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  • Her little sister needed a kidney. The donation let them both live their dreams

    Her little sister needed a kidney. The donation let them both live their dreams

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    As children, sisters Amaris and Dominique Elston were inseparable. Their parents remember the two of them sharing everything and always having each others’ backs, no matter the situation. 

    That bond didn’t change as they grew older, and when an 18-year-old Dominique was diagnosed with focal segmental
    glomerulosclerosis, a chronic kidney disease that soon led to kidney failure, Amaris was again ready to help her sister.

    “I told Amaris ‘Dominique is in kidney failure. Her kidney function was at 19%, and she’s going to need a kidney transplant eventually,’” Denise Elston, their mother, said. “Thirty seconds later, Amaris said, ‘Can I give her one?’” 

    Amaris (back) and Dominique (front) Elston as children. 

    The Elston family


    Amaris, then interviewing for medical schools, knew her family had a history of kidney disease, so she wasn’t sure she’d be able to donate. Dominique didn’t want her sister to put her life on hold but as her condition deteriorated and her kidney function dropped to just 5%, despite dialysis treatments, Amaris knew she had to do something. Without telling Dominique, she got tested and learned she was a match. 

    “She’s my little sister,” Amaris said. “As a big sister, it’s natural to want to jump in and save her from everything that life has to offer, even failing kidneys. I knew this was the best option that she had at getting back on track with life and doing all the things she wanted to do. It was never really a question.” 

    Avoiding years on a waiting list 

    About 140,000 people are on the waiting list for a kidney transplant in the United States, according to Dr. Kelly Birdwell, medical director of kidney transplantation at Vanderbilt University Medical Center, who was not involved in the Elston sisters’ care.

    The average American waits about five years for a kidney donation through the waiting list. Black Americans are also disproportionately represented on the waiting list, Birdwell said. Black people are more likely to have Type B blood, which has fewer compatible donors, she said, and there is also “an excess risk of kidney disease in the African American population.” 

    In 2019, more than 14,000 Black kidney transplant candidates were moved up on the national waitlist after it was found a widely-used test was overestimating how well Black people’s kidneys were functioning, making them seem healthier than they were and extending the amount of time they waited. 


    Thousands of Black kidney transplant candidates moved up on waitlist after testing bias found

    03:20

    Amaris said all of those factors were on her mind when she decided she wanted to donate to her sister. In 2023, 21,765 kidney transplants were completed, with 6,294 of those organs coming from living donors. About 60% of living donors are related to the recipient, Birdwell said. 

    To donate a kidney, interested family members do a round of initial testing that confirms the donor is compatible with the recipient. That’s followed by a longer evaluation, Birdwell explained, to make sure the donation won’t put the potential donor at risk. The evaluation includes bloodwork and imaging to confirm the potential donor is in good health. Once those stages are successfully completed, it’s just a matter of scheduling the surgery. 

    For the Elstons, that meant waiting until Amaris finished her first semester of medical school at the University of Alabama at Birmingham. In December 2018, the sisters were again side-by-side, waiting for their operations at the University of Vanderbilt’s Transplant Center. Amaris’ operation was first. Birdwell estimates that a donor surgery is about two hours, while a recipient’s surgery, scheduled for later in the day, is about three hours. 

    When Amaris and Dominique reunited after their operations, the eldest of the two could already see a change in her baby sister. 

    “I remember laying in the bed and being in a lot [of] pain, and Dominique walking down the hallways like ‘No big deal,’ and in that moment, it solidified that I knew I had made the right decision,” Amaris said. “She looked like a whole new person, in less than 24 hours. She was just bopping in my room, sitting in my chair. It was worth it.” 

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    Dominique (left) and Amaris (right) after transplant. 

    The Elston family


    Working together to save lives 

    Amaris gave her younger sister more than a kidney. She also gave Dominique the chance to follow her sister into the field of medicine. 

    Amaris graduated from UAB’s Heersink School of Medicine in 2022. Just two years later, Dominique graduated from the UAB School of Nursing with her bachelor’s degree in nursing. Amaris cheered her on from the audience. 

    “After going through what we went through, it was kind of like a calling for me to go into (nursing),” Dominique said. “It wasn’t really something I had to think about. I felt like it was something that was meant for me.” 

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    Dominique (left) and Amaris (right) at Dominique’s graduation ceremony from UAB. 

    The Elston family/UAB


    Now, both sisters are working in the neurology field. Amaris is a neurology resident at the Medical University of South Carolina, and Dominique is a neurology intensive care unit nurse at UAB. The two are the first members of their family to enter the medical field. Though the sisters are now separated by more than more than 400 miles, their bond is stronger than ever. 

    “It’s been fun having somebody that is with you through everything, because if you want to talk about the bad parts, the good parts, you can,” Amaris said. “It feels good to know that there’s somebody right beside you that can understand how you feel and what you’re going through. We’ve been each other’s best friends amid some of our darkest moments, so this is just another journey that we’re on together.”  

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  • Rare drug-resistant flu variant identified in the US, CDC says

    Rare drug-resistant flu variant identified in the US, CDC says

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    (CNN) — A rare flu variant that has shown some resistance to the most commonly used antiviral treatment has been detected in at least two people in the United States, according to the US Centers for Disease Control and Prevention.

    Influenza viruses are constantly changing, but this variant has two concerning mutations in places that could lower the effectiveness of treatment with oseltamivir phosphate, known by the brand name Tamiflu.

    “There’s active global surveillance going on looking for these mutations,” said Dr. Andy Pekosz, a virologist at the Johns Hopkins Bloomberg School of Public Health. “We want to know when they come up, because that could really have major implications for how we treat influenza.”

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  • Are Gen Z Men and Women Really Drifting Apart?

    Are Gen Z Men and Women Really Drifting Apart?

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    Judging by recent headlines, young men and women are more politically divided now than ever before. “A new global gender divide is emerging,” the Financial Times data journalist John Burn-Murdoch wrote in a widely cited January article. Burn-Murdoch’s analysis featured several eye-popping graphs that appeared to show a huge ideological rift opening up between young men and young women over the past decade. The implications—for politics, of course, but also for male-female relations and, by extension, the future of the species—were alarming. A New York Times opinion podcast convened to discuss, according to the episode title, “The Gender Split and the ‘Looming Apocalypse of the Developed World.’” The Washington Post editorial board warned, “If attitudes don’t shift, a political dating mismatch will threaten marriage.”

    But nearly as quickly as the theory gained attention, it has come under scrutiny. “For every survey question where you can find a unique gender gap among the youngest age cohort, you can find many other questions where you don’t find that gap,” John Sides, a political-science professor at Vanderbilt University, told me. “Where we started with this whole conversation was that there’s this big thing happening; it’s happening worldwide. Then you just pick at it for a few minutes, and it becomes this really complex story.” Skeptics point out that, at least as far as the United States goes, the claims about a new gender divide rest on selective readings of inconclusive evidence. Although several studies show young men and women splitting apart, at least as many suggest that the gender gap is stable. And at the ballot box, the evidence of a growing divide is hard to find. The Gen Z war of the sexes, in other words, is probably not apocalyptic. It may not even exist at all.

    The gender gap in voting—women to the left, men to the right—has been a fixture of American politics since at least the 1980 presidential election, when, according to exit polls, Ronald Reagan won 55 percent of male voters but only 47 of women.

    Some evidence suggests that the divide has recently widened. In 2023, according to Gallup data, 18-to-29-year-old women were 15 percentage points more likely than men in the same age group to identify as liberal, compared with only seven points a decade ago. Young men’s ideology has remained more stable, but some surveys suggest that young white men in particular have been drifting rightward. The Harvard Youth Poll, for example, found that 33 percent of white men aged 18 to 24 identified as Republican in 2016, compared with 41 percent in 2023. This trend has begun appearing in new-voter-registration data as well, according to Tom Bonier, a Democratic political strategist. “Believe me, as a partisan Democrat, I would prefer that it’s not the case—but it appears to be true,” he told me. “We’re still generally arguing about if it’s happening, which to me is silly. The conversation hasn’t moved to why.”

    Ronald Brownstein: Is Gen Z coming for the GOP?

    Why indeed? Several factors present themselves for consideration. One is social-media-induced gender polarization. (Think misogynistic “manosphere” influencers and women who talk about how “all men are trash.”) Another, as always, is Donald Trump. Twenty-something-year-old women seemed repelled by Trump’s ascendance in 2016, John Della Volpe, who heads the Harvard Youth Poll, told me. They were much more likely to vote for Hillary Clinton. Then there’s the #MeToo movement, which emerged in 2017, soon after Trump took office. Daniel Cox, a senior fellow at the American Enterprise Institute, a free-market-conservative think tank, argues that it durably shaped young women’s political consciousness. A 2022 poll found that nearly three-quarters of women under 30 say they support #MeToo, the highest of any age group. The Supreme Court’s decision to overturn Roe v. Wade also seems to have been a turning point. Going into the 2022 midterm election, 61 percent of young women said abortion was a “critical” concern, according to a survey conducted by AEI. “Young women increasingly believe that what happens to any woman in the United States impacts their lives and experiences as well,” Cox told me. “That became really salient after Roe was overturned.” Gen Z women are more likely than Generation X or Baby Boomer women—though slightly less likely than Millennial women—to say that they have been discriminated against because of their gender at some point in their life.

    Not so fast, say young men. Gen Z men are also more likely than older generations to say that they’ve been discriminated against based on gender. “There’s this kind of weird ping-pong going on between Gen Z men and women about who’s really struggling, who’s really the victim,” Richard Reeves, a senior fellow at the Brookings Institution, told me. Reeves, who founded the American Institute for Boys and Men, argues that although men still dominate the highest levels of society in the U.S., those on the lower rungs are doing worse than ever. They are far less likely than women to go to college or find a good job, and far more likely to end up in prison or dead. These young men feel—rightly, in Reeves’s view—that mainstream institutions and the Democratic Party haven’t addressed their problems. And, in the aftermath of #MeToo, some seem to believe that society has turned against men. Survey data indicate that Gen Z men are much less likely to identify as feminists than Millennial men are, and about as likely as middle-aged men. “I really do worry that we’re trending toward a bit of a women’s party and a men’s party in politics,” Reeves told me.

    But if young men and women really were drifting apart politically, you would expect to see evidence on Election Day. And here’s where the theory starts showing cracks. The Cooperative Election Study, a national survey administered by YouGov, found that nearly 68 percent of 18-to-29-year-old men voted for Joe Biden in the 2020 presidential election, compared with about 70 percent of women in that age group—the same percentage gap as in 2008. (The split was larger—nearly seven points—in 2016, when Trump’s personal behavior toward women was especially salient.) Catalist, a progressive firm that models election results based on voter-file data, found that the gender divide was roughly the same for all age groups in recent elections. In the 2022 midterms, according to Pew’s analysis of validated voters, considered the gold standard of postelection polling, the youngest voters had the smallest gender divide, and overwhelmingly supported Democrats.

    Richard V. Reeves: Redshirt the boys

    Many of the polls that show a widening gender divide ask about ideology. But research shows that many people don’t have a clear idea of what the labels mean. Gallup, whose data partly inspired the gender-gap frenzy, notes that only about half of Democrats identify as liberal. Ten percent describe themselves as conservative, and the remainder say their views are moderate. The ideological lines are only slightly less scrambled among self-identified Republicans. “Everything here hinges on what characteristics or questions we are trying to measure,” Sides told me. “When you ask people if they identify as liberal or as a feminist, you learn whether people believe that label describes them. But you didn’t ask how they define that label.” People might dislike the term liberal but still support, say, abortion access and high government spending. Indeed, 2020 polling data from Nationscape, which assesses people’s positions on individual issues, indicated that young men and women are no more divided than older generations. In every age group, for example, women are more in favor of banning assault rifles and providing universal health care than men are, by a comparable margin.

    Or perhaps the unique Gen Z gender divide just hasn’t shown up electorally yet. Most 2024 election polling doesn’t break down different age groups by gender—and even if it did, trying to draw firm conclusions would be foolish. Twenty-somethings are just hard to study. Young people are less engaged in politics, with high rates of independent and unaffiliated voters. Their worldviews are still malleable. Many of them are reluctant to answer questions, especially over the phone. Under those circumstances, even high-quality polls show wildly, even implausibly divergent possibilities for the youth vote. A recent USA Today/Suffolk University poll found that, in a hypothetical 2024 rematch, Trump beat out Biden among registered voters under 35—an almost-unheard-of shift within four years. In October, a New York Times/Siena poll suggested that the youngest generation is equally split between Trump and Biden, whereas last month’s Times survey showed Biden winning young voters by double digits even as he lost ground overall.

    Whatever is going on inside all of those young minds, the old people studying them have yet to figure it out. The biggest chasm, as always, may be not between young men and young women, but between young people and everyone else.

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    Rose Horowitch

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  • HBCU Grad Makes History As First Black Female Neurosurgeon Resident At Vanderbilt

    HBCU Grad Makes History As First Black Female Neurosurgeon Resident At Vanderbilt

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    Florida A&M University alumna Tamia Potter is now the first Black woman to become a neurosurgeon resident at Vanderbilt University — and Twitter users can’t hold back their excitement for the history-making pioneer.

    The FAMU graduate shared the monumental news Friday on Twitter.

    “My first job was a certified nursing assistant at 17 years old in 2014. Today, on March 17, 2023, I was blessed to be selected as the first African American female neurosurgery resident to train at [Vanderbilt University Medical Center for neurosurgery],” she wrote.

    In one clip shared by Potter, the medical student is seen getting visibly emotional during a phone call, which confirmed that she’s the first Black woman to train at Vanderbilt’s neurosurgery department.

    The groundbreaking news came on “National Match Day,” the third Thursday of March, where medical students across the United States are matched to a specialty and residency for training.

    Twitter users quickly stepped in to praise Potter, gushing over her trailblazing achievement.

    “Congratulations Dr. Tamia Potter,” one user wrote, noting how major her win is as there are only 33 Black female neurosurgeons in the United States.

    Potter, who completed her bachelors in chemistry at FAMU in 2018, was also a member of the Beta Alpha Chapter of Alpha Kappa Alpha Sorority, according to the University’s blog, Rattler Nation.

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  • Vanderbilt University apologizes for using ChatGPT to write mass-shooting email | CNN Business

    Vanderbilt University apologizes for using ChatGPT to write mass-shooting email | CNN Business

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    New York
    CNN
     — 

    Vanderbilt University’s Peabody School has apologized to students for using artificial intelligence to write an email about a mass shooting at another university, saying the distribution of the note did not follow the school’s usual processes.

    Last Friday, the Tennessee-based school emailed its student body to address the tragedy at Michigan State that killed three students and injured five more people: “The recent Michigan shootings are a tragic reminder of the importance of taking care of each other, particularly in the context of creating inclusive environments,” reads the letter in part, as first reported by the Vanderbilt Hustler, a student newspaper.

    At the end of the school’s email was a surprising line: “Paraphrase from OpenAI’s ChatGPT AI language model, personal communication, February 15, 2023,” read a parenthetical in smaller font.

    Following an outcry from students about the use of AI to write a letter about community during human tragedy, the associate dean of Peabody sent an apology note the next day. Nicole Joseph, one of the three signatories of the original letter, called using ChatGPT “poor judgment,” according to the Vanderbilt Hustler.

    On Tuesday, Vanderbilt said Joseph and assistant dean Hasina Mohyuddin, another signer of the email, have stepped back from their responsibilities while the school conducts a complete review.

    “The development and distribution of the initial email did not follow Peabody’s normal processes providing for multiple layers of review before being sent. The university’s administrators, including myself, were unaware of the email before it was sent,” according to a statement Tuesday to CNN from Camilla P. Benbow, the Patricia and Rodes Hart Dean of Education and Human Development.

    Since it was made available in late November, ChatGPT has been used to generate original essays, stories and song lyrics in response to user prompts. It has drafted research paper abstracts that fooled some scientists. Some CEOs have even used it to write emails or do accounting work.

    While it has gained traction among users, it has also raised some concerns, including about inaccuracies, its potential to perpetuate biases and spread misinformation, and the ability to help students cheat.

    Vanderbilt’s letter also included reference to “recent Michigan shootings,” though only one occurred.

    “As dean of the college, I remain personally saddened by the loss of life and injuries at Michigan State, which I know have affected members of our own community,” Benbow said. “I am also deeply troubled that a communication from my administration so missed the crucial need for personal connection and empathy during a time of tragedy.”

    Rachael Perrotta, editor in chief of the Vanderbilt student newspaper, said that students told her “they are outraged about this situation and confused as to what prompted administrators to turn to ChatGPT to write their message about the Michigan State shooting.”

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  • Which Universities Spent the Most Money on Research Last Year?

    Which Universities Spent the Most Money on Research Last Year?

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    Academic institutions spent $89.9 billion on research and development in the 2021 fiscal year, up 4 percent from the year before.

    Nearly all of the $3.4-billion increase in research spending was funded by the federal government, according to a report on the National Science Foundation’s newly released Higher Education Research and Development survey.

    As in previous years, universities that had at least $1 billion in research and development expenditures in the 2021 fiscal year dominated the top 30 institutions that reported the highest spending totals. No longer in that top group is the University of California at Berkeley. New to the top 30: Vanderbilt University and Vanderbilt University Medical Center, which moved from 31 to 24 after accounting changes that contributed to a $115-million increase in spending, the report says.

    Federally supported research and development rose 6.6 percent in the 2021 fiscal year to $49 billion, and now accounts for 55 percent of research funding at all universities. The next largest source of research-and-development funds, 25 percent, came from institutions themselves, for a total of $459 million. That’s a 2.1-percent increase from 2020.

    The foundation collected data for the survey from 910 institutions that award bachelor’s degrees or higher and that spent at least $150,000 on research and development in the 2021 fiscal year. The survey is sponsored by the National Center for Science and Engineering Statistics.

    Here’s a closer look at the data:

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    Audrey Williams June

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  • Will Flu and RSV Always Be This Bad?

    Will Flu and RSV Always Be This Bad?

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    In the Northern Hemisphere, this year’s winter hasn’t yet begun. But Melissa J. Sacco, a pediatric-intensive-care specialist at UVA Health, is already dreading the arrival of the one that could follow.

    For months, the ICU where Sacco works has been overflowing with children amid an early-arriving surge of respiratory infections. Across the country, viruses such as RSV and flu, once brought to near-record lows by pandemic mitigations, have now returned in force, all while COVID-19 continues to churn and the health-care workforce remains threadbare. Most nights since September, Sacco told me, her ICU has been so packed that she’s had to turn kids away “or come up with creative ways to manage patients in emergency rooms or emergency departments,” where her colleagues are already overwhelmed and children more easily slip through the cracks. The team has no choice: There’s nowhere else for critically ill kids to go.

    Similar stories have been pouring in from around the nation for weeks. I recently spoke with a physician in Connecticut who called this “by far the worst spike in illness I’ve seen in 20 years”; another in Maryland told me, “There have been days when there is not an ICU bed to be found anywhere in the mid-Atlantic.” About three-quarters of the country’s pediatric hospital beds are full; to accommodate overflow, some hospitals have set up tents outside their emergency department or contemplated calling in the National Guard. Last week, the Children’s Hospital Association and the American Academy of Pediatrics asked the Biden administration to declare a national emergency. And experts say there’s no end to the crisis in sight. When Sacco imagines a similar wave slamming her team again next fall, “I get that burning tear feeling in the back of my eyes,” she told me. “This is not sustainable.”

    Read: The worst pediatric-care crisis in decades

    The experts I spoke with are mostly optimistic that these cataclysmic infection rates won’t become an autumn norm. But they also don’t yet fully understand the factors that have been driving this year’s surge, making it tough to know with certainty whether we’re due for an encore.

    One way or another, COVID has certainly thrown the typical end-of-year schedule out of whack. Respiratory viruses typically pick up speed in late fall, peak in mid-to-late winter, and then bow out by the spring; they often run in relay, with one microbe surging a bit before another. This year, though, nearly every pathogen arrived early, cresting in overlapping waves. “Everything is happening at once,” says Kathryn Edwards, a pediatrician and vaccinologist at Vanderbilt University. November isn’t yet through, and RSV has already sent infant hospitalizations soaring past pre-pandemic norms. Flu-hospitalization rates are also at their worst in more than a decade; about 30 states, plus D.C. and Puerto Rico, are reporting high or very high levels of the virus weeks before it usually begins its countrywide climb. And the country’s late-summer surge in rhinovirus and enterovirus has yet to fully abate. “We just haven’t had a break,” says Asuncion Mejias, a pediatrician at Nationwide Children’s Hospital.

    Previous pandemics have had similar knock-on effects. The H1N1-flu pandemic of 2009, for example, seems to have pushed back the start of the two RSV seasons that followed; seasonal flu also took a couple of years to settle back into its usual rhythms, Mejias told me. But that wonky timetable wasn’t permanent. If the viral calendar is even a little more regular next year, Mejias said, “that will make our lives easier.”

    This year, flu and RSV have also exploited Americans’ higher-than-average vulnerability. Initial encounters with RSV in particular can be rough, especially in infants, whose airways are still tiny; the sickness tempers with age as the body develops and immunity builds, leaving most children well protected by toddlerhood. But this fall, the pool of undefended kids is larger than usual. Children born just before the pandemic, or during the phases of the crisis when mitigations aplenty were still in place, may be meeting influenza or RSV for the first time. And many of them were born to mothers who had themselves experienced fewer infections and thus passed fewer antibodies to their baby while pregnant or breastfeeding. Some of the consequences may already have unfurled elsewhere in the world: Australia’s most recent flu season hit kids hard and early, and Nicaragua’s wave at the start of 2022 infected children at rates “higher than what we saw during the 2009 pandemic,” says Aubree Gordon, an epidemiologist at the University of Michigan.

    Read: What a ‘tripledemic’ means for your body

    In the U.S., many hospitals are now admitting far more toddlers and older children for respiratory illnesses than they normally do, says Mari Nakamura, a pediatric-infectious-disease specialist at Boston Children’s Hospital. The problem is worsened by the fact that many adults and school-age kids avoided their usual brushes with flu and RSV while those viruses were in exile, making it easier for the pathogens to spread once crowds flocked back together. “I wouldn’t be surprised,” Gordon told me, “if we see 50 to 60 percent of kids get infected with flu this year”—double the estimated typical rate of 20 to 30 percent. Caregivers too are falling sick; when I called Edwards, I could hear her husband and grandson coughing in the background.

    By next year, more people’s bodies should be clued back in to the season’s circulating strains, says Helen Chu, a physician and an epidemiologist at the University of Washington. Experts are also hopeful that the toolkit for fighting RSV will soon be much improved. Right now, there are no vaccines for the virus, and only one preventive drug is available in the U.S.: a tough-to-administer monoclonal antibody that’s available only to high-risk kids. But at least one RSV vaccine and another, less cumbersome antibody therapy (already being used in Europe) are expected to have the FDA’s green light by next fall.

    Even with the addition of better tech, though, falls and winters may be grueling for many years to come. SARS-CoV-2 is here to stay, and it will likely compound the respiratory burden by infecting people on its own or raising the risk of co-infections that can worsen and prolong disease. Even nonoverlapping illnesses might cause issues if they manifest in rapid sequence: Very serious bouts of COVID, for instance, can batter the respiratory tract, making it easier for other microbes to colonize.

    A few experts have begun to wonder if even milder tussles with SARS-CoV-2 might leave people more susceptible to other infections in the short or long term. Given the coronavirus’s widespread effects on the body, “we can’t be cavalier” about that possibility, says Flor Muñoz Rivas, a pediatrician at Baylor College of Medicine. Mejias and Octavio Ramilo, also at Nationwide, recently found that among a small group of infants, those with recent SARS-CoV-2 infections seemed to have a rougher go with a subsequent bout of RSV. The trend needs more study, though; it’s not clear which kids might be at higher risk, and Mejias doubts that the effect would last more than a few months.

    Gordon points out that some people may actually benefit from the opposite scenario: A recent brush with SARS-CoV-2 could bolster the body’s immune defenses against a second respiratory invader for a few days or weeks. This phenomenon, called viral interference, wouldn’t halt an outbreak by itself, but it’s thought to be part of the reason waves of respiratory disease don’t usually spike simultaneously: The presence of one microbe can sometimes crowd others out. Some experts think last year’s record-breaking Omicron spike helped punt a would-be winter flu epidemic to the spring.

    Even if all of these variables were better understood, the vagaries of viral evolution could introduce a plot twist. A new variant of SARS-CoV-2 may yet emerge; a novel strain of flu could cause a pandemic of its own. RSV, for its part, is not thought to be as quick to shape-shift, but the virus’s genetics are not well studied. Mejias and Ramilo’s data suggest that the arrival of a gnarly RSV strain in 2019 may have pushed local hospitalizations past their usual highs.

    Read: Will we get Omicron’d again?

    Behavioral and infrastructural factors could cloud the forecast as well. Health-care workers vacated their posts in droves during the pandemic, and many hospitals’ pediatric-bed capacity has shrunk, leaving supply grossly inadequate to address current demand. COVID-vaccination rates in little kids also remain abysmal, and many pediatricians are worried that anti-vaccine sentiment could stymie the delivery of other routine immunizations, including those against flu. Even temporary delays in vaccination can have an effect: Muñoz Rivas points out that the flu’s early arrival this year, ahead of when many people signed up for their shot, may now be aiding the virus’s spread. The new treatments and vaccines for RSV “could really, really help,” Nakamura told me, but “only if we use them.”

    Next fall comes with few guarantees: The seasonal schedule may not rectify itself; viruses may not give us an evolutionary pass. Our immune system will likely be better-prepared to fend off flu, RSV, rhinovirus, enterovirus, and more—but that may not be enough on its own. What we can control, though, is how we choose to arm ourselves. The past few years proved that the world does know how to drive down rates of respiratory disease. “We had so little contagion during the time we were trying to keep COVID at bay,” Edwards told me. “Is there something to be learned?”

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    Katherine J. Wu

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  • The Double-Negative Election

    The Double-Negative Election

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    This has become the double-negative election.

    Most Americans consistently say in polls that they believe that President Joe Biden and congressional Democrats have mismanaged crime, the border, and, above all, the economy and inflation. But roughly as many Americans say that they view the modern Republican Party as a threat to their rights, their values, or to democracy itself.

    Based on Biden’s first two years in office, surveys show that most Americans are reluctant to continue following the policy path he has laid out. But polls also show no enthusiasm for returning to the programs, priorities, and daily chaos of Donald Trump’s presidency. In an NBC national survey released last weekend, half of registered voters said they disagreed with most of what Biden and congressional Democrats want to do, but more than that said the same about congressional Republicans and Trump. About half of all voters said they had little, or no, confidence in either party to improve the economy, according to another recent national survey from CNBC.

    Read: Why this election is so weird

    It remains likely that two negatives will still yield a positive result for Republicans. Most voters with little faith in both sides may ultimately decide simply to give a chance to the party that’s not in charge now, Jay Campbell, a Democratic pollster who helps conduct the CNBC survey, told me. That would provide a late boost to the GOP, particularly in House races, where the individual candidates are less well known. But even if that dynamic develops, Campbell said, the Democrats’ ability to hold so much of their coalition over concerns about the broader Republican agenda has reduced the odds that the GOP can generate the kind of decisive midterm gains enjoyed by Democrats in 2018 and 2006, or Republicans in 2010 and 1994.

    If Republicans make only modest gains this fall, it will be a clear warning that the party, as currently defined by Trump’s imprint, faces a hard ceiling on its potential support. But even a small Republican gain would send Democrats an equal warning that concerns about the GOP’s values and commitment to democracy may not be sufficient to deny them the White House in 2024. “If I was advising the Biden administration, I would say this is the No. 1 priority: Fix the fundamentals,” John Sides, a political scientist at Vanderbilt University and a co-author of a new book on the 2020 presidential election, The Bitter End, told me. “The biggest priority is inflation, and everything else is secondary.”

    By precedent, Democrats should be facing a rout next month. That’s partly because the first midterm election for a new president is almost always tough on his party, but also because most voters express deep pessimism about the country’s current conditions. Despite robust job growth, the combination of inflation, rising interest rates, and tumbling stock markets has generated intense economic dissatisfaction. National surveys, like last week’s CNBC poll, routinely find that on key economic measures, voters prefer Republicans over Democrats by double-digit margins. A September NPR/PBS NewsHour/Marist poll found that nearly three-fifths of voters say Biden’s policies have weakened the economy, compared with only about one-third who say they have strengthened it.

    Given those attitudes, academic models predict that Democrats should lose about 40 to 45 House seats next month, Sides recently noted.

    Likewise, Democrats are swimming upstream against the growing tendency of voters to align their selections for the Senate with their assessment of the incumbent president. In 2018, Republicans lost every Senate race in a state where Trump’s approval rating in exit polls stood at 48 percent or less; in 2010, Democrats lost 13 of the 15 Senate races in states where then-President Barack Obama’s approval rating stood at 47 percent or less. This year, Biden’s approval rating does not exceed 45 percent in any of the states hosting the most hotly contested Senate races, and more often stands at only about 40 percent, or even less.

    These precedents could ultimately produce Republican gains closer to these historic benchmarks. In polling, the party out of the White House traditionally has gained strength in the final weeks before midterm voting, as most undecided and less-attuned voters break their way.

    Bill McInturff, a veteran Republican pollster, told me that dynamic could be compounded this year because independent and less partisan voters remain focused on inflation (rather than the issues of abortion and democracy animating Democrats) and express preponderantly negative views about the economy and Biden’s performance. Campbell agreed that for those reasons, independent voters could move against Democrats, especially in House races. The number of blue-leaning House districts where Democrats are nonetheless spending heavily on defense in the final weeks testifies to that likelihood. Several House-race forecasters have recently upped their projections of likely Republican gains closer to the midterm average since World War II for the party out of the White House, about 26 seats.

    But even with all of these formidable headwinds, Democrats have remained highly competitive in polling on national sentiment for the House, and in the key Senate battlegrounds (including Arizona, Georgia, Nevada, New Hampshire, Ohio, Pennsylvania, and Wisconsin). And although Democrats face unexpectedly difficult challenges in governor’s races in New York and Oregon, they remain ahead or well within reach in Arizona, Michigan, Nevada, Pennsylvania, and Wisconsin. To be sure, Democrats are not decisive favorites in any of these races (except for governor of Pennsylvania), but despite the gloomy national climate, neither have any of these contests moved out of their reach.

    That’s largely because the party has minimized defections and increased engagement from the key groups in its coalition—including young people, college-educated voters, women, and people of color—by focusing more attention on issues where those voters perceive the Trump-era GOP as a threat. Weak or extreme Republican candidates have eased that work in several of these Senate and governor races.

    But another factor allowing Democrats to remain competitive is that, for all the doubts Americans are expressing about their performance, there is no evidence of rising confidence in Republicans.

    Read: What to expect when you’re expecting a Republican house

    For instance, the latest national NBC survey, conducted by the bipartisan team of Public Opinion Strategies and Hart Research, found that 48 percent of voters said they would be less likely to vote for a candidate who promised to continue Biden’s policies. That sounds ominous for Democrats, but voters were slightly more negative about a candidate who promised to pursue Trump’s policies (50 percent less likely). Only about one-third of independents said they preferred a candidate who would continue the policies of either Biden or Trump. All of that tracks with the survey’s other finding that although half of voters said they disagreed with most of what Biden and the Democrats are trying to do, even more said they mostly disagreed with the agenda of congressional Republicans (53 percent) and Trump (56 percent).

    Other polls have also found this double-barreled skepticism. The latest CNBC poll (also conducted by the Hart Research/Public Opinion Strategies team) found the two parties facing almost identically bleak verdicts on their ability to improve the economy: Only a little more than one-fifth of voters expressed much confidence in each party, while more than three-fourths expressed little or none.

    When a Yahoo/YouGov America poll recently asked whether each party was focusing on the right issues, only about 30 percent of voters in each case said yes, and about half said no. Only about one-fourth of women said Republicans have the right priorities; only about one-fourth of men said Democrats have the right priorities. The capstone on all of these attitudes is the consistent finding that most Americans (an identical 57 percent in the Yahoo/You Gov survey) don’t want either Biden or Trump to run again in 2024.

    In baseball, they say a tie goes to the runner. The political analogue might be that equally negative assessments of the two parties are likely to break in favor of the side out of power. Campbell points out that while a striking 81 percent of independents say they have little or no confidence in Republicans to improve the economy, that number rises to 90 percent about Democrats. In the NBC survey, voters who said they mostly disagreed with both Biden’s and Trump’s policy agenda preferred Republicans to control Congress by a margin of three to one, according to detailed results provided by McInturff.

    Democrats seem acutely, though perhaps belatedly, aware of these challenges. They now warn that Republicans, if given control of one or both congressional chambers, would threaten Medicare and Social Security, most pointedly by demanding cuts in return for raising the federal debt ceiling next year. But it’s not clear that those arguments can break through the lived reality of higher prices for gas and groceries squeezing so many families. “Inflation, rising gas prices, interest rates—those are things people feel every day,” Tony Fabrizio, the lead pollster for Trump in 2020, told me recently. “There is no TV commercial that is going to change what they feel when they go to the grocery store or the gas station.”

    The challenge those daily realities pose to Democrats is not unique: As the political analyst John Halpin recently noted, “inflation is a political wrecking ball for incumbent governments” across the Western world (as demonstrated by England’s recent chaos and the election of right-wing governments in Sweden and Italy). No democratically elected government may enjoy much security until more people in its country feel secure about their own finances. For Democrats, the risk of an unexpectedly bad outcome next month seems greater than the possibility of an unexpectedly good one.

    Republican gains this fall would only extend a core dynamic of modern American politics: the inability of either party to establish a durable advantage over the other. If Democrats lose one or both congressional chambers, it will mark the fifth consecutive time that a president who went into a midterm election with unified control of government has lost it. The prospect of very tight races next month in almost all of the same states that decided the 2020 presidential election underscores the likelihood that the 2024 race for the White House will again divide the country closely and bitterly.

    Yet the undertow threatening Democrats now previews the difficulty they will face in two years if economic conditions don’t improve. In presidential races, political scientists say voters start to harden their verdicts on the economy about a year before Election Day. That means Biden is running out of time to tame inflation, especially if, as most economists expect, doing so will require at least a modest recession. Even amid widespread anxiety about both inflation and recession, Democrats remain competitive this fall by highlighting doubts about Republicans, particularly among the voters in their own coalition. But that cannot be an experiment any Democrat would look forward to repeating in 2024.

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    Ronald Brownstein

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  • Vanderbilt University Medical Center to pause gender-affirming surgeries for minors to review practices

    Vanderbilt University Medical Center to pause gender-affirming surgeries for minors to review practices

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    Officials at Vanderbilt University Medical Center announced Friday that they are pausing gender-affirming surgeries for minors in order to review their practices.

    The news, delivered in a letter sent to a lawmaker who has demanded an end to the surgeries, was publicly released Friday afternoon. It comes amid mounting political pressure from Tennessee’s Republican leaders — many of whom are running for reelection — who called for an investigation into the private nonprofit hospital after videos surfaced on social media last month of a doctor touting that gender-affirming procedures are “huge money makers.” Another video showed a staffer saying anyone with a religious objection should quit.

    None of the politicians could point to a specific law that the hospital had violated, and no agency to date has committed to an investigation. Republican Gov. Bill Lee’s office said they had passed their concerns to the Attorney General Jonathan Skrmetti, but his office has not commented on whether he is looking into the Nashville-based hospital.

    “We are pausing gender affirmation surgeries on patients under age 18 while we complete this review, which may take several months,” wrote C. Wright Pinson, VUMC’s deputy CEO and chief health system officer.

    The GOP-dominated Legislature is scheduled to reconvene in January, and many lawmakers have vowed to introduce legislation further limit gender-affirming treatments. If successful, it’s unclear if VUMC would be allowed to resume gender-affirming surgeries for minors, regardless of their internal review.

    “We should not allow permanent, life-altering decisions that hurt children,” Lee tweeted late Friday. “With the partnership of the General Assembly, this practice should end in Tennessee.”

    According to Pinson, the World Professional Association for Transgender Health recently changed its recommendations for transgender treatment, which helped prompt the need for a review. 

    The American Academy of Pediatrics recommends “providing youth with access to comprehensive gender-affirming and developmentally appropriate health care.” In a 2018 policy statement, the AAP also notes that the “supportive involvement of parents and family is associated with better mental and physical health outcomes.”

    On average, VUMC has provided five gender-affirming surgeries to minors every year since its transgender clinic opened in 2018. All were over the age of 16 and had parental consent, and none received genital procedures.

    “The revenues from this limited number of surgeries represent an immaterial percentage of VUMC’s net operating revenue,” Pinson wrote.

    Emails provided to The Associated Press through a public records request show hundreds of Tennesseans reached out to the governor’s office in support of shutting down VUMC’s transgender youth health clinic, with some asking him to call a special legislative session to address the issue. Others asked if he could suspend the licenses of the doctors who work at the clinic.

    A few criticized Lee for not taking harsher steps earlier when he signed legislation banning doctors from providing gender-confirming hormone treatment to prepubescent minors.

    Only a handful defended the clinic’s services, with some saying the transgender health care they received had been life-saving.

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