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The challenge is that unlike some of our other organs, like the skin and liver, the heart has a very limited ability to self-heal. Heart muscle cells replicate at a rate of just 0.5% a year, not sufficient to repair any significant damage. Instead, the dead cells are replaced by thick layers of tough, rigid scar tissue, meaning that sections of the heart simply cease to function.

But along with a team of stem cell biologists at the University of Cambridge’s Stem Cell Institute, Sinha is working on a slightly different idea: heart patches.

One of the main challenges with this approach is how to electrically integrate the new patch with the heart to ensure that both beat in synchrony. Any defective electrical connections could stimulate an abnormal heart rhythm.

Again, the survey isn’t a perfect proxy for the opinions of right-leaning intellectuals, but it strongly suggests that there is nothing close to consensus on the right as to whether or not racially disparate outcomes are due to innate group differences. What’s more, while Charles Murray and others have emphasized IQ as a key factor that explains both interracial and intraracial disparities, my impression is that theirs is far from the leading narrative on the right.

A third story covered the Fresno State professor criticized for insulting Barbara Bush upon her death. A fourth reported on a Breitbart reporter who was suspended from Twitter for declaring that 100 percent of transgender people are “mental patients.” A fifth notes that the U.K. now ranks embarrassingly low on the Press Freedom Index. A sixth notes that a British man was fined in court for teaching his dog to do a Nazi salute––he says that he did it as a joke in order to annoy his girlfriend. A seventh praised Kanye West for ostensibly winning a victory for free speech. Those are the first articles that I pulled up, not a random sample, but they illustrate that the site’s coverage of free speech includes many controversies that, boiled down, have nothing to do with “the right to say races and sexes are inherently different without fear of censure,” along with some that do.

He concludes his Twitter essay, “The age of Trump is one of racial and gender animus. Trump’s divisiveness and hate have infected every corner of our intellectual landscape, poisoned every discussion.” With his last sentence I concur: “American intellectual life is just one more thing that won’t be healthy again until Trump is gone.”

Gaddis keeps pounding — to the point of monotony — the seemingly self-evident: The grand strategist must prune away emotion, ego and conventional wisdom to accept that “if you seek ends beyond your means, then sooner or later you’ll have to scale back your ends to fit your means.

Their implicit idea is to remind America’s future best and brightest how the mostly successful grand strategy of the past saw America become the pre-eminent world power of the 20th century by winning two world conflicts along with the Cold War.

The case studies are variously drawn from some 16 years of co-teaching a well-regarded seminar on “Studies in Grand Strategy” at Yale

Paul Kennedy’s edited “Grand Strategies in War and Peace,” Charles Hill’s “Grand Strategies: Literature, Statecraft, and World Order” and more recently Linda Kulman’s “Teaching Common Sense: The Grand Strategy Program at Yale University.”

His repetitious observation about proportionality might have been banal — if so many leaders, many of them geniuses, had not forgotten it

A recurrent theme is the danger of omnipresent hubris. Even a great power cannot master the unexpected and uncontrollable — from the great plague at Athens, to the harsh Russian winter, to I.E.D.s and tribal factionalism in Iraq

The book is as much personal remembrance as strategic reflection, and is chock-full of aphorisms and enigmatic adages.

Gaddis believes the best way to hone strategic thinking is not just by mastering the advice of Machiavelli or Clausewitz (who both figure prominently in the class), much less contemporary high-tech wizardry, but also by understanding the interplay of history, literature and philosophy over 2,500 years of Western civilization — with occasional insights from Sun Tzu and other non-Western thinkers

In some sense “On Grand Strategy” is a traditional argument for the value of classical education in the broadest sense.

The student of strategy learns to balance a grasp of detail with proper humility: It is, of course, wise to have a plan and contingencies. But how will these prompt rival counter-responses? Do such agendas have the means adequate for their ends? Or are they more dreams, warped by ego and emotion

In contrast, the often arrogant neglect of grand strategic thinking has led to postwar quagmires, stalemates and the assorted misadventures that often drained American resources for either impossible or irrelevant aims, while tearing the country apart over the last 70 years.

Understanding the underappreciated role of irony is essential for a leader, and might have prevented the disasters of both 415 B.C. and 1588.

Tolstoy and Clausewitz appreciated that bad things can come from good intentions and vice versa. The best generals live with and react to paradoxes, Gaddis argues. The worst ignore or seek to undo them.

Gaddis sees these more successful global strategists as rope-a-dope pragmatists who remain elastic and patient enough to capitalize on events and opportunities as they unfold, rather than forcing them to fit preconceived schemes.

Morality matters, if defined less as self-righteous ardor and more as self-awareness of a leader’s effect on those around him and an appreciation of paradox.

A pragmatic St. Augustine has no problem with war — if it is a last resort to save civilization, without which there can be neither calm nor organized religion.

Still, courting calculated risk is essential

The gambler Winston Churchill took chances in 1940, albeit rational ones backed by educated guesses that, for all Hitler’s bluster, the Third Reich had neither the air nor sea power to destroy the Anglosphere

Gaddis’s American heroes are Abraham Lincoln and Franklin Roosevelt, who he thinks “rescued democracy and capitalism.”

Roosevelt somehow was cognizant early on of how the singular military and economic potential of America might save Europe and Asia, but only if he first prepared reluctant Americans materially and psychologically for the inevitable war to come

Gaddis concludes with an invaluable warning that true morality embraces neither messianic interventionism nor the quest for utopianism

Instead, ethical leadership pursues the art of the possible for the greater (not the greatest) good

With regard to the American 21st century, Gaddis’s favorite novelists and philosophers perhaps argue against both optional intercessions abroad and moralistic lead-from-behind recessionals. The better course is to marshal American power to prepare for the often unavoidable existential crises on the horizon, with the full expectation that we do not have to be perfect to be good.

“On Grand Strategy” is many things — a thoughtful validation of the liberal arts, an argument for literature over social science, an engaging reflection on university education and some timely advice to Americans that lasting victory comes from winning what you can rather than all that you want.

"Women in West Virginia smoked during pregnancy more than five times as often as women in the states with the lowest prevalence,"

The researchers also found that prevalence of smoking during pregnancy varied by age and race. The prevalence was highest among women 20 to 24 at 10.7%, followed by women 15 to 19 at 8.5% and 25 to 29 at 8.2%.

The prevalence also was highest among non-Hispanic American Indian or Alaska Native women at 16.7%, followed by non-Hispanic white women at 10.5%, non-Hispanic black women at 6%, Hispanic women at 1.8% and non-Hispanic Asian women at 0.6%.

"We still have a serious issue with infant mortality -- prematurity and infant mortality are clearly linked to cigarette smoking, as is low birth weight -- and when you begin to explain these things to patients, it really does appear to make a difference to them," he said.Brown pointed out that some of the states in the new CDC report with the highest prevalence of smoking during pregnancy also tend to have high rates of infant mortality. A CDC data brief released in January showed that, between 2013 and 2015, West Virginia and Kentucky had infant mortality rates higher than the overall national rate.

Ever since President Trump came into office, a record high turnover and unfilled jobs have emptied offices across wide sections of the federal bureaucracy. Now, current and former administration officials and disaster experts say the coronavirus has exposed those failings as never before and left parts of the federal government unprepared and ill equipped for what may be the largest public health crisis in a century.

Some 80 percent of the senior positions in the White House below the cabinet level have turned over during Mr. Trump’s administration, with about 500 people having departed since the inauguration

At the Department of Veterans Affairs, workers are scrambling to order medical supplies on Amazon after its leaders, lacking experience in disaster responses, failed to prepare for the onslaught of patients at its medical centers.

Equally notable may have been the resignation last year of Scott Gottlieb, the commissioner of the Food and Drug Administration, who was an early advocate for broad coronavirus testing and stronger mitigation policies. He was succeeded by Dr. Stephen M. Hahn, a noted oncologist, who has struggled during Senate hearings to explain some of his positions. The agency is largely viewed as slow in engaging the private sector to develop tests for the coronavirus. Many members of Mr. Gottlieb’s team departed with him, leaving the agency with many people new to their jobs.

The Department of Homeland Security, the agency tasked with screening at airports and carrying out the travel restrictions that were Mr. Trump’s first major action to combat the coronavirus, is full of vacancies. Of the 75 senior positions listed on the department’s website, 20 are either vacant or filled by acting officials.

Even National Park Service vacancies have taken a toll. The park service — which has its own police force — in recent days closed some parking lots near the Tidal Basin on the National Mall, where the cherry blossoms attract huge crowds each year, and urged people to stay away. Mayor Muriel Bowser stepped in and limited access to the area and sent police officers and members of the National Guard to enforce the shutdown.

Even the Pentagon, which is broadly viewed as better positioned than many other agencies for the pandemic response, is not immune. More than a third of all Senate-confirmed civilian positions at the Defense Department are vacant or filled by temporary officials, a peak level for the administration outside of the transition period, according to Pentagon statistics. Of 60 senior positions, 21 lack permanent appointees.

not least because of the actions of Xi Jinping’s own government.

Since then, cases have skyrocketed across the United States, which now has the highest number of confirmed cases anywhere in the world, with more than 100,000 people infected

The U.S., meanwhile, is entering what’s perhaps the darkest phase of its own crisis—its domestic problems hobbling it from providing significant international aid or coordinating a comprehensive response. (The U.S. announced on Thursday that it had made available $274 million in emergency aid to 64 countries.)

As recently as yesterday, Xi offered Chinese support to the U.S. in a phone call with Trump.

This is happening all around the world now,” says David Shullman, a China expert at the International Republican Institute. “[There] is a really long list of places where China is offering this equipment and assistance …

Most immediately, it could mean that the coronavirus ground zero continues to generate and export more cases

Desperate countries were happy to accept Chinese help

The real short-term risk of China’s leadership exercise is that, should the country make the calculation to prize its economic health over public-safety concerns, other countries contending with the pandemic’s economic devastation may find themselves tempted to follow suit

. At that point, the China model may look even more tempting.

I’m a geriatrician at UC San Francisco, whose medical center consistently ranks in the top 10 nationally and as the best on the West Coast

Our response to COVID-19 has been remarkable in its intensity and scope.

During my nearly 30-year medical career here, I’ve never witnessed anything like the system-wide mobilization I’ve seen in recent weeks. And yet some of what I’m seeing is also disturbing, especially because my geriatrics colleagues around the country say that elder-specific needs and medical science aren’t being adequately addressed at their centers either.

health-screening procedures for visitors were put into place at our children’s hospital at the start of March, while similar procedures weren’t implemented for our adult hospital until two weeks later.

Transgressions like these are minor in the face of global calamity

Let me be perfectly clear: I’m not witnessing the actions of malicious, underperforming people

On the contrary, UCSF leadership has been heroic and selfless, working around the clock to provide the best care possible to those with COVID-19 while protecting other patients and staff

Medical schools devote months to teaching students about child physiology and disease, and years to adults, but just weeks to elders; geriatrics doesn’t even appear on the menu of required training

Public responses to the coronavirus pandemic on social media have laid bare the not-so-subtle interplay between medical culture and American culture at large

They worried that a vaccine would initially elude scientists, that weary citizens would abandon restrictions despite the risks, that the virus would be with us from now on.

Most experts believed that once the crisis was over, the nation and its economy would revive quickly. But there would be no escaping a period of intense pain.

Exactly how the pandemic will end depends in part on medical advances still to come. It will also depend on how individual Americans behave in the interim. If we scrupulously protect ourselves and our loved ones, more of us will live. If we underestimate the virus, it will find us.

More Americans may die than the White House admits.

The epidemiological model often cited by the White House, which was produced by the University of Washington’s Institute for Health Metrics and Evaluation, originally predicted 100,000 to 240,000 deaths by midsummer. Now that figure is 60,000.

The institute’s projection runs through Aug. 4, describing only the first wave of this epidemic. Without a vaccine, the virus is expected to circulate for years, and the death tally will rise over time.

Fatality rates depend heavily on how overwhelmed hospitals get and what percentage of cases are tested. China’s estimated death rate was 17 percent in the first week of January, when Wuhan was in chaos, according to a Center for Evidence-Based Medicine report, but only 0.7 percent by late February.

Various experts consulted by the Centers for Disease Control and Prevention in March predicted that the virus eventually could reach 48 percent to 65 percent of all Americans, with a fatality rate just under 1 percent, and would kill up to 1.7 million of them if nothing were done to stop the spread.

A model by researchers at Imperial College London cited by the president on March 30 predicted 2.2 million deaths in the United States by September under the same circumstances.

China has officially reported about 83,000 cases and 4,632 deaths, which is a fatality rate of over 5 percent. The Trump administration has questioned the figures but has not produced more accurate ones.

The tighter the restrictions, experts say, the fewer the deaths and the longer the periods between lockdowns. Most models assume states will eventually do widespread temperature checks, rapid testing and contact tracing, as is routine in Asia.

In this country, hospitals in several cities, including New York, came to the brink of chaos.

Only when tens of thousands of antibody tests are done will we know how many silent carriers there may be in the United States. The C.D.C. has suggested it might be 25 percent of those who test positive. Researchers in Iceland said it might be double that.

China is also revising its own estimates. In February, a major study concluded that only 1 percent of cases in Wuhan were asymptomatic. New research says perhaps 60 percent were.

The virus may also be mutating to cause fewer symptoms. In the movies, viruses become more deadly. In reality, they usually become less so, because asymptomatic strains reach more hosts. Even the 1918 Spanish flu virus eventually faded into the seasonal H1N1 flu.

The lockdowns will end, but haltingly.

it is likely a safe bet that at least 300 million of us are still vulnerable.

Until a vaccine or another protective measure emerges, there is no scenario, epidemiologists agreed, in which it is safe for that many people to suddenly come out of hiding. If Americans pour back out in force, all will appear quiet for perhaps three weeks.

The gains to date were achieved only by shutting down the country, a situation that cannot continue indefinitely. The White House’s “phased” plan for reopening will surely raise the death toll no matter how carefully it is executed.

Every epidemiological model envisions something like the dance

On the models, the curves of rising and falling deaths resemble a row of shark teeth.

Surges are inevitable, the models predict, even when stadiums, churches, theaters, bars and restaurants remain closed, all travelers from abroad are quarantined for 14 days, and domestic travel is tightly restricted to prevent high-intensity areas from reinfecting low-intensity ones.

In his wildly popular March 19 article in Medium, “Coronavirus: The Hammer and the Dance,” Tomas Pueyo correctly predicted the national lockdown, which he called the hammer, and said it would lead to a new phase, which he called the dance, in which essential parts of the economy could reopen, including some schools and some factories with skeleton crews.

Even the “Opening Up America Again” guidelines Mr. Trump issued on Thursday have three levels of social distancing, and recommend that vulnerable Americans stay hidden. The plan endorses testing, isolation and contact tracing — but does not specify how these measures will be paid for, or how long it will take to put them in place.

On Friday, none of that stopped the president from contradicting his own message by sending out tweets encouraging protesters in Michigan, Minnesota and Virginia to fight their states’ shutdowns.

China did not allow Wuhan, Nanjing or other cities to reopen until intensive surveillance found zero new cases for 14 straight days, the virus’s incubation period.

Compared with China or Italy, the United States is still a playground.Americans can take domestic flights, drive where they want, and roam streets and parks. Despite restrictions, everyone seems to know someone discreetly arranging play dates for children, holding backyard barbecues or meeting people on dating apps.

Even with rigorous measures, Asian countries have had trouble keeping the virus under control

But if too many people get infected at once, new lockdowns will become inevitable. To avoid that, widespread testing will be imperative.

Reopening requires declining cases for 14 days, the tracing of 90 percent of contacts, an end to health care worker infections, recuperation places for mild cases and many other hard-to-reach goals.

Immunity will become a societal advantage.

Imagine an America divided into two classes: those who have recovered from infection with the coronavirus and presumably have some immunity to it; and those who are still vulnerable.

“It will be a frightening schism,” Dr. David Nabarro, a World Health Organization special envoy on Covid-19, predicted. “Those with antibodies will be able to travel and work, and the rest will be discriminated against.”

Soon the government will have to invent a way to certify who is truly immune. A test for IgG antibodies, which are produced once immunity is established, would make sense

Dr. Fauci has said the White House was discussing certificates like those proposed in Germany. China uses cellphone QR codes linked to the owner’s personal details so others cannot borrow them.

As Americans stuck in lockdown see their immune neighbors resuming their lives and perhaps even taking the jobs they lost, it is not hard to imagine the enormous temptation to join them through self-infection

My daughter, who is a Harvard economist, keeps telling me her age group needs to have Covid-19 parties to develop immunity and keep the economy going,”

It would be a gamble for American youth, too. The obese and immunocompromised are clearly at risk, but even slim, healthy young Americans have died of Covid-19.

The virus can be kept in check, but only with expanded resources.

Resolve to Save Lives, a public health advocacy group run by Dr. Thomas R. Frieden, the former director of the C.D.C., has published detailed and strict criteria for when the economy can reopen and when it must be closed.

once a national baseline of hundreds of thousands of daily tests is established across the nation, any viral spread can be spotted when the percentage of positive results rises.

To keep the virus in check, several experts insisted, the country also must start isolating all the ill — including mild cases.

“If I was forced to select only one intervention, it would be the rapid isolation of all cases,”

In China, anyone testing positive, no matter how mild their symptoms, was required to immediately enter an infirmary-style hospital — often set up in a gymnasium or community center outfitted with oxygen tanks and CT scanners.

There, they recuperated under the eyes of nurses. That reduced the risk to families, and being with other victims relieved some patients’ fears.

Still, experts were divided on the idea of such wards

Ultimately, suppressing a virus requires testing all the contacts of every known case. But the United States is far short of that goal.

In China’s Sichuan Province, for example, each known case had an average of 45 contacts.

The C.D.C. has about 600 contact tracers and, until recently, state and local health departments employed about 1,600, mostly for tracing syphilis and tuberculosis cases.

China hired and trained 9,000 in Wuhan alone. Dr. Frieden recently estimated that the United States will need at least 300,000.

There will not be a vaccine soon.

any effort to make a vaccine will take at least a year to 18 months.

the record is four years, for the mumps vaccine.

for unclear reasons, some previous vaccine candidates against coronaviruses like SARS have triggered “antibody-dependent enhancement,” which makes recipients more susceptible to infection, rather than less. In the past, vaccines against H.I.V. and dengue have unexpectedly done the same.

A new vaccine is usually first tested in fewer than 100 young, healthy volunteers. If it appears safe and produces antibodies, thousands more volunteers — in this case, probably front-line workers at the highest risk — will get either it or a placebo in what is called a Phase 3 trial.

It is possible to speed up that process with “challenge trials.” Scientists vaccinate small numbers of volunteers, wait until they develop antibodies, and then “challenge” them with a deliberate infection to see if the vaccine protects them.

Normally, it is ethically unthinkable to challenge subjects with a disease with no cure, such as Covid-19.

“Fewer get harmed if you do a challenge trial in a few people than if you do a Phase 3 trial in thousands,” said Dr. Lipsitch, who recently published a paper advocating challenge trials in the Journal of Infectious Diseases. Almost immediately, he said, he heard from volunteers.

The hidden danger of challenge trials, vaccinologists explained, is that they recruit too few volunteers to show whether a vaccine creates enhancement, since it may be a rare but dangerous problem.

if a vaccine is invented, the United States could need 300 million doses — or 600 million if two shots are required. And just as many syringes.

“People have to start thinking big,” Dr. Douglas said. “With that volume, you’ve got to start cranking it out pretty soon.”

Treatments are likely to arrive first.

The modern alternative is monoclonal antibodies. These treatment regimens, which recently came very close to conquering the Ebola epidemic in eastern Congo, are the most likely short-term game changer, experts said.

as with vaccines, growing and purifying monoclonal antibodies takes time. In theory, with enough production, they could be used not just to save lives but to protect front-line workers.

Having a daily preventive pill would be an even better solution, because pills can be synthesized in factories far faster than vaccines or antibodies can be grown and purified.

Goodbye, ‘America First.’

A public health crisis of this magnitude requires international cooperation on a scale not seen in decades. Yet Mr. Trump is moving to defund the W.H.O., the only organization capable of coordinating such a response.

And he spent most of this year antagonizing China, which now has the world’s most powerful functioning economy and may become the dominant supplier of drugs and vaccines. China has used the pandemic to extend its global influence, and says it has sent medical gear and equipment to nearly 120 countries.

This is not a world in which “America First” is a viable strategy, several experts noted.

“If President Trump cares about stepping up the public health efforts here, he should look for avenues to collaborate with China and stop the insults,”

If we alienate the Chinese with our rhetoric, I think it will come back to bite us,” he said.“What if they come up with the first vaccine? They have a choice about who they sell it to. Are we top of the list? Why would we be?”

Once the pandemic has passed, the national recovery may be swift. The economy rebounded after both world wars, Dr. Mulder noted.

In one of the most provocative analyses in his follow-up article, “Coronavirus: Out of Many, One,” Mr. Pueyo analyzed Medicare and census data on age and obesity in states that recently resisted shutdowns and counties that voted Republican in 2016.

He calculated that those voters could be 30 percent more likely to die of the virus.

In the periods after both wars, Dr. Mulder noted, society and incomes became more equal. Funds created for veterans’ and widows’ pensions led to social safety nets, measures like the G.I. Bill and V.A. home loans were adopted, unions grew stronger, and tax benefits for the wealthy withered.

If a vaccine saves lives, many Americans may become less suspicious of conventional medicine and more accepting of science in general — including climate change

Crucially, Germany started testing people even with milder symptoms relatively early on, meaning the total number of confirmed cases may give a more accurate picture of the virus’s spread than in other states.

That’s also the central task of Donald Trump’s presidency.

In one of his book’s early scenes, he relates a professional homily from a man he identifies as prominent Russian TV presenter. “We all know there will be no real politics” in Putin’s Russia, the man says at a staff conference.“But we still have to give our viewers the sense something is happening. They need to be kept entertained. So what should we play with? Shall we attack the oligarchs? Who’s the enemy this week? Politics has got to feel like … like a movie!”

This is why there’s a Colosseum in Rome, and why public spectacle, theater, cinema, TV and now the internet have always been handmaids of dictators

“The new Kremlin,” Pomerantsev notes, “won’t make the same mistake the old Soviet Union did: It will never let TV become dull.” Authoritarian dominion requires effective methods of mass distraction.

Trump does control his Twitter feed, with its 43.6 million followers. And he exerts a deeper level of control simply through his ability to bait hostile media at will with his every seemingly nutty utterance.

The benefits, for Trump, are threefold:

a political opposition that is exhausting itself — and much of the public — with its perpetual state of moral apoplexy

a political base that thrills to his readiness to scandalize the bien pensant

and an effective means of distraction from his electoral, legislative and foreign policy failures.

the president is conducting a kind of meta-politics, the purpose of which is to erase ordinary standards of political judgment.

The question is not “How am I doin’?” as the late New York City mayor Ed Koch used to ask. It is, gladiator-like, “Are you not entertained?”

The truth about Trump is not that he’s crazy. He’s a narcissist and a neurotic with a feral talent for attracting the attention he craves

if one part of the system is all about wild performance,” writes Pomerantsev of Putin’s media calculations, “another is about slow, patient co-optation.” Like it or not, we all inhabit the Trump-verse and we all are subject to its consequences.

Dr. Francis Collins, director of the National Institutes of Health, echoed that sentiment in an interview with NPR's Mary Louise Kelly this month. Collins said Americans need to be patient and continue with masks and social distancing for a bit longer.

In another disruption to the national rites of spring, the pandemic blew out some March Madness brackets over the weekend. In the NCAA men's basketball tournament, a surreal score line of 1-0 popped up on tracking apps for the game between Virginia Commonwealth University and the University of Oregon. VCU was forced to pull out of the event after reporting multiple positive coronavirus tests.

VCU coach Mike Rhoades said on a videoconference Saturday night announcing his team's withdrawal from the tournament.

Rhoades said there were "no dry eyes" when he told his players the news. "This is what you dream of as a college player and a coach, and to get it taken away like this is just a heartbreaking moment in their young lives."

But Rhoades added that all his squad did was lose a basketball game, while "500,000 people have lost their lives."

instructs the Department of Health and Human Services to open a special enrollment period for the Affordable Care Act through HealthCare.gov,

"As we continue to battle COVID-19, it is even more critical that Americans have meaningful access to affordable care," a White House fact sheet reads.

His second executive action aims "to protect and expand access to comprehensive reproductive health care" by rescinding the Mexico City policy, also known as the global gag rule. This policy, reinstated and expanded by the Trump administration, bars international nongovernmental organizations that provide abortion counseling or referrals from receiving U.S. funding. Biden on Thursday called the gag rule an "attack on women's health access."

Last November, the Trump administration and several Republican-led states argued at the U.S. Supreme Court that the program should be voided, which would have eliminated popular elements of the law such as protections for those with preexisting conditions.

The Supreme Court will hear a case that could decide the legality of work requirements for Medicaid recipients.

Biden is reversing course and directing federal agencies to reconsider those work requirement rules. He is also asking agencies to review policies that undermined protections for people with preexisting conditions, including complications related to COVID-19.

The administration faced pressure to open HealthCare.gov for anyone to enroll in the Affordable Care Act in response to the pandemic, but it never did.

For decades, Democratic and Republican presidents have alternately rescinded or reinstated the global gag rule, with Democrats, such as Biden, opposing the policy. Republicans have argued that the rule would reduce the number of abortions.

However, a study released last year suggested the policy failed to reduce the rate of abortions and ultimately had the opposite effect. The study said the rate of abortions increased by about 40% in the countries studied — most likely because the funding ban caused a reduction in access to contraception and a consequent rise in unwanted pregnancies.

Under the actions announced on Thursday, the president is telling federal agencies to review a Trump-era rule that limited the use of Title X federal funds meant for family planning and reproductive health services for low-income patients. Under this program, organizations that provided abortions or abortion counseling could not have access to those federal funds. The White House said, "Across the country and around the world, people — particularly women, Black, Indigenous and other people of color, LGBTQ+ people, and those with low incomes — have been denied access to reproductive health care."

Ketamine has been used illegally as a club drug. The medication, which is used in hospitals primarily as an anesthetic, generates an intense high and dissociative effects. EMS providers in Colorado need a waiver from the CDPHE to use ketamine in the field. The drug is allowed to be administered for patients "with a presumptive diagnosis or excited delirium,"

Paramedics administered ketamine to McClain after he was stopped one night in August 2019 by three White Aurora police officers as he walked home from a convenience store. A 911 called had reported a "suspicious person," according to a police news release that said McClain "resisted contact" with officers before a struggle ensued. McClain is heard in footage from an officer's body camera telling the officers, "I'm an introvert, please respect the boundaries that I am speaking."

Paramedics arrived and administered ketamine, the letter said. McClain was taken to a hospital but suffered a heart attack on the way, and he was declared brain dead three days later, the letter said.

The report noted McClain's history of asthma and the carotid hold, though the autopsy did not determine whether it contributed to McClain's death. The concentration of ketamine in his system was at a "therapeutic level," the report said.

The district attorney declined to file criminal charges at the time, but the case attracted renewed attention last summer after the police killings of George Floyd and Breonna Taylor. As protests took place across the country, demonstrations in the Denver suburb focused on McClain and his family's calls for justice, and Gov. Jared Polis tapped Colorado Attorney General Phil Weiser to review the case. Weiser announced this month he was opening a grand jury investigation into McClain's death

twice as many non-college-educated white men said Trump is providing helpful, rather than harmful, information on the virus; college-educated white women were more than three times as likely to say that his information was harmful rather than helpful,

“If they like him, everything he does just affirms why they like him, and if they don’t like him, everything he does reaffirms why they don’t like him.”

In last week’s national CNN poll, two-thirds of white men without a college degree said they approved of Trump’s handling of the outbreak

While 55 percent of blue-collar men said in the CNN poll that they are comfortable returning to their normal routines, 68 percent of college-educated white women said they are not

“I think, generally, the last two months have been a good reminder that most people made up their minds about Donald Trump a long time ago, and nothing is going to change their opinion,”

non-college-educated white women exhibit more strain over the outbreak than college-educated white men. In the Navigator polling, these women were considerably more likely to say that they worry about falling behind on bills. And while a slight majority of the men in the CNN survey said they are comfortable returning to their routines, three-fifths of the women said they are not.

while these women report more unease over the pandemic, they are more likely than the men to praise Trump’s response to it. In the Navigator polling, 56 percent of the women said they approved of Trump’s handling of the outbreak, compared with just 44 percent of the men

education trumps gender in shaping attitudes about the president’s performance.

Operatives in both parties believe that Trump’s volatile and often-erratic pronouncements about the outbreak—such as suggesting the use of bleach and ultraviolet light to treat patients, and announcing that he is taking hydroxychloroquine—have compounded existing doubts among many well-educated white voters about his fitness for the presidency.

the 2018 exit polls generally showed the GOP suffering some erosion among blue-collar white women, with the party’s advantage slipping to 14 percentage points. The latest round of surveys suggests that, among those women, Trump has stabilized at that diminished level, leading by roughly a dozen points (or slightly less) among them.

ox News surveys last month in Pennsylvania and Michigan put Biden even among non-college-educated white women, and he led Trump among them in the latest Marquette University Law School poll in Wisconsin.

Among nonwhite voters, gender, not education, remains the key divide

In New England, it was quite the opposite. “Order was an obsession” for the Puritan founders. Everything was regulated.

Cotton Mather defined an “honorable” person as one who was “studious, humble, patient, reserved and mortified.” These habits have lingered, too.

“Albion’s Seed” makes the brazen case that the tangled roots of America’s restless and contentious spirit can be found in the interplay of the distinctive societies and value systems brought by the British emigrations — the Puritans from East Anglia to New England; the Cavaliers (and their indentured servants) from Sussex and Wessex to Virginia; the Quakers from north-central England to the Delaware River valley; and the Scots-Irish from the borderlands to the Southern hill country.

The values of the Virginia Cavaliers caused the unusual brutality of the American system of Black enslavement.)

Fischer writes of the Scots-Irish: The people of the Southern hill country region “were intensely resistant to change and suspicious of ‘foreigners.’ … In the early 20th century, they would become intensely negrophobic and antisemitic.”

But how does one prove such an assertion? The only way is through the meticulous accumulation of detail. Over nearly a thousand pages, Fischer describes 22 different patterns of behavior or “folkways” for each of the four cultures — from dress and cooking, to marriage and child-rearing, to governance and criminal justice

These culminate in four distinctive definitions of liberty. Freedom, he writes, “has never been a single idea, but a set of different and even contrary traditions in creative tension with each other.”

Here is the nub of the book: The Puritan, Cavalier, Quaker and Scots-Irish notions of liberty were radically different, but each provided an essential strain of the American idea

The Puritans practiced an “ordered freedom” with the state parceling out liberties: Fishing licenses allowed the freedom to fish

The Scots-Irish were the opposite: Their sense of “natural freedom” was deeply libertarian. You moved to the backcountry so that you could do what you wanted

“Natural liberty was not a reciprocal idea. It did not recognize the right of dissent or disagreement,

Scots-Irish leaders were charismatic — Andrew Jackson was the paragon — and their religion was evangelical,

Honor was valor, a physical trait (among the Puritans and Quakers, honor was spiritual).

The Virginia definition of freedom was complex, contradictory — and remains problematic. It was hierarchical, the freedom to be unequal. “I am an aristocrat,” John Randolph of Roanoke said. “I love liberty; I hate equality.”

Freedom was defined by what it wasn’t. It wasn’t slavery. It was the freedom to enslave. It was a freedom, granted to the plantation masters, to indulge themselves, gamble and debauch.

Over time, this plutocratic libertarianism found natural allies, if strange bedfellows, in the fiercely egalitarian Scots-Irish hill country folk. Neither wanted to be “ruled” by a strong central government. Look at the Covid maps: The regional alliance remains to this day.

The Quakers seem an afterthought, but their migration was larger in size than that of the Puritans or Cavaliers. And their version of liberty seems most amenable today. It was “reciprocal freedom,” based on the golden rule.

American cuisine mirrored the cultures — the Puritans baked (as in beans and pies), the Cavaliers roasted (as in barbecue), the Quakers boiled (as in cream cheese) and the Scots-Irish fried and mashed (as in pancakes and grits)

The Scots-Irish spoke a dialect that predated current British English, and that, because of their notion of freedom, included “an actual antipathy to fixed schemes of grammar and orthography and punctuation.”

Culture is a sticky thing. “To change a culture in any fundamental way,” Fischer writes, “one must transform many things at once.”

Child-rearing was wildly different in the four colonial systems, for example. And, in turn, that affected education, which affected criminal justice and traditions of governance.

The second letter was signed by more than 100 LGBTQ+ and civil rights groups, including Glaad and the Human Rights Campaign. It expressed support for the contributor letter and accused the Times of platforming “fringe theories” and “dangerous inaccuracies”. It noted that while the Times has produced responsible coverage of trans people, “those articles are not getting front-page placement or sent to app users via push notification like the irresponsible pieces are”. And it observed that rightwing politicians have been using the Times’s coverage of trans issues to justify criminalizing gender-affirming care.

Charlie Stadtlander, the Times’ director of external communication, put out a statement stating that the organization pursues “independent reporting on transgender issues that include profiling groundbreakers in the movement, challenges and prejudice faced by the community, and how society is grappling with debates about care”. While that was all very diplomatic, the executive editor, Joe Kahn, and opinion editor, Kathleen Kingsbury, sent around a rather more pointed newsroom memo condemning the letters on Thursday.

“It is not unusual for outside groups to critique our coverage or to rally supporters to seek to influence our journalism,” Kahn wrote in the memo. “In this case, however, members of our staff and contributors to The Times joined the effort … We do not welcome, and will not tolerate, participation by Times journalists in protests organized by advocacy groups or attacks on colleagues on social media and other public forums.”

Here’s the thing: there is no clear-cut line between advocacy and journalism. All media organizations have a perspective about the world and filter their output (which will, of course, strive to be fairly reported) through that perspective. To pretend otherwise is dishonest. Like it or not, the Times is involved in advocacy. It just needs to step back for a moment and think about who it’s advocating for.