Group items tagged

Chloroquine had produced what he called “spectacular improvements” in the Chinese patients. “It’s excellent news — this is probably the easiest respiratory infection to treat of all,” Raoult said. “The only thing I’ll tell you is, be careful: Soon the pharmacies won’t have any chloroquine left!”

Raoult wrote his first research paper, in 1979, on a tick-borne infection sometimes known as Marseille fever. The disease was also called “benign summer fever,” and more than 50 years of science said it was nonlethal. And yet one of the 41 patients in his data set had died.

Before submitting the paper, Raoult, who was then a young resident, gave it to a supervising professor for review. “And he takes it,” Raoult told me, “he doesn’t show it to me again, and he publishes it — and he’d taken out the death. Because he didn’t know how to make sense of the death.”

Raoult was disgusted, and the incident shaped his philosophy of scientific inquiry. “I learned that the people who wanted to follow the familiar path were prepared to cheat in order to do it,” he said.

In Raoult’s view, French science was a duchy of appearances, connections and self-reverence. “It was people saying” — he mimed the drone of an aristocrat — “ ‘Oh, him, yes, he’s very good.’ And this reputation, you don’t know what it’s based on, but it’s not the truth.”

“He was a ‘follower,’” Raoult said of the professor. “And these ‘followers’ are all cheaters. That’s what I thought. And it’s still what I think.”

He is, fundamentally, a contrarian. In Raoult’s view, little of consequence has been accomplished by researchers who endorse the habitual tools and theories of their age.

“I’ve spent my life being ‘against,’” he told me. “I tell young scientists: ‘You know, you don’t need a brain to agree. All you need is a spinal cord.’” He is thrilled by conflict. It is a matter both of philosophy — the influence, no doubt, of the thinker he refers to admiringly as “master Nietzsche” — and of temperament.

His peers shake their heads at this behavior but grant him a grudging respect. “You can’t knock him down,” said Mark Pallen, a professor of microbial genomics at the University of East Anglia. “In terms of his place in the canon, the sainthood of science, he’s pretty secure there.”

In 1985 and 1986, Raoult worked at the Naval Medical Research Institute in Bethesda, Md., where he discovered the Science Citation Index. The index, a tool that can be used to measure a scientist’s influence on the basis of his or her publication history, was relatively unknown in France. Raoult looked up the researchers reputed to be the best in Marseille. “It was really the emperor wears no clothes,” he said. “These people didn’t publish. There was one who hadn’t written a paper in 10 years.”

In subsequent work, he demonstrated that Marseille fever was indeed fatal in almost precisely one in every 41 cases.

Raoult’s name sits atop several thousand; in each of the past eight years, he has produced more than 100. In 2020, he has already published at least 54.

Like many doctors, Molina viewed Raoult’s study with skepticism, but he was also curious to see if his proposed treatment regimen might in fact work. He tested hydroxychloroquine and azithromycin in 11 of his own patients. “We had severe patients, and we wanted to try something,” Molina told me. Within five days, one had died, and two others had been transferred out of his service to intensive care. In another patient, the treatment was suspended after the onset of cardiac issues, a known side effect of the drugs. Eight of the 10 surviving patients still tested positive for SARS-CoV-2 at the conclusion of the study period

Raoult is reputed to be an indefatigable worker, but he also achieves his extreme rate of publication by attaching his name to nearly every paper that comes out of his institute.

In recent years, Raoult has amused himself, it seems, by staking out tendentious scientific claims, sometimes in territories that are well beyond the scope of his expertise.

He is skeptical, for instance, of the utility of mathematical modeling in the realm of epidemiology.

The same logic has led him to conclude that climate modelers are no more than “soothsayers” for our “scientistic era” and that their dire predictions are mostly just an attempt to expiate our intense but irrational feelings of guilt.

Raoult’s most recent book, “Epidemics: Real Dangers and False Alerts,” was published in late March, by which time the W.H.O. had reported more than 330,000 confirmed cases of Covid-19 worldwide and more than 14,500 deaths. “This anguish over epidemics,” he writes, “is completely untethered from the reality of deaths from infectious diseases.”

Testing had been scheduled to run for two weeks per patient, but after only six days, the results were so favorable that Raoult decided to end the trial and publish

Others might have proceeded with more caution or perhaps waited to confirm these results with a larger, more rigorous trial. Raoult likes to think of himself as a doctor first, however, with a moral obligation to treat his patients that supersedes any desire to produce reliable data.

For decades, Raoult has boasted of his prodigious rates of publication and citation, which, as objective statistics, he considers to be the best measure of his worth as a researcher.

This observation has come to be known as the parachute paradigm: We tend to accept the claim that parachutes reduce injury among people who leap from airplanes, but this effect has never been proved in a randomized study that compares an experimental parachute group to an unlucky parachuteless control.

“If you don’t have something that’s visible in 10 patients, or 30, it’s useless. It’s not of any consequence.” An effective treatment for a potentially lethal infectious disease will be visible to the naked eye.

There is much about Raoult that might make him, and by extension his proposed treatment, appealing to a man like Trump. He is an iconoclast with funny hair; he thinks almost everyone else is stupid, especially those who are typically regarded as smart; he is beloved by the angry and conspiracy-minded; his self-congratulation is more or less unceasing.

Raoult classified Trump’s psychology as that of an “entrepreneur,” by way of contrast with that of a “politician.” “Entrepreneurs are people who know how to decide, who know how to take risks,” he said. “And at a certain point, to decide is to take a risk. Every decision is a risk.”

The French waited far too long, in his estimation, to approve the use of hydroxychloroquine in Covid-19 patients. The authorization came only after Raoult announced in the press that he would continue, “in accordance with the Hippocratic oath” and effectively in defiance of the government, to treat patients with his combination therapy. “I’m convinced that in the end, everyone will be using this treatment,” Raoult told Le Parisien. “It’s just a matter of time before people agree to eat their hats.”

Raoult had already begun assembling data for a larger study, but he dismissed the need for anything particularly vast or lengthy. Like other critics of the R.C.T., he likes to point out that a number of self-evidently useful developments in the realm of human health have never been validated by such rigorous tests.

Raoult’s study had measured only viral load. It offered no data on clinical outcomes, and it was not clear if the patients’ actual symptoms had improved or indeed whether the patients lived or died. At the outset, 26 patients were assigned to receive hydroxychloroquine, six more than the 20 who appeared in the final results.

The six additional patients had been “lost in follow-up,” the authors wrote, “because of early cessation of treatment.” The reasons given were concerning. One patient stopped taking the drug after developing nausea. Three patients had to be transferred out of the institute to intensive care. One patient died. (Another patient elected to leave the hospital before the end of the treatment cycle.)

“So four of the 26 treated patients were actually not recovering at all,” noted Elisabeth Bik, a scientific consultant who wrote a widely circulated blog post on Raoult’s study. She paraphrased the sarcasm circulating on Twitter: “My results always look amazing if I leave out the patients who died.”

The report was also riddled with discrepancies and apparent errors.

This apparent sloppiness was unsurprising to many of those who have tracked Raoult’s work in the past. A prominent French microbiologist told me that, in terms of publication, Raoult’s reputation among scientists has been “long gone” for some time.

Beyond its apparent errors and omissions, the study’s design — its small size, its flawed control, the unrandomized assignment of patients to the treatment and control groups — was widely viewed to render its results meaningless. Fauci repeatedly called its results “anecdotal”;

Large, well-controlled randomized trials are by no means the only way to arrive at useful scientific insights. Their utility is that they enhance statistical signals such that, amid the noise of human variability and random chance, even the faint effect of some new treatment can be detected.

The results of his initial trial have yet to be replicated. “I think what he secretly hopes is that no one will ever be able to show anything,”

The prime statistical hurdle that any proposed treatment for Covid-19 will have to overcome — one that is delicate for even Raoult’s critics to make note of, amid the sorrow and fear of this pandemic — is that the signal is likely to be very faint, because the disease is, in the end, rarely fatal. Nearly everyone survives; an effective treatment will save the life of the one or so patients in every hundred who would not have lived without it.

“Alzheimer’s drugs, obesity drugs, cardiovascular drugs, osteoporosis drugs: Over and over, there have been what looked like positive results that evaporated on closer inspection. After you’ve experienced this a few times, you take the lesson to heart that the only way to be sure about these things is to run sufficiently powered controlled trials. No shortcuts, no gut feelings — just data.”

“I’ve invented 10 or so treatments in my life,” Raoult told me. “Half of them are prescribed all over the world. I’ve never done a double-blind study in my life, never. Never! Never done anything randomized, either.”

“When you tell the story, it’s extremely straightforward, no? It’s subject, verb, complement: You detect a disease; there’s a drug that’s cheap, whose safety we know all about because there’s two billion people who take it; we prescribe it, and it changes what it changes. It might not be a miracle product, but it’s better than doing nothing, no?”

Raoult had by then begun to lose his composure. He accused Lacombe of being a shill for the pharmaceutical industry; his fans sent her death threats. On Twitter, he called Bik, the consultant who wrote critically about the first study, a “witch hunter” and called a study that she tweeted — one of several published in April and May that seemed to suggest that Raoult’s treatment regimen was ineffectual or even harmful — “fake news.” The authors of another such study were accused of “scientific fraud.” “My detractors are children!” Raoult told an interviewer.

It is possible that hydroxychloroquine and azithromycin are an effective treatment for Covid-19. But Raoult’s study showed, at best, that 20 people who would almost certainly have survived without any treatment at all also survived for six days while taking the drugs Raoult prescribed.

In recent weeks, Raoult has in fact tempered his claims about the virtues of his treatment regimen. The published, peer-reviewed version of the final study noted that another two patients had died, bringing the total to 10. Where the earlier version called the drugs “safe and efficient,” they were now described merely as “safe.”

He has shown flickers of what appears to be doubt.

“I don’t trust popularity,” he told the interviewer. “When too many people think you’re wonderful, you should start to wonder.” His initial YouTube video, “Coronavirus: Game Over!” has also been renamed. The new language is more measured, and in place of the exclamation point there now stands a question mark.

Despite appearing to be a free-standing new operation, the Honest Elections Project is just a legal alias for the Judicial Education Project, a well-financed nonprofit connected to a powerful network of dark money conservative groups, according to business records reviewed by the Guardian and OpenSecrets.

For nearly a decade, the organization has been almost entirely funded by DonorsTrust, known as a “dark money ATM” backed by the Koch network and other prominent conservative donors, according to data tracked by OpenSecrets. In 2018, more than 99% of the Judicial Education Project’s funding came from a single $7.8m donation from DonorsTrust.

The Honest Elections Project is merely a fictitious name – an alias – the fund legally adopted in February. The change was nearly indiscernible because The 85 Fund registered two other legal aliases on the same day, including the Judicial Education Project, its old name. The legal maneuver allows it to operate under four different names with little public disclosure that it is the same group.

There is a lot of overlap between the Honest Elections Project and the Judicial Crisis Network. Both groups share personnel, including Carrie Severino, the influential president of the Judicial Crisis Network.

The Honest Elections Project has become active as Republicans are scaling up their efforts to fight to keep voting restrictions in place ahead of the election. The Republican National Committee will spend at least $20m on litigation over voting rights and wants to recruit up to 50,000 people to help monitor the polls and other election activities.

“It isn’t any surprise to those of us that do work in both of these spaces that our opponents [who] want to constrict access to voting, access to the courts, who are seeking an anti-inclusive, anti-civil rights agenda are one in the same,” she said.

South Korea did everything the UK government could have done, but refused to implement. Its death toll so far: 263. It still has an occasional cluster of infection, which it promptly contains. By contrast, the entire UK is now a cluster of infection.

Had the government acted in February, we can hazard a guess about what the result would have been, as the world has conducted a clear controlled experiment: weighing South Korea, Taiwan and New Zealand against the UK, the US and Brazil.

The climate modeller James Annan has used his analytical methods to show what would have happened if the UK government had imposed its lockdown a week earlier. Starting it on 16 March, rather than 23 March, his modelling suggests, would by now have saved around 30,000 lives, reducing the rate of illness and death from coronavirus roughly by a factor of five.

In other words, none of these are failures of knowledge or capacity. They are de-preparations, conscious decisions not to act.

on 12 March, Johnson abandoned both containment and nationwide testing and tracking. A week later, the status of the pandemic was lowered, which meant that the government could reduce the standard of personal protective equipment required in hospitals, and could shift infectious patients into non-specialist care. Again, there was no medical or scientific justification for this decision.

Exercise Cygnus, a pandemic simulation conducted in 2016, found that the impacts in care homes would be catastrophic unless new measures were put in place. The government insists that it heeded the findings of this exercise and changed its approach accordingly. If this is correct, by allowing untested patients to be shifted from hospitals to care homes, while failing to provide the extra support and equipment the homes needed and allowing agency workers to move freely within and between them, it knowingly breached its own protocols. Tens of thousands of highly vulnerable people were exposed to infection.

While other countries either closed their borders or quarantined all arrivals, in the three months between the emergence of the virus and the UK’s lockdown, 18 million people arrived on these shores, of whom only 273 were quarantined. Even after the lockdown was announced, 95,000 people entered the UK without additional restrictions.

They start to become explicable only when we recognise what they have in common: a refusal to frontload the costs. This refusal is common in countries whose governments fetishise what we call “the market”: the euphemism we use for the power of money.

Johnson’s government, like that of Donald Trump and Jair Bolsonaro, represents a particular kind of economic interest. For years politicians of their stripe have been in conflict with people who perform useful services: nurses, teachers, care workers and the other low-paid people who keep our lives ticking, whose attempts to organise and secure better pay and conditions are demonised by ministers and in the media.

This political conflict is always fought on behalf of the same group: those who extract wealth.

The interests of wealth extractors are, by definition, short term. They divert money that might otherwise have been used for investment into dividends and share buybacks.

Years of experience have shown that it is much cheaper to make political donations, employ lobbyists and invest in public relations than to change lucrative but harmful commercial policies

Working through the billionaire press and political systems that are highly vulnerable to capture by money, in the UK, US and Brazil they have helped ensure that cavalier and reckless people are elected.

It’s not that any of these interests – whether the Daily Mail or the US oil companies – want coronavirus to spread. It’s that the approach that has proved so disastrous in addressing the pandemic has been highly effective, from the lobbyists’ point of view, when applied to other issues: delaying and frustrating action to prevent climate breakdown; pollution; the obesity crisis; inequality; unaffordable rent; and the many other plagues spread by corporate and billionaire power.

Thanks in large part to their influence, we have governments that fail to protect the public interest, by design. This is the tunnel. This is why the exits are closed. This is why we will struggle to emerge.

The first documented burial took place on April 22, 1869, according to Melinda Hunt, director of the Hart Island Project, a nonprofit organization identifying and tracking burials on the island.

This concept of honoring the dead was particularly relevant during the AIDS epidemic of the late ’80s and ’90s, which killed more than 100,000 people in New York. Many AIDS patients were laid to rest at Hart Island in an isolated area from other remains and in deeper individual graves because of the stigma and lack of knowledge about how AIDS spread.

Those epidemics include the yellow fever and tuberculosis outbreaks of the 19th century, when the island was used as a quarantine station for those who were infected. It also proved key in handling the waves of victims associated with the spread of the great flu pandemic of 1918, when over 30,000 deaths were recorded in the city — 20,000 of which came that fall alone.

Mass burials on Hart Island often hold a negative association, most likely because of the way burials have evolved throughout history, as private funerals have become the norm.

Hunt says New York City as a whole has never run out of burial space. “The city is able to recycle graves after 25 years

The burials were long conducted by inmates, most often from Rikers Island. “You hear people who say if you go to Hart’s, you’re going to be haunted the rest of your life,” said Saxon Palmer, a former Rikers inmate, who was on the job for the entirety of his four-month sentence in 2019. “Then most people wouldn’t come back the next week.”

“I’ve often referred to Hart Island as New York City’s family tomb. … There’s something really meaningful about that, to be buried with earlier generations,” Hunt said. “We want for people to be able to stay connected … because that’s what is going to make us feel safe in the end, that the city has honored every life.”

Biden said Congress should come together to pass a "robust" aid package, but also repeated his call for "immediate relief" in the lame-duck period, before he takes office.

He also laid out a laundry list of economic goals that must be addressed early on in his administration. These include keeping businesses and schools open safely, delivering economic relief for those who have lost jobs or had hours cut, stabilizing the nation's health care system and addressing racial inequities the virus has laid bare.

Yellen would become the first woman to lead the department in its 231 years of existence.

She would be just the fourth woman and the first Black woman to lead the CEA since it was established nearly 75 years ago.

Biden also named Wally Adeyemo, who, if confirmed, would become the Treasury Department's first Black deputy secretary.

Tanden — who is the CEO of the left-leaning public policy organization the Center for American Progress and a veteran of both the Clinton and Obama administrations — would be the first woman of color to lead OMB.

it would probably be many years until it was safe enough to “return to approximately the lifestyle we had.” She said, “We have to settle to live with the virus.”

Epidemiologists are worried about many unknowns, including how long immunity lasts; how the virus may mutate; the challenges of vaccine distribution; and the possible reluctance to accept the vaccine among some groups.

the epidemiologists are living with stringent precautions and new workarounds in place, far stricter than those of many ordinary Americans

Most scientists say around 70 percent of the population will need to be immune for the United States to reach herd immunity, when the virus slows down significantly or stops

Three-quarters of respondents said they planned to spend Christmas, Hanukkah or other winter holidays only with members of their household, or not celebrate at all, similar to how they spent Thanksgiving.

most epidemiologists agreed on these general principles: They are less worried about outdoor activities and about touching surfaces, and more worried about indoor activities and those with large groups.

“Indoor venues with lots of people is the riskiest situation,” said Leland Ackerson of the University of Massachusetts. “Outdoors with few people, social distancing and precautions is the least risky.” He said that during the last month, he had hiked with friends, opened mail without precautions and run errands.

“It’s funny: When you asked this before, I was so optimistic about the U.S. being able to lead and address this in a timely fashion,” said Rachel Widome, associate professor at the University of Minnesota. “I told you I thought things would be better by now. I was very wrong. They are dramatically worse.”

Of 23 activities of daily life that the survey asked about, there were only three that the majority of respondents had done in the last month: gathering outdoors with friends; bringing in mail without precautions; and running errands, like going to the grocery store or pharmacy.

Nearly a third of respondents said they would be comfortable returning to more activities of daily life once they were vaccinated. Some said they would feel comfortable doing only certain things, like socializing with people who had also been vaccinated

A few said they would wait until the country had reached the herd immunity threshold and they had received a vaccine themselves.

“I would do some minimal travel, small indoor gatherings with other close relatives when I am vaccinated, but maintain safety precautions such as wearing a mask and social distance.”

Some said they were less worried than last spring about socializing outdoors, touching surfaces or sending young children to school. They were more worried about indoor air transmission and the dangers of not wearing masks.

“It entirely depends upon what we do as a nation to address the pandemic,” said Emeli Anderson, a doctoral student of epidemiology at Emory. “Right now, we are not nearly doing enough.”

Many epidemiologists expressed disappointment and frustration that public health messaging had not been more effective, and that a growing share of Americans seemed to distrust science. They feared that the politicization of measures like wearing masks and staying home would have long-term consequences.

“This virus has humbled me as a professional and a person,” said Michelle Odden, associate professor of epidemiology at Stanford. “I did not think this level of failure in a federal response was possible in the United States. We have a lot of work to do.”

assuming a highly effective therapeutic drug isn’t developed, a significant number said it would be at least a year before they felt it would be safe to do many of the things they used to.

“I expect that wearing a mask will become part of my daily life, moving forward, even after a vaccine is deployed,”

Many said they planned to keep working from home at least part of the time. Some said they would always be more hesitant about greeting people with a handshake or a hug, being in crowded places or traveling internationally.

“I think it will be a few years before gathering with large groups of people in crowded public places and being on airplanes and other public transportation will feel safe to me,”

Others cautioned that even when the physical dangers of the pandemic recede, other consequences are likely to be long-lasting. They mentioned the effects of isolation on children’s developing brains; the exposure of deep inequities in health care and in safety nets; and the fear and sadness of so much illness and death.

It’s sad that voters feel like they only have a choice between democratic socialism and white supremacy.

Ms. Witzke’s ascent in Joseph R. Biden Jr.’s home state may be the nadir of the Delaware Republican Party’s rapid swerve from patrician moderation to the far-right fringe

Republicans running statewide are facing a choice: Appeal to the vocal extreme or find some way to assemble a more centrist coalition that could actually elect them.

That was an easy case to make not long ago in tiny Delaware, population 974,000, where “the Delaware way” was a model of centrist political accommodation.

The F.B.I. has warned that QAnon poses a potential domestic terrorism threat.

“People are so tired of George Bush-era politics. Nationalist populism is the future,” Ms. Witzke said. “America First is the future. And that is what I am.”

The Republican Party has to be open-minded about the people who live in this country and get back on some sort of track that makes sense to the average voter,

You can’t just have ideological beliefs that don’t appeal to a majority of people in a state — or the country.

Ms. Witzke’s message to moderates, she said: “It’s me or Antifa.”

On Wednesday, a day after Mr. Trump’s Proud Boys remarks during the first presidential debate, Ms. Witzke took to Twitter to create more headaches for her party. “The Proud Boys showed up to one of my rallies to provide free security for me when #BLM and ANTIFA were protesting my candidacy,” she wrote, neglecting to mention that the Proud Boys outnumbered the McDole family protesters at the event.

“We are sick and tired of pandering and people electing government officials who will cave to the mob,”

Gathered with her in the parking lot of the Republican Party headquarters here was a self-appointed security guard with a gun on his hip, a political adviser whose losing clients include candidates accused of racism and anti-Semitism, and a smattering of Proud Boys, the far-right brawlers whom President Trump told to “stand back and stand by.”

oe Biden by at least five percentage points

Melania Trump, the first lady, said that they had tested positive for the coronavirus, throwing the White House and the presidential race into upheaval.

Here how the diagnosis will impact the Trump campaign, and a caution:

eyond that, the origin of their cases is unknown,

Mr. Biden’s running mate, all tested negative for the coronavirus in the past 24 hours.

Oct. 15.

Maybe a debate over Zoom?

white supremacy group, the Proud Boys, telling them to “stand back and stand by.”

“losers” and “suckers.” But Mr. Trump, who has previously dismissed that news report as false, did not take the time to do it onstage or affirm his support for service members. H

even some Republicans said that moment crossed the line.

But the growing momentum for reforms like ending the filibuster faces a six-foot roadblock: Mr. Biden.

There has been little tension about Barrett's nomination since a sufficient number of members of the Senate majority suggested they would go along generally and support her specifically, and she appears on track to be confirmed.

These

"These are lifetime appointments. They last for decades. What is done here will affect policies long after our lifetimes end," she said. "There's never been a situation quite like this."

Biden announced Harris as his choice for vice president on August 11, and in interviews, some Democratic women donors described a concerted effort to flood the campaign with cash in support of Biden's choice

Harris' sorority sisters, who have made more than 22,000 donations in increments of $19.08 -- marking the year, 1908, that Alpha Kappa Alpha Sorority, Inc. was founded at Howard University.

Polls show Trump consistently lagging behind Biden in surveys of women voters.

The cash infusion in August helped Biden and his aligned party committees shatter the single-month fundraising record for a presidential contender and helped fuel an advertising blitz for the former vice president as the fall campaign swung into view.

The lopsided support for the Biden-Harris ticket among female donors who give in larger amounts comes as women have stepped up their political activity more broadly. This year, a record 298 women are running in the general election for US House seats, topping the previous record of 234, set during the 2018 midterms, according to the Center for American Women and Politics at Rutgers University.

And women have contributed $2 billion to federal candidates in this cycle, surpassing the $1.3 billion they donated in 2016 when Democrat Hillary Clinton sought the presidency, according to the Center for Responsive Politics

"They realized they need to have a role and a voice because this was a place affecting their lives and the lives of their families, and they couldn't sit on the sidelines," she said.

The gap has only grown wider as Biden has outpaced the President in overall fundraising.

The Center for Responsive Politics, a nonpartisan nonprofit that tracks money in politics, identifies donors' gender by applying an algorithm that compares the most popular US Census names to the names of donors reported to the Federal Election Commission

The growing influence of women donors is no accident. Donors and strategists have worked for years help direct political money to female candidates.

For instance, Electing Women Bay Area -- a "giving group" with 100 members in Northern California -- financially supports Democratic women in competitive races

"One of the things we have long stressed ... is this idea that men are used to writing the checks, and it's a muscle that has to be exercised," said Alexandra Acker-Lyons, who is Electing Women Bay Area's political director and runs her own philanthropic and political consulting firm. "Much like being a voter is a habit, being a donor is a habit."

Once it became clear that Biden intended to pick a female vice presidential nominee, some donors timed their contributions to make a big splash

"The fact that it was Kamala made it even made it even more intentional," she said, "because we were, and obviously still are, in a moment in our country where we particularly wanted to show up for a black woman nominee."

"Almost immediately, I started to see $19.08, $19.08, $19.08 on repeat," Clayton Cox, the Democratic National Committee's finance director, said of the stream of new donations that began popping up the day Harris joined the ticket.

More than 22,500 donations in increments of $19.08 have flowed into the Biden Victory Fund-- bringing in more than $430,000,

Michelle Arrington, an Atlanta attorney who pledged AKA at Howard a decade after Harris, has long supported Harris' political campaigns, dating back to her bid for California attorney general. Harris' push to promote research into uterine fibroids -- a condition Arrington has faced and that disproportionately afflicts Black women -- underscores the value of broad representation in government, she said.

But the informal movement to donate in amounts that reflects sorority's founding date was no surprise, she said. "It's indicative of the types of things we do: We'll start meetings at 12:08 or 7:08 p.m."

Americans have since ramped up spending on everything from home improvements to bicycles with the help of stimulus checks sent to millions, though overall expenditures remain below pre-pandemic levels.

A nationwide decline in combined state revenue has happened after only two events in 90 years: following the Sept. 11, 2001, attacks and in the aftermath of the 2008 financial crisis.

The U.S. economy has steadily recovered since the spring, and more than 11 million jobs of the 22 million lost earlier in the year have come back. Still, the unemployment rate recently hovered at 7.9%, and there has been an uptick in permanent layoffs.

Economists warn a two-track recovery is emerging, with well-educated and well-off people and some businesses prospering, at the same time lower-wage workers with fewer credentials, old-line businesses and regions tied to tourism are mired in a deep decline.

After 2008, some states implemented or added to rainy day funds—cash reserves that can be used to fill revenue gaps caused by a potential shock

School systems also usually receive local funds through property taxes.

Schools received federal aid from the pandemic-stimulus packages passed by Congress earlier this year.

The money was quickly spent

The Ohio Education Association, a teachers union, said the state’s school districts could face budget shortfalls for the 2022 and 2023 budget years of between 20% and 25%.

Many states are pleading for more aid from Congress, which has so far sent money in its coronavirus relief packages to deal with the health crisis but not to offset revenue losses.

Congress has doled out about $150 billion in Covid-19 response dollars to state and local governments, plus some additional money to cover elevated Medicaid costs.

President Trump and Senate Majority Leader Mitch McConnell have said they don’t want Covid-19 aid used to address longstanding financial problems.

Community Health Resources, which offers mental-health and addiction services to 27,000 children and adults, is concerned it won’t receive its expected more than $40 million in state funding—62% of the organization’s annual budget—in the next fiscal year, which begins in July.

In 2016, Mr. Trump won votes from 51% of men but only 40% of women—an 11-point gender gap that tied the record Bill Clinton set in his re-election of 1996.

With strong economic numbers to tout today, Mr. Trump will surely be banking on the economy to boost his campaign—and to narrow what could be a historic gender gap

Clemency, as structured by the Constitution, has no check or balance other than politics. And, in yet another political cycle, we are utterly failing to employ that lone check on this power of kings.

The Constitution gives the president sole discretion over clemency, a remarkable and uniquely unchecked power. Historically, at its best, presidents have used it to smooth over the roughest edges of criminal justice.

President Gerald Ford used it to grant thousands of conditional pardons to Vietnam-era draft evaders and deserters after the exigency of that war was over, and President John F. Kennedy used it to shorten the sentences of some sentenced under a draconian marijuana law.

clemency has not been the focus of a question at a presidential debate in the past few decades

no "undecided voter" has pressed a candidate for their views on how the pardon power should be employed.

in the last debate, neither candidate talked about how they would use clemency prospectively, even in a heated discussion on criminal justice.

Trump and Biden present very different issues relating to clemency (which includes the power to shorten sentences through a commutation or forgive convictions through pardons). Trump already has shown his cards: Even taking into consideration the commutations granted last Wednesday to five worthy petitioners, his use of the pardon power has mostly favored friends and Fox News celebrities

While interviewers continually (and appropriately) pepper Trump with questions about whether he will relinquish power if he loses, it is rare that anyone asks him who he might pardon after the election, despite the long and positively bizarre track record he has established.

"Usually the story for a typical election in recent years has been that the early vote is Democratic and the Election Day vote is Republican," he said. "And it looks as though we're going to have the same story this year, and we're going to have to wait to see what happens with that Election Day vote before we can really say what's going to happen."

"Typically, when we talk about early voting, we're talking about Democrats voting in person early and Republicans voting by mail," McDonald said. "This election, those roles are reversed. But when you look at the overall electorate, there are many more people voting by mail than in person early in most states."

The shift could be at least in part due to President Trump's consistent false claims that voting by mail leads to widespread fraud, whereas Joe Biden's campaign has been aggressive in urging supporters to vote early, whether in person or by mail.

the numbers of young people voting early have skyrocketed, particularly in states that will be critical for Biden and Trump to win, such as Michigan, Florida and North Carolina.

Young people could wield significant political power: Millennials and some members of Generation Z make up 37% of eligible voters, roughly the same share of the electorate that baby boomers and older voters ("pre-boomers") make up, according to census data analyzed by the Brookings Institution.

As early voting began, the pent-up voting interest showed as long lines formed in states such as Georgia and Texas, with some voters waiting for hours. Election officials had warned that some in-person voting locations would face longer lines as some jurisdictions have had to consolidate polling places and adjust logistics to accommodate social distancing during the pandemic.

"There is no place in the United States of America where two-, three-, four-hour waits to vote is acceptable and just because it's happening in a blue state doesn't mean it's not voter suppression," she said. "If this was happening in a swing state, there would be national coverage."

That's some 15 million more pre-election votes than were cast in the 2016 election, according to the U.S. Elections Project

With about a week still remaining until Election Day, Americans have already cast a record-breaking 62 million early ballots, putting the 2020 election on track for historic levels of voter turnout.

"It's good news, because we were very much concerned about how it would be possible to conduct an election during a pandemic," he said, citing concerns that mail-in ballots would be returned by voters en masse at the conclusion of the early voting period, overwhelming election officials. "Instead, what appears to be happening is people are voting earlier and spreading out the workload for election officials."

voters have cast more than 45% of the total votes counted in the 2016 election.

In 2019, McDonald predicted that 150 million people would vote in 2020's general election, which would be a turnout rate of about 65% — the highest since 1908. But he's going back to the drawing board. "I have increasingly been confident that 150 [million] is probably a lowball estimate," he said Monday. "I think by the end of the week I'll be upping that forecast."

Some states are quickly approaching their 2016 vote totals. In Texas, for example, nearly 7.4 million early votes had been cast as of Sunday, marking 82% of the state's total votes in 2016.

Montana, North Carolina, Tennessee and Georgia have also reached 65% or more of their 2016 vote totals.

Normally

Trump is describing the pandemic as better than it really is, and, of these people, more than three-quarters said that he’s doing it because he “wants to ignore a real problem.”

As Trump crisscrosses the country this week in an effort to rally his base and counteract Biden’s big advantage in paid media, he would love to change the subject—to Hunter Biden, the economy, immigration, anything but the pandemic. But nearly sixty million Americans have already voted, and the virus is still spreading rapidly. In a year defined by the coronavirus, it looks like the election may well be defined by it, too.

Using "timestamps" that track when patients check in and out, Neprash and her team analyzed exactly how long primary care doctors spent with their patients. They compared male and female physicians not just throughout the country, but within the same practices, which helped control for regional variations in the number of patients doctors are expected to see in a day.

Female primary care physicians spent about 15% more time with patients in each visit compared to male primary care physicians. As a result, they saw fewer patients over the course of a year.

In the U.S. healthcare system where most insurance companies pay doctors based on the number of patients they see — not how much time they spend with them — this means that women physicians generated about 11% less annual revenue for their practices than their male colleagues.

This could account for why female physicians are paid less than men, Neprash argues: They actually spend more time with patients.

Often patients come in for a straightforward medical concern, and I find myself discussing how stressed out they are about child care, or how hard it's been to pay the bills on time during the COVID-19 crisis.

But by not getting down to business immediately, could I end getting paid less than male doctors?

In addition to their visits generally taking longer, women also go to the doctor more than men, and female physicians are more likely to see female patients.

In one 2016 study, researchers found that the median salary for male physicians in the United States was almost $86,000 more per year than the median salary for female physicians in the early 2010s.

That 2.4 minutes may seem inconsequential. But the New England Journal study authors argue that the extra time female physicians spend with their patients adds up quickly and has profound implications for the pay gap between women and men.

"When you look at how many minutes they are spending with their patients over a year, female physicians are spending 20 hours more — despite the fact that they're seeing fewer of them, and they're earning less money," Neprash says.

Some researchers say female doctors spend more time with their patients, because patients have higher expectations of them.

Allen says she feels it's important to ask about her patients' home lives. But that kind of small talk adds up. Many evenings she finds herself still working in the office, long after her male co-workers have gone home.

"I do wonder if some of our male colleagues second guess themselves, or go above and beyond in the ways some of us as women tend to do,"

"We know that women have longer visits in general. They're twice as likely to raise emotional content in their visits, which generally takes longer to manage."

Another study published earlier this year found that in their very first jobs after training, male physicians earned about $36,000 more, on average, than their female counterparts.

Research suggests that the extra time female doctors spend connecting with patients may have a positive impact. One study found significant differences in the practice style of female and male doctors, and found the patients of female physicians tend to be more satisfied with their care.

And a widely publicized 2016 study found that when elderly hospitalized patients are cared for by female physicians, they are less likely to die or return to the hospital compared to patients who have male doctors.

I became a primary care doctor because I like getting to know my patients as people, not just as a list of diseases. I truly believe it helps me provide better care. But getting to know them takes time, and that means squeezing fewer patients into each workday. That could mean less money for my practice. It seems to be a price that many female primary care physicians are willing to pay.

Mara Gordon is a family physician in Camden, N.J., and a contributor to NPR.

the 2020 election is the first in history where climate change has played a pivotal role in a major candidate’s campaign, even if the issue wasn’t always in the headlines.

For the last two years, Trump has repeatedly played to his base with various rejections of climate science. The Biden campaign, in contrast, has used the issue to carefully build a broad coalition.

A landmark climate report in the final months of 2018 sparked a global awakening on the issue and, in the U.S., the Sunrise Movement pressed politicians on the topic in high-profile protests.

Last summer, Biden introduced his first full-throated plan, which proposed a $1.7 trillion federal outlay over ten years to tackle climate change.

Biden’s all-in strategy on climate may have already paid dividends: analysts say the youth vote has surged in early voting.

Biden leaned in rather than back down. Two-thirds of Americans support aggressive action on climate change, according to a Pew Research poll released in June, one of many showing heightened voter concern over the issue.

a growing group of Americans rank the issue among their top concerns and cite it as a motivating factor in their political engagement.

To activate these voters, Biden created a handful of task forces and committees to address the issue. Climate change played a key role in a “unity task force” composed of Biden and Sanders supporters. Meanwhile, Biden convened a separate “advisory council” made up of high-profile environmental, labor and environmental justice leaders as well as climate activists to develop a common-ground plan.

Historically, candidates track to the center to appear more palatable for a general election audience. Widespread voter concern over the spread of COVID-19 also could have bumped the issue from Biden’s agenda.

In recent years, young people have been the most vocal activists calling for action on climate change, and Biden allies saw taking a vocal stance on the issue as a strategic move to push young people, who often stay home on Election Day, to the polls.

the campaign framed the $2 trillion program as an opportunity to create jobs, invest in protecting communities of color and decarbonize the economy. “It was not that they went off in a room and came up with it,”

“If you go out and talk to most young people in America right now, the issue at the top of their list is going to be climate change.”

“They asked us questions—policy questions, personal questions: what are you dealing with? What are you hearing?” says Justin Onwenu, a community organizer at the Sierra Club in Michigan and a member of the DNC’s platform committee. “I think that went a long way.”

“I’m the first person I’m aware of that went to every major labor union in the country and got them to sign on to my climate change plan,” Biden said on Pod Save America on Oct. 24. The move to engage unions almost served a prebuttal of the Trump campaign’s primary climate talking point: that addressing the global warming would be too expensive and cost jobs.

In recent years, Trump’s climate policy has largely consisted of rolling back regulations and aiding fossil fuel companies, policies that remain deeply unpopular with American voters. This cycle, the campaign’s message — which was sometimes disrupted by off-the-cuff remarks from Trump — has shifted the focus slightly, asserting not that climate change isn’t real, but that addressing it would be too costly.

“Joe Biden has even admitted that he will be an anti-energy president,” said Rick Perry, a former Texas governor and President Trump’s first energy secretary on a call of journalists. “Biden’s radical proposal to eliminate oil and gas and coal from the US power grid by 2035 will have a devastating consequence on workers and families.”

Trump’s messaging may resonate in some parts of Pennsylvania where the fracking industry employs some 25,000 and indirectly supports many more jobs. Trump has hammered home the talking point in messaging in the state, including TV ads running there.

Biden clarified that move would be gradual and not be completed during his time as president. He would, instead, end subsidies for fossil fuels. At the same time, he reiterated his promise to create more jobs in clean industry.

There’s a sense among the activists and strategists who have spent months if not years plotting how to engage voters on climate that the acknowledgement of the oil industry’s long-term decline may not have struck the chord that it would have even a few years ago.

“I think [Biden] has been on the defensive a bit,” on fracking, said Michael Catanzaro, a former energy and environmental policy advisor in the Trump White House, before the debate. “But I think it’s actually working for him… he’s talking to union voters. He’s using his blue collar roots to push back pretty hard.”

If passed, the amendment would give Florida the highest minimum wage among Southern states and impact an estimated 2.5 million workers. 

There are seven other states already on track to hit $15 in the coming years, but those tend to be blue states with liberal labor policies.

Some proponents also say passage of Amendment 2 could help the push for a $15 wage floor at the federal level, especially if Democrats win the White House and control of the Senate.

“If $15 passes in Florida, it will send a clear message to the incoming [Biden] administration that raising the minimum wage is not just good policy but also good politics.”

But despite the general popularity of minimum wage hikes ― most have sailed through on the ballot in recent years ― the Florida proposal is by no means a sure thing.

“I think we feel good, but we need to turn out every single voter in the state,” said Stephanie Porta, the executive director of Organize Florida, a progressive group that supports the referendum.

Florida voters last approved a minimum wage increase in 2004, when they voted to raise it to $6.15 per hour. The current minimum wage is $8.56 thanks to inflation adjustments included in the 2004 referendum, but progressive advocates say that still falls far short of a living wage,

A single adult with no children would need to make more than $12 an hour to earn a living wage in Florida, according to the Massachusetts Institute of Technology.

The increase to $15 would boost pay for about a quarter of the state’s workforce, according to the Florida Policy Institute, a progressive think tank.

A third of Florida’s female workers would see a raise; 38% of women of color in the workforce would receive a pay increase, the institute says. 

Florida has a $3.02-per-hour “tip credit” for business owners. It’s what allows Johnson to pay a server $5.54 before gratuities, rather than $8.56, under the current minimum wage. That $3.02 credit would stay under the new law, but it would have less impact over time.

“Any restaurant that’s on the bubble right now, especially with COVID ― when they have those additional costs, I don’t know if they make it through,”

Much of the financial backing for the amendment has come from the law firm of John Morgan, a high-profile Florida attorney who represents workers in class-action lawsuits.

a 2005 study that found “no empirical evidence” that Florida’s last, more modest minimum wage increase caused employers to lay off workers.

The COVID-19 pandemic has limited in-person organizing efforts, especially in the lower-income communities that would benefit most from the wage increase, and progressive groups and the Florida Democratic Party fell short of their voter registration targets.

We need to turn out every single voter in the state. Stephanie Porta, executive director of Organize Florida

Democratic presidential nominee Joe Biden has endorsed raising the federal minimum wage to $15, and Democrats and progressives in Florida hope that support for Amendment 2 could boost his chances of defeating President Donald Trump in the crucial swing state.

In 2018, Florida voters said yes on a referendum to restore voting rights to people with felony convictions, a major progressive priority, even as Republicans Ron DeSantis and Rick Scott won narrow victories in the state’s gubernatorial and U.S. Senate races, respectively. 

“I’m sure the legislature will try to screw with it,” Porta said. “They always try to go against the people ― that is their M.O. But we will be ready to fight.”

But as cases skyrocket again in many states, many health officials have conceded that interviewing patients and dutifully calling each contact will not be enough to slow the outbreak. “Contact tracing is not going to save us,” said Dr. Ogechika Alozie, chief medical officer at Del Sol Medical Center in El Paso, where hospitalizations in the county have soared by more than 400 percent and officials issued a new order for residents to stay at home.

Uncovering the path of transmission from person to person, known as contact tracing, is seen as a key tool for containing the spread of the coronavirus.

Infections are rising in 41 states, the country is recording an average of more than 79,000 new cases each day, and more Americans say they feel left to do their own lonely detective work.

The problem, of course, is that failing to fully track the virus makes it much harder to get a sense of where the virus is flourishing, and how to get ahead of new outbreaks.

In some places, overwhelmed health officials have abandoned any pretense of keeping up.

Now, though, any sense of control has vanished. Active cases of Covid-19 have quadrupled since the beginning of October to 912 in Grand Forks County, and about half the people contacted by the health department say they are not sure how they became infected.

In earlier, quieter periods of the pandemic, the virus spread with some degree of certainty. In all but the hardest-hit cities, people could ask a common question — “Where did you get it?” — and often find tangible answers.

A popular college bar in East Lansing, Mich., Harper’s Restaurant and Brewpub, became a hot spot this summer after dozens of people piled into the bar, drinking, dancing and crowding close together. At least 192 people — 146 people at the bar and 46 people with ties to those at the bar — were infected. Afterward, Gov. Gretchen Whitmer shut down indoor dining in bars in parts of the state.

Heidi Stevens is among the newly infected who considers her case a mystery. As a columnist at The Chicago Tribune, Ms. Stevens works from home. Her children attend school online. She wears a mask when she goes for a run, and she has not had a haircut since January.So when she got a precautionary test a few weeks ago, with the hopes of inviting friends over to have cake for her daughter’s 15th birthday, Ms. Stevens was shocked to learn she was positive.