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N.Y.C. Reports 38 Cases of Virus-Related Syndrome in Children N.Y.C. Reports 38 Cases of Virus-Related Syndrome in Children
(21 days later)
[This briefing has ended. For the latest updates on the coronavirus outbreak in the New York area, read Monday’s live coverage.][This briefing has ended. For the latest updates on the coronavirus outbreak in the New York area, read Monday’s live coverage.]
Mayor Bill de Blasio said Sunday that 38 New York City children have been inflicted with a serious new inflammatory syndrome that city health officials say appears to be linked to an immune response to Covid-19.Mayor Bill de Blasio said Sunday that 38 New York City children have been inflicted with a serious new inflammatory syndrome that city health officials say appears to be linked to an immune response to Covid-19.
That is more than double the 15 cases the city health department warned of in an alert to city health providers on Monday.That is more than double the 15 cases the city health department warned of in an alert to city health providers on Monday.
The illness, known as pediatric multisystem inflammatory syndrome, introduces a troubling new aspect to the Covid-19 pandemic, which has largely spared children from serious disease. Statewide, three children have died of the inflammatory condition, including one in New York City, and state officials were investigating 85 potential cases, Gov. Andrew M. Cuomo said on Sunday.The illness, known as pediatric multisystem inflammatory syndrome, introduces a troubling new aspect to the Covid-19 pandemic, which has largely spared children from serious disease. Statewide, three children have died of the inflammatory condition, including one in New York City, and state officials were investigating 85 potential cases, Gov. Andrew M. Cuomo said on Sunday.
Of the three children who have died, two were of elementary school age and one was an adolescent, said Dr. Howard Zucker, the state health commissioner. They lived in three different counties, and were not known to have pre-existing conditions.Of the three children who have died, two were of elementary school age and one was an adolescent, said Dr. Howard Zucker, the state health commissioner. They lived in three different counties, and were not known to have pre-existing conditions.
“The most important thing parents should do is err on the side of caution,” Dr. Zucker said.“The most important thing parents should do is err on the side of caution,” Dr. Zucker said.
The syndrome was first brought to the attention of New Yorkers in the past week, but Dr. Oxiris Barbot, the city’s health commissioner, said that the health department had alerted health providers to the syndrome on May 1, after hearing reports of the condition from the United Kingdom.The syndrome was first brought to the attention of New Yorkers in the past week, but Dr. Oxiris Barbot, the city’s health commissioner, said that the health department had alerted health providers to the syndrome on May 1, after hearing reports of the condition from the United Kingdom.
The inflammatory syndrome, health officials say, resembles toxic shock or Kawasaki disease. Children with the virus-related condition may have prolonged high fevers, rash, severe abdominal pain, racing hearts and a change in skin color, such as redness of the tongue.The inflammatory syndrome, health officials say, resembles toxic shock or Kawasaki disease. Children with the virus-related condition may have prolonged high fevers, rash, severe abdominal pain, racing hearts and a change in skin color, such as redness of the tongue.
“This is still evolving,” Dr. Barbot said at the mayor’s Sunday briefing. She called for the federal government to assist with increased virus testing citywide to help identify children at risk.“This is still evolving,” Dr. Barbot said at the mayor’s Sunday briefing. She called for the federal government to assist with increased virus testing citywide to help identify children at risk.
A handful of cases have been reported in other states, including Louisiana, Mississippi and California. At least 50 cases have been reported in European countries, including Britain, France, Switzerland, Spain and Italy.A handful of cases have been reported in other states, including Louisiana, Mississippi and California. At least 50 cases have been reported in European countries, including Britain, France, Switzerland, Spain and Italy.
Among the other developments from Mr. de Blasio’s briefing on Sunday:Among the other developments from Mr. de Blasio’s briefing on Sunday:
At least 260 city employees have died from complications of the coronavirus, Mr. de Blasio said. The city will now extend by 45 days health insurance coverage for those families, but the mayor also emphasized that federal help would be necessary to extend further benefits to all essential workers.At least 260 city employees have died from complications of the coronavirus, Mr. de Blasio said. The city will now extend by 45 days health insurance coverage for those families, but the mayor also emphasized that federal help would be necessary to extend further benefits to all essential workers.
The city will increase the number of city employees acting as “social distancing ambassadors” to 2,300, up from 1,000. The move comes after criticism that city police were unfairly enforcing such rules. According to recent figures from the NYPD, 35 of the 40 people arrested for violating social distancing rules are black.The city will increase the number of city employees acting as “social distancing ambassadors” to 2,300, up from 1,000. The move comes after criticism that city police were unfairly enforcing such rules. According to recent figures from the NYPD, 35 of the 40 people arrested for violating social distancing rules are black.
Mr. de Blasio said recent indicators showing the city’s attempt to curtail the spread of the coronavirus were a “mixed bag.” As of May 8, the number of new coronavirus patients hospitalized held steady at 69, the same as the prior day. The number of patients in ICU treatment was 540, down slightly from 559 the day before.Mr. de Blasio said recent indicators showing the city’s attempt to curtail the spread of the coronavirus were a “mixed bag.” As of May 8, the number of new coronavirus patients hospitalized held steady at 69, the same as the prior day. The number of patients in ICU treatment was 540, down slightly from 559 the day before.
Mr. de Blasio also dismissed concerns that enforcing social-distancing rules was infringing on the freedom of speech of protesters, some of whom have gathered in recent days to criticize a variety of issues. Mr. de Blasio called such gatherings “idiotic” and said they were “literally out of step with the times we’re living in to believe that the only way to get something done is to gather in the middle of the pandemic.”Mr. de Blasio also dismissed concerns that enforcing social-distancing rules was infringing on the freedom of speech of protesters, some of whom have gathered in recent days to criticize a variety of issues. Mr. de Blasio called such gatherings “idiotic” and said they were “literally out of step with the times we’re living in to believe that the only way to get something done is to gather in the middle of the pandemic.”
Gov. Andrew M. Cuomo announced a series of new measures on Sunday to help protect the roughly 100,000 New Yorkers who are living in nursing homes, which have seen thousands of deaths due to Covid-19.Gov. Andrew M. Cuomo announced a series of new measures on Sunday to help protect the roughly 100,000 New Yorkers who are living in nursing homes, which have seen thousands of deaths due to Covid-19.
He also warned that any nursing home operator that failed to provide appropriate care for each of its residents, whether because of a shortage of personal protective equipment, staff, or inability to appropriately isolate Covid-19 positive patients, would lose its operating license.He also warned that any nursing home operator that failed to provide appropriate care for each of its residents, whether because of a shortage of personal protective equipment, staff, or inability to appropriately isolate Covid-19 positive patients, would lose its operating license.
“The rule is very simple,” Mr. Cuomo said. “If a nursing home cannot provide care for a person and provide the appropriate level of care for any reason, they must transfer the person out of the facility.”“The rule is very simple,” Mr. Cuomo said. “If a nursing home cannot provide care for a person and provide the appropriate level of care for any reason, they must transfer the person out of the facility.”
Nursing homes that cannot find an appropriate place to place a patient can call the state Department of Health to seek a transfer, the governor said. The state will then put the patient in one of roughly 40,000 excess-capacity hospital beds, including the Javits Center, that have been created statewide during the Covid-19 crisis.Nursing homes that cannot find an appropriate place to place a patient can call the state Department of Health to seek a transfer, the governor said. The state will then put the patient in one of roughly 40,000 excess-capacity hospital beds, including the Javits Center, that have been created statewide during the Covid-19 crisis.
Going forward, all nursing home workers statewide must be tested for Covid-19 twice a week, Mr. Cuomo said. Staff must wear masks, and workers dealing with Covid-positive patients must wear appropriate personal protection equipment.Going forward, all nursing home workers statewide must be tested for Covid-19 twice a week, Mr. Cuomo said. Staff must wear masks, and workers dealing with Covid-positive patients must wear appropriate personal protection equipment.
In another key change, hospitals are no longer permitted to discharge Covid-19 positive patients to nursing homes, the governor said. Instead, he said, they should either hold them or transfer them to a Covid-19 only facility.In another key change, hospitals are no longer permitted to discharge Covid-19 positive patients to nursing homes, the governor said. Instead, he said, they should either hold them or transfer them to a Covid-19 only facility.
The new guidance appeared to reverse a March 25 state order that barred nursing homes from discriminating against Covid-19 patients seeking admission. But Mr. Cuomo denied the new policy was a reversal, saying that nursing homes at any time could have refused Covid-positive patients if they were incapable of caring for them.The new guidance appeared to reverse a March 25 state order that barred nursing homes from discriminating against Covid-19 patients seeking admission. But Mr. Cuomo denied the new policy was a reversal, saying that nursing homes at any time could have refused Covid-positive patients if they were incapable of caring for them.
Other updates from Mr. Cuomo’s briefing:Other updates from Mr. Cuomo’s briefing:
The total number of Covid-19 patients hospitalized in the state is 7,262, down about 500 patients from the day before. The three-day average for the new Covid-19 hospitalizations is 521, down from 572. That latest figure is “basically right where we were” when Mr. Cuomo signed an executive order in late March to essentially shut down the state’s economy, he said.The total number of Covid-19 patients hospitalized in the state is 7,262, down about 500 patients from the day before. The three-day average for the new Covid-19 hospitalizations is 521, down from 572. That latest figure is “basically right where we were” when Mr. Cuomo signed an executive order in late March to essentially shut down the state’s economy, he said.
The state reported an additional 207 deaths for May 9, which is lower than the last few days.The state reported an additional 207 deaths for May 9, which is lower than the last few days.
Mr. Cuomo reiterated his call for federal funding, and said the state needed $35 billion “this year just to compensate for the total amount of losses.”Mr. Cuomo reiterated his call for federal funding, and said the state needed $35 billion “this year just to compensate for the total amount of losses.”
Mr. Cuomo also said federal money should not go to any business that reduces the size of its work force. If that guarantee is not in place, Mr. Cuomo said, “You will see corporations using this pandemic to lay off workers.”Mr. Cuomo also said federal money should not go to any business that reduces the size of its work force. If that guarantee is not in place, Mr. Cuomo said, “You will see corporations using this pandemic to lay off workers.”
Tomorrow, Mr. Cuomo and county executives will discuss reopening parts of the state as early as May 15, when his order limiting nonessential business and activities is set to end. When asked about opening one region in particular, the mid-Hudson Valley, Mr. Cuomo said it was unlikely to occur by May 15.Tomorrow, Mr. Cuomo and county executives will discuss reopening parts of the state as early as May 15, when his order limiting nonessential business and activities is set to end. When asked about opening one region in particular, the mid-Hudson Valley, Mr. Cuomo said it was unlikely to occur by May 15.
Two weeks after New York City shut down, Poonam Sharma Mathis went into labor.Two weeks after New York City shut down, Poonam Sharma Mathis went into labor.
Ms. Mathis chronicled her journey bringing life into this uncertain time in a video diary for The New York Times. From the birth at NewYork-Presbyterian/Weill Cornell Medical Center, which was slammed with critically ill coronavirus patients to her first time breastfeeding her baby — while wearing a mask, Ms. Mathis shares her challenging experience.Ms. Mathis chronicled her journey bringing life into this uncertain time in a video diary for The New York Times. From the birth at NewYork-Presbyterian/Weill Cornell Medical Center, which was slammed with critically ill coronavirus patients to her first time breastfeeding her baby — while wearing a mask, Ms. Mathis shares her challenging experience.
With Asha, her new baby, in her arms, is the loveliness of having a newborn, offset by deep uncertainty about what lies ahead.With Asha, her new baby, in her arms, is the loveliness of having a newborn, offset by deep uncertainty about what lies ahead.
Mayor Bill de Blasio on Sunday praised the city’s efforts to engage homeless people and provide shelter for them as the subway shuts down nightly, though advocates continued to urge the city to provide more resources.Mayor Bill de Blasio on Sunday praised the city’s efforts to engage homeless people and provide shelter for them as the subway shuts down nightly, though advocates continued to urge the city to provide more resources.
Since the Metropolitan Transportation Authority began its nightly closure of the subway system on Wednesday, the city’s Department of Homeless Services has been working with the transit agency and the police to aggressively engage homeless people on the trains to coax them into shelters.Since the Metropolitan Transportation Authority began its nightly closure of the subway system on Wednesday, the city’s Department of Homeless Services has been working with the transit agency and the police to aggressively engage homeless people on the trains to coax them into shelters.
Mr. de Blasio reported Sunday that 384 people had been engaged the previous night, and 175 of them had agreed to go to shelters while 23 went to hospitals. Friday night, when 416 people were engaged, 183 went to shelters and 29 to hospitals — though the commissioner of social services, Steven Banks, noted that not every person who was taken to a shelter necessarily entered and stayed.Mr. de Blasio reported Sunday that 384 people had been engaged the previous night, and 175 of them had agreed to go to shelters while 23 went to hospitals. Friday night, when 416 people were engaged, 183 went to shelters and 29 to hospitals — though the commissioner of social services, Steven Banks, noted that not every person who was taken to a shelter necessarily entered and stayed.
But, Mr. Banks said, “simply getting you to the front door, for that individual, is a step forward.”But, Mr. Banks said, “simply getting you to the front door, for that individual, is a step forward.”
When temperatures dipped on Friday night into Saturday, the M.T.A. provided stationary, warming buses at some end-of-the line stations as shelter. But it did not provide the same service Saturday night, when the weather was warmer.When temperatures dipped on Friday night into Saturday, the M.T.A. provided stationary, warming buses at some end-of-the line stations as shelter. But it did not provide the same service Saturday night, when the weather was warmer.
Kayla Shults, a spokeswoman for the M.T.A., said in a statement that the buses had been a “one-time measure due to unseasonably cold temperatures.”Kayla Shults, a spokeswoman for the M.T.A., said in a statement that the buses had been a “one-time measure due to unseasonably cold temperatures.”
“Ensuring access to shelter and social services for homeless New Yorkers continues to be a city responsibility,” she added.“Ensuring access to shelter and social services for homeless New Yorkers continues to be a city responsibility,” she added.
The city’s homeless services agency did not immediately respond to questions about the M.T.A.’s decision. As of Friday, 73 homeless people had died of the virus, according to the agency. Nearly three out of four of those deaths have been people who had lived in shelters for single adults.The city’s homeless services agency did not immediately respond to questions about the M.T.A.’s decision. As of Friday, 73 homeless people had died of the virus, according to the agency. Nearly three out of four of those deaths have been people who had lived in shelters for single adults.
Advocates have urged the city to open hotel rooms to thousands of homeless people in shelters and on the streets. The city has moved people who have tested positive for Covid-19, elderly people, medically fragile individuals or those who lived in densely populated shelters into rooms, but has not expanded those efforts to the general homeless population.Advocates have urged the city to open hotel rooms to thousands of homeless people in shelters and on the streets. The city has moved people who have tested positive for Covid-19, elderly people, medically fragile individuals or those who lived in densely populated shelters into rooms, but has not expanded those efforts to the general homeless population.
The Times is regularly profiling essential workers in the New York region during the pandemic.The Times is regularly profiling essential workers in the New York region during the pandemic.
Where do you live? The Bronx.Where do you live? The Bronx.
Where do you work? Unitex Services in Mt. Vernon, N.Y., for 25 years, picking up and delivering laundry — gowns, linens, towels — from hospitals.Where do you work? Unitex Services in Mt. Vernon, N.Y., for 25 years, picking up and delivering laundry — gowns, linens, towels — from hospitals.
How has your job changed?How has your job changed?
We have five guys who caught the disease. It’s really hard to cope with but we have do the job. We have to keep working. I am blessed in the middle of this crisis that I still have a job.We have five guys who caught the disease. It’s really hard to cope with but we have do the job. We have to keep working. I am blessed in the middle of this crisis that I still have a job.
Updated May 28, 2020
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.
Have you seen things that disturbed you?Have you seen things that disturbed you?
We are in and out of the hospital, so seeing all the diseased, seeing all the bodies, putting them in the freezers, the trailers, that really takes its toll.We are in and out of the hospital, so seeing all the diseased, seeing all the bodies, putting them in the freezers, the trailers, that really takes its toll.
What keeps you going?What keeps you going?
It’s very stressful, but it’s an honor for me to be doing it, knowing that it’s very important now, to serve the city that I live in and to serve my people.It’s very stressful, but it’s an honor for me to be doing it, knowing that it’s very important now, to serve the city that I live in and to serve my people.
We deliver the linen to all of the city’s major hospitals, and it’s a need for them to have the sheets, the towels, the pillow cases, all the medical equipment and special gowns for the patients. We feel like we are part of this whole ordeal, like we’re helping.We deliver the linen to all of the city’s major hospitals, and it’s a need for them to have the sheets, the towels, the pillow cases, all the medical equipment and special gowns for the patients. We feel like we are part of this whole ordeal, like we’re helping.
Nearly 190,000 people were tested for the coronavirus in New York City over the past two weeks. Mayor Bill de Blasio has announced plans to hire 1,000 disease detectives to track down the contacts of every infected New Yorker.Nearly 190,000 people were tested for the coronavirus in New York City over the past two weeks. Mayor Bill de Blasio has announced plans to hire 1,000 disease detectives to track down the contacts of every infected New Yorker.
The city is also paying for hotels to house people who cannot quarantine in their cramped apartments, and it may use the USTA Billie Jean King National Tennis Center in Queens for the same purpose.The city is also paying for hotels to house people who cannot quarantine in their cramped apartments, and it may use the USTA Billie Jean King National Tennis Center in Queens for the same purpose.
And Gov. Andrew M. Cuomo has established a framework for reopening New York State, based on seven concrete, health-related milestones, soliciting advice from dozens of advisers from the upper echelons of New York’s business world.And Gov. Andrew M. Cuomo has established a framework for reopening New York State, based on seven concrete, health-related milestones, soliciting advice from dozens of advisers from the upper echelons of New York’s business world.
Still, despite all the plans and initiatives, the reopening of New York City remains a long way off.Still, despite all the plans and initiatives, the reopening of New York City remains a long way off.
The factors that made the city the U.S. epicenter of the pandemic — its density, tourism and dependence on mass transit — complicate a return to normalcy. The city, which has had more than 19,000 virus deaths so far, is still far from meeting the public health metrics necessary to reopen, from available critical-care beds to new hospital admissions for the virus.The factors that made the city the U.S. epicenter of the pandemic — its density, tourism and dependence on mass transit — complicate a return to normalcy. The city, which has had more than 19,000 virus deaths so far, is still far from meeting the public health metrics necessary to reopen, from available critical-care beds to new hospital admissions for the virus.
And New York State is moving cautiously, anticipating a partial reopening later this month, mostly in rural areas.And New York State is moving cautiously, anticipating a partial reopening later this month, mostly in rural areas.
So how long might it take to restart New York City’s economy?So how long might it take to restart New York City’s economy?
“Nobody can tell you,” Mr. Cuomo said last week.“Nobody can tell you,” Mr. Cuomo said last week.
The key to reopening is containing the virus, and that will take a vast infrastructure of testing and contact tracing unlike anything the United States has ever seen, public health experts say.The key to reopening is containing the virus, and that will take a vast infrastructure of testing and contact tracing unlike anything the United States has ever seen, public health experts say.
Even when the new public health apparatus is fully staffed and running, it will merely lay a foundation for businesses and residents to feel safe returning to work and play. Many may choose to stay home.Even when the new public health apparatus is fully staffed and running, it will merely lay a foundation for businesses and residents to feel safe returning to work and play. Many may choose to stay home.
A true reopening of the city, Mr. de Blasio said this month, remained “a few months away at minimum.”A true reopening of the city, Mr. de Blasio said this month, remained “a few months away at minimum.”
The coronavirus outbreak has brought much of life in New York to a halt and there is no clear end in sight. But there are also moments that offer a sliver of strength, hope, humor or some other type of relief: a joke from a stranger on line at the supermarket; a favor from a friend down the block; a great meal ordered from a restaurant we want to survive; trivia night via Zoom with the bar down the street.The coronavirus outbreak has brought much of life in New York to a halt and there is no clear end in sight. But there are also moments that offer a sliver of strength, hope, humor or some other type of relief: a joke from a stranger on line at the supermarket; a favor from a friend down the block; a great meal ordered from a restaurant we want to survive; trivia night via Zoom with the bar down the street.
We’d like to hear about your moments, the ones that are helping you through these dark times. A reporter or editor may contact you. Your information will not be published without your consent.We’d like to hear about your moments, the ones that are helping you through these dark times. A reporter or editor may contact you. Your information will not be published without your consent.
Reporting was contributed by J. David Goodman, Sarah Maslin Nir, Sharon Otterman, Joel Petterson, Azi Paybarah, Michael Rothfeld, and Nikita Stewart.Reporting was contributed by J. David Goodman, Sarah Maslin Nir, Sharon Otterman, Joel Petterson, Azi Paybarah, Michael Rothfeld, and Nikita Stewart.