With David Lim and Rachel Roubein

PROGRAMMING NOTE: Morning Pulse will not publish on Thursday, Nov. 26 and Friday, Nov. 27. We'll be back on our normal schedule on Monday, Nov. 30.

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— The Thanksgiving holiday is set to test Americans’ collective will, as health experts warn travel over the next few days could seed an explosion of cases.

— President-elect Joe Biden is nearing a decision on his pick for health secretary, with the New Mexico governor and a former surgeon general at the top of his list.

— State governors are taking a range of approaches to combating the Covid-19 surge, in a patchwork response unlikely to suppress the virus.

WELCOME TO WEDNESDAY PULSE — where health expert Aaron Carroll has a succinct, straightforward answer to the thorny question of big holiday gatherings that’s worth watching ‘til the very end.

What’s the most creative alternative Thanksgiving plan you’ve seen? Send them and tips to [email protected] and [email protected].

THE THANKSGIVING PARADOX — The coming holiday is either a triumph of restraint or a coronavirus explosion waiting to happen, based on how you view the mix of available data and increasingly dire warnings.

— One conclusion: Many Americans are choosing to stay home. Travel through the nation's airports is down more than 50 percent compared to last year, according to the TSA, and a majority of Americans have told pollsters that they're not going to celebrate Thanksgiving beyond their immediate circle.

"[O]nly around 27 percent of Americans plan to dine with people outside their household," according to the New York Times' Upshot team, concluding that most Americans were following the advice of public health officials.

— The other conclusion: Too many Americans are still traveling. Since Friday, the TSA has screened nearly 1 million travelers per day, by far the highest daily average since the pandemic exploded in March, even as the virus is surging. Meanwhile, AAA predicted as many as 50 million Americans would still travel for Thanksgiving, which would be a mere 10 percent drop from last year's holiday.

And even the New York Times' conclusion — that "only" 27 percent of American adults plan to celebrate with people outside of their household — would translate to 70 million people expecting to mix with other circles this week, a huge number that could create multiple new clusters.

— ROBERT REDFIELD: Small gatherings are driving the viral spikes. CDC data suggests that the "public square" isn't fueling the nationwide surge of cases, the agency's director said on Fox News.

"Who would ever think rural North Dakota would be in the red zone?" Redfield said. "It's really being driven by household gatherings."

Redfield was responding to a New York Times story on Monday originally titled "Small Social Gatherings Aren’t Driving the Virus Surge (So Far)." That story questioned health officials' repeated assertions about small gatherings, although acknowledged that the data is still in flux.

BIDEN CLOSES IN ON HHS SECRETARY PICK — New Mexico Gov. Michelle Lujan Grisham and former Surgeon General Vivek Murthy are top contenders to be Biden’s health secretary, POLITICO’s Adam Cancryn and Alice Miranda Ollstein report.

The race pits a rising star governor against a widely respected doctor — with the two vying for the privilege to join the Cabinet at the highest-stakes moment for an HHS secretary in recent memory.

— The case for LUJAN GRISHAM: The nation’s first Latina governor has extensive management experience — having run New Mexico’s health agency and then the entire state — and knows how to navigate Washington, thanks to her three terms as a House lawmaker.

Lujan Grisham has also been among the most aggressive state leaders in combating the pandemic, and has plenty of allies; the Congressional Hispanic Caucus has spent recent weeks lobbying the Biden team to make her the first Latina HHS secretary.

— The case for MURTHY: The former surgeon general is close to Biden in an administration that puts a premium on pre-existing relationships, having served as his close health adviser for months.

A co-chair of Biden’s Covid-19 advisory board, Murthy has also overseen the transition’s pandemic planning for months, and is well-liked within the Democratic establishment and on Capitol Hill. His selection would also signal a recommitment to public health issues that have been overshadowed in recent administrations, leaving the nation susceptible to disasters like Covid-19.

CDC, HHS RAMP UP TESTING SURVEILLANCE EFFORTS — CDC and HHS are working to stand up a Strategic Surveillance Program to aggressively screen certain communities for Covid-19 on a weekly or bi-weekly basis, HHS testing czar Brett Giroir told reporters Tuesday. The goal is to see if the more aggressive testing can effectively curb new spread of the virus.

The administration is setting aside about 1.8 million rapid coronavirus tests made by Abbott and Cue Health for use in Colorado, North Dakota, Pennsylvania, Rhode Island, Utah, Veterans Affairs and certain tribes. HHS said the effort is not a new program, but instead represents an extension of other surge testing efforts to date.

“This is being done in conjunction with the CDC, who are helping us learn from all the lessons that we have and really test the hypothesis: Can serial testing of a large population with less of an emphasis on isolation after close contact really stop the outbreaks?” Giroir said.

The new resources and support began to roll out last week, but it is unclear what percentage of people living in the communities being studied will be tested.

“CDC is working with states to assist in the development of a strategic approach that includes repeated testing to identify possible outbreaks before they occur as well as robust reporting,” HHS spokesperson Mia Heck said.

HOW NINE GOVERNORS ARE HANDLING THE CORONAVIRUS SURGE — With Trump largely absent from leading the Covid-19 response, governors are again in charge — and they’re reacting with a patchwork policy that’s unlikely to head off the long-warned “dark winter” in America.

— What they’re not doing: Returning to the all-or-nothing approach of the pandemic’s earliest month, sparing a disease-weary public another round of lockdowns. POLITICO’s reporters took a look at how nine governors — from across the country and from across the political spectrum — are responding to what experts fear may become the deadliest coronavirus surge yet in the U.S.

— In Texas, Republican Gov. Greg Abbott has resisted calls to tighten capacity limits and shut down businesses, and he’s even tied the hands of local officials who are trying to curb the virus spread through renewed measures.

— In New York, Democratic Gov. Andrew Cuomo is using a “micro-cluster” strategy, an approach where the state implements restrictions in areas where Covid-19 is surging.

— And in South Dakota, Republican Gov. Kristi Noem has declined to implement a mask mandate, downplaying the virus and stopping short of even encouraging residents to wear masks. It's one of the more hands-off approaches in the nation, even as the state has one of the highest rates of cases per capita.

And speaking of South Dakota…

SANFORD CEO OUT AFTER ANTI-MASK EMAIL — Kelby Krabbenhoft is leaving Sanford Health just days after his controversial email to staff about coronavirus, which was quickly disavowed by other senior executives at the health system that serves South Dakota, North Dakota and Minnesota.

Krabbenhoft, who led the health giant for about 25 years, told employees last week that he didn't see the need to wear a mask because he'd already had Covid-19 and believed he had immunity, Jeremy Fugleberg writes for the Inforum.

"For me to wear a mask defies the efficacy and purpose of a mask and sends an untruthful message that I am susceptible to infection or could transmit it," Krabbenhoft wrote to staff last week. "I have no interest in using masks as a symbolic gesture when I consider that my actions in support of our family leave zero doubt as to my support of all 50,000 of you."

Sanford is based in South Dakota, which is grappling with a particularly bad Covid-19 outbreak and where the local battle over masks has attracted national attention. Sanford also is in the process of merging with Utah-based Intermountain Healthcare.

PROVIDER GROUPS: HERE's HOW TO ENSURE ESSENTIAL SURGERIES STILL GET DONE — The American Hospital Association, American College of Surgeons, American Society of Anesthesiologists and Association of periOperative Registered Nurses released revised guidance on how health facilities and workers can meet the needs surgeries during the pandemic. Among the considerations: pursue regional alliances to ensure local capacity, establish an in-hospital prioritization policy committee and address health care workers' well-being so they don't burn out.

"Now in their ninth month of stretching to treat growing numbers of COVID-19 patients, health care organizations, physicians and nurses must be able to meet the escalating demands for patients hospitalized with COVID-19 and those in need of essential surgical services," the groups said in a joint statement.

MORE OBAMACARE INSURERS EXCLUDED CARE FOR TRANS PATIENTS — That's according to a new analysis by Out2Enroll, which found that 7 percent of insurers in the 2021 plan year excluded treatments like hormone therapy, mental health services, and surgical procedures. That's a jump from 3 percent last year, which the group pinned on the Trump administration’s effort to roll back LGBTQ protections in the Affordable Care Act.

"While most insurers did the right thing, the analysis underscores why we need strong federal protections like what we had in the 2016 rule," said Katie Keith, a health lawyer who works with Out2Enroll. Biden has vowed to reverse Trump's rollback of the Obama-era protections.

In The New York Times, Ashish Jha points to a recent Senate hearing that focused on hydroxychloroquine as evidence of the disinformation campaigns that have hobbled the pandemic response.

"Because of COVID, we did not have a ground game," former HHS secretary and outgoing Florida Rep. Donna Shalala tells Slate's Mary Harris, reflecting on the recent election.

The pandemic is delaying the results of research studies that the VA needs to determine whether new health conditions should be added to a list of Agenda Orange-connected disease, Military.com’s Patricia Kime reports.