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Is there a fuel blockade in Yemen? It’s complicated.
A March CNN report reignited calls, mainly from Democrats and progressive activists, for the US to do more to pressure Saudi Arabia to end what they call its “blockade” of Yemen.
The report said Saudi warships were blockading the Yemeni coast, preventing fuel tankers from docking in the country’s main port of Hodeidah, and that this fuel blockade is directly contributing to the ongoing famine and humanitarian crisis in the country.
Understandably, this led some activists and lawmakers to demand Biden do more to make Saudi lift the blockade and allow in the desperately needed fuel.
There’s just one problem: The Biden administration says there isn’t a blockade — and that any restrictions that are in place aren’t coming directly from the Saudis, but mainly from Yemen’s internationally recognized government. The issue is exacerbated, they say, by the Houthi rebels who control most of the country.
That’s a pretty stark disagreement. And it’s one that has critical implications for the lives of millions of Yemenis who are caught in the middle.
Here’s what we know about what’s actually happening in Yemen, who is responsible for the shortages causing millions of Yemenis to suffer, and whether the Biden administration can or should be doing more to help.
Saudi Arabia, along with several other countries in the region that joined its war effort, has been fighting a war in Yemen since 2015. They’re fighting to oust the Houthis, a rebel group backed by Iran that had just overthrown Yemen’s internationally recognized government led by President Abd Rabbu Mansour Hadi.
The Saudi-led coalition, which until recently was also supported by the US, wants to return Hadi, who currently lives in exile in Saudi Arabia, to power.
When Saudi Arabia and its allies launched the war, they used military force to stop planes from landing and ships from docking in Yemen, saying such measures were necessary to stop the Houthis from smuggling in weapons, including from Iran.
But critics warned the blockade would keep much-needed food, fuel, medicine, and humanitarian aid from reaching desperate Yemenis, including millions of children, who are caught in the middle of the fighting.
That concern proved devastatingly prophetic.
The Integrated Food Security Phase Classification, the world’s top authority on food security, said last year that 47,000 Yemenis were suffering from famine-like conditions and that more than 16 million — over half of Yemen’s population — couldn’t reliably and adequately feed themselves. United Nations agencies have said that at least 400,000 Yemeni children could die this year alone if conditions don’t improve.
What CNN found last month fit the years-long pattern: Saudi warships had kept all oil tankers from docking in the Houthi-controlled port of Hodeidah since the start of the year.
“The Saudi vessels that patrol the waters of Hodeidah have control over which commercial ships can dock and unload their cargo,” the outlet reported. “Some goods are getting through — CNN witnessed aid being loaded on to trucks at the port after being delivered by ship — but not any fuel to deliver them.”
This is what has activists so angry. “Food and medicine can’t be transported without fuel,” said Hassan El-Tayyab, the Friends Committee on National Legislation’s lead lobbyist for Middle East policy. “It’s causing a humanitarian nightmare in Yemen right now.”
What’s more, in the midst of the coronavirus pandemic, hospitals are losing power because they don’t have enough fuel to keep the lights on.
In early February, President Joe Biden promised the US would stop supporting the Saudi-led coalition’s offensive operations in the war. But, he added, “We’re going to continue to support and help Saudi Arabia defend its sovereignty and its territorial integrity and its people.”
In light of the CNN report, progressive activists and some Democrats want Biden to go further. Last week, nearly 80 Democrats sent a letter to the president demanding he do more to push Riyadh to end the blockade once and for all.
The problem, though, is that the Biden administration has a totally different read of the situation.
While reporting on the letter Democrats sent to Biden, I asked the State Department for comment, as the agency’s special envoy for Yemen, Tim Lenderking, is leading America’s diplomatic response to the crisis.
It turns out the State Department disagrees with the growing narrative since the CNN report’s release.
“It is not a blockade,” a spokesperson for the agency said Monday. “Food is getting through, commodities are getting through, so it is not a blockade.”
However, the administration does acknowledge there has been a slowdown in the amount of fuel coming into the country, and they’re concerned about it. “The United States understands the urgent need for fuel to get into Hodeidah port,” Lenderking told me on Tuesday. “This is a constant priority in our conversations with the Republic of Yemen government and Saudi Arabia.”
But the primary culprit for the fuel slowdown, the State Department and the National Security Council contend, is not Saudi Arabia but rather the Hadi government.
Here’s why: Even though it doesn’t actually control the bulk of the country and is operating out of Saudi Arabia, it is still the legitimate, recognized government of Yemen and thus retains authority over who is allowed to dock in Yemen’s ports.
Which means that if the Hadi government doesn’t grant permission to a particular ship to dock in Hodeidah (or elsewhere), that ship can’t dock. The Saudi-led coalition enforces those decisions if necessary with its ships and planes, blocking any vessels Hadi’s government says can’t come in.
And that process of approving ships to dock is where the State Department says the real problem lies, leading to the fuel shortage.
The State Department said it opposes any arbitrary restrictions of commodities entering Yemen, but that “we respect the right of the government to control its access to ports.” However, the spokesperson added, “We do press them and work with them to make sure that their process improves and runs as smoothly as possible.”
In other words, nobody, including the Saudis, is solely for malicious purposes trying to cut off fuel from Yemen. It’s just that the Hadi government’s approval whims are the main issue here.
“It may have faltered, it may not be perfect, it may not be smooth, but it is a Yemeni government process, it is not a Saudi government process,” the State Department spokesperson told me. “We are working with many government officials to try to improve it, to make it as smooth as possible.”
It’s important to keep three main questions in mind when trying to figure out who’s right and who’s wrong:
The answer to the first question seems to be yes. Data from the United Nations Verification and Inspection Mechanism for Yemen, the UN body that inspects certain ships coming into the country, clearly shows a significant drop-off of fuel making it into the country over the past two months.
However, the Biden administration is correct that it’s not exactly a “blockade,” as UN data shows food and fuel are still getting in. The below snapshot from a March 2021 report shows that food imports actually increased from 2019 to 2020.
And even as fuel went down to zero in February and barely rose in March, food and other cargo were still getting into Yemen, including through Hodeidah.
As to who is blocking the fuel, both sides are kind of right and kind of wrong.
The Biden administration is correct that any ship carrying fuel must receive approval from the Hadi government to unload at a Yemeni port like Hodeidah. “They have the final say on who gets in,” a spokesperson for the UN office overseeing the crisis in Yemen told me.
But Saudi Arabia’s ships are the ones doing the actual physical blocking. So it is partly their fault, too, as they could choose not to do that.
The Houthis are partly to blame here, too. Experts told me the rebels aren’t great about dispersing the fuel that is allowed to come off the ships. Sometimes they shut down gas stations so that the price of fuel they control on the black market goes up. So they are also responsible for why fuel isn’t getting to those who need it.
As to the third question, is any of this happening on purpose, the answer also seems to be yes. All three parties — the Hadi government, the Saudis, and the Houthis — are guilty of purposely using fuel, and access to it, as a weapon in this war.
In 2018, the warring parties agreed in Stockholm, Sweden, to, among other things, use revenues from imports at Hodeidah to pay civil service salaries in Yemen. In March 2020, though, the Houthis diverted 50 billion Yemeni rials (roughly $200 million) and used the money mostly to fund their fight — a conclusion confirmed by the United Nations in January.
The State Department spokesperson made the same charge: “The Houthis profit from the trade, fuel, and those funds to support their warfront.”
Experts told me in order to stop the Houthis from doing that, the Hadi government — with the Saudi-led coalition’s help — has denied permits to fuel ships in Hodeidah.
In other words, the severe restrictions in fuel imports at Hodeidah aren’t happening out of pure malice, but they are happening on purpose. It’s part of an effort by the Hadi government and the Saudis to stop the Houthis from exploiting fuel revenues for their own benefit. The Hadi government “has declined to let them in [to Hodeidah] because of a long-running dispute with the Houthis over revenue payments,” the UN spokesperson told me.
But that doesn’t mean State is pleased with what’s going on. The spokesperson said that the US is telling the Hadi government it should still allow fuel ships to dock and unload in Hodeidah despite their concerns over the Houthis. “We’ve really been encouraging them to understand the humanitarian imperative,” they told me.
So case closed? Not exactly.
It’s true that the Hadi government is denying permits for some vessels. It’s also true that the Houthis are siphoning off fuel for their own benefit. But could fuel flow more easily into Yemen if the Saudi-led coalition chose not to block ships from docking and unloading? Of course.
This is a point activists can’t see past. “I don’t buy that is the Yemeni government’s fault. They do not have the navy or aircraft to bomb a ship that threatens to break the blockade,” said Aisha Jumaan, president of the Yemen Relief and Reconstruction Foundation. “This is nonsense, and the State Department knows that.”
“It is hard to fathom that after six years, the US is casting doubt about the existence of the oppressive blockade,” she continued. “It is harder because it is from the Biden administration from whom we expected better judgment.”
In other words, it’s pretty clear that the Biden administration is downplaying the Saudi role during this entire episode. Secretary of State Antony Blinken on March 1 did “call on all parties to allow the unhindered import and distribution of fuel,” but didn’t specifically call Riyadh out.
That’s surprising for two reasons, experts say. First, the Biden administration has said that human rights are “at the center of US foreign policy.” Minimizing Riyadh’s role in blocking fuel into Yemen isn’t making human rights a priority.
Second, it’s not like the Saudis have downplayed their own role. In March, Saudi Foreign Minister Prince Faisal bin Farhan Al Saud proposed to reopen the airport in Sana’a in exchange for a ceasefire — the first time Riyadh openly acknowledged carrying out any kind of blocking effort in Yemen.
Further, the Saudi-led coalition allowed at least four fuel ships in Hodeidah’s port in March after the Hadi government gave its approval, shortly following pressure from the CNN report. It’s clear, then, that Riyadh plays a key role in deciding which ships do and don’t get to operate in Hodeidah.
This is something UN World Food Program Director David Beasley noted openly last month. “The people of Yemen deserve our help. That blockade must be lifted, as a humanitarian act. Otherwise, millions more will spiral into crisis,” he said in a speech to the UN Security Council. When I asked Beasley’s team what he precisely meant by “blockade,” a spokesperson said that “the fuel shortage is in reference to the coalition blockade.”
Beasley’s remarks follow many other instances of the UN calling the Saudi-led coalition’s efforts a “blockade.”
The question now is why the Biden administration won’t more openly and forcefully deride Riyadh’s involvement in blocking fuel from getting into Yemen.
Analysts say one consideration is that the US is trying to broker a peace agreement between the Saudi-led coalition, the Hadi government, and the Houthis. If the Biden administration berates the Saudis repeatedly, they might lose leverage with a key party in those talks.
Another reason experts noted is that the US is in the middle of negotiations to reenter the Iran nuclear deal, an accord Riyadh doesn’t like. By not speaking out against Saudi Arabia’s complicity in blocking fuel into Yemen, then Riyadh implicitly understands it isn’t to speak out about the Iran diplomacy.
There’s one more: Pushing for Saudi Arabia and its partners to “end the blockade” could lead to the dissolution of the UN ship-inspection system that was put in place to facilitate shipments during a war and humanitarian crisis and curb the smuggling of weapons to the Houthis. If that happens, then it’d be far easier for Iran to send arms to the Houthis and further inflame the war. That also wouldn’t reverse the humanitarian disaster brought on by years of fighting.
Whatever the reason, a bipartisan group of lawmakers is calling on the Biden administration to “urgently push” Riyadh to stop helping keep fuel from reaching Yemeni ports.
“The interference, delay, and outright blocking of commercial goods and humanitarian assistance shipped to Yemen’s ports is a principal cause of price inflation, food insecurity, economic collapse, and the failure of public services in Yemen,” House of Representatives members wrote in a letter to Secretary of State Blinken on Tuesday.
It’s unclear if Biden or his team will listen to them. What is clear, though, is that without Riyadh, a lot more fuel would be flowing into Yemen.
Democrats want to raise taxes. So why are they debating cutting them for some well-off taxpayers?
Democrats are trying to figure out how to pay for President Joe Biden’s infrastructure plan and raise hundreds of billions of dollars to put toward rebuilding American roads and bridges. And yet somehow one of the big internal battles happening on the left is not about putting in place a more progressive tax regime, but reinstating one that can look quite regressive.
In their 2017 tax bill, Republicans partially closed a tax loophole that mainly affected higher-income people in high-tax areas — i.e., relatively well-off people in blue states. They capped the state and local tax deduction (SALT) people can take when calculating their federal income tax at $10,000. People can still deduct state and local taxes from their federal tax bill, but only up to that point.
Many Democrats — namely, those from states such as New York, New Jersey, and California — want to repeal the SALT deduction cap and go back to the old regime, where people could deduct all (or at least more) of their state and local taxes. They argue the cap unfairly drives up their constituents’ tax bills, might keep their states from implementing more progressive tax regimes on high-income people, and was a vindictive move by the GOP in the first place.
“It was mean-spirited to begin with, politically targeted,” House Speaker Nancy Pelosi (D-CA) said at a press conference on April 1.
But some Democrats, Republicans, and economists are saying hold the phone.
“The vast majority of the benefits of repealing the SALT cap would go to the people at the very top. It would also be costly — and for that amount, we could finance much more worthy efforts to support American families and workers. We can say we are for a progressive tax code and for fighting inequality, or we can support the SALT deduction, but it is really hard to do both,” said Sen. Michael Bennet (D-CO) in a statement to Vox. When the Senate took up a vote on whether to repeal the SALT cap in December 2019, he was the only Democrat to vote against it.
It’s an issue where, ideologically, the stars don’t entirely align: Rep. Katie Porter wants to scrap the SALT cap; JPMorgan CEO Jamie Dimon doesn’t.
A poll conducted by Vox and Data for Progress found that repealing the SALT cap isn’t popular among the broader electorate. Independents and Republicans generally oppose axing it, though a plurality of Democrats support repeal. According to the survey, which was conducted from April 9-12 of 1,217 likely voters, urban voters were likelier to support repealing the cap than rural and suburban voters. The poll noted that restoring the full state and local tax deduction would primarily benefit well-off Americans.
Many moderate Democrats are arguing for the SALT deduction cap to be lifted, but so are some progressives. Take a look at New York Rep. Tom Suozzi, a moderate who represents parts of Long Island and Queens in New York, and has adopted, “No SALT, no deal,” as a sort of tagline on infrastructure as of late. “The first thing is just basic fairness, it’s not fair that you pay taxes on taxes you’ve already paid,” he said in an interview with Vox. Suozzi is joined by Reps. Jamaal Bowman and Mondaire Jones on the issue. They’re both Rep. Alexandria Ocasio-Cortez-aligned progressives and newly minted members of “the Squad.”
Yesterday, I joined @RepMondaire @RepTomSuozzi @RyeGSL to discuss repealing the $10,000 cap on the State and Local Tax (SALT) deduction.
— Congressman Jamaal Bowman (@RepBowman) March 26, 2021
We need to repeal this cap and put money back into the hands of middle-class families. pic.twitter.com/212GhFUvdT
The debate over Democrats’ next move on infrastructure, which Biden has put forth as part of his American Jobs Plan, and whether and how to pay for it through taxes, is just getting started. Plenty of proposals are going to be on the table, including SALT. The White House has signaled some openness to it, but the matter is far from settled.
“If Democrats want to propose a way to eliminate SALT — which is not a revenue raiser, as you know; it would cost more money — and they want to propose a way to pay for it, and they want to put that forward, we’re happy to hear their ideas,” White House press secretary Jen Psaki said at a press briefing on April 1.
When people file their taxes, they can deduct certain expenses to make their taxable incomes lower. A lot of people just take the “standard deduction” and lop off a flat amount. Others, however, choose to itemize their deductions, so they can subtract things like charitable deductions and medical expenses. Generally, taxpayers choose whichever avenue will be more beneficial for them — as in, whichever will leave them with less income to be taxed.
For decades, taxpayers who itemized their federal income taxes could deduct what they paid in state and local property taxes and either income or sales taxes (whichever was higher). It was one of the biggest federal tax expenditures, according to the Tax Policy Center. “One way to view the deduction was as an indirect subsidy for states, and basically, the federal government was saying to taxpayers, ‘We’ll take up 37 percent of the cost of your state and local taxes,’” said Frank Sammartino, a senior fellow at the Urban-Brookings Tax Policy Center.
But with the passage of the Tax Cuts and Jobs Act (TCJA) of 2017 under then-President Donald Trump, that changed: the law capped the state and local deduction at $10,000. Sammartino explained who was hit: “If you’re high-income and in a state with high state and local taxes, this is going to bite you.”
The legislation also basically doubled the standard deduction from $6,500 to $12,000 for individuals and from $13,000 to $24,000 for couples, which softened the blow a little bit. But for many taxpayers, it still stung.
Prior to the 2017 tax bill, about 30 percent of taxpayers itemized deductions on their federal returns, including claiming the SALT deduction. The higher-income the household, the likelier the deduction: in 2017, 16 percent of taxpayers with incomes between $20,000 and $50,000 claimed the deduction, compared to two-thirds of taxpayers in the $100,000 to $200,000 threshold and 9 in 10 taxpayers with incomes above $200,000. After the 2017 law, the proportion of people who itemize deductions on their taxes fell to about 10 percent, and an estimated two-thirds of them have an income of over $100,000. “Those that continue to itemize are generally high-income taxpayers,” Sammartino said.
According to estimates from the Center on Budget and Policy Priorities, if the SALT cap — which is set to expire in 2025 — were to be repealed earlier, it would overwhelmingly benefit those at the higher end of the income scale — the ones who were hurt by the bill back in 2017. The CBPP estimates that more than half of the benefit would go to the top 1 percent, and over 80 percent would go to the top 5 percent, of earners.
The deduction is geographically concentrated as well. Prior to the TCJA, the 10 counties benefiting the most from the deduction were in four states: California, Connecticut, New Jersey, and New York. And six states claimed over half of the deduction: California, Illinois, New Jersey, New York, Pennsylvania, and Texas. It’s popular in other states, too, including Utah, Minnesota, Virginia, Maryland, Connecticut, Massachusetts and Washington, DC.
While the burden of the SALT cap falls disproportionately on high-income taxpayers in those states, it can affect other people too. In a state like New Jersey, people’s property taxes can be high even though they’re not super rich. And in New York City, $150,000 in annual income isn’t landing you in a Fifth Avenue penthouse. Still, given the data, it’s hard to argue that scrapping the cap on SALT deductions is squarely aimed at helping the middle class.
Some economists have even changed their minds on it. Jason Furman, President Barack Obama’s chief economist, did a tweet thread in 2017 that my colleague Dylan Matthews documented at the time, arguing lawmakers should keep the SALT deduction in place, making the case that Republicans were doing away with it to pay for tax cuts for even richer people (which to a certain extent, they were). Furman has since described restoring the deduction as a “waste of money” and the “Democratic version of trickle-down economics.”
I like calling SALT repeal the Democratic version of trickle-down economics.
— Jason Furman (@jasonfurman) January 29, 2021
It is slightly better trickle down but slightly better than terrible is, well, pretty bad.
Jared Bernstein, one of Biden’s top economic advisers, isn’t a fan of putting the full SALT deduction back in place, either.
2a) Again, re SALT cap repeal, if you told me I’d be siding with R’s against D’s on a tax change, I would have concluded you’d lost your mind.
— Jared Bernstein (@econjared) December 14, 2019
Many lawmakers — Democrats and Republicans alike — have been mad about the SALT cap since before the ink on the 2017 law was even dry. Since-retired Republican Rep. Rodney Frelinghuysen of New Jersey voted against the legislation in 2017, when he was chair of the House Appropriations Committee. He specifically cited the SALT limit in his reasoning, warning that it would “hurt New Jersey families who already pay some of the highest income and property taxes in the nation.” The SALT cap may have hurt Republicans in the 2018 midterms, as they wound up losing in some key impacted districts.
In 2019, the House of Representatives voted to roll back the SALT cap, with many Democrats and some Republicans going along. Rep. Alexandria Ocasio-Cortez (D-NY) voted against the bill at the time, but she left the door open to doing something to “restructure” SALT. The bill failed in the Senate, which was then controlled by Republicans, but all Democratic senators voted for it except for one — Bennet from Colorado.
Now, SALT is back up for discussion as part of the broader conversation around Biden’s plan for spending on infrastructure and jobs, which includes talk of potential changes to the tax code. Some Democrats are pushing for the restoration of the full deduction, or at the very least, some changes to the current cap, to be included as part of a broader upcoming package, even though those changes would mean a decrease in revenue at a moment when the White House is looking to raise it. How on board Biden is with that is unclear: Axios reports the president isn’t planning to rejuvenate the SALT deduction, but there are some big names encouraging him to go along.
Pelosi has described the limit as “devastating” to California voters and said she shares the “exuberance” of lawmakers who are looking to do something about it. “Hopefully we can get it into the bill,” she said in April. “I never give up hope for something like that.”
Senate Majority Leader Chuck Schumer, who is up for reelection in New York in 2022, has also urged Biden to bring back the SALT deduction in full and has tried to further his argument by noting how hard-hit his home state has been by the Covid-19 pandemic. “Double taxing hardworking homeowners is plainly unfair; we need to bring our federal dollars back home to … cushion the blow this virus — and this harmful SALT cap — has dealt so many homeowners and families locally,” he said in a statement in January.
Some Democratic members of the House have gone as far as to declare, “No SALT, no deal,” in an effort to force the president’s hand on the issue.
I’ve got a few words for anyone considering altering federal tax rates for families in North Jersey:
— Rep Josh Gottheimer (@RepJoshG) March 30, 2021
No SALT, No Dice // No SALT, No Deal!
See the statement below from my colleagues @BillPascrell, @RepTomSuozzi, & me: pic.twitter.com/DFd22JgDSt
“I’m going to talk to my colleagues on the Ways and Means staff and I’m going to talk to the White House and I am going to talk to my other colleagues that are in a similar predicament as my state is in,” Suozzi told Vox. “Right now, no SALT, no deal.”
Proponents of restoring the SALT deduction make multiple arguments. One is that capping it will cause wealthy people to flee from high-tax states. There’s not really a lot of evidence for millionaire mass migration when their taxes go up. The SALT deduction is a relatively bigger hit, but there’s not clear proof that rich people are fleeing high-tax states en masse because of it — plus, people move for plenty of reasons. (See: the pandemic.) They also say that the SALT deduction lets state and local governments tax high-income people to pay for public services for low- and middle-income people. The reasoning goes that letting rich people deduct their state and local taxes means states can tax them more to pay for health care, education, public transit, etc., and that it stops states from engaging in a race to the bottom to cut taxes.
“For my progressive friends, I want to say very clearly, don’t be bamboozled by the conservative movement. They’ve been planning this for 40 years to figure out how to undo the progressive policies in progressive states by getting rid of the state and local tax deduction,” Suozzi said.
Richard Reeves, a senior fellow in economic studies at the Brookings Institution and co-author of A New Contract with the Middle Class, said that to the extent the SALT deduction is an attempt to accomplish those goals, it’s doing so in a very roundabout way. “The idea that the best way to get states to spend more money, particularly on services that are actually progressive, is to give a massive tax break to the people who live there in the hopes that it will allow the states and cities to therefore tax them a bit more because they know they’ve got a break, and that that extra revenue will be used in a progressive way — that might be happening, but wow, that’s a pretty long way around,” he said.
Democrats also make the point that the deduction limit wound up in the 2017 tax bill as a way for Trump to exact revenge on blue states that didn’t support him. “The notion that if Democrats had enacted a policy specifically targeted at Texas and Florida, the members from Texas and Florida wouldn’t try to reverse it … obviously [they would] if the shoe were on the other foot,” one Democratic aide said. “Republicans were so clear about what they were doing in 2017, they wanted to shift money from wealthier people in New Jersey and New York to wealthier people in Texas and Florida and other red states.”
Reeves sees it a different way: “Good policy gets made for bad reasons.”
The fault lines around the SALT deduction aren’t really so ideological as they are geographic, which makes sense, given whose constituents are impacted by this and whose aren’t. It’s a non-issue for voters in many parts of the country, but places where it matters, it really matters: Rep. Mikie Sherrill, the Democrat now representing the district Frelinghuysen retired from, ran ads during the 2018 about the SALT deduction.
The Congressional Progressive Caucus, which represents the left-leaning faction of the House, has declined to take a position on the matter — its membership is split. “There are some members that feel very strongly about it because they’re in a state where that’s a very big issue for their revenue,” Rep. Pramila Jayapal (D-WA), the CPC’s chair, told the Hill.
The politics of the SALT deduction are a bit messy, but the bigger issue is really the policy angle, said Celinda Lake, a Democratic pollster who advised Biden’s 2020 presidential campaign. The Biden team wants to raise revenue to pay for infrastructure and other priorities, and lifting the SALT cap will do the opposite. It would cost an estimated $600 billion through 2025.
“I don’t think it has much downside politically, it’s more of a dilemma for the economic team and the budget team,” Lake said. “Democrats right now are concentrating on who’s not paying their fair share as opposed to who’s paying their fair share.”
The debate over what to do about the SALT deduction doesn’t have to be a binary one. There are other alternatives, like reducing all itemized deductions or limiting the tax rate applying to itemized deductions. Or, the federal government could raise the SALT cap to $20,000 for couples to at least get rid of the marriage penalty currently in place, or raise the top individual income rate back to 39.6 percent, where it was pre-TJCA.
“If you wanted to raise revenue from higher-income people, you could just raise the top rates. It’s pretty straightforward, and it doesn’t distinguish between different regions of the country,” Sammartino said.
Reeves chafed at the idea of raising the top rate to counterbalance lifting the deduction cap. “Why would you take with one hand and give back with the other? Why not just take with one hand and make the tax code a bit simpler?” he said. He instead pointed to a proposal from the Tax Policy Center for the federal government to help create a kind of “rainy day fund” to help states.
Lake said she believes it would be “fairly easy to obtain some kind of compromise.”
Biden ran on his ability to bring Democrats and Republicans together. It’s become increasingly obvious Republicans aren’t coming along for the ride with him on much of anything, and even though some of them might want to restore the SALT deduction, it’s likely to be tucked into a broader package that the GOP isn’t going to go for. And so the challenge on state and local taxes, as with so many other issues, is for the White House and congressional leadership to keep Democrats together. The debate on this, and myriad other tax proposals, is just beginning.
From disturbing the gut microbiome to lingering in the brain, there are many ways the coronavirus might cause lasting symptoms.
Most people who get the coronavirus will fully recover and go right back to their lives. But the latest research suggests that at least 10 percent have long-term symptoms, even after their body has apparently cleared the virus.
The condition, known as “long Covid,” has emerged as a scary feature of the pandemic — a reminder that even as hospitalizations and deaths come down, millions of people will continue to suffer from the aftermath of infection.
And, as it turns out, “this isn’t unique to Covid,” Akiko Iwasaki, an immunologist at the Yale School of Medicine, told Vox.
Instead, Covid-19 appears to be one of many infections, from Ebola to strep throat, that can give rise to stubborn symptoms in an unlucky subset of patients. “It is more typical than not that a virus infection leads to long-lasting symptoms in some fraction of individuals,” Iwasaki said.
The difference now is that, with 137 million Covid-19 cases worldwide and counting, long-haulers are more visible: Their suffering has come on in unprecedented numbers. It’s also possible the coronavirus causes long-term symptoms even more frequently than other infections.
In this week’s episode of Unexplainable, we dive into what we know about long Covid and what other viruses can teach us about the condition, including the leading hypotheses for what might be driving symptoms in Covid long-haulers.
We also look at what we can learn from patients who have been grappling with medically unexplained symptoms — the kind that don’t correspond to problematic diagnostic test results or imaging — for years before the pandemic hit. Here’s a rundown of what scientists think could explain the mysterious symptoms, and why even the vaccine might not help.
The first explanation for what might cause persistent symptoms in people who’ve been infected with Covid-19 is the simplest: The virus or its components might still be lurking in the body somewhere, long after a person starts testing negative.
We’ve learned from other long-term viral illnesses that, in some cases, pathogens do not fully clear the body. “It’s out of the blood but gets into tissue in a low level — the gut, even maybe the brain in some people who are really sick — and you have a reservoir of the virus that remains,” PolyBio Research Foundation microbiologist Amy Proal told Vox. “And that drives a lot of inflammation and symptoms.”
These viral reservoirs have been documented following infections with many other pathogens. During the 2014-2016 Ebola epidemic, studies emerged showing the Ebola virus could linger in the eye and semen. There were similar findings during the 2015-2016 Zika epidemic when health officials warned about the possibility that Zika could be sexually transmitted. (Viral reservoirs are also why the moniker “post-viral” can be problematic, Proal added.)
A related explanation for what might be happening with long-Covid patients is what Iwasaki calls “viral ghosts.” While the intact virus may have left the body, “there may be RNA and protein from the virus that’s lingering and continuing to stimulate the immune system,” Iwasaki said. “It’s almost like having a chronic viral infection — it keeps stimulating the immune system because the virus or viral components are still there, and the body doesn’t know how to shut it off.”
Recent studies in Nature and The Lancet documented coronavirus RNA and protein in a variety of body systems, including the gastrointestinal tract and brain.
In autopsies of people with chronic fatigue syndrome, researchers also found enterovirus RNA and proteins in patients’ brains, including, in one case, in the brain stem region. The brain stem controls sleep cycles, autonomic function (the largely unconscious system driving bodily functions, such as digestion, blood pressure, and heart rate), and the flu-like symptoms we develop in response to inflammation and injury.
“If that area of the brain signaling becomes dysregulated [by viruses],” Proal said, “[that] can result in sets of symptoms that meet a diagnostic criteria for [chronic fatigue syndrome], or even for long Covid.”
Other pathogens already lurking in the body prior to a coronavirus infection might also exacerbate symptoms. For example, viruses in the herpes family — such as Epstein-Barr (the cause of mono) or varicella zoster (the cause of chickenpox and shingles) — stay dormant in the body forever. Under normal conditions, the immune system can keep them in check.
“So, for example, 90 percent of people in the world already have herpes viruses,” said Proal. “But in those patients, the immune system keeps them in a place where they can’t replicate, where they can’t express proteins. They’re kind of controlled.”
But then Covid-19 comes along, and all of a sudden these other viruses get a chance to gain a foothold again. With the immune system tied up fighting Covid-19, the other viruses may reawaken. And they — not the coronavirus — drive symptoms.
Another key hypothesis: Long-Covid patients have developed an autoimmune disorder. The virus interrupts normal immune function, causing it to misfire, so that molecules that normally target foreign invaders — like viruses — turn on the body.
These “rogue antibodies,” known as autoantibodies, “attack either elements of the body’s immune defences or specific proteins in organs such as the heart,” according to Nature. The assault is thought to be distinct from cytokine storm, an acute immune system disorder that appeared as a potential threat early in the pandemic.
“Under that scenario, we talk about molecular mimicry,” Proal said. “Basically, the virus creates proteins that look like human proteins or tissue, and that kind of tricks the immune system.” Here, the the immune system tries to target the virus, which “if it has a similar size and shape to a human tissue or protein, it fires on the human tissue or protein as well,” she added.
It’s also possible the coronavirus might deplete important microorganisms in the gut microbiome — the trillions of bacteria, viruses, and fungi that live in and on the body.
In one study, researchers tracked blood and stool samples from 100 patients hospitalized with SARS-CoV-2 infection, testing some up to 30 days after they cleared the virus. (They also collected samples from a control group for comparison.) And they found Covid-19 infection was linked to a “dysbiotic gut microbiome,” even after the virus cleared the respiratory tract; they also hypothesized that it might contribute to the persistent health problems some patients are experiencing.
“Under conditions of health, those communities are in a state of balance. It’s like a forest, like different organisms are doing different things, but it’s in a harmonious state,” Proal said. But Covid-19 could lead to an imbalance in the microbiome. “And a huge number of symptoms are tied to microbiome dysbiosis. Irritable bowel syndrome or even neuro-inflammatory symptoms can be driven by these ecosystems when they go out of balance, too.”
The virus might have cleared the body but left injuries in its wake — scars in the lungs or damage to the heart, for example — and these injuries might give rise to symptoms.
According to a recent preprint involving 201 patients, 70 percent had impairments in one or more organs four months after their initial Covid-19 symptoms set in. In other unpublished research, radiologists at the University of Southern California tracked hospitalized patients’ lung recovery using CT scans. They found one-third had scars caused by tissue death more than a month later. Other patients may have brain damage that causes neurological symptoms.
There’s also growing evidence of widespread cardiac injury, even in patients who aren’t hospitalized. In a JAMA Cardiology study, researchers performed cardiac MRIs on 100 patients in Germany who had recovered from Covid-19 within the past two to three months. An astounding 78 percent still had heart abnormalities.
For coronavirus patients who had to be admitted to intensive care units, there’s a related explanation: Long before the pandemic, the intensive care community coined a term for the persistent symptoms people frequently experience following stays in an ICU for any reason, from cancer to tuberculosis. These symptoms include muscle weakness, brain fog, sleep disturbances, and depression — the aftermath of a body lying around in a hospital bed for days on end and injuries or side effects from treatments patients received, including intubation.
The term “post-intensive care syndrome” was “created to raise awareness and education, because so many of our ICU survivors were going to their primary care doctor saying they were fatigued,” said Dale Needham, who has been treating Covid-19 patients in the ICU at Johns Hopkins. “They had trouble remembering, and they were weak. Their primary care doctor would do some lab tests and say, ‘Oh, there’s nothing wrong with you.’ The patient might walk away and feel like the doctor was saying, ‘It’s all in your head. You’re making it up.’”
So what might help alleviate the nagging symptoms of Covid long-haulers? One idea that’s been circulating is the Covid-19 vaccine: Some long-haulers are reporting their symptoms improving after they’ve gotten immunized. But others have reported feeling worse — and still others, no different. So researchers are racing to understand the effects of vaccination on long Covid, but it isn’t looking like a silver bullet just yet.
Proal had a simpler solution that could be implemented today: “It’s time for medicine to be rooted in just believing the patient.”
Even with growing awareness about long Covid, patients with the condition — and other chronic “medically unexplained” symptoms — are still too often minimized and dismissed by health professionals.
People “want disease to kill you, or they want you to return to miraculous good health,” said Jaime Seltzer, director of scientific and medical outreach at the chronic fatigue syndrome advocacy group ME Action. “When you stay sick, compassion can fade. And that is not just friends and family. That is your clinicians as well; they want somebody fixable.”
But long-haulers of any chronic condition can exist in a space between sickness and health for years, sometimes without a diagnosis. Their unexplainable symptoms can elicit outright skepticism in health professionals who are trained to consider patient feedback the “lowest form of evidence on [the evidence hierarchy], even under research on mice,” Proal said.
The situation can be even more challenging for patients who never had a positive PCR test confirming their Covid-19 diagnosis. Of the dozens of medical appointments one Covid-19 long-hauler, Hannah Davis, had for her ongoing symptoms — which include memory loss, muscle and joint pain, and headaches a year after her initial disease — one of the best experiences involved a doctor who simply said, “I don’t know.”
“The doctor [told me], ‘We are seeing hundreds of people like you with neurological symptoms. Unfortunately, we don’t know how to treat this yet. We don’t even understand what’s going on yet. But just know you’re not alone,’” she recounted. “And that’s the kind of conversation that needs to be happening. Because we can wait, but we can’t have the doctor’s anxiety being projected onto us as patients.”
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When it’s flaccid you can only see WY.
On a trip to the Caribbean I went to the bathroom and was standing at the trough next to a local.
I briefly gazed down and saw that he too had WY tattooed on his penis.
I asked him if his girlfriends name was also Wendy.
He said ‘No. When I am aroused it says “Welcome to Jamaica- Have a nice day” ‘.
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I thought, that’s a strange way to start a conversation.
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They rub it, and a genie appears.
“I have three wishes, so I’ll give one to each of you,” the genie announces.
The first dinosaur thinks hard.
“Alright,” he says, “I’ll have a big, juicy, piece of meat.”
Instantly, the biggest, juiciest piece of meat he’d ever seen appears in front of him.
Not to be outdone, the second dinosaur thinks even harder.
“I know! I’ll have a shower of meat!”
Immediately, huge pieces of meat rain down around him.
The third dinosaur, certainly not to be outdone, thinks harder than the previous dinosaurs.
“I’ve got it!” he cries, “I want a MEATIER shower!”
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as she is standing behind him in a hotel lobby. The man apologizes profusely and says “if your heart is as soft as your breasts, I know you’ll forgive me.”
To which the woman replied “if your dick is as hard as your elbow, I’m in room 318.”
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Or something shorter, like “co-vid”.
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