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bountyofbeads · 5 years ago

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WE ARE LIVING IN A FAILED STATE

The coronavirus didn’t break America. It revealed what was already broken.

By George Packer | SPECIAL PREVIEW: JUNE 2020 Issue | The Atlantic Magazine | Posted April 21, 2020 |

When the virus came here, it found a country with serious underlying conditions, and it exploited them ruthlessly. Chronic ills—a corrupt political class, a sclerotic bureaucracy, a heartless economy, a divided and distracted public—had gone untreated for years. We had learned to live, uncomfortably, with the symptoms. It took the scale and intimacy of a pandemic to expose their severity—to shock Americans with the recognition that we are in the high-risk category.

The crisis demanded a response that was swift, rational, and collective. The United States reacted instead like Pakistan or Belarus—like a country with shoddy infrastructure and a dysfunctional government whose leaders were too corrupt or stupid to head off mass suffering. The administration squandered two irretrievable months to prepare. From the president came willful blindness, scapegoating, boasts, and lies. From his mouthpieces, conspiracy theories and miracle cures. A few senators and corporate executives acted quickly—not to prevent the coming disaster, but to profit from it. When a government doctor tried to warn the public of the danger, the White House took the mic and politicized the message.

Every morning in the endless month of March, Americans woke up to find themselves citizens of a failed state. With no national plan—no coherent instructions at all—families, schools, and offices were left to decide on their own whether to shut down and take shelter. When test kits, masks, gowns, and ventilators were found to be in desperately short supply, governors pleaded for them from the White House, which stalled, then called on private enterprise, which couldn’t deliver. States and cities were forced into bidding wars that left them prey to price gouging and corporate profiteering. Civilians took out their sewing machines to try to keep ill-equipped hospital workers healthy and their patients alive. Russia, Taiwan, and the United Nations sent humanitarian aid to the world’s richest power—a beggar nation in utter chaos.

Donald Trump saw the crisis almost entirely in personal and political terms. Fearing for his reelection, he declared the coronavirus pandemic a war, and himself a wartime president. But the leader he brings to mind is Marshal Philippe Pétain, the French general who, in 1940, signed an armistice with Germany after its rout of French defenses, then formed the pro-Nazi Vichy regime. Like Pétain, Trump collaborated with the invader and abandoned his country to a prolonged disaster. And, like France in 1940, America in 2020 has stunned itself with a collapse that’s larger and deeper than one miserable leader. Some future autopsy of the pandemic might be called Strange Defeat, after the historian and Resistance fighter Marc Bloch’s contemporaneous study of the fall of France. Despite countless examples around the U.S. of individual courage and sacrifice, the failure is national. And it should force a question that most Americans have never had to ask: Do we trust our leaders and one another enough to summon a collective response to a mortal threat? Are we still capable of self-government?

This is the third major crisis of the short 21st century. The first, on September 11, 2001, came when Americans were still living mentally in the previous century, and the memory of depression, world war, and cold war remained strong. On that day, people in the rural heartland did not see New York as an alien stew of immigrants and liberals that deserved its fate, but as a great American city that had taken a hit for the whole country. Firefighters from Indiana drove 800 miles to help the rescue effort at Ground Zero. Our civic reflex was to mourn and mobilize together.

Partisan politics and terrible policies, especially the Iraq War, erased the sense of national unity and fed a bitterness toward the political class that never really faded. The second crisis, in 2008, intensified it. At the top, the financial crash could almost be considered a success. Congress passed a bipartisan bailout bill that saved the financial system. Outgoing Bush-administration officials cooperated with incoming Obama administration officials. The experts at the Federal Reserve and the Treasury Department used monetary and fiscal policy to prevent a second Great Depression. Leading bankers were shamed but not prosecuted; most of them kept their fortunes and some their jobs. Before long they were back in business. A Wall Street trader told me that the financial crisis had been a “speed bump.”

All of the lasting pain was felt in the middle and at the bottom, by Americans who had taken on debt and lost their jobs, homes, and retirement savings. Many of them never recovered, and young people who came of age in the Great Recession are doomed to be poorer than their parents. Inequality—the fundamental, relentless force in American life since the late 1970s—grew worse.

This second crisis drove a profound wedge between Americans: between the upper and lower classes, Republicans and Democrats, metropolitan and rural people, the native-born and immigrants, ordinary Americans and their leaders. Social bonds had been under growing strain for several decades, and now they began to tear. The reforms of the Obama years, important as they were—in health care, financial regulation, green energy—had only palliative effects. The long recovery over the past decade enriched corporations and investors, lulled professionals, and left the working class further behind. The lasting effect of the slump was to increase polarization and to discredit authority, especially government’s.

Both parties were slow to grasp how much credibility they’d lost. The coming politics was populist. Its harbinger wasn’t Barack Obama but Sarah Palin, the absurdly unready vice-presidential candidate who scorned expertise and reveled in celebrity. She was Donald Trump’s John the Baptist.

Trump came to power as the repudiation of the Republican establishment. But the conservative political class and the new leader soon reached an understanding. Whatever their differences on issues like trade and immigration, they shared a basic goal: to strip-mine public assets for the benefit of private interests. Republican politicians and donors who wanted government to do as little as possible for the common good could live happily with a regime that barely knew how to govern at all, and they made themselves Trump’s footmen.

Like a wanton boy throwing matches in a parched field, Trump began to immolate what was left of national civic life. He never even pretended to be president of the whole country, but pitted us against one another along lines of race, sex, religion, citizenship, education, region, and—every day of his presidency—political party. His main tool of governance was to lie. A third of the country locked itself in a hall of mirrors that it believed to be reality; a third drove itself mad with the effort to hold on to the idea of knowable truth; and a third gave up even trying.

Trump acquired a federal government crippled by years of right-wing ideological assault, politicization by both parties, and steady defunding. He set about finishing off the job and destroying the professional civil service. He drove out some of the most talented and experienced career officials, left essential positions unfilled, and installed loyalists as commissars over the cowed survivors, with one purpose: to serve his own interests. His major legislative accomplishment, one of the largest tax cuts in history, sent hundreds of billions of dollars to corporations and the rich. The beneficiaries flocked to patronize his resorts and line his reelection pockets. If lying was his means for using power, corruption was his end.

This was the American landscape that lay open to the virus: in prosperous cities, a class of globally connected desk workers dependent on a class of precarious and invisible service workers; in the countryside, decaying communities in revolt against the modern world; on social media, mutual hatred and endless vituperation among different camps; in the economy, even with full employment, a large and growing gap between triumphant capital and beleaguered labor; in Washington, an empty government led by a con man and his intellectually bankrupt party; around the country, a mood of cynical exhaustion, with no vision of a shared identity or future.

If the pandemic really is a kind of war, it’s the first to be fought on this soil in a century and a half. Invasion and occupation expose a society’s fault lines, exaggerating what goes unnoticed or accepted in peacetime, clarifying essential truths, raising the smell of buried rot.

The virus should have united Americans against a common threat. With different leadership, it might have. Instead, even as it spread from blue to red areas, attitudes broke down along familiar partisan lines. The virus also should have been a great leveler. You don’t have to be in the military or in debt to be a target—you just have to be human. But from the start, its effects have been skewed by the inequality that we’ve tolerated for so long. When tests for the virus were almost impossible to find, the wealthy and connected—the model and reality-TV host Heidi Klum, the entire roster of the Brooklyn Nets, the president’s conservative allies—were somehow able to get tested, despite many showing no symptoms. The smattering of individual results did nothing to protect public health. Meanwhile, ordinary people with fevers and chills had to wait in long and possibly infectious lines, only to be turned away because they weren’t actually suffocating. An internet joke proposed that the only way to find out whether you had the virus was to sneeze in a rich person’s face.

When Trump was asked about this blatant unfairness, he expressed disapproval but added, “Perhaps that’s been the story of life.” Most Americans hardly register this kind of special privilege in normal times. But in the first weeks of the pandemic it sparked outrage, as if, during a general mobilization, the rich had been allowed to buy their way out of military service and hoard gas masks. As the contagion has spread, its victims have been likely to be poor, black, and brown people. The gross inequality of our health-care system is evident in the sight of refrigerated trucks lined up outside public hospitals.

We now have two categories of work: essential and nonessential. Who have the essential workers turned out to be? Mostly people in low-paying jobs that require their physical presence and put their health directly at risk: warehouse workers, shelf-stockers, Instacart shoppers, delivery drivers, municipal employees, hospital staffers, home health aides, long-haul truckers. Doctors and nurses are the pandemic’s combat heroes, but the supermarket cashier with her bottle of sanitizer and the UPS driver with his latex gloves are the supply and logistics troops who keep the frontline forces intact. In a smartphone economy that hides whole classes of human beings, we’re learning where our food and goods come from, who keeps us alive. An order of organic baby arugula on AmazonFresh is cheap and arrives overnight in part because the people who grow it, sort it, pack it, and deliver it have to keep working while sick. For most service workers, sick leave turns out to be an impossible luxury. It’s worth asking if we would accept a higher price and slower delivery so that they could stay home.

The pandemic has also clarified the meaning of nonessential workers. One example is Kelly Loeffler, the Republican junior senator from Georgia, whose sole qualification for the empty seat that she was given in January is her immense wealth. Less than three weeks into the job, after a dire private briefing about the virus, she got even richer from the selling-off of stocks, then she accused Democrats of exaggerating the danger and gave her constituents false assurances that may well have gotten them killed. Loeffler’s impulses in public service are those of a dangerous parasite. A body politic that would place someone like this in high office is well advanced in decay.

The purest embodiment of political nihilism is not Trump himself but his son-in-law and senior adviser, Jared Kushner. In his short lifetime, Kushner has been fraudulently promoted as both a meritocrat and a populist. He was born into a moneyed real-estate family the month Ronald Reagan entered the Oval Office, in 1981—a princeling of the second Gilded Age. Despite Jared’s mediocre academic record, he was admitted to Harvard after his father, Charles, pledged a $2.5 million donation to the university. Father helped son with $10 million in loans for a start in the family business, then Jared continued his elite education at the law and business schools of NYU, where his father had contributed $3 million. Jared repaid his father’s support with fierce loyalty when Charles was sentenced to two years in federal prison in 2005 for trying to resolve a family legal quarrel by entrapping his sister’s husband with a prostitute and videotaping the encounter.

[ Francis Fukuyama: The thing that determines a country’s resistance to the coronavirus]

Jared Kushner failed as a skyscraper owner and a newspaper publisher, but he always found someone to rescue him, and his self-confidence only grew. In American Oligarchs, Andrea Bernstein describes how he adopted the outlook of a risk-taking entrepreneur, a “disruptor” of the new economy. Under the influence of his mentor Rupert Murdoch, he found ways to fuse his financial, political, and journalistic pursuits. He made conflicts of interest his business model.

So when his father-in-law became president, Kushner quickly gained power in an administration that raised amateurism, nepotism, and corruption to governing principles. As long as he busied himself with Middle East peace, his feckless meddling didn’t matter to most Americans. But since he became an influential adviser to Trump on the coronavirus pandemic, the result has been mass death.

In his first week on the job, in mid-March, Kushner co-authored the worst Oval Office speech in memory, interrupted the vital work of other officials, may have compromised security protocols, flirted with conflicts of interest and violations of federal law, and made fatuous promises that quickly turned to dust. “The federal government is not designed to solve all our problems,” he said, explaining how he would tap his corporate connections to create drive-through testing sites. They never materialized. He was convinced by corporate leaders that Trump should not use presidential authority to compel industries to manufacture ventilators—then Kushner’s own attempt to negotiate a deal with General Motors fell through. With no loss of faith in himself, he blamed shortages of necessary equipment and gear on incompetent state governors.

To watch this pale, slim-suited dilettante breeze into the middle of a deadly crisis, dispensing business-school jargon to cloud the massive failure of his father-in-law’s administration, is to see the collapse of a whole approach to governing. It turns out that scientific experts and other civil servants are not traitorous members of a “deep state”—they’re essential workers, and marginalizing them in favor of ideologues and sycophants is a threat to the nation’s health. It turns out that “nimble” companies can’t prepare for a catastrophe or distribute lifesaving goods—only a competent federal government can do that. It turns out that everything has a cost, and years of attacking government, squeezing it dry and draining its morale, inflict a heavy cost that the public has to pay in lives. All the programs defunded, stockpiles depleted, and plans scrapped meant that we had become a second-rate nation. Then came the virus and this strange defeat.

The fight to overcome the pandemic must also be a fight to recover the health of our country, and build it anew, or the hardship and grief we’re now enduring will never be redeemed. Under our current leadership, nothing will change. If 9/11 and 2008 wore out trust in the old political establishment, 2020 should kill off the idea that anti-politics is our salvation. But putting an end to this regime, so necessary and deserved, is only the beginning.

We’re faced with a choice that the crisis makes inescapably clear. We can stay hunkered down in self-isolation, fearing and shunning one another, letting our common bond wear away to nothing. Or we can use this pause in our normal lives to pay attention to the hospital workers holding up cellphones so their patients can say goodbye to loved ones; the planeload of medical workers flying from Atlanta to help in New York; the aerospace workers in Massachusetts demanding that their factory be converted to ventilator production; the Floridians standing in long lines because they couldn’t get through by phone to the skeletal unemployment office; the residents of Milwaukee braving endless waits, hail, and contagion to vote in an election forced on them by partisan justices. We can learn from these dreadful days that stupidity and injustice are lethal; that, in a democracy, being a citizen is essential work; that the alternative to solidarity is death. After we’ve come out of hiding and taken off our masks, we should not forget what it was like to be alone.

This article appears in the June 2020 print edition with the headline “Underlying Conditions.”

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We want to hear what you think about this article. Submit a letter to the editor or write to [email protected].

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GEORGE PACKER is a staff writer at The Atlantic. He is the author of Our Man: Richard Holbrooke and the End of the American Century and The Unwinding: An Inner History of the New America.

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Why Some People Get Sicker Than Others

COVID-19 is proving to be a disease of the immune system. This could, in theory, be controlled.

By James Hamblin | Published April 21, 2020 10:41 AM ET | The Atlantic Magazine | Posted April 21, 2020 |

The COVID-19 crash comes suddenly. In early March, the 37-year-old writer F. T. Kola began to feel mildly ill, with a fever and body aches. To be safe, she isolated herself at home in San Francisco. Life continued apace for a week, until one day she tried to load her dishwasher and felt strangely exhausted.

Her doctor recommended that she go to Stanford University’s drive-through coronavirus testing site. “I remember waiting in my car, and the doctors in their intense [protective equipment] coming towards me like a scene out of Contagion,” she told me when we spoke for The Atlantic’s podcast Social Distance. “I felt like I was a biohazard—and I was.” The doctors stuck a long swab into the back of her nose and sent her home to await results.

Lying in bed that night, she began to shake, overtaken by the most intense chills of her life. “My teeth were chattering so hard that I was really afraid they would break,” she said. Then she started to hallucinate. “I thought I was holding a very big spoon for some reason, and I kept thinking, Where am I going to put my spoon down?”

An ambulance raced her to the hospital, where she spent three days in the ICU, before being moved to a newly created coronavirus-only ward. Sometimes she barely felt sick at all, and other times she felt on the verge of death. But after two weeks in the hospital, she walked out. Now, as the death toll from the coronavirus has climbed to more than 150,000 people globally, Kola has flashes of guilt and disbelief: “Why did my lungs make it through this? Why did I go home? Why am I okay now?”

[ Read: The best hopes for a coronavirus drug]

COVID-19 is, in many ways, proving to be a disease of uncertainty. According to a new study from Italy, some 43 percent of people with the virus have no symptoms. Among those who do develop symptoms, it is common to feel sick in uncomfortable but familiar ways—congestion, fever, aches, and general malaise. Many people start to feel a little bit better. Then, for many, comes a dramatic tipping point. “Some people really fall off the cliff, and we don’t have good predictors of who it’s going to happen to,” Stephen Thomas, the chair of infectious diseases at Upstate University Hospital, told me. Those people will become short of breath, their heart racing and mind detached from reality. They experience organ failure and spend weeks in the ICU, if they survive at all.

Meanwhile, many others simply keep feeling better and eventually totally recover. Kola’s friend Karan Mahajan, an author based in Providence, Rhode Island, contracted the virus at almost the same time she did. In stark contrast to Kola, he said, “My case ended up feeling like a mild flu that lasted for two weeks. And then it faded after that.”

(Related Podcast: Listen to James Hamblin interview Kola and Mahajan on an episode of Social Distance, The Atlantic’s podcast about life in the pandemic)

“There’s a big difference in how people handle this virus,” says Robert Murphy, a professor of medicine and the director of the Center for Global Communicable Diseases at Northwestern University. “It’s very unusual. None of this variability really fits with any other diseases we’re used to dealing with.”

This degree of uncertainty has less to do with the virus itself than how our bodies respond to it. As Murphy puts it, when doctors see this sort of variation in disease severity, “that’s not the virus; that’s the host.” Since the beginning of the pandemic, people around the world have heard the message that older and chronically ill people are most likely to die from COVID-19. But that is far from a complete picture of who is at risk of life-threatening disease. Understanding exactly how and why some people get so sick while others feel almost nothing will be the key to treatment.

Hope has been put in drugs that attempt to slow the replication of the virus—those currently in clinical trials like remdesivir, ivermectin, and hydroxychloroquine. But with the flu and most other viral diseases, antiviral medications are often effective only early in the disease. Once the virus has spread widely within our body, our own immune system becomes the thing that more urgently threatens to kill us. That response cannot be fully controlled. But it can be modulated and improved.

One of the common, perplexing experiences of COVID-19 is the loss of smell—and, then, taste. “Eating pizza was like eating cardboard,” Mahajan told me. Any common cold that causes congestion can alter these sensations to some degree. But a near-total breakdown of taste and smell is happening with coronavirus infections even in the absence of other symptoms.

Jonathan Aviv, an ear, nose, and throat doctor based in New York, told me he has seen a surge in young people coming to him with a sudden inability to taste. He’s unsure what to tell them about what’s going on. “The non-scary scenario is that the inflammatory effect of the infection is temporarily altering the function of the olfactory nerve,” he said. “The scarier possibility is that the virus is attacking the nerve itself.” Viruses that attack nerves can cause long-term impairment, and could affect other parts of the nervous system. The coronavirus has already been reported to precipitate inflammation in the brain that leads to permanent damage.

Though SARS-CoV-2 (the new coronavirus) isn’t reported to invade the brain and spine directly, its predecessor SARS-CoV seems to have that capacity. If nerve cells are spared by the new virus, they would be among the few that are. When the coronavirus attaches to cells, it hooks on and breaks through, then starts to replicate. It does so especially well in the cells of the nasopharynx and down into the lungs, but is also known to act on the cells of the liver, bowels, and heart. The virus spreads around the body for days or weeks in a sort of stealth mode, taking over host cells while evading the immune response. It can take a week or two for the body to fully recognize the extent to which it has been overwhelmed. At this point, its reaction is often not calm and measured. The immune system goes into a hyperreactive state, pulling all available alarms to mobilize the body’s defense mechanisms. This is when people suddenly crash.

Bootsie Plunkett, a 61-year-old retiree in New Jersey with diabetes and lupus, described it to me as suffocating. We met in February, taping a TV show, and she was her typically ebullient self. A few weeks later, she developed a fever. It lasted for about two weeks, as did the body aches. She stayed at home with what she presumed was COVID-19. Then, as if out of nowhere, she was gasping for air. Her husband raced her to the hospital, and she began to slump over in the front seat. When they made it to the hospital, her blood-oxygen level was just 79 percent, well below the point when people typically require aggressive breathing support.

Such a quick decline—especially in the later stages of an infectious disease—seems to result from the immune response suddenly kicking into overdrive. The condition tends to be dire. Half of the patients with COVID-19 who end up in the intensive-care unit at New York–Presbyterian Hospital stay for 20 days, according to Pamela Sutton-Wallace, the regional chief operating officer. (In normal times, the national average is 3.3 days). Many of these patients arrive at the hospital in near-critical condition, with their blood tests showing soaring levels of inflammatory markers. One that seems to be especially predictive of a person’s fate is a protein known as D-dimer. Doctors in Wuhan, China, where the coronavirus outbreak was first reported, have found that a fourfold increase in D-dimer is a strong predictor of mortality, suggesting in a recent paper that the test “could be an early and helpful marker” of who is entering the dangerous phases.

These and other markers are often signs of a highly fatal immune-system process known as a cytokine storm, explains Randy Cron, the director of rheumatology at Children’s of Alabama, in Birmingham. A cytokine is a short-lived signaling molecule that the body can release to activate inflammation in an attempt to contain and eradicate a virus. In a cytokine storm, the immune system floods the body with these molecules, essentially sounding a fire alarm that continues even after the firefighters and ambulances have arrived.

At this point, the priority for doctors shifts from hoping that a person’s immune system can fight off the virus to trying to tamp down the immune response so it doesn’t kill the person or cause permanent organ damage. As Cron puts it, “If you see a cytokine storm, you have to treat it.” But treating any infection by impeding the immune system is always treacherous. It is never ideal to let up on a virus that can directly kill our cells. The challenge is striking a balance where neither the cytokine storm nor the infection runs rampant.

Cron and other researchers believe such a balance is possible. Cytokine storms are not unique to COVID-19. The same basic process happens in response to other viruses, such as dengue and Ebola, as well as influenza and other coronaviruses. It is life-threatening and difficult to treat, but not beyond the potential for mitigation.

At Johns Hopkins University, the biomedical engineer Joshua Vogelstein and his colleagues have been trying to identify patterns among people who have survived cytokine storms and people who haven’t. One correlation the team noticed was that people taking the drug tamsulosin (sold as Flomax, to treat urinary retention) seemed to fare well. Vogelstein is unsure why. Cytokine storms do trigger the release of hormones such as dopamine and adrenaline, which tamsulosin can partially block. The team is launching a clinical trial to see if the approach is of any help.

One of the more promising approaches is blocking cytokines themselves—once they’ve already been released into the blood. A popular target is one type of cytokine known as interleukin-6 (IL-6), which is known to peak at the height of respiratory failure. Benjamin Lebwohl, director of research at Columbia University’s Celiac Disease Center, says that people with immune conditions like celiac and inflammatory bowel disease may be at higher risk of severe cases of COVID-19. But he’s hopeful that medications that inhibit IL-6 or other cytokines could pare back the unhelpful responses while leaving others intact. Other researchers have seen promising preliminary results, and clinical trials are ongoing.

[Read: The best hopes for a coronavirus drug]

If interleukin inhibitors end up playing a significant role in treating very sick people, though, we would run out. These medicines (which go by names such as tocilizumab and ruxolitinib, reading like a good draw in Scrabble) fall into a class known as “biologics.” They are traditionally used in rare cases and tend to be very expensive, sometimes costing people with immune conditions about $18,000 a year. Based on price and the short supply, Cron says, “my guess is we’re going to rely on corticosteroids at the end of the day. Because it’s what we have.”

That is a controversial opinion. Corticosteroids (colloquially known as “steroids,” though they are of the adrenal rather than reproductive sort), can act as an emergency brake on the immune system. Their broad, sweeping action means that steroids involve more side effects than targeting one specific cytokine. Typically, a person on steroids has a higher risk of contracting another dangerous infection, and early evidence on the utility of steroids in treating COVID-19, in studies from the outbreak in China, was mixed. But some doctors are now using them to good effect. Last week, the Infectious Diseases Society of America issued guidelines on steroids, recommending them in the context of a clinical trial when the disease reaches the level of acute respiratory distress. They may have helped Plunkett, the 61-year-old from New Jersey. After three days on corticosteroids, she left the ICU—without ever being intubated.

Deciding on the precise method of modulating the immune response—the exact drug, dose, and timing—is ideally informed by carefully monitoring patients before they are critically ill. People at risk of a storm could be monitored closely throughout their illness, and offered treatment immediately when signs begin to show. That could mean detecting the markers in a person’s blood before the process sends her into hallucinations—before her oxygen level fell at all.

In typical circumstances in the United States and other industrialized nations, patients would be urged to go to the hospital sooner rather than later. But right now, to avoid catastrophic strain on an already overburdened health-care system, people are told to avoid the hospital until they feel short of breath. For those who do become critically ill and arrive at the ER in respiratory failure, health-care workers are then behind the ball. Given those circumstances, the daily basics of maintaining overall health and the best possible immune response become especially important.

The official line from the White House Coronavirus Task Force has been that “high-risk” people are older and those with chronic medical conditions, such as obesity and diabetes. But that has proven to be a limited approximation of who will bear the burden of this disease most severely. Last week, the Centers for Disease Control and Prevention released its first official report on who has been hospitalized for COVID-19. It found that Latinos and African Americans have died at significantly higher rates than white Americans. In Chicago, more than half of the people who have tested positive, and nearly 60 percent of those who have died, were African American. They make up less than one-third of the city’s population. Similar patterns are playing out across the country: Rates of death and severe disease are several times higher among racial minorities and people of low socioeconomic status.

[Read: What the racial data show]

These disparities are beginning to be acknowledged at high levels, but often as though they are just another one of the mysteries of the coronavirus. At a White House briefing last week, Vice President Mike Pence said his team was looking into “the unique impact that we’re seeing reported on African Americans from the coronavirus.” Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, has noted that “we are not going to solve the issues of health disparities this month or next month. This is something we should commit ourselves for years to do.”

While America’s deepest health disparities absolutely would require generations to undo, the country still could address many gaps right now. Variation in immune responses between people is due to much more than age or chronic disease. The immune system is a function of the communities that brought us up and the environments with which we interact every day. Its foundation is laid by genetics and early-life exposure to the world around us—from the food we eat to the air we breathe. Its response varies on the basis of income, housing, jobs, and access to health care.

The people who get the most severely sick from COVID-19 will sometimes be unpredictable, but in many cases, they will not. They will be the same people who get sick from most every other cause. Cytokines like IL-6 can be elevated by a single night of bad sleep. Over the course of a lifetime, the effects of daily and hourly stressors accumulate. Ultimately, people who are unable to take time off of work when sick—or who don’t have a comfortable and quiet home, or who lack access to good food and clean air—are likely to bear the burden of severe disease.

Much is yet unknown about specific cytokines and their roles in disease. But the likelihood of disease in general is not so mysterious. Often, it’s a matter of what societies choose to tolerate. America has empty hotels while people sleep in parking lots. We are destroying food while people go hungry. We are allowing individuals to endure the physiological stresses of financial catastrophe while bailing out corporations. With the coronavirus, we do not have vulnerable populations so much as we have vulnerabilities as a population. Our immune system is not strong.

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We want to hear what you think about this article. Submit a letter to the editor or write to [email protected].

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JAMES HAMBLIN, M.D., is a staff writer at The Atlantic. He is also a lecturer at Yale School of Public Health and author of the forthcoming book Clean.

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thisdaynews · 5 years ago

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Trump confuses public on gun control stance, but keeps private discussions alive

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Trump confuses public on gun control stance, but keeps private discussions alive

President Donald Trump is considering the political ramifications of any action on gun control, according to several Republicans. | Zach Gibson/Getty Images

white house

Trump was expected to receive a formal briefing on Tuesday from his staff about possible options before making any decisions, according to a White House official.

It’s a classic Donald Trump move: Keep Washington in suspense.

While Trump’s recent remarks on gun control legislation have been widely interpreted as a step back from an earlier push to expand background checks during gun sales, White House and congressional aides continue to meet privately to discuss possible congressional and executive actions, according to Republicans and Democrats and advocacy groups on both sides. Yet as White House aides solicit ideas, they are not revealing what, if anything, Trump wants to do.

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Trump received a formal briefing on Tuesday from his staff about possible options, according to a White House official.

Part of the calculus for Trump is the fact that any decision will carry significant political ramifications, according to several Republicans. Moving on a bill — any bill — could help win over moderate suburban voters in 2020 that he has lost over the past two years. But doing so could also anger Trump’s fervent base, another critical voting bloc, in the upcoming election.

“I don’t think the president even knows what he is doing on this,” said Dudley Brown, president of the National Association for Gun Rights, which opposes new gun restrictions.

Trump was coy on Tuesday.

“We have very, very strong background checks right now,” he told reporters at the White House. “But we have sort of missing areas and areas that don’t complete the whole circle.”

The White House official said Trump is considering changes to background check laws or pushing for so-called red flag laws, which allow authorities to take guns from individuals a judge deems dangerous. He is also looking at other policies that would address domestic terrorism, violent video games and mental health treatment.

A Republican close to the White House who is involved with the discussions said Trump is looking at these options for when Congress returns from its August recess.

The person said it’s “politically achievable” to pass some legislation, perhaps a scaled-back background checks bill or a red flag measure, if Trump backs them. “If he gets behind something, then Republicans will follow,” the person said. “At some point, the president has to signal to the party what he’s for.”

Still, the odds of serious gun control legislation clearing Congress and being signed into law remain slim, especially as a pair of shootings in Texas and Ohio that left 32 people dead, including the perpetrator in Ohio, fade from public memory.

In recent days, many conversations at the White House and on Capitol Hill have focused on the red flag proposal.

Sen. Lindsey Graham (R-S.C.), a Trump ally and chairman of the Judiciary Committee, is working on legislation that would provide grants to states to implement red flag laws. Sen. Marco Rubio (R-Fla.) also has a red flag bill that would give money to states to enact such laws.

“It is a legitimate political argument to make that our background check system should be more extensive, but I don’t understand why that has become the holy grail of action when that has nothing to do with what caused these shootings,” Rubio said in a recent interview.

Red flag legislation is likely the best bet for the GOP to get something through. But gun rights groups andseveral Republican lawmakers— including Wyoming Sen. John Barrasso, the No. 3 Senate Republican, and Sen. Mike Rounds of South Dakota — have expressed concerns about whether targets of the law would have access to proper due process. Wisconsin GOP Sen. Ron Johnson, who chairs the Homeland Security Committee, said Tuesday he did not support a federal red flag law but could get behind Graham’s bill.

“I don’t anticipate we’re going to pass a federal red flag law,” Johnson said. “I think that all that Chairman Graham is talking about is a grant program … which I think would be the appropriate thing — let states decide.”

Many Democrats are still pushing for a background check bill, which might draw limited GOP support. A spokesperson for Sen. Pat Toomey (R-Pa.) said the office has “had ongoing conversations, at the staff level, with the White House regarding background checks both last week and this week.”

Sen. Chris Murphy (D-Conn.) said he spoke to Trump last week and expressed support for working across the aisle to develop a background check bill that can pass the Senate. “Until I hear directly from him, I’m not willing to concede that history repeated itself and that he has walked away from the commitment he made,” Murphy said Tuesday.

Trump said on Tuesday that “we are in very meaningful discussions with the Democrats.”

Some Republicans have accused the Democrats of overreaching by pushing policies they know will never pass, including a ban on assault weapons. This tactic, these Republicans argued, decreases the chances the two sides will come together to pass anything.

When the Democratic-controlled House returns from its own recess, the Judiciary Committee plans to approve a trio of bills: one that would ban high-capacity magazines, another encouraging states to adopt policies to keep firearms from people deemed “a risk to themselves or others” and another to prohibit people convicted of misdemeanor hate crimes from possessing guns.

It’s unlikely the GOP-led Senate would take up any of the measures.

“The Democrats’ overreach destroys any kind of process. They’re unrealistic about what’s going to happen,” said Alan Gottlieb, founder of the Second Amendment Foundation, which opposes further gun control legislation. “Initially I thought something was going to happen. I’m not sure anymore.”

At the White House, aides have been meeting with several gun rights groups, which are all hesitant about new legislation. The Committee for the Rights to Keep and Bear Arms came in for a meeting, and followed up with written information, the group said. John Velleco, the executive vice president for Gun Owners of America, is also on the books for a meeting later this week, the group said. White House staffers have also been talking to Democratic congressional aides.

Some Republicans have urged Trump to adopt gun control measures in a bid to bolster support among suburban voters that were instrumental to the president’s 2016 win.

“The reflexive political analyses are too focused on this idea that any action on these measures will alienate ‘base’ Republicans and Second Amendment supporters,” said Republican strategist Kevin Madden, who worked for 2012 presidential nominee Mitt Romney. “The data indicates there is a powerful political coalition of suburban voters, women voters, independents and a majority of Republicans that will support pragmatic measures to combat gun violence. So, for Trump and other Republicans, the opportunity is there to appeal to and have an impact with these voters who are crucial to 2020.”

Trump’s campaign is conducting a poll to gauge interest among Republicans for different actions, according to the Republican close to the White House. And a former adviser who remains close to the campaign cautioned that the president won’t make a move until he sees how Republicans react after the publicity surrounding the latest shootings subsides.

Brown, of the National Association for Gun Rights, said Trump will never get support from those who support additional gun control. “If Donald Trump believes he’s getting the votes of left-wing gun control advocates, he’s not listening to good advice,” he said.

Trump has previously expressed support for implementing more gun restrictions, most notably after the February 2018 mass shooting at high school in Parkland, Fla. Trump initially seemed to endorse strengthened background checks, but then backed down after opposition from the National Rifle Association and fellow Republicans.

But the nation’s politics have shifted since then, argued Robin Lloyd, managing director of Giffords, a group founded by former Rep. Gabby Giffords after she was shot and gravely wounded. Lloyd noted that several House members, including Democrats Abigail Spanberger of Virginia, Lizzie Fletcher of Texas and Andy Krug in Minnesota, won swing elections after campaigning on gun control.

“The exit polling [in 2018] show this is a really important issue to voters,” she said. “If he wants to get re-elected, he needs to do something on gun safety.”

Yet the president has remained a cipher on the subject in recent weeks. While at first he said there was a “great appetite” for tightening background checks, he has more recently stressed the fact that the U.S. already has “very strong background checks” and emphasized the need to address mental health issues. Many have noted that the shifting rhetoric came after Trump spoke several times with NRA President Wayne LaPierre.

Some advocates chalk up the apparent waffling to the president’s tendency to parrot the views of the people he spoke to last.

“I don’t want to overread this,” said Michael Hammond, legislative counsel for Gun Owners of America, which opposes new gun restrictions. “He likes to make the person he’s speaking to happy so he says what they want to hear.”

Burgess Everett and Marianne Levine contributed to this report.

#discussions #Foreign #Politics #private

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swipestream · 6 years ago

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New Release Roundup, 7 July 2018: Science Fiction

A time traveler defies Fate to keep his family safe, a battered fleet leads invaders on a wild goose chase through unexplored space, and a delivery man unearths a conspiracy from before the rise of man in this week’s roundup of the newest releases in science fiction.

Alliance Insurgent (Alliance Trilogy #3) – Michael Wallace

Captain Jess Tolvern of HMS Blackbeard led a Royal Navy expedition across long-dormant space lanes toward Old Earth when an alien fleet ambushed her battle cruiser. The aliens are Adjudicators, an ancient race whose ethos is to judge other species and reduce their survivors to a stone age existence.

Tolvern sent a desperate message back to headquarters. By the time she returned home, the aliens already invaded Alliance territory with a powerful fleet of star fortresses and accompanying dragoon ships, trapping and laying siege to the allied fleet. A desperate defense wins a short respite, but victory turns to chaos when the Adjudicators awaken an ancient star leviathan and send it against the allied fleet. Falling back to friendly territory ahead of this terrifying weapon, Jess Tolvern and the allied command muster the combined forces of the Alliance planets to finally defeat the Adjudicators and push across the inner frontier to reestablish contact with the remaining civilizations of Old Earth.

Black Dawn (Blood on the Stars #8) – Jay Allan

War is coming, darker and more terrible than any that have come before.

The Hegemony is coming to impose its brutal system of genetic supremacy on the Confederation and the other nations on the Rim, to make its elite Masters the unchallenged rulers of all human habitation in the galaxy.

The White Fleet had been an expression of optimism, a grand expedition to explore the vast reaches of the long-dead empire. Tasked to uncover the secrets of the devastating Cataclysm and to seek and recover the advanced ancient technology that humanity had once possessed, it found something else instead.

A new enemy. A vast domain, one with advanced technology, massive fleets, and a genetically-ordered society and hierarchy it intends to impose on all humanity everywhere. The Hegemony is like nothing Tyler Barron and his comrades have ever encountered…but the veteran admiral must find a way to fight the far superior enemy, to rally the Confederation’s forces, and those of the other Rim nations, for what may well be the final war.

Cryptic Commands – Steve Rzasa

Watch your back…

Vincent Chen makes sure his comms ferry satellites don’t harbor malfunctions. He’d prefer they didn’t hide people inside, too.

The woman left comatose aboard one he recovers is on a vital mission. She must stop criminals from stealing classified secrets and selling them to the highest bidder. But those criminals know she’s on the run, and Vincent is caught up in the chase.

Determined they stay silent, she’s left him only one choice: to seek help from his fellow comms jockeys, in hopes they can fend off a raid and keep the data safe. When their plans fall apart, Vincent must rely on others when he’d rather be on his own…

And trusting anyone is dangerous.

Discovery (First Colony #5) – Ken Lozito

Exploring New Earth should be a thrilling undertaking. Instead, the more the colonists learn about the planet, the more alarmed they become. Alien ruins hint at a species who fought great wars among themselves and disappeared centuries ago.

When Connor Gates discovers a hidden bunker, he finds something he never expected. Everything the colonists have learned about New Earth’s previous inhabitants is wrong. Connor must race to unravel the mystery. The colonists must face the possibility that they are not alone and that New Earth was never theirs for the taking.

Earth Unrelenting (Forgotten Earth #2) – M. R. Forbes

A fugitive captured. A hero forsaken.

A secret revealed.

It wasn’t supposed to be this way. Three days. That’s what they promised. But on Earth the danger is unrelenting, and promises are hard to keep.

Now Sheriff Duke is the one on the run, chased by an unexpected enemy eager to finish what they started. An enemy with an agenda that begins with killing him but ends with something worse.

Much, much worse.

Once the secret is out, the universe will never be the same…

Mech Wars (Mech Wars omnibus) – Scott Bartlett

Humanity is tired of losing. Enter the mech.

Jake Price has always dreamed of joining the Darkstream military, like his father before him. When he’s told his gaming scores are good enough to qualify him for a brand new training program, designed to find recruits talented enough to pilot humanity’s first mechs, he can hardly believe it.

He’s right to be doubtful. There are hundreds of other recruits competing for the same eight jobs, and they’re all as skilled as he is. Worse, the training instructor is an unhinged chief with a particular dislike for Jake.

But Jake refuses to give up, refuses to wash out. Because humanity is facing its greatest threat yet. If someone doesn’t step up, it could all be over for the human species.

Quantum Synapse – Russell Blake

A plan to enslave humanity begins with a conspiracy from the dawn of time.

Only one man can stop the unthinkable from happening.

Veritas Grey is a down-on-his-luck delivery worker in a dystopian future, until an accident turns his world upside down.

Hunted by a powerful cabal, Veritas and a young woman with a murky past must beat impossible odds if humanity is to continue to exist. Can they untangle a centuries-old secret in time to survive? Will Veritas embrace a forgotten past that could destroy him and those he loves? Can a conspiracy that dates to Mesopotamia be thwarted before the world’s enslaved?

In order to do so, Veritas must navigate a treacherous maze of secret societies, forbidden knowledge, quantum theory, and ancient technologies, and decipher a mystery at the root of mankind’s existence.

The Song of Earth (Children of Earthrise #5) – Daniel Arenson

Earth burns.

After generations in exile, we returned to our long-lost planet. Scarred. Haunted. Survivors. We–the last humans–are finally home.

But our enemies still crave our blood.

Seven alien species unite. Seven fleets bombard our planet. Seven armies invade our beautiful world. They have one goal: To kill us all.

We refuse to lose Earth again. We will resist. We will fight for every hill, every valley, every stone and blade of grass. We will defend our planet. At any cost.

Together, we will raise our voices. We will sing the song of Earth. We will tell the enemy: Earth is ours!

The Warp Clock (In Times Like These #4) – Nathan Van Coops

To Save Her Future, He Can’t Have One.

Ben Travers is facing an impossible choice. When a girl arrives from his future claiming to be family, she brings nothing but bad news. Ben has two possible fates, and no matter which he chooses, he has to die.

In a desperate bid to alter his future, Ben must seek a mysterious device that the Quickly family would rather keep hidden. He’ll confront a rogue faction of temporal fugitives—his only ally a girl he never knew existed.

Adventure. Family. Time Travel. For Ben Travers, it’s all going to collide.

Weaver (Four Horsemen Tales #2) – Kacey Ezell and Mark Wandrey

A Tortantula and a Flatar. The most enigmatic teaming in the mercenary guild, it’s also a perfect pairing, where one’s strengths cover the other’s weakness. Raised together from birth, their lives are a brutal series of tests. From the moment they’re thrust together, they are forced to kill their own kind just to survive. No excuses, no mercy, no room for failure. Succeed…or die.

Azah isn’t like most other female Tortantula; she’s much smaller and made fun of constantly. No one expects her to survive, much less succeed, but she’s still given a chance and assigned a Flatar: Sadek. The two quickly bond and find they complement each other. Against all odds, they survive the breeding dome and join the ranks of their races’ mercenaries.

But Azah begins to exhibit some extremely odd abilities, and everything changes. When Sadek uncovers a plan to manipulate the Tortantula breeding program, he’s unable to determine what their goals are…only that they have plans for Azah. Powerless to stop their shadowy machinations, the two know one thing: they want to stay together ‘Zha Oort’—until the ending.

But Fate is calling, and Fate doesn’t care what anyone wants.

Winter Overrun (Lost Time #4) – Damien Boyes

Finsbury Gage is terrified of what’s inside him.

He’s been dead more than once, and haunted now by the memories of lives he never lived. All he wants to do is hide—from a world he doesn’t belong to and the person he doesn’t recognize—until he’s forced from his self-imposed exile by a threat the police can’t handle and a request he can’t refuse.

A girl has gone missing. Arrived in the big city from the Preserves and immediately disappeared. Her brother’s come looking for her, and while a lifetime on a farm hasn’t prepared him to navigate the dangerous Reszo underworld, he’s not about to let that or anything else stop him from finding his sister.

Finsbury will be drawn into a hunt for a killer no one believes in. Someone who doesn’t just kill—he steals the thoughts of his victims and makes them part of himself.

Finsbury Gage is about to meet Winter, and neither of them will ever be the same.

The World Armada (Superluminary #3) – John C. Wright

Although the Lords of Creation survived the awesome onslaught of the world-killing space vampires, there is nowhere in the lifeless galaxy that they can hope to hide their planets and people forever. How can they hope to destroy what is already dead?

The vampiric necroforms are a massive empire of anti-life, terrible beyond all imagining, ruling a vast network of dead stars and planets they have drained of all life. Aeneas, the Emperor of Man, realizes that if the human race is going to survive, he is going to have to find a way to re-seed the entire galaxy with life while burning down the interstellar undead empire with the precious light it cannot bear. And not only does Aeneas have to do the impossible, he is going to have to do it while keeping a wary eye out for the ruthless betrayer at his back.

SUPERLUMINARY is the latest and most brilliant creation of science fiction grandmaster John C. Wright, the Dragon-award winning author of THE UNWITHERING REALM, THE GOLDEN AGE, MOTH & COBWEB, and AWAKE IN THE NIGHT LAND. THE WORLD ARMADA is the third and final book in the trilogy.

New Release Roundup, 7 July 2018: Science Fiction published first on https://medium.com/@ReloadedPCGames

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