Capitol Hill is not an easy place to navigate. It’s not just the maze of hallways that can torture a new member of Congress, but the vicious political maneuvering that takes place behind the scenes.
To help the freshman class, we asked retiring members of the House and Senate to offer one piece of advice to the newcomers. The responses from 14 lawmakers range from the practical — let your chief of staff hire your whole office — to the philosophical — savor the “pinch me” moments — to the bipartisan — yes, really get a beer with someone from the other party.
So, here are some words of wisdom for the newbies. They’re going to need it.
“Take time for yourself. You can drown in the job if you don’t. The free world will survive even if you don’t work on Sunday.”
“The intent of our founding fathers was that we bring our energy and ideas to try to make a difference in Congress, and then we move on. Don’t spend the rest of your life in Congress. Try to make a maximum impact throughout the time you have in Congress, but then leave before too long and allow someone else to come in and take your position. You would be making our founding fathers much prouder.”
“Always remember that everyone has the same right to believe what they believe as you to believe what you believe. Try to understand their reasoning for their beliefs to start to improve mutual understanding. Do not condemn before you have the explanation. It can start a mutual respect you never thought you would have.”
“Find opportunities to reach across the aisle. When in doubt, beer is a great bridge to help span the partisan divide.”
“Please keep the filibuster. It is the only mechanism that forces bipartisan consensus. It prevents governance from the extremes. By forcing bipartisanship, it results in more durable legislation and so lessens the likelihood of big swings in policies. It provides stability for our constituents.”
“I know that many of my colleagues view service in the House as a high calling, involving serious moral obligations. But we need to think of these obligations in institutional terms, rejecting the temptation to always play the outsider. We must criticize our institutions when they go astray, but our larger obligation is to enable our committees, parties and the House as a whole to function in a way that promotes democratic accountability and effectiveness.”
“Read Tip and the Gipper: When Politics Worked. The book details the relationship between Republican President Ronald Reagan and Democratic Speaker of the House Tip O’Neill, two diametrically opposed political leaders that were able to compromise and make progress on key issues for the good of the nation. At a time in which Washington is seemingly more divided than ever, this story is a powerful reminder for incoming Members of Congress that bipartisanship can still work.”
“My advice is to work for your constituents and nobody else, particularly not corporations and donors. Stay authentic, transparent, honest and hardworking. Moving forward, I recommend all members of Congress stop taking Corporate PAC money and rein in Super PACs completely, as it only does harm."
“98% of your constituents are not using Twitter, but 99% of DC media live, eat and breathe on it. Don’t let them make you into a story that goes beyond that platform and affects the job you can do for your voters back home.”
“If you are here to make progress and get things done, there’s no substitute for developing meaningful relationships with members of both parties.”
“Over my eight terms in Congress, it’s become more and more clear that we need to find ways to talk to each other more frequently and do a better job of listening. And I don't just mean members of Congress — I think conservatives and liberals across the country need to find avenues for discussion because right now we're like two railroad tracks going parallel but never meeting. And that’s holding us back as a country. I will miss the serious, thoughtful, and often noble discussions about how we can make a positive difference in the lives of so many Americans, even if we rarely agree on how to do it. It’s imperative that those discussions keep happening.”
“I learned under the Reagan model where you had a GOP president and a Congress that was controlled by Democrats. Reagan got things done. Fast forward to today, and looking at the narrow margins in Congress, it is clear that members will need to be bipartisan to get anything done. That is why groups like the Problem Solvers Caucus are so important.”
“Never tire of appreciating the ‘pinch me moments’ you will encounter in this building, like seeing the Capitol bathed in light at night.”
Even before Elon Musk’s dramatic and controversial takeover of Twitter, the restless mogul was pitching the social-media company as his key to realizing a much bigger dream.
Musk calls his next idea the “X App.” And if Musk-owned Twitter has already been a challenge for Washington’s politicians and regulators, the disruption caused by the X App could easily dwarf it.
The idea is a Western version of WeChat, the Chinese super-app that more than a billion people use for messaging, payments, shopping, rideshares, gaming, news and other daily activities. Musk is clearly serious about the plan: He tweeted about it this fall and pitched it to Twitter employees before he even bought the company, and reiterated the idea during a Twitter Spaces session in early December, saying “WeChat has a lot of functionality that Twitter should have.”
But building a “super-app” like WeChat is a far more complicated challenge than Twitter, with far more points of conflict with regulators in Washington, California, Brussels and elsewhere. Nothing like it exists yet in the West, and it could create a “regulatory nightmare,” said Caitriona Fitzgerald, the deputy director for the Electronic Privacy Information Center, a nonprofit that advocates for privacy reform.
For all its influence on media and politics, Twitter is a far smaller social platform than Facebook or TikTok, with relatively little exposure to government oversight. Anything that involves payments, health information or deeper uses of consumer data would be a whole different beast. And that’s all without integrating some of Musk’s wider and more futuristic interests, like his brain-computer interface company, his space-launch business, or his network of satellites, all of which draw their own kind of scrutiny.
If Musk tried to launch it, he’d be doing it in a moment when regulators and politicians are increasingly worried about Big Tech’s appetite for data, its impact on consumers’ lives and its unique ability to build monopolies — to say nothing of the political storm Musk has brought down on his own head with his increasingly partisan forays into politics. (Twitter did not reply to a request for comment about Musk's app plans or regulatory strategy.)
There are plenty of business-world obstacles to the X App, and Musk has had his hands more than full just keeping Twitter afloat. But he’s also seen as ambitious enough to try anyway.
“Twitter is just one end of this future conglomerate app,” said Michael Sayman, a developer who helped create Instagram Stories, speculating that the X App could include finance, commerce, communication, news, entertainment, dating, music — and, of course, transportation, Musk’s chief business interest.
What could a Musk-owned super-app look like, and how would it collide with Washington? There’s no one authoritative answer — and a Twitter collapse would bring a quick end to the vision for now — but from observers and analysts, it’s possible to engineer a kind of preview of the maximal version of what he wants to do, and project just how many corners of Washington could find themselves facing off against one of the wealthiest men on earth.
The first and biggest question hanging over an “everything app” is money — specifically, payments and even banking.
Musk pitched investors on building Twitter into a digital payments behemoth that could generate as much as $1.8 billion by 2028 when he was getting financing for the buyout earlier this year. He hasn’t dropped that ambition: “It’s kind of a no-brainer for Twitter to have payments — in terms of both currency and crypto — and make that simple for people to use,” Musk said in the December Twitter Spaces.
Musk is publicly floating the concept of Twitter offering high-yield money market accounts, debit cards and checks. He has reportedlyalready filed paperwork to process payments. This clearly takes a page from WeChat’s playbook: The Chinese app created new ways for consumers and businesses to transact without cards or hardware, making money through merchant and withdrawal fees.
He’s not the first tech mogul to dream of an American version. Meta CEO Mark Zuckerberg tried to launch his own digital currency, the Libra, and failed — but still considers it a missed opportunity. Twitter co-founder and former CEO Jack Dorsey also co-founded the payments company Block (formerly known as Square) and pursued a payments strategy that let Twitter users incorporate their handles for CashApp. The company also partnered with Stripe to let users pay businesses and creative outlets they discover on the social network. Those efforts haven’t transformed Twitter into a payments powerhouse, however.
Musk wouldn’t be coming to this cold: The Tesla CEO has an extensive background at payment-focused fintech startups — he co-founded the online bank X.com, which later merged with a Peter Thiel-led business to form PayPal. And his backers in the buyout include Binance, the global crypto exchange, as well as Sequoia Capital, a Silicon Valley venture firm that’s invested heavily in digital asset startups.
“I think it would make sense to integrate payments into Twitter so that it’s easy to send money back and forth,” Musk said at a Twitter all-hands meeting earlier this year. “Currency as well as crypto.”
But if he tries, he’ll be entering one of the most tightly regulated spaces in American business. Unlike social-media platforms, which only hit Washington’s radar recently, banking and payment companies have been under the microscope for decades, with multiple agencies and vast regulatory requirements to meet — a task that Musk has struggled with, even disdained, as an entrepreneur.
If the X App developed digital wallets for users or a crypto-friendly token for payments, Musk could face opposition from banking regulators like the Federal Reserve and Treasury as well as top lawmakers on the Senate Banking and House Financial Services committees. The Consumer Financial Protection Bureau would likely weigh in on how the social network handled instances of fraud and abuse. And Musk could invite even more scrutiny from the Securities and Exchange Commission if he were to bring crypto trading to the platform.
Zuckerberg’s experience in trying to launch Libra — later rebranded as Diem — in 2019 is a sobering precedent: Despite an aggressive international lobbying campaign, policymakers from both parties — and on the other side of the Atlantic — blasted his far-reaching proposal for being a potential threat to global finance and commerce.
Consumer groups that opposed Meta’s efforts are already bracing for a similar fight if Musk tries to get into the game — possibly even more intense, given Musk’s newly contentious political brand, highly impulsive management style and propensity to tweak Congress and regulators.
“A big part of what really led to the downfall of Diem was the bad press around Mark Zuckerberg and Meta specifically,” said Cheyenne Hunt-Majer, a big tech policy advocate at Public Citizen. “I wouldn't be surprised at all if Elon Musk is looking at this and saying, ‘Okay, well, I can do this differently.’”
Any successful X App would bring in a massive new haul of consumer data – and would require the company to navigate a complicated, evolving new patchwork of U.S. and EU data-privacy rules.
Musk has already suggested Twitter’s immediate future would includeadvertisements carefully tailored to individual users — which could mean more sophisticated use of customer data. This data collection would likely only increase with an X App that touched more parts of people’s lives.
Even before Musk took over, however, Twitter struggled to meet basic privacy and data-handling requirements.
The company has been under a consent decree with FTC since 2011 for previously mishandling user data and paid a$150 million fine in May 2022 for breaking its commitment to protect user data again. The FTC is currently investigating allegations made by former Twitter security chief Peiter ‘Mudge’ Zatko, who claims the company intentionally misled the agency and violated the terms of the 2011 settlement, according to a person familiar with the probe who is not authorized to speak publicly.
At Twitter, Musk’s abrupt staff cuts, and the exodus of its top privacy, cybersecurity and compliance executives, have already drawn a rare warning shot from the Federal Trade Commission: The FTC said in a statement in mid-November, “We are tracking recent developments at Twitter with deep concern,” adding, “no CEO or company is above the law, and companies must follow our consent decrees.”
And Democrats on Capitol Hill are paying attention too — calling on the FTC to enforce its consent decree — which could mean large fines and penalties for Musk’s Twitter if it is found to have violated the settlement terms.
His ambition also arrives amid growing concerns about U.S. consumer data security and privacy protections. Though Congress hasn’t managed to pass a comprehensive data privacy bill, several states are already plowing ahead with their own rules, including California, Virginia and Colorado, creating a complicated patchwork for tech companies to navigate. And any company with a global presence also needs to worry about Europe’s data privacy law — the General Data Protection Regulation (GDPR) — which gives consumers the right to opt out of data collection. Some aspects of the X App would also be subject to sectoral federal privacy laws, like in finance and health care.
Musk would also immediately draw a spotlight from privacy advocates, who worry that he’d potentially have access to millions of Americans’ data without any federal law to ensure it's properly protected.
“As a society, we really have kind of started getting to a point where we feel uncomfortable with the loss of privacy,” said Karan Lala, a software engineer who previously worked at Facebook. “Maybe folks are not fully comfortable with having one person having access to all of that information.”
In China, people can look up doctors, book them, conduct a telehealth appointment and even manage their medical records inside of WeChat. In other countries, patients can use WhatsApp to book their doctor appointments over text.
In the U.S., that kind of user-friendly approach to health care is largely blocked by the Health Insurance Portability and Accountability Act, the 1996 patient-protection law setting strict rules around how health care providers share and store data.
So an X App could track your fitness, scrape your data and log your steps, but hit a wall when it comes to the highly regulated world of the American medical system. It doesn’t mean Musk wouldn’t try — but he’d need to find partners willing to test the edges of what’s possible under the law.
Musk does have his own medical venture, though, and that raises another question. Neuralink is a brain-computer interface that allows a person to navigate a computer directly from their brain with an implantable device. Musk says the company has submitted “most” of the paperwork needed to get the FDA go ahead for a clinical trial in 2023 in order to bring that invention to market.
Right now, brain-computer interfaces are being trialed to help people with paralysis, but Neuralink’s website tantalizingly promises a “non-medical application” and says the technology could someday “expand how we interact with each other and experience the world around us.”
If a person used a Neuralink chip to interact with the X App, would the app literally be reading that person’s mind? And what happens to the data? Brain data isn’t necessarily protected by HIPAA, and the issue is not yet on Washington’s radar, but it’s a real concern among policy thinkers; Chile recently became the first country to protect “neurorights.”
At this point, the idea of a neural connection to any app is purely speculative. However, it’s not as sci-fi as it might sound: Synchron, a competing BCI company, which launched an FDA clinical trial earlier this year, already allowed one patient to Tweet directly from their brain.
Though Musk is often lumped in with pure tech moguls like Zuckerberg, he’s primarily a transportation mogul — a maker of cars and rockets, with some interest in tunnels.
Musk hasn’t talked specifically about the transportation side of an X App. But WeChat also offers a ride-hailing service, and the X app has a range of potential applications for ride-hailing, transit and more.
Ian McAdams, a specialist in the automotive technology practice at the Orrick law firm, envisions an app that offers a “hub of information” for easy access to “hopping on transit, hopping in a rideshare, hailing an automated system — who knows what that will look like, at what point.”
Putting Musk at the center of an identity-verification app with security implications could be problematic, though. McAdams said government regulators might be skeptical of the arrangement — to say nothing of any connection to Tesla, whose cars are already software-intensive products that constantly track user behavior. “The big question mark right now is, we’ve got an FTC and a DOJ that takes a really dim view of all kinds of data-sharing arrangements and particularly of consolidation,” McAdams said. The FTC is “going to take a fine-tooth comb through everything that they attempt to do.”
Both the Federal Trade Commission and the Department of Justice are looking more and more closely at big tech companies’ anti-competitive behavior. And While Musk’s businesses don’t currently run afoul of monopoly review by either agency, that could easily change if he were to buy a lot of other apps, said Charlotte Slaiman, the competition policy director at nonprofit Public Knowledge.
She said antitrust regulators may be concerned about a vertical relationship wherein Musk incentivizes his X App offering over competitors. And antitrust regulators may weigh in if Musk purchases another app that competes directly on his platform.
“From a competitive climate, now might not be the best time to even put up the fact that you want an app that does everything,” former Facebook engineer Lala said. “I don't think Congress is going to take lightly to that, so that might be victim number one.”
There’s a counterargument, though, based on the fact that the X App would be the first of its kind. Graham DuFault, a senior director of public policy at ACT | The App Association, a trade group representing app developers, says that U.S. policies tend to be conducive to new market entrants — at least to start.
“One of the striking things about the U.S. competition, law and policy landscape is that it's pretty permissive in that it treats a new company's entry as something that is a benefit to competition and a benefit to consumers unless there really is evidence that is going to harm competition, and then therefore harm consumers,” DuFault said in an interview.
When it comes to other competitors, Musk has an offering that many others still don’t have — Starlink, the world’s satellite internet constellation company. Operated by his firm SpaceX, it provides service to at least 36 countries, with plans to offer mobile phone service with T-Mobile in 2023.
Depending on how he links up the satellites and the X App, Musk could start to collide with California’s net neutrality law — which says internet service providers are not allowed to slow down or limit services online, especially efforts to advantage their products over competitors. Ever since the Trump administration rescinded the FCC’s net neutrality policy — and Congress has failed to enact it into law — California’s law is the de facto law of the land.
Using Starlink internet, Musk would be able to streamline faster and more efficient access to the X App services — and potentially throttle access to competing mega-apps, Sayman said. This preference of service could potentially run afoul of California's rules.
It could be worth him testing the waters on that, even if it’s risky: “The level of fundamental dominance that could be achieved — if he’s able to do that well — I think positions his ‘X’ company to be able to do all the rest of this stuff,” Sayman said.
For the average big tech giant, politics is a third-tier risk at best: The companies and moguls strategically spread out their political donations, and only occasionally do executives run afoul of elected officials, or get hauled in front of Congress.
Musk is different. After being out of the political wind for years, he has jumped full-bore into the American culture wars, attacking Democrats by name, re-platforming Donald Trump and hosting elaborate Twitter threads suggesting collusion between the FBI and his own company. He’s also aligned himself with Republicans, encouraging votes for the GOP in the 2022 midterms and backing a Ron DeSantis run for president in 2024, earning him the kind of support from the GOP that other tech billionaires can only dream of.
However, Congress has failed to pass bipartisan tech legislation — and is unlikely to next year under a split House and Senate — so the action is expected to continue in state capitals where legislatures have passed the most aggressive laws regulating tech platforms to date.
So far, there has been more smoke than fire on the political front. But a bigger consumer platform could easily change that, as activists, think tanks, elected officials and voters increasingly see Musk as a player in American political life – either for better or worse.
Just hours before the speakership vote, Kevin McCarthy’s opponents are warning they still aren’t ready to give him the support he needs.
With the House slated to start voting on who will command the gavel around midday Tuesday, McCarthy remains short of the necessary 218 votes. And his last-ditch efforts, including a long list of concessions he released to his conference over the weekend, has done little to sway his most ardent detractors.
In fact, there were further signs Monday that the California Republican’s bid is in deep trouble. The influential conservative group Club for Growth released a whip notice for the speakership vote, urging a no vote on McCarthy — without explicitly naming him — if he didn’t concede to various rules being pushed by some of those opposing him, many of them members of the House Freedom Caucus.
The lawmakers’ demands have included allowing any one member to force a vote on the House floor to depose a speaker. The Club for Growth also mirrored those members' calls for prohibiting the Congressional Leadership Fund, a campaign committee closely aligned with McCarthy, from “spending money or providing grants to any Super PAC to engage … in open Republican primaries or against any Republican incumbent.” The group also took issue with the lack of "true conservatives" being represented in leadership.
And even as McCarthy predicted concessions he made to the House rules are helping him pick up support, his opponents and skeptics spent Monday lobbing new criticisms his way.
“Why didn’t we get McCarthy’s proposed rules package at least 72 hours in advance?” tweeted Rep. Dan Bishop (R-N.C.), a Freedom Caucus member.
Electing a speaker is typically a symbolic moment, with the vote decided weeks if not months ahead of time. But absent a sudden flip among his detractors, McCarthy’s bid for the gavel will prompt a historically rare showdown, marking just the second time since the Civil War that the race could go beyond one ballot.
Despite not yet having a lock on the gavel, McCarthy is spending Monday working out of the speaker’s office, a tradition routinely granted to the speaker-elect. If he falls short, he would have to move back out of the prestigious office.
Republicans are preparing for a long day Tuesday. Many expect the vote will drag out into multiple ballots, which could mean a dayslong gavel battle.
Rep. Kelly Armstrong (R-N.D.), a McCarthy ally, predicted Republicans will go “however long it takes.” But the first vote would provide some early indications on how the day would play out, he added.
“The way the alphabet works, you’ll know on the first ballot pretty quickly. And then we’ll figure out how it grinds out,” Armstrong said, referring to the alphabetical process for calling on members to cast their votes.
Meanwhile, Rep. Andy Biggs (R-Ariz.), who McCarthy opponents are backing as a figurehead for their frustration, described the Californian as being in “total bargaining mode” but that he doesn’t believe McCarthy “will ever get to 218 votes.”
Others issued more cryptic takes: “Some people who run campaigns against the swamp sure are quick to wilt in the face of challenges (to different degrees) to that very swamp…” tweeted Rep. Chip Roy (R-Texas) on Monday.
But as McCarthy’s opponents take a hard line, some of his supporters are reviving their own threats.
McCarthy ally Rep. Don Bacon (R-Neb.) said Monday his previous warning — that a band of moderate Republicans would work with Democrats to elect a centrist GOP speaker, if conservatives tank McCarthy — remains on the table.
“If a few won’t be part of the 218 members we need to govern, we’ll then find other ways to get to 218,” Bacon wrote in an op-ed in the Daily Caller.
Russia deployed multiple exploding drones in another nighttime attack on Ukraine, officials said Monday, as the Kremlin signaled no letup in its strategy of using bombardments to target civilian infrastructure and wear down Ukrainian resistance to its invasion.
The barrage was the latest in a series of relentless year-end attacks, including one that killed three civilians on New Year’s Eve.
Kyiv Mayor Vitali Klitschko said Monday that 40 drones “headed for Kyiv” overnight. All of them were destroyed, according to air defense forces.
Klitschko said 22 drones were destroyed over Kyiv, three in the outlying Kyiv region and 15 over neighboring provinces.
Energy infrastructure facilities were damaged as the result of the attack and an explosion occurred in one city district, the mayor said. It wasn’t immediately clear whether that was caused by drones or other munitions. A wounded 19-year-old man was hospitalized, Klitschko added, and emergency power outages were underway in the capital.
In the outlying Kyiv region a “critical infrastructure object” and residential buildings were hit, Gov. Oleksiy Kuleba said.
Russia has carried out airstrikes on Ukrainian power and water supplies almost weekly since October.
Ukrainian President Volodymyr Zelenskyy has accused Russia of “energy terrorism” as the aerial bombardments have left many people without heat amid freezing temperatures. Ukrainian officials say Moscow is “weaponizing winter” in its effort to demoralize the Ukrainian resistance.
Ukraine is using sophisticated Western-supplied weapons to help shoot down Russia’s missiles and drones, as well as send artillery fire into Russian-held areas of the country.
Moscow’s full-scale invasion on Feb. 24 has gone awry, putting pressure on Russian President Vladimir Putin as his ground forces struggle to hold ground and advance. He said in his New Year’s address to the nation that 2022 was “a year of difficult, necessary decisions.”
Putin insists he had no choice, but to send troops into Ukraine because it threatened Russia’s security — an assertion condemned by the West, which says Moscow bears full responsibility for the invasion.
Russia is currently observing public holidays through Jan. 8.
Drones, missiles and artillery shells launched by Russian forces also struck areas across Ukraine.
Five people were wounded in the Monday morning shelling of a Ukraine-controlled area of the southern Kherson region, its Ukrainian Gov. Yaroslav Yanushevich said on Telegram.
The Russian forces attacked the city of Beryslav, the official said, firing at a local market, likely from a tank. Three of the wounded are in serious condition and are being evacuated to Kherson, Yanushevich said.
Seven drones were shot down over the southern Mykolaiv region, according to Gov. Vitali Kim, and three more were shot down in the southeastern Dnipropetrovsk region, Gov. Valentyn Reznichenko said.
In the Dnipropetrovsk region, a missile was also destroyed, according to Reznichenko. He said that energy infrastructure in the region was being targeted.
Ukraine’s Air Force Command reported Monday that 39 Iranian-made exploding Shahed drones were shot down overnight, as well as two Russian-made Orlan drones and a X-59 missile.
“We are staying strong,” the Ukrainian defense ministry tweeted.
A blistering New Year’s Eve assault killed at least four civilians across the country, Ukrainian authorities reported, and wounded dozens. The fourth victim, a 46-year-old resident of Kyiv, died in a hospital on Monday morning, Klitschko said.
Multiple blasts rocked the capital and other areas of Ukraine on Saturday and through the night. The strikes came 36 hours after widespread missile attacks Russia launched Thursday to damage energy infrastructure facilities, and the unusually quick follow-up alarmed Ukrainian officials.
In Russia, a Ukrainian drone hit an energy facility in the Bryansk region that borders with Ukraine, Bryansk regional governor Alexander Bogomaz reported on Monday morning. A village was left without power as a result, he said.
The lack of specialized Covid-19 treatments for people with weak immune systems has left millions of Americans with limited options if they get sick as the pandemic heads into an uncertain winter.
Once heralded as game-changers for Covid patients considered at risk for getting seriously ill — one was used to treat then-President Donald Trump in 2020 — monoclonal antibodies are now largely ineffective against current Covid variants. Easier-to-administer antiviral drugs, such as Paxlovid, have largely taken their place but aren’t safe for all immune-compromised people because they interact with many other drugs.
But the federal government funding that drove drug development in the early days of the pandemic has dried up, and lawmakers have rebuffed the Biden administration’s pleas for more. Without that, there’s little incentive for drugmakers to work on new antibody treatments that could be more effective.
And without a government program like Operation Warp Speed to develop second-generation vaccines and treatments, at-risk patients could be in danger of developing severe cases of Covid and flooding hospitals when the U.S. health care system is already strained, thanks to an influx of patients with an array of respiratory illnesses, including flu and RSV.
“Just because we have exited the emergency phase of the pandemic does not mean that Covid is over or that it no longer poses a danger,” said Leana Wen, a public health professor at George Washington University and former Baltimore health commissioner. “There are millions of Americans who are vulnerable to severe illness.”
The FDA pulled authorizations for four antibody treatments in 2022 as Omicron and its myriad subvariants wiped out their effectiveness. The treatments were geared toward adult and pediatric patients with mild-to-moderate Covid who were considered at risk of developing severe disease and ending up hospitalized.
While antiviral pills are plentiful and remain an option for some with weak immune systems, they won’t work for everyone — Pfizer’s Paxlovid interacts with many widely prescribed drugs.
Monoclonal antibodies — which have been made by companies like Regeneron, Eli Lilly and Vir — are lab-created molecules designed to block a virus’ entry into human cells. But they must bind to the virus’ spike protein to neutralize it, and the coronavirus’ many mutations since its 2019 emergence have gradually rendered the available products ineffective.
“It’s a bit risky to develop this,” said Arturo Casadevall of the Johns Hopkins Bloomberg School of Public Health, pointing to how quickly some Covid variants have surfaced before quickly receding.
A massive spending bill that lawmakers passed before Christmas left out the administration’s $9 billion request for more money to fight the pandemic, meaning there are fewer dollars to be spread around to address emerging Covid needs.
“Due to congressional inaction and a lack of funding, HHS does not have the resources it needs to fund the development of new treatments, and we could find ourselves with a very limited medicine cabinet at a time when we need more tools to combat Covid-19,” a department spokesperson told POLITICO, adding that HHS is working with providers and other groups “to ensure that Americans are able to take advantage of all available treatment options.”
The Biden administration has strongly promoted oral antiviral regimens like Paxlovid, which debuted a year ago and marked a turning point in managing the virus for most Americans.
Immunocompromised individuals — who are either born with immune-suppressing conditions or acquire them after organ transplants or by taking certain drugs — also may not mount sufficient immune responses after vaccination, making treatment options like antibody therapies a critical tool for them.
A CDC alert issued Dec. 20 to clinicians and public health professionals warned of the lack of viable monoclonal antibody treatments — including the diminished efficacy of a prophylactic antibody, Evusheld — and the availability of the antiviral options that to date have seen lackluster uptake. The agency urged providers to consult the National Institutes of Health’s Covid treatment guidelines for ways to potentially manage drug interactions with Paxlovid, such as temporary pauses or reductions in dose.
Remdesivir, an antiviral administered intravenously, is another treatment option for the immunocompromised, but it requires infusions over three days in either hospital or outpatient settings. HHS is urging states to support its health departments and systems in setting up infusion clinics to expand access to remdesivir, especially on an outpatient basis, and is working with maker Gilead to broaden the types of providers eligible to buy the drug.
Covid convalescent plasma remains an option for immunocompromised people who contract the virus, but its availability is scattershot across the country, Casadevall said. The treatment has pros and cons, he said — it’s less likely to be defeated by any one variant and can adapt to different strains, but it’s difficult to administer and requires blood-typing to be done for the recipient.
Still, Casadevall said, the main issue is educational because its use has changed since the pandemic’s early days, when treatments were scarce. Some hospital systems, like Hopkins, use it routinely, while some doctors don’t know plasma is still an option, he said.
The FDA has authorized the emergency use of convalescent plasma containing high Covid antibody levels for immunocompromised patients. But NIH has remained neutral on the treatment in that population, which Janet Handal, president of the Transplant Recipients and Immunocompromised Patient Advocacy Group, says has led to some hospitals balking at administering it.
NIH spokesperson Renate Myles pointed to the agency’s treatment guidelines for Covid, which are developed by an expert panel.
The recommendations for Covid convalescent plasma, last updated on Dec. 1, say there’s “insufficient evidence” to recommend for or against the treatment’s use in immunocompromised patients, while noting some panel members would use plasma to treat an immunocompromised person “with significant symptoms attributable to COVID-19 and with signs of active [viral] replication and who is having an inadequate response to available therapies.”
“In these cases, clinicians should attempt to obtain high-titer [Covid convalescent plasma] from a vaccinated donor who recently recovered from Covid-19 likely caused by a … variant similar to the variant causing the patient’s illness,” the guidelines say.
Casadevall, who leads the Covid-19 Convalescent Plasma Project, says NIH’s stance on plasma is inconsistent with its previous recommendations of monoclonal antibodies, which were made without clinical efficacy data, since Covid antibodies are the active component in both therapies. He led a petition earlier this month — signed by several doctors, including past and current presidents of the Infectious Diseases Society of America — asking NIH to change its recommendations.
Handal’s group also has asked the NIH and the White House to convene a meeting with scientists on the issue.
“To just not be having a dialogue about it is infuriating to us,” Handal said. “People are dying while people are just going through this bureaucratic dance.”
The FDA and European Medicines Agency held a virtual workshop this month to bring doctors, industry and regulators together to discuss supporting novel monoclonal antibody treatments.
“The FDA is committed to working with industry sponsors to expedite the development of new drug products to meet unmet needs, such as the need for new preventive therapies for immune-suppressed patients who are unlikely to respond to vaccination,” an agency spokesperson said.
In the meantime, Regeneron spokesperson Tammy Allen said the company, whose antibody cocktail’s use was limited in January, is committed to evaluating antibody treatment options as the coronavirus evolves.
“We believe monoclonal antibodies have played an important role in the COVID-19 pandemic to date and may again in the future, particularly among people with immunocompromising conditions,” Allen said.
Vir, which partnered with GSK on sotrovimab, continues to study whether the treatment could work against emerging variants and is also evaluating next-generation antibodies and small-molecule therapies, said spokesperson Carly Scaduto.
Still, pharmaceutical companies may be more inclined — both financially and practically — to pursue developing better antiviral pills that pose fewer drug interactions and are easier to administer, said Jason Gallagher, a clinical pharmacy specialist in infectious diseases at Temple University Hospital. Antivirals also hold up better against an ever-changing virus, he added.
“There’s way more money in Paxlovid than there is in any monoclonal” antibody treatment, Gallagher said, and it may take incentives to drugmakers to encourage their development. “They’re not going to make anyone really rich.”
Every class has its clown, and in the House GOP no one has earned that reputation quite like Rep. Tim Burchett.
When the Tennessee Republican first met the wife of Rep. Kelly Armstrong (R-N.D.) in 2018, he simultaneously complimented her appearance while jokingly digging at her husband’s — taking off his glasses, handing them to her and saying: “Ma’am, you need these more than me.”
He once corrected someone who mispronounced his last name by telling them: “It is ‘birch’ like the tree, and ‘shit’ like the thing you ate for breakfast this morning.” And after visiting then-President Donald Trump at the White House with other members, Burchett was the last to run onto the bus — yelling they needed to peel out because he’d just stolen the baby Jesus from the Nativity scene (he had not actually done so).
“With Billy Long leaving Congress, the conference is in search of a new class clown,” said Rep. Steve Womack (R-Ark.). “And I nominate Tim Burchett … he’s so unpredictable. He says the craziest things.”
Approachable and unguarded, Burchett is perhaps one of the least filtered members, making comments even to reporters that most politicians would fight to bury. His wisecracking and jovial nature have attracted him friends on both sides of the aisle, despite his conservative voting record, in a time when the House’s cross-party relationships are growing rarer. Asked about his unusual freewheeling approach, he replied that his constituents from East Tennessee “don’t care about that stuff.”
“I don’t take myself seriously. I take the job seriously,” Burchett said in an interview, one day before Christmas Eve.
Others agreed. GOP Leader Kevin McCarthy could tick off multiple funny moments courtesy of Burchett, but also praised him as a constituent-focused member. He said Burchett “uses that ‘aw shucks,’ but he’s very smart.”
“He has the ability to take a serious situation, lighten the room, but also make his point,” McCarthy said.
This month, Burchett invited media, colleagues and staff to a holiday party set to last 15 minutes, and said there would “possibly” be refreshments. The party, which did in fact last 15 minutes, featured a PB&J sandwich stand, a “charcuterie” board that was just Burchett spraying cheese whiz on Ritz crackers, and Christmas music courtesy of Texas GOP Reps. Louie Gohmert and Brian Babin strumming guitars.
And while the funny-guy persona has a way of overshadowing his message at times, he also uses his jokes to inoffensively vent about Hill dynamics. He isn’t a fan of the power structures that govern who rises in leadership or receives coveted committee roles, for example, which often includes alliances with party leaders, fundraising and general schmoozing.
“I get frustrated with the whole system,” Burchett said, noting that he has approached McCarthy requesting positions on certain panels, like the House Intelligence Committee. “I don’t kiss enough butt and I don’t raise money to move up in conference, so I get aggravated about that. There’s definitely some people I would say should be in some positions that they’re not, just because of that. And I hate missed opportunity.”
He also tries to provide levity in tense situations — with mixed results. Earlier this month, he elicited both chuckles and cringes during a heated moment in a conference-wide meeting, as some of his colleagues grew irritated that McCarthy allies were getting extra time from their colleagues to speak in defense of his speakership bid.
Burchett went to a microphone and bashed their weekly conference meetings as a waste of time where they never learn anything. And he told Rep. Elise Stefanik (R-N.Y.), who was managing whose turn it was to speak, that if he wanted to be disrespected by a woman, he’d go home to his wife and daughter. Some appreciated the humor, while others felt that directing the comment at the top woman in Republican leadership took the joke too far.
Generally, there is a sense among his Capitol Hill colleagues that Burchett is just that kind of person who can get away with comments that the rest of them couldn’t pull off.
“He says whatever the hell he wants to and people can get offended. He didn’t give a flip,” said GOP Rep. Mark Green, who is part of the Tennessee delegation with Burchett. “And he’s gotten to the point where people take it from him. If I said that, there’d be a [negative] article about me.”
There are plenty of incidents that back up Green’s claim. Rep. David Kustoff (R-Tenn.) said Burchett calls him his “favorite Jew after Jesus.” And, according to Armstrong, when Burchett’s chief of staff got hit by a scooter and they’d verified he was OK, he and some others gifted the chief a helmet, whistle and cape branded with Burchett’s friendly nickname for his top staffer: “Big Sexy.”
At times, Burchett’s jokes feel absolutely random. Last year, he waltzed up to Rep. Madeleine Dean (D-Pa.), a first-term lawmaker who was wearing a purple ribbon to raise awareness about the opioid epidemic at the time, and told her purple was his favorite color. He said he grew up sleeping in purple sheets, but then when he was 12 his mom tried to throw them away after a baby gerbil ate holes in them.
“No, Momma, not my purple sheets!” he yelled, recalling the episode to a confused but amused Dean, whom Burchett said he had just met.
Unlike most politicians on Capitol Hill, the Tennessee Republican isn’t carefully constructing his image or donning the beltway uniform of penny loafers and button-down shirts. In fact, Burchett’s colleagues were more concerned about sharing the lawmaker’s jokes publicly, fearing bad optics or negative misinterpretations by the public, than Burchett was himself.
He saunters around the Capitol in the same tan-brown Carhartt jacket (don’t get his friends started on the reports that have dubbed Sen.-elect John Fetterman [D-Pa.] as Congress’ Carhartt ambassador), throwing out fist-bumps to friends, checking in on strangers and scandalized colleagues in a Holden Caulfield fashion, talking about how much he loves his wife and daughter, and randomly striking up conversations about when he used to sell items on Ebay as a side-hustle.
And while his voting record resembles those of members in the House Freedom Caucus, his relationships across the aisle are starkly different. He and Speaker Nancy Pelosi publicly embraced after Burchett told her that he was praying for her husband after the violent assault at Pelosi’s San Francisco home, as the Tennessean recalled. He is also known to fist-bump with Democrats like progressive Rep. Alexandria Ocasio-Cortez (D-N.Y.), an association that his GOP colleagues say would destroy other members among base voters.
But he doesn’t want his interactions with Democrats to end there. He has three goals he remembers listing off to now-former Rep. Joe Kennedy (D-Mass.):
“I want to run down South Beach hand-in-hand with [former Rep.] Donna Shalala. I want to go to the Bronx and party with AOC. I don’t know if she lives in the Bronx or not … I’ve never been to New York,” Burchett said. “And I said I want to party in the Kennedy compound.”
