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Tag: rural areas

  • The states where Americans are trading city lights for homestead life

    It’s not just preppers or back-to-the-land dreamers anymore. Across the U.S., families, digital nomads, and remote workers are trading city apartments for open skies and garden plots. According to Fannie Mae, mortgage applications in rural areas have surged 80% since the pandemic—and even as interest rates climbed, demand hasn’t slowed.

    Realtor.com data shows the same trend: between July 2019 and July 2025, rural home prices grew 64%, compared with 42% in metro areas. The so-called “rural discount” is shrinking (down to 14% from 25% just a few years ago), but affordability still plays a major role in why people are making the move.

    So where are the best places to start a homestead? We pulled together states that stand out for their soil, land prices, growing seasons, and strong homesteading communities.

    Georgia

    Georgia’s warm climate and fertile soil make it a gardener’s paradise. With extended seasons, you can grow just about anything here—from peaches to peanuts.

    Montana

    Montana offers affordable farmland and endless pastures, making it ideal for livestock. It’s the picture of rural self-sufficiency. The trade-off? Winters are harsh, rainfall is limited, and mountain growing seasons can be short. Still, for many families leaving crowded cities, that wide-open landscape is worth it.

    Idaho

    Idaho blends rich soil with a strong agricultural community that supports both newcomers and traditional farmers. It’s especially attractive for modern homesteaders who want both community ties and independence.

    Wyoming

    Vast, affordable land and strong wind power potential make Wyoming attractive for off-grid homesteaders. Ranching thrives here, but gardening is tougher—low rainfall and strong winds make cultivation a challenge.

    Missouri

    If your dream homestead is heavy on produce, Missouri delivers. The land is affordable, the soil is fertile, and the growing season is long. Humidity and summer pests can be frustrating, but for vegetable gardeners, it’s a rewarding state.

    Arkansas

    Arkansas offers mild winters, fertile land, and plenty of water, making it easy to raise both crops and livestock. Tornadoes and humidity pose challenges, but the balance of affordability and resources makes it popular with new homesteaders.

    Tennessee

    Tennessee has a long tradition of small-scale farming, affordable rural land, and abundant natural resources like water and timber. The climate is well-suited to gardening, though humidity and occasional severe weather are factors. Many families moving here say the strong sense of community is part of the appeal.

    Kentucky

    With its established farming culture, Kentucky offers fertile land for crops and livestock. For homesteaders seeking tradition and opportunity, it’s a welcoming state.

    Maine

    Homesteading is woven into Maine’s history. Summers are cooler and great for crops like berries and root vegetables, though the growing season is short. Winters are long, but many homesteaders here embrace the rhythm of the season. The cultural support for self-sufficiency makes up for the climate challenges.

    North Carolina

    North Carolina has it all—mountains, coastlines, fertile valleys, and affordable rural land. The long growing season is perfect for new gardeners.

    Texas

    Big land, big sky, and big potential—Texas is full of affordable rural acreage. It’s ideal for those who want to scale up, whether with crops or livestock. But heat, drought, and water access vary widely across the state, so choosing the right location is key.

    Oregon

    With rich soil and a culture of sustainability, Oregon has long been a hub for homesteading. Western Oregon’s rain can be overwhelming, and eastern Oregon is dry and less fertile, but with the right location, it’s one of the most rewarding states for modern homesteaders.

    Colorado

    Colorado shines for off-grid enthusiasts thanks to abundant sunshine for solar power. Rural land is relatively affordable, and the mountain climate suits livestock.

    Arizona

    Abundant sun makes Arizona perfect for solar energy and nearly year-round gardening. The catch? Extreme heat and limited water require careful planning and investment in irrigation. For those who want to grow food throughout the winter, it remains a top choice.

    South Dakota

    With low property taxes, affordable land, and a deep homesteading heritage, South Dakota appeals to those looking for a simple, grounded life. The growing season is short, but the land prices are hard to beat.

    Alaska

    Alaska is not for the faint of heart. Long summer days make for impressive growing potential, but the winters are punishing, and logistics can be tough. For those who crave independence and wild beauty, it’s the ultimate challenge.

    Florida

    If citrus, avocados, or tropical crops are your dream, Florida is the place. Warm weather and long seasons are ideal for growing, but pests, hurricanes, and humidity are constant battles.

    The bigger picture

    Each state has something unique to offer modern homesteaders. What unites them all is the growing appeal of self-sufficiency. Rising food costs, global supply chain worries, and the flexibility of remote work have made rural living more attractive than ever.

    Homesteading isn’t about one definition—it can be a remote cabin powered by solar panels or an acre with a garden and a few chickens. What matters is the balance: space, community, sustainability, and the chance to live closer to the land. And as the data shows, more Americans are taking the leap.

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  • Could South Carolina Change Everything?

    Could South Carolina Change Everything?

    For more than four decades, South Carolina has been the decisive contest in the Republican presidential primaries—the state most likely to anoint the GOP’s eventual nominee. On Saturday, South Carolina seems poised to play that role again.

    Since the state moved to its prominent early position on the GOP presidential-primary calendar in 1980, the candidate who has won there has captured the nomination in every contested race except one. Given Donald Trump’s overall lead in the GOP race, a victory for him in South Carolina over Nikki Haley, the state’s former governor, would likely uphold that streak.

    “We all underestimate how deeply ingrained the Trump message is in the rank and file of our party,” Warren Tompkins, a longtime South Carolina–based GOP strategist and lobbyist, told me. “Take the personality out of it: What he stands for, what he says he’ll do, and what he did as president; he’s on the money.”

    This year, though, there may be a twist in South Carolina’s usual role of confirming the eventual GOP winner: Even as the state demonstrates Trump’s strength in the primary, it may also spotlight his potential difficulties as a general-election nominee. Like the first contests in Iowa and New Hampshire, South Carolina may show that though most Republican voters are ready to renominate Trump, a substantial minority of the GOP coalition has grown disaffected from him. And in a general-election rematch, that could provide a crucial opening for President Joe Biden, despite all of his vulnerabilities, to attract some ordinarily Republican-leaning voters.

    “Trump is essentially the incumbent leader of the party who is not able to get higher than, say, 65 percent” in the primaries, Alex Stroman, a former executive director of the South Carolina Republican Party, told me.

    Local observers say Haley has run a textbook South Carolina campaign, barnstorming the state in a bus, appearing relentlessly on national television, spending heavily on television advertising, and notably intensifying her criticism of Trump as “unhinged” and “diminished.” Trump, meanwhile, has breezed through the state as quickly as a snowbird motoring down I-95 from New York to Florida for the winter. Yet he has retained an imposing lead reaching as high as two to one over Haley in the polls.

    “I think you can argue Haley is running a fantastic campaign” in South Carolina, Jordan Ragusa, a political scientist at the College of Charleston and a co-author of a history of the South Carolina primary, told me. “But the pool of available voters is just so small that no matter what she does, it’s going to be hard for her to move the needle.”

    Over the past generation, South Carolina has had an extraordinary impact in shaping the outcome of GOP presidential-nomination contests. The state moved near the front of the GOP primary calendar in 1980, when Republicans were just establishing themselves as a competitive force in the state. GOP leaders created the primary, with its unusual scheduling on a Saturday, as a way to generate more attention for the party, which had previously selected its delegates at a convention attended by party insiders.

    The other key factor in creating the primary was support from Ronald Reagan’s presidential campaign, including Lee Atwater, a prominent GOP strategist then based in South Carolina. South Carolina did what Atwater hoped when Reagan won it in a rout, after unexpectedly losing the Iowa caucus to George H. W. Bush.

    Reagan’s victory in South Carolina placed him back on the path for the GOP nomination and cut a mold that has endured, with only one exception, in every contested GOP presidential-primary race through 2016. Each of those races followed the same formula: One candidate won the Iowa caucus, a second candidate won the New Hampshire primary, and then one of those two won South Carolina and eventually captured the nomination. (The exception came in 2012, when a backlash to a debate question about his marriage propelled Newt Gingrich to a decisive South Carolina win over Mitt Romney, who recovered to claim the nomination.)

    In 2016, Trump’s narrow victory in South Carolina effectively cemented the nomination for him after he had lost Iowa to Senator Ted Cruz of Texas and then recovered to win in New Hampshire. A victory for Trump on Saturday would allow him to equal a feat achieved only by incumbent GOP presidents: sweeping Iowa, New Hampshire, and South Carolina.

    Three factors, above all, explain South Carolina’s enduring influence in the GOP race. One is that it reflects the overall Republican coalition better than either of the two states that precede it. In Iowa, the Republican electorate leans heavily toward evangelical Christians who prioritize social issues; in New Hampshire, where there are few evangelicals, economic conservatives focused on taxes and spending, as well as a sizable group of libertarian voters, have dominated. South Carolina is the synthesis of both: It has a large evangelical population and a substantial cohort of suburban, business-oriented Republicans outside its three principal population centers of Greenville, Columbia, and Charleston.

    “In a lot of ways, the state party here is a microcosm of the national party,” Jim Guth, a longtime political scientist at Furman University, in Greenville, told me. “We replicate the profile of the national party maybe better than New Hampshire [or] Iowa.”

    It has been possible for candidates over the years to win Iowa or New Hampshire primarily by mobilizing just one group, such as social conservatives in Iowa and moderate independents in New Hampshire. But because the South Carolina GOP contains so many different power centers, “you have to have a broader appeal,” Tompkins, who has worked in every GOP presidential primary since Reagan, told me.

    The second key factor in South Carolina’s importance has been its placement on the GOP calendar. From the outset, in 1980, the primary was designed by its sponsors as a “First in the South” contest that they hoped would signal to voters across the region which candidate had emerged as the favorite. As more southern states over the years concentrated their primaries on Super Tuesday, in early March, that multiplied the domino effect of winning the state.

    “Given the demographic alignment between South Carolina and a lot of the southern Super Tuesday states, and the momentum effect, it really made South Carolina pivotal,” Ragusa said.

    The third dynamic underpinning South Carolina’s influence has been its role as a fire wall against insurgent candidates such as John McCain in 2000 and Patrick J. Buchanan in the 1990s. South Carolina’s Republican leadership has usually coalesced predominantly behind the candidate with the most support from the national party establishment and then helped power them to victory in the state. That model wavered in 2012, when Gingrich won his upset victory, and even in 2016, when Trump won despite clear splits in the national GOP establishment about his candidacy. But most often, South Carolina has been an empire-strikes-back place where the establishment-backed front-runner in the race snuffs out the last flickers of viable opposition.

    All of these historic factors appear virtually certain to benefit Trump this year. Super Tuesday no longer revolves as much around southern states. But it remains a huge landscape: 15 states and American Samoa will all pick a combined 874 Republican delegates on March 5, nearly three-fourths of the total required to win the nomination.

    In the limited polling across the Super Tuesday states, Trump now leads, usually commandingly, in all of them. Haley has already announced campaign appearances in Super Tuesday states through next week. But with all of the Super Tuesday states voting just 10 days after South Carolina, it will be virtually impossible for Haley to close the gap in so many places at once without winning her home state or at least significantly exceeding expectations. Like earlier underdogs, she faces a stark equation: To change the race anywhere on Super Tuesday, she must change it everywhere through her showing in South Carolina.

    Saturday’s result could also reconfirm South Carolina’s other key historic roles. Trump is now the candidate of most of the GOP establishment—a dynamic reflected in his endorsement by virtually all of the leading Republicans in Haley’s home state. He’s also become the contender with the broadest appeal inside the Republican Party. Because Trump is so polarizing for the general public, it’s difficult to see him in that light. But South Carolina is likely to buttress the indications from Iowa and New Hampshire that Trump, as a quasi-incumbent, now has a broader reach across the Republican Party than Haley does, or, for that matter, than he himself did in 2016. In most South Carolina polls, Trump is now leading her with every major demographic group, except among the independents who plan to participate in the primary.

    Yet South Carolina, like Iowa and New Hampshire before it, will also provide important clues about the extent of the remaining resistance to Trump within the Republican coalition.

    Haley is likely to perform best among well-educated voters around the population centers of Columbia and Charleston. “Haley must run up the score with traditional Reagan Republicans who want to actually nominate a candidate who can win in the general election,” Stroman told me. “She is going to be absolutely swamped in the MAGA-rich right-wing upstate, and in rural areas across the state—so she needs the suburbs and cities to turn out to hopefully keep her closer than expected.”

    In New Hampshire, Haley finished closer to Trump than most polls projected, because a large number of independent voters, and even a slice of Democrats, turned out to support her.  She’ll need a similar dynamic to finish credibly in South Carolina, where she has said her goal is to exceed her 43 percent of the vote in New Hampshire. The better the showing for Haley among independents, and among college-educated voters in the suburbs, the stronger the general-election warning signs for Trump.

    Democratic voters could be a wild card on Saturday after relatively few of them turned out for the party’s own primary earlier this month. South Carolina does not have party registration, which means that any voter who did not participate in the Democratic primary can vote in the Republican contest. A group called Primary Pivot has launched a campaign to encourage Democrats and independents to swarm the GOP primary to weaken Trump. If Haley exceeds expectations in South Carolina, it will be because, as in New Hampshire, more independents and Democrats turn out for her than pollsters anticipated.

    Besting Trump for the nomination may no longer be a realistic goal for Haley if she loses her home state. But, after mostly dodging confrontation with Trump for months, she is now delivering a more cogent and caustic argument against him, and showing a determination to force Republicans to wrestle with the general-election risks they are accepting by renominating him. The biggest question in South Carolina may not be whether Haley can beat Trump, but whether the state provides her more evidence, even in defeat, to make that case.

    Ronald Brownstein

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  • What Trump’s Victory in Iowa Reveals

    What Trump’s Victory in Iowa Reveals

    Donald Trump’s victory in the Iowa caucus was as dominant as expected, underscoring the exceedingly narrow path available to any of the Republican forces hoping to prevent his third consecutive nomination. And yet, for all Trump’s strength within the party, the results also hinted at some of the risks the GOP will face if it nominates him again.

    Based on Trump’s overwhelming lead in the poll conducted of voters on their way into the voting, the cable networks called the contest for Trump before the actual caucus was even completed. It was a fittingly anticlimactic conclusion to a caucus contest whose result all year has never seemed in doubt. In part, that may have been because none of Trump’s rivals offered Iowa voters a fully articulated case against him until Florida Governor Ron DeSantis unleashed more pointed arguments against the front-runner in the final days.

    Trump steamrolled over the opposition of the state’s Republican and evangelical Christian leadership to amass by far the largest margin of victory ever in a contested Iowa GOP caucus. He drew strong support across virtually every demographic group—though, in a preview of a continuing general election challenge if he wins the nomination, his vote notably lagged among caucus-goers with at least a four-year college degree.

    The results as of late Monday evening showed DeSantis solidifying a small lead over former South Carolina Governor Nikki Haley for a distant second place behind Trump. Even though DeSantis held off Haley, his weak finish after investing so much time and money in the state—and attracting endorsements from local political leaders including Governor Kim Reynolds—likely extinguishes his chances of winning the nomination. That’s true whether he remains in the race, as he pledged on Monday, or drops out in the next few weeks.

    Though Haley could not overtake DeSantis here, she has a second chance to establish momentum next week in New Hampshire, where she is running close to Trump in some surveys. But the magnitude of Trump’s Iowa victory shows how far Haley remains from creating a genuine threat to the front-runner. Her support largely remained confined to an archipelago of better-educated, more moderate voters in the state’s largest population centers.

    After the Iowa results, “she’ll be the alternative to Donald Trump,” said Douglas Gross, a longtime GOP Iowa activist who supported Haley. Her credible showing “is not because of organization or message, because she didn’t have either. It’s because she’s perceived as the alternative to Trump and the other candidates tried to be Trump.”

    Haley, though, clearly signaled her intent to escalate her challenge to Trump as the race moves on to New Hampshire. In an energetic post-caucus speech, she debuted a new line of argument against Trump, linking him to President Joe Biden as an aging symbol of a caustic and divisive past that American voters must transcend. “Our campaign is the last best hope of stopping the Trump-Biden nightmare,” she insisted, in a line of argument likely to dominate her message in the week until New Hampshire votes on January 23.

    For Haley, the first challenge may be reversing the gathering sense in the party that Trump is on the verge of wrapping up the contest even as it just begins. The behavior of GOP elected officials in the final days before the caucus may have revealed as much about the state of the race as the result of the first voting itself. Trump in recent days has received a parade of endorsements, including from Utah Senator Mike Lee, who criticized him sharply in 2016, and Florida Senator Marco Rubio, whom Trump mercilessly belittled and mocked when he ran in the 2016 presidential race.

    As telling: Reynolds, the most prominent supporter of DeSantis, and New Hampshire Governor Chris Sununu, Haley’s most prominent backer, each declared in separate television interviews just hours before the vote that they would support Trump if he’s the nominee. Haley did the same in an interview on Fox: “I would take Donald Trump over Joe Biden any day of the week,” she told the Fox News Channel host Neil Cavuto on Monday, hours before she unveiled her much tougher message toward the former president Monday night.

    Trump himself revealed his confidence in a restrained victory speech Monday night that included rare praise of DeSantis, Haley, and Vivek Ramaswamy, who finished fourth and then dropped out of the race. Trump’s uncharacteristically sedate and conciliatory remarks suggested that he sees the opportunity to force out the others, and consolidate the party, before very long.

    Trump’s commanding lead in the vote testified to the depth of his victory. Results from the “entrance poll” of caucus-goers on their way to cast their votes underscored the breadth of his win.

    Across every demographic divide in the party, Trump improved over his performance in 2016, when he narrowly lost the state to Texas Senator Ted Cruz. This time, Trump won both men and women comfortably, according to the entrance poll conducted by Edison Research for a consortium of media organizations. He won nearly half of voters in both urban and suburban areas, as well as a majority in rural areas, the poll found.

    DeSantis won endorsements from much of the state’s evangelical-Christian leadership, but Trump crushed him among those voters by almost two to one, according to the entrance poll. In 2016, Iowa evangelicals had preferred Cruz to Trump by double digits. Trump on Monday also carried nearly half of voters who were not evangelicals, beating Haley among them by about 20 percentage points. In 2016, Trump managed only a three-percentage-point edge over Rubio among Iowa caucus-goers who were not evangelicals. (In both the 2012 and 2016 Republican presidential primaries, the candidate who won Iowa voters who are not evangelicals ultimately won the nomination.)

    Before Trump, the most important dividing line in GOP presidential primaries had been between voters who were and were not evangelical Christians. But on Monday night, as in 2016, Trump reoriented that axis: Education was a far better predictor of support for him than whether a voter identified as an evangelical.

    Trump carried two-thirds of the caucus-goers who do not have a four-year college degree, the entrance poll found on Monday night. That was more than twice as much as Trump won among those voters in 2016, when Cruz narrowly beat him among them.

    Other findings in the entrance poll also testified to Trump’s success at reshaping the party in his image. The share of caucus-goers who identified as “very conservative” was much higher than in 2016. About two-thirds of those attending the caucuses said they do not believe that President Joe Biden legitimately won the 2020 election. Rural areas that Trump split with Cruz in 2016 broke decisively for him this time.

    Yet amid all these signs of strength, the entrance poll offered some clear warning signs for Trump in a potential general election—as did some of the county-level results.

    Despite some predictions to the contrary, Trump still faced substantial resistance from college-educated voters, just as he did in 2016. In the entrance poll Monday night, he drew only a little more than one-third of them. That was enough to push Trump safely past Haley, who split the remainder of those voters primarily with DeSantis (each of them won just under three in 10 of them). But compared with the 2016 Iowa result, Trump improved much less among college-educated voters than he did among those without degrees.

    Trump’s relative weakness among college-educated voters in the 2016 GOP primary presaged the alienation from him in white-collar suburbs that grew during his presidency. Though Biden’s approval among those voters has declined since 2021, Trump’s modest showing even among the college-educated voters willing to turn out for a GOP caucus likely shows that resistance to him also remains substantial. When the results are tallied, Trump might win all 99 counties in Iowa, an incredible achievement if he manages it. But Trump drew well under his statewide percentage in Polk County, the state’s most populous; in fast-growing Dallas County; and in Story and Johnson, the counties centered on Iowa State University and the University of Iowa. (Johnson is the one county where Trump trails as of now.) Those are all the sorts of places that have moved away from the GOP in the Trump years.

    Also noteworthy was voters’ response to an entrance-poll question about whether they would still consider Trump fit for the presidency if he was convicted of a crime. Nearly two-thirds said yes, which speaks to his strength within the Republican Party. But about three in 10 said no, which speaks to possible problems in a general election. That result was consistent with the findings in a wide array of polls that somewhere between one-fifth and one-third of GOP partisans believe that Trump’s actions after the 2020 election were a threat to democracy or illegal. How many of those Republican-leaning voters would ultimately support him will be crucial to his viability if he wins the nomination. On that front, it may be worth filing away that more than four in 10 college graduates who participated in the caucus said they would not view Trump as fit for the presidency if he’s convicted of a crime, the entrance poll found.

    Those are problems Trump will need to confront on another day, if he wins the nomination. For now, he has delivered an imposing show of strength within a party that he has reshaped in his belligerent, conspiratorial image. The winter gloom in Iowa may not be any bleaker than the spirits tonight of the dwindling band of those in the GOP hoping to loosen Trump’s iron grip on the party.

    Ronald Brownstein

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  • Is Ben Wikler the Most Important Democrat in America?

    Is Ben Wikler the Most Important Democrat in America?

    The man who has been hailed as “the best state chair in the country” is not a national household name. He’s not even a household name in his own state. But on a recent afternoon in the small village of Grafton, Wisconsin, Ben Wikler might as well have been Bono.

    Two dozen middle-aged and retired volunteers stood in line to clutch the hand of the chair of the Wisconsin Democrats. “Thank you for everything you do,” they said, beaming at Wikler as he took a lap through the Ozaukee County party headquarters. “We’re so happy you’re here.” Like proud children before an admiring parent, the volunteers told him how much money they’d raised and how many doors they’d knocked on this summer.

    “This is Connie,” someone said, patting a woman’s shoulder. “She just won the school-board race.” “Yay, school board!” Wikler cheered.

    He was there to kick off the last day of door knocking for a Wisconsin state-assembly candidate who had very little chance of winning in solid-red Ozaukee County, an exurban district on the shore of Lake Michigan north of Milwaukee. But the point was not to win, it was to lose by less. That afternoon, Wikler managed to deliver a speech with almost the same inspirational zeal as Aragorn at the Black Gate. “This election is a demonstration to ourselves as Democrats and to the country that there is change happening right now,” he told the volunteers—and a reminder to Republicans “that Democrats have not given up on democracy.”

    Since becoming chair in 2019, Wikler has brought his party back from virtual irrelevance in Wisconsin. Four years after Donald Trump had demolished the so-called blue wall in the upper Midwest, Wikler’s leadership helped tip Wisconsin—and the entire presidential election—to the Democrats in 2020. Then, earlier this year, the millions of dollars Wikler had raised helped a progressive candidate prevail in the off-cycle state-supreme-court race, which will likely lead to a reworking of Wisconsin’s extremely gerrymandered maps.

    Wikler’s talent is getting people to show up. He does this by framing every race as the election of a lifetime. “Resources tend to flow toward the places where they can make a difference or their imagination has been captured,” he told me.

    Resources is something of a euphemism; he really means dollars. Thanks to legislation passed by Republicans a few years ago, Wisconsin is one of the few states in which individuals can donate unlimited amounts to political parties, which can, in turn, transfer unlimited funds to candidates. It is Wikler’s particular genius to have turned that weapon of fundraising against the party that made it law.

    In the run-up to next year’s presidential election, American eyeballs will once again be on Wikler’s home. “If we could have a Ben Wikler in all 50 states, the Democratic Party would be in better shape,” Jon Favreau, the podcaster and former Obama speechwriter, told me. But people may be getting tired of elections with existential stakes, however much the party spends persuading them to go out and vote. Capturing imaginations once again, especially on behalf of an elderly incumbent with less-than-great approval ratings, could be Wikler’s most formidable challenge yet.

    I hitched a ride to the Ozaukee County event with Wikler’s posse in their rented minivan. When I slid open the back door, I found the state party chair buckled into a seat in the middle row, his head grazing the ceiling. The 42-year-old Wikler, who is goateed and tall (6 foot 4), was wearing clear-framed glasses and a denim shirt over denim jeans. He looked like a Brooklyn dad—but Wikler is a dad from Madison, a fact he is very proud of.

    I’d hardly sat down before Wikler launched into a 30-minute refresher course, for my benefit, on Wisconsin’s idiosyncratic past. Robert La Follette and the state’s socialist roots. Senator Joe McCarthy. Governor Tommy Thompson’s welfare reform. Then more recent history: Scott Walker’s ascension to the governor’s mansion in 2011, and Republicans’ success in flipping both chambers of the state legislature. Walker’s Act 10 legislation, which eroded the power of public unions. The GOP’s controversial and secretive redistricting project.

    “How many times have you delivered that spiel?” I asked when he was done.

    He smiled. “There’s actually an extended version.”

    Today, Wikler lives in his childhood home on Madison’s west side with his wife, his three kids, and their enormous, excitable Bernese mountain dog. But before moving back to the upper Midwest, Wikler was the Washington, D.C., director of the progressive organization MoveOn, for which he led protests against Republican attempts to overturn the Affordable Care Act. Prior to that, Wikler hosted a politics podcast called The Good Fight after a spell as a researcher and producer for Al Franken. The former senator from Minnesota remains a close friend. “He’s just brilliant—really funny and a really good writer,” Franken told me of Wikler last month, over the phone. “He has the full package, and that’s hard to get in a state chairman.” (The title of Franken’s 2003 book, Lies and the Lying Liars Who Tell Them, was Wikler’s idea, Franken said.)

    Then, in 2016, Trump hurtled through the blue wall, winning Wisconsin’s Electoral College votes for the Republicans for the first time since Ronald Reagan in 1984. Which is why Wikler ultimately decided to move back home and help revive his party’s fortunes.

    As chair, Wikler is known for posting climactic Twitter threads about Wisconsin elections that go viral. He’s constantly giving interviews to convey the urgency of races up- and down-ballot. The central strategy of his chairmanship, Wikler told me, “has been to buy a bigger siren, and put it as high up as we possibly can.”

    Most state parties in America have somewhere around half a dozen full-time paid staff members, but Wikler has expanded his staff from 30 to 70. He has a comprehensive digital operation, an in-house research group, and a full-time staff of youth organizers.

    Since 2019, Wikler has used his connections in national politics to raise more than $110 million, an astoundingly high amount for a state party. His team’s most successful money-gathering endeavor was getting celebrities such as Robin Wright and Julia Louis-Dreyfus to care about the Badger State: In September 2020, the Wisconsin Democrats hosted a Zoom table reading of the 1987 film The Princess Bride that reunited most of the original cast. The event attracted more than 100,000 viewers and raised $4.25 million. So they did it twice more, with the casts of The West Wing and Veep.

    Wisconsin could have gone the way of neighboring Iowa, which has turned sharply to the right in these past six years. In the Badger State, the trend toward Democrats began in 2018, when many voters revolted against Trump. But thanks in large part to the machine that Wikler has built, the party has continued to win by bigger and bigger margins in the state’s metropolitan areas in the past few cycles, and it’s losing by smaller margins in the Republican-leaning suburbs of Milwaukee. Although Democrats nationally have been hemorrhaging voters in rural areas, they’ve managed to at least stop the bleeding in rural Wisconsin, Craig Gilbert, the retired Washington bureau chief for the Milwaukee Journal Sentinel, told me.

    Statewide elections have proved to be the most rewarding battlegrounds for Democrats. In Wisconsin, Biden beat Trump in 2020 by 20,000 votes, and last year Democratic Governor Tony Evers narrowly won reelection. The only major disappointment was Mandela Barnes’s loss to the incumbent Republican senator, Ron Johnson. But just this past spring, Wisconsinites elected Janet Protasiewicz to the state supreme court in a race that broke turnout records and attracted donations from George Soros, Steven Spielberg, and Illinois Governor J. B. Pritzker.

    Wikler’s legacy as a Democratic leader will be the nationalization of the state party’s donor base—something he’s achieved by arguing that Wisconsin is at the epicenter of America’s political battle. Whether that’s good for democracy is another matter.

    The wealthy Democrats from California or Illinois who’ve done much of the donating are not ideal stand-ins for regular Wisconsinites. “Elections shouldn’t be a tug-of-war between a handful of billionaires on the right and a handful of billionaires on the left,” Matthew Rothschild, the former executive director of the Wisconsin Democracy Campaign, told me. “But Ben didn’t make the playing field. Republicans in Wisconsin made the playing field. The U.S. Supreme Court made the playing field.”

    If Wikler’s strategy is to make politics in Wisconsin national, he is also committed to hyperlocal campaigning: Democrats should have a presence everywhere, Wikler believes. Which is why the van drove another two hours west from Grafton to Baraboo for an annual agricultural-equipment expo.

    The state party’s Rural Caucus had set up a tent between the crop-spraying-drone display and a demonstration area for grinding forest products. Wikler gave a pep talk to some of his members before striding over to the Sauk County Republicans’ tent. “Hi, I’m the Democratic Party chair,” he said, extending his hand toward a trio of 60-something men chatting in the shade. For a few minutes, the four men went back and forth, a little awkwardly, about the successes and failures of the former Governor Walker and whether any of them were particularly excited about a second nomination of Trump. (They weren’t.) It was all pleasant enough.

    Then, as Wikler turned to leave, one of the men took him aside. “I gotta tell you something,” he said, in a low voice. “I spoke with a gentleman over at your tent this morning, and I have never met a finer man or had a more reasonable conversation.” Wikler beamed. “As a party chair, that’s a delight to hear,” he replied.

    We left Baraboo in the late afternoon for a volunteer picnic in Middleton, a leafy Madison suburb along Lake Mendota. The gathering was held in a lush backyard, full of unruly flowering shrubs and the kind of wacky animal lawn ornaments that seem to announce, A Democrat lives here!

    The yard was full of gray-haired volunteers from different neighborhood door-knocking teams. “I don’t think we could have done anything without Ben,” JoAnna Richard, the host of the event, told me. “His leadership has been key: his connections, and how we fundraise and organize year-round.” A few minutes later, Wikler was giving his third and final motivational speech of the day, thanking people for their work over the past few years. We’re “building something bigger than any of us,” he told them. “You’re at the heart of that project, in a place that is the most key furnace for democracy—the key engine, the center of the web.”

    Republicans are working hard for a rebound in Wisconsin. Later this month, they’ll host the first debate of the GOP presidential primary in Milwaukee, and the Republican National Convention will be held in the same city next summer. That national attention will be good for the state party, which has recently under-raised Democrats.

    “They’ve been very good at getting Hollywood money,” Brian Schimming, the state GOP chair, told me by phone, with what sounded like a mix of shade and envy. “It’s hard to compete with” the Democrats’ celebrities and wealthy out-of-state donors, he said. “I need to nationalize Wisconsin a bit more.”

    This time around, Republicans are certainly going to be more focused on fundraising. “Ben would be kidding himself if he thinks he or his successor can always win the money race,” Rothschild told me. But money is not the race that ultimately matters.

    “I’d rather have my problem than the problem Ben has, which is an extraordinarily unpopular sitting incumbent,” Schimming told me. “Our folks are really fired up about this race.”

    Wikler, in fact, does seem a little nervous. He worries about a low-turnout election—and that people aren’t taking seriously enough the very real possibility of a second Trump presidency. “In 2020, people were ready to do anything to beat Trump. I had people retiring early and moving to Wisconsin to volunteer,” he told me in the car. “None of that’s happening right now.”

    Every recent presidential election in Wisconsin has been decided on a razor-thin margin, and Wikler’s job is to engage more than just the highly educated, high-income activist types. He’ll need to stitch together a delicate coalition and get them all to fill out a ballot: young people in Dane County; Black voters in Milwaukee; moderates in the suburbs and the small cities around Green Bay. The hurdles are already high, and Biden doesn’t exactly get many people’s blood pumping. “I’ve been concerned about that since 2020,” Favreau said. “It’s easy to see a scenario where a couple people say, ‘[Biden’s] too old. I’m going back to Trump.’” It’s even easier to see a situation in which some Wisconsinites, weary of it all, simply don’t vote.

    In JoAnna Richard’s backyard in Middleton, Wikler was winding up his pep talk, a little breathlessly. They’d be working “throughout this year, and into next spring in the local elections, and into next fall in 2024,” he said. “And then we’ll continue six months after that in the 2025 local elections! And the next state-supreme-court race—”

    A few people audibly sighed at this point, likely in anticipation of another two exhausting years door knocking and phone banking and envelope licking in defense of democracy. A man near me shouted, “We’re tired!” But that moment of wavering enthusiasm lasted only a fraction of a second before the whole group began to laugh.

    Sure, they’re tired. But for Wikler, they’ll show up.

    Will everyone else?

    Elaine Godfrey

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  • Telehealth Is Filling Gaps in Sexual-Assault Care

    Telehealth Is Filling Gaps in Sexual-Assault Care

    This article was originally published by Kaiser Health News.

    Amanda Shelley was sitting in her dentist’s waiting room when she received a call from the police. A local teenage girl had been sexually assaulted and needed an exam.

    Shelley, a nurse in rural Eagle County, Colorado, went to her car and called a telehealth company to arrange an appointment with a sexual-assault nurse examiner, or SANE. The nurse examiners have extensive training in how to care for assault survivors and collect evidence for possible criminal prosecution.

    About an hour later, Shelley met the patient at the Colorado Mountain Medical urgent-care clinic in the small town of Avon. She used a tablet to connect by video with a SANE about 2,000 miles away, in New Hampshire.

    The remote nurse used the video technology to speak with the patient and guide Shelley through each step of a two-hour exam. One of those steps was a colposcopy, in which Shelley used a magnifying device to closely examine the vagina and cervix. The remote nurse saw, in real time, what Shelley could see, with the help of a video camera attached to the machine.

    The service, known as “teleSANE,” is new at Shelley’s hospital. Before, sexual-assault patients faced mountains of obstacles—literally—when they had to travel to a hospital in another county for care.

    “We’re asking them to drive maybe over snowy passes and then [be there] three to four hours for this exam and then drive back home—it’s disheartening for them,” Shelley says. “They want to start the healing process and go home and shower.”

    To avoid this scenario, teleSANE services are expanding across the country in rural, sparsely populated areas. Research shows that SANE programs encourage psychological healing, provide comprehensive health care, allow for professional evidence collection, and improve the chance of a successful prosecution.

    Jennifer Pierce-Weeks is the CEO of the International Association of Forensic Nurses, which created the national standards and certification programs for sexual-assault nurse examiners. She says every sexual-assault survivor faces health consequences. Assaults can cause physical injuries, sexually transmitted infections, unwanted pregnancies, and mental-health conditions that can lead to suicide attempts and drug and alcohol misuse.

    “If they are cared for on the front end, all of the risks of those things can be reduced dramatically with the right intervention,” Pierce-Weeks says.

    Pierce-Weeks says there are no comprehensive national data on the number and location of health-care professionals with SANE training. But she says studies show that there’s a nationwide shortage, especially in rural areas.

    Some rural hospitals struggle to create or maintain in-person SANE programs because of staffing and funding shortfalls, Pierce-Weeks says.

    Training costs money and takes time. If rural hospitals train nurses, they still might not have enough to provide round-the-clock coverage. And nurses in rural areas can’t practice their skills as often as those who work in busy urban hospitals.

    Some hospitals without SANE programs refer sexual-assault survivors elsewhere because they don’t feel qualified to help and aren’t always legally required to provide comprehensive treatment and evidence collection.

    Avel eCare, based in Sioux Falls, South Dakota, has been providing telehealth services since 1993. It recently added teleSANE to its offerings.

    Avel provides this service to 43 mostly rural and small-town hospitals across five states and is expanding to Indian Health Service hospitals in the Great Plains. Native Americans face high rates of sexual assault and might have to travel hours for care if they live in one of the region’s large, rural reservations.

    Jen Canton, who oversees Avel’s teleSANE program, says arriving at a local hospital and being referred elsewhere can be devastating for sexual-assault survivors. “You just went through what is potentially the worst moment of your life, and then you have to travel two, three hours away to another facility,” Canton says. “It takes a lot of courage to even come into the first hospital and say what happened to you and ask for help.”

    Patients who receive care at hospitals without SANE programs might not receive trauma-informed care, which focuses on identifying sources of trauma, determining how those experiences may affect people’s health, and preventing the retraumatizing of patients. Emergency-department staffers may not have experience with internal exams or evidence collection. They also might not know about patients’ options for involving police.

    Patients who travel to a second hospital might struggle to arrange for and afford transportation or child care. Other patients don’t have the emotional bandwidth to make the trip and retell their story.

    That’s why some survivors, such as Ada Sapp, don’t get an exam.

    Sapp, a health-care executive at Colorado Mountain Medical, was assaulted before the hospital system began its SANE program. She was shocked to learn that she would need to drive 45 minutes to another county for an exam. “I didn’t feel comfortable doing that by myself,” Sapp says. “So my husband would have had to come with me, or a friend. The logistics made it feel insurmountable.”

    Sapp’s experience inspired her to help bring SANE services to Colorado Mountain Medical.

    Shelley and several other of the hospital system’s nurses have SANE training but appreciate having telehealth support from the remote nurses with more experience. “We are a rural community, and we’re not doing these every single day,” Shelley says. “A lot of my nurses would get really anxious before an exam because maybe they haven’t done one in a couple months.”

    A remote “second set of eyes” increases the confidence of the in-person nurse and is reassuring to patients, she says.

    Avera St. Mary’s Hospital in Pierre, South Dakota, recently began using teleSANE. Rural towns, farms, and ranches surround this capital city, home to about 14,000 people. The nearest metropolitan area is more than a two-and-a-half-hour drive.

    Taking a break from a recent busy morning in the emergency department, the nurse Lindee Miller rolled out the mobile teleSANE cart and colposcope device from Avel eCare. She pulled out a thick binder of instructions and forms and opened drawers filled with swabs, evidence tags, measuring devices, and other forensic materials.

    “You’re never doing the same exam twice,” Miller said. “It’s all driven by what the patient wants to do.”

    She said some patients might want only medicines to prevent pregnancy and sexually transmitted infections. Other patients opt for a head-to-toe physical exam. And some might want her to collect forensic evidence.

    Federal laws provide funding to pay for these sexual-assault exams, but some survivors are billed because of legal gaps and a lack of awareness of the rules. A proposed federal law, the No Surprises for Survivors Act, would close some of those gaps.

    SANE programs, including telehealth versions aimed at rural communities, are expected to continue expanding across the country.

    President Joe Biden signed a bill last year that provides $30 million annually through 2027 to expand SANE services, especially those that use telehealth and help rural, tribal, and other underserved communities. The law also requires the Justice Department to create a website listing the locations of the programs and grant opportunities for starting them.

    Arielle Zionts

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  • What the Georgia Runoff Revealed

    What the Georgia Runoff Revealed

    Senator Raphael Warnock’s win in yesterday’s Georgia Senate runoff capped a commanding show of strength by Democrats in the states that decided the 2020 race for the White House—and will likely pick the winner again in 2024.

    With Warnock’s victory over Republican Herschel Walker, Democrats have defeated every GOP Senate and gubernatorial candidate endorsed by Donald Trump this year in the five states that flipped from supporting him in 2016 to backing Joe Biden in 2020: Michigan, Pennsylvania, Wisconsin, Georgia, and Arizona.

    Coming even amid widespread discontent over the economy, this year’s Democratic sweep against the Trump-backed candidates underscores the continuing resistance to the former president’s influence. In particular, Warnock’s decisive margins in Atlanta and its suburbs yesterday extended the Democratic dominance of white-collar (and usually racially diverse) metropolitan areas, as varied as the suburbs of Detroit and Philadelphia and the booming hot spots of Phoenix and Madison.

    “The huge question after the election of 2020 was whether the suburbs would snap back to the GOP column after Trump was no longer on the ballot,” Ben Wikler, the Democratic Party chair in Wisconsin, told me. “What we saw in 2022 was suburbs continuing to trend toward Democrats.”

    Apart from perhaps Michigan, none of these states appears entirely out of reach for the GOP in 2024. Whit Ayres, a longtime GOP pollster, told me that although suburban voters recoiled against “delusional candidates” who “parroted” Trump’s lies about the 2020 election, Republicans “could very well come back and win the suburbs” with “non-delusional candidates.”

    Of the five pivotal states from the last presidential election, Republicans this year actually performed best in Georgia, where the party swept the other statewide offices. Even Walker remained stubbornly close to Warnock in the final results, despite an avalanche of damaging personal revelations and gaffes. Across these states, Republican dominance in rural areas that the GOP consolidated under Trump continued through this year’s midterm and allowed several of his endorsed candidates, like Walker, to remain competitive despite big deficits in the largest population centers.

    But in the end, the Democratic strength in the largest metropolitan areas proved insurmountable for the seven Trump-backed candidates in governor or Senate races across these five states. The only Republicans who won such contests in these states were Georgia Governor Brian Kemp, who sharpened an image of independence by standing up to Trump’s efforts to overturn his 2020 loss in the state, and Wisconsin Senator Ron Johnson, who echoes many of Trump’s themes but has an established political identity apart from him. (Johnson barely held off his Democratic challenger, Mandela Barnes.)

    “You have a large percentage of Americans who are wary of MAGA and have now voted against MAGA three times,” Simon Rosenberg, the president of NDN, a Democratic research and advocacy group, told me. Rosenberg was the most forceful public skeptic of the “red wave” theory. “They are now going to have to take all those people and turn them into Republican voters in 2024. It’s certainly not impossible, but I’d much rather be us than them going into the 2024 election”

    In many ways, yesterday’s Georgia result underscored the partisan chasm that has left the country closely divided for at least the past decade. Walker was, by any objective measure, among the weakest general-election candidates for a major office either party has produced in modern memory. Tarred by an endless procession of scandals, prone to nonsensical statements on the campaign trail (as when he mused on the relative merits of vampires and werewolves), and unwilling or unable to articulate positions on many major issues, he nonetheless drew unflagging support from national Republican leaders and held the large majority of the state’s Republican votes.

    That Walker came as close as he did to winning underscores the growing parliamentary nature of House and Senate elections, in which fewer voters are casting their ballots based on personal assessments of the two candidates and more are deciding based on which party they want to control the national agenda.

    Yet all of that still left Walker, like the other Trump-backed candidates, short in the face of solid margins for Democrats in and around these states’ major population centers. Exit polls showed Democrats posting big advantages among all the demographic groups that tend to congregate in large metropolitan areas: young people, people of color, college-educated voters, secular voters, and LGBTQ adults.

    Thriving Cobb and Gwinnett Counties outside Atlanta, with a combined population of 1.7 million people, encapsulate the suburban evolution that has tilted the balance of power. For years, these counties were Republican redoubts: George W. Bush won them by roughly a combined 150,000 votes in the 2004 presidential race, and even as late as the hard-fought 2014 Georgia Senate race, the winning GOP nominee, David Perdue, carried each of them by double-digit margins.

    But both counties have grown more diverse. White people now make up only about three-fifths of the population in Cobb and a little more than half in Gwinnett, and nearly half of Cobb adults hold at least a four-year college degree. This has alienated them from a GOP that Trump has reshaped to reflect the cultural priorities and grievances of culturally conservative white voters, particularly those without college degrees or who live outside urban areas. Hillary Clinton narrowly carried both counties in 2016, Biden won just under 60 percent of the vote in each in 2020, and Warnock in November roughly matched Biden’s performance. As of the latest count, Warnock yesterday again carried about three-fifths of the vote in both Cobb and Gwinnett. He also ran up big margins in the suburban counties just south of Atlanta.

    The same patterns were evident in the large white-collar suburbs of the other states that Republicans must win back to recapture the White House in 2024. In Michigan, Governor Gretchen Whitmer, in crushing her Trump-backed opponent, Tudor Dixon, won a higher share of the vote in Oakland and Kent Counties than she managed in 2018 or than Biden did in 2020. In Pennsylvania, Senator-elect John Fetterman matched Biden in exceeding three-fifths of the vote in both Delaware and Montgomery Counties, outside Philadelphia. In Arizona, Senator Mark Kelly carried Maricopa County, centered on Phoenix, by almost 100,000 votes—more than doubling Biden’s margin in 2020, when he became the first Democratic presidential nominee to win the county since Harry Truman in 1948. In Wisconsin, Governor Tony Evers won booming Dane County, centered on Madison, by 25,000 more votes than he had in 2018, and an analysis of the statewide results showed him improving the most over his first election in the counties with the highest levels of educational attainment.

    After this year’s defeats, many analysts in both parties are dubious that Trump can recapture enough (and maybe any) of these five states in 2024. The bigger question facing Republicans is whether another candidate, one who does not have Trump’s personal baggage but who shares most of his culture-war views, such as Florida Governor Ron DeSantis, could perform much better.

    Republicans are generally optimistic that DeSantis could regain ground Trump has lost among suburban voters who leaned Republican not too long ago. They point to Georgia Republican Governor Kemp performing better than Walker did in the Atlanta suburbs as evidence that a more mainstream Republican can slice the Democratic advantage in such places. DeSantis, Ayres said, “has got a lot of things he can sell to suburban Republican voters that Trump just can’t sell.”

    Almost universally, Democrats believe that Republicans are underestimating how hard it will be to reel back in college-educated suburban voters who have now mobilized against Trump’s vision for America in three consecutive elections, especially in these battleground states. Although DeSantis is less belligerent than Trump, and not associated with the violence and subversion of the January 6 insurrection, so far he has emphasized a similar style of politics focused on conservative grievance against “woke” cultural liberalism. “Ron DeSantis is every bit as MAGA as Donald Trump,” Rosenberg said. “This idea that he is some more moderate version of Trump is just farcical.”

    The fact that even a candidate as weak as Walker remained as competitive as he did underscores how difficult it may be for either side to establish a comfortable advantage in these states in 2024. (The exceptions could be Michigan, which even many Republicans agree looks daunting for them, and maybe Pennsylvania, which also tilted blue last month.)

    These states provided Democrats with their own warning signs this year. Exit polls last month showed that most voters in these states disapproved of Biden’s job performance and that big majorities in Pennsylvania and Wisconsin, the states where the question was asked, did not want him to run again. Democrats also faced a worrying trend of lagging Black turnout in many urban centers this year, though Black voters came out in big numbers in Georgia’s early voting, and activists in the state are confident they will remain highly engaged through 2024. “Our goal was to build a culture of voting, and that’s what we have done in Georgia over the past five years,” Amari Fennoy, the state coordinator for the NAACP Georgia State Conference, told me.

    Yet the consistency of the results this year, both demographically and geographically, signal that the re-sorting of the parties in the Trump era has left Democrats with a narrow, but potentially durable, advantage in these five crucial states. That doesn’t mean Democrats are guaranteed to win them in the 2024 presidential race, but it does suggest an important takeaway from the 2022 election that finally ended last night: As long as voters still perceive Republicans to be operating in Trump’s shadow (much less if they again nominate Trump himself), Democrats will begin with an advantage in the states most likely to pick the next president.

    “I think that the coalition that turned out to stop Trump is going to be the starting point for the next presidential race,” Wikler said. “There are new threats and new opportunities, but this was not a one-off coalition that came together for a special occasion and went home.” Georgia, again, made that very clear last night.

    Ronald Brownstein

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  • How to Make Sense of This Fall’s Messy COVID Data

    How to Make Sense of This Fall’s Messy COVID Data

    It is a truth universally acknowledged among health experts that official COVID-19 data are a mess right now. Since the Omicron surge last winter, case counts from public-health agencies have become less reliable. PCR tests have become harder to access and at-home tests are typically not counted.

    Official case numbers now represent “the tip of the iceberg” of actual infections, Denis Nash, an epidemiologist at the City University of New York, told me. Although case rates may seem low now, true infections may be up to 20 times higher. And even those case numbers are no longer available on a daily basis in many places, as the CDC and most state agencies have switched to updating their data once a week instead of every day.

    How, then, is anyone supposed to actually keep track of the COVID-19 risk in their area—especially when cases are expected to increase this fall and winter? Using newer data sources, such as wastewater surveillance and population surveys, experts have already noticed potential signals of a fall surge: Official case counts are trending down across the U.S., but Northeast cities such as Boston are seeing more coronavirus in their wastewater, and the CDC reports that this region is a hotspot for further-mutated versions of the Omicron variant. Even if you’re not an expert, you can still get a clearer picture of how COVID-19 is hitting your community in the weeks ahead. You’ll simply need to understand how to interpret these alternate data sources.

    The problem with case data goes right to the source. Investment in COVID-19 tracking at the state and local levels has been in free fall, says Sam Scarpino, a surveillance expert at the Rockefeller Foundation’s Pandemic Prevention Initiative. “More recently, we’ve started to see lots of states sunsetting their reporting,” Scarpino told me. Since the Pandemic Prevention Initiative and the Pandemic Tracking Collective started publishing a state-by-state scorecard of breakthrough-case reporting in December 2021, the number of states with a failing grade has doubled. Scarpino considers this trend a “harbinger of what’s coming” as departments continue to shift resources away from COVID-19 reporting.

    Hospitalization data don’t suffer from the same reporting problems, because the federal government collects information directly from thousands of facilities across the country. But “hospitalizations often lag behind cases by a matter of weeks,” says Caroline Hugh, an epidemiologist and volunteer with the People’s CDC, an organization providing COVID-19 data and guidance while advocating for improved safety measures. Hospitalizations also don’t necessarily reflect transmission rates, which still matter if you want to stay safe. Some studies suggest, for example, that long COVID might now be more likely than hospitalization after an infection.

    For a better sense of how much the coronavirus is circulating, many experts are turning to wastewater surveillance. Samples from our sewage can provide an advanced warning of increased COVID-19 spread because everyone in a public-sewer system contributes data; the biases that hinder PCR test results don’t apply. As a result, Hugh and her colleagues at the People’s CDC consider wastewater trends to be more “consistent” than constantly fluctuating case numbers.

    When Omicron first began to wreak havoc in December 2021, “the wastewater data started to rise very steeply, almost two weeks before we saw the same rise” in case counts, Newsha Ghaeli, the president and a co-founder of the wastewater-surveillance company Biobot Analytics, told me. Biobot is now working with hundreds of sewage-sampling sites in all 50 states, Ghaeli said. The company’s national and regional dashboard incorporates data from every location in its network, but for more local data, you might need to go to a separate dashboard run by the CDC or by your state health department. Some states have wastewater surveillance in every county, while others have just a handful of sites. If your location is not represented, Ghaeli said, “the wastewater data from communities nearby is still very applicable.” And even if your county does have tracking, checking up on neighboring communities might be good practice. “A surge in a state next door … could very quickly turn into a surge locally,” Ghaeli explained.

    Ghaeli recommends watching how coronavirus levels in wastewater shift over time, rather than homing in on individual data points. Look at both “directionality” and “magnitude”: Are viral levels increasing or decreasing, and how do these levels compare with earlier points in the pandemic? A 10 percent uptick when levels are low is less concerning than a 10 percent uptick when the virus is already spreading widely.

    Researchers are still working to understand how wastewater data correlate with actual infections, because every community has unique waste patterns. For example, big cities differ from rural areas, and in some places, environmental factors such as rainfall or nearby agriculture may interfere with coronavirus tracking. Still, long-term-trend data are generally thought to be a good tool that can help sound the alarm on new surges.

    Wastewater data can help you figure out how much COVID-19 is spreading in a community and can even track all the variants circulating locally, but they can’t tell you who’s getting sick. To answer the latter question, epidemiologists turn to what Nash calls “active surveillance”: Rather than relying on the COVID-19 test results that happen to get reported to a public-health agency, actively seek out and ask people whether they recently got sick or tested positive.

    Nash and his team at CUNY have conducted population surveys in New York City and at the national level. The team’s most recent survey (which hasn’t yet been peer-reviewed), conducted from late June to early July, included questions about at-home test results and COVID-like symptoms. From a nationally representative survey of about 3,000 people, Nash and his team found that more than 17 percent of U.S. adults had COVID-19 during the two-week period—about 24 times higher than the CDC’s case counts at that time.

    Studies like these “capture people who might not be counted by the health system,” Nash told me. His team found that Black and Hispanic Americans and those with low incomes were more likely to get sick during the survey period, compared with the national estimate. The CDC and Census Bureau take a similar approach through the ongoing Household Pulse Survey.

    These surveys are “a goldmine of data,” though they need to be “carefully designed,” Maria Pyra, an epidemiologist and volunteer with the People’s CDC, told me. By showing the gap between true infections and officially reported cases, surveys like Nash’s can allow researchers to approximate how much COVID-19 is really spreading.

    Survey results may be delayed by weeks or months, however, and are typically published in preprints or news reports rather than on a health agency’s dashboard. They might also be biased by who chooses to respond or how questions are worded. Scarpino suggested a more timely option: data collected from cellphone locations or social media. The Delphi Group at Carnegie Mellon University, for example, provides data on how many people are Googling coldlike symptoms or seeking COVID-related doctor visits. While such trends aren’t a perfect proxy for case rates, they can be a helpful warning that transmission patterns are changing.

    Readers seeking to monitor COVID-19 this fall should “look as local as you can,” Scarpino recommended. That means examining county- or zip-code-level data, depending on what’s available for you. Nash suggested checking multiple data sources and attempting to “triangulate” between them. For example, if case data suggest that transmission is down, do wastewater data say the same thing? And how do the data match with local behavior? If a popular community event or holiday happened recently, low case numbers might need to be taken with a grain of salt.

    “We’re heading into a period where it’s going to be increasingly harder to know what’s going on with the virus,” Nash told me. Case numbers will continue to be undercounted, and dashboards may be updated less frequently. Pundits on Twitter are turning to Yankee Candle reviews for signs of surges. Helpful sources still exist, but piecing together the disparate data can be exhausting—after all, data reporting and interpretation should be a job for our public-health agencies, not for concerned individuals.

    Rather than accept this fragmented data status quo, experts would like to see improved public-health systems for COVID-19 and other diseases, such as monkeypox and polio. “If we get better at collecting and making available local, relevant infectious-disease data for decision making, we’re going to lead healthier, happier lives,” Scarpino said.

    Betsy Ladyzhets

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  • Polio Is Exploiting a Very Human Weakness

    Polio Is Exploiting a Very Human Weakness

    In 1988, the World Health Assembly announced a very ambitious goal: Polio was to be vanquished by the year 2000. It was a reach, sure, but feasible. Although highly infectious, polioviruses affect only people, and don’t hide out in wild animals; with two extraordinarily effective vaccines in regular use, they should be possible to snuff out. Thanks to a global inoculation campaign, infections had, for years, been going down, down, down.

    But 2000 came and went, as did a second deadline, in 2005, and a third, in 2012, and so on. The world will almost certainly miss an upcoming target at the end of 2023 too. In theory, eradication is still in sight: The virus remains endemic in just two countries—Pakistan and Afghanistan—and two of the three types of wild poliovirus that once troubled humanity are gone. And yet, polio cases are creeping up in several countries that had eliminated them, including the United Kingdom, Israel, and the United States. Earlier this year, New York detected America’s first paralytic polio case in nearly a decade; last week, the governor declared a state of emergency over a fast-ballooning outbreak.

    This is the cruel logic of viruses: Give them enough time—leave enough hosts for them to infect—and they will eventually find a way to spread again. “You have to stop transmission everywhere, all at the same time,” says Kimberly Thompson, a health economist and the president of the nonprofit Kid Risk. Which means eradication will demand a near-perfect syncing of vaccine supply, access, equity, political will, public enthusiasm, and more. To beat the virus, population immunity must outlast it.

    Right now, though, the world’s immunological shield is too porous to stop polio’s spread. At the center of the new epidemics are vaccine-derived polioviruses that have begun to paralyze unimmunized people in places where immunity is low—a snag in the eradication campaign that also happens to be tightly linked to one of its most essential tools. Vaccine performance has always depended on both technology and human behavior. But in this case especially, because of the nature of the foe at hand, those twin pillars must line up as precisely as possible or risk a further backslide into a dangerous past.


    In the grand plan for eradication, our two primary polio vaccines were always meant to complement each other. One, an ultra-effective oral formulation, is powerful and long-lasting enough to quash wild-poliovirus transmission—the perfect “workhorse” for a global vaccination campaign, says Adam Lauring, an evolutionary virologist at the University of Michigan. The other, a supersafe injectable, sweeps in after its colleague has halted outbreaks one country at a time, maintaining a high level of immunity in post-elimination nations while the rest of the world catches up.

    For decades, the shot, chaser approach found remarkable success. In the 1980s, wild poliovirus struck an estimated 300,000 to 400,000 people each year; by 2021, the numbers had plummeted to single digits. But recently, as vaccine coverage in various countries has stalled or slipped, the loopholes in this vaccination tactic have begun to show themselves and grow.

    The oral polio vaccine (OPV), delivered as drops in the mouth, is one of the most effective inoculations in the world’s roster. It contains weakened forms of polioviruses that have been altered away from their paralysis-causing forms but still mimic a wild infection so well that they can stop people from spreading wild pathogens for years, even decades. In the weeks after people receive the vaccine, they can also pass the weakened virus to others in the community, helping protect them too. And OPV’s transportability, low price point, and ease of administration make it a “gold standard for outbreak interruption,” says Ananda Bandyopadhyay, the deputy director for the polio team at the Bill & Melinda Gates Foundation. Since its mid-20th-century debut, OPV has helped dozens of countries—including the U.S.—eliminate the virus. Those nations were then able to phase out OPV and switch to inoculating people with the injected vaccine.

    But OPV’s most potent superpower is also its greatest weakness. Given enough time and opportunity to spread and reproduce, the neutered virus within the vaccine can regain the ability to invade the nervous system and cause paralysis in unvaccinated or immunocompromised people (or in very, very rare cases, the vaccine recipient themselves). Just a small handful of genetic modifications—three or fewer—can spark a reversion, and the mutants, which are “better at replicating” than their kin, can take over fast, says Raul Andino, a virologist at UC San Francisco. In recent years, a few thousand cases of vaccine-derived polio have been detected around the world, far outstripping the toll of wild viruses; dozens of countries, the U.S. now among them, are battling such outbreaks, and the numbers seem to be only going up. Vaccine-derived polio is still a true rarity: Billions of oral vaccines have been delivered since the global campaign began. But it underscores “the real problem” with OPV, Lauring told me. “You’re fighting fire with fire.”

    The injected polio vaccine, or IPV, which contains only chemically inactivated versions of the virus, carries none of that risk. To purge all polio cases, “you have to stop using oral polio vaccine,” Thompson told me, and transition the entire globe to IPV. (Post-eradication, countries would need to keep IPV in their routine immunization schedule for at least 10 years, experts have said.) But the injected vaccine has a different drawback. Although the shot can very effectively stave off paralysis, IPV doesn’t elicit the kind of immunity that stops people from getting infected with polioviruses and then passing them on. In places that rely on injected vaccines, “even immune individuals can participate in transmission,” Thompson told me. Which opens up a vulnerability when too many people have skipped both types of vaccines: Paralyzing polioviruses erupt out of communities where the oral vaccine is still in use—then can spread in undervaccinated areas. It might be tempting to blame OPV for our troubles. But that’s not the main threat, Bandyopadhyay told me. “It’s the lack of adequate vaccination.”

    As things stand, the goal in the endemic countries of Pakistan and Afghanistan remains achieving sufficiently high vaccine coverage, Bandyopadhyay said. But many of the communities in these nations are rural or nomadic, and tough to reach even with convenient drop-in-the-mouth vaccines. Civil and political unrest, misinformation, natural disasters, and most recently, the COVID pandemic have raised additional hurdles. So have intermittent bans on house-to-house vaccination in Afghanistan, says John Vertefeuille, the chief of the polio-eradication branch at the CDC. Cases of wild polio have experienced a recent jump in Pakistan, and have also been imported into the non-endemic countries of Malawi and Mozambique.

    But the toll of those outbreaks—all featuring type 1 polio—currently pales in comparison with those featuring vaccine-derived type 2. The last case of wild type 2 polio was detected in 1999, but that version of the virus has persisted in its modified form in oral polio vaccines. And when it reverts to its dangerous form, it gains particularly infectious oomph, allowing it to spread unchecked wherever immunity is low. Some 30 countries around the world are battling outbreaks of poliovirus whose origin can be traced back to the oral inoculations; vaccine-derived type 2 is what’s been circulating in Jerusalem, London, and New York, where it ultimately paralyzed an unvaccinated young man. The extent to which the virus is churning in other parts of the country isn’t fully known; routine immunization has dropped since the COVID pandemic’s start, and the U.S. hasn’t regularly surveyed its wastewater for the pathogen.

    The success of these vaccine-derived viruses is largely the result of our own hubris—of a failure, experts told me, to sync the world’s efforts. In 2016, 17 years after the last wild type-2 case had been seen, officials decided to pivot to a new version of OPV that would protect against just types 1 and 3, a sort of trial run for the eventual obsolescence of OPV. But the move may have been premature. The switch wasn’t coordinated enough; in too many pockets of the world, type-2 polio, from the three-part oral vaccine, was still moseying about. The result was disastrous. “We opened up an immunity gap,” Thompson told me. Into it, fast-mutating vaccine-derived type-2 viruses spilled, surging onto a global landscape populated with growing numbers of children who lacked protection against it.


    A new oral vaccine, listed for emergency use by the WHO in 2020, could help get the global campaign back on track. The fresh formulation, developed in part by Andino and his colleagues, still relies on the immunity-boosting powers of weakened, replicating polioviruses. But the pathogens within have had their genetic blueprints further tweaked. “We mucked around” with the structure of poliovirus, Andino told me, and figured out a way to make a modified version of type 2 that’s far stabler. It’s much less likely to mutate away from its domesticated, non-paralyzing state, or swap genes with related viruses that could grant the same gifts.

    Technologically, the new oral vaccine, nicknamed nOPV2, seems to be as close to a slam dunk as immunizations can get. “To me, it’s just super cool,” Lauring told me. “You keep all the good things about OPV but mitigate this evolutionary risk.” In the year and a half since the vaccine’s world premiere, some 450 million doses of nOPV2 have found their way into children in 22 countries—and a whopping zero cases of vaccine-derived paralysis have followed.

    But nOPV2 is “not a silver bullet,” Andino said. The vaccine covers just one of the three poliovirus types, which means it can’t yet fully replace the original oral recipe. (Trials for type-1 and -3 versions are ongoing, and even after those recipes are ready for prime time, researchers will have to confirm that the vaccine still works as expected when the three recipes are mixed.) The vaccine’s precise clinical costs are also still a shade unclear. nOPV2 is a safer oral polio vaccine, but it’s still an oral polio vaccine, chock-full of active viral particles. “You can think of it as more attenuated,” Thompson said. “But I don’t think anybody expects that it won’t have any potential to evolve.” And nOPV2’s existence doesn’t change the fact that the world will still have to undergo a total, coordinated switch to IPV before eradication is won.

    As has been the case with COVID vaccines, and so many others, the primary problem isn’t the technology at all—but how humans have deployed it, or failed to. “Vaccine sitting in a vial, no matter how genetically stable and how effective it is, that’s not going to solve the problem of the outbreaks,” Bandyopadhyay said. “It’s really vaccination and getting to that last child in that last community.”

    If dwindling vaccination trends don’t reverse, even our current vaccination strategies could require a rough reboot. In 2013, health officials in Israel—which had, for years prior, run a successful IPV-only campaign for its children—detected wild type-1 virus, imported from abroad, in the country’s sewage, and decided to roll out another round of oral vaccines to kids under 10. Within a few weeks, nearly 80 percent of the targeted population had gotten a dose. Even “polio-free countries are not polio-risk-free,” Bandyopadhyay told me. The situation in New York is different, in part because type-1 polio causes paralysis more often than type-2 does. But should circumstances grow more dire—should substantial outbreaks start elsewhere in the country, should the nation fail to bring IPV coverage back to properly protective levels—America, too, “may have to consider adding OPV as a supplement,” says Purvi Parikh, an immunologist and a physician at NYU, “especially in rural areas” where emergency injected-vaccine campaigns may be tough. Such an approach would be a pretty extreme move, and a “very big political undertaking,” Thompson said, requiring a pivot back to a vaccine that was phased out of use decades ago. And even then, there’s no guarantee that Americans would take the offered oral drops.

    The CDC, for now, is not eager for such a change. Noting that most people in the U.S. are vaccinated against polio, Katherina Grusich, an agency spokesperson, told me that the CDC has no plans to add OPV or nOPV to the American regimen. “We are a long way from reaching for that,” she said.

    But this week, the U.S. joined the WHO’s list of about 30 nations with circulating vaccine-derived-poliovirus outbreaks. The country could have avoided this unfortunate honor had it kept shot uptake more uniformly high. It’s true, as Grusich pointed out, that more than 90 percent of young American children have received IPV. But they are not distributed evenly, which opens up vulnerabilities for the virus to exploit. Here, the U.S., in a sense, had one job: maintain its polio-free status while the rest of the world joined in. That it did not is an admonition, and a reminder of how unmerciful the virus can be. Polio, a fast mutator, preys on human negligence; the vaccines that guard against it contain both a form of protection and a catch that reinforces how risky treating these tools as a discretionary measure can be.

    Katherine J. Wu

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