vox--2020-09-17--A woman in ICE detention says her fallopian tube was removed without her consent

Pauline Binam , a 30-year-old former detainee at Irwin County Detention Center in Ocilla , Georgia , had been in custody for about two years when she started having irregular menstrual bleeding .
She feared that confinement was taking its toll on her body .
Binam , who came to the US from Cameroon when she was 2 years old , was being held at the Immigration and Customs Enforcement ( ICE ) detention center while awaiting deportation .
According to her attorney , Van Huynh , she consulted with medical staff at the facility who told her that the @ @ @ @ @ @ @ surgical procedure in which a doctor dilates the cervix and scrapes off the lining of the uterus .
Instead , the doctor informed her that he had also removed one of her fallopian tubes and that she could expect to have difficulty conceiving if she wanted to have more children .
Binam is now at the center of a congressional inquiry into allegations of a pattern of nonconsensual gynecological procedures , including hysterectomies , performed on detainees at Irwin in recent years .
ICE ordered her deported on Wednesday morning , but she @ @ @ @ @ @ @ members got involved in her case .
“ I ’ m often not surprised by things in the world of immigration nowadays , ” Huynh said .
“ I was shocked and appalled , hearing Nurse [ Dawn ] Wooten confirming what Pauline had been telling me all through 2019.
” Binam says she had invasive surgery with no opportunity to consent Before her procedure in August 2019 , Binam gave verbal consent , indicating that she understood the course of treatment .
But she was not given the opportunity to consent to @ @ @ @ @ @ @ she received while under anesthesia .
She later expressed to a psychiatrist that she was “ bothered ” that she had one of her fallopian tubes removed when she was expecting a different procedure , according to medical records from August 2019 , which Huynh shared with Vox .
“ She was adamant that she did not give consent for them to do anything to her fallopian tubes , ” Huynh said .
“ Had she been informed of what was being done with regard to her fallopian tubes , she would have @ @ @ @ @ @ @ ” To this day , Binam , who has a US-citizen daughter , doesn ’ t know whether she ’ ll be able to conceive again , or whether it was medically necessary that her fallopian tube be removed .
Wooten , a nurse at the facility , was the first to raise concerns about the hysterectomies , which were performed by a gynecologist described as “ the uterus collector ” in a whistleblower complaint filed Monday .
Multiple attorneys have since come forward alleging that their clients had been subjected to hysterectomies @ @ @ @ @ @ @ Jayapal , vice chair of the House immigration subcommittee , said that , based on conversations with three of those attorneys , it appears that at least 17 detainees had such procedures .
Mahendra Amin , a gynecologist associated with Coffee Regional Medical Center and Irwin County Hospital in Georgia , allegedly performed at least some of the gynecological procedures , including hysterectomies , that were described in the whistleblower complaint and by the detainees ’ attorneys .
( His attorney has “ vigorously ” denied the allegations . )
It ’ s @ @ @ @ @ @ @ procedure on Binam or cooperated with other doctors , but he is listed as the “ ordering ” doctor on a pathology report relating to her surgery .
The House Committee on Homeland Security is investigating the allegations in the complaint , and more than 170 members of Congress have called for a separate investigation from the Homeland Security inspector general ’ s office .
Testimony from Binam and other detainees at Irwin will likely be critical to those inquiries .
Binam was almost deported — just as she came forward with the @ @ @ @ @ @ @ she was 2 years old from Cameroon .
She might have been eligible for the Deferred Action for Childhood Arrivals Program , which has allowed more than 700,000 unauthorized immigrants who came to the US as children to live and work in the country legally , if it weren ’ t for a shoplifting conviction from when she was 17 .
She paid a resulting fine without understanding the consequences : She was essentially admitting guilt to the charges against her .
A couple of years later , she was charged with larceny @ @ @ @ @ @ @ shoplifting incident and was offered a plea deal .
She took the deal , again admitting her guilt , which qualified as a second strike on her record .
Immigration officials consequently launched deportation proceedings against her and detained her at Irwin starting in October 2017 .
Though a mother of a US citizen who had lived in the US for decades would typically be able to apply for deportation relief , Binam ’ s conviction and plea deal made her ineligible .
In immigration court , she claimed that she feared returning @ @ @ @ @ @ @ has never called home , and where there is ongoing conflict between the state and anglophone separatists .
She was nevertheless ordered deported in an immigration court ruling that she is now appealing before the 11th Circuit .
Even though her appeal is still pending , ICE could have deported her at any moment .
But it was only on Wednesday — in the wake of the whistleblower complaint ’ s publication and after Huynh sought an emergency pause on her deportation , identifying her as a victim of a nonconsensual gynecological procedure @ @ @ @ @ @ @ her on a 9:30 am deportation flight out of Chicago .
“ We were just shocked to find out that — just as we were learning about all these things that were coming out from Nurse Wooten — they wanted to put her on a flight and try to deport her as soon as possible , ” Huynh said .
A petition that garnered more than 1,800 signatures overnight also sought to halt her deportation .
But it wasn ’ t until Jayapal and Rep. Sheila Jackson Lee ( D-TX ) intervened that @ @ @ @ @ @ @ at the last moment and sent to another immigration detention center , the Montgomery Processing Center in Conroe , Texas .
“ There ’ s so much about immigration detention that takes away from a person ’ s life , ” Huynh said .
“ It robbed her and her future because of what we ’ re learning today.
” Help keep Vox free for all Millions turn to Vox each month to understand what ’ s happening in the news , from the coronavirus crisis to a racial reckoning to what is @ @ @ @ @ @ @ presidential election of our lifetimes .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
But our distinctive brand of explanatory journalism takes resources .
Even when the economy and the news advertising market recovers , your support will be a critical part of sustaining our resource-intensive work .
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Pauline Binam, a 30-year-old former detainee at Irwin County Detention Center in Ocilla, Georgia, had been in custody for about two years when she started having irregular menstrual bleeding. She feared that confinement was taking its toll on her body.
Binam, who came to the US from Cameroon when she was 2 years old, was being held at the Immigration and Customs Enforcement (ICE) detention center while awaiting deportation.
According to her attorney, Van Huynh, she consulted with medical staff at the facility who told her that the condition could be treated by a minor surgical procedure in which a doctor dilates the cervix and scrapes off the lining of the uterus.
Instead, the doctor informed her that he had also removed one of her fallopian tubes and that she could expect to have difficulty conceiving if she wanted to have more children.
Binam is now at the center of a congressional inquiry into allegations of a pattern of nonconsensual gynecological procedures, including hysterectomies, performed on detainees at Irwin in recent years. ICE ordered her deported on Wednesday morning, but she narrowly avoided deportation only after two Congress members got involved in her case.
“I’m often not surprised by things in the world of immigration nowadays,” Huynh said. “I was shocked and appalled, hearing Nurse [Dawn] Wooten confirming what Pauline had been telling me all through 2019.”
Binam says she had invasive surgery with no opportunity to consent
Before her procedure in August 2019, Binam gave verbal consent, indicating that she understood the course of treatment. But she was not given the opportunity to consent to the much more invasive and life-altering surgery she received while under anesthesia. She later expressed to a psychiatrist that she was “bothered” that she had one of her fallopian tubes removed when she was expecting a different procedure, according to medical records from August 2019, which Huynh shared with Vox.
“She was adamant that she did not give consent for them to do anything to her fallopian tubes,” Huynh said. “Had she been informed of what was being done with regard to her fallopian tubes, she would have been able to respond fairly to that.”
To this day, Binam, who has a US-citizen daughter, doesn’t know whether she’ll be able to conceive again, or whether it was medically necessary that her fallopian tube be removed.
Wooten, a nurse at the facility, was the first to raise concerns about the hysterectomies, which were performed by a gynecologist described as “the uterus collector” in a whistleblower complaint filed Monday.
Multiple attorneys have since come forward alleging that their clients had been subjected to hysterectomies and other gynecological procedures. Rep. Pramila Jayapal, vice chair of the House immigration subcommittee, said that, based on conversations with three of those attorneys, it appears that at least 17 detainees had such procedures.
Mahendra Amin, a gynecologist associated with Coffee Regional Medical Center and Irwin County Hospital in Georgia, allegedly performed at least some of the gynecological procedures, including hysterectomies, that were described in the whistleblower complaint and by the detainees’ attorneys. (His attorney has “vigorously” denied the allegations.)
It’s not clear whether he alone performed the procedure on Binam or cooperated with other doctors, but he is listed as the “ordering” doctor on a pathology report relating to her surgery.
The House Committee on Homeland Security is investigating the allegations in the complaint, and more than 170 members of Congress have called for a separate investigation from the Homeland Security inspector general’s office.
Testimony from Binam and other detainees at Irwin will likely be critical to those inquiries.
Binam was almost deported — just as she came forward with the allegations
Binam came to the US when she was 2 years old from Cameroon. She might have been eligible for the Deferred Action for Childhood Arrivals Program, which has allowed more than 700,000 unauthorized immigrants who came to the US as children to live and work in the country legally, if it weren’t for a shoplifting conviction from when she was 17. She paid a resulting fine without understanding the consequences: She was essentially admitting guilt to the charges against her.
A couple of years later, she was charged with larceny in a separate case from the first shoplifting incident and was offered a plea deal. She took the deal, again admitting her guilt, which qualified as a second strike on her record. Immigration officials consequently launched deportation proceedings against her and detained her at Irwin starting in October 2017.
Though a mother of a US citizen who had lived in the US for decades would typically be able to apply for deportation relief, Binam’s conviction and plea deal made her ineligible. In immigration court, she claimed that she feared returning to Cameroon, a place that she has never called home, and where there is ongoing conflict between the state and anglophone separatists. She was nevertheless ordered deported in an immigration court ruling that she is now appealing before the 11th Circuit.
Even though her appeal is still pending, ICE could have deported her at any moment. But it was only on Wednesday — in the wake of the whistleblower complaint’s publication and after Huynh sought an emergency pause on her deportation, identifying her as a victim of a nonconsensual gynecological procedure — that ICE finally tried to put her on a 9:30 am deportation flight out of Chicago.
“We were just shocked to find out that — just as we were learning about all these things that were coming out from Nurse Wooten — they wanted to put her on a flight and try to deport her as soon as possible,” Huynh said.
A petition that garnered more than 1,800 signatures overnight also sought to halt her deportation. But it wasn’t until Jayapal and Rep. Sheila Jackson Lee (D-TX) intervened that she was finally pulled off the plane at the last moment and sent to another immigration detention center, the Montgomery Processing Center in Conroe, Texas.
“There’s so much about immigration detention that takes away from a person’s life,” Huynh said. “It robbed her and her future because of what we’re learning today.”


vox--2020-09-17--The new Covid-19 case surge in Europe, explained

VIENNA — “ I have never seen an emergency room so crowded with very , very sick patients , ” recalls Annalisa Malara , a doctor at Codogno Hospital in Lombardy , Italy .
“ We were literally overwhelmed by the number.
” That was late February , when Malara diagnosed Italy ’ s first case of locally transmitted Covid-19 .
An emotionally wrenching marathon of hospital shifts followed .
Malara felt like she was constantly scrambling — to get enough oxygen to keep patients alive , to arrange patient transfers to other hospitals , to try and sleep so @ @ @ @ @ @ @ had to watch patients die , ” she said .
“ It ’ s something that I think I can ’ t forget — I will never forget.
” More recently , Codogno Hospital has been Covid-19-free .
But with case counts rising across the country and the continent again , Malara worries about a return to tragedy .
Last week , she spent hours on the phone with colleagues to check on the status of their intensive care units .
The situation was stable — though no one was sure how long @ @ @ @ @ @ @ very scared , ” she confessed .
Only six months after Italy ’ s coronavirus crisis became a warning to the West about how quickly the virus could strain even the best-resourced health systems in the world , the World Health Organization warned today of a “ very serious situation ” unfolding again in Europe .
Italian officials are once again reporting around 1,500 new infections each day .
That ’ s not yet anywhere near the last peak of 6,500 — but it ’ s a significant rise from 200 in early @ @ @ @ @ @ @ the hardest-hit countries in the region , are tracking an onslaught of cases even worse than their springtime peaks .
On September 7 , Spain became the first European country to count half a million total cases — more than 100,000 of them diagnosed in the two weeks prior .
Days later , France recorded a jump of 10,000 new cases in one day .
In Austria , between late April and mid-June , cases stayed below 100 for weeks , then gradually rose , with 768 reported on September 16 .
Even @ @ @ @ @ @ @ response excellence in Europe , has slowly seen its daily case count edge up , with nearly 2,000 infections — a doubling from August 1 .
As a whole , the European Union ’ y daily tally is currently much closer to America ’ s — with about 30,000 ( 65 cases per million ) cases to about 38,000 ( 115 cases per million ) in the US .
According to WHO , more than half of European countries have documented a greater-than-10 percent surge in the past two weeks .
Yet one @ @ @ @ @ @ @ pandemic going on in many parts of the continent .
Here in Vienna , where Covid-19 infections are rising so fast Germany just declared the city a high-risk hot spot , restaurants in my neighborhood are full of maskless people practically sitting elbow-to-elbow , kids are back on the playgrounds across the city , and opera season has reopened .
This disjuncture — between the rapidly rising case counts and relatively relaxed social life — has left some confused , and others complacent .
When I showed up at a small garden brunch @ @ @ @ @ @ @ ’ d wondered whether they should cancel — worrying what their neighbors would think of the gathering — after they heard the news that morning that Austria had just recorded more than 800 new daily infections .
Meanwhile , a 20-something university student told me that the coronavirus now feels like old news to her peers .
Part of the confusion has to do with the fact that the current phase in Europe — despite how bad it looks according to case numbers alone — has a different dynamic from the first phase @ @ @ @ @ @ @ because Covid-19-related hospitalizations and deaths aren ’ t rising nearly as quickly as they did in the spring .
But it ’ s a dynamic that ’ s hard to see when you consider case counts or even hospitalizations alone .
“ Even more than in March and April , we need to use [ all the data we have ] to paint a picture that ’ s complex and balanced , ” said Edouard Mathieu , the Paris-based data manager of Oxford University ’ s Our World in Data project .
Indeed @ @ @ @ @ @ @ is a much more nuanced story than the previous one — but it ultimately ends in the same place : a looming and very real risk of exponentially growing cases , leading to thousands of unnecessary deaths and the threat of new lockdowns .
Why cases alone can ’ t tell us about Europe ’ s new Covid-19 surge There are a few important caveats to keep in mind when examining Europe ’ s surging coronavirus case count .
The biggest one : “ [ You can ’ t ] take the numbers @ @ @ @ @ @ @ the earlier curve and assume it ’ s the same thing , ” Flavia Riccardo , a researcher at the Italian National Institute of Health , told Vox .
Official case numbers are always an artifact of how testing is being done — and how testing is done has changed dramatically over the course of the pandemic .
“ Most cases we were seeing at the beginning [ of the pandemic ] were clearly symptomatic , because the indication was to test only symptomatic people , ” Riccardo said .
“ Generally people @ @ @ @ @ @ @ had more severe symptoms .
That ’ s the opposite of what ’ s happening now.
” That broadening of the Covid-19 testing criteria , along with an increased capacity to swab , has meant many more tests are being done , and more cases documented .
In mid-March , German officials performed roughly 20,000 tests per day , according to Our World in Data .
Now the number is a staggering 150,000 .
By the end of May , France and Spain were doing 37,000 and 44,000 daily tests , respectively ; @ @ @ @ @ @ @ and Spain , 89,000 .
This suggests two things : During the first wave of the pandemic , health officials only captured a fraction of the coronavirus infections in the population , so the real peak in the spring was much higher than the official graphs suggested .
“ We probably measured something like less than 10 percent of what happened , ” Mathieu said .
Second , the recent surge looks relatively large compared to the spring spike — but in reality , it ’ s probably smaller .
Still , the @ @ @ @ @ @ @ fully explain the current case uptick , at least not in every country .
That ’ s where another metric — test per case — becomes useful .
The test-per-case ratio tracks exactly what it sounds like : the number of tests being done divided by the confirmed cases .
When the number drops too low it means an epidemic is likely out of control , since officials can no longer keep up with the demand for testing and see where new pockets of disease are spreading .
And that ’ s what @ @ @ @ @ @ @ most notably Spain , Italy , and France — where cases are rising faster than can be explained by the increase in testing alone .
For example , back in June , Spanish officials did 130 tests for every confirmed case .
As of September 12 , that number had dropped to only nine tests per case .
In Austria , the number of tests per confirmed case has fallen from 250 in early June to 20 .
A similar decline in the UK is proving to be worrisome .
There , reports @ @ @ @ @ @ @ and delays in people getting notified of positive results have sparked rumors of another lockdown .
Hospitalizations and deaths in Europe are rising — just at a slower rate than before But there ’ s another aspect to the data we have to consider in order to understand the trends in Europe : how quickly infections , hospitalizations , and deaths are rising .
Now they are generally increasing at a much slower rate than in the spring ( you can see that more clearly when you plot the data on a logarithmic @ @ @ @ @ @ @ news , the trends are still worrisome .
Let ’ s focus on hospitalizations for a moment to understand why .
Hospitalizations are often an intermediate step between rising cases and increased mortality .
They can also signal the extent to which a health care system is strained and , when they start rising , provide a warning that more resources need to be marshaled quickly .
Earlier in the pandemic , there was a two-week lag between an uptick in cases and a rise in hospitalizations , said Maria DeJoseph Van Kerkhove @ @ @ @ @ @ @ Covid-19 technical lead .
And when hospitalizations started increasing , that was followed by an increase in Covid-19 deaths .
Yet , for most of the summer , the surging Covid-19 caseload in European countries wasn ’ t accompanied by that growth in hospitalizations or deaths — a trend many attributed to the shift in transmission from mainly older to younger groups .
“ Across Europe [ over the summer ] , there were a number of outbreaks in social settings — nightclubs , restaurants , and social gatherings , ” Van Kerkhove @ @ @ @ @ @ @ cases dropped .
So even though cases overall grew , hospitalizations and deaths were down — and that makes sense because younger people are more likely to experience mild or symptom-free infections .
Now , Covid-19 demographics are changing again — shifting back into older populations .
In France , for example , 4 percent of tests performed on people age 60 and older are now positive — a doubling from two weeks ago .
By September 10 , there was a 44 percent increase in the proportion of people over age 75 @ @ @ @ @ @ @ compared to the previous week .
In Italy , the median age of cases went down from nearly 60 in February to 30 at the end of August .
Now , it ’ s back up to 40 — and Riccardo thinks it ’ ll rise again as outbreaks move from social settings like nightclubs into households again .
So it has taken time for hospitalizations and deaths to start rising again — but they are now in France and Spain , Van Kerkhove said .
Mathieu walked me through the situation in @ @ @ @ @ @ @ tracking .
In July , cases started increasing in a way that couldn ’ t be explained by testing alone — albeit slowly , doubling every two weeks instead of every 3.5 days , like in March .
A rise in hospitalizations didn ’ t follow immediately .
Now it ’ s clear that was because younger people were catching the virus .
“ [ By mid-August ] , the virus started to affect older people , and then a few weeks later , hospitalizations have started to increase , ” said Mathieu @ @ @ @ @ @ @ public health ministry reported that new Covid-19 hospitalizations were growing in all but one region of the country .
“ Now we are starting to see deaths increase , ” Mathieu added .
In late July , there were 10 Covid-19 deaths per day .
Now , there are 30 .
“ This whole process took almost two months instead of [ several ] weeks.
” The exact same trend is playing out now in Spain , he added .
“ In March , the number of deaths was doubling every two to @ @ @ @ @ @ @ said .
“ The current rate is much slower — deaths are doubling on average every two weeks.
” But they ’ re still doubling .
Even if it ’ s happening more slowly this time , it ’ s still exponential growth that could require more lockdowns There ’ s one last factor to consider in the slowing Covid-19 death rate : Doctors are better at diagnosing and treating the disease than they were at the start of the pandemic , so patients are more likely to survive .
“ Governments like @ @ @ @ @ @ @ seeing the level of hospitalizations and deaths as we saw at peak — and the reason for that is not because Covid isn ’ t still burning in the same way , ” said Lawrence Gostin , a Georgetown University global expert .
“ We ’ re catching it earlier and treating it better .
So you see lower death rates because of earlier detection , better treatment , and elderly and vulnerable were either exposed and died or they learned the lesson and are staying away.
” These treatments include cheap and @ @ @ @ @ @ @ , which can cut the risk of dying in very sick patients by a third .
While that ’ s certainly comforting , when cases start to rise and resources to deal with patients — drugs , personal protective equipment , beds , staff — don ’ t grow fast enough to meet demand , “ your fatality rate will increase again , ” Devi Sridhar , professor and chair of Global Public Health at the University of Edinburgh , warned .
And that ’ s when the specter of lockdowns starts reappearing @ @ @ @ @ @ @ up and ICU beds being full , [ politicians will ] have no choice but to implement some kind of lockdown unless you want your health system to collapse , ” Sridhar added .
“ You can ’ t have people dying in hospital doorways because they can ’ t get access to oxygen.
” Sridhar wasn ’ t at all surprised that Israel just imposed a new lockdown , or that Madrid — where doctors are calling the situation “ March in slow motion ” — is also resorting to lockdown measures @ @ @ @ @ @ @ more to come for Europe — that we ’ ll “ pay for summer holidays with winter lockdowns.
” “ Every country was under pressure to lift restrictions as soon as possible , ” she said .
“ What ’ s happened is a muddling of economic and health objectives — we ’ re not doing either properly.
” Mathieu finds this frustrating since it was so predictable .
“ [ It ’ s ] exactly what happened the first time : People failed to think in terms of exponential growth.
” During @ @ @ @ @ @ @ outbreaks proliferated exponentially , meaning an uptick in cases that appeared slow at first rapidly accelerated , outstripping the ability to manage them .
Governments were forced to use the only instrument they had to deal with unchecked Covid-19 spread — one that didn ’ t require an exponential increase in doctors or hospital beds , Mathieu pointed out : the lockdown .
This time , the growth is happening even more slowly — we have an even better warning .
Yet , Mathieu said , “ There ’ s a weird benchmark @ @ @ @ @ @ @ there ’ s a threshold of terribleness and as long as we ’ re under that threshold , we shouldn ’ t worry about it ” — even though it ’ s still exponential growth .
Take France , for example .
While the country ’ s death rate is nowhere near the last peak , when 1,000 people were dying each day from Covid-19 , “ 30 could soon be 50 or 100 .
And that ’ s dangerous for a mathematical reason ... exponential growth.
” If hospitalizations in France keep @ @ @ @ @ @ @ 30 percent per week , for example , it ’ ll take only eight weeks to reach April levels again .
“ For now , every line is going up exponentially in France — hospitalizations , ICU admissions , death — even though for now the absolute numbers are still very low.
” “ We need to strike a balance , ” he added , “ between telling people it ’ s not the same thing [ as the first coronavirus peak ] , it ’ s not as bad , it ’ @ @ @ @ @ @ @ something about it.
” Oliver Johnson , a professor of information theory and the director of the Institute for Statistical Science at the University of Bristol , is also worried that people have already forgotten about exponential growth .
“ Two , three weeks ago , [ people were saying ] it ’ s just cases [ rising ] .
Now , people are saying it ’ s just hospitalizations .
And it ’ s like okay , well — what ’ s the next stage after that ?
” Now we ’ @ @ @ @ @ @ @ distancing is more challenging and people are more likely to gather indoors , where the virus has a much better chance of spreading .
“ We have reason to believe these kinds of viruses spread better when it ’ s cold .
And if you start counting even to Christmas , it starts to look quite scary , ” Johnson added .
“ My worry is that it ’ s a long winter.
” Help keep Vox free for all Millions turn to Vox each month to understand what ’ s happening in @ @ @ @ @ @ @ to a racial reckoning to what is , quite possibly , the most consequential presidential election of our lifetimes .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
But our distinctive brand of explanatory journalism takes resources .
Even when the economy and the news advertising market recovers , your support will be a critical part of sustaining our resource-intensive work .
If you have already contributed , thank you .
If you haven ’ t , please consider helping everyone @ @ @ @ @ @ @ : Contribute today from as little as $ 3 .

VIENNA — “I have never seen an emergency room so crowded with very, very sick patients,” recalls Annalisa Malara, a doctor at Codogno Hospital in Lombardy, Italy. “We were literally overwhelmed by the number.”
That was late February, when Malara diagnosed Italy’s first case of locally transmitted Covid-19. An emotionally wrenching marathon of hospital shifts followed. Malara felt like she was constantly scrambling — to get enough oxygen to keep patients alive, to arrange transfers to other hospitals, to try and sleep so she could keep going. “We had to watch patients die,” she said. “It’s something that I think I can’t forget — I will never forget.”
More recently, Codogno Hospital has been Covid-19-free. But with case counts rising across the country and the continent again, Malara worries about a return to tragedy. Last week, she spent hours on the phone with colleagues to check on the status of their intensive care units. The situation was stable — though no one was sure how long that would last. “Everyone is very scared,” she confessed.
Only six months after Italy’s coronavirus crisis became a warning to the West about how quickly the virus could strain even the best-resourced health systems in the world, the World Health Organization warned Thursday of a “very serious situation” unfolding again across the agency’s European region, as weekly cases surpassed those reported during the first peak of the pandemic in March. This “should serve as a wake-up call for all of us,” Dr. Hans Kluge, the WHO regional director for Europe, said.
At the country level, the situation is no more reassuring. Italian officials are once again reporting around 1,500 new infections each day. That’s not yet anywhere near the last peak of 6,500 — but it’s a significant rise from 200 in early July. France and Spain, currently the hardest-hit countries in the region, are tracking an onslaught of cases even worse than their springtime peaks. On September 7, Spain became the first European country to count half a million total cases — more than 100,000 of them diagnosed in the two weeks prior. Days later, France recorded a jump of 10,000 new cases in one day. In Austria, between late April and mid-June, cases stayed below 100 for weeks, then gradually rose, with 768 reported on September 16.
Even Germany, an oft-cited example of coronavirus response excellence in Europe, has slowly seen its daily case count edge up, with nearly 2,000 infections — a doubling from August 1.
Yet one can almost forget there’s a pandemic going on in many parts of the continent.
Here in Vienna, where Covid-19 infections are rising so fast Germany just declared the city a high-risk hot spot, restaurants in my neighborhood are full of maskless people practically sitting elbow-to-elbow, kids are back in school and on the playgrounds, and opera season has reopened.
This disjuncture — between the rapidly rising case counts and relatively relaxed social life — has left some confused, and others complacent. When I showed up at a small garden brunch on Saturday, the hosts said they’d wondered whether they should cancel — worrying what their neighbors would think of the gathering — after they heard the news that morning that Austria had just recorded more than 800 new daily infections. Meanwhile, a 20-something university student told me that the coronavirus now feels like old news to her peers.
Part of the confusion has to do with the fact that the current phase in Europe — despite how bad it looks according to case numbers alone — has a different dynamic from the first. And that’s not only because Covid-19-related hospitalizations and deaths aren’t rising nearly as quickly as they did in the spring. This new dynamic is hard to see when you consider case counts or even hospitalizations alone.
“Even more than in March and April, we need to use [all the data] to paint a picture that’s complex and balanced,” said Edouard Mathieu, the Paris-based data manager of Oxford University’s Our World in Data project. Indeed, Europe’s latest coronavirus chapter is a much more nuanced story than the previous one — but it ultimately ends in the same place: a looming and very real risk of exponentially growing cases, leading to thousands of unnecessary deaths and the threat of new lockdowns.
Why cases alone can’t tell us about Europe’s new Covid-19 surge
There are a few important caveats to keep in mind when examining Europe’s surging coronavirus case count. The biggest one: You can’t “take the numbers today and place them on top of the earlier curve and assume it’s the same thing,” Flavia Riccardo, a researcher at the Italian National Institute of Health, told Vox.
Official case numbers are always an artifact of how testing is being done — and how testing is done has changed dramatically over the course of the pandemic. “Most cases we were seeing at the beginning were clearly symptomatic, because the indication was to test only symptomatic people,” Riccardo said. “Generally people were asked to stay home until they had more severe symptoms. That’s the opposite of what’s happening now.”
That broadening of the testing criteria for the coronavirus, along with an increased capacity to swab, has meant many more tests are being done, and more cases documented. In mid-March, German officials performed roughly 20,000 tests per day, according to Our World in Data. Now the number is a staggering 150,000. By the end of May, France and Spain were doing 37,000 and 44,000 daily tests, respectively; France now does 144,000 tests per day and Spain, 89,000.
This suggests two things: During the first wave of the pandemic, health officials only captured a fraction of the coronavirus infections in the population, so the real peak in the spring was much higher than the official graphs suggested. “We probably measured something like less than 10 percent of what happened,” Mathieu said. Second, the recent surge looks relatively large compared to the spring spike — but in reality, it’s probably smaller.
Still, the expansion in testing alone can’t fully explain the current case uptick, at least not in every country. That’s where another metric — test per case — becomes useful.
The test-per-case ratio tracks exactly what it sounds like: the number of tests being done divided by the confirmed cases. When the number drops too low it means an epidemic is likely out of control, since officials can no longer keep up with the demand for testing and see where new pockets of disease are spreading.
That’s what’s happening now in Europe — most notably Spain, Italy, and France — where cases are rising faster than can be explained by the increase in testing alone.
For example, back in June, Spanish officials did 130 tests for every confirmed case. As of September 12, that number had dropped to only nine tests per case. In Austria, the number of tests per confirmed case has fallen from 250 in early June to 20. A similar decline in the UK is proving to be worrisome. There, reports of an explosion in testing wait times and delays in people getting notified of positive results have sparked rumors of another lockdown.
Hospitalizations and deaths in Europe are rising — just at a slower rate than before
But there’s another aspect to the data we have to consider in order to understand the trends in Europe: how quickly infections, hospitalizations, and deaths are rising. Today, they are generally increasing at a much slower rate than in the spring (you can see that more clearly when you plot the data on a logarithmic scale). While this is good news, the trends are still worrisome.
Let’s focus on hospitalizations for a moment to understand why. Hospitalizations are often an intermediate step between rising cases and increased mortality. They can also signal the extent to which a health care system is strained and, when they start rising, provide a warning that more resources need to be marshaled quickly.
Earlier in the pandemic, there was a two-week lag between an uptick in cases and a rise in hospitalizations, said Maria DeJoseph Van Kerkhove, the WHO’s Covid-19 technical lead. And when hospitals became crowded with Covid-19 patients, that was followed by an increase in Covid-19 deaths.
Yet, for most of the summer, the surging Covid-19 caseload in European countries wasn’t accompanied by that growth in hospitalizations or deaths — a trend many attributed to the shift in transmission from mainly older to younger groups.
“Across Europe, there were a number of outbreaks in social settings — nightclubs, restaurants, and social gatherings,” Van Kerkhove told Vox. The median age of cases dropped. So even though cases overall grew, hospitalizations and deaths were down — and that makes sense because younger people are more likely to experience mild or symptom-free infections.
Covid-19 demographics are changing again — shifting back into older populations. In France, for example, 4 percent of tests performed on people age 60 and older are now positive — a doubling from two weeks ago. By September 10, there was a 44 percent increase in the proportion of people over age 75 who have been diagnosed with the virus compared to the previous week.
In Italy, the median age of cases went down from nearly 60 in February to 30 at the end of August. It’s back up to 40 — and Riccardo thinks it’ll rise again as outbreaks move from social settings like nightclubs into households again.
So it has taken time for hospitalizations and deaths to start rising again — but they are now in France and Spain, Van Kerkhove said.
[Updated data for September 14] Ongoing hospitalizations for COVID-19 in France's 10 largest urban areas
• Nice: 38% of its first-wave peak
• Bordeaux: 36%
• Marseille: 34%
• Toulouse: 31%
• Rennes: 29% pic.twitter.com/ThAFQnLxX6 — Edouard Mathieu (@redouad) September 14, 2020
[Updated data for September 15]
Latest COVID-19 figures for French hospitals:
• 2,713 new hospitalizations in the last week (+30% week-on-week)
• 479 new ICU admissions (+34%)
• 183 new deaths (+26%) pic.twitter.com/xlpAxJJqwx — Edouard Mathieu (@redouad) September 15, 2020
Mathieu walked me through the situation in France, which he’s been tracking. In July, cases started increasing in a way that couldn’t be explained by testing alone — albeit slowly, doubling every two weeks instead of every 3.5 days, like in March. A rise in hospitalizations didn’t follow immediately.
It’s become clear that was because younger people were catching the virus. By mid-August, “the virus started to affect older people, and then a few weeks later, hospitalizations have started to increase,” said Mathieu. By September 10, the French public health ministry reported that new Covid-19 hospitalizations were growing in all but one region of the country.
“Now we are starting to see deaths increase,” Mathieu added. In late July, there were 10 Covid-19 deaths per day. Now, there are 30. “This whole process took almost two months instead of [several] weeks.”
The exact same trend is playing out now in Spain, he added. “In March, the number of deaths was doubling every two to three days in Spain,” he said. “The current rate is much slower — deaths are doubling on average every two weeks.” But they’re still doubling.
Even if it’s happening more slowly this time, it’s still exponential growth that could require more lockdowns
There’s one last factor to consider in the slowing Covid-19 death rate — and it’s good news. Doctors are better at diagnosing and treating the disease than they were at the start of the pandemic, so patients are more likely to survive.
“Governments like to congratulate themselves because they are not seeing the level of hospitalizations and deaths as we saw at peak — and the reason for that is not because Covid isn’t still burning in the same way,” said Lawrence Gostin, a Georgetown University global expert. “We’re catching it earlier and treating it better. So you see lower death rates because of earlier detection, better treatment, and elderly and vulnerable were either exposed and died or they learned the lesson and are staying away.”
These treatments include cheap and readily available drugs like dexamethasone and hydrocortisone, which can cut the risk of dying in very sick patients by a third.
While that’s certainly comforting, when cases start to rise and resources to deal with patients — drugs, personal protective equipment, beds, staff — don’t grow fast enough to meet demand, “your fatality rate will increase again,” Devi Sridhar, professor and chair of Global Public Health at the University of Edinburgh, warned.
And that’s when the specter of lockdowns starts reappearing. “If you see hospitals filling up and ICU beds full, [politicians will] have no choice but to implement some kind of lockdown unless you want your health system to collapse,” Sridhar added. “You can’t have people dying in hospital doorways because they can’t get access to oxygen.”
Sridhar wasn’t at all surprised that Israel just imposed a new lockdown, or that Madrid — where doctors are calling the situation “March in slow motion” — is also resorting to lockdown measures. She also predicts there will be more to come for Europe — that we’ll “pay for summer holidays with winter lockdowns.”
“Every country was under pressure to lift restrictions as soon as possible,” she said. “What’s happened is a muddling of economic and health objectives — we’re not doing either properly.”
Mathieu finds this frustrating since it was so predictable. It’s “exactly what happened the first time: People failed to think in terms of exponential growth.”
During phase one of the pandemic, coronavirus outbreaks proliferated exponentially, meaning an uptick in cases that appeared slow at first rapidly accelerated, outstripping countries’ abilities to manage them. Governments were forced to use the only instrument they had to deal with unchecked Covid-19 spread — one that didn’t require an exponential increase in doctors or hospital beds, Mathieu pointed out: the lockdown.
This time, the growth is happening even more slowly — we have an even better warning. Yet, Mathieu said, “There’s a weird benchmark thing going on where some people think there’s a threshold of terribleness and as long as we’re under that threshold, we shouldn’t worry about it” — even though it’s still exponential growth.
Take France, for example. While the country’s death rate is nowhere near the last peak, when 1,000 people were dying each day from Covid-19, “30 could soon be 50 or 100. And that’s dangerous for a mathematical reason ... exponential growth.”
If hospitalizations in France keep increasing exponentially at the current rate of 30 percent per week, for example, it’ll take only eight weeks to reach April levels again. “For now, every line is going up exponentially in France — hospitalizations, ICU admissions, death — even though for now the absolute numbers are still very low.”
“We need to strike a balance,” he added, “between telling people it’s not the same thing [as the first coronavirus peak], it’s not as bad, it’s slower — but we should do something about it.”
Oliver Johnson, a professor of information theory and the director of the Institute for Statistical Science at the University of Bristol, is also worried that people have already forgotten about exponential growth. “Two, three weeks ago, [people were saying] it’s just cases. Now, people are saying it’s just hospitalizations. And it’s like okay, well — what’s the next stage after that?”
Now we’re heading into winter, when social distancing is more challenging and people are more likely to gather indoors, where the virus has a much better chance of spreading. “We have reason to believe these kinds of viruses spread better when it’s cold. And if you start counting even to Christmas, it starts to look quite scary,” Johnson added. “My worry is that it’s a long winter.”


vox--2020-09-17--Former model Amy Dorris says Donald Trump sexually assaulted her

Former model Amy Dorris has accused President Donald Trump of sexually assaulting her during a US Open tournament in September 1997 , according to an exclusive report by the Guardian .
Her account is now among more than 20 allegations of sexual misconduct that have been brought against the president .
Dorris alleges that Trump forcibly kissed her and groped her outside the bathroom of his VIP box at the US Open , allegations that he denied through his lawyers .
Dorris says she was visiting New York City with her then-boyfriend Jason Binn , who introduced her to Trump @ @ @ @ @ @ @ US Open in Trump ’ s VIP box , and attended events with him in other parts of the city that September .
After she went to use the restroom at the US Open , Dorris says , Trump approached her .
“ He just shoved his tongue down my throat and I was pushing him off .
And then that ’ s when his grip became tighter and his hands were very gropey and all over my butt , my breasts , my back , everything , ” Dorris told the Guardian @ @ @ @ @ @ @ stop .
“ I was in his grip , and I couldn ’ t get out of it.
” The publication confirmed that Dorris had told both a friend in the city and her mother about the incident — both of whom corroborated her account .
Binn did not offer comment to the Guardian for the article , though Trump ’ s lawyers say Binn has told them he does not recall Dorris telling him about any inappropriate behavior by Trump .
Dorris says she does not remember if she told him about @ @ @ @ @ @ @ Guardian she asked him to tell Trump to back off more broadly .
Dorris said she had thought about coming forward in 2016 but was concerned about the potential backlash she and her family might face .
She says she ultimately decided to do so this year , in part because she wants to set an example for her twin daughters .
“ Now I feel like my girls are about to turn 13 years old and I want them to know that you don ’ t let anybody do anything to you @ @ @ @ @ @ @ ” she told the Guardian .
Dorris ’ s account adds to more than 20 allegations of sexual misconduct that have been levied against Trump Trump has now faced allegations of sexual misconduct from at least 22 women .
He ’ s also openly bragged about committing sexual assault in a leaked Access Hollywood tape , during which he talked about grabbing women “ by the pussy.
” As Vox ’ s Anna North has reported , the sexual misconduct allegations against Trump span decades , though it appears the Republican Party has @ @ @ @ @ @ @ he runs for reelection this year : There was Jessica Leeds , who said Trump grabbed her breasts and tried to put his hand up her skirt when they were seated on a flight together in the 1980s .
“ He was like an octopus , ” she told the New York Times .
“ His hands were everywhere.
” There was Natasha Stoynoff , who said that when she visited Mar-a-Lago to write a People magazine story about Trump in 2005 , he pushed her up against a wall and forced his @ @ @ @ @ @ @ was pregnant at the time .
And there was Summer Zervos , who said Trump invited her to dinner with him at the Beverly Hills Hotel in 2007 .
She went , hoping for career help .
Instead , she said , Trump brought her to his private bungalow , where he touched her breast and pressed his genitals against her .
Writer E. Jean Carroll is one of the women who most recently came forward ; she accused Trump of raping her in the dressing room of an upscale department store in @ @ @ @ @ @ @ .
Both Carroll and Zervos also have ongoing defamation lawsuits against Trump , who has publicly attacked their looks and their motivations for coming forward .
Democratic presidential candidate Joe Biden has also been accused of sexual assault — by former Senate staffer Tara Reade , an allegation he ’ s denied .
High-profile Democrats have largely supported Biden despite the allegation , with many saying they ’ re satisfied with his denial .
The GOP ’ s response to the allegations against Trump this cycle also shows how the party ’ s @ @ @ @ @ @ @ presidency .
In 2016 , there was uproar from some members of the Republican Party after the Access Hollywood tape leaked , predominantly driven by women .
Since then , however , it appears many GOP lawmakers have simply accepted the existence of these allegations and are continuing to back Trump for the presidency anyway .
Last June , after Carroll came forward , many top Republicans said they were satisfied with Trump ’ s denial of her allegation , emphasizing that they stood by the president .
The party ’ s reaction @ @ @ @ @ @ @ s account is unlikely to affect support from many members of Trump ’ s base come November .
Help keep Vox free for all Millions turn to Vox each month to understand what ’ s happening in the news , from the coronavirus crisis to a racial reckoning to what is , quite possibly , the most consequential presidential election of our lifetimes .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
But our distinctive brand of explanatory journalism takes resources @ @ @ @ @ @ @ news advertising market recovers , your support will be a critical part of sustaining our resource-intensive work .
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Former model Amy Dorris has accused President Donald Trump of sexually assaulting her during a US Open tournament in September 1997, according to an exclusive report by the Guardian. Her account is now among more than 20 allegations of sexual misconduct that have been brought against the president.
Dorris alleges that Trump forcibly kissed her and groped her outside the bathroom of his VIP box at the US Open, allegations that he denied through his lawyers. Dorris says she was visiting New York City with her then-boyfriend Jason Binn, who introduced her to Trump. Both she and Binn watched the US Open in Trump’s VIP box, and attended events with him in other parts of the city that September. After she went to use the restroom at the US Open, Dorris says, Trump approached her.
“He just shoved his tongue down my throat and I was pushing him off. And then that’s when his grip became tighter and his hands were very gropey and all over my butt, my breasts, my back, everything,” Dorris told the Guardian, adding that she told him to stop. “I was in his grip, and I couldn’t get out of it.”
The publication confirmed that Dorris had told both a friend in the city and her mother about the incident — both of whom corroborated her account. The New York Times has also spoken with two additional friends of Dorris, who said she told them about the incident shortly after it occurred as well.
Binn told The Times he recalled the weekend but had no memory of any advances that were made by Trump to Dorris. He said The Guardian story was the “first time I heard or saw anything.” Dorris says she likely didn’t tell Binn the specifics of the incident, but asked him to tell Trump to back off more broadly.
Dorris said she had thought about coming forward in 2016 but was concerned about the potential backlash she and her family might face. She says she ultimately decided to do so this year, in part because she wants to set an example for her twin daughters. “Now I feel like my girls are about to turn 13 years old and I want them to know that you don’t let anybody do anything to you that you don’t want,” she told the Guardian.
Dorris’s account adds to more than 20 allegations of sexual misconduct that have been levied against Trump
Trump has now faced allegations of sexual misconduct from at least 22 women. He’s also openly bragged about committing sexual assault in a leaked Access Hollywood tape, during which he talked about grabbing women “by the pussy.”
As Vox’s Anna North has reported, the sexual misconduct allegations against Trump span decades, though it appears the Republican Party has been content to keep overlooking them as he runs for reelection this year:
There was Jessica Leeds, who said Trump grabbed her breasts and tried to put his hand up her skirt when they were seated on a flight together in the 1980s. “He was like an octopus,” she told the New York Times. “His hands were everywhere.” There was Natasha Stoynoff, who said that when she visited Mar-a-Lago to write a People magazine story about Trump in 2005, he pushed her up against a wall and forced his tongue down her throat. Melania Trump was pregnant at the time. And there was Summer Zervos, who said Trump invited her to dinner with him at the Beverly Hills Hotel in 2007. She went, hoping for career help. Instead, she said, Trump brought her to his private bungalow, where he touched her breast and pressed his genitals against her.
Writer E. Jean Carroll is one of the women who most recently came forward; she accused Trump of raping her in the dressing room of an upscale department store in the 1990s, which he has denied. Both Carroll and Zervos also have ongoing defamation lawsuits against Trump, who has publicly attacked their looks and their motivations for coming forward.
Democratic presidential candidate Joe Biden has also been accused of sexual assault — by former Senate staffer Tara Reade, an allegation he’s denied. High-profile Democrats have largely supported Biden despite the allegation, with many saying they’re satisfied with his denial.
The GOP’s response to the allegations against Trump this cycle also shows how the party’s attitudes on them have shifted during his presidency. In 2016, there was uproar from some members of the Republican Party after the Access Hollywood tape leaked, predominantly driven by women. Since then, however, it appears many GOP lawmakers have simply accepted the existence of these allegations and are continuing to back Trump for the presidency anyway. Last June, after Carroll came forward, many top Republicans said they were satisfied with Trump’s denial of her allegation, emphasizing that they stood by the president.
The party’s reaction to past allegations suggests that Dorris’s account is unlikely to affect support from many members of Trump’s base come November.


vox--2020-09-17--The policing reforms in the Breonna Taylor settlement, explained

A $ 12 million payout certainly won ’ t bring Breonna Taylor back .
But the city of Louisville ’ s historic settlement with her family also includes a set of police reforms that may — depending on how and if they are implemented — help prevent police killings like the one that ended Taylor ’ s life in March .
The set of reforms , announced as part of the family ’ s civil suit on Tuesday , addresses three areas of policing in Louisville : community connections between police and the people they serve ; search warrant protocol @ @ @ @ @ @ @ , the reforms encourage officers to increase their casual presence in certain communities and include social workers in their dispatch runs .
Altogether , the reforms represent an opportunity to move the city forward but remain far from activist calls to defund or abolish the police .
“ As we have those broader conversations about what policing should look like in the future , we also need to continue thinking about what limits should apply to the police that we have now and the public safety arm that we will have in the @ @ @ @ @ @ @ professor and police accountability expert Joanna Schwartz told Vox .
“ That requires both thinking about the policies that guide their behavior and the mechanisms for accountability when they violate those policies.
” While Louisville Mayor Greg Fischer presented the reforms as a way for the city to take immediate action , many of the reforms aren ’ t set in stone , nor can they take place overnight .
Some still have to be negotiated with the Fraternal Order of Police , a police membership organization that engages in collective bargaining and @ @ @ @ @ @ @ Community relations measures are encouraged but not mandatory Some lawmakers , including presidential candidate Joe Biden , have suggested that the way forward on police reform is to help improve relations between the community and police by increasing the number of positive interactions between the two groups .
The settlement borrows from this line of thinking .
To improve the relationship between police and the people of Louisville , Fischer announced a plan to create a housing credit program to incentivize officers to live within “ Qualified Census Tracts , ” areas identified @ @ @ @ @ @ @ Development as having a poverty rate of 25 percent or more or where 50 percent of households have incomes below 60 percent of the area median gross income .
The city plans to build on models already underway in cities like Chicago , Atlanta , and Washington , DC .
Relatedly , Fischer said that officers would also be “ encouraged ” to volunteer at least two hours during the workday per pay period in the community they serve .
According to Schwartz , the proposals are interesting and innovative and are trying @ @ @ @ @ @ @ police are too separated , physically and culturally , from the communities they serve .
One recent study found that community policing does help improve people ’ s perception of law enforcement , but there ’ s no way to guarantee that officers have positive interactions when they go out into the community .
Moreover , the report ’ s authors said that positive interactions with the police are “ no panacea for long-standing issues in policing that include police brutality , corruption , and racial bias.
” “ It ’ s easier @ @ @ @ @ @ @ it is to come up with concrete ways of moving forward .
But these are two very concrete means of encouraging more connections , ” Schwartz said .
Since the programs are not mandatory , though , it ’ s unclear how popular they will become and the extent to which officers will participate .
Social workers will assist police — but won ’ t replace them In a proposal that meets activists in the middle , Fischer announced that the department will retain social workers to support and assist officers on dispatch @ @ @ @ @ @ @ funded through forfeiture funds and will contract social workers .
The proposal addresses some of the conversation coming out of the defund movement , which is forcing leaders to think deeply about when to dispatch police — and when not to .
“ There are a lot of instances in which getting mental health professionals or social workers could be a far better approach , ” Schwartz said , pointing to the police killing of Daniel Prude , who was experiencing a mental health crisis when Rochester police were called to the scene @ @ @ @ @ @ @ , had there been a number to call to get the help of social workers , the result might have been different , according to Schwartz .
But activists aren ’ t just calling for social workers to work alongside police officers — they ’ re demanding that social workers supplant them in situations where people need a deescalation response .
And specifically , they say funding for police departments should be redirected to these emergency response workers and social services .
As Rochester Mayor Lovely Warren put it , “ Mr .
@ @ @ @ @ @ @ , our mental health care system , our society , and by me.
” In announcing reforms in Rochester , Warren went a step further than Louisville ’ s Fischer , separating out some social programs from policing and promising to double the availability of mental health professionals .
“ We will take our family crisis intervention team out of the police department and move it and its funding to the department of youth and recreation services , ” Warren said .
Changes made to the search warrant protocol that could have saved @ @ @ @ @ @ @ s killing has raised public attention about no-knock warrants and about search warrants in general .
Taylor was shot eight times in her home after three officers used a battering ram to enter it under the authority of a no-knock warrant .
Since then , the Louisville Metro Council unanimously voted to pass “ Breonna ’ s Law , ” an ordinance that bans the use of no-knock warrants .
The settlement ’ s stated reforms make three additional changes to standard operating procedure around warrants .
First , a commanding officer must @ @ @ @ @ @ @ an officer seeks judicial approval for the warrant , in an attempt to calculate and assess risk .
Second , the department plans to overhaul the process and chain of command for simultaneous search warrants .
These may work to address the problematic search warrant procedures that took place in Taylor ’ s case .
The family ’ s lawsuit alleged that police were looking for a drug dealer and had the wrong information about his address .
Police also reportedly mistook Taylor ’ s car , which was parked outside her apartment @ @ @ @ @ @ @ ’ s car , according to the lawsuit .
An extra review of the warrant by a commanding officer could have assessed the risk associated with acting on information that was reportedly wrong and outdated .
Fischer stressed that these updates , together with Breonna ’ s Law , are “ substantial ” and create a new level of scrutiny for obtaining search warrants .
Third , the department now requires that EMS and/or paramedics be at the scene where forced entry warrants are used .
In the lawsuit against the city , @ @ @ @ @ @ @ 26-year-old was not given any medical attention and was left to die in the apartment .
Officials countered the claim , saying they tended to Taylor as soon as they could , though they didn ’ t initially know she was injured since everything happened in the dark .
The coroner told the New York Times that the injuries were so severe that Taylor likely died in less than a minute .
Still , the family maintains that immediate medical attention should have been provided .
The police department even confirmed that “ @ @ @ @ @ @ @ to request medical help before executing high-risk warrants .
Still , the very presence of paramedics at sites where forced entry warrants are to be used could suggest the expectation that someone will be harmed .
Perhaps the presence of EMS workers could have saved Taylor ’ s life , as her attorneys say , but this would not have changed the fact that she was already the victim of excessive force the moment officers stormed in and started shooting .
Louisville is behind on police accountability measures To foster accountability , LMPD @ @ @ @ @ @ @ , which will track use of force incidents , citizen complaints , and investigations , among other events .
According to the department ’ s standard operating procedures document , the department had previously used the system to identify “ work-related problematic behavioral patterns among members.
” And now , according to Mayor Fischer , LMPD will take steps to reactivate it .
Vox contacted Fischer ’ s office about why and when the system was deactivated but has not received a response .
“ Early intervention systems have been viewed as a @ @ @ @ @ @ @ for quite some time , ” said Schwartz .
“ The Department of Justice , in its investigations and consent decrees with police departments , has recommended this for well over probably two decades.
” Schwartz notes that as the department plans to reimplement this tracking system , it ’ s also important to consider exactly what the department is tracking , who is doing the tracking , and how well .
According to Fischer , the warning system will be monitored through the Office of the Inspector General .
Brett Hankison , @ @ @ @ @ @ @ the Taylor investigation , had a record of sexual assault allegations against him that were all dismissed .
Meanwhile , Hankison is also being sued by a man who says Hankison harasses suspects with unnecessary arrests and by planting drugs on them .
While the system will formally track such complaints , the allegations against Hankison were already known — and didn ’ t bar him from staying on the job .
Drug testing could identify others forms of police misconduct The department plans to negotiate in 2021 with the Fraternal Order of @ @ @ @ @ @ @ to make sure every officer is tested at least once a year .
The department also plans to negotiate with the FOP that they expand the kinds of records that live in an officer ’ s file .
According to Schwartz , there have been instances in which police officers on prescription medications like Xanax have been impaired on the job .
Regular testing can help the department identify officers with substance abuse issues as well .
But drug testing just once a year is a low bar , according to Schwartz .
@ @ @ @ @ @ @ much the FOP will push back on these and other issues .
The reforms are a start and the monetary settlement is significant The settlement was announced as Kentucky Attorney General Daniel Cameron and the FBI continue criminal investigations of the three officers who fired their weapons into Taylor ’ s apartment .
While the results of the criminal investigation are important , the significance of the settlement should not be downplayed , said Schwartz , especially as the current movement for Black lives has left many questioning the effectiveness of America ’ @ @ @ @ @ @ @ prosecution and civil litigation accomplish different goals .
Criminal prosecutions are intended to punish officers , to deter future criminal behavior .
I don ’ t view criminal prosecution as the only answer for a lot of questions , ” said Schwartz .
“ We must be careful about relying on prosecution and the criminal justice system for deterrence.
” Civil litigation , and the statues under which these officers and departments were sued , were created in the years after the Civil War to remedy racism and police and Ku Klux Klan @ @ @ @ @ @ @ , according to Schwartz .
“ There ’ s no way that Breonna Taylor ’ s family can be made whole , but we shouldn ’ t overlook the importance of compensating the families of people who have been harmed or killed , and civil suits do that in a way that criminal prosecutions don ’ t , ” Schwartz said .
To create lasting community change , meaningful reforms should also be a component of civil settlements .
But the reforms presented in Louisville are so far only scratching the surface of @ @ @ @ @ @ @ s core .
Help keep Vox free for all Millions turn to Vox each month to understand what ’ s happening in the news , from the coronavirus crisis to a racial reckoning to what is , quite possibly , the most consequential presidential election of our lifetimes .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
But our distinctive brand of explanatory journalism takes resources .
Even when the economy and the news advertising market recovers , your support will @ @ @ @ @ @ @ resource-intensive work .
If you have already contributed , thank you .
If you haven ’ t , please consider helping everyone make sense of an increasingly chaotic world : Contribute today from as little as $ 3 .

A $12 million payout certainly won’t bring Breonna Taylor back. But the city of Louisville’s historic settlement with her family also includes a set of police reforms that may — depending on how and if they are implemented — help prevent police killings like the one that ended Taylor’s life in March.
The set of reforms, announced as part of the family’s civil suit on Tuesday, addresses three areas of policing in Louisville: community connections between police and the people they serve; search warrant protocol; and police accountability. For example, the reforms encourage officers to increase their casual presence in certain communities and include social workers in their dispatch runs. Altogether, the reforms represent an opportunity to move the city forward but remain far from activist calls to defund or abolish the police.
“As we have those broader conversations about what policing should look like in the future, we also need to continue thinking about what limits should apply to the police that we have now and the public safety arm that we will have in the future,” UCLA School of Law professor and police accountability expert Joanna Schwartz told Vox. “That requires both thinking about the policies that guide their behavior and the mechanisms for accountability when they violate those policies.”
While Louisville Mayor Greg Fischer presented the reforms as a way for the city to take immediate action, many of the reforms aren’t set in stone, nor can they take place overnight. Some still have to be negotiated with the Fraternal Order of Police, a police membership organization that engages in collective bargaining and has historically worked against police accountability.
Community relations measures are encouraged but not mandatory
Some lawmakers, including presidential candidate Joe Biden, have suggested that the way forward on police reform is to help improve relations between the community and police by increasing the number of positive interactions between the two groups.
The settlement borrows from this line of thinking.
To improve the relationship between police and the people of Louisville, Fischer announced a plan to create a housing credit program to incentivize officers to live within “Qualified Census Tracts,” areas identified by the Department of Housing and Urban Development as having a poverty rate of 25 percent or more or where 50 percent of households have incomes below 60 percent of the area median gross income. The city plans to build on models already underway in cities like Chicago, Atlanta, and Washington, DC.
Relatedly, Fischer said that officers would also be “encouraged” to volunteer at least two hours during the workday per pay period in the community they serve.
According to Schwartz, the proposals are interesting and innovative and are trying to address the criticisms and concerns that police are too separated, physically and culturally, from the communities they serve. One recent study found that community policing does help improve people’s perception of law enforcement, but there’s no way to guarantee that officers have positive interactions when they go out into the community. Moreover, the report’s authors said that positive interactions with the police are “no panacea for long-standing issues in policing that include police brutality, corruption, and racial bias.”
“It’s easier to diagnose the problems of policing than it is to come up with concrete ways of moving forward. But these are two very concrete means of encouraging more connections,” Schwartz said.
Since the programs are not mandatory, though, it’s unclear how popular they will become and the extent to which officers will participate.
Social workers will assist police — but won’t replace them
In a proposal that meets activists in the middle, Fischer announced that the department will retain social workers to support and assist officers on dispatch runs. The developing program will be funded through forfeiture funds and will contract social workers.
The proposal addresses some of the conversation coming out of the defund movement, which is forcing leaders to think deeply about when to dispatch police — and when not to.
“There are a lot of instances in which getting mental health professionals or social workers could be a far better approach,” Schwartz said, pointing to the police killing of Daniel Prude, who was experiencing a mental health crisis when Rochester police were called to the scene and restrained him. In that situation, had there been a number to call to get the help of social workers, the result might have been different, according to Schwartz.
But activists aren’t just calling for social workers to work alongside police officers — they’re demanding that social workers supplant them in situations where people need a deescalation response. And specifically, they say funding for police departments should be redirected to these emergency response workers and social services. As Rochester Mayor Lovely Warren put it, “Mr. Daniel Prude was failed by our police, our mental health care system, our society, and by me.”
In announcing reforms in Rochester, Warren went a step further than Louisville’s Fischer, separating out some social programs from policing and promising to double the availability of mental health professionals. “We will take our family crisis intervention team out of the police department and move it and its funding to the department of youth and recreation services,” Warren said.
Changes made to the search warrant protocol that could have saved Breonna Taylor’s life
Taylor’s killing has raised public attention about no-knock warrants and about search warrants in general. Taylor was shot eight times in her home after three officers used a battering ram to enter it under the authority of a no-knock warrant. Since then, the Louisville Metro Council unanimously voted to pass “Breonna’s Law,” an ordinance that bans the use of no-knock warrants.
The settlement’s stated reforms make three additional changes to standard operating procedure around warrants. First, a commanding officer must review and approve all search warrants before an officer seeks judicial approval for the warrant, in an attempt to calculate and assess risk. Second, the department plans to overhaul the process and chain of command for simultaneous search warrants.
These may work to address the problematic search warrant procedures that took place in Taylor’s case. The family’s lawsuit alleged that police were looking for a drug dealer and had the wrong information about his address. Police also reportedly mistook Taylor’s car, which was parked outside her apartment that night, as the drug dealer’s car, according to the lawsuit. An extra review of the warrant by a commanding officer could have assessed the risk associated with acting on information that was reportedly wrong and outdated. Fischer stressed that these updates, together with Breonna’s Law, are “substantial” and create a new level of scrutiny for obtaining search warrants.
Third, the department now requires that EMS and/or paramedics be at the scene where forced entry warrants are used.
In the lawsuit against the city, Taylor’s family alleged that the 26-year-old was not given any medical attention and was left to die in the apartment. Officials countered the claim, saying they tended to Taylor as soon as they could, though they didn’t initially know she was injured since everything happened in the dark. The coroner told the New York Times that the injuries were so severe that Taylor likely died in less than a minute. Still, the family maintains that immediate medical attention should have been provided. The police department even confirmed that “it is common practice” for officers to request medical help before executing high-risk warrants.
Still, the very presence of paramedics at sites where forced entry warrants are to be used could suggest the expectation that someone will be harmed. Perhaps the presence of EMS workers could have saved Taylor’s life, as her attorneys say, but this would not have changed the fact that she was already the victim of excessive force the moment officers stormed in and started shooting.
Louisville is behind on police accountability measures
To foster accountability, LMPD will implement the police integrity software IAPro, which will track use of force incidents, citizen complaints, and investigations, among other events. According to the department’s standard operating procedures document, the department had previously used the system to identify “work-related problematic behavioral patterns among members.” And now, according to Mayor Fischer, LMPD will take steps to reactivate it. Vox contacted Fischer’s office about why and when the system was deactivated but has not received a response.
“Early intervention systems have been viewed as a key cornerstone of police supervision and accountability for quite some time,” said Schwartz. “The Department of Justice, in its investigations and consent decrees with police departments, has recommended this for well over probably two decades.”
Schwartz notes that as the department plans to reimplement this tracking system, it’s also important to consider exactly what the department is tracking, who is doing the tracking, and how well. According to Fischer, the warning system will be monitored through the Office of the Inspector General.
Brett Hankison, the only officer to be terminated during the Taylor investigation, had a record of sexual assault allegations against him that were all dismissed. Meanwhile, Hankison is also being sued by a man who says Hankison harasses suspects with unnecessary arrests and by planting drugs on them. While the system will formally track such complaints, the allegations against Hankison were already known — and didn’t bar him from staying on the job.
Drug testing could identify others forms of police misconduct
The department plans to negotiate in 2021 with the Fraternal Order of Police that they expand random drug testing to make sure every officer is tested at least once a year. The department also plans to negotiate with the FOP that they expand the kinds of records that live in an officer’s file.
According to Schwartz, there have been instances in which police officers on prescription medications like Xanax have been impaired on the job. Regular testing can help the department identify officers with substance abuse issues as well.
But drug testing just once a year is a low bar, according to Schwartz. And it remains to be seen how much the FOP will push back on these and other issues.
The reforms are a start and the monetary settlement is significant
The settlement was announced as Kentucky Attorney General Daniel Cameron and the FBI continue criminal investigations of the three officers who fired their weapons into Taylor’s apartment. While the results of the criminal investigation are important, the significance of the settlement should not be downplayed, said Schwartz, especially as the current movement for Black lives has left many questioning the effectiveness of America’s criminal justice system.
“Criminal prosecution and civil litigation accomplish different goals. Criminal prosecutions are intended to punish officers, to deter future criminal behavior. I don’t view criminal prosecution as the only answer for a lot of questions,” said Schwartz. “We must be careful about relying on prosecution and the criminal justice system for deterrence.”
Civil litigation, and the statues under which these officers and departments were sued, were created in the years after the Civil War to remedy racism and police and Ku Klux Klan killings of Black people in the South, according to Schwartz.
“There’s no way that Breonna Taylor’s family can be made whole, but we shouldn’t overlook the importance of compensating the families of people who have been harmed or killed, and civil suits do that in a way that criminal prosecutions don’t,” Schwartz said.
To create lasting community change, meaningful reforms should also be a component of civil settlements. But the reforms presented in Louisville are so far only scratching the surface of problems that run deep through policing’s core.