More than 60 infants younger than 4 months were hospitalized in the state. One died.

Whooping cough, or pertussis, is just the most stark example of what happens when vaccination rates decline. But it is far from the only one.

How measles, whooping cough, and worse could roar back on RFK Jr.’s watch

The pandemic interrupted childhood immunizations across the country, and rates have not yet recovered. As a result, hundreds of thousands of children are increasingly vulnerable to diseases once largely relegated to history books.

Most of them predominantly affect young children, like measles, mumps and rubella. But if immunizations continue to fall over the next few years — because of rising distrust, or more restrictive federal policies — preventable infectious diseases will resurface in all age groups, experts say.

“It might take a year or two, but there’s no question,” said Pejman Rohani, an infectious disease epidemiologist at the University of Georgia.

“We will have outbreaks,” he said.

It’s not just the unvaccinated who will have to worry. Even adults who were vaccinated decades ago may find themselves vulnerable to what are now considered childhood diseases.

Most people have forgotten the dangers of childhood diseases, said Dr. Alex Richter, a clinical immunologist at the University of Birmingham in Britain, where there are worrying upticks in measles and mumps.

Just a few decades ago, many children younger than 5 died from infectious illnesses. Now children are more threatened by traffic accidents, drug overdoses and gun violence while disease has faded as a concern.

“That could all change if we don’t continue with vaccine policies,” Richter said.

High vaccination rates in a community protect not just the vaccinated, but also people who cannot receive some vaccines or who may not respond to them because of certain medical conditions, their age or weakened immune systems.

If fewer people are vaccinated, “we are making an active decision to make the world a less safe place for a significant proportion of the population,” Richter said.

For example, rubella, or German measles, can be dangerous for pregnant women and their babies. Yet pregnant women cannot be immunized against the disease because the vaccine contains a weakened live virus.

These days, they are typically not at risk, because there are fewer than a dozen rubella cases in the United States each year. That may change if vaccination rates drop. Worldwide, rubella is the leading vaccine-preventable cause of birth defects.

“If you’ve got nonimmune mothers catching rubella, then you have the lifelong complications of blindness and deafness and everything else,” Richter said.

Elsa Sjunneson knows that only too well. Her mother was infected with rubella during an outbreak in New York City in 1985 when she was pregnant, and Sjunneson was born with congenital rubella syndrome, or CRS.

In her case, that meant thick cataracts, hearing loss and a heart defect.

Before her first birthday, she had two surgeries that mostly fixed the heart defect, and seven eye surgeries that did not entirely restore her vision. She is blind in her right eye, has limited vision in the left and still needs hearing aids.

“I actually was really lucky — a lot of people who were born with CRS didn’t survive,” said Sjunneson, who is a disability advocate and champions vaccination for rubella. “People don’t deserve to be exposed to diseases that can kill them.”

Anti-vaccine campaigns have often targeted the MMR vaccine, which protects against measles, mumps and rubella. Experts tend to worry most about a resurgence of measles.

The virus is extraordinarily contagious, lingering in the air for up to two hours after an infected person has left the room. Each infected person can spread the virus to as many as 18 others.

The past offers a preview: In the late 1980s, budget cuts by the Reagan administration brought down vaccination rates, particularly among low-income Black and Hispanic children.

The fallout was swift. From 1989 through 1991, measles infected more than 55,000 Americans and killed 166.

Vaccines for low income children lag behind, CDC study finds

Before the first measles vaccine was introduced in the 1960s, the disease killed an estimated 2.6 million people worldwide each year. The virus cripples immune defenses, leaving the body vulnerable to other pathogens.

A 2015 study estimated that before widespread vaccination, measles may have accounted for as many as half of all infectious disease deaths in children. Even now, the consequences can be serious. About 40% of people infected last year were hospitalized, according to the Centers for Disease Control and Prevention.

Before the pandemic, immunization rates for MMR and for pertussis held steady at roughly 95%, in part because of requirements for admission to public schools.

A drop during the pandemic was not surprising. But even as society has returned to normal, vaccination rates have continued to decline, dipping below 93% nationwide for the 2023-24 school year.

That means about 280,000 schoolchildren remain susceptible to these diseases, raising the risk of outbreaks in schools and other public spaces.

Unvaccinated adults are at risk, of course, but so are those who do not mount an adequate immune response to vaccines or who received only a single dose.

And there is another unexpected consequence to declining vaccination rates.

The immunity induced by some vaccines can wear off over the decades. The decline means that if outbreaks were to occur more often, even vaccinated adults might be vulnerable to certain illnesses.

In rare cases, for example, immunity gained from the measles vaccine may wane. Of the 284 measles cases recorded among Americans last year, 11% were in people who had received one or two doses of the vaccine.

That may help explain why 27% of cases were adults older than 20.

“We’ve now moved away from a time when measles was only in children,” said Alexis Robert, a research fellow in infectious disease modeling at the London School of Hygiene and Tropical Medicine.

Immunity against mumps also may decline. Although vaccination overall has decreased the number of mumps cases 99%, there have been outbreaks in schools and universities, where students have close, prolonged contact.

Mumps is often a mild condition in children, but it can sometimes cause fertility problems in boys and severe complications in adults.

But whooping cough may be the illness that even vaccinated children and adults should worry most about.

The illness may be mistaken for a typical respiratory infection at first, but it can bloom into a painful, full-body “100-day cough.” Each bout of coughing ends with a whooping sound, and may result in vomiting, cracked ribs and difficulty breathing.

Decades ago, the vaccine relied on whole cells from the bacteria that cause whooping cough. It was potent but harsh, often setting off high fevers and seizures.

“There’s no way, I mean absolutely no way, that parents would tolerate that sort of reaction currently,” said Dr. Kathryn Edwards, a vaccine expert who has studied pertussis for 40 years.

A newer version of the vaccine, introduced in the 1990s, is much easier on the body. In most people, this formulation provides decades of protection against severe disease.

But the new pertussis vaccines do not fully prevent infection, and sometimes, the protection wears off.

Experts now believe this is one reason that more adolescents than young children have become infected with whooping cough during outbreaks in recent years.

“That was really the first hint” of declining vaccine immunity, Edwards said. The CDC now recommends a booster dose for adolescents.

If the vaccination rates were to fall to 75% in the next few years, older adults who received the original vaccine might still be protected.

But people who were never immunized or adults who received the newer vaccine as children might be susceptible.

According to epidemiological modeling by Rohani and his colleagues, cases would rise most drastically in infants — who are too young to be fully vaccinated — and in children ages 5-15.

School-aged children tend to have the most contacts, so they are the “core transmission groups,” Rohani said.

He and other experts said they hoped vaccination rates would not tumble sharply, and worried about the consequences of even modest declines.

Vaccines are always a tougher sell than treatments, because they are given to healthy individuals, Richter said.

In the extremely rare cases when someone experiences a serious side effect, it can be catastrophic.

“All you need is one or two of those stories to have a massive impact on vaccine takeup,” she said. “This is where you have a tension between community and individual.”

This article originally appeared in The New York Times.

In fact, the researchers found, the shift to teletherapy has exacerbated existing disparities.

The increase in psychotherapy has occurred among groups that already enjoyed more access: people in higher-income brackets, living in cities, with steady employment and more education, researchers found in a series of studies, the most recent of which was published last week in The American Journal of Psychiatry.

Among those who have not benefited from the boom, the team found, are children from low-income families, Black children and adolescents, and adults with “serious psychological distress.”

“I think that the whole system of care — and maybe the internet delivery is a piece of this — appears to be pivoting away from those in greatest need,” said Dr. Mark Olfson, a professor of psychiatry at Columbia University Irving Medical Center and the lead author of the studies on access to care.

“We’re seeing that those with the greatest distress are losing ground, in terms of their likelihood of being treated, and that to me is a very important and disconcerting trend,” he added.

It wasn’t supposed to be this way. In the 1990s, teletherapy was championed as a way to reach disadvantaged patients living in remote locations where there were few psychiatrists. A decade later, it was presented as a more accessible alternative to face-to-face sessions, one that could radically lower barriers to care.

“Telehealth did not live up to the hype,” said C. Vaile Wright, senior director of the office of health care innovation at the American Psychological Association. The reasons, she added, are no surprise: Many Americans lack access to reliable broadband, and insurers do not adequately reimburse providers, who, in turn, choose to treat privately paying clients.

“If you can’t afford it, no matter the modality, you just can’t afford it,” Wright said. It may be, she added, that weekly therapy sessions are simply not scalable to a broad population and the field should explore light-touch alternatives, like single-session interventions and digital therapeutics.

As telehealth platforms grow, they may be attracting clinicians from community settings with the promise of flexible hours and better conditions, said Dr. Jane M. Zhu, an associate professor of medicine at Oregon Health and Science University who studies the accessibility of mental health services.

Selecting from a large patient pool, they may opt to treat patients with milder conditions and more ability to pay. “It’s certainly something we should know,” Zhu said. “There should be light around this. Who are these companies serving? And what does this mean for patients who are most in need?”

The percentage of Americans receiving psychotherapy remained relatively steady, at 3% to 4%, for decades before beginning a gradual rise, said Olfson.

Then two factors — the pandemic and the explosion of teletherapy — contributed to a sharp increase, with the number of adults receiving psychotherapy rising to 8.5% in 2021 from 6.5% in 2018. (By comparison, the annual percentage of adults taking psychotropic medication remained stable, at around 17.5%.)

Olfson said he was surprised by the magnitude of the increase. “We haven’t had something like COVID before, and we haven’t had this technology before,” Olfson said. “There was a lot of social isolation, a lot of loneliness. And those are things that psychotherapy is designed to address, in a way that medication can’t.”

The findings are based on the Medical Expenditure Panel Survey, which is conducted by the federal government and measures how American civilians use and pay for health care. The survey does not include those in the military, incarcerated or in nursing homes, hospitals or homeless shelters.

Previous studies, based on insurance data, showed that Americans’ mental health spending increased by 54% from 2020 to 2022, amid a tenfold increase in the use of teletherapy.

The new studies flesh out which Americans are receiving the care. An analysis of 89,619 adults published in JAMA Psychiatry last month found psychotherapy use grew most among the youngest respondents, among the most educated and among those in the highest two income brackets.

An analysis of the use of telehealth by children and adolescents from 2,445 households reached similar conclusions. The study found that children from wealthier families, using private insurance, were far more likely to use teletherapy. Children in urban areas were nearly three times as likely to use it as their rural counterparts.

During the years of the pandemic, the use of mental health services by Black children and adolescents decreased, falling to 4% in 2021 from 9.2% in 2019. In the same period, the use of mental health care among white children rose, to 18.4% from 15.1%, the team found in another study.

“What we find is that it does appear to be just exacerbating existing disparities,” Olfson said. “I think there’s a real need to try to address that.”

This article originally appeared in The New York Times.

Israeli Prime Minister Benjamin Netanyahu’s office identified the freed hostages as Romi Gonen, Emily Damari and Doron Steinbrecher. They were captured during the Oct. 7, 2023, Hamas-led attacks in Israel that set off the war. Israel was expected to release 90 Palestinian prisoners, all women or minors, later Sunday in exchange for the hostages.

In video released by the Israeli military, the released hostages are seen stepping out of a vehicle and walking under their own power, as they are handed over from the Red Cross to Israeli troops. One hostage, Emily Damari, has a bandaged left hand, and in a photo later posted online by the military, she appears to have lost two fingers on that hand.

As the truce took effect Sunday morning, joyful Palestinians honked car horns and blasted music in the central Gaza city of Deir al Balah, where celebratory gunfire rang out and children ran around in the streets.

And as Israeli officers said their forces had begun to withdraw from parts of Gaza, including two towns north of Gaza City, Hamas sought to signal that it was still standing and moving to reassert control, with masked gunmen taking to the streets in several cities. The Hamas-run police force in Gaza, whose uniformed officers had all but disappeared to avoid Israeli attacks, said that it was deploying personnel across the territory to “preserve security and order,” according to the government media office.

Achieving the agreement on a delicate, multistage ceasefire required months of talks mediated by Qatar, Egypt and the United States. The start of an initial, six-week phase on Sunday was delayed by almost three hours, with Israel saying it had not formally received the names of the first three hostages to be released. During the delay, the Israeli military continued striking targets in Gaza.

Here’s what we’re covering:

— Hostage and prisoner releases: Israel and Hamas have agreed to observe a 42-day truce, during which Hamas is expected to stagger the release of 33 of the roughly 100 hostages it still holds, some of whom are believed to be dead. In exchange, Israel is expected to begin releasing more than 1,000 Palestinian prisoners held in Israeli jails.

— Gaza’s destruction: The start of the ceasefire capped a 470-day war that has killed more than 46,000 Palestinians and injured more than 110,000 others, according to the Gaza health ministry, which does not distinguish between combatants and civilians. Much of Gaza has been destroyed, and most of its roughly 2 million people have been displaced at least once by the war, which began after Hamas invaded southern Israel, killing roughly 1,200 people and capturing 250 hostages.

— Humanitarian aid: United Nations trucks carrying humanitarian supplies began entering Gaza just 15 minutes after the ceasefire took effect, according to Jonathan Whittall, head of the U.N. humanitarian office for the Palestinian territories. The ceasefire deal calls for 600 trucks to be allowed to bring aid to Palestinians in Gaza daily, although it was not clear how the supplies would be distributed.

— Next phase: Big diplomatic hurdles lie ahead. Israel and Hamas reached the ceasefire agreement in part by putting off their most intractable disputes until a nebulous “second phase” that neither side is sure it will reach.

This article originally appeared in The New York Times.

At least three Be’eri residents who were abducted during the assault are still being held in the Gaza Strip. “Watching them come home would be a moment of real joy,” said Hegyi, who supports the deal. “We’re hoping for that.”

But the provisional ceasefire also underscored the fact that Hamas mostly remained in power in Gaza for now, despite 15 months of Israeli efforts to uproot the group by force, said Hegyi.

“I’m hoping for a ceasefire, but I know we’ll eventually go back to fighting,” he said.

Roughly 100 people were killed in Be’eri during the Oct. 7, 2023, attacks, according to Israeli authorities. The loss constituted almost 1 in every 10 people who lived in Be’eri, a small collective kibbutz just east of the border with Gaza.

Another village in southern Israel close to the border that was overrun by Hamas militants was Nir Oz. More than 50 people were killed and 70 others taken hostage from Nir Oz on that day, including Sagui Dekel-Chen, an Israeli American.

Jonathan Dekel-Chen, Sagui’s father, said he would feel relief only when his son and the other hostages in Gaza returned to Israel. Sagui, 36, is a father of three daughters, including one whom he hasn’t met.

“We’ve had too many disappointments, too many additional horrors over the course of these last 15 months,” Jonathan Dekel-Chen said. “So we are just taking this day by day.”

The residents of Be’eri once hoped to return to their homes without fear of another attack like the Oct. 7, 2023, incursion. But many now have begun to accept that any truce would most likely only pause, not end, the conflict with Hamas, said Hegyi.

“If we return to Be’eri, we’ll still be living under air-raid sirens and rocket attacks,” lamented Hegyi. “I don’t see there being peace. In order for there to be peace, there must be new leadership in Gaza and Israel, as well as years of quiet and education for peace and mutual understanding.

“What’s the chance of all that happening? Practically zero,” he added.

This article originally appeared in The New York Times.

Marion Nestle, an emerita professor of nutrition, food studies and public health at New York University, agreed to come to my local supermarket so we could look at food labels together. I also chatted with two other experts to learn how they make choices when they’re shopping.

Read labels and compare.

First, think of an ultraprocessed food you regularly buy: Maybe it’s frozen pizza or a packaged snack.

Then, go to a grocery store and read the label for that food. Note how many ingredients you don’t recognize. Take a few minutes and compare it with similar items: If you’re looking at strawberry yogurt, scan its ingredients list alongside those of other strawberry yogurts. Is there a less processed choice you can make that still falls within your price range?

Notice typical UPF ingredients.

As we cruised the aisles, Nestle flagged certain ingredients that signal that a food or drink may be ultraprocessed. These include thickeners like modified starches, gums (xanthan gum, guar gum), emulsifiers (like soy lecithin and carrageenan), sugar substitutes (like Stevia and Splenda), synthetic food dyes (like Red 40 and Yellow 5), artificial flavors and other ingredients that aren’t normally found in home kitchens or even stores.

And while the conventional wisdom is that a long list of ingredients means a food is ultraprocessed, that is not always the case, Nestle said.

Some frozen meals, for example, may have a lengthy list of ingredients, but all of them are recognizable, she said. From the freezer case, she pulled out a frozen lasagna made with ingredients like tomatoes, mozzarella cheese, beef and onions.

“Nothing artificial,” Nestle said.

Be curious about ingredients you don’t recognize.

Nutrition experts, even with their deep knowledge, still come across unfamiliar ingredients. During our trip, Nestle peered at the label of a flavored yogurt: “Cultured dextrose,” she remarked. “I don’t know what that is.” She looked it up and said that it appeared to inhibit bacteria growth in food.

If you encounter an ingredient that you don’t recognize, Nestle said, that may be a sign that it’s a UPF. She recommended checking the database of food additives from the Center for Science in the Public Interest, a nonprofit consumer advocacy organization. (Nestle and I did this right in Aisle 7.)

Then you can decide if it’s right for you. The presence of just one of these ingredients makes it an ultraprocessed food, but you may be fine with that, said Maya Vadiveloo, an associate professor of nutrition at the University of Rhode Island. If you see an emulsifier in a whole-grain bread, “it’s not necessarily a reason to not pick it up,” she said.

And some ingredients that are unrecognizable to many people may actually be vitamins, Nestle said, like sodium ascorbate (vitamin C), pyridoxine (vitamin B6) and alpha-tocopherol acetate (vitamin E). These do not make something a UPF, she said.

Don’t equate words like ‘wholesome’ and ‘natural’ with ‘unprocessed.’

Just because a food label contains a picture of a garden or words like “natural” or “plant-based” doesn’t mean it’s not ultraprocessed, said Josiemer Mattei, an associate professor of nutrition at the Harvard T.H. Chan School of Public Health.

Foods such as veggie burgers or frozen “healthy” meals can have many ingredients that make them ultraprocessed.

On the package, the manufacturer may list what is not in the food (“no trans fats,” “no high-fructose corn syrup”), but the item may contain other ingredients that make it a UPF, Mattei added.

Do a quick comparison of similar products.

I soon learned that the level of processing can vary wildly among my favorite snacks, even those from the same brand. When I showed Nestle my afternoon go-to — White Cheddar PopCorners — she examined the label and said it was ultraprocessed. Then she picked up the kettle corn-flavored version. “Aha,” she said. “Yellow corn, sunflower oil, cane sugar and sea salt. That’s it. Four ingredients. Not ultraprocessed.”

If you’re willing to make a relatively painless swap — like trading cheese for kettle corn — it’s worth taking a few minutes to scan labels for less processed alternatives, Nestle added.

When options are limited, look for short ingredient lists.

Later, Nestle and I drove to a convenience store, where I asked her to find some snacks that were not ultraprocessed.

Nestle grabbed an apple, orange juice, plain yogurt, salted pistachios and Fritos (its three ingredients — corn, vegetable oil and salt — make it a non-UPF), although the store did not have her preferred “lightly salted” version of the chips.

My diet will never be as wholesome as Nestle’s. (“One rule I have is never to eat anything artificial,” she said.) But I did note her unflagging energy at age 88: When I drove her back to the train station, she jogged briskly up the steps. I, however, needed a nap.

This article originally appeared in The New York Times.

As President-elect Donald Trump’s so-called Department of Government Efficiency girds for battle against “wasteful” spending, it is preparing to dispatch individuals with ties to its co-leaders, Elon Musk and Vivek Ramaswamy, to agencies across the federal government.

After Inauguration Day, the group of Silicon Valley-inflected, wide-eyed recruits will be deployed to Washington’s alphabet soup of agencies. The goal is for most major agencies to eventually have two DOGE representatives as they seek to cut costs like Musk did at X, his social media platform.

This story is based on interviews with roughly a dozen people who have insight into DOGE’s operations. They spoke to The New York Times on the condition of anonymity because they were not authorized to speak publicly.

On the eve of Trump’s presidency, the structure of DOGE is still amorphous and closely held. People involved in the operation say that secrecy and avoiding leaks are paramount, and much of its communication is conducted on Signal, the encrypted messaging app.

Trump has said the effort would drive “drastic change,” and that the entity would provide outside advice on how to cut wasteful spending. DOGE itself will have no power to cut spending — that authority rests with Congress. Instead, it is expected to provide recommendations for programs and other areas to cut.

But parts of the operation are becoming clear: Many executives involved are expecting to do six-month voluntary stints inside the federal government before returning to their high-paying jobs. Musk has said they will not be paid — a nonstarter for some originally interested tech executives — and have been asked by him to work 80-hour weeks. Some, including possibly Musk, will be so-called special government employees, a specific category of temporary workers who can only work for the federal government for 130 days or less in a 365-day period.

The representatives will largely be stationed inside federal agencies. After some consideration by top officials, DOGE itself is now unlikely to incorporate as an organized outside entity or nonprofit. Instead, it is likely to exist as more of a brand for an interlinked group of aspirational leaders who are on joint group chats and share a loyalty to Musk or Ramaswamy.

“The cynics among us will say, ‘Oh, it’s naive billionaires stepping into the fray.’ But the other side will say this is a service to the nation that we saw more typically around the founding of the nation,” said Trevor Traina, an entrepreneur who worked in the first Trump administration with associates who have considered joining DOGE.

“The friends I know have huge lives,” Traina said, “and they’re agreeing to work for free for six months, and leave their families and roll up their sleeves in an attempt to really turn things around. You can view it either way.”

DOGE leaders have told others that the minority of people not detailed to agencies would be housed within the Executive Office of the President at the U.S. Digital Service, which was created in 2014 by former President Barack Obama to “change our government’s approach to technology.”

DOGE is also expected to have an office in the Office of Management and Budget, and officials have also considered forming a think tank outside the government in the future.

Musk’s friends have been intimately involved in choosing people who are set to be deployed to various agencies. Those who have conducted interviews for DOGE include Silicon Valley investors Marc Andreessen, Shaun Maguire, Baris Akis and others who have a personal connection to Musk. Some who have received the Thiel Fellowship, a prestigious grant funded by Thiel given to those who promise to skip or drop out of college to become entrepreneurs, are involved with programming and operations for DOGE. Brokering an introduction to Musk or Ramaswamy, or their inner circles, has been a key way for leaders to be picked for deployment.

That is how the co-founder of Loom, Vinay Hiremath, said he became involved in DOGE in a rare public statement from someone who worked with the entity. In a post this month on his personal blog, Hiremath described the work that DOGE employees have been doing before he decided against moving to Washington to join the entity.

“After 8 calls with people who all talked fast and sounded very smart, I was added to a number of Signal groups and immediately put to work,” he wrote. “The next 4 weeks of my life consisted of 100s of calls recruiting the smartest people I’ve ever talked to, working on various projects I’m definitely not able to talk about, and learning how completely dysfunctional the government was. It was a blast.”

These recruits are assigned to specific agencies where they are thought to have expertise. Some other DOGE enrollees have come to the attention of Musk and Ramaswamy through X. In recent weeks, DOGE’s account on X has posted requests to recruit a “very small number” of full-time salaried positions for engineers and back-office functions like human resources.

The DOGE team, including those paid engineers, is largely working out of a glass building in SpaceX’s downtown office located a few blocks from the White House. Some people close to Ramaswamy and Musk hope that these DOGE engineers can use artificial intelligence to find cost-cutting opportunities.

The broader effort is being run by two people with starkly different backgrounds: One is Brad Smith, a health care entrepreneur and former top health official in Trump’s first White House who is close with Jared Kushner, Trump’s son-in-law. Smith has effectively been running DOGE during the transition period, with a particular focus on recruiting, especially for the workers who will be embedded at the agencies.

Smith has been working closely with Steve Davis, a collaborator of Musk’s for two decades who is widely seen as working as Musk’s proxy on all things. Davis has joined Musk as he calls experts with questions about the federal budget, for instance.

Other people involved include Matt Luby, Ramaswamy’s chief of staff and childhood friend; Joanna Wischer, a Trump campaign official; and Rachel Riley, a McKinsey partner who works closely with Smith.

Musk’s personal counsel — Chris Gober — and Ramaswamy’s personal lawyer — Steve Roberts — have been exploring various legal issues regarding the structure of DOGE. James Burnham, a former Justice Department official, is also helping DOGE with legal matters. Bill McGinley, Trump’s initial pick for White House counsel who was instead named as legal counsel for DOGE, has played a more minimal role.

“DOGE will be a cornerstone of the new administration, helping President Trump deliver his vision of a new golden era,” said James Fishback, the founder of Azoria, an investment firm, and confidant of Ramaswamy who will be providing outside advice for DOGE.

Despite all this firepower, many budget experts have been deeply skeptical about the effort and its cost-cutting ambitions. Musk initially said the effort could result in “at least $2 trillion” in cuts from the $6.75 trillion federal budget. But budget experts say that goal would be difficult to achieve without slashing popular programs like Social Security and Medicare, which Trump has promised not to cut.

Both Musk and Ramaswamy have also recast what success might mean. Ramaswamy emphasized DOGE-led deregulation on X last month, saying that removing regulations could stimulate the economy and that “the success of DOGE can’t be measured through deficit reduction alone.”

And in an interview last week with Mark Penn, the chair and CEO of Stagwell, a marketing company, Musk downplayed the total potential savings.

“We’ll try for $2 trillion — I think that’s like the best-case outcome,” Musk said. “You kind of have to have some overage. I think if we try for $2 trillion, we’ve got a good shot at getting one.”

This article originally appeared in The New York Times.

The notice Monday was one in a series of warnings issued by the National Weather Service about the powerful Santa Ana winds that were about to blow through Southern California, which hadn’t seen serious rain in months.

Officials in Los Angeles, a city that is accustomed to treacherous fire conditions, turned to a well-worn playbook. The city predeployed nine trucks in vulnerable areas and called in 90 extra firefighters. The county fire department moved 30 extra engines into the field and called up 100 off-duty firefighters. The U.S. Forest Service brought in trucks and support units as well as bulldozers, helicopters and planes.

But by Tuesday afternoon, five hours after a fire ignited high in a canyon in the oceanside Pacific Palisades neighborhood, it was clear their preparations would not be enough. As furious wind gusts approaching 100 mph tore through the city and propelled showers of embers that ignited entire neighborhoods, Anthony Marrone, the chief of the Los Angeles County Fire Department, stood at a command post on the edge of the Pacific Ocean.

Blasted by dust and dirt kicked up by the relentless wind, he snapped a picture with his phone of smoke obscuring the sun and looked out at a panorama of flames, smoke and debris. The fire, he thought to himself, looked unstoppable. It was moving “like a funnel, like a speedway,” he said. “I knew that if we had one start, we probably weren’t going to be able to contain it.”

The conflagrations that killed at least 11 people and destroyed thousands of homes have raised questions about whether the dozens of federal, state, county and city fire departments involved in this past week’s fire response deployed enough resources — and the extent to which modern firefighting tools are effective against the megafires that have become increasingly common in California over the past decade.

It was only hours before a situation that bore no resemblance to an ordinary red-flag alert, the kind set off when the Santa Ana winds blow in over the Mojave Desert from the inland West, began to evolve. A second huge fire broke out in Altadena, the unincorporated area adjacent to Pasadena, destroying more than 5,000 structures. A third ignited in Sylmar, to the north, and yet another, the next day, in the Hollywood Hills.

Marrone quickly acknowledged that the 9,000 firefighters in the region were not enough to stay ahead of the fires.

“We’re doing the very best we can, but no, we don’t have enough fire personnel,” he said at a news briefing Wednesday afternoon. “The LA County Fire Department was prepared for one or two major brush fires, but not four.”

The hurricane-force winds, low humidity and parched landscape created unusually perilous conditions: On the first day, when the Palisades and Eaton fires broke out, it was too windy by late afternoon to send up the aircraft whose drops of water and fire retardant might have helped slow the spread of the blazes.

Marrone said the parched terrain and the concentration of homes, surrounded by forested hillsides, also combined to create an indefensible landscape.

“The next time, I’m not going to do anything differently, because I don’t feel that I did anything wrong this time,” he said in an interview.

Los Angeles city fire officials had a similar view. “The fire chief did everything she could with the resources she had,” said Patrick Leonard, a battalion chief with the Los Angeles Fire Department, referring to the city’s fire chief, Kristin Crowley.

The question of resources will almost certainly arise in the weeks ahead as the fire response is analyzed. The Los Angeles Fire Department has said for years it is dangerously underfunded. A memo sent to city leaders in December by Crowley complained that recent budget cuts had “severely limited the department’s capacity to prepare for, train for, and respond to large-scale emergencies, including wildfires.”

But there are a host of other factors at play. Fire experts have long warned that climate change and more homebuilding outside urban areas are straining firefighters’ ability to prevent and contain fires. As fires have grown in size and complexity, California has explored mitigation through thinning brush out of forests, safer power grids and shoring up home protection. But it has been far from enough, they say.

The fires in Los Angeles have also raised the critical question of how departments can battle so many powerful infernos at once. After the Woolsey fire burned more than 1,600 structures in the northern part of the county in 2018 — at the same time that other major fires were raging across the state — Los Angeles County commissioned an assessment that found that the simultaneous outbreaks had slowed the ability of other fire agencies to fight the blaze because they were already busy.

Lori Moore-Merrell, the head of the U.S. Fire Administration, a division of the Federal Emergency Management Agency, who flew this past week to Los Angeles to inspect the firefighting efforts and damage, said she believed that the reason for the widespread devastation was not the firefighting response.

“They deployed enough,” Moore-Merrell said in an interview. “This fire was so intense. There isn’t a fire department in the world that could have gotten in front of this.”

The question of predeployment will almost certainly prove one of the keys to understanding the response.

It nearly always involves weighing a host of unknown factors. Firefighting experts agree that having engines and firefighters close to the site of an outbreak is essential, especially in very windy conditions; fires in those cases must be stamped out immediately, or they will very likely begin to spread out of control.

“Once a wind-driven fire is well established, you’re not going to put it out,” said Patrick Butler, a former assistant chief of the Los Angeles Fire Department who ran the response to many of the major fires the city has faced over the past decade.

With the threat of highly destructive fires increasing, he said, fire authorities should “flood” fire-prone areas with extra fire engines and crews during times of high winds.

But such predeployments are enormously costly, and fire chiefs often have a tough task convincing political leaders to repeatedly spend the money on them — especially when no fires break out.

(BEGIN OPTIONAL TRIM.)

Butler, who now runs the fire department in Redondo Beach, California, said he prepositioned firefighters on a large scale at least 30 times during heightened fire threats. Fires broke out after those threats just three times, but to him, it was worth the cost.

“I’m not in the business of making decisions that are politically palatable,” he said.

(END OPTIONAL TRIM.)

Marrone began preparing for his own predeployments after meteorologists at the National Weather Service, on the first weekend of the new year, issued a bulletin warning of a “Particularly Dangerous Situation” — code words for a severe weather warning, the kind the federal government issues only about two dozen times a year. Based on the conditions in Los Angeles, it was clear that fire would almost certainly ensue.

The chief authorized overtime and supplemental state funding to add an additional 100 people from his 3,100 firefighters so they could have more units prepositioned in areas known to be vulnerable to fire, including Santa Clarita and the Santa Monica mountains.

He prepositioned four strike teams, each with five trucks, and asked the California Department of Forestry and Fire Protection, the state fire agency known as Cal Fire, to preposition two more teams. The staffing was typical for a red-flag wind event, he said.

And the U.S. Forest Service, which fights fires in national forests, also began mobilizing. Adrienne Freeman, an agency spokesperson, said that on Monday, the day before the winds kicked up and the first fires started, the agency had 30 trucks from out of state and Northern California in place at four Southern California forests and at a local coordination center. On Monday night, the agency called in 50 more trucks that arrived Tuesday, she said.

The city fire department proceeded with prepositioning the nine fire trucks it was deploying Tuesday morning, according to an internal document reviewed by The New York Times, three each in Hollywood, Sunland Valley — in the northwestern part of the city — and near the city of Calabasas in the western foothills. The extra 90 firefighters the city was predeploying were called up on overtime. No extra trucks were sent to Pacific Palisades.

(BEGIN OPTIONAL TRIM.)

Those extra firefighters the city of Los Angeles called on made up less than a tenth of the approximately 1,000 on duty on any given day. And the 100 additional people called up by the county added to its daily firefighting force of 900.

Leonard, the city battalion chief, said the trucks were positioned based on historical patterns of fire during high-wind events.

(END OPTIONAL TRIM.)

“Predicting where the fire is going to start is a scientific guess,” Leonard said.

Then the wind started, and the first embers started flying.

Crowley, with the city department, texted the chiefs in counties surrounding Los Angeles at 10:35 a.m. Tuesday, five minutes after the Palisades fire was first reported, notifying them, according to an account of the messages shared with the Times.

Marrone responded immediately. “What do you need?” he texted.

The Ventura County chief said he was sending strike teams. “They’re on the road now,” he wrote.

Orange County’s chief said he could provide three strike teams of five trucks each, along with a helicopter and a crew that uses hand tools to cut firebreaks.

The Los Angeles Fire Department put out a call for off-duty members to come to their stations and scoured mechanic yards for vehicles.

Tens of thousands of people were being evacuated out of Pacific Palisades as the fire spread out of the foothills, leaping across the four lanes of Pacific Coast Highway and wiping out restaurants and homes along the coast.

Then, at 6:18 p.m. Tuesday, came more stunning news: the second major fire, in Altadena, had ignited.

Marrone put Eaton Canyon, the site of the new fire, into a navigation app and set off from the Palisades. Stuck in bumper-to-bumper freeway traffic, he could see the fresh fire and its smoke swelling into the sky.

Around 9 p.m., he called Brian Marshall, chief of fire and rescue for the California Office of Emergency Services.

“I said, ‘We are out of resources; we need help,’” Marrone said. He requested 50 strike teams, a total of 250 fire engines and 1,000 firefighters.

At 10:29 p.m., a third major fire ignited in Sylmar, in the northernmost part of the San Fernando Valley, about 25 miles northwest of downtown Los Angeles, and a fourth broke out near Santa Clarita on Wednesday afternoon.

Mutual aid teams from across the West and beyond began streaming toward Los Angeles.

Firefighters tried and failed to stay ahead of the furious flames.

“Resources were scarce” during the initial hours of the blazes, said Capt. Jason Rolston of the Orange County Fire Authority, who was among those who traveled to join the firefighting effort in Los Angeles. “There were too many houses to protect and not enough fire engines.”

The wind was gusting so powerfully that smoke boiled across the terrain. Firefighters said the barrage of ash and soot was so overwhelming at times that they struggled to even move through the fire zone.

“There would be times when you couldn’t see 10 feet in front of the rig,” said Capt. Shawn Stacy, another Orange County firefighter who deployed to the Palisades fire. “What went wrong is that you had 80-mph winds.”

Some firefighters said there was so much demand on water systems that they ran out of water.

(BEGIN OPTIONAL TRIM.)

Capt. Ryan Brumback of the Los Angeles County Fire Department said he was five hours into an all-out effort to save buildings in Altadena from the Eaton fire early Wednesday morning when the hydrants started running dry — a situation firefighters also faced in the Palisades.

Suddenly, he said, “we noticed our hoses became very limp and soft.” The problem, he said, was that a power shut-off intended to prevent additional ignitions also shut off the pumps that help with water pressure in Altadena. “It was devastating, because you want to do all that you can do.”

(END OPTIONAL TRIM.)

By Friday, both initial major fires were still burning with little containment, and others that ignited later in the week also required aggressive responses, particularly in the Hollywood Hills on Wednesday evening and in the West Hills, northwest of Los Angeles, late Thursday. Fire officials were still focused on saving lives and homes and said they would spend time later looking at whether their preparations had been sufficient.

That analysis, several experts said, will have to take into account that the standard guidelines that have long determined red-alert fire responses may no longer apply as weather and fires become more virulent.

(STORY CAN END HERE. OPTIONAL MATERIAL FOLLOWS.)

“There’s going to be a real reckoning about land use, escape routes, water pressure, water supply,” said Zev Yaroslavsky, a former longtime Los Angeles City Council member and county supervisor. Yaroslavsky said the fire might serve as a “Pearl Harbor” moment for the city, an alarm bell that signals fundamental new questions about how the city approaches the threat of wildfires.

“A lot,” he said, “will be reassessed.”

This article originally appeared in The New York Times.

Directly behind Trump will be the metal-and-glass doors where protesters, inflamed by his lie that the 2020 election had been stolen from him, stormed the Capitol with clubs, chemical irritants and other weapons. To his left, the spot where roaring rioters and outnumbered police officers fought hand to hand. To his right, where the prostrate body of a dying woman was jostled in the bloody fray.

And before him, a dozen marble steps descending to a lectern adorned with the presidential seal. The same steps where, four years earlier, Trump flags were waved above the frenzied crowd and wielded like spears; where an officer was dragged face down to be beaten with an American flag on a pole and another was pulled into the scrum to be kicked and stomped.

In the wake of the attack on the Capitol, Trump’s volatile political career seemed over, his incendiary words before the riot rattling the leaders of his own Republican Party. Myriad factors explain his stunning resurrection, but not least of them is how effectively he and his loyalists have laundered the history of Jan. 6, turning a political nightmare into a political asset.

What began as a strained attempt to absolve Trump of responsibility for Jan. 6 gradually took hold, as his allies in Congress and the media played down the attack and redirected blame to left-wing plants, Democrats and even the government. Violent rioters — prosecuted, convicted and imprisoned — somehow became patriotic martyrs.

This inverted interpretation defied what the country had watched unfold, but it neatly fit the persecution narrative that binds Trump to many of his faithful. Once he committed to running again for president, he doubled down on flipping the script about the riot and its blowback, including a congressional inquiry and two criminal indictments against him, as part of an orchestrated victimization.

That day was an American calamity. Lawmakers huddled for safety. Vice President Mike Pence eluded a mob shouting that he should be hanged. Several people died during and after the riot, including one protester by gunshot and four police officers by suicide, and more than 140 officers were injured in a protracted melee that nearly upended what should have been the routine certification of the electoral victory of Trump’s opponent, Joe Biden.

But with his return to office, Trump now has the platform to further rinse and spin the Capitol attack into what he has called “a day of love.” He has vowed to pardon rioters in the first hour of his new administration, while his congressional supporters are pushing for criminal charges against those who investigated his actions on that chaotic day.

Asked about the reframing of the Capitol riot, and whether Trump accepts any responsibility for what unfolded Jan. 6, his spokesperson, Karoline Leavitt, instead referred in a statement to the “political losers” who tried to derail his career and asserted that “the mainstream media still refuses to report the truth about what happened that day.” She added: “The American people did not fall for the Left’s fear mongering over January 6th.”

The Jan. 6 tale that Trump tells is its own kind of replacement theory, one that covers over the marble-hard facts the way a blue carpet will cover those tainted Capitol steps on Inauguration Day.

The Seeds of Suspicion

What happened and why seemed beyond debate.

Hundreds of thousands of tips. Tens of thousands of hours of video footage. Thousands of seized cellphones. The attack on the Capitol was, after all, the largest digital crime scene in history, the total estimated cost of its aftermath exceeding $2.7 billion.

The Justice Department has experienced some setbacks in its criminal prosecutions — including a Supreme Court ruling that it overreached in using a controversial obstruction statute — but its success rate has been overwhelming. More than half of the nearly 1,600 defendants have pleaded guilty, while 200 more have been convicted after trial, resulting in sentences ranging from a few days in jail for misdemeanor trespassing to 22 years in prison for seditious conspiracy.

The story told by many of the indictments begins with a mixed-message speech delivered before the riot by Trump in a park near the White House. After falsely claiming that the 2020 election had been stolen, he encouraged people to march “peacefully and patriotically” to the Capitol, but reminded them that “we fight like hell.”

Trump retired to the White House, where he watched the televised violence and ignored advice to tell the mob to leave. Then, after sending two tweets calling for peaceful protest, he posted a video repeating his rigged-election falsehood and saying: “We have to have peace. So go home. We love you. You’re very special.”

A follow-up tweet ended with “Remember this day forever!”

Condemnation came swiftly. As shaken Republican leaders denounced him and Democrats moved to impeach him for “incitement of insurrection,” a seemingly chastened Trump called the riot “a heinous attack on the United States Capitol.” In those early days, he referred to Jan. 6 as “the calamity at the Capitol” and warned that lawbreakers “will pay.”

The departing president called for national unity but declined to attend his successor’s inauguration. The Republican-controlled Senate acquitted him of incitement, but its leader, Mitch McConnell, declared him “practically and morally responsible for provoking the events of the day” — a sentiment apparently shared by most Americans, with nearly 60% saying in polls that he should never hold office again.

But sand was already being thrown in the eyes of history.

Before the Capitol had even been secured, Rep. Paul Gosar, R-Ariz., was asserting on Twitter that the events had “all the hallmarks of Antifa provocation.” Hours later, Fox News commentator Laura Ingraham was telling viewers that “there are some reports that antifa sympathizers may have been sprinkled throughout the crowd.” And by morning, Rep. Matt Gaetz, R-Fla., was claiming on the House floor that some rioters “were masquerading as Trump supporters and in fact were members of the violent terrorist group antifa.” (Gaetz would become President-elect Trump’s first choice for attorney general before being derailed by scandal.)

According to MIT Technology Review, this fabrication was repeated online more than 400,000 times in the 24 hours after the Capitol attack, amplified by a cast of MAGA influencers, Republican officials and members of Trump’s family.

Trump remained mostly silent in the weeks that followed. But in a late March 2021 interview with Washington Post reporters that was not made public until months later, he provided an early hint of how he would frame the Jan. 6 attack.

The day he had previously called calamitous was now largely peaceful. The mob that stormed the Capitol had been “ushered in” by police. And those who had rallied with him beforehand were a “loving crowd.”

Blaming the Deep State

Through the spring and summer of 2021, Trump’s Republican allies sought to sow doubt and blame others. It was as if McConnell, among other leading Republicans, had never publicly declared Trump responsible. As if the world had not seen what it had seen.

In early May 2021, on the same day House Republicans stripped Rep. Liz Cheney, R-Wyo., of her leadership role for labeling Trump a threat to democracy, they used an Oversight Committee hearing to minimize the riot. Rep. Ralph Norman, R-S.C., questioned whether all of those rioters wearing Trump gear and shouting pro-Trump chants were truly Trump supporters, while Rep. Andrew Clyde, R-Ga., likened much of the trespassing to a “normal tourist visit.”

This benign interpretation of Jan. 6 gave way to a much more startling theory, posed in mid-June 2021 by Fox News host Tucker Carlson, at the time perhaps the most-watched commentator in cable news: The riot had been a false-flag operation orchestrated by the FBI.

Gaetz and another Republican loyalist, Rep. Marjorie Taylor Greene, R-Ga., quickly seconded the deep state conspiracy theory, while Gosar entered the article on which it was based — written by Darren Beattie, a former Trump speechwriter who had been fired for speaking at a conference beside white supremacists — into the Congressional Record.

Soon after, Trump broke his monthslong silence about Jan. 6. At an early July rally in Sarasota, Florida, he invoked the name of Ashli Babbitt, a pro-Trump rioter who had been fatally shot by a Capitol police officer while trying to breach the House floor, where lawmakers and staff members had sought safety. She was fast becoming a martyr to the cause.

“Shot, boom,” Trump said. “There was no reason for it. Who shot Ashli Babbitt?”

He also referred to the jailed rioters. Floating the specter of a justice system prejudiced against conservatives, he questioned why “so many people are still in jail over January 6” when antifa and Black Lives Matter hadn’t paid a price for the violent protests that followed the murder of a Black man, George Floyd, by a white Minneapolis police officer in 2020.

The fog machine of conspiracy was turned up a few notches that fall, when the Fox Nation streaming service released “Patriot Purge,” a three-part series in which Carlson expanded on his specious contention that the Capitol attack was a government plot to discredit Trump and persecute conservatives.

The widely denounced claim was deemed so outrageous that two Fox News contributors, Jonah Goldberg and Stephen Hayes, resigned in protest. In a scathing blog post, they wrote that the program was a hodgepodge of “factual inaccuracies, half-truths, deceptive imagery and damning omissions.”

Carlson’s documentary, they wrote, “creates an alternative history of January 6, contradicted not just by common sense, not just by the testimony and on-the-record statements of many participants, but by the reporting of the news division of Fox News itself.”

Martyrs and Vigils

Amid the conspiratorial swirl of antifa agitators and deep state plots, a related narrative was gaining traction: the glorification of those who had attacked the Capitol. Instead of marauders, vandals and aggressors, they were now political prisoners, hostages, martyrs. Patriots.

This movement’s energy radiated from a detention center in Washington where a few dozen men charged with attacking police officers and committing other violent offenses were held. A defiant esprit de corps developed among them in the so-called Patriot Wing, where inmates in prison-issue orange gathered every night to sing the national anthem.

Outside the center’s razor-wire walls, their supporters kept vigil in a spot dubbed the “Freedom Corner.” Led by Babbitt’s mother, among others, they set out snacks, flew American flags and livestreamed phone conversations with inmates.

Sympathy that might have been reserved for the injured police officers was directed instead to those who had assaulted them. And Trump — whose Jan. 6 actions were now being investigated by the Justice Department and a bipartisan House select committee — emerged in 2022 as their No. 1 sympathizer.

At a mid-January rally in Florence, Arizona, he described the Jan. 6 defendants as persecuted political prisoners. Later that month, in Conroe, Texas, he promised that if he was reelected, and if pardons were required, “we will give them pardons because they are being treated so unfairly.”

Trump’s counteroffensive began taking shape. The House Jan. 6 select committee, of which Cheney was vice chair, became in his words the “unselect committee” and the prevailing narrative of Jan. 6 as an insurrection “a lot of crap.”

One of his most repeated contentions was that the Democratic House speaker, Nancy Pelosi, had rejected his recommendation to have 10,000 soldiers present Jan. 6. But subsequent investigations demonstrated that it was his own military advisers, not Pelosi, who blocked the idea, concerned with both the optics of armed soldiers at a political protest and the possibility that Trump might invoke the Insurrection Act to place the troops under his direct command.

“There is absolutely no way I was putting U.S. military forces at the Capitol,” the acting defense secretary, Chris Miller, later told investigators. Doing so, he said, could have created “the greatest constitutional crisis probably since the Civil War.”

As the select committee began holding hearings in early June 2022, Trump used speeches and his social media platform, Truth Social, to clap back at the damaging evidence and testimony. One post read: “The so-called ‘Rush on the Capitol’ was not caused by me, it was caused by a Rigged and Stolen Election!”

In a speech in Nashville, Tennessee, that month, he dismissed the riot as a “simple protest” that “got out of hand”; again floated the possibility of pardons; and furthered the false-flag theory by mentioning Ray Epps, a protester falsely portrayed by Carlson on Fox News and Republicans in Congress as a government plant who had stage-managed the riot.

Trump’s efforts seemed to be working. By mid-2022, an NBC News poll found that fewer than half of Americans still considered Trump “solely” or “mainly” responsible for Jan. 6.

For some supporters, though, Trump was not doing enough. In the late summer, he agreed to meet two advocates for the Jan. 6 defendants at his golf club in Bedminster, New Jersey: Julie Kelly, a conservative journalist who had written skeptically about the Capitol attack, and Cynthia Hughes, a founder of the Patriot Freedom Project, which supported the inmates’ families. Hughes was also an aunt of Timothy Hale-Cusanelli, a professed Adolf Hitler fanboy who had spent time in the Patriot Wing.

They told Trump that the defendants and their families felt abandoned by him, Kelly later recalled, and that some of the federal judges in Washington he had appointed were among the worst in their handling of Jan. 6 cases.

These jurists had earned the ire of people like Kelly by rejecting arguments that the defendants could not get fair trials in liberal Washington or had been unduly prosecuted for their pro-Trump politics. The judges also knocked down the contention that nonviolent rioters should not have been charged at all, ruling that everyone in the mob, “no matter how modestly behaved,” contributed to the chaos at the Capitol.

After his meeting with the women, Trump donated $10,000 to Hughes’ organization and told a conservative radio host that if he was elected, there would be full pardons and “an apology to many.” Days later, Hughes was given a speaking role at a Trump rally in Wilkes-Barre, Pennsylvania.

Hughes’ Patriot Freedom Project closed out 2022 with a fundraising holiday party at the Capitol Hill Hilton, in sight of the riot scene. Children received gifts, inmates spoke to the crowd from jail and tearful family members shared their hardships. There was also a surprise video message of encouragement from Trump, who had recently announced his candidacy.

Then, just before Christmas, the House select committee released its final report, based largely on testimony from those inside Trump’s orbit. It accused him of repeatedly lying about a stolen election and summoning the angry mob that thwarted a peaceful transition between administrations.

In the foreword, Cheney recalled how her great-great-grandfather answered Abraham Lincoln’s call to defend the union by joining the 21st Ohio Volunteer Infantry. He fought for four years, she wrote, for the same essential principle the committee was empaneled to protect: the peaceful transfer of power.

Trump and the Prison Choir

Perhaps the moment when Trump and his allies fully embraced their alternate version of history came March 3, 2023, when a new song appeared on major streaming platforms.

The song, “Justice for All,” featured Trump reciting the Pledge of Allegiance while the men of the Patriot Wing, now billing themselves as the J6 Prison Choir, sang the national anthem. In other words, it was a collaboration between a man seeking the Republican presidential nomination and about 20 men charged with attacking the nerve center of the republic.

Trump recorded his contribution at his Mar-a-Lago residence in Florida, while the choir was recorded with a phone in the Washington jail. The song — a fundraising effort that Trump loyalist Kash Patel, now the president-elect’s pick to head the FBI, helped produce — concludes with a defiant echo of the “USA!” chants that resounded during the Jan. 6 attack.

The first Trump campaign rally for the 2024 election took place three weeks later, in Waco, Texas, where a deadly standoff between federal agents and a religious cult in 1993 became a far-right touchstone. Before launching into complaints about persecution and promises of retribution, the candidate placed his hand over his heart for the playing of what an announcer called “the No. 1 song” on iTunes and Amazon, featuring Trump “and the J6 Choir.”

Trump’s version of the attack on the Capitol had firmly taken hold, at least within his party. A YouGov poll at the time found that most Republicans believed the events of Jan. 6 reflected “legitimate political discourse.”

In August 2023, Trump was indicted twice on charges of interfering with the 2020 election results: at the state level, for illegally seeking to overturn the results of the election in Georgia, which he had narrowly lost; and at the federal level, for conspiring to impede the Jan. 6 certification of Biden’s election.

A subsequent court filing by Jack Smith, the special counsel leading the federal investigation, cited Trump’s steadfast endorsement of the rioters and of the prison choir, “many of whose criminal history and/or crimes on January 6 were so violent that their pretrial release would pose a danger to the public.”

Trump, it continued, “has financially supported and celebrated these offenders — many of whom assaulted law enforcement on January 6 — by promoting and playing their recording of the national anthem at political rallies and calling them ‘hostages.’”

All true. Still, Trump continued to play “Justice for All” at rallies and at Mar-a-Lago, spread his rigged-election lie, drop intimations of false-flag conspiracies, refer to those who stormed the Capitol as patriots — and, now, transformed the indictments into further fuel for his persecution narrative.

In so many ways, Jan. 6 had become part of his brand — a brand in which an attack on the symbol of American democracy became a defense of that same democracy: a blow against political thugs and closet communists, deep state plots and an unjust justice system.

A part of the brand that, two months ago, helped Trump win election as the 47th president of the United States.

Promises of Pardons

Once he takes office, Trump will be positioned to finish refashioning Jan. 6 as a modern Lost Cause of the Confederacy.

With the help of Republican loyalists, the Senate acquitted him of incitement at his impeachment trial. The Supreme Court he had helped mold rejected an attempt to keep him off the ballot under a constitutional ban against insurrectionists from holding office.

And his legal maneuvering — to delay, delay, delay — succeeded: In the days after the election, Smith dropped his election-subversion case, adhering to a Justice Department policy not to prosecute a sitting president.

An emboldened Trump has indicated that his presidential agenda will include payback for those who declared him responsible for the Capitol attack. He has said that Smith “should be thrown out of the country,” and that Cheney and other leaders of the House select committee — “one of the greatest political scams in history,” his spokesperson, Leavitt, said — should “go to jail,” without providing evidence to warrant such extreme measures.

At the same time, Trump’s repeated vows to pardon those implicated in the Capitol riot, an act of erasure that would validate their claims of political persecution, has electrified the Jan. 6 community of families, defendants and felons. On election night, those keeping vigil outside the Washington jail celebrated with Champagne.

Even though Trump has not specified whom he would pardon, many Jan. 6 participants are anticipating a general amnesty for everyone involved. One defendant, charged with attacking police officers with a baseball bat, even promoted an artificial intelligence video of inmates in orange jumpsuits parading triumphantly out of jailhouse doors.

Many defendants have requested delays in their court proceedings because, they say, the imminent pardons will render their cases moot. Among those employing this argument was Philip Sean Grillo, convicted of several misdemeanors after entering the Capitol through a broken window and later boasting in a recording that “we stormed the Capitol. We shut it down! We did it!”

But to Grillo’s misfortune, the federal judge handling his case was Royce C. Lamberth, 81, a no-nonsense former prosecutor who had been appointed by President Ronald Reagan in 1987. Lamberth not only rejected Grillo’s request for a delay, he filed a court document to “clear the air” and “remind ourselves what really happened.”

With clinical precision, Lamberth recalled how an angry mob invaded and occupied the Capitol with intentions to “thwart the peaceful transfer of power that is the centerpiece of our Constitution and the cornerstone of our republican legacy”; how they ignored directives to turn back and desist; and how some engaged in “pitched battle” with police, “stampeding through and over the officers.”

“They told the world that the election was stolen, a claim for which no evidence has ever emerged,” Lamberth wrote. “They told the world that they were there to put a stop to the transfer of power, even if that meant ransacking, emptying, and desecrating our country’s most hallowed sites. Most disturbingly, they told the world that particular elected officials who were present at the Capitol that day had to be removed, hurt, or even killed.”

The country came “perilously close” to letting the orderly transfer of power slip away, Lamberth wrote. He knew this, he said, because he and his colleagues had presided over hundreds of trials, read hundreds of guilty pleas, heard from hundreds of law enforcement witnesses — “and viewed thousands of hours of video footage attesting to the bedlam.”

With that, Lamberth ordered Grillo to be taken immediately into custody to begin a sentence of one year in prison.

As he was being handcuffed, the Jan. 6 rioter taunted the veteran judge by saying it didn’t matter: He would be pardoned anyway — by a man who will soon benefit from the peaceful transfer of power while standing on a blue carpet covering an old crime scene.

​​

This article originally appeared in The New York Times.

It is the latest salvo in a fierce debate about the risks and benefits of moderate drinking as the influential U.S. Dietary Guidelines for Americans are about to be updated. For decades, moderate drinking was said to help prevent heart attacks and strokes.

That perception has been embedded in the dietary advice given to Americans. But growing research has linked drinking, sometimes even within the recommended limits, to various types of cancer.

Labels currently affixed to bottles and cans of alcoholic beverages warn about drinking while pregnant or before driving and operating other machinery, and about general “health risks.”

But alcohol directly contributes to 100,000 cancer cases and 20,000 related deaths each year, the surgeon general, Dr. Vivek Murthy, said.

He called for updating the labels to include a heightened risk of breast cancer, colon cancer and at least five other malignancies now linked by scientific studies to alcohol consumption.

“Many people out there assume that as long as they’re drinking at the limits or below the limits of current guidelines of one a day for women and two for men, that there is no risk to their health or well-being,” Murthy said in an interview.

“The data does not bear that out for cancer risk.”

Only Congress can mandate new warning labels of the sort Murthy recommended, and it’s not clear that the incoming administration would support the change.

Still, President-elect Donald Trump does not drink, and his choice to head the Health and Human Services Department, Robert F. Kennedy Jr., swore off alcohol and drugs decades ago, and says he regularly attends Alcoholics Anonymous meetings.

There is no question that heavy consumption is harmful. But supporters of moderate drinking — including makers of wine, beer and spirits, and some physicians and scientists — argue that a little alcohol each day may reduce cardiovascular disease, the No. 1 killer in the United States.

Newer scientific studies have criticized the methodology of earlier studies, however, and have challenged that view, which was once a consensus.

While most cancer deaths occur at drinking levels that exceed the current recommended dietary guidelines, the risk for cancers of the breast, the mouth and the throat may rise with consumption of as little as one drink a day, or even less, Murthy said on Friday.

Overall, 1 of every 6 breast cancer cases is attributable to alcohol consumption, Murthy said. More recent studies have also linked moderate alcohol consumption to certain forms of heart disease, including atrial fibrillation, a heart arrhythmia.

Two scientific reviews will be used to inform the updated recommendations about alcohol consumption in the federal dietary guidelines.

Five years ago, the scientific report that informed the writing of the 2020-25 dietary guidelines acknowledged that alcohol is a carcinogen and generally unhealthy and suggested “tightening guidelines” by capping the recommendation for men at one standard drink, or 14 grams of alcohol a day.

When the final guidelines were drafted, however, there was no change in the advice that moderate drinking of up to two drinks a day for men was acceptable.

But the government acknowledged emerging evidence indicating that “even drinking within the recommended limits may increase the overall risk of death from various causes, such as from several types of cancer and some forms of cardiovascular disease.”

Since then, even more studies have linked alcoholic beverages to cancer. Yet any attempt to change the warning labels on alcoholic beverages is likely to face an uphill battle.

The current warning label has not been changed since it was adopted in 1988, even though the link between alcohol and breast cancer has been known for decades.

It was first mentioned in the 2000 U.S. Dietary Guidelines. In 2016, the surgeon general’s report on alcohol, drugs and health linked alcohol misuse to seven different types of cancer.

More recently, a scientific review of the research on moderate drinking, carried out under the auspices of the National Academies of Sciences, Engineering and Medicine, was commissioned by Congress.

That analysis found a link between alcohol consumption and a slight increase in breast cancer, but no clear link to any other cancers. The report also revived the theory that moderate drinking is linked to fewer heart attack and stroke deaths, and fewer deaths overall, compared with never drinking.

The World Health Organization says there is no safe limit for alcohol consumption, however, and 47 nations require warnings on alcoholic beverages. But cancer is rarely mentioned.

(BEGIN OPTIONAL TRIM.)

To date, only South Korea has a label warning about liver cancer, though manufacturers can choose alternative labels that don’t mention cancer. Ireland is currently slated to introduce labels that say there is a “direct link between alcohol and fatal cancers” in 2026.

The industry has a strong history of fighting warning labels that mention cancer, and alcohol-producing nations have also challenged warning labels under international trade law.

Industry opposition led to the premature termination of a federally funded Canadian study of the impact of warning labels that mentioned cancer.

(END OPTIONAL TRIM.)

The surgeon general’s advisory provided a brief overview of research studies and reviews published in the past two decades, including a global study of 195 countries and territories involving 28 million people.

They all found that higher levels of alcohol consumption were associated with a greater risk of cancer.

Other studies looked at specific cancers, like breast cancer and mouth cancer, finding the risks increased 10% and 40%, respectively, for those who had just one drink a day, when compared with those who did not drink.

(BEGIN OPTIONAL TRIM.)

The report described the biological mechanisms by which alcohol is known to induce cancerous changes at the cellular level.

The most widely accepted theory is that inside the body, alcohol breaks down into acetaldehyde, a metabolite that binds to DNA and damages it, allowing a cell to start growing uncontrollably and creating a malignant tumor.

Animal experiments have shown that rodents whose drinking water was spiked with either ethanol, the alcohol used in alcoholic beverages, or with acetaldehyde developed large numbers of tumors all over their bodies.

Research has shown that alcohol generates oxidative stress, which increases inflammation and can damage DNA.

It also alters levels of hormones like estrogen, which can play a role in breast cancer development, and makes it easier for carcinogens like tobacco smoke particles to be absorbed into the body, increasing susceptibility to cancers of the mouth and the throat.

(END OPTIONAL TRIM.)

The surgeon general’s report goes into detail about the increase in risk associated with drinking, differentiating between the increases in absolute risk and in relative risk.

For example, the absolute risk of breast cancer over a woman’s life span is about 11.3% (11 out of 100) for those who have less than a drink a week.

The risk increases to 13.1% (13 of 100 individuals) at one drink a day, and up to 15.3% (15 of 100) at two drinks per day.

For men, the absolute risk of developing an alcohol-related cancer increases from about 10% (10 of every 100 individuals) for those who consume less than one drink a week to 11.4% (11 per 100) for those who have a drink every day on average. It rises to 13% (13 of 100 individuals) for those who have two drinks a day on average.

(BEGIN OPTIONAL TRIM.)

Many Americans don’t know there is a link between alcohol and cancer.

Fewer than half of Americans identified alcohol use as a risk factor for cancer, compared with 89% who recognized tobacco as a carcinogen, according to a 2019 survey of U.S. adults ages 18 and older carried out by the American Institute for Cancer Research.

Yet alcohol consumption is the third leading preventable causes of cancer, after tobacco and obesity, according to the surgeon general’s report.

(END OPTIONAL TRIM.)

Murthy said it was important to know that the risk rises as alcohol consumption increases. But each individual’s risk of cancer is different, depending on family history, genetic makeup and environmental exposures.

“I wish we had a magic cutoff we could tell people is safe,” he said. “What we do know is that less is better when it comes to reducing your cancer risk.”

“If an individual drinks occasionally for special events, or if you’re drinking a drink or two a week, your risk is likely to be significantly less than if you’re drinking every day,” he said.

This article originally appeared in The New York Times.

An online video stream from the popular nightlife area showed police officers gathered in a cordoned-off area of the street.

The incident occurred at the intersection of Canal and Bourbon streets during New Year’s Eve celebrations, which bring large, raucous crowds to the city’s French Quarter.

This article originally appeared in The New York Times.