Call it a premonition or a traumatic flashback, but Ryan Cusick knew he would have to leave his country on July 24, 2024 -- the day Donald Trump secured the Republican nomination for president.

Cusick, 42, born and raised in Missouri, identifies as nonbinary and transmasculine. That day in July took him back to when he was a teenager. When Cusick was 14, he lived with his mother and an abusive stepfather. The stepfather eventually ended up in jail.

“When he got out, he walked back into our lives, and I had no say in it,” Cusick said. He left home at 17.

Last summer, he watched political attacks on the trans community ramp up. He feared Trump’s campaign promises to restrict trans rights even more.

“This felt so much like an abuser coming back,” Cusick said. “And I thought, ‘Never again will I sit back and let an abuser come back.’”

Still, it was an extremely painful decision to leave the U.S. He loved St. Louis and his life there. He had a remote job and a great apartment next to a park. He'd worked in medical records for a health care system for nearly a decade. He had found a supportive friend group and had been dating his partner for several years.

But he knew he could not feel safe under a Trump presidency. He worried that federal laws would override protections passed in any state.

So he set his sights on Mexico. In preparation for the move, Cusick used the site Numbeo.com to compare the cost of living, climate and public transit options in hundreds of cities in Mexico. He joined Facebook groups for expats and looked for a place where he could become part of the local community. He picked up daily lessons on Duolingo to supplement the Spanish he remembered from high school.

He wasn’t able to continue his job remotely from another country due to network security issues, so he saved a few paychecks and cashed out his remaining PTO. He hoped it would be enough to live on until he found another job.

He secured an Airbnb in the northern Mexican state of Durango to rent long-term. He packed a carry-on and a backpack.

Cusick boarded a plane to leave on Nov. 4 -- the day before the election. From Durango, he watched the returns come in with a growing sense of dread.

“It was like watching a car wreck that you know is going to happen,” he said.

The early actions of the administration have reaffirmed his decision to leave. On his first day back in the White House, Trump signed an executive order recognizing only two unchangeable sexes -- basically stating people like Cusick did not exist. About 1.6% of U.S. adults identify as transgender or nonbinary, according to a 2022 Pew Research Center survey. Information about transgender people has been removed from government websites. Requests for gender change markers on passports are now being denied. Transgender women are being moved into men’s prisons. Trump wants to remove transgender troops from the military.

“That kind of erasure will never be OK with me,” Cusick said.

He expects he can live frugally off his retirement savings for a couple of years, if needed, and he continues to look for remote work. While he’s befriended a neighbor and gotten to know local shop owners, starting a new life in a country where he knows no one is very difficult.

“At the end of the day, you are 1,500 miles from everyone you know and love,” he said. “It hits me every day.”

It hits hardest on the days when the president signs another anti-trans executive order: “I feel the loneliest when I can’t hug my friends and tell them they do exist, no matter what the government says.”

Mexico has granted him temporary residence to stay for four years. He hired an immigration facilitator to help with visa issues. He can work, access health care and eventually have his status made permanent, if he chooses.

He cried when he got his identification card. It represented safety.

“It was such an emotional day. It means a lot that Mexico is willing to be so open with their immigration practices,” Cusick said.

Still, he hopes that one day he can return home.

Dr. Maya Moody treats flu-infected children daily during one of the worst flu outbreaks in the past 15 years.

Most will recover with rest, plenty of fluids, and medications to treat their symptoms. But some are suffering serious complications from the flu.

“I have a very, very, very sick 4-year-old patient in the hospital,” she said. The young girl has been hospitalized for nearly a month -- at times on a ventilator -- with four tubes placed in her chest for drainage.

“She’s been in the pediatric ICU with recurrent secondary pneumonia to the point that it’s rotting her lungs,” Moody said. Moody is the immediate past president of the Missouri Chapter of the American Academy of Pediatrics and practices at Mercy Hospital in St. Louis. Her 4-year-old patient was not vaccinated for influenza because her parents wanted to spare her the pain of the needle prick.

“It breaks your heart because it could have been prevented,” Moody said.

Doctors say it’s not too late to get the vaccine to help prevent or lessen the severity of the flu, which has led to at least 310,000 hospitalizations and 13,000 deaths -- including at least 57 children -- so far this season.

Moody is seeing more patients with secondary bacterial infections after catching the influenza virus. They are coming back with a new fever, ear infection or pneumonia, she said.

“It’s not just influenza,” she said. “There’s still some RSV and a little bit of COVID sprinkled in there.”

In many states, including Missouri, flu numbers are still rising.

Dr. Steven Lawrence, an infectious disease specialist with Washington University School of Medicine, says there are a few possible reasons why flu cases are so high this season. During the first COVID year, with many people isolating at home, there was very little flu exposure. When there are years of fewer than normal flu cases, it can lower immunity on a population level. Additionally, in December, the CDC stated that fewer children had gotten the flu vaccine than the previous year -- in fact, it was the lowest rate in 12 years.

That combination of lower population immunity and lower vaccination rates may have contributed to the staggering spread this season.

Unfortunately, public trust in vaccines has been eroding in recent years. There’s an outbreak of measles in Texas right now, and whooping cough has made a comeback in Idaho. Idaho bears the distinction of being the first place a regional health district banned public clinics from giving people the COVID vaccine -- a vaccine that saved countless lives during the pandemic.

Speaking of COVID, one of the ways to protect yourself from the rampant flu virus is by wearing a mask when you have to be in an enclosed area indoors with other people.

Basic hygiene protocol still applies: Cover your mouth when you cough, wash your hands frequently, clean high-touch areas often, avoid touching your face, and wear a mask if you have symptoms.

Those who are at increased risk for complications, such as very young children and older adults, or those with underlying health conditions, need to prioritize getting vaccinated. Even when the number of cases starts to decline, doctors say they expect to see the flu continue to circulate for another month or so.

Most parents want to do whatever they can to keep their children safe. With all the conflicting information circulating about vaccines, it’s worthwhile to think about who you call when your child gets sick.

If you trust your pediatrician when you are worried about a child spiking a fever for days or experiencing prolonged pain or throwing up uncontrollably, then ask them whether they recommend getting the flu vaccine.

Then, take that advice.

Two years after Jack Dorsey and his buddies launched Twitter in 2006, I reluctantly joined the site.

We were encouraged to start tweeting by a former editor who saw the microblogging social media app as a way to reach new audiences. At first, it seemed odd to share fleeting thoughts and observations with strangers. But journalists, politicians and activists from around the world started showing up. They attracted more people who wanted to learn and share interesting things. It was a text-based site, so it drew the word nerds and news junkies.

These were my people.

I started spending big cultural moments -- sports championships, annual awards ceremonies and breaking news events -- with the Twitter community.

Logging into Twitter felt like stopping by a witty cocktail party. The site became the first thing I looked at in the morning to see what was trending and the last thing I looked at before going to bed. I discovered story ideas and found sources on it. Over the course of 16 years, posting on it became a daily habit -- even when the party wasn’t as entertaining anymore. Trolls and bots and propagandists infiltrated, and the rhetoric turned uglier.

In 2022, billionaire Elon Musk bought Twitter for $44 billion.

I worried that it was the beginning of the end for the one social media site that felt indispensable. I naively hoped Musk’s desire to protect his financial interests would prevent him from ruining the place. Dorsey even tweeted that Musk was the “singular solution I trust” to fix Twitter.

I was wrong, and so was Dorsey.

Musk’s decisions degraded the reliability of information on the site, and it became rampant with hate speech and far-right trolls. Still, I kept my account on his rebranded X. I had curated a list of 1,000 people I followed and had more than 25,000 followers -- not a massive platform, but a well-connected one.

But I started looking for a new place for online conversations.

The easiest way to break a bad habit is to replace it with a better one. When an open-source social media site, Bluesky, also started by Dorsey, began gaining traction, I decided to check it out. People there were posting about issues in a thoughtful way and sharing news links I wanted to read.

My interest in checking X dropped to glancing at it once a week or so. I felt less agitated first thing in the morning and slept better at night. I was finally implementing a change in my own life that I had preached to my children for all of theirs: Spend less time looking at screens and more time in the real world.

Dorsey left the board of Bluesky and described X as “freedom technology.”

It doesn’t look like freedom to support a king.

The past few weeks have changed the way I view participation on X.

Musk, the world’s richest man and a private citizen, has amassed an unprecedented amount of power in the federal government. None of us ever voted for Musk, who grew up in a wealthy family in apartheid South Africa, for any elected office. But he’s now acting as America’s co-president, with access to all our information in the U.S. Treasury and the ability to shut down congressionally appropriated programs like USAID, scrub government websites of public data and dismiss civil servants without cause.

Musk, a “special government employee” who could become the world’s first trillionaire by 2027, directly benefits from billions in contracts with the U.S. government. (Those contracts are paid by our tax dollars.)

Musk wanted Twitter for its ability to influence. He’s gotten more than his money’s worth.

I finally requested and downloaded an archive of my data from X. I’m using Cyd, a free desktop app, to delete more than 26,000 old tweets. I’ve made my account private. I might occasionally retweet posts that I think should be amplified, but I have no desire to post on the site of a billionaire who is tearing apart our country and its Constitution while growing his fortune with our tax dollars.

For nearly 17 years, I created free content for a company whose owners have made billions from our personal information, thoughts and analysis.

Leaving it behind was easier than I expected.