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Among those confirmed were US Ambassador to Japan Rahm Emanuel, US Ambassador to France Denise Campbell Bauer, and US Ambassador to the European Union Mark Gitenstein.

The Senate also confirmed its 40th Biden-nominated judge, according to Washington Post reporter Seung Min Kim, more than any president in his first year in office since Ronald Reagan.

The last-minute rush of confirmations on Friday — the last day of the Senate’s 2021 session — was an effort to work through a backlog of about 150 presidential nominees. Many diplomatic and national security posts remain open thanks to stonewalling from Senate Republicans and the slow pace of nominations from the Biden administration. Despite Friday’s progress, many of the nominees still in the backlog will have to be re-nominated by the president in the new session, further delaying the process.

Republicans stalled confirmations to advance their own agendas

The overall process of confirming presidential nominees has become increasingly difficult in recent years, but Friday’s backlog was the result of several specific demands from Republican senators.

In particular, Sens. Ted Cruz, Josh Hawley, and Marco Rubio have all held up Biden foreign service and national security nominees until their own priorities were guaranteed a vote.

Most presidential nominees have’t been subject to the filibuster since a 2013 rule change (and none are as of 2017), so it’s not technically possible for a single Republican senator to block the confirmation of a nominee outright. They can make it a grueling process, however, by denying unanimous consent to confirm nominations.

Specifically, while a single senator doesn’t have the power to halt the process full stop — provided the nominee has the support of at least 50 senators with the vice president to break a tie — they can open up the floor for debate. That takes up significant time in the Senate, which would be a challenge at any time, but particularly when the confirmation backlog is so large and the chamber has other major priorities to address.

“In past years, many of these nominees would have sailed through with consent and cooperation, but this year a handful of Republicans have hijacked the rules of the Senate to slow the process down,” Senate Majority Leader Chuck Schumer said on the Senate floor Thursday. “It’s cynical, it’s entirely pointless, and worst of all it’s damaging — seriously damaging — to our national security.”

.@SenSchumer on confirming Biden nominees: “A handful of Republicans have hijacked the rules of the Senate to slow the process down. It’s cynical, it’s entirely pointless, and worst of all, it is damaging, seriously damaging to our national security.” pic.twitter.com/YzenPmylkg

— The Hill (@thehill) December 16, 2021

Prior to Friday, Cruz tried to strike a deal with Schumer to exchange a vote on sanctions for Russia’s Nord Stream 2 gas pipeline for votes to confirm 16 ambassadors and State Department officials, without any luck. While the US isn’t in favor of Nord Stream 2, a natural gas pipeline running from Russia to Germany, the Biden administration rescinded sanctions against the company building it to preserve the US relationship with Germany, a key ally which has approved the pipeline.

“I’ve made clear to every State Department official, to every state department nominee, that I will place holds on these nominees unless and until the Biden administration follows the law and stops this pipeline and imposes the sanctions,” Cruz said in August statement.

Ultimately, Cruz secured his vote — it’s scheduled for January 14 — and agreed to release his hold on dozens of diplomatic nominations, which were confirmed overnight.

Also: This is precisely why Schumer didn’t take the Cruz offer to confirm 16 people. he got 41 ambassadors

— Jake Sherman (@JakeSherman) December 18, 2021

Hawley has also tried Cruz’s stalling tactic, albeit with less success. After the US’s disastrous pullout from Afghanistan in August, Hawley pledged to block all of Biden’s national security and Pentagon nominees unless Defense Secretary Lloyd Austin, National Security Adviser Jake Sullivan, and Secretary of State Antony Blinken resigned their posts. That hasn’t happened, but Hawley has threatened to hold up the confirmation process “as long as it takes,” as he said in early December. “If I’m still on the floor doing this in 2023, so be it, 2024, so be it, until somebody is held accountable.”

Hawley and Cruz in particular may have broader reasons for their obstruction — both have been accused of blocking the nominations at least in part to position themselves as antagonists to Biden in potential 2024 runs.

Despite the challenges from Cruz and Hawley, Democrats pressed on with 56 total voice votes, according to the Washington Post, as well as a floor vote to confirm Emanuel as ambassador to Japan.

Schumer, for his part, seemed quite satisfied with the outcome of the long night of voting.

“At the end of the day, we will have invoked cloture on two circuit judges, confirmed nine district court judges, confirmed 41 ambassadors, and confirmed five other members of President Biden’s team,” he said Saturday, according to the Hill. “It’s been a long day but a good day’s work. I thank my colleagues.”

Ambassadorships are critical diplomatic positions

In addition to Friday’s confirmation spree, the Senate also confirmed one of Biden’s highest-profile ambassadorial nominees on Thursday after Rubio agreed to allow the confirmation of Nicholas Burns as ambassador to China to proceed smoothly.

Burns, a career diplomat who served under both Republicans and Democrats over a 30-year career, including as undersecretary of state from 2005 to 2008 and as US ambassador to NATO, was nominated in August; until this week, his position had gone unfilled for the past 14 months amid increasing US-China tensions.

Rubio had been holding Burns’s nomination hostage pending a vote on his legislation to sanction goods made by slave labor in the Xinjiang Uyghur Autonomous Region of China. The Senate passed the bill unanimously on Thursday, and Biden has indicated he will sign it into law.

But the logic of holding key nominations over individual legislative priorities, even when they’re related, is opaque at best, and potentially damaging at worst.

As Sen. Chris Murphy (D-CT) pointed out on the Senate floor in September, that kind of obstruction prevents professionals who could help accomplish those priorities, or at least manage diplomatic relationships, from doing their jobs.

“It just takes a lot of chutzpah for my colleagues to stand here on the floor and criticize the president’s conduct of foreign policy at the same time that they are refusing to allow the President to have staff to conduct foreign policy,” Murphy said.

Similarly, according to Politico, European politicians had reportedly also grown frustrated by Cruz’s obstruction prior to Friday’s confirmations. “Cruz is blocking everything,” one senior EU official lamented.

What happens next?

After filing for cloture on 22 Biden nominees up for confirmation, Schumer warned Thursday that “we could be back here in the near future doing this whole thing over again.”

That’s because, despite the number of nominees confirmed Friday, many of those still pending will have to go back to Biden’s desk to be be re- nominated in the new year — going through the same committee process and potentially giving Republicans more chances to slow-walk their confirmation.

Currently, the Senate is set to reconvene January 3, and will vote on the confirmation of Gabriel Sanchez to the Ninth Circuit Court of Appeals.

In the long term, however, the confirmation process could be revised to prevent long delays. According to Politico’s Andrew Desiderio, some senators are pushing for a rule change to prevent this sort of confirmation lag from happening again. A bipartisan group met Monday to discuss potential rule changes to prevent the kind of obstruction that contributed to the current confirmation backlog, but it’s unclear what those changes might look like.

In the interim, Murphy told Desiderio he is worried about future confirmation fights.

“My worry is that this is not going away, not just on ambassadors,” Murphy said. “I mean, everybody’s got a hold on every agency. So it just doesn’t feel like the rules, as they stand now, work for nominees.”

“No one wants to experience a breakthrough infection,” Madad says. “We know that even fully vaccinated people can transmit the virus, obviously at a lower extent, to fully vaccinated individuals. I think that’s really important for people to understand. It’s not just about you. I know here in America, it’s a lot about me, me, me, but we need to make sure we’re also looking at we, collectively.”

The best mask is one that fits, so make sure yours does, and think about replacing your cloth masks with N95, KN95, or surgical masks. If you want to stick with cloth, consider whether it’s time to replace your current supply. (Vox reported in September 2020 that a cloth mask likely needs to be replaced after 100 rounds in the washer or 50 in the dryer because the fabric will start to break down and become more porous.)

Determine who will be your main source of medical care if you get sick

A lot of people in the US simply don’t have a primary care provider they see regularly — even people who are insured. That’s a tough spot to be in when you’re sick and everything you’re reading is telling you to “talk to your doctor” about symptoms, and treatments.

“I would definitely encourage people to make sure that they have a primary care physician,” Madad says. Of course, many people don’t, and can’t, for a slew of structural and systemic reasons. Madad says she’d like to see more centralized hotlines that people can call about symptoms, for guidance on what types of treatments (like monoclonal antibodies) they might qualify for, and to know whether or not to go to the hospital. Until that happens, the best thing for you personally to do is to spend some time on your public health department’s website and the nearest public hospital’s website to find additional resources and information about free or low-cost telehealth options.

If you do have the resources to get a primary health care provider and have simply been procrastinating doing the research to find one, make that a priority in the next couple of weeks. The good news is that the advent of telehealth means this might be considerably easier, since you won’t need to worry as much about the doctor being a long car or bus ride away.

Have a plan for how you’ll isolate if you test positive

The Covid-19 vaccines are so effective at reducing hospitalization and death that it’s possible to start to feel like we’re post-pandemic or that getting Covid-19 is no big deal. It might not be a death sentence if you’re young, vaccinated, and generally healthy, but it’s still not the same as, say, getting a cold (even if it literally feels like you just have a cold). Plus, plenty of people are simply not young or generally healthy and very much want to avoid getting Covid-19 entirely. Which is all to say: It’s important to take isolation seriously.

With that in mind, take some time to familiarize yourself with the current CDC recommendations for the Covid-positive. Plan that, per current recommendations, you’ll likely need to be at home for 10 days — and not just mostly at home, but literally not leaving your home, except to get medical care, for 10 days. (Also keep in mind the current guidance could change with omicron.) Here are some other things to think about:

The answer to some of these questions might be, “Well, I guess I’m screwed!” which absolutely does not represent a moral failing on your part. But facing the bleak reality that things like sick leave and child care in the US are not built for a pandemic (or for a non-pandemic, to be frank) is a tiny bit easier and less overwhelming when you’re feeling relatively healthy.

Stock up on essentials

One thing that will make it massively easier to isolate and to focus on getting better is a well-stocked medicine chest and pantry.

To tend to your symptoms, you’ll likely want to have a variety of cold and cough medicines, pain relievers and fever reducers (like acetaminophen and ibuprofen), cough drops, a thermometer, and a few boxes of tissues. Madad says a pulse oximeter to monitor changes in your oxygen levels also isn’t a bad idea, though the reliability of this tool varies somewhat, especially for those with dark skin. Think about what you like to eat when you’re sick and/or don’t have much appetite (jello, popsicles, instant ramen, soup, etc.) and consider bulking up your grocery list for a few weeks with pantry staples and freezer meals for the benefit of Future You.

For extra credit, here are two items that unexpectedly made my own bout of Covid-19 much easier: a big water bottle with a straw (like this), which made it much easier to stay hydrated, and a small trash receptacle to put next to the bed or couch, because having a runny nose and taking lots of individually wrapped cold meds generates a ton of trash, which quickly takes over your nightstand and adds to the generally rotten vibe of having a respiratory illness.

Mentally prepare for how much rest you’ll need when you’re sick

One of the big benefits of planning ahead like this is that it’ll make it easier to do nothing after you’ve tested positive — something that is critical to the healing process.

During the mild case of Covid-19 I had last January, I immediately took time off work, but I didn’t totally understand what it means to truly rest, in the doctor-prescribed sense. I thought I could do light chores if I felt mostly up to them, for example, or read a book. I even, somewhat inexplicably, set my alarm for a normal wake-up time every morning, like it was an average weekend instead of … time off to deal with the respiratory illness I’d spent a year avoiding. It took me a few days to accept that doing anything but lying down and watching TV was draining, and even if I felt okay in the moment, I’d pay for it by feeling awful in the hours that followed. If you’ve been healthy your whole life, it can be difficult to comprehend how physically wiped you might feel after doing your typical version of “doing nothing.”

“We want to give our bodies time to recover,” Madad says. “You’re not going to get that healing time or recovery time if you’re going to constantly be active and on your feet and doing things that we do on a daily basis. I know so many of us live active lives, and to just stay in bed is something that’s really hard for many of us. But it’s really important.” And know that if you can’t take it easy — because, say, your boss expects you to get back to work or you have to take care of your kids, or both — it might take you longer to feel like yourself again. “If you are not giving that time to your body, then it probably will take longer for you to deal with Covid,” Madad says.

Pick up the phone if/when the health department calls you

If you’re not one to answer phone calls from unknown numbers, consider making an exception in the days following your positive test — it could very well be the local health department getting in touch. Depending on where you live, they could be calling to get your help with contact tracing, or they might want to ask you some questions about your symptoms, answer any questions you have, and provide you with important info and resources. (On the other hand, Madad says a lot of states are currently overwhelmed, so you may not get a call at all.)

Madad says that people might feel hesitant to share their friends’ or coworkers’ personal information with the health department, but stresses that contact tracing is still a critical piece of preventing future outbreaks. “Oftentimes, I hear, ‘I’m not going to give out my personal information,’ or ‘I’m not going to give information of who I have been in contact with because it’s none of their business,’” she says. “But, again, I would look at it as a form of community service. If you get that call, give that information, because their goal is to end this pandemic. By giving that information, you’re contributing to helping reduce the spread of this virus, which ultimately will help end this pandemic eventually.”

Be ready to feel a wave of emotions

Even if you’ve told yourself you’ll likely get Covid-19 eventually and it’s probably not a big deal, it’s still totally reasonable to feel overwhelmed and upset by a positive test. (It’s also completely reasonable to think it is a very big deal, and to feel afraid.) “It’s okay to be concerned, it’s okay to have those types of feelings,” Madad says. “No one wants to experience illness of any kind, whether we’re talking about Covid-19 or any type of a virus — no one wants to get sick. That’s not a condition that anybody wants to experience, especially when you talk about a variant that we’re still learning more about.”

It’s also very normal to feel a sense of shame or guilt, but Madad says it’s important to not let those feelings stop you from taking necessary steps to protect others. “Regardless of how you got infected, you want to do the right thing in terms of preventing other people from getting sick and contributing to that community transmission that is happening,” she says. That means telling close contacts they need to get tested and taking isolation seriously. “I think there should be no shame, no embarrassment,” Madad says. “You’re doing community service — you’re letting people know to protect themselves, because you’re infected, and you want to make sure that you’re staying away from them.”

A technician works at the African Health Research Institute in Durban, South Africa, on December 15. | Waldo Swiegers/Bloomberg via Getty Images 
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How we fund research is stifling creativity. Here’s one potential fix.

Ask a bunch of scientists what’s wrong with their field, as Vox did a few years ago, and one thing nearly all of them will name is the funding process. You might think that top scientists at top universities are paid by those universities for the research they do, but for the most part, you’d be wrong: Nearly all academic researchers in the sciences rely on outside grants in order to pay salaries, buy their equipment, and run their experiments.

Those grants end up powerfully shaping the academic sciences. By some estimates, many top researchers spend 50 percent of their time writing grants. Interdisciplinary research is less likely to get funding, meaning critical kinds of research don’t get done. And scientists argue that the constant fighting for funding undermines good work by encouraging researchers to overpromise and engage in questionable practices, overincentivizing publication in top journals, disincentivizing replications of existing work, and stifling creativity and intellectual risk- taking.

A new biomedical research institute, called the Arc Institute, announced on Wednesday as a nonprofit in collaboration between Stanford, UC Berkeley, and UC San Francisco and funded by some of the biggest names in tech, is meant to address some of those problems — and show what could be a better way to fund science.

Arc is “an institutional experiment in how science is conducted and funded,” Patrick Collison, CEO of Stripe and one of the Institute’s funders, told me. Researchers get eight-year grants to do whatever they want, instead of three-year grants tied to a specific project.

The institute is also hiring for people who want to work on improving key biological research tools instead of on conducting experiments and writing papers. It’s an expensive approach that can, even at best, only solve the problems with our current system for a tiny fraction of the researchers affected by it. But its founders hope it can at least show that solutions are possible — and inspire further experimentation.

Arc, explained

The key idea behind Arc is that the current system for biomedical scientists has enabled a lot of great research. But there’s an overwhelming sentiment among scientists that some key work is falling through the cracks.

Top investigators “spend over half of our time fundraising. The rest of that time we’re shouldering serious managerial, operational, logistical things,” Patrick Hsu, an assistant professor of bioengineering at the University of California Berkeley and one of Arc’s founders, told me.

The system “doesn’t empirically seem to enable people to pursue what they themselves think is their best idea,” Collison said.

Last year, Collison was involved in funding a major scientific grantmaking endeavor called FastGrants — an effort to get money out to researchers doing critical work on Covid-19. With the funds, they sent a survey. One question included was “if you have the same amount of funding but you could use it however you want, and it was stable, would you change your research program,” Silvana Konermann, an assistant professor of biochemistry at Stanford and the new executive director of Arc, told me.

Eighty percent of the scientists who answered said they would change their research program substantially.

Arc is a bet on doing exactly that. The researchers it brings on as core investigators will get less restricted, eight-year grants. The idea is that they’ll spend less time fundraising and feel secure to switch course and focus on whatever they believe is most essential, giving them what Konermann said is the “flexibility and freedom to pursue the research they’re the most passionate about and take risks and take on projects that might fail.”

The institute is also hoping to better support those scientists with “technology development centers” that focus on inventing better tools and processes for biomedical research. It’s the kind of work that is essential to science but that doesn’t lead to academic papers and that is therefore not seen as a viable career path.

With the current system, “there aren’t long-term careers for the people doing it,” Hsu told me. “It should be possible to work for 20 years on refining some super-useful technology” — for cutting and pasting DNA, for example, or something similarly fundamental. Right now there aren’t good career options in the academic biosciences for people who want to work on slow, slight engineering improvements on a key problem. It’d be nice to change that.

Arc will operate out of Palo Alto, California, where Stanford is located, as an independent nonprofit collaborating with Stanford, Berkeley, and UCSF — all institutions with highly regarded biomedical programs.

It’ll be expensive — part of why no one has fixed biomedical science is that it isn’t cheap. The venture has funding commitments from — along with Patrick Collison (who is Konermann’s husband) and his brother and Stripe co-founder John Collison — cryptocurrency billionaire Vitalik Buterin, and Dustin Moskovitz and Cari Tuna (whose ambitious philanthropy crops up frequently here on Future Perfect), among others.

What’s missing from our scientific funding system

If you’re a tenured professor doing academic research in many scientific fields, you’ll be responsible for running a lab. That means you’ll need to hire graduate students and postdocs, as well as pay for equipment, supplies, and publication fees.

Universities pay a share of these expenses, but the bulk is expected to come from research grants. In the US, most of those grants come from the federal government: Biomedical research is funded by the National Institutes of Health (NIH), and much other research is funded by the National Science Foundation (NSF).

Grant applications tend to be long and complicated, and often require “preliminary work” on a project, which means a lab has to already commit significant resources toward it before they can even apply for future work on it to be paid for, Hsu told me.

And the number of grant applications to institutions like the NIH has been going up, while funding hasn’t necessarily kept pace, so grant rejection rates are sky-high. In the 1970s when the program got started, the share of NIH grant applications that are approved was about 35 to 40 percent — now it’s about 20 percent. That means most of the time and effort on writing grant applications is effectively wasted.

The process isn’t just time-consuming — it’s also stunningly capricious. One study found very little correlation between how a grant was scored in the NIH process for grant approvals and whether the research it produced was eventually cited.

Another study, looking at high-quality proposals, found there was virtually no agreement on their merits — two researchers might come to vastly different conclusions about whether the grant should be approved. Another analysis looked at successful grants and found that 59 percent of them could have been rejected due to random variability in scoring. Watching how NIH grants were reviewed was “very eye-opening for me,” Hsu told me — and not in a good way.

Then there’s the fact that grants tend to expire after a few years. As John Pooley, a neurobiology postdoc at the University of Bristol, told Vox, that inclines researchers toward tackling something that they can address in a few years. But some of the most important problems in medicine will take much longer to crack.

To be clear, a lot of incredible biomedical research is happening in academic laboratories today. The US leads the world in biomedicine, and key inventions like CRISPR happened in US laboratories. While the system certainly needs improvement, no one wants to lose what makes US biomedicine already lead the world.

“It’s not that the current model is really bad for everyone — I think the current model actually works really well for some people,” Konermann told me. “The hope is not that everything will be like Arc, but that each of these models will have their own downsides and their own upsides,” making for a “healthier overall ecosystem.”

Of course, even if there are flaws in the current system, Arc might not necessarily address them. For one thing, it’s really small and not an option for most biomedical researchers, no matter how much they’d like it. For another, Arc represents a bet on what conditions produce good science — and while their case for their bet is compelling, they could be wrong that giving scientists more flexibility and more autonomy actually produces the lifesaving cures we hope for from biomedicine.

Experimenting with our scientific process

A wide range of ideas have been aired for how to fix the scientific grant process, from lotteries to limiting applications to one page. There have been private attempts to do better — like FastGrants, which aimed to get out Covid-19 research money in 48 hours instead of weeks or months, and which has moved more than $50 million to date.

But one key thing, Collison emphasized to me, is simply having more options. There’s nothing wrong with the NIH grant process as one way that researchers can secure money for an idea. But when it’s the only way, any science that doesn’t fit neatly into the NIH process won’t get done at all.

Arc is one more option, but it will only be able to fund a few core investigators and a limited number of full-time careers working on developing new tools in its technology development centers.

That’s why Collison says one measure of Arc’s success — alongside the more obvious ones, like whether its researchers report that they’re able to focus on science, and whether they discover new things that make the world a better place — is whether “other funders, other institutions, other stakeholders in our prevailing systems, are compelled to themselves pursue other experiments and other models.” If Arc works, then that raises new questions — what else might work? What other potential is going untapped in the current system?

It’s an experiment that the beneficiaries of biomedical research — which is to say, everyone — ought to watch with interest.

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