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Biden chooses Murthy as nation’s top doctor, offers Fauci key role as coronavirus team takes shape (nationthailand.com)

Biden chooses Murthy as nation’s top doctor, offers Fauci key role as coronavirus team takes shape

InternationalDec 04. 2020Joe Biden conducts a a health briefing with Vivek Murthy, former surgeon general, and Celine Gounder, clinical assistant professor at New York University’s Department of Medicine, in October 2020. MUST CREDIT: Washington Post phooto by Demetrius Freeman 

By The Washington Post · Toluse Olorunnipa, Amy Goldstein

WILMINGTON, Del. – President-elect Joe Biden has selected a close adviser to help lead the nation’s response to the coronavirus crisis, choosing a veteran of the Obama administration to serve as America’s top doctor as the country suffers from a surging pandemic.

Vivek Murthy, a former U.S. surgeon general, has been asked to reprise the role in an expanded version in the new administration, according to an individual familiar with the decision.

He is expected to be part of a team of health-care officials who will handle the issue Biden said would his top priority, according to people with knowledge of the matter, who, like others, spoke on the condition of anonymity because decisions have not been announced.

On Thursday, Biden told CNN that Anthony Fauci, the nation’s top infectious-disease expert, would serve as a chief medical adviser and help his administration with its coronavirus response plan. Fauci, who served on President Donald Trump’s coronavirus task force, has been criticized by the president in recent months as he has contradicted the White House’s message that the pandemic is under control and on the verge of disappearing.

“I asked him to stay on the exact same role he’s had for the past several presidents, and I asked him to be a chief medical adviser for me as well and be part of the covid team,” Biden told CNN’s Jake Tapper.

Biden’s health-care team will be crucial to the success or failure of his presidency, far more than for most administrations. He is posed to take office during a raging pandemic that has killed roughly 275,000 Americans and counting, and at a time when many Republicans are trying to undo the Affordable Care Act, a law that provides insurance to millions.

Biden also said Thursday that he would ask Americans on the first day of his presidency to commit to wearing a mask for a limited period in an effort to bring the transmission rates down from their current record levels.

“Just 100 days to mask, not forever – 100 days,” he told CNN. “And I think we’ll see a significant reduction.”

Fauci said separately Thursday that he had begun speaking with the incoming administration about plans for controlling the deadly virus and distributing a vaccine in the new year.

Fauci is director of the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, a position he’s held since 1984. Ordinarily, Biden’s decision to keep him on would not be noteworthy, but because he’s come under fire from Trump, Fauci has emerged as a national symbol of sound medical advice.

Biden’s comments came against the backdrop of two grim daily records set by the U.S. on Wednesday, when more than 200,000 new coronavirus cases were reported and more than 100,000 patients were hospitalized.

Other officials who have been advising Biden on the novel coronavirus, which can cause the illness covid-19, and who could take key roles in the White House include Jeff Zients, who served as a top economic adviser to President Barack Obama, and Marcella Nunez-Smith, a professor at the Yale University school of medicine who specializes in health-care inequities. Politico reported Thursday that Zients was expected to become coronavirus coordinator and that Nunez-Smith would also take a senior position in Biden’s White House.

Murthy may also receive a White House title, beyond his surgeon general position, to signify that he is a central member of the team battling the pandemic, according to a person familiar with the matter who said it was possible that Murthy and Zients could be designated co-leaders of the effort.

One of the team’s central challenges will be in overseeing the logistically and ethically complex distribution of a coronavirus vaccine once it is approved. The decisions about who will fill these crucial jobs are not yet final, according to individuals familiar with the transition team’s work.

The search for a secretary of health and human services, the nation’s top health official, appears to be underway, with at least three people widely believed to have been under consideration no longer in contention. No front-runner is visible.

The position faced considerable turbulence under Trump; Tom Price, his first HHS secretary, resigned under an ethics cloud, and current Secretary Alex Azar has confronted the president’s displeasure.

Murthy had been one of the candidates under consideration by the Biden transition team for HHS secretary, but Biden’s transition leaders appear to be leaning toward a governor or someone else with more extensive management experience. Murthy is trained in internal medicine, has a public health background and is regarded as a skillful communicator, but he has not run a bureaucracy on the scale of the HHS.

New Mexico Gov. Michelle Lujan Grisham, a Democrat, had been considered a leading candidate for HHS secretary, but she was said this week to be out of the running. Another prospect, Democratic Rhode Island Gov. Gina Raimondo, told WPRI 12 News on Thursday that she would not be taking the job.

“I am not going to be President-elect Biden’s nominee for HHS secretary,” she said. “My focus is right here in Rhode Island, as I have said.”

The statement was another jolt to a process that has seen several candidates floated as possibilities before quickly disappearing from contention.

In an interview on Thursday, Lujan Grisham said it was “flattering” to have been mentioned in connection with the HHS job and that she “deeply cares” about health care. But she said she has not had specific conversations about any particular position with members of Biden’s team.

“I have not talked to them,” she said. A co-chair of Biden’s transition efforts since September, Lujan Grisham said that she is “honored to do the transition work that I’m doing” and that Biden will ultimately pick a well-qualified HHS secretary.

“He’s got lots of folks to choose from,” said Lujan Grisham, who has been overseeing her own state’s response to a coronavirus surge that is overwhelming New Mexico hospitals.

The Biden team offered Lujan Grisham the role of interior department secretary, but she declined, a source familiar with the events said. On Thursday, the Democratic Governors Association announced that Lujan Grisham would serve as its chair for 2021.

The Biden team appears to be sending a message that it will be different from the Trump administration, which has often seemed at war with its own public health agencies. Trump criticized Fauci’s assessments and blasted the Food and Drug Administration’s vaccine approval process, while flouting mask-wearing and other measures urged by his own public health officials.

Ronald Klain, who will be Biden’s White House chief of staff, probably will be particularly attuned to the coronavirus pandemic in part because he coordinated the Obama administration’s response to the Ebola outbreak.

As the pandemic enters a critical phase, with experts predicting an explosion of cases this winter, medical and public health advocates are pressing the Biden transition to include in the new administration’s Cabinet at least one person with a background in medicine or public health, whether that is Murthy or someone else.

Leana Wen, a visiting professor at George Washington University and a former Baltimore health commissioner, wrote on Twitter that she was “thrilled” with Murthy’s appointment and would like to see the position given greater prominence.

“Medical groups are pushing for Surgeon General being a Cabinet role,” she wrote Thursday. “Pres-elect @JoeBiden should heed this, as he has with climate post, to solidify importance of public health in administration.” (Wen is a contributing columnist for The Washington Post.)

Murthy, 43, served as surgeon general from late 2014 until a few months into Trump’s tenure. He issued the first surgeon general’s report on addiction, at a time when opioid overdoses had become a national crisis. Since then, Murthy has written a book about loneliness, which he casts as an epidemic in America.

Zients, who led the Obama administration’s National Economic Council, does not have a background in medicine or public health. But he maintains a close relationship with Biden, and he is credited with helping repair healthcare.gov, the Affordable Care Act’s insurance enrollment website, after a rocky rollout in 2013.

Fauci said Thursday that he had recently spoken with Zients, who is a co-chair of the Biden transition team, and that he expects to have more substantive talks with the team. Those talks, long delayed after the Trump administration spent weeks declining to acknowledge that Biden had won the election, were set to begin in earnest Thursday, Fauci said in an interview with MSNBC’s “Andrea Mitchell Reports.”

“I’m looking forward to it,” he said. “It likely will be the first of a series of normal type of transition undertaking.”

Nominations for other key health-care positions could be announced as early as next week, according to people familiar with the planning.

Coordination between the various agencies and positions will be critical because of the worsening coronavirus crisis, which has killed at least 275,000 Americans and is rapidly spreading in much of the country, said Max Skidmore, a political science professor at the University of Missouri at Kansas City and the author of a book on presidential responses to pandemics.

Skidmore said Biden would need to choose a team that could coordinate strategy smoothly among various government agencies, from the Centers for Disease Control and Prevention to the National Institutes of Health and the FDA.

“All of these and others need to have a unified approach,” Skidmore said. “We need a unified national program for public health, which we do not have, and that requires a team, but it also requires coordination of the team.”

Meanwhile, Vice President-elect Kamala Harris also made progress in building her team, announcing Thursday that she had chosen Tina Flournoy as chief of staff, tapping an operative with decades of Washington experience to help run the vice-presidential operation.

Harris’s longtime aide Rohini Kosoglu will serve as her domestic policy adviser, and former ambassador to Bulgaria Nancy McEldowney will advise Harris on national security.

Flournoy had been serving as chief of staff to former president Bill Clinton, hovering out of the direct Washington spotlight for a few years after serving in several prominent roles in the Democratic Party throughout the 1990s and 2000s.

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Vaccines offer hope for end to pandemic, but brutal months lie ahead (nationthailand.com)

Vaccines offer hope for end to pandemic, but brutal months lie ahead

InternationalDec 04. 2020

By The Washington Post · Joel Achenbach, Jose A. Del Real

Coronavirus vaccines are poised to be approved and distributed in the coming weeks in the United States, but that promising news comes amid record levels of infections and hospitalizations, with experts warning that the most brutal period of the pandemic lies ahead.

This is a split-screen moment: Progress on vaccines means people can now plausibly talk about what they will do when the pandemic is over. But with new infections topping 212,000 Thursday – another daily record, topping one set Wednesday – it won’t be over in a snap. This remains a dismal slog.

“The vaccine has not come in time to do much about the winter wave,” said Christopher Murray, director of the University of Washington’s Institute for Health Metrics and Evaluation. “Vaccination is coming too late even if we do a really great job of scale-up. It’s coming too late to do much by March 1, or really by April 1.” Only at that point, he added, will the widespread distribution of vaccines begin to crush the virus.

In the meantime, the country faces what could turn out to be the most challenging few months in the public health history of the nation, Centers for Disease Control and Prevention director Robert Redfield warned in a speech Wednesday. That kind of dire language is increasingly coming from the top experts in the field and from the highest levels of the federal medical establishment. “We are in a very dangerous place,” declared a White House coronavirus task force document circulated to governors earlier this week.

To date, at least 275,000 people in the United States have died of the virus, a toll that includes more than 2,700 deaths reported Thursday, according to health data tracked by The Washington Post. That is among more than 14 million confirmed infections.

A new national ensemble forecast – an aggregation of 37 models sent to the CDC – projected that 9,500 to 19,500 people would of covid-19, the disease caused by the virus, in the week encompassing Christmas. Murray’s institute, meanwhile, has been putting the final touches on a new forecast that he said would show an increase from its Nov. 19 projection of 470,000 deaths by March 1.

Two vaccines are being reviewed by the Food and Drug Administration and expected to receive clearance in the coming weeks. One of them, from Pfizer and the Germany company BioNTech, was approved this week in the United Kingdom. Four more vaccine candidates are in late-stage trials. Later this year or early next year, there could be more than a million doses of vaccines going into arms every day in the United States.

But it will take time to change the trajectory of the epidemic. The fall wave of infections that began in September in the Upper Midwest and Northern Great Plains is now crashing across much of the country, including in the high population centers of California and the Northeast, such as metropolitan New York City, which was pummeled by the virus in the spring.

“The assessment does indeed look pretty frightening when you see how this is spreading now not just in a subset of the country but across most of the landscape,” Francis Collins, director of the National Institutes of Health, said Thursday. “We are seeing a person dying every minute. We have an enormously significant challenge here to try to get this turned around.”

In some of the worst hit hospitals in the country, health care workers are navigating a punishing surge in cases that has left them short on beds and staff. In Jackson, Miss., the University of Mississippi Medical Center on Thursday had 35 more patients than beds, said Vice Chancellor LouAnn Woodward. Those patients are being held for now in the emergency department and in the recovery room. And because the hospital is the premiere destination for specialized medical care in Mississippi, like trauma and transplants, the covid surge has also placed significant pressure on all facets of health care in the state.

“It is challenging all the way around. It is alarming. It is a very uncomfortable place for us to be,” she said.

Woodward noted that the exhaustion felt by medical staff, and in particular nurses, is afrightening component of this latest surge that sets it apart from the most difficult peaks in the spring and summer.

“They feel defeated. They are working so hard. Their concern and dedication for their work hasn’t changed, but they are tired and they are worn out. And they just don’t feel like they can catch a break,” she said. “And the piece that is so hard to describe is that you literally go through hell taking care of these patients . . . and then you leave work and your friends are talking about going to a wedding the next weekend.”

She said the vaccine news has been a “bright spot,” and is “the best news we’ve had in awhile,” but she stressed that the problems confronting the country will not ease up with the early vaccine distributions.

For now, the message from infectious-disease experts and a growing number of governors and mayors is that everyone needs to mask up, stay at home as much as possible, and hang on.

“Help is on the way,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Thursday on MSNBC. “We’re going to be giving vaccines towards the middle and end of December, and then more in January and then more in February. . . . If we can just hang on and do those fundamental public health measures to try and blunt some of these surges, ultimately we can get out of this. It isn’t all despair.”

Fauci said he intends to stay at his institute and help with the coronavirus response from the Biden administration. Later in the day, President-elect Joe Biden on CNN confirmed he had asked Fauci to stay in his role and be “a chief medical adviser for me as well.”

Biden also said that on the day of his inauguration he will ask Americans to wear masks for 100 days. “Just 100 days to mask – not forever, just 100 days. And I think we’ll see a significant reduction” in infections, Biden said.

On Thursday, California Gov. Gavin Newsom, a Democrat, announced that regions in the state where intensive care unit capacity fell below 15% would be put on strict shelter-at-home orders for three weeks. As of Thursday afternoon, about 18,600 new covid-19 cases were counted in the state, the second-highest single-day record, which was set Wednesday. About 9,700 people in California are currently hospitalized with covid-19.

The mayor of the city of Los Angeles, Eric Garcetti, has forcefully urged the city’s residents to stay at home except for essential activities like buying food.

“My message couldn’t be simpler. It’s time to hunker down. It’s time to cancel everything. And if it isn’t essential, don’t do it,” Garcetti said during a news conference. “Don’t meet up with others outside your household, don’t host a gathering, don’t attend a gathering.”

Even if vaccines roll out quickly, daily death tolls may not peak in the United States until mid- to late January, Murray said.

Emily Allen, a registered nurse at St. Joseph’s Hospital in St. Paul, Minn., said the intensive care unit where she works the night shift has become a “revolving door” of increasingly sick covid-19 patients. If the trajectory of the pandemic was grim in the spring, she said, it has reached an altogether new low in recent weeks. To meet demand in her region, her hospital will soon accept only covid patients.

“We cannot get beds cleaned fast enough by the time we have another patient coming in. On the night shift we have two doctors for 50 ventilated patients. We can have three patients crashing at the same,” she said. “It’s every single shift that is overwhelming. It doesn’t shut off.”

Patients are now sometimes held in the emergency room because beds are not readily available, she said. Others are sent to rural hospitals. There is often not enough space to readily accept transfer patients who need specialized care.

She described the exhausting process of correctly handling a covid patient with severe lung problems who must be placed carefully on his or her stomach.

“We just took a patient from a facility 15 minutes from us and right away we were proning, which takes 11 or 12 people do safely. The patient took a very, very fast turn,” she said. “We don’t have a team of people just waiting around to help prone.”

Redfield, the CDC director, has joined the chorus of experts saying that what the country needs desperately is a unified message on how to respond to the virus, and in his speech Wednesday he expressed dismay over the debate about whether masks are helpful in limiting the contagion. Officials in some states, including ones slammed badly by the virus, continue to resist issuing mask mandates or other restrictions, such as limiting indoor dining.

But the CDC says these measures produce results. That’s been seen in North Dakota, where Gov. Doug Burgum, a Republican, three weeks ago announced limits on indoor dining and a public mask mandate. Since then, the state’s average number of new cases has dropped from 1,400 per day to about 700 per day, according to data tracked by The Washington Post.

Trisha Jungels, a nurse in Jamestown, N.D., credits those steps with bringing some much needed relief to health care workers at Jamestown Regional Medical Center, a critical access hospital with 25 beds where she is chief nursing officer. Two weeks ago, the hospital came close to shutting down other units to create more beds to host incoming coronavirus patients.

She noted that covid-19 patients take more time and resources than others to care for, which in turn puts a strain on medical staff that can also affect the quality of care non-covid patients receive.

“We still have other illnesses happening. It’s not just covid,” she said. “It’s covid on top of the work that we were already doing, making sure that we have resources to take care of people that have a heart attack.”

It is impossible to know when life will get back to normal, or something that feels close to it. The vaccine rollout will take many months under even the most optimistic scenarios. But the vaccine news has boosted optimism even among the experts who are warning of a rough winter.

“We can be in baseball stadiums in the summer,” Murray said. “By July we can be very back to normal. Personally I’m starting to think we have a very bad three months ahead – actually four months ahead – and then things start to look more optimistic.”

William Schaffner, a professor of infectious disease at Vanderbilt University Medical School, said doctors are “all kind of grimly prepared” for what this cold-weather surge in cases will mean for the country. But he welcomed the recent news about the vaccines.

“No magic wand here. It’s still going to take months. But hey, long journeys take first steps,” Schaffner said.

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Trump’s losses stack up as Wisconsin Supreme Court declines to hear campaign challenge to election results (nationthailand.com)

Trump’s losses stack up as Wisconsin Supreme Court declines to hear campaign challenge to election results

InternationalDec 04. 2020Absentee ballots sit in stacks during a recount of Milwaukee County results at the Wisconsin Center on Nov. 20, 2020. MUST CREDIT: Photo for The Washington Post by Taylor Glascock 

By The Washington Post · Rosalind S. Helderman, Emma Brown, Elise Viebeck

WASHINGTON – The daily drumbeat of legal losses for President Donald Trump continued Thursday as he and his allies once again hit roadblocks in court on cases seeking to have the election overturned.

The Wisconsin Supreme Court declined to hear a challenge to the election results filed by Trump’s campaign, finding that under state law, the campaign should have gone first to a lower-level court.

In Arizona, a judge dismissed a key part of a suit seeking to overturn the election filed by the state’s Republican Party chairwoman.

And in Pennsylvania, where the state Supreme Court had dismissed a Republican lawsuit challenging universal mail voting, the court on Thursday issued a one-sentence order unanimously refusing to stay the dismissal.

Despite the steady stream of legal defeats, Trump and his allies pressed forward with their attempts to open new fronts and roll back President-elect Joe Biden’s win.

A day after Trump delivered a 46-minute, falsehood-filled rant from the White House attacking the integrity of the election, his personal attorney Rudy Giuliani continued his traveling road show, in which he has been making baseless allegations about fraud to audiences of Republican state lawmakers.

On Thursday, he was at the Georgia Capitol, where he encouraged GOP legislators to reject Biden’s victory in the popular vote and instead choose electors who will back Trump.

“State law doesn’t in any way prevent you, the legislature, from immediately taking this over and deciding this,” Giuliani said at a state Senate subcommittee hearing.

Ray Smith, legal counsel for Trump in the state, said the campaign will be filing a new lawsuit asking the Fulton County Superior Court for a new election; he urged Georgia legislators to select electors independently.

Meanwhile, in the Pennsylvania case, Trump allies late Thursday formally asked the U.S. Supreme Court to block the state high court’s rejection of their challenge to Act 77, the 2019 law that established universal mail voting there.

But judges across the country continued to express skepticism at claims lodged by Trump and his allies. During a hearing in Michigan on Thursday, where Biden’s win has already been certified, state Judge Timothy Kenny quizzed an attorney for a group of Republican poll workers seeking an audit of the results in Wayne County about the intentions of the plaintiffs.

“You really are trying to change the results, are you not?” Kenny asked.

“Honestly, Judge, I don’t know what the results will be,” attorney David Kallman responded.

David Fink, an attorney for Detroit, asked the judge to not just reject the request but also to sanction the plaintiffs for bringing it. “They want to undermine our democracy,” he said. “Grant significant sanctions, because this has to stop. They are trying to use this court in a very improper way.” The judge said he would rule by Tuesday.

In Arizona, Maricopa County Judge Randall Warner dismissed part of a challenge brought by state GOP Chair Kelli Ward, saying she had brought the claim too late.

He held an hours-long hearing Thursday on another piece of her suit, allowing her lawyers to present evidence they claimed shows that the processing of ballots in Maricopa County was so flawed that the election results – which were certified this week – were either wrong or so uncertain that they should not be allowed to stand.

Ward’s lawyers focused on errors in the duplication of ballots that were damaged or otherwise unreadable by tabulation machines. In such cases, a bipartisan board of election workers looks at the ballot to determine the voter’s intent and fills in a clean ballot accordingly.

Before Thursday’s hearing, Ward’s lawyers were allowed to compare 1,626 duplicated ballots to the originals in the presence of attorneys for Democrats and Secretary of State Katie Hobbs. They found a total of nine errors, an error rate of about 0.5%.

In other words, county elections official Scott Jarrett said Thursday, 99.45% of the inspected ballots were duplicated properly.

Jarrett said some level of human error is unavoidable. “We’re all people,” he said. “It would be unreasonable to expect there would be no errors.”

Seven of the errors deprived Trump of votes, compared with two that deprived Biden. Applying the same error rate to the more than 27,000 ballots that were duplicated countywide, Trump would gain a total of 103 votes, Jarrett said.

That is far less than Biden’s margin of victory of 10,457 votes.

The judge said he would continue to hear evidence Friday and did not disclose when he plans to rule on the matter.

In Wisconsin, where Biden defeated Trump by more than 20,000 votes, the Trump campaign’s top lawyer in the state said that despite Thursday’s rejection from the Supreme Court, the campaign plans to seek action “immediately” in front of a lower-level state circuit court and expects “to be back in front of the Supreme Court very soon.”

The refusal of the state’s highest court to take up Trump’s petition was a particularly stinging rebuke, given that conservatives hold a 4-to-3 majority on the elected panel.

One conservative member of the panel, Brian Hagedorn, joined the court’s three more-liberal members in declining to take the case.

In a concurring opinion, he wrote, “We do well as a judicial body to abide by time-tested judicial norms, even – and maybe especially – in high-profile cases. Following the law governing challenges to election results is no threat to the rule of law.”

Hagedorn wrote that the court should decline to take the case so the Trump campaign could “promptly exercise” its right to seek action in a lower court.

Trump’s campaign had argued that the matter was of such pressing and urgent concern that it should be considered immediately by the high court. In the petition, it argued that more than 220,000 ballots cast in the state’s two most Democratic counties were improperly accepted by election officials and should be thrown out.

The campaign did not allege that individual voters committed fraud or engaged in wrongdoing but rather that election officials misinterpreted state law regarding several large categories of ballots. That included all ballots cast early and in person in the two counties. The campaign challenged the practices, even though they were identical to those in places statewide and were unchanged since before the 2016 election, which Trump won and did not contest.

Three of the court’s conservative members appeared open to the Trump campaign’s arguments and said they wanted to take the case.

“Petitioners assert troubling allegations of noncompliance with Wisconsin’s election laws by public officials on whom the voters rely to ensure free and fair elections,” wrote Justice Rebecca Bradley in the dissent. “The majority’s failure to embrace its duty (or even an impulse) to decide this case risks perpetuating violations of the law by those entrusted to follow it.”

The judicial discussion did not indicate how the court would ultimately view the merits of the Trump campaign’s arguments should the matter return to the state’s highest court. Nor did justices offer any indication that they believed that overturning the election would be the proper recourse if the court decided to eventually hear it.

Chief Justice Patience Roggensack, who is part of the conservative wing, wrote that she believed the court should take the case to decide whether the state gave incorrect advice to local clerks about how to run the election.

“However, doing so does not necessarily lead to striking absentee ballots that were cast by following incorrect . . . advice,” she wrote. “The remedy Petitioners seek may be out of reach for a number of reasons.”