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In the throes of a pandemic, the 2020 US election has a different feel.

Last night, President Donald Trump and former Vice President Joe Biden went to head to head in an extraordinary first debate, hosted by the Cleveland Clinic and Case Western Reserve University in Ohio. Everyone in attendance (family, media, and campaign staff only) was masked up and tested for COVID-19 prior to arrival. The candidates didn’t shake hands when they took the stage, again to limit transmission of the virus.

The pandemic cropped up multiple times during the 90-minute debate—but it wasn’t the only science issue on the table. Here are five important takeaways about the candidates’ platforms and priorities in public health, the environment, and more.

The future of the Affordable Care Act looks murky.

Passed and signed by then-President Barack Obama in March of 2010, the Affordable Care Act (ACA) has been subject to plenty of change in the past decade. But recent proposals to revise the law, which provides insurance coverage for at least 20 million people in the US, could be more impactful.

In July the Supreme Court of the US (SCOTUS) ruled that more companies could refuse to provide contraceptive coverage for employees on the grounds of religious freedom. SCOTUS will face another big decision regarding the ACA when it takes on a lawsuit filed by 18 states and the Trump administration this November. The case argues that the policy is unconstitutional because it forces the American people to enroll in insurance without offering necessary tax relief.

Mention of the ACA came early last night, with Biden arguing its importance during a global pandemic. “There are 100 million people who have pre-existing conditions, and [their insurance] will be taken away,” he said. Trump countered with the fact that he signed an executive order last week that protects patients with pre-existing conditions from being denied coverage. The text of the plan doesn’t outline how those protections differ from those already provided by the ACA.

Read President Trump and Biden’s full health care platforms online.

The US still needs a pandemic-response plan.

As the candidates dove deeper into the debate, they hit on the past, present, and future of the current coronavirus crisis. Last week, the US COVID-19 death toll passed 200,000, a number that the Centers for Disease and Control (CDC) estimate would be the upper limit for mortalities in the country. The daily case rate has taken a dip since the peak of the first wave in July, but epidemiologists expect another spike in the winter months ahead.

President Trump assured the public that a vaccine would be out this year, contradicting the “Operation Warpspeed” timeline set by the Centers for Disease and Control (CDC), which slates initial doses for January of 2021 at the earliest. “We could have the answer by November 1,” the president said. “We have the military logistically all set up [to distribute the drug].”

Biden noted that the back and forth between the White House and public health agencies like the CDC has seeded distrust in Americans. He cited polls showing that at least half of the country is wary of getting vaccinated for COVID-19, and also pointed out that better guidelines on mask wearing could have helped save lives earlier in the pandemic. President Trump responded that the casualty rate would have been worse if it weren’t for his international-travel ban, which mainly targeted China. The US’s first outbreaks, however, likely stemmed from Europe.

Neither candidate offered specifics when grilled on how they’d counter the virus and all its ripple effects over these next few months. Shutdowns stood out as a hot-button issue, as the two debaters went back and forth on the effectiveness of closing down schools and businesses to limit community spread. Trump also noted that he’s speaking at two large rallies this weekend in Wisconsin, but downsized the threat of viral spread because they’re being held outdoors.

The pandemic has exposed the effects of systemic racism in the US.

The event then veered into issues of race, equality, and police brutality. On the topic of how systemic social issues affect public health, Biden pointed out that Black and Latino people have suffered the toughest losses from COVID-19, largely due to imbalances in medical care and resources. “One in 500 African Americans will have been killed by COVID-19 by end of the year” if the country doesn’t take direct action, he said. Neither politician addressed the outbreaks on tribal reservations in Western states.

You can’t talk about climate change without talking about the economy.

With an entire discussion question on climate change, both Trump and Biden had plenty of time to expand on their plans to deal with carbon emissions and major storms and wildfires that have ravaged the country this year. Trump agreed that humans are responsible for global warming (in part), but he doubled down on his decision to withdraw the US from the Paris Accord. He also noted that he wants to grow billions of new trees to make the air and water cleaner for Americans—a correlation that isn’t quite scientifically sound—and give more tax incentives to electric vehicle makers and buyers.

Biden, for his part, summarized a $2 trillion proposal, which he stressed was different from the “radical” Green New Deal, to combat the climate crisis, resolve environmental justice issues, and jumpstart economic recovery. “We can get to net zero energy by 2035,” he said, referring to the benchmark for carbon-free power sources set by many other countries. To reach that goal, the US would have to rebuild much of its utility infrastructure, invest in new engineering, weatherize homes and offices, and add charging stations along every highway. This movement, Biden said, would create hundreds of thousands of new jobs, while saving the country billions in damages from storms and wildfires exacerbated by climate change. He pointed specifically to the floods that washed out cropland in South Dakota and other Midwestern states last year, costing some farmers their properties and livelihoods.

Trump also spoke to the disastrous wildfire situation on the West Coast. “We need forest management,” he said, in reference to prescribed burns and selective logging. “The floor is covered with dead trees.” Back in March, the US Forest Service put a temporary hold on prescribed burns due to the pandemic.

COVID-19 could throw voting into a tailspin.

In preparation for this virus-plagued election season, nine states have switched to mostly mail-in voting, while 36 others are allowing residents to request mail-ballots, no questions asked. The goal is to keep people’s civic rights intact, while also keeping them from flocking to tight spaces and swapping pathogens. Poll workers, who are typically 60 years of age and older, would be particularly vulnerable.

But the focus on mail-in voting has raised all sorts of questions. President Trump highlighted a few of them last night, stressing that the potential for fraud and miscounts is higher when an election is mainly conducted over paper and post. This conflicts with statements made by F.B.I. Director Chris Wray. It would “be a major challenge for an adversary” to forge or change enough ballots to shift the outcome of the election, he told the Senate Homeland Security Committee last week.

Biden conceded that tallying mail-in ballots can be difficult, especially with the US Postal Service’s strapped budget, which is causing major lag in deliveries. But he also pointed out that as long as voters drop their ballots into a mailbox on time, their choice should matter, even if the envelope arrives in local election offices after November 3. The most foolproof option, however, is to fill out and return the ballot as soon as it arrives. Early voting could be the one boon in this extremely uncertain election process.

The first vice presidential debate is on October 7 in Salt Lake City, Utah. The next presidential debate is on October 15 in Miami, Florida.

Correction: The article previously misidentified the university hosting the debate as Case Western. It is Case Western Reserve.


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