A new Oxford University study found that the duration of an encounter with a person sick with COVID was as important as the distance kept from them.

Over the past year, the writers on The Atlantic’s Science, Technology, and Health desk have learned about the dynamics of the cosmos and tiny microbes, the nature of the human brain and artificial intelligence. We’ve also covered some of the most pressing issues facing the planet: the climate crisis, infectious-disease outbreaks, a new wave of transformative weight-loss drugs. Along the way, our reporting has revealed some fascinating, sobering, and unusual facts. We wanted to share some of the most intriguing tidbits we’ve stumbled across, and we hope you enjoy them as much as we do.

Mars has seasons, and in the winter, it snows. Bats are arguably the healthiest mammals on Earth. Mammal milk changes depending on the time of day, a baby’s age and sex, the mom’s diet, and more. The genetic mutation behind “Asian glow” might help protect people against certain pathogens—including tuberculosis. The overwhelming majority of sweaters available on the American mass market are made at least partly of plastic. In 2003, a NASA Investigation Board blamed the disintegration of the space shuttle Columbia in part on PowerPoint. As much as 36 percent of the world’s annual carbon-dioxide emissions from fossil fuels are sequestered, at least temporarily, in fungi. Mice and rats can’t vomit. In the 1930s, the U.S. Army considered distributing daily rations of yerba mate to soldiers. You have two noses, and you can control them separately via your armpits. It’s possible to lactate without ever having been pregnant. But if you are pregnant, your feet might grow roughly half a shoe size and lengthen by about 0.4 inches. Gender-neutral baby names are more popular in conservative states than in liberal ones. By 2051, North America may run out of three-digit area codes. Today’s average NBA athlete is 4 to 7 percent better than the average player from more than 10 years ago. Hawaii’s feral chickens are out of control. When you look at a tattoo, you’re seeing ink shining in the “belly” of an immune cell that has gobbled up the ink and failed to digest it. The technology behind the first rice cookers, sold in 1955, is still widely used today—because it’s perfect. Meanwhile, the corrugated pizza box used by basically every pizzeria has not changed since its invention in 1966, and it does a bad job of maintaining a take-out pizza. A database of nearly 200,000 pirated books is powering many generative-AI models. Americans are suffering from cockroach amnesia. The hippopotamuses released from Pablo Escobar’s personal zoo in Colombia are engineering the local ecosystem. Compostable plastic bags buried in soil for three years can still hold a full load of groceries. Allergy season really is getting worse. Last month, for two consecutive days, the Earth reached global temperatures of 2 degrees Celsius above preindustrial levels for the first time. There are Lord of the Rings–style hobbit-house Airbnbs, an Airbnb in the shape of a spaceship, and an Airbnb inside a freestanding harbor crane. Cat owners in Cyprus are giving leftover COVID drugs to their pets, but not for COVID. The same molecule that makes cat urine smell like cat urine is, in lower concentrations, commonly used in air fresheners and household cleaners. The Sphere, in Las Vegas, can transform its 366-foot-tall exterior into a gargantuan emoji that astronauts can reportedly see from space. Within eight seconds of flushing, a toilet bowl can shoot a plume of aerosols nearly five feet into the air—and straight into your face. Until the 1800s, merchants, lawyers, and aristocrats each wrote in their own distinctive script. The English words flow, mother, fire, and ash come from Ice Age peoples. By hacking a Tesla’s rear heated seats, German researchers inadvertently accessed private user data. Many eye creams are functionally identical to facial moisturizers but are far more expensive. A Dutch man and his family have a perplexing brain condition called “color agnosia”: They can see colors, but they cannot name them. Hurricane Otis confounded extreme-weather warning systems by gaining more than 100 miles per hour of wind speed in 24 hours. Foxes have committed mass murder against flamingos at least three times during the past 30 years. Despite nearly half a century of trying, we don’t have any medication that effectively treats anorexia. There are no established clinical guidelines for diagnosing and treating adult ADHD. Elephant seals sleep only two hours a day, for many months at a time, via a series of super-short naps, taken as they dive deep beneath the ocean’s surface. UPS handles so many packages every year that its workers put their hands on roughly 6 percent of the country’s gross domestic product. One of Saturn’s moons likely has a habitable ocean. AI avatars led a church service in Germany this summer. There’s a lifeguard shortage in America. It’s been going on for a century. A pill may be easier to swallow if you turn your head as it goes down. During the original run of Seinfeld, the show’s costumers had a hard time sourcing the clothing for Kramer’s wardrobe because his quirky style had become so popular with the general public that they were buying up all of the vintage clothing that made up his look. AI models can analyze the brain scans of somebody listening to a story and then reproduce the gist of every sentence. A new idea to curb emissions takes inspiration from the Cold War: a fossil-fuel-nonproliferation treaty. During a 2018 war game in which the president had been cut off from his nuclear forces, many participants—including former heads of state, foreign ministers, and senior NATO officers—recommended leaving the decision of whether to enter a nuclear exchange to an AI. Decades of research suggest that hypnosis might be an effective treatment for irritable bowel syndrome, at least in the short term. Rest is not necessarily the best treatment for a concussion. People have been living on the Galápagos Islands since the early 1800s. Bird chicks aren’t innately able to recognize their mother’s calls—they learn to do so while in their eggs and can be manipulated to respond to another species’ voice. People are likely spending billions of dollars tipping creators on TikTok Live. Before Tesla and Meta, Palo Alto’s biggest tech giant was a farm that bred racehorses. Reports of pediatric melatonin overdoses have increased by 530 percent over the past decade. iPhone cameras can perform trillions of operations to optimize a single photo. Modern flip phones stink because they’re just made of recycled scraps from the smartphone-manufacturing process. If you think all phones are passé, you can buy a pair of screen eyes from Apple for $3,499. Some people loop playlists in their sleep to help them game the Spotify algorithm and get more impressive Spotify Wrapped results. An index ranking the transparency of flagship AI models from 10 major companies gave every single one a resounding F.

Lemon-lime isn’t a flavor so much as a sensibility that defines soft drinks. The Italian government provides gluten-free-food vouchers for people with celiac disease. Some people taking Ozempic to lose weight are also effortlessly quitting smoking, drinking, and online shopping. Scantron tests, a defining feature of American education, are dying. Fifteen percent of daily Google searches have never been searched before, according to the company. American cars hit more than 1 million large animals and as many as 340 million birds every year. Animals at watering holes in South Africa’s Greater Kruger National Park were twice as likely to flee when they heard a human voice as when they heard lions. Hundreds of craters on the moon never receive direct sunlight. The total surface area of the Antarctic’s sea ice in July was more than four standard deviations smaller than the average for that time of year, shattering records. Oxygen might actually be bad for multicellular evolution. Last year, the Sunset Limited train from New Orleans to Los Angeles was on time for just 19 percent of trips, making it the tardiest train in the country. About a third of pregnancies in women 40 and older are unplanned. MSG stays on the tongue long after food is swallowed, resulting in a lingering savory sensation. Podiatrists have seen a spike in plantar-fasciitis cases since the coronavirus pandemic began, partly because so many people who work from home shuffle around barefoot on hard floors. OpenAI’s chief scientist commissioned a wooden effigy intended to represent an AI that does not meet a human’s objectives. He set it on fire at a leadership meeting this year, according to two people familiar with the event. A luxury trip to Antarctica can cost upwards of $65,000. Many football fans punch, shoot, run over, or otherwise destroy their TV when things don’t go well for their team. Checked-bag fees may feel like they’ve been a scourge since the birth of aviation, but they were only introduced in 2008.

Dolphins have their own version of baby talk. Gravity-wise, the Earth doesn’t resemble a blue marble so much as a potato.

The Smithfield Market's traditional event returned on Saturday for the first time since before the Covid pandemic.

The Supreme Court’s upcoming decision about the most common pharmaceutical used for medication abortions may be just the beginning of the political battle over the drug.

Earlier this month, the Supreme Court agreed to hear an appeal of lower-court rulings that would severely reduce access to mifepristone. The Court’s acceptance of the case marked a crucial juncture in the legal maneuvering over the medication.

But however the high court rules, pressure is mounting inside the GOP coalition for the next Republican president to broadly use executive authority at the Food and Drug Administration and the Justice Department to limit access to mifepristone and to reduce what abortion opponents call “chemical abortion.”

“Chemical abortion will be front and center and presented front and center by the pro-life movement if there is a Republican president,” Kristan Hawkins, the president of Students for Life of America, told me. “There is going to be a lot of action we want to see taken.”

The possibility of new executive-branch restrictions on abortion drugs, which are now used in a majority of all U.S. abortions, underscores the stakes over abortion in the 2024 presidential election. Even if Donald Trump or another Republican wins back the White House next year, they might not have enough votes in Congress to pass a nationwide ban on the practice. But through executive action, the next GOP president could unilaterally retrench access to mifepristone in every state, however the Supreme Court decides the current case. Multiple former FDA officials and advocates on both sides of the issue told me that through regulatory and legal actions by the FDA, the Justice Department, or both, the next Republican president could impose all the limits on access to mifepristone that anti-abortion groups are seeking in the lawsuit now before the high court.

[Read: Abortion is inflaming the GOP’s biggest electoral problem]

“The FDA is a highly regulated space, so there are a lot of hoops they would have to jump through,” Jeremy Sharp, the FDA’s deputy commissioner for policy planning, legislation, and analysis during part of Barack Obama’s second term, told me. “But if they got a commissioner in there that was ideologically motivated, and if they changed the staff leadership, then there’s a lot they could do before anybody could get in the way and stop them.”

The growing Republican focus on using executive-branch authority against abortion access marks a new front in the broader political confrontation over reproductive rights. While Roe v. Wade was in place, the social conservative movement was focused overwhelmingly on trying to reverse the nationwide right to abortion and “wasn’t zoned in on this issue” of federal regulatory authority over abortion drugs, Hawkins noted.

Medication abortion involves two drugs: mifepristone followed by misoprostol (which is also used to prevent stomach ulcers). From 2000 through 2022, almost 6 million women in the U.S. used mifepristone to end a pregnancy, according to the FDA. In all those cases of women using the drug, the agency has recorded only 32 deaths (including for reasons unrelated to the drug) and a little more than 1,000 hospitalizations. The risk of major complications has been less than half of 1 percent.

Neither of the past two Republican presidents acted against the drugs administratively or even faced sustained pressure from social conservatives to do so. The FDA initially approved mifepristone for use in abortion during the final months of Bill Clinton’s presidency, in 2000. But during Republican President George W. Bush’s two terms, the FDA made no effort to rescind that approval.

During Obama’s final year, the FDA significantly loosened the restrictions on usage of the drug. (Among other things, the agency reduced the number of physician visits required to obtain the drugs from three to one; increased from seven to 10 the number of weeks into a pregnancy the drugs could be used; and permitted other medical professionals besides physicians to prescribe the drugs if they received certification.) During Trump’s four years, the FDA did not move to undo any of those decisions.

But the right’s focus on abortion drugs has significantly increased since Trump left office. According to Hawkins, one reason is that the COVID pandemic crystallized awareness of how many abortions are performed remotely with the drugs, rather than in medical settings. Even more important may have been the decision by the six GOP-appointed Supreme Court justices in 2022 to overturn Roe. By fulfilling the top goal of anti-abortion activists, that decision both freed them to concentrate on other issues and raised their ambitions.

In one measure of that growing zeal, social conservative groups and Republican elected officials have pushed back much harder against Joe Biden’s attempts to expand access to mifepristone than they did against Obama’s moves. Under Biden, the FDA has eliminated the requirement for an in-person visit to obtain mifepristone; instead it allows patients to get a prescription for the drug through a telehealth visit and then receive it through the mail. The FDA under Biden has also allowed pharmacies that receive certification to dispense the drug.

As I wrote earlier this year, the paradox is that Biden’s rules will be felt almost entirely in the states where abortion remains legal. Almost all red states have passed laws that still require medical professionals to be present when the drugs are administered, and, even though the FDA allows their use through 10 weeks of pregnancy, the drugs cannot be prescribed in violation of state time limits (or absolute bans) on abortion.

Shortly after last November’s midterm election, an alliance of conservative groups sued in federal court to overturn not only Biden’s measures to ease access to the drug but also the changes approved in 2016 under Obama, and even the decision under Clinton in 2000 to approve the drug at all.

[​​Read: Why Trump might just roll to the presidential nomination]

In April 2023, Judge Matthew J. Kacsmaryk, a Trump appointee and abortion opponent, ruled almost entirely for the plaintiffs, striking down the Biden and Obama regulations and the FDA’s original approval of the drug. In August, a panel of three Republican-appointed judges on the Fifth Circuit Court of Appeals upheld Kacsmaryk’s ruling overturning the Obama and Biden regulatory changes. But the panel, by 2–1, ruled that it was too late to challenge the drug’s original approval.

The Supreme Court along the way blocked the implementation of any of these rulings until it reached a final decision in the case, so mifepristone has remained available. In its announcement earlier this month, the Court agreed to hear appeals to the Fifth Circuit decision erasing the Obama and Biden administrations’ regulatory changes but declined to reconsider the circuit court’s upholding of mifepristone’s original approval. Those choices have raised hopes among abortion-rights activists that the Court appears inclined to reverse the lower court’s ruling and preserve the existing FDA rules. “We are very hopeful this is an indicator the Court is not inclined to rule broadly on medication abortion and they are concerned about the reasoning of the decisions [so far],” said Rabia Muqaddam, a senior staff attorney at the Center for Reproductive Rights, a group that supports legal abortion.

But the legal process has shown that even a Supreme Court decision maintaining the current rules is unlikely to end the fight over mifepristone. The reason is that the proceedings have demonstrated much broader support in the GOP than previously for executive-branch action against the drug.

For instance, 124 Republicans in the House of Representatives and 23 GOP senators have submitted a brief to the Supreme Court urging it to affirm the Fifth Circuit’s ruling overturning the Obama and Biden actions on mifepristone. “By approving and then deregulating chemical abortion drugs, the FDA failed to follow Congress’ statutorily prescribed drug approval process and subverted Congress’ critical public policy interests in upholding patient welfare,” the Republican legislators wrote. Republican attorneys general from 21 states submitted a brief with similar arguments in support of the decision reversing the Obama and Biden administrations’ regulatory actions.

In another measure, a large majority of House Republicans voted last summer to reverse the FDA’s decisions under Biden that expanded access to the drugs. Though the legislation failed when about two dozen moderates voted against it, the predominant support in the GOP conference reflected the kind of political pressure the next Republican president could face to pursue the same goals through FDA regulatory action.

Simultaneously, conservatives have signaled another line of attack they want the next GOP president to pursue against medication abortions. In late 2022, the Justice Department’s Office of Legal Counsel issued an opinion that the Postal Service could deliver the drugs without violating the 19th-century Comstock Act, which bars use of the mail “to corrupt the public morals.” That interpretation, the opinion argued, was in line with multiple decisions by federal courts spanning decades that the law barred the mailing of only materials used in illegal abortions.

Conservatives are arguing that the next Republican administration should reverse that OLC ruling and declare that the Comstock Act bars the mailing of medications used in any abortions.

The fact that both Kacsmaryk and Circuit Court Judge James Ho, also appointed by Trump, endorsed that view in their rulings on mifepristone this year offers one measure of the receptivity to this idea in conservative legal circles. As telling was a letter sent last spring by nine GOP senators to major drug-store chains warning that they could be held in violation of the Comstock Act not only if they ship abortion drugs to consumers but even if they use the mail or other freight carriers to deliver the drugs to their own stores.

Trump and his leading rivals for the 2024 GOP nomination, Florida Governor Ron DeSantis and former South Carolina Governor Nikki Haley, have avoided explicit commitments to act against medication abortions. But all of these efforts are indications of the pressure they would face to do so if elected. Hawkins said that anti-abortion groups have chosen not to press the candidates for specific plans on regulatory steps against mifepristone but instead intend to closely monitor the views of potential appointments by the next GOP president, the same tactic signaled by the senators in their letter to drug-store chains. “It will make for probably the most contentious fight ever over who is nominated and confirmed” for the key positions at the FDA and other relevant agencies, Hawkins told me.

Stephen Ostroff, who served as acting FDA commissioner under both Obama and Trump, told me that future Republican appointees would likely find more success in reconsidering the regulations governing access to mifepristone than in reopening the approval of the drug altogether this long after the original approval. Even reconsidering the access rules, he predicts, would likely ignite intense conflict between political appointees and career scientific staff.

“I think it would be challenging for a commissioner to come in and push the scientific reviewers and other scientific staff to do things they don’t think are appropriate to do,” Ostroff told me. “You’d have to do a lot of housecleaning in order to be able to accomplish that.” But, he added, “I’m not saying it is impossible.”

In fact, political appointees under presidents of both parties have at times overruled FDA decisions. Kathleen Sebelius, the Health and Human Services secretary for Obama, blocked an FDA ruling allowing the over-the-counter sale of emergency contraception to girls younger than 17; the Biden White House has delayed an FDA decision to ban the sale of menthol cigarettes, amid concerns about a possible backlash among Black voters.

Many legal and regulatory experts closely following the issue believe that a Republican president’s first target would be the FDA’s decision to allow mifepristone to be prescribed remotely and shipped by mail or dispensed in pharmacies. To build support for action against mifepristone, a new FDA commissioner also might compel drug companies to launch new studies about the drug’s safety or require the agency’s staff to reexamine the evidence despite the minimal number of adverse consequences over the years, Sharp told me.

Faced with continuing signs of voter backlash on efforts to restrict abortion, any Republican president might think twice before moving aggressively against mifepristone. And any future attempt to limit the drug—through either FDA regulations or a revised Justice Department opinion about the Comstock Act—would face an uncertain outcome at the Supreme Court, however the Court decides the current case. The one certainty for the next GOP president is that the pressure from social conservatives for new regulatory and legal action against mifepristone will be vastly greater than it was the most recent two times Republicans controlled the executive branch. “We want all the tools in the tool kit being used to protect mothers and children from these drugs,” Hawkins told me. Amid such demands, the gulf between the FDA’s future decisions about the drug under a Republican or Democratic president may become much wider than it has been since mifepristone first became available, more than two decades ago.

MP Penny Mordaunt tells the Covid inquiry messages to Boris Johnson and Michael Gove went missing.

Earlier this month, Congress held a dramatic hearing with the heads of three private corporations that manage important forums for public debate. Members of Congress criticized these leaders in the strongest possible terms for their alleged failure to stem harmful speech on their property. The White House weighed in the next day to denounce the leaders’ equivocal answers, and both the Biden administration and Congress have announced multiple investigations into whether these and other institutions have violated federal law by not cracking down on this speech.

The previous paragraph obviously describes the efforts by federal lawmakers to pressure university presidents to more aggressively police anti-Semitic speech on campus. But it could just as easily describe another recent pressure campaign—the one directed at social-media platforms. These companies’ CEOs, too, have been hauled before Congress to account for their speech rules, had their policies denounced by the White House, been threatened with legal liability, and had private communications with government employees about what speech they allow on their platforms.

Despite these similarities, the two pressure campaigns have been received very differently. The Biden administration’s effort to influence social-media platforms’ content policies sparked a vociferous outcry from Republican officials, culminating in a First Amendment lawsuit that is now before the Supreme Court. The pressure campaign over university speech policies, by contrast, has generated very little alarm about the First Amendment interests of either the schools or their students. This is a problem, because the threat of government interference with free speech is very real in both contexts.

[Genevieve Lakier: The great free-speech reversal]

For years, the Biden administration and Democrats in Congress have pressured social-media companies to stamp out COVID misinformation, election denialism, and other harmful speech on their platforms. And for nearly as long, a loose group of Republican lawmakers, conservative influencers, and COVID contrarians has insisted that this constitutes a kind of “censorship by surrogate” that violates the First Amendment. In 2022, two Republican state attorneys general filed a federal lawsuit seeking to block the administration from this sort of “jawboning.” A conservative panel of the Fifth Circuit Court of Appeals ruled in their favor. The Supreme Court paused the ruling from going into effect, but agreed to hear an appeal in the case this term.

The Fifth Circuit’s decision in Murthy v. Missouri (originally called Missouri v. Biden) is sloppy on both the facts and the law, but it nonetheless articulates an important principle: We should be wary of overbearing government pressure on private speech intermediaries. The government possesses a great deal of power to make life better or worse for the private companies that it regulates. And companies are, in this context, often quite responsive to even subtle governmental threats, promises, or acts of intimidation. The result is that, by holding public hearings, arranging private meetings, and threatening economic or legal consequences if they do not comply, officials may be able to pressure private companies into suppressing constitutionally protected speech. They may, in other words, be able to wield the power that in theory the First Amendment says they may not wield: the power to decide what views and voices can participate in public discourse.

The pressure campaign against universities raises the same constitutional issue. Yet some of its leaders are among the most vocal critics of the Biden administration’s relationship with social-media platforms. Representative Elise Stefanik—who has gone viral for her questioning of the university presidents at the hearing this month—has decried this “weaponization of the federal government.” She joined with 11 other Republican members of Congress in an amicus brief on behalf of the challengers in the case, calling for an end to such “government meddling” in the marketplace of ideas.

In fact, the amount of pressure being wielded against universities may outstrip what social-media companies have faced. Despite constant threats, hearings, and proposed legislation, the platforms’ broad immunity from liability provided by Section 230 of the Communications Decency Act remains intact, and the prospect of legislative reform remains as elusive as ever. Contrast this with the very immediate threat of legal liability for universities under Title VI of the Civil Rights Act, which prohibits discrimination on the basis of shared ancestry or ethnic characteristics. The Department of Education has announced investigations into more than a dozen schools over whether they have violated Title VI by not cracking down sufficiently on anti-Semitic and Islamophobic speech. University officials have disclosed that DOE officials have also privately warned universities that they must act against specific controversial pro-Palestinian statements such as “From the river to the sea, Palestine will be free”—which, as many have noted, is in most contexts protected speech under the First Amendment. Members of Congress are working on a bill to strip schools of federal funding, and have agreed to a bipartisan resolution calling on Harvard’s and MIT’s presidents to resign. These are very serious threats for universities already facing immense pressure from donors and alumni to do more to restrict student speech.

You may not like what students are saying on campus, nor what the university presidents had to say about it during their congressional testimony. But the First Amendment is fundamentally concerned with how to treat speech that some people don’t like. At private institutions, university leaders, not government officials, ultimately get to decide what speech is permissible. At public universities, meanwhile, the broad protections of the First Amendment apply: political advocacy cannot be censored, no matter how controversial, intemperate, or even hateful. The Supreme Court has declared that “the proudest boast of our free speech jurisprudence is that we protect the freedom to express ‘the thought that we hate.’” But while this freedom may exist on paper, the enormous pressure from government officials is likely to make it hard for schools—and, by extension, their students—to exercise it in practice.

Of course, universities must act to prevent discrimination and harassment on campus, and the Department of Education has a responsibility to enforce Title VI. But when the government suggests universities need to repress speech that does not satisfy the relatively narrow statutory definition of harassment or discrimination, that is a problem. A risk-averse university will have a powerful incentive to suppress constitutionally protected speech to avoid even the possibility of legal trouble. This is a particular concern with regard to the debate over the Israel-Hamas war, because a defining feature of this debate is profound contestation over the boundary between political critique and bigotry. The result will be, almost invariably, the repression not only of truly anti-Semitic speech but a great deal of controversial political rhetoric.

[Yascha Mounk: The universities that don’t understand academic freedom]

This is not just about three elite East Coast schools. For every Harvard, there are dozens of other universities whose leaders are no doubt thinking about how to avoid becoming the next target of public humiliation and governmental pressure. This already appears to be having a marked impact on schools’ speech policies. After the hearing, several universities took the opportunity to issue public statements, unprompted, that on their campuses, the kind of speech that drew Stefanik’s ire would not be permitted.

Government officials have free-speech rights too, of course. Indeed, their job often requires them to articulate their views on matters of public importance. But in exercising this right, officials must not threaten or coerce. Nor should they exploit mechanisms, such as closed-door meetings or opaque investigations, that are not subject to democratic oversight. Where to draw the line between government speech and illegitimate pressure can be an extremely hard question to answer. The Supreme Court will hopefully give more guidance when it decides Missouri v. Murthy this term. Just as not all governmental criticisms of social-media companies violate the First Amendment, neither do all governmental criticisms of university policies.

We should not let the intense political disagreements of this moment blind us to this fundamental organizing principle of the democratic public sphere: Although the government can offer criticism, it cannot be permitted to do an end run around the Constitution. If the First Amendment protects against anything, it protects against illegitimate government pressure to censor protected speech.

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A little more than halfway into his speech in Waterloo, Iowa, last night, former President Donald Trump returned to his new favorite line.

“They’re destroying the blood of our country,” Trump said, complaining that immigrants are arriving from Africa, Asia, South America, and “all over the world.” He said that unnamed individuals (presumably his advisers) do not like it when he uses these sorts of phrases. During this section of his speech, the packed crowd inside the Waterloo Convention Center was pin-drop silent. He suddenly assured everybody that he’s never read Mein Kampf. “They said, ‘Oh, Hitler said that,’” he explained, adding, “in a much different way.” Then he was right back to it. “They could bring in disease that’s going to catch on in our country,” Trump warned. “They’re destroying the blood of our country; they’re destroying the fabric of our country.”

Trump has enjoyed a double-digit lead in the polls for months. “We could put this to bed after Iowa, if you want to know the truth,” he said of the GOP-primary race. His first-place finish in the caucus less than four weeks from now seems all but certain. He continues to trounce Florida Governor Ron DeSantis, whose campaign has become something like a balloon expelling air, chaotically fluttering in its descent. And although former United Nations Ambassador Nikki Haley has continued to rise in the polls, she remains a long shot in Iowa, and only slightly less of a long shot in New Hampshire. Congressional Republicans are coalescing around their leader. Over the weekend, Representatives Lee Zeldin of New York, Wesley Hunt of Texas, and Matt Gaetz of Florida were all stumping for Trump in Iowa. The former president smells it in the air. Last night, he seemed animated, as if taking a preemptive victory lap.

[Read: ‘Nothing is going to stop Donald Trump’]

As Trump’s position in the race has improved, his rhetoric has become more extreme. Speaking to the overwhelmingly white crowd in Waterloo, he spent even more time than usual demonizing nonwhite people. Immigrants, Trump said, are dumped on our borders, pouring into our country, bringing in crime. He said they were coming from other nations’ prisons and mental institutions, that they were “emptying out the insane asylums.” Later, he went after the kids. “You have children going to school, speaking languages that nobody even knows what the language is,” Trump said, adding that “there’s no room for our students in the classrooms”—emphasis on the “our.” He once again promised that, if reelected, he’ll carry out the largest deportation operation in American history.

Two weeks ago, Trump said he would be a dictator “on day one.” Last night, he praised the “great gentleman” Viktor Orbán of Hungary. “He’s the leader, he’s the boss, he’s everything you want to call him,” Trump said of the autocratic Orbán. He cautioned that our planet is on the brink of World War III, and that he, Donald Trump, is the only one who can prevent it. (He bragged about how he personally made sure our nuclear stockpile was “all tippy-top.”) Trump scoffed at his indictments, particularly the classified-documents case against him: “I have total protection. I’m allowed to do it.” He vowed to “take over our horribly run Washington, D.C.” and give indemnification to any police officer who “gets in trouble” for pursuing a criminal. I’ve watched Trump speak live in several different settings over the past several months. I’ve never seen him more bombastic this year than he seemed last night; he sounded like an unmoored strongman.

Scott Olson / Getty

Trump’s pageant of darkness unfolded against a backdrop of Christmas cheer. The former president was flanked by two Christmas trees, each topped with a red MAGA hat. Prop presents in Trump-branded wrapping paper dotted the stage. Red, green, and white lights glowed down from the ceiling. Trump opened with a long monologue from his earlier days: how we’re all saying “Merry Christmas” again. (His campaign volunteers handed out signs plastered with the phrase.) Even the press laminates were decorated with a string of cartoon Christmas lights.

One of Trump’s warm-up speakers, Iowa Attorney General Brenna Bird, asked the audience, “What do you give the man who has everything as a Christmas present?” This was a slightly confusing setup for a joke about how Christmas is going to come late for Trump this year, when he wins the Iowa caucus in mid-January. People sort of got it.

Before Trump took the stage, I spotted Santa Claus leaning against a brick wall outside the assembly hall and asked for an interview. He wavered, then reluctantly agreed. The back of his red suit said MAGA CLAUS in gold block letters. Santa, it turns out, is a man in his mid-20s named Alex. He said he lives in Northern Virginia and works for Public Advocate of the United States, a conservative nonprofit group. He told me he plays all sorts of characters, such as Cupid and an evil doctor/mad scientist who forces people to take a COVID vaccine. He told me he had showed up at the Loudoun County school protests dressed as Uncle Sam. Two of his organization’s signs hung outside the venue’s entryway: Make the Family Great Again! and There are only TWO genders: Male & Female. Merry Christmas.

[Read: What is this ‘Christmas’ you speak of?]

Sitting at a nearby table was 81-year-old Susan Holland and her husband, Buzz. Both welcomed me with a nod as I pulled up a chair next to them. Holland, wearing a bedazzled Trump hat and an American-flag sweater with flag earrings, told me she had seen Trump in person about 10 times over the years. “We can hardly wait ’til he’s sworn in again,” she said. I asked her where she gets her news. “We watch Fox News,” she said. “We watch the regular news too.”

Over the past several months, I’ve asked dozens of Trump supporters if there is anything the former president could do or say that would make them withdraw their support. Mike Benson, a 62-year-old retired carpenter from Waterloo, was posted up a few blocks away from the venue at the Broken Record Bar earlier in the afternoon, wearing a red TRUMP 2024 hat, nursing a Bud. He told me about being out of step with his union buddies, who all staunchly vote Democratic. (He said he cast his first presidential vote for Ronald Reagan and has supported the GOP ever since.) I brought up that Trump had been praising people like Vladimir Putin, Kim Jong Un, and Orbán, and asked if he thought Trump himself would end up a dictator.

“Not a chance,” Benson said. “People confuse Trump’s praise for them. He’s not praising them; he’s acknowledging that they’re smart people. They’re smart enough to manipulate their population, and Trump is acknowledging that,” he said. “The devil is smart,” he added.

I asked him if he thinks Trump manipulates our population.

“No,” he said. “He puts what he believes is true out there, and if you believe that too, all you have to do is follow him. He’s not strong-arming people around. He’s not manipulating facts. He’s not militarizing government departments to go after opponents. He’s not doing any of that.”

Less than an hour before Trump took the stage last night, the Colorado Supreme Court had ruled that the former president was disqualified from appearing on the state’s ballot under the Fourteenth Amendment because of his actions leading up to the January 6, 2021, attack on the Capitol. His campaign has already said that it will appeal the decision, and the case appears destined to wind up before the Supreme Court.

In Waterloo, Trump didn’t mention the Colorado ruling. Instead, he focused on Biden, the swamp, and the “deep state.” “We’re going to bring our country back from hell; our country’s gone to hell,” Trump said. By Christmas 2024, he countered, the economy will be roaring back and energy prices will be plummeting. He claimed responsibility for the presently high stock market—arguing that returns are up because people believe he is returning to office.

[John Hendrickson: Could the courts actually take Trump off the ballots?]

“Crooked Joe Biden” is “a low-IQ individual” and “the most incompetent, most corrupt president in the history of our country,” Trump said. “Other than that, I think quite a bit of him.” Later, Trump mocked Biden’s slow speech at a recent news conference.

Throughout the night, Trump pandered to Iowa voters, attacking electric cars, talking about persecution of Christians, and praising those who “still till that soil.” He fired off some strange ad-libs: “Does everybody in this room love their children? Does anybody in this room not love their children? Raise your hand. Oh, that guy in the blue jacket raised his hand!”

But his grotesque anti-immigrant rhetoric kept returning—a messier, ganglier version of “Build the Wall.”

As attendees filtered into the convention center, a 69-year-old man stood outside in the frigid cold and wind holding a handwritten sign. It read: EVERY TIME YOU EAT A PORK CHOP OR RIBEYE STEAK THANK AN IMMIGRANT. The man, Paul, had driven from his home in Manchester, about 50 miles east. He told me he used to work alongside many immigrants at a seed-corn plant. He said he was dismayed by all the slurs he had been hearing about foreigners. “I decided I was gonna come, I was gonna hold the sign,” and offer a message that was “at least halfway positive,” he said. I didn’t see any members of Trump’s flock stopping to consider it.

Emails published by the Covid inquiry show advisers thought the group were less scared of the virus.

Covid and other infections could rise in many parts of the world this winter, the experts warn.

Earlier this month, Taison Bell walked into the intensive-care unit at UVA Health and discovered that half of the patients under his care could no longer breathe on their own. All of them had been put on ventilators or high-flow oxygen. “It was early 2022 the last time I saw that,” Bell, an infectious-disease and critical-care physician at the hospital, told me—right around the time that the original Omicron variant was ripping through the region and shattering COVID-case records. This time, though, the coronavirus, flu, and RSV were coming together to fill UVA’s wards—“all at the same time,” Bell said.

Since COVID’s arrival, experts have been fearfully predicting a winter worst: three respiratory-virus epidemics washing over the U.S. at once. Last year, those fears didn’t really play out, Sam Scarpino, an infectious-disease modeler at Northeastern University, told me. But this year, “we’re set up for that to happen,” as RSV, flu, and COVID threaten to crest in near synchrony. The situation is looking grim enough that the CDC released an urgent call last Thursday for more vaccination for all three pathogens—the first time it has struck such a note on seasonal immunizations since the pandemic began.

Nationwide, health-care systems aren’t yet in crisis mode. Barring an unexpected twist in viral evolution, a repeat of that first terrible Omicron winter seems highly unlikely. Nor is the U.S. necessarily fated for an encore of last year’s horrors, when enormous, early waves of RSV, then flu, slammed the country, filling pediatric emergency departments and ICUs past capacity, to the point where some hospitals began to pitch temporary tents outside to accommodate overflow. On the contrary, more so than any other year since SARS-CoV-2 appeared, our usual respiratory viruses “seem to be kind of getting back to their old patterns” with regard to timing and magnitude, Kathryn Edwards, a vaccine and infectious-disease expert at Vanderbilt University, told me.

[Read: The worst pediatric-care crisis in decades]

But even so-so seasons of RSV, flu, and SARS-CoV-2 could create catastrophe if piled on top of one another. “It really doesn’t take much for any of these three viruses to tip the scale and strain hospitals,” Debra Houry, the CDC’s chief medical officer, told me. It also—in theory—shouldn’t take much to waylay the potential health-care crisis ahead. For the first time in history, the U.S. is offering vaccines against flu, COVID, and RSV: “We have three opportunities to prevent three different viral infections,” Grace Lee, a pediatrician at Stanford, told me. And yet, Americans have all but ignored the shots being offered to them.

So far, flu-shot uptake is undershooting last year’s rate. According to recent polls, as many as half of surveyed Americans probably or definitely aren’t planning to get this year’s updated COVID-19 vaccine. RSV shots, approved for older adults in May and for pregnant people in August, have been struggling to get a foothold at all. Distributed to everyone eligible to receive them, this trifecta of shots could keep as many as hundreds of thousands of Americans out of emergency departments and ICUs this year. But that won’t happen if people continue to shirk protection. The specific tragedy of this coming winter will be that any suffering was that much more avoidable.

Much of the agony of last year’s respiratory season can be chalked up to a terrible combination of timing and intensity. A wave of RSV hit the nation early and hard, peaking in November and leaving hospitals no time to recover before flu—also ahead of schedule—soared toward a December maximum. Children bore the brunt of these onslaughts, after spending years protected from respiratory infections by pandemic mitigations. “When masks came down, infections went up,” Lee told me. Babies and toddlers were falling seriously sick with their first respiratory illnesses—but so were plenty of older kids who had skipped the typical infections of infancy. With the health-care workforce still burnt out and substantially pared down from a pandemic exodus, hospitals ended up overwhelmed. “We just did not have enough capacity to take care of the kids we wanted to be able to take care of,” Lee said. Providers triaged cases over the phone; parents spent hours cradling their sick kids in packed waiting rooms.

And yet, one of the biggest fears about last year’s season didn’t unfold: waves of RSV, flu, and COVID cresting all at once. COVID’s winter peak didn’t come until January, after RSV and flu had substantially died down. Now, though, RSV is hovering around the high it has maintained for weeks, COVID hospitalizations have been on a slow but steady rise, and influenza, after simmering in near-total quietude, seems to be “really taking off,” Scarpino told me. None of the three viruses has yet approached last season’s highs. But a confluence of all of them would be more than many hospitals could take. Across the country, many emergency departments and ICUs are nearing or at capacity. “We’re treading water okay right now,” Sallie Permar, the chief pediatrician at Weill Cornell Medical Center and NewYork-Presbyterian Hospital, told me. “Add much more, and we’re thrown into a similar situation as last year.”

That forecast isn’t certain. RSV, which has been dancing around a national peak, could start quickly declining; flu could take its time to reach an apex. COVID, too, remains a wild card: It has not yet settled into a predictable pattern of ebb and flow, and won’t necessarily maintain or exceed its current pace. This season may still be calmer than last, and impacts of these diseases similarly, or even more, spaced out.

But several experts told me that they think substantial overlap in the coming weeks is a likely scenario. Timing is ripe for spread, with the holiday season in full swing and people rushing through travel hubs on the way to family gatherings. Masking and testing rates remain low, and many people are back to shrugging off symptoms, heading to work or school or social events while potentially still infectious. Nor do the viruses themselves seem to be cutting us a break. Last year’s flu season, for instance, was mostly dominated by a single strain, H3N2. This year, multiple flu strains of different types appear to be on a concomitant rise, making it that much more likely that people will catch some version of the virus, or even multiple versions in quick succession. The health-care workforce is, in many ways, in better shape this year. Staffing shortages aren’t quite as dire, Permar told me, and many experts are better prepared to deal with multiple viruses at once, especially in pediatric care. Kids are also more experienced with these bugs than they were this time last year. But masking is no longer as consistent a fixture in health-care settings as it was even at the start of 2023. And should RSV, flu, and COVID flood communities simultaneously, new issues—including co-infections, which remain poorly understood—could arise. (Other respiratory illnesses are still circulating too.) There’s a lot experts just can’t anticipate: We simply haven’t yet had a year when these three viruses have truly inundated us at once.

[Read: The big COVID question for hospitals this fall]

Vaccines, of course, would temper some of the trouble—which is part of the reason the CDC issued its clarion call, Houry told me. But Americans don’t seem terribly interested in getting the shots they’re eligible for. Flu-shot uptake is down across all age groups compared with last year—even among older adults and pregnant people, who are at especially high risk. And although COVID vaccination is bumping along at a comparable pace to 2022, the rates remain “atrocious,” Bell told me, especially among children. RSV vaccines have reached just 17 percent of the population over the age of 60. Among pregnant people, the other group eligible for the vaccines, uptake has been stymied by delays and confusion over whether they qualify. Some of Permar’s pregnant physician colleagues have been turned away from pharmacies, she told me, or been told their shots might not be covered by insurance. “And then some of those same parents have babies who end up in the hospital with RSV,” she said. Infants were also supposed to be able to get a passive form of immunity from monoclonal antibodies. But those drugs have been scarce nationwide, forcing providers to restrict their use to babies at highest risk—yet another way in which actual protection against respiratory disease has fallen short of potential. “There was a lot of excitement and hope that the monoclonal was going to be the answer and that everybody could get it,” Edwards told me. “But then it became very apparent that this just functionally wasn’t going to be able to happen.”

Last year, at least some of the respiratory-virus misery had become inevitable: After the U.S. dropped pandemic mitigations, pathogens were fated to come roaring back. The early arrivals of RSV and flu (especially on the heels of an intense summer surge of enterovirus and rhinovirus) also left little time for people to prepare. And of course, RSV vaccines weren’t yet around. This year, though, timing has been kinder, immunity stronger, and our arsenal of tools better supplied. High uptake of shots would undoubtedly lower rates of severe disease and curb community spread; it would preserve hospital capacity, and make schools and workplaces and travel hubs safer to move through. Waves of illness would peak lower and contract faster. Some might never unfold at all.

[Read: The pandemic broke the flu … again]

But so far, we’re collectively squandering our chance to shore up our defense. “It’s like we’re rushing into battle without armor,” Bell told me, even though local officials have been begging people to ready themselves for months. Which all makes this year feel terrible in a different kind of way. Whatever happens in the coming weeks and months will be a worse version of what it could have been—a season of opportunities missed.