The Washington Post National Weekly. April 26, 2020

SUNDAY, APRIL 26, 2020

. IN COLLABORATION WITH

ABCDE National Weekly

the coronavirus pandemic

Amid uncertainty

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poll

Public perceptions of pandemic BY

S COTT C LEMENT AND D AN B ALZ

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ost Americans expect no immediate easing of the health risks associated with the coronavirus pandemic, despite calls by President Trump and others to begin reopening the economy quickly. A majority say it could be June or later before it will be safe for larger gatherings to take place again, according to a Washington Post-University of Maryland poll.

Most Americans — 54 percent — give the president negative marks for his handling of the outbreak in this country and offer mixed reviews for the federal government as a whole.

By contrast, 72 percent of Americans give positive ratings to the governors of their states for the way they have dealt with the crisis, with workers also rating their employers positively.

Personal health concerns are widespread, with 57 percent saying they are “very” or “somewhat” worried about becoming infected and seriously ill from the coronavirus, including at least 40 percent of people in every major demographic and political group. For those most concerned — particularly Republicans — the fear is enough to override partisanship when it comes to the safety of public gatherings.

Disruptions caused by the coronavirus outbreak continue to ripple through households across the nation, with businesses and schools closed and most Americans being urged to stay at home. About 7 in 10 adults, and more women than men, say the pandemic has been a source of stress in their lives. Half of all adults say the crisis has produced financial hardship for themselves or members of their family.

Those results are almost identical to findings from a Post-ABC News survey a month ago and a more recent CNN poll that focused on financial hardship.

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Chris Graythen/Agence France-Presse/Getty Images

A painting by the graffiti artist Bandit titled “Our Nurses, Our Saints” is seen on a wall in New Orleans this month, to honor some of the workers on the front lines of the crisis.

The latest Post-U. Md. poll finds that about 1 in 3 Americans are concerned about their household being able to pay bills over the next month, while a similar percentage are worried about affording food and basic household items. Some 48 percent of Hispanics are concerned about affording food or other basic items, as are 39 percent of blacks and 23 percent of whites.

“I found those numbers alarming,” said Michael Hanmer, a professor of government and politics at the University of Maryland who co-directed the survey. “There’s a big gap between whites and nonwhites for financial hardship and particularly when you get into paying the bills.”

The nationwide survey was conducted during a week when demonstrators in multiple states protested stay-at-home orders and re-

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strictions on business activity, and were encouraged by Trump’s tweets to “LIBERATE” Minnesota, Michigan and Virginia, where demonstrations were held.

Yet in contrast to that overt pressure to reopen the country, the poll finds that a clear majority of Americans expect that social distancing practices will be necessary until at least the beginning of the summer.

Asked when they expect the outbreak to be controlled enough that people can safely attend gatherings of 10 or more people, just 10 percent predict that such gatherings will be safe by the end of April or earlier, while 21 percent expect them to be safe by the end of May. More than twice as many — 65 percent — say it may take until the end of June or later for people to safely gather in groups of 10 or more.

Partisans divide on this question, with 77 percent of Democrats and Democratic-leaning independents saying they expect that public gatherings won’t be safe until the end of June or later, compared with 51 percent of Republicans and Republican leaners who say the same.

Americans are also pessimistic about how quickly the economy will recover after the outbreak is under control. A 63 percent majority expect that the economy will recover slowly, while 37 percent think it will bounce back quickly.

The poll was conducted by The Washington Post and the University of Maryland’s Center for Democracy and Civic Engagement. Interviews were conducted April 14-19 among a random national sample of 1,013 adults, 69 percent of whom were reached on cellphones and 31 percent on landlines. Overall results have a margin of sampling error of plus or minus 3.5 percentage points. n

Contents The coronavirus 4 Books 18 Opinion 20 Five Myths 23

On the cover A patient sits in consultation with health-care workers before being tested for covid-19 in Cape Town, South Africa, on April 7. Photo by BARRY CHRISTIANSON for Agence FrancePress via Getty Images

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The coronavirus pandemic

The money behind the protests

BY I SAAC S TANLEY- B ECKER AND T ONY R OMM

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he ads on Facebook sounded populist and passionate: “The people are rising up against these insane shutdowns,” they said. “We’re fighting back to demand that our elected officials reopen America.”

But the posts, funded by an initiative called “Convention of States,” were not the product of a grass-roots uprising alone. Instead, they represented one salvo in a wide-ranging and well-financed conservative campaign to undermine restrictions that medical experts say are necessary to contain the coronavirus — but that protesters call overkill and whose economic fallout could damage President Trump’s political prospects.

A network of right-leaning individuals and groups, aided by nimble online outfits, has helped incubate the fervor erupting in state capitals across the country.

The activism is often organic and the frustration deeply felt, but it is also being amplified, and in some cases coordinated, by longtime conservative activists, whose robust operations were initially set up with help from Republican megadonors.

The Convention of States project launched in 2015 with a highdollar donation from the family foundation of Robert Mercer, a billionaire hedge fund manager and Republican patron. It boasts past support from two members of the Trump administration — Ken Cuccinelli, acting director of U.S. Citizenship and Immigration Services, and Ben Carson, secretary of housing and urban development.

It also trumpets a prior endorsement from Ron DeSantis, the Republican governor of Florida and a close Trump ally who is pursuing an aggressive plan to reopen his state’s economy. Cuccinelli, Carson and DeSantis did not respond to requests for comment.

The initiative, aimed at curtailing federal power, is now leverag-

Stefani Reynolds/Getty Images

Right-wing activists, GOP megadonors help fuel anti-quarantine fervor ing its sweeping national network and digital arsenal to help stitch together scattered demonstrations across the country, making opposition to stay-at-home orders appear more widespread than is suggested by polling.

“We’re providing a digital platform for people to plan and communicate about what they’re doing,” said Eric O’Keefe, board president of Citizens for Self-Governance, the parent organization of the Convention of States project.

A longtime associate of the conservative activist Koch family, O’Keefe helped manage David Koch’s 1980 bid for the White House when he served as the No. 2 on the Libertarian ticket.

“To shut down our rural coun-

ties because of what’s going on in New York City, or in some sense Milwaukee, is draconian,” said O’Keefe, who lives in Wisconsin.

Polls suggest most Americans support local directives encouraging them to stay at home as covid-19, the disease caused by the new coronavirus, ravages the country, killing more than 44,000 people in the United States so far.

Public health officials, including epidemiologists advising Trump’s White House, agree that sweeping restrictions represent the most effective mitigation strategy in the absence of a vaccine, which could be more than a year away.

Still, some activists insist that states should lift controls on commercial activity and public assembly, citing the effects of mass

Demonstrators in Albany, N.Y., on Wednesday call for Gov. Andrew Cuomo to reopen the state.

Similar rallies also took place in other state capitals over the past week in response to restrictions.

closures on businesses. They have been encouraged at times by Trump, whose attorney general, William P. Barr, said in an interview with radio host Hugh Hewitt on Tuesday that the Justice Department would consider supporting lawsuits against restrictions that go “too far.”

Further afield, the protests have been encouraged by some of the president’s allies outside the White House, including Stephen Moore, once considered for a top post at the Federal Reserve.

The swelling frustration on the right coincides with major policy changes in some states, especially those with Republican governors.

Georgia, South Carolina and Tennessee have all begun relaxing their restrictions in recent days

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The coronavirus pandemic after bowing to pressure and imposing far-reaching guidelines.

The protests are reminiscent in some ways of the tea party movement and the demonstrations against the Affordable Care Act that erupted in 2010, which also involved a mix of homegrown activism and shrewd behind-thescenes funding.

For the Convention of States, public health is an unusual focus.

It was founded to push for a convention that would add a balanced-budget amendment to the Constitution. That same anti-government impulse is now animating the group’s campaign against coronavirus precautions.

“Heavy-handed government orders that interfere with our most basic liberties will do more harm than good,” read its Facebook ads, which had been viewed as many as 36,000 times as of Tuesday evening.

Asking for a $5 donation “to support our fight,” the paid posts are part of an online blitz called “Open the States,” which also includes newly created websites, a data-collecting petition and an ominous video about the economic effects of the lockdown.

The group’s president, Mark Meckler, said his aim was to act as a “clearinghouse where these guys can all find each other” — a role he learned as co-founder of the Tea Party Patriots. FreedomWorks, a libertarian advocacy group also active in the tea party movement, is seeking to play a similar function, creating an online calendar of protests.

“The major need back in 2009 was no different than it is today — some easy centralizing point to list events, to allow people to communicate with each other,” he said.

Meckler, who draws a salary of about $250,000 from the Convention of States parent group, a tax-exempt nonprofit organization, according to filings with the Internal Revenue Service, hailed the “spontaneous citizen groups self-organizing on the Internet and protesting what they perceive to be government overreach.”

So far, the protests against stay-at-home orders in states including Washington and Pennsylvania have captured headlines and drawn rebukes from some governors and epidemiologists.

Experts say a sudden, widespread

Nicholas Kamm/Agence france-presse/Getty Images

Josh Edelson/Agence france-presse/Getty Images

Demonstrators in Harrisburg, Pa., top, and Sacramento protest stay-at-home orders. The activism is often organic and the frustration deeply felt, but it is also being amplified and coordinated by longtime conservative activists whose robust operations were initially set up with help from Republican megadonors.

reopening of the country is likely to worsen the outbreak, overwhelming hospitals and killing tens of thousands.

Trump’s public comments — including his recent tweets calling for supporters to “liberate” states including Michigan, a coronavirus hot spot — have catalyzed some of the broader public reaction. Following those tweets, tens of thousands of people joined Facebook groups calling for protests in states including Pennsylvania and Ohio, where the efforts are coordinated by a trio of brothers who typically focus their efforts on fighting gun control.

In recent days, conservatives have set their sights on Wisconsin, where a few dozen protesters turned out at the Capitol to air their frustrations with Gov. Tony Evers, a Democrat, after he extended his state’s stay-at-home order until late May. Ahead of the demonstration, Moore, the Trump ally, revealed on a live stream that he was “working with a group” in the state with the goal of trying “to shut down the capital.”

Moore, who served as a Trump campaign adviser in 2016, said he had located a big donor to aid in the effort, though he never elaborated. “I told him about this, and he said, ‘Steve, I promise to pay the bail and legal fees for anyone who gets arrested,’ ” Moore said in the video. He likened his quest to the civil rights movement, adding, “We need to be the Rosa Parks here and protest against these government injustices.”

Moore, who has also worked at the right-leaning Heritage Foundation, did not respond to a request for comment.

In Michigan, among those organizing “Operation Gridlock” was Meshawn Maddock, who sits on the Trump campaign’s advisory board and is a prominent figure in the “Women for Trump” coalition. Funds to promote the demonstrations on Facebook came from the Michigan Freedom Fund, which is headed by Greg McNeilly, a longtime adviser to the family of Education Secretary Betsy DeVos. McNeilly said the money used to advance the anti-quarantine protests came from “grass-roots fundraising efforts” and had “nothing to do with any DeVos work.”

Many of the seemingly scattered, spontaneous outbursts of citizen activism reflect deeply interwoven networks of conservative and libertarian nonprofit organizations. One of the most vocal groups opposing the lockdown in Texas is an Austin-based conservative think tank called the Texas Public Policy Foundation, which also hails the demonstrations nationwide.

“Some Americans are angry,” its director wrote in an op-ed promoted on Facebook and placed in the local media, telling readers in Texas about the achievements of protesters in Michigan.

The board vice chairman of the Texas Public Policy Foundation, oil executive Tim Dunn, is also a founding board member of the group promoting the Convention of States initiative. And the foundation’s former president, Brooke Rollins, now works as an assistant to Trump in the Office of American Innovation.

Neither Dunn nor Rollins responded to requests for comment.

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The John Hancock Committee for the States — the name used in IRS filings by the group behind the Convention of States — gave more than $100,000 to the Texas Public Policy Foundation in 2011.

The Convention of States project, meanwhile, has received backing from DonorsTrust, a taxexempt financial conduit for right-wing causes that does not disclose its contributors. The same fund has helped bankroll the Idaho Freedom Foundation, which is encouraging protests of a stay-at-home order imposed by the state’s Republican governor, Brad Little.

In 2014, the year before it launched the Convention of States initiative, Citizens for SelfGovernance received $500,000 from the Mercer Family Foundation, a donation Meckler said helped jump-start the campaign.

Mercer declined to comment.

While groups and individual activists associated with the Koch brothers have boosted this farflung network, Emily Seidel, the chief executive of the Kochbacked Americans for Prosperity advocacy group, sought to distance the organization from the protest activity, which she said was “not the best way” to “get people back to work.”

“Instead, we are working directly with policymakers, to bring business leaders and public health officials together to help develop standards to safely reopen the economy without jeopardizing public health,” Seidel said.

But others see linkages to groups pushing anti-quarantine uprisings.

“The involvement of the Koch institutional apparatus in groups supporting these protests is clear to me,” said Robert J. Brulle, a sociologist at Drexel University whose research has focused on climate lobbying. “The presence of allies on the board usually means that they are deeply engaged in the organization and most likely a funder.”

Brulle said the blowback against the coronavirus precautions carries echoes of efforts to deny climate change, both of which rely on hostility toward government action.

“These are extreme right-wing efforts to delegitimize government,” he said. “It’s an anti-government crusade.” n

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The coronavirus pandemic

Masks are the latest national divide

BY M ARC F ISHER, C LARENCE W ILLIAMS AND L ORI R OZSA

real threat to them — despite what Trump has said — may further tip the balance against masks.”

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evin Krannawitter won’t wear a mask because he just doesn’t think it’s necessary, whatever the scientists say. Marilyn Singleton won’t wear one either — and she’s a physician — because she says it’s un-American for the government to force people to cover their faces. You won’t see Ricardo Thornton in a mask because it reminds him of a time when he wasn’t free to make his own decisions about his life.

Even as governors, mayors and the federal government urge or require Americans to wear masks in stores, transit systems and other public spaces to contain the spread of the novel coronavirus, the nation is divided about whether to comply. And it is divided in painfully familiar ways — by politics and by attitudes about government power and individual choice.

Almost overnight, masks have become common in some places, even as they are still rare in others.

Laredo, Tex., a small border city, last month became one of the first in the nation to threaten steep fines — up to $1,000 — for residents who do not, as one city councilman put it, “keep their droplets to themselves” by wearing masks whenever they are outside.

The mayor, Pete Saenz, wears a surgical mask. His spokesman, Rafael Benavides, uses a homemade one that the city manager’s wife crafted for all municipal employees.

“Now it feels weird to see someone who isn’t wearing a mask,” said Lucy DeLeon, co-pastor of New Vision Community Church in Laredo. Eager to set an example, she and her co-pastor husband have formed mask-sewing brigades to outfit as many people as they can.

The mayor said he has fielded calls from people asking: “Where is the science behind us wearing a mask?”

Marvin Joseph/The Washington Post

Politics, history, culture and race factor into whether people choose to cover their faces “I told them I had to go with what the doctors are telling us,” Saenz said. “We are a small city, and we can be overwhelmed quickly.”

Saenz is a Democrat, as are most of the governors who have issued mask orders. President Trump announced a few weeks ago that the federal government now recommends wearing masks whenever people are outdoors and social distancing is difficult, but Trump said he will not wear one. “It’s going to be really a voluntary thing,” he said. “I’m choosing not to do it, but some people may want to do it and that’s okay.”

For Trump’s supporters, declining to wear a mask is a visible way to demonstrate “that ‘I’m a Republican,’ or ‘I want businesses to start up again,’ or ‘I support the president,’ ” said Robert Kahn, a law professor at the University of St. Thomas in Minneapolis who has studied Americans’ attitudes toward masks. “Masks will quickly become the new normal in blue

states, but if social distancing continues through 2022, the mentality among Republicans could well change, too: If I can go to work and the cost of marginal improvement in my life is wearing a mask, maybe Americans of both parties do accommodate ourselves to it.”

But the political divisions contributing to the split over maskwearing have proved to be persistent so far, and those who oppose covering their mouth and nose have comfortably fit that position into their existing worldview.

“Trump supporters, many of whom may live in less-populated red states, may currently know fewer people with covid, and may therefore minimize the threat,” said Robert Klitzman, a psychiatrist at Columbia University who specializes in bioethics. “They don’t want to wear masks — they may feel they are being imposed and are ‘un-American,’ perhaps something only people in the Far East do. The fact that wearing masks suggests that the virus is a

D.C. resident Ricardo Thornton, who spent 12 years in a mental institution, says that when he goes out for walks each evening, he will not wear a mask. “I got my freedom back, and I’m not giving it up.”

‘God has got this’ The men hanging out around the front stoop of King City Carryout in the Anacostia section of Washington, D.C., paid no mind to social-distancing rules. None wore a mask.

Marcus McNeely, 31, laid off from a warehouse job where he operated a forklift and stacked boxes, saw no call to wear protective gear.

“There’s a million diseases out here, and everybody is worried about this one,” said McNeely, who does not know anyone who has caught the virus.

Down the block, Terrance Griffin, 31, stood out in midday sunshine on a break from working at a corner store to talk to a friend.

Neither man wore a mask. Griffin said he entrusted his cares to a higher power.

“God has got this,” he said.

Griffin said he does not want to be treated like he is infected, a person to be avoided or bundled up behind a mask.

“I don’t want to be treated like a lab rat,” Griffin said. “I want to be treated like a human.”

Not far away, Devonte Jefferson, 27, and Larry Buckner, 18, played with a 2-year-old terrier in a strip-mall parking lot. Neither had masks, gloves or any concern about the coronavirus.

Jefferson, who works demolishing properties for building renovations, said he is more worried about asbestos or lead paint on his job than about the pandemic. And, living in Southeast Washington his entire life, the toll of gun violence ranks far higher on his scale of concern.

“I’ve seen a lot of dead bodies after shootings,” Jefferson said.

“We don’t worry about problems like this.”

Objections to masks can be aesthetic (they look scary or ugly), ornery (you can’t tell me what to do), or political (the pandemic is overblown by the government, the news media or the Demo-

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The coronavirus pandemic crats). But American history also plays a significant part in the opposition.

For black Americans like McNeely and the other men in Anacostia, “there’s a concern that an African American who wears a mask could be considered guilty of a crime,” said Kahn, the law professor. “American attitudes toward masks are fraught with questions about race.”

Wearing masks in public is illegal in about 15 states and in many cities and counties, especially in the South, where anti-mask laws were passed in the period after the Civil War and in the 1920s and 1950s to combat the Ku Klux Klan and convince people that racial attitudes in the South had progressed. Some of those laws, including Virginia’s, have exceptions for medical masks or when there is a declared public health emergency. Governors have emphasized in recent weeks that no one will be arrested under old anti-mask laws.

But masks have powerful emotional meaning that makes many people reluctant to use them, even to defend against a deadly virus.

“We don’t quite trust who’s behind a mask, in part because of the history of the Klan,” Kahn said. “And courts have often argued that someone wearing a mask is more likely to steel up the courage to commit a crime.” For that reason, courts have added years to prison sentences for criminals who wore masks.

Even now, some black Americans have reported being called out by police or security guards while they were in shops wearing masks. Two black men in Wood River, Ill., who wore medical masks inside a Walmart recorded themselves last month being followed by an officer who ushered them out of the store. A statement from the city’s police chief said the officer “incorrectly informed the individuals that the Wood River City Ordinance prohibited the wearing of masks.”

Antipathy to masks is deeply ingrained in American culture, unlike in some Asian countries, where many people wear them whenever they are in public, as protection against bugs and air pollution.

Past health crises have demonstrated that Americans’ discomfort with masks is difficult to

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rence, a small college town in Kansas, said he is eager to get business moving again, and although he tries to follow all sides of the issue, he worries that “in general, we are hearing the science-only side.”

Michael Robinson Chavez/The Washington Post

overcome. In 2004, when a nationwide shortage of flu vaccine led to fears of an influenza epidemic, some public health officials encouraged mask-wearing, and news reports predicted masks would become standard garb on sidewalks and streets forevermore. That did not happen.

‘Not a police state’ Carol A. Grigsby, who chairs the D.C. Developmental Disabilities Council, has hauled out her dusty, old sewing machine and set it up in her dining room in Northwest Washington. She is making masks for a population that can have a hard time grasping what is going on.

“I have to explain why the staff that works with them need to wear masks, that it’s because they care about you, not because they need to be protected from you,” she said.

Ricardo Thornton spent 12 years at Forest Haven, a harrowing, long-shuttered mental institution in suburban Maryland where thousands of D.C. youths were warehoused. Now 61, he and his wife live independently in Washington. He is mostly staying at home, but when he goes out for walks, he will not wear a mask.

“I got my freedom back, and I’m not giving it up,” he said. “Put a mask on me and it’s like going

back to Forest Haven, when people thought we were carrying some disease. There’s nothing wrong with me, so I’m not planning to wear one.”

Mixed messages from the government have not helped persuade people, many experts said.

“Initially, we were told that masks did nothing,” said Marilyn Singleton, an anesthesiologist in Los Angeles and former president of the Association of American Physicians and Surgeons, a conservative medical society. “And having people wear masks while they’re walking down a road by themselves doesn’t do anything for anybody. We’re not a police state, and this should be a personal choice.”

Although many of the political leaders who have appeared in public wearing masks have been Democrats, such as Virginia Gov. Ralph Northam and Colorado Gov. Jared Polis, some Republicans have done so as well, including Florida Gov. Ron DeSantis and Maryland Gov. Larry Hogan.

An increasing number of Republican governors, such as Ohio’s Mike De­Wine, have issued orders strongly recommending maskwearing.

For many Trump supporters, the mask seems to be a symbol of an approach to the virus that weighs too heavily against relaunching the economy. Kevin Krannawitter, who lives in Law-

A man wearing a makeshift mask, walks in front of the U.S. Supreme Court in Washington on March 24, well before officials started urging the public to wear face coverings. Now, masks have become mandatory in some parts of the country.

‘Nobody can see me smile’ Officials in Palm Beach County, like in the rest of South Florida, recently told residents they “should” wear masks in stores, on public transit, and at construction sites and other public places.

In Lake Worth, a city in Palm Beach County, Commissioner Omari Hardy pushed for a tougher ordinance that would have fined store owners who allowed unmasked patrons in to shop, but he was voted down.

Hardy’s mother gave him a stack of masks weeks ago, along with a pile of bandannas, and he started using them.

“It was strange for me, without a doubt,” he said. “But you have to get over it. This isn’t a fashion show. You’re wearing a mask to protect your family and your neighbors.”

Palm Beach Town Manager Kirk Blouin said that even without a mandate, residents of the wealthy island have been calling police to report people who have not been donning masks.

In Laredo, where masks are mandatory, those who defy the order face a visit from law enforcement. Police Chief Claudio Treviño said off-duty officers working security at grocery stores have handed out hundreds of warnings and about two dozen citations. He said the reaction has not been divided by politics; the most conservative parts of town complied early and well.

Back in Florida, Kim Rommel Enright, an attorney with the Legal Aid Society of Palm Beach County, had trouble finding masks, so she is making her own.

She is also artistic director of the local Maplewood Playhouse, where she helps make costumes.

She has made about 200 masks, and she is giving them away, or asking those who want to pay to donate to her theater.

Enright sports a rainbow Pride mask when out in public.

“I hate it,” she said. “I can’t stand it. Nobody can see me smile.”

But she wears it. n

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The coronavirus pandemic

World’s faithful adapt religious rituals BY

MIRIAM BERGER

lated lockdown to travel from one city to another to visit a different wife.

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rganized religions were not built for social distancing.

Worshipers in churches, mosques, synagogues and temples from India to South Korea to Ukraine have found themselves unwitting coronavirus vectors. And from Israel to Iran to the United States, some religious communities have been at the forefront of resistance to social distancing, especially orders to close or restrict places of worship. Across continents, celebrations around holidays including Easter, Passover, Nowruz and Ramadan, which began Thursday, have been upended as people forgo communal prayers and rites.

In the face of all manner of disruptions and cataclysms, religious practices have adapted and persevered — and the coronavirus pandemic is no different.

Across continents, rituals have begun to adapt to a changing way of life.

Here’s a look at some new ways of sustaining old traditions.

Israel Under Jewish law, the body of the deceased must be ritually washed before burial in a smock and shroud.

These days in Israel, the group of people who ritually wash and prepare the body, known as the chevra kadisha, wear hazmat suits. They receive bodies wrapped in impermeable plastic wrappings, which they remove for the ritual and replace before removing again to lower the deceased into the ground.

For Jews around the world, the seven-day mourning period that follows the death of a loved one, known as shiva, is a time when people visit the house of the mourner to pay respects and pray. There’s no easy equivalent. Nonetheless, some have turned to virtual shivas on platforms such as Zoom as a way to comfort the bereaved.

Thailand Many Buddhist monks rely on alms as a source of sustenance and connection with the lay community. In Thailand, they have taken to wearing face shields as they interact with face mask-wearing devotees, who provide donations of food in prepackaged bags or through plastic shields to reduce physical contact.

Devout followers are finding new ways to maintain old traditions while practicing social distancing

Russia The kissing of icons, revered in the Russian Orthodox Church, is still allowed. A volunteer sanitizes the icon after every worshiper partakes in the tradition. It’s a workaround that still leaves public health officials worried.

The Moscow Patriarchate has introduced other preventive measures, like ordering church personnel to don disposable gloves when giving out ritual bread, or serving a traditionally communal ceremonial drink with disposable spoons instead.

Italy Pope Francis has opposed the Italian government’s move to close churches — which remain open for personal prayer under certain circumstances — but he has urged followers to consider alternatives to confession in person.

“If you cannot find a priest to confess to, speak directly with God, your father, and tell him the truth. Say, ‘Lord, I did this, this, this. Forgive me,’ and ask for pardon with all your heart,” the pope said during a live-streamed morning mass on March 20, Crux Now reported.

Priests in Italy are permitted to hear confessions if they wear masks and gloves and remain at least three feet away from the parishioner. Pope Francis has canceled all of his public appearances and conducts prayers via live-streaming.

Pakistan Pakistan requires that people of a certain income pay zakat, a traditional Muslim charity tax. But with an estimated 25 percent of the population unable to afford to eat twice a day during the country’s lockdown, according to Prime Minister Imran Khan, the coronavirus has become a central focus of zakat giving.

Religious charity networks, usually busiest around holidays, are mobilizing to receive donations and distribute basic goods including antibacterial soap. Supermarket shoppers in Karachi are pausing after they shop to offer food or money to impoverished people on the street, the BBC reported. The exchange often comes with a simple request: that the recipient pray for the coronavirus pandemic to end soon. n

Chalinee Thirasupa/Reuters

United Arab Emirates Amid the pandemic, the Ministry of Justice in the United Arab Emirates, a Muslim-majority country in the Persian Gulf, has launched an online platform for Muslim marriages.

“Once all the required information is submitted, the couple then have to book an appointment with the Ministry of Justice, who will then appoint an imam to recite the Koran via a video conference,” Gulf News reported. After the fees have been paid online, approvals will be texted to the couple’s phones.

Polygamy is legal in the UAE, where, according to Islamic law, men can have up to four wives (often, if they can afford it, in separate homes). But, religious authorities have warned, it’s a violation of the coronavirus-re-

Thai Buddhist monks wear face shields as they collect alms in Bangkok on March 31. Many Buddhist monks rely on alms as a source of sustenance and connection with the lay community.

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The coronavirus pandemic

Where have the ER patients gone?

BY L ENNY B ERNSTEIN AND F RANCES S TEAD S ELLERS

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oon after he repurposed his 60-bed cardiac unit to accommodate covid-19 patients, Mount Sinai cardiovascular surgeon John Puskas was stumped: With nearly all the beds now occupied by victims of the novel coronavirus, where had all the heart patients gone? Even those left almost speechless by crushing chest pain weren’t coming through the ER. Variations on that question have puzzled clinicians not only in New York, the most severe area of the U.S. outbreak, but across the country and in Spain, the United Kingdom and China. Five weeks into a nationwide coronavirus lockdown, many doctors say the pandemic has produced a silent sub-epidemic of people who need care at hospitals but dare not come in. They include people with inflamed appendixes, infected gall bladders, bowel obstructions and, more ominously, chest pains and stroke symptoms, according to these physicians and early research.

“Everybody is frightened to come to the ER,” Puskas said.

Some doctors worry that illness and mortality from unaddressed health problems may rival the carnage produced in regions less affected by covid-19, the disease the virus causes. And some expect they will soon see patients who have dangerously delayed seeking care as ongoing symptoms force them to overcome their fear.

Evert Eriksson, the trauma medical director at the Medical University of South Carolina, described a man in his 20s who tried to ignore the growing pain in his belly, toughing it out at home with the aid of over-the-counter painkillers. By the time he showed up at the Charleston hospital, perhaps 10 days after he should have, he had developed a large abscess, one that was gnawing through the muscle in his abdominal wall.

A fairly routine surgery and a night in the hospital had become a lengthy and difficult inpatient stay, with doctors operating and

Caitlin Ochs/Reuters

Many with severe ailments seem to be avoiding hospitals using antibiotics to control the widespread infection, according to Eriksson. Only after they succeed in vanquishing the infection can they address the appendix itself.

“That’s going to be a real wound-care challenge for him moving forward,” said Eriksson, who is caring for the patient. “He said to me he could [imagine] the virus crawling on the hospital. He was just scared to come.”

At MUSC, Eriksson’s general surgery floor, which has 20 beds, housed as few as three people for two to three weeks, he said. Now the census is back over 20.

“What we’re seeing is late presentation,” he said. “I would say 70 percent of the appendicitis on my service right now are late pre-

sentations. What happens when you present late with appendicitis is, we can’t operate on you safely.”

Yet the 700-bed hospital is only about 60 percent full because, like most facilities, MUSC discharged everyone it could to make room for the expected coronavirus surge. So far, that hasn’t materialized. The hospital has not had more than 10 covid-19 patients admitted at any time, he said.

“We have five covid patients in the hospital right now, and we have five appendicitis cases” with complications from waiting too long to come in for care, Eriksson said.

Much of the reporting about missing patients is anecdotal — in medical chat rooms and on doctors’ social media accounts. Doc-

An empty bed outside Maimonides Medical Center in Brooklyn. Many doctors say fear of coronavirus infection has produced a dearth of patients with inflamed appendixes, infected gall bladders, bowel obstructions and even chest pains and stroke symptoms.

tors say it’s unlikely there has been a decline in most of these conditions, which suggests that at least a few people may be dying at home, although there is no data yet to corroborate that.

In the case of severe heart attacks, the evidence is mounting that a large percentage of patients with symptoms that typically prompt urgent interventions are simply not showing up.

A report to be published in the Journal of the American College of Cardiology on nine high-volume cardiac catheterization labs across the country found a 38 percent drop in patients being treated for a life-threatening event known as a STEMI — the blockage of one of the major arteries that supplies oxygen-rich blood to the heart.

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The coronavirus pandemic The study compared what happened this past March, when covid-19 cases were climbing, with the treatments delivered from Jan. 1, 2019, through February 2020.

Those results — from hospitals across the country — are counterintuitive, physicians say. The stress caused by the pandemic would lead them to anticipate an increase in heart attacks. Covid-19 is also an inflammatory disease that can damage the heart muscle.

“We should have higher incidences of these events, but we are seeing dramatically fewer in the hospital system,” Puskas said.

“That has to mean they are at home or in the morgue.”

A Gallup online poll taken March 28 to April 2 asked people with different conditions how concerned they would be about exposure to the coronavirus if they needed “medical treatment right now” at a hospital or doctor’s office. Eighty-six percent of people with heart disease said they would be either “very concerned” or “moderately concerned.” Among people with high blood pressure, the figure was 83 percent.

With elective surgeries on hold, many hospitals such as Brigham and Women’s in Boston have found themselves trading treatment of traditional heart attacks for the complex assaults the novel coronavirus is making on the organ and the body’s ability to clot blood.

“People with smaller heart attacks, they may say, ‘Well I hope this is just indigestion,’ ” said Gregory Piazza, one of the hospital’s cardiovascular specialists.

At MUSC, another doctor worried that mild stroke patients are enduring symptoms such as numbness, loss of sensation or weakness on one side of the body at home. Symptoms of small strokes can be transient, but they also can be warnings of larger strokes to come.

MUSC, a major stroke center, averaged 550 calls per month over the past four months about possible stroke patients from the 45 to 50 emergency rooms that refer patients. But it has seen just 100 in the first half of April, said Alex Spiotta, the director of neurovascular surgery. Phone calls from patients to MUSC’s telestroke program dropped from as many as 20 daily to about nine in mid-April.

“That’s literally patients and

KLMNO Weekly

“What we would surmise is that more mild to moderate cases are not calling 911 or are afraid to come into the hospitals.”

Ralph Sacco, the chairman of neurology at the University of MiamiJackson Memorial Comprehensive Stroke Center Adam Glanzman/Bloomberg News

their families who fear that it’s dangerous” to go to the hospital, he said. “We are worried that there might be a higher death toll from neglect of other diseases” than from covid-19.

At the University of MiamiJackson Memorial Comprehensive Stroke Center, the March census of stroke patients is down almost 30 percent from February’s, said Ralph Sacco, the chairman of neurology and the former president of the American Academy of Neurology.

“What we would surmise is that more mild to moderate cases are not calling 911 or are afraid to come into the hospitals,” Sacco said.

Hospitals are beginning to reach out to the public through social media and public service announcements to ease fears about hospital safety.

“We’ve changed what we do,” to keep patients safe from the virus, Sacco said. “But we’re still able to care for people.”

The possibility that patients may be suffering — and even dying — at home rather than going to a hospital led the American College of Cardiology to launch a “Cardiosmart” campaign, attempting to reassure a wary population and encourage those with symptoms to call 911 for urgent care and to continue routine appointments, through telemedicine when prac-

tical: “Hospitals have safety measures to protect you from infection,” it reads.

“The emphasis here is safety,” said Harlan Krumholz, a cardiologist and health-care researcher at Yale University and Yale New Haven Hospital, who advised on the campaign. “We want to make sure preventable deaths aren’t happening.”

There is no pill, no action, no behavior, he said, that could account for the almost 40 percent drop in STEMI patients. “We don’t have a means to cut your risk in half,” he said. “Not even primary angioplasty or stopping smoking.”

Still, the shift has many doctors looking for other explanations, including the massive behavioral overhaul caused by the lockdown.

MUSC has seen a steep drop in trauma from car accidents, for example, because fewer people are driving, but no reduction in domestic violence or assaults among people who don’t live together, Eriksson said.

Many people who suffer from exertional angina are now sitting at home rather than climbing the subway stairs every day, and the threshold of discomfort that would drive them to seek care is probably far higher.

Joseph Puma, an interventional cardiologist at Mount Sinai, said he believes multiple changes created by the lockdown may be play-

ing a role, including a decrease in air pollution and fewer high-fat restaurant meals after work.

“The plaques in arteries have not gone away,” he said. “You can argue that forced behavioral modifications may have taken away the triggers” that release them into the bloodstream.

And these days, some people who suffer cardiac arrests never make it to a hospital in New York, where EMTs and paramedics transport patients only if their pulse returns after CPR or defibrillation.

Puskas, the Mount Sinai cardiovascular surgeon, whose unit is now occupied entirely by covid-19 patients, suspects a few of the heart patients may not be missing but right there among the most seriously ill people in his new unit.

The virus strikes most harshly among people suffering from diabetes, obesity and high blood pressure — the very same conditions that predispose people to strokes and heart attacks.

“Some of them may be under our noses,” he said.

The role those factors may be playing will emerge over time from studies and shoe-leather epidemiology. But for now, Krumholz said, the key is to make sure people with symptoms overcome their fears and get prompt treatment that may save their lives or avoid long-term complications. n

A medical worker wearing protective gear enters the UMass Memorial Health Care field hospital at the DCU Center, an arena in Worcester, Mass.

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The coronavirus pandemic

Colleges weigh when to reopen BY

N ICK A NDERSON

I

n a different year, incoming freshmen would already have in hand a tightly choreographed schedule for late summer and early fall: the movein date, the orientation and, finally, the first day of classes.

But on the coronavirus pandemic calendar, there are no dates yet for the next academic year. Just scenarios. And that unprecedented uncertainty is fueling a second wave of crisis for schools already plunged into financial distress.

Colleges and universities nationwide are gaming out whether, when and how they can reopen campus after the abrupt shutdowns in March. Support from governors is essential but is hardly the only factor. Every prospective and returning student is hanging on the answers.

The possibilities range from a return to normalcy, which few higher education insiders believe at this point, to a fall semester with dorms shuttered and students taking classes from home until at least January.

“Obviously, we would love to open in the fall — meaning, have students back. That’s true of my colleagues in Virginia and across the country,” said University of Virginia President James E. Ryan.

“What we’re trying to do right now is ask the question, ‘Under what conditions can we safely open?’ ” Ryan sees three scenarios for the 24,000-student public university.

U-Va. could start classes on Aug. 25 as scheduled, with students in Charlottesville but under new social distancing restrictions to guard public health. It could delay the semester and plan to open in person some weeks later.

Or it could launch the school year without students on campus and teach remotely until circumstances allow a return.

Schools everywhere face variations of these choices. All carry a degree of risk. Opening campuses, whether sooner or later, will require a plan for what to do

Erin Edgerton/Associated Press

Some contingency plans include teaching online or delaying a semester, but uncertainty persists when someone is found to be a carrier or falls ill with covid-19.

“You can’t pretend away the virus,” Ryan said.

The most immediate question is how long higher education leaders can wait to make a decision. Several estimated they have until mid-June. Yale University President Peter Salovey said the school will make the call by early July.

Leaders have to give faculty time to prepare. And they face pressure to develop prudent plans that will ensure students enroll in adequate numbers and pay tuition. They can’t afford mass desertions.

Some are going public now, albeit with caveats. California State University at Fullerton, with 40,000 students, disclosed plans for a remote opening in the fall.

“We will at least start virtually,” the university’s provost, Pamella Oliver, said this past week in an online town hall. “And of course, that can change.”

Purdue University, with 44,000

students, is gearing up for an in-person opening. The public university in Indiana “intends to accept students on campus in typical numbers this fall, sober about the certain problems that the COVID-19 virus represents, but determined not to surrender helplessly to those difficulties but to tackle and manage them aggressively and creatively,” Purdue President Mitchell E. Daniels Jr. wrote.

But most schools are still biding time as students anxiously await clarity.

Jay A. Perman, the chancellor of the University System of Maryland, which includes U-Md. and 14 other public universities and education centers, said he is “reasonably optimistic” campuses will reopen by September. “If we can’t, we can’t,” Perman said. “But collectively, the institutions are starting to think toward being ready for a fall opening.”

Perman, a medical doctor, said universities must think through many issues. Among them:

The University of Virginia, in Charlottesville, last month. “Obviously, we would love to open in the fall,” said University of Virginia President James E. Ryan. “What we’re trying to do right now is ask the question, ‘Under what conditions can we safely open?’ ”

Should students, faculty and staff be screened for the virus and its antibodies? Can lectures with hundreds of students be broken into smaller groups or delivered remotely? What restrictions will be needed for dorms, dining halls and social life?

Mark Schlissel, the president of the 46,000-student University of Michigan, who is an immunologist, said he is aiming for a fall reopening that is “public healthinformed.” Remote teaching is exceedingly difficult, he said, with laboratory classes and others that require physical activity. “There isn’t anything that can replace doing experiments with your own hands and seeing and interpreting results,” he said.

Underlying questions about when and how to open are huge fiscal challenges. Schools already face shortfalls after refunding room-and-board payments this spring and paying unforeseen expenses. State budgets are under threat with the economy at a standstill. Families are rethinking how much they can afford in a time of job losses and shrunken savings — and how much they are willing to pay for a style of learning that was not what was advertised.

University leaders defend their rates. “When people pay tuition they are paying for credit, ultimately, for a degree,” Perman said.

The system will continue to provide that, he said, with a quality education regardless of format.

But at schools around the country, students have already demanded discounts and refunds on spring tuition. Remaining online in the fall will fuel more calls for price cuts.

“When you save their entire lives to send them to this fabulous experience — the idyllic location, the labs, small discussion groups — and you’re writing this huge check for this comprehensive experience — to say that’s equivalent to an online course?” asked Elizabeth Zehner, of Bethesda, Md., who has two daughters in college. “It’s not true.”

Zehner, whose husband is a teacher, works for a nonprofit

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The coronavirus pandemic

KLMNO Weekly

Top schools turn down relief money

BY S USAN S VRLUGA AND D ANIELLE D OUGLAS- G ABRIEL

Adam Glanzman/Bloomberg News

Boston University, a private school with 34,000 students, suggested the possibility of opening campus in January, instead of in the fall.

organization dedicated to international health. She said she would urge her daughters to take the next semester off if campuses aren’t open. “For us, it’s not worth the financial sacrifice.”

If colleges aren’t delivering what they promise — on time — they could be in deep trouble.

Especially if competitors decide to fully reopen.

“It’s revenue pressure, and the sense that ‘If we’re the one that doesn’t open, we lose our share of the market permanently,’ ” said Robert Zemsky, a professor of higher education at the University of Pennsylvania.

Private colleges with modest endowments and enrollment are vulnerable. Their brands are built on close contact between professors and students. That means face to face, not through Zoom.

“It would be pretty hard to find an industry that is more threatened by this particular pandemic than residential higher education,” said Brian Rosenberg, president of Macalester College in Minnesota. “There’s almost no way for us to do what we do halfway. We’re all about closeness.

And not just in the classroom.

Everywhere.”

His college, with about 2,100 students, is pledging every effort to offer a full school year in person. To go online for a semester, Rosenberg said, might cost Macalester a quarter of its enrollment.

For any college, he said, that would produce “very, very dramatic financial consequences.”

It could mean furloughs, layoffs, salary cuts and, for some schools, the threat of closure.

Rosenberg said one of the toughest problems is providing housing with social distance.

Most schools can’t offer each student a room without a roommate.

Nor do they have extra beds for those who might need to be quarantined — or those who were expecting to go overseas next fall but now can’t study abroad.

“There are so many uncertainties,” he said. “The discussions about it make your head want to explode.”

Boston University, a private school with 34,000 students, made waves recently when it floated the possibility of opening campus in January. School officials emphasize they are focused on bringing students back in fall.

“We’re planning for September,” said BU President Robert A. Brown. “But it’s irresponsible not to have backup scenarios.”

Brown said BU is consumed with planning to reopen research laboratories, clean dorm rooms, “de-densify” lecture halls and other steps. One of his core concerns is preserving the freshman experience.

“The first 90 days in college are incredibly important,” he said. “I don’t know how to do that remotely.”

Kevin Moody, 17, of Billerica, Mass., is deciding among U-Va., Villanova University and other schools. He’s itching to go away to college in the fall, but he’s heard of the January contingency plans at BU and elsewhere. “I want to experience the full student life,” Moody said. The idea that he could still be home come September? “Mind-blowing,” he said. n

F

acing a public backlash and pressure from the Trump administration, wealthy universities are declining funding from the stimulus package designed to help schools and students pummeled by the coronavirus pandemic.

Even as they turn over campus buildings to house emergency workers, treat sick patients in their hospitals, race to find vaccines and implement their own budget cuts in the cratering economy, some top universities said they would not accept federal relief money.

Harvard University announced Wednesday that it would ask the Education Department to reallocate $8.6 million that had been directed to the school. It had faced criticism from President Trump, Education Secretary Betsy DeVos and others for accepting the money, which it said it intended to use to help students with urgent financial needs caused by the pandemic. Princeton and Yale also announced that they would not seek money each school was eligible to receive.

Higher education leaders had asked Congress for more than $50 billion in aid, predicting that the emergency response to the public health crisis would cost schools hundreds of billions of dollars. The stimulus bill ultimately included $14 billion for higher education, most of which is earmarked for emergency grants to students in need of help with child care, housing and food.

(Guidance issued Tuesday by the Education Department narrows student eligibility to only those who can participate in federal student aid programs, which effectively shuts out undocumented and international students.)

More than 5,000 colleges and universities are entitled to receive money, with public four-year universities taking in the largest share. But using federal aid to help

schools with massive endowments became a lightning rod for criticism this past week.

Like all universities, Stanford is facing significant financial pressures and sustained uncertainty from a combination of lost revenue, increased costs, and a market downturn. Stanford, like many schools, is committing significant funds to combat the pandemic on multiple fronts including research, health care and community aid.

But the crisis brings an existential threat to many smaller colleges and universities in the United States, school officials said in a written statement, and they concluded that keeping those institutions viable, to provide access to higher education for as many students as possible, should be a priority. “Therefore, Monday morning we contacted the Department of Education to ask that our application for relief funds . . . be rescinded.”

There is no assurance from the Education Department that the money wealthy universities forgo will be redistributed to schools with the greatest need. The department did not immediately respond to requests for comment.

Harvard’s endowment stood at $40.9 billion at its most recent reporting, for the fiscal year that ended in June. About 80 percent of those funds are restricted, and the value of the endowment has likely taken a hit as the pandemic has rocked the global markets.

Recently, Harvard said it would cancel discretionary spending, forgo new hires, delay some projects and reduce the salary of its executive leadership by 25 percent in response to the financial impact of the pandemic.

Other wealthy universities have announced similar plans, including Stanford. Both the provost and the president have taken 20 percent pay cuts, and said the university anticipates a $200 million shortfall amid decreased revenue, increased costs and new expenditures related to the pandemic. n

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the coronavirus pandemic

As U.S. deports migrants, worries grow

BY K EVIN S IEFF AND N ICK M IROFF

T

hey arrive 24 hours a day in the Mexican border city of Reynosa, groups of men, women and children deported by the United States. Each time, at the edge of the international bridge, Ricardo Calderón Macias and his team get ready.

They put on masks and gloves.

They prepare their thermometers and health forms. They wonder, sometimes aloud: Will anyone in this group test positive?

“We’re worried that eventually, with these deportations, we’re all going to get infected,” said Calderón, the regional director of the Tamaulipas state immigration institute.

Since the coronavirus struck the United States, immigration authorities have deported dozens of infected migrants, leaving governments and nonprofits across Mexico, Central America and the Caribbean struggling to respond.

When some countries resisted continued deportations, U.S. officials said they would screen migrants slated for removal. But they did not commit to administering coronavirus tests. In many instances, the screenings, which consist primarily of taking a person’s temperature, have failed to detect cases. Even though overall deportations declined this month, the United States has returned thousands of people across the Western Hemisphere in April.

President Trump announced this past week that he would “suspend immigration” to the United States. Even before that announcement, officials in the region were concerned about the deportations. Guatemala’s health minister spoke this month of the worrying number of infected deportees sent from the United States — the “Wuhan of the Americas,” he said.

Mexico’s Tamaulipas state, across the Rio Grande from the southern tip of Texas, is receiving roughly 100 deportees per day, officials there say. In some cases,

Moises Castillo/Associated Press

Screened but not tested, those expelled may import infection to vulnerable countries repatriation workers have noticed that deportees are visibly sick as they arrive. Those deportations are blamed for at least one new outbreak in a Mexican migrant shelter.

On Monday, the Mexican government asked the U.S. Department of Homeland Security to test deportees for the virus, but DHS has not committed to doing so, according to a Mexican official with knowledge of the conversations who spoke on the condition of anonymity to describe diplomatic talks.

In Guatemala, at least 50 deportees have tested positive, about 17 percent of the country’s total confirmed cases. Threequarters of passengers on a deportation flight to Guatemala City last month were infected, according to the country’s Health Ministry. Guatemalan officials said this month they would suspend returns from the United States.

In Haiti, the poorest country in the Western Hemisphere, three people sent back from the United

States in early April have tested positive, officials said. The country has 62 ventilators for 11 million people. The Trump administration reportedly was planning another deportation flight to Haiti this past week.

“Rather than be deported where they face serious harm if they fall ill and risk infecting thousands of others, they should be released from detention into the care of their friends and families so that they may safely quarantine,” a coalition of 164 human rights and religious organizations said in an open letter pleading for suspension of deportations.

In Mexico a few weeks ago, two deportees tested positive for the virus. Calderón’s team spotted a deportee in Reynosa who was visibly ill, with a dry cough, red eyes and a fever. They wondered how the man, who arrived from Atlanta, had made it through U.S. health screenings.

A second man was deported to Nuevo Laredo from Houston “without knowing he was a carri-

Health workers carry supplies delivered by family members to a temporary shelter for Guatemalan citizens deported from the United States in Guatemala City.

er of the virus,” the Tamaulipas state government said in a statement, and was sent to a migrant shelter in the city.

That case apparently prompted an outbreak in the shelter, Casa del Migrante Nazareth; 14 others have since tested positive.

“The risk we face is bringing a massive contagion into our own country,” said Raúl Cardenas, the city manager of Nuevo Laredo.

“We’re mortified that these deportations are continuing.”

U.S. Immigration and Customs Enforcement reported Monday that 220 of the roughly 32,000 detainees it holds have tested positive. But given limited testing, officials say privately, the actual number is likely much higher.

In an email, ICE said it had deported 2,985 people in the first 11 days of April, on track for a significant decrease from previous months. Between January and March, ICE deported an average of 20,881 people per month.

The agency did not respond to questions about continuing deportations during the pandemic.

On its website, the agency says it conducts medical screenings of detainees before they board deportation flights.

Any detainee who fails a screening or is suspected of being contagious “will be denied boarding and referred to an ICE approved facility for screening,” the agency says. Starting a few weeks ago, it said, “any detainee with a temperature of 99 degrees or higher will be immediately referred to a medical provider for further evaluation and observation.”

Acting ICE director Matthew T. Albence told Congress recently that the agency had released about 700 people with underlying conditions that make them particularly vulnerable during the pandemic but was not considering further releases of others at high risk. In the email to The Post, an ICE official wrote that the agency’s “expectation is that each country will continue to meet its international obligation to accept its own nationals.”

On Monday, a federal judge in

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The coronavirus pandemic California ordered ICE to review the cases of all high-risk detainees to consider their release. U.S. District Judge Jesus Bernal said ICE “likely exhibited callous indifference to the safety and wellbeing” of vulnerable detainees.

U.S. officials say the pandemic requires the suspension of immigration laws, including shutting down the asylum system. But they also say they’re bound by law to continue deportations.

“ICE is trying to thread the needle between getting folks out of detention facilities as quickly and safely as possible but not releasing them en masse without testing,” said one DHS official who spoke on the condition of anonymity to describe internal deliberations.

The agency has discretion to parole certain detainees, such as asylum seekers with pending cases. But many of its detainees have been charged with serious crimes and must be held, the official said.

The official said DHS is unlikely to administer tests to every deportee unless foreign governments make that a condition for taking people back.

Many migrant shelters in Mexico and Central America, worried about the outbreak, have closed their doors. Some deportees have spent decades in the United States and aren’t easily able to find housing or food upon being sent back to the country of their birth.

Under new rules applied during the pandemic, Central Americans who are caught crossing the border are now also deported to Mexico.

Mexico has raised concerns with DHS that border agents are expelling Ecuadoran migrants and other third-country nationals who are not supposed to be returned under the emergency agreement, the official said.

The Rev. Francisco Gallardo, who runs a migrant shelter in Matamoros, called the possibility that deportees will arrive infected “a great concern for us.”

“The deportees arrive at a bus station where migration officials receive them, but they don’t have a serious health protocol in place,” Gallardo said. “They just check for fevers and that’s it. The migrants are already vulnerable, and this just adds to the level of discrimination.”

He decided to close the shelter three weeks ago. n

KLMNO Weekly

South Africa takes health care to its communities

BY B ONOLO M OGOTSI AND M AX B EARAK

in Krugersdorp, South Africa

A

s South Africa’s health experts watched the coronavirus race through Europe and begin to seed itself in their country, they made a pivotal decision.

Instead of waiting for sick people to start swamping their health system, potentially overwhelming it, they mobilized tens of thousands of medical workers — and brought care to the people instead.

More than 28,000 health-care workers have spread out across South Africa’s nine provinces.

Some go door to door, taking down people’s travel histories, temperatures and other risk factors. Others, especially in dense, poor communities known as townships, set up pop-up clinics where turnout has been high.

“Only South Africa has done that,” said Salim Abdool Karim, a member of the country’s pandemic task force, referring to the scale of the effort.

Two million South Africans — out of a population of 57 million — have been screened this way, according to the Health Ministry.

Tens of thousands have been tested who may not otherwise have been. South Africa has more than 3,400 confirmed cases — the highest number in Africa — but its government considers that a result of aggressive testing. As of Tuesday, more than 125,000 people had been tested.

Other countries, such as China, Cuba, Ethiopia and India, have deployed large numbers of health-care workers to conduct door-to-door checkups or screenings, but South Africa is the only country to do so nationwide, and with the intention of gathering data about who is most at risk and who should be tested.

In a country where many don’t have their own cars or money to pay for public transportation, many here are grateful for the

Waldo Swiegers/Bloomberg News

Residents line up for a health check at a screening point in Rustenburg, South Africa, this month. More than 28,000 health-care workers have spread out across South Africa’s nine provinces.

door-to-door checkups and mobile clinics.

“They didn’t sit and wait for corona to come to them. They went and faced it head-on,” said Eunice Ratlhagane, 55, who is unemployed and lives in a township in Krugersdorp, just outside Johannesburg, South Africa’s biggest city.

Around her, however, was a scene that an aggressive healthcare response can’t fix. Despite an ongoing lockdown, in which people are supposed to leave home only for essential reasons, rows of shops were open. Kids played tag.

Street traffic was bustling.

The high number of patients at the mobile clinics demonstrates South Africans’ desire to be part of the solution, but the inability of many to stay home reflects widespread poverty.

“Right now I need to make sure my stock sells out, and I have enough to feed my family,” said Peter Pooe, 55, who owns a spaza shop, a South African version of a corner store. He supports the government’s strategy because he thinks many are underestimating the pandemic.

“But I don’t know if it will work, as many people here are less concerned with covid than wanting to just survive,” he said.

A quarter of South Africans

live in townships where running water is intermittent, often built right up against sparkling estates with swimming pools. It is one of the most unequal societies in the world.

Health experts have cautioned that in such countries, lockdowns may cause more harm than good, and may even lead to societal unrest. That makes extensive testing, monitoring and quarantining even more essential. South Africa is working toward testing 30,000 people every day by the end of this month, according to the National Health Laboratory Service.

For now, South Africa’s curve does not appear to be growing exponentially, as many had feared. Cases rose quickly for about 10 days, but new ones haven’t exploded since the lockdown was imposed and the mobile health teams were deployed.

Hospitals are easily coping with the cases they have.

“What South Africa has done is impressive, absolutely,” said John Nkengasong, the director of the Africa Centers for Disease Control and Prevention. “We should stop being afraid of covid and do things that work. That’s what they did. They are getting data, which is what will be required to unlock the country.” n

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Opinions

We need a leader with a plan to feed the hungry José Andrés is the owner of ThinkFoodGroup and founder of World Central Kitchen.

They say you cannot see hunger. ¶ But what do you see in thousands of cars outside a food bank in San Antonio? Or cars lined up for hours outside supermarkets in Puerto Rico when people heard about food and water deliveries after Hurricane Maria? ¶ I am a cook. Over the past few years, I have learned a lot by feeding the many, not the few, after disasters across the world. ¶ The good news is that communities grow stronger in disaster: New leaders emerge in unlikely places, and neighbors look after one another.

The bad news is that until reliable supplies of food and medicine are guaranteed, people cannot return to normal. The search for food will be their top priority, taking up precious hours every day.

Recovery starts with admitting that we have a food crisis — in addition to the health crisis of the pandemic and economic crisis of the recession.

Some see this pandemic as a war. If this is a war, it is one we are waging with no generals and a volunteer army funded by philanthropy.

Our food supply should be a national security priority. This pandemic shows that food has been an afterthought, handled by charities and volunteers who cannot cope with the scale of today’s challenge. Under the Federal Emergency Management Agency, “mass care” — including feeding — is a joint exercise among traditional charities, faith groups and the private sector. This is called a whole community response.

This sort of patchwork is no match for covid-19. In Hurricane Maria, the system collapsed.

People had no money, supermarkets had no power, restaurants were closed, and traditional charities struggled to adapt. Above all, there was no leadership dedicated to food and water.

Leadership counts. We need leaders who listen to experts and do not pass the buck. Today there are no leaders when it comes to feeding all our citizens — nobody is responsible for the nation’s needs.

The United States is blessed with great farms and a food supply chain that delivers to restaurants, hotels and supermarkets. In normal times, the private sector does most of the work, supported by an invisible army of immigrants. In normal times, the rest of us take this for granted because shelves are full and food can be delivered.

In normal times, America can feed itself; unlike other elements of our economy, the food supply doesn’t rely on Chinese factories or Saudi tankers.

But these are far from normal times. Dairy farmers are dumping millions of gallons of milk into lagoons and pits and destroying millions of eggs.

Vegetable farmers are plowing ripe produce back into the ground. Meanwhile, food banks are overwhelmed, and the elderly cannot safely shop at supermarkets.

Our government’s response is a patchwork that falls far short of what’s needed. Restaurants — the second-largest private employer in the country — are

Frederic J. Brown/Agence france-presse/Getty Images

Volunteers outside a food bank that was opened in response to the coronavirus pandemic on Monday in El Monte, Calif.

supported by the Small Business Administration, which has been overwhelmed. Farmers are supported by the U.S. Department of Agriculture.

Most of the USDA’s $19 billion in aid is earmarked for farmers’ losses. Just $3 billion is supposed to help feed hungry Americans. Food aid should be prioritized, and cash allowed to flow through to distributors and small farmers.

We urgently need a food czar who sits on the National Security Council to serve as our general for this crisis and those that lie ahead. Just as we reimagined our national defenses after 9/11, we need to reimagine our health defense to include food. We realized that we had never taken the terrorist threats seriously enough until after the attacks. Ignoring the serious threat posed by food insecurity repeats those mistakes. Early studies have found a connection between obesity and deaths from covid19, especially among younger Americans.

Health defense starts with healthy food. Groups such as Mission: Readiness, supported by hundreds of retired generals and admirals, understand that we cannot have a strong country without healthy, well-fed children.

This crisis points up the need

to rethink every part of our broken food chain and turn the private sector into a force for public good, as I have proposed with my America Eats Now plan. Doing so would allow Congress to deliver food and economic assistance at the same time.

Shuttered arenas and convention centers should be turned into large-scale food banks and community kitchens, as World Central Kitchen has done at Nationals Park.

Restaurants should reopen to prepare and deliver food to the elderly and sick, through partners such as Grubhub and Uber Eats. If necessary, the National Guard could help deliver food to food banks.

Food aid through the Supplemental Nutrition Assistance Program should be extended, urgently, to online purchases and hot meals. Take politics out of it. Hunger and food insecurity exist in both red and blue states, just like the pandemic and recession.

We need to think back to the Great Depression to understand the magnitude of today’s crisis and how to respond. “Wherever they’s a fight so hungry people can eat, I’ll be there,” Tom Joad says in “The Grapes of Wrath.”

Hungry people are fighting to eat all across this country. We need to be there now. n

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SUNDAY, April, 26, 2020 sunday, april 26, 2020

Opinions

KLMNO Weekly

Tom Toles

Biden’s low profile won’t hurt him Paul Waldman is an opinion writer for The Washington Post’s Plum Line blog.

Where is Joe Biden? If you haven’t heard a Democrat ask that question in a plaintive, almost desperate tone recently, you probably don’t know too many Democrats.

He’s invisible! He’s absent! Trump is on TV every night, and the presumptive Democratic nominee is nowhere to be found! This is a disaster!

No, it isn’t. It’s true that Biden isn’t putting himself at the forefront of everyone’s mind, but that’s (mostly) not his fault. And if your concern is that this period of quiescence will hurt Biden’s chances for reelection, you probably shouldn’t worry.

The answer to the question “Where’s Biden?” is that, like most of us, he’s stuck in his house.

Given that reality, his options for campaigning are very limited. So what is he doing?

Well, he’s doing interviews.

And his campaign is making videos; I’m sure he’s involved with that. He now has a podcast.

If your response to that is, “A candidate with more social media savvy could be doing a lot more!” then you’re right. Joe Biden is never going to be Alexandria Ocasio-Cortez. Would it be better if he were making a cool Instagram video every day?

Maybe.

But the real problem — and the reason your retired mother is one of the ones asking “Where’s Biden” — is that the pandemic has deprived him of the ability to make news.

That’s because news, as we in the news biz define it, revolves largely around events. Things that happen, at a particular time and a particular place. That is what Biden cannot create right now.

Let’s take, for example, two substantively identical speeches, one given at a rally in Scranton, Pa., and one given in Biden’s living room. The text could be exactly the same, but only the former will be treated as news.

News organizations can stick their own cameras in front of it.

They can show Biden on the stage and the reactions of the crowd.

They can get comments from the supporters who attended. They can speculate about whether

Biden’s Scranton roots will help him win Pennsylvania, a critical battleground state in the fall.

If Biden gives that same speech from his living room, none of that is possible. News organizations might do a brief piece about whatever Biden proposed, but it will be given only cursory coverage, if any. It won’t lead all the nightly network newscasts or appear on front pages.

That’s the thing about a traditional campaign: Even if today’s campaigning is essentially the same as yesterday’s, it’s still new, even if only in trivial ways.

And if it’s new, then it’s news.

Yes, it’s odd to see Democratic governors such as New York’s Andrew M. Cuomo getting more attention than the person who’s supposedly the leader of the party.

But because Cuomo is the governor of the state most affected by the pandemic, journalists rightly see him as a key actor in this story. That’s why his press conferences are news in the way a Biden video isn’t.

To be clear, I’m not saying Biden couldn’t be doing more while confined to his house. I’ve suggested some things he could do, including the formation of a shadow cabinet. And as Michael Tomasky argues, congressional Democrats should be aggressively counter-programming Trump

with nightly presentations of their own.

But if you say “If only Biden would do this, then everything would be different,” then you have to explain why your recommendation — More press conferences? More videos? — would have a significant effect on the race. And there’s little reason to think that any of the options available to him actually would.

One thing we can say for sure is that Biden’s relative quiet isn’t changing anything fundamental about the contest between him and President Trump. He leads Trump by about six points in poll matchups right now. On March 1, he was ahead by about five. On Feb. 1, he was ahead by about six.

On Jan. 1, he was ahead by about six.

In other words, it’s not like Biden’s seclusion is losing him any votes. You might argue that if there were no pandemic, Biden would be winning more converts every day, but there isn’t much reason to believe that’s true.

Meanwhile, Trump is getting poor marks for his performance, even if his support within his base remains in place.

So could Biden be doing more from his fortress of semi-solitude?

Sure. But if he did, most voters wouldn’t notice anyway. And it wouldn’t make much difference. n

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SUNDAY, April, 26, 2020

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