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  • Why Kevin McCarthy Can’t Lose George Santos

    Why Kevin McCarthy Can’t Lose George Santos

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    The Republican Party has had no better friend than Nassau County in the past few years.

    Of America’s largest counties, few have turned more sharply toward the GOP than New York City’s neighbor to the east. This collection of Long Island suburbs swept Democrats out of local office in 2021, and last fall, Nassau County voted resoundingly Republican in New York’s gubernatorial race. Most important for the national GOP, the county helped elect three Republicans to Congress, including two candidates who flipped Democratic seats in districts that President Joe Biden had carried in 2020.

    Representative George Santos was one of those recent winners, and now Nassau County Republicans are worried that his abrupt fall from grace will cost the GOP far more than the seat that his lies helped the party pick up in November. They want Santos to step down, even though that means his seat would be vacant until a special election later this year, which the Democrats would aggressively contest. Local Republicans are flummoxed that national party leaders, starting with House Speaker Kevin McCarthy, haven’t joined their united call for Santos to resign. And they see McCarthy’s continued tolerance of Santos as an attempt to hold on to a Republican vote in the near term without enough consideration for whether he’d lose it—and cause Republicans to lose many others—in the longer term.

    Tom Nichols: Amazingly, George Santos is a member of Congress

    “It’s the right thing to do morally, ethically, and politically,” former Representative Peter King, a Long Island Republican who represented the district next to Santos’s in the House for 28 years, told me about trying to oust Santos. “If you want to keep controlling the Congress, you can’t just have the short-sighted view that you need his vote next week or next month. You’re gonna lose all the votes in two years when you’re no longer in the majority.”

    With 2024 in mind, and as the list of Santos’s biographical fabrications grows (seemingly by the day), Nassau County’s GOP machine has treated the congressman-for-now as a boil to be lanced.

    “As far as I’m concerned, he’s nonexistent. I will not deal with him. I will not deal with his office,” Bruce Blakeman, the Republican who was elected Nassau County executive in 2021, told me. Last week, Blakeman joined a group of local GOP leaders, including county Republican Party Chairman Joseph Cairo and Representative Anthony Garbarino, in demanding that Santos resign.

    Yet for the moment, the political imperatives of Long Island Republicans no longer align with those of McCarthy, who plainly cannot afford to lose Santos’s vote with such a narrow margin in the House. Santos backed McCarthy in all 15 ballots for speaker earlier this month, and McCarthy’s allies rewarded him with a pair of committee assignments earlier this week. The new speaker said that Santos has “a long way to go to earn trust” but has made no move to sanction him.

    “The voters of his district have elected him. He is seated. He is part of the Republican conference,” McCarthy told reporters last week.

    Democrats have already filed a complaint about Santos with the House Ethics Committee, and he is under investigation by federal and local prosecutors in New York who are reportedly looking into whether he committed financial crimes or violated federal campaign-disclosure laws.

    Santos has defied calls to resign, and McCarthy might need his vote even more should another House Republican, Representative Greg Steube of Florida, miss an extended period of time after he sustained serious injuries from a 25-foot fall off a ladder earlier this week.

    McCarthy’s office did not respond to requests for comment. The National Republican Congressional Committee, which traditionally backs GOP incumbents, echoed McCarthy’s ambivalence toward Santos. “Voters in New York will have the final say on who represents them,” NRCC spokesperson Jack Pandol told me by email. “Rep. Santos will have to earn back their trust as he serves them in Congress.”

    Steve Israel: How a perfectly normal New York suburb elected a con man

    King and others in Nassau County are trying to impress upon McCarthy that the longer he stands by Santos, the more damage he will do to a Republican brand that has been on the rise. “The only reason Kevin McCarthy has the majority is because of the very close marginal seats that Republicans won in New York,” King said. “We can lose all of them in the next election.”

    Even if McCarthy wanted to force Santos out, however, there’s not much he can do. He could try to expel him, but that would take the support of two-thirds of the House, and members of both parties might be leery of setting precedent by kicking out a member who has not been charged, much less convicted, of a crime. King suggested that McCarthy insist on an expedited investigation by the Ethics Committee—the panel’s probes tend to drag on for months—but there’s little history of that either.

    Election to the House “is an unshakable contract for two years,” Doug Heye, a former House GOP leadership aide who has advised lawmakers ensnarled in ethics investigations, told me. “Unless two-thirds of the House say, ‘Get out of here,’ or you give it up yourself, nothing happens.”

    Santos has almost no incentive to leave of his own accord anytime soon, especially now that Long Island Republicans have all but foreclosed the possibility of his winning renomination to his seat. “He’s not going to have a career. He’s not going to have a public life, and he’s going to be ostracized in his own community,” Blakeman told me. Santos was wealthy enough to lend his campaign $700,000. But his present personal finances are, like so much else about his life, a mystery, so he may need the paychecks that come with a $174,000 annual salary. And his seat could be a crucial bit of leverage in potential negotiations with prosecutors, Heye noted; resigning his seat, in that scenario, could help him avoid other penalties, including prison time.

    As his struggle just to get the speakership demonstrated, McCarthy doesn’t exactly have an ironclad grip on his conference. The Republicans from Nassau County seem to realize that the new speaker has limited sway over Santos. But McCarthy’s decision to protect and even validate Santos’s standing inside Congress is at odds with a party clinging both to its House majority and to its precarious stronghold on Long Island. “I’ve dealt with people with all sorts of issues,” Blakeman told me,” and enabling them is not a good thing.”

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    Russell Berman

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  • Speaker in Name Only

    Speaker in Name Only

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    Having at long last put down a rebellion from within his party, Kevin McCarthy is now House speaker. He finally has the gavel he’s long coveted, but the job he secured after 14 consecutive drubbings is not the one he envisioned.

    Last night, he suffered one more indignity to get it, perhaps the most stunning in a week’s worth of humiliations. McCarthy had to literally beg his most hated Republican foe, Representative Matt Gaetz of Florida, for the deciding vote, and a fight nearly broke out on the House floor. But after 14 failed votes, it was finally over.

    McCarthy’s victory on the 15th ballot concluded an extraordinary week of defeats that froze half of Congress and turned the California Republican into a national laughingstock. The denouement was the most dramatic scene yet, as the House reconvened for what McCarthy assured reporters would be the final victorious vote. Earlier yesterday, McCarthy had convinced all but six of his GOP opponents to support him, and he needed only to turn two more. But Gaetz, who had repeatedly vowed never to support him, waited until the very end and withheld his vote one more time. In full view of C-Span’s cameras, Gaetz refused animated appeals from McCarthy’s closest allies and even from the would-be speaker himself. McCarthy walked over to Gaetz, spoke to him for a few minutes and then, head down, slumped back to his chair. A furious Representative Mike Rogers of Alabama had to be physically restrained from lunging at Gaetz.

    Dejected and confused, McCarthy’s allies moved to adjourn the House until Monday. But while that vote was going on, McCarthy secured the acquiescence of Gaetz and the remaining holdouts. The House stayed in session and voted again. “Madam Clerk, I rise to say, ‘Wow,’” Democratic Representative Dean Phillips of Minnesota said to laughter from a stunned chamber. On the 15th and last ballot, McCarthy’s remaining GOP opponents all voted “present” and allowed McCarthy to clear the majority threshold without their explicit support.

    With the speaker’s gavel in hand, McCarthy will soon find out whether it was all worth it. To end the crisis, he cut a deal that essentially traded away a sizable chunk of power from the position, placing the new speaker at the mercy of the very hardliners who had thwarted him.

    Read: Kevin McCarthy’s predicament is a warning

    Under the agreement McCarthy struck, any Republican will be able to demand a vote on his ouster. McCarthy is reportedly guaranteeing the far-right House Freedom Caucus enough seats on the Rules Committee to give the group an effective veto over most legislation that comes up for a vote. He’s committing the party to pursuing steep—and, in all likelihood, politically unpopular—budget cuts while ensuring a partisan brawl over the debt ceiling that could damage the nation’s economy.

    What transpired this week was the most prolonged stalemate to begin a new session of Congress since before the Civil War. McCarthy’s struggle to lock down the speakership illuminated just how much of a challenge any Republican would have in leading a narrow, deeply divided majority. But his capitulation to the far-right holdouts could make the House all but ungovernable.

    For many if not most of the renegades, that was precisely the point. They saw the modern speakership, whether in Republican or Democratic hands, as a vessel for corrupt deals that resulted in too much spending and a bloated federal government. If a byproduct of decentralizing power in the House is dysfunction, they reasoned, so be it.

    McCarthy’s concessions have frustrated and angered some of his fellow Republicans. At least one McCarthy supporter, Representative Tony Gonzales of Texas, vowed to oppose a package of House rules formalizing much of the agreement between the new speaker and the holdouts. But for the most part, more moderate House Republicans have given McCarthy wide latitude to negotiate.

    Earlier this week, it looked as if McCarthy’s bid for speaker had stalled and that, for the second time in eight years, he might be forced to withdraw his nomination in the face of conservative opposition. But having evidently determined that a weakened speakership was better than no speakership, McCarthy persisted, dispatching emissaries to a flurry of meetings between failed floor votes. Progress came slowly, and then nearly all at once. McCarthy suffered 21 GOP defections on eight straight votes between Wednesday and Thursday. “Mr. McCarthy does not have the votes today. He will not have the votes tomorrow, and he will not have the votes next week, next month, next year,” Gaetz said on the floor before the 12th failed vote yesterday afternoon. A group of McCarthy’s allies walked out of the chamber in disgust, and it was on that ballot that McCarthy turned his faltering candidacy around. He flipped 14 of the 21 defectors, who voted without enthusiasm for the GOP leader while citing the emerging agreement. After one more vote, Republicans successfully adjourned the House to buy time for absent members to come back last night.

    McCarthy will likely receive some credit for sticking it out. He can also take some solace in the fact that expectations for what House Republicans could accomplish with a narrow majority are already quite low. The mere fact of a Republican majority in the House alongside a Democratic-controlled Senate guarantees that neither party’s legislative wish list will make it to President Joe Biden’s desk.

    Ask most House Republicans what they realistically hope to do over the next two years, and the answer is some variation of the phrase “hold Joe Biden accountable.” In the near term, that means issuing subpoenas and holding hearings focused on everything from the administration’s Southern border policy to Hunter Biden’s personal life and business dealings. Some members of the House GOP conference want to pursue the impeachment of Biden Cabinet officials such as Homeland Security Secretary Alexander Mayorkas, and potentially even the president himself, but it was already questionable whether Republicans could muster the votes for those moves with such a small number of votes to spare.

    McCarthy must confront how to raise the debt ceiling and how to keep the government open when the current fiscal year ends on September 30. His opponents have extracted promises that he’ll seek deep spending cuts alongside each task, which will undoubtedly be opposed by Democrats, who hold an equal share of power in the Senate and in the White House. Even before reports of his concessions were confirmed, the top Democrat on the House Appropriations Committee, Representative Rosa DeLauro of Connecticut, issued a statement warning that the GOP’s proposed budget cuts were “all but guaranteeing a shutdown.”

    For McCarthy, however, those are crises for another day. For now, he has won over just enough of his critics, and with it, the speakership. All he had to do was sacrifice power, and no small part of his dignity, to get it.

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    Russell Berman

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  • COVID Antibody Treatments Are in Decline

    COVID Antibody Treatments Are in Decline

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    For the first couple of years of the coronavirus pandemic, the crisis was marked by a succession of variants that pummeled us one at a time. The original virus rapidly gave way to D614G, before ceding the stage to Alpha, Delta, Omicron, and then Omicron’s many offshoots. But as our next COVID winter looms, it seems that SARS-CoV-2 may be swapping its lead-antagonist approach for an ensemble cast: Several subvariants are now vying for top billing.

    In the United States, BA.5—dominant since the end of spring—is slowly yielding to a slew of its siblings, among them BA.4.6, BF.7, BQ.1, and BQ.1.1; another subvariant, XBB, threatens to steal the spotlight from overseas. Whether all of these will divvy up infections in the next few months, or whether they’ll be pushed aside by something new, is still anyone’s guess. Either way, the forecast looks a little grim. None of the new variants will completely circumvent the full set of immune defenses that human bodies, schooled by vaccines or past infections, can launch. Yet all of them seem pretty good at dodging a hefty subset of our existing antibodies.

    For anyone who gets infected, such evasions could make the difference between asymptomatic and feeling pretty terrible. And for the subset of people who become sick enough to need clinical care, the consequences could get even worse. Some of our best COVID treatments are made from single antibodies tailored to the virus, which may simply cease to work as SARS-CoV-2 switches up its form. Past variants have already knocked out three such concoctions—REGEN-COV, sotrovimab, and bamlanivimab/etesevimab—from the U.S. arsenal. The only two left are bebtelovimab, a treatment for people who have already been infected, and Evusheld, a crucial supplement to vaccination for those who are moderately or severely immunocompromised; both are still deployed in hospitals countrywide. But should another swarm of variants take over, these two lone antibody therapies could also be obsolete within months, if not weeks. “It seems like the writing is on the wall,” says Erin McCreary, an infectious-disease pharmacist at the University of Pittsburgh Medical Center. “I live constantly low-key worried that I’m not going to have an active therapy for my patients, and I won’t be able to help them.”

    All of this bodes poorly for this winter and beyond. In the near term, millions of immunocompromised people could be left without viable options either to keep SARS-CoV-2 at bay or to temper its blaze once an infection begins to burn. And that loss would set a troubling precedent for seasons to come. The business end of the virus “is now adapting so rapidly that I don’t know how it’s going to be possible for monoclonals to keep up,” says Jeanne Marrazzo, an infectious-disease physician at the University of Alabama at Birmingham. Experts may need to revamp the strategies they use to bring new therapies to market—or find themselves, once again, in a serious bind. “I worry,” Marrazzo told me, “that we’re on a razor’s edge.”

    Whatever happens this winter, doctors will still have some options to treat COVID patients. Experts don’t think the virus will develop widespread resistance to our antiviral drugs—molnupiravir, remdesivir, and Paxlovid—“anytime soon,” Marrazzo said. But the vanishing of effective antibody therapies would still leave a massive hole that other treatments can’t fill. The benefits of molnupiravir seem lackluster at best; remdesivir offers a few more perks but is a hassle to administer, requiring several days of infusions. And although Paxlovid has worked wonders for people in high-risk groups, one of its ingredients can screw with a long list of other drugs. McCreary has seen many patients hospitalized, she told me, because their physicians prescribed Paxlovid without properly adjusting their regular meds. “Plus,” she added, “Paxlovid tastes awful.”

    Read: Paxlovid mouth is real—and gross

    Monoclonal antibodies aren’t perfect. But at their best, they’re astoundingly effective and safe, and often the first thing McCreary reaches for when caring for newly infected people. Some patients are also “just more comfortable with monoclonal antibodies than they are with antivirals,” says Mari Nakamura, an infectious-disease specialist at Boston Children’s Hospital. And Evusheld remains the only COVID treatment that is authorized to guard people before they encounter the virus at all. People who don’t mount much of a response to vaccines can sign up for a pair of injections—one into each gluteal muscle—and expect to have their defenses buoyed for a good six months. “I see it as an extension of vaccines for those who are vulnerable,” says Jonathan Abraham, an immunologist and physician at Harvard Medical School.

    The greatest strength of these treatments, however, also happens to be their most glaring weakness. Monoclonal antibodies work their magic by glomming so tightly onto SARS-CoV-2’s surface that the virus can’t dock onto our cells. Their grip is ultra precise—enough so that it can be nullified by just one viral mutation in exactly the right spot. Those genetic changes have already booted antibody treatments from our lineup. Now the data hint that bebtelovimab might not work against BQ.1 or BQ1.1. The list of subvariants that might be able to resist Evusheld is even longer: BQ.1, BQ.1.1, BA.4.6, BA.2.75.2, BF.7, and XBB.

    Soon health-care providers will have to start making tough calls about when to retire these two antibody treatments—and with few hard rules to guide them. Resistance can be a pretty murky concept: Viral mutations sometimes soften an antibody’s grasp without totally obliterating it. With antibiotics, for example, doctors can respond to some forms of low-level drug resistance just by increasing the dose, McCreary told me. But COVID monoclonal antibodies are still new to the scene. Even when an antibody cocktail has clearly become functionally useless against a given set of variants, there’s no universal standard for deciding when those variants have become so common that the cocktail should be shelved. (When I asked the FDA about this, it declined to comment on specifics.) So the choice is often left up to individual hospitals, Nakamura told me, which can create a bit of a patchwork in how experts are approaching COVID treatment—and put a burden on surveillance efforts to deliver hyperlocal data in real time.

    In Pittsburgh, McCreary’s team has, in prior seasons, pulled monoclonals when they stop working against just 20 to 30 percent of the reported variant milieu. Alpana Waghmare, a physician at the Fred Hutchinson Cancer Center and Seattle Children’s Hospital, told me her threshold may be closer to about 50 percent, though she pointed out that the more the options dwindle, the more willing health-care workers may be to keep using a variant-mismatched antibody. Alfred Kim, a rheumatologist at Washington University in St. Louis, told me he’d need to see resistant variants make up “the majority in a region” before he’d even consider putting an antibody out to pasture. There’s little downside to administering the treatments, he said, and for his patients, the potential cost of withholding them is just too immense.

    Should bebtelovimab and Evusheld be forced from the stage in the coming months, they might, at least, have a few understudies waiting in the wings. Regeneron, the maker of the late REGEN-COV, has two antibody treatments in Phase 1 trials, according to a spokesperson; AstraZeneca, Evusheld’s parent, also has replacements in development, though a spokesperson declined to provide more details on where in the pipeline they sat. Eli Lilly, which manufactures bebtelovimab and the now-gone bamlanivimab/etesevimab, didn’t respond to my questions about whether they were cooking up new recipes for future use. Vir, which makes sotrovimab—still available overseas—is working on “several highly potent” new antibodies “that have shown activity against all COVID-19 variants tested to date including BQ1.1,” according to a spokesperson.

    Clearing drugs for human use remains a plodding process; all of those options could be months away from regular use. “The virus may have moved on” by then, Abraham told me. Already, experts are grappling with whether once-a-year shots will be enough to keep pace with coronavirus evolution; updates on the treatment side may have to come much faster. The problem could get worse as SARS-CoV-2 lineages continue to jockey for control. For the moment, at least, the leading variants are invalidating antibody treatments in relatively similar ways. But if variants diverge further, pharmaceutical companies could have an even tougher time devising broadly effective antibody therapies.

    Some experts are also concerned that the market for monoclonals may be going dry. Antibodies are expensive to produce, and with a turnover rate this high, the industry may not have much incentive to stay involved, McCreary told me. Marrazzo, too, thinks the urgency may have lessened with the advent of oral antivirals, and the rush to return to “normal.” If anything, though, the need for good monoclonal options may be growing in urgency. Treatments such as REGEN-COV and bamlanivimab/etesevimab once had clearance to be used in people right after they were exposed to SARS-CoV-2—a sort of emergency antiviral contraceptive. Now no monoclonals are available for so-called postexposure prophylactic use. Kids, too, could use more treatment options. Children under 12 are eligible for three-day courses of remdesivir, given by IV infusion—but those are a tough ask for many families who don’t have the time or means to make such frequent trips to the hospital, Nakamura told me. “And that’s pretty much it.”

    Yet no one would feel the loss of antibody-based COVID treatments more than the immunocompromised, Waghmare told me. “It’s this horrible nexus,” Marrazzo said: The most vulnerable people will lose their best options first. Many of those who received Evusheld in the spring will soon be due for their second set of injections, scheduled six months after the first. As of right now, “we’re still telling patients to come in,” McCreary told me. But that may not be the advice she gives next month, or the next. Robyn Ruth, of Augusta County, Virginia, is at that decision point now. Her first experience with the treatment, in April, was momentous: “I had my first hug since the beginning of the pandemic,” Ruth told me. “I just remember my knees buckled, because I hadn’t touched another human being in so long.” In the weeks after, Ruth felt safe enough to go to a couple of doctor appointments and visit a few friends, even garden in their company—activities she hadn’t engaged in since the start of 2020. But as variants continue to chip away at Evusheld’s efficacy, Ruth is steeling herself for the possibility that another dose won’t bring the same relief.

    Caregivers and patients alike must now strategize for what could be a very difficult winter stretch. Many immunocompromised people can still benefit from vaccines, even if not as much as others. Marrazzo also cautiously pointed out that if things get bad enough, some providers might go back to convalescent plasma—a treatment with just so-so effectiveness that’s hard to roll out in large quantities, and that doesn’t deliver consistent results—as a desperate stopgap. Other than that, though, it’ll come down to the behavioral measures that many Americans have long since abandoned: isolation, quarantine, masking, distancing.

    Read: It’s gotten awkward to wear a mask

    Nakamura told me she’s been struggling to deliver optimistic advice. “All they can do is try not to get the virus,” she said. She also worries about what might happen should her young patients actually fall ill. “Our hospitals are already overflowing,” she said, amid an early seasonal surge of respiratory viruses, including RSV, and a massive mental-health crisis. McCreary, too, knows many tough conversations are ahead. “There’s nothing worse than one day having something safe and highly effective,” she told me, “and the next day, it’s, ‘Sorry, we don’t have that anymore.’”

    For some, the simultaneous disappearance of bebtelovimab and Evusheld could almost rewind the clock to the pandemic’s start. Sara Anne Willette, a data analyst in Ames, Iowa, has a condition called common variable immunodeficiency that keeps her from making certain types of protective antibodies. She also has a history of anaphylaxis to antivirals, potentially making bebtelovimab her only postinfection treatment option should she fall ill. Willette’s second dose of Evusheld is scheduled for December, but she’s not sure whether, by that point, risking the trip will even be practical. “It feels like we’re back at square one,” she told me. “I get COVID, and it’s ‘go it alone.’”

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    Katherine J. Wu

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