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Neera Tanden’s Nomination Has to Die So Decency Can Live Again

Andrew Harnik/Getty

Neera Tanden has mean-tweeted that Tom Cotton is a “fraud,” that “vampires have more heart” than Ted Cruz, and that Susan Collins is “the worst.” Fact check: mostly true.

Still, it’s good that her mean tweets will probably doom her chances of being confirmed to head the Office of Management and Budget. You reap what you sow, and Tanden deserves this.

For those of you just now joining this melodrama, Tanden’s confirmation hopes went on life support this week after announcements from Democrat Joe Manchin and Republicans Susan Collins and Mitt Romney that they would not support her nomination.

Read more at The Daily Beast.

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A pharmacy technician holds a dose of the Johnson & Johnson Covid-19 vaccine before it’s used for a clinical trial on December 15, 2020, in Aurora, Colorado. | Michael Ciaglo/Getty Images The vaccine is very effective — and most importantly, it only requires one shot. One big reason to be excited about the new Johnson & Johnson vaccine for Covid-19, which was authorized by the Food and Drug Administration over the weekend for emergency use in the US: Unlike the Moderna and Pfizer vaccines already in use, it requires only one shot for full protection. That’s a big deal. From a practical standpoint, it means that the new vaccine could really speed up America’s vaccination campaign — certainly more than another two-dose vaccine would. It also fixes a problem that’s long bedeviled medical treatments that require multiple doses: A lot of patients tend to drop off after the first appointment. “Especially when you’re trying to think about a massive public health program like this vaccine rollout, a single-dose vaccine would have made it much, much simpler” if it were the first to get approval, Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, told me. Some have been skeptical of the Johnson & Johnson vaccine because the reported data on its efficacy was lower than that from the Moderna and Pfizer vaccines. Initially, the vaccine was reported at 66 percent effectiveness against Covid-19, which paled in comparison to 90-plus percent for the other two authorized vaccines. But in many ways, that’s looking at the wrong number. The vaccine’s effectiveness at preventing people from getting sick with symptoms is arguably much less important than the vaccine’s effectiveness against hospitalization and death. And there is the promising news: In trials, the Johnson & Johnson vaccine brings both of those down to zero. It squashes the biggest thing that made Covid-19 so threatening to people: its ability to kill. Given the ongoing supply constraints and high demand, experts say people should get whichever vaccine is first available to them — that’s how we’ll beat Covid-19 as quickly as possible. But for people who are bad at follow-up appointments (including me) and from a broader public health perspective where speeding and smoothing the vaccine rollout is crucial, the Johnson & Johnson vaccine and other one-shot inoculations are genuine game changers. 1) The one-shot vaccine we have is really effective In non-pandemic times, Americans deal with common infectious illnesses that don’t force society to shut down schools, businesses, and other interactions with people outside our households. Nobody likes getting the common flu or cold, but because most of us don’t expect it to hospitalize or kill us, we by and large just live with them. (Though, seriously, more people should get their flu shots — that would still save lives.) This is the marvel of the Covid-19 vaccines approved so far: They turn the coronavirus into something much more manageable, like a cold or flu. Some people who get the vaccine may still develop sniffles or even a fever if the virus infects them. But based on the clinical trial and some real-world data, the risk of severe illness, hospitalization, and death drops massively — to zero or almost zero, particularly for hospitalizations or deaths. The Johnson & Johnson vaccine is no different in this regard. According to data released by the FDA last week, the clinical trials found an efficacy rate of about 72 percent in the US. But that’s the number that only tells us about any symptomatic infection, down to the sniffles or a short-lived fever. For hospitalizations and death, the Johnson & Johnson vaccine reported 100 percent effectiveness after 28 days (all of the vaccines so far take weeks to build up the body’s defenses). So Johnson & Johnson’s vaccine might not be as effective as the competition against the milder symptomatic cases, but it’s as effective for the kinds of illnesses that make Covid-19 truly scary. “I would take it,” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told me. “A lot of us who look at the data say we would definitely take a vaccine that’s that effective.” One of the big concerns right now is whether the vaccines work against Covid-19 variants. There, too, is good news: Johnson & Johnson ran part of its trials in South Africa, where the variant with the most confirmed effect on immunity has shown up. The vaccine still worked, with a 64 percent overall effectiveness against any symptomatic disease and 100 percent effectiveness against hospitalization and death. There are still some genuine unknowns about the vaccine. We don’t know how much it stops the spread of the disease, although the early data suggests it likely has at least some effect. Some of the data indicated the vaccine might not be quite as effective among older populations with comorbidities like heart disease or diabetes, but the sample size was too small to draw hard conclusions. For the vast majority of people, though, the Johnson & Johnson vaccine does exactly what you would want it to do: It makes it so Covid-19 is no longer deadly — the kind of pathogen you can give as much thought to in any given year as a common flu or cold. 2) A vaccine that doesn’t require follow-up is a big deal In health care, simply getting people in the door can be the first big hurdle. People in need might not have health insurance or be able to afford care. Even if they have insurance, they can have other problems — inconsistent transportation or an inflexible job schedule — that make them less likely to end up at a doctor’s office. Or people might think too much of their own health because they’re young and fit, or they might not like going to the doctor. This is a well-known problem in public health. For some people, getting multiple doses of a treatment is “a lot,” Saskia Popescu, an infectious disease epidemiologist at George Mason University, told me. “That’s why it’s really hard to get people to get their full hep B vaccine.” Studies back this up. As Dylan Scott wrote for Vox: [B]ased on research that evaluated compliance with other multi-dose vaccines, patients are really, really bad at getting their second dose. Bad as in, as many as half of patients never do. Studies conducted in both the US and UK on the hepatitis B vaccine — which, like the Covid-19 vaccines, is supposed to have around a one-month period between the first and second doses — found that roughly 50 percent of patients failed to get their follow-up shot within a year after their first. 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In the US, about 14 percent of the population has gotten the first dose of a Moderna or Pfizer vaccine, while just 7 percent has gotten the second dose, according to the New York Times. Some of this is because the rollout is still in its early stages, but nearly 3 million Americans haven’t received their second vaccine doses on time. How much the gap between first and second doses closes — or widens — will show the need for Johnson & Johnson’s vaccine and other one-shot vaccines. 3) A one-shot vaccine could really speed our path to herd immunity One of the most obvious benefits to a one-shot Covid-19 vaccine is it could dramatically speed up — literally double — the US’s vaccine rollout. Over the past couple of weeks, America has hovered around 1.5 million vaccine doses a day. That number had been steadily climbing until the recent snowstorms, which temporarily slowed things down. But imagine the US somehow gets stuck at the current rates. 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Like the rest of us, he’s been making his way through the plodding, gray nothingness of this pandemic, and from talking to him, it’s clear that live basketball has been a respite — like any sports fan, he’s relying on the nightly slate of games to break up the interminable doldrums. We talked about that, as well as his anxieties heading into the bubble, and how, in the absence of a rowdy crowd, energetic announcing is the best way to motivate the home team out of a timeout. What do you remember about getting invited to go to the NBA bubble? When they first started talking about the bubble, I was concerned that I wasn’t going to be able to call the rest of the season. I was like, “Will they bring any announcers down there? How will this work?” As I learned more details, I resigned to the idea that I probably wouldn’t be calling any more games. But then they announced that teams could bring down some individuals, and I wondered if I’d get the call. I didn’t reach out to the Nuggets, I just kinda waited around to hear. Then one day, they contacted me and said, “Hey, the NBA wants you in the bubble, is that something you could do?” I talked about it with my wife. As long as she was on board, I was on board. I got approval from my day job, because at my company, we’ve all been working from home. So I figured I could work from everywhere. So you were working from your hotel room in between your time calling the games? Absolutely. A lot of people were in the bubble because their job demanded it. But I was working full time down there as well. Were you nervous about going down there? “Once the ball goes up, it’s just basketball” It was like, “Okay, what’s it going to be like in the bubble? Am I going to be safe?” We had to quarantine for seven days, and I didn’t know what that was going to be like. But I was quarantining at home, so switching to a hotel room felt kinda normal. It wasn’t as bad as I thought it was going to be. One of my biggest concerns was flying down there and going through the airport. There were a few Denver TSA employees who had come down with Covid, and I knew Orlando was a hot spot at the time. So landing in that airport was also kind of concerning. I had my N95 mask, I didn’t touch anything, and didn’t eat anything, I just got through it. The NBA has done a lot of work to create a sense of normalcy during both the bubble and this current season. A big part of that is having a PA announcer making the calls, even if there isn’t a crowd around. Is that important to you? Do you believe that you’re responsible for creating that normalcy? My mentality has shifted from trying to encourage the crowd to just trying to encourage my team. You realize the crowd isn’t there, but the people pumping in the fake crowd noise have gotten really good at it. For me, it’s like they feed off my reactions and what’s going on in the game, and if you close your eyes, when everything is in sync, it feels like there’s a crowd in the building. Once the ball goes up, it’s just basketball. Was there an adjustment period for you? Was it awkward at all at first announcing for no people? Or did you find it pretty seamless? For me, it wasn’t. Going into the bubble, I felt like my purpose was to remain professional at all times and really support whatever team I’m calling for. It was just part of the job for me. I don’t think about the lack of a crowd. We’re playing, and let’s try to get a victory. I was watching a Cavaliers game a couple days ago, and after coming back from commercial, their PA guy said something like, “Everyone wins free curly fries from Arby’s!” as part of a giveaway — even though there were maybe a couple thousand people in the stands. Are you still doing stuff like that? How much have you cut out from your announcing schedule? We’ve cut out anything like that. It’s funny, there are certain things we’d do with our crowd where I’m like, “Well, can’t do that now.” One tradition we have is that nobody sits down until we score our first bucket. I feel that in my brain, but I’m not actually saying it. We’ve done free Chick-fil-A nuggets in the fourth quarter if the other team misses two free throws, and I yell out, “Free chicken!” And those moments are definitely not there. We had our mascot Rocky hit his world-famous backward basketball shot, and that was sponsored, so we’re not doing that as well. We miss that stuff, we look forward to having them again. Also, I have a lot of calls that are crowd-specific. If our guy hits a three-pointer, I’ll say, “So-and-so for one, two,” and the crowd shouts “three.” But we went and recorded a crowd yelling “three,” so we can still do that. If there’s a traveling violation, I’ll say, “Whose ball?” And we have a recording of “Nuggets’ ball!” Justin Edmonds/Getty Images Speller announcing with a crowd of fans behind him, in 2012. One of the narratives during this NBA season is that we’ve had a lot of blowouts. One of the theories behind that is that, without a home crowd, players can’t latch onto that energy when they’re down 10 to go on a run. Have you felt that at all in your games? Have you been able to fill that void? I think on occasion it has happened with our squad. I’m just an announcer, so who knows, but there’s been a couple games where we picked up our intensity, and so did they. There was one time where our guys were down, and I was frustrated by their performance, and I wasn’t feeling like doing anything at that moment. My boss was like, “You know what, let’s give it a shot.” So he picked up his energy, and the next thing we knew, the momentum shifted and we won that game. This is my 16th season, and there’s been numerous times where I’ve been a part of that. But there’s also been times where we tried to pick up our intensity and it worked for a minute, but we still wound up taking an L. But I do think we’re making a difference. We’re coming up on a year since the last time you had a home court full of fans. How much do you miss it? I can’t wait for them to come back. It’s just not the same. We’re holding it down until they can come back. And when they do? Oh, man, it’s gonna be awesome. There are certain fans that are season ticket members, and you get used to knowing where they are every game. We’re a big family. I miss those folks.
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