Esper Is Out

Jim Mattis was Donald Trump's original Secretary of Defense. However, after about a year, the President grew disenchanted with "Mad Dog," and after a few months in the Mad Doghouse, Mattis was out. He was ultimately replaced by Mark Esper, who also pleased the President for about a year, and then also ended up in the doghouse. On Monday, the new Secretary met the same fate as the old Secretary, and was asked for his resignation, via Twitter, which he gave, not via Twitter.

This development was about as foreseeable as the President claiming victory on election night, or the sun rising in the east, or the Steelers losing to the Packers in the Super Bowl. Absolutely everyone knew it was coming, including Esper himself. He actually drafted his resignation letter a couple of weeks ago, and had it sitting in his desk drawer, ready to go. His unpardonable sin, committed back in June, was refusing to deploy soldiers against protesting civilians. The (now-former) Secretary is a dyed-in-the-wool conservative, but doing that was just a tad bit too authoritarian for his tastes. Since that time, he's been frozen out of the administration's decision-making process.

Esper will be replaced by Christopher Miller, who has been serving as director of the National Counterterrorism Center. Miller will presumably be the interim secretary for the balance of Trump's term, since the President prefers interim secretaries anyhow, and the Senate isn't likely to waste the time needed to confirm someone if they are only going to serve for 70 days or so. There was some gnashing of teeth and rending of garments at the news, on the theory that Trump is installing a loyalist at the Pentagon so he can do something nefarious, like nuke Mexico or, for that matter, deploy troops against American citizens.

It is certainly possible that Trump is thinking this way; we long ago gave up on trying to understand his thought process. However, it does not matter who is serving as secretary—they are merely a conduit between the White House (which gives the orders) and the military leadership (who carries them out). The President can skip the middle man, if he wants, and go right to the military. So, the person who occupies the Secretaryship is irrelevant. And whether or not a middle man is used to convey orders, the generals and admirals have a right and a legal and moral responsibility to refuse unethical orders. This they will surely do, if it comes to that, particularly when dealing with a lame duck president who has a reputation for being impetuous and reckless.

Rather than laying the groundwork for some sort of wild abuse of power, it is more likely that Trump is angry (and frightened?) about losing the election, and is lashing out, as he is prone to do. It is entirely plausible that other Cabinet or Cabinet-level officials could be axed this week; FBI Director Christopher Wray and CIA Director Gina Haspel, both having angered Trump due to their refusal to investigate the "deep state," are the likeliest candidates for the unemployment line.

Another possibility for the chopping block is AG Bill Barr. Although he's been among the most loyal of Trump foot soldiers, bending both law and ethics the way a black hole bends light, he ultimately failed to come up with a usable October Surprise, with the result that Trump threatened his job just a few weeks ago. Barr clearly saw which way the winds were blowing, and so on Monday issued a memo authorizing all federal prosecutors to "pursue substantial allegations of voting and vote tabulation irregularities prior to the certification of elections in your jurisdictions." It is irregular to look into this issue without actual evidence, particularly before results are official or even tentatively complete. So irregular, in fact, that the Dept. of Justice's top election crimes prosecutor, Richard Pilger, promptly resigned in protest.

We have no reason to believe that Pilger's resignation was prompted by anything other than a sense of duty and propriety. That said, there are undoubtedly a lot of people in this administration who are looking to get out while the gettin's good, and to put some distance between themselves and Trump. And that will be on top of the firings that are surely coming. So, we could be looking at quite the bloodbath between now and Jan. 20. (Z)

Three GOP Lanes Are Forming

Let us begin with three propositions that are, we would say, incontrovertible:

1. Joe Biden has won the presidential election.
2. Donald Trump, at least publicly, has refused to accept that.
3. Nobody knows exactly what the post-Trump Republican Party will look like.

As a consequence of these things, the GOP is currently sorting itself into three distinct factions as regards the election results:

1. The Realists: These are the folks who dream of returning the Republican Party to what it was 10 years ago, namely the party of John McCain and Mitt Romney. Some (or maybe all) of them because they care about their party and/or their country, and some of them because they clearly plan to run for president in 2024 in the "return to normalcy" lane. Thus far, only four GOP members of the Senate have publicly congratulated Biden on his victory: Susan Collins (R-ME), Lisa Murkowski (R-AK), Mitt Romney (R-UT), and Ben Sasse (R-NE). Of those, all are "Romney" Republicans, and Sasse is most definitely eyeing a 2024 run. Similarly, Gov. Larry Hogan (R-MD) appeared on CNN on Sunday and said "Whether you like it or not, it's time to get behind the winner of the race." When asked if he was going to run for the White House in 2024, Hogan hemmed and hawed and came up a couple of light years short of the Full Sherman. So, add his name to the list of normalcy candidates, as well.
   
   
2. The Denialists: These are the folks who continue to parrot the President's talking points lock, stock, and barrel. This list includes Press Secretary Kayleigh McEnany, presidential adviser Corey Lewandowski, TV lawyer and lawn care enthusiast Rudy Giuliani, AG Bill Barr (see above) and the Trump sons. You will notice that all of these people depend specifically on Trump's remaining in office, either for their influence, or for their jobs, or both. There are also a handful of Senators who are all-in on claims of fraud, like Ted Cruz (R-TX) and Josh Hawley (R-MO). Those two are also 2024 presidential candidates, in the Trump v2.0 lane.
   
   
3. The Pragmatists: This is the most interesting group, and is currently being led by Senate Majority Leader Mitch McConnell (R-KY). They are trying to thread the needle between Trumpism and post-Trumpism, and so their position on the election results is a bit more muted than that of either of the other two groups. On one hand, the pragmatists are refusing to recognize Biden's election. On the other hand, they are also refusing to commit to the notion that fraud and chicanery definitely took place. Instead, their position, as expressed by McConnell, is "President Trump is 100 percent within his rights to look into allegations of irregularities and weigh his legal options."
   
   The approach being taken by the pragmatists has little to do with the White House (which they know full well is lost), and everything to do with the two Senate seats in Georgia that are headed to a Jan. 5 runoff. What McConnell & Co. fear is that if they publicly accept Biden as president-elect, it will alienate Trump's base in Georgia, and the base will retaliate by sitting the special election out. If the pragmatist faction was to have its druthers, the "uncertainty" around the election would last into January, ideally keeping Trump's base motivated and on board the S.S. GOP. Failing that, they hope that the base will be satisfied that most Republican officeholders had the President's back until the bitter end, and will not be angry with the Republican Party when January rolls around. Put another way, the lion's share of Republicans in Congress (and in other offices) are willing to do further damage to the fabric of the American democracy in service of holding those two Senate seats. Apparently they do not take to heart Dante's admonition that "The hottest places in hell are reserved for those who, in times of great moral crisis, maintain their neutrality."

The Republican Party's self-sorting raises two important questions. The first, which is a short-term question, is whether Team McConnell can actually hold the various factions together through Jan. 5. It is supremely unlikely that the "doubt" about the presidential result can be dragged out for that long. In fact, it will be tough for Team Trump to keep it going until December, much less January. Our guess is that Republican turnout will be way down for the Senate races, not necessarily because of anger at the GOP establishment, but because of disappointment and because Trump's name will not be on the ballot. Of course, it is also possible that between now and January, the President will do something to drive an insurmountable wedge between factions of the Party. In that case, his base could absolutely be in the mood to punish the establishment.

The second question, which is obviously more long-term, is whether the pragmatists are just accommodating Trump one last time while he's still in office, or if walking the line between Trumpism and non-Trumpism will be a defining feature of the Republican Party going forward. If line-walking is required, it's not going to be easy, especially once Trump is completely unfettered, and can say whatever he wants on OANN or Fox News or social media. And if the line-walking is just temporary, well, it's clearly not going to be easy to keep the entirety of the Trump base in the tent (and getting out to vote). Either way, it is clear that McConnell, et al., realize they've got a real challenge on their hands. (Z)

COVID-19: The Short-Term Prognosis Is Not so Good...

Americans are getting more lax about COVID-19 prevention measures (more below). Further, the cold portion of the year is upon us, meaning a lot more time spent inside and in close proximity to others. And so, the number of cases is spiking. Perhaps it is appropriate that Election Day, the day that Donald Trump was subjected to the judgment of voters, was the first time the U.S. recorded more than 100,000 new cases. That has continued every day since, which means the streak has reached one week. Last week also saw 1,000 or more deaths for five days in a row. As of Monday, the U.S. has had more than 10 million total cases, and nearly 240,000 deaths. Both of those figures outpace every other country in the world. India is in second in cases with 8.6 million and third in deaths with 127,000 while Brazil is in second in deaths with 163,000 and third in cases with 5.7 million. Probably just a coincidence that the three countries with the worst outcomes are led by authoritarian types with a propensity for denying reality.

Unfortunately—and contrary to predictions from conspiratorial Republicans, including Eric Trump, that COVID-19 would disappear the moment the election was over—the country is clearly experiencing an R value greater than 1 right now. There is, in fact, no state currently trending downward. And so, things are going to get worse before they get better. In fact, it is probable that the U.S. will surpass 200,000 cases/day in the next few weeks. With 59,000 of the afflicted already hospitalized, that could push the nation's hospitals beyond their capacity, which is the disaster everyone most feared at the start of the pandemic.

Faced with these numbers, and with the looming disaster, any other presidential administration would surely treat this as time to pull out all the stops and to get all hands on deck. However, the current president concerns himself with only one thing: what is good for him. There is no real benefit to Trump in getting serious about the pandemic and, in fact, doing so would be tantamount to admitting he was wrong, which he simply does not do. And so, the White House is focused entirely on firing people (see above) and tilting at election-related windmills, and is doing nothing about COVID-19.

Actually, that's not completely true. The administration is doing one thing on the COVID front: They are helping to spread the disease. There was an outbreak in the White House last week, with six people, including Chief of Staff Mark Meadows, testing positive. Meadows tried to hide this news, and apparently remained on the job, which presumably caused additional folks to be infected. And then, on election night, Team Trump held a largely maskless superspreader event...er, election party. Among attendees, HUD Secretary Ben Carson and David Bossie, who is overseeing all the legal challenges to the election results, have already tested positive for COVID-19. Undoubtedly, others will follow; the only question is whether their diagnoses become public. (Z)

...But the Long-Term Prognosis Is Looking Better

As expected, President-elect Joe Biden unveiled the full membership of his COVID-19 Advisory Board on Monday. Here they are:

Person	Current Affiliation	Notes
Vivek Murthy, MD, MBA	Harvard Medical School	Advisory Board Co-chair; former Surgeon General
David A. Kessler, MD	Author	Advisory Board Co-chair; former dean of Yale Medical School and former FDA commissioner
Marcella Nunez-Smith, MD	Yale Medical School	Advisory Board Co-chair; research focuses on healthcare among marginalized populations
Luciana Borio, MD	VP at In-Q-Tel	Central figure in managing Obama-era pandemic responses
Zeke Emanuel, MD	University of Pennsylvania	Helped write the Affordable Care Act
Rick Bright, MD	None	Oversaw federal vaccine programs until being forced out on Oct. 6 of this year
Atul Gawande, MD	Harvard Medical School	MacArthur Genius Grant winner, has authored four books on public health
Celine Gounder, MD	NYU Medical School	Previously worked for the Gates Foundation; specialist in infectious diseases
Julie Morita, MD	Robert Wood Johnson Foundation	One of the United States' foremost experts on public health
Michael Osterholm, MD	University of Minnesota	Former State Department Science Envoy for Health Security
Loyce Pace, MPH	Global Health Council	Long career in public health, speaks five languages and has lived on three continents
Robert Rodriguez, MD	UCSF School of Medicine	Has treated many COVID-19 patients in both the U.S. and Mexico
Eric Goosby, MD	UN Special Envoy on Tuberculosis	Held many positions under Clinton/Obama, most notably U.S. Global AIDS Coordinator

Looking at the list, there are certain themes that stand out:

• Diversity: The team has cultural diversity, of course, beginning with the fact that the three co-chairs are Asian, white, and Black, respectively. Beyond that, however, the folks selected have a broad range of medical specialties (oncology, epidemiology, immunology, internal medicine, surgery, pediatrics, etc.) and areas of expertise.
  
  
• Familiarity: Although Team Biden made a point of including a few individuals (Bright, Osterholm) from the Trump administration, the majority of the advisory board members are people that served, at one time or another, under Barack Obama. Undoubtedly, some of them crossed paths with the then-VP as they worked on the cancer moonshot. And now, Joe Biden and his team presumably feel they know these individuals and can rely upon them.
  
  
• Expertise: Everyone on the list has an advanced degree and a commitment to evidence and the scientific method. The executive branch's war on science is going to end on Jan 20.

In short, if you are someone who hopes for an effective pandemic response from the government, you have to feel like the matter is now in very good hands. And this list doesn't even include the fact that folks like Anthony Fauci will soon find themselves with a seat at the table once again.

Meanwhile, at the same time the public sector appears to be getting its pandemic house in order, the private sector is making good progress. Specifically, Pfizer announced that its vaccine appears to be 90% effective at preventing COVID-19. Don't count the chickens before the eggs are hatched, of course, but Pfizer CEO Albert Bourla was ecstatic, opining that "I think that likely, based on impact, this will be the greatest medical advance in the last 100 years." Pfizer expects to request emergency FDA approval by the end of November, to administer up to 50 million doses this year, along with more than 1 billion doses next year.

Speaking from the vantage point of politics, the timing here couldn't have worked out much better for the incoming Biden administration. Perhaps the Trump administration deserves some of the credit for the possibly imminent vaccine. We are inclined to think Pfizer would have moved very rapidly regardless of who was in the White House or what they did. And it is also the case, as they pointed out after Mike Pence attempted to take credit, that they are not part of Operation Warp Speed. Anyhow, the successful vaccine—whether Pfizer's or that of some other concern—will mostly or entirely be administered under the Biden administration. Team Biden has also committed to a radically different tone and approach to the pandemic, which voters will surely notice.

And finally, and perhaps most importantly, time is on the President-elect's side. Donald Trump was absolutely correct when he intuited that the timing of the pandemic, vis-a-vis Election Day, was very bad for him. And because time was so tight, he chose a risky approach to COVID-19 that ultimately backfired on both him and on the country. Biden, by contrast, has no hard and fast deadline that he needs to meet. Undoubtedly, he will hope to dial down the pandemic (and the sickness and the death) as soon as practicable, but he doesn't need to take dangerous risks. Also, if harsh measures are needed (say, a total national lockdown), they can be imposed 18-20 months before the next election. Whatever annoyance is generated by such measures will surely dissipate, particularly if they work, and life returns to some semblance of normalcy.

In short, for anyone looking for the light at the end of the tunnel, a tiny, tiny pinpoint might just have presented itself on Monday. (Z)

COVID-19 Diaries: The Darkness Before the Light?

People who voted for Donald Trump mostly thought the economy and jobs were most important, while those who voted for Joe Biden were more concerned with the COVID pandemic. Now, Trump's presidency has become another casualty of the pandemic.

The soon-to-be-former President's continual assurances that we are "rounding the turn," and that the pandemic is almost over are reminiscent of one of the more memorable scenes from the movie "The Princess Bride": "You keep using that word. I do not think it means what you think it means."

In fact, the turn we are rounding is back towards exponential growth (see above for more). New Jersey is a good case study. It was one of the first states hit by COVID-19 and was hit very hard. For the early months, New Jersey, New York, and Massachusetts made up the majority of U.S. cases. I watched happily when New Jersey got the disease mostly under control, and went from a high of 3,000-4,000 cases a day down to a low of 300-400. But now, more and more people are going back to pre-pandemic behavior with an associated uptick. New cases have more than tripled since the start of September and there is no end in sight. Hospitalizations are up by a similar amount. And as sad as this is, New Jersey is not even in the top 10 states for new cases. The entire country has partly or fully surrendered, and is yielding to the grim prediction of Mark Meadows, who said shortly before the election that the U.S. is "not going to control" the spread of COVID-19. This was before his own diagnosis; one wonders if he still feels so cavalierly.

Many states are on an aggressive growth curve, including Texas, Wisconsin, Illinois, Michigan, Missouri, and Ohio. Some of the smallest (and reddest) states have the most aggressive growth: North Dakota, South Dakota and Wyoming.

The apathy on the part of the administration was on full display last month when Education Secretary Betsy DeVos declared that it is not her responsibility or that of the federal government to track school districts, their coronavirus infection rates, or how they are reopening. By contrast, Australia (my favorite winner in the COVID war) has only a handful of cases every day and virtually no deaths.

The problem is that COVID-19 is a very infectious disease. Either you take it very seriously or it spreads very rapidly. Think of it like a wildfire in a very dry area. Either you tamp it down with everything you have or it spreads like...well...wildfire.

The misinformation campaign being waged by the right is particularly destructive to public health:

• "We only have so many cases because we test so much."
• "Deaths are over-counted because doctors are paid to report COVID-19 deaths."
• "Everybody who dies has a pre-existing condition so COVID-19 wasn't the real cause of death."
• "Masks are useless because viruses are tiny and go right through."

And then there are the completely nutty theories:

• "5G networks spread COVID-19."
• "Drinking hot water cures COVID-19."
• "Eating garlic cures COVID-19."

A Cornell study on COVID misinformation found that a main source of misinformation was Trump (not a particularly startling result). I find the "Oh well, there is nothing we can do" attitude to be the most disheartening. Australia's success battling COVID-19 proves that it can be beaten but we, in the U.S., just choose not to. We can only hope that the advent of a new presidential administration and a new approach inspires Americans to once again get serious about the greatest public health disaster in recent memory. (PD)

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Dr. Paul Dorsey, Ph.D., works in medical software, providing software to support medical practices and hospitals nationwide.

Democrats Score Their First Big House Flip

This cycle, the Democrats were hoping to knock off a bunch of solid-red-district Republicans as part of Blue Wave v2.0. It didn't happen, of course; the new seats they captured were either open Democratic-leaning seats, or were handed to them by the redrawn map in North Carolina, or both. However, on Monday, the blue team officially flipped its first solid-red seat. GA-07 was open after Rob Woodall (R) announced his retirement, but it is also R+9. And now, it will be represented by Democrat Carolyn Bourdeaux, who came within a whisker of winning the seat in 2018, and has now pulled it off in her second attempt.

At the moment, all outlets project the Democrats to keep control of the House. With 218 seats needed to make that official, 216 have been called for the Democrats, 198 for the Republicans, and 22 are still pending. Of those 22, 10 are favored to go for the Democrats, 2 are expected to go for the Republicans, 8 are tossups, and 1 is headed to a runoff, likely between two Republicans (due to Louisiana's jungle-style primary). If we split the tossups equally, then it looks like the House will end up 230-205. At the moment, it is 232-197-1 with 5 seats vacant. So, the Democratic caucus is going to be a shade bit smaller, but not drastically so. (Z)

Bustos Is Done as DCCC Chair

This cycle, the Democrats essentially held serve in the House (see above). And, when all the numbers are crunched, it may turn out that holding serve was actually pretty good. However, given Democratic dreams of winning 10 or 20 or 30 seats, holding serve feels like a huge disappointment. And so that means that Rep. Cheri Bustos (D-IL), who has been chairing the Democratic Congressional Campaign Committee (DCCC) since 2019, won't be back for another cycle.

Democratic members had a number of criticisms of Bustos, including that she didn't do enough to push back on Republican attacks against Democrats, that she wasted resources on unwinnable districts, that she failed to modernize the DCCC's digital operations, and that her leadership team was not diverse enough. These issues, coupled with the returns at the ballot box, were enough to send Bustos packing, despite the record-breaking fundraising she oversaw this year.

The DCCC did quite well under its last chair, now-Senator-elect Ben Ray Luján, and it's looking like they may want to go with another Latino, as Reps. Tony Cárdenas and Linda Sánchez (both D-CA) are reportedly the frontrunners to replace Bustos. That said, once the results of the census are known, and various GOP-run states have been gerrymandered to the Nth degree, whoever gets the job may rue their "good luck." (Z)

Lots of news today, leaving too little time to score and format the remaining contest results. Tomorrow!

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