. Unify the Democratic Party.

    4. Fend off any surprises uncovered during their public (and at-scale) vetting.

    5. Earn credit in the minds of voters for the Biden economy.

    6. Distance themselves from unpopular Biden policies.

    7. Portray themselves as a credible commander in chief.

    8. Lay out a coherent governing vision.

    9. Persuade roughly 51 percent of the country to support them.

    Perhaps it’s possible. But that strikes me as a particularly tall order, even if one of them is a generational political talent. Which—again with the odds—they probably aren’t.

    We’ve got one final problem with the monkey’s paw: It doesn’t exist. If Biden withdrew from the race, the Democratic Party would confront a messy, time-consuming process to replace him. Perhaps a rigorous but amicable write-in campaign would produce a strong nominee and a unified party. But perhaps the party would experience a demolition derby that results in a suboptimal nominee and hard feelings.

    Or maybe party elites at a brokered convention would choose a good nominee. (This is the Ezra Klein scenario, and I’m sympathetic to it. Smoke-filled back rooms get a bad rap; historically they produced better candidates than the modern primary system.) But very few living people have participated in a brokered convention. It could easily devolve into chaos and fracture the moderate, liberal, and progressive wings of the party.

    The point is: Biden has a 50–50 shot. Maybe a little bit worse, maybe a little bit better—like playing blackjack. Every other option is a crapshoot in which the best outcome you can reasonably hope for is 50–50 odds and the worst outcome pushes the odds to something like one in three.

    Joe Biden is Joe Biden. He isn’t going to win a 10-point, realigning victory. But his path to reelection is clear: Focus like a laser on suburban and working-class white voters in a handful of swing states. Remind them that Trump is a chaos agent who wrecked the economy. Show them how good the economy is now. Make a couple of jokes about the antlers. And then bring these people home—because many of them already voted for him once.

    Having a sure thing would certainly be nice, given the ongoing authoritarian threat we face. But there isn’t one. Joe Biden is the best deal democracy is going to get.

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    Jonathan V. Last

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  • ‘Gut Health’ Has a Fatal Flaw

    ‘Gut Health’ Has a Fatal Flaw

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    In my childhood home, an often-repeated phrase was “All disease begins in the gut.” My dad, a health nut, used this mantra to justify his insistence that our family eat rice-heavy meals, at the exact same time every day, to promote regularity and thus overall health. I would roll my eyes, dubious that his enthusiasm for this practice was anything more than fussiness.

    Now, to my chagrin, his obsession has become mainstream. Social-media testimonials claim that improving your “gut health” not only helps with stomach issues such as bloating and pain but also leads to benefits beyond the gastrointestinal system (easing problems including, but not limited to, itching, puffy face, slow-growing hair, low energy, acne, weight gain, and anxiety). You can now find a staggering range of products claiming to support digestive health: Joining traditionally gut-friendly fermented foods such as yogurt and sauerkraut are “probiotic” or “prebiotic” teas, cookies, gummies, supplements, powders, and even sodas.

    The reality is less straightforward. Maintaining the health of the gastrointestinal tract, like the health of any body part, is always a good idea. But expecting certain foods and products to overhaul gut health is unrealistic, as is believing that they will guarantee greater overall well-being. Those claims are “a little bit premature,” Karen Corbin, an investigator at the Translational Research Institute of Metabolism and Diabetes, told me. Obsessing over it just isn’t worth the trouble, and can even do more harm than good. “Gut health” cookies, after all, are still cookies.

    In my dad’s defense, your gut does matter for your health. A massive microbial civilization lives mostly along the large intestine, helping the body get the most out of food. Broadly, a healthy gut is one where the different segments of this population—numerous species of bacteria, fungi, and viruses—live in harmony. An unhealthy one implies a disturbance of the peace: One group may grow too powerful, or an invading microbe may throw things off-balance, leading to problems including gastroenteritis and a compromised immune system.

    Diet in particular has a profound impact on the gut—and how it subsequently makes you feel. “Food can have effects on the microbiome, which can then secondarily affect the host,” Purna Kashyap, a gastroenterologist at the Mayo Clinic, told me. The effects of food on a person and their microbes, he added, are generally congruent; fast food, for example, is “bad for both of us.” Neglect to feed your microbiome and the balance of microbes could tip into disarray, resulting in an imbalanced gut and corresponding bloating, stomach pain, and problems with bowel movements.

    Fermented foods such as yogurt and kimchi, long considered good for digestive health, are known as “probiotics” because they contain live bacteria that take up residence in your gut. Other foods are considered “prebiotic” because they feed the microbes already in your gut—mostly fiber, because it isn’t digested in the stomach. Getting more fiber improves regularity and supports a more normal GI system, Corbin said.

    But the fundamental problem with the gut-health obsession is that “there’s no clear definition of a healthy gut microbiome,” Corbin said. The makeup and balance of people’s microbiomes vary based on numerous factors, including genes, diet, environment, and even pets. This means that a treatment that works to rebalance one gut might not work for another. It also means that a product promoting a healthy gut doesn’t mean anything concrete. The idea that achieving gut health, however it’s defined, can solve stomach-related issues is misguided; many diseases can cause abdominal distress.

    Less certain is how much gut health is responsible for benefits beyond the gastrointestinal tract. No doubt the microbiome is connected to other parts of the body; recent research has suggested that it has a role in weight gain, depression, and even cancer, supporting the idea that having a healthy gut could lead to other benefits. But the mechanisms underpinning them are largely unknown. Which microbes are involved? What are they doing? There are “a lot of tall claims based on animal studies that the microbiome influences diabetes or obesity or whatever,” and the translatability of those studies to humans is “really unlikely,” Daniel Freedberg, a gastroenterologist at Columbia University, told me. Until scientists can show definitively that microbe X leads to outcome Y, Corbin said, any relationships between the gut and overall health are “just correlations.”

    None of this is to say that paying more attention to your digestive health is a bad idea. Especially for people diagnosed with gastrointestinal problems like IBS or Crohn’s disease, it can be essential. For everyone else, pursuing a healthy gut with food and supplements can be a nonspecific process with poorly defined goals. The food industry has capitalized on interest in probiotics and prebiotics—as well as lesser-known postbiotics and synbiotics—making products such as “insanely probiotic” yogurt, probiotic-fortified chocolate and spaghetti, and prebiotic sodas. Particularly with probiotics, the specifics are lacking. Which bacteria, and how many of them, actually make it past the stomach into the colon isn’t well understood. “A lot of probiotics are unlikely to contain viable bacteria, and probably very few of them are really making it through to the colon,” Freedberg said.

    Prebiotics are generally more important, although the source matters. Prebiotic fiber is “one of the most important things that determines what bacteria are there,” Freedberg told me, but getting small amounts from fiber-fortified products isn’t going to make a huge difference. The soda brands Poppi and Olipop largely contain inulin, a type of fiber that’s common in food manufacturing for its slightly sweet taste, Freedberg explained, though it probably doesn’t contain a lot, otherwise it would become “sludgy.” Olipop contains about nine grams of fiber per can, roughly the same amount as one cup of cooked lima beans.

    Of course, any product that is inherently unhealthy won’t magically become good for you the moment fiber or live bacteria are added to it. With desserts and salty snacks, no amount of fiber “is going to overcome the issue” that they are full of sugar or salt, Corbin said. Concerns about medium aside, though, gut-health products elicited a shrug from her: Buying foods containing additional prebiotic fiber is a “reasonable approach,” so long as they’re healthy to begin with. If probiotics make a patient feel “fantastic,” Freedberg said, “I’m not going to rock the boat.” Prebiotic and probiotic products may help to a degree, but don’t expect them to overhaul an unhealthy gut one soda at a time. All of the experts I spoke with said that people concerned about their gut health should eat a lot of fruits, vegetables, whole grains, and legumes, and cut out junk that won’t feed their microbiome. In other words, a basic healthy diet is more than enough to achieve good gut health.

    My dad’s gut-health mantra was apparently borrowed from Hippocrates, suggesting that people have been obsessing over the digestive system for thousands of years with the belief that it is the key to overall health. The draw of this idea is its simplicity: Proposing that the body’s many ills can be collapsed into a single mega-ailment makes treatment seem refreshingly uncomplicated compared with the medical interventions needed to address individual problems. That the proposed treatments are easy and self-administrable—sipping fibrous soda, popping bacteria-packed pills—adds to the appeal.

    But perhaps what is most compelling about the idea is that there is some truth to it. Lately, research on the microbiome has seen some promising advances. A large study published in 2022 showed significantly elevated levels of certain bacteria in people with depressive symptoms. Another study, co-authored by Corbin in 2023, was one of the first to show, in a human clinical trial, that a high-fiber diet shifts the microbiome in a way that could promote weight loss. This moment is especially confusing because we are finally beginning to understand the gut’s connections to the rest of the body, and how eating certain foods can soothe it. Much more is known about the gut than in the days of Hippocrates, but still far less than the gut influencers on social media would have you believe.

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    Yasmin Tayag

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  • Golden Gate Bridge toll could climb to more than $12 under new proposal

    Golden Gate Bridge toll could climb to more than $12 under new proposal

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    Motorists driving south across the famed Golden Gate Bridge could have to shell out more than $12 a trip under a new proposal from the transit agency responsible for tolls.

    Meanwhile, commuters from the North Bay with FasTrak passes could see their daily toll rise to more than $11 by 2028, according to a proposal from the Golden Gate Bridge, Highway & Transportation District.

    The current tolls are $9.75 for invoice payments for infrequent users and $8.75 for FasTrak pass holders, according to the transit agency.

    Daily bridge crossings have fallen since the pandemic ushered in the rise of remote work and reduction of commuter travel. Traffic on the bridge is now at 85% of pre-pandemic levels with commute hours down almost 30%, according to an agency staff report.

    That has translated to a loss of up to $30 million a year, the staff report said. The transportation agency relies heavily on bridge tolls to fund its operation and says it’s facing a five-year projected shortfall of at least $220 million.

    The new proposal lays out four possible toll rate options that would steadily increase over five years. The priciest option for motorists would generate $139 million over the five-year period — still far short of the anticipated funding gap.

    “I was a little bit shaken by the fact that anything we do is only half of the shortfall,” said board member Barbara Pahre, who represents Napa County, as reported by the San Francisco Chronicle. “It’s not just about tolls, it’s about cinching our belts a little bit. This might end up being the easy part.”

    The priciest option would raise tolls by 50 cents each year starting in July. Under that option, FasTrak pass holders would see their daily toll rise to $9.25 this summer and to $11.25 by 2028 while invoice drivers who pay the highest rate would owe $10.75 this summer and $12.25 by 2028.

    A public hearing has been scheduled for Feb. 22 and the board will vote in March. Any new toll approved would go into effect July 1, according to the agency.

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    Ben Poston

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  • The Future of Obesity Drugs Just Got Way More Real

    The Future of Obesity Drugs Just Got Way More Real

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    A wild idea recently circulated about the future of aviation: If passengers lose weight via obesity drugs, airlines could potentially cut down on fuel costs. In September, analysts at Jefferies Bank estimated that in the “slimmer society” obesity drugs will create, United Airlines could save up to $80 million in jet fuel annually.

    In the past year, as more Americans have learned about semaglutide, which is sold for diabetes under the brand name Ozempic and for obesity under the name Wegovy, hype has become completely divorced from reality. For all the grand predictions, just a fraction of Americans who qualify for obesity drugs are on them. With a list price of roughly $1,350 a month, Wegovy is far too expensive, under-covered by insurance, and in limited supply to be a routine part of health care.

    But that possibility is beginning to seem very real. The results of a highly anticipated study published on Saturday indicate that Wegovy can have profound effects on heart health, which potentially opens up the drug to even more patients. A few days earlier, the FDA approved Zepbound, an obesity drug that is a bit cheaper and appears more potent than Wegovy. If there was any doubt before, now it is undeniable: Obesity drugs “are here to stay,” Kyla Lara-Breitinger, a cardiologist at the Mayo Clinic, told me. “There’s only going to be more and more of them.” They are now poised to become deeply entrenched in American health care, perhaps eventually even joining the ranks of commonly used drugs such as statins and metformin.

    Considering that obesity is linked to all sorts of major heart ailments, it is no big surprise that a weekly shot for weight loss might have some cardiovascular benefits. But because this class of obesity drugs, known as GLP-1 agonists for the hunger hormone they target, is so new, doctors did not know that for sure. Starting in 2018, Novo Nordisk, the company that manufactures semaglutide, began to look for answers in a study of more than 17,600 people with obesity and cardiovascular disease. In this group, results of a trial named SELECT show that Wegovy reduced the risk of major cardiac events—stroke, heart attack, death—by 20 percent. Even compared with studies on common heart medications such as Praluent and Repatha, the Wegovy results are “impressive,” Eugene Yang, a cardiologist and professor of medicine at the University of Washington, told me.

    How exactly the drug prevents major cardiac events isn’t fully understood. Some of the effects can likely be chalked up to weight loss itself, which is associated with improvements in metrics that influence heart health, such as blood pressure, Yang said. But mechanisms independent of weight loss may also be at work. In the trial, lower rates of cardiovascular events began showing up before participants lost weight. One explanation is the drug’s impact on inflammation, which is associated with heart disease: C-reactive protein, a rough proxy for inflammation, dropped by nearly 40 percent in study participants.

    Regardless of how Wegovy works, Yang said, “it has the potential benefit of being very significant” as a new line of treatment for heart disease, the leading cause of death nationwide. Novo Nordisk has already applied for expanded FDA approval and anticipates receiving it within six months. Approval would also show that Wegovy has a medical benefit beyond weight loss, pressuring insurers to cover it. Right now, for instance, Medicare does not, in part because obesity has long been viewed as a cosmetic issue, not a medical one. Even with private coverage, the drug is still frequently out of reach. The SELECT trial makes it “unequivocally clear” that obesity is a health condition that can be treated with drugs, Ted Kyle, an obesity-policy expert, told me. Still, the study leaves room for pushback: The absolute risk reduction of cardiovascular events was 1.5 percent, which is, by some reckonings, quite small. A higher risk reduction would have “put more pressure” on insurers and manufacturers to make the drugs more affordable for Americans, Lara-Breitinger said.

    Still, the findings are robust enough that it seems likely that the heart benefits of obesity drugs will lead more Americans to take them—if not immediately, then eventually. The approval of a new drug could do the same. Tirzepatide, which Eli Lilly has sold as a diabetes drug under the name Mounjaro, will be marketed as Zepbound for obesity—and it is coming for Wegovy’s throne. In one study, people on tirzepatide lost an average of 18 percent of their body weight; for comparison, in another study patients on Wegovy lost an average of 15 percent. At a little over $1,000 a month, Zepbound is not cheap, but its list price is hundreds of dollars lower than that of Wegovy. (The manufacturers of both drugs have said that most insured patients pay far less than that.)

    Zepbound’s approval is just the beginning. Unlike semaglutide, which targets only one hormone, GLP-1, to exert its effects on appetite and fullness, tirzepatide targets two. Other drugs that target two or even three hormones are in the works, as are versions that come in a more appealing pill format rather than as an injection. Generic versions of these drugs, likely beginning with liraglutide, a predecessor to semaglutide sold as Saxenda, could become available soon, Yang said. This competition will help bring down costs, but it will go only so far. Drug pricing is “a little bit screwy,” Kyle said, complicated by the wide gap between the list price and the net price created by manufactures, insurers, and intermediaries between them.

    Each new competitor and new study is a step toward a future in which a substantial proportion of Americans with obesity are routinely prescribed these drugs. In a single week, obesity drugs leapt a new era—one in which they are about to become significantly more mainstream. No doubt that future is a bright one for millions of people who might benefit from treatment. Still, many questions about the drugs remain unanswered, such as their long-term safety and endless supply shortages.

    But the potential for obesity drugs to truly change America has never felt closer—with all of the dizzying questions this creates about what “a slimming society” might mean for exercise, the food industry, and apparently even airline jet fuel.

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    Yasmin Tayag

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  • Trump’s Rivals Pass Up Their Chance

    Trump’s Rivals Pass Up Their Chance

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    “We’ve become a party of losers,” the conservative businessman Vivek Ramaswamy declared during the opening minutes of tonight’s Republican primary debate in Florida. He bemoaned the GOP’s lackluster performance in Tuesday’s elections, and then he identified the Republican he held personally responsible for the party’s defeats. Was this the moment, a viewer might have wondered, that a top GOP presidential contender would finally take on Donald Trump, the absent frontrunner who hasn’t deigned to join his rivals on the debate stage?

    Of course not.

    Ramaswamy proceeded to blame not the GOP’s undisputed leader for the past seven years but Ronna McDaniel, the party functionary unknown to most Americans who chairs the Republican National Committee. After calling on McDaniel to resign, Ramaswamy then attacked one of the debate moderators, Kristen Welker of NBC News, before turning his ire on two of his onstage competitors, Nikki Haley and Ron DeSantis.

    The moment was a fitting encapsulation of a debate that, like the first two Republican primary match-ups, all but ignored the candidate who wasn’t there. Five Republicans stood on the Miami stage tonight—Ramaswamy, Haley, DeSantis, Chris Christie, and Tim Scott—and none of them are likely to be elected president next year. The candidate of either party most likely to win the election is Trump, who held a rally a half hour away. His putative challengers barely uttered his name.

    NBC’s moderators tried to force the issue at the start. Lester Holt asked each of the candidates to explain why they should be president and Trump should not. Haley and DeSantis, who are now Trump’s closest competitors (a modest distinction), offered some mild criticism. The Florida governor chastised Trump for increasing the national debt and failing to get Mexico to pay for his Southern border wall. “I thought he was the right president at the right time. I don’t think he’s the right president now,” was the most that Haley, who was Trump’s ambassador to the United Nations, could muster. Only Christie, the former New Jersey governor who has become Trump’s fiercest GOP critic on the campaign trail, assailed the former president with any relish. “Anybody who’s going to be spending the next year-and-a-half of their life focusing on keeping themselves out of jail cannot lead this party or this country,” Christie said.

    And with that, Trump became an afterthought for the remainder of the debate. The evening featured plenty of substance, as the candidates offered mostly robust defenses of Israel in its war with Hamas, denounced rising anti-Semitism on college campuses, and disputed how much support the U.S. should give Ukraine. At the behest of moderator Hugh Hewitt, they spent several minutes discussing the optimal size of America’s naval fleet.

    The spiciest exchanges involved Ramaswamy and Haley, who made no effort to hide their disdain for one another. Ramaswamy drew boos from the audience after he criticized Haley’s hawkish foreign policy by calling her “Dick Cheney in three-inch heels.” Later he invoked her daughter’s use of TikTok to accuse her of hypocrisy on China’s ownership of the social-media platform. “Keep my daughter’s name out of your voice,” Haley shot back. “You’re just scum.” Ramaswamy and Haley also went after DeSantis, though in less personal terms.

    That Ramaswamy would target Haley was not a surprise. She came into the debate as the challenger of the moment, having displaced Ramaswamy, whose candidacy has lost momentum since his breakout performance in the first GOP primary debate in August. He can partly blame Haley for his slide: Her mocking retort—“Every time I hear you, I feel a little bit dumber”—was the highlight of the last everyone-but-Trump pile-up in September. The former South Carolina governor’s consistency across both debates has helped her overtake DeSantis for second place in New Hampshire and gain on him in Iowa. Haley also fared the best in a hypothetical general-election match-up with Biden in a batch of swing-state polls released this week by The New York Times and Siena College.

    As my colleague Elaine Godfrey reported this week, Haley is appealing to primary voters who are “yearning for a standard-issue Republican”—a tax-cutting, socially conservative foreign-policy hawk who won’t have to spend the next several months fighting felony charges in courtrooms up and down the Eastern Seaboard. Her performance tonight—as steady as during the first two debates—seems unlikely to hurt her standing. The problem for Haley, as for the other contenders on tonight’s stage, is that less than half of the GOP electorate wants a standard-issue Republican. Trump still has a tight grip on a majority of GOP voters, and his lead over Biden in recent polling undermines his rivals’ argument that his nomination could cost the party next year’s election.

    If nothing else, each of these Trump-less debates offers his opponents a free shot to make the case against him, a platform to criticize the frontrunner without facing an immediate rebuttal. For the third time in a row, Haley and her competitors mostly passed up their chance. If they’re angling to be Trump’s running mate or emergency replacement, perhaps they’ve advanced their cause. But if their goal is to dislodge Trump as the nominee, opportunities like tonight’s are slipping away.

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    Russell Berman

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  • Donald Trump’s Gift to Adam Schiff

    Donald Trump’s Gift to Adam Schiff

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    Representative Adam Schiff was mingling his way through a friendly crowd at a Democratic barbecue when the hecklers arrived—by boat. Schiff and two other Senate candidates, Representatives Katie Porter and Barbara Lee, convened on the back patio of a country club overlooking the port of Stockton, California. Schiff spoke first. “It’s such a beautiful evening,” he said, thanking the host, local Democratic Representative Josh Harder.

    It was hard to know what to make of the protest vessel, except that its seven passengers were yelling things as Schiff began his remarks. And not nice things. Although their words were tough to decipher, the flag flying over the craft made clear where they were coming from: FUCK BIDEN. Notably, of the three candidates, Schiff was the only one I heard singled out by name—or, in one case, by a Donald Trump–inspired epithet (“Shifty”) and, in another, a four-letter profanity similar to the congressman’s surname (clever!).

    Schiff is used to such derision and says it proves his bona fides as a worthy Trump adversary. Given the laws of political physics today, it also bodes well for his Senate campaign. The principle is simple: to be despised by the opposition can yield explicit benefits. This is especially true when you belong to the dominant party, as Schiff does in heavily Democratic California. One side’s villain is the other side’s champion. Adam Schiff embodies this rule as well as any politician in the country.

    In recent years, Schiff has had a knack for eliciting loud and at times unhinged reactions from opponents, even though he himself tends to be quite hinged. The 45th president tweeted about Schiff 328 times, as tallied by Schiff’s office. Tucker Carlson called the congressman “a wild-eyed conspiracy nut.” A group of QAnon followers circulated a report in 2021 that U.S. Special Forces had arrested Schiff and that he was in a holding facility awaiting transfer to Guantánamo Bay for trial (the report proved erroneous). Before Schiff had a chance to meet his new Republican colleague Anna Paulina Luna, of Florida, she filed a resolution condemning his “Russia hoax investigation” and calling for him to potentially be fined $16 million (the resolution failed).

    This onslaught has also been good for business, inspiring equal passion in Schiff’s favor. A former prosecutor, he became an icon of the left for his emphatic critiques of Trump’s behavior in office, including as the lead House manager in Trump’s first impeachment trial. “You know you can’t trust this president to do what’s right for this country,” Schiff said as part of his closing argument, a speech that became a rallying cry of the anti-Trump resistance. (“I am in tears,” the actor Debra Messing wrote on Twitter.) Opponents gave grudging respect. “They nailed him,” Senate Republican leader Mitch McConnell told Mitt Romney, according to an account in a new Romney biography by my colleague McKay Coppins. Schiff’s own Trump-era memoir, Midnight in Washington, became a No. 1 New York Times best seller.

    Representative Adam Schiff speaks to supporters at a barbecue hosted by fellow Democratic House member Josh Harder in Stockton, California. (Photographs by Austin Leong for The Atlantic)

    You could draw parallel lines charting the levels of vilification that Schiff has encountered and his name recognition and fundraising numbers. Both the good and the grisly have boosted Schiff’s media profile, which he has adeptly cultivated. Schiff has come in at or near the top of the polls in the Senate race so far, along with Porter. A Berkeley IGS survey released last week revealed him as the best-known of the candidates vying for the late Dianne Feinstein’s job; 69 percent of likely voters said they could render an opinion of him (40 percent favorable, 29 percent unfavorable). He raised $6.4 million in the most recent reporting period, ending the quarter with $32 million cash on hand, or $20 million more than the runner-up, Porter. That’s more than any Senate candidate in the country this election cycle, and a massive advantage in a state populated by about 22 million registered voters covering some of the nation’s most expensive media markets.

    “He’s become an inspiration and a voice of reason for many of us,” Becky Espinoza, of Stockton, told me at the Democratic barbecue.

    Or at least the sector of “many of us” who don’t want him dead.

    Schiff started getting threats a few months into Trump’s presidency. “Welcome to the club,” Nancy Pelosi, his longtime mentor, told him. He endured anti-Semitic screeds online and actual bullets sent to his office bearing the names of Schiff’s two kids. “I can’t stand the fact that millions of people hate you; they just hate you,” Schiff’s wife, Eve—yes, Adam and Eve—told her husband after the abuse started. “They just hate you.”

    No one deserves to be subjected to such menace, and the threats can be particularly chilling for a member of Congress who would not normally have a protective detail. (Schiff’s office declined to discuss its security staffing and protocols.) Schiff is not shy about repeating these ugly stories, however. There’s an element of strategic humblebragging to this, as he is plainly aware that being a target of the MAGA minions can be extremely attractive to the Democratic voters he needs.

    In June, congressional Republicans led a party-line vote to censure Schiff for his role in investigating Trump. As then-Speaker Kevin McCarthy attempted to preside, Democrats physically rallied around Schiff on the House floor chanting “shame” at McCarthy. On the day of his censure, Schiff was interviewed on CNN and twice on MSNBC; the next morning he appeared on ABC’s The View. “Whoever it was that introduced that censure resolution against him probably ensured Adam’s victory,” Representative Mike Thompson, another California Democrat, told me. A few colleagues addressed him that day as “Senator Schiff.”

    I dropped in on Schiff periodically over the past few months as he traversed the chaos of the Capitol, weighed in on Trump’s legal travails, and campaigned across California. What did a Senate candidacy look like for a Trump-era cause célèbre who is revered and reviled with such vigor? I found it a bit odd to see Schiff out in the political wild—glad-handing, granny-hugging, and, at the barbecue in late August, nearly knocking a plate of brisket from the grip of an eager selfie-seeker. He has graduated to a full-on news-fixture status, someone perpetually framed by a screen or viewed behind a podium, as if he emerged from his mother’s womb and was dropped straight into a formal courtroom, hearing room, or greenroom setting.

    I watched a number of guests in Stockton clutch Schiff’s hand and address him in plaintive tones. “After I stopped crying a little bit, I just wanted to thank him for all he did during impeachment and to just save our democracy,” said Espinoza, following her brief meeting with the candidate.

    Nearby, David Hartman, of Tracy, California, put down a paper plate of chicken, pickles, and corn salad and made his way to Schiff. “I just want to shake the man’s hand and thank him,” Hartman told me, which is what he did. So did his wife, Tracy (of Tracy!), who was likewise surprised to find herself in tears.

    “I’m like a human focus group,” Schiff told me, describing how strangers approach him at airports. “Sometimes I will have two people come up to me simultaneously. One will say, ‘You are Adam Schiff. I just want to shake your hand. You’re a hero.’ And the other will say, ‘You’re not my hero. Why do you lie all the time?’”

    For his first eight terms in Congress, Schiff, 63, was not much recognized beyond the confines of the U.S. Capitol or the cluster of affluent Los Angeles–area neighborhoods he has represented in the House since 2001. “I think, before Trump, if you had to pick one of these big lightning rods or partisan bomb-throwers, you would not pick me,” Schiff told me.

    Largely true. Schiff speaks in careful, somewhat clipped tones, with a slight remnant of a Boston accent from his childhood in suburban Framingham, Massachusetts. (His father was in the clothing business and moved the family to Arizona and eventually California.) A Stanford- and Harvard-trained attorney, Schiff gained a reputation as an ambitious but low-key legislator in the House, and a deft communicator in service of his generally liberal positions.

    Diptych: two women , one a fox news reporter peer into windows; balloons and American flags in a room.
    A Fox News reporter and other guests at the barbecue in Stockton.(Photographs by Austin Leong for The Atlantic)

    After Trump’s election, however, Schiff’s district effectively became CNN, MSNBC, and the network Sunday shows, along with the scoundrel’s gallery of right-wing media that pulverized him hourly. This included a certain Twitter feed. The worst abuse Schiff received started after Trump’s maiden tweet about him dropped on July 24, 2017. This was back in an era of relative innocence, when it was still something of a novelty for a sitting president to attack a member of Congress by name—“Sleazy Adam Schiff,” in this case.

    Schiff tweeted back that Trump’s “comments and actions are beneath the dignity of the office.” Schiff would later reveal that he rejected a less restrained rejoinder suggested by Mike Thompson, his California colleague: “Mr. President, when they go low, we go high. Now go fuck yourself.” Anyway, that was six years, two impeachments, four indictments, 91 felony counts, and 327 tweets by Donald Trump about Adam Schiff ago.

    “Adam is one of the least polarizing personalities you will ever find,” said another Democratic House colleague, Dan Goldman, of New York. “The reason he’s become such a bogeyman for the Republican Party is simply that he’s so effective.” Goldman served as the lead majority counsel during Trump’s first impeachment, working closely with Schiff. “We originally met in the greenroom of MSNBC in June of 2018,” Goldman told me. (Of course they did.)

    Schiff understands that some of the rancor directed at him is performative, and likes to point out the quiet compliments he receives from political foes. Trump used to complain on Twitter that Schiff spent too much time on television—in reality, a source of extreme envy for the then-president. Schiff tells a story about how Jared Kushner, Trump’s son-in-law, came to Capitol Hill for a deposition from members of Schiff’s Intelligence committee in 2017. “Kushner comes up to me to make conversation, and to ingratiate himself,” Schiff told me. “And he said, ‘You know, you do a great job on television.’ And I said, ‘Well, apparently your father-in-law doesn’t think so,’ and [Kushner] said, ‘Oh, yes, he does.’” (Kushner didn’t respond to a request for comment.)

    One of Trump’s most fervent bootlickers, Senator Lindsey Graham, walked up to Schiff in a Capitol hallway during the first impeachment trial and told him how good of a job he was doing. Schiff, who relayed both this and the Kushner stories in his memoir, says he gets that from other Republicans, too, usually House members he’s worked with—including some who lampoon him in front of microphones. A few House Republicans apologized privately to Schiff, he told me, right after they voted to censure him.

    “The apologies are always accompanied by ‘You’re not going to say anything about this, are you?’” Schiff said. When I urged Schiff to name names, to call out the hypocrites, he declined.

    I asked Schiff if he would prefer the more anonymous, pre-2017 version of himself running in this Senate campaign, as opposed to the more embattled, death-threat-getting version, who nonetheless enjoys so many advantages because of all the attention. He paused. “I’d rather the country didn’t have to go through all this with Donald Trump,” he said, skirting a direct answer.

    As with many members of Congress seeking a promotion or an exit, Schiff gives off a strong whiff of being done with the place. “The House has become kind of a basket case,” he told me, citing one historic grandiloquence that he was recently privy to—the episode in which Representative Marjorie Taylor Greene called her colleague Lauren Boebert a “little bitch” on the House floor.

    “And I remember thinking to myself, There used to be giants who served in this body,” Schiff said. He sighed, as he does.

    I met with Schiff at the Capitol in early October, amid the usual swirl of weighty events: Feinstein had died three days earlier; news that Governor Gavin Newsom would appoint the Democratic activist Laphonza Butler as her replacement came the night before. That afternoon, Republican Representative Matt Gaetz had filed his fateful “motion to vacate” that would result in the demise of McCarthy’s speakership the next day. Schiff stood just off the House floor, colleagues passing in both directions, Republicans looking especially angry, and reporters gathering around Schiff in a small scrum.

    No matter what happens next November, Schiff is not running for reelection in the House. He told me he has long believed that he’d be a better fit for the Senate anyway, where he has been coveting a seat for years. Schiff said he considered running in 2016, after the retirement of the incumbent Barbara Boxer (who was eventually succeeded by Kamala Harris).

    A Democrat will almost certainly win the 2024 California race. Senate contests in the state follow a two-tiered system in which candidates from both parties compete in a March primary, and then the two top finishers face off in November, regardless of their affiliation. In addition to Schiff, Porter, and Lee, the former baseball star Steve Garvey, known also for his various divorce and paternity scandals, recently entered the race as a Republican. A smattering of long shots are also running, including the requisite former L.A. news anchor and requisite former Silicon Valley executive. Butler announced on October 19 that she would not seek the permanent job.

    To varying degrees, all of the three leading Democratic candidates have national profiles. Lee, who has represented her Oakland-area district for nearly 25 years, previously chaired both the Congressional Progressive and Black Caucuses. Porter was elected to Congress in 2018 and has gained a quasi-cult following as a progressive gadfly who has a knack for conducting pointed interrogations of executives and public officials that go rapidly viral. A few of her fans were so excited to meet Porter at the Stockton barbecue that three actually spilled drinks on her—this according to the congresswoman, speaking at an event a few days later.

    Schiff, Porter, and Lee all identify as progressive Democrats on most issues, though Schiff tends to be more hawkish on national security. He voted to authorize the wars in Afghanistan and Iraq and supported the 2011 U.S. missile strikes against Libya. Lee, who opposed all three, recently criticized Schiff’s foreign-policy views as “part of the status quo thinking” in Washington. (Porter was not in office then.) Schiff expressed “unequivocal support for the security and the right of Israel to defend itself” after last month’s attacks by Hamas. Lee has been more critical of the Israeli government, and called for a cease-fire immediately after the Hamas attacks. As for Porter, she has been a rare progressive to focus her response on America’s Iran policy, which she called lacking and partly to blame for the attacks.

    Although Schiff is best known for his work as a Trump antagonist—and happily dines out on that—he is also wary of letting the former president define him entirely. “This is bigger than Trump,” he reminds people whenever the conversation veers too far in Trump’s inevitable direction. Schiff dutifully pivots to more standard campaign themes, namely the “two hugely disruptive forces” he says have shaped American life: “the changes in our economy” and “the changes in how we get our information.” He reels off the number of cities in California that he’s visited, events he’s done, and endorsements he’s received as proof that he is a workmanlike candidate, not just a citizen of the greenroom.

    people look out over the water where a boat with a flag is floating.
    A group of hecklers in a boat floats by near the barbecue. (Photographs by Austin Leong for The Atlantic)

    Recently, he lamented that many of his Republican colleagues are now driven by a “perverse celebrity” that he believes the likes of Greene and Boebert have acquired through their Trump-style antics and ties to the former president. I pointed out to Schiff that he, too, has received a lot of Trump-driven recognition. Doesn’t being affiliated with Trump, whether as an ally or an adversary, have benefits for both sides?

    “Well, I don’t view it that way at all,” Schiff said. “I don’t view it as having any kind of equivalence. On one hand, we’re trying to defend our democracy. And on the other hand, we have these aiders and abettors of Trump by these vile performance artists. It’s quite different.”

    Schiff’s biggest supporter has been Pelosi, who endorsed him over two other members of her own caucus and delegation. This included Lee, whom Pelosi described to me as “like a political sister.” I spoke by phone recently with the former speaker, who was effusive about Schiff and scoffed at any suggestion that he benefited from his resistance to Trump and the counter-backlash that ensued. “If what’s-his-name never existed, Adam Schiff would still be the right person for California,” Pelosi said. It was one of two occasions in our interview in which she refused to utter the word “Trump.”

    “I just don’t want to say his name,” she explained. “Because I worry that he’s going to corrode my phone or something.”

    In one of my conversations with Schiff, I asked him this multiple-choice question: Who had raised the most money for him—Adam Schiff, Nancy Pelosi, or Donald Trump? My goal was to get Schiff to acknowledge that, without Trump, he would be nowhere near as well known, well financed, or well positioned to potentially represent the country’s most populous state in the Senate.

    “I’m not sure how to answer that,” he said. After a pause, he picked himself. “I am my own biggest fundraiser,” he declared. Okay, I said, but wasn’t Trump the single biggest motivator for anyone to donate?

    “It’s the whole package,” Schiff maintained, ceding nothing. He then made sure to mention the person who’s been “most formative in helping shape my career and phenomenally helpful in my campaign—Nancy Pelosi.” He was in no rush to give what’s-his-name any credit.

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    Mark Leibovich

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  • The Age of Vaccine Pessimism

    The Age of Vaccine Pessimism

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    The world has just seen the largest vaccination campaign in history. At least 13 billion COVID shots have been administered—more injections, by a sweeping margin, than there are human beings on the Earth. In the U.S. alone, millions of lives have been saved by a rollout of extraordinary scope. More than three-fifths of the population elected to receive the medicine even before it got its full approval from the FDA.

    Yet the legacy of this achievement appears to be in doubt. Just look at where the country is right now. In Florida, the governor—a likely Republican presidential candidate—openly pursues the politics of vaccine resistance and denial. In Ohio, kids are getting measles. In New York, polio is back. A football player nearly died on national TV, and fears about vaccines fanned across the internet. Vaccinologists, pediatricians, and public-health experts routinely warn that confidence is wavering for every kind of immunization, and worry that it may collapse in years to come.

    In other words, America is mired in a paradoxical and pessimistic moment. “We’ve just had a national vaccination campaign that has exceeded almost all previous efforts in a dramatic fashion,” says Noel Brewer, a psychologist at the University of North Carolina who has been studying decision making about vaccines for more than 20 years, “and people are talking about vaccination as if there’s something fundamentally wrong.”

    It’s more than talk. Americans are arguing, Americans are worrying, Americans are obsessing over vaccines; and that fixation has produced its own, pathological anxiety. To fret about the state of public trust is rational: When vaccine adherence wobbles, lives are put in peril; in the midst of a pandemic, the mortal risk is even greater. More than 60 million Americans haven’t gotten a single COVID shot, and a few thousand deaths are attributed to the disease every week. But the scale of this concern—the measure of our instability—may be distorted by the heights to which we’ve climbed. Evidence that the nation has arrived at the brink of collapse does not hold up to scrutiny. No one knows where vaccination rates are really heading, and the coming crash is more an idea—a projection, even—than a certainty. The future of vaccination in America may be no worse than its recent past. In the end, it might be better.

    The first alarms about a widespread vaccination crisis—the first suggestions that a leeriness of COVID shots had “spread its tentacles into other diseases”—were raised by clinicians. Megha Shah, a pediatrician with the Los Angeles public-health department, told me that she began to worry in the spring of 2021, while volunteering at a medical center. Two years earlier, she recalled, working there had been uneventful. She’d meet with parents—mostly from low-income Latino families—to discuss the standard vaccination schedule: Okay, here’s what we’re recommending for your child. This protects against this; that protects against that. The parents would ask a couple of questions, and she’d answer them. The child would be immunized, almost every time.

    But in the middle of the COVID-vaccine rollout, she found that those conversations were playing out differently. “Oh, I’m just not sure,” she said some parents told her. Or, “I need to talk this over with my partner.” She saw families refuse, flat-out, to give their infants routine shots. “It just was very, very surprising,” Shah said. “I mean, questions are good. We want parents to be engaged and informed decision makers.” But it seemed to her—and her colleagues too—that healthy “engagement” had gone sour.

    Last year, she and her colleagues took a closer look. For a study published in Pediatrics, they drew on national survey data collected from April 2020 through early 2022, of parents’ attitudes toward standard childhood vaccines. In some respects, the results looked good: Parents endorsed the importance and effectiveness of these vaccines at a high and stable rate throughout the pandemic—in the vicinity of 91 percent. But over the same period, concerns about potential harms marched upward. In April 2020, about 25 percent of those surveyed agreed that vaccines “have many known harmful side effects” and “may lead to illness or death”; by the end of the year, that number had increased to 30 percent, and then to nearly 35 percent the following June. “Parents still seemed very confident overall in the benefits of vaccinations,” Shah told me, “but there was a huge jump over the course of the pandemic about the safety.”

    Those results jibed with a theory that has now been invoked so many times, it reads as common knowledge: “Perhaps this was a spillover effect,” Shah said, “from all of the vaccine misinformation that was circling during the pandemic.” That effect—the spreading tentacles of doubt—can be seen around the world, says Heidi Larson, a professor at the London School of Hygiene & Tropical Medicine who has studied attitudes toward vaccination across Europe since the start of the coronavirus pandemic. “The public-health community was assuming that COVID would be a great boon to public confidence in vaccines, but it hasn’t worked out that way. The trend has been actually a negative knock-on effect,” Larson told me. In a troubling alignment, even anti-vaccine activists now endorse the notion of hesitancy spillover, calling it a “wonderful silver lining” to the pandemic.

    But hold on a minute. Here in the U.S., it’s certainly true that vaccine worries have been broadcast and rebroadcast, at ever greater volumes, through a clamorous network of influencers and politicians. This campaign of hesitancy is growing more open and insistent by the day, and the consequences can be atrocious: Americans with false beliefs about vaccines are falling sick and dying stubborn and alone. But even as these anecdotes accrue, misinformation’s greater sway—the extent to which it shapes Americans’ behavior toward vaccines for COVID, measles, or the flu—remains murky, if not altogether undetectable. The best numbers to go on in this country, drawn from polls of people’s attitudes about vaccines and official vaccination surveys from the CDC, don’t hint at any comprehensive change. When concerning blips and mini-trends arise—shifts in parents’ attitudes, as seen in Shah’s research, or drops in local rates of children getting immunized—they’re set against a landscape with a flat horizon.

    It’s not a pretty view, for that: The U.S. lags five points behind the average wealthy country in its rate of people fully vaccinated against COVID, and two points behind in its vaccination rate for measles. And even blips can translate into many thousands of at-risk kids, Shah pointed out. Yet one might still be grateful for the sameness overall. A seedbed of resistance to the COVID shots, disproportionately Republican, was already present near the start of the pandemic, and hasn’t seemed to thrive despite two years’ worth of fertilizer runoff from Fox News and other outlets spewing doubt. In August 2020, the Harris Poll’s weekly COVID-19 tracker found that 15 percent of American adults said they were “not at all likely” to get the vaccine when it finally became available. In August 2022, Harris reported that 17 percent weren’t planning to be immunized. Other long-running surveys have found similar results. In September 2020, Kaiser Family Foundation’s vaccine monitor pegged the rate of refusal at 20 percent. In December 2022, it was … still 20 percent.

    The most recent uptake numbers from the CDC suggest that children born in 2018 and 2019 (who would have been babies or toddlers when COVID first appeared) had higher vaccination rates by age 2 than children born in 2016 and 2017. Some of these kids did miss out on shots amid the pandemic’s early lapses in routine medical care, but they quickly caught up. Another, more alarming batch of data from the CDC shows that measles-mumps-rubella coverage among the nation’s kindergartners has dropped for two years in a row, down from 95.2 to 93.5 percent, and is now lower than it’s been since at least 2013. Still, the proportion of kids who get exempted from school vaccine requirements for medical or philosophical reasons has hardly changed at all, and the headline-grabbing “slide” in rates appears instead to be at least in part a product of “provisional enrollments”—i.e., children who missed some vaccinations (perhaps in early 2020) and were allowed to enter school while they caught up. If there really is a wave of newly red-pilled, anti-vaxxer parents, then going by these data, they’re nowhere to be seen.

    Some public-health disasters hit like hurricanes; others spread like rust. “We may not have a full picture yet,” Shah told me, referring to the latest evidence from the CDC on where vaccination rates are heading. “My gut and my clinical experience tell me that it’s too soon to say.”

    Other experts share that view. Robert Bednarczyk, an epidemiologist at Emory University, has been estimating the susceptibility of U.S. children to measles outbreaks since 2016. National immunization surveys have not shown substantial drops in coverage for 2020 and 2021, he told me, “but there is a large caveat to this. These surveys have a lag time.” Any children from the CDC’s data set who were born in 2018, he noted, would have gotten most of their vaccines before the pandemic started, during their first year of life. The same problem applies to teens. The government’s latest stats for adolescents—which looked as good as ever in 2021—capture many who would have gotten all their shots pre-COVID. Until more data are released, researchers still won’t know whether or how far kids’ vaccination rates have really dipped during the 2020s.

    The time delay is just one potential problem. Parents who are suspicious of vaccines, and angry at the government for encouraging their use, may be less willing to participate in CDC surveys, Daniel Salmon, the director of the Institute for Vaccine Safety at Johns Hopkins Bloomberg School of Public Health, told me. “Having studied this for 25 years, I would be surprised if we don’t see a substantial COVID effect on childhood vaccines,” he said. “These data are a little bit reassuring, that it’s not, like, an oh-my-god huge effect. But we need more time and more data to really know the answer.”

    Uncertainty doesn’t have to be a source of terror, though. Early uptake data already provide some signs of a “vaccine-hesitancy spillover effect” happening in reverse, UNC’s Brewer told me, driving more enthusiasm, not less, for getting different kinds of shots. Just look at how the push to dose the nation with half a billion COVID shots goosed the rates of grown-ups getting flu shots: For decades now, our public-health establishment has pushed for better influenza coverage, even as the rate for older Americans was stuck at roughly 65 percent. Then COVID came along and, voilà, senior citizens’ flu-shot coverage jumped to 75 percent—higher than it ever was before. This all fits with a familiar idea in the field, Brewer said, that going in for any one vaccine makes you much more likely to get another in the future. “There does seem to be a sort of positive spillover,” he said, “probably because the forces that led to previous vaccinations are still mostly in place.”

    Even some of the scariest signals we’ve seen so far—reports that anti-vaccine sentiment is clearly on the rise—can seem ambiguous, depending on one’s breadth of view. Consider the finding from Heidi Larson’s group, that vaccine confidence has declined across the whole of the European Union throughout the pandemic, according to surveys taken in 2020 and 2022. The same report says that attitudes have now returned to where they were in 2018 and that confidence in the MMR vaccine, in particular, remains higher than it was four years ago. Given that the 2020 surveys were conducted mostly in March, at the very onset of the first pandemic lockdowns, they might have captured a temporary spike of interest in vaccines. After all, vaccines can seem more useful when you’re terrified of death.

    In other words, America may truly have experienced a recent drop in vaccine confidence—but from an inflated and unsustainable high. That could help explain other recent findings too, including Shah’s. “You need to take the long view,” says Douglas Opel, a pediatric bioethicist at Seattle Children’s Hospital who has been studying the ups and downs of vaccine hesitancy for more than a decade. For a paper published last July, he and colleagues looked at vaccine attitudes among 4,562 parents from late 2019 to the end of 2020. They found that the parents grew more enthusiastic about childhood immunizations when the pandemic started, but their feelings later returned to baseline.

    Larson told me that a “transient COVID effect” may well explain some of what her team has found, but said it was very unlikely to account in full for the worrying trend. In any case, she told me, “we shouldn’t assume this and should instead make an extra effort to continue to build confidence.”

    No crunching of the numbers can excuse the spread of vaccine misinformation, or suggest that those who peddle it are anything but a hateful scourge on individuals and a threat to public health. But you can’t simply ignore the fact that, as far as we can see, all the gnashing about vaccines’ supposed risks simply hasn’t changed a lot of people’s minds. It certainly hasn’t caused a steep and sudden rise in vaccine refusal. The idea that we’re in the midst of some new vaccine-hesitancy contagion is based as much on vibes as proven fact.

    The problem is, bad vibes can leave us prone to misinterpretation. Take the recent measles outbreak in Ohio: It’s alarming, but not so relevant to recent trends in vaccination, despite many claims to that effect. More than one-quarter of the affected children were too young to have been eligible for the MMR vaccine, while others were old enough to have missed their first shot by 2020, before any hesitancy “spillover” could have taken place. And at least a meaningful proportion of the affected families, from the state’s Democratic-leaning Somali American community, wouldn’t seem to represent the GOP’s white, unvaccinated constituency.

    The stark politicization of the COVID shots can be misread too. Despite the 30-point gap between Democrats and Republicans in COVID vaccination rates, those rates are much, much higher—for members of both parties—than they’ve ever been for flu shots. And interparty differences in flu-shot uptake seem to be long-standing. A preprint study from Minttu Rönn, a researcher at the Harvard T. H. Chan School of Public Health, and colleagues found a broadening divide in coverage between Democratic- and Republican-voting states, based on data going back to 2010. But this may not be a bad thing. Rönn doesn’t think the change arises from a loss of trust among Republicans; rather, she told me, it looks to be related to rising flu-shot coverage overall, with proportionally greater gains in Democratic-leaning areas. (That difference could be the result of local attitudes, ease of access, or insurance coverage, she said.) In other words, red states aren’t necessarily falling behind on vaccination. Blue states are surging forward.

    Optimism here may seem perverse. COVID booster uptake is absurdly low right now, even for the elderly. The politicization of vaccines (whenever it began) certainly isn’t letting up. Given what would happen if trust in vaccination really did collapse, perhaps it makes more sense to err on the side of freaking out. As Larson said, every effort should be taken to build confidence, no matter what.

    But the truth of what we know right now ought to be important too. Maybe it’s okay to feel okay. Maybe there’s value in maintaining calm and taking stock of what we’ve accomplished or what we’ve maintained in the face of all these efforts to confuse us. At the risk of trying way too hard to find some solace in disturbing facts, here’s another case in point. Remember Shah’s results, that parents’ concerns about the health effects of childhood vaccines have steadily gone up throughout the pandemic, even as their belief in vaccines’ benefits stayed high? That increase wasn’t clearly more pronounced in any specific group. Belief that vaccination can result in illness or death went up across the board for men and women in the survey, for young and old, for Black and white alike. It rose among Republicans and also Democrats—in just about the same proportions. If America’s parents have been getting more attuned to potential risks from vaccination, we’re doing it together.

    I’m in that number too. As a scientist by training and a science journalist by trade, I’ve been reporting and editing stories about vaccination for years. Still, I’ve never thought so hard about the topic, and in such critical detail, as I have since 2021. At no point in my life has vaccination been this pervasive, perplexing, and important. When it came time to get my children COVID shots, I learned everything I could about potential risks and benefits. I looked at data on the incidence of myocarditis, I considered very rare but deadly outcomes, and I weighed the efficacy of different shots against their measured side effects. These investigations did not arise from distrust of authority, podcast propaganda, or a belief in microchips so small they fit inside of a syringe. I wasn’t fearful; I was curious. I had questions, and I got answers—and now every member of my family has gotten their shots.

    We’ve all been forced by circumstance to think in different ways about our health. Before the pandemic, Larson told me, most people simply didn’t have to pay attention to vaccines. Parents with young children, sure, but everybody else? “I think they probably said, Yeah, vaccines are important. Yeah, they’re safe enough,” she said. But now the stakes are raised across the population. “I mean, there are these groups around the world where you’re like, ‘why do they care about vaccines?’ And it’s because of COVID.”

    The emergence of so many groups with newfound interest in vaccines could end up being dangerous, of course—in the same way that newly minted drivers are a menace on the road. “A lot of people went online asking questions about vaccines,” Larson told me, in a tone that made it sound as though online were a synonym for “straight to hell.” But sometimes asking questions gets you useful information, and sometimes useful information leads to wise decisions. Debates about vaccines may be louder than they’ve ever been before, but that doesn’t mean that vaccination rates are bound to fall.

    Even if the situation isn’t getting that much worse, the country might still be left to wallow in its status quo. Yes, more than 200 million Americans have been fully immunized against COVID—and more than 100 million haven’t. “This has been a problem for a long time,” Daniel Salmon told me. “It was already ‘a crisis in confidence’ a dozen years ago. We don’t see a free fall—that’s somewhat reassuring—but that’s very different from saying that we’re good to go.”

    The fact of this crisis, however long it’s been around, will never matter more than its effects. After all, “confidence” itself is not the only factor, or even the most important one, that determines who gets shots. “Generally speaking, access to vaccination is a much bigger driver than what people think and feel,” Noel Brewer told me. Early in the pandemic, lots of parents wanted to vaccinate their kids and simply couldn’t. Now many of them can. But obstacles persist, and their effects aren’t evenly distributed. According to the CDC, toddlers’ vaccination rates are somewhat lower among those who live in poverty, or reside in rural areas, or don’t identify as white or Asian. Since the pandemic started, these gaps in opportunity appear to have increased. A grand and tragic spillover of people’s vaccination doubts—the anti-vaxxers’ hoped-for “silver lining” to the pandemic—may or may not come. In the meantime, though, there are other problems to address.

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    Daniel Engber

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  • Is COVID Immunity Hung Up on Old Variants?

    Is COVID Immunity Hung Up on Old Variants?

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    In the two-plus years that COVID vaccines have been available in America, the basic recipe has changed just once. The virus, meanwhile, has belched out five variants concerning enough to earn their own Greek-letter names, followed by a menagerie of weirdly monikered Omicron subvariants, each seeming to spread faster than the last. Vaccines, which take months to reformulate, just can’t keep up with a virus that seems to reinvent itself by the week.

    But SARS-CoV-2’s evolutionary sprint might not be the only reason that immunity can get bogged down in the past. The body seems to fixate on the first version of the virus that it encountered, either through injection or infection—a preoccupation with the past that researchers call “original antigenic sin,” and that may leave us with defenses that are poorly tailored to circulating variants. In recent months, some experts have begun to worry that this “sin” might now be undermining updated vaccines. At an extreme, the thinking goes, people may not get much protection from a COVID shot that is a perfect match for the viral variant du jour.

    Recent data hint at this possibility. Past brushes with the virus or the original vaccine seem to mold, or even muffle, people’s reactions to bivalent shots—“I have no doubt about that,” Jenna Guthmiller, an immunologist at the University of Colorado School of Medicine, told me. The immune system just doesn’t make Omicron-focused antibodies in the quantity or quality it probably would have had it seen the updated jabs first. But there’s also an upside to this stubbornness that we could not live without, says Katelyn Gostic, an immunologist and infectious-disease modeler who has studied the phenomenon with flu. Original antigenic sin is the reason repeat infections, on average, get milder over time, and the oomph that enables vaccines to work as well as they do. “It’s a fundamental part,” Gostic told me, “of being able to create immunological memory.”

    This is not just basic biology. The body’s powerful first impressions of this coronavirus can and should influence how, when, and how often we revaccinate against it, and with what. Better understanding of the degree to which these impressions linger could also help scientists figure out why people are (or are not) fighting off the latest variants—and how their defenses will fare against the virus as it continues to change.


    The worst thing about “original antigenic sin” is its name. The blame for that technically lies with Thomas Francis Jr., the immunologist who coined the phrase more than six decades ago after noticing that the initial flu infections people weathered in childhood could bias how they fared against subsequent strains. “Basically, the flu you get first in life is the one you respond to most avidly for the long term,” says Gabriel Victora, an immunologist at Rockefeller University. That can become somewhat of an issue when a very different-looking strain comes knocking.

    In scenarios like these, original antigenic sin may sound like the molecular equivalent of a lovesick teen pining over an ex, or a student who never graduates out of immunological grade school. But from the immune system’s point of view, never forgetting your first is logically sound. New encounters with a pathogen catch the body off guard—and tend to be the most severe. A deep-rooted defensive reaction, then, is practical: It ups the chances that the next time the same invader shows up, it will be swiftly identified and dispatched. “Having good memory and being able to boost it very quickly is sometimes a very good thing,” Victora told me. It’s the body’s way of ensuring that it won’t get fooled twice.

    These old grudges come with clear advantages even when microbes morph into new forms, as flu viruses and coronaviruses often do. Pathogens don’t remake themselves all at once, so immune cells that home in on familiar snippets of a virus can still in many cases snuff out enough invaders to prevent an infection’s worst effects. That’s why even flu shots that aren’t perfectly matched to the season’s most prominent strains are usually still quite good at keeping people out of hospitals and morgues. “There’s a lot of leniency in how much the virus can change before we really lose protection,” Guthmiller told me. The wiggle room should be even bigger, she said, with SARS-CoV-2, whose subvariants tend to be far more similar to one another than, say, different flu strains are.

    With all the positives that immune memory can offer, many immunologists tend to roll their eyes at the negative and bizarrely moralizing implications of the phrase original antigenic sin. “I really, really hate that term,” says Deepta Bhattacharya, an immunologist at the University of Arizona. Instead, Bhattacharya and others prefer to use more neutral words such as imprinting, evocative of a duckling latching onto the first maternal figure it spots. “This is not some strange immunological phenomenon,” says Rafi Ahmed, an immunologist at Emory University. It’s more a textbook example of what an adaptable, high-functioning immune system does, and one that can have positive or negative effects, depending on context. Recent flu outbreaks have showcased a little bit of each: During the 2009 H1N1 pandemic, many elderly people, normally more susceptible to flu viruses, fared better than expected against the late-aughts strain, because they’d banked exposures to a similar-looking H1N1—a derivative of the culprit behind the 1918 pandemic—in their youth. But in some seasons that followed, H1N1 disproportionately sickened middle-aged adults whose early-life flu indoctrinations may have tilted them away from a protective response.

    The backward-gazing immune systems of those adults may have done more than preferentially amplify defensive responses to a less relevant viral strain. They might have also actively suppressed the formation of a response to the new one. Part of that is sheer kinetics: Veteran immune cells, trained up on past variants and strains, tend to be quicker on the draw than fresh recruits, says Scott Hensley, an immunologist at the Perelman School of Medicine at the University of Pennsylvania. And the greater the number of experienced soldiers, the more likely they are to crowd out rookie fighters—depriving them of battlefield experience they might otherwise accrue. Should the newer viral strain eventually return for a repeat infection, those less experienced immune cells may not be adequately prepared—leaving people more vulnerable, perhaps, than they might otherwise have been.

    Some researchers think that form of imprinting might now be playing out with the bivalent COVID vaccines. Several studies have found that the BA.5-focused shots are, at best, moderately more effective at producing an Omicron-targeted antibody response than the original-recipe jab—not the knockout results that some might have hoped for. Recent work in mice from Victora’s lab backs up that idea: B cells, the manufacturers of antibodies, do seem to have trouble moving past the impressions of SARS-CoV-2’s spike protein that they got from first exposure. But the findings don’t really trouble Victora, who gladly received his own bivalent COVID shot. (He’ll take the next update, too, whenever it’s ready.) A blunted response to a new vaccine, he told me, is not a nonexistent one—and the more foreign a second shot recipe is compared with the first, the more novice fighters should be expected to participate in the fight. “You’re still adding new responses,” he said, that will rev back up when they become relevant. The coronavirus is a fast evolver. But the immune system also adapts. Which means that people who receive the bivalent shot can still expect to be better protected against Omicron variants than those who don’t.

    Historical flu data support this idea. Many of the middle-aged adults slammed by recent H1N1 infections may not have mounted perfect attacks on the unfamiliar virus, but as immune cells continued to tussle with the pathogen, the body “pretty quickly filled in the gaps,” Gostic told me. Although it’s tempting to view imprinting as a form of destiny, “that’s just not how the immune system works,” Guthmiller told me. Preferences can be overwritten; biases can be undone.


    Original antigenic sin might not be a crisis, but its existence does suggest ways to optimize our vaccination strategies with past biases in mind. Sometimes, those preferences might need to be avoided; in other instances, they should be actively embraced.

    For that to happen, though, immunologists would need to fill in some holes in their knowledge of imprinting: how often it occurs, the rules by which it operates, what can entrench or alleviate it. Even among flu viruses, where the pattern has been best-studied, plenty of murkiness remains. It’s not clear whether imprinting is stronger, for instance, when the first exposure comes via infection or vaccination. Scientists can’t yet say whether children, with their fiery yet impressionable immune systems, might be more or less prone to getting stuck on their very first flu strain. Researchers don’t even know for certain whether repetition of a first exposure—say, through multiple doses of the same vaccine, or reinfections with the same variant—will more deeply embed a particular imprint.

    It does seem intuitive that multiple doses of a vaccine could exacerbate an early bias, Ahmed told me. But if that’s the case, then the same principle might also work the other way: Maybe multiple exposures to a new version of the virus could help break an old habit, and nudge the immune system to move on. Recent evidence has hinted that people previously infected with an early Omicron subvariant responded more enthusiastically to a bivalent BA.1-focused vaccine—available in the United Kingdom—than those who’d never encountered the lineage before. Hensley, at the University of Pennsylvania, is now trying to figure out if the same is true for Americans who got the BA.5-based bivalent shot after getting sick with one of the many Omicron subvariants.

    Ahmed thinks that giving people two updated shots—a safer approach, he points out, than adding an infection to the mix—could untether the body from old imprints too. A few years ago, he and his colleagues showed that a second dose of a particular flu vaccine could help shift the ratio of people’s immune responses. A second dose of the fall’s bivalent vaccine might not be practical or palatable for most people, especially now that BA.5 is on its way out. But if next autumn’s recipe overlaps with BA.5 in ways that it doesn’t with the original variant—as it likely will to at least some degree, given the Omicron lineage’s continuing reign—a later, slightly different shot could still be a boon.

    Keeping vaccine doses relatively spaced out—on an annual basis, say, à la flu shots—will likely help too, Bhattacharya said. His recent studies, not yet published, hint that the body might “forget” old variants, as it were, if it’s simply given more time: As antibodies raised against prior infections and injections fall away, vaccine ingredients could linger in the body rather than be destroyed by prior immunity on sight. That slightly extended stay might offer the junior members of the immune system—lesser in number, and slower on the uptake—more of an opportunity to cook up an Omicron-specific response.

    In an ideal world, researchers might someday know enough about imprinting to account for its finickiness whenever they select and roll out new shots. Flu shots, for instance, could be personalized to account for which strains babies were first exposed to, based on birth year; combinations of COVID vaccine doses and infections could dictate the timing and composition of a next jab. But the world is not yet living that reality, Gostic told me. And after three years of an ever-changing coronavirus and a fluctuating approach to public health, it’s clear that there won’t be a single vaccine recipe that’s ideal for everyone at once.

    Even Thomas Francis Jr. did not consider original antigenic sin to be a total negative, Hensley told me. According to Francis, the true issue with the “sin” was that humans were missing out on the chance to imprint on multiple strains at once in childhood, when the immune system is still a blank slate—something that modern researchers could soon accomplish with the development of universal vaccines. Our reliance on first impressions can be a drawback. But the same phenomenon can be an opportunity to acquaint the body with diversity early on—to give it a richer narrative, and memories of many threats to come.

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    Katherine J. Wu

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  • Doctors Are Failing Patients With Disabilities

    Doctors Are Failing Patients With Disabilities

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    This piece was originally published by Undark Magazine.

    Ben Salentine, the associate director of health-sciences managed care at the University of Illinois Hospital and Health Sciences System, hasn’t been weighed in more than a decade. His doctors “just kind of guess” his weight, he says, because they don’t have a wheelchair-accessible scale.

    He’s far from alone. Many people with disabilities describe challenges in finding physicians prepared to care for them. “You would assume that medical spaces would be the most accessible places there are, and they’re not,” says Angel Miles, a rehabilitation-program specialist at the Administration for Community Living, part of the Department of Health and Human Services.

    Not only do many clinics lack the necessary equipment—such as scales that can accommodate people who use wheelchairs—but at least some physicians actively avoid patients with disabilities, using excuses like “I’m not taking new patients” or “You need a specialist,” according to a paper in the October 2022 issue of Health Affairs.

    The work, which analyzed focus-group discussions with 22 physicians, adds context to a larger study published in February 2021 (also in Health Affairs) that showed that only 56 percent of doctors “strongly” welcome patients with disabilities into their practice. Less than half were “very confident” that they could provide the same quality of care to people with disabilities as they could to other patients. The studies add to a larger body of research suggesting that patients with conditions that doctors may deem difficult to treat often struggle to find quality care. The Americans With Disabilities Act of 1990 (ADA) theoretically protects the one in four adults in the U.S. with a disability from discrimination in public and private medical practices—but enforcing it is a challenge.

    Laura VanPuymbrouck, an assistant professor in the Department of Occupational Therapy at Rush University, calls the 2021 survey “groundbreaking—it was the crack that broke the dam a little bit.” Now researchers are hoping that medical schools, payers, and the Joint Commission (a group that accredits hospitals) will push health-care providers for more equitable care.


    Due in part to scant data, information about health care for people with disabilities is limited, according to Tara Lagu, a co-author of both the 2021 and 2022 papers and the director of the Institute for Public Health and Medicine’s Center for Health Services & Outcomes Research at Northwestern University Feinberg School of Medicine. The few studies that have been done suggest that people with disabilities get preventive care less frequently and have worse outcomes than their nondisabled counterparts.

    About a decade ago, Lagu was discharging a patient who was partially paralyzed and used a wheelchair. The patient’s discharge notes repeatedly recommended an appointment with a specialist, but it hadn’t happened. Lagu asked why. Eventually, the patient’s adult daughter told Lagu that she hadn’t been able to find a specialist who would see a patient in a wheelchair. Incredulous, Lagu started making calls. “I could not find that kind of doctor within 100 miles of her house who would see her,” she says, “unless she came in an ambulance and was transferred to an exam table by EMS—which would have cost her family more than $1,000 out of pocket.”

    In recent years, studies have shown that even when patients with disabilities can see physicians, their doctors’ biases toward conditions such as obesity, intellectual disabilities, and substance-use disorders can have profound impacts on the care they receive. Physicians may assume that an individual’s symptoms are caused by obesity and tell them to lose weight before considering tests.

    For one patient, this meant a seriously delayed diagnosis of lung cancer. Patients with mobility or intellectual challenges are often assumed to be celibate, so their providers skip any discussion of sexual health. Those in wheelchairs may not get weighed even if they’re pregnant—a time when tracking one’s weight is especially important, because gaining too little or too much is associated with the baby being at risk for developmental delays or the mother being at risk for complications during delivery.

    These issues are well known to Lisa Iezzoni, a health-policy researcher at Massachusetts General Hospital and a professor of medicine at Harvard Medical School. Over the past 25 years, Iezzoni has interviewed about 300 people with disabilities for her research into their health-care experiences and outcomes, and she realized that “every single person with a disability tells me their doctors don’t respect them, has erroneous assumptions about them, or is clueless about how to provide care.” In 2016, she decided it was time to talk to doctors. Once the National Institutes of Health funded the work, she and Lagu recruited the 714 physicians that took the survey for the study published in 2021 in Health Affairs.

    Not only did many doctors report feeling incapable of properly caring for people with disabilities, but a large majority held the false belief that those patients have a worse quality of life, which could prompt them to offer fewer treatment options.

    During the 2021 study, Iezzoni’s team recorded three focus-group discussions with 22 anonymous physicians. Although the open-ended discussions weren’t included in the initial publication, Lagu says she was “completely shocked” by some of the comments. Some doctors in the focus groups welcomed the idea of additional education to help them better care for patients with disabilities, but others said that they were overburdened and that the 15 minutes typically allotted for office visits aren’t enough to provide these patients with proper care. Still others “started to describe that they felt these patients were a burden and that they would discharge patients with disability from their practice,” Lagu says. “We had to write it up.”

    The American Medical Association, the largest professional organization representing doctors, declined an interview request and would not comment on the most recent Health Affairs study. When asked about the organization’s policies on caring for patients with disabilities, a representative pointed to the AMA’s strategic plan, which includes a commitment to equity.


    Patients with disabilities are supposed to be protected by law. Nearly 50 years ago, Congress passed Section 504 of the Rehabilitation Act of 1973, which prohibited any programs that receive federal funding, such as Medicare and Medicaid, from excluding or discriminating against individuals with disabilities. In 1990, the ADA mandated that public and private institutions also provide these protections.

    The ADA offers some guidelines for accessible buildings, including requiring ramps, but it does not specify details about medical equipment, such as adjustable exam tables and wheelchair-accessible scales. Although these items are necessary to provide adequate care for many people with disabilities, many facilities lack them: In a recent California survey, for instance, only 19.1 percent of doctor’s offices had adjustable exam tables, and only 10.9 percent had wheelchair-accessible scales.

    Miles says she’s noticed an improvement in care since the ADA went into effect, but she still frequently experiences challenges in health care as a Black woman who uses a wheelchair. “We need to keep in mind the ADA is not a building code. It’s a civil-rights law,” says Heidi Johnson-Wright, an ADA coordinator for Miami-Dade County in Florida, who was not speaking on behalf of the county. “If I don’t have access to a wellness check at a doctor’s office or treatment at a hospital, then you’re basically denying me my civil rights.”

    The ADA isn’t easy to enforce. There are no “ADA police,” Johnson-Wright says, to check if doctor’s offices and hospitals are accessible. In many cases, a private citizen or the Department of Justice has to sue a business or an institution believed to be in violation of the ADA. Lawyers have filed more than 10,000 ADA Title III lawsuits each year since 2018. Some people, sympathizing with businesses and doctors, accuse the plaintiffs of profiteering.

    And it’s not just about accessible equipment. In 2018, the Justice Department sued a skilled nursing facility for violating the ADA, after the facility refused to treat a patient with a substance-use disorder who needed medication to help maintain sobriety. Since then, the department settled with eight other skilled nursing facilities for similar discrimination. “It is a violation of the ADA” to deny someone care based on the medications they need, Sarah Wakeman, an addiction-medicine specialist at Massachusetts General Hospital, wrote in an email, “and yet continues to happen.”

    Indeed, in the focus groups led by Lagu and Iezzoni, some of the doctors revealed that they view the ADA and the people it protects with contempt. One called people with disabilities “an entitled population.” Another said that the ADA works “against physicians.”

    The Department of Health and Human Services is aware of the issue. In a response to emailed questions, an HHS spokesperson wrote, “While we recognize the progress of the ADA, important work remains to uphold the rights of people with disabilities.” The Office of Civil Rights, the spokesperson continued, “has taken a number of important actions to ensure that health care providers do not deny health care to individuals on the basis of disability and to guarantee that people with disabilities have full access to reasonable accommodations when receiving health care and human services, free of discriminatory barriers and bias.”


    Researchers and advocates told me that the key to improving health care for those with disabilities is addressing it directly in medical education and training. “People with disabilities are probably one of the larger populations” that physicians serve, Salentine said.

    Ryan McGraw, a community organizer with Access Living, helps provide education about treating patients with disabilities to medical schools in the Chicago area. He regularly receives positive feedback from medical students but says the information needs to be embedded in the medical-school curriculum, so it’s not “one and done.”

    In one effort to address the issue, the Alliance for Disabilities in Health Care Education, a coalition of professionals and educators of which McGraw is a member, put together a list of 10 core competencies that should be included in a doctor’s education, including considerations for accessibility, effective communication, and patient-centered decision making.

    One of the simplest solutions might be hanging signs or providing accessible information in exam rooms on patients’ rights. “It’d be there for patients, but it’d be also there as a reminder to the providers. I think that’s a super easy thing to do,” Laura VanPuymbrouck says. Miles says this could be a good start, but “it’s not enough to just give people a little pamphlet that tells you about your rights as a patient.” Although all doctors should be willing and able to care for patients with disabilities, she thinks a registry that shows which providers take certain types of insurance, such as Medicaid, and also have disability accommodations, such as wheelchair-accessible equipment, would go a long way.

    Some advocates have called on the Joint Commission for more than 10 years to require disability accommodations for hospitals that want accreditation. The step could be effective, because accreditation “is extremely important” to hospitals, Lagu says.

    On January 1, 2023, new Joint Commission guidelines will require that hospitals create plans to identify and reduce at least one health-care disparity among their patients. Improving outcomes for people with disabilities could be one such goal. However, Maureen Lyons, a spokesperson for the Joint Commission, adds, “if individuals circumvent the law, standards won’t be any more effective.”

    Finally, Lagu says, “we have to pay more when you are providing accommodations that take time or cost money. There’s got to be some accounting for that in the way we pay physicians.”

    One of the most basic things people with disabilities are asking for is respect. The biggest finding of the 2021 survey, Iezzoni says, is that doctors don’t realize that the proper way to determine what accommodations a facility needs for patients with disabilities is to just ask the patients.

    “I can’t tell you how many times I go to a doctor’s office and I’m talking, but they’re not hearing anything,” Salentine says. “They’re ready to speak over me.”

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    Emma Yasinski

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  • Why Can’t I Stop Rooting for a God-Awful Basketball Team?

    Why Can’t I Stop Rooting for a God-Awful Basketball Team?

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    When I attended a Washington Wizards open practice at D.C.’s Capital One Arena earlier this month, the focus was more on spectator entertainment than Rocky-style workouts. The season opener was a week away, and the players ran drills at half speed and engaged in silly skills competitions for fans, including a basketball version of Connect Four. But as a lifelong Wiz devotee, I was having an awestruck, love-you-man moment. Here I was posing for a photo with Phil freakin Chenier. Franchise royalty. My childhood idol. Back in the 1970s, when Chenier was draining jumpers and sporting a Richard Pryor mustache, the team routinely chased titles. These days? Not so much.

    Being an NBA fan who loves the Wizards is a little like being a foodie who adores turnips: It just doesn’t make sense. Since the 2000–01 season, only the Knicks and Timberwolves have lost more games. The franchise last advanced beyond the second round of the playoffs in 1979 (back when they were called the Bullets), and they’ve missed the playoffs 16 of the past 25 years. We fans have endured 40-plus years of frustration and disappointment, mainly from the typical issues—bad defense, bad draft picks, bad trades—but sometimes from … weirder ones: One All-Star player was charged with a gun felony involving a teammate, and another was once suspended without pay for being overweight. It’s all #SoWizards, to use a Twitter hashtag.

    And yet, I made it out to the open practice with a few hundred fans on a Tuesday night, wearing a Wizards T-shirt and feeling the faint, irrational warmth of preseason hope. Anyone can root for a winner. That’s easy. Last season, the NFL teams with the top-selling merchandise were the Cowboys, 49ers, Patriots, Steelers, and Chiefs. Each team finished with a winning record. In Philadelphia, the currently undefeated Eagles and the World Series–bound Phillies have generated a 20 percent or more increase in business for local restaurants, sports bars, and memorabilia stores.

    But rooting for the middling Wizards takes guts at best and is downright masochism at worst. Still, even though the team is more likely to bring me agony than elation, I can’t fathom supporting any other franchise. The same is surely true of my fellow Wizards fans—and many fans of other perennial losers (hey, the Detroit Lions somehow still have fans). So why do we stay hooked?

    My Wizards fandom began in the D.C. suburbs in the ’70s, when I was a Bullets-crazed kid devouring box scores on the sports page, shooting jumpers on a backyard dirt court, and pretending to be Chenier. I was 12 when the Bullets paraded down Pennsylvania Avenue to celebrate their only title, and the subsequent 44 years have brought lots of bad memories: Last season, the Wizards somehow blew a 35-point lead against the L.A. Clippers. The worst part? I wasn’t surprised.

    Recent pain should feel stronger than childhood joy, I would think—even for fans like me, whose support was passed down geographically. But these deep, die-hard roots can influence our adult behavior. “Early learning is incredibly powerful and hard to erase,” Chris Crandall, a psychology professor at the University of Kansas who has studied fan allegiance, told me. The team’s success 50 years ago may have boosted my childhood loyalty, Crandall explained, and their subsequent failures did not remove it. A new attitude (“Wow, these guys stink”) essentially “lays over the old one, but the old one is still there,” Crandall said. “And it’s very difficult to get rid of it.”

    I’m at least old enough to remember the team’s lone championship. The top memory for Wizards fans in their 30s is probably John Wall’s dramatic game-winning three-pointer in Game 6 of the Eastern Conference semifinals. The Wizards, of course, then lost Game 7. But one reason fans stick around is the perverse pride they have in their fandom, Edward Hirt, a professor at the University of Indiana who has studied sports-fan psychology, told me. Rooting for the Lakers or the Dallas Cowboys is like wearing khakis: You hardly stand out in a crowd. Loving the Wizards gives me a defiant sense of individuality. “Do you want to be like everybody else, or do you want to be different?” Hirt said. “The answer is neither. We want to be a little bit of both. We like feeling like we belong, but we don’t want to be seen as a clone of everybody else, either.”

    Supporting a loser satisfies both of those desires. I can commune with fellow fans at a sports bar or game, but when I walk through an airport, even in D.C., I’m often the only guy wearing a Wizards cap. And honestly, I like that. My Wiz fandom, Andrew Billings, a sports-media professor at the University of Alabama, told me, sends a message to the world: “How loyal am I? I root for the Washington Wizards.” (Which, let’s be real, would be a great T-shirt). In a 2015 study of students from seven universities, football fans were 55 percent less likely to wear team apparel following a defeat compared with a win. But those who do are making a statement: I’m not a fair-weather fan; I’m dedicated and trustworthy.

    Those noble qualities explain why fans of lousy teams despise fair-weather fans, Hirt added. Bandwagon fans skip the suffering but embrace the glory. If the Wizards somehow reached the NBA Finals this year, I’d be both thrilled and infuriated by the mobs of rapturous fans at downtown watch parties. Where were these bandwagon yahoos in 2001, when the team finished 19–63?

    But maybe winning matters less than we think—even for die-hard fans who react to each loss with a primal scream. In one 2019 study, fans of a college football team felt a two-day rise in self-esteem after a victory. But self-esteem levels didn’t drop significantly among losing fans. One of the reasons: Even if your team loses, you can raise your self-esteem simply by commiserating with friends, Billings, a co-author, said.

    Yes, suffering sucks, but suffering together has some upsides. It can be a social glue that intensifies bonds with the team and fellow fans. “Going through this hardship with your sports team makes you much more likely to stick with them,” Omri Gillath, a psychology professor at the University of Kansas, told me. Fans don’t just bask in reflected glory, or BIRG, as psychologists call it; they also BIRF—bask in reflected failure. “It’s about having a community of people that understand you and like the same thing that you do,” Gillath said.

    Last season, a friend and I attended the Wizards’ home finale, and they got shellacked by the equally lousy Knicks. But my friend and I enjoyed laughs over pregame beers. We made sarcastic comments as the Wiz turned a 10–0 lead into a 22-point deficit. I bought an end-of-the-season discounted T-shirt at the team store. Listening to Knicks fans hoot about their victory was annoying, but we had fun. And we bonded.

    But rooting for a losing team may be a dying phenomenon. Sports betting and streaming have made sports more solitary and less tied to where you live—undercutting some of the reasons fans endure their god-awful teams. “Geographic loyalty is particularly powerful for older generations, partly because they weren’t nearly as mobile with their jobs or their careers as younger people are,” Billings said. “I live in Alabama. If I wanted to be a Golden State Warriors fan, I could access all 82 of their regular-season games in a way that was not possible for older generations when they built their fandom.” Younger fans may also be more likely to follow a single player than a particular team, Billings believes.

    Let’s be clear: Winning is way better than losing. A 2013 study found that on the Monday after NFL games, fans of losing teams were more likely to consume saturated fats and sugars compared with fans of winning teams. But I truly believe—and maybe this is loser talk—that my decades of Wizards fandom have made me a better human. I have well-developed coping skills. My friends and I are like Statler and Waldorf, the crusty hecklers on The Muppet Show: We manage head-smacking losses with well-timed quips. I don’t get too elated after a victory—although victories mean more when they’re rare—or too down after a defeat. Hell, maybe it’s even made me more empathetic to people’s challenges. After all, most of us in life can relate more like the constantly struggling Wizards than the trophy-hoisting Warriors.

    Even though I know better, I’m optimistic this season won’t be a #SoWizards year. Maybe the team will jell. Maybe the young players will develop. Maybe the veterans will stay healthy. Or, you know, maybe not. A struggling sports franchise, I’ve decided, is like your idiot brother or jackass uncle. Despite all their obvious flaws, you still love them. And so I’ll cherish disco-era Bullets memories, celebrate the unexpected victories, cling to foolish hope, and brace myself for the worst. If they miss the playoffs—again—well, there’s always next year.

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    Ken Budd

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  • What Will Happen in Georgia?

    What Will Happen in Georgia?

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    ATLANTA—The three dozen young Black men and women who gathered in a church meeting room last Friday night were greeted with a rousing exhortation that had the added benefit of being true.

    In welcoming remarks, Bryce Berry, a senior at nearby Morehouse College and the president of the Young Democrats of Georgia club, told the group that none of the party’s national-policy accomplishments of the past two years would have been possible without people like them. “Without young Georgians, young Black Georgians,” Berry said for emphasis, “there would be no Associate Justice Ketanji Brown Jackson, no American Rescue Plan … no Inflation Reduction Act, no student-debt relief, and no gun-safety bill.”

    It was the sort of thing speakers always say to motivate a crowd at political rallies. But in this case it was historically accurate: Massive turnout and huge margins among young voters, especially young voters of color, were crucial to the twin runoff victories of Georgia Senators Jon Ossoff and Raphael Warnock in January 2021 that delivered Democrats their unexpected majority in the upper chamber.

    Young adults have become an essential electoral asset for Democrats—and loom as a potentially decisive factor in determining whether the party can avoid the worst outcomes up and down the ballot this November. In particular, young voters may decide whether Democrats can preserve the fragile hold on the Senate that Georgia provided to them.

    A sharp generation gap is among the most consistent findings in public polling across almost every competitive Senate race this year. Here in Georgia, for instance, an array of recent public polls (including surveys by Quinnipiac University, Marist College, Monmouth University, and the University of Georgia) have found Warnock leading the Republican Herschel Walker by as much as two to one among young adults from about 18 to 34 and consistently by a margin of about 10 percentage points among those in early middle age. Polls almost always show Walker at least slightly ahead among those in their later working years, and solidly leading among those 65 and older. (This week’s explosive allegations about Walker—the claim that he allegedly funded an abortion for a girlfriend and the subsequent accusations of domestic violence from his son—seem likely to weaken him, perhaps substantially, with every group, but are unlikely to erase these sharp generational differences.)

    These patterns are so common across the competitive states that it’s hard to imagine Democrats maintaining their Senate majority unless young voters like those who gathered at Atlanta’s Allen Temple AME Church turn out in substantial numbers.

    Compared with older generations, Millennials and members of Generation Z are more racially diverse, more likely to hold postsecondary degrees, and less likely to identify with any religious tradition. Both cohorts have leaned sharply Democratic since the first Millennials entered the electorate in large numbers in the 2004 election; the party has routinely carried about three-fifths of young adults in recent presidential contests. In 2018, Democrats hit a peak of support among young voters, winning two-thirds of those younger than 30 and three-fifths of those ages 30 to 44, according to estimates by Catalist, a Democratic targeting firm.

    Millennials and Gen Z are especially crucial to Democratic fortunes across Sun Belt states like Georgia and Arizona. In this region, younger generations are far more racially diverse than the mostly white, older voters who provide the backbone of GOP strength. In Arizona, for instance, Latino voters and other people of color compose almost three-fifths of the population under 30 but less than one-fifth of the population over 65, according to calculations from census data by William Frey, a demographer at Brookings Metro. In Georgia, Black voters and other people of color represent half of eligible voters under 45 but only three in 10 of those over 65. The gap between what I’ve called “the brown and the gray”—the diverse younger and the mostly white older generations—is comparably large in Texas and Nevada and nearly as big in North Carolina, Frey’s data show.

    For Democrats, this year’s nightmare scenario of losing both the House and Senate is a repeat of 2010 and 2014, when the GOP midterm sweeps were turbocharged by a catastrophic falloff in turnout among young people from the presidential race two years earlier.

    The anemic youth turnout in those off-year elections during Barack Obama’s presidency fueled a widespread perception that Democrats now faced a structural disadvantage in midterms because the electorate in those years was destined to be much older and whiter than in the presidential contest. But the 2018 results upended that assumption: Much more robust turnout among young adults helped power the Democratic gains that allowed them to recapture the House of Representatives. Compared with 2014, youth turnout increased in every state in 2018, more than doubling across the country overall, Circle, a think tank at Tufts University that studies young voters, has calculated. Some of the biggest increases occurred in Sun Belt states where the youth population is the most racially diverse, including Georgia, Arizona, and Nevada.

    The turnout surge continued into 2020, when exactly half of adults younger than 30 showed up to vote, a big increase from the 39 percent in 2016, Circle concluded. Georgia again ranked among the states with the biggest youth-turnout increase compared with 2016—a key factor in the Democrats’ razor-thin victories there in the presidential race and the two Senate runoffs.

    Democrats this year are highly unlikely to win as big a share of youth voters as they did during their 2018 sweep (they didn’t even equal it in 2020). But one of the pivotal questions remaining for the 2022 election is how close Democrats can come to matching the strength with young voters they displayed while Donald Trump was in the White House.

    Democrats face some serious headwinds. Never enthusiastic about President Joe Biden during the 2020 Democratic primaries, young people have given him lackluster approval ratings throughout his presidency. Generally operating with less of a financial cushion than older voters, young people have also been more affected by the highest inflation in four decades. “The cost of living is going up, but our salaries are not,” Alexia Brookins, a manager at a construction company, told me at the AME event sponsored by the group Millennials of Faith last weekend.

    In a mid-September NPR/PBS NewsHour/Marist poll, just 37 percent of Millennials and Gen Z said that Biden’s actions had strengthened the economy; 55 percent said that he had weakened it. In a late-September Yahoo News/YouGov survey, only about one-fifth of young adults ages 18 to 44 said life was better for people like them since Biden took office (the rest said it was unchanged or worse).

    Terrance Woodbury, a partner at HIT Strategies, a Democratic consulting firm that focuses on young voters of color, worries that these verdicts will make it difficult for Democrats to reach the turnout and margins they need among young voters. In polling that HIT recently conducted for the NAACP, he told me, three-fourths of Black adults younger than 50 said their lives had not improved since Biden took office.

    Woodbury told me that although the media seem fixated on whether potential Republican gains among men will widen the Black gender gap this year, he expects that the “generational gap” in the African American community will be much wider. “Younger voters are much more likely to say Democrats take Black voters for granted, much less likely to approve of the direction of the country, and much less likely to approve of the performance of Democrats in Congress and the White House,” he told me. “All of that is significantly higher by generation than by gender. I actually do think there is a real risk of Democrats underperforming with young voters, and specifically young voters of color.” Equis Research, a Democratic polling firm that specializes in Latino voters, raised similar warnings about young Hispanic voters in a late-September memo analyzing the upcoming election.

    But other factors may help Democrats approach, if not necessarily match, their recent advantages with young voters.

    More young adults may vote in 2022 simply because so many of them registered and voted in 2018 and 2020. One reason for that is structural: There are more young people on the voter rolls because of the [2018 and 2020] elections, which is a huge boost, because it means they are more likely to be contacted by parties and organizations,” and those contacts increase the likelihood of people voting, Abby Kiesa, Circle’s deputy director, told me.

    The other key reason is attitudinal: Higher youth turnout may mean that not only is voting becoming a habit for those who have already done it; it is also becoming more expected among the 18-year-olds who age into the electorate every two years (more than 8 million of them since 2020, Circle projects). At the AME event, for instance, Kendeius Mitchell, a disability-claims manager, told me that youth engagement in Georgia is feeding on itself. “Just having it around so much in the conversation now is making people take accountability,” he said.

    John Della Volpe, the director of polling at the Harvard Kennedy School Institute of Politics, sees the same trend in the institute’s national surveys. “Voting … could be becoming a part of this new generation and how they think,” he told me.

    Also lifting Democratic hopes is the party’s summer succession of policy advances on issues important to young people. Della Volpe said the “No. 1” criticism of Biden among young adults in the Harvard poll was “ineffectiveness.” But the passage of the Inflation Reduction Act, with its sweeping provisions to combat climate change, and the president’s decision to cancel up to $20,000 in student debt for millions of borrowers have provided Democratic organizers and ad makers something they lacked earlier this year: evidence to argue to young adults that their votes did produce change on things they care about. Biden gave organizers another talking point yesterday afternoon, when he announced a sweeping pardon of all people convicted of simple marijuana possession under federal law.

    On the ground in Georgia, Keron Blair, the chief organizing and field officer for the New Georgia Project, a grassroots political organization founded by the Democratic gubernatorial candidate Stacey Abrams, told me that with the Democrats’ recent successes, “it feels a little bit easier” than in the spring to make the case to young adults that their vote counts.

    Looking across the overall record of Democrats since they took power, “people aren’t like, ‘Oh my God, this is amazing,’” Blair told me. “But people are clear that some of the wins and the political and economic shifts that we are seeing [are] the result of the [voting] choices that people have made.”

    Also working for Democrats is the gulf in values between most young voters and the Trump-era Republican Party. Fully 70 percent of adults younger than 30, for instance, said in a Pew Research Center poll this summer that abortion should remain legal in all or most circumstances, by far the most of any age group. That places them in sharp opposition to a GOP that is intensifying talk of passing a national ban on abortion if it wins control of Congress. “If we maintain that [recent] surge among young voters and voters of color,” Woodbury said, “they are voting against the crazy on the other side.”

    Although different public surveys have sent different signals about youth engagement, the latest IOP youth survey, which is considered a benchmark in the field, found that as many young people said they “definitely” intend to vote this fall as did in 2018.

    That prospect points toward an incremental but inexorable power shift. In 2020, for the first time, Millennials and Gen Z roughly equaled Baby Boomers and their elders as a share of eligible voters. By 2024, the younger generations will establish a clear advantage. As their numbers grow, so does their capacity to influence the national direction. There’s no guarantee they will exercise that inherent power next month by turning out to vote in large numbers. But more young people appear to be recognizing how much their choices can matter. Berry, the young Georgia activist, told me that his message to his friends is centered on understanding the strength in numbers that they are accumulating: “I really impress on folks, ‘Look at what happened because of you. You understood the moment in 2020; now you have to understand the moment in 2022.’”

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    Ronald Brownstein

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  • A Simple Rule for Planning Your Fall Booster Shot

    A Simple Rule for Planning Your Fall Booster Shot

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    In less than two weeks, you could walk out of a pharmacy with a next-generation COVID booster in your arm. Just a few days ago, the Biden administration indicated that the first updated COVID-19 vaccines would be available shortly after Labor Day to Americans 12 and older who have already had their primary series. Unlike the shots the U.S. has now, the new doses from Pfizer and Moderna will be bivalent, which means they’ll contain genetic material based both on the ancestral strain of the coronavirus and on two newer Omicron subvariants that are circulating in the U.S.

    These shots’ new formulation promises some level of protection that simply hasn’t been possible with the original vaccines. “A bivalent vaccine will have some benefit for almost everybody who gets it,” Rishi Goel, an immunologist at the University of Pennsylvania, told me. “How much benefit that is, we’re still not exactly sure.” People who aren’t at high risk could end up only marginally more protected against severe outcomes, and no one thinks the shots will banish COVID infections for good. There is, however, a simple rule of thumb that nearly everyone can follow to maximize the uncertain gains from a shot: Wait three to six months from your last COVID infection or vaccination.

    Put that rule into action, and it plays out a little differently, depending on your circumstances.

    If you haven’t had an Omicron infection:

    If you haven’t had COVID since about November 2021, the advantage of a bivalent booster over the original formula is obvious, and as long as you haven’t gotten boosted recently, there’s every reason to get the new one right away. (If you have been boosted in the past few months, your antibody levels are probably still too high for a new shot to do much for you.) Marion Pepper, an immunologist at the University of Washington, told me that Americans who have already gotten three or more doses “have probably maxed out the protective capacity” of the original shots. By contrast, the bivalent vaccines offer something new to those who have so far escaped Omicron: a lesson on the spike proteins of the BA.4 and BA.5 subvariants, which will help the immune system fight the real thing should it get into your body. “I’m just super excited to get the bivalent vaccine,” says Jenna Guthmiller, an immunologist at the University of Colorado who has not yet had COVID. “I think it’ll be really nice and ease my mind a little bit.”

    If you have had an Omicron infection:

    Veterans of Omicron infections might still have something to gain from seeing the BA.4 and BA.5 spike proteins—especially if your goal is to avoid getting sick with COVID at all. Past a certain number of shots, boosters’ impact on your long-term protection against severe disease is unclear, Goel told me. Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia, told me he doesn’t plan on getting a booster at all this fall because, after three vaccine doses and an infection, “I think I’m protected against serious illness.” But if you want to stave off infection, Goel said, “the bivalent vaccines, or really any variant-containing vaccines, have real value.” That’s because formulas based on a given variant have been shown to temporarily increase your stock of antibodies that target that variant.

    How long that extra-protective state lasts, or whether it’s sufficient to prevent any infection whatsoever, is still a scientific puzzle. The original boosters were shown to increase antibody levels to a peak about two weeks after the shot, then decay steadily over the following three months. We don’t know yet whether a bivalent formula will change that timeline, Goel said.

    But you can still use it to estimate approximately when your protection will be at its highest. You might, for example, choose to err on the early side of that three-to-six-month timeline if you have a particularly high-risk event coming up in the next few weeks. “If all we had was the original booster and I was going to an indoor wedding or something, I think it would be reasonable to get that booster,” Pepper said.

    If you had an Omicron infection this summer:

    “You’re still riding the wave of antibodies that you generated as a result of that infection,” Guthmiller told me, so a shot won’t do much for you yet. That’s true regardless of which Omicron subvariant you might have been infected with, she said, because BA.2 infections have been shown to protect fairly well against today’s dominant strains, BA.4 and BA.5. (BA.2 became dominant in the United States back in March.) The severity of your illness doesn’t really matter either, Goel said. A higher fever and more intense cough might indicate that your immune system got extra revved up, he said, but they could just as easily mean that your body needs more help responding to the coronavirus. In either case, once a little more time has passed, getting the bivalent vaccine could help extend your body’s memory of its last COVID encounter, and keep infection at bay.

    If you’re at high risk:

    Certain groups of people should get any booster as soon as it’s available to them, the experts I spoke with emphasized to me: immunocompromised people, people over the age of 50 or so, and people with medical conditions that put them at high risk of severe disease. If you fall in one of these categories and haven’t received all the boosters you’re eligible for, “I wouldn’t wait for the bivalent,” Offit said. For people in these high-risk categories who have already gotten the recommended number of boosters, you should get the new one as soon as it’s available to you. (The FDA and CDC have not yet indicated whether they will recommend a waiting period between your most recent shot and the bivalent booster.) Goel recommended waiting at least a month after your most recent infection or shot, but if you’re very worried about your risk, you don’t need to stretch the delay to three months. Your body might still have extra antibodies floating around, but with no practical way to check at scale, “I’m honestly in favor of recommending boosting as a way to maximize individual benefit,” he said.

    If you want to wait and see:

    Waiting is always an option if you want to know more about how the bivalent vaccines perform. The FDA and CDC are set to green-light the shots based on human data from the existing boosters and other experimental bivalent boosters that didn’t make it to market in the U.S.—plus trials on the new formula in mice. Pfizer and Moderna simply haven’t progressed very far in their human trials. While there’s no reason to suspect that the new shots won’t be safe, Offit recommended opting for the original boosters until more safety and efficacy data are available, which could be as soon as a couple of months after the rollout—as long as the vaccine makers or the government collects that information and makes it public. But Guthmiller and Goel said they weren’t concerned about the lack of human data, and the bivalent shot is almost certainly the better bet.

    There is one significant reason to avoid waiting too long for the bivalent shot: It offers the greatest protection against infection from the subvariants it’s actually designed around. BA.4 and BA.5 might be with us through the fall and winter—or they might give way to a different branch of Omicron, or even a variant that’s entirely unlike Omicron. You’d certainly be better off against this new variant with a bivalent booster than no booster at all. But if you want to maximize your anti-infection shield while you have it, consider putting it up against the enemy you know.

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    Rachel Gutman-Wei

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  • Caitlin Dickerson on the Moral Catastrophe of Family Separations

    Caitlin Dickerson on the Moral Catastrophe of Family Separations

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    Jeffrey Goldberg, The Atlantic’s editor in chief, joined staff writer Caitlin Dickerson to discuss her cover story, a years-long investigation into the secret history of the Trump administration’s family-separation policy. Dickerson’s story argues that separating children was not an unintended side effect, as previously claimed, but its core intent. How did officials work to keep families apart longer? Did they obscure the truth to both Congress and the public? What will happen if the Trump administration is restored to power in the 2024 election? This dialogue is an edited and condensed version of a conversation Dickerson and Goldberg had on Friday for The Atlantic’s “Big Story” broadcast.

    Leer este artículo en español.


    Jeffrey Goldberg: When did you realize that the Trump administration was doing something new?

    Caitlin Dickerson: There were two things here that really stood out from the norm in my experience as a reporter. The first, with family separations, is just the mere fact that they took place in relative secrecy. In 2017, hundreds of separations took place starting out in El Paso, Texas, in a program that later expanded. But when reporters would ask about it, the administration would tell us, “No, this isn’t happening. You know, we’re not separating families.” There’s some complicated reasons for that which we can get into, but that’s really not normal. As a reporter, you’re used to hearing “no comment” in response to a story that the government doesn’t want you to report. Or you’re used to hearing a public-affairs officer offer some context that at least helps to soften the blow of a story that they know the public is not going to react kindly to. But in this case, we actually got denials.

    And then, of course, having looked back at immigration policy all the way back to the 19th century in the United States, separating children from their parents as an immigration policy hasn’t happened before. It was the harshest application any of us have seen of this basic concept of prevention by deterrence, which is how we approach immigration enforcement generally. And it was so harsh and painful for parents and for children, and continues to be, that I had to stick with it.

    Goldberg: So to be clear, no presidential administration going back all the way had ever done anything this dramatic?

    Dickerson: No. As you know, there are examples of kids being taken from their parents in American history, though not in a border context. We’ve had some pretty cruel and pretty harsh border-enforcement policies. But the forcible separation of children from their parents is just not something that the Border Patrol has ever engaged in in American history.

    Goldberg: One of the great achievements of your story is that you take us all the way into the bureaucratic decision making that allowed this to happen. But somebody had to think of this first. The assumption, on the part of people who think about this, is that it must have been Stephen Miller, Donald Trump’s very hard-line adviser. He worked for Jeff Sessions and brought a lot of his ideas to Donald Trump. But it’s more complicated than that.

    Dickerson: It took a lot more than Stephen Miller, Donald Trump, and Jeff Sessions to forcefully separate thousands of kids from their parents. The idea actually came from within the border-enforcement apparatus: a man named Tom Homan, who started out as a Border Patrol agent in his early 20s, spent a career in enforcement, and ultimately became the head of ICE under President Trump.

    He first came up with the idea to separate families as an escalation of the concept of prevention by deterrence: this idea of introducing consequences to discourage illegal border crossing, even when it’s for the purposes of seeking asylum. He first proposes separating children from their parents in 2014, during the Obama administration, which is when we saw the first major surge of children and families crossing the border. Border Patrol was totally overwhelmed at the time. Congress didn’t intervene. And so you have, essentially, a police force that’s left to figure this out—this policy, which is really humanitarian policy; it’s economic policy. When you leave this to the Border Patrol, the solution that they come up with time and again is punishment. So Homan proposes it, and Jeh Johnson, who was Homeland Security secretary at the time, rejects the idea. Then the idea resurfaces very soon after Donald Trump takes office.

    Goldberg: So there was a bureaucratic impetus from below. Take us through that—Donald Trump wins in 2016, comes into office, and this dormant idea is brought to whom?

    Dickerson: Trump comes into office and is visiting Border Patrol headquarters and Customs and Border Protection headquarters and saying, “Hey, we’ve got to shut this border down, and, really, we’ll stop at nothing to do it. Bring me your best ideas.” Tom Homan, who was the head of ICE, and a man named Kevin McAleenan, who was the head of Customs and Border Protection, very quickly reraise this concept that they had already talked about and already favored. They tell Miller about it, who gets really excited and kind of obsessed with it. And Miller continues to push for the next year and a half until it’s officially implemented. Donald Trump also begins to favor it.

    I was surprised about this, ultimately, but the story ends up being kind of a case for the bureaucracy. I learned, in reporting this, the way the policies are made. Typically, you have principals, who are the heads of agencies and have great decision-making power but have huge portfolios. Policy ideas should only ever reach the desk of someone like Kirstjen Nielsen—who was the Homeland Security secretary, who ultimately signs off on family separation—if they’ve been thoroughly vetted. Subject-matter experts have determined these policies are logistically feasible, they’re legal, they’re ethical. They make sense politically for the administration in office. All these layers exist to prevent bad policies from ever even reaching somebody who has the authority to sign. And these systems were really either sidelined, disempowered, or just completely cut out of the conversation. Everybody who was raising red flags was really cut out.

    Goldberg: I want you to talk about child separation in its details. The idea is preventative. Which is to say, if word gets out into Guatemala, Honduras, wherever, that if you try to cross the border with your kid, the U.S. government will take your kid from you—actually kidnap your child in some kind of bureaucratically legal way—then all the people who are trying to come to America, asylum seekers, workers, etc., will not come. Is that the theory of the case?

    Dickerson: That is the theory of the case. And there’s a lot of reason to believe it’s not a good theory.

    Goldberg: Why is it not a good theory? It sounds pretty scary if you’re sitting in Guatemala and somebody says you might lose your kid.

    Dickerson: It does. That’s what’s difficult about it: that it is somewhat intuitive, this idea of prevention by deterrence. Academics have been studying it for a long time and know what ways it works, and what ways it doesn’t work. In the early 2000s, we started prosecuting individual adults who crossed the border illegally.

    To begin with, there’s this program called Operation Streamline. It completely floods courts along the border, and immediately, prosecutors—assistant U.S. attorneys—are unhappy with it because they’re saying it’s taking away resources from these more important cases that we need to deal with. And not only that, but it doesn’t seem to be influencing long-term trends.

    If you look at shifts in migration that have taken place over the last 20 years, those can be explained entirely by looking at economic shifts and demographic shifts in the United States and the countries where people are coming from. All of those changes are attributable to the availability of resources here and the availability of jobs here, and then the inverse: what opportunities people have available to them in their home countries, as well as whether people actually feel safe.

    Even though prevention by deterrence, first in the form of Streamline, wasn’t making a dent in border crossings in any significant way, this idea becomes more and more popular until ultimately we get to the point of separating children from their parents. Anecdotally, Lee Gelernt—the ACLU lawyer who’s heading up the federal case against family separations, the main case that prompted family reunification—talks about asking every parent that he interviewed for that case, “If you had known about family separation, would you have left your country to begin with? Would you have decided to stay home?” And they’d just kind of shrug their shoulders and say, “Well, what was I going to do? You know, we left because our lives were in danger. I couldn’t stay.” That is something that people like Tom Homan, who came up with the idea to separate families, didn’t really take into account.

    Goldberg: The level of desperation at home is the key determinant of whether somebody is going to start the trek.

    Dickerson: It’s a very, very high bar to surpass when you’re talking to a parent who not only can’t feed themselves or their child, but on a day-to-day basis fears that their child may be killed.

    Goldberg: Stay on that for one second so people understand this population. You’re talking about people who are living in very dangerous Central American countries, mainly.

    Dickerson: You’re talking about a lot of times a combination of deep poverty, daily fear of death, and daily encounters with violence. I can tell you about my experiences reporting in parts of Mexico, where people come to the United States from, and in Central America. When The New York Times sent me to Guatemala to write about a family that was trying to get into the United States, I had security with me the entire time. Many people, just within this family, had been murdered. It’s a domino effect where a gang identifies one person in a family and wants that person to join the gang. If that first individual doesn’t do right by the gang, relatives continue to be murdered.

    When I would go house to house to visit with people associated with this family, we were hiding. They couldn’t let anybody know where they lived. They couldn’t let anybody know that I was there, because it would have put them in greater danger. The poverty, too, is really something that I don’t know a lot of Americans have really sat down and thought about. Houses that have no roofs, no floors. Families of four that are splitting a tortilla among them. Access to school is almost nonexistent. Kids don’t have shoes. It’s stuff that I think most Americans have a hard time envisioning. Think about how scared you would have to be to decide to go to the United States, knowing that you’re going to have to travel through a hot and dangerous desert and encounter murderous gangs. Nobody signs up to do that unless they feel like they have absolutely no choice.

    Goldberg: Let’s come back to the narrative of the adoption of this policy. One of the reasons, when we were talking about doing this story over the past year and a half, was to try to understand the mentality of government officials and bureaucrats. Somehow the idea of taking children from their parents becomes socialized within these government structures. Talk about that. Did anybody along the way say, “Hey, I’m all for deterrence. I have these views on immigration. I’m a hard-liner. But this does not seem to comport with my notions”—and I’m using this term advisedly—“my notions of family values”?

    Dickerson: A lot of people said that. And ultimately, by the time the decision to pursue separating families is made, they had been left out of the room. When family separations are first proposed, they’re described in pretty blatant terms. I interviewed Jeh Johnson—again, who was the Homeland Security secretary under President Obama, and did believe in deterrence—but he said, “That’s too far for me. I’m not comfortable with it.” John Kelly, who was President Trump’s first Homeland Security secretary and considered the idea after it was proposed by Tom Homan, Kevin McAleenan, and others, said the same thing. He wasn’t really a big believer in deterrence, but he’d taken the job for the Trump administration. But this felt too far for him.

    Goldberg: John Kelly then goes to the White House as chief of staff and is there when all of this is still going on. What role did he play there?

    Dickerson: Kelly told me that his approach to opposing family separations was to focus purely on the logistics. When the idea is formally proposed to him, he requests a briefing to find out whether it’s possible. And he learns, rightly, that the federal government did not have the resources to impose such a program without total chaos, which we ultimately saw—without losing track of parents and kids, without really inhumane situations where kids are being physically taken out of their parents’ arms. You need training, theoretically, to do this in a way that isn’t chaotic if you’re going to do it at all.

    He told me that he knew that appealing to the president and to Stephen Miller on some sort of moral basis wasn’t going to be effective. They weren’t going to listen. Instead, he said, you focus purely on the logistics. “It’s not possible. We just can’t do it.” He would say, “Mr. President, if you want to pursue this, you need to go ask Congress for the money,” knowing that Donald Trump wouldn’t be willing to do that. The problem is that when you ask these more hawkish members of the administration what their understanding of John Kelly’s view is, they would say to me, “Well, I didn’t know he had any issue with it. All he said was that we needed more money; we needed more training.” You can see that there’s logic behind Kelly’s approach, but there’s also, as a result of it, repeated meetings where this idea is being discussed. He could have jumped up and down and screamed and said, “I oppose this; I don’t want to do it.” But he didn’t. He just said, “Sir, we don’t have the money.”

    Goldberg: I mean, to be fair to Kelly, he did have a reasonable understanding that Trump would never respond to the humanitarian argument.

    Dickerson: There are so many different approaches that people say they took to try to prevent this, and it ultimately didn’t work. The higher the numbers rose, the more obsessed Donald Trump became with finding some way to minimize them.

    Goldberg: I do want to ask about two people whose names are very intimately associated with this. Kirstjen Nielsen, who was the DHS secretary and signed off on this, and Stephen Miller. I want you to talk about her role, which is more complicated, morally, than we initially thought. And Miller, who obviously is still the ideological driver of a whole set of policies.

    Dickerson: Kirstjen Nielsen came into the Trump administration a moderate. She was a cybersecurity expert who helped to establish DHS the first time under George W. Bush. No experience in immigration, and no real strong feelings about immigration. She’s one of a lot of people whom I interviewed who joined DHS under Trump and just said, “I didn’t know all that much about immigration. It wasn’t that important to me.” From the very beginning, they seemed a bit misguided in terms of what their expectations for their job might look like, given how much this White House really cared about the issue.

    Family separations are proposed to her right after she’s confirmed, in December of 2017, and she says, “Absolutely not. John Kelly has said no to this. I’m not doing it. I oppose it. I don’t believe in it.” Over time, this alternative version of achieving the same end is proposed to her via prosecution, and conveyed to her in these terms that are quite bland. You know, “We’re going to pursue a prosecution initiative. There are people who have been committing misdemeanor crimes; we’ve been letting them go simply because they’re parents.” There was a lot of fearmongering around this idea that a lot of the parents might have been smugglers, that families may not have actually been related at all, that these children might all have been victims of trafficking. There’s no evidence to support that a significant number of those false families existed. She’s also told, “It’s been done before,” and that systems and processes exist to prevent chaos from ensuing. And so, based on that information, she ends up approving the policy.

    Another really important thing to know about her is she came into her role at a disadvantage because she was viewed as a moderate. She was one of a lot of people who were viewed very skeptically in the White House.

    Goldberg: Are these people who are trying to prove they’re tough so that Donald Trump likes them?

    Dickerson: Or keeps them in their job.I heard in my reporting that, in fact, “You’re not tough enough” is a quote that Trump repeated to Nielsen all the time. At one point an adviser suggested, “Maybe you should write a memoir and call it Tough Enough because he’s always telling you you’re not tough enough.” Nielsen was always trying to kind of meet these expectations and show that she wasn’t a closeted liberal. She eventually signs off on this policy that she intellectually, at least prior, seemed to totally oppose, but had convinced herself of a lot of illogical realities and decided, Okay, I agree to zero tolerance. She’s a really smart person, but she worked so hard to please her bosses.

    The other person you were asking about was Stephen Miller. What I understand from people close to him and familiar with his thinking is that he continues to believe that President Trump’s harshest immigration policies were Trump’s most popular and successful accomplishments. I think he still believes in separating families and doing anything to seal the border, stopping at nothing. He’s even made clear to close confidants that the groundwork has been laid so that a future Trump administration, or a future Republican administration that looks like Trump’s, can pursue these policies even more quickly and even more dramatically.

    He exerted pressure really kind of shamelessly. He would call not only Kirstjen Nielsen, who was Homeland Security secretary, but all of her advisers and even lower people in DHS: people who had no authority to sign off on anything. He was calling people incessantly to press for his policies, trying to get buy-in. I heard about something he would do on a conference call where he would introduce an idea and say, “Hey, I believe X, Y, and Z needs to happen. And this head of this division of DHS agrees with me.” Then that head of the division might say, “Oh, well, I have some questions about that. You know, I’m not exactly sure.” And Stephen would say, “Well, are you saying that this isn’t a priority?” And they would say, “Oh, no, I do agree with you that it’s a priority.” And Stephen would say, “Great; I have your support.” And then he would go into White House meetings and then repeat it and say that he had buy-in from DHS. He was bullying people into accidentally or tacitly or passively agreeing with his ideas. He was not embarrassed to keep people on the phone after midnight, ranting, not even letting the other person speak. It was a singular focus for him.

    Goldberg: John Kelly would give him the cold shoulder. But not everybody had John Kelly’s power, right?

    Dickerson: Exactly. And John Kelly is a career military official and general. He believed really strongly in the chain of command. He couldn’t believe that Miller would call people below Kelly and make demands and try to pressure Kelly into making decisions. And so Kelly would call the White House and actually try to get Miller in trouble. He’s one of the few people to do it. But other people much higher in the official chain of command, such as cabinet secretaries, really let themselves be bullied by Miller. When I would ask why, they basically just said Miller had this mystique. He was so close to the president and was protected because of this narrative that immigration is the reason why Donald Trump was elected president and was the key to him being able to hold on to power. Because of that, Miller was insulated from any kind of accountability, even as he defied the chain of command over and over again.

    Goldberg: Do you think that these same people, if they came back to government, would do it better? Do you think that they have learned lessons about how to try to pull this off in a more efficient, effective way that wouldn’t draw so much attention?

    Dickerson: I do think that a lot of them still believe in this idea, and they’ve taken lessons away from the experience in order to be able to “do it better.” They didn’t have a system for keeping track of parents and kids, so children were sent over to the Department of Health and Human Services, which houses any kid who’s in federal custody on their own. That agency doesn’t have computer systems that talk to DHS. Something like that could be updated. I do think that these officials would go into such a policy in the future a little bit more eyes open about what would actually happen once the separation occurs. But they still believe in this idea. And a lot of them, Tom Homan and many others, would sort of whisper out of the side of their mouth to me in interviews like, “Nobody really likes to say this, but it really worked. And zero tolerance was effective.” Again, the data that they’re citing is inaccurate. There isn’t evidence that family separations were effective. In fact, after zero tolerance ended was the year when a million people crossed the border under President Trump. It was a record-breaking year for border crossings.

    Goldberg: Are there any heroes in the story, from your perspective?

    Dickerson: There are a lot of people within the federal bureaucracy who tried to prevent family separations from taking place. Within the Health and Human Services agency, which cares for children, there was a man named Jonathan White who oversaw, at the beginning of the Trump administration, the program that houses kids in federal custody. He found out about family separation in an early and rare meeting where you actually had HHS invited to meet with the law-enforcement side. Normally those two agencies—which have to work together on immigration—really don’t play well together, because HHS is made up of a lot of people like White, who are social workers and have backgrounds in child welfare, and then are sitting in the room with cops. It’s a fraught relationship that is detrimental for all sides.

    White finds out in an early meeting about this proposal to separate families. And he starts writing up reports mentioning that the agency did not have enough space to house children who are separated, who tend to be younger than those who crossed the border on their own. They didn’t have the resources to deal with the emotional fallout that was easily anticipated by any expert familiar with child welfare and the state a child is going to be in when they’ve just been separated from their parent. He also pointed out that children who cross the border with their parents don’t necessarily have anywhere to go. A child who chooses to cross the border on their own is typically coming here because they have an aunt or a relative, somebody who can take them in in the United States. A child who comes to the United States with their parent is expecting to remain with their parent. Whether they get asylum status or are ultimately deported, the expectation is that they’re going to stay together. And so White started to point out, along with several of his colleagues, that not only did they believe this was a bad idea, the resources just didn’t exist.

    You have versions of that same fight, that same argument, being made within DHS, the DOJ, and the U.S. Marshal system. I found examples in all of these places of people within the federal bureaucracy who tried to raise concerns with the White House, with people in their agency leadership, about why this was such a bad idea. There are a lot of people who fought back, and ultimately they didn’t win the argument.

    Goldberg: What’s your assessment of the success of President Biden’s executive order setting up the task force for family reunification? How many children do we still think are out there floating in the bureaucratic abyss who haven’t been unified with their parents?

    Dickerson: Almost all of the children who were separated have been released from federal custody. If they haven’t been reunified with their parents, they’re in the care of a sponsor: an extended relative or a family friend who went through an application process and was approved to take that child in. That’s very different from reuniting them with the parent with whom they crossed the border, with whom they were living and planning to continue living more than four years ago. That number is between 700 and 1,000—those who have not been officially reunited with their parents, according to government records. Some of them may have, and are thought to have found, their parents on their own and just not reported it to the U.S. government, kind of understandably—not wanting to deal with the U.S. government anymore and fearing future consequences.

    The Biden administration had a really tall order in front of it when this task force to reunify separated families was established. So much time had passed, and record keeping was so poor that they had very little to work with. Thus far they’ve been able to track down more than 400 families that have been reunified, and there are several hundred more who are in the process of applying. What I hear from the ACLU and advocacy groups is that the Biden administration is working really hard and doing its best to reunify these families, and they’ve had a significant amount of success in the face of this challenge.

    But now they’re dealing with really complicated cases. I’ve heard about parents, for example, who were deported without their kids. That happened in over 1,000 cases. They’ve been back at home since then, and they’ve had to perhaps take custody of an extended relative’s child. I heard about one parent whose sister had been killed. And so the sister’s children were now being taken care of by the separated parent. So then the separated parent is applying to come back and rejoin their own child. And are those other children eligible to come to the United States? It’s not totally clear. I mean, this is what happens. It’s very messy logistically when you separate a family for four years and then try to bring them back together. And so the numbers are shrinking, but the challenge is kind of growing in terms of getting these final families reunified.

    Goldberg: Something that, in the colloquial sense, is completely unbelievable to me is that when family separation actually started, no one—for weeks—thought to even write down, keep a log, an Excel spreadsheet, of where the children were going, who their parents were. You could define that as negligence, but negligence bleeds over into immorality very quickly. That, to me, of all the incredible reporting that you did, struck me as almost too much. What for you is the aspect of this entire multiyear saga that you still can’t get your mind around? What’s the thing that still stays in your mind as, “I can’t believe that actually happened?”

    Dickerson: The one that I still can’t really believe is the number of people I interviewed who held very significant roles in DHS or in the White House overseeing this issue, to whom I had to explain basic tenets of the immigration-enforcement system. They would say to me, “We never expected to lose track of parents and children. Couldn’t have imagined things would go as poorly as they did.” That just doesn’t make any sense. You can call up any prosecutor in the country and ask them, “Hey, tomorrow I want to start prosecuting hundreds of parents at a time who are traveling with young children who are outside of their communities, with nobody nearby to take those children in. And by the way, they don’t speak the language that most government officials talking to them are going to be using. Is that going to work?” They would tell you it obviously won’t. I was shocked that, to this day, many people involved in this decision making still don’t understand how immigration enforcement works.

    Watch: Atlantic editor in chief Jeffrey Goldberg in conversation with staff writer Caitlin Dickerson

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