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Americans across the country are getting ready to wait.

Knowing the winner of the presidential election by tomorrow night is a real possibility. But the race could also take several days to be called, as it did in 2020, and some House races are likely to take days. In most other modern presidential elections (leaving aside the recount of the  2000 election), news outlets have declared a winner within hours of the polls closing. But in this week’s election, the closeness of the race and the popularity of mail-in voting could lead to a longer timeline. Amid all the unknowns, one American tradition may get lost: the social ritual of Election Night.

Over the generations, Election Night has brought Americans together and prepared them to accept the outcome of a race. Many voters missed out on that gathering in 2020, in part because they were in pandemic isolation. And as my colleague Kate Cray wrote at the time, “Watch parties and their kitschy decor don’t necessarily fit with an election in which many voters fear the collapse of democracy.” A communal gathering was even less appealing to liberals “still traumatized by 2016,” Kate noted. This year, Americans of all political loyalties are finding the election anxiety-inducing: A recent survey from the American Psychological Association found that 69 percent of polled adults rated the U.S. presidential election as a significant source of stress, a major jump from 52 percent in 2016 (and a slight bump from 68 percent in 2020).

Still, some Americans are preparing for classic election watch parties at friends’ homes or in bars. But this time around, voters’ self-preservational instincts are kicking in too. A recent New York magazine roundup of readers’ Election Night plans in the Dinner Party newsletter included streaming unrelated television, drinking a lot, and “Embracing the Doom Vibes.” For some, prolonged distraction is the move: The cookbook author Alison Roman suggests making a complicated meal. Even party enthusiasts seem wary: In an etiquette guide about how to throw a good Election Night party with guests who have different political views, Town & Country suggested that “hosting a soiree of this nature in 2024 is like setting up a game of croquet on a field of landmines.” One host suggested giving guests a “safe word” to avoid conflict.

Election Night was once a ritual that played out in public—generally over the course of several days, Mark Brewin, a media-studies professor at the University of Tulsa and the author of a book on Election Day rituals, told me. A carnival-like atmosphere was the norm: People would gather at the offices of local newspapers to wait for results, and winners’ names were projected on walls using “magic lanterns.” Fireworks sometimes went off, and bands played. With the popularity of radio and TV in the 20th century, rituals moved farther into private spaces and homes, and results came more quickly. But even as technology improved, “this process is always at the mercy of the race itself,” Brewin explained.

Election Night rituals of years past weren’t just about celebration. They helped create the social conditions for a peaceful reconciliation after impassioned election cycles, Brewin said. In the 19th century, for example, once an election was called, members of the winning party would hand a “Salt River ticket” to the friends whose candidates lost (Salt River is a real body of water, but in this case, the term referred to a river of tears). The humor of the gesture was its power: It offered people a way to move forward and work together. Such rituals marked the moment when people “stop being partisans and become Americans again,” Brewin said.

That concept feels sadly quaint. This week, Americans are bracing for chaos, especially if Donald Trump declares prematurely that he won or attempts to interfere in the results of the race. An election-watch gathering might seem trivial in light of all that. But Americans have always come together to try to make sense of the changes that come with a transfer of power, and doing so is still worthwhile—especially at a time when unifying rituals feel out of reach.

Related:

Is this the end of the Election Night watch party? How to get through Election Day

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Trump’s followers are living in a dark fantasy, Adam Serwer writes. Inside the ruthless, restless final days of Trump’s campaign The “blue dot” that could clinch a Harris victory How is it this close?

Today’s News

Vice President Kamala Harris will finish her last day of campaigning in Philadelphia, and Donald Trump will host his last rally in Grand Rapids, Michigan. A Pennsylvania judge ruled that Elon Musk’s America PAC can continue with its $1 million daily giveaway through Election Day. Missouri sued the Department of Justice in an effort to block the department from sending federal poll monitors to St. Louis.

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The Wonder Reader: Isabel Fattal explores the appliances we’ve relied on for decades, and those that claim to usher in new ways of living—with varied success.

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Evening Read

Illustration by The Atlantic. Sources: Jacopin / BSIP / Getty; Velimir Zeland / Shutterstock.

A ‘Crazy’ Idea for Treating Autoimmune Diseases Might Actually Work

By Sarah Zhang

Lupus, doctors like to say, affects no two patients the same. The disease causes the immune system to go rogue in a way that can strike virtually any organ in the body, but when and where is maddeningly elusive. One patient might have lesions on the face, likened to wolf bites by the 13th-century physician who gave lupus its name. Another patient might have kidney failure. Another, fluid around the lungs. What doctors can say to every patient, though, is that they will have lupus for the rest of their life. The origins of autoimmune diseases like it are often mysterious, and an immune system that sees the body it inhabits as an enemy will never completely relax. Lupus cannot be cured. No autoimmune disease can be cured.

Two years ago, however, a study came out of Germany that rocked all of these assumptions.

Read the full article.

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David Frum: No one has an alibi. Donald Trump’s hatred of free speech The shadow over Kamala Harris’s campaign The institutions failed. Xi may lose his gamble. Samer Sinijlawi: My hope for Palestine

Culture Break

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Mourn. We’ll never get a universal cable, Ian Bogost writes. It’s the broken promise of USB-C.

Watch. Kamala Harris made a surprise appearance on Saturday Night Live, but another segment that night made a sharper political point, Amanda Wicks writes.

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P.S.

One peek into Americans’ mental state on Election Night comes from their orders on food apps. In 2016, Election Night alcohol demand on Postmates was nearly double that of the prior Tuesday—and that demand spiked again at lunchtime the next day. For the delivery app Gopuff, alcohol orders were high on Election Night in 2020—especially champagne and 12-packs of White Claw. And, less festively, orders for Tums and Pepto Bismol rose too. However you pass the time waiting for results this year, I hope you stay healthy.

— Lora

Stephanie Bai contributed to this newsletter.

When you buy a book using a link in this newsletter, we receive a commission. Thank you for supporting The Atlantic.

Lupus, doctors like to say, affects no two patients the same. The disease causes the immune system to go rogue in a way that can strike virtually any organ in the body, but when and where is maddeningly elusive. One patient might have lesions on the face, likened to wolf bites by the 13th-century physician who gave lupus its name. Another patient might have kidney failure. Another, fluid around the lungs. What doctors can say to every patient, though, is that they will have lupus for the rest of their life. The origins of autoimmune diseases like it are often mysterious, and an immune system that sees the body it inhabits as an enemy will never completely relax. Lupus cannot be cured. No autoimmune disease can be cured.

Two years ago, however, a study came out of Germany that rocked all of these assumptions. Five patients with uncontrolled lupus went into complete remission after undergoing a repurposed cancer treatment called CAR-T-cell therapy, which largely wiped out their rogue immune cells. The first treated patient has had no symptoms for almost four years now. “We never dared to think about the cure for our disease,” says Anca Askanase, a rheumatologist at Columbia University’s medical center who specializes in lupus. But these stunning results—remission in every patient—have fueled a new wave of optimism. More than 40 people with lupus worldwide have now undergone CAR-T-cell therapy, and most have gone into drug-free remission. It is too early to declare any of these patients cured for life, but that now seems within the realm of possibility.

Beyond lupus, doctors hope CAR-T portends a bigger breakthrough against autoimmune diseases, whose prevalence has been on a troubling rise. CAR-T has already been used experimentally to treat patients with other autoimmune diseases, including multiple sclerosis, myositis, and myasthenia gravis. And the success of CAR-T has inspired researchers to borrow other—cheaper and simpler—strategies from cancer therapy to kill immune cells gone awry. Not all of these ideas will pan out, but if any do, the next few years could bring an inflection point in treating some of the most frustrating and intractable diseases of our modern era.

CAR-T-cell therapy was originally developed as a way to kill malignant cells in blood cancer. It could, scientists later reasoned, also be used to kill specific white blood cells, called B cells, that go haywire with certain autoimmune diseases. One group tried a CAR-T-like therapy against an autoimmune disease called pemphigus vulgaris, and another CAR-T against lupus. It worked—but these experiments were only in mice.

This was the sum total of available scientific evidence when a 20-year-old woman came to her doctors in Erlangen, Germany, asking to try anything for her severe and uncontrolled lupus. None of the long-term medications typically used to manage lupus were working. Her kidneys, heart, and lungs were all failing, and she could walk only 30 feet by herself. CAR-T was risky, her doctor agreed, but lupus was killing her.

CAR-T-cell therapy could essentially turn her immune system against itself. First, doctors extracted from her blood a class of immune cells, called T cells, which they then engineered into chimeric antigen receptor T (CAR-T) cells that could recognize and destroy the B cells driving her lupus. CAR-T cells can cause dangerous and overwhelming inflammatory responses in cancer patients, and her doctors did worry that CAR-T could do the same for someone with autoimmune disease, whose immune system is already in overdrive. “We take the T cells out, activate them like crazy, and then shoot those massively overactivated T cells in an activated autoimmune disease. So if you think about it, that's kind of crazy to do that, right?” says Fabian Müller, a hematologist-oncologist at the University Hospital of Erlangen and one of the doctors on the German team that pioneered the treatment. But fortunately, the woman with lupus did not have any serious side effects, nor did any of the other patients the German group has since dosed. They are all living their everyday lives, free of lupus symptoms and medications. The woman who could walk a mere 30 feet now runs five times a week, Müller told me. She’s gone back to school and is considering studying for a master’s in immunology.

Müller and his colleagues believe that CAR-T-cell therapy works by wiping out enough B cells to trigger a “deep reset” of the immune system. CAR-T cells are dogged little assassins; they are able to find and destroy even the B cells hiding deep in the body’s tissues. A patient’s B-cell count eventually recovers, but the new ones no longer erroneously attack the body itself. Cancer patients are sometimes considered “cured” after five years of remission, and the first lupus patient to receive CAR-T is not so far off from that milestone. But the therapy cannot erase the genetic predisposition many patients have for the disease, says Donald Thomas, a rheumatologist in Maryland. Whether remission is actually durable enough to be a “cure” will take time to find out.

Still, these extraordinary results have set off a gold rush among biotech companies eager to solve autoimmune diseases. CAR-T start-ups founded to treat cancer are pivoting to target autoimmune diseases. And large pharmaceutical companies such as Bristol Myers Squibb, AstraZeneca, and Novartis are developing their own therapies. Columbia’s Askanase is now an investigator on five separate trials, all using CAR-T or a similar cellular therapy, and she hears from more companies all the time. There’s so much interest, she told me, “I don’t even know there are enough patients” to test new treatments. About 1.5 million Americans have lupus, but only a minority of them—those sick enough to justify experimental treatment but not so sick that they’ve suffered too much irreversible organ damage—are eligible for trials.

For now, CAR-T for lupus and other autoimmune diseases is pretty much only accessible in the U.S. through clinical trials—which, in effect, means it’s inaccessible to almost all lupus patients. Jonathan Greer, a rheumatologist in Florida, works in a seven-doctor practice that treats hundreds of people with lupus; not a single one has received CAR-T. He doesn’t know of a single center in Florida that is up and running to do these studies, so interested patients would have to travel out of state.

Even if it becomes FDA approved for autoimmune diseases, CAR-T is a long and expensive process. Because each patient’s own cells are reengineered, it cannot be easily scaled up. The cost of CAR-T for cancer runs about $500,000. Patients also need chemotherapy to kill existing T cells to make room for CAR-T, which adds risk, and in lupus, they usually need to taper off any medications keeping their disease in check, which can cause flare-ups. All these complications make the current iteration of CAR-T suitable only for lupus patients with severe disease, who have run out of other options.

The practical limitations of CAR-T have dogged the cancer field for a long time now, and researchers have already come up with ideas to get around it. A number of simpler strategies for killing B cells are now making their way from blood cancer to autoimmune disease. They include using donor T cells, a different type of immune cell called natural killer cells, or a molecule that binds a T cell to the B cell it’s meant to destroy. Those molecules, called bispecific T-cell engagers, or BiTEs, are “cheap, fast, uncomplicated,” Müller said, but they may not penetrate as deeply into the tissues where B cells reside. Nevertheless, in September, The New England Journal of Medicine published two successful case reports describing successful treatment in a handful of autoimmune diseases, including lupus, with a BiTE called teclistamab. Similar BiTES on the market could be repurposed for autoimmune disease too.

These simpler therapies may ultimately be “good enough,” Askanase said. And their ease of use could ultimately beat out custom CAR-T therapy, which is unlikely to reach all of the millions of people with lupus worldwide. It’s simply too expensive and too cumbersome, a problem that has held back other cutting-edge therapies that were approved to much initial fanfare. Even if CAR-T itself is never widely adopted for autoimmune diseases, it has opened the door to new ideas that could one day revolutionize their treatment.