npr--2020-11-25--Near Crisis, Some Hospitals Face Tough Decisions In Caring For Floods Of Patients

Near Crisis , Some Hospitals Face Tough Decisions In Caring For Floods Of Patients Far more people in the U.S. are hospitalized for COVID-19 now than at any other moment of the coronavirus pandemic — more than twice as many as just a month ago .
Hospitals in some of the hardest-hit states are exhausting every health care worker , hospital room and piece of equipment to evade the worst-case scenario , when crisis plans have to be set in motion and care may have to be rationed .
Many states are warning they 're on the brink .
On @ @ @ @ @ @ @ are already straining the system and changing how hospitals provide care .
An NPR data analysis supports what health care leaders and researchers have cautioned : This stress may even be contributing to higher death rates .
`` We accept a small amount of risk each time that we expand our capacities , '' says Dr. John Hick , a committee member of the Forum on Medical and Public Health Preparedness for Disasters and Emergencies of the National Academies of Sciences , Engineering , and Medicine .
`` It 's not at all @ @ @ @ @ @ @ some worse outcomes . ''
The care crisis is already here Hospitals have a road map for how to manage during a catastrophe .
It 's called crisis standards of care , and it guides clinical and ethical decisions on how to triage care when resources are tight .
It 's a last resort — a fundamental change from doing everything possible for one patient to maximizing the benefits for many , says Dr. Dan Hanfling , who served on the crisis standards of care committee for NASEM with Hick .
And while @ @ @ @ @ @ @ standards of care , hospitals are already resorting to workarounds to `` maximize , to the closest extent possible , the usual standards of care , '' says Hanfling .
Hospital capacity expands like an `` accordion , '' but at some point , he says , `` you overwhelm even those capabilities .
And you get to the point where space , staff and stuff are really not being consistent with the level of care that we are used to delivering . ''
Some experts believe clinicians are already informally making decisions @ @ @ @ @ @ @ 's been a lot of language around 'we 're right on the edge of entering crisis capacity , ' but what I 'm worried about is that there 's kind of a blurred entry , '' says Dr. Kate Butler , a nephrologist and acting instructor at the University of Washington School of Medicine .
Butler has studied how health care workers dealt with these clinical dilemmas during the spring COVID-19 surge .
`` Everybody gets a little bit of bad care , '' said one worker she interviewed , referencing shorter dialysis @ @ @ @ @ @ @ in high demand .
In an interview with NPR , Butler said , `` there 's been far less preparation for this gray zone where resources are limited , and we 're seeing impact on patient care — potentially people dying — because they 're not getting the care that would otherwise be offered to them . ''
During the current surge , hospitals are again grappling with tricky decisions around how far you can stretch care .
In Wisconsin , where the state has set up makeshift beds at the Wisconsin State @ @ @ @ @ @ @ , the Mayo Clinic Health System has moved beds into waiting rooms and even a parking garage .
`` Literally every bed in northwest Wisconsin was full , and hospitals just were n't able to admit new patients , '' said Dr. Paul Horvath as he described a recent shift at the emergency room to Wisconsin Public Radio .
`` And that means that I had the challenge of managing ICU-level care in my ER for hours , which is obviously not routine . ''
An NPR data analysis provides preliminary evidence that @ @ @ @ @ @ @ hospital conditions .
Since the beginning of the pandemic , COVID-19 death rates have fallen for patients who get hospitalized , thanks in part to improvements in treatment .
But in places where hospitalizations have been rising rapidly , deaths rose even faster , suggesting a concerning correlation between hospital crowding and deaths .
These death rates — measured as the ratio of average daily deaths to hospitalizations in a state — are going up in places like South Dakota , Wisconsin and Montana .
Last week , for example , South Dakota @ @ @ @ @ @ @ hospitalized each day .
The U.S. overall had fewer than two deaths per 100 hospitalizations each day .
Without detailed data on hospitalizations , which are not made public by the federal government , it 's difficult to tell if this trend is driven by hospital capacity issues or other factors like the age and severity of patients .
But researchers and public health experts worry that overcrowding in hospitals is , at the very least , a contributing factor .
`` It 's definitely something we need to pay more attention to @ @ @ @ @ @ @ a data science fellow at the Alan Turing Institute in the United Kingdom .
He used detailed government data there to study the COVID-19 death rate .
His findings from London echo the experience in New York City : The highest death rates came during the beginning of the pandemic when hospitals were full .
Mateen says even though there 's not enough research yet to definitively prove that crowded hospitals lead to higher death rates , it would be better to assume so and act aggressively now to stop the surge in @ @ @ @ @ @ @ [ doctors ] are telling you that they 're at their wits ' end of what they are capable of , why would you not do the sensible thing and recognize the health system is at a breaking point ? ''
Separate research published in the Journal of General Internal Medicine in August found that when more beds were occupied by COVID-19 patients , the number of deaths rose over the next week , though it did not examine whether a higher percentage of patients died as hospitals filled up .
Pinar Karaca-Mandic @ @ @ @ @ @ @ Minnesota and the lead author of that study , told NPR that the most recent data available show roughly the same trend .
Care on the brink of crisis Around the country , the surge has upended how some hospitals typically provide care , and health care workers are making tough on-the-ground decisions .
In the spring , physicians expected that a shortage of ventilators would force them to call on crisis standards of care , but now hospitals overwhelmingly say the limiting factor is turning out to be skilled staff who can @ @ @ @ @ @ @ machines or beds .
How many ICU patients can a single nurse handle ?
When is it OK to discharge patients early to free up space ?
Who gets moved to a field hospital with fewer staff members ?
`` I do n't really see these choices as being black and white , you 're going to get care or you 're not , '' says Hick , who 's also an emergency physician with Hennepin Health in Minnesota .
Utah is warning it 's perilously close to implementing its statewide crisis plan @ @ @ @ @ @ @ who are not quite as sick to designated COVID-19 nursing facilities to free up hospital space , says Kevin McCulley , director of preparedness and response for the Utah Department of Health .
`` We recognize that even with deeper and deeper contingency strategies , that it may not be enough , '' he says .
The Utah-based hospital chain Intermountain Healthcare has deployed nurses who are n't usually at the bedside , has adjusted staffing ratios when necessary and has brought in nursing students who are almost done with school to help @ @ @ @ @ @ @ standards of care , says Jim Sheets , its chief operating officer .
`` That 's our biggest goal , is to avoid that at all , at all costs , '' says Sheets .
`` This week , our ICU and our hospitals were over 90 % , and that 's really full , that can be problematic , but we 've been able to be stabilized there for a couple weeks . ''
At St. Luke 's Health System in Idaho , hundreds of COVID-19 patients are being sent home with @ @ @ @ @ @ @ iPads so their vitals can be monitored remotely in case their conditions deteriorate .
The hospital has also set up ICU doctors to look after multiple patients via telehealth so their expertise can go as far as possible .
But the health care system is on a dangerous trajectory if cases keep climbing , says Dr. Robert Cavagnol , executive medical director for St. Luke 's Clinic .
`` We 're going to run out of staff to take care of people .
They 're just going to be overwhelmed , and people @ @ @ @ @ @ @ Cavagnol says .
`` At some point , we will reach that capacity , but we 're not there today . ''
In Illinois , Chicago nurse Consuelo Vargas says critically ill patients are being held in her emergency room for up to several days .
`` This leads to an increase in patient falls ; this leads to bedsores ; this leads to delays in patient care , '' says Vargas .
Under the rapidly growing pressure of COVID-19 patients , hospitals are running out of alternative strategies to make room for @ @ @ @ @ @ @ goal of crisis plans is to prevent clinicians from making tough ethical decisions about patient care on their own .
Yet in a report published Tuesday , a group of New York City ICU physicians said it was unclear to them whether their hospitals were formally operating in crisis standards of care or not during the spring surge .
`` Many participants felt strongly that the dividing line between being extraordinarily busy — ' a bad Saturday night ' — and a [ crisis standards of care ] event was not as clear @ @ @ @ @ @ @ to the report .
`` The situation was much more dynamic . ''
The crisis is putting enormous strain on health care workers , who are striving to do everything they can to save people 's lives .
And communities may be paying the price for this even after the pandemic ends , warns Mateen .
`` We 'll get through the pandemic , but you 'll have worked ragged a generation of doctors who might not be able to give you their all the next 10 years , '' says Mateen .
@ @ @ @ @ @ @ them as martyrs , but it 's not easy , and I 'm genuinely worried about them and how much they can physically and emotionally and mentally go through . ''

Near Crisis, Some Hospitals Face Tough Decisions In Caring For Floods Of Patients
Enlarge this image toggle caption Go Nakamura/Getty Images Go Nakamura/Getty Images
Far more people in the U.S. are hospitalized for COVID-19 now than at any other moment of the coronavirus pandemic — more than twice as many as just a month ago.
Hospitals in some of the hardest-hit states are exhausting every health care worker, hospital room and piece of equipment to evade the worst-case scenario, when crisis plans have to be set in motion and care may have to be rationed.
Many states are warning they're on the brink. On the ground, equipment and staff shortages are already straining the system and changing how hospitals provide care. An NPR data analysis supports what health care leaders and researchers have cautioned: This stress may even be contributing to higher death rates.
"We accept a small amount of risk each time that we expand our capacities," says Dr. John Hick, a committee member of the Forum on Medical and Public Health Preparedness for Disasters and Emergencies of the National Academies of Sciences, Engineering, and Medicine. "It's not at all unexpected that we're going to have some worse outcomes."
The care crisis is already here
Hospitals have a road map for how to manage during a catastrophe. It's called crisis standards of care, and it guides clinical and ethical decisions on how to triage care when resources are tight.
It's a last resort — a fundamental change from doing everything possible for one patient to maximizing the benefits for many, says Dr. Dan Hanfling, who served on the crisis standards of care committee for NASEM with Hick.
And while most places have not officially activated crisis standards of care, hospitals are already resorting to workarounds to "maximize, to the closest extent possible, the usual standards of care," says Hanfling.
Hospital capacity expands like an "accordion," but at some point, he says, "you overwhelm even those capabilities. And you get to the point where space, staff and stuff are really not being consistent with the level of care that we are used to delivering."
Some experts believe clinicians are already informally making decisions akin to rationing care.
"There's been a lot of language around 'we're right on the edge of entering crisis capacity,' but what I'm worried about is that there's kind of a blurred entry," says Dr. Kate Butler, a nephrologist and acting instructor at the University of Washington School of Medicine.
Butler has studied how health care workers dealt with these clinical dilemmas during the spring COVID-19 surge.
"Everybody gets a little bit of bad care," said one worker she interviewed, referencing shorter dialysis sessions for patients when the machines were in high demand.
In an interview with NPR, Butler said, "there's been far less preparation for this gray zone where resources are limited, and we're seeing impact on patient care — potentially people dying — because they're not getting the care that would otherwise be offered to them."
During the current surge, hospitals are again grappling with tricky decisions around how far you can stretch care.
In Wisconsin, where the state has set up makeshift beds at the Wisconsin State Fair Park to handle mild COVID-19 cases, the Mayo Clinic Health System has moved beds into waiting rooms and even a parking garage.
"Literally every bed in northwest Wisconsin was full, and hospitals just weren't able to admit new patients," said Dr. Paul Horvath as he described a recent shift at the emergency room to Wisconsin Public Radio. "And that means that I had the challenge of managing ICU-level care in my ER for hours, which is obviously not routine."
Rising death rates?
An NPR data analysis provides preliminary evidence that death rates may be affected by crowded hospital conditions.
Since the beginning of the pandemic, COVID-19 death rates have fallen for patients who get hospitalized, thanks in part to improvements in treatment. But in places where hospitalizations have been rising rapidly, deaths rose even faster, suggesting a concerning correlation between hospital crowding and deaths.
These death rates — measured as the ratio of average daily deaths to hospitalizations in a state — are going up in places like South Dakota, Wisconsin and Montana. Last week, for example, South Dakota had 4.4 deaths for every 100 patients hospitalized each day. The U.S. overall had fewer than two deaths per 100 hospitalizations each day.
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Without detailed data on hospitalizations, which are not made public by the federal government, it's difficult to tell if this trend is driven by hospital capacity issues or other factors like the age and severity of patients. But researchers and public health experts worry that overcrowding in hospitals is, at the very least, a contributing factor.
"It's definitely something we need to pay more attention to," says Dr. Bilal Mateen, a data science fellow at the Alan Turing Institute in the United Kingdom. He used detailed government data there to study the COVID-19 death rate. His findings from London echo the experience in New York City: The highest death rates came during the beginning of the pandemic when hospitals were full.
Mateen says even though there's not enough research yet to definitively prove that crowded hospitals lead to higher death rates, it would be better to assume so and act aggressively now to stop the surge in hospitalizations.
"Why on earth if [doctors] are telling you that they're at their wits' end of what they are capable of, why would you not do the sensible thing and recognize the health system is at a breaking point?"
Separate research published in the Journal of General Internal Medicine in August found that when more beds were occupied by COVID-19 patients, the number of deaths rose over the next week, though it did not examine whether a higher percentage of patients died as hospitals filled up. Pinar Karaca-Mandic, a professor at the University of Minnesota and the lead author of that study, told NPR that the most recent data available show roughly the same trend.
Care on the brink of crisis
Around the country, the surge has upended how some hospitals typically provide care, and health care workers are making tough on-the-ground decisions.
In the spring, physicians expected that a shortage of ventilators would force them to call on crisis standards of care, but now hospitals overwhelmingly say the limiting factor is turning out to be skilled staff who can care for severely ill patients — not machines or beds.
How many ICU patients can a single nurse handle? When is it OK to discharge patients early to free up space? Who gets moved to a field hospital with fewer staff members?
"I don't really see these choices as being black and white, you're going to get care or you're not," says Hick, who's also an emergency physician with Hennepin Health in Minnesota.
Utah is warning it's perilously close to implementing its statewide crisis plan. The state is moving COVID-19 patients who are not quite as sick to designated COVID-19 nursing facilities to free up hospital space, says Kevin McCulley, director of preparedness and response for the Utah Department of Health.
"We recognize that even with deeper and deeper contingency strategies, that it may not be enough," he says.
The Utah-based hospital chain Intermountain Healthcare has deployed nurses who aren't usually at the bedside, has adjusted staffing ratios when necessary and has brought in nursing students who are almost done with school to help, all in hopes of avoiding crisis standards of care, says Jim Sheets, its chief operating officer.
"That's our biggest goal, is to avoid that at all, at all costs," says Sheets. "This week, our ICU and our hospitals were over 90%, and that's really full, that can be problematic, but we've been able to be stabilized there for a couple weeks."
At St. Luke's Health System in Idaho, hundreds of COVID-19 patients are being sent home with blood pressure cuffs, pulse oximeters and iPads so their vitals can be monitored remotely in case their conditions deteriorate. The hospital has also set up ICU doctors to look after multiple patients via telehealth so their expertise can go as far as possible.
But the health care system is on a dangerous trajectory if cases keep climbing, says Dr. Robert Cavagnol, executive medical director for St. Luke's Clinic.
"We're going to run out of staff to take care of people. They're just going to be overwhelmed, and people can only do so much," Cavagnol says. "At some point, we will reach that capacity, but we're not there today."
In Illinois, Chicago nurse Consuelo Vargas says critically ill patients are being held in her emergency room for up to several days.
"This leads to an increase in patient falls; this leads to bedsores; this leads to delays in patient care," says Vargas.
Lack of clarity burdens health care workers
Under the rapidly growing pressure of COVID-19 patients, hospitals are running out of alternative strategies to make room for patients without somehow compromising care.
The goal of crisis plans is to prevent clinicians from making tough ethical decisions about patient care on their own.
Yet in a report published Tuesday, a group of New York City ICU physicians said it was unclear to them whether their hospitals were formally operating in crisis standards of care or not during the spring surge.
"Many participants felt strongly that the dividing line between being extraordinarily busy — 'a bad Saturday night' — and a [crisis standards of care] event was not as clear as plans had assumed," according to the report. "The situation was much more dynamic."
The crisis is putting enormous strain on health care workers, who are striving to do everything they can to save people's lives. And communities may be paying the price for this even after the pandemic ends, warns Mateen.
"We'll get through the pandemic, but you'll have worked ragged a generation of doctors who might not be able to give you their all the next 10 years," says Mateen. "I don't want to paint them as martyrs, but it's not easy, and I'm genuinely worried about them and how much they can physically and emotionally and mentally go through."


npr--2020-11-25--Army Corps of Engineers Denies Permit To Controversial Alaska Gold Mine

The U.S. Army Corps of Engineers has denied a permit for the massive Pebble Mine project in Alaska – a proposed open-pit copper and gold mine that would be upstream from the world 's largest sockeye salmon fishery .
The Corps said in a statement Wednesday that it has determined that the plan `` does not comply with Clean Water Act guidelines '' and it had concluded that `` the proposed project is contrary to the public interest . ''
Fishermen and tribes have been fighting the mine proposal upstream of Bristol Bay for a decade , fearing it would @ @ @ @ @ @ @ heart of the area 's economy and indigenous culture .
The project 's outlook became cloudier in August when President Trump 's son , Donald Trump , Jr. – an avid fisherman – tweeted his opposition to the mine .
Nanci Morris Lyon , co-owner and operator of Bear Trail Lodge in King Salmon says she got the news by text .
`` It is an incredible relief .
I felt like sitting down and just crying , '' she says .
Lyon says the prospect of the mine has held the whole @ @ @ @ @ @ @ like her did n't know if they could invest in their businesses .
Commercial fishermen were n't sure they could buy new boats .
She says Donald Trump Jr. and Eric Trump had stayed at the lodge about eight years ago .
`` I always said that I had faith that after they had visited here and they spent time here , they understood that this place did n't need something like that marring it , scarring it , ruining it forever . ''
Pebble Limited Partnership CEO John Shively says the company @ @ @ @ @ @ @ .
He told the Anchorage Daily News that it was a `` lost opportunity '' and said the company was `` dismayed by today 's news . ''
He pointed to conclusions in the Corps ' environmental report from July on the mine , which said the project would have no measurable impact on Bristol Bay salmon .
But that report was ambiguous , since it also said the mine would harm the area 's water resources .
The Corps noted that its review process had taken nearly three years and is `` @ @ @ @ @ @ @ with existing laws and regulations .
... USACE is committed to maintaining and restoring the nation 's aquatic resources , while allowing reasonable development . ''
The Pebble Mine came under increased scrutiny in September when an environmental group released secret recordings in which the then-CEO of Pebble claimed to have swayed politicians into either supporting or keeping mum on the project .
Executives also were caught saying that they ultimately planned a much larger mine that they had requested a permit for .
Joel Reynolds of the National Resources Defense Fund says @ @ @ @ @ @ @ the next step is for the U.S. Environmental Protection Agency to use a particular section of the Clean Water Act `` to permanently protect the Bristol Bay watershed from large scale mining for all time . ''
The Army Corps ' decision can be reversed , Reynolds notes , and the company can reapply if they make changes to the project .
But with a Biden administration soon to take office , Pebble has little time left for such maneuvers .

Army Corps of Engineers Denies Permit To Controversial Alaska Gold Mine
Enlarge this image toggle caption Luis Sinco/Los Angeles Times via Getty Images Luis Sinco/Los Angeles Times via Getty Images
The U.S. Army Corps of Engineers has denied a permit for the massive Pebble Mine project in Alaska – a proposed open-pit copper and gold mine that would be upstream from the world's largest sockeye salmon fishery.
The Corps said in a statement Wednesday that it has determined that the plan "does not comply with Clean Water Act guidelines" and it had concluded that "the proposed project is contrary to the public interest."
Fishermen and tribes have been fighting the mine proposal upstream of Bristol Bay for a decade, fearing it would harm the wild sockeye salmon at the heart of the area's economy and indigenous culture.
The project's outlook became cloudier in August when President Trump's son, Donald Trump, Jr. – an avid fisherman – tweeted his opposition to the mine.
Nanci Morris Lyon, co-owner and operator of Bear Trail Lodge in King Salmon says she got the news by text. "It is an incredible relief. I felt like sitting down and just crying," she says.
Lyon says the prospect of the mine has held the whole region hostage for years. Lodge owners like her didn't know if they could invest in their businesses. Commercial fishermen weren't sure they could buy new boats.
She says Donald Trump Jr. and Eric Trump had stayed at the lodge about eight years ago.
"I always said that I had faith that after they had visited here and they spent time here, they understood that this place didn't need something like that marring it, scarring it, ruining it forever."
Pebble Limited Partnership CEO John Shively says the company plans to appeal the Corps' decision. He told the Anchorage Daily News that it was a "lost opportunity" and said the company was "dismayed by today's news."
He pointed to conclusions in the Corps' environmental report from July on the mine, which said the project would have no measurable impact on Bristol Bay salmon. But that report was ambiguous, since it also said the mine would harm the area's water resources.
The Corps noted that its review process had taken nearly three years and is "based on all available facts and complies with existing laws and regulations. ... USACE is committed to maintaining and restoring the nation's aquatic resources, while allowing reasonable development."
The Pebble Mine came under increased scrutiny in September when an environmental group released secret recordings in which the then-CEO of Pebble claimed to have swayed politicians into either supporting or keeping mum on the project. Executives also were caught saying that they ultimately planned a much larger mine that they had requested a permit for.
Joel Reynolds of the Natural Resources Defense Council says to ensure that the protections last, the next step is for the U.S. Environmental Protection Agency to use a particular section of the Clean Water Act "to permanently protect the Bristol Bay watershed from large scale mining for all time."
The Army Corps' decision can be reversed, Reynolds notes, and the company can reapply if they make changes to the project. But with a Biden administration soon to take office, Pebble has little time left for such maneuvers.


npr--2020-11-25--Biden And Trump Offer Jarring Contrast Minutes Apart On Thanksgiving Eve

Biden And Trump Offer Jarring Contrast Minutes Apart On Thanksgiving Eve The day before Thanksgiving offered a jarring contrast between President-elect Joe Biden and President Trump , who has yet to concede he lost the election .
Biden on Wednesday delivered a Thanksgiving address in Wilmington , Del.
, calling on Americans to unite in protecting their communities as they celebrate the holiday this year amid the raging coronavirus pandemic .
Minutes earlier , Trump called in from the White House to an informal meeting of Pennsylvania lawmakers , repeating baseless claims about the election being `` rigged . ''
@ @ @ @ @ @ @ around , '' Trump said , though the election results have already been certified in a number of key states , including Pennsylvania , and the formal transition process to the incoming Biden administration is underway .
Soon after on Wednesday , Trump pardoned his first national security adviser , Michael Flynn , who had pleaded guilty in 2017 to lying to the FBI about contact with Russia .
`` Congratulations to [ Gen. Flynn ] and his wonderful family , '' Trump wrote on Twitter .
`` I know you will now @ @ @ @ @ @ @ In his remarks , the president-elect spoke of resolve amid a difficult holiday season .
`` [ The virus has ] divided us , angered us , set us against one another , '' Biden said while speaking at the Queen theater .
`` I know the country has grown weary of the fight .
But we need to remember : We 're at war with the virus , not with one another . ''
Citing the sacrifices of doctors , nurses and other frontline workers , Biden called on Americans to redouble @ @ @ @ @ @ @ referring to basic health safety measures such as social distance and mask-wearing as a `` patriotic duty . ''
The Centers for Disease Control and Prevention is urging people to stay home and not travel for Thanksgiving to help prevent the spread of the virus .
Nevertheless , millions of Americans are still traveling for the holiday .
Biden said he will go without his traditional large family gathering on Thursday , opting instead to celebrate Thanksgiving with a small group of his wife , daughter and son-in-law .
`` I know how @ @ @ @ @ @ @ , but it is so very important , '' Biden said .
`` Our country is in the middle of a dramatic spike in cases .
... That is the plain and simple truth , and I believe you deserve to always hear the truth from your president . ''
Trump spoke at a Gettysburg , Pa. , hearing as one of his attorneys , Jenna Ellis , held her phone up on speakerphone .
He recited false claims including that Republican poll observers were denied access to voting sites and threatened by @ @ @ @ @ @ @ tampered with .
The Trump campaign and GOP allies have filed nearly three dozen post-election lawsuits , and nearly every case has been dismissed , mostly because none of the claims have stood up to legal scrutiny and conventional standards of evidence .
Trump has touted his administration 's response to the pandemic , including halting some travel from China and getting vaccines on the cusp of approval .
Biden acknowledged the Americans who have lost loved ones to the coronavirus , reflecting on the loss of family members he 's experienced in @ @ @ @ @ @ @ that first Thanksgiving , the empty chair , the silence — [ it ] takes your breath away .
It 's really hard to care .
It 's hard to give thanks .
It 's hard to even think of looking forward , it 's so hard to hope , '' he said .
But he concluded : `` Out of pain comes possibility , out of frustration comes progress , and out of division , unity . ''

Biden And Trump Offer Jarring Contrast Minutes Apart On Thanksgiving Eve
Enlarge this image toggle caption Mark Makela/Getty Images Mark Makela/Getty Images
The day before Thanksgiving offered a jarring contrast between President-elect Joe Biden and President Trump, who has yet to concede he lost the election.
Biden on Wednesday delivered a Thanksgiving address in Wilmington, Del., calling on Americans to unite in protecting their communities as they celebrate the holiday this year amid the raging coronavirus pandemic.
Minutes earlier, Trump called in from the White House to an informal meeting of Pennsylvania lawmakers, repeating baseless claims about the election being "rigged."
"This election has to be turned around," Trump said, though the election results have already been certified in a number of key states, including Pennsylvania, and the formal transition process to the incoming Biden administration is underway.
Soon after on Wednesday, Trump pardoned his first national security adviser, Michael Flynn, who had pleaded guilty in 2017 to lying to the FBI about contact with Russia.
"Congratulations to [Gen. Flynn] and his wonderful family," Trump wrote on Twitter. "I know you will now have a truly fantastic Thanksgiving!"
toggle caption Samuel Corum/Getty Images
In his remarks, the president-elect spoke of resolve amid a difficult holiday season.
"[The virus has] divided us, angered us, set us against one another," Biden said while speaking at the Queen theater. "I know the country has grown weary of the fight. But we need to remember: We're at war with the virus, not with one another."
Citing the sacrifices of doctors, nurses and other frontline workers, Biden called on Americans to redouble their efforts in combating the virus, referring to basic health safety measures such as social distance and mask-wearing as a "patriotic duty."
The Centers for Disease Control and Prevention is urging people to stay home and not travel for Thanksgiving to help prevent the spread of the virus. Nevertheless, millions of Americans are still traveling for the holiday.
Biden said he will go without his traditional large family gathering on Thursday, opting instead to celebrate Thanksgiving with a small group of his wife, daughter and son-in-law.
"I know how hard it is to forgo family traditions, but it is so very important," Biden said. "Our country is in the middle of a dramatic spike in cases. ... That is the plain and simple truth, and I believe you deserve to always hear the truth from your president."
Trump spoke at a Gettysburg, Pa., hearing as one of his attorneys, Jenna Ellis, held her phone up on speakerphone. He recited false claims including that Republican poll observers were denied access to voting sites and threatened by Democrats, and that voting machines were tampered with.
The Trump campaign and GOP allies have filed nearly three dozen post-election lawsuits, and nearly every case has been dismissed, mostly because none of the claims have stood up to legal scrutiny and conventional standards of evidence.
Trump has touted his administration's response to the pandemic, including halting some travel from China and getting vaccines on the cusp of approval.
Biden acknowledged the Americans who have lost loved ones to the coronavirus, reflecting on the loss of family members he's experienced in his own life.
"I remember that first Thanksgiving, the empty chair, the silence — [it] takes your breath away. It's really hard to care. It's hard to give thanks. It's hard to even think of looking forward, it's so hard to hope," he said.
But he concluded: "Out of pain comes possibility, out of frustration comes progress, and out of division, unity."


npr--2020-11-25--Netflix Removes 'Chappelle's Show' At Dave Chappelle's Request

Comedian Dave Chappelle had a strange request for his fans .
Do n't stream his show .
`` I 'm begging you .
If you ever liked me , '' he said in a video of a stand-up routine he shared on Tuesday .
`` Boycott Chappelle 's Show .
Do not watch it unless they pay me . ''
Chappelle was calling out the network Comedy Central , which first aired Chappelle 's Show from 2003 to 2006 .
He said in the video the company licensed the show to Netflix and HBO Max without paying him or informing @ @ @ @ @ @ @ Comedy Central was able to do so because as a young man he had been snared in an unfair contract , which allows the network to continue profiting from his show and prevents Chappelle from using its name .
Chappelle famously walked out on the show in 2005 before finishing the third season , forgoing what could 've been a $ 50 million deal .
He had served as the series ' creator , executive producer and star .
Comedy Central aired the three episodes for that season already recorded .
As he @ @ @ @ @ @ @ out Chappelle 's Show was going to be streamed on Netflix , he called the streaming service to express his misgivings .
A Netflix spokesperson confirmed the company removed the show early Tuesday morning at the comedian 's request after airing it for less than a month but declined to comment further .
The streaming service has a robust business relationship with the comedian , reportedly paying Chappelle up to $ 60 million for five stand-up specials in 2016 .
`` That 's why I f*** with Netflix , because they pay me @ @ @ @ @ @ @ say they 're gon na do , '' Chappelle said in the video .
`` And they went above and beyond what you could expect from a businessman . ''
Chappelle 's quarrel is not a legal one — he acknowledges he signed the contract with Comedy Central .
But Chappelle said he was then 28 , broke and expecting a child .
`` Perfectly legal , '' he said .
`` But is that right ?
I did n't think so either . ''
Chappelle 's strategy is to call on his @ @ @ @ @ @ @ It is still on HBO Max as well as CBS All Access .
Neither Viacom , which owns Comedy Central , nor HBO Max responded to requests for comment by publication time .
While Chappelle targeted Comedy Central in what he described as `` publicly flogging a network , '' he said the mistreatment of artists is an industrywide problem .
Chappelle drew comparisons of financial mistreatment to the abuses and sexual harassment brought to light by the # MeToo movement .
`` I 'm not up here trying to tell you guys @ @ @ @ @ @ @ me a raw deal just because I 'm Black , '' he said .
`` I believe that they gave me a raw deal , because this f***ing industry is a monster . ''
Reese Oxner is an intern for NPR 's Newsdesk .

Netflix Removes 'Chappelle's Show' At Dave Chappelle's Request
Enlarge this image toggle caption David Livingston/Getty Images David Livingston/Getty Images
Comedian Dave Chappelle had a strange request for his fans. Don't stream his show.
"I'm begging you. If you ever liked me," he said in a video of a stand-up routine he shared on Tuesday. "Boycott Chappelle's Show. Do not watch it unless they pay me."
Chappelle was calling out the network Comedy Central, which first aired Chappelle's Show from 2003 to 2006. He said in the video the company licensed the show to Netflix and HBO Max without paying him or informing him about the deal.
Chappelle said Comedy Central was able to do so because as a young man he had been snared in an unfair contract, which allows the network to continue profiting from his show and prevents Chappelle from using its name.
Chappelle famously walked out on the show in 2005 before finishing the third season, forgoing what could've been a $50 million deal. He had served as the series' creator, executive producer and star. Comedy Central aired the three episodes for that season already recorded.
As he recounted on Instagram, when Chappelle found out Chappelle's Show was going to be streamed on Netflix, he called the streaming service to express his misgivings.
A Netflix spokesperson confirmed the company removed the show early Tuesday morning at the comedian's request after airing it for less than a month but declined to comment further. The streaming service has a robust business relationship with the comedian, reportedly paying Chappelle up to $60 million for five stand-up specials in 2016.
"That's why I f*** with Netflix, because they pay me my money, they do what they say they're gonna do," Chappelle said in the video. "And they went above and beyond what you could expect from a businessman."
Chappelle's quarrel is not a legal one — he acknowledges he signed the contract with Comedy Central. But Chappelle said he was then 28, broke and expecting a child.
"Perfectly legal," he said. "But is that right? I didn't think so either."
Chappelle's strategy is to call on his fans to stop watching the show. It is still on HBO Max as well as CBS All Access.
Neither Viacom, which owns Comedy Central, nor HBO Max responded to requests for comment by publication time.
While Chappelle targeted Comedy Central in what he described as "publicly flogging a network," he said the mistreatment of artists is an industrywide problem.
Chappelle drew comparisons of financial mistreatment to the abuses and sexual harassment brought to light by the #MeToo movement.
"I'm not up here trying to tell you guys that I believe that Comedy Central gave me a raw deal just because I'm Black," he said. "I believe that they gave me a raw deal, because this f***ing industry is a monster."
Reese Oxner is an intern for NPR's Newsdesk.


npr--2020-11-25--Critics Want Sacklers To Face Criminal Charges For Role In Opioid Crisis

Critics Want Sacklers To Face Criminal Charges For Role In Opioid Crisis Newly public documents paint a detailed and often damning portrait of the role played by members of the Sackler family , owners of Purdue Pharma , during years when the privately owned drug company launched criminal schemes designed to `` turbocharge '' sales of Oxycontin and other highly addictive opioid medications .
In court filings this week , Purdue Pharma admitted extensive criminal wrongdoing as part of a settlement with the Justice Department , including a decade-long conspiracy to deceive the Drug Enforcement Administration that continued until 2017 @ @ @ @ @ @ @ prescription opioids has contributed to a national tragedy of addiction and deaths , '' Deputy Attorney General Jeffrey Rosen said in a statement after the guilty plea was entered .
This is n't the first time the company admitted criminal wrongdoing in its effort to boost opioid profits on the Sackler 's watch .
In 2007 , the family 's firm pleaded guilty to charges in a DOJ settlement and agreed to pay more than $ 600 million in fines , while promising to follow strict new ethics guidelines .
The Sacklers then @ @ @ @ @ @ @ officials now acknowledge Purdue Pharma almost immediately launched new criminal schemes aimed at boosting opioid sales , even as overdoses were killing tens of thousands of Americans .
`` Purdue deeply regrets and accepts responsibility for the misconduct detailed by the Department of Justice , '' Purdue Pharma 's board chair Steve Miller said in a statement .
NPR reviewed internal company records from the last decade , including memos , planning documents and emails between family members , disclosed in recent weeks as part of civil and criminal proceedings , as well @ @ @ @ @ @ @ reveal how the Sacklers appeared to exert close control over the firm , pressuring staff to boost sales during the period when much of the illegal activity occurred .
In one 2010 email cited by DOJ , Richard Sackler scolded company executives for not setting higher sales quotas for Oxycontin .
`` I 'm disappointed and do n't agree with you .
This is a matter that the board will have to take up and give you a settled direction , '' Sackler wrote .
A consultant who helped develop the company 's @ @ @ @ @ @ @ memo that family members were the only decision-makers in the room during a key meeting .
In another email from 2017 cited by the Justice Department , a top Purdue Pharma executive describes the Sacklers acting as the `` de-facto CEO '' of their drug company .
Despite these revelations , the new DOJ settlement did n't include criminal charges against the Sacklers , nor do they admit wrongdoing .
The deal instead requires them to forfeit $ 225 million as part of a civil penalty separate from Purdue Pharma 's criminal plea @ @ @ @ @ @ @ of their wealth estimated by Forbes at $ 10 to $ 13 billion .
`` I 'm very disappointed , '' said Nan Goldin , an artist and activist who became addicted to Oxycontin in 2014 and has since led protests against the Sacklers .
`` I think we 're going further toward injustice . ''
The lack of criminal charges is controversial , in part , because the Justice Department itself alleges in new filings that members of the Sackler family approved a scheme to boost opioid prescribing that the company now @ @ @ @ @ @ @ family 's authority Purdue Pharma `` intensified their marketing of OxyContin to extreme , high-volume prescribers who were already writing 25 times as many OxyContin scripts as their peers , '' according to the DOJ .
Federal prosecutors name David Sackler , Jonathan Sackler , Kathe Sackler , Mortimer Sackler and Richard Sackler as playing a direct role in that effort .
Justice Department officials also allege the Sacklers engaged in `` fraudulent '' financial activity , as they worked to shelter billions of dollars in opioid profits from future lawsuits .
In @ @ @ @ @ @ @ the Justice Department , board member Jonathan Sackler proposed a `` smart milking '' program to drain value from the company at a time when legal and regulatory challenges were growing .
According to the DOJ , criminal charges may still be filed against individuals at Purdue Pharma , but legal experts tell NPR that appears unlikely .
`` I do n't see a strong likelihood the government is going to want to indict , '' said John Coffee Jr. , an expert on corporate crime at Columbia University .
He added the @ @ @ @ @ @ @ for fifteen years and it has worked for them . ''
The Sacklers , meanwhile , maintain they did nothing wrong .
In a statement issued last month after the outlines of the DOJ deal were made public , members of the family said they `` acted ethically and lawfully . ''
They described as `` proper '' billions of dollars of financial distributions funneled into private trusts and offshore accounts .
But the company 's many critics say a starkly different story is emerging as the wall of secrecy surrounding the Sacklers @ @ @ @ @ @ @ a legal brief filed this month in federal bankruptcy court , attorneys representing 25 states argued evidence is now overwhelming that the Sacklers engaged in `` pervasive fraud and crime . ''
The growing list of allegations is lengthy , but the big picture is relatively simple .
As sales of the family 's rockstar drug Oxycontin began to decline over the last decade , members of the Sackler family pushed ever more aggressive efforts to maximize profits , according to court filings by the Justice Department and attorneys representing states suing Purdue @ @ @ @ @ @ @ Purdue Pharma hired a consultant tasked with creating a campaign to `` turbocharge the sales engine , '' according to documents included in lawsuit filed last year against members of the Sackler family by the state of Massachusetts .
Purdue Pharma now admits some of the company 's aggressive sales tactics during this period were illegal .
Criminal behavior described in the plea agreement includes : - Paying kickbacks to a software company after it agreed to embed `` prompts '' in the handheld devices used by physicians .
Without their knowledge , @ @ @ @ @ @ @ other Purdue products , even when other treatments might be safer and equally effective .
- Misleading the DEA by claiming Purdue Pharma had an effective program to prevent diversion and misuse of Oxycontin , as required by law .
Under the plea agreement , the company now admits deliberately marketing opioids to doctors who were behaving suspiciously .
Purdue Pharma and its consultants also developed a plan that was never implemented to secretly pay insurance companies thousands of dollars every time a patient became addicted or overdosed while using Oxycontin , according @ @ @ @ @ @ @ suing the company .
Due in part to these revelations , the settlement with the Sacklers has sparked outrage among lawmakers .
Thirty members of Congress sent a letter to Attorney General William Barr last month in an unsuccessful effort to block the new deal .
They noted that street dealers who admit to selling much smaller quantities of opioids often spend years in federal prison .
Under this latest settlement , the Sacklers give up ownership of the company and Purdue Pharma has promised to eventually pay roughly $ 8.3 billion in @ @ @ @ @ @ @ by NPR say it 's unlikely the bulk of those federal fines will ever be paid .
While the Sacklers have emerged as one of the richest families in America , their company entered bankruptcy last year facing a tsunami of opioid-related lawsuits .
`` They 've stripped the company of its assets , '' said John Coffee Jr. at Columbia University .
`` We can pile up to the billions the penalties [ Purdue Pharma ] pleads guilty to , but there are no assets to pay them with .
It 's @ @ @ @ @ @ @ negotiations that have n't been finalized , the Sacklers have also pledged to pay roughly $ 3 billion of their personal fortune to settle opioid-related lawsuits , according to a document filed last year in federal bankruptcy court .
Some state attorneys general have said that offer is insufficient .
Under the Justice Department agreement , Purdue Pharma may also emerge following bankruptcy as a `` public benefit corporation , '' with future profits from future opioid sales going to compensate individuals and communities harmed by the addiction crisis .
That arrangement , @ @ @ @ @ @ @ of Congress and two dozen state attorneys general , who object to the government entering into a long-term financial relationship with a drug company linked to persistent criminal activity .
The House Committee on Oversight and Reform has scheduled a hearing on the Purdue Pharma settlement for Dec. 8 .
Democrats who control the committee have invited members of the Sackler family as well as company CEO Craig Landau to testify .

Critics Want Sacklers To Face Criminal Charges For Role In Opioid Crisis
Enlarge this image toggle caption Toby Talbot/AP Toby Talbot/AP
Updated at 7:20 p.m. ET
Newly public documents paint a detailed and often damning portrait of the role played by members of the Sackler family, owners of Purdue Pharma, during years when the privately owned drug company launched criminal schemes designed to "turbocharge" sales of Oxycontin and other highly addictive opioid medications.
In court filings this week, Purdue Pharma admitted extensive criminal wrongdoing as part of a settlement with the Justice Department, including a decade-long conspiracy to deceive the Drug Enforcement Administration that continued until 2017.
"The abuse and diversion of prescription opioids has contributed to a national tragedy of addiction and deaths," Deputy Attorney General Jeffrey Rosen said in a statement after the guilty plea was entered.
This isn't the first time the company admitted criminal wrongdoing in its effort to boost opioid profits on the Sackler's watch.
In 2007, the family's firm pleaded guilty to charges in a DOJ settlement and agreed to pay more than $600 million in fines, while promising to follow strict new ethics guidelines. The Sacklers then faced no criminal charges.
But company officials now acknowledge Purdue Pharma almost immediately launched new criminal schemes aimed at boosting opioid sales, even as overdoses were killing tens of thousands of Americans.
"Purdue deeply regrets and accepts responsibility for the misconduct detailed by the Department of Justice," Purdue Pharma's board chair Steve Miller said in a statement.
NPR reviewed internal company records from the last decade, including memos, planning documents and emails between family members, disclosed in recent weeks as part of civil and criminal proceedings, as well as during a congressional probe.
They reveal how the Sacklers appeared to exert close control over the firm, pressuring staff to boost sales during the period when much of the illegal activity occurred.
In one 2010 email cited by DOJ, Richard Sackler scolded company executives for not setting higher sales quotas for Oxycontin.
"I'm disappointed and don't agree with you. This is a matter that the board will have to take up and give you a settled direction," Sackler wrote.
A consultant who helped develop the company's aggressive sales tactics claimed in a 2013 memo that family members were the only decision-makers in the room during a key meeting.
In another email from 2017 cited by the Justice Department, a top Purdue Pharma executive describes the Sacklers acting as the "de-facto CEO" of their drug company.
Despite these revelations, the new DOJ settlement didn't include criminal charges against the Sacklers, nor do they admit wrongdoing.
The deal instead requires them to forfeit $225 million as part of a civil penalty separate from Purdue Pharma's criminal plea. That amount represents a small fraction of their wealth estimated by Forbes at $10 to $13 billion.
"I'm very disappointed," said Nan Goldin, an artist and activist who became addicted to Oxycontin in 2014 and has since led protests against the Sacklers. "I think we're going further toward injustice."
The lack of criminal charges is controversial, in part, because the Justice Department itself alleges in new filings that members of the Sackler family approved a scheme to boost opioid prescribing that the company now admits was illegal.
Acting on the family's authority Purdue Pharma "intensified their marketing of OxyContin to extreme, high-volume prescribers who were already writing 25 times as many OxyContin scripts as their peers," according to the DOJ.
Federal prosecutors name David Sackler, Jonathan Sackler, Kathe Sackler, Mortimer Sackler and Richard Sackler as playing a direct role in that effort.
Justice Department officials also allege the Sacklers engaged in "fraudulent" financial activity, as they worked to shelter billions of dollars in opioid profits from future lawsuits.
In one email exchange from 2014 cited by the Justice Department, board member Jonathan Sackler proposed a "smart milking" program to drain value from the company at a time when legal and regulatory challenges were growing.
According to the DOJ, criminal charges may still be filed against individuals at Purdue Pharma, but legal experts tell NPR that appears unlikely.
"I don't see a strong likelihood the government is going to want to indict," said John Coffee Jr., an expert on corporate crime at Columbia University.
He added the Sacklers have "been playing this game for fifteen years and it has worked for them."
The Sacklers, meanwhile, maintain they did nothing wrong.
In a statement issued last month after the outlines of the DOJ deal were made public, members of the family said they "acted ethically and lawfully."
They described as "proper" billions of dollars of financial distributions funneled into private trusts and offshore accounts.
But the company's many critics say a starkly different story is emerging as the wall of secrecy surrounding the Sacklers' actions continues to crumble.
In a legal brief filed this month in federal bankruptcy court, attorneys representing 25 states argued evidence is now overwhelming that the Sacklers engaged in "pervasive fraud and crime."
The growing list of allegations is lengthy, but the big picture is relatively simple.
As sales of the family's rockstar drug Oxycontin began to decline over the last decade, members of the Sackler family pushed ever more aggressive efforts to maximize profits, according to court filings by the Justice Department and attorneys representing states suing Purdue Pharma.
To meet those goals, Purdue Pharma hired a consultant tasked with creating a campaign to "turbocharge the sales engine," according to documents included in lawsuit filed last year against members of the Sackler family by the state of Massachusetts.
Purdue Pharma now admits some of the company's aggressive sales tactics during this period were illegal. Criminal behavior described in the plea agreement includes:
- Paying kickbacks to a software company after it agreed to embed "prompts" in the handheld devices used by physicians. Without their knowledge, doctors were urged to prescribe Oxycontin and other Purdue products, even when other treatments might be safer and equally effective.
- Misleading the DEA by claiming Purdue Pharma had an effective program to prevent diversion and misuse of Oxycontin, as required by law. Under the plea agreement, the company now admits deliberately marketing opioids to doctors who were behaving suspiciously.
Purdue Pharma and its consultants also developed a plan that was never implemented to secretly pay insurance companies thousands of dollars every time a patient became addicted or overdosed while using Oxycontin, according to documents filed by attorneys representing states suing the company.
Due in part to these revelations, the settlement with the Sacklers has sparked outrage among lawmakers. Thirty members of Congress sent a letter to Attorney General William Barr last month in an unsuccessful effort to block the new deal.
They noted that street dealers who admit to selling much smaller quantities of opioids often spend years in federal prison.
Under this latest settlement, the Sacklers give up ownership of the company and Purdue Pharma has promised to eventually pay roughly $8.3 billion in fines and penalties.
But experts interviewed by NPR say it's unlikely the bulk of those federal fines will ever be paid. While the Sacklers have emerged as one of the richest families in America, their company entered bankruptcy last year facing a tsunami of opioid-related lawsuits.
"They've stripped the company of its assets," said John Coffee Jr. at Columbia University. "We can pile up to the billions the penalties [Purdue Pharma] pleads guilty to, but there are no assets to pay them with. It's illusory."
As part of separate negotiations that haven't been finalized, the Sacklers have also pledged to pay roughly $3 billion of their personal fortune to settle opioid-related lawsuits, according to a document filed last year in federal bankruptcy court. Some state attorneys general have said that offer is insufficient.
Under the Justice Department agreement, Purdue Pharma may also emerge following bankruptcy as a "public benefit corporation," with future profits from future opioid sales going to compensate individuals and communities harmed by the addiction crisis.
That arrangement, too, has faced criticism from members of Congress and two dozen state attorneys general, who object to the government entering into a long-term financial relationship with a drug company linked to persistent criminal activity.
The House Committee on Oversight and Reform has scheduled a hearing on the Purdue Pharma settlement for Dec. 8. Democrats who control the committee have invited members of the Sackler family as well as company CEO Craig Landau to testify.


npr--2020-11-25--Educators And Native Leaders Recommend Bringing Anti-Racism To The Thanksgiving Table

Educators And Native Leaders Recommend Bringing Anti-Racism To The Thanksgiving Table For Walter Fleming , an enrolled member of the Kickapoo tribe in Kansas , Thanksgiving will be difficult this year because so many Native Americans have died from COVID-19 .
`` Particularly because it 's been among our elders , the grieving is gon na be that much more , '' Fleming said .
`` These are the cultural guardians . ''
Fleming is a professor of Native American studies at Montana State University , who observes the holiday .
He says it 's a chance for people to @ @ @ @ @ @ @ `` It 's not because they 've been colonized or because they might support any myths around Thanksgiving , '' Fleming said .
`` It is that we 've grown up with the custom of celebrating Thanksgiving .
It 's just been a feast day . ''
Some Native Americans celebrate Thanksgiving by taking the opportunity to gather with loved ones and focus on gratitude .
Others consider it a day for mourning because it perpetuates the myth that Pilgrims had a symbiotic relationship with Indigenous people and glosses over past atrocities committed @ @ @ @ @ @ @ behind the Thanksgiving holiday have been a factor in erasing Indigenous realities for decades , especially the myth that the Pilgrim and other European invasions were peaceful or friendly , '' said Mahtowin Munro , who is Lakota , and co-leader of the United American Indians of New England .
This year Thanksgiving comes as chronically under-resourced Native populations are contracting COVID-19 at record rates .
In August , the Centers for Disease Control and Prevention reported that Native Americans are 3.5 times more likely to get COVID-19 than white people .
According @ @ @ @ @ @ @ Native Americans and Alaska Natives have contracted the virus and nearly 1,300 have died — a number that is likely an underestimate because many jurisdictions do n't compile data on ethnicity .
Thanksgiving also comes on the heels of widespread protests demanding racial justice .
Native Americans have their own history with police brutality , and are incarcerated and killed by police at disproportionately high rates .
SomeIndigenous and Black advocacy groups have partnered together in the push for racial justice .
Following the record-breaking election of six Native Americans to Congress , @ @ @ @ @ @ @ latest reckoning with race will lead to change .
`` I think there is a strong and empowered desire , and not just from Indigenous peoples , but from a broader body politic , '' said Shannon O'Loughlin , who is Choctaw , and executive director of the Association on American Indian Affairs .
But , Native leaders say , more needs to be done .
`` I do n't think there can be any reconciliation until conditions actually change for Native people , '' Munro said .
`` This is not just @ @ @ @ @ @ @ about what is happening right now in 2020 . ''
While the injustices are clear , O'Loughlin says , addressing them is hard at a time when people are polarized .
`` I think people want to resolve the burdens of our history .
I think what 's been painful is that people do n't know how to do it , '' O'Loughlin said , adding that taking the day as a chance to combat racism is a step forward .
`` Even if it 's only one day , '' said O'Loughlin @ @ @ @ @ @ @ us to re-learn . ''
Here are some ways educators and Native leaders recommend bringing anti-racism to the table this year : • Watch the National Day of Mourning on Nov. 26 and learn about it .
Munro recommends learning about the National Day of Mourning , an annual event held in Plymouth , Mass.
, to protest and mourn the destruction of Indigenous people by white colonizers .
Hosted by the United American Indians of New England , this year it will be livestreamed on Thanksgiving .
• Learn about Native American @ @ @ @ @ @ @ this month .
Indigenous organizations report a flood of attention every November during American Indian and Alaska Native Heritage Month , and then a drop off .
`` It 's frustrating every year Native organizations and people like me are asked the same questions , '' O'Loughlin said .
`` And we go out to all different sorts of groups to educate them about Indian Country and Native America , and every year we have the same questions asked of us . ''
• Know that Native Americans are not a monolith .
@ @ @ @ @ @ @ tribe .
Native Americans — a term that encompasses 574 federally recognized tribes — have different histories , beliefs and cultural practices .
`` We are not all the same , '' said Mahtowin Munro , co-leader of the United American Indians of New England .
• Honor the original inhabitants of the land you 're on .
Colonizers seized land from Native tribes , and land repatriation is at the core of some Native activism efforts .
`` If we 're looking to celebrate Thanksgiving in an anti-racist way , we have @ @ @ @ @ @ @ people on whose land we stand , '' said O'Loughlin .
She recommends checking out the Native Land Digital website , where you can search for first inhabitants by entering your address .
• Support Native American organizations , causes and efforts .
`` Do something good in Indian Country , '' said O'Loughlin , `` whether it 's donating to a native nonprofit whose doing work that you believe in , or thinking about what used to be here before you and recognizing those people had the same desires and dreams .
@ @ @ @ @ @ @ hard .
`` Give yourself grace , '' said Olga Pagan , an educator at the Center for Racial Justice in Education .
She recommends setting realistic goals , and approaching people gently — a strategy she is using this year .
`` I 'm not gon na talk with people about genocide ; I 'm gon na read two books and say a note about the land that we 're on , '' said Pagan .
`` And if people want to talk more , cool , but if they do n't @ @ @ @ @ @ @ and the seeds have been planted . ''
Piper McDaniel is an intern on NPR 's National Desk .

Educators And Native Leaders Recommend Bringing Anti-Racism To The Thanksgiving Table
Enlarge this image toggle caption Boston Globe/Boston Globe via Getty Images Boston Globe/Boston Globe via Getty Images
For Walter Fleming, an enrolled member of the Kickapoo tribe in Kansas, Thanksgiving will be difficult this year because so many Native Americans have died from COVID-19.
"Particularly because it's been among our elders, the grieving is gonna be that much more," Fleming said. "These are the cultural guardians."
Fleming is a professor of Native American studies at Montana State University, who observes the holiday. He says it's a chance for people to come together, feast and celebrate.
"It's not because they've been colonized or because they might support any myths around Thanksgiving," Fleming said. "It is that we've grown up with the custom of celebrating Thanksgiving. It's just been a feast day."
Some Native Americans celebrate Thanksgiving by taking the opportunity to gather with loved ones and focus on gratitude. Others consider it a day for mourning because it perpetuates the myth that Pilgrims had a symbiotic relationship with Indigenous people and glosses over past atrocities committed against Native Americans.
"The myths behind the Thanksgiving holiday have been a factor in erasing Indigenous realities for decades, especially the myth that the Pilgrim and other European invasions were peaceful or friendly," said Mahtowin Munro, who is Lakota, and co-leader of the United American Indians of New England.
This year Thanksgiving comes as chronically under-resourced Native populations are contracting COVID-19 at record rates. In August, the Centers for Disease Control and Prevention reported that Native Americans are 3.5 times more likely to get COVID-19 than white people.
According to the CDC, more than 53,000 Native Americans and Alaska Natives have contracted the virus and nearly 1,300 have died — a number that is likely an underestimate because many jurisdictions don't compile data on ethnicity.
Thanksgiving also comes on the heels of widespread protests demanding racial justice. Native Americans have their own history with police brutality, and are incarcerated and killed by police at disproportionately high rates. SomeIndigenous and Black advocacy groups have partnered together in the push for racial justice.
Following the record-breaking election of six Native Americans to Congress, some advocates are hopeful the nation's latest reckoning with race will lead to change.
"I think there is a strong and empowered desire, and not just from Indigenous peoples, but from a broader body politic," said Shannon O'Loughlin, who is Choctaw, and executive director of the Association on American Indian Affairs.
But, Native leaders say, more needs to be done.
"I don't think there can be any reconciliation until conditions actually change for Native people," Munro said. "This is not just about history and Thanksgiving; this is about what is happening right now in 2020."
While the injustices are clear, O'Loughlin says, addressing them is hard at a time when people are polarized.
"I think people want to resolve the burdens of our history. I think what's been painful is that people don't know how to do it," O'Loughlin said, adding that taking the day as a chance to combat racism is a step forward.
"Even if it's only one day," said O'Loughlin, "it's an opportunity for us to re-learn."
Here are some ways educators and Native leaders recommend bringing anti-racism to the table this year:
Watch the National Day of Mourning on Nov. 26 and learn about it. Munro recommends learning about the National Day of Mourning, an annual event held in Plymouth, Mass., to protest and mourn the destruction of Indigenous people by white colonizers. Hosted by the United American Indians of New England, this year it will be livestreamed on Thanksgiving.
Learn about Native American culture and history — and not just this month. Indigenous organizations report a flood of attention every November during American Indian and Alaska Native Heritage Month, and then a drop off. "It's frustrating every year Native organizations and people like me are asked the same questions," O'Loughlin said. "And we go out to all different sorts of groups to educate them about Indian Country and Native America, and every year we have the same questions asked of us."
Know that Native Americans are not a monolith. Be specific when talking about someone's tribe. Native Americans — a term that encompasses 574 federally recognized tribes — have different histories, beliefs and cultural practices. "We are not all the same," said Mahtowin Munro, co-leader of the United American Indians of New England.
Honor the original inhabitants of the land you're on. Colonizers seized land from Native tribes, and land repatriation is at the core of some Native activism efforts. "If we're looking to celebrate Thanksgiving in an anti-racist way, we have to acknowledge and be grateful for the people on whose land we stand," said O'Loughlin. She recommends checking out the Native Land Digital website, where you can search for first inhabitants by entering your address.
Support Native American organizations, causes and efforts. "Do something good in Indian Country," said O'Loughlin, "whether it's donating to a native nonprofit whose doing work that you believe in, or thinking about what used to be here before you and recognizing those people had the same desires and dreams."
Know that confronting racism is hard. "Give yourself grace," said Olga Pagan, an educator at the Center for Racial Justice in Education. She recommends setting realistic goals, and approaching people gently — a strategy she is using this year. "I'm not gonna talk with people about genocide; I'm gonna read two books and say a note about the land that we're on," said Pagan. "And if people want to talk more, cool, but if they don't, I'm gonna move on and the seeds have been planted."
Piper McDaniel is an intern on NPR's National Desk.


npr--2020-11-25--China's Xi Jinping Congratulates Biden On Election Win, Urges Cooperation

Chinese President Xi Jinping sent a message of congratulations to President-elect Joe Biden on Wednesday , saying he hopes China and the United States can focus on cooperation and keep their differences in check , according to Chinese state media .
The message comes three weeks after the election , making Xi one of the last major world leaders to wish the former U.S. vice president well .
China 's Foreign Ministry offered congratulations on Nov. 13 , but analysts say Xi had been playing his hand more cautiously , as President Trump mounted legal challenges to the vote and @ @ @ @ @ @ @ n't conceded , but this week his administration approved the beginning of the formal transition process .
Pivotal states where Trump had been challenging the vote also certified election results showing Biden won .
`` Promoting healthy and stable development of China-U.S. relations not only serves the fundamental interests of the people in both countries , but also meets the common expectation of the international community , '' China 's state news agency Xinhua reported Xi as saying in the message to Biden .
Xi said he hopes the two sides would `` @ @ @ @ @ @ @ , mutual respect and win-win cooperation , focus on cooperation , manage differences , advance the healthy and stable development of China-U.S. ties , and join hands with other countries and the international community to promote the noble cause of world peace and development , '' according to Xinhua .
After Trump was elected in 2016 , Xi sent congratulations that included similar language the following day .
China-U.S. relations have plumbed new depths during the past 3 1/2 years .
The Trump administration drew Beijing into a bruising trade war and engaged @ @ @ @ @ @ @ and media .
This year , Trump has placed full blame on China for the coronavirus pandemic and said Beijing would pay a price for its early mishandling of the virus .
The Chinese government denies culpability .
On the 2020 U.S. presidential campaign trail , China figured prominently , with both Trump and Biden pledging to be tough on Beijing .
Biden referred to Xi as a `` thug '' on multiple occasions .
But analysts expect at least the tone to change under Biden , who met Xi several times as @ @ @

China's Xi Jinping Congratulates Biden On Election Win, Urges Cooperation
Enlarge this image toggle caption Carolyn Kaster/AP Carolyn Kaster/AP
Chinese President Xi Jinping sent a message of congratulations to President-elect Joe Biden on Wednesday, saying he hopes China and the United States can focus on cooperation and keep their differences in check, according to Chinese state media.
The message comes three weeks after the election, making Xi one of the last major world leaders to wish the former U.S. vice president well.
China's Foreign Ministry offered congratulations on Nov. 13, but analysts say Xi had been playing his hand more cautiously, as President Trump mounted legal challenges to the vote and refused to concede.
Trump still hasn't conceded, but this week his administration approved the beginning of the formal transition process. Pivotal states where Trump had been challenging the vote also certified election results showing Biden won.
"Promoting healthy and stable development of China-U.S. relations not only serves the fundamental interests of the people in both countries, but also meets the common expectation of the international community," China's state news agency Xinhua reported Xi as saying in the message to Biden.
Xi said he hopes the two sides would "uphold the spirit of non-conflict, non-confrontation, mutual respect and win-win cooperation, focus on cooperation, manage differences, advance the healthy and stable development of China-U.S. ties, and join hands with other countries and the international community to promote the noble cause of world peace and development," according to Xinhua.
After Trump was elected in 2016, Xi sent congratulations that included similar language the following day.
China-U.S. relations have plumbed new depths during the past 3 1/2 years. The Trump administration drew Beijing into a bruising trade war and engaged in tit-for-tat restrictions on business, officials and media. This year, Trump has placed full blame on China for the coronavirus pandemic and said Beijing would pay a price for its early mishandling of the virus. The Chinese government denies culpability.
On the 2020 U.S. presidential campaign trail, China figured prominently, with both Trump and Biden pledging to be tough on Beijing. Biden referred to Xi as a "thug" on multiple occasions.
But analysts expect at least the tone to change under Biden, who met Xi several times as vice president.


npr--2020-11-25--Book Publisher Simon & Schuster Sold To Rival

Publishing company Simon & Schuster has been sold to its competitor Penguin Random House .
The news was announced Wednesday by Simon & Schuster 's parent company , ViacomCBS .
The $ 2.175 billion sale is expected to close in 2021 , pending regulatory approvals .
According to the statement announcing the sale , Simon & Schuster will `` continue to be managed as a separate publishing unit '' underneath Penguin Random House , which itself is owned by the German media giant Bertelsmann .
Simon & Schuster is the third largest among the so-called `` Big Five '' publishers @ @ @ @ @ @ @ Random House being at the top ) .
It 's behind such current bestsellers as the late Alex Trebek 's recent memoir The Answer Is ... : Reflections On My Life , Stephen King 's latest novel The Institute , and the Mary Higgins Clark thriller Kiss the Girls and Make Them Cry .
The company 's backlist also includes F. Scott Fitzgerald 's The Great Gatsby and Doris Kearns Goodwin 's seminal Abraham Lincoln book , Team of Rivals .
As for ViacomCBS , it will be using the money from the @ @ @ @ @ @ @ invest in streaming .
The company had announced in September plans to rebrand its CBS All Access streaming service early next year as Paramount+ .
The company — fresh off its own recent merger — had put Simon & Schuster up for sale earlier this year , saying the publisher was n't a `` core asset '' for the company .
Since then , Simon & Schuster has been the center of attention over the summer for publishing books critical of President Trump , including John Bolton 's memoir The Room Where it @ @ @ @ @ @ @ Too Much and Never Enough : How My Family Created the World 's Most Dangerous Man , and the Bob Woodward book Rage .
Should the sale go through , it 'd be an even further consolidation of the book publishing industry .
It was n't so long ago that Penguin and Random House were separate companies .

Book Publisher Simon & Schuster Sold To Rival
Enlarge this image toggle caption Jim Watson/Getty Images Jim Watson/Getty Images
Publishing company Simon & Schuster has been sold to its competitor Penguin Random House. The news was announced Wednesday by Simon & Schuster's parent company, ViacomCBS.
The $2.175 billion sale is expected to close in 2021, pending regulatory approvals.
According to the statement announcing the sale, Simon & Schuster will "continue to be managed as a separate publishing unit" underneath Penguin Random House, which itself is owned by the German media giant Bertelsmann.
Simon & Schuster is the third largest among the so-called "Big Five" publishers in the book world (with Penguin Random House being at the top). It's behind such current bestsellers as the late Alex Trebek's recent memoir The Answer Is...:Reflections On My Life, Stephen King's latest novel The Institute, and the Mary Higgins Clark thriller Kiss the Girls and Make Them Cry. The company's backlist also includes F. Scott Fitzgerald's The Great Gatsby and Doris Kearns Goodwin's seminal Abraham Lincoln book, Team of Rivals.
As for ViacomCBS, it will be using the money from the sale to pay down debts, and invest in streaming. The company had announced in September plans to rebrand its CBS All Access streaming service early next year as Paramount+. The company — fresh off its own recent merger — had put Simon & Schuster up for sale earlier this year, saying the publisher wasn't a "core asset" for the company.
Since then, Simon & Schuster has been the center of attention over the summer for publishing books critical of President Trump, including John Bolton's memoir The Room Where it Happened, Mary L. Trump's book Too Much and Never Enough: How My Family Created the World's Most Dangerous Man, and the Bob Woodward book Rage.
Should the sale go through, it'd be an even further consolidation of the book publishing industry. It wasn't so long ago that Penguin and Random House were separate companies.


npr--2020-11-25--Amazon Warehouse Workers In Alabama Petition To Unionize

Amazon warehouse workers in Bessemer , Ala. , have notified federal labor authorities of their plans to hold a unionization vote , teeing up a potentially groundbreaking labor battle at the retail giant known for its opposition to unionizing .
A filing , posted by the National Labor Relations Board , says Amazon workers at the fulfillment center outside of Birmingham want to form a bargaining unit of all 1,500 full- and part-time employees at the facility , to be represented by the Retail , Wholesale and Department Store Union .
Such a filing typically requires at least 30 % @ @ @ @ @ @ @ they want a union .
The NLRB plans a hearing on Dec. 11 as it determines whether the petition meets the criteria to proceed to an election .
A RWDSU spokesperson declined to comment .
The Bessemer facility is one of Amazon 's newer warehouses , ramped up during the pandemic online-shopping surge that has pushed the retailer to record-setting profits .
Amazon 's recent hiring sprees have ballooned its global workforce past 1 million permanent and temporary staff , mainly in warehouses .
Much of Amazon 's workforce in Europe is represented @ @ @ @ @ @ @ so far successfully fought off labor organizing efforts in the U.S .
The Alabama workers ' petition does not list specific grievances , but a union-backed website calls for changes to procedures for disciplining , firing and safety .
`` Nineteen workers have died at Amazon facilities since 2013 .
We face outrageous work quotas that have left many with illnesses and lifetime injuries , '' the website says .
`` With a union contract , we can form a worker safety committee , and negotiate the highest safety standards and protocols for @ @ @ @ @ @ @ a statement , argued that the company `` already offers what these groups claim they want . ''
Amazon regularly touts its minimum pay of $ 15 an hour as well as health and other benefits .
`` We do n't believe this group represents the majority of our employees ' views , '' spokesperson Lisa Levandowski said in an email .
`` Our employees choose to work at Amazon because we offer some of the best jobs available everywhere we hire , and we encourage anyone to compare our overall pay , @ @ @ @ @ @ @ other company with similar jobs . ''
Vermont Sen. Bernie Sanders , a powerful union backer and longtime Amazon critic , quickly announced his support of the Bessemer workers .
`` If Amazon workers in Alabama – a strong anti-union state – vote to form a union , it will be a shot heard around the world , '' Sanders tweeted .
`` If they can negotiate higher wages and better working conditions in the South , it will benefit every worker in America . ''
The worker petition news was reported earlier @ @ @ @ @ @ @ is owned by Amazon CEO Jeff Bezos .
Editor 's note : Amazon is among NPR 's financial supporters .

Amazon Warehouse Workers In Alabama Petition To Unionize
Enlarge this image toggle caption Johannes Eisele/AFP via Getty Images Johannes Eisele/AFP via Getty Images
Amazon warehouse workers in Bessemer, Ala., have notified federal labor authorities of their plans to hold a unionization vote, teeing up a potentially groundbreaking labor battle at the retail giant known for its opposition to unionizing.
A filing, posted by the National Labor Relations Board, says Amazon workers at the fulfillment center outside of Birmingham want to form a bargaining unit of all 1,500 full- and part-time employees at the facility, to be represented by the Retail, Wholesale and Department Store Union.
Such a filing typically requires at least 30% of the workers signing paperwork to say they want a union. The NLRB plans a hearing on Dec. 11 as it determines whether the petition meets the criteria to proceed to an election. A RWDSU spokesperson declined to comment.
The Bessemer facility is one of Amazon's newer warehouses, ramped up during the pandemic online-shopping surge that has pushed the retailer to record-setting profits. Amazon's recent hiring sprees have ballooned its global workforce past 1 million permanent and temporary staff, mainly in warehouses.
Much of Amazon's workforce in Europe is represented by unions, but the company has so far successfully fought off labor organizing efforts in the U.S.
The Alabama workers' petition does not list specific grievances, but a union-backed website calls for changes to procedures for disciplining, firing and safety.
"Nineteen workers have died at Amazon facilities since 2013. We face outrageous work quotas that have left many with illnesses and lifetime injuries," the website says. "With a union contract, we can form a worker safety committee, and negotiate the highest safety standards and protocols for our workplace."
Amazon, in a statement, argued that the company "already offers what these groups claim they want." Amazon regularly touts its minimum pay of $15 an hour as well as health and other benefits.
"We don't believe this group represents the majority of our employees' views," spokesperson Lisa Levandowski said in an email. "Our employees choose to work at Amazon because we offer some of the best jobs available everywhere we hire, and we encourage anyone to compare our overall pay, benefits, and workplace environment to any other company with similar jobs."
Vermont Sen. Bernie Sanders, a powerful union backer and longtime Amazon critic, quickly announced his support of the Bessemer workers.
"If Amazon workers in Alabama – a strong anti-union state – vote to form a union, it will be a shot heard around the world," Sanders tweeted. "If they can negotiate higher wages and better working conditions in the South, it will benefit every worker in America."
The worker petition news was reported earlier by the The Washington Post, which is owned by Amazon CEO Jeff Bezos.
Editor's note: Amazon is among NPR's financial supporters.


npr--2020-11-25--Scotland Becomes 1st Country To Make Period Products Free

Scotland has passed a bill that has made period products such as tampons and pads free to all who need them .
The Period Products ( Free Provision ) ( Scotland ) Bill , which passed unanimously , requires local authorities to ensure that period products are generally obtainable free of charge .
Schools and colleges must ensure period products are freely available to students , and designated public places must also make the products available .
The Scottish government has estimated the measure will cost 24 million pounds a year – about $ 32 million .
`` Proud to @ @ @ @ @ @ @ Scotland the first country in the world to provide free period products for all who need them .
An important policy for women and girls , '' she wrote on Twitter .
Monica Lennon , who introduced and championed the legislation , thanked those who have campaigned for period dignity and to her colleagues for backing the bill .
`` A proud day for Scotland and a signal to the world that free universal access to period products can be achieved , '' she tweeted .
The debate over the bill spurred what @ @ @ @ @ @ @ of issues rarely spoken about in government chambers .
Members of the Scottish Parliament discussed endometriosis and heavy bleeding , why toilet paper and bins for menstrual products are required in restrooms but not menstrual products themselves , and the wide base of support the legislation had drawn from men as well as women .
Two years ago , Scotland began providing free period products in schools , colleges and universities – another first .
As NPR reported , that program followed a survey of 2,000 students in Scotland that found 1 in @ @ @ @ @ @ @ .
And Scotland has taken pride in blazing this trail .
`` That 's right , Scotland has become the first country in the world to make period products free for all , '' the country 's official account tweeted .
`` Because in Scotland , we believe it 's fundamental to dignity , equality and human rights . ''

Scotland Becomes 1st Country To Make Period Products Free
Enlarge this image toggle caption Jeff J Mitchell/Getty Images Jeff J Mitchell/Getty Images
Scotland has passed a bill that has made period products such as tampons and pads free to all who need them.
The Period Products (Free Provision) (Scotland) Bill, which passed unanimously, requires local authorities to ensure that period products are generally obtainable free of charge. Schools and colleges must ensure period products are freely available to students, and designated public places must also make the products available.
The Scottish government has estimated the measure will cost 24 million pounds a year – about $32 million.
Nicola Sturgeon, Scotland's first minister, cheered the bill's passage.
"Proud to vote for this groundbreaking legislation, making Scotland the first country in the world to provide free period products for all who need them. An important policy for women and girls," she wrote on Twitter.
Monica Lennon, who introduced and championed the legislation, thanked those who have campaigned for period dignity and to her colleagues for backing the bill. "A proud day for Scotland and a signal to the world that free universal access to period products can be achieved," she tweeted.
The debate over the bill spurred what was at times a remarkable public discussion of issues rarely spoken about in government chambers. Members of the Scottish Parliament discussed endometriosis and heavy bleeding, why toilet paper and bins for menstrual products are required in restrooms but not menstrual products themselves, and the wide base of support the legislation had drawn from men as well as women.
Two years ago, Scotland began providing free period products in schools, colleges and universities – another first. As NPR reported, that program followed a survey of 2,000 students in Scotland that found 1 in 4 respondents struggled to access sanitary products.
And Scotland has taken pride in blazing this trail.
"That's right, Scotland has become the first country in the world to make period products free for all," the country's official account tweeted. "Because in Scotland, we believe it's fundamental to dignity, equality and human rights."