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“For Biden’s policies toward China, the part about making China play by the international rules, I think, is very hollow,” said Wang Dan, who helped lead the 1989 Tiananmen protests as a university student. “As we know, the Chinese Communist Party hardly abides by international rules.”

“The Trump Administration by far has done more to raise our issue than all other countries combined,” said Salih Hudayar, who was born in Xinjiang and moved to the United States as a child. “I’m very skeptical of a Biden administration because I am worried he will allow China to go back to normal, which is a 21st-century genocide of the Uighurs.”

“These guys are utilitarian, and they believe that if Trump is waging war against the C.C.P. then he’s right for them,” Mr. Badiucao said. “That mentality fits the whole ‘America First’ ideology, where it’s OK for other people to suffer if your goal is met, and their goal is overthrowing the C.C.P.”

In June, Mr. Trump signed legislation that led to sanctions being placed on Chinese officials who have overseen the construction of mass detention camps in the northwestern region of Xinjiang, where more than a million people, mostly members of the Uighur Muslim minority, have been imprisoned.

“The United States must realize that there will be no improvements on human rights issues in China if there is no regime change,” Mr. Wang added. He has continued to question Mr. Trump’s electoral loss, baseless claims shared by other prominent Chinese-born dissidents.

uring the presidential campaign, Mr. Biden released a statement calling the situation in Xinjiang a “genocide.” The Trump Administration has not used such a designation, and a book by his former national security adviser said that Mr. Trump told Mr. Xi that he should continue building the detention camps in Xinjiang.

Foreign policy advisers to Mr. Biden say that it is unfair to presume that he will continue the Obama administration’s moderate stance. It is, they say, a different era. The recent human rights legislation championed by the Trump administration has received broad bipartisan support.

And some Asian dissidents acknowledge that the antipathy toward Mr. Biden is driven in part by a deluge of online misinformation that paints the president-elect as a secret socialist or contends, without any proof, that foreign “communist money” turned the election against Mr. Trump. Such unsubstantiated claims have been repeated by niche online publications in Vietnamese, Chinese and other languages.

“The crisis of democracy in the world makes people, especially activists, confused and susceptible to the influence of conspiracy theories and information manipulation,” said Nguyen Quang A, a Vietnamese dissident

Federal health officials also offered two new ways to shorten quarantine periods. Those without symptoms may end quarantine after seven days if they are tested for the virus and receive a negative result, or after 10 days without a negative test.

“We are at the point now, even before Christmas, that there may not be room at your hospital, because we don’t have enough health care workers to take care of you,”

Some patients may not develop symptoms until two weeks after exposure, and even longer in a very small fraction of cases. Infected individuals may pass the virus to others before they develop symptoms; recent studies show they are most infectious two days before symptoms begin, and for about five days afterward.

Daily deaths have been exceeding 2,000 for the first time since early May, and close to 100,000 Americans are already hospitalized.

Until now, the C.D.C. has recommended a 14-day quarantine period following potential exposure, and Dr. Walke stressed that the full two weeks is still considered ideal and the surest way to curb transmissions.

Federal health officials also offered two new ways to shorten quarantine periods. Those without symptoms may end quarantine after seven days if they are tested for the virus and receive a negative result, or after 10 days without a negative test.

“We can safely reduce the length of quarantine, but accepting that there is a small residual risk that a person who is leaving quarantine early could transmit to someone else if they became infected,”

Some patients may not develop symptoms until two weeks after exposure, and even longer in a very small fraction of cases. Infected individuals may pass the virus to others before they develop symptoms; recent studies show they are most infectious two days before symptoms begin, and for about five days afterward.

“In a lot of ways, Iowa is serving as the control group of what not to do,”

Perencevich and other public-health experts predict that the state’s lax political leadership will result in a “super peak” over the holidays, and thousands of preventable deaths in the weeks to come. “We know the storm’s coming,” Perencevich said. “You can see it on the horizon.”

Joe English, a 37-year-old respiratory therapist, spends every day traveling between hospital units, hooking up seriously ill COVID-19 patients to ventilators or ECMO machines. When there’s nothing left to be done, English is the one who turns off those machines; he’s done so at least 50 times in the past few months. “What I’m seeing [among health-care workers] is just frustration, desperation,” English told me. “People have been acting like we’ve been fighting a war for months.”

There is a name for this feeling, says Kevin Doerschug, the director of the hospital’s medical ICU: moral distress, or the sense of loss and helplessness associated with health-care workers navigating limitations in space, treatment, and personnel

A recent New York Times analysis clearly showed that states with the tightest COVID-19 restrictions have managed to keep cases per capita lower than states with few restrictions.

What makes all of this suffering and death exponentially more painful is the simple fact that much of it was preventable

Democrats in Iowa believe that Reynolds’s inaction has always been about politics. Early on, she’d assumed an important role making sure that Trump would win Iowa in the November election, State Senator Joe Bolkcom, who represents Iowa City, told me. “She did that by making people feel comfortable” about going out to eat, going to bars, and going back to school. “She mimicked Trump’s posture” to get him elected. Ultimately, Reynolds was successful in her efforts: Trump won Iowa by 8 points. But Iowans lost much more.

Iowa’s problem is not that residents don’t want to do the right thing, or that they have some kind of unique disregard for the health of their neighbors. Instead, they looked to elected leaders they trust to tell them how to navigate this crisis, and those leaders, including Trump and Reynolds, told them they didn’t need to do much at all.

Which means that not only are health-care professionals tasked with saving sick Iowans’ lives, but it’s also fallen on them to communicate the truth about the pandemic.

The crisis in Iowa’s hospitals could be improved in a matter of weeks if Iowans started wearing a mask whenever they leave the house and stopped spending time indoors with people outside their households.

Without state leadership on board, none of those changes will happen. “The endgame of uncontrolled spread is a choice between massive death and suffering and overflowing hospitals, or shutting things down,” he said. “This is the equivalent [of] choosing between death or amputation—when you could have had an earlier surgery, which would have been painful but would have prevented this scenario from developing in the first place.”

Reynolds needs to order bars closed and restaurants to move to takeout only, at least until the surge is over, public-health experts told me. Reynolds and other state leaders could frame mask wearing and self-isolation as a matter of patriotic duty. “We need to make the right thing to do the easy thing to do,” T

right now, Iowa is on a disastrous path. Experts expect to see a spike in COVID-19 cases in the state roughly one week from now, two weeks after the Thanksgiving holiday. That spike will likely precede a surge in hospitalizations and, eventually, a wave of new deaths—maybe as many as 80 a day, Perencevich, the infectious-disease doctor, estimates. Add Christmas and New Year’s to the mix, and Iowans can expect to see nothing less than a tsunami

Dr. Vivek Murthy, who served as surgeon general under President Barack Obama, will reprise that role for Mr. Biden. A telegenic confidant of the president-elect, Mr. Murthy will become one of Mr. Biden’s closest advisers on medical issues and will lead much of the public outreach on the pandemic.

Jeffrey D. Zients, an entrepreneur and management consultant who served as the head of Mr. Obama’s National Economic Council and fixed the bungled rollout of the health law’s online insurance marketplace, will become a coronavirus czar in the White House, leading efforts to coordinate the fight against the coronavirus pandemic among the government’s sprawling agencies.

An outspoken advocate of improved health care access, Mr. Becerra said in 2017 that he would “absolutely” support Medicare for all, a proposal for government-run health care that Mr. Biden has explicitly rejected. A source familiar with the selection said Mr. Becerra would support the president-elect’s call for strengthening and preserving the A.C.A. and would not be pushing Medicare for all while in office.

As California’s top law enforcement official, Mr. Becerra helped lead legal fights across the nation for access to health care, focusing in particular on dismantling barriers for women struggling to get medical services.

“Over the past 24 hours, the president has continued to improve,” adding, “He’s met or exceeded all standard hospital discharge criteria.”

The president’s doctors evaded some key questions about the president’s condition, including his lung function and the date of his last negative coronavirus test before he tested positive. They said that he had received a third dose of the antiviral drug remdesivir, and that he has continued to take dexamethasone, a steroid drug that has been shown to be beneficial to patients who are very sick with Covid-19.

“One thing that’s for certain: don’t let it dominate you; don’t be afraid of it. You’re going to beat it.”

The president’s comments drew outrage from scientists, ethicists and doctors, as well as some people whose relatives and friends were among the nearly 210,000 people who died in the United States.

“Is he actually trying to put more lives at risk?” Mr. Peoples said. “He needs to be held accountable for the deaths that could have been prevented if he never downplayed it.”

The coronavirus outbreak in the West Wing continued to spread on Monday, as the White House press secretary and two of her deputies joined the list of aides close to President Trump who tested positive for the virus, heightening fears that more cases are still to come.

his plummeting blood oxygenation, high fever and treatment with medication reserved for patients with severe Covid-19. Yet Mr. Trump and his team have insisted on projecting a rosy image of a president nearly undisturbed by his illness.

Mr. Trump told his Twitter followers today not to fear Covid-19 and “don’t let it dominate your life,”

Often the deceptions and exaggerations spread by Mr. Trump and his allies have been about the president’s image and self-regard: the size of his rallies, for example, or his net worth or charitable foundation.

His health is a far more serious matter, one that puts national security at risk.

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The level of the bath water is very low. But it’s being filled rapidly. However, the spigot is being tightened so the pace at which the water is rising has slowed.

Disney’s plan to cut 28,000 theme park workers. Major airlines are poised to cut tens of thousands of jobs after the expiration of a provision requiring them to keep workers on their payrolls as a condition of bailout money.

The incumbent party points to whatever looks good in the data as proof that its policies are working, and the challenger identifies flaws that remain.

We may not know the answers to those questions, but it matters a lot for understanding what kind of economy either a second-term President Trump or President Joe Biden will have to handle. For now it’s not looking good.

"may not be out of the woods yet."

just because he's going home, he's not completely out of the woods,

some of these patients have long-term lung impact

Trump's oxygen levels were healthy and he was breathing well, but he declined to answer a reporter question about whether there is evidence of pneumonia on the President's lung scans

Masud notes that recovering COVID-19 patients who were hospitalized need to be closely monitored in case they get worse, especially older adults.

It's a good sign that he was well enough to be discharged

"Individuals that have mild disease to start out with, just mild symptoms, they can in a week or so feel worse, worse enough to be in an ICU," she says.

most people with mild symptoms don't get the kind of aggressive treatment that Trump received. He's received an experimental antibody treatment, a course of remdesivir and the steroid dexamethasone, all treatments generally reserved for patients hospitalized with severe symptoms.

"It's possible that [the interventions] could make him better sooner," she says. "[But] we don't know really what happens to people that have mild disease and then get treatment with antibody medications, antivirals or steroids. I think we're sort of a little bit in a data-free zone, where we're not sure."

he'll be getting his vitals checked at least every day or every couple times a day in order to make sure nothing is happening." He will also need to complete his course of medications — the Remdesivir and dexamethasone

The President did have a fever, fatigue and a mild cough late last week, but hasn't had fever in 72 hours, his doctors said.

confusion, issues with memory, fatigue and not being able to catch their breath

Though Trump is not on oxygen now, his physicians did disclose he had "several little temporary drops in his oxygen" and took supplemental oxygen twice.

Masud says if he had a patient with Trump's profile — male, over 70 years and overweight — who was hospitalized for a few days and received aggressive treatments, he would want to monitor the patient's oxygen levels closely even after they went home.

We like to watch them for a day or two to make sure there's no relapse because we've had patients who relapsed also and required oxygen, especially when they become active ... they get tired and they can't catch their breath."

also monitor markers of inflammation

When speaking with reporters, Conley said the President would be closely monitored by the medical team at the White House at least through the weekend. "If we can get through Monday with him remaining the same or improving, better yet, then we will all take that final, big sigh of relief," he said.

one of the key things which has been shown to help patients recover is having good sleep, long duration of sleep

With a grueling election season ahead of him, lack of sleep and adequate breaks could hurt Trump's recovery, he adds.

the 2015 Paris climate accord to cut global greenhouse-gas emissions. Mr. Trump wants no part of it, while Mr. Biden and his party have promised to keep the U.S. in the pact.

Mr. Biden last month, in the second of two major climate speeches he gave this summer, said it is important for the U.S. to show international leadership on climate. As part of a recommitment he would make to the Paris pact, he would push other countries to further cut emissions.

One of the few mentions the Trump campaign agenda makes of environmental issues is joining “with Other Nations to Clean Up our Planet’s Oceans.”

The power sector would go first and end its emissions by 2035, with the government’s help. In contrast to Mr. Trump’s skepticism of climate science, Mr. Biden’s goals mirror the emissions-reduction path recommended by a U.N. scientific panel in 2018.

the Biden campaign has proposed a mix of financial incentives, regulatory mandates and new laws that may face a stiff challenge in Congress.

Mr. Trump says deregulation is the way to help companies create jobs, and his appointees have spent years making industry-friendly changes to rules governing coal, oil and natural-gas production.

Mr. Biden has tried to counter charges of overregulation by making his climate policy largely about infrastructure and investment. His proposal to spend $2 trillion over four years aims to ease global warming and harden infrastructure for what extreme weather can’t be avoided, but also to help revive the economy.

They promise a nationwide expansion of mass transit in every city of more than 100,000 people, with an emphasis on emissions-free systems. They would upgrade more than four million buildings to improve efficiency, and boost research and development on clean-energy technology, including commercial battery storage and advanced nuclear power.

Mr. Trump favors oil, gas and coal interests, and they need more interstate pipelines and export terminals to keep growing, Mr. McKenna said.

Dr. Conley said Monday it was possible the president would no longer be contagious before the 10-day period ends.

The president has repeatedly played down the threat of the virus, which medical experts say is very real, especially for older people and people with pre-existing health problems. After returning to the White House on Monday from Walter Reed National Military Medical Center, Mr. Trump stood on a White House balcony, removed his mask and flashed two thumbs up.

Biden said that he was glad Mr. Trump “seems to be coming along pretty well” but that he hoped the president would “communicate the right lesson to the American people: Masks matter.”

including Regeneron Pharmaceuticals Inc.’s experimental antibody drug cocktail

Mr. Trump’s physicians declined to answer several questions about the president’s case

“That’s crucial information,” he said. Without it, he said, it isn’t clear how badly the illness has affected him, particularly whether he contracted pneumonia. Mr. Trump’s early treatment with dexamethasone, which is typically given to people with more-severe breathing problems who are further along in the illness, raised questions, Dr. Chin-Hong said.

One way or another, everyone pays for health care. It accounts for about 18 percent of G.D.P. — nearly $11,000 per person. Individuals directly pay about a quarter, the federal and state governments pay nearly half, and most of the rest is paid by employers.

Many Americans think their health insurance is a gift from their employers — a “benefit” bestowed on lucky workers by benevolent corporations. It would be more accurate to think of employer-provided health insurance as a tax.

Rising health care costs account for much of the half-century decline in the earnings of men without a college degree, and contribute to the decline in the number of less-skilled jobs.

Employer-based health insurance is a wrecking ball, destroying the labor market for less-educated workers and contributing to the rise in “deaths of despair.”

We face a looming trillion-dollar federal deficit caused almost entirely by the rising costs of Medicaid and Medicare, even without the recent coronavirus relief bill.

Rising costs are an untenable burden on our government, too. States’ payments for Medicaid have risen from 20.5 percent of their spending in 2008 to 28.9 percent in 2019. To meet those rising costs, states have cut their financing for roads, bridges and state universities. Without those crucial investments, the path to success for many Americans is cut off

Every year, the United States spends $1 trillion more than is needed for high quality care.

executives at hospitals, medical device makers and pharmaceutical companies, and some physicians, are very well paid.

American doctors control access to their profession through a system that limits medical school admissions and the entry of doctors trained abroad — an imbalance that was clear even before the pandemic

Hospitals, many of them classified as nonprofits, have consolidated, with monopolies over health care in many cities, and they have used that monopoly power to raise prices

These are all strategies that lawmakers and regulators could put a stop to, if they choose.

The health care industry has armored itself, employing five lobbyists for each elected member of Congress. But public anger has been building — over drug prices, co-payments, surprise medical bills — and now, over the fragility of our health care system, which has been laid bare by the pandemic

A single-payer system is just one possibility. There are many systems in wealthy countries to choose from, with and without insurance companies, with and without government-run hospitals. But all have two key characteristics: universal coverage — ideally from birth — and cost control.

In the United States, public funding is likely to play a significant role in any treatments or vaccines that are eventually developed for Covid-19. Americans should demand that they be available at a reasonable price to everyone — not in the sole interest of drug companies.

We are believers in free-market capitalism, but health care is not something it can deliver in a socially tolerable way.

They choose not to. And so we Americans have too few doctors, too few beds and too few ventilators — but lots of income for providers

America is a rich country that can afford a world-class health care system. We should be spending a lot of money on care and on new drugs. But we need to spend to save lives and reduce sickness, not on expensive, income-generating procedures that do little to improve health. Or worst of all, on enriching pharma companies that feed the opioid epidemic.

Medical device manufacturers have also consolidated, in some cases using a “catch and kill” strategy to swallow up nimbler start-ups and keep the prices of their products high.

Ambulance services and emergency departments that don’t accept insurance have become favorites of private equity investors because of their high profits

Britain, for example, has the National Institute for Health and Care Excellence, which vets drugs, devices and procedures for their benefit relative to cost

At the very least, America must stop financing health care through employer-based insurance, which encourages some people to work but it eliminates jobs for less-skilled workers

Our system takes from the poor and working class to generate wealth for the already wealthy.

passed a coronavirus bill including $3.1 billion to develop and produce drugs and vaccines.

The industry might emerge as a superhero of the war against Covid-19, like the Royal Air Force in the Battle of Britain during World War II.

illions have lost their paychecks and their insurance

two officers confronted Walter Wallace Jr., a 27-year-old with a history of mental health problems. A lawyer for the family said that he was experiencing a crisis that day and that the family told officers about it when they arrived at the scene

Gov. Tom Wolf called in the National Guard. On Wednesday, the city declared a 9 p.m. curfew.

The shooting and its aftermath were guaranteed to ratchet up tensions in a country already on edge.

The White House blamed the “liberal Democrats’ war against the police” for the destruction that followed the protests

Joseph R. Biden Jr. and Senator Kamala Harris lamented Mr. Wallace’s death and condemned the looting that followed, but added that none of this would be solved with a president who fanned “the flames of division in our society.”

To vote is to believe that problems can be solved, and the election has presented a stark division as to how best solve a litany of national problems, including racial divisions and the coronavirus pandemic.

The Philadelphia police have for many years been criticized by community activists for excessive use of force against people of color.

“The department has a long history of abusive behavior, violent behavior and brutality when it comes to residents in this city, and more specifically, when it comes to Black and brown Philadelphians,”

the A.C.L.U. found that Black people in the city are more than 50 percent more likely to be stopped by the police without reasonable suspicion than white people are, and 40 percent more likely to be frisked without reasonable suspicion.

Efforts to strengthen accountability have gained some steam in Philadelphia since the death of George Floyd in Minneapolis in May set off a national outcry over abusive policing practices

But the debates about how to improve police accountability are only made more complicated by what happened on Tuesday night nearly a dozen miles away from where crowds were protesting in Mr. Wallace’s name

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.

e could prevail next week

A Biden win would doom Mr. Trump’s chances for re-election. More significantly, it would herald the arrival of a formidable multiracial Democratic coalition in the country’s largest red state. That would hand the Democrats an electoral upper hand nationwide and all but block Republicans from the White House until they improve their fortunes with college-educated white voters, younger people and minorities.

Yet even as leading figures in both parties urge their respective presidential nominees to take Texas seriously, the campaigns are still reluctant to spend precious remaining time and money there.

Though the state isn’t essential to a Biden victory, Democrats have been more aggressive here. Mr. Biden is dispatching his running mate, Senator Kamala Harris, to Texas on Friday, and Democrats have also planned a multicity bus tour across the state.

Texas Republicans and Democrats alike believe the long-awaited m

The pandemic has slowed the Texas economy, the top selling point for its politicians

With two days left of early voting, turnout in Texas has nearly exceeded the total number of votes cast in the state in the 2016 election. Voters under 30 have showed up in historic numbers, with over 904,000 of them already casting ballots (only 1.1 million such young Texans voted in all of 2016).

“It is a competitive state, meaning a Democrat can now win statewide,” acknowledged Steve Munisteri, a former chairman of the Texas Republican Party, noting that about 10 million people had moved to the state in the last 20 years. “We’ve had the equivalent of two medium-sized states move in.”

In border communities like Brownsville and McAllen, the question for Mr. Biden is not whether voters will support a Democrat — they do so reliably — but whether voters in this working-class region hit hard by the coronavirus will turn out at the same levels as the more affluent parts of the state.

Visits to a pair of precincts last week in the Rio Grande Valley revealed a noticeable number of first- or second-time voters, including many students. Many of them were Hispanic and they cast their ballots overwhelmingly for Mr. Biden — or, as they put it, against Mr. Trump.

If Mr. Biden can significantly expand beyond the 54 percent of the vote Hillary Clinton garnered there in 2016, the gain in raw votes in such a highly populated community could draw him close to Mr. Trump statewide.

“I think most of the young generation is for Biden,” explained Brian Nguyen, a 20-year-old college student, after he voted.

“Texas is changing,” said Mr. Cruz. “We’re not home to just oil and gas wildcatters.”

Wallace was experiencing a psychological episode on Monday, according to a family attorney. His mother attempted to calm him, the lawyer said, but was unable to and called 911 for an ambulance. But the police arrived first.

"As Black Lives Matter protests demanding justice for Walter Wallace Jr. will likely converge with demonstrations related to the elections, Philadelphia's history of using tear gas, rubber bullets, and pepper spray against its own citizens also looms large," according to a statement from the council.

The Philadelphia City Council on Thursday approved a measure that would bar the use of non-lethal crowd dispersal tactics, including the use of rubber bullets, tear gas and pepper spray on those peacefully protesting.

This spring, the pandemic prompted unprecedented polling place consolidations during the primaries in jurisdictions across the U.S., sparking an outcry over images of voters standing in hours-long lines in places such as Milwaukee and Atlanta. The Centers for Disease Control and Prevention called for election administrators to "maintain or increase the total number of polling places available to the public on Election Day to improve the ability to social distance." The guidance also says to avoid increasing the number of potential registered voters assigned to each polling place "unless there is no other option."

Everything about the act of voting in 2020 has been shaken by COVID-19. A record number of ballots have been cast early, either by mail or in person. All over the country, sports teams are turning over their arenas to be used as large-scale, socially distanced polling places.

Iowa voters won't be able to cast their ballot at any of those polling places this Election Day because of hundreds of closures and consolidations that have rippled across the state due to the coronavirus pandemic.

"I'm certain that it's going to make it harder for people to vote. But I am seeing a resolve right now, where people are determined," Brown said. "Whatever you do, we're going to counteract it."

What that index didn't take into account — and what has compounded months of governmental failures — is that even before COVID-19 arrived on its shores, the U.S. was an unusually sick country for its level of wealth and development.

High blood pressure, obesity and metabolic disorders are all on the rise in the U.S.

Healthy life expectancy — the number of years people can expect to live without disability — is 65.5 years in the U.S., more than two decades fewer than in Japan.

65,700 Americans died of drug overdoses in 2019, more than double the number in 2010. Those deaths account for more than half of all drug overdose fatalities worldwide and held down life expectancy in the U.S.

Mortality for mothers and children under 5 is 6.5 per 1,000 live births in the U.S., compared to 4.9 for other wealthy countries.

All in all, more than 40% of American adults have a pre-existing health condition that puts them at higher risk of severe COVID-19.

A study published in August found cardiovascular disease can double a patient's risk of dying from COVID-19, while diabetics — who number more than 30 million in the U.S. — are 1.5 times more likely to die.

Context: Lancet Editor-in-Chief Richard Horton has called COVID-19 a "syndemic" — a synergistic epidemic of a new and deadly infectious disease and numerous underlying health problems. The U.S. is squarely in the heart of that syndemic.

Those conditions are particularly prevalent in minority communities with unequal health care access that have disproportionately suffered from COVID-19.

A report from McKinsey earlier this month estimated that poor health costs the U.S. economy about $3.2 trillion a year

For every $1 invested in targeting population health, the U.S. stands to gain almost $4 in economic benefit, and altogether health improvements could add up to a 10% boost to U.S. GDP by 2040.

The bottom line: There is no excuse for the way the U.S. has mishandled COVID-19, but the seeds of this catastrophe were planted well before the novel coronavirus arrived on American shores.

2. How movement spread COVID-19

What's happening: Researchers in Germany studied the effect of entry bans and mandatory quarantines on COVID-19 mortality, and found the earlier such measures were implemented, the greater the effect they had on limiting deaths.

Of note: The study found mandatory quarantines for incoming travelers were more effective than outright entry bans, largely because such bans often exempted citizens and permanent residents, while quarantines usually applied to everyone.

The U.S. lost track of at least 1,600 people flying in from China in just the first few days after the ban went into effect, according to reporting from the AP.

Border controls are of little use if governments don't track and quarantine travelers coming from infected areas.

The bottom line: A virus only moves with its host. One lesson we should learn for future pandemics is that restricting that movement is key to controlling a new pathogen, even though the costs of such controls will only grow in a globalized world.

“at how profoundly divided we’ve become. Donald Trump capitalized on that — he didn’t invent it — but someday soon we’re going to have figure out how to bring our country together, because right now we’re on a dangerous path, so very dangerous, and so vulnerable to bad actors.”

I can’t know all their motives for wanting to speak to me, but one thing many of them share is a desire to make clear that the alarm bells heard across the country are ringing loudly inside the administration too, where there are public servants looking to avert conflict, at all costs.

History may note that the most important thing that happened that day had little to do with the religious leader and his large life, save a single thread of his legacy.

You don’t know Donald Trump like we do. Even though they can’t predict exactly what will happen, their concerns range from the president welcoming, then leveraging, foreign interference in the election, to encouraging havoc that grows into conflagrations that would merit his calling upon U.S. forces.

“That’s really him. Not the myth that’s been created. That’s Trump.”

He’d switch subjects, go on crazy tangents, abuse and humiliate people, cut them off midsentence. Officials I interviewed described this scenario again and again.

Even if it takes weeks or months before the result is known and fully certified, it could be a peaceful process, where all votes are reasonably counted, allowing those precious electors to be distributed based on a fair fight. The anxiety we’re feeling now could turn out to be a lot of fretting followed by nothing much, a political version of Y2K.Or not.

For Mr. Trump, the meeting was a face-to-face lifeline call. When he returned to Washington, he couldn’t stop talking about troop withdrawals, starting with Afghanistan. During his campaign, he had frequently mentioned his desire to bring home troops from these “endless wars.”

“were it Obama or Bush, or whatever, they’d meet Billy Graham’s grandson and they’d be like ‘Oh that’s interesting,’ and take it to heart, but then they’d go and they’d at least try to validate it with the policymakers, or their military experts. But no, with him, it’s like improv. So, he gets this stray electron and he goes, ‘OK, this is the ground truth.’ ”

Senior leadership of the U.S. government went into a panic. Capitol Hill, too. John Bolton, who was still the national security adviser then, and Virginia Boney, then the legislative affairs director of the National Security Council, hit the phones, calling more than a dozen senators from both parties.

“Is there any way we can reverse this?” he pleaded. “What can we do?”

Mr. Kelly was almost done cleaning out his office. He, too, had had enough. He and Mr. Trump had been at each other every day for months. Later, he told The Washington Examiner, “I said, whatever you do — and we were still in the process of trying to find someone to take my place — I said whatever you do, don’t hire a ‘yes man,’ someone who won’t tell you the truth — don’t do that.”

“I think the biggest shock he had — ’cause his assumption was the generals, ‘my generals,’ as he used to say and it used to make us cringe — was this issue of, I think, he just assumed that generals would be completely loyal to the kaiser,”

In February 2019, William Barr arrived as attorney general, having auditioned for the job with a 19-page memo arguing in various and creative ways that the president’s powers should be exercised nearly without limits and his actions stand virtually beyond review.

“President Trump serves the American people by keeping his promises and taking action where the typical politician would provide hollow words,” she said. “The president wants capable public servants in his administration who will enact his America First agenda and are faithful to the Constitution — these principles are not mutually exclusive. President Trump is delivering on his promise to make Washington accountable again to the citizens it’s meant to serve and will always fight for what is best for the American people.”

To replace Mr. Coats, Trump selected Representative John Ratcliffe of Texas, a small-town mayor-turned-congressman with no meaningful experience in intelligence — who quickly withdrew from consideration after news reports questioned his qualifications; he lacked support among key Republican senators as well.

There are many scenarios that might unfold from here, nearly all of them entailing weeks or even months of conflict, and giving an advantage to the person who already runs the U.S. government.

“sends letters constantly now, berating, asking for the sun, moon, stars, the entire Russia investigation, and then either going on the morning talk shows or calling the attorney general whenever he doesn’t get precisely what he wants.” The urgency, two F.B.I. officials said, ratcheted up after Mr. Trump was told three weeks ago that he wouldn’t get the “deliverables” he wanted before the election of incriminating evidence about those who investigated and prosecuted his former national security adviser, Michael Flynn.

The speculation is that they could both be fired immediately after the election, when Mr. Trump will want to show the cost paid for insufficient loyalty and to demonstrate that he remains in charge.

Nov. 4 will be a day, said one of the former senior intelligence officials, “when he’ll want to match word with deed.” Key officials in several parts of the government told me how they thought the progression from the 3rd to the 4th might go down.

A group could just directly attack a polling place, injuring poll workers of both parties, and creating a powerful visual — an American polling place in flames, like the ballot box in Massachusetts that was burned earlier this week — that would immediately circle the globe.

Would that mean that Mr. Trump caused any such planned activities or improvisations? No, not directly. He’s in an ongoing conversation — one to many, in a twisted e pluribus unum — with a vast population, which is in turn in conversations — many to many — among themselves.

“stand back and stand by” instructions? Is Mr. Trump telling his most fervent supporters specifically what to do? No. But security officials are terrified by the dynamics of this volatile conversation.

Conservative media could then say the election was being stolen, summoning others to activate, maybe violently. This is the place where cybersecurity experts are on the lookout for foreign actors to amplify polling location incidents many times over, with bots and algorithms and stories written overseas that slip into the U.S. digital diet.

Those groups are less structured, more like an “ideology or movement,” as Mr. Wray described them in his September testimony. But, as a senior official told me, the numbers on the left are vast.

That army Trump can direct in the difficult days ahead and take with him, wherever he goes. He may activate it. He may bargain with it, depending on how the electoral chips fall. It’s his insurance policy.

Inside the Biden campaign they are calling this “too big to rig.”

Races tend to tighten at the end, but the question is not so much the difference between the candidates’ vote totals, or projections of them, as it is what Mr. Trump can get his supporters to believe. Mr. Trump might fairly state, at this point, that he can get a significant slice of his base to believe anything.

There were enormous efforts to do so, largely but not exclusively by the Russians, in 2016, when election systems in every state were targeted.

The lie easily outruns truth — and the best “disinformation,” goes a longtime C.I.A. rule, “is actually truthful.” It all blends together. “Then the president then substantiates it, gives it credence, gives it authority from the highest office,” says the senior government official.

Mr. Trump will claim some kind of victory on Nov. 4, even if it’s a victory he claims was hijacked by fraud — just as he falsely claimed that Hillary Clinton’s three million-vote lead in the popular vote was the result of millions of votes from unauthorized immigrants.

In the final few weeks of the campaign, and during Mr. Trump’s illness, he’s done two things that seem contradictory: seeking votes from anyone who might still be swayed and consolidating and activating his army of most ardent followers.

The F.B.I. has been under siege since this past summer, according to a senior official who spoke on the condition of anonymity. “The White House is using friendly members of Congress to try to get at certain information under the guise of quote-unquote, oversight, but really to get politically helpful information before the election,”

“They’re the reason he took off the damned mask when he got to the White House” from Walter Reed, the official said. “Those people eat that up, where any reasonable, rational person would be horrified.

You ask it to be refilmed, and you take off your mask, which, in my mind, has become a signal to his core base of supporters that are willing to put themselves at risk and danger to show loyalty to him.”