npr--2020-09-29--How Operation Warp Speed's Big Vaccine Contracts Could Stay Secret

The Trump administration has compared Operation Warp Speed 's crash program to develop a COVID-19 vaccine to the Manhattan Project .
And like the notoriously secretive government project to make the first atomic bomb , the details of Operation Warp Speed 's work may take a long time to unravel .
One reason is that Operation Warp Speed is issuing billions of dollars ' worth of coronavirus vaccine contracts to companies through a nongovernment intermediary , bypassing the regulatory oversight and transparency of traditional federal contracting mechanisms , NPR has learned .
Instead of entering into contracts directly with vaccine @ @ @ @ @ @ @ in Operation Warp Speed funding has been routed through a defense contract management firm called Advanced Technologies International , Inc. ATI then awarded contracts to companies working on COVID-19 vaccines .
As a result , the contracts between the pharmaceutical companies and ATI may not be available through public records requests , and additional documents are exempt from public disclosure for five years .
Vaccine contracts awarded this way include $ 1.6 billion for Novavax , $ 1.95 billion for Pfizer , $ 1.79 billion for Sanofi and $ 1 billion for Johnson @ @ @ @ @ @ @ Operation Warp Speed 's approach when our request for one of the contracts under the federal Freedom of Information Act came up empty .
A senior administration official tells NPR the government chose to use the intermediary for Operation Warp Speed contracts `` to take advantage of certain acquisition authorities provided by Congress that are available to address situations like the coronavirus pandemic . ''
Generally , these kinds of agreements allow the government to be more nimble .
Simplifying government bureaucracy during a crisis is n't necessarily a bad thing , says @ @ @ @ @ @ @ University of California Hastings College of the Law , who focuses on the pharmaceutical industry and drug policy .
But there 's a tradeoff when it comes to accountability .
`` We have to be careful about what we throw out in that process , '' she says .
Most government contracts are governed by a set of rules called the Federal Acquisition Regulation , or FAR .
`` It 's really a bible that the government and contractors are supposed to follow with respect to a given acquisition , '' says attorney @ @ @ @ @ @ @ and English , who has been involved with thousands of government contracts in his career .
`` It is supposed to establish the process from soup to nuts , right from the beginning to the very end of a procurement . ''
The acquisition regulations contain everything Congress stipulates should `` govern the expenditure of taxpayer dollars , '' from anti-human-trafficking clauses to ethics and company conduct requirements , Turner says .
But the resulting process can be time-consuming .
Sometimes , it can stretch for years , especially if competitive bidding is @ @ @ @ @ @ @ award through a formal protest process .
So , in special cases , the government has been turning to an alternative mechanism , called an Other Transaction Agreement , or OTA .
These agreements got their start in the late 1950s , when NASA was created .
The goal was to streamline the contracting process and attract newer , smaller companies and inventors to work with the government that otherwise might not have the resources or willingness to do so .
`` I do n't think that they operate to relieve liability , @ @ @ @ @ @ @ , if anything , to streamline the process for a variety of reasons , depending on the acquisition at issue . ''
But there can be a downside to these agreements .
`` A number of analysts warn that along with the potential benefits come significant risks , including potentially diminished oversight and exemption from laws and regulations designed to protect government and taxpayer interests , '' the Congressional Research Service wrote in a 2019 report about the rising use of OTAs by the Department of Defense .
The report also noted that @ @ @ @ @ @ @ than traditional government contracts , because the Department of Defense has n't tracked that information .
Kathryn Ardizzone , a lawyer at Knowledge Ecology International , examined a handful of early Operation Warp Speed research and development contracts obtained through public records requests to HHS that did n't go through an intermediary .
KEI is a nonprofit group that focuses on intellectual property policy .
Many were OTAs that weakened or excluded Bayh-Dole clauses , which , among other things , allow the government to `` march in '' and take control of @ @ @ @ @ @ @ that received federal funding engages in price gouging , for example .
Ardizzone and NPR have both , separately , tried to get copies of the later ( and larger ) procurement contracts through public records requests and so far have been unsuccessful .
We requested contracts between the federal government and the pharmaceutical companies — not the intermediary , Advanced Technology International .
In response to NPR 's request , HHS said it had `` no records '' for the $ 1.6 billion contract with Novavax , indicating that the department leading @ @ @ @ @ @ @ n't have a copy of the contract .
NPR has since made the same request of the Department of Defense and is awaiting the response .
`` It 's not clear that using the Freedom of Information Act , we can access agreements that are maintained by a private entity , '' Ardizzone says .
In that case , we do n't know what taxpayer protections the contracts may have left out .
`` The stakes are as high as you could ever imagine , '' Ardizzone says .
If the government does @ @ @ @ @ @ @ , something she called `` shocking but not impossible , '' it would `` add a layer of complexity '' to whether the contracts can be disclosed under a public records request .
Advance Technology International manages contracts and facilitates dealings with the government for several consortia of academics , companies and more , using OTAs .
In March and early April , the Department of Defense talked with ATI about a consortium of academics and companies that it manages called the Medical CBRN Defense Consortium , which is tasked with developing medical @ @ @ @ @ @ @ The Department of Defense , a partner in Operation Warp Speed , already had an overarching OTA with ATI concerning this group .
To expand it for the COVID-19 response was a matter of adding more money and issuing a request for proposals concerning coronavirus vaccines and other COVID-19 items .
`` The federal government came to me and said , you know , you already have all the members ... all the industrial organizations that we would want to complete this work with , '' ATI former Chief Operating Officer Robert Tuohy @ @ @ @ @ @ @ a consultant since stepping down as COO in 2019 .
( The Medical CBRN Defense Consortium added Pfizer and Novavax to its membership , according to an August notice in the Federal Register . )
In a bureaucratic twist , ATI was never explicitly told it was helping with Operation Warp Speed , Tuohy says , calling that fact `` invisible '' to the nonprofit .
`` So the government then asks us to actually run a competition very similar to what the government would run within the membership of the consortia , @ @ @ @ @ @ @ saves the government time and resources .
ATI 's job is to put out a request for proposals , collect the essential information ( which is typically less than what 's required in FAR-based contracts ) , make sure they 're all in the same format and send them to the federal government for evaluation .
Once the federal government makes its decision , ATI issues its own OTAs to the chosen members .
`` Then they hand us the money and ask us to award essentially a sub-OTA to the team that @ @ @ @ @ @ @ the consortium , '' says Tuohy .
The Medical CBRN Defense Consortium was set up about four years ago to do contract work concerning chemical , biological , radiological and nuclear defense `` as related to enhancing the mission effectiveness of military personnel . ''
As a result , Ardizzone wonders if it 's operating too far outside its original scope .
This , she says , could be a sign the intermediary arrangement is `` to just avoid the procedures and regulations that protect the American public in the government contracting process @ @ @ @ @ @ @ established with a flexible mission , adding that OTAs often get a bad rap , but they do n't deserve it .
Even if the contracts do n't include things like the Bayh-Dole protections , he says they often have similar replacement language .
When asked about whether these contracts could be disclosed to the public under public records requests , he said it was up to the government .
ATI could n't point to an example of one of its contracts to consortium members being disclosed this way , but this may @ @ @ @ @ @ @ .
Reporters asked Operation Warp Speed officials about when the contracts would be released to the public during a press briefing on Sept. 16 .
`` With respect to the contracts , the contracts are between ourselves , the United States government and private entities , and they are releasable to an extent .
Obviously everything can not be released , but they are releasable to an extent and they will be made available at some point in time , '' said Lt. Gen. Paul Ostrowski , who directs Operation Warp Speed 's @ @ @ @ @ @ @ .
`` And I will tell you that they entail information that allows us to all know that we paid a fair and reasonable price for each one of these vaccines as we went forward . ''
Feldman , of UC Hastings , says the administration 's comparison of Operation Warp Speed to the Manhattan Project is troubling .
`` I think that 's completely the wrong image , '' she says .
`` The right analogy , I think , for Operation Warp Speed is the penicillin effort in World War II @ @ @ @ @ @ @ to create the entire penicillin industry .
It changed how we treat disease .
It ushered in the era of mass-produced pharmaceuticals .
That 's what I think as the best you could do here .
But it 's a completely different image than Manhattan Project . ''
She says the penicillin effort is proof that public-private partnerships can produce great work .
`` We can do a lot of good together , but we have to make sure pharma companies are n't taking advantage of the crisis , '' she says .
@ @ @ @ @ @ @ some will try .
We know from history — current and past — that some will try . ''

How Operation Warp Speed's Big Vaccine Contracts Could Stay Secret
Enlarge this image toggle caption Drew Angerer/Getty Images Drew Angerer/Getty Images
The Trump administration has compared Operation Warp Speed's crash program to develop a COVID-19 vaccine to the Manhattan Project. And like the notoriously secretive government project to make the first atomic bomb, the details of Operation Warp Speed's work may take a long time to unravel.
One reason is that Operation Warp Speed is issuing billions of dollars' worth of coronavirus vaccine contracts to companies through a nongovernment intermediary, bypassing the regulatory oversight and transparency of traditional federal contracting mechanisms, NPR has learned.
Instead of entering into contracts directly with vaccine makers, more than $6 billion in Operation Warp Speed funding has been routed through a defense contract management firm called Advanced Technologies International, Inc. ATI then awarded contracts to companies working on COVID-19 vaccines.
As a result, the contracts between the pharmaceutical companies and ATI may not be available through public records requests, and additional documents are exempt from public disclosure for five years.
Vaccine contracts awarded this way include $1.6 billion for Novavax, $1.95 billion for Pfizer, $1.79 billion for Sanofi and $1 billion for Johnson & Johnson.
NPR first looked into Operation Warp Speed's approach when our request for one of the contracts under the federal Freedom of Information Act came up empty.
A senior administration official tells NPR the government chose to use the intermediary for Operation Warp Speed contracts "to take advantage of certain acquisition authorities provided by Congress that are available to address situations like the coronavirus pandemic."
Generally, these kinds of agreements allow the government to be more nimble.
Simplifying government bureaucracy during a crisis isn't necessarily a bad thing, says Robin Feldman, a professor at the University of California Hastings College of the Law, who focuses on the pharmaceutical industry and drug policy. But there's a tradeoff when it comes to accountability. "We have to be careful about what we throw out in that process," she says.
Throwing out the contracting bible
Most government contracts are governed by a set of rules called the Federal Acquisition Regulation, or FAR.
"It's really a bible that the government and contractors are supposed to follow with respect to a given acquisition," says attorney Franklin Turner, a partner at McCarter and English, who has been involved with thousands of government contracts in his career. "It is supposed to establish the process from soup to nuts, right from the beginning to the very end of a procurement."
The acquisition regulations contain everything Congress stipulates should "govern the expenditure of taxpayer dollars," from anti-human-trafficking clauses to ethics and company conduct requirements, Turner says. But the resulting process can be time-consuming. Sometimes, it can stretch for years, especially if competitive bidding is involved or a losing company challenges an award through a formal protest process.
So, in special cases, the government has been turning to an alternative mechanism, called an Other Transaction Agreement, or OTA. These agreements got their start in the late 1950s, when NASA was created. The goal was to streamline the contracting process and attract newer, smaller companies and inventors to work with the government that otherwise might not have the resources or willingness to do so.
"I don't think that they operate to relieve liability," Turner says. "They operate, if anything, to streamline the process for a variety of reasons, depending on the acquisition at issue."
But there can be a downside to these agreements.
"A number of analysts warn that along with the potential benefits come significant risks, including potentially diminished oversight and exemption from laws and regulations designed to protect government and taxpayer interests," the Congressional Research Service wrote in a 2019 report about the rising use of OTAs by the Department of Defense. The report also noted that it was unclear whether OTAs are faster than traditional government contracts, because the Department of Defense hasn't tracked that information.
Kathryn Ardizzone, a lawyer at Knowledge Ecology International, examined a handful of early Operation Warp Speed research and development contracts obtained through public records requests to HHS that didn't go through an intermediary. KEI is a nonprofit group that focuses on intellectual property policy.
Many were OTAs that weakened or excluded Bayh-Dole clauses, which, among other things, allow the government to "march in" and take control of a drug or vaccine if a manufacturer that received federal funding engages in price gouging, for example.
Ardizzone and NPR have both, separately, tried to get copies of the later (and larger) procurement contracts through public records requests and so far have been unsuccessful. We requested contracts between the federal government and the pharmaceutical companies — not the intermediary, Advanced Technology International.
In response to NPR's request, HHS said it had "no records" for the $1.6 billion contract with Novavax, indicating that the department leading the way on Operation Warp Speed doesn't have a copy of the contract. NPR has since made the same request of the Department of Defense and is awaiting the response.
"It's not clear that using the Freedom of Information Act, we can access agreements that are maintained by a private entity," Ardizzone says. In that case, we don't know what taxpayer protections the contracts may have left out.
"The stakes are as high as you could ever imagine," Ardizzone says. If the government doesn't have a copy of these records, something she called "shocking but not impossible," it would "add a layer of complexity" to whether the contracts can be disclosed under a public records request.
Repurposing a Defense Department consortium
Advance Technology International manages contracts and facilitates dealings with the government for several consortia of academics, companies and more, using OTAs.
In March and early April, the Department of Defense talked with ATI about a consortium of academics and companies that it manages called the Medical CBRN Defense Consortium, which is tasked with developing medical countermeasures to threats against the military. The Department of Defense, a partner in Operation Warp Speed, already had an overarching OTA with ATI concerning this group. To expand it for the COVID-19 response was a matter of adding more money and issuing a request for proposals concerning coronavirus vaccines and other COVID-19 items.
"The federal government came to me and said, you know, you already have all the members ... all the industrial organizations that we would want to complete this work with," ATI former Chief Operating Officer Robert Tuohy tells NPR. He stayed on as a consultant since stepping down as COO in 2019. (The Medical CBRN Defense Consortium added Pfizer and Novavax to its membership, according to an August notice in the Federal Register.)
In a bureaucratic twist, ATI was never explicitly told it was helping with Operation Warp Speed, Tuohy says, calling that fact "invisible" to the nonprofit.
"So the government then asks us to actually run a competition very similar to what the government would run within the membership of the consortia," he says, adding that it saves the government time and resources. ATI's job is to put out a request for proposals, collect the essential information (which is typically less than what's required in FAR-based contracts), make sure they're all in the same format and send them to the federal government for evaluation. Once the federal government makes its decision, ATI issues its own OTAs to the chosen members.
"Then they hand us the money and ask us to award essentially a sub-OTA to the team that they have selected within the membership of the consortium," says Tuohy.
The Medical CBRN Defense Consortium was set up about four years ago to do contract work concerning chemical, biological, radiological and nuclear defense "as related to enhancing the mission effectiveness of military personnel." As a result, Ardizzone wonders if it's operating too far outside its original scope. This, she says, could be a sign the intermediary arrangement is "to just avoid the procedures and regulations that protect the American public in the government contracting process."
Tuohy says the consortium was established with a flexible mission, adding that OTAs often get a bad rap, but they don't deserve it. Even if the contracts don't include things like the Bayh-Dole protections, he says they often have similar replacement language. When asked about whether these contracts could be disclosed to the public under public records requests, he said it was up to the government. ATI couldn't point to an example of one of its contracts to consortium members being disclosed this way, but this may have happened without it being made aware.
Reporters asked Operation Warp Speed officials about when the contracts would be released to the public during a press briefing on Sept. 16.
"With respect to the contracts, the contracts are between ourselves, the United States government and private entities, and they are releasable to an extent. Obviously everything cannot be released, but they are releasable to an extent and they will be made available at some point in time," said Lt. Gen. Paul Ostrowski, who directs Operation Warp Speed's efforts on supply, production and distribution. "And I will tell you that they entail information that allows us to all know that we paid a fair and reasonable price for each one of these vaccines as we went forward."
Feldman, of UC Hastings, says the administration's comparison of Operation Warp Speed to the Manhattan Project is troubling.
"I think that's completely the wrong image," she says. "The right analogy, I think, for Operation Warp Speed is the penicillin effort in World War II. So there, the nation mobilized to create the entire penicillin industry. It changed how we treat disease. It ushered in the era of mass-produced pharmaceuticals. That's what I think as the best you could do here. But it's a completely different image than Manhattan Project."
She says the penicillin effort is proof that public-private partnerships can produce great work.
"We can do a lot of good together, but we have to make sure pharma companies aren't taking advantage of the crisis," she says. "And we know from history that some will try. We know from history — current and past — that some will try."
You can contact NPR pharmaceuticals correspondent Sydney Lupkin at slupkin@npr.org.


npr--2020-09-29--Biden, Harris Release 2019 Tax Returns Hours Before The First Debate

Biden , Harris Release 2019 Tax Returns Hours Before The First Debate Two days after The New York Times published reporting on several years of President Trump 's recent tax returns , Democratic nominee Joe Biden released his 2019 return and financial disclosures .
The 2019 tax return from Biden and his wife , Jill , shows taxable income of $ 944,737 and a federal tax bill of $ 299,346 .
Their 2019 financial disclosure shows about $ 250,000 in income from book deals , speeches and the University of Pennsylvania , where Biden 's a professor .
The disclosure @ @ @ @ @ @ @ .
Biden released the return and disclosure just hours before the first presidential debate , where Trump is expected to face questions over his tax returns .
In a call with reporters Tuesday , the Biden campaign said the former vice president has now released 22 years of tax returns .
Biden 's running mate , Sen. Kamala Harris , and her husband , Doug Emhoff , also released their 2019 tax return and financial disclosure Tuesday , marking 15 years of Harris ' returns now available to the public .
Harris and @ @ @ @ @ @ @ and paid $ 1,185,628 in taxes .
Trump has notably refused to release his tax returns , breaking precedent that decades of major party presidential nominees have followed .
The president has said he will release his tax returns when he 's no longer under audit , though an audit does not prevent the president from releasing his records .
The New York Times reported that Trump 's tax returns show millions in losses and that Trump only paid $ 750 in income tax in 2016 and 2017 , and in 10 of @ @ @ @ @ @ @ tax at all .
It also raised questions about questionable tax deductions made by Trump that could run afoul of tax law .
The president called the reporting `` fake news '' during a Sunday news conference .
Biden will likely raise the revelations about the president 's taxes during the debate Tuesday night .
`` Donald Trump thinks that the vast majority of hardworking Americans who pay their taxes are suckers , '' Biden deputy campaign manager Kate Bedingfield told reporters Tuesday .
`` President Trump only sees the world from Park @ @ @ @ @ @ @ stock market but looks down on workers and middle-class families struggling to get by . ''

Biden, Harris Release 2019 Tax Returns Hours Before The First Debate
Enlarge this image toggle caption Carolyn Kaster/AP Carolyn Kaster/AP
Two days after The New York Times published reporting on several years of President Trump's recent tax returns, Democratic nominee Joe Biden released his 2019 return and financial disclosures.
The 2019 tax return from Biden and his wife, Jill, shows taxable income of $944,737 and a federal tax bill of $299,346. Their 2019 financial disclosure shows about $250,000 in income from book deals, speeches and the University of Pennsylvania, where Biden's a professor. The disclosure shows less than $100,000 in debt.
Biden released the return and disclosure just hours before the first presidential debate, where Trump is expected to face questions over his tax returns. In a call with reporters Tuesday, the Biden campaign said the former vice president has now released 22 years of tax returns.
Biden's running mate, Sen. Kamala Harris, and her husband, Doug Emhoff, also released their 2019 tax return and financial disclosure Tuesday, marking 15 years of Harris' returns now available to the public. Harris and Emhoff reported $3,018,127 in taxable income and paid $1,185,628 in taxes.
Trump has notably refused to release his tax returns, breaking precedent that decades of major party presidential nominees have followed. The president has said he will release his tax returns when he's no longer under audit, though an audit does not prevent the president from releasing his records.
The New York Times reported that Trump's tax returns show millions in losses and that Trump only paid $750 in income tax in 2016 and 2017, and in 10 of the last 15 years paid no income tax at all. It also raised questions about questionable tax deductions made by Trump that could run afoul of tax law. The president called the reporting "fake news" during a Sunday news conference.
Biden will likely raise the revelations about the president's taxes during the debate Tuesday night.
"Donald Trump thinks that the vast majority of hardworking Americans who pay their taxes are suckers," Biden deputy campaign manager Kate Bedingfield told reporters Tuesday. "President Trump only sees the world from Park Avenue. He looks out for the stock market but looks down on workers and middle-class families struggling to get by."


npr--2020-09-29--Rochester Hospital Released Daniel Prude Hours Before Fatal Encounter With Police

When Joe Prude called Rochester , New York , police to report his brother missing , he was struggling to understand why Daniel Prude had been released from the hospital hours earlier .
Joe Prude described his brother 's suicidal behavior .
`` He jumped 21 stairs down to my basement , headfirst , '' Joe says in the early hours of March 23 , in a video recorded by the responding officer 's body camera .
Joe 's wife , Valerie , described Daniel nearly jumping in front of a train the previous day , on the tracks that @ @ @ @ @ @ @ train missed him by this much , '' Joe says , holding his thumb and pointer finger a few inches apart .
`` When the doctor called me and told me that they released him , I 'm saying , 'How you going to sit here and tell me you 're going to release him when he was hurting himself ?
Come on .
You were n't sworn to do that , ' '' he says on the body camera footage .
At that point in the recorded conversation , it was just @ @ @ @ @ @ @ knew only that Daniel was missing , delusional and vulnerable .
They did n't know his next encounter with the police would be fatal .
Police would find Daniel minutes later ― naked , acting irrationally .
Because he spat in the direction of officers and allegedly said he had the novel coronavirus , officers placed a white hood , called a `` spit hood , '' over his head .
When he started trying to stand up , despite being restrained by handcuffs , an officer placed much of his body weight @ @ @ @ @ @ @ into the pavement .
Daniel died a week later when his family took him off life support .
The county medical examiner 's autopsy described his death as a homicide and listed the immediate cause of death as `` complications of asphyxia in the setting of physical restraint . ''
After the police footage was released in early September , the incident garnered widespread attention as another example of a Black man killed after an encounter with police .
Less attention has been paid to what happened to Daniel Prude in the preceding @ @ @ @ @ @ @ released after a psychiatric assessment at Strong Memorial Hospital , run by the University of Rochester Medical Center .
On March 22 , Joe Prude had called police at about 7 p.m. because he needed help getting Daniel to the hospital .
Daniel had been having problems with a PCP addiction , Joe told officers .
Now he had begun telling Joe and Valerie that people were out to get him , and he wanted to die .
By about 11 p.m. that night , Daniel was released from the hospital , according @ @ @ @ @ @ @ He was calm as hell when he got back here , '' Joe told police .
`` He was fine for a little bit , then all of a sudden started acting crazy , '' Joe said .
He told police later that Daniel asked him for a cigarette , and when he went to get one , Daniel took off running .
He was barefoot , wearing only a tank top and long johns in 30 degree weather .
`` He was gone .
Track star status .
Hauled ass like Carl @ @ @ @ @ @ @ 3 a.m. , four hours after his release from the hospital , emergency dispatchers started fielding calls about Daniel Prude .
His brother called to report him missing , and a tow truck driver had spotted him , naked and bloodied , on West Main Street , police records show .
Police body camera footage shows that by 3:20 a.m. , officer Mark Vaughn was pressing Daniel Prude 's head into the pavement .
While he was restrained , Prude 's breathing stopped .
An ambulance crew resuscitated him , but he was @ @ @ @ @ @ @ damaged after being deprived of oxygen .
He died a week later at Strong Memorial after being taken off life support .
The University of Rochester Medical Center said patient privacy laws bar it from discussing the specifics of Prude 's treatment and release , according to spokesperson Chip Partner .
But in general , Partner added , the hospital is bound by a New York state law that requires patients to be released within 24 hours unless they have a mental illness that is likely to result in serious harm to themselves @ @ @ @ @ @ @ observation , care and hospital treatment .
The details of Prude 's encounters with law enforcement and the health care system offer a look into the practice of emergency psychiatry , and how , as in many branches of medicine in the U.S. , mistakes in that field are disproportionately borne by Black people .
Medical decisions in a case like Daniel Prude 's are high-stakes , with little margin for error , says Dr. Ken Duckworth , chief medical officer of the National Alliance on Mental Illness ( NAMI ) .
`` @ @ @ @ @ @ @ and the potential for catastrophic outcomes following your decision is very real , '' he says .
The hospital where Prude died has faced scrutiny over its treatment of psychiatric patients and discharge procedures before .
In April 2018 , federal inspectors found security officers at the hospital had used law enforcement restraint techniques against a pediatric psychiatry patient , breaking her arm and sending her to the emergency room .
Months later , inspectors found the hospital discharged a patient who was in the emergency room with a history of dementia and @ @ @ @ @ @ @ in her address between her medical record and the information she gave hospital staff .
In early 2016 , inspectors found that hospital staff had placed patients in ankle and wrist restraints without an order to do so , and placed another patient in restraints without documenting when the restraints were released .
Restraints are meant to be used only with a physician 's order , and federal rules require precise documentation of their use .
None of these incidents at Strong Memorial Hospital garnered media attention at the time they happened or @ @ @ @ @ @ @ public .
Hospital spokesperson Chip Partner says that immediately after the April 2018 inspection , the hospital changed its public safety protocol , eliminating the use of law enforcement techniques to manage a violent patient unless that patient is being arrested .
In addition , updated staff training and discharge protocols for psychiatric incidents now decrease the risk of discharging someone who is not ready to be released , Partner says .
`` These protocols were well established in 2020 and had absolutely no bearing on the evaluation or treatment of Daniel Prude @ @ @ @ @ @ @ case is unusual because the consequences of doctors ' decision to release him have played out so publicly , says NAMI 's Duckworth .
Usually , emergency room psychiatrists never find out what happens to their patients .
`` You make a very big decision , which usually has no known outcome .
You put this person in the hospital , you go on to the next patient .
You send this person home , you go on to the next patient , '' he explains .
Duckworth adds that he would not @ @ @ @ @ @ @ team in the moment , but with the benefit of hindsight , `` there 's overwhelming evidence that he had a psychotic illness and was quite vulnerable , '' he says .
`` He did n't need to die . ''
In a statement , URMC said its treatment of Prude was `` medically appropriate and compassionate . ''
The Joint Commission , which certifies hospitals to receive federal funding , said it 's reviewing Prude 's treatment at Strong .
New York state 's Justice Center is investigating on behalf of the @ @ @ @ @ @ @ university medical center itself is still conducting an internal clinical review .
Dr. Altha Stewart , past president of the American Psychiatric Association , says unconscious bias can cloud clinicians ' judgment and make it difficult for them to make the best possible decisions for their patients .
`` It is very clear that in today 's health care system , bias is built in structurally , '' Stewart says .
`` Seeing a tall , imposing Black man who is behaving aggressively puts in place a series of ideas and thoughts and @ @ @ @ @ @ @ disorders in Black patients are less likely to be taken seriously than in white patients , Stewart says .
The unequal treatment starts early .
Black boys are viewed as adults more often than white boys of the same age , says Stewart , who is also the director of the Center for Health in Justice Involved Youth at the University of Tennessee .
`` So a Black child with a meltdown is described as aggressive , obstinate , oppositional , '' she says , `` as opposed to traumatized , depressed , @ @ @ @ @ @ @ boys through adulthood and in the health care system , increasing the odds that doctors will view Black men as a lost cause and provide subpar care , Stewart says .
She stressed that she does not have any direct knowledge of deficiencies in the care of Daniel Prude , but she says that Black men , like Prude , are disproportionately likely to be misdiagnosed , mistreated and written off as a result of structural bias and unconscious racism .
In response to questions from NPR and Kaiser Health News about whether @ @ @ @ @ @ @ have been affected by his race , Partner says the medical center decided to ask Dr. Stewart `` to conduct a third-party independent review through her lens as a national expert on racism and bias in psychiatric care . ''
A group of medical students at the University of Rochester wrote in an open letter that Daniel Prude was `` sentenced to death by our failed healthcare system . ''
`` Not only do our current models of healthcare leave gaping holes for individuals such as Daniel to fall through , but they @ @ @ @ @ @ @ with racism , '' the students wrote .
Partner , the medical center spokesperson , said the psychiatry department 's Office of Diversity , Inclusion , Culture and Equity will evaluate Daniel 's treatment for potential bias .
He says the medical center `` recognizes that we have a long way to go before we can confidently say that our policies and practices are universally culturally appropriate to the populations we serve . ''
Both Stewart and Duckworth say that reducing the role of police in addressing mental health crises would increase the @ @ @ @ @ @ @ too early from psychiatric care .
Federal inspection reports show that hospitals across the country have released patients who , like Prude , ended up in grave danger only shortly thereafter .
• In March 2018 , a patient with a history of schizophrenia , post-traumatic stress disorder and suicide attempts arrived at Russell County Hospital in Kentucky complaining of alcohol withdrawal , depression , anxiety and pain .
An hour and a half later , the patient was discharged with instructions to `` follow up with his/her primary care provider and take @ @ @ @ @ @ @ later , the patient was back in the same hospital .
A physician 's notes said the patient had drunk a bottle of Benadryl `` in effort to kill self . ''
• In August 2018 , federal inspectors found that UT Health Pittsburg , a hospital in east Texas , discharged a patient who had verbalized a plan for suicide .
The patient got a ride to his truck from the county sheriff .
Later that day , the patient was found dead in the truck from a self-inflicted gunshot wound .
@ @ @ @ @ @ @ in Kansas , a patient arrived in the emergency room saying she had drunk half a liter of vodka because she was upset and wanted to die .
She told hospital staff that she started drinking that day after two years of sobriety and that she `` did not feel safe to go home due to the presence of alcohol . ''
The hospital discharged her 11 minutes later .
• Earlier this year , inspectors found that a patient with a history of psychosis went to the emergency room at Mercy Hospital @ @ @ @ @ @ @ needed to get back on her medication .
She was delusional , disoriented , homeless and unable to give her name .
She was discharged with a voucher for cab fare but no follow-up appointments or services and no plan to ensure she got her medication .
A spokesperson for UT Health East Texas said the health system has since implemented a process for staff to more thoroughly document mental health concerns in patient records .
Mercy Hospital in St. Louis said it takes the health and safety of each patient very seriously @ @ @ @ @ @ @ ability to pay . ''
Neither of the other hospitals responded to emails or calls seeking comment .
This story comes from NPR 's reporting partnership with Kaiser Health News .

Rochester Hospital Released Daniel Prude Hours Before Fatal Encounter With Police
Enlarge this image toggle caption Ted Shaffrey/AP Ted Shaffrey/AP
When Joe Prude called Rochester, New York, police to report his brother missing, he was struggling to understand why Daniel Prude had been released from the hospital hours earlier. Joe Prude described his brother's suicidal behavior.
"He jumped 21 stairs down to my basement, headfirst," Joe says in the early hours of March 23, in a video recorded by the responding officer's body camera. Joe's wife, Valerie, described Daniel nearly jumping in front of a train the previous day, on the tracks that run behind their house.
"The train missed him by this much," Joe says, holding his thumb and pointer finger a few inches apart.
"When the doctor called me and told me that they released him, I'm saying, 'How you going to sit here and tell me you're going to release him when he was hurting himself? Come on. You weren't sworn to do that,'" he says on the body camera footage.
At that point in the recorded conversation, it was just after 3 a.m. Joe and Valerie Prude knew only that Daniel was missing, delusional and vulnerable. They didn't know his next encounter with the police would be fatal.
Police would find Daniel minutes later ― naked, acting irrationally. Because he spat in the direction of officers and allegedly said he had the novel coronavirus, officers placed a white hood, called a "spit hood," over his head. When he started trying to stand up, despite being restrained by handcuffs, an officer placed much of his body weight over Daniel's head and pushed it into the pavement.
Daniel died a week later when his family took him off life support. The county medical examiner's autopsy described his death as a homicide and listed the immediate cause of death as "complications of asphyxia in the setting of physical restraint." After the police footage was released in early September, the incident garnered widespread attention as another example of a Black man killed after an encounter with police.
Less attention has been paid to what happened to Daniel Prude in the preceding hours, when he was treated and released after a psychiatric assessment at Strong Memorial Hospital, run by the University of Rochester Medical Center.
On March 22, Joe Prude had called police at about 7 p.m. because he needed help getting Daniel to the hospital. Daniel had been having problems with a PCP addiction, Joe told officers. Now he had begun telling Joe and Valerie that people were out to get him, and he wanted to die.
By about 11 p.m. that night, Daniel was released from the hospital, according to Joe and police records. "He was calm as hell when he got back here," Joe told police.
That didn't last.
"He was fine for a little bit, then all of a sudden started acting crazy," Joe said. He told police later that Daniel asked him for a cigarette, and when he went to get one, Daniel took off running. He was barefoot, wearing only a tank top and long johns in 30 degree weather.
"He was gone. Track star status. Hauled ass like Carl Lewis," Joe said.
Around 3 a.m., four hours after his release from the hospital, emergency dispatchers started fielding calls about Daniel Prude. His brother called to report him missing, and a tow truck driver had spotted him, naked and bloodied, on West Main Street, police records show.
Police body camera footage shows that by 3:20 a.m., officer Mark Vaughn was pressing Daniel Prude's head into the pavement.
While he was restrained, Prude's breathing stopped. An ambulance crew resuscitated him, but he was in critical condition. His brain was damaged after being deprived of oxygen. He died a week later at Strong Memorial after being taken off life support.
The University of Rochester Medical Center said patient privacy laws bar it from discussing the specifics of Prude's treatment and release, according to spokesperson Chip Partner. But in general, Partner added, the hospital is bound by a New York state law that requires patients to be released within 24 hours unless they have a mental illness that is likely to result in serious harm to themselves or others, and that requires immediate observation, care and hospital treatment.
The details of Prude's encounters with law enforcement and the health care system offer a look into the practice of emergency psychiatry, and how, as in many branches of medicine in the U.S., mistakes in that field are disproportionately borne by Black people.
Medical decisions in a case like Daniel Prude's are high-stakes, with little margin for error, says Dr. Ken Duckworth, chief medical officer of the National Alliance on Mental Illness (NAMI).
"Emergency psychiatric assessment is very challenging, and the potential for catastrophic outcomes following your decision is very real," he says.
The hospital where Prude died has faced scrutiny over its treatment of psychiatric patients and discharge procedures before.
toggle caption Roth and Roth LLP via AP, File
In April 2018, federal inspectors found security officers at the hospital had used law enforcement restraint techniques against a pediatric psychiatry patient, breaking her arm and sending her to the emergency room.
Months later, inspectors found the hospital discharged a patient who was in the emergency room with a history of dementia and multiple medical problems — despite a discrepancy in her address between her medical record and the information she gave hospital staff.
In early 2016, inspectors found that hospital staff had placed patients in ankle and wrist restraints without an order to do so, and placed another patient in restraints without documenting when the restraints were released. Restraints are meant to be used only with a physician's order, and federal rules require precise documentation of their use.
None of these incidents at Strong Memorial Hospital garnered media attention at the time they happened or at the time the reports were made public.
Hospital spokesperson Chip Partner says that immediately after the April 2018 inspection, the hospital changed its public safety protocol, eliminating the use of law enforcement techniques to manage a violent patient unless that patient is being arrested.
In addition, updated staff training and discharge protocols for psychiatric incidents now decrease the risk of discharging someone who is not ready to be released, Partner says. "These protocols were well established in 2020 and had absolutely no bearing on the evaluation or treatment of Daniel Prude on March 22."
Prude's case is unusual because the consequences of doctors' decision to release him have played out so publicly, says NAMI's Duckworth. Usually, emergency room psychiatrists never find out what happens to their patients.
"You make a very big decision, which usually has no known outcome. You put this person in the hospital, you go on to the next patient. You send this person home, you go on to the next patient," he explains.
Duckworth adds that he would not second-guess the actions of Prude's hospital team in the moment, but with the benefit of hindsight, "there's overwhelming evidence that he had a psychotic illness and was quite vulnerable," he says. "He didn't need to die."
In a statement, URMC said its treatment of Prude was "medically appropriate and compassionate."
Several oversight organizations are investigating.
The Joint Commission, which certifies hospitals to receive federal funding, said it's reviewing Prude's treatment at Strong. New York state's Justice Center, which investigates incidents in psychiatric facilities, is also investigating.
The university medical center itself is still conducting an internal clinical review.
Dr. Altha Stewart, past president of the American Psychiatric Association, says unconscious bias can cloud clinicians' judgment and make it difficult for them to make the best possible decisions for their patients.
"It is very clear that in today's health care system, bias is built in structurally," Stewart says. "Seeing a tall, imposing Black man who is behaving aggressively puts in place a series of ideas and thoughts and assumptions that direct decision-making."
Psychiatric disorders in Black patients are less likely to be taken seriously than in white patients, Stewart says. The unequal treatment starts early.
toggle caption Lindsay DeDario/Reuters
Black boys are viewed as adults more often than white boys of the same age, says Stewart, who is also the director of the Center for Health in Justice Involved Youth at the University of Tennessee.
"So a Black child with a meltdown is described as aggressive, obstinate, oppositional," she says, "as opposed to traumatized, depressed, anxious."
Those expectations follow Black boys through adulthood and in the health care system, increasing the odds that doctors will view Black men as a lost cause and provide subpar care, Stewart says.
She stressed that she does not have any direct knowledge of deficiencies in the care of Daniel Prude, but she said that Black men, like Prude, are disproportionately likely to be misdiagnosed, mistreated and written off as a result of structural bias and unconscious racism.
Partner, the medical center spokesperson, said the psychiatry department's Office of Diversity, Inclusion, Culture and Equity will evaluate Daniel's treatment for potential bias. He said the medical center "recognizes that we have a long way to go before we can confidently say that our policies and practices are universally culturally appropriate to the populations we serve."
A group of medical students at the University of Rochester wrote in an open letter that Daniel Prude was "sentenced to death by our failed healthcare system."
"Not only do our current models of healthcare leave gaping holes for individuals such as Daniel to fall through, but they do so in manners which are fraught with racism," the students wrote.
Medical center administrators acknowledged "systemic gaps in how our community cares for people in crisis" and said they are cooperating with all of the investigations underway to determine "what we can learn from this terrible event."
Both Stewart and Duckworth say that reducing the role of police in addressing mental health crises would increase the odds of survival for a person released too early from psychiatric care.
toggle caption Joshua Rashaad McFadden/Getty Images
Federal inspection reports show that hospitals across the country have released patients who, like Prude, ended up in grave danger only shortly thereafter.
In March 2018, a patient with a history of schizophrenia, post-traumatic stress disorder and suicide attempts arrived at Russell County Hospital in Kentucky complaining of alcohol withdrawal, depression, anxiety and pain. An hour and a half later, the patient was discharged with instructions to "follow up with his/her primary care provider and take medications as prescribed." Two hours later, the patient was back in the same hospital. A physician's notes said the patient had drunk a bottle of Benadryl "in effort to kill self."
In August 2018, federal inspectors found that UT Health Pittsburg, a hospital in east Texas, discharged a patient who had verbalized a plan for suicide. The patient got a ride to his truck from the county sheriff. Later that day, the patient was found dead in the truck from a self-inflicted gunshot wound.
Last summer at Stafford County Hospital in Kansas, a patient arrived in the emergency room saying she had drunk half a liter of vodka because she was upset and wanted to die. She told hospital staff that she started drinking that day after two years of sobriety and that she "did not feel safe to go home due to the presence of alcohol." The hospital discharged her 11 minutes later.
Earlier this year, inspectors found that a patient with a history of psychosis went to the emergency room at Mercy Hospital in St. Louis and told staff she needed to get back on her medication. She was delusional, disoriented, homeless and unable to give her name. She was discharged with a voucher for cab fare but no follow-up appointments or services and no plan to ensure she got her medication.
A spokesperson for UT Health East Texas said the health system has since implemented a process for staff to more thoroughly document mental health concerns in patient records. Mercy Hospital in St. Louis said it takes the health and safety of each patient very seriously "regardless of race, ethnicity or ability to pay."
Neither of the other hospitals responded to emails or calls seeking comment.
This story comes from NPR's reporting partnership with Kaiser Health News.


npr--2020-09-29--California Fires: 3 More People Killed As Blazes Rage In Wine Country

California Fires : 3 More People Killed As Blazes Rage In Wine Country Firefighters are battling multiple fast-spreading wildfires in Northern California , including the heart of the state 's wine country , as authorities say at least three civilians have been killed by the Zogg Fire in Shasta County .
At a Tuesday afternoon news conference , Daniel Berlant with the California Department of Forestry and Fire Protection , or Cal Fire , said that firefighters responded to 19 new wildfires throughout the state Monday .
Berlant also said that the August Complex Fire continues to be the largest @ @ @ @ @ @ @ grew significantly yesterday to 938,000 acres '' — almost 60,000 acres ( more than 90 square miles ) in a single day .
Firefighters are struggling to contain the wind-driven blaze , he said .
Gusty winds on Monday helped two major fires — Zogg and Glass — to multiply in size .
By Tuesday morning , California fire authorities said the winds had decreased overnight , raising hopes they would be able to make progress in containing the blazes .
The Zogg Fire in Shasta County and the Glass Fire , which @ @ @ @ @ @ @ both started on Sunday .
As of late Tuesday morning local time , both are 0 % contained .
In Napa , authorities have imposed a mandatory evacuation order due to the Glass Fire for the city of Calistoga , which has a population of about 5,000 .
Some 60,000 residents in Napa and Sonoma counties are under evacuation orders or advisories , according to Reuters .
As of Tuesday afternoon , the Glass Fire has destroyed at least 94 structures , according to Cal Fire , in an area known for picturesque @ @ @ @ @ @ @ almost quadrupled in size since Monday , growing from about 11,000 acres to more than 42,000 on Tuesday .
The Zogg Fire in Shasta County , near California 's northern border , has grown even faster .
On Monday , it covered some 7,000 acres .
On Tuesday , it covered more than 40,000 acres .
Since Sunday , it has destroyed nearly 150 structures .
The causes of both the Glass and Zogg fires are under investigation , according to Cal Fire .
Since mid-August , 29 people have died in California @ @ @ @ @ @ @ including the three fatalities from the Zogg Fire .
Temperatures on Tuesday are 15 to 20 degrees cooler than the previous day along the Northern California coast , but the National Weather Service warns that inland areas will remain warm to hot through much of the week .
The weather service has issued a red flag warning for parts of Southern California .
On Monday , California Gov .
Gavin Newsom declared a state of emergency in Napa , Sonoma and Shasta counties due to the Glass and Zogg fires .
For the @ @ @ @ @ @ @ governor sent President Trump a letter requesting a presidential major disaster declaration to assist state and local wildfire response and recovery efforts .
The first request was approved .
The governor said a `` substantial '' number of structures had been destroyed in these latest fires , including wineries .
So far , California has experienced more than 8,100 fires this season .
Cal Fire reported that more than 3.8 million acres have burned .
`` California has broken almost every record there is to break , and continues to see increased wildfire @ @ @ @ @ @ @ .

California Fires: 3 More People Killed As Blazes Rage In Wine Country
Enlarge this image toggle caption Noah Berger/AP Noah Berger/AP
Updated at 4 p.m. ET
Firefighters are battling multiple fast-spreading wildfires in Northern California, including the heart of the state's wine country, as authorities say at least three civilians have been killed by the Zogg Fire in Shasta County.
At a Tuesday afternoon news conference, Daniel Berlant with the California Department of Forestry and Fire Protection, or Cal Fire, said that firefighters responded to 19 new wildfires throughout the state Monday.
Berlant also said that the August Complex Fire continues to be the largest in the state and that "it grew significantly yesterday to 938,000 acres" — almost 60,000 acres (more than 90 square miles) in a single day. Firefighters are struggling to contain the wind-driven blaze, he said.
Gusty winds on Monday helped two major fires — Zogg and Glass — to multiply in size. By Tuesday morning, California fire authorities said the winds had decreased overnight, raising hopes they would be able to make progress in containing the blazes.
The Zogg Fire in Shasta County and the Glass Fire, which has hit Napa and Sonoma counties, both started on Sunday. As of late Tuesday morning local time, both are 0% contained.
In Napa, authorities have imposed a mandatory evacuation order due to the Glass Fire for the city of Calistoga, which has a population of about 5,000. Some 60,000 residents in Napa and Sonoma counties are under evacuation orders or advisories, according to Reuters.
As of Tuesday afternoon, the Glass Fire has destroyed at least 94 structures, according to Cal Fire, in an area known for picturesque wineries and rolling hills. It has almost quadrupled in size since Monday, growing from about 11,000 acres to more than 42,000 on Tuesday.
The Zogg Fire in Shasta County, near California's northern border, has grown even faster. On Monday, it covered some 7,000 acres. On Tuesday, it covered more than 40,000 acres. Since Sunday, it has destroyed nearly 150 structures.
The causes of both the Glass and Zogg fires are under investigation, according to Cal Fire.
Since mid-August, 29 people have died in California as a result of the fires, including the three fatalities from the Zogg Fire.
Temperatures on Tuesday are 15 to 20 degrees cooler than the previous day along the Northern California coast, but the National Weather Service warns that inland areas will remain warm to hot through much of the week. The weather service has issued a red flag warning for parts of Southern California.
On Monday, California Gov. Gavin Newsom declared a state of emergency in Napa, Sonoma and Shasta counties due to the Glass and Zogg fires.
For the second time this wildfire season, the governor sent President Trump a letter requesting a presidential major disaster declaration to assist state and local wildfire response and recovery efforts. The first request was approved.
The governor said a "substantial" number of structures had been destroyed in these latest fires, including wineries.
So far, California has experienced more than 8,100 fires this season. Cal Fire reported that more than 3.8 million acres have burned.
"California has broken almost every record there is to break, and continues to see increased wildfire activity," Cal Fire said Tuesday.


npr--2020-09-29--Kuwait's Emir, Sheikh Sabah Al-Ahmad Al-Sabah, Dies At 91

The ruler of Kuwait , Sheikh Sabah al-Ahmad al-Sabah , has died at the age of 91 .
Born in an era when the tiny Gulf emirate 's economy relied on pearl diving , his life spanned the discovery of oil and Kuwait 's emergence as one of the world 's richest countries .
Sheikh Sabah spent four decades as Kuwait 's foreign minister before becoming emir in 2006 .
He navigated relations with the U.S.-led coalition that drove Iraqi forces out of Kuwait after Saddam Hussein 's 1990 invasion of the emirate .
A proponent of having U.S. forces @ @ @ @ @ @ @ he encouraged the establishment of American military bases there , including in Kuwait , where more than 13,000 U.S. troops are stationed .
Sheikh Sabah was also known as a master diplomat who tried to mediate disputes in the volatile region .
After the 2003 U.S. invasion of Iraq — despite widespread antipathy by most Sunni Muslim Gulf countries to the country 's Shiite-led government — Sabah spearheaded the normalization of ties with Baghdad .
The move , including his visits to Iraq , helped lead to reconciliation between Iraq and other Gulf @ @ @ @ @ @ @ hosted a summit aimed at funding the rebuilding of Iraq after its battles against ISIS .
He also made raising funds for the reconstruction of war-torn Syria a priority .
In recent years , Sheikh Sabah also tried to mediate a bitter dispute between Qatar and other Gulf states .
Within Kuwait , he also struggled with the fallout of the 2011 Arab Spring protests calling for an end to the old regimes and for more freedoms .
An official from the Royal Court , Sheikh Ali Jarrah al-Sabah announced the emir 's @ @ @ @ @ @ @ a statement he held with shaking hands and saying Sheikh Sabah had 'moved to the realm of the lord ' .
He did not give the cause of death .
In July , in an unusual move for a foreign leader , a U.S. Air Force C-17 medically evacuated the Kuwaiti ruler to the U.S. , where he was admitted to the Mayo Clinic in Rochester , Minn. An official source in Jordan , who asked not to be identified because Kuwait had not yet announced the news , said the emir had @ @ @ @ @ @ @ body was expected to arrive in Kuwait by Wednesday .
`` Today we lost a big brother and a wise and loving leader ... who spared no effort for Arab unity , '' Jordan 's King Abdullah said on Twitter .
Former White House Middle East envoy Brett McGurk tweeted that the emir had been a peacemaker as well as a good friend of the U.S. : `` His role in the early days building the coalition against ISIS was essential .
He always strived to bring people together . ''
The emir @ @ @ @ @ @ @ and crown prince , Sheikh Nawaf al-Ahmad al-Sabah .
Sheikh Nawaf is not expected to usher in any dramatic change to oil or foreign policy .
Unusually in a region where multiple wives and dozens of children are expected of an Arab ruler , Sheikh Sabah was a long-time widower who did not remarry .
He is survived by two sons and predeceased by a daughter who died of cancer in 2002 .

Kuwait's Emir, Sheikh Sabah Al-Ahmad Al-Sabah, Dies At 91
Enlarge this image toggle caption Amr Nabil/AP Amr Nabil/AP
The ruler of Kuwait, Sheikh Sabah al-Ahmad al-Sabah, has died at the age of 91. Born in an era when the tiny Gulf emirate's economy relied on pearl diving, his life spanned the discovery of oil and Kuwait's emergence as one of the world's richest countries.
Kuwaiti state television announced the emir's death Tuesday after playing Quranic prayers.
Sheikh Sabah spent four decades as Kuwait's foreign minister before becoming emir in 2006. He navigated relations with the U.S.-led coalition that drove Iraqi forces out of Kuwait after Saddam Hussein's 1990 invasion of the emirate.
A proponent of having U.S. forces in the deeply conservative Gulf region, he encouraged the establishment of American military bases there, including in Kuwait, where more than 13,000 U.S. troops are stationed.
Sheikh Sabah was also known as a master diplomat who tried to mediate disputes in the volatile region. After the 2003 U.S. invasion of Iraq — despite widespread antipathy by most Sunni Muslim Gulf countries to the country's Shiite-led government — Sabah spearheaded the normalization of ties with Baghdad. The move, including his visits to Iraq, helped lead to reconciliation between Iraq and other Gulf states. Two years ago, he hosted a summit aimed at funding the rebuilding of Iraq after its battles against ISIS. He also made raising funds for the reconstruction of war-torn Syria a priority.
In recent years, Sheikh Sabah also tried to mediate a bitter dispute between Qatar and other Gulf states. Within Kuwait, he also struggled with the fallout of the 2011 Arab Spring protests calling for an end to the old regimes and for more freedoms.
An official from the Royal Court, Sheikh Ali Jarrah al-Sabah announced the emir's death on state TV, reading from a statement he held with shaking hands and saying Sheikh Sabah had 'moved to the realm of the lord'. He did not give the cause of death.
In July, in an unusual move for a foreign leader, a U.S. Air Force C-17 medically evacuated the Kuwaiti ruler to the U.S., where he was admitted to the Mayo Clinic in Rochester, Minn. An official source in Jordan, who asked not to be identified because Kuwait had not yet announced the news, said the emir had died in the United States. His body was expected to arrive in Kuwait by Wednesday.
"Today we lost a big brother and a wise and loving leader ... who spared no effort for Arab unity," Jordan's King Abdullah said on Twitter.
Former White House Middle East envoy Brett McGurk tweeted that the emir had been a peacemaker as well as a good friend of the U.S.: "His role in the early days building the coalition against ISIS was essential. He always strived to bring people together."
The emir's designated successor is his 83-year-old brother and crown prince, Sheikh Nawaf al-Ahmad al-Sabah. Sheikh Nawaf is not expected to usher in any dramatic change to oil or foreign policy.
Unusually in a region where multiple wives and dozens of children are expected of an Arab ruler, Sheikh Sabah was a long-time widower who did not remarry. He is survived by two sons and predeceased by a daughter who died of cancer in 2002.


npr--2020-09-29--'Russia Doesn't Have To Make Fake News': Biggest Election Threat Is Closer To Home

'Russia Does n't Have To Make Fake News ' : Biggest Election Threat Is Closer To Home National security officials say the Kremlin is at it again : Just like in 2016 , Russia is using social media to try to undermine the U.S. presidential election , only with even more sophisticated tools .
But this time around , Russia may not have to try so hard .
Social media companies and outside experts say in 2020 , the biggest threats to the election may be coming from Americans in the form of possible violence , mistruths about mail-in balloting @ @ @ @ @ @ @ possibly delayed election results — not to mention a president who has repeatedly questioned the legitimacy of the vote .
`` In some ways , the people who know the most about how to mislead Americans are other Americans , '' said Yoel Roth , Twitter 's head of site integrity .
NPR national security correspondent Greg Myre and NPR technology correspondent Shannon Bond break down some of the key questions : Q .
Where are the biggest foreign threats coming from ?
Greg Myre : National security officials and analysts who study @ @ @ @ @ @ @ the main foreign threat , and by a long shot .
China and Iran are also trying to influence the election but at a much lower level .
The Russians have been attempting to interfere for many years , and their approach keeps evolving .
Last time , they hacked into Democratic Party emails and also used automated fake accounts on social media , said Nina Jankowicz , of the Wilson Center and the author of How to Lose the Information War : Russia , Fake News , and the Future of Conflict @ @ @ @ @ @ @ laundering , that is planting a narrative with an influential individual who can then amplify that narrative , '' she said .
In one instance , the Russians created a phony website and paid freelance American journalists to write stories .
The Americans did n't know who they were working for .
But this was small stuff .
There 's no evidence so far of a foreign campaign gaining major traction .
The U.S. intelligence community is much better prepared for this election , said Thomas Rid , author of the new book @ @ @ @ @ @ @ Disinformation and Political Warfare .
The CIA and the National Security Agency can legally monitor and take action against a foreign group or individual spreading disinformation .
But in the U.S. , free speech protections normally prevent that kind of action .
`` For some agencies , like the CIA , it 's illegal to operate domestically .
And for the FBI , it is politically a very hot potato , a very problematic thing to be countering domestic disinformation because it is so political , '' said Rid .
Q .
What @ @ @ @ @ @ @ about domestic disinformation ?
Shannon Bond : Security experts are warning that the atmosphere is ripe for disinformation , and there are a lot of false claims and rumors already circulating .
That includes `` everything from Qanon [ a baseless conspiracy theory ] to mobilizations to protest , COVID-19 conspiracies and then ultimately mail-in ballots and voter fraud , '' said Clint Watts , a former FBI special agent who tracks online security threats at the Foreign Policy Research Institute .
Researchers and social media platforms say bad actors are capitalizing on @ @ @ @ @ @ @ confuse people about how to vote , undermine confidence in the election results and even threaten violence .
In some cases , they say , would-be foreign meddlers need only amplify falsehoods being spread by U.S. social media users .
`` Russia does n't have to make fake news .
They just repeat what conspiracies are coming out of the White House and the administration , '' Watts said .
Election watchers are particularly concerned about efforts to undermine confidence in voting — as President Trump has done repeatedly , with his tweets @ @ @ @ @ @ @ that mail-in ballots are vulnerable to fraud .
Q .
What are the social companies doing ?
Bond : Facebook and Twitter have both tightened rules against voting misinformation , casting doubt on the election results and premature claims of victory before results are final .
In Twitter 's case , Roth said its most recent changes were `` specifically in recognition of some of the recent threats that we 've seen emerge around attempts to undermine public confidence in voting techniques like voting by mail . ''
The companies meet monthly , @ @ @ @ @ @ @ , to discuss threats and their responses .
Facebook and Twitter both say they are prepared to take measures to crack down on content that presents a threat of real-world harm , like violence or voter suppression .
Twitter frequently applies fact-checking labels to President Trump 's posts about voting , and Facebook has begun to do the same .
That has given fodder to Republican critics of the companies , however , who have long claimed , without clear evidence , that tech platforms are biased against conservatives .
But even as @ @ @ @ @ @ @ taking the threat of disinformation — and especially foreign influence — more seriously than they did four years ago , critics say they are still too slow .
In many cases , posts that break the rules are labeled or removed only after they have spread widely .
Critics say it 's not just about whether the platforms set the right rules — it 's about how they enforce those rules .
This week , former Vice President Joe Biden 's campaign condemned Facebook for not removing Trump 's false claims about voting @ @ @ @ @ @ @ understands that Facebook will not hold him to their clearly stated policies , '' the campaign wrote in a letter to Facebook obtained by Axios .
A Facebook spokesman says the company applies its rules `` impartially . ''
Q .
President Trump is repeatedly questioning the legitimacy of the election .
How is this shaping the wider discussion ?
Myre : The Trump administration is sending very mixed messages , Jankowicz said .
`` On the one hand , we see these stark warnings coming from the U.S. intelligence agencies .
And @ @ @ @ @ @ @ is joking about fake news with [ Russian leader ] Vladimir Putin , '' she said .
Trump has declared repeatedly at campaign events that widespread mail-in balloting will lead to `` the most corrupt election in the history of our country . ''
In contrast , FBI Director Christopher Wray , along with many other national security and election officials , are offering assurances that election systems have been hardened and that it will be extremely difficult to tamper with actual votes , in-person or by mail .
Q .
What do @ @ @ @ @ @ @ for in the coming weeks ?
Bond : Facebook and Twitter are sounding the alarm over potential `` hack and leak '' operations like we saw in 2016 .
Just last week , the companies took down accounts connected to Kremlin-backed actors they said were involved in the leak of hacked emails from the Democratic National Committee and Hillary Clinton 's campaign four years ago .
The risk of disinformation and manipulation does not end on Election Day .
The big question is : What will the platforms do to stop bad information @ @ @ @ @ @ @ if it takes days or even weeks for final election results ?
`` This is probably going to take a little bit longer to do the counting because of the increase in absentee ballots , '' Christopher Krebs , director of the U.S. Cybersecurity and Infrastructure Security Agency , said recently .
`` Have a little bit of patience . ''
Greg Myre is an NPR national security correspondent .
Follow him @ gregmyre1 .
Shannon Bond is an NPR tech correspondent .
Follow her @ shannonpareil .
Editor 's note : Facebook @ @ @ @ @ @ @

'Russia Doesn't Have To Make Fake News': Biggest Election Threat Is Closer To Home
Enlarge this image toggle caption Paul Sancya/AP Paul Sancya/AP
National security officials say the Kremlin is at it again: Just like in 2016, Russia is using social media to try to undermine the U.S. presidential election, only with even more sophisticated tools.
But this time around, Russia may not have to try so hard. Social media companies and outside experts say in 2020, the biggest threats to the election may be coming from Americans in the form of possible violence, mistruths about mail-in balloting, and misinformation in the wake of possibly delayed election results — not to mention a president who has repeatedly questioned the legitimacy of the vote.
"In some ways, the people who know the most about how to mislead Americans are other Americans," said Yoel Roth, Twitter's head of site integrity.
NPR national security correspondent Greg Myre and NPR technology correspondent Shannon Bond break down some of the key questions:
Q. Where are the biggest foreign threats coming from?
Greg Myre: National security officials and analysts who study this are absolutely clear: Russia is the main foreign threat, and by a long shot. China and Iran are also trying to influence the election but at a much lower level.
The Russians have been attempting to interfere for many years, and their approach keeps evolving. Last time, they hacked into Democratic Party emails and also used automated fake accounts on social media, said Nina Jankowicz, of the Wilson Center and the author of How to Lose the Information War: Russia, Fake News, and the Future of Conflict.
"Russia has pivoted to information laundering, that is planting a narrative with an influential individual who can then amplify that narrative," she said.
In one instance, the Russians created a phony website and paid freelance American journalists to write stories. The Americans didn't know who they were working for. But this was small stuff. There's no evidence so far of a foreign campaign gaining major traction.
The U.S. intelligence community is much better prepared for this election, said Thomas Rid, author of the new book Active Measures: The Secret History of Disinformation and Political Warfare. The CIA and the National Security Agency can legally monitor and take action against a foreign group or individual spreading disinformation. But in the U.S., free speech protections normally prevent that kind of action.
"For some agencies, like the CIA, it's illegal to operate domestically. And for the FBI, it is politically a very hot potato, a very problematic thing to be countering domestic disinformation because it is so political," said Rid.
Q. What are the biggest concerns at this point about domestic disinformation?
Shannon Bond: Security experts are warning that the atmosphere is ripe for disinformation, and there are a lot of false claims and rumors already circulating.
That includes "everything from Qanon [a baseless conspiracy theory] to mobilizations to protest, COVID-19 conspiracies and then ultimately mail-in ballots and voter fraud," said Clint Watts, a former FBI special agent who tracks online security threats at the Foreign Policy Research Institute.
Researchers and social media platforms say bad actors are capitalizing on the uncertainty created by the pandemic to confuse people about how to vote, undermine confidence in the election results and even threaten violence.
In some cases, they say, would-be foreign meddlers need only amplify falsehoods being spread by U.S. social media users.
"Russia doesn't have to make fake news. They just repeat what conspiracies are coming out of the White House and the administration," Watts said.
Election watchers are particularly concerned about efforts to undermine confidence in voting — as President Trump has done repeatedly, with his tweets and Facebook posts claiming, falsely, that mail-in ballots are vulnerable to fraud.
Q. What are the social companies doing?
Bond: Facebook and Twitter have both tightened rules against voting misinformation, casting doubt on the election results and premature claims of victory before results are final.
In Twitter's case, Roth said its most recent changes were "specifically in recognition of some of the recent threats that we've seen emerge around attempts to undermine public confidence in voting techniques like voting by mail."
The companies meet monthly, along with government and law enforcement agencies, to discuss threats and their responses. Facebook and Twitter both say they are prepared to take measures to crack down on content that presents a threat of real-world harm, like violence or voter suppression.
Twitter frequently applies fact-checking labels to President Trump's posts about voting, and Facebook has begun to do the same. That has given fodder to Republican critics of the companies, however, who have long claimed, without clear evidence, that tech platforms are biased against conservatives.
But even as the social media giants are to be taking the threat of disinformation — and especially foreign influence — more seriously than they did four years ago, critics say they are still too slow. In many cases, posts that break the rules are labeled or removed only after they have spread widely.
Critics say it's not just about whether the platforms set the right rules — it's about how they enforce those rules.
This week, former Vice President Joe Biden's campaign condemned Facebook for not removing Trump's false claims about voting. "By now Mr. Trump clearly understands that Facebook will not hold him to their clearly stated policies," the campaign wrote in a letter to Facebook obtained by Axios.
A Facebook spokesman says the company applies its rules "impartially."
Q. President Trump is repeatedly questioning the legitimacy of the election. How is this shaping the wider discussion?
Myre: The Trump administration is sending very mixed messages, Jankowicz said.
"On the one hand, we see these stark warnings coming from the U.S. intelligence agencies. And on the other hand, President Trump is joking about fake news with [Russian leader] Vladimir Putin," she said.
Trump has declared repeatedly at campaign events that widespread mail-in balloting will lead to "the most corrupt election in the history of our country."
In contrast, FBI Director Christopher Wray, along with many other national security and election officials, are offering assurances that election systems have been hardened and that it will be extremely difficult to tamper with actual votes, in-person or by mail.
Q. What do the platforms say they are looking out for in the coming weeks?
Bond: Facebook and Twitter are sounding the alarm over potential "hack and leak" operations like we saw in 2016. Just last week, the companies took down accounts connected to Kremlin-backed actors they said were involved in the leak of hacked emails from the Democratic National Committee and Hillary Clinton's campaign four years ago.
The risk of disinformation and manipulation does not end on Election Day. The big question is: What will the platforms do to stop bad information from spreading in an information vacuum, if it takes days or even weeks for final election results?
"This is probably going to take a little bit longer to do the counting because of the increase in absentee ballots," Christopher Krebs, director of the U.S. Cybersecurity and Infrastructure Security Agency, said recently. "Have a little bit of patience."
Greg Myre is an NPR national security correspondent. Follow him @gregmyre1. Shannon Bond is an NPR tech correspondent. Follow her @shannonpareil.
Editor's note: Facebook is among NPR's financial supporters.


npr--2020-09-29--Sen. Ted Cruz Says Judge Amy Coney Barrett 'Will Make A Strong Justice'

Senate Republicans plan to move forward with Judge Amy Coney Barrett 's Supreme Court nomination with hearings before the Judiciary Committee starting Oct. 12 .
Barrett 's likely confirmation will lock in arguably the most conservative Supreme Court since the 1930s , with the potential to weaken patient protections of the Affordable Care Act and abortion rights in Roe v. Wade , among other decisions .
`` I think she 's a strong nominee , '' said Republican Sen. Ted Cruz of Texas , who sits on the committee .
Barrett , a judge on the 7th U.S .
Circuit @ @ @ @ @ @ @ conservative views on abortion rights , the Affordable Care Act , guns and campus sexual assault issues .
She clerked for the late conservative Justice Antonin Scalia , calling his `` judicial philosophy ... mine , too . ''
Cruz told NPR 's Steve Inskeep on Morning Edition that Barrett `` has an impeccable background . ''
She has only been on the appeals court since 2017 after President Trump nominated her .
`` I think she handled herself quite well '' at confirmation hearings in 2017 , Cruz said .
`` So @ @ @ @ @ @ @ My preference is always someone with a longer proven record .
But I think she will make a strong justice . ''
Cruz said he believes that `` Republicans have a much lousier record '' historically than Democrats when it comes to appointing Supreme Court justices .
`` Almost every Democratic nominee votes exactly as the Democratic president who appointed them would have wanted in virtually every case , '' Cruz said .
But Republican nominees `` bat .500 at best . ''
Too often , as Cruz argues in his new book @ @ @ @ @ @ @ by Republican presidents violate `` their oath of office and the Constitution '' by switching to make what he views as liberal decisions .
Cruz writes in the book that having five conservative justices on the Supreme Court `` can ensure the American experiment continues to thrive , but five liberal activist justices could fundamentally transform our Nation . ''
He adds , `` And far more often than we should be comfortable with , we are just one vote away from losing these fundamental rights and freedoms . ''
Barrett 's likely @ @ @ @ @ @ @ 6-3 majority on the high court .
Chief Justice John Roberts , who is considered a conservative , has in the past sided with the court 's liberals in some controversial decisions , including to uphold the ACA .
With Barrett 's addition , a potential Roberts swing vote will no longer be enough to sway divided court decisions in liberals ' favor .
The most pressing Supreme Court decision may come in November .
Trump said he expects the election results to end up at the court and wants nine justices in @ @ @ @ @ @ @ on standby to file aggressive legal challenges around voting issues .
Cruz said he does not think Barrett should recuse herself from a court decision on the election should it come before her as a justice .
`` The reason we need a fully functioning court is to have nine justices who can resolve any dispute and ensure that the law and Constitution are followed , '' Cruz told NPR .
A Supreme Court with eight justices , as it is now , `` lacks the constitutional authority to decide anything , '' @ @ @ @ @ @ @ could have multiple conflicting opinions from multiple courts of appeals and weeks or months of chaos and uncertainty . ''
That differs from what Cruz said in 2016 .
After Scalia 's death , Senate Republicans refused to consider President Barack Obama 's nominee , Merrick Garland , for most of the year .
`` There is certainly long historical precedent for a Supreme Court with fewer justices , '' Cruz told reporters in October 2016 .
Republicans now argue they were justified in their inaction because Obama was a Democrat while the @ @ @ @ @ @ @ they say , both the White House and the Senate are held by Republicans .

Sen. Ted Cruz Says Judge Amy Coney Barrett 'Will Make A Strong Justice'
Enlarge this image toggle caption Susan Walsh/Pool/Getty Images Susan Walsh/Pool/Getty Images
Senate Republicans plan to move forward with Judge Amy Coney Barrett's Supreme Court nomination with hearings before the Judiciary Committee starting Oct. 12.
Barrett's likely confirmation will lock in arguably the most conservative Supreme Court since the 1930s, with the potential to weaken patient protections of the Affordable Care Act and abortion rights in Roe v. Wade, among other decisions.
"I think she's a strong nominee," said Republican Sen. Ted Cruz of Texas, who sits on the committee.
Barrett, a judge on the 7th U.S. Circuit Court of Appeals in Chicago, has conservative views on abortion rights, the Affordable Care Act, guns and campus sexual assault issues. She clerked for the late conservative Justice Antonin Scalia, calling his "judicial philosophy ... mine, too."
Cruz told NPR's Steve Inskeep on Morning Edition that Barrett "has an impeccable background."
She has only been on the appeals court since 2017 after President Trump nominated her.
"I think she handled herself quite well" at confirmation hearings in 2017, Cruz said. "So I think she has strong attributes. My preference is always someone with a longer proven record. But I think she will make a strong justice."
Cruz said he believes that "Republicans have a much lousier record" historically than Democrats when it comes to appointing Supreme Court justices.
"Almost every Democratic nominee votes exactly as the Democratic president who appointed them would have wanted in virtually every case," Cruz said. But Republican nominees "bat .500 at best."
Too often, as Cruz argues in his new book, One Vote Away, justices appointed by Republican presidents violate "their oath of office and the Constitution" by switching to make what he views as liberal decisions.
Cruz writes in the book that having five conservative justices on the Supreme Court "can ensure the American experiment continues to thrive, but five liberal activist justices could fundamentally transform our Nation."
He adds, "And far more often than we should be comfortable with, we are
just one vote away from losing these fundamental rights and freedoms."
Barrett's likely confirmation will mean conservatives will have a 6-3 majority on the high court. Chief Justice John Roberts, who is considered a conservative, has in the past sided with the court's liberals in some controversial decisions, including to uphold the ACA. With Barrett's addition, a potential Roberts swing vote will no longer be enough to sway divided court decisions in liberals' favor.
The most pressing Supreme Court decision may come in November. Trump said he expects the election results to end up at the court and wants nine justices in place by then. Republican lawyers are on standby to file aggressive legal challenges around voting issues.
Cruz said he does not think Barrett should recuse herself from a court decision on the election should it come before her as a justice.
"The reason we need a fully functioning court is to have nine justices who can resolve any dispute and ensure that the law and Constitution are followed," Cruz told NPR.
A Supreme Court with eight justices, as it is now, "lacks the constitutional authority to decide anything," Cruz said. "And so we could have multiple conflicting opinions from multiple courts of appeals and weeks or months of chaos and uncertainty."
That differs from what Cruz said in 2016. After Scalia's death, Senate Republicans refused to consider President Barack Obama's nominee, Merrick Garland, for most of the year.
"There is certainly long historical precedent for a Supreme Court with fewer justices," Cruz told reporters in October 2016.
Republicans now argue they were justified in their inaction because Obama was a Democrat while the Senate was GOP-controlled. This time, they say, both the White House and the Senate are held by Republicans.
Reena Advani and Jim Wildman produced the audio interview.


npr--2020-09-29--'This Is Too Much': Working Moms Are Reaching The Breaking Point During The Pandemic

'This Is Too Much ' : Working Moms Are Reaching The Breaking Point During The Pandemic Youli Lee is proud of the years she worked for the U.S. government , prosecuting cybercrime in some of the world 's darkest places .
These days , she 's the one hiding out — mostly from her three children , ages 8 , 11 , and 13 .
`` I just actually locked my door so that nobody could come here , '' she says , from her bedroom .
The constant interruptions from children are happening in households across the country .
@ @ @ @ @ @ @ the U.S. started the school year with remote learning , including Lee 's district in Fairfax County , Va. With the added complexities of managing multiple Zoom calls at work and online learning for the kids , parents – especially moms — are hitting a breaking point .
For Lee , the juggling act fell apart in the spring .
Her husband , a doctor , was at the hospital seven days a week while she worked from home , struggling to maintain her own grueling schedule of nonstop work calls .
That @ @ @ @ @ @ @ that her younger two children were routinely skipping lunch .
Without the structure of the school day , the kids never quite knew when it was time to eat .
So , when news came that the kids ' schools would only partially reopen at best , she realized that was it .
`` I ca n't keep this up , '' she remembers thinking .
`` This is too much . ''
Lee decided to take a leave of absence .
`` It 's an impossible task , '' says C. Nicole @ @ @ @ @ @ @ Institute for Women 's Policy Research , a Washington , D.C. , think tank focused on economic equity for women .
`` Until we can figure out care , until we can figure out how to open the schools , you can just hang it up ... for many women . ''
Mason is a single mom whose 10-year-old twins are also doing remote school from home this fall .
And she 's furious there is no federal priority to address problems families are facing in the pandemic .
`` The primary focus @ @ @ @ @ @ @ these businesses back open .
That 's important .
But the strategy from Day 1 should have been thinking about how to get kids back into school safely , '' Mason says .
Still , Mason counts herself among the fortunate , given she is able to work from home .
Rocio Flores , a single mom of two in Avondale , Pa. , had just started a new job at a day care when the pandemic hit .
In mid-March , the day care shut down for a couple of weeks , @ @ @ @ @ @ @ reopened , but her children 's school did not .
In need of a paycheck , she had no other option but to leave her children , then 7 and 12 , home alone .
`` I had to call like every hour — 'Are you guys OK ? '
I told my neighbor — keep an eye on them , please , '' Flores says .
`` That 's the way I did it , going to work scared that something could happen . ''
This fall , her son , now @ @ @ @ @ @ @ doing virtual school .
Her daughter , almost 8 , was able to get a spot at another day care , where she does her distance learning alongside other school-age children .
Flores worries about how much either of them will learn without their teachers in the same room .
She also worries about her daughter getting sick and about her own job security given the uncertainty of the coronavirus .
`` It 's scary , thinking I could lose the job again , '' she says .
`` I just hope the @ @ @ @ @ @ @ of people suffering because of this . ''
The obstacles and hardships facing working mothers are not new , but the pandemic has given them more visibility , says Caitlyn Collins , a sociologist at Washington University in St. Louis and author of the book Making Motherhood Work : How Women Manage Careers and Caregiving .
`` Low-income families , single parents , they see how little support they have constantly because they 're in a never-ending battle to figure out how to put food on the table , to keep a roof @ @ @ @ @ @ @ ] someone to watch their kids so they are n't alone at home while they go to work , '' Collins says .
`` It 's advantaged people who have long not seen these difficulties . ''
Now , the global pandemic and its horrifying trajectory in the U.S. have given Americans a chance to reflect on what could be different .
`` The U.S. has no paid parental leave for parents to take during this difficult time .
We have no universal child care system on which parents can rely .
We @ @ @ @ @ @ @ and sick days , unlike every other Western industrialized country , '' Collins says .
`` Parents seem angry in a way that I have n't seen them in the past . ''
She says American mothers — who studies have found spend nearly twice as much time on housework and caregiving as their husbands — are realizing that it should n't be solely up to them to reconcile work and family commitments .
`` I think that Americans for the first time are thinking , wait a second .
Maybe this impossible @ @ @ @ @ @ @ not inevitable , '' she says .
As a sociologist , Collins sees this awakening as a cause for optimism and political mobilization .
Mason , too , is encouraged by the chatter she 's hearing around issues she has championed for years .
`` What about child care as a public good ?
How about child care as a right ? ''
she posits .
The pandemic , she says , has jump-started conversations that were not possible six months ago .

'This Is Too Much': Working Moms Are Reaching The Breaking Point During The Pandemic
Enlarge this image toggle caption SDI Productions/Getty Images SDI Productions/Getty Images
Updated at 10:39 a.m. ET Friday
Youli Lee is proud of the years she worked for the U.S. government, prosecuting cybercrime in some of the world's darkest places. These days, she's the one hiding out — mostly from her three children, ages 8, 11, and 13.
"I just actually locked my door so that nobody could come here," she says, from her bedroom.
The constant interruptions from children are happening in households across the country. Nearly half of all school districts in the U.S. started the school year with remote learning, including Lee's district in Fairfax County, Va. With the added complexities of managing multiple Zoom calls at work and online learning for the kids, parents – especially moms — are hitting a breaking point.
And, as the school year began with many students still home, women left the workforce in September at four times the rate that men did, the Labor Department reported Friday.
For Lee, the juggling act fell apart in the spring. Her husband, a doctor, was at the hospital seven days a week while she worked from home, struggling to maintain her own grueling schedule of nonstop work calls. That went on for weeks until she realized that her younger two children were routinely skipping lunch. Without the structure of the school day, the kids never quite knew when it was time to eat.
So, when news came that the kids' schools would only partially reopen at best, she realized that was it. "I can't keep this up," she remembers thinking. "This is too much."
Lee decided to take a leave of absence.
"It's an impossible task," says C. Nicole Mason, president and CEO of the Institute for Women's Policy Research, a Washington, D.C., think tank focused on economic equity for women. "Until we can figure out care, until we can figure out how to open the schools, you can just hang it up ... for many women."
Mason is a single mom whose 10-year-old twins are also doing remote school from home this fall. And she's furious there is no federal priority to address problems families are facing in the pandemic.
"The primary focus was, we've got to get these businesses back open. That's important. But the strategy from Day 1 should have been thinking about how to get kids back into school safely," Mason says.
Still, Mason counts herself among the fortunate, given she is able to work from home.
Enlarge this image toggle caption Rocio Flores Rocio Flores
Rocio Flores, a single mom of two in Avondale, Pa., had just started a new job at a day care when the pandemic hit. In mid-March, the day care shut down for a couple of weeks, leaving her without pay. It soon reopened, but her children's school did not. In need of a paycheck, she had no other option but to leave her children, then 7 and 12, home alone.
"I had to call like every hour — 'Are you guys OK?' I told my neighbor — keep an eye on them, please," Flores says. "That's the way I did it, going to work scared that something could happen."
This fall, her son, now 13, is still home alone, doing virtual school. Her daughter, almost 8, was able to get a spot at another day care, where she does her distance learning alongside other school-age children. Flores worries about how much either of them will learn without their teachers in the same room. She also worries about her daughter getting sick and about her own job security given the uncertainty of the coronavirus.
"It's scary, thinking I could lose the job again," she says. "I just hope the government understands that it's a lot of people suffering because of this."
The obstacles and hardships facing working mothers are not new, but the pandemic has given them more visibility, says Caitlyn Collins, a sociologist at Washington University in St. Louis and author of the book Making Motherhood Work: How Women Manage Careers and Caregiving.
"Low-income families, single parents, they see how little support they have constantly because they're in a never-ending battle to figure out how to put food on the table, to keep a roof over their heads, [to find] someone to watch their kids so they aren't alone at home while they go to work," Collins says. "It's advantaged people who have long not seen these difficulties."
Now, the global pandemic and its horrifying trajectory in the U.S. have given Americans a chance to reflect on what could be different.
"The U.S. has no paid parental leave for parents to take during this difficult time. We have no universal child care system on which parents can rely. We have no federal minimum standard for vacation and sick days, unlike every other Western industrialized country," Collins says. "Parents seem angry in a way that I haven't seen them in the past."
She says American mothers — who studies have found spend nearly twice as much time on housework and caregiving as their husbands — are realizing that it shouldn't be solely up to them to reconcile work and family commitments.
"I think that Americans for the first time are thinking, wait a second. Maybe this impossible scenario in which I find myself is not inevitable," she says.
As a sociologist, Collins sees this awakening as a cause for optimism and political mobilization.
Mason, too, is encouraged by the chatter she's hearing around issues she has championed for years.
"What about child care as a public good? How about child care as a right?" she posits.
The pandemic, she says, has jump-started conversations that were not possible six months ago.