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      'Very worst of the pandemic' ahead in US with no apparent strategy, experts say

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      A lame-duck presidency and political gridlock after a bitterly fought election are set to worsen the US’s coronavirus crisis just as the pandemic enters its deadliest phase, according to health experts.With two months to go before a presidential handover from Donald Trump to Joe Biden, the federal government’s strategy for containing the virus has experts worried.Outside of embracing conspiracy theories, Trump administration officials appear to have pinned their hopes on improved testing and eventual vaccine approval.“The strategy, if you can summarize in one word, is hope,” said Dr Carlos del Rio, executive associate dean of the Emory School of Medicine and Grady Health System in Georgia. “And hope is not a strategy.”And as Covid-19 cases surge, the economic recovery falters and coronavirus government aid runs out, the lack of a coordinated response to the pandemic during the interregnum will have serious consequences, according to experts.“We are heading into the very worst of the pandemic right now,” said Dr Megan Ranney, an emergency room doctor at Brown University who has lobbied to protect healthcare workers during the pandemic. “The degree of spread of this infection and its toll on our country is going to be, to a large extent, determined by what happens in the next two months.”The swell of autumn Covid-19 cases is already proving to be the most intense period for new infections of the entire pandemic. By various counts, the US broke a world record for new cases – 100,000 in a day – this week. Those new infections will portend new hospitalizations, and eventually deaths. Already, more than 230,000 Americans have died from Covid-19.“If we don’t do anything to stop it, we are in the trajectory going straight up,” said Del Rio.Del Rio predicted the United States could see 200,000 cases a day by Thanksgiving, if Americans do not adopt social distancing and universal masking immediately.There are other grim signs. The nursing home industry, which cares for America’s most medically fragile residents, has warned that Covid-19 cases among the elderly and infirm are growing because of intense spread in surrounding communities.“It is incredibly frustrating,” said Mark Parkinson, president and CEO of the American Health Care Association, an industry group for private nursing homes. “If everybody would wear a mask and social distance to reduce the level of Covid in the community, we know we would dramatically reduce these rates in long-term care facilities.”Nursing homes house less than 1% of the population, but represent more than 40% of deaths.Hospital administrators are scaling back non-urgent, but medically necessary, surgeries which serve as one of their largest sources of profit. State governments in the upper midwest are setting up field hospitals, but staffing will be difficult with increased spread and worker burnout. More

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      'The system is broken': Americans cast their vote for better healthcare

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      Ramae Hamrin was a high school math teacher in rural northern Minnesota, in a small town with a Paul Bunyan statue and snow on the ground by October.
      Hamrin, 50, instructed low-income students in calculus. It was not an easy job, but it provided health insurance for her and her three children. When it came to voting, like many Americans, she was put off by the two-party system. She voted third-party and often libertarian.
      Then, Hamrin slipped, fell and broke her hip. She went to hospital, doctors discovered a 9-centimetre (3.5-inch) lesion on her femur, and within weeks was diagnosed with cancer: multiple myeloma. Within two years, she was unable to work, permanently disabled by the ravages of cancer treatment.
      “Before I got diagnosed, I would have never thought about healthcare or drug prices,” as a voting issue, said Hamrin. “Now, really that’s my only issue.”
      This year, she said, she is voting one way: “strictly Democratic”.
      With the US election just over a week away, Hamrin is one of millions of Americans who’s been heading to the polls this fall with healthcare and drug prices as their top voting issue.
      The United States’ massive, largely private and very expensive health industry has ranked as a top voter concern for years, and helped drive Democrats to victory in the midterm elections of 2018, when the party took control of the House of Representatives.
      But over the last six months of the coronavirus pandemic, which has killed more than 220,000 Americans, Covid-19 eclipsed healthcare as the top issue of the election, though health voters like Hamrin argue the two are inseparable. Her daughter, an accomplished cross-country runner in college, was diagnosed with Covid-19 and now needs an inhaler.
      “I do trust the Democrats more than I trust the Republicans to get anything done on this issue,” said Hamrin. Although, she added: “It’s hard to know who to trust these days.”
      Although healthcare reform elicits concern across parties, it’s one in which Democrats hold a huge advantage. Biden has a 20-point lead over Trump on issues ranging from how to lower Americans’ health costs and to how to protect people from loathed insurance industry practices.
      “Covid has made us all healthcare voters,” said David Mitchell, founder of Patients for Affordable Drugs, one of a handful of advocacy groups which does not take money from pharmaceutical companies. More

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      Trump v Biden: the key moments of the final presidential debate – video highlights

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      Joe Biden and Donald Trump have gone head-to-head for the last time before the US election on 3 November in the final television debate, helped by a mute button on the candidates’ microphones that prevented interruptions.
      Squaring off in Nashville, Biden had to field aggressive questioning about his son’s business dealings and when Trump compared himself to Abraham Lincoln, the challenger branded his opponent ‘one of the most racist presidents we’ve had in modern history’. Here is a look back at the key moments
      The final presidential debate – as it happened
      Troubled Florida, divided America: will Donald Trump hold this vital swing state? – video
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      How Trump success in ending Obamacare will kill Fauci plan to conquer HIV

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      In his State of the Union address in February 2019, Donald Trump vowed to end the HIV epidemic by 2030.
      But if Trump has his way and the supreme court strikes down the Affordable Care Act (ACA), the resulting seismic disruption to the healthcare system would end that dream.
      Democrats have expressed grave concern that if Amy Coney Barrett is seated on the supreme court, the conservative jurist could cast a decisive vote to destroy the ACA in the California v Texas case scheduled for oral argument starting 10 November. The Senate judiciary committee will vote on Barrett’s nomination on Thursday. A full Senate vote is expected on Monday.
      The brainchild of Dr Anthony Fauci and other top brass at the Department of Health and Human Services, the ambitious Ending the HIV Epidemic: A Plan for America has received for its debut year $267m in new federal spending, largely targeted at HIV transmission hotspots across the US. More

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      American Crisis review: Andrew Cuomo on Covid, Trump … and a job with Joe Biden?

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      On Thursday, the US reported 65,000 new cases of Covid-19 and Donald Trump falsely told a television town hall 85% of people who wear masks contract the disease. With more than two weeks to the election and a record-shattering 17 million Americans having already voted, the rhythms and tropes of the past seven months will only intensify between now and 3 November.Early in the pandemic, Andrew Cuomo’s daily briefings emerged as must-see television, counter-programming to the campaign commercials that masqueraded as presidential press conferences. The New York governor was forthright and reassuring, even as the body count mounted.Covid-related deaths in the Empire State now exceed 25,000, the highest in the US. New York was both frontline and lab experiment. What happened there foreshadowed national tragedy. Red states were not immune. Right now, the plague rages in the heartland.Cuomo’s new book, subtitled Leadership Lessons from the Covid-19 Pandemic, is his effort to shape perceptions of his own performance amid the pandemic while pointing a damning finger at Trump and Bill de Blasio, New York City’s woefully inept mayor. Like the governor, American Crisis is informative and direct – but not exciting.I believe that this was on a par with the greatest failure to detect an enemy attack since Pearl HarborAndrew CuomoThe book reads like a campaign autobiography except that Cuomo, by his own admission, will never run for president. It contains its share of heroes, villains and family vignettes. Cuomo’s three daughters appear throughout.Like the governor, American Crisis is programmatic, neither poetic nor poignant. Indeed, in a final chapter tritely titled A Blueprint for Going Forward, the governor offers 28 pages of policy proposals.Covid has taken nearly 220,000 American lives. The US suffered 58,000 combat deaths in Vietnam, 116,000 in the first world war. Only the second world war, the civil war and the flu pandemic of 1918-1919 resulted in greater casualties.Not surprisingly, Cuomo saves his harshest words for the Trump administration: “New York was ambushed by Covid. I believe that this was on a par with the greatest failure to detect an enemy attack since Pearl Harbor.”On that score, Cuomo compares Trump to FDR and of course finds him wanting. The administration did deliver early warnings – to members of the financial community and Republican donors. With that in mind, Cuomo’s take is almost mild.Cuomo’s relationship with the president was already fraught. On top of Trump and congressional Republicans capping deductions for state and local taxes, the governor acknowledges fighting with the administration over “immigration policy, environmental policy, you name it”. He adds: “I found his pandering to the far right alternately disingenuous and repugnant.”American Crisis also relays a conversation with the president in which the governor urged the former resident of Queens, a borough of New York City, to invoke the Defense Production Act and mandate private industry to produce tests and personal protective equipment. Trump declined, claiming such a move would smack of “big government” – as opposed to issuing diktats to big tech, directing that companies relocate, unilaterally imposing tariffs on imports and offering private briefings to those favored by the administration.Time has passed. In the 1980s, Governor Mario Cuomo and his son Andrew were Trump allies, of a sort. Back then, Trump retained the services of twentysomething Andrew Cuomo’s law firm, in connection with commercial leases on Manhattan’s West Side. According to Trump, they were “representing us in a very significant transaction”. Not any more.The president is not the only member of the administration to come in for criticism. Mark Meadows, the latest White House chief of staff, receives a large dollop of Cuomo’s wrath. In Cuomo’s telling, Meadows conditioned assistance to New York on it conveying hospital test results for hydroxychloroquine, Trump’s one-time Covid treatment of choice.Cuomo said the state would provide the test data once it was available, not before. Meadows told him the federal government was ready to release hospital funding to states, but “strongly implied” that if the test results did not soon arrive, New York would not “receive any funding”. To Cuomo, that reeked of extortion. More

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      Amy Coney Barrett: key moments from the supreme court confirmation hearings – video

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      Amy Coney Barrett spent most of her time avoiding key questions during three days of Senate hearings to confirm her as a supreme court justice. 
      Barrett would become the third justice on the court to be appointed by Donald Trump – and her confirmation would give conservatives a bulletproof, six-justice majority on the nine-member court, which decides cases by a simple majority.
      Barrett, a conservative Christian who has criticized the high court’s decision to uphold the Affordable Care Act (ACA), who has publicly opposed reproductive rights and who was a trustee at a school whose handbook included a stated opposition to same-sex marriage, is seen on the left as part of a power play by Donald Trump 

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