npr--2020-10-21--Are The Risks Of Reopening Schools Exaggerated?

Are The Risks Of Reopening Schools Exaggerated ?
Despite widespread concerns , two new international studies show no consistent relationship between in-person K-12 schooling and the spread of coronavirus .
And a third study from the United States shows no elevated risk to childcare workers who stayed on the job .
Combined with anecdotal reports from a number of U.S. states where schools are open , as well as a crowdsourced dashboard of around 2000 U.S. schools , some medical experts are saying it 's time to shift the discussion from the risks of opening K-12 schools to the risks @ @ @ @ @ @ @ a pediatrician , I am really seeing the negative impacts of these school closures on children , '' Dr. Danielle Dooley , a medical director at Children 's National Hospital in Washington , D.C. , told NPR .
She ticked off mental health problems , hunger , obesity due to inactivity , missing routine medical care and the risk of child abuse — on top of the loss of education .
`` Going to school is really vital for children .
They get their meals in school , their physical activity , their @ @ @ @ @ @ @ course . ''
While agreeing that emerging data is encouraging , other experts said the United States as a whole has made little progress toward practices that would allow schools to make reopening safer — from rapid and regular testing , to contact tracing to identify the source of outbreaks , to reporting school-associated cases publicly , regularly and consistently .
`` We are driving with the headlights off , and we 've got kids in the car , '' said Melinda Buntin , chair of the Department of Health Policy at Vanderbilt @ @ @ @ @ @ @ for reopening schools with precautions .
Enric Álvarez at the Universitat Politècnica de Catalunya looked at different regions within Spain for his recent co-authored working paper .
Spain 's second wave of coronavirus cases started before the school year began in September .
Still , cases in one region dropped three weeks after schools reopened , while others continued rising at the same rate as before , and one stayed flat .
Nowhere , the research found , was there a spike that coincided with reopening : `` What we found is that @ @ @ @ @ @ @ absolutely no difference , '' Álvarez told NPR .
Spain does extensive contact tracing , so Álvarez was also able to analyze how much schools are contributing to the spread of COVID-19 .
Álvarez said his research suggests the answer is : Not much .
He found that , for all the students and staff who tested positive , 87 % of them did not infect anyone else at the school .
They were single cases .
`` We are not sure that the environments of the schools may not have a small @ @ @ @ @ @ @ , `` But it 's pretty clear that they do n't have very major epidemic-changing effects , at least in Spain , with the measures that are being taken in Spain . ''
These safety measures include mask-wearing for all children over 6 , ventilation , keeping students in small groups or `` bubbles , '' and social distancing of 1.5 meters — slightly less than the recommended 6 feet in the United States .
When a case is detected , the entire `` bubble '' is sent home for quarantine .
Insights @ @ @ @ @ @ @ education ministries around the globe .
For their report , which was not peer reviewed , they analyzed school reopening dates and coronavirus trends from February through the end of September across 191 countries .
`` There is no consistent pattern , '' said Dr. Randa Grob-Zakhary , who heads the organization .
`` It 's not that closing schools leads to a decrease in cases , or that opening schools leads to a surge in cases . ''
Some countries , such as Thailand and South Africa , fully opened when cases @ @ @ @ @ @ @ on transmission .
Others , such as Vietnam and Gambia , had cases rising during summer break , yet those rates actually dropped after schools reopened .
Japan , too , saw cases rise , and then fall again , all while schools were fully reopened .
But the United Kingdom saw a strong upward trend that started around the time of reopening schools .
`` We 're not saying at all that schools have nothing to do with cases , '' Grob-Zachary said .
What the data suggests instead is that opening @ @ @ @ @ @ @ case numbers .
What about the U.S. ?
On Oct. 14 , the Infectious Diseases Society of America gave a briefing on safe school reopenings .
Bottom line ?
`` The data so far are not indicating that schools are a superspreader site , '' said Dr. Preeti Malani , an infectious disease specialist at the University of Michigan 's medical school .
One place in the U.S. where systematic data gathering is happening — Utah — seems to echo the conclusions drawn by the new international studies .
Utah 's state COVID @ @ @ @ @ @ @ .
And while coronavirus spread is relatively high in the state , State Superintendent of Public Instruction Sydnee Dickson believes that schools are not , for the most part , driving spread .
`` Where you see cases on the rise in a neighborhood , in a county , we see that tend to be reflected in a school , '' Dickson said .
`` [ But ] we 're not seeing spread by virtue of being in school together . ''
Tom Hudachko of the state 's health department said that after @ @ @ @ @ @ @ September , there was a rise in cases among the 15-24 age group .
But with targeted public health messaging those cases have started to come down .
For the most part , Hudachko said , K-12 school clusters have been concentrated at high schools .
`` We have had some outbreaks in middle schools .
They 've been far less frequent .
And elementary school numbers seem to be one-offs here and there . ''
And these clusters — including one large reported outbreak with at least 90 cases — have largely @ @ @ @ @ @ @ homes , not to classrooms .
( Álvarez , in Spain , also said that clusters among young people there have been traced to social gatherings , including rooftop and beach parties ) .
Few states are reporting school-related data as clearly as Utah .
And that 's a shame , said Buntin at Vanderbilt .
`` One might argue that we 're running really a massive national experiment right now in schools , '' Buntin said , `` and we 're not collecting uniform data . ''
The largest centralized effort at @ @ @ @ @ @ @ — the unofficial , crowdsourced COVID-19 School Response Dashboard — has gotten a lot of publicity .
But it is self-reported , not a representative sample of schools .
Buntin and other experts said it 's likely that the dashboard is biased toward schools that are doing an exemplary job of following safety precautions and are organized enough to share their results .
Also , the dashboard does n't yet offer the ability to compare coronavirus cases reported at schools with local case rates .
In the absence of data , there are @ @ @ @ @ @ @ the country dying of COVID-19 .
But it 's hard to extrapolate from these incidents .
It 's not immediately clear whether the educators contracted the virus at school , whether they are part of school-based clusters , or what safety precautions were or were not followed by the schools in question .
A recent study from Yale University could potentially shed some light on these questions .
It tracked 57,000 childcare workers , located in all 50 states , Washington , D.C. , and Puerto Rico , for the first three months @ @ @ @ @ @ @ .
About half continued caring for very young children , such as the children of essential workers , while the other half stayed home .
The study found no difference in the rate of coronavirus infections between the two groups , after accounting for demographic factors .
Walter Gilliam , lead author of the study and a professor of psychology at the Yale Child Study Center , cautioned that it 's difficult to generalize this report to a K-12 schools setting , because the children were mostly under the age of 6 and @ @ @ @ @ @ @ , he said , the childcare workers were trained in health and safety and reported following strict protocols around disinfection .
However , he said , `` I think it would be great to do this study with school teachers and see what we can find out . ''
When you add up what we know and even what we still do n't know , some doctors and public health advocates said there are powerful arguments for in-person schooling wherever possible , particularly for younger students and those with special needs .
`` @ @ @ @ @ @ @ are at quite low risk of acquiring symptomatic disease , '' from the coronavirus , said Dr. Rainu Kaushal of Weill Cornell Medical Center .
And they rarely transmit it either .
It 's a happy coincidence , Kaushal and others said , that the youngest children face lower risk and are also the ones who have the hardest time with virtual learning .
`` I would like to see the students , especially the younger students , get back , '' said Malani at the University of Michigan .
`` I feel @ @ @ @ @ @ @ a safe and thoughtful way . ''
Chicago Public Schools , one of the largest districts in the country , seemed to take that guidance into consideration when it announced recently a phased reopening starting with pre-K and special education .
Kaushal said it 's important to keep in mind that Black , Latinx and Native American communities are much more severely affected by COVID-19 .
And that many of the `` children that are at the severest risk of disease , are also at the severest risk of not having a school @ @ @ @ @ @ @ security , adult time , security , losing the time to learn or losing the skills that they have acquired over the last year or so . ''
Any decision made on school reopening , she said , has to focus on equity as well as safety .
There are no easy trade-offs here .

Are The Risks Of Reopening Schools Exaggerated?
Enlarge this image toggle caption Alvaro Barrientos/AP Alvaro Barrientos/AP
Despite widespread concerns, two new international studies show no consistent relationship between in-person K-12 schooling and the spread of the coronavirus. And a third study from the United States shows no elevated risk to childcare workers who stayed on the job.
Combined with anecdotal reports from a number of U.S. states where schools are open, as well as a crowdsourced dashboard of around 2,000 U.S. schools, some medical experts are saying it's time to shift the discussion from the risks of opening K-12 schools to the risks of keeping them closed.
"As a pediatrician, I am really seeing the negative impacts of these school closures on children," Dr. Danielle Dooley, a medical director at Children's National Hospital in Washington, D.C., told NPR. She ticked off mental health problems, hunger, obesity due to inactivity, missing routine medical care and the risk of child abuse — on top of the loss of education. "Going to school is really vital for children. They get their meals in school, their physical activity, their health care, their education, of course."
While agreeing that emerging data is encouraging, other experts said the United States as a whole has made little progress toward practices that would allow schools to make reopening safer — from rapid and regular testing, to contact tracing to identify the source of outbreaks, to reporting school-associated cases publicly, regularly and consistently.
"We are driving with the headlights off, and we've got kids in the car," said Melinda Buntin, chair of the Department of Health Policy at Vanderbilt School of Medicine, who has argued for reopening schools with precautions.
Emerging evidence
Enric Álvarez at the Universitat Politècnica de Catalunya looked at different regions within Spain for his recent co-authored working paper. Spain's second wave of coronavirus cases started before the school year began in September. Still, cases in one region dropped three weeks after schools reopened, while others continued rising at the same rate as before, and one stayed flat.
Nowhere, the research found, was there a spike that coincided with reopening: "What we found is that the school [being opened] makes absolutely no difference," Álvarez told NPR.
What we found is that the school [being opened] makes absolutely no difference.
Spain does extensive contact tracing, so Álvarez was also able to analyze how much schools are contributing to the spread of the coronavirus. Álvarez said his research suggests the answer is: not much. He found that, for all the students and staff who tested positive, 87% of them did not infect anyone else at the school. They were single cases.
"We are not sure that the environments of the schools may not have a small and systematic effect," said Álvarez, "But it's pretty clear that they don't have very major epidemic-changing effects, at least in Spain, with the measures that are being taken in Spain."
These safety measures include mask-wearing for all children older than 6, ventilation, keeping students in small groups or "bubbles," and social distancing of 1.5 meters — slightly less than the recommended 6 feet in the United States. When a case is detected, the entire "bubble" is sent home for quarantine.
Insights for Education is a foundation that advises education ministries around the globe. For their report, which was not peer reviewed, they analyzed school reopening dates and coronavirus trends from February through the end of September across 191 countries.
"There is no consistent pattern," said Dr. Randa Grob-Zakhary, who heads the organization. "It's not that closing schools leads to a decrease in cases, or that opening schools leads to a surge in cases."
Some countries, such as Thailand and South Africa, fully opened when cases were low, with no apparent impact on transmission. Others, such as Vietnam and Gambia, had cases rising during summer break, yet those rates actually dropped after schools reopened. Japan, too, saw cases rise, and then fall again, all while schools were fully reopened. But the United Kingdom saw a strong upward trend that started around the time of reopening schools.
"We're not saying at all that schools have nothing to do with cases," Grob-Zakhary said. What the data suggests instead is that opening schools does not inevitably lead to increased case numbers.
What about the U.S.?
On Oct. 14, the Infectious Diseases Society of America gave a briefing on safe school reopenings. Bottom line? "The data so far are not indicating that schools are a superspreader site," said Dr. Preeti Malani, an infectious disease specialist at the University of Michigan's medical school.
One place in the U.S. where systematic data gathering is happening — Utah — seems to echo the conclusions drawn by the new international studies. Utah's state COVID-19 database clearly reports school-associated cases by district. And while coronavirus spread is relatively high in the state, State Superintendent of Public Instruction Sydnee Dickson believes that schools are not, for the most part, driving spread.
"Where you see cases on the rise in a neighborhood, in a county, we see that tend to be reflected in a school," Dickson said. "[But] we're not seeing spread by virtue of being in school together."
Tom Hudachko of the state's health department said that after both colleges and schools reopened in early September, there was a rise in cases among the 15-24 age group. But with targeted public health messaging those cases have started to come down.
For the most part, Hudachko said, K-12 school clusters have been concentrated at high schools. "We have had some outbreaks in middle schools. They've been far less frequent. And elementary school numbers seem to be one-offs here and there."
And these clusters — including one large reported outbreak with at least 90 cases — have largely been traced to informal social gatherings in homes, not to classrooms. (Álvarez, in Spain, also said that clusters among young people there have been traced to social gatherings, including rooftop and beach parties).
Few states are reporting school-related data as clearly as Utah. And that's a shame, said Buntin at Vanderbilt. "One might argue that we're running really a massive national experiment right now in schools," Buntin said, "and we're not collecting uniform data."
The largest centralized effort at such data collection in the United States — the unofficial, crowdsourced COVID-19 School Response Dashboard — has gotten a lot of publicity. But it is self-reported, not a representative sample of schools.
Buntin and other experts said it's likely that the dashboard is biased toward schools that are doing an exemplary job of following safety precautions and are organized enough to share their results. Also, the dashboard doesn't yet offer the ability to compare coronavirus cases reported at schools with local case rates.
In the absence of data, there are scary and tragic anecdotes of teachers around the country dying of COVID-19. But it's hard to extrapolate from these incidents. It's not immediately clear whether the educators contracted the virus at school, whether they are part of school-based clusters, or what safety precautions were or were not followed by the schools in question.
A recent study from Yale University could potentially shed some light on these questions. It tracked 57,000 childcare workers, located in all 50 states, Washington, D.C., and Puerto Rico, for the first three months of the pandemic in the United States. About half continued caring for very young children, such as the children of essential workers, while the other half stayed home. The study found no difference in the rate of coronavirus infections between the two groups, after accounting for demographic factors.
Walter Gilliam, lead author of the study and a professor of psychology at the Yale Child Study Center, cautioned that it's difficult to generalize this report to a K-12 schools setting, because the children were mostly under the age of 6 and kept in very small groups — and, he said, the childcare workers were trained in health and safety and reported following strict protocols around disinfection. However, he said, "I think it would be great to do this study with school teachers and see what we can find out."
Risk and benefit
When you add up what we know and even what we still don't know, some doctors and public health advocates said there are powerful arguments for in-person schooling wherever possible, particularly for younger students and those with special needs.
"Children under the age of 10 generally are at quite low risk of acquiring symptomatic disease," from the coronavirus, said Dr. Rainu Kaushal of Weill Cornell Medicine. And they rarely transmit it either. It's a happy coincidence, Kaushal and others said, that the youngest children face lower risk and are also the ones who have the hardest time with virtual learning.
"I would like to see the students, especially the younger students, get back," said Malani at the University of Michigan. "I feel more encouraged that that can happen in a safe and thoughtful way."
Chicago Public Schools, one of the largest districts in the country, seemed to take that guidance into consideration when it announced recently a phased reopening starting with pre-K and special education.
Kaushal said it's important to keep in mind that Black, Latinx and Native American communities are much more severely affected by COVID-19. And that many of the "children that are at the severest risk of disease, are also at the severest risk of not having a school open, whether it be for food security, adult time, security, losing the time to learn or losing the skills that they have acquired over the last year or so."
Any decision made on school reopening, she said, has to focus on equity as well as safety. There are no easy trade-offs here.


npr--2020-10-21--'All You Want Is To Be Believed': Sick With COVID-19 And Facing Racial Bias In The ER

'All You Want Is To Be Believed ' : Sick With COVID-19 And Facing Racial Bias In The ER In mid-March , Karla Monterroso flew home to Alameda , Calif. after a hiking trip in Utah 's Zion National Park .
Four days later she began to develop a bad , dry cough .
Her lungs felt sticky .
The fevers that persisted for the next nine weeks grew so high — 100.4 , 101.2 , 101.7 , 102.3 — that on the worst night , she was in the shower on all fours , ice cold water running down @ @ @ @ @ @ @ go down .
`` That night I had written down in a journal , letters to everyone I 'm close to , the things I wanted them to know in case I died , '' she remembers .
Then came a new batch of symptoms in the second month , headaches and shooting pains in her legs and abdomen that made her worry she could be at risk for the blood clots and strokes that other COVID-19 patients in their thirties were starting to report .
But still , she was n't sure @ @ @ @ @ @ @ .
`` As women of color , you get questioned a lot about your emotions and the truth of your physical state .
You get called an exaggerator a lot throughout the course of your life , '' says Monterroso , who is Latina .
`` So there was this weird , ' I do n't want to go and use resources for nothing ' feeling . ''
It took four friends to convince her that she needed to call 911 .
But what happened in the emergency room at Alameda Hospital only @ @ @ @ @ @ @ every turn during her emergency room visit , providers dismissed her symptoms and concerns , Monterroso says .
Her low blood pressure ?
That 's a false reading .
Her cycling oxygen levels ?
The machine 's wrong .
The shooting pains in her leg ?
Probably just a cyst .
`` The doctor came in and said , ' I do n't think that much is happening here .
I think we can send you home , ' '' Monterroso recalls .
Her experiences in the medical system , she reasons , @ @ @ @ @ @ @ are disproportionately affected by the coronavirus .
She says it is not just because they 're more likely to have front-line jobs that expose them to the virus , and the underlying health conditions that can lead to a more serious COVID-19 infection .
`` That is certainly part of it , but the other part is the lack of value people see in our lives , '' Monterroso wrote in a Twitter thread detailing her experience .
Research shows how doctors ' unconscious bias affects the care people receive , with Latino @ @ @ @ @ @ @ receive pain medications or get referred for advanced care , when compared to white patients with the same complaints or symptoms .
Black and Native American patients are also more likely to die in childbirth from preventable complications .
In the hospital that day in May , Monterroso was feeling woozy and having trouble communicating , so she called a friend and her friend 's cousin , a cardiac nurse , for help .
They started asking the doctor questions : What about Karla 's accelerated heart rate ?
Her low oxygen levels @ @ @ @ @ @ @ The doctor walked out of the room .
He refused to care for Monterroso while her friends were on the phone , she says , and when he came back , the only thing he wanted to talk about was Monterroso 's tone and her friends ' tone .
`` The implication was that we were insubordinate , '' Monterroso says .
She told the doctor she did n't want to talk about her tone .
She wanted to talk about her health care .
She was worried about possible blood clots in @ @ @ @ @ @ @ CT scan .
`` Well , you know , the CT scan is radiation right next to your breast tissue .
Do you want to get breast cancer ? ''
Monterroso recalls the doctor saying to her .
`` I only feel comfortable giving you that test if you say that you 're fine getting breast cancer . ''
Monterroso thought to herself , `` Swallow it up , Karla .
You need to be well . ''
And so she said to the doctor : `` I 'm fine getting breast cancer @ @ @ @ @ @ @ .
Monterroso asked for a different doctor , and then for a hospital advocate .
No and no , she was told .
She began to worry for her safety .
She wanted to get out of there .
Her friends , all calling every medical professional they knew to confirm that this treatment was not right , came to pick her up from Alameda Hospital .
They drove her to another hospital , UC-San Francisco .
The team there gave her an EKG , a chest x-ray and a CT scan .
@ @ @ @ @ @ @ and she was like , ' I heard about your ordeal .
I just want you to know that I believe you .
And we are not going to let you go until we know that you are safe to go , ' '' Monterroso recalls .
`` And I started bawling .
Because that 's all you want , is to be believed .
You spend so much of the process not believing yourself , and then to not be believed when you go in ?
It 's really hard to be @ @ @ @ @ @ @ Health System , which operates Alameda Hospital , declined to comment on the specifics of Monterroso 's case , but said in a statement that it is `` deeply committed to equity in access to health care '' and `` providing culturally-sensitive care for all we serve . ''
After Monterroso filed a grievance with the hospital , management invited her to come talk to their staff and residents , but she declined .
She believes her experience is an example of why people of color are faring so badly in the pandemic @ @ @ @ @ @ @ seek care , if we are advocating for ourselves , we can be treated as insubordinate , '' she says .
`` And if we are not advocating for ourselves , we can be treated as invisible . ''
Experts say this happens routinely , and regardless of the doctor 's intentions or race .
Monterroso 's doctor in the Alameda ER was not white , for example .
Unconscious bias in health care can emerge in high-stress settings Research shows that every doctor , every human being , has biases they 're @ @ @ @ @ @ @ Salazar , assistant dean for diversity at the University of Texas at Austin medical school .
`` Do I question a white man in a suit who 's coming in looking like he 's a professional when he asks for pain meds versus a black man ? ''
Salazar says , noting one of his own possible biases .
Unconscious bias most often surfaces in high stress environments , like emergency rooms — where doctors are under tremendous pressure and have to make quick , high stakes decisions .
Add in a deadly @ @ @ @ @ @ @ by the day , and things can spiral .
`` There 's just so much uncertainty , '' Salazar says .
`` When there is this uncertainty , there always is a level of opportunity for bias to make its way in and have an impact . ''
Salazar used to teach at UC-San Francisco where he helped develop unconscious bias training for medical and pharmacy students .
While dozens of medical schools are picking up the training , he says it 's not as common for hospitals .
Even when a negative @ @ @ @ @ @ @ , the intervention is usually weak .
`` How do I tell my clinician , 'Well , the patient thinks you 're racist ? '
'' Salazar says .
`` It 's a hard conversation : ' I got ta be careful , I do n't want to say the race word because I 'm going to push some buttons here . '
So it just starts to become really complicated . ''
Using data to explore unconscious bias can help doctors get on board Dr. Ronald Copeland says he remembers when doctors @ @ @ @ @ @ @ trainings in cultural sensitivity or unconscious bias , they were met with a backlash .
`` It was viewed almost from a punishment standpoint : 'Doc , your patients of this persuasion do n't like you and you 've got to do something about it . '
It 's like , 'You 're a bad doctor , and so your punishment is you have to go get training , '' says Copeland , who is chief of equity , inclusion and diversity at the Kaiser Permanente health system .
These days Kaiser Permanente @ @ @ @ @ @ @ patient surveys .
The patients are asked if they felt respected , if the communication was good and if they were satisfied with the medical experience .
KP then breaks this data down by demographics , to see if a doctor may get good scores on respect and empathy from white patients , but not Black patients .
`` If you see a pattern evolving around a certain group and it 's a persistent pattern , then that tells you there 's something that from a cultural , from an ethnicity , from @ @ @ @ @ @ @ in common , that you 're not addressing , '' Copeland says .
`` Then the real work starts . ''
When doctors are presented with the data from their patients and the science on unconscious bias , they 're less likely to resist it or deny it , Copeland says .
At his health system , they 've reframed the goal of training around the importance of delivering better quality care and getting better patient outcomes , so doctors are motivated to participate .
`` Folks do n't flinch about it , @ @ @ @ @ @ @ eager to learn more about it , particularly about how you mitigate it . ''
Months later , she 's still coping with symptoms — and her treatment experiences It 's been nearly six months since Karla Monterroso first got sick , and she 's still not feeling well .
Her heart rate continues to spike , and doctors told her she may need gallbladder surgery to address the gallstones she developed as a result of COVID-related dehydration .
She decided recently to leave the Bay Area and move to Los Angeles , @ @ @ @ @ @ @ family for the long recovery .
When Monterroso declined Alameda Hospital 's invitation to speak to their staff about her experience , she concluded it was n't her responsibility to fix the system that abused her .
But she still wants Alameda — and the broader health care system — to take responsibility for the bias perpetuated in hospitals and clinics .
Monterroso acknowledges that Alameda Hospital is public , and it does n't have the kind of financial resources that Kaiser and UCSF do .
A recent audit warned that Alameda Health @ @ @ @ @ @ @ .
But her experience still haunts her .
Monterroso is the CEO of Code2040 , a nonprofit that works on issues of racial equity in the tech sector .
Despite her professional status and experience working on these issues , she still needed to summon an army of friends to support her as a patient and make sure that she was heard .
`` Ninety percent of the people that are going to come through that hospital are not going to have what I have , to fight that , '' she says @ @ @ @ @ @ @ say what 's happening , then people with much less resources are going to come into this experience and they 're going to die . ''
This story comes from NPR 's reporting partnership with KQED and Kaiser Health News .
Kaiser Health News ( KHN ) is an editorially independent program of Kaiser Family Foundation ( KFF ) ; neither have any affiliation with Kaiser Permanente .

'All You Want Is To Be Believed': Sick With COVID-19 And Facing Racial Bias In The ER
Enlarge this image toggle caption Kenneth Eke/Code2040 Kenneth Eke/Code2040
In mid-March, Karla Monterroso flew home to Alameda, Calif. after a hiking trip in Utah's Zion National Park. Four days later she began to develop a bad, dry cough. Her lungs felt sticky.
The fevers that persisted for the next nine weeks grew so high — 100.4, 101.2, 101.7, 102.3 — that on the worst night, she was in the shower on all fours, ice cold water running down her back, willing her temperature to go down.
"That night I had written down in a journal, letters to everyone I'm close to, the things I wanted them to know in case I died," she remembers.
Then came a new batch of symptoms in the second month, headaches and shooting pains in her legs and abdomen that made her worry she could be at risk for the blood clots and strokes that other COVID-19 patients in their thirties were starting to report.
But still, she wasn't sure if she should go to the hospital.
"As women of color, you get questioned a lot about your emotions and the truth of your physical state. You get called an exaggerator a lot throughout the course of your life," says Monterroso, who is Latina. "So there was this weird, 'I don't want to go and use resources for nothing' feeling."
It took four friends to convince her that she needed to call 911.
But what happened in the emergency room at Alameda Hospital only confirmed her worst fears.
At nearly every turn during her emergency room visit, providers dismissed her symptoms and concerns, Monterroso says. Her low blood pressure? That's a false reading. Her cycling oxygen levels? The machine's wrong. The shooting pains in her leg? Probably just a cyst.
"The doctor came in and said, 'I don't think that much is happening here. I think we can send you home,'" Monterroso recalls.
Her experiences in the medical system, she reasons, are part of why people of color are disproportionately affected by the coronavirus. She says it is not just because they're more likely to have front-line jobs that expose them to the virus, and the underlying health conditions that can lead to a more serious COVID-19 infection.
"That is certainly part of it, but the other part is the lack of value people see in our lives," Monterroso wrote in a Twitter thread detailing her experience.
Research shows how doctors' unconscious bias affects the care people receive, with Latino and Black patients being less likely to receive pain medications or get referred for advanced care, when compared to white patients with the same complaints or symptoms. Black and Native American patients are also more likely to die in childbirth from preventable complications.
In the hospital that day in May, Monterroso was feeling woozy and having trouble communicating, so she called a friend and her friend's cousin, a cardiac nurse, for help. They started asking the doctor questions: What about Karla's accelerated heart rate? Her low oxygen levels? Why are her lips blue?
The doctor walked out of the room. He refused to care for Monterroso while her friends were on the phone, she says, and when he came back, the only thing he wanted to talk about was Monterroso's tone and her friends' tone.
"The implication was that we were insubordinate," Monterroso says.
She told the doctor she didn't want to talk about her tone. She wanted to talk about her health care. She was worried about possible blood clots in her leg and she asked for a CT scan.
"Well, you know, the CT scan is radiation right next to your breast tissue. Do you want to get breast cancer?" Monterroso recalls the doctor saying to her. "I only feel comfortable giving you that test if you say that you're fine getting breast cancer."
Monterroso thought to herself, "Swallow it up, Karla. You need to be well." And so she said to the doctor: "I'm fine getting breast cancer."
He never ordered the test.
Monterroso asked for a different doctor, and then for a hospital advocate. No and no, she was told. She began to worry for her safety. She wanted to get out of there. Her friends, all calling every medical professional they knew to confirm that this treatment was not right, came to pick her up from Alameda Hospital. They drove her to another hospital, UC-San Francisco. The team there gave her an EKG, a chest x-ray and a CT scan.
"One of the nurses came in and she was like, 'I heard about your ordeal. I just want you to know that I believe you. And we are not going to let you go until we know that you are safe to go,'" Monterroso recalls.
"And I started bawling. Because that's all you want, is to be believed. You spend so much of the process not believing yourself, and then to not be believed when you go in? It's really hard to be questioned in that way."
Alameda Health System, which operates Alameda Hospital, declined to comment on the specifics of Monterroso's case, but said in a statement that it is "deeply committed to equity in access to health care" and "providing culturally-sensitive care for all we serve." After Monterroso filed a grievance with the hospital, management invited her to come talk to their staff and residents, but she declined.
She believes her experience is an example of why people of color are faring so badly in the pandemic.
"Because when we go and seek care, if we are advocating for ourselves, we can be treated as insubordinate," she says. "And if we are not advocating for ourselves, we can be treated as invisible."
Experts say this happens routinely, and regardless of the doctor's intentions or race. Monterroso's doctor in the Alameda ER was not white, for example.
Unconscious bias in health care can emerge in high-stress settings
Research shows that every doctor, every human being, has biases they're not aware of, says Dr. Rene Salazar, assistant dean for diversity at the University of Texas at Austin medical school.
"Do I question a white man in a suit who's coming in looking like he's a professional when he asks for pain meds versus a black man?" Salazar says, noting one of his own possible biases.
Unconscious bias most often surfaces in high stress environments, like emergency rooms — where doctors are under tremendous pressure and have to make quick, high stakes decisions. Add in a deadly pandemic, where the science is changing by the day, and things can spiral.
"There's just so much uncertainty," Salazar says. "When there is this uncertainty, there always is a level of opportunity for bias to make its way in and have an impact."
Salazar used to teach at UC-San Francisco where he helped develop unconscious bias training for medical and pharmacy students. While dozens of medical schools are picking up the training, he says it's not as common for hospitals. Even when a negative patient encounter like Monterroso's is addressed, the intervention is usually weak.
"How do I tell my clinician, 'Well, the patient thinks you're racist?'" Salazar says. "It's a hard conversation: 'I gotta be careful, I don't want to say the race word because I'm going to push some buttons here.' So it just starts to become really complicated."
Using data to explore unconscious bias can help doctors get on board
Dr. Ronald Copeland says he remembers when doctors resisted these conversations. When managers suggested trainings in cultural sensitivity or unconscious bias, they were met with a backlash.
"It was viewed almost from a punishment standpoint: 'Doc, your patients of this persuasion don't like you and you've got to do something about it.' It's like, 'You're a bad doctor, and so your punishment is you have to go get training," says Copeland, who is chief of equity, inclusion and diversity at the Kaiser Permanente health system.
These days Kaiser Permanente's approach is rooted in data from patient surveys. The patients are asked if they felt respected, if the communication was good and if they were satisfied with the medical experience.
KP then breaks this data down by demographics, to see if a doctor may get good scores on respect and empathy from white patients, but not Black patients.
"If you see a pattern evolving around a certain group and it's a persistent pattern, then that tells you there's something that from a cultural, from an ethnicity, from a gender, something that group has in common, that you're not addressing," Copeland says. "Then the real work starts."
When doctors are presented with the data from their patients and the science on unconscious bias, they're less likely to resist it or deny it, Copeland says. At his health system, they've reframed the goal of training around the importance of delivering better quality care and getting better patient outcomes, so doctors are motivated to participate.
"Folks don't flinch about it," he says. "They're eager to learn more about it, particularly about how you mitigate it."
Months later, she's still coping with symptoms — and her treatment experiences
It's been nearly six months since Karla Monterroso first got sick, and she's still not feeling well.
Her heart rate continues to spike, and doctors told her she may need gallbladder surgery to address the gallstones she developed as a result of COVID-related dehydration. She decided recently to leave the Bay Area and move to Los Angeles, so she could be closer to her family for the long recovery.
When Monterroso declined Alameda Hospital's invitation to speak to their staff about her experience, she concluded it wasn't her responsibility to fix the system that abused her. But she still wants Alameda — and the broader health care system — to take responsibility for the bias perpetuated in hospitals and clinics.
Monterroso acknowledges that Alameda Hospital is public, and it doesn't have the kind of financial resources that Kaiser and UCSF do. A recent audit warned that Alameda Health System was on the brink of insolvency.
But her experience still haunts her. Monterroso is the CEO of Code2040, a nonprofit that works on issues of racial equity in the tech sector. Despite her professional status and experience working on these issues, she still needed to summon an army of friends to support her as a patient and make sure that she was heard.
"Ninety percent of the people that are going to come through that hospital are not going to have what I have, to fight that," she says. "And if I don't say what's happening, then people with much less resources are going to come into this experience and they're going to die."
This story comes from NPR's reporting partnership with KQED and Kaiser Health News.
Kaiser Health News (KHN) is an editorially independent program of Kaiser Family Foundation (KFF); neither have any affiliation with Kaiser Permanente.


npr--2020-10-21--The Final Biden-Trump Debate Is Thursday. Here's What You Need To Know

The Final Biden-Trump Debate Is Thursday .
Here 's What You Need To Know With less than two weeks until voting concludes , President Trump and Democratic presidential nominee Joe Biden will face off for the final time in a debate on Thursday , likely marking Trump 's last chance to reach a massive audience as he trails Biden in polls nationally and in key states .
They will share the stage three weeks after their first debate , which was headlined by Trump 's near-constant interrupting of both his opponent and the moderator , a tactic that appeared to @ @ @ @ @ @ @ The nonpartisan Commission on Presidential Debates acknowledged the chaos and pledged to add `` additional structure '' to the format of the remaining debates to avoid a repeat performance .
On Monday evening , the commission announced the muting of microphones to start each of Thursday 's debate segments .
Under the new rules , Biden and Trump will each have two minutes of uninterrupted time at the beginning of each 15-minute segment .
Afterward , they can discuss issues with each other with both microphones open .
The Trump campaign has said @ @ @ @ @ @ @ in favor of Biden .
Still , in a statement following the new rule change , Trump campaign manager Bill Stepien said : `` President Trump is committed to debating Joe Biden regardless of last minute rule changes from the biased commission in their latest attempt to provide advantage to their favored candidate . ''
Second — not third — presidential debate Since the two candidates first squared off on Sept. 29 , the president tested positive for the coronavirus , was hospitalized at Walter Reed National Military Medical Center for COVID-19 treatment @ @ @ @ @ @ @ all-clear from his medical team .
The two were set to meet again in a town hall-style debate last week , but Trump balked when the debate commission opted to make the event virtual , given the president 's recent COVID-19 diagnosis .
The debate was then canceled .
Instead , both candidates participated in dueling broadcast town halls on the night the debate was originally scheduled .
Thursday 's final debate offers an opportunity for Trump to pick up some momentum in front of a large audience as he trails behind Biden @ @ @ @ @ @ @ NewsHour/Marist poll , Biden leads Trump 54 % to 43 % nationally among likely voters .
The former vice president is also ahead by several percentage points in crucial states such as Pennsylvania , Michigan and Wisconsin , according to RealClearPolitics polling averages — with smaller margins in places like Florida and North Carolina .
But despite the leads in survey snapshots , the Biden campaign is urging supporters not to get complacent .
In a memo Saturday , Biden campaign manager Jen O'Malley Dillon warned , `` Donald Trump can still win @ @ @ @ @ @ @ is that this race is far closer than some of the punditry we 're seeing on Twitter and on TV would suggest , '' she wrote .
`` In the key battleground states where this election will be decided , we remain neck and neck with Donald Trump . ''
Trump also faces a financial challenge .
Despite starting his reelection campaign with a large cash advantage , he 's being outspent by Biden on TV ads in six key states .
The Biden campaign announced last week that along with allied Democratic @ @ @ @ @ @ @ in September alone — about $ 135 million more than the Trump campaign and Republican affiliates collected last month .
As of Tuesday evening , nearly 36 million people had already voted in this election , according to the U.S .
Elections Project .
Here are the details for the final presidential debate : When ?
9 to 10:30 p.m .
ET Thursday .
( You can listen to the debate on NPR , and we 'll have a livestream video online . )
Trump is sticking to his habit of criticizing the @ @ @ @ @ @ @ [ Welker 's ] been screaming questions at me for a long time .
She 's no good , '' Trump said during a Monday rally in Prescott , Ariz .
But Trump senior adviser Jason Miller told Fox News ' Martha MacCallum in early October that he has a `` very high opinion '' of Welker and that `` she 's a journalist who 's very fair in her approach . ''
What 's the format ?
The debate will be divided into six 15-minute segments .
Each candidate will have two @ @ @ @ @ @ @ of each segment .
What are the topics ?
Welker released the tentative topics a week ahead of the debate .
Not necessarily in this order , these are the topics : Stepien , Trump 's campaign manager , sent the debate commission a letter on Monday slamming it for not including a section on foreign policy , which the campaign sees as a weak point for Biden .
( Before he was vice president , Biden chaired the Senate Foreign Relations Committee . )
Stepien asked the commission to `` rethink and @ @ @ @ @ @ @ the debate , with an emphasis on foreign policy .

The Final Biden-Trump Debate Is Thursday. Here's What You Need To Know
Enlarge this image toggle caption Caroline Amenabar/NPR; Gage Skidmore/Flickr Caroline Amenabar/NPR; Gage Skidmore/Flickr
With less than two weeks until voting concludes, President Trump and Democratic presidential nominee Joe Biden will face off for the final time in a debate on Thursday, likely marking Trump's last chance to reach a massive audience as he trails Biden in polls nationally and in key states.
They will share the stage three weeks after their first debate, which was headlined by Trump's near-constant interrupting of both his opponent and the moderator, a tactic that appeared to have hurt him in subsequent polling.
The nonpartisan Commission on Presidential Debates acknowledged the chaos and pledged to add "additional structure" to the format of the remaining debates to avoid a repeat performance.
On Monday evening, the commission announced the muting of microphones to start each of Thursday's debate segments.
Under the new rules, Biden and Trump will each have two minutes of uninterrupted time at the beginning of each 15-minute segment. Afterward, they can discuss issues with each other with both microphones open.
The Trump campaign has said without evidence that debate organizers are biased in favor of Biden. Still, in a statement following the new rule change, Trump campaign manager Bill Stepien said: "President Trump is committed to debating Joe Biden regardless of last minute rule changes from the biased commission in their latest attempt to provide advantage to their favored candidate."
Second — not third — presidential debate
Since the two candidates first squared off on Sept. 29, the president tested positive for the coronavirus, was hospitalized at Walter Reed National Military Medical Center for COVID-19 treatment and resumed in-person campaigning once given the all-clear from his medical team.
The two were set to meet again in a town hall-style debate last week, but Trump balked when the debate commission opted to make the event virtual, given the president's recent COVID-19 diagnosis. The debate was then canceled.
Instead, both candidates participated in dueling broadcast town halls on the night the debate was originally scheduled. When the two meet again in person on Thursday, they will be separated by two plexiglass barriers.
State of play
Thursday's final debate offers an opportunity for Trump to pick up some momentum in front of a large audience as he trails behind Biden in polls.
In the latest NPR/PBS NewsHour/Marist poll, Biden leads Trump 54% to 43% nationally among likely voters.
The former vice president is also ahead by several percentage points in crucial states such as Pennsylvania, Michigan and Wisconsin, according to RealClearPolitics polling averages — with smaller margins in places like Florida and North Carolina.
But despite the leads in survey snapshots, the Biden campaign is urging supporters not to get complacent. In a memo Saturday, Biden campaign manager Jen O'Malley Dillon warned, "Donald Trump can still win this race."
"The reality is that this race is far closer than some of the punditry we're seeing on Twitter and on TV would suggest," she wrote. "In the key battleground states where this election will be decided, we remain neck and neck with Donald Trump."
Trump also faces a financial challenge. Despite starting his reelection campaign with a large cash advantage, he's being outspent by Biden on TV ads in six key states.
The Biden campaign announced last week that along with allied Democratic groups, it raised $383 million in September alone — about $135 million more than the Trump campaign and Republican affiliates collected last month.
As of Tuesday evening, nearly 36 million people had already voted in this election, according to the U.S. Elections Project.
Here are the details for the final presidential debate:
When? 9 to 10:30 p.m. ET Thursday. (You can listen to the debate on NPR, and we'll have a livestream video online.)
Where? Belmont University in Nashville, Tenn.
Who's moderating? Kristen Welker of NBC News
Trump is sticking to his habit of criticizing the moderator ahead of a debate.
"[Welker's] been screaming questions at me for a long time. She's no good," Trump said during a Monday rally in Prescott, Ariz.
But Trump senior adviser Jason Miller told Fox News' Martha MacCallum in early October that he has a "very high opinion" of Welker and that "she's a journalist who's very fair in her approach."
What's the format? The debate will be divided into six 15-minute segments. Each candidate will have two minutes of uninterrupted time at the beginning of each segment.
What are the topics? Welker released the tentative topics a week ahead of the debate. Not necessarily in this order, these are the topics:
fighting COVID-19
American families
race in America
climate change
national security
leadership
Stepien, Trump's campaign manager, sent the debate commission a letter on Monday slamming it for not including a section on foreign policy, which the campaign sees as a weak point for Biden. (Before he was vice president, Biden chaired the Senate Foreign Relations Committee.) Stepien asked the commission to "rethink and reissue a set of topics" for the debate, with an emphasis on foreign policy.


npr--2020-10-21--GOP Welcomes Steve Wynn's Millions, Despite Rape And Harassment Allegations

A major political donor , who just two years ago was forced out of his position as Finance Chair of the Republican National Committee , has contributed millions of dollars this election cycle to Republican candidates and political action committees aligned with the party .
Steve Wynn 's political contributions were once seen as toxic .
A series of investigative reports in the Wall Street Journal detailed alleged rape , assault and harassment by the now-disgraced casino mogul .
Wynn has denied all of the allegations .
He is now back — or at least his money is .
In @ @ @ @ @ @ @ money from Harvey Weinstein , who was later convicted of rape .
In this case , Republicans have continued to accept Wynn 's money .
GOP leaders , including Sen. Mitch McConnell of Kentucky and Super PACs connected with him , have been the primary beneficiaries of Wynn 's contributions .
In fact , Wynn has given more than $ 6 million to 2020 political campaigns , which appears to be the largest amount he has ever individually donated .
Among Wynn 's contributions identified by NPR : • A $ 4 million @ @ @ @ @ @ @ a Super PAC closely allied with Mitch McConnell , and led by McConnell 's former chief of staff .
• $ 1.5 million in donations to American Crossroads , another McConnell-aligned Super PAC .
Robert `` Mike '' Duncan , a longtime Republican Party official and chairman of the Postal Service Board of Governors , is among the Super PAC 's board of directors .
• A $ 25,000 donation to the McConnell Victory Committee , and an additional $ 5,600 directly to McConnell 's senate campaign .
• A $ 468,500 donation @ @ @ @ @ @ @ supporting the President 's re-election .
Much of that donation was transferred to the Republican National Committee ( RNC ) .
• Around $ 200,000 in donations to entities connected with the National Republican Senatorial Committee ( NRSC ) .
• $ 5,600 in donations to New York Republican Congresswoman Elise Stefanik .
The Trump Campaign referred NPR 's inquiries to the RNC , which did not respond .
McConnell 's campaign declined to comment .
The Senate Leadership Fund , American Crossroads , the NRSC and Stefanik 's campaign did not respond @ @ @ @ @ @ @ who have represented Wynn also did not return messages seeking comment .
It 's unclear whether Wynn may also be making additional donations to so-called `` dark money '' groups - political organizations that do not have to disclose their donors to the Federal Election Commission - but he has in the past .
Between 2010 and 2012 , when he was still the head of Wynn Resorts , the company donated half a million dollars to a conservative organization called Americans For Job Security .
That donation was only revealed in 2019 @ @ @ @ @ @ @ for Responsibility and Ethics in Washington .
Wynn joined the ranks of political megadonors after making a fortune in his decades-long career in casinos .
Wynn founded and led Wynn Resorts , running businesses in Macau , Las Vegas , and Boston .
In 2016 , Donald Trump tapped Wynn , a friend and former rival in the casino business , to help lead fundraising efforts for the Republican Party .
That year , he individually gave more than $ 1 million to political candidates and committees , followed by a $ 729,217 @ @ @ @ @ @ @ his company .
Then , in Jan. 2018 , the Wall Street Journal reported that `` dozens '' of his employees had witnessed a `` a decades-long pattern of sexual misconduct by Mr .
Wynn . ''
Subsequent investigations by the Massachusetts Gaming Commission and Nevada Gaming Control Board detailed allegations against Wynn , including a `` non consensual sexual relationship '' with one employee , and complaints that Wynn inappropriately exposed himself to employees during massages .
The most serious allegation stemmed from 2005 .
A Wynn employee was called in to @ @ @ @ @ @ @ manicure .
The employee said that Wynn then raped her in a massage room connected to his office , according to the Massachusetts Gaming Commission .
Wynn later testified in a separate civil lawsuit that he believed the encounter with his employee was consensual , though it reflected `` bad judgment on my part . ''
Wynn paid the woman a $ 7.5 million settlement on the condition that she sign a non-disclosure agreement .
The company failed to `` conduct any investigation whatsoever '' into the rape allegation , the Commission found @ @ @ @ @ @ @ n't have a voice , '' the new CEO of Wynn Resorts , Matthew Maddox , told the Commission in 2019 .
`` That if they were to speak up they could be retaliated against .
Or if they did , it would not be investigated .
For that , I am truly sorry . ''
Wynn has denied all allegations of sexual misconduct , calling them `` preposterous . ''
He characterized the rape allegation as `` extortion . ''
He has not faced criminal charges .
Still , he stepped down @ @ @ @ @ @ @ head of the Republican Party , Ronna McDaniel , said she `` removed '' Wynn from his role as finance chair of the Republican National Committee .
Some Republicans , including Ohio Senator Rob Portman and then-House Speaker Paul Ryan , donated contributions they 'd received from Wynn to charity .
McDaniel and the RNC , on the other hand , told Fox News that they would keep Wynn 's contributions , saying that Wynn `` should be allowed due process . ''
Still , McDaniel pledged in Jan. 2018 that if investigations @ @ @ @ @ @ @ we will absolutely return 100 % of that money . ''
Just a few months before that , in Oct. 2017 , officials and advisors with Republican PACs criticized Democrats for taking contributions from Harvey Weinstein , the former movie producer who was later convicted of rape .
McDaniel called Weinstein 's money `` dirty . ''
Under pressure from Republicans , top Democrats - such as former Secretary of State Hillary Clinton , Sen. Kamala Harris and Senate Minority Leader Chuck Schumer - pledged to donate Weinstein 's contributions to charity or @ @ @ @ @ @ @ .
But now that the shoe is on the other foot , the RNC has taken a different stance .
Despite the findings of casino regulators in Nevada and Massachusetts , the RNC , McConnell , and top Republican officials have accepted Steve Wynn 's contributions .

GOP Welcomes Steve Wynn's Millions, Despite Rape And Harassment Allegations
Enlarge this image toggle caption Jessica Rinaldi/Boston Globe via Getty Images Jessica Rinaldi/Boston Globe via Getty Images
A major political donor, who just two years ago was forced out of his position as finance chair of the Republican National Committee, has contributed millions of dollars this election cycle to Republican candidates and political action committees aligned with the party.
Steve Wynn's political contributions were once seen as toxic. A series of investigative reports in The Wall Street Journal in 2018 detailed alleged rape, assault and harassment by the now-disgraced casino mogul. Wynn has denied all of the allegations.
He is now back — or at least his money is. In the past, Republicans demanded Democrats return money from Harvey Weinstein, who was later convicted of rape. In this case, Republicans have continued to accept Wynn's money.
GOP leaders, including Sen. Mitch McConnell of Kentucky and super PACs connected with him, have been the primary beneficiaries of Wynn's contributions. In fact, Wynn has given more than $6 million to 2020 political campaigns, which appears to be the largest amount he has ever individually donated. Among Wynn's contributions identified by NPR:
A $4 million donation to the Senate Leadership Fund, a super PAC closely allied with McConnell, and led by McConnell's former chief of staff.
$1.5 million in donations to American Crossroads, another McConnell-aligned super PAC. Robert "Mike" Duncan, a longtime Republican Party official and chairman of the Postal Service Board of Governors, is among the super PAC's board of directors.
A $25,000 donation to the McConnell Victory Committee, and an additional $5,600 directly to McConnell's Senate campaign.
A $468,500 donation to Trump Victory, a fundraising committee supporting the president's reelection. Much of that donation was transferred to the Republican National Committee (RNC).
Around $200,000 in donations to entities connected with the National Republican Senatorial Committee (NRSC).
$5,600 in donations to New York Republican Rep. Elise Stefanik.
The Trump campaign referred NPR's inquiries to the RNC, which did not respond. McConnell's campaign declined to comment. The Senate Leadership Fund, American Crossroads, the NRSC and Stefanik's campaign did not respond to NPR's messages. Two attorneys who have represented Wynn also did not return messages seeking comment.
It's unclear whether Wynn may also be making additional donations to so-called "dark money" groups — political organizations that do not have to disclose their donors to the Federal Election Commission — but he has in the past. Between 2010 and 2012, when he was still the head of Wynn Resorts, the company donated half a million dollars to a conservative organization called Americans For Job Security. That donation was only revealed in 2019 after litigation by the watchdog group Citizens for Responsibility and Ethics in Washington.
Wynn joined the ranks of political megadonors after making a fortune in his decades-long career in casinos. Wynn founded and led Wynn Resorts, running businesses in Macau, Las Vegas and Boston.
In 2016, Trump tapped Wynn, a friend and former rival in the casino business, to help lead fundraising efforts for the Republican Party. That year, he individually gave more than $1 million to political candidates and committees, followed by a $729,217 donation to President Trump's inauguration through his company.
In 2017, before Wynn stepped down from his company amid allegations of sexual misconduct, he appeared at a White House event. President Trump applauded Wynn for "raising so much money for our great Republican Party." The White House YouTube
Then, in January 2018, The Wall Street Journal reported that "dozens" of his employees had witnessed a "a decades-long pattern of sexual misconduct by Mr. Wynn." Subsequent investigations by the Massachusetts Gaming Commission and Nevada Gaming Control Board detailed allegations against Wynn, including a "nonconsensual sexual relationship" with one employee, and complaints that Wynn inappropriately exposed himself to employees during massages.
The most serious allegation stemmed from 2005. A Wynn employee was called in to Steve Wynn's office to provide a manicure. The employee said that Wynn then raped her in a massage room connected to his office, according to the Massachusetts Gaming Commission.
Wynn later testified in a separate civil lawsuit that he believed the encounter with his employee was consensual, though it reflected "bad judgment on my part." Wynn paid the woman a $7.5 million settlement on the condition that she sign a nondisclosure agreement. The company failed to "conduct any investigation whatsoever" into the rape allegation, the commission found.
Victims "felt that they didn't have a voice," the new CEO of Wynn Resorts, Matthew Maddox, told the commission in 2019. "That if they were to speak up they could be retaliated against. Or if they did, it would not be investigated. For that, I am truly sorry."
Wynn has denied all allegations of sexual misconduct, calling them "preposterous." He characterized the rape allegation as "extortion." He has not faced criminal charges. Still, he stepped down as CEO of his company. The head of the Republican Party, Ronna McDaniel, said she "removed" Wynn from his role as finance chair of the Republican National Committee. Some Republicans, including Ohio Sen. Rob Portman and then-House Speaker Paul Ryan, donated contributions they'd received from Wynn to charity.
McDaniel and the RNC, on the other hand, told Fox News that they would keep Wynn's contributions, saying that Wynn "should be allowed due process." Still, McDaniel pledged in Jan. 2018 that if investigations of Wynn found "any wrongdoing, we will absolutely return 100% of that money."
Just a few months before that, in October 2017, officials and advisors with Republican PACs criticized Democrats for taking contributions from Harvey Weinstein, the former movie producer who was later convicted of rape. McDaniel called Weinstein's money "dirty."
Under pressure from Republicans, top Democrats — such as former Secretary of State Hillary Clinton, Sen. Kamala Harris and Senate Minority Leader Chuck Schumer — pledged to donate Weinstein's contributions to charity or committees supporting female candidates for political office.
But now that the shoe is on the other foot, the RNC has taken a different stance. Despite the findings of casino regulators in Nevada and Massachusetts, the RNC, McConnell, and top Republican officials have accepted Steve Wynn's contributions.


npr--2020-10-21--Millions Of Homes Are At Risk Of Wildfires, But It's Rarely Disclosed

Millions Of Homes Are At Risk Of Wildfires , But It 's Rarely Disclosed Jennifer Montano watches her two kids ' faces as they quietly clamber out of the car in their driveway in Vacaville , Calif .
It 's been a week since the children were last home , but where their house once stood , there 's ash and rubble now .
In August , the Montanos ' house was destroyed by the LNU Lightning Complex Fire , one of more than 10,000 structures lost in record-breaking blazes across the West this year .
The children start walking @ @ @ @ @ @ @ nothing is recognizable .
The fridge is a charred metal box .
Montano pulls up a tangle of wires and realizes it used to be their piano .
`` Our goal is to make sure they feel this as little as possible , '' she says .
Her 10-year-old daughter , Aliyah , uncovers a red and green ceramic mug .
`` Yay , part of Christmas survived , '' she says .
It 's an unofficial rule that many fire survivors discover : Usually all you can salvage is a mug or @ @ @ @ @ @ @ two emergency responders showed up late at night at their house .
With the fire moving in fast , the responders told the Montanos they only had 10 minutes to evacuate .
`` Once you see fear in a firefighter 's eyes , '' Ryan Montano says , `` that 's when you know things are n't good . ''
When they moved here seven years ago , the Montanos loved the views of grassy hillsides and oak trees .
The possibility of wildfire did n't occur to them .
After wildfires struck @ @ @ @ @ @ @ , they considered what to take with them if one hit , but they did n't expect a fire to overrun their home and strip everything away .
`` We had a good preparation plan for evacuation , but you can prepare to only take so much , '' Ryan Montano says .
`` You ca n't just throw your house on the back of a truck and go . ''
The Montanos are among millions of people in the West who move into fire-prone landscapes without getting any warning about that risk @ @ @ @ @ @ @ or sellers .
Almost 60 million homes were within less than a mile of a wildfire between 1992 and 2015 .
And those numbers only continue to grow as climate change increases the risk of bigger , more frequent blazes in the American West .
An NPR analysis finds that most wildfire-prone states have no requirements for disclosing fire risk to someone who buys or rents a home .
In the two states that do , the disclosures amount to only a few lines of text , buried in the hundreds of pages @ @ @ @ @ @ @ new home .
Knowing wildfire risk can spell the difference between saving or losing a home , or even saving lives .
Informed homeowners in fire country would be more likely to have evacuation plans .
They would be more likely to take fire-proofing steps .
Cutting back flammable brush and making a roof or eaves more fire-resistant greatly increases the odds that , after a wildfire , people will still have a home to which they can return .
Just two states with wildfire disclosures Wildfire has always been part of the @ @ @ @ @ @ @ , but climate change is priming the region to burn big .
At the same time , millions of people have moved into wildfire country .
Between 1990 and 2015 , 32 million homes were built in neighborhoods that border wildlands , an area known as the `` wildland-urban interface . ''
Only California and Oregon require wildfire risk be disclosed to new homebuyers .
Home disclosure forms and guidelines in nine other fire-prone states in the West make no specific mention of wildfires .
In contrast , 29 U.S. states require flood @ @ @ @ @ @ @ sits in a flood plain or how much flood insurance costs .
`` If we 've done it with flood , I do n't understand why we would n't also want to do it with wildfire , '' says Kimiko Barrett , policy analyst at Headwaters Economics , a land management think tank .
`` And similarly with hurricanes .
I think the way climate change is impacting all aspects of where and how we live and under what conditions , we 're going to have to start to think about all those @ @ @ @ @ @ @ '' The lack of information means millions of people potentially make one of the largest investments of their lives without considering wildfires .
In one study , researchers surveyed homeowners in Colorado 's Front Range and found the majority vastly underestimated how likely their homes are to burn .
`` Surprisingly , a number of people said : 'Well , I did n't know I lived in a place with wildfire risk until I got this survey , ' `` says Patty Champ , research economist at the U.S. Forest Service 's Rocky @ @ @ @ @ @ @ survey .
Even in states that disclose wildfire risk , the necessary information is n't clear .
Homebuyers in Oregon do n't see the word `` wildfire '' mentioned in the seven-page disclosure statement that 's filed during a sale .
Instead , one line specifies if a property is in the `` forestland-urban interface , '' a potential wildfire zone mapped by state officials .
California has a special form for disclosing natural hazards , which specifies if a property either has `` very high '' fire potential or has `` substantial @ @ @ @ @ @ @ applies , homeowners must clear flammable brush and dry vegetation around their house to reduce the fire risk by creating `` defensible space . ''
Those rules are enforced in some parts of the state but not others .
After so many lives were lost in recent wildfires , California lawmakers passed a bill last year to increase wildfire disclosures .
Starting in 2021 , sellers must inform a buyer if they 're in compliance with flammable brush rules and provide a list of potential ways the home might be susceptible to igniting @ @ @ @ @ @ @ if they 've completed retrofits to make the home more fire-resistant .
Even if other states wanted to require disclosure of wildfire risk as California has done , that information is n't necessarily available .
While federal flood maps have been available since the 1970s , indicating risk down to the individual address level , wildfire maps are few .
Some states , such as California , Nevada and Colorado , have assessments of wildfire risk online , which homeowners can use to look up their addresses .
Other states have n't done @ @ @ @ @ @ @ detailed modeling since fire behavior can vary greatly over short distances due to terrain and vegetation .
The U.S. Forest Service released new maps this year showing community risk nationwide , but the agency says the maps are n't fine-scaled enough to use for individual properties .
Insurance companies have done the most detailed risk analysis , but many homeowners do n't find out until their insurance rates go up or their policy is canceled .
Most existing wildfire maps also do n't reflect added risk from climate change as hotter temperatures fuel @ @ @ @ @ @ @ , the air saps moisture from plants and vegetation , making them more flammable .
Typically , night was a time when temperatures and fire activity fell , giving firefighters a much needed break .
Now , climate change has pushed evening temperatures higher , which means big fires can stay active through the night .
The total forested area that burned in the U.S. from 1984 to 2015 is nearly double what it would have been had the climate not gotten warmer , researchers found .
Some areas , such as California @ @ @ @ @ @ @ flammable vegetation because over the last century , fire agencies fought to extinguish all fires .
Native American tribes had long used fires to clear out brush and promote new growth , but they were forcibly removed from their lands , halting the use of controlled burns to limit the vegetation that fuels fires .
As a result , many ecosystems , normally adapted to low-grade fires , are now fueling megafires .
Fire agencies are slowly returning controlled burning to the landscape , but with tens of millions of acres in need @ @ @ @ @ @ @ climb .
Disclosing more information about wildfire risk could help homebuyers make better informed decisions .
Still , providing that information after a buyer has decided to make the purchase may not be effective since it 's often buried in hundreds of pages of information provided by the seller , some disaster experts say '' Imagine that you 're sitting and buying your first home and you 're so excited about it , '' says Alice Hill , a senior fellow at the Council on Foreign Relations who worked on disaster planning in @ @ @ @ @ @ @ thinking about measuring the curtains , and someone puts a huge stack of papers in front of you .
And in that stack is some very small print .
You 're just not going to register it at that point .
You 're too far along . ''
Some communities are working on educating homeowners in other ways .
In Eagle , Colo. , homeowner Kathryn Eddy is having a personalized inspection of her new home .
`` We want to look at how this structure will fare when the vegetation around it @ @ @ @ @ @ @ '' says Eric Lovgren , wildfire mitigation coordinator for Eagle County , as he walks around the outside of the house with Eddy .
Lovgren works in the county 's REALFire program , which helps homeowners understand fire risk and make their homes more fire-resistant .
Most homes are n't destroyed by wildfires burning directly up to their walls .
Instead , they 're ignited by embers that are blown far ahead of the fire .
Even simple fixes can decrease the chances of ignition , such as cutting dry brush right around @ @ @ @ @ @ @ , cleaning out gutters and covering attic vents with a fine mesh to prevent embers from entering .
Other more expensive fixes can also help , such as installing double-pane windows and replacing wood roofs and siding with fire-resistant materials .
`` There 's one vulnerable thing that I see and that is your firewood pile underneath that window , and that 's a real common thing , '' Lovgren says to Eddy .
For Eddy , it 's all new information .
It 's her first time living in Colorado .
`` @ @ @ @ @ @ @ , '' Eddy tells him .
`` I 'm from east Tennessee , and we have water everywhere .
With climate change , trees are drier , winds are gusty . ''
For Lovgren , the program is about changing people 's mindsets about fire .
`` We can develop a better relationship with wildfire knowing it 's a thing that 's going to be with us , '' Lovgren says .
`` And we can create these fire-adapted communities that have a much better chance of coming out , not unharmed , @ @ @ @ @ @ @ wildfire event . ''
Homeowners often find the REALFire program through their real estate agents , because it 's partially funded by the Vail Board of Realtors .
Some fire inspections have even been part of home sale negotiations , with Lovgren 's findings affecting the final price of a house .
While not all local real estate agents participate , some see discussion of wildfire risk as helping , not hurting , a potential sale .
`` I think it 's adding a service , '' says Mike Budd , a Vail @ @ @ @ @ @ @ program .
`` We want to be sure that we 've helped our clients in every conceivable fashion . ''
The program began six years ago after more stringent wildfire safety recommendations from a statewide task force were rejected .
That included disclosing wildfire risk in real estate transactions , potentially before a prospective buyer has even made an offer on a property .
The statewide Colorado Association of Realtors lobbied against the provision , saying that voluntary programs and education would be enough .
`` We were just coming out of the @ @ @ @ @ @ @ had a lot of foreclosures , '' Budd says .
`` We felt what was being recommended was n't taking those things into consideration . ''
Today , the REALFire program inspects about 80 homes per year , a small fraction of the houses in Eagle County .
To reduce wildfire risk truly in the community , almost every home would need to participate .
Even one home with flammable brush puts others at risk , because fires spread from structure to structure .
`` Voluntary measures by the homeowner just are n't @ @ @ @ @ @ @ , the policy analyst at Headwaters Economics .
`` One homeowner is going to do everything right , and their neighbor is going to decide not to do anything .
And therefore , they 're still at risk . ''
Fire experts say homeowner education is a crucial element in reducing the destructiveness of Western wildfires .
Even if homeowners clear defensible space one year , brush and grass grow back , requiring continuing maintenance .
Preparing for wildfires is n't a one-time job .
Still , homeowners alone wo n't be able @ @ @ @ @ @ @ fires in a warming world .
The decision to build in fire-prone areas is usually made by developers and local officials , guided by large-scale zoning plans that often do n't take wildfire risk into account .
Financially , many local governments are incentivized to keep allowing new development , even in risky areas .
`` They collect the tax revenue from those properties , '' Barrett says .
`` And yet , when it comes to wildfire , they 're not the ones who have to foot that bill when it comes @ @ @ @ @ @ @ from the federal government and taxpayers . ''
To prepare communities for future wildfires and reduce their destructive toll , fire risk in a warming world needs to be transparent at all levels — from federal policymaking to decisions that individuals must make every day , such as choosing a safe place to live .

Millions Of Homes Are At Risk Of Wildfires, But It's Rarely Disclosed
Enlarge this image toggle caption Lauren Sommer/NPR Lauren Sommer/NPR
Jennifer Montano watches her two kids' faces as they quietly clamber out of the car in their driveway in Vacaville, Calif. It's been a week since the children were last home, but where their house once stood, there's ash and rubble now.
In August, the Montanos' house was destroyed by the LNU Lightning Complex Fire, one of more than 10,000 structures lost in record-breaking blazes across the West this year.
The children start walking around the pile that remains. Almost nothing is recognizable. The fridge is a charred metal box. Montano pulls up a tangle of wires and realizes it used to be their piano. "Our goal is to make sure they feel this as little as possible," she says.
Her 10-year-old daughter, Aliyah, uncovers a red and green ceramic mug. "Yay, part of Christmas survived," she says. It's an unofficial rule that many fire survivors discover: Usually all you can salvage is a mug or two.
The family left home when two emergency responders showed up late at night at their house. With the fire moving in fast, the responders told the Montanos they only had 10 minutes to evacuate.
"Once you see fear in a firefighter's eyes," Ryan Montano says, "that's when you know things aren't good."
When they moved here seven years ago, the Montanos loved the views of grassy hillsides and oak trees. The possibility of wildfire didn't occur to them. After wildfires struck other parts of California in recent years, they considered what to take with them if one hit, but they didn't expect a fire to overrun their home and strip everything away.
"We had a good preparation plan for evacuation, but you can prepare to only take so much," Ryan Montano says. "You can't just throw your house on the back of a truck and go."
The Montanos are among millions of people in the West who move into fire-prone landscapes without getting any warning about that risk from the government, real estate agents or sellers. Almost 60 million homes were within less than a mile of a wildfire between 1992 and 2015. And those numbers only continue to grow as climate change increases the risk of bigger, more frequent blazes in the American West.
toggle caption Lauren Sommer/NPR
An NPR analysis finds that most wildfire-prone states have no requirements for disclosing fire risk to someone who buys or rents a home. In the two states that do, the disclosures amount to only a few lines of text, buried in the hundreds of pages buyers typically receive when closing on a new home.
Knowing wildfire risk can spell the difference between saving or losing a home, or even saving lives. Informed homeowners in fire country would be more likely to have evacuation plans. They would be more likely to take fire-proofing steps. Cutting back flammable brush and making a roof or eaves more fire-resistant greatly increases the odds that, after a wildfire, people will still have a home to which they can return.
Just two states with wildfire disclosures
Wildfire has always been part of the West as an integral cycle in ecosystems, but climate change is priming the region to burn big.
At the same time, millions of people have moved into wildfire country. Between 1990 and 2015, 32 million homes were built in neighborhoods that border wildlands, an area known as the "wildland-urban interface."
Only California and Oregon require wildfire risk be disclosed to new homebuyers. Home disclosure forms and guidelines in nine other fire-prone states in the West make no specific mention of wildfires. In contrast, 29 U.S. states require flood disclosure information, including whether a property sits in a flood plain or how much flood insurance costs.
"If we've done it with flood, I don't understand why we wouldn't also want to do it with wildfire," says Kimiko Barrett, policy analyst at Headwaters Economics, a land management think tank. "And similarly with hurricanes. I think the way climate change is impacting all aspects of where and how we live and under what conditions, we're going to have to start to think about all those climatic hazards in a new way."
The lack of information means millions of people potentially make one of the largest investments of their lives without considering wildfires. In one study, researchers surveyed homeowners in Colorado's Front Range and found the majority vastly underestimated how likely their homes are to burn.
Enlarge this image toggle caption Josh Edelson/AFP via Getty Images Josh Edelson/AFP via Getty Images
"Surprisingly, a number of people said: 'Well, I didn't know I lived in a place with wildfire risk until I got this survey,' " says Patty Champ, research economist at the U.S. Forest Service's Rocky Mountain Research Station, who conducted the survey.
Even in states that disclose wildfire risk, the necessary information isn't clear. Homebuyers in Oregon don't see the word "wildfire" mentioned in the seven-page disclosure statement that's filed during a sale. Instead, one line specifies if a property is in the "forestland-urban interface," a potential wildfire zone mapped by state officials.
California has a special form for disclosing natural hazards, which specifies if a property either has "very high" fire potential or has "substantial forest fire risk." If either applies, homeowners must clear flammable brush and dry vegetation around their house to reduce the fire risk by creating "defensible space." Those rules are enforced in some parts of the state but not others.
After so many lives were lost in recent wildfires, California lawmakers passed a bill last year to increase wildfire disclosures. Starting in 2021, sellers must inform a buyer if they're in compliance with flammable brush rules and provide a list of potential ways the home might be susceptible to igniting. From 2025, sellers must say if they've completed retrofits to make the home more fire-resistant.
Lack of risk information
Even if other states wanted to require disclosure of wildfire risk as California has done, that information isn't necessarily available. While federal flood maps have been available since the 1970s, indicating risk down to the individual address level, wildfire maps are few.
Some states, such as California, Nevada and Colorado, have assessments of wildfire risk online, which homeowners can use to look up their addresses. Other states haven't done detailed analyses. Mapping wildfire risk requires detailed modeling since fire behavior can vary greatly over short distances due to terrain and vegetation.
The U.S. Forest Service released new maps this year showing community risk nationwide, but the agency says the maps aren't fine-scaled enough to use for individual properties. Insurance companies have done the most detailed risk analysis, but many homeowners don't find out until their insurance rates go up or their policy is canceled.
Loading...
Most existing wildfire maps also don't reflect added risk from climate change as hotter temperatures fuel more extreme fires. During heat waves, the air saps moisture from plants and vegetation, making them more flammable. Typically, night was a time when temperatures and fire activity fell, giving firefighters a much needed break. Now, climate change has pushed evening temperatures higher, which means big fires can stay active through the night.
The total forested area that burned in the U.S. from 1984 to 2015 is nearly double what it would have been had the climate not gotten warmer, researchers found.
Some areas, such as California's Sierra Nevada, are overloaded with flammable vegetation because over the last century, fire agencies fought to extinguish all fires. Native American tribes had long used fires to clear out brush and promote new growth, but they were forcibly removed from their lands, halting the use of controlled burns to limit the vegetation that fuels fires. As a result, many ecosystems, normally adapted to low-grade fires, are now fueling megafires. Fire agencies are slowly returning controlled burning to the landscape, but with tens of millions of acres in need, they have a steep hill to climb.
toggle caption Lauren Sommer/NPR
Fires hitting home
Disclosing more information about wildfire risk could help homebuyers make better informed decisions. Still, providing that information after a buyer has decided to make the purchase may not be effective since it's often buried in hundreds of pages of information provided by the seller, some disaster experts say
"Imagine that you're sitting and buying your first home and you're so excited about it," says Alice Hill, a senior fellow at the Council on Foreign Relations who worked on disaster planning in the Obama administration. "You're thinking about measuring the curtains, and someone puts a huge stack of papers in front of you. And in that stack is some very small print. You're just not going to register it at that point. You're too far along."
Some communities are working on educating homeowners in other ways. In Eagle, Colo., homeowner Kathryn Eddy is having a personalized inspection of her new home.
"We want to look at how this structure will fare when the vegetation around it is putting embers on the house," says Eric Lovgren, wildfire mitigation coordinator for Eagle County, as he walks around the outside of the house with Eddy.
Lovgren works in the county's REALFire program, which helps homeowners understand fire risk and make their homes more fire-resistant. Most homes aren't destroyed by wildfires burning directly up to their walls. Instead, they're ignited by embers that are blown far ahead of the fire.
Even simple fixes can decrease the chances of ignition, such as cutting dry brush right around a home, cutting back tree limbs, cleaning out gutters and covering attic vents with a fine mesh to prevent embers from entering. Other more expensive fixes can also help, such as installing double-pane windows and replacing wood roofs and siding with fire-resistant materials.
"There's one vulnerable thing that I see and that is your firewood pile underneath that window, and that's a real common thing," Lovgren says to Eddy.
For Eddy, it's all new information. It's her first time living in Colorado.
"This is a different climate for me," Eddy tells him. "I'm from east Tennessee, and we have water everywhere. With climate change, trees are drier, winds are gusty."
For Lovgren, the program is about changing people's mindsets about fire.
"We can develop a better relationship with wildfire knowing it's a thing that's going to be with us," Lovgren says. "And we can create these fire-adapted communities that have a much better chance of coming out, not unharmed, but with minimal damage from a catastrophic wildfire event."
toggle caption Josh Edelson/AFP via Getty Images
Enlisting real estate agents
Homeowners often find the REALFire program through their real estate agents, because it's partially funded by the Vail Board of Realtors. Some fire inspections have even been part of home sale negotiations, with Lovgren's findings affecting the final price of a house.
While not all local real estate agents participate, some see discussion of wildfire risk as helping, not hurting, a potential sale.
"I think it's adding a service," says Mike Budd, a Vail real estate agent who helped develop the program. "We want to be sure that we've helped our clients in every conceivable fashion."
The program began six years ago after more stringent wildfire safety recommendations from a statewide task force were rejected. That included disclosing wildfire risk in real estate transactions, potentially before a prospective buyer has even made an offer on a property.
The statewide Colorado Association of Realtors lobbied against the provision, saying that voluntary programs and education would be enough.
"We were just coming out of the real estate bust, and we'd had a lot of foreclosures," Budd says. "We felt what was being recommended wasn't taking those things into consideration."
Today, the REALFire program inspects about 80 homes per year, a small fraction of the houses in Eagle County. To reduce wildfire risk truly in the community, almost every home would need to participate. Even one home with flammable brush puts others at risk, because fires spread from structure to structure.
"Voluntary measures by the homeowner just aren't going to work," says Barrett, the policy analyst at Headwaters Economics. "One homeowner is going to do everything right, and their neighbor is going to decide not to do anything. And therefore, they're still at risk."
Fire experts say homeowner education is a crucial element in reducing the destructiveness of Western wildfires. Even if homeowners clear defensible space one year, brush and grass grow back, requiring continuing maintenance. Preparing for wildfires isn't a one-time job.
Still, homeowners alone won't be able to turn the tide against increasingly extreme fires in a warming world. The decision to build in fire-prone areas is usually made by developers and local officials, guided by large-scale zoning plans that often don't take wildfire risk into account. Financially, many local governments are incentivized to keep allowing new development, even in risky areas.
"They collect the tax revenue from those properties," Barrett says. "And yet, when it comes to wildfire, they're not the ones who have to foot that bill when it comes to wildfire suppression efforts. That comes from the federal government and taxpayers."
To prepare communities for future wildfires and reduce their destructive toll, fire risk in a warming world needs to be transparent at all levels — from federal policymaking to decisions that individuals must make every day, such as choosing a safe place to live.


npr--2020-10-21--Parents Of 545 Children Separated At U.S.-Mexico Border Still Can't Be Found

Parents Of 545 Children Separated At U.S.-Mexico Border Still Ca n't Be Found Despite a federal judge 's order that the government reunite families who had been separated at the U.S.-Mexico border under the Trump administration 's `` no tolerance '' migration policy , the parents of 545 children still ca n't be found , according to a court document filed Tuesday by the U.S. Justice Dept .
and the American Civil Liberties Union .
Thousands of families were separated under the policy before the Trump administration ended the practice in 2018 .
The ACLU successfully sued the government , @ @ @ @ @ @ @ .
Thousands of parents and children were reunited within weeks .
But about 1,000 families who had been separated in a pilot program in 2017 were not covered by the initial court order — reunification of this group was ordered only last year .
The passage of time has made finding both parents and children more difficult .
`` What has happened is horrific , '' says Lee Gelernt , deputy director of the ACLU Immigrants ' Rights Project , who has been leading the litigation .
`` Some of these children were @ @ @ @ @ @ @ Some of these children may now have been separated for more than half their lives .
Almost their whole life , they have not been with their parents . ''
The update on reunification efforts was filed ahead of a status conference scheduled for Thursday before U.S. District Judge Dana Sabraw in San Diego , Calif .
The filing estimates two-thirds of the separated parents are believed to have returned to their home countries .
Non-governmental groups appointed by the court have `` engaged in time consuming and arduous on-the-ground searches for parents @ @ @ @ @ @ @ '' according to the filing , but those efforts were halted by the coronavirus pandemic and are only now resuming in limited fashion .
NPR 's Joel Rose reports that the children initially went into a shelter system before being placed with sponsors across the country , and that many will likely try to remain in the United States .
The ACLU 's Gelernt says about 360 of the children still have not been located .
The case is Ms. L. v. U.S. Immigration and Customs Enforcement et al.
, in U.S. District @ @ @ @ @ @ @ , 3:18-cv-428 .

Parents Of 545 Children Separated At U.S.-Mexico Border Still Can't Be Found
Enlarge this image toggle caption Ringo H.W. Chiu/AP Ringo H.W. Chiu/AP
Despite a federal judge's order that the government reunite families who had been separated at the U.S.-Mexico border under the Trump administration's "no tolerance" migration policy, the parents of 545 children still can't be found, according to a court document filed Tuesday by the U.S. Justice Department and the American Civil Liberties Union.
Thousands of families were separated under the policy before the Trump administration ended the practice in 2018. The ACLU successfully sued the government, winning a court order to reunite families. Thousands of parents and children were reunited within weeks.
But about 1,000 families who had been separated in a pilot program in 2017 were not covered by the initial court order — reunification of this group was ordered only last year. The passage of time has made finding both parents and children more difficult.
"What has happened is horrific," says Lee Gelernt, deputy director of the ACLU Immigrants' Rights Project, who has been leading the litigation. "Some of these children were just babies when they were separated. Some of these children may now have been separated for more than half their lives. Almost their whole life, they have not been with their parents."
The update on reunification efforts was filed ahead of a status conference scheduled for Thursday before U.S. District Judge Dana Sabraw in San Diego.
The filing estimates that two-thirds of the separated parents are believed to have returned to their home countries. Nongovernmental groups appointed by the court have "engaged in time consuming and arduous on-the-ground searches for parents in their respective countries of origin," according to the filing, but those efforts were halted by the coronavirus pandemic and are only now resuming in limited fashion.
NPR's Joel Rose reports that the children initially went into a shelter system before being placed with sponsors across the country and that many will likely try to remain in the United States. The ACLU's Gelernt says about 360 of the children still have not been located.
The case is Ms. L. v. U.S. Immigration and Customs Enforcement et al., in U.S. District Court for the Southern District of California, 3:18-cv-428.