Good morning! And thanks to the readers who sent hosting tips and recipes over the last few days. We hope you have a great day. In the holiday spirit, The Health 202 is going to lay low on Thursday and Friday. We'll be back in your inbox on Monday for what's likely to be a hectic December: As always, reach out: rachel.roubein@washpost.com.

Today, we take a deep dive into the financials of Biden's pick to run the FDA and a jury found three major retailers helped flood two Ohio counties with opioids. But first:

The good, bad and ugly about this year's pandemic Thanksgiving

Thanksgiving in America is getting closer to normal. 

Airports and roads are almost as congested as before the pandemic. Just 16 percent of Americans are planning a holiday Zoom. And two-thirds of Americans plan to get together with family or friends from outside of their household for Thanksgiving.

Anthony Fauci, the president’s chief medical adviser, is encouraging vaccinated Americans to enjoy the holiday, no masks needed. That’s a sharp contrast from last year when public health officials pleaded with the public to avoid dinners with their loved ones.

  • “Last year, I told people to stay home, and I don't tell people that this year,” said Shira Doron, an infectious-disease physician at Tufts Medical Center. “We are really not in the same place and that’s [because of] vaccines.”

But the coronavirus is still killing over 1,200 people per day — and many Americans are essentially becoming desensitized to the high toll. 

With the pandemic, there’s good news. There’s bad news. And there are the hard truths.

The good news: Last year, federal officials and states were prepping for the country’s largest ever vaccination campaign. But the first coronavirus shot wasn’t authorized for another few weeks. 

Now, as the holidays arrive, there are three coronavirus vaccines in the United States, including one that’s safe for kids. All adults are allowed to get boosters shots. And the first pills to treat the virus at home could get the greenlight in the coming weeks. 

  • On vaccinations, experts point to one promising data point: Roughly 86 percent of adults 65 and older are fully immunized, according to the Centers for Disease Control and Prevention.
  • “What was worrisome last year was the fact that none of the high risk people had been vaccinated,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

The bad news: Both hospitalizations and deaths rose again in the past week, per The Post’s coronavirus data tracker. New daily reported cases also rose 10 percent. 

  • There was a 4 percent increase in hospitalizations. More than half the states saw a rise in these rates.
  • For instance: Earlier this week, New Hampshire and Maine set a record for the number of people treated for covid-19 in hospitals, and states like Michigan are sounding the alarm.
  • There was a 10 percent rise in deaths. A rise in deaths typically follows an increase in cases by about a month.

“That’s concerning to me about what it says about what the winter can really look like,” said Natalie Dean, assistant professor of biostatistics at Emory University. 

The hard truth: While the death rate is substantially lower than last January, over 1,000 Americans are still dying from the coronavirus each day. The unvaccinated are 14 times as likely to die of covid-19 compared with those who are vaccinated, per the CDC.

By the numbers: 

  • Nearly 70 percent of Americans have received one shot.
  • About 59 percent are fully vaccinated.
  • And roughly 19 percent have gotten a booster shot.

Yet, the summer’s delta surge didn’t convince tens of millions of Americans to get immunized. Roughly 60 million of those eligible to get the shot have refused it for months, Fauci said Sunday on CNN — a number he called “dangerous” for both the unvaccinated and the vaccinated. The more the virus is circulating, the more breakthrough infections among vaccinated people can occur. 

  • To put it bluntly: “There’s still a substantial amount of morbidity and mortality,” Dean said. “And it says very much, this is not over.”

Agency alert

Behind the financials of Biden’s FDA pick: Robert Califf earned over $2.7 million in salary as a senior adviser to Verily, the Alphabet-owned research organization devoted to life sciences, while also netting over $77,600 from serving on the board of two pharmaceutical companies, as well as stock options with all three, according to newly disclosed financial documents.  

Earlier this month, Biden nominated Califf, who ran the Food and Drug Administration for a year under President Barack Obama, to once again helm the agency after a months-long search. The new documents also detail his stock portfolio, which he will divest once he’s confirmed. It includes a range of companies, from pharmaceutical companies to health technology. He will also recuse himself from decisions related to the companies he’s advised. Politico first reported the disclosure forms.

His confirmation has already faced criticism from several Democrats who are concerned he has close ties to the pharmaceutical industry or worried about the FDA’s record on opioids. Advocates scrutinizing executive branch appointees — such as Jeff Hauser, executive director of the Revolving Door Project — raised concerns, saying “he’s just very, very connected in the entire space that he is now going to be regulating.”

  • A White House official defended the nominee, contending “almost anyone who is qualified to run the FDA will have experiences with drugmakers.”
  • The official also noted the administration’s ethics agreement — which Califf signed — includes divestment and refusals as an “example of the robust steps the Biden administration is taking to make sure nominees like Dr. Califf address any potential conflicts of interest.”

The timing: The Senate HELP Committee, which is charged with advancing Califf's nomination, had originally hoped to slate his hearing for the week of Dec. 6. But the White House didn't file the paperwork by the time needed to meet that goal, Politico's Adam Cancryn reported.

In the courts

A jury found CVS, Walgreens and Walmart responsible for flooding Ohio counties with opioids

In a first-of-its-kind verdict, the federal jury determined that the three major retailers helped flood two Ohio counties with addictive opioids, The Post’s Meryl Kornfield and Lenny Bernstein report.

Ohio’s Lake and Trumbull counties called the verdict “a milestone victory,” after arguing the pharmacies failed to take action to stop mass quantities of opioid pills from reaching the market and fueling the nation’s opioid epidemic.

The counties made the case that the companies’ failure to act created a public nuisance — a legal argument that has faced pushback from courts in Oklahoma and California.

What happens next: U.S. District Judge Dan A. Polster in Cleveland is expected in April or May to decide how much the pharmacies will pay the counties, according to attorneys for the counties. The companies, however, have denied wrongdoing and say they plan to appeal the verdict.

Meanwhile, trials over similar claims are ongoing in state courts in New York and Washington, and a ruling is expected soon in a trial before a federal judge in West Virginia.

The Justice Department asked a federal appeals court to reinstate Biden’s testing or vaccine requirement

The Biden administration asked the Ohio-based U.S. Court of Appeals for the 6th Circuit to reinstate its coronavirus vaccine or testing requirements “as soon as possible” and to get rid of an earlier ruling that temporarily blocked the policy, our colleague Ann E. Marimow reports.

  • The administration’s requirements have faced dozens of challenges from Republican-led states, private employers and conservative groups. 

Even if the 6th Circuit isn’t inclined to reinstate the ruling, the federal government is asking it to narrow an earlier ruling from the Louisiana-based 5th Circuit and allow the masking-and-testing policy to remain in effect while litigation is ongoing. The policy was set to go into effect in January.

At issue: The 5th Circuit repeatedly characterized the federal government’s requirements as a “mandate” and called it a “one-size-fits-all sledgehammer,” arguing that the administration had exceeded its authority. But the Biden administration has taken issue with that framing, noting that employers are free to allow workers to remain unvaccinated and instead comply with masking and testing requirements.

Coronavirus

  • The CDC moved Germany and Denmark to its “do not travel” list amid surging coronavirus cases in Europe, The Post’s Annabelle Timsit reports. They join other European destinations on the list of countries given a Level 4 warning, including Hungary, Iceland, the Czech Republic and Guernsey — all added last week.
  • Amid pandemic-fueled labor shortages, many wealthy nations are looking to immigration as a way to fill out their workforce, The New York Times’s Damien Cave and Christopher F. Schuetze report. Disruptions from the pandemic have caused people to leave the workforce. Now several developed countries are ramping up efforts to recruit, train and integrate workers from other countries.

Top health stories

Sugar rush

Thanks for reading! See y'all Monday.