Vienna (Austria), 2 February 2021 — The shareof children among detected trafficking victims has tripled while the share of boys has increased five times in the past 15 years. Girls are mainly trafficked for sexual exploitation, while boys are used for forced labour, according to the Global Report on Trafficking in Persons, launched by the United Nations Office on Drugs and Crime (UNODC) today.
In 2018 about 50,000 human trafficking victims were detected and reported by 148 countries. However, given the hidden nature of this crime, the actual number of victims trafficked is far higher. The Report shows traffickers particularly target the most vulnerable, such as migrants and people without jobs. The COVID-19-induced recession is likely to expose more people to the risk of trafficking.
“Millions of women, children and men worldwide are out of work, out of school and without social support in the continuing COVID-19 crisis, leaving them at greater risk of human trafficking. We need targeted action to stop criminal traffickers from taking advantage of the pandemic to exploit the vulnerable,” said UNODC Executive Director Ghada Waly.
“The UNODC Global Report on Trafficking in Persons 2020, coupled with the technical assistance UNODC provides through its global programmes and field network, aims to inform governments’ anti-trafficking responses, end impunity, and support victims as part of integrated efforts to build forward from the pandemic.”
Profile of the Victims
Female victims continue to be the primary targets for trafficking in persons. For every 10 victims detected globally in 2018, about five were adult women and two were young girls. Around 20 per cent of human trafficking victims were adult men and 15 per cent were young boys.
Over the last 15 years, the number of detected victims has increased, while their profile has changed. The share of adult women among the detected victims fell from more than 70 per cent to less than 50 per cent in 2018, while the share of children detected has increased, from around 10 per cent to over 30 per cent. In the same period, the share of adult men has nearly doubled, from around 10 per cent to 20 per cent in 2018.
Overall, 50 per cent of detected victims were trafficked for sexual exploitation, 38 per cent were exploited for forced labour, six per cent were subjected to forced criminal activity, while one per cent were coerced into begging and smaller numbers into forced marriages, organ removal, and other purposes.
Victims’ profiles differ according to the form of exploitation. In 2018, most women and girls detected were trafficked for sexual exploitation, whereas men and boys were mainly trafficked for forced labour.
The share of detected victims trafficked for forced labour has steadily increased for more than a decade. Victims are exploited across a wide range of economic sectors, particularly in those where work is undertaken in isolated circumstances including agriculture, construction, fishing, mining, and domestic work.
Profile of the Offenders
Globally, most persons prosecuted and convicted of trafficking in persons continue to be male, with around 64 and 62 per cent respectively. Offenders can be members of organized crime groups, which traffic the great majority of victims, to individuals operating on their own or in small groups on an opportunistic basis.
Traffickers see their victims as commodities without regard for human dignity and rights. They sell fellow human beings for a price that can range from tens of US dollars to tens of thousands, with large criminal organizations making the highest incomes.
Traffickers have integrated technology into their business model at every stage of the process, from recruiting to exploiting victims. Many children are approached by traffickers on social media and they are an easy target in their search for acceptance, attention, or friendship. UNODC has identified two types of strategies: “hunting” involving a trafficker actively pursuing a victim, typically on social media; and “fishing”, when perpetrators post job advertisements and wait for potential victims to respond. The internet allows traffickers to live stream the exploitation of their victims, which enables the simultaneous abuse of one victim by many consumers around the globe.
Trafficking Flows
Based on the data collected from 148 countries, UNODC was able to record 534 different trafficking flows around the globe although victims are typically trafficked within geographically close areas. A typical example involves girls recruited in a suburban area and exploited in nearby motels or bars. Globally, most victims are rescued in their own country of origin. For more details, please consult the attached table on regional trends, or the Report.
The Global Report on Trafficking in Persons is produced by UNODC every two years, to inform an effective response to this crime and place it within the context of the UN Sustainable Development Agenda. The 2020 edition covers data from the world’s largest database on trafficking victims, compiling figures from official sources across 148 countries. It also analyses 489 court cases from 71 different countries, providing more qualitative information on the perpetrators and the characteristics of this crime.
Democratic Gov. Phil Murphy of New Jersey is still in a close race for reelection while a Republican political newcomer has delivered a stunning upset in the Virginia governor’s race.By Associated Press|Nov. 3, 2021, at 1:47 p.m.SaveMore
Close Race for Governor in NJ, GOP’s Youngkin Takes VirginiaMore
Republican New Jersey gubernatorial candidate Jack Ciattarelli, center, greets a supporter at his election night party in Bridgewater, N.J., early Wednesday, Nov. 3, 2021. (AP Photo/Stefan Jeremiah) THE ASSOCIATED PRESS
By WILL WEISSERT and SARAH RANKIN, Associated Press
RICHMOND, Va. (AP) — Democratic Gov. Phil Murphy of New Jersey remained in a close race for reelection Wednesday while a Republican political newcomer delivered a stunning upset in the Virginia governor’s race, sending a warning to Democrats that their grip on power in Washington may be in peril.Recommended VideosPowered by AnyClipUS election: Youngkin wins Virginia governor’s race, jolting Democrats46Play Videohttps://imasdk.googleapis.com/js/core/bridge3.487.0_en.html#goog_103752678https://imasdk.googleapis.com/js/core/bridge3.487.0_en.html#goog_1806576887Ad: (3)
US election: Youngkin wins Virginia governor’s race, jolting DemocratsNOW PLAYING
Republicans capture Virginia governorship, dealing setback to Biden
McAuliffe, Youngkin set out on final day of campaigning ahead of Virginia’s gubernatorial election
In Virginia, Glenn Youngkin became the first Republican to win statewide office in a dozen years, tapping into culture war fights over schools and race to unite former President Donald Trump’s most fervent supporters with enough suburban voters to notch a victory.
Meanwhile, Murphy’s reelection effort was frustrated by a surprisingly strong showing from GOP challenger Jack Ciattarelli, who campaigned on issues including taxes and opposition to pandemic mask and vaccination mandates. The race was too early to call with votes still being tallied.
The two states’ results were particularly alarming to Democrats because of where they happened. President Joe Biden carried Virginia by 10 points last year. He took New Jersey by more than 15. Given the scale of those victories, neither state was seen as especially competitive when this year’s campaigns began.
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But the first major elections of Biden’s presidency suggested growing discontent among voters. They also underscored that, with Trump out of office, Democrats can’t center their messages on opposition to him. The results ultimately pointed to a potentially painful year ahead for Democrats as they try to maintain thin majorities in Congress.
And they put a new focus on congressional Democrats’ inability so far to pass Biden’s massive domestic policy legislation, though it’s unclear whether the defeat will be enough to jolt his party into action.
Republicans celebrated their strong showing with Youngkin telling a cheering crowd of supporters that “this is the spirit of Virginia coming together like never before.” The GOP’s strength extended to down-ballot contests, including the lieutenant governor’s race, which Winsome Sears won, becoming the first woman of color to win Virginia statewide office.
McAuliffe formally conceded in a statement Wednesday morning that congratulated Youngkin.
“Losing is never easy,” he said. “We put ourselves out there and left it all on the field.”
A political neophyte, Youngkin was able to take advantage of apparent apathy among core Democratic voters fatigued by years of elections that were seen as must-wins, as well as growing frustrations with Biden and the economy. He successfully portrayed McAuliffe, a former Virginia governor, Democratic National Committee chairman and close friend of Bill and Hillary Clinton, as part of an elite class of politicians. He also seized on a late-stage stumble by McAuliffe, who during a debate performance suggested parents should have a minimal role in shaping school curriculums.
Perhaps most significantly, Youngkin prevailed in a task that has stumped scores of Republicans before him: attracting Trump’s base while also appealing to suburban voters who were repelled by the former president’s divisive behavior.
During the campaign, Youngkin stated his support for “election integrity,” a nod at Trump’s lie that the 2020 presidential election was stolen, while also focusing on education and business-friendly policies. He never campaigned in person with Trump, successfully challenging McAuliffe’s effort to cast him as a clone of the former president.
That approach could provide a model for Republicans competing in future races that feature significant numbers of Democratic or independent voters.
Elsewhere in the country Tuesday, mayoral contests helped shape the leadership of some of the nation’s largest cities. Democratic former police captain Eric Adams won in New York, and Boston voters elected City Councilor Michelle Wu, the city’s first female and Asian American mayor. Cincinnati is getting its first Asian American mayor, Aftab Pureval.
Minneapolis voters rejected a ballot initiative that sought to overhaul policing in their city, where George Floyd was killed by a white police officer on Memorial Day 2020, sparking the largest wave of protests against racial injustice in generations. The initiative would have replaced the police force with a Department of Public Safety charged with undertaking “a comprehensive public health” approach to policing.
But no other contest in this off-year election season received the level of national attention — and money — as the governor’s race in Virginia, a state with broad swaths of college-educated suburban voters who are increasingly influential in swaying control of Congress and the White House.
A former co-CEO at the Carlyle Group with a lanky, 6′6″ build that once made him a reserve forward on Rice University’s basketball team, Youngkin poured vast amounts of his personal fortune into a campaign that spent more than $59 million. Favoring fleece vests, Youngkin sought to cut the image of a genial suburban dad.
Youngkin ran confidently on a conservative platform. He opposed a major clean energy mandate the state passed two years ago and objected to abortion in most circumstances.
He also opposed mask and vaccine mandates, promised to expand Virginia’s limited charter schools and ban critical race theory, an academic framework that centers on the idea that racism is systemic in the nation’s institutions and that they function to maintain the dominance of white people. In recent months, it has become a catch-all political buzzword for any teaching in schools about race and American history.
McAuliffe tried to energize the Democratic base by highlighting abortion, denouncing a new Texas law that largely banned the procedure and warning that Youngkin would seek to implement similar restrictions.
Youngkin didn’t discuss abortion much publicly, and a liberal activist caught him on tape saying the issue couldn’t help him during the campaign. He said an election win would allow the party to “start going on offense” on the issue.
While McAuliffe pulled on the star power of a host of national Democrats, including former President Barack Obama and ex-Georgia governor candidate Stacey Abrams, Youngkin largely campaigned on his own, focusing on issues he said were important to Virginians.https://c6dfb0b41dafa413c1b71b919d839d39.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html
Youngkin also proved perhaps most successful in deflecting McAuliffe’s efforts to tie him to Trump and the former president’s divisive political style.
Polls showed the race tightening after McAuliffe said during a late September debate that he didn’t think “parents should be telling schools what they should teach.” That prompted Youngkin to run hundreds of TV ads on the statement and to focus on his own pledges to make school curricula less “un-American” and to overhaul policies on transgender students and school bathrooms.
The race took an especially bitter turn last week, when Youngkin ran an ad featuring a mother and GOP activist who eight years ago led an effort to ban “Beloved,” the Pulitzer Prize-winning novel by Black Nobel laureate Toni Morrison, from classrooms.
McAuliffe accused Youngkin of uncorking a “racist dog whistle,” but Youngkin said Virginia parents knew what was really at stake — and so did families across the country. That was a nod to how tapping into parental activism could work for the GOP next year and in future election cycles.
“America is watching Virginia,” Youngkin said as part of his closing argument.
___
Associated Press writers Ben Finley in Norfolk, Virginia, Hank Kurz in Richmond, Alexandra Jaffe in McLean and Jill Colvin in New York contributed to this report.
Reveal your story: a place to connect WE THE PEOPLE and share your individual journey through this historic time. What if the recent 2020 Presidential election were not about President Trump and Vice President Biden but about you? The first three words in our Constitution are what again? WE THE PEOPLE. So what does that mean exactly? According to Socratic.org “The writers of the Constitution began their document with the three words “We the People” because they wanted to signify the fact that the citizens of the United States give the power to the government. Without this, our government would fail to be a democratic republic – a government controlled by the people.” So let’s examine this fact: “the citizens of the United States give the power to the government.” That’s a pretty big role WE THE PEOPLE hold. According to dictionary.com the definition of how the people give government power is “A condition urged by many as a requirement for legitimate government: that the authority of a government should depend on the consent of the people, as expressed by votes in elections.” When we analyze this fact, as previously stated above, “Without this, our government would fail to be a democratic republic – a government controlled by the people, we need to discuss the current challenges in our current 2020 election. What is the definition of a credible election? According to usaid.gov the definition is “The most fundamental principle defining credible elections is that they must reflect the free expression of the will of the people. To achieve this, elections should be transparent, inclusive, and accountable, and there must be equitable opportunities to compete in the elections.” If we analyze the definition of a credible election we find the following interpretations: Freedom of expression, also known as freedom of speech, is a principle that supports the freedom of an individual or a community to articulate their opinions and ideas without fear of retaliation, censorship, or legal sanction; the Will of the people in political theory, is a collectively held will that aims at the common good or common interest.Transparency is defined as a key principle for credible elections and is a key process in which each step is open to scrutiny by stakeholders (political parties, election observers and voters alike), who are able to independently verify the process is conducted according to procedures and no irregularities have occurred. Providing transparency in an election helps establish trust and public confidence in the process, as voters have a means to verify the results are an accurate reflection of the will of the people.Inclusive meaning including or covering all the services, facilities, or items normally expected or required also not excluding any of the parties or groups involved in something; accountable meaning of a person, organization, or institution required or expected to justify actions or decisions responsible.Lastly defining the word compete which means strive to gain or win something by defeating or establishing superiority over others who are trying to do the same would mean you would have to have an equal playing field.
If we circle back to our fundamental power over the government through our election process, WE ARE THE PEOPLE that give power to the government through our freedom of speech which in an election are our votes. So how is this recent election and it’s potential unconstitutional actions affecting anyone other than us? After all, essentially we control the government with our right of freedom of speech through a credible election and votes. As it states if we the people do not control our government then we in fact fail to be a democratic republic. Is anyone scared? As mentioned before this is not about who you voted for; however, feel free to express that here. This introduction is simply to shed light on the fact that doesn’t it seem like the government, big tech, the media, shady swamp politician potential election buy-outs and shady business deals, rigged voting machines, maybe even China are now controlling OUR government – the one that WE THE PEOPLE have the ULTIMATE POWER OVER? This site bets that you may have an opinion on this historic electoral time. WE THE PEOPLE need our voices heard. Oh and one more thing to let simmer in your mind. Have you ever looked up the definition of a politician? Well, according to the dictionary a politician is “a person who is professionally involved in politics, especially as a holder of or a candidate for an elected office.” OR the very interesting latter “a person who acts in a manipulative and devious way, typically to gain advancement within an organization.” What do WE THE PEOPLE believe to be truth during this 2020 Presidential election and how has your journey through this election affected you? Reveal your story…
Advance directives are essential but often overlooked
By Jim Miller, Special to the Star-Advertiser
June 23, 2020
Dear Savvy Senior: All this horrible coronavirus carnage got me thinking about my own end-of-life decisions if I were to get sick. Can you recommend some good resources that can help me create a living will or advance directive, or other pertinent documents? I’ve put it off long enough. — Almost 70
Dear Almost: Creating a living will (also known as an advance directive) is one of those things most people plan to do but rarely get around to actually doing. Only about one-third of Americans currently have one. But the cold, hard reality of the novel coronavirus may be changing that. Here’s what you should know, along with some resources to help you create an advance directive.
Advance directivesADVERTISING
To adequately spell out your wishes regarding your end-of-life medical treatment, you need two key documents: A “living will,” which tells your doctor what kind of care you want to receive if you become incapacitated, and a “health care power of attorney” (or health care proxy), which names a person you authorize to make medical decisions on your behalf if you become unable to.
These two documents are known as an “advance directive,” and will only be utilized if you are too ill to make medical decisions yourself. You can also change or update it whenever you please.
It isn’t necessary to hire a lawyer to prepare an advance directive. There are free or low-cost resources available today to help you create one, and it takes only a few minutes from start to finish.
One that I highly recommend that’s completely free to use is My Directives (mydirectives.com). This is an online tool and mobile app that will help you create, store and share a detailed, customized digital advance directive. The easy-to-use platform combines eight thoughtful questions to guide you through the process. If you’re not computer-savvy, ask a family member or trusted friend to help you.
The advantage of having a digital advance directive versus a paper document is being able to access it quickly and easily via smartphone, which is crucial in emergency situations, when they’re most often needed.
If, however, you’d rather have a paper document, one of the best do-it-yourself options is the Five Wishes advance directive (online forms are available, too). Created by Aging With Dignity, a nonprofit advocacy organization, Five Wishes costs $5 and is available in many languages. To learn more or to receive a copy, visit fivewishes.org or call 850-681-2010.
Another tool you should know about that will compliment your advance directive is the Physician Orders for Life-Sustaining Treatment, or POLST (sometimes called Medical Orders for Life- Sustaining Treatment, or MOLST). A POLST form translates your end-of-life wishes into medical orders to be honored by your doctors. To learn more about your state’s program or set one up, see POLST.org.
Readers should also know that if you’ve already prepared an advance directive paper document, a POLST form or the VA advance directive form 10-0137, you can upload, store and share these documents at mydirectives.com.
STAY INFORMED ABOUT COVID-19
And finally, to ensure your final wishes are followed, make sure to tell your family members, health care proxy and doctors. If you make a digital advance directive or have uploaded your existing forms, you can easily share them electronically to everyone involved. Or, if you make a paper advance directive that isn’t uploaded, you should provide everyone copies to help prevent stress and arguments later.
Jim Miller is a contributor to NBC-TV’s “Today” program and author of “The Savvy Senior.” Send your questions to Savvy Senior, P.O. Box 5443, Norman, OK 73070; or visit savvysenior.org.
Most Americans Say Coronavirus Outbreak Has Impacted Their Lives
More than half have prayed for an end to the virus’s spread
How we did this
As the number of confirmed COVID-19 cases continues to rise and schools, workplaces and public gathering spaces across the United States remain closed, a new Pew Research Center survey finds that the coronavirus outbreak is having profound impacts on the personal lives of Americans in a variety of ways. Nearly nine-in-ten U.S. adults say their life has changed at least a little as a result of the COVID-19 outbreak, including 44% who say their life has changed in a major way.
Amid widespread calls from experts for Americans to socially distance from one another to avoid spreading the virus, what recently seemed like mundane daily activities now elicit concerns from large swaths of the population. About nine-in-ten U.S. adults (91%) say that, given the current situation, they would feel uncomfortable attending a crowded party. Roughly three-quarters (77%) would not want to eat out at a restaurant. In the midst of a presidential election year, about two-thirds (66%) say they wouldn’t feel comfortable going to a polling place to vote. And smaller but still substantial shares express discomfort even with going to the grocery store (42%) or visiting with a close friend or family member in their home (38%).
How are people adapting their behavior in light of the outbreak? Four-in-ten working-age adults ages 18 to 64 report having worked from home because of coronavirus concerns – a figure that rises to a majority among working-age adults with college degrees and upper-income earners. Still, despite current circumstances, about two-thirds of adults with children under 12 at home say it’s been at least somewhat easy for them to handle child care responsibilities.
The virus also has impacted Americans’ religious behaviors. More than half of all U.S. adults (55%) say they have prayed for an end to the spread of coronavirus. Large majorities of Americans who pray daily (86%) and of U.S. Christians (73%) have taken to prayer during the outbreak – but so have some who say they seldom or never pray and people who say they do not belong to any religion (15% and 24%, respectively).
Among U.S. adults who said in an earlier survey they attend religious services at least once or twice a month, most (59%) now say they have scaled back their attendance because of the coronavirus – in many cases, presumably because churches and other houses of worship have canceled services. But this does not mean they have disengaged from collective worship entirely: A similar share (57%) reports having watched religious services online or on TV instead of attending in person. Together, four-in-ten regular worshippers appear to have replaced in-person attendance with virtual worship (saying that they have been attending less often but watching online instead).
These are among the findings of a Pew Research Center survey of 11,537 U.S. adults conducted March 19-24, 2020, using the Center’s American Trends Panel.1 Other key findings from the survey include:
Republicans are more likely than Democrats to say they feel comfortable proceeding with a variety of activities despite the coronavirus outbreak. For example, 69% of Republicans and people who lean toward the GOP say they would be comfortable visiting with a close friend or family member at their home, compared with 55% of Democrats and Democratic leaners. Along these same lines, Democrats are more likely than Republicans to say their lives have changed in a major way as a result of the virus, and that they have been feeling psychological distress.
Compared with older Americans, young adults are more likely to say they are comfortable going to a crowded party, a restaurant or a small gathering with close family or friends. Still, most adults under 30 say they are uncomfortable eating out at a restaurant (73%) or going to a crowded party (87%). Young adults are more likely than their elders to say they have used a food delivery service due to the outbreak.
Concerns about public activities and changes to personal lives have been felt more acutely in states with higher numbers of COVID-19 cases. For instance, 51% of those living in highly impacted states say their lives have changed in a major way, compared with 40% of those in states with the lowest numbers of cases.
Most Americans say their personal life has been affected by the coronavirus outbreak
Nearly nine-in-ten U.S. adults say their personal life has changed at least a little bit as a result of the coronavirus outbreak, with 44% saying their life has changed in a major way. Just 12% say their life has stayed about the same as it was before the outbreak.
Women (47%) are more likely than men (41%) to say their personal life has changed in a major way as a result of the coronavirus outbreak. And while more than four-in-ten white (45%) and Hispanic (47%) adults say this has changed their lives significantly, about a third of black adults (34%) say the same.
Income and education are also linked to assessments of the personal impact of the coronavirus outbreak. More than half of those with higher incomes (54%) say this has changed their life in a major way, compared with 44% of those with middle incomes and 39% of those with lower incomes.2
Similarly, 61% of those with postgraduate degrees, and a narrower majority of those with bachelor’s degrees (54%), say the coronavirus outbreak has changed their life in a major way. By comparison, 43% of those with some college and about a third of those with a high school diploma or less education (35%) say this has happened to them. Across income groups, those with at least a bachelor’s degree are more likely than those with less education to say the coronavirus outbreak has changed their life in a major way.
Across age groups, similar shares say the coronavirus outbreak has had a major impact on their personal life. For example, 43% of adults younger than 30 say the outbreak has changed their life in a major way, as do 45% of those ages 65 and older.
Not surprisingly, those in states with a high number of coronavirus cases are more likely than those in states that haven’t been as affected to say their personal life has changed in a major way because of the outbreak. About half of those who live in states with a high number of cases (51%) say their life has changed in a major way, compared with 43% of those in states with a medium number of cases and 40% of those in states with a low number of cases.3
Among the 33% of Americans who say they or someone in their household has either lost a job or took a pay cut because of the coronavirus outbreak, 54% say their personal life has changed in a major way as a result of the outbreak. This compares with 39% of those who say they have not experienced either of these situations.
About half of Democrats say their life has changed in a major way because of the coronavirus
Democrats are more likely than Republicans to say their personal life has changed in a major way as a result of the coronavirus outbreak: About half of Democrats and Democratic leaners (51%) say this, compared with 38% of Republicans and those who lean to the GOP.
These partisan differences remain even after accounting for the fact that Democrats are more likely than Republicans to live in states with a high number of confirmed cases of COVID-19. About a third of Democrats (34%) live in these states, compared with 22% of Republicans. More than half of Democrats in states with a high number of cases (57%) say their life has changed in a major way, compared with 42% of Republicans in states with a high number of cases. Similarly, in states with a medium or low number of cases, Democrats are more likely than their Republican counterparts to say the coronavirus outbreak has impacted their life in a major way.
More than three-quarters of Americans say they are not comfortable eating out in a restaurant given the current situation with coronavirus
About six-in-ten Americans say they would feel comfortable visiting with close friends and family members at their home (62%) and going to the grocery store (57%), given the current coronavirus outbreak. Roughly four-in-ten say they would not be comfortable doing these things (38% and 42%, respectively). Far fewer express comfort in going to a polling place to vote (33%) or eating out in a restaurant (22%), and only about one-in-ten (9%) say they would feel comfortable attending a crowded party.
There are some notable demographic differences in what Americans are comfortable doing during the current outbreak. In particular, younger adults are more likely than older Americans to express comfort with leaving their homes for various reasons. Across all age groups, majorities of Americans say they are uncomfortable eating out in a restaurant; still, about one-quarter of young adults ages 18 to 29 (27%) say they would be comfortable doing this, compared with just 16% of Americans 65 and older. Younger Americans are also more likely to feel comfortable visiting with family and friends: 68% of adults younger than 30 say they’d be comfortable doing this, compared with 60% of Americans ages 30 to 49, 64% of adults ages 50 to 64 and 56% of those 65 and older.
Republicans are more likely than Democrats to feel comfortable visiting with a friend, going grocery shopping
Across a variety of measures, Republicans are more likely than Democrats to say they are comfortable continuing with regular activities. Republicans are significantly more likely than Democrats to say they are comfortable going to a grocery store and visiting friends and are far more likely than Democrats to say they are comfortable eating in a restaurant.
Roughly seven-in-ten Republicans (69%) say they are comfortable visiting with a close friend or family member at their home, while 31% say they would be uncomfortable. Democrats are more divided: 55% say they would be comfortable doing this while 45% say they would not be comfortable.
When it comes to Americans’ comfort with visiting with those close to them, partisan differences remain even after accounting for the fact that Democrats are more likely than Republicans to live in states with a high number of confirmed cases of COVID-19. About two-thirds of Republicans in states with a high number of cases (65%) say they would be comfortable visiting with close family and friends, compared with 50% of Democrats in these states. Similarly, in states with a medium or low number of cases, Republicans are more likely than their Democratic counterparts to say they are comfortable visiting with family and friends.
Overall, Americans living in suburban and rural areas are more likely than those living in urban communities to feel comfortable visiting with close friends and relatives. However, Americans living in urban areas are divided depending on how many confirmed cases of COVID-19 are in their state. Those living in urban areas in states with a high number of cases are the least likely to feel comfortable visiting with others (47%) while urban dwellers in states with a medium (56%) or low (67%) number of cases are more likely to feel comfortable going out to visit friends. These differences are not as stark in suburban areas, and there is no difference in comfort with visiting others among Americans in rural communities, regardless of the number of cases in the state.
About one-in-five adults say they have used a food delivery service because of the coronavirus outbreak
Amid recommendations for social distancing to help prevent the spread of COVID-19, about one-in-five adults (21%) say they have used a food delivery service instead of going to a restaurant or grocery store as a result of the coronavirus outbreak.
Adults younger than 30 are particularly likely to say they have used a food delivery service because of the coronavirus outbreak: Three-in-ten in this group say they have done this. A quarter of adults ages 30 to 49 also say they have used a food delivery service because of the coronavirus outbreak, while smaller shares of those ages 50 to 64 (15%) and those 65 and older (14%) say the same.
Hispanic adults (26%) are more likely than white (19%) and black (20%) adults to have used a food delivery service instead of going to a restaurant or grocery store as a result of the coronavirus outbreak. And while about a quarter of women (23%) say they have done this, about one-in-five men (19%) say the same. There are no notable differences by educational attainment, income, or whether people live in states with a high, medium or low number of coronavirus cases.
Most working-age adults with at least a bachelor’s degree have worked from home as a result of the coronavirus outbreak
Four-in-ten working-age adults – those ages 18 to 64 – say they have worked from home as a result of the coronavirus outbreak.4 Men and women in this age group are about equally likely to say they have worked from home.
About three-quarters of working-age adults with a postgraduate degree (73%) say they have worked from home as a result of the coronavirus outbreak, as do 62% of those with a bachelor’s degree. Far smaller shares of working-age adults with some college (35%) or with a high school diploma or less education (22%) say they have worked from home.
Similarly, working-age adults with higher incomes are more likely than those with lower incomes to say they have worked from home because of the coronavirus outbreak: 61% of those in the upper-income tier say they have done this, compared with 41% in the middle-income tier and an even smaller share (27%) of those with lower incomes.
In states with a high number of coronavirus cases, 45% of working-age adults say they have worked from home because of the outbreak; smaller shares in states with a medium or low number of cases say the same (38% each).
Most adults with young children at home say it has been easy for them to handle child care responsibilities
Even as many schools have closed because of the coronavirus outbreak, 65% of adults with children younger than 12 at home say it has been at least somewhat easy for them to handle child care responsibilities during this time, with 32% saying it has been very easy. About a third (35%) say this has been very or somewhat difficult for them.
Similar shares of men (68%) and women (63%) with young children at home say it has been easy for them to handle child care responsibilities during the coronavirus outbreak (the difference between the shares of men and women saying this is not statistically significant).
Black and Hispanic adults with children younger than 12 at home are more likely than white adults with children in the same age group to say handling child care responsibilities has been difficult for them during the outbreak: About four-in-ten black (38%) and Hispanic (40%) adults with young children say this, compared with 28% of their white counterparts. Still, majorities of at least six-in-ten in each group say it has been easy for them to handle child care responsibilities during this time.
Majorities across income groups also say handling child care responsibilities has been at least somewhat easy for them so far, but those with middle incomes are more likely than those with upper or lower incomes to say this. Seven-in-ten middle-income adults with children younger than 12 at home say it’s been easy for them to handle child care responsibilities, compared with 58% of those in the upper-income tier and 63% in the lower-income tier.
Many Americans are praying and staying away from religious services in response to coronavirus
More than half of U.S. adults say they have prayed for an end to the spread of the coronavirus. Evangelical Protestants are among the most likely to say they have prayed for an end to the virus (82% say they’ve done so). A similar share of adherents of the historically black Protestant tradition (79%) say they have done the same. Two-thirds of Catholics (68%) and mainline Protestants (65%) also say they have prayed for an end to the outbreak.
Roughly one-third of Jews (35%) say they have prayed to end the virus. Religious “nones” – especially self-described atheists and agnostics – are less likely than those who identify with a religion to say they have prayed for an end to the outbreak, though 36% of those who describe their religion as “nothing in particular” say they have prayed about the virus.
Fully 86% of people who pray every day say they have prayed specifically about the virus, as have two-thirds of those who say they pray on a weekly basis. Half of those who say they pray a few times a month report having prayed about the coronavirus, as have 15% of those who generally seldom or never pray.
More women than men say they have prayed for an end to the spread of the disease, and more black respondents than white and Hispanic respondents say the same. Older people are more likely than younger adults to say they have prayed for an end to the virus, and more Republicans than Democrats have prayed about the outbreak. These patterns are consistent with overall differences in the religiousness of these groups.
The survey also shows that the outbreak has changed the religious attendance habits of U.S. adults, at least for the time being. Among people who said in a previous survey that they generally attend religious services at least once or twice a month, 59% now say they have attended less often recently as a result of the outbreak. And a similar share (57%) say they have watched religious services online or on TV instead of in-person.5
Across Christian groups, half or more of those who typically attend church at least monthly say they have been going less often because of the virus. Many of them – including two-thirds of evangelical Protestants – say they have tuned in to church services online or on television instead of attending in person.
Women who attend worship services monthly or more often are a bit more likely than men who attend with the same frequency to say they have turned to the internet or television to watch religious services (though no more likely to say they have been attending less often in-person). White church attenders are more likely than blacks and Latinos to say they have attended less often. Higher shares of Republicans than Democrats say they have stayed away from religious services and that they have turned to virtual alternatives in reaction to the outbreak.
Combining the two questions suggests that four-in-ten Americans who typically attend religious services at least monthly appear to have replaced their in-person attendance with virtual religious participation; 40% say they have been attending religious services less often and that they have been watching them online or on television instead as a result of the outbreak. One-in-five (19%) are attending less often but not replacing in-person attendance with watching services electronically, and 17% appear to be supplementing their in-person attendance with virtual participation (i.e., they say they are not attending less but that they are watching online or on TV). One quarter of those who typically attend religious services monthly say their attendance habits have not changed – they are not attending less often, nor are they watching services online or on television.
Among those who typically attend church at least monthly, the share of Christians who indicate they have replaced in-person attendance with watching church services online or on TV tops out at 47% among evangelical Protestants. White people are more likely than black and Hispanic respondents to say they are now watching religious services online while attending less in person, while black and Hispanic people are more likely than white respondents to say they are supplementing their in-person attendance with virtual religious participation or that their attendance habits have not changed.
CORRECTION (April 1, 2020): A previous version of the first chart in the report had an incorrect percentage for the share of Americans who would feel uncomfortable going out to the grocery store. It should have been 42%. This change does not substantively affect the report’s findings.
For more details, see the Methodology section of the report. ↩
Family incomes are based on 2018 earnings and adjusted for differences in purchasing power by geographic region and for household sizes. Middle income is defined here as two-thirds to double the median annual income for all panelists. Lower income falls below that range; upper income falls above it. ↩
COVID-19 state health impact is based on per-capita cases and/or total number of cases. See Appendix for details. ↩
This analysis includes all working-age adults ages 18 to 64, including some who may not be employed. ↩
The questions that ask respondents whether they have been attending religious services less often or watching them online or on TV instead of attending in-person were asked of everyone. Among all respondents, 27% say they have attended religious services less often and 25% (including 11% who generally attend religious services a few times a year or less) say they have watched them online or on TV in response to the outbreak. To facilitate interpretation of these data, the analyses reported here are based on those who said in a previous survey (conducted in the summer and fall of 2019) that they generally attend religious services at least once or twice a month. Those who indicated in the previous survey that they attend religious services a few times a year or less often may report low levels of having attended less often or having watched online in response to the virus because they attended sporadically or not at all to begin with, not because they are unconcerned by the virus. The survey included too few interviews with non-Christian respondents who attend religious services regularly to permit analysis of their responses to these questions. ↩
Small businesses in New York City are fighting for their survival amid the COVID-19 outbreak. After over a month without earning any revenue, many, including long-standing icons like Manhattan’s Strand bookstore, have laid off the majority of their staff. The independent bookseller has filed a request to be designated an essential business, so that it could take and fill online orders.
The Strand is just one of many well-known businesses and cultural institutions that may not survive COVID-19 pandemic and its economic repercussions – or that have already announced their closure, leading many New Yorkers to fret about a potentially devastating blow to the city’s character.
Here are some of the city’s icons that may permanently shutter as a result of the coronavirus.
Paris Cafe
It may not be the oldest bar in New York City, but 147 years in business is nothing to sneeze at. Since it first opened its doors in 1873, the Paris Cafe has been a fixture in the South Street Seaport in downtown Manhattan, just steps away from the East River. The bar and restaurant survived Hurricane Sandy in 2012, when the storm caused massive damage and flooding at the riverside haunt. Although it managed to come back seven months after Sandy, it seems that the coronavirus crisis proved too much to overcome. After posting an announcement on Facebook of its temporary closure on March 17, the owners announced in another post on May 3 that the Paris Cafe would shutter for good. The bar’s logo includes “Since 1873 till forever.” Unfortunately, it seems that forever has come sooner than anyone expected.
Gem Spa
It doesn’t sell jewelry and you can’t get a massage there, the East Village bodega became a true institution in spite of its misleading name. A pack of smokes, cheap sunglasses, a bottle of Coca-Cola – you could get anything there, but what made it special were the egg creams, the poor man’s milkshake which is slowly vanishing from the city where it was invented. Gem Spa, on the corner of St. Marks and 2nd Avenue, had been in dire straits for a while in the high rent neighborhood, and tried to stave off closure by upping its influence on social media. But the coronavirus was the last straw, and the home of “New York’s Best Egg Cream” says it’s closing for good.
Casa Magazines
On the corner of 8th Avenue and 12th Street in Manhattan’s West Village stands a magazine shop that has managed to walk the tightrope between old and new. The signage – and the customer service of owner Mohammed Ahmed – fit a previous decade, maybe the 1940s, but the inventory gets updated daily, with some 2,000 magazines from the mass-market to the ultra-niche. But a loss of customers during the coronavirus forced Ahmed to temporarily close the shop and he’s created a GoFundMe to stave off permanent closure. Capitalizing on its hip location, this shrine to the glossy page has also started selling t-shirts and prints to raise money.
Tenement Museum
Many museums are housed in former mansions, displaying the art and furniture of the rich and famous. Few are in decrepit, dimly lit apartments, documenting the lives of the poor and anonymous – but that’s what the Tenement Museum on Manhattan’s Lower East Side does. According to a report published by the public policy think tank Center for an Urban Future, the Tenement Museum is among the cultural institutions hardest hit by the virus. Its loss would be significant to many New Yorkers – especially the millions who trace their lineage to the Irish, Italian and Jewish immigrants whose first New York homes were tenements in Lower Manhattan. But, according to The New York Times, with 75% of its $11.5 million annual operating budget coming from admissions and gift shop sales, the museum will struggle to survive the pandemic. Founded in 1988, the museum consists of two buildings, on which it owes $9.5 million in mortgage loans, costing $50,000 per month. The buildings include about a dozen apartments, for which the museum must continue to pay for maintenance even if the tenants cannot pay their rent. The institution cut monthly payroll for its 67 full-time and 75 part-time workers, slashing it from almost $700,000 to $100,000. Recently, the institution laid off all of its 75 part-time employees and reduced its full-time staff from 67 to 51 workers, of which only 15 are currently on payroll. While the museum had to cancel its April gala, it asked supporters to purchase virtual tickets and tables. The museum has also received donations from supporters, a $250,000 emergency grant from the New York Community Trust’s $75 million COVID-19 impact fund and it applied for the CARES Act loan from the U.S. Small Business administration. Tenement Museum President Morris Vogel is currently amping up the museum’s online programming, adding a digital exhibit on the census, a craft-making program for children inspired by former tenement residents and educational materials covering the pandemic. However, it remains unclear whether the museum’s efforts are sufficient to curb the crisis. Even after reopening, Vogel expects an ongoing drop in revenue due to decreased tourism.
Upright Citizens Brigade
The 30-year-old improv group, which has long served as a home to up-and-coming comedians, is planning to close its permanent theater in Hell’s Kitchen and its training center on Eighth Avenue. The organization formed in the 1990s and soon grew into a comedy hub and launching pad for A-list comedians, including Ellie Kemper, Aziz Ansari and Kate McKinnon. The pandemic closure is the final straw, after years of successive struggles to pay rent, property taxes and other expenses. The group had moved to its Hell’s Kitchen location following the closures of its Chelsea theater in 2017 and East Village location early last year. In 2018, the theater also laid off its New York-based staff members and increased ticketing prices amid financial challenges.
Coogan’s
The Irish pub, a multiethnic gathering spot in Washington Heights, Manhattan, recently announced it would not be reopening, due to the pandemic. The bar and restaurant, which first opened in 1985, was a sanctuary in a neighborhood tormented by violence and the illegal drug trade during the 1990s. Its guests included Dominican Americans, African Americans, Caribbean Africans, Irish Americans, Jewish-German refugees, off-duty NYPD officers and medical workers from nearby Columbia University Irving Medical Center, the largest campus of NewYork–Presbyterian Hospital. Coogan’s nearly closed in 2018, after its landlord, the hospital, demanded a $40,000 raise in the monthly rent. The two sides reached an agreement, with the help of Rep. Adriano Espaillat, Manhattan Borough President Gale Brewer and Luis A. Miranda Jr., a political consultant and father of a Broadway star. However, now the time has come for New Yorkers to bid farewell to Coogan’s. According to The New York Times, the bar’s owners convinced a beverage supplier to take back cases and kegs of beer to meet the last payroll.
Forbidden Planet NYC
One of the oldest and biggest comic book stores in New York City, a few blocks from the Strand, Forbidden Planet may close permanently. Since its opening in 1981, the science fiction emporium has occupied three different locations on the same block, just south of Union Square. Due to its closure amid the pandemic, the store has not made any revenue in a month, according to Jeff Ayers, Forbidden Planet’s general manager. Despite having transitioned to online mailing, the store is struggling to pay its expenses. Income accrued from online orders is projected to cover only a small portion of the amount that is needed for the comic store to reopen. Ayers recently launched a GoFundMe site to support the business, which raised $29,500 of their $300,000 goal in a single day.
Neir’s Tavern
Saved by Mayor Bill de Blasio in January, the historic 19th-century bar in Woodhaven, Queens is once again on the cusp of death. Known for its cameo in the 1990 mob classic “Goodfellas” and the 2011 film “Tower Heist” with Ben Stiller and Eddie Murphy, Neir’s Tavern seemed destined to close at the beginning of the year, due to increases in rent and other costs, until de Blasio stepped in. The mayor facilitated a handshake deal for a new five-year lease between bar owner Locyent Gordon and building owner Henry Shi. The city’s Department of Small Business Services also gave the bar a $90,000 small business grant to keep the establishment alive. With the closure of restaurants mid-March, Neir’s Tavern began offering take-out and delivery service. However, Gordon decided to close the business for the month of April, to protect guests and staff. According to Gothamist, Gordon applied for relief funds and asked Shi for two months’ rent forgiveness in hopes of reopening.
Gotham Bar & Grill
The fine dining restaurant in the West Village shut its business after 36 years of service. Last summer, the upscale American restaurant, marked by chef Adam Portale’s 34-year tenure, hired a new chef, Victoria Blamey, hoping to attract younger diners. Chef Blamey received a three out of four-star rating from Times restaurant critic Pete Wells. However, despite good reviews, including Michelin stars and James Beard Awards, Gotham Bar & Grill experienced financial hardship. A spokesperson for the restaurant told Eater, “The situation created by the coronavirus has made the operation of the restaurant untenable.”
Lucky Strike
After 31 years in business, SoHo restaurant Lucky Strike is closing. Keith McNally, the owner of the French-American bistro, who himself had COVID-19, told Grub Street that the COVID-19 pandemic made its financial situation impossible to fix. According to a statement on its website, the restaurant stopped offering take-out and delivery options as of March 22 in the “interest and well-being of its customers and staff.” In a 2016 interview with Eater, McNally cited the eatery’s financial troubles, indicating Lucky Strike did not make “any money.”
‘A Heart-Wrenching Thing’: Hospital Bans on Visits Devastate Families
To curb the risk of spreading the coronavirus, hospitals nationwide are banning visits from family and friends.
Peter John Dario of Edison, N.J., never got to say goodbye to his father, Peter Dario, who died of complications from Covid-19 in the hospital.Credit…Bryan Anselm for The New York Times
The last time Peter John Dario saw his father alive was on March 14, at the entrance to a hospital in Edison, N.J. An employee took him away in a wheelchair, telling Mr. Dario and his mother gently but unequivocally that they could not go in the building.
In a fog of worry and confusion, as he watched his father’s diminished silhouette disappear through the door, Mr. Dario forgot to say goodbye.
Five days later, his father, Peter Dario, died of respiratory failure from an infection caused by the coronavirus. He was 59. None of the members of his large family — several of them now also sick with Covid-19 — were at his side.
Of all the ways the coronavirus pandemic has undermined the conventions of normal life, perhaps none is as cruel as the separation of seriously ill patients and their loved ones, now mandated at hospitals around the world.
Hospitals in all 50 states and dozens of countries are barring visitors. Lobbies are bare, visitor parking lots empty, flower deliveries stopped. The number of accessible entry points has been reduced, and security guards and staff are posted at those that remain to turn away patients’ relatives and friends.
“It’s a heart-wrenching thing to do,” said Dr. Laura Forese, executive vice president and chief operating officer of NewYork-Presbyterian Hospital in New York. “But it’s for everyone’s protection.”
At most hospitals, exceptions are being made only for patients receiving end of life care, hospitalized children and pregnant women in labor.
Last week, after New York-Presbyterian discovered that multiple pregnant and postpartum patients in its labor and delivery unit had Covid-19 — with minimal or no symptoms — it barred all visitors, including partners. Mt. Sinai Hospital System followed suit. But on Saturday night, following an outcry from expectant parents, Gov. Andrew M. Cuomo signed an executive order requiring all medical facilities licensed by New York State to allow one support person for patients who are in labor.
“This disease has demonstrated to us just how vulnerable the greater community can be when we have a virus circulating that no one has any immunity to,” said Nancy Foster, a vice president of the American Hospital Association. “And that extraordinary reality has forced us to take extraordinary measures.”
While the infection control rationale is clear and sound, the consequences — for patients, their loved ones and the hospital personnel who must enforce the rules — are profound.
Clinicians and hospital staff said keeping families away had been among the darkest experience of their professional lives. The restrictions run contrary to a hospital’s desire to keep patients and families together, not only for the salutary effect of something as simple as a hand held, or a chair pulled close to a bed, but because having a relative present can ease the workload of a medical team. It can also provide crucial information that a confused patient may not be able to offer.
Hospitals are receiving frequent requests for leniency, especially for patients in intensive care units.
“This isn’t easy but we have to deny the vast majority of them,” said Dr. Shereef Elnahal, president and chief executive of University Hospital in Newark, N.J., which is, like other hospitals, managing the requests on a case-by-case basis.
The restrictions raise distressing questions, especially when it comes to end-of-life visits. How close to the end of life must a patient be to merit a visitor? Is near death the right time? Why not earlier, when a patient is healthier, and of sound mind?
As is happening in Italy and elsewhere around the world, people like Peter Dario are dying alone, despite hospital exceptions for end-of-life visitors.
Peter John Dario holds a photograph of his mother, Luzviminda Dario, who’s recovering from Covid-19, and his father, Peter Dario, who died of Covid-19.Credit…Bryan Anselm for The New York Times
Peter Dario, who had diabetes and was on dialysis, started to look sick at the beginning of March, said his daughter Marsha Dario, 32, a nurse. His 86-year-old mother-in-law, who also lives in the household, was already sick with Covid-like symptoms.
When Marsha Dario picked her father up from dialysis on March 7, he was weak, dizzy and vomiting. She told him he needed to go to the hospital. But he refused.
His condition worsened. Struggling to breathe a few days later, he finally agreed to go to the hospital — but only if his wife, Luzviminda Dario, 63, came too. Although his wife was sick by then as well, she went. “They were inseparable,” said Peter John Dario, his son, who is 23.
The day after he was admitted to John F. Kennedy Medical Center, Peter Dario lay unconscious, intubated and on a ventilator. Three days later, on the night of March 19, the hospital called the family to say his fever had spiked and he was unstable.Finally, a nurse said one family member would be allowed in. The previous day, Luzviminda and Marsha Dario had received positive test results for the coronavirus and were in quarantine at home, so Peter John Dario rushed to the hospital. While he was being screened at the entrance for the symptoms of coronavirus infection, his father died.
Just as difficult is the prohibition of visits with patients who have other grave illnesses or are undergoing risky surgery.
This month, Brittany Sanchez, 32, was at home in Las Vegas getting her two small children ready for bed when she had a seizure and collapsed.
She was taken by ambulance to Valley Hospital Medical Center in Las Vegas. A scan revealed a brain tumor so aggressive that Ms. Sanchez needed immediate surgery.
Her mother, Heather Last, stayed at the hospital with her for two days, then went home to pick up a few things and feed the pets, only to get a call from Ms. Sanchez telling her that the visiting rules had changed and that she could not return.
Brittany Sanchez, center, who had emergency surgery for a brain tumor with no family allowed into the hospital, with her parents Heather and Don Last. Credit…Anastasiia Sapon for The New York Times
The next morning, her parents went to the hospital anyway. A security guard refused to let them enter the building.
“Heather said they’d have to call the police on her to keep her from going in,” her father, Don Last, said. Eventually both were allowed in.
A few days later, Ms. Sanchez was flown on a medevac jet to the University of California, San Francisco Medical Center for a major neurosurgical procedure. U.C.S.F., too, was in lockdown and Ms. Sanchez’s parents were not allowed in the hospital.
The surgery would be complex and dangerous. “There was a reasonable chance she was going to have a problem,” said Dr. Mitchel Berger, the neurosurgeon who performed the procedure. Dr. Berger tried and failed to persuade his hospital to make an exception to the no-visitor rule.
Ms. Sanchez’s father was beside himself. The night before the surgery, he sent Dr. Berger a text.
“You will have my daughter Brittany’s life in your hands tomorrow,” he wrote. “I expect you to treat her as if she were your own daughter. I will never forgive myself that I was not able to hold her hand through this. Bring her back home to me whole.”
The surgery lasted nearly seven hours. As soon as he was finished, Dr. Berger went to find the Lasts, who were waiting outside the hospital. From six feet away, he told them the surgery had gone well, and apologized again for being unable to allow them in.
“They said they knew it wasn’t my fault, but that I just couldn’t imagine what it would be like to be in that situation,” he said. “And they’re right. I couldn’t imagine it.”
Some hospitals are buying iPads to give to patients for virtual visits. Others are helping patients speak with their family and friends over FaceTime.
Sandi Hutchinson being helped into a car by her son, Thomas, and her husband, Dell, at Summit Medical Center in Oakland, Calif. Her family couldn’t visit at the end of a month-long hospital stay.Credit…Preston Gannaway for The New York Times
Dell Hutchinson, who lives in Oakland, Calif., would gladly have accepted a virtual visit with his wife, but she was too sick to use her cellphone. Mr. Hutchinson’s wife, Sandi Hutchinson, was hospitalized on Feb. 19 with a subarachnoid hemorrhage, bleeding around her brain. On March 15, the hospital stopped allowing visitors.
This left Mr. Hutchinson with one option: calling her room through the main switchboard. But she also could not operate the bedside telephone, Mr. Hutchinson said, which meant he had to hope there was a doctor, nurse or other staff member in the room to pick up when he called.
When Mr. Hutchinson did manage to speak to his wife, he wasn’t able to glean much. Her voice was monotonic. “Without being able to read her body language, how could I know how she was really doing?” he asked. “I couldn’t.”
Just as the Dario family was absorbing the news of Peter Dario’s death, tragedy swept through the household again. On Monday, Cresenciano Victolero, Luzviminda Dario’s 86-year-old father, weak and short of breath, was rushed to the same hospital where his son-in-law had died. No one was allowed to visit.
On Wednesday, a nurse called to say they were unable to maintain his blood pressure. A granddaughter headed to the hospital. Mr. Victolero died while she was en route.
“But they held pronouncing him until she got there,” Marsha Dario said. “The nurse cried with her.”
The John A. Roebling Suspension Bridge spans the Ohio River and connects Cincinnati, Ohio, to Covington, Ky. (Photo via MamaGeek /Wikipedia Commons)
(CN) — Last week, Kentucky Governor Andy Beshear signed an executive order that prohibits Kentuckians from crossing state lines, save for a limited number of exceptions, including employment, trips for necessary supplies or to seek medical care.
While the Democrat and neighboring Ohio Governor Mike DeWine, a Republican, have been lauded by political allies and opponents alike for their decisive action in response to the Covid-19 outbreak, the interstate travel ban marked a decisive shift in tactics.
More than the reiteration of guidelines for social distancing or closure of nonessential businesses, Beshear’s executive order subjects violators to possible criminal prosecution, and also requires residents currently located in another state to submit to a 14-day quarantine upon their return to the Bluegrass State.
Civil litigation followed on the heels of Beshear’s order. Kentucky resident Allison S. Alessandro – located immediately across the Ohio River from Cincinnati in Campbell County, Kentucky — sued the governor and Secretary of State Daniel Cameron three days later.
Alessandro argues the order violates her 14th Amendment rights and has prevented her from traveling to Ohio to visit friends and family, and has also deprived her of the use of Hamilton County, Ohio’s public parks.
Attorney Brian O’Connor, with the Cincinnati-based firm Santen & Hughes, denied a request to interview his client but gave his thoughts about the suit via email.
“I think our papers clearly show that the travel ban is unconstitutional,” O’Connor said, “and I’m confident the federal court will agree. Given the current state of affairs in our country, I sadly expect that we’re going to see a wave of constitutional cases like this across the country.”
The attorney continued, “Just this morning, I read a story in the Washington Post about police in New Jersey forcibly stopping an orthodox rabbi’s funeral and arresting people at the religious service.”
O’Connor said elected officials are continuing “to test the boundary between their authority and individual rights” during the coronavirus pandemic.
“And I feel strongly that constitutional lawyers like my partner Lou Sirkin and me have a duty to hold them accountable when they overstep,” he said.
O’Connor’s prediction of lawsuits stemming from travel bans seems well-founded, as Courthouse News has already reported on several similar cases across the country.
In Greensboro, North Carolina, a group of anti-abortion advocates who routinely stand and pray outside an abortion clinic filed a federal lawsuit against Mayor Nancy Vaughan and the Greensboro Police Department after several protesters were arrested and cited for violating a stay-at-home order.
Four Mocksville, North Carolina, residents claim the city continues to violate their First Amendment rights by refusing to allow them to congregate outside the clinic, even though the Greensboro order includes an exception for outdoor activities that comply with social distancing guidelines.
The skyline of Greensboro, N.C. (Photo via Beyonce245/Wikipedia Commons)
Courthouse News spoke with lead attorney Stephen Crampton of the Thomas More Society in Chicago, who said his firm is monitoring several situations regarding so-called prayer walks at abortion clinics across the country.
“One of the consistent factors,” he said, “in fact, uniform in every one we’ve looked at so far, is a recognition of outdoor activity and a right to do that.”
“There’s really not a travel ban in [the Greensboro] order, but they are reading one particular sentence … and saying that because our people happen to be from outside the county, they didn’t have a right to travel in to the clinic,” Crampton added.
The attorney called the interpretation a “bit of a stretch,” and said that travel bans and stay-at-home orders issued across the country represent “a great threat, given the circumstances.”
“The potential for overreach is very great here,” Crampton continued, saying the Greensboro city attorney told his clients and their volunteer group Love Life that the order was being interpreted as a ban on First Amendment activities.
According to Crampton, Greensboro claims its stay-at-home order authorized the city to suspend First Amendment activities while the virus outbreak is still ongoing.
“He took it, in other words, as a total setting aside of the First Amendment,” Crampton said of the city attorney.
One of the plaintiffs in the Greensboro case, David Troyer, spoke with Courthouse News and said he feels the anti-abortion group is being unfairly targeted by the city.
“My two daughters were out,” Troyer said, “and they were threatened with arrest right along[side] other people on the same sidewalk who were completely ignored, and they were not even given the opportunity to explain … why they can be there.”
When asked about the city’s stay-at-home order, Troyer said he believes it’s an overreach, “especially in consideration that we do keep the social distancing, and also that we see a lot of people out there in the same area that get completely ignored.”
Professor Ken Katkin from Northern Kentucky University’s Chase School of Law spoke to Courthouse News about Beshear’s interstate travel ban and its constitutional ramifications.
Katkin emphasized that while the U.S. Constitution does protect the right of its citizens to travel from one state to another, the right is subject to limitation in support of a compelling governmental interest.
“Here,” the professor said, “Kentucky undoubtedly has a compelling interest in protecting its residents against becoming infected by the Covid-19 pandemic. And this compelling government interest clearly is advanced by enforcing public health measures that reduce interaction between people.”
But Katkin said the constitutional question is whether Beshear’s use of a blanket ban on interstate travel, while allowing some in-state travel, “is narrowly tailored to achieve this compelling government interest.”
Moving forward, Katkin said he believes the actions being taken by local, state and federal agencies will result in a slew of lawsuits, although not all of them will be based on constitutional violations.
“I think that 2021 will be the year of Covid-19 lawsuits in all kinds of courts,” he said. “Most of these lawsuits will be commercial lawsuits between private parties, not constitutional cases. There will be enormous numbers of disputes about whether purchasers of goods and services are entitled to refunds for goods and the like.”
The professor added that funds from stimulus and disaster relief bills passed by Congress could be used to resolve some of the legal disputes – “which means there will be litigation over who is entitled to this government money, and how much.”
When asked about Kentucky’s interstate travel ban, Crampton, the attorney in the Greensboro case, was hesitant to say the current situation warrants such severe measures.
“They do have the authority to initiate and impose a travel ban on their borders, but the circumstances must be extraordinary,” he said. “And it’s an open question whether they have those circumstances here or not.”
Beshear, who has given updates on Covid-19 cases in the Bluegrass State on a near daily basis, seems unconcerned by Alessandro’s suit.
“I haven’t read it, I’m not worried about it, and we will win it,” the governor said during a press conference last Friday.
Alessandro was denied a temporary restraining order late last week, and both sides are preparing to brief their cases in the coming weeks.
Concerned parents celebrated the victory of VirginiaRepublicangubernatorial candidate Glenn Youngkin on Tuesday night, hailing the win as a victory for parental rights in education.
Yael Levin-Sheldon, a Virginia mother of two boys and communication officer at No Left Turn in Education, told Fox News that Youngkin’s victory is “a win for parents all over the Commonwealth.”
“Glenn Youngkin’s victory showcases the Commonwealth’s desire to elect a public servant instead of a political servant,” Elizabeth Perrin, a Virginia mother, told Fox News. “What we have seen is the importance of family values and parental rights in our education system.
“It has been great to see how the importance of our children’s education and the parents matter movement has brought so many people together,” Brandon Michon, a father of three who has spoken out at Loudoun County School Board meetings for months, told Fox News on Tuesday night. “This is Virginia’s opportunity to raise the bar, and we will be doing it with Glenn Youngkin as governor.”
“Parental rights in education were on the ballot this election,” Laura Zorc, director of education reform at Building Education for Students Together (BEST), told Fox News. “Parents (Republican, Independent, and Democrat) across the country have been saying, ‘We don’t want your politics in our schools.’ Tonight, parents delivered on their promises to vote these elites out of office.”
Laura Zorc headshot, courtesy of Laura Zorc. (Laura Zorc)
“This election has demonstrated that education is a salient political issue, and one that is likely to persist for the foreseeable future,” Nicole Neily, a Virginia mother and president of Parents Defending Education, told Fox News. “If politicians ignore it — or denigrate voters and parents — they do so at their peril.”
Patti Hidalgo Menders, a Loudoun County parent and president of the Loudoun County Republican Women’s Club.
Youngkin’s victory “means that Virginians heard us, that we matter, that our children matter,” Patti Menders, a mother and president of the Loudoun County Republican Women’s Club, who has spoken out at school board meetings, told Fox News in an interview at the Youngkin victory rally.
Youngkin shot up in the polls after his Democratic opponent, Terry McAuliffe, said, “I don’t think parents should be telling schools what they should teach.” A Fox News poll found that a majority of Virginia parents say that parents “should be telling schools what to teach.” Youngkin consistently rebutted this narrative, championing parents’ rights to decide how their children are educated.
Virginians gather to support Glenn Youngkin (Tyler O’Neil/Fox News)
Tyler O’Neil is an editor at Fox News. Follow him on Twitter at @Tyler2ONeil. If you’ve got a tip, you can email Tyler at [email protected].
Thaddeus Mason Pope, JD, PhD, has focused his legal career on improving medical care decision-making and protecting patients’ rights at the end of life. His specific areas of legal expertise include patients’ rights, informed consent, and end-of-life medicine. Dr. Pope is the coauthor of The Right to Die: The Law of End-of-Life Decisionmaking (Wolters Kluwer).
The ASCO Post talked with Dr. Pope, Director of the Health Law Institute and Professor of Law at Mitchell Hamline School of Law in St. Paul, Minnesota, about the growing incidence of lawsuits brought against physicians and medical institutions that ignore or override advance directives, resuscitating patients against their written instructions, and providing unwanted life-preserving care; the liability oncologists face for not explicitly warning patients about the limited benefits of care; and what health-care providers can do to protect against legal action for failing to let a patient die.
Medical Liability for Ignoring Advance Directives
Please talk about the increasing frequency of lawsuits being brought against health-care providers for disregarding or overriding patients’ advance directives. How big a change is it from the number of lawsuits that fail to save patients’ lives?
It is difficult to calculate the exact number of lawsuits against health-care providers in the United States because often these complaints go through arbitration and are settled out of court, so both the number of complaints and their resolutions are private. The subset of lawsuits we are seeing for failing to honor patients’ advance directives is just the tip of the iceberg and have only become public because they have been appealed or reported on in the press.
What has changed legally to allow these lawsuits is that the appellate courts are saying it is wrong to resuscitate a patient if the patient did not want to be resuscitated and said so in an advance directive. And that’s helpful because the law wasn’t 100% clear prior to these lawsuits. Now courts are increasingly more willing to impose penalties on health-care providers who deliberately or negligently disregard advance directives and do-not-resuscitate orders.
Medicare now better covers the cost of advance care planning discussions, and the data show these discussions have increased, so that’s good news. But articulating and recording preferences are valuable only if advance directives are later found and honored.
Guarding Against Potential Legal Jeopardy
What are the legal hazards oncologists should be aware of when counseling patients about their end-of-life care? And how can oncologists and hospitals protect against potential legal jeopardy at a patient’s end-of-life?
There is an increased awareness on the part of oncologists about the importance of talking to their patients about their end-of-life wishes. But the big, big problem in oncology is there is a lot of unwanted treatment at the end of life; it’s unwanted not because the patient said he didn’t want a specific treatment or procedure, for example, to be put on mechanical ventilation and he was anyway. That is a very crisp, concrete violation of that patient’s expressed medical preference.
Today, informed consent law focuses more on what information the physician discloses and less on how clearly the physician conveys it.— Thaddeus Mason Pope, JD, PhD
The far bigger issue in oncology is a patient’s true preferences for specific treatment may not be known because the physician never adequately explained the risks, benefits, and alternatives to the treatment being proposed. If the patient knew how limited the benefit of the treatment might be relative to its side effects—for example, a 10% chance of living an additional 6 weeks but having severe toxicity—the patient might refuse the treatment. In that case, the patient might have gone on hospice instead.
Although only intentional or deliberate misrepresentation leads to criminal sanctions, even merely negligent or careless misrepresentation leads to both medical board discipline and medical malpractice liability.
Honoring Patients’ End-of-Life Wishes
What are the legal ramifications for physicians and hospitals if they fail to adhere to patients’ end-of-life wishes in advance directives or in Physician Orders for Life Sustaining Treatment (POLST) orders?
Patients’ end-of-life care preferences can be manifested in any of these orders or expressed through a surrogate, and they should be normally followed. If physicians or hospitals violate an advance directive or POLST order, they risk three types of sanctions. First, hospitals can be penalized for violating Medicare conditions of participation. Second, physicians can be disciplined by the state medical licensing board. Third, both physicians and hospitals can also be exposed to medical malpractice liability. For example, in May 2017, a Georgia hospital settled a lawsuit alleging noncompliance with a patient’s advance directive for $1 million.1
Obtaining Informed Consent for End-of-Life Care
How can oncologists ensure they obtained adequate informed consent from patients? And what are the legal hazards oncologists should be aware of when counseling patients about their end-of-life care?
In health care, informed consent is the process in which the patient and the physician have a conversation about a proposed medical treatment’s consequences, harms, benefits, risks, and alternatives. It is a fundamental principle of health care. Providing treatment without telling patients of the risks, benefits, and alternatives of that treatment is a denial of informed consent and constitutes medical malpractice.
Ethical issues in palliative and end-of-life care can arise when there is conflict among clinicians, patients, and family members about what constitutes appropriate care as patients near death, which is why it is so important to have the patient’s advance directive or POLST order for guidance. And because medical litigation is so prevalent in the United States, it is not uncommon for physicians to practice defensive medicine and go beyond what is medically necessary or wanted at the end of life, which, as we talked about earlier, can also result in lawsuits for failing to honor patients’ end-of-life preferences.
The legal standards regarding end-of-life care vary by state, so if physicians or members of the care team have doubt about the validity or meaning of a patient’s informed consent or instructions in an advance directive, they should seek legal counsel or assistance from the medical institution’s risk management team or ethics consultation service before proceeding with treatment.
Today, informed consent law focuses more on what information the physician discloses and less on how clearly the physician conveys it. But the nature of informed consent is going to radically change over the next 5 to 10 years as the use of certified patient decision aids becomes legally required in patient decision-making. In the meantime, it’s important for physicians to document everything they told the patient about the significant risks and the alternatives to an intervention being proposed.
The bottom line is practicing good medicine means listening to what the patient wants and then acting on those wishes. ■
Editor’s Note: The Law and Ethics in Oncology column is meant to provide general information about legal topics, not legal advice. The law is complex, varying from state to state, and each factual situation is different. Readers are advised to seek advice from their own attorney.
DISCLOSURE: Dr. Pope reported no conflicts of interest.
MEDICAL ERRORS BASED ON WRONG DECISIONS MADE IN THE EMERGENCY ROOM
What causes medical errors to be made in hospital emergency rooms? Most likely bad decisions by doctors, according to recent new research.
Medical errors have been estimated the third leading cause of death in the United States. There are a wide range of serious medical mistakes made every day, including wrong site surgery, hospital-acquired infections, and medication errors.
Wrong Emergency Room Diagnosis
A hospital emergency room offers unique challenges to medical care providers. In this setting, how doctors process information can be key. A wrong diagnosis in the emergency room, for example, can send healthcare providers down the wrong treatment path and patients to a much longer than necessary hospital stay – or potentially an outcome much worse.
These are the findings of an emergency room care study published in the July 2018 issue of De Gruyter’s Journal Diagnosis (“Cognitive Error in an Academic Emergency Department”).
Researchers reviewed patient records of a New York City hospital’s emergency department. They focused on patients who returned within 72 hours of their original visit and had to be admitted to the hospital, as this is a likely sign that some medical mistakes were made the first time. A team of outside doctors reviewed these records to determine if and what type of medical errors were made in the emergency room.
Wrong Medical Decisions Made With Right Medical Information
The researchers noted that a previous study found that mistakes during primary care visits typically involved errors during history taking as well as in the patient exam. In this emergency room study, it often wasn’t bad information that led to medical errors; it’s how the doctors acted based on good information that was the culprit.
By far the largest group of ER medical errors – 45 percent – was categorized as problems with information processing. This means that treating physicians had the correct data to properly treat the patient but they made a wrong decision.
The second leading group of medical mistakes in the hospital emergency room was linked to problems in checking the patient information that was gathered.
The remaining broad categories, both of which were minimal, were faulty information gathering and faulty medical knowledge.
Researchers found there were two most common specific medical errors made in the emergency room. One was misjudging how important a particular medical finding was. The other was making an incorrect diagnosis of a patient.
While a hospital room can be a demanding environment for physicians, they are still expected to provide a standard level of care. When they make clearly wrong decisions, their patients may suffer needlessly.
If you suffered harm or had a family member die while receiving medical care, consult an attorney who represents victims of medical malpractice and review the details of your experience.
When the coronavirus emergency abates, what happens to California’s disrupted education system and how might policymakers respond now?
Daniel C. Humphrey
The double blow of fewer resources and greater needs promises a perfect storm for education in California after the pandemic. Four things are certain:
California faces a serious decline in the tax revenue that education relies upon.
School closures will adversely affect the academic and social and emotional well-being of all students.
The pandemic lays bare the inequities of educational opportunities for children most in need.
Educators will need help to address the academic losses and social/emotional needs of their students now and when schools re-open.
While it now seems like a long time ago, Gov. Gavin Newsom’s proposed 2020-21 budget included major investments to address some of the most pressing challenges facing our education system.
These investments included grants to address professional development for educators, teacher and school support staff shortages, and the needs of students living in poverty.
With the dizzying speed and catastrophic impact of the pandemic, these needs will grow. The likelihood, however, that the governor’s proposed grants will survive the May revision of the state budget is small.
It is hard to imagine that the state’s schools will return to anything remotely like “normal” anytime soon. Now is the time for policymakers to redesign key components of the education system to anticipate the scary future.
The way that California distributes education funding, decides how funds are spent and holds districts and schools accountable for their performance dramatically changed in 2013 with the enactment of the Local Control Funding Formula. The law established that:
Districts with high numbers of students with the most needs receive additional funds.
Most of the old funding system, where money was earmarked for special purposes and programs, was eliminated. This allowed districts more flexibility and required parents, teachers, community members and students to have a say in how funds are used.
Districts’ and schools’ performance is measured by multiple indicators, including academic achievement, English-learner progress, chronic absenteeism, graduation rate, suspension rate and college/career readiness.
Districts needing assistance (determined by their performance on these indicators) can receive it through the state’s system of support from their county office of education.
One of the many examples of how the pandemic has upended California’s education systems is how the state’s new system of support is suddenly irrelevant and needs to be rethought. At the heart of the system of support is the California School Dashboard, an evaluation tool with multiple indicators of school and district performance. For the 2019-20 school year, nearly one-third of California school districts were identified for differentiated assistance — a second tier of state and county help — because of poor performance by various student subgroups on two or more indicators.
With schools closed and testing suspended, the 2020 dashboard will not include data on most indicators, which makes identifying districts for differentiated support nearly impossible.
Before the pandemic swept the state, a recent report that I co-authored with Jennifer O’Day found glaring weaknesses in the system of support.
Among the findings, the dashboard undermines sustained improvement because the districts identified for assistance change year to year and funding for county offices is tied to the number of identified districts. In addition, the timing of dashboard release is out of sync with districts’ planning cycles and truncates the amount of time county offices have to assist identified districts.
Moreover, the support side of the system fails to draw upon the full complement of expertise in the state and is not well-aligned with other accountability components of the Local Control Funding Formula, especially the requirement to involve teachers, parents, community members and others in decision-making.
One thing is clear: When the pandemic has run its course, all of California’s schools and districts will need help to get back on their feet, and the current system of support will need to be rethought in order to respond to new needs. A redesigned system of support should:
Draw upon expertise beyond the county offices of education (e.g., non-profits, higher education and district networks).
Be a multiyear intervention, based on level of need and constantly refined.
Include opportunities for meaningful involvement of teachers, parents, community members and others.
Be driven by locally defined needs that have emerged from the pandemic.
Trying to put Band-Aids on the existing system is certainly not going to result in better outcomes than those California achieved before the pandemic. As the coronavirus crisis unfolds, policymakers need to take advantage of the disruption to redesign the existing structures, like the system of support, to respond to daunting needs of California’s education system.
© Yasser Rezahi
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