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JUST IN: Austin Calls for More NATO Help in Countering China – News Channels


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Royal Danish navy frigate HDMS Peter Willemoes, right, the underway replenishment oiler USNS Patuxent, center, and the Royal Netherlands navy frigate HNLMS Van Speijk, left, transit the Atlantic Ocean during NATO exercise Cutlass Fury 2019.

U.S. Navy photo by Petty Officer 2nd Class Cameron Stoner

The United States needs its NATO allies to invest more in their military capabilities and help the Pentagon address the growing threat posed by China, Secretary of Defense Lloyd Austin III said Feb. 19.

Austin attended a virtual NATO ministerial meeting with his alliance counterparts earlier this week. Discussion topics included a resurgent Russia, disruptive technologies, climate change, the war in Afghanistan, terrorism and “an increasingly aggressive China,” he told reporters during his first Pentagon press briefing since taking office.

“I made it clear that the United States is committed to defending the international rules-based order, which China has consistently undermined for its own interests,” he said, describing the rival nation as the Defense Department’s “primary pacing challenge.”

“We believe NATO can help us better think through our operating concepts and investment strategies when it comes to meeting that challenge,” he added.

NATO was formed in the early years of the Cold War to help defend Western Europe and North America against the Soviet Union. However, since the end of the Cold War, the alliance has pivoted to combating other threats such as international terrorism. NATO is expected to produce a new “Strategic Concept” as part of a series of reform efforts, which may include a greater focus on addressing China’s growing military capabilities.

Austin noted that more and more NATO allies are now meeting their commitments to spend at least 2 percent of their GDP on defense, including 20 percent of that amount on modernization. But, like many previous U.S. defense leaders, he pressed for other NATO countries to do more burden sharing.

“We must each of us do our part to procure, prepare and provide ready forces and capabilities,” he said. “Now we’re into our seventh year of steady defense spending increases, and naturally we want this trend to continue and we want to see every member of the alliance contribute their fair share.”

The Biden administration has identified strengthening alliances and partnerships as a key pillar of its foreign policy.

Non-NATO partners including Finland, Sweden and the European Union also participated in the ministerial, and offered their perspectives about China, Austin noted.

The Biden administration recently began its own deep dive on these issues. On Feb. 10, just three weeks after President Joe Biden was sworn in, it set up a new China Task Force led by Special Assistant to the Secretary of Defense Ely Ratner. It includes representatives from the Office of the Secretary of Defense, the Joint Staff, the military services, combatant commands and the intelligence community.

“This initiative will provide a baseline assessment of DoD policies, programs and processes on China-related matters and provide the Secretary of Defense recommendations on key priorities and decision points to meet the China challenge,” according to a Pentagon fact sheet.

The task force is expected to address: strategy; operational concepts; technology and force structure; force posture and force management; intelligence; U.S. alliances and partnerships; and defense relations with China.

Its findings and recommendations are due by mid-June.

During the press briefing, Austin was asked if he sees any areas where the United States and China could potentially cooperate or collaborate on international security issues.

“There no doubt are some areas where we will see common interests and there may be an opportunity to engage,” Austin said.

“Now having said that, from a Department of Defense standpoint … my No. 1 concern and my No. 1 job is to defend this country and protect our interests,” he added. “And so we in this department are going to do everything possible to ensure that we have the right operational concepts, the right plans in place, and that we have resourced those plans with the right capabilities to present a credible deterrent, not only to China [but] any other adversary who would want to take us on.”

Topics: DOD LeadershipInternation Cooperation

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Europe applauds Biden’s approach, stresses cooperation


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BERLIN (AP) — Collective sighs of relief could be heard from many European capitals Saturday after U.S. President Joe Biden made clear in his first major foreign policy address since taking office that he rejected the “America First” and transactional approach of his predecessor and urged cooperation among Western allies.

At the same time, politicians and observers cautioned that some of the sources of tension from Donald Trump’s presidency remained and that the allies have serious work ahead of them, once Biden’s honeymoon is over.

“Biden gave exactly the speech that many Europeans wanted to hear – an America that pats you on the shoulders, that doesn’t criticize or demand,” wrote Germany’s influential Der Spiegel magazine after Biden on Friday became the first American president to appear at the Munich Security Conference, albeit in virtual form.

“Will it stay that way? For the moment, it was certainly the right message: It was primarily intended to patch up the injuries of the Trump years,” the magazine said in an analysis.

The annual Munich Security Conference has long been heralded as a gathering where world leaders are able to share and debate ideas in an informal setting.

Biden’s speech highlighted the condensed agenda for this year’s conference, which was held online due to the coronavirus pandemic.

In his keynote address, Biden assured other participants, including French President Emmanuel Macron, German Chancellor Angela Merkel and British Prime Minister Boris Johnson, that the United States was “determined to reengage with Europe, to consult with you, to earn back our position of trusted leadership.”

Over the last four years, the NATO alliance was shaken by Trump’s questioning of its relevance and his suggestion that the United States might not come to the aid of members who failed to meet pledges to commit 2% of gross domestic product to defense spending.

But Biden made no mention of Washington’s opposition to the Germany-Russia joint Nord Stream 2 pipeline project and steered away from criticizing Germany and others for failing to meet NATO defense spending goals. Instead, he emphasized Washington’s commitment to Article 5 of the NATO founding treaty, which states that an attack on one alliance member is considered an attack on all.

It is now important for Germany and the rest of Europe to seize upon the renewed U.S. willingness to engage in dialogue and work hard toward resolving areas of disagreement, said Juergen Hardt, the foreign policy spokesman for Merkel’s parliamentary group.

“With his speech, Joe Biden reached out to Europe,” Hardt said. “

The coming months must be used intensively to resolve numerous open issues, such as punitive tariffs, extra-territorial sanctions on Nord Stream 2, or digital tax,” he said.

Merkel told reporters Friday after Biden’s speech that it is up to Europe to take an example from his first days in office, and follow words with actions.

She cited the United States’ return to the Paris climate agreement, its decision to stay in the World Health Organization and to engage with the U.N. Human Rights Council, to extend the New START treaty and to try to revive the Iran nuclear agreement as “important steps toward more multilateral cooperation.”

“I can only support (the idea) that it is up to democratic countries not just to talk about freedom and values, but to produce results,” Merkel said.

In a nod toward Biden’s call for cooperation in addressing economic and national security challenges posed both by Russia and China, several leaders suggested more could be done.

The leader of the European Union’s executive branch, European Commission President Ursula von der Leyen, noted at the conference that “a more and more assertive China” showed robust economic growth in 2020 despite the pandemic and “a more and more defiant Russia continues to breach international rules at home and abroad.”

“It is up to us, the United States and Europe, to strengthen our cooperation again as proven and trusted partners, as indispensable allies, shoulder to shoulder,” von der Leyen said. “Because if we lead the way, this is not only about joining forces, this is a signal to the world.”

European Council President Charles Michel underlined the need for a common approach to “defend the rules-based international order from the attacks of autocratic regimes, whether from Russia, China or Iran,” saying “a strong partnership needs strong partners.”

“That’s why we, in Europe, are growing stronger, to increase our strategic ability to act,” Michel said.

France’s Macron, who has pushed since his own presidency began in 2017 for Europe to do more for its own defense, suggested that by doing so, it would be strengthening the U.S. ability to focus more on the Pacific region.

“I think it is time for us to take much more of the burden of our own protection,” he said.

Merkel, meanwhile, stressed that “it is very important that we develop a common trans-Atlantic Russia agenda, which on the one hand makes cooperative offers, but on the other hand very clearly names the differences.”

“The second and perhaps more complicated thing is for us to develop a common agenda toward China,” she said, noting that the country is both a systemic competitor and needs to tackle issues such as climate change.

“There is a great deal to do,” Merkel said. “Germany stands ready for a new chapter of the trans-Atlantic partnership.”

_____

Angela Charlton and Sylvie Corbet in Paris, and Geir Moulson in Berlin contributed to this story.

Copyright 2021 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without permission.

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4:30 AM 2/13/2021 – INVESTIGATE THE INVESTIGATORS!!! | Pro-Trump faction within the FBI and Thomas Edward Caldwell | Feds need to tell us a lot more about the Capitol riot investigation (opinion) | Former FBI official … https://thenewsandtimes.blogspot.com/2021/02/430-am-2132021.html 

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Steve Bannon believed Trump had dementia and plotted to remove him as president, according to new book | Investigation of Donald Trump and Trumpism – trumpinvestigation.net: What role did the retired FBI agents play in Capitol riot? | In new defense, dozens of Capitol rioters say law enforcement ‘let us in’ to building


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U.S. Department of Justice

U.S. Department of Justice

By ALEXANDER MALLIN, ALEX HOSENBALL and OLIVIA RUBIN, ABC News

(WASHINGTON) — As authorities continue to pursue individuals who participated in the Jan. 6 insurrection at the United States Capitol, a growing number of those charged are employing a new defense: blaming the police for letting them in.

At least 29 people arrested for their role in the Jan. 6 events have claimed they thought they were free to enter the Capitol because law enforcement authorities either didn’t stop them from coming in or never told them they were not allowed to be there, according to affidavits and court filings reviewed by ABC News.

“He was not at the front of the lines, he didn’t see barricades being knocked down, he didn’t see officers getting assaulted, he didn’t see anything other than large crowds at the Capitol,” Thomas Mayr, the lawyer for Christopher Grider, one of the people accused of participating in the riot, told ABC News. “He went through an open door.”

Grider, of Texas, is one of dozens of suspected rioters who claimed to be unaware they were not allowed inside — some of whom argued that they were actually ushered in by officers. He now faces multiple charges including violent entry and disorderly conduct on Capitol grounds.

Jacob Lewis of California told investigators he was never told that he could not enter the Capitol, and that he was “escorted” by police into the building. When reached by ABC News, Lewis said he would be releasing video footage to “back up his story.” He declined to share the video with ABC News. Lewis was indicted on four misdemeanor charges, including disorderly and disruptive conduct in a restricted building.

Even as scrutiny of Capitol police continues to build, experts say it is unlikely such a defense will work in most situations.

“In general, ignorance of the law is not an excuse for criminal behavior,” said Taryn Merkl, senior counsel in the Justice Program at the Brennan Center for Justice and a former federal prosecutor in the Eastern District of New York.

Many accused rioters also face multiple charges for crimes they allegedly committed once inside the building, which experts say would render their claims of legal entry meaningless.

“Whether or not people knew that it was not lawful to enter the grounds as they did, many are charged with parading, demonstrating, or picketing — and that is prohibited, and no intent is required,” Merkl said.

Brandon Fellows, for example, told investigators he did not think he was going to get in trouble because the police officers seemed to be “on our side,” but he was later seen with his feet up on the desk of Sen. Jeff Merkley, D-Ore.

“Even if the officer had permitted him in the rotunda area or somewhere that might conceivably be a public space, anybody knows that breaking into a private senatorial office is wrongful, and would obstruct the administration of government,” Merkl said.

U.C. Berkeley law professor Charles Weisselberg, a former public defender, said the defense might help those charged with crimes where intent is required.

“If someone believes that they are allowed to do something, it might negate the intent that’s otherwise required to convict,” Weisselberg told ABC News. “Whether it is successful or not depends on the facts, what they heard, saw, and believed, but I could see that being presented.”

Merkl, however, noted that the majority of the rioters are charged under specific statutes that apply to the protection of the Capitol, for which prosecutors don’t have to prove intent on the part of the accused.

Dimitry Shakhnevich, a criminal defense attorney and adjunct assistant professor at John Jay College of Criminal Justice, also said that defense wouldn’t work.

“If I leave my door open to my house, you can’t bolt in, even though I left the door open,” Shakhnevich said. “It’s still trespassing … and making the argument that I impliedly consented to access by leaving my door open is silly.”

Still, claims by those who say they were unaware they were committing illegal acts could sharpen the distinction between Trump supporters who may have gotten swept up in the moment and hardened extremists who went to the Capitol with plans to commit violence. An ABC News analysis of court records, military records, interviews and available news reports found that at least 19 of those arrested have associations or possible ties to extremist groups, including the Proud Boys, Oath Keepers and Three Percenters. Numerous individuals associated with those groups have since been charged with conspiracy.

And while some accused rioters say they believed law enforcement allowed them to enter, others are saying they believed they were acting under direct orders from then-President Donald Trump, who told his supporters at the rally before the attack that they should “fight like hell” and that he would be joining them on their march to the Capitol.

An ABC News analysis found at least a dozen rioters have mounted such a defense, a point that was raised multiple times by Democrats as they sought last week to convict Trump on charges that he directly incited the mob.

Weisselberg said that authorities prosecuting accused rioters will likely dispute such claims by pointing directly to what the rioters observed upon arriving at the Capitol.

“You’re looking at the location where they entered, you’re looking at the time that they entered, you’re looking to see whether it would have appeared that that they were entering a restricted space,” Weisselberg said. “The prosecution might counter with other facts, arguing that for a person who came up to the building at this particular location, they actually couldn’t have believed that they were entitled to enter because they saw broken glass, damage, and other things that should have been apparent to this person entering at that particular point in time.”

The claims, whether successful or not, bring a renewed focus on the conduct of police that day. In the aftermath of the attack, officials began questioning why law enforcement was not better prepared, and numerous investigations have been opened in the weeks since.

Earlier this week, Speaker of the House Nancy Pelosi announced that Congress would create an outside commission to investigate the riot, including “the preparedness and response of the United States Capitol Police and other Federal, State, and local law enforcement in the National Capitol Region.”

The Senate is scheduled to hold its first hearing into the security preparations leading up to Jan. 6 next week, and has called current and former officials responsible for securing the U.S. Capitol building to testify.

Bryce Lowry Caldwell, an attorney for one of the alleged rioters, told ABC News they were “looking into” the actions of the Capitol Police as a possible defense.

“Numerous individuals have been charged for being on a piece of property when they shouldn’t be,” he told ABC News. “If someone let them on … that’s an issue.”

Caldwell’s client, Jordan Revlett, had posted on Snapchat that “a capitol police officer opened the door from inside to let us in,” according to the FBI affidavit. Revlett also told investigators he “did not see any signs that would have restricted his entry” and that “a police officer was standing behind the door he entered, who did not try to stop his entry.”

“There’s several other defendants who said the same,” Caldwell told ABC News. “I would feel safe to say that’s an issue the Department of Justice would be looking into.”

When asked for comment, a DOJ official referred ABC News to its previous statements that “any individuals who intentionally committed a crime that day will be charged.”

Investigations have since been opened into the actions of 35 Capitol Police officers, a congressional official told ABC News, and at least two officers have been suspended, according to Rep. Tim Ryan, D-Ohio.

Other officers have been honored for their heroism in protecting the Capitol during the attack, which left five dead, including a Capitol Police officer, and injured dozens of officers.

Capitol police did not respond to ABC News’ request for comment.

“I certainly believe that the Capitol Police role in this should be fully investigated, whether it’s by prosecutors or by the House Oversight Committee,” said Merkl, the former federal prosecutor. “There needs to be a review of what the Capitol Police role, if any, was in facilitating this or aiding and abetting it.”

Nevertheless, Merkl said, “the actions of the government aren’t on trial in a criminal case. What’s on trial is the action of the defendant.”

Copyright © 2021, ABC Audio. All rights reserved.

The post In new defense, dozens of Capitol rioters say law enforcement ‘let us in’ to building | Connect FM | Local News Radio first appeared on My News Links – mynewslinks.com – Current News.

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In new defense, dozens of Capitol rioters say law enforcement ‘let us in’ to building | Connect FM | Local News Radio


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U.S. Department of Justice

U.S. Department of Justice

By ALEXANDER MALLIN, ALEX HOSENBALL and OLIVIA RUBIN, ABC News

(WASHINGTON) — As authorities continue to pursue individuals who participated in the Jan. 6 insurrection at the United States Capitol, a growing number of those charged are employing a new defense: blaming the police for letting them in.

At least 29 people arrested for their role in the Jan. 6 events have claimed they thought they were free to enter the Capitol because law enforcement authorities either didn’t stop them from coming in or never told them they were not allowed to be there, according to affidavits and court filings reviewed by ABC News.

“He was not at the front of the lines, he didn’t see barricades being knocked down, he didn’t see officers getting assaulted, he didn’t see anything other than large crowds at the Capitol,” Thomas Mayr, the lawyer for Christopher Grider, one of the people accused of participating in the riot, told ABC News. “He went through an open door.”

Grider, of Texas, is one of dozens of suspected rioters who claimed to be unaware they were not allowed inside — some of whom argued that they were actually ushered in by officers. He now faces multiple charges including violent entry and disorderly conduct on Capitol grounds.

Jacob Lewis of California told investigators he was never told that he could not enter the Capitol, and that he was “escorted” by police into the building. When reached by ABC News, Lewis said he would be releasing video footage to “back up his story.” He declined to share the video with ABC News. Lewis was indicted on four misdemeanor charges, including disorderly and disruptive conduct in a restricted building.

Even as scrutiny of Capitol police continues to build, experts say it is unlikely such a defense will work in most situations.

“In general, ignorance of the law is not an excuse for criminal behavior,” said Taryn Merkl, senior counsel in the Justice Program at the Brennan Center for Justice and a former federal prosecutor in the Eastern District of New York.

Many accused rioters also face multiple charges for crimes they allegedly committed once inside the building, which experts say would render their claims of legal entry meaningless.

“Whether or not people knew that it was not lawful to enter the grounds as they did, many are charged with parading, demonstrating, or picketing — and that is prohibited, and no intent is required,” Merkl said.

Brandon Fellows, for example, told investigators he did not think he was going to get in trouble because the police officers seemed to be “on our side,” but he was later seen with his feet up on the desk of Sen. Jeff Merkley, D-Ore.

“Even if the officer had permitted him in the rotunda area or somewhere that might conceivably be a public space, anybody knows that breaking into a private senatorial office is wrongful, and would obstruct the administration of government,” Merkl said.

U.C. Berkeley law professor Charles Weisselberg, a former public defender, said the defense might help those charged with crimes where intent is required.

“If someone believes that they are allowed to do something, it might negate the intent that’s otherwise required to convict,” Weisselberg told ABC News. “Whether it is successful or not depends on the facts, what they heard, saw, and believed, but I could see that being presented.”

Merkl, however, noted that the majority of the rioters are charged under specific statutes that apply to the protection of the Capitol, for which prosecutors don’t have to prove intent on the part of the accused.

Dimitry Shakhnevich, a criminal defense attorney and adjunct assistant professor at John Jay College of Criminal Justice, also said that defense wouldn’t work.

“If I leave my door open to my house, you can’t bolt in, even though I left the door open,” Shakhnevich said. “It’s still trespassing … and making the argument that I impliedly consented to access by leaving my door open is silly.”

Still, claims by those who say they were unaware they were committing illegal acts could sharpen the distinction between Trump supporters who may have gotten swept up in the moment and hardened extremists who went to the Capitol with plans to commit violence. An ABC News analysis of court records, military records, interviews and available news reports found that at least 19 of those arrested have associations or possible ties to extremist groups, including the Proud Boys, Oath Keepers and Three Percenters. Numerous individuals associated with those groups have since been charged with conspiracy.

And while some accused rioters say they believed law enforcement allowed them to enter, others are saying they believed they were acting under direct orders from then-President Donald Trump, who told his supporters at the rally before the attack that they should “fight like hell” and that he would be joining them on their march to the Capitol.

An ABC News analysis found at least a dozen rioters have mounted such a defense, a point that was raised multiple times by Democrats as they sought last week to convict Trump on charges that he directly incited the mob.

Weisselberg said that authorities prosecuting accused rioters will likely dispute such claims by pointing directly to what the rioters observed upon arriving at the Capitol.

“You’re looking at the location where they entered, you’re looking at the time that they entered, you’re looking to see whether it would have appeared that that they were entering a restricted space,” Weisselberg said. “The prosecution might counter with other facts, arguing that for a person who came up to the building at this particular location, they actually couldn’t have believed that they were entitled to enter because they saw broken glass, damage, and other things that should have been apparent to this person entering at that particular point in time.”

The claims, whether successful or not, bring a renewed focus on the conduct of police that day. In the aftermath of the attack, officials began questioning why law enforcement was not better prepared, and numerous investigations have been opened in the weeks since.

Earlier this week, Speaker of the House Nancy Pelosi announced that Congress would create an outside commission to investigate the riot, including “the preparedness and response of the United States Capitol Police and other Federal, State, and local law enforcement in the National Capitol Region.”

The Senate is scheduled to hold its first hearing into the security preparations leading up to Jan. 6 next week, and has called current and former officials responsible for securing the U.S. Capitol building to testify.

Bryce Lowry Caldwell, an attorney for one of the alleged rioters, told ABC News they were “looking into” the actions of the Capitol Police as a possible defense.

“Numerous individuals have been charged for being on a piece of property when they shouldn’t be,” he told ABC News. “If someone let them on … that’s an issue.”

Caldwell’s client, Jordan Revlett, had posted on Snapchat that “a capitol police officer opened the door from inside to let us in,” according to the FBI affidavit. Revlett also told investigators he “did not see any signs that would have restricted his entry” and that “a police officer was standing behind the door he entered, who did not try to stop his entry.”

“There’s several other defendants who said the same,” Caldwell told ABC News. “I would feel safe to say that’s an issue the Department of Justice would be looking into.”

When asked for comment, a DOJ official referred ABC News to its previous statements that “any individuals who intentionally committed a crime that day will be charged.”

Investigations have since been opened into the actions of 35 Capitol Police officers, a congressional official told ABC News, and at least two officers have been suspended, according to Rep. Tim Ryan, D-Ohio.

Other officers have been honored for their heroism in protecting the Capitol during the attack, which left five dead, including a Capitol Police officer, and injured dozens of officers.

Capitol police did not respond to ABC News’ request for comment.

“I certainly believe that the Capitol Police role in this should be fully investigated, whether it’s by prosecutors or by the House Oversight Committee,” said Merkl, the former federal prosecutor. “There needs to be a review of what the Capitol Police role, if any, was in facilitating this or aiding and abetting it.”

Nevertheless, Merkl said, “the actions of the government aren’t on trial in a criminal case. What’s on trial is the action of the defendant.”

Copyright © 2021, ABC Audio. All rights reserved.

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What role did the retired FBI agents play in Capitol riot?


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What role did the retired FBI agents play in Capitol riot? – GS

Oath Keepers – GS

Retired FBI agents and Oath Keepers – GS

Society of Former Special Agents of the FBI and Oath Keepers – GS

_______________________

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More Oath Keepers on Capitol riot charges | The Canberra Times


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Oath Keepers boss quoted Trump before Capitol riot


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    Categories
    Michael Novakhov - SharedNewsLinks℠

    Why do COVID death rates seem to be falling?


    Michael_Novakhov
    shared this story
    from Nature – Issue – nature.com science feeds.

    Many regions of the world have experienced the pandemic in punishing waves, but Chennai in India endured a six-month flood, according to Bharath Kumar Tirupakuzhi Vijayaraghavan. The Apollo Main Hospital, where Vijayaraghavan works as an intensive-care specialist, was never overwhelmed, but it was relentlessly busy. And although the numbers of people with COVID-19 finally began to fall in mid-October, Vijayaraghavan worries about the possible impact of the festival season, which began on 20 October, and the public’s waning compliance with health measures. “Everybody is exhausted,” he says. “It’s become a never-ending health-care problem.”

    One shining light that he can point to is his intensive-care unit’s dwindling fatality rate. In April, up to 35% of those in the unit with COVID-19 perished, and about 70% of those on ventilators died. Now, the intensive-care mortality rate for people with the illness is down to 30%, and for those on ventilators it is around 45–50%. “This itself was a relief,” says Vijayaraghavan.

    Around the world, similar stories are emerging. Charlotte Summers, an intensive-care physician at the University of Cambridge, UK, says that data collected by the country’s National Health Service (NHS) show a decline in death rates1 (see ‘Mortality falls’). Critical-care physician Derek Angus at the University of Pittsburgh in Pennsylvania says that his hospital’s statistics team also saw reductions over time. “Without question, we’ve noticed a drop in mortality,” says Angus. “All things being equal, patients have a better chance of getting out alive.”

    The reasons are not entirely obvious. There have been no miracle drugs, no new technologies and no great advances in treatment strategies for the disease that has infected more than 50 million and killed more than 1.2 million around the world. Shifts in the demographics of those being treated might have contributed to perceived boosts in survival. And at many hospitals, it seems clear that physicians are getting incrementally better at treating COVID-19 — particularly as health-care systems become less overwhelmed. Still, those gains could be erased by increasing case loads around the world.

    Vijayaraghavan credits the improvements in mortality at his institution to hard-earned experience, a better understanding of how to use steroids and a shift away from unproven drugs and procedures.

    Marcus Schultz, an intensive-care specialist at Amsterdam University Medical Center in the Netherlands, agrees, adding that it took time to realize that standard treatments were among the most effective. “In just half a year, I think we repeated 20 years of research in acute respiratory distress,” he says. “Everything was done again, and everything came with the same result.”

    Crunching the numbers

    Researchers have struggled to work out whether the COVID-19 death rates are truly dropping. The calculations can be complex. Case-fatality rates depend on testing: a country that tests only people with severe symptoms, for example, will have an outsized case-fatality rate compared with one in which asymptomatic testing is widespread. And fatality rates in intensive-care units can mislead if the demographics of the people admitted change over time. For example, many hospitals reported high numbers of younger patients as the pandemic wore on.

    The detailed data that are needed to parse these differences have been hard to come by in many countries, and that frustrates Andrew Levin, an economist at Dartmouth College in Hanover, New Hampshire. “We still don’t have the data that scientists and public-health officials should have,” he says.

    As a result, it has taken researchers some time to determine whether the number of deaths per SARS-CoV-2 infection is really falling, particularly for older people, says epidemiologist Ali Mokdad at the University of Washington in Seattle. Mokdad and his colleagues have been monitoring global data, with a focus on the United States and Europe. A provisional analysis, he says, which includes data from the American Hospital Association, now suggests that the number of fatalities per infection might have fallen by 20%.

    Intensive-care physicians say that treatment has improved, but not always in ways that are easy to pinpoint. Vijayaraghavan and others credit a shift in mindset. In the early days of the pandemic, COVID-19 was viewed as something frightening and new — and worthy of resorting to unproven interventions in a desperate act to save patients. “Unfortunately, a lot of the initial discourse was complicated by noise about how this disease was entirely different or entirely new,” says Vijayaraghavan. “This distraction caused more harm — we were all probably poised to go off track.”

    Summers points to the furore around hydroxychloroquine, a malaria drug that some initial studies suggested might help to treat COVID-19. The possibility set off a run on the drug, with some physicians and politicians advocating its use without strong evidence that it was effective. In June, a large study in the United Kingdom2 showed that the drug did not benefit people hospitalized with COVID-19. Meanwhile, that study and others suggested that hydroxychloroquine could be harming some patients, in particular by causing heart damage, and especially when combined with the antibiotic azithromycin3. Hundreds of hydroxychloroquine clinical trials were launched, wasting resources and effort that could have been directed elsewhere, says Summers. “In terms of hospitalized patients, hydroxychloroquine is dead,” says Summers. “That’s one less thing for us to worry about.”

    Chasing miracles

    Intensive-care physicians point to early concerns about the increased production of proteins called cytokines that can rev up immune responses in some people with severe COVID-19. This phenomenon, known as a ‘cytokine storm’, stimulated interest in using targeted therapies to dampen immune responses. Vijayaraghavan says that this prompted some physicians in India to treat COVID-19 with tocilizumab, an antibody that blocks the activity of the cytokine interleukin-6 (IL-6). But, he says, the treatment might have made patients more susceptible to other infections, a particular risk in regions where drug-resistant bacteria are common.

    Since then, additional studies have shown that, although IL-6 levels are raised in some people with severe COVID-19 compared with healthy individuals or those with mild infections, they are not elevated when compared with others with acute respiratory distress4. Researchers have been looking — without success — at targeted ways to dampen immune responses in critically ill people for decades, says Angus. “And we have 20 to 30 years of failing to improve outcome with therapies that try to block the cytokine cascade.”

    Some studies have borne out Angus’s pessimism. A test of another IL-6-blocking antibody called sarilumab in the United States was halted because it showed no benefit, and a study of tocilizumab also found no effect on COVID-19 death rates5. A large, randomized, controlled clinical trial of tocilizumab taking place in the United Kingdom should have a result before the end of December, says Summers.

    In contrast to more-targeted drugs, blanket suppression of the immune system using steroids has been shown to cut death rates when used to treat severe COVID-19. On 16 June, the UK RECOVERY trial found that a common steroid called dexamethasone could reduce COVID-19 fatalities by as much as one-third when administered to patients who require supplemental oxygen or are on ventilators6. (However, Summers cautions that dexamethasone treatment has not been shown to carry a benefit for people with mild COVID-19 who do not need oxygen support, possibly because it weakens defences against the virus itself.)

    Some intensive-care physicians were already giving low doses of dexamethasone to critically ill patients as part of their standard treatment for acute respiratory distress, but the safety of that approach was debated. The RECOVERY trial results encouraged more to use the drugs, and the doses were low enough that infections did not increase, says Vijayaraghavan.

    Thus far, steroids are the only medicine that has been shown to have a dramatic effect on COVID-19 mortality. “Anyone who’s very sick should get steroids,” says Angus. “And everything else is a crapshoot.”

    The antiviral drug remdesivir, developed by the biopharmaceutical company Gilead Sciences in Foster City, California, has been shown by a US National Institutes of Health study to shorten hospital stays7. A subsequent trial coordinated by the World Health Organization found that the drug had little, if any, effect on mortality, but the US Food and Drug Administration nevertheless approved it for treating COVID-19 on 22 October.

    Hundreds of other therapies are being tested against COVID-19, but many of the ongoing trials are too small to yield convincing results soon. Among the furthest along are studies of antibodies against SARS-CoV-2 — either purified antibodies administered individually or in cocktails, or antibody-rich blood plasma taken from people recovering from the disease.

    Convalescent plasma studies have been hampered in the United States by the widespread availability of the treatment outside clinical trials, but the UK RECOVERY trial hopes to have data on this approach from a large, randomized, controlled trial this year. Meanwhile, a 464-person, open-label study in India found that convalescent plasma did not prevent moderate COVID-19 from progressing to severe disease or reduce deaths8.

    Tests of purified antibodies are also under way — such as those assessing the mixture of two antibodies produced by the biotechnology firm Regeneron Pharmaceuticals in Tarrytown, New York, that was administered to US President Donald Trump. These mainly target people who have mild COVID-19 symptoms. Despite Trump’s claims that the treatment was a “cure”, large trials of the cocktail have not yet been completed, and there is no evidence that it has an impact on death rates from COVID-19.

    Some studies in people with mild disease have shown that treatment with these antibodies can reduce hospitalizations. However, in October, the US National Institutes of Health halted a trial of an antibody produced by the pharmaceutical company Eli Lilly in Indianapolis, Indiana, in people hospitalized with COVID-19 after finding no benefit from the treatment. Regeneron has also stopped enrolment in a trial of its antibody cocktail for people with severe symptoms.

    Researchers are also looking to find out whether drugs that prevent blood clots — an unexpected hallmark of COVID-19 — could be given at higher doses or earlier during infection.

    Angus would like to see studies that test combinations of these treatments. He is an investigator for REMAP-CAP (Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired Pneumonia), a trial that spans more than 260 sites in 19 countries and is designed to allow treatments to be added or dropped. “For example, remdesivir might be better in the presence of steroids,” he says. “We need trials that simultaneously randomize several choices.”

    Back to basics

    Some intensive-care researchers are sceptical of the chances that a highly effective medicine will be found, citing decades of failed attempts to find a ‘magic bullet’ for acute respiratory distress. “Apart from a vaccine, I think the differences in outcome will be driven by things like other ways to supply oxygen or help patients in their gas exchange,” says Schultz.

    In the early days of the pandemic, physicians were alarmed by the rapid deterioration of some people with COVID-19, says Eddy Fan, an intensive-care physician at University Health Network in Toronto, Canada. “There were a lot of unknowns about the best way to manage this,” he says. “Because the patient could deteriorate very quickly, the thought was to put them on a ventilator and breathing tube quickly to prevent deterioration.”

    But, in retrospect, clinicians might have been overzealous at times. Schultz recalls asking patients to get off of their mobile phones so he could put them on a ventilator, but a candidate for a ventilator normally wouldn’t be well enough to hold a telephone conversation. As physicians became more comfortable treating people with COVID-19, many realized that early ventilation was not necessary, says Fan.

    Unfortunately, the public began to become concerned that ventilators themselves were causing harm, says Summers. Now, she says, families are upset when physicians recommend that their loved ones be put on a ventilator — even when there are no other suitable ways of providing oxygen. “The narrative you’ve heard is that ventilators kill people,” she says. “That’s been particularly unhelpful.” The NHS health-care centres with the lowest mortality rates during the pandemic used ventilators, but not too early. They followed standard protocols for when to use the devices, says Summers.

    Ultimately, Summers and others attribute possible drops in death rates more to shoring up standard health-care practices than to medical advances. “It’s the little subtle things,” says Angus.

    This might mean that keeping death rates low could hinge on measures to reduce transmission. In Singapore, where COVID-19 death rates are among the lowest in the world, intensive-care physician Jason Phua at Alexandra Hospital says the key to the country’s success has been suppressing transmission, so that hospitals were never overwhelmed. Early reports of mortality from Wuhan approached 97% for people with COVID-19 who were on ventilators, he says. In Singapore, mortality rates in intensive-care units have been less than 15%. “I don’t think it’s because we are using the correct drugs,” he says. “I think what’s happening is that the others are overwhelmed.”

    In response to the pandemic, many hospitals rapidly expanded their numbers of intensive-care beds, but that meant bringing in extra staff from other departments. Over time, those staff members have become more familiar with intensive care, learning to recognize the patterns that can signal when a patient is about to deteriorate. And hospitals have learnt to triage those who have risk factors for more severe disease, placing them under more careful observation.

    Ultimately, reducing the COVID-19 death rate by 10–20% would feel like a huge win in an intensive-care ward, says Levin. But that would still leave the number of deaths relatively high, particularly among older people, in whom the case-fatality rate approaches 30% for those more than 80 years old. Instead, he says, suppressing transmission is the best way to reduce COVID-19 deaths: “In the grand scheme of things, from a public-policy angle, we need to say, ‘Let’s make sure that people in their 70s and 80s don’t get infected.’”