Last fall, when RSV and flu came roaring back from a prolonged and erratic hiatus, and COVID was still killing thousands of Americans each week, many of the United States’ leading infectious-disease experts offered the nation a glimmer of hope. The overwhelm, they predicted, was probably temporary—viruses making up ground they’d lost during the worst of the pandemic. Next year would be better.

And so far, this year has been better. Some of the most prominent and best-tracked viruses, at least, are behaving less aberrantly than they did the previous autumn. Although neither RSV nor flu is shaping up to be particularly mild this year, says Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security, both appear to be behaving more within their normal bounds.

But infections are still nowhere near back to their pre-pandemic norm. They never will be again. Adding another disease—COVID—to winter’s repertoire has meant exactly that: adding another disease, and a pretty horrific one at that, to winter’s repertoire. “The probability that someone gets sick over the course of the winter is now increased,” Rivers told me, “because there is yet another germ to encounter.” The math is simple, even mind-numbingly obvious—a pathogenic n+1 that epidemiologists have seen coming since the pandemic’s earliest days. Now we’re living that reality, and its consequences. “What I’ve told family or friends is, ‘Odds are, people are going to get sick this year,’” Saskia Popescu, an epidemiologist at the University of Maryland School of Medicine, told me.

Even before the pandemic, winter was a dreaded slog—“the most challenging time for a hospital” in any given year, Popescu said. In typical years, flu hospitalizes an estimated 140,000 to 710,000 people in the United States alone; some years, RSV can add on some 200,000 more. “Our baseline has never been great,” Yvonne Maldonado, a pediatrician at Stanford, told me. “Tens of thousands of people die every year.” In “light” seasons, too, the pileup exacts a tax: In addition to weathering the influx of patients, health-care workers themselves fall sick, straining capacity as demand for care rises. And this time of year, on top of RSV, flu, and COVID, we also have to contend with a maelstrom of other airway viruses—among them, rhinoviruses, parainfluenza viruses, human metapneumovirus, and common-cold coronaviruses. (A small handful of bacteria can cause nasty respiratory illnesses too.) Illnesses not severe enough to land someone in the hospital could still leave them stuck at home for days or weeks on end, recovering or caring for sick kids—or shuffling back to work, still sick and probably contagious, because they can’t afford to take time off.

To toss any additional respiratory virus into that mess is burdensome; for that virus to be SARS-CoV-2 ups the ante all the more. “This is a more serious pathogen that is also more infectious,” Ajay Sethi, an epidemiologist at the University of Wisconsin at Madison, told me. This year, COVID-19 has so far killed some 80,000 Americans—a lighter toll than in the three years prior, but one that still dwarfs that of the worst flu seasons in the past decade. Globally, the only infectious killer that rivals it in annual-death count is tuberculosis. And last year, a CDC survey found that more than 3 percent of American adults were suffering from long COVID—millions of people in the United States alone.

[Read: Is COVID a common cold yet?]

With only a few years of data to go on, and COVID-data tracking now spotty at best, it’s hard to quantify just how much worse winters might be from now on. But experts told me they’re keeping an eye on some potentially concerning trends. We’re still rather early in the typical sickness season, but influenza-like illnesses, a catchall tracked by the CDC, have already been on an upward push for weeks. Rivers also pointed to CDC data that track trends in deaths caused by pneumonia, flu, and COVID-19. Even when SARS-CoV-2 has been at its most muted, Rivers said, more people have been dying—especially during the cooler months—than they were at the pre-pandemic baseline. The math of exposure is, again, simple: The more pathogens you encounter, the more likely you are to get sick.

A larger roster of microbes might also extend the portion of the year when people can expect to fall ill, Rivers told me. Before the pandemic, RSV and flu would usually start to bump up sometime in the fall, before peaking in the winter; if the past few years are any indication, COVID could now surge in the summer, shading into RSV’s autumn rise, before adding to flu’s winter burden, potentially dragging the misery out into spring. “Based on what I know right now, I am considering the season to be longer,” Rivers said.

With COVID still quite new, the exact specifics of respiratory-virus season will probably continue to change for a good while yet. The population, after all, is still racking up initial encounters with this new coronavirus, and with regularly administered vaccines. Bill Hanage, an epidemiologist at Harvard’s T. H. Chan School of Public Health, told me he suspects that, barring further gargantuan leaps in viral evolution, the disease will continue to slowly mellow out in severity as our collective defenses build; the virus may also pose less of a transmission risk as the period during which people are infectious contracts. But even if the dangers of COVID-19 are lilting toward an asymptote, experts still can’t say for sure where that asymptote might be relative to other diseases such as the flu—or how long it might take for the population to get there. And no matter how much this disease softens, it seems extraordinarily unlikely to ever disappear. For the foreseeable future, “pretty much all years going forward are going to be worse than what we’ve been used to before,” Hanage told me.

[Read: The next stage of COVID is starting now]

In one sense, this was always where we were going to end up. SARS-CoV-2 spread too quickly and too far to be quashed; it’s now here to stay. If the arithmetic of more pathogens is straightforward, our reaction to that addition could have been too: More disease risk means ratcheting up concern and response. But although a core contingent of Americans might still be more cautious than they were before the pandemic’s start—masking in public, testing before gathering, minding indoor air quality, avoiding others whenever they’re feeling sick—much of the country has readily returned to the pre-COVID mindset.

When I asked Hanage what precautions worthy of a respiratory disease with a death count roughly twice that of flu’s would look like, he rattled off a familiar list: better access to and uptake of vaccines and antivirals, with the vulnerable prioritized; improved surveillance systems to offer  people at high risk a better sense of local-transmission trends; improved access to tests and paid sick leave. Without those changes, excess disease and death will continue, and “we’re saying we’re going to absorb that into our daily lives,” he said.

And that is what is happening. This year, for the first time, millions of Americans have access to three lifesaving respiratory-virus vaccines, against flu, COVID, and RSV. Uptake for all three remains sleepy and halting; even the flu shot, the most established, is not performing above its pre-pandemic baseline. “We get used to people getting sick every year,” Maldonado told me. “We get used to things we could probably fix.” The years since COVID arrived set a horrific precedent of death and disease; after that, this season of n+1 sickness might feel like a reprieve. But compare it with a pre-COVID world, and it looks objectively worse. We’re heading toward a new baseline, but it will still have quite a bit in common with the old one: We’re likely to accept it, and all of its horrors, as a matter of course.

Does Nikki Haley really have a shot at beating Donald Trump? Does any Republican?

On Monday afternoon, a basketball gym in Bluffton, South Carolina, was packed with people who had come to hear Haley’s latest sales pitch. Hundreds more were waiting outside. No Republican candidate besides Trump can reliably draw more than a thousand attendees, but about 2,500 showed up for Haley. (Granted, this speech was in Haley’s home state, where she formerly served as governor. Also, the gym was a stone’s throw from the Sun City retirement community, a place where, gently speaking, people may have had nothing better to do at 2 p.m. on a Monday.) One of Haley’s volunteers told me this weekday event had originally been booked at a nearby restaurant, but that, given the current excitement of the campaign, organizers pivoted to the gym, on the University of South Carolina at Beaufort campus. Everyone in Haley’s orbit is understandably riveted. She’s squarely challenging Florida Governor Ron DeSantis for second place in the Republican presidential primary, no matter how second that place may be.

While the former president still floats high above his dwindling field of competitors, Haley is the only person who keeps rising in the polls. Her climb is steady, not a blip. Haley’s campaign and super PAC are planning to spend $10 million on advertisements over the next eight weeks across Iowa and New Hampshire. On Tuesday, she received an endorsement from the Koch brothers’ network, Americans for Prosperity Action, and along with it an undisclosed amount of financial support. (It will be a lot.) But this year-end, all-in effort to stop Trump ignores the fact that he is a singular vortex, a once-in-a-century figure, a living martyr with a traveling Grateful Dead–like roadshow. His abhorrent behavior and legal woes do not matter. Three weeks ago, at his rally in South Florida, vendors told me that items with Trump’s mug shot are their biggest sellers. How does a mere generational figure, as her supporters hope Haley might be, compete with that?

Haley bounded up onstage in a light-blue blazer and jeans. “We’ve been through a lot together,” she told the crowd. She meandered back and forth—no lectern, no teleprompter. When you ask people what they like about her, many point to her presence, her poise. Haley delivers her stump speech in a singsong voice. A few words, a pause, a smile. Speaking to the Low Country crowd, she seemed to be thickening her southern accent and peppering in a few extra-emphatic finger points for good measure. She’s just a down-home, neighborly southerner whose most recent job happened to be in Manhattan, serving at the United Nations. The volunteer who had bragged to me about the venue change later pulled out his phone and showed me a photo of himself and Haley at a wedding reception. He pointed to her bare feet. She’s so real, he said.

[Read: Nikki Haley offers an alternate reality]

Several women in the audience were wearing pink shirts with a Margaret Thatcher quote on the back: If you want something said, ask a man. If you want something done, ask a woman. Sue Ruby, a 74-year-old attendee from nearby Savannah, Georgia, was wearing a WOMEN FOR NIKKI button on her sweater. “I feel like we’ve given men a lot of years to straighten our society out, and they haven’t done so great, so let’s try a woman,” she said. Ruby told me she’s a Republican who begrudgingly voted for Hillary Clinton and Joe Biden in the past two elections because she viewed Trump as a threat to democracy. A Sun City resident named Lorraine, age 79, told me that “it’s time for a woman,” but that she would nevertheless vote for Trump if he wins the nomination. “I don’t want to vote for the opposite,” she said, refusing to say Biden’s name. Carolyn Ballard, an 80-year-old woman from Hilton Head, South Carolina, told me she’s a lifelong Republican who voted for Trump twice, but that she believes he’s past his prime and that Haley is her candidate. “He just irritates people and he stirs up a lot of trouble,” she said of Trump. “Although he’s very smart, and he did a lot for the country. I mean, everybody was happy when he was president.”

Haley doesn’t lean as hard into gender dynamics as past female presidential candidates have. Nevertheless, she skillfully uses her womanhood and Indian heritage as setups for certain lines. “I have been underestimated in everything I’ve ever done,” she told the room. “And it’s a blessing, because it makes me scrappy. No one’s going to outwork me in this race. No one’s going to outsmart me in this race.” Or this: “Strong girls become strong women, and strong women become strong leaders,” which had a surprise left turn: “And none of that happens if we have biological boys playing in girls’ sports.” (Huge applause.)

Courting Never Trump voters, exhausted Trump voters, and, yes, even some likely Trump voters simultaneously is not an easy trick. She hardly ever criticizes her former boss. Here’s her most biting critique from Monday: “I believe President Trump was the right president at the right time … and I agree with a lot of his policies. But the truth is, rightly or wrongly, chaos follows him.” (Note the passivity; she won’t even say Trump catalyzes the chaos.) Having already served as his ambassador to the UN, she may be under consideration for vice president. Compared with his attacks on Ron DeSantis, Trump has gone relatively soft on her, opting for the mid-century misogynistic slight “birdbrain.” Like most of her competitors, Haley has said she would pardon him.

Whereas Trump has tacked authoritarian and apocalyptic, Haley has mostly kept her messaging grounded. At the rally, she bemoaned the price of groceries and gas. “Biden worries more about sagebrush lizards than he does about Americans being able to afford their energy,” she quipped. (She also called out her fellow Republicans for adding to the deficit.) She’s a military wife, and spoke about her husband’s PTSD and the persistent problem of homeless veterans. Though she lacks Trump’s innate knack for zingers, she landed one about how things might change if members of Congress got their health care through the VA: “It’ll be the best health care you’ve ever seen, guaranteed.”

Although many of her fellow Republicans have adopted a nativist view of the world, Haley waxes at length about America’s geopolitical role. (And subsequently gets tagged as a globalist.) “The world is literally on fire,” she said Monday. She affirmed her support for both Israel and Ukraine, and went long on the triple threat of Russia, China, and Iran, paying particular attention to China as a national-security issue. In doing so, knowingly or not, she began to sound quite Trumpy. “They’re already here. They’ve already infiltrated our country,” Haley said. “We’ve got to start looking at China the way they look at us.” She called for an end to normal trade relations with China until they stop “murdering” Americans with fentanyl. She chastened the audience with images of China’s 500 nuclear warheads and its rapidly expanding naval fleet. “Dictators are actually very transparent. They tell us exactly what they’re going to do,” she said.

Perhaps Haley’s biggest advantage right now is her relative youth. She’ll turn 52 three days before the New Hampshire primary. Trump has lately been making old-man gaffes, drawing comparisons to Biden, who was first elected to the Senate the year Haley was born. She speaks wistfully of “tomorrow,” of leaving certain things—unspecified baggage—in the past. “You have to go with a new generational leader,” Haley proclaimed. Onstage, she endorsed congressional term limits and the idea of mental-competency tests for public servants older than 75. The Senate, she joked, had become “the most privileged nursing home in the country.” Throwing shade at both Trump and Biden, she spoke of the need for leaders at “the top of their game.” Hundreds of gray-and-white-haired supporters before her nodded and murmured in approval.

Monday’s event took place roughly 90 miles south of Charleston, where, in 2015, Dylann Roof murdered nine Black parishioners at Emanuel AME Church, hoping to start a race war. At the time, Haley was governor of South Carolina, and Trump—who had descended the golden escalator and announced his candidacy for president just the day before—still seemed like a carnival act. Photos of Roof posing with a Confederate flag ricocheted across social media. Haley had the flag taken down from the South Carolina statehouse, a reversal from her earlier position on the flag. Five years later, after the murder of George Floyd, Haley tweeted that, “in order to heal,” Floyd’s death “needs to be personal and painful for everyone.” During Monday’s rally, though, she sounded much more like an old-school Republican: “America’s not racist; we’re blessed,” she said. “Our kids need to love America. They need to be saying the Pledge of Allegiance when they start school.”

As her audience grows, she continues to tiptoe along a very fine line: not MAGA, not anti-MAGA. In lieu of Trump-style airbrushed fireworks and bald eagles and Lee Greenwood, she’s going for something slightly classier (leaving the stage to Tom Petty’s “American Girl”) while still seizing every opportunity to own the libs. At the rally, she attacked the military’s gender-pronoun training and received substantial applause. “We’ve got to end this national self-loathing that’s taken over our country,” she said. Early in her speech, she promised that she would speak hard truths. As she approached her conclusion, one hard truth stuck out: “Republicans have lost the last seven out of eight popular votes for president. That is nothing to be proud of. We should want to win the majority of Americans.” It was the closest thing to a truly forward-thinking message that any serious Republican has offered this cycle.

In the most generous of interpretations, the race for the GOP nomination is now among three people: Haley, DeSantis, and Trump. Mike Pence is already out. Tim Scott, Haley’s fellow South Carolinian, dropped out two weeks ago. Vivek Ramaswamy, who has struggled to break out of single digits in the polls, recently rented an apartment in Des Moines and will almost certainly stay in the race through the Iowa caucuses. Ramaswamy has also unexpectedly become Haley’s punching bag: Her campaign said she pulled in $1 million in donations after calling him “scum” during the last debate.

At next week’s debate in Alabama, the stage will likely be winnowed to Ramaswamy, Haley, and DeSantis. (“When the stage gets smaller, our chances get bigger,” Haley told her rally crowd.) DeSantis seems to be betting his whole campaign on Iowa, and has secured the endorsement of Iowa Governor Kim Reynolds. This weekend, DeSantis will complete his 99-county tour of the state. Haley needs to beat DeSantis, but she also needs his voters if she has any serious shot of taking on Trump. If DeSantis drops out before Haley, his supporters are far more likely to flock to Trump. So maybe Haley needs a deus ex machina. In 2020, Biden’s campaign was viewed as all but cooked when, here in South Carolina, with the help of Representative Jim Clyburn, everything turned around, propelling him to Super Tuesday and the nomination.

Haley’s campaign declined to let her speak with me. A spokesperson, Olivia Perez-Cubas, instead emailed me the following statement: “Poll after poll show Nikki Haley is the best challenger to Donald Trump and Joe Biden. That’s why the largest conservative grassroots coalition in the country just got behind her. Nikki is second in Iowa, New Hampshire, and South Carolina and is the only candidate with the momentum to go the distance. Ron DeSantis has a short shelf life with his Iowa-or-bust strategy.”

[David A. Graham: Nikki Haley is the new Ron DeSantis]

As rally-goers made their way to the parking lot, I struck up conversation with a man in a T-shirt that read NOPE NOT AGAIN, with Trump’s hair and giant red necktie decorating the O. He wore a camouflage baseball hat with an American flag on the dome. The man, Mike Stevens, told me he was a 25-year Army veteran, and that he was disgusted with Trump.

“He’s a bully. He’s not good. He causes hate and discontent,” Stevens said. “I mean, he didn’t uphold the Constitution. And now we’ve had a judge say that. First time ever—no peaceful transfer of power? Even Al Gore did it. I’ve always been a Republican, but if it’s him and Biden, I’ll vote for Biden, I guess.”

He was excited about Haley, and had been texting his friends and family about her rally—trying to wean them off their Trump addiction. But he also told me he had written Haley a letter: He was dismayed by her promise to pardon Trump, and he needed her to know that.