theatlantic--2020-10-01--Trump’s Ex–National Security Adviser on His Failure to Condemn White Supremacy

Nicholas : Do you blame one candidate more than the other for the tone of the debate ?
McMaster : These days , both reflect and magnify divisions in our society .
I don ’ t think Donald Trump invented these divisions .
But he certainly doesn ’ t do as much as he could to lessen those divisions and bring us back together .
Oftentimes , we focus on the president ’ s bombastic or offensive rhetoric .
The reaction to that rhetoric oftentimes is just as bad and pulls us apart from each other as well .
All @ @ @ @ @ @ @ moment .
Do we get dragged down into this , even if we don ’ t want to , and then become part of the problem ?
Or do we try to transcend it ?
We have to try to transcend the partisan politics , transcend the candidates .
If there ’ s hope for us , which I believe there is , the solution is not going to be apparent in this presidential campaign .
We ’ re going to have to do more work ourselves to come together as a people @ @ @ @ @ @ @ government—including the presidential candidates .
Nicholas : Will democracy survive this election ?
Do you worry that if Trump refuses to concede in the event of a defeat , that could be a danger to our democracy ?
McMaster : I don ’ t .
Our Founders wrote the Constitution with every crisis they could imagine in mind .
I have confidence in that system .
It ’ s going to work .
Read : James Mattis denounces President Trump , describes him as a threat to the Constitution Nicholas : Could the @ @ @ @ @ @ @ dispute that arises ?
McMaster : No .
The military will have no role .
Even any talk about the military having a role in the transition should be unconscionable .
[ The Constitution ’ s authors ] feared any military role that would undercut this radical [ American ] idea that sovereignty lies with the people .
Not with the king or parliament , but with the people .
The only time you could say [ that principle has ] been violated on a large scale is the Civil War , when @ @ @ @ @ @ @ slavery .
And so we have to make sure we don ’ t even have discussions about this .
The responsibility for maintaining the military ’ s studiously apolitical status and civilian control is on the profession of arms .
But it ’ s also incumbent on politicians to keep the military out of it .
Nicholas : On a different subject : Is the president ’ s “ America First ” strategy driving away friends and allies ?
Do you worry that he might pull out of NATO if he ’ s @ @ @ @ @ @ @ many Americans do as well—the less tangible benefits of our allies , and in particular the influence the United States enjoys because of our ability to work with like-minded partners bound together not just by mutual interests , but by democratic principles that we hold dear .
I think our allies give us a great deal of moral authority—and they lessen the burden of defense .
They also make us more prosperous .
They help us establish and maintain an economic order internationally that is conducive to fair and reciprocal trade and commerce @ @ @ @ @ @ @ the president challenges our European allies to contribute more to collective defense .
They have pledged to share that burden , and some countries are not living up to it .
The president doesn ’ t do it very tactfully , and that ’ s what alienates some of our allies and leads to popular doubts within those countries about the reliability of the U.S. as an ally .
I don ’ t [ worry that Trump will abandon NATO if reelected ] .
There would be such an overwhelming response from those @ @ @ @ @ @ @ the alliance .

As the election nears, a parade of ex-administration officials and political advisers has come forward to denounce President Donald Trump and offer firsthand accounts of incompetence and venality running through his government.
One notable exception has been H. R. McMaster. The retired Army general served as Trump’s second national security adviser, leaving in early 2018 after about a year in the job. McMaster was part of a coterie of high-level advisers who met often with Trump, explaining global threats and laying out options for him to consider. He presumably knows plenty about the character of the 45th president and whether he’s fit to lead the free world. On that score, McMaster has typically kept mum. Writing a review in The Washington Post about McMaster’s recent book, Battlegrounds, Ben Rhodes, a former deputy NSA in the Obama administration, concluded: “In it, we learn almost nothing about his interactions with Trump or his personal opinion of the man.”
But although that might be how McMaster wants it, it’s not an easy position to hold. With other Trump alumni taking clear sides, pressure increases on those who haven’t. And with Trump failing to clearly condemn white supremacists at Tuesday’s debate, maintaining silence might grow more untenable.
Read: Why can’t he just say it?
Though McMaster isn’t likely to be the next James Mattis, who denounced Trump in a lengthy statement earlier this year, he’s not entirely neutral, either. He has clear opinions. As he told me yesterday, he believes Trump needs to speak out more directly about the evils of white supremacy. He worries that the president’s comments might leave such groups feeling emboldened. Though he’s not given to alarm or blame, he casts Trump as something of a destabilizing force in our politics.
Our conversation has been edited for clarity and length.
Peter Nicholas: At the debate, Trump was asked to condemn white-nationalist groups. He said, of the Proud Boys—a far-right group of “Western chauvinists”—that they should “stand back, and stand by.” Is that an adequate response?
H. R. McMaster: No, it’s not. No leader should encourage any group that is based on a narrow identity that aims to supersede our identity as Americans. We have these centripetal forces in our society today, created by this interaction of identity politics with racism and bigotry. We need leaders who can bring us back together and generate confidence in our identity as Americans and as human beings.
Nicholas: Do white-supremacist groups pose a national-security threat to the United States, and should the president condemn them more clearly and directly than he has to date?
McMaster: Yes and yes. To use a sports analogy, condemning white supremacists should be a layup for any leader. What we’re undervaluing these days is the importance of bringing Americans back together to reinforce our common identity. As a military officer, it breaks my heart to see divisions, because what you see is people come into the Army from all different walks of life. They carry with them certain prejudices and predilections. But you see that all melt away when they’re part of the team.
Read: A far-right militant group has recruited thousands of police, soldiers, and veterans
Nicholas: Why would Trump not seize the chance to denounce white supremacists?
McMaster: I don’t know. It’s certainly a missed opportunity, but it also gives space to these groups that foment hatred and intolerance. And whenever you have a group at one end of the spectrum who define themselves in a particular way, you tend to get an equal and opposite reaction on the other end of the spectrum. Those of us who have more of a common identity as Americans and don’t judge people by race, color, creed, or sexual orientation—but have faith in our identity as Americans and in humanity—we tend to get drowned out by those on the extreme. Our leaders should give voice to those of us who reject extremists and intolerance.
Nicholas: Trump made repeated interruptions throughout the debate. Is that a good look for our country?
McMaster: It’s not. This was a poor example of democracy internationally, but also within our own country.
Nicholas: Do you blame one candidate more than the other for the tone of the debate?
McMaster: These days, both reflect and magnify divisions in our society. I don’t think Donald Trump invented these divisions. But he certainly doesn’t do as much as he could to lessen those divisions and bring us back together. Oftentimes, we focus on the president’s bombastic or offensive rhetoric. The reaction to that rhetoric oftentimes is just as bad and pulls us apart from each other as well.
All of us face a choice at this moment. Do we get dragged down into this, even if we don’t want to, and then become part of the problem? Or do we try to transcend it? We have to try to transcend the partisan politics, transcend the candidates. If there’s hope for us, which I believe there is, the solution is not going to be apparent in this presidential campaign. We’re going to have to do more work ourselves to come together as a people and demand better in all of our government—including the presidential candidates.
Nicholas: Will democracy survive this election? Do you worry that if Trump refuses to concede in the event of a defeat, that could be a danger to our democracy?
McMaster: I don’t. Our Founders wrote the Constitution with every crisis they could imagine in mind. I have confidence in that system. It’s going to work.
Read: James Mattis denounces President Trump, describes him as a threat to the Constitution
Nicholas: Could the military get drawn into a post–Election Day dispute that arises?
McMaster: No. The military will have no role. Even any talk about the military having a role in the transition should be unconscionable. [The Constitution’s authors] feared any military role that would undercut this radical [American] idea that sovereignty lies with the people. Not with the king or parliament, but with the people. The only time you could say [that principle has] been violated on a large scale is the Civil War, when military officers essentially became traitors to preserve slavery. And so we have to make sure we don’t even have discussions about this.
The responsibility for maintaining the military’s studiously apolitical status and civilian control is on the profession of arms. But it’s also incumbent on politicians to keep the military out of it.
Nicholas: On a different subject: Is the president’s “America First” strategy driving away friends and allies? Do you worry that he might pull out of NATO if he’s reelected?
McMaster: The president undervalues—and many Americans do as well—the less tangible benefits of our allies, and in particular the influence the United States enjoys because of our ability to work with like-minded partners bound together not just by mutual interests, but by democratic principles that we hold dear.
I think our allies give us a great deal of moral authority—and they lessen the burden of defense. They also make us more prosperous. They help us establish and maintain an economic order internationally that is conducive to fair and reciprocal trade and commerce. It’s actually good when the president challenges our European allies to contribute more to collective defense. They have pledged to share that burden, and some countries are not living up to it.
The president doesn’t do it very tactfully, and that’s what alienates some of our allies and leads to popular doubts within those countries about the reliability of the U.S. as an ally.
I don’t [worry that Trump will abandon NATO if reelected]. There would be such an overwhelming response from those who are familiar with the benefits of the alliance.


theatlantic--2020-10-02--Could Trump Have Infected Biden?

Could Trump Have Infected Biden?

The variability around both the tests and the disease itself makes it hard to reconstruct a firm timeline of what happened to Trump and those close to him .
For example , Hope Hicks , a senior adviser , tested positive for COVID-19 on Wednesday , a day before Trump did .
But this timing doesn ’ t mean that Hicks gave the virus to him , or even that she was infected before he was .
Trump could have been infected first but slower to develop symptoms .
He might have had several false-negative test results , while Hicks @ @ @ @ @ @ @ .
Hicks might have been tested more frequently than Trump : Anyone in proximity to the president is tested daily , and although the White House says the president is tested “ multiple times a day , ” Trump himself has said he is tested only once every two or three days .
“ This visceral response that he got it from Hicks—we can ’ t say that , ” says Saskia Popescu , an infection preventionist at the University of Arizona .
“ We can only loosely understand the general timeframes.
” @ @ @ @ @ @ @ the virus from a third person , or from completely different people .
Indeed , there are plenty of candidates .
Many of Trump ’ s supporters and aides have been vocal about not wearing masks , and frequently came into close contact with other people in indoor spaces .
Melania Trump has also tested positive , as have Ronna McDaniel , the chair of the Republican National Committee , Senator Mike Lee of Utah , and the University of Notre Dame president , John Jenkins .
Many of them were at the @ @ @ @ @ @ @ when Trump officially nominated Amy Coney Barrett to the Supreme Court .
Others in the White House , at Trump ’ s rallies , and at Tuesday ’ s debate could have been exposed .
Contact tracing in these situations will be extremely difficult .
“ Everyone who was at the debate should now be quarantining as much as possible , monitoring themselves closely for symptoms , wearing masks , and keeping their physical distance as much as possible , ” says Eleanor Murray , an epidemiologist at Boston University .
That goes @ @ @ @ @ @ @ ’ s negative test .
After being exposed to the virus , half of the people who go on to show symptoms are symptomatic by day five—that would be Sunday for Biden , if he was exposed during the debate .
About 98 percent of people are symptomatic by day 12 , which would be next Sunday .
If Biden is still testing negative a week from now , “ it ’ ll be a good sign that there ’ s little likelihood of having been infected , ” Murray says .
Until @ @ @ @ @ @ @ The image of Trump shouting at Biden on a national stage raises the specter of the former infecting the latter .
But as ever , the pandemic says as much about the world we live in as the behavior of individuals .
That we are even weighing the possibility of the incumbent president inadvertently infecting his opponent with a pandemic virus during a nationally televised event should be an indictment of America ’ s laxity in dealing with the pandemic—its reticence to restrict indoor activities , which give the virus the best chance @ @ @ @ @ @ @ to enforce measures like masks , which might render such events safer ; and its continuing inability to control the disease , which many nations have brought to heel .

Updated at 2:20 p.m. ET on October 4, 2020.
“I don’t wear masks like him,” President Donald Trump said during Tuesday night’s presidential debate, deriding his opponent, former Vice President Joe Biden. “Every time you see him, he’s got a mask.” But at nearly 1 a.m. eastern time today, Trump announced that he had tested positive for the SARS-CoV-2 coronavirus, which causes COVID-19.
As president, Trump’s dire mishandling of the U.S. pandemic response has contributed to the deaths of about 200,000 Americans and at least 7.2 million infections. But now that he himself is sick, one has to wonder: How many people has Trump personally infected? And could Biden be one of them? Encouragingly, Biden tested negative for the virus today, but “a negative test doesn’t say he’s completely in the clear,” says Angela Rasmussen, a virologist at Columbia University. Several factors suggest that he could have been exposed to the virus during the debate, and should continue to take precautions for at least another week.
First, there are the conditions of the debate itself. The coronavirus mostly spreads through the air, traveling from the nose and mouth of an infected person in either large, wet particles (droplets) or smaller, drier ones (aerosols). Most droplets fall to the ground within six feet of their source, and Trump and Biden were clearly standing farther apart than that. But “aerosols behave like cigarette smoke and don’t stop at six feet,” says Linsey Marr, who studies airborne-disease transmission at Virginia Tech. “Imagine Trump was smoking the whole time. Would Biden have been exposed to some of that?”
Read: This overlooked variable is the key to the pandemic
When thinking about COVID-19 transmission, there are no absolutes, only probabilities. The distance between Trump and Biden lowered the odds of infection: The farther Trump’s aerosols traveled, the more dilute they would have become. But almost everything else about the debate increased the risk that those aerosols could have found their way into Biden’s nose. People release about 10 times more aerosols when talking than when breathing silently, Marr says, and even more when talking loudly. Trump certainly did that—for 90 minutes, in an enclosed space, without wearing a mask, and often in Biden’s direction. “It wasn’t a one-off cough by someone in the audience,” says Joseph Allen, an environmental-health expert at Harvard University. “It was one and a half hours of constant emissions.” These are the same conditions that make bars and restaurants such risky venues for COVID-19 transmission.
The debate took place inside a spacious atrium at Case Western Reserve University, in Cleveland, and ventilation—how often air is circulated, how thoroughly it is filtered, and where the vents are—would have affected Biden’s risk of catching viruses from Trump. These factors are unclear. Under advice from the Cleveland Clinic, the university detailed several steps to protect the health of participants, including limited attendance, disinfectant measures, and extra space between seats. “But what was notably absent was any mention of healthy building strategies, like filtration and ventilation,” Allen says. “These are things that should be thought about all the time, and certainly in this case.”
Second, there’s the matter of Trump himself. One of the most crucial questions—and the biggest unknowns—is whether he was contagious during the debate. The incubation period for COVID-19—the time between becoming infected and developing symptoms—can last two to 14 days, but is most often four to five days. But people can be infectious one to three days before their symptoms first emerge. Assuming that Trump first developed symptoms on Wednesday (when aides say he was feeling poorly) or yesterday (when he got the test that led to his diagnosis), he would most likely have been infected last weekend, and been infectious on the night of the debate.
Read: Vaccine chaos is looming
In a statement, the Cleveland Clinic said that “everyone permitted inside the debate hall tested negative for COVID-19 prior to entry.” After the debate, moderator Chris Wallace said that both campaigns were on the “honor system,” responsible for their own testing prior to arriving in Cleveland. But no test is perfect, and the fastest ones are more likely to produce false-negative results, failing to detect viruses that are actually present. Even the more sensitive tests have false-negative rates of 38 percent on the first day of symptoms, and almost 100 percent four days before that. In those early days, “you’d expect virus levels to be increasing exponentially,” Rasmussen says. “It’s completely plausible that you could test negative, and a few hours later, test positive.”
The variability around both the tests and the disease itself makes it hard to reconstruct a firm timeline of what happened to Trump and those close to him. For example, Hope Hicks, a senior adviser, tested positive for COVID-19 on Wednesday, a day before Trump did. But this timing doesn’t mean that Hicks gave the virus to him, or even that she was infected before he was. Trump could have been infected first but slower to develop symptoms. He might have had several false-negative test results, while Hicks was first to have a true positive. Hicks might have been tested more frequently than Trump: Anyone in proximity to the president is tested daily, and although the White House says the president is tested “multiple times a day,” Trump himself has said he is tested only once every two or three days. “This visceral response that he got it from Hicks—we can’t say that,” says Saskia Popescu, an infection preventionist at the University of Arizona. “We can only loosely understand the general timeframes.”
Both Hicks and Trump could have caught the virus from a third person, or from completely different people. Indeed, there are plenty of candidates. Many of Trump’s supporters and aides have been vocal about not wearing masks, and frequently came into close contact with other people in indoor spaces. Melania Trump has also tested positive, as have Ronna McDaniel, the chair of the Republican National Committee, Senator Mike Lee of Utah, and the University of Notre Dame president, John Jenkins. Many of them were at the Rose Garden event on September 26, when Trump officially nominated Amy Coney Barrett to the Supreme Court. Others in the White House, at Trump’s rallies, and at Tuesday’s debate could have been exposed. Contact tracing in these situations will be extremely difficult.
“Everyone who was at the debate should now be quarantining as much as possible, monitoring themselves closely for symptoms, wearing masks, and keeping their physical distance as much as possible,” says Eleanor Murray, an epidemiologist at Boston University. That goes for Biden, too, despite today’s negative test. After being exposed to the virus, half of the people who go on to show symptoms are symptomatic by day five—that would be Sunday for Biden, if he was exposed during the debate. About 98 percent of people are symptomatic by day 12, which would be next Sunday. If Biden is still testing negative a week from now, “it’ll be a good sign that there’s little likelihood of having been infected,” Murray says. Until then, he has to wait.
The image of Trump shouting at Biden on a national stage raises the specter of the former infecting the latter. But as ever, the pandemic says as much about the world we live in as the behavior of individuals. That we are even weighing the possibility of the incumbent president inadvertently infecting his opponent with a pandemic virus during a nationally televised event should be an indictment of America’s laxity in dealing with the pandemic—its reticence to restrict indoor activities, which give the virus the best chance of finding new hosts; its failure to enforce measures like masks, which might render such events safer; and its continuing inability to control the disease, which many nations have brought to heel.


theatlantic--2020-10-02--The Probable Outcomes of Trump’s Diagnosis

The president ’ s prognosis includes the full spectrum of possible outcomes .
Many people infected by the coronavirus have no symptoms at all .
Today , the White House chief of staff , Mark Meadows , told reporters that Trump has been showing “ mild ” symptoms , akin to those of a common cold .
That suggests he has been infected for at least two days , possibly many more .
He could clear the virus and test negative in short order , and return to the campaign trail within days .
He could also have a prolonged @ @ @ @ @ @ @ ventilator , during which time Vice President Mike Pence would take charge .
The president could die .
Death is not the most likely outcome , but it is far from unlikely .
Based on age and sex alone , Trump is at high or very high risk for severe disease .
Eight percent of COVID-19 patients ages 65 to 74 die from the disease .
Those 75 to 84 are at far higher risk : 18 percent die .
And men are significantly more likely to die of COVID-19 than women .
@ @ @ @ @ @ @ course .
Compared with people in the “ normal ” BMI range , obese patients are 74 percent more likely to be admitted to an ICU and 48 percent more likely to die .
( Despite the uncertainty about Trump ’ s precise BMI classification , his risk is demonstrably elevated . )
The president ’ s doctors have assured the nation during his time in office that he is in good health and does not have chronic medical conditions .
But we know that Trump ’ s lifestyle does not portend an @ @ @ @ @ @ @ is erratic , he does not exercise , and he subsists on fast food and declines vegetables .
He is prone to angry outbursts .
These lifestyle factors , taken together , are suggestive of impaired resiliency , and could leave him more susceptible to being laid low by the virus .
But a key variable in Trump ’ s case is that , because he is president , he will have the best possible medical monitoring and care .
Should he need it , Trump will have care at the world ’ @ @ @ @ @ @ @ Anthony Fauci , the nation ’ s leading infectious-disease expert , whose advice Trump has spurned and rejected .
Trump will have health care of the sort he has dangled as a campaign promise to all Americans since 2016 , but never delivered .
Trump is also white .
This means he is statistically less likely to experience severe disease , or to die of COVID-19 , compared with nonwhite Americans .
Even as the pandemic has killed more than 1 million people , Trump has continued to downplay and deny the severity @ @ @ @ @ @ @ to wear a mask .
If he does experience a mild case , his perception may skew even further away from the realities of the crisis .
Still , no one can be guaranteed an easy course of disease .
COVID-19 can have lasting effects , and being in and out of the ICU can be traumatic .
If Trump has an intense case , the experience may reorient him to take the virus more seriously .
Severe cases of COVID-19 have a way of reorienting people ’ s capacity to fear it @

Updated at 5:55 p.m. ET on October 2, 2020
Donald Trump is 74, and he is male.
Little else is known about his physical condition. Throughout his presidency, he has disclosed almost nothing in the way of medical records. He stands accused, by one of his former doctors, of dictating his medical assessment as a candidate in 2016. Even Trump’s body-mass index—a basic, objective measure of a person’s body weight divided by their height—is disputed. His reported height increased by an inch in his 2018 physical exam, which left him one pound shy of obese for his height.
This is the context in which, in the predawn hours this morning, the world received news that the president had tested positive for the coronavirus. Trump disclosed his diagnosis in a tweet, and his doctor, Sean Conley, said in a statement that Trump and his wife, Melania, have the virus but are doing well and are at home in the White House. By this afternoon, Conley had announced that Trump received an unproven cocktail of synthetic antibodies. Later, it was announced that Trump was being transferred to Walter Reed National Military Medical Center in Bethesda, Maryland, for further evaluation. In a statement, White House press secretary Kayleigh McEnany said the president “will be working from the presidential offices at Walter Reed for the next few days.”
The president’s prognosis includes the full spectrum of possible outcomes. Many people infected by the coronavirus have no symptoms at all. Today, the White House chief of staff, Mark Meadows, told reporters that Trump has been showing “mild” symptoms, akin to those of a common cold. That suggests he has been infected for at least two days, possibly many more. He could clear the virus and test negative in short order, and return to the campaign trail within days. He could also have a prolonged hospitalization involving weeks of unconsciousness on a ventilator, during which time Vice President Mike Pence would take charge. The president could die.
Death is not the most likely outcome, but it is far from unlikely. Based on age and sex alone, Trump is at high or very high risk for severe disease. Eight percent of COVID-19 patients ages 65 to 74 die from the disease. Those 75 to 84 are at far higher risk: 18 percent die. And men are significantly more likely to die of COVID-19 than women. Obesity is also predictive of a severe course. Compared with people in the “normal” BMI range, obese patients are 74 percent more likely to be admitted to an ICU and 48 percent more likely to die. (Despite the uncertainty about Trump’s precise BMI classification, his risk is demonstrably elevated.)
Read: White House, Petri dish
The president’s doctors have assured the nation during his time in office that he is in good health and does not have chronic medical conditions. But we know that Trump’s lifestyle does not portend an optimized immune system. His sleep schedule is erratic, he does not exercise, and he subsists on fast food and declines vegetables. He is prone to angry outbursts. These lifestyle factors, taken together, are suggestive of impaired resiliency, and could leave him more susceptible to being laid low by the virus.
But a key variable in Trump’s case is that, because he is president, he will have the best possible medical monitoring and care. Should he need it, Trump will have care at the world’s best hospitals from doctors such as Anthony Fauci, the nation’s leading infectious-disease expert, whose advice Trump has spurned and rejected. Trump will have health care of the sort he has dangled as a campaign promise to all Americans since 2016, but never delivered.
Trump is also white. This means he is statistically less likely to experience severe disease, or to die of COVID-19, compared with nonwhite Americans. Even as the pandemic has killed more than 1 million people, Trump has continued to downplay and deny the severity of the disease, and mostly declined to wear a mask. If he does experience a mild case, his perception may skew even further away from the realities of the crisis.
Read: Fauci to meddling HHS official: ‘Take a hike’
Still, no one can be guaranteed an easy course of disease. COVID-19 can have lasting effects, and being in and out of the ICU can be traumatic. If Trump has an intense case, the experience may reorient him to take the virus more seriously. Severe cases of COVID-19 have a way of reorienting people’s capacity to fear it.


theatlantic--2020-10-02--What I Saw Today at the White House

What I Saw Today at the White House

But he left a White House that , even though he ’ s been stricken with a potentially fatal disease , seemed no safer than at any other point in the pandemic .
Officials don ’ t appear to have learned much from the nightmare .
As far as I could tell , the White House ’ s lone concession to the catastrophe unfolding before our eyes was that a few junior aides working in the suite of offices accessible to the press corps sat at their desks in masks .
During my August trip , none of the aides @ @ @ @ @ @ @ warren of offices had seen fit to wear one .
David A. Graham : Trump ’ s denial has now produced what he feared On this day , of all days , a mask would have seemed indispensable .
But a senior White House official told the Associated Press this afternoon that masks amount to a “ personal choice.
” Larry Kudlow , the president ’ s top economic adviser , was effectively goaded into wearing one during an impromptu press conference today .
Kudlow said he wanted to make sure the press @ @ @ @ @ @ @ distance , and so he hadn ’ t worn a mask .
When a reporter suggested that he set an example for the nation , he put one on .
When White House Chief of Staff Mark Meadows spoke with reporters on the north driveway this morning , he didn ’ t wear one at all .
In a seven-minute appearance , the barefaced Meadows efficiently demonstrated so much of what ’ s gone wrong with the White House ’ s handling of the pandemic .
He opened not by talking about the @ @ @ @ @ @ @ the United States is infected , but by touting monthly job numbers that might prove helpful to Trump ’ s reelection .
Meadows spoke vaguely about “ protocols in place ” to keep everyone healthy .
When CNN ’ s Jim Acosta asked him why he wasn ’ t wearing a mask , Meadows trotted out the same tired defense that the White House deployed from the start : He gets tested regularly .
But , of course , so does Trump .
And yet Trump was inside , sick .
“ In @ @ @ @ @ @ @ his boss was probably watching TV and “ critiquing the way that I ’ m answering these questions.
” Inside the building , the atmosphere seemed tense .
A former administration official , speaking on condition of anonymity in order to be frank , told me he ’ s worried that he ’ s been exposed and plans to get tested .
More people at the White House are getting infected , as Meadows predicted this morning they would .
Yesterday came news that Trump ’ s senior adviser Hope Hicks was ill. @ @ @ @ @ @ @ tested positive , along with a group of journalists .
Unless and until the White House starts taking this pandemic much more seriously , anyone visiting the grounds is at risk .
The president has been for months .
After my visit in August , I wrote that if I ’ d torn off my mask and had a coughing fit inside the White House , it didn ’ t seem like anyone would ’ ve especially cared .
That felt true today too .
But by then , it wouldn ’ t @ @ @ @ @ @ @ d brought into the building would ’ ve already been in the air .

On the White House grounds this morning, senior West Wing aides walked around without masks. They spoke with the press without masks. They huddled privately with one another and didn’t wear masks.
When I visited the White House in August, no one checked to see if I was running a fever or suppressing a hacking cough as I passed through the security booth. The ritual was the same today: I showed up hours after we’d learned that President Donald Trump had tested positive for the coronavirus, yet no one asked about my health. Instead, I was simply searched for weapons and allowed in.
I’ve written twice in recent months about the dangerous conditions around the president—about lax testing of journalists flying with him on Air Force One, about troubling working arrangements inside the executive mansion itself. Trump’s illness seems an outgrowth of the administration’s flagrant disregard for public-health precautions. And yet, there’s no sign of a real course correction: The practices today seemed every bit as lax. When Trump walked deliberately toward Marine One tonight, in a dark suit and matching mask, he waved to reporters who all day had been trying to find out information about his condition.
But he left a White House that, even though he’s been stricken with a potentially fatal disease, seemed no safer than at any other point in the pandemic. Officials don’t appear to have learned much from the nightmare.
As far as I could tell, the White House’s lone concession to the catastrophe unfolding before our eyes was that a few junior aides working in the suite of offices accessible to the press corps sat at their desks in masks. During my August trip, none of the aides breathing the same air in this cramped warren of offices had seen fit to wear one.
David A. Graham: Trump’s denial has now produced what he feared
On this day, of all days, a mask would have seemed indispensable. But a senior White House official told the Associated Press this afternoon that masks amount to a “personal choice.” Larry Kudlow, the president’s top economic adviser, was effectively goaded into wearing one during an impromptu press conference today. Kudlow said he wanted to make sure the press could hear him while he kept his distance, and so he hadn’t worn a mask. When a reporter suggested that he set an example for the nation, he put one on.
When White House Chief of Staff Mark Meadows spoke with reporters on the north driveway this morning, he didn’t wear one at all. In a seven-minute appearance, the barefaced Meadows efficiently demonstrated so much of what’s gone wrong with the White House’s handling of the pandemic. He opened not by talking about the shattering revelation that the 45th president of the United States is infected, but by touting monthly job numbers that might prove helpful to Trump’s reelection. Meadows spoke vaguely about “protocols in place” to keep everyone healthy. When CNN’s Jim Acosta asked him why he wasn’t wearing a mask, Meadows trotted out the same tired defense that the White House deployed from the start: He gets tested regularly.
But, of course, so does Trump. And yet Trump was inside, sick. “In true fashion,” Meadows said, his boss was probably watching TV and “critiquing the way that I’m answering these questions.”
Inside the building, the atmosphere seemed tense. A former administration official, speaking on condition of anonymity in order to be frank, told me he’s worried that he’s been exposed and plans to get tested. More people at the White House are getting infected, as Meadows predicted this morning they would. Yesterday came news that Trump’s senior adviser Hope Hicks was ill. Today it was a press aide who tested positive, along with a group of journalists.
Unless and until the White House starts taking this pandemic much more seriously, anyone visiting the grounds is at risk. The president has been for months. After my visit in August, I wrote that if I’d torn off my mask and had a coughing fit inside the White House, it didn’t seem like anyone would’ve especially cared. That felt true today too. But by then, it wouldn’t have mattered. Whatever illness I’d brought into the building would’ve already been in the air.


theatlantic--2020-10-02--What I Saw at the White House

What I Saw at the White House


theatlantic--2020-10-02--Biden’s Negative Test Result Isn’t Enough to Say He’s in the Clear


theatlantic--2020-10-03--Pence in the Wings

Pence in the Wings

What most surprised me when I first began reporting on Pence three years ago was the scale of his ambition .
His public persona to that point had been defined by a kind of theatrical subservience , earning him the reputation of a feckless Trump sycophant who was just happy to have a job .
Pence , after all , was an unpopular governor on the verge of losing reelection when Trump plucked him from Indiana and put him on the 2016 ticket .
( He reportedly endeared himself to Trump during a game of golf , after which he @ @ @ @ @ @ @ beaten him “ like a drum.
” ) This dynamic solidified in the White House , where Trump would frequently ridicule Pence .
He greeted guests who had recently met with the vice president by asking , “ Did Mike make you pray ?
” He once joked that Pence , a religious conservative , wanted to “ hang ” all gay people .
He even privately mocked the Pences for moving their family pets—including two cats , a snake , and a rabbit—into the Naval Observatory .
“ He thinks the Pences @ @ @ @ @ @ @ adviser told me in 2017 .
But Pence ’ s willingness to endure the president ’ s disdain has always belied a more calculating side .
He understands his political value to Trump ; he knows that he ’ s essential to keeping conservative Christians on board .
And he ’ s leveraged that fact to help advance an array of religious-right priorities—from flooding the judiciary with anti-abortion-rights judges to relocating the U.S. embassy in Israel to Jerusalem .
Some Trump loyalists have long suspected that Pence will eventually turn on the president—and @ @ @ @ @ @ @ As I first reported in a profile of the vice president , Pence briefly contemplated a campaign coup late in the 2016 election , after the Access Hollywood tape was released .
Though he quickly fell back in line , ever since , some in the president ’ s orbit have been convinced that Pence is simply biding his time as he waits for his shot at the Oval Office .
He ’ s often named among the Republican officials likely to run for the White House in 2024 .
Read : What @ @ @ @ @ @ @ would a Pence presidency look like ?
It depends on the context .
Compared with his boss , Pence is a fairly conventional politician , and it ’ s hard to imagine him attempting governance by rage-tweet .
If his gubernatorial record is any indication , his policy agenda would constitute a throwback to pre-Trump Republican fusionism—mixing tax cuts and deregulation with the hard-line social conservatism that he sincerely believes in , and that Trump only pretends to .
He ’ d also have a stronger working relationship with the congressional GOP , @ @ @ @ @ @ @ Representatives .
But of course , if Trump were no longer able to perform his duties , Pence would be thrust into office under highly abnormal conditions .
He ’ d be taking over a White House packed with Trump cronies and family members .
If it ’ s hard to imagine a more dysfunctional version of the current administration , consider the prospect of Pence trying to steer an executive branch that ’ s been remade in the image of Donald Trump .
Would Jared Kushner take orders from Pence ?
Would @ @ @ @ @ @ @ now , at least , these questions are hypothetical—but they may already be weighing on Pence .
This is a man who ’ s been dreaming of the White House since his fraternity days in college ; a man who believes , according to friends , that divine forces have conspired to place him within a heartbeat of the presidency .
Ralph Reed , an evangelical power broker who ’ s close with Pence , put it to me this way in 2017 : “ If you ’ re Mike Pence , and @ @ @ @ @ @ @ know God had a plan .
”

Updated on October 3, 2020, at 11:35 a.m. ET.
Above the fireplace in the vice-presidential residence hangs a plaque with a verse from the Bible: “For I know the plans I have for you,” declares the Lord. “Plans to prosper you and not to harm you, plans to give you hope and a future.”
The passage is one of Mike Pence’s favorites, and the subtext is hard to ignore. His rise from beleaguered small-state governor to vice president of the United States has often seemed like one long, strange accident of fate—a political story so unlikely that it could be explained only by divine intervention. The president testing positive for a dangerous virus may be the most consequential turn in that story yet.
Although the likelihood that Donald Trump will become incapacitated, let alone die in office, is low, his diagnosis in the final weeks of the election has undoubtedly elevated Pence. Next week’s vice-presidential debate is now a high-stakes affair. Pence’s campaign schedule and public comments will be closely watched, and his own health intensely monitored. And while Pence is not formally assuming presidential powers, he’s already been called upon to fill in for Trump at the White House and on the 2020 trail. Having aspired to the presidency since he was a teenager, Pence is now closer to the Oval Office than he’s ever been before.
Read: God’s plan for Mike Pence
What most surprised me when I first began reporting on Pence three years ago was the scale of his ambition. His public persona to that point had been defined by a kind of theatrical subservience, earning him the reputation of a feckless Trump sycophant who was just happy to have a job. Pence, after all, was an unpopular governor on the verge of losing reelection when Trump plucked him from Indiana and put him on the 2016 ticket. (He reportedly endeared himself to Trump during a game of golf, after which he gushed to reporters that the then-candidate had beaten him “like a drum.”)
This dynamic solidified in the White House, where Trump would frequently ridicule Pence. He greeted guests who had recently met with the vice president by asking, “Did Mike make you pray?” He once joked that Pence, a religious conservative, wanted to “hang” all gay people. He even privately mocked the Pences for moving their family pets—including two cats, a snake, and a rabbit—into the Naval Observatory. “He thinks the Pences are yokels,” one longtime Trump adviser told me in 2017.
But Pence’s willingness to endure the president’s disdain has always belied a more calculating side. He understands his political value to Trump; he knows that he’s essential to keeping conservative Christians on board. And he’s leveraged that fact to help advance an array of religious-right priorities—from flooding the judiciary with anti-abortion-rights judges to relocating the U.S. embassy in Israel to Jerusalem.
Some Trump loyalists have long suspected that Pence will eventually turn on the president—and they’re not without evidence. As I first reported in a profile of the vice president, Pence briefly contemplated a campaign coup late in the 2016 election, after the Access Hollywood tape was released. Though he quickly fell back in line, ever since, some in the president’s orbit have been convinced that Pence is simply biding his time as he waits for his shot at the Oval Office. He’s often named among the Republican officials likely to run for the White House in 2024.
Read: What I saw at the White House
What would a Pence presidency look like? It depends on the context. Compared with his boss, Pence is a fairly conventional politician, and it’s hard to imagine him attempting governance by rage-tweet. If his gubernatorial record is any indication, his policy agenda would constitute a throwback to pre-Trump Republican fusionism—mixing tax cuts and deregulation with the hard-line social conservatism that he sincerely believes in, and that Trump only pretends to. He’d also have a stronger working relationship with the congressional GOP, given his years in the House of Representatives.
But of course, if Trump were no longer able to perform his duties, Pence would be thrust into office under highly abnormal conditions. He’d be taking over a White House packed with Trump cronies and family members. If it’s hard to imagine a more dysfunctional version of the current administration, consider the prospect of Pence trying to steer an executive branch that’s been remade in the image of Donald Trump. Would Jared Kushner take orders from Pence? Would Stephen Miller write his speeches?
For now, at least, these questions are hypothetical—but they may already be weighing on Pence. This is a man who’s been dreaming of the White House since his fraternity days in college; a man who believes, according to friends, that divine forces have conspired to place him within a heartbeat of the presidency. Ralph Reed, an evangelical power broker who’s close with Pence, put it to me this way in 2017: “If you’re Mike Pence, and you believe what he believes, you know God had a plan.”


The Complicit Physician

Conley has also referenced “ expected ” findings in Trump ’ s chest-imaging tests , but that ’ s different from “ normal , ” the term doctors use to denote that nothing is wrong .
“ Expected ” findings are not necessarily good .
Conley repeatedly declined to elaborate .
He also mentioned abnormal blood tests , but would not say more .
On Monday , he alluded to abnormalities in Trump ’ s kidney functioning , saying that blood tests showed the president had been “ dehydrated , ” but that this test had returned to normal .
@ @ @ @ @ @ @ is not uncommon .
It ’ s not typically concerning .
What is concerning is Conley ’ s unwillingness to just say that , instead resorting to dodges like “ I ’ m not going to get into operations ” and invoking HIPAA when asked about abnormal findings .
Every patient has a right to privacy , and there are some issues that the president may not want to go into extreme detail about .
It ’ s possible that Trump directed his doctor not to talk about certain findings .
As the @ @ @ @ @ @ @ not an elected official : His primary duty is to Trump .
He may consider himself to be a responsible citizen and doctor as long as he is leaving the American people with a basic feeling that the president is doing fine .
But a doctor who is at liberty to discuss only normal and positive findings should not be holding a press conference .
The job of a physician is not to reflect an upbeat attitude .
It is not to conflate optimism with obfuscation .
The job of a physician is @ @ @ @ @ @ @ nor overemphasize them .
The unique bioethical dilemma of the moment is that we are in the middle of a pandemic .
Accepting reality , and a shared set of facts , is vital .
And there is one crucial exception to a doctor ’ s obligation to protect a patient ’ s privacy : when that patient is a threat to others .
On Monday , when Conley told reporters that he had given Trump the go-ahead to return to the White House , he could not say whether or how Trump @ @ @ @ @ @ @ his illness .
He is presumably still contagious ( unless he has already had the virus for 10 days ) .
That is : The president , in the throes of COVID-19 , was being discharged back to the very site of a major coronavirus cluster .
Why send a contagious person back to the place where an outbreak is still unfolding , if he is able to quarantine and execute his duties in his presidential suite at Walter Reed ?
Read : Trump ’ s doctor comes from a uniquely American brand @ @ @ @ @ @ @ ’ s decision on Sunday to break quarantine and go on a car ride with Secret Service agents , which an attending physician at Walter Reed called “ insanity.
” At the very least , the appropriate response from Conley would have been to say “ I advised against that.
” Statistically , Trump is most likely to continue recovering uneventfully .
This decision to return home is not clearly medically unwise for him .
But the declaration of victory and the overall downplaying of Trump ’ s medical status do a grave @ @ @ @ @ @ @ it is within Trump ’ s purview , going back home is , at the very least , inconsiderate of the staff at the White House .
That creates risk not just for those who work there , but everyone who has contact with those people , and then everyone who has contact with those people .
As the current cluster at the White House has made abundantly clear , a single negligent act can end up leading to multiple cases .

For the past several days, President Donald Trump has had COVID-19. It’s unclear for how many days, because the president’s physician, Sean Conley, refuses to share that information. When asked again yesterday, Conley told reporters, “I don’t want to move backwards.” In fact, Conley has shared very little about the course of the president’s illness. On Friday, the same day Trump informed Americans that he had tested positive, he was taken to the hospital “out of an abundance of caution,” according to his press secretary. By the next morning, the narrative had shifted. Conley said that Trump was “doing much better,” but relative to what, exactly? Then, on Monday, Conley told reporters that the president was to be discharged to the White House. “He’s back,” Conley said with a smile.
To hear Conley tell it, Trump was also never gone. The story of his illness jumped from “nothing to see here” to “mission accomplished.” Trump reportedly worked out of the presidential suite at the military hospital as the White House reassured Americans that his job could be done well from there. It released images of him in a suit at a desk, next to a telephone. Now, according to Conley, the president is back at the White House, where he can get “world-class medical care, 24/7.” (Conley could not be reached directly, and the White House did not immediately respond to a request for comment.)
Last night, Trump was helicoptered back to the White House, crossing the lawn and removing his mask to salute Marine One in a spectacle that quickly was turned into a gauzy campaign-style video. The president is declaring victory. “Don’t be afraid of COVID,” he tweeted earlier in the day. “Don’t let it dominate your life.”
This is a dangerous narrative, and Trump’s doctor has helped to shape it. Conley has served as Trump’s publicist in a white coat, reassuring Americans at every turn that Trump is doing well, while leaving out conspicuous details. His vaguery and obfuscation have repeatedly undermined these reassurances. His ethical obligation to his patient is in direct conflict with the basic moral imperative not to lie, by omission or otherwise. Any physician has a duty to the public as well, specifically when dealing with a patient who poses a direct threat to others. Conley is seemingly intent on informing the country how strong the president is, making him complicit in the downplaying of this disease when what the country needs is the bare truth.
The American people still do not know when the president was infected with the coronavirus. We know little more than Trump’s age, his current vital signs, and some of the medications he is taking. Just since Saturday, Conley has declined to answer the most basic questions: Does the president have pneumonia? Why did he start taking dexamethasone? What blood tests have been abnormal? When asked by reporters for discrete data such as the president’s oxygen-saturation levels, Conley said, “Less than 94.” If there is one value that a doctor should know precisely about a patient who is being monitored for respiratory failure—for which the low 90s constitute an unstable zone—it’s this number.
Read: The president is not well
Conley has changed the story. In a press conference on Saturday, he said that Trump was not on supplemental oxygen, and then conspicuously avoided three direct questions as to whether he ever had been. But then, on Sunday, he claimed that the president had received supplemental oxygen in two instances during his illness. Conley said that he had concealed the fact before because he “was trying to reflect the upbeat attitude that the team, the president, [and] his course of illness has had … In doing so, you know, it came off that we were trying to hide something, which wasn’t necessarily true.”
Maybe the biggest lingering question surrounding Conley’s statements is the decision to start Trump on dexamethasone, even while Conley has repeatedly denied that the president has had significant respiratory issues. Dexamethasone is a commonly used steroid, sometimes prescribed for COVID-19 patients in an attempt to tamp down the immune response that can cause them to crash after an initial phase of mild symptoms. But the Infectious Disease Society of America does not recommend the drug for patients who are not in “severe” or “critical” stages of COVID-19. When reporters asked Conley to explain this treatment decision on Monday, he expressed indignation at the question: “I’m not going to go into specifics of what he is and is not on.”
Conley has also referenced “expected” findings in Trump’s chest-imaging tests, but that’s different from “normal,” the term doctors use to denote that nothing is wrong. “Expected” findings are not necessarily good. Conley repeatedly declined to elaborate. He also mentioned abnormal blood tests, but would not say more. On Monday, he alluded to abnormalities in Trump’s kidney functioning, saying that blood tests showed the president had been “dehydrated,” but that this test had returned to normal.
For dehydration to temporarily impair the kidneys is not uncommon. It’s not typically concerning. What is concerning is Conley’s unwillingness to just say that, instead resorting to dodges like “I’m not going to get into operations” and invoking HIPAA when asked about abnormal findings. Every patient has a right to privacy, and there are some issues that the president may not want to go into extreme detail about. It’s possible that Trump directed his doctor not to talk about certain findings. As the president’s physician, Conley is not an elected official: His primary duty is to Trump. He may consider himself to be a responsible citizen and doctor as long as he is leaving the American people with a basic feeling that the president is doing fine.
But a doctor who is at liberty to discuss only normal and positive findings should not be holding a press conference. The job of a physician is not to reflect an upbeat attitude. It is not to conflate optimism with obfuscation. The job of a physician is to deal in reality—to neither minimize threats nor overemphasize them.
The unique bioethical dilemma of the moment is that we are in the middle of a pandemic. Accepting reality, and a shared set of facts, is vital. And there is one crucial exception to a doctor’s obligation to protect a patient’s privacy: when that patient is a threat to others.
On Monday, when Conley told reporters that he had given Trump the go-ahead to return to the White House, he could not say whether or how Trump would isolate himself for the rest of his illness. He is presumably still contagious (unless he has already had the virus for 10 days). That is: The president, in the throes of COVID-19, was being discharged back to the very site of a major coronavirus cluster. Why send a contagious person back to the place where an outbreak is still unfolding, if he is able to quarantine and execute his duties in his presidential suite at Walter Reed?
Read: Trump’s doctor comes from a uniquely American brand of medicine
Conley even defended the president’s decision on Sunday to break quarantine and go on a car ride with Secret Service agents, which an attending physician at Walter Reed called “insanity.” At the very least, the appropriate response from Conley would have been to say “I advised against that.”
Statistically, Trump is most likely to continue recovering uneventfully. This decision to return home is not clearly medically unwise for him. But the declaration of victory and the overall downplaying of Trump’s medical status do a grave disservice to the public. And though it is within Trump’s purview, going back home is, at the very least, inconsiderate of the staff at the White House. That creates risk not just for those who work there, but everyone who has contact with those people, and then everyone who has contact with those people. As the current cluster at the White House has made abundantly clear, a single negligent act can end up leading to multiple cases.
Such acts are preventable. Most happen because of failures to take basic precautionary measures. Since the beginning of the pandemic, Trump has repeatedly failed to take such measures, and he continues to dismiss the threat, denying simple facts and implying that some form of exceptionalism will exempt Americans from suffering. Meanwhile, more than 200,000 Americans have died from COVID-19. Conley has had ample opportunities to do what Trump hasn’t done—speak objectively about the medical facts. Simply doing so would emphasize the importance of wearing masks and taking the virus seriously.
Instead, Conley has opted for complicity, becoming a mouthpiece for Trump’s show of personal strength. Americans are left to speculate about Trump’s health based on what they see in curated videos and press photos—none of which show him in a hospital gown or even in a medical setting. In another time and place, it may be fine to respect a president’s privacy regarding medical issues that have no bearing on ability to govern. But downplaying Trump’s case of COVID-19 in this unique moment has widespread consequences. The hundreds of millions of Americans who are still at risk of contracting this disease could have seen the realities of what it is like, and better understood the value of stopping the virus. Instead, they have been shown that the consequences of negligence are cinematic helicopter rides and a weekend spent wearing a suit in the hospital.


theatlantic--2020-10-06--Trump’s Doctor Comes From a Uniquely American Brand of Medicine

Read : The president is not well Today , osteopathic manipulative medicine consists of dozens of manual techniques—many of them also employed by massage therapists , chiropractors , and physical therapists .
There ’ s high velocity , low amplitude , or HVLA , a pretzel of trust in which a doctor wraps their arm around a curled-up patient to deliver a quick , popping thrust .
Strain/counterstrain , which involves holding a patient ’ s aching joint in a pain-free position , is so gentle that it can feel like nothing at all .
D.O.s also do soft-tissue work @ @ @ @ @ @ @ techniques , such as pumping a patient like a Shake Weight at 100 beats per second to encourage drainage ; and myofascial release , a subtle but sustained pressure on irritated trigger points .
Many patients of osteopathic doctors , myself included , are exceedingly loyal .
D.O.s believe that their holistic approach distinguishes their practice from that of allopathic doctors , and although they spend about the same amount of time with patients as other primary-care doctors , they are more likely than allopathic doctors to ask about a patient ’ s @ @ @ @ @ @ @ For those who respond to it , manipulative treatment can also provide a drug-free form of pain relief—something that the opioid crisis has shown patients desperately need , yet few doctors feel equipped to address .
Whether they know the term or not , many Americans want what the osteopathic philosophy promises : a doctor who trusts their self-knowledge and sees them as a person , not a disembodied set of symptoms .
Osteopathic medical schools are still seen as inferior to allopathic ones , and many students apply to D.O .
schools @ @ @ @ @ @ @ won ’ t be getting into an allopathic one .
But today , many D.O .
practices look no different from those of M.D.s , and the two often work side by side .
Data are difficult to come by , but in a 2003 survey , 75 percent of D.O.s said they never or rarely used their osteopathic techniques .
Some likely never intended to practice manipulative medicine , while others simply stopped training—and trusting in—their hands after graduation .
But osteopathic techniques have filtered into other practices , and osteopathic doctors @ @ @ @ @ @ @ this year , D.O .
and M.D .
programs combined their residency programs for the first time .
Growing up , whenever I had the slightest ache , I would climb onto my grandpa ’ s brown-leather exam table for a treatment .
Like his parents and his two older half brothers , my grandpa was a doctor of osteopathic medicine .
Born and raised in Iowa , he graduated in 1962 from A.T .
Still University , the original osteopathic medical school in the humid hillocks of Kirksville , Missouri .
He @ @ @ @ @ @ @ —often a pejorative , even then , for D.O.s dedicated to the manipulative tradition , in contrast to the “ osteopathic ” doctors focused on the future of medicine .
As a primary-care physician in the agricultural communities of eastern Washington State , he delivered babies , performed small surgeries , and prescribed medicine .
But I remember him best in the exam room he kept at a relaxing half-light , his big hands cupped around the base of a patient ’ s upturned head .

(Johann Rousselot / laif / Redux)
Updated at 9:03 p.m. ET on Oct. 6, 2020.
After three of Andrew Taylor Still’s children died of spinal meningitis in 1864, the midwestern healer turned against mainstream medicine. Eschewing drugs and surgery, Still gravitated toward the wellness offerings of his era, dabbling in magnetic healing and hydrotherapy, before outlining a philosophy of his own. Drawing from the teachings of his Methodist-preacher father and his own experiences farming on the frontier, Still argued that the body was a self-healing machine. When physical, psychological, and spiritual afflictions interfered, a doctor’s job was to gently return a patient to homeostasis, usually through hands-on manipulation of the spine. Still called this new discipline osteopathy.
While allopathic, or medical, doctors can trace their lineage back to Hippocrates and ancient Greece, osteopathy is a uniquely American tradition, comparable to jazz, says Wolfgang Gilliar, the dean of osteopathic medicine at Touro University, in Nevada. One in five Americans has never heard of osteopathic doctors, according to the American Osteopathic Association, but they are a substantive presence in health care. About 16 percent of medical residents are now graduates of osteopathic schools, and D.O.s have quietly come to account for 11 percent of all physicians in the United States. While M.D.s may specialize in ever more complicated fields, many D.O.s are proud generalists, and they’re more likely to serve patients’ most basic health needs as primary-care doctors. They are especially prevalent in rural settings, but one is also in the White House: In 2018, President Donald Trump selected the osteopathic doctor Sean Conley as his physician.
Read: The president is not well
Today, osteopathic manipulative medicine consists of dozens of manual techniques—many of them also employed by massage therapists, chiropractors, and physical therapists. There’s high velocity, low amplitude, or HVLA, a pretzel of trust in which a doctor wraps their arm around a curled-up patient to deliver a quick, popping thrust. Strain/counterstrain, which involves holding a patient’s aching joint in a pain-free position, is so gentle that it can feel like nothing at all. D.O.s also do soft-tissue work, including kneading and stretching; lymphatic techniques, such as pumping a patient like a Shake Weight at 100 beats per second to encourage drainage; and myofascial release, a subtle but sustained pressure on irritated trigger points.
Many patients of osteopathic doctors, myself included, are exceedingly loyal. D.O.s believe that their holistic approach distinguishes their practice from that of allopathic doctors, and although they spend about the same amount of time with patients as other primary-care doctors, they are more likely than allopathic doctors to ask about a patient’s family life in relation to health. For those who respond to it, manipulative treatment can also provide a drug-free form of pain relief—something that the opioid crisis has shown patients desperately need, yet few doctors feel equipped to address. Whether they know the term or not, many Americans want what the osteopathic philosophy promises: a doctor who trusts their self-knowledge and sees them as a person, not a disembodied set of symptoms.
Osteopathic medical schools are still seen as less prestigious than allopathic ones, and many students apply to D.O. schools only when it’s clear they won’t be getting into an allopathic one. But today, many D.O. practices look no different from those of M.D.s, and the two often work side by side. Data are difficult to come by, but in a 2003 survey, 75 percent of D.O.s said they never or rarely used their osteopathic techniques. Some likely never intended to practice manipulative medicine, while others simply stopped training—and trusting in—their hands after graduation. But osteopathic techniques have filtered into other practices, and osteopathic doctors have assimilated into mainstream medicine—so fully that this year, D.O. and M.D. programs combined their residency programs for the first time.
Osteopath Dr. J. Marshall Hoag treating patient at Le Roy Hospital. (Walter Sanders / The LIFE Picture Collection / Getty)
Growing up, whenever I had the slightest ache, I would climb onto my grandpa’s brown-leather exam table for a treatment. Like his parents and his two older half brothers, my grandpa was a doctor of osteopathic medicine. Born and raised in Iowa, he graduated in 1962 from A.T. Still University, the original osteopathic medical school in the humid hillocks of Kirksville, Missouri. He was an old-school “10-fingered osteopath”—often a pejorative, even then, for D.O.s dedicated to the manipulative tradition, in contrast to the “osteopathic” doctors focused on the future of medicine. As a primary-care physician in the agricultural communities of eastern Washington State, he delivered babies, performed small surgeries, and prescribed medicine. But I remember him best in the exam room he kept at a relaxing half-light, his big hands cupped around the base of a patient’s upturned head.
Osteopathy’s “founding myth,” as Dan Bensky, a D.O. in Seattle, calls it, is set during the 1918 pandemic, when influenza spread through the United States. D.O.s treated more than 100,000 infected patients across the country and only 257 died, according to one 1920 article in an osteopathic medical journal. A century later, even a D.O. can look at this study with reservations, given the notorious unreliability of self-reported data and the profound lack of epidemiological context for the disease. But at the time, the results made osteopathy look appealing to prospective patients, because the mortality rate was drastically lower than what M.D.s were reporting.
Read: How the 1918 pandemic frayed social bonds
From the moment that Americans began to embrace osteopathy, the medical establishment grew skeptical of its alternative offerings. In 1910, an investigation into the state of North American medical education, the Flexner Report, castigated the field—and homeopathy, botanical medicine, and osteopathy in particular. Medical doctors responded by urbanizing, specializing, and pursuing the evidence-based approach the report demanded. But D.O.s stayed behind to work in primary care and rural medicine, where many lacked the time, money, and high-volume hospitals necessary to pursue systematic scientific research on osteopathic techniques.
This skepticism from the medical establishment meant that it took decades for all 50 states to grant D.O.s the same rights to practice as M.D.s. Not until 1973, after Mississippi finally began licensing its osteopaths, did the last holdout in the United States finally recognize them as physicians. In the decades since, M.D.s and D.O.s have worked in concert, but the evidence base for distinct osteopathic practices remains thin.
Only in the past 20 years or so have researchers begun to rigorously evaluate osteopathic practices. The studies that do exist remain “equivocal,” says Norman Gevitz, a senior vice president at A.T. Still University and author of The D.O.s: Osteopathic Medicine in America. In patients with pneumonia, for example, osteopathic manipulation can reduce the number of days they spend in the hospital. For chronic low-back pain, studies show either no or minimal reduction in pain or disability following a muscle-energy treatment, a highly controlled form of wrestling where the provider and patient push against each other to lengthen tissues. And although one paper indicated that osteopathic manipulation could alleviate low-back and pelvic pain during pregnancy, the intervention was no more effective than a sham ultrasound.
That hasn’t stopped the diffusion of osteopathic ideas into mainstream medicine. Chiropractors, physical therapists, massage therapists, and sports doctors have all utilized osteopathic techniques, Gevitz says. Muscle energy, which a D.O. developed in 1948, and myofascial release, which a D.O. and physical therapist pioneered, are popular among other “professional touchers,” in the words of the poet Diane Ackerman. These strategies are even used by M.D.s, plenty of whom attend continuing-education courses on osteopathic methods. Although research has yet to validate many of these methods, patients continue to seek these treatments. Whether they’re experiencing a real change or a placebo effect, accumulating evidence suggests there’s probably a benefit either way.
Osteopathic doctors are happy to share their techniques, but most could stand to receive a little more credit for their contributions. In recent years, M.D.s have gathered scientific evidence that supports osteopathic claims, but often without referencing those osteopathic origins. For example, D.O.s contend that the growing interest in fascia—tissue that sheaths and supports muscles and organs throughout the body—and the 2012 “discovery” of the glymphatic system, which drains waste away from the brain, both correspond to concepts Still described more than 100 years ago. Some osteopathic doctors feel validated by these developments. For others, the sense of disrespect runs deep. My D.O., whom I visited roughly every three weeks prior to the pandemic, teared up when talking about scientists who say that the glymphatic system was “previously unknown.”
Read: Please, Michael Phelps, stop cupping
In the past decade, professional organizations and academic institutions have begun to invest more heavily in osteopathic research. But at this point, the most compelling evidence for the continued practice of osteopathic medicine is the studies showing that, in certain cases, there’s no significant difference in patient outcomes, whether they’re managed by a D.O. or an M.D. It sounds like a low bar, but Gevitz argues it shows that different patients benefit from different kinds of care. Some people hate touch; for others, it’s restorative. “There are different paths to healing,” Gevitz says, and the opportunity to choose is itself important.
26th February 1949: An osteopath treating a little girl who has trouble with her pelvic joints at the British School of Osteopathy clinic. (Raymond Kleboe / Picture Post / Hulton Archive / Getty)
My grandfather died of multiple myeloma in 2014, and a few months later, the meniscus in my jaw dislocated. Achy and tired, at one point I Ubered around Seattle looking for a TMJ specialist until, finally, my mom set up an appointment with an osteopathic physician. As the doctor’s big hands cupped the base of my head, I felt like a time traveler coming home.
Still defined the osteopathic tradition, from its inception, in opposition to the mainstream medicine of his day. It was only natural that mainstream medicine shunned osteopathic doctors in turn, relegating them to their own hospitals and refusing to refer patients their way. But today, osteopathic and allopathic doctors are difficult to distinguish, and the curricula at osteopathic and allopathic schools have largely synchronized, because D.O.s and M.D.s must ultimately pass similar licensing exams in order to practice.
“D.O.s are having an identity crisis,” Gevitz says. “Because who are they? What is the rationale for being a separate profession of medicine?”
The two disciplines are only growing closer. This spring, after years of negotiations, allopathic and osteopathic organizations agreed to sort their students into residency programs through a single, unified competency-based system, which evaluates all residents on six domains, including medical knowledge and systems-based practice. Although the majority of the programs are allopathic, some pursued a special osteopathic recognition, which signals their commitment to continuing education on osteopathic principles and manipulative medicine.
For some, this residency looks like another step on the path to self-annihilation. Gevitz predicts that fewer D.O.s will apply for osteopathic licensing or join osteopathic associations when they launch their career. He thinks it’s even possible that administrators will one day use the residency merger to argue for a medical-school merger, too, which many fear would be the end of osteopathic education altogether. But others are optimistic that the new system will ensure that residents get the rigor of the allopathic system while still preserving osteopathic traditions. The merger is already exposing new doctors to osteopathic techniques: Young M.D.s also applied for osteopathically recognized programs. Like the eager chiropractors, massage therapists, and physical therapists who came before them, they are open to incorporating physical touch into their practice.
Read: Why young doctors work such awful hours
However osteopathy remains relevant, many patients say it must. Without it, those who rely on manipulative medicine would suffer, their pain harder to manage without the skilled application of osteopathic techniques. And a D.O. disappearance would contribute to the slow and steady homogenization of our health-care system, further constricting the spectrum of care.
Osteopathy could still have a unique role to play in American medicine. At the height of the coronavirus pandemic, in April, when doctors at St. Barnabas, a nonprofit hospital in the Bronx, could hardly hear themselves think over the whirring of the ventilators, a group of osteopathic doctors was determined to keep human touch at the center of their practice. Swaddled in personal protective equipment, Hugh Ettlinger, D.O., and his residents in osteopathic medicine treated 35 infected patients a day. “We were there and we talked to them and we put our hands on them,” he told me.
While other doctors tried to limit their exposure to infected patients, Ettlinger and his team spent 15 to 20 minutes with each person. Using the techniques they learned in school, they sought to ease breathing by manipulating the ribs and spine, and worked to improve the flow of the lymphatic system. “We probably had more bedside contact than anyone else in the hospital,” Ettlinger said. He hopes that this moment could show that osteopathy has advantages that other techniques don’t offer: once again, the D.O.s collected data on their pandemic patients, and intend to publish in the coming months.


theatlantic--2020-10-08--Without Trump Onstage, There Is No Chaos

The Pence-Harris debate was wholly unlike last week ’ s meeting between Trump and Biden , an evening that Trump turned unwatchable by his interruptions and insults , and by his steadfast refusal to adhere to any semblance of debate rules .
Pence and Harris interrupted each other plenty , and they talked over moderator Susan Page , but they did so in the normal way of a smooth , long-winded politician that viewers surely found familiar .
Unlike Trump ’ s propensity for outright lies , their exaggerations and distortions were carefully cloaked in political rhetoric .
When Harris @ @ @ @ @ @ @ to the pandemic as a “ failure , ” for example , the vice president slyly tried to accuse her of insulting the American public instead .
Read : The man who wouldn ’ t shut up Both candidates played their roles effectively .
Pence defended the administration ’ s record and softened Trump ’ s rough edges , substituting a measure of eloquence for the president ’ s bluster .
He said the administration would “ follow the science ” on a COVID-19 vaccine , even though the president has dismissed science @ @ @ @ @ @ @ is changing , ” even as Trump repeatedly calls climate change “ a hoax.
” The vice president highlighted Trump ’ s belated denunciation of white supremacy , despite the president ’ s habitual refusal to do so at important moments .
Harris , the former prosecutor , turned just about every question into an indictment of the Trump presidency , including its handling of the pandemic and the economy and its attempt to eviscerate the health-care protections of the Affordable Care Act .
Trump was , of course , an invisible star @ @ @ @ @ @ @ record up for debate , and his name was mentioned , on average , once a minute .
But his mere absence transformed the forum into something quieter , more approachable .
It served as a reminder that although the fissures in American society that he has exploited predate his arrival as a politician , the chaos of the past four years belongs to him .
Trump is the chaos , and without him , there is no chaos .
At least that ’ s the easy answer .
When Pence was given @ @ @ @ @ @ @ of power if Biden wins , he , too , refused to do so—though in his typical fashion , the answer was a simple deflection , not a veiled threat laden with the suggestion of violence .
Trump ’ s exit won ’ t erase the deep political disagreements Americans have , nor will it automatically restore the norms he has weakened .
But tonight ’ s debate hinted that , at a minimum , those battles will proceed more civilly .
If that is the main takeaway that viewers have , perhaps @ @ @ @ @ @ @ matter how effectively Pence made the president ’ s case tonight .
After all , it is Biden who is offering America a return to normalcy—a calmer , yes , even a more boring presidency .
Tonight the country saw what that might look like .
It watched , in Pence and Harris , a pair of career politicians take the stage once again , offering a window into a world without Donald Trump at its center .

In perhaps the most chaotic week of a chaotic presidency, what was most surprising about tonight’s vice-presidential debate was how oddly normal it felt.
Five days ago, the president of the United States was hospitalized after contracting a virus that has killed more than 200,000 Americans. There were legitimate questions about whether Donald Trump could execute the powers of his office. In the days since, dozens of people who work in or closely with the White House and the president’s reelection campaign have become infected, including senior officials in the government, the Republican Party, and the U.S. military. The president has proclaimed himself to be “cured” of the virus, but the extent of his illness remains unknown to the public. Meanwhile, Trump has continued to undermine the integrity of the election, refused to commit to relinquishing power if he loses, and, as recently as this afternoon, suggested that his opponent, former Vice President Joe Biden, “shouldn’t be allowed” to even run.
In front of that backdrop, Vice President Mike Pence and Senator Kamala Harris politely traded milquetoast zingers and debated policy for 90 minutes like it was 2012—or some other year before Trump commandeered American politics and remade it in his own image.
Pence and Harris recited talking points and dutifully attacked the men leading each other’s tickets; they dodged questions and tried to talk for longer than they were allowed; the time-honored debate rejoinder “You’re entitled to your opinion, but not your own facts” made not one, but two appearances. In other words, tonight’s debate was like every other general-election matchup before Trump came on the scene. The most memorable moment of the entire affair belonged not to the candidates but to a fly that landed on Pence’s head and remained stuck in his shock of white hair for a few minutes, likely distracting the viewing audience from an important discussion of racial injustice.
The Pence-Harris debate was wholly unlike last week’s meeting between Trump and Biden, an evening that Trump turned unwatchable by his interruptions and insults, and by his steadfast refusal to adhere to any semblance of debate rules. Pence and Harris interrupted each other plenty, and they talked over moderator Susan Page, but they did so in the normal way of a smooth, long-winded politician that viewers surely found familiar. Unlike Trump’s propensity for outright lies, their exaggerations and distortions were carefully cloaked in political rhetoric. When Harris attacked the Trump administration’s response to the pandemic as a “failure,” for example, the vice president slyly tried to accuse her of insulting the American public instead.
Read: The man who wouldn’t shut up
Both candidates played their roles effectively. Pence defended the administration’s record and softened Trump’s rough edges, substituting a measure of eloquence for the president’s bluster. He said the administration would “follow the science” on a COVID-19 vaccine, even though the president has dismissed science, and he said “the climate is changing,” even as Trump repeatedly calls climate change “a hoax.” The vice president highlighted Trump’s belated denunciation of white supremacy, despite the president’s habitual refusal to do so at important moments. Harris, the former prosecutor, turned just about every question into an indictment of the Trump presidency, including its handling of the pandemic and the economy and its attempt to eviscerate the health-care protections of the Affordable Care Act.
Trump was, of course, an invisible star of the night. It was his record up for debate, and his name was mentioned, on average, once a minute. But his mere absence transformed the forum into something quieter, more approachable. It served as a reminder that although the fissures in American society that he has exploited predate his arrival as a politician, the chaos of the past four years belongs to him. Trump is the chaos, and without him, there is no chaos. At least that’s the easy answer. When Pence was given a chance to guarantee a peaceful transfer of power if Biden wins, he, too, refused to do so—though in his typical fashion, the answer was a simple deflection, not a veiled threat laden with the suggestion of violence. Trump’s exit won’t erase the deep political disagreements Americans have, nor will it automatically restore the norms he has weakened. But tonight’s debate hinted that, at a minimum, those battles will proceed more civilly.
If that is the main takeaway that viewers have, perhaps the advantage goes to Biden, no matter how effectively Pence made the president’s case tonight. After all, it is Biden who is offering America a return to normalcy—a calmer, yes, even a more boring presidency. Tonight the country saw what that might look like. It watched, in Pence and Harris, a pair of career politicians take the stage once again, offering a window into a world without Donald Trump at its center.


theatlantic--2020-10-08--When the Chaos Candidate Goes Missing

When the Chaos Candidate Goes Missing