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Biden to visit Texans battered by deadly storm, pandemic

When President Biden visits Texas’s largest city on Friday, epicenter for the state’s most deadly winter storm in modern history, he will be welcomed by many Texans who blame state leaders for failing to quickly respond to the disaster.

“He’s coming for all Texans, for people like myself who were without power,” said Douglas Brinkley, a presidential historian at Houston’s Rice University. “It’s a symbolic gesture.”

Biden, who declared a major disaster in Texas last weekend, signaled his interest at the time in traveling to the storm-ravaged state but said he would wait until his presence and the accompanying entourage wouldn’t distract from or impede recovery efforts.

At the same time, “If he let another weekend go by and he wasn’t in Texas, he would have been in trouble,” Brinkley said, noting the backlash Texas Republican Sen. Ted Cruz faced for traveling to Cancun with his family in the midst of the mayhem. “You don’t want to join the Ted Cruz club and be the butt of derision.”

The president’s trip will be his third outside the Washington, D.C., region. Although he has curtailed most travel because of the pandemic, Biden flew last week to Wisconsin and Michigan for a town hall and factory visit, respectively, as part of his effort to drum up support for his $1.9-trillion coronavirus rescue package.

Last week’s storm, which could prove the costliest disaster in Texas history, left millions of residents without power even as they suffered burst water pipes and other storm-related damage. Millions lost electricity for days as the independent power grid that serves the state’s largest cities — the only one not connected to other major U.S. grids — crashed. Scores died, including an 11-year-old boy north of Houston whose family’s trailer lost power and heat during the storm.

At least a million Texans were still without drinking water this week. Many more were struggling to find plumbers, supplies and money to repair flooded homes even as they received hefty power bills due to Texas’s deregulated utility market. As grocery stores slowly restocked, food giveaways in the state’s largest cities spawned mile-long lines.

While visiting Houston, the country’s fourth-largest city, Biden plans to meet with Republican Gov. Greg Abbott and local officials to discuss recovery efforts and to visit a COVID-19 vaccination center. Republican Sen. John Cornyn of Texas has expressed interest in accompanying the president, although his staff could not confirm that he would attend. Cruz was scheduled to speak at the annual Conservative Political Action Conference in Orlando, Fla., Friday morning, but his staff said he “would certainly be open to joining President Biden if schedules permitted.”

Brinkley said Biden will have to be careful about optics and not overstep.

“People are angry; some still don’t have their water back. Biden’s got to be sympathetic, offer aid,” he said, adding that the president is likely to be warmly received in Houston.

“It’s a power center of the Democratic Party nationally, and there’s a lot of federal investment there with NASA and the energy sector,” Brinkley said. “People feel Harris County was the hardest hit with the storm, so he’s coming into the bull’s-eye, which is the right thing to do. ”

Biden has asked federal agencies to identify additional resources to address the suffering. He has also approved disaster and emergency declarations for other hard-hit Southern states and spoken by phone with seven governors, most of them Republicans. The Federal Emergency Management Agency has sent generators and other supplies to the affected states.

Biden will arrive in Texas as public furor over state leaders’ mismanagement of the storm response mounts. Six members of the board that manages the state’s power grid resigned this week. On Thursday, state lawmakers launched hearings to investigate the disaster.

Gilberto Hinojosa, chair of the state Democratic Party, called for Gov. Abbott to testify at hearings about the state’s response to the storm.

“He needs to answer: Why were our folks left to freeze?” Hinojosa said. “It’s like the leadership of the state decided that Texans were tough and they could tough it out. They did not take care of people.”

Abbott initially blamed outages on green energy sources and just weeks before the storm had ordered state agencies to find ways to sue the Biden administration over energy regulations. On Wednesday, he responded to criticism of his storm response with a rare statewide address touting his proposal to force power plants to winterize and vowing the state Legislature won’t adjourn until public outcry is addressed.

“You deserve answers. You will get those answers,” Abbott said.

White House Press Secretary Jen Psaki said Thursday that any conversation about what is to blame for the blackouts would have to wait until after Biden’s visit.

“The president doesn’t view the crisis and the millions of people who have been impacted by it as a Democratic or Republican issue. He views it as an issue where he’s eager to get relief, to tap into all the levers of the federal government,” she said. “There’s plenty of time to have a policy discussion about better weatherization, better preparations, and I’m sure that’s one that will be had. But right now we’re focused on getting relief to people in the state, getting updated briefings, tapping into all the levers of the federal government.”

Houston officials have opened their own investigations into the power outages. The storm’s local death toll included Carroll “Andy” Anderson, 75, a Vietnam veteran in a suburb who died of hypothermia and a lack of oxygen after the electricity that ran his oxygen tank was cut during the storm. His widow, Gloria “Toni” Anderson, filed a wrongful death lawsuit against the state last week. She said she hopes Biden hears from Texans like her who want to see power companies better regulated, despite resistance from the state’s Republican leaders.

Vietnam veteran Carrol “Andy” Anderson, 75, (right) died during the winter storm in Texas last week after his suburban Houston home lost power that fueled his oxygen tank. His widow, Gloria Anderson, (left) has sued state power grid managers.

(Photo courtesy of Gloria Anderson

“Abbott and all the politicians who are saying Texans don’t want the regulations — well, yes we do, if it will keep our power when we have major things like this happen,” said Anderson, 75, a retired hairdresser and chemical plant worker.

During the storm, a pipe burst in the attic above her kitchen, buckling the ceilings, Formica counters, walls and floors. Some of her neighbors haven’t been able to find drinking water or food at local markets.

Anderson worries that federal aid won’t reach those who need it most. A couple down the street from her are still living in a trailer four years after Hurricane Harvey flooded their home because they haven’t received federal aid.

“There is a ton of recovery going on,” she said, urging Biden to “make sure it goes where it needs to go. There’s so many people who need it that are in really bad shape.”

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Coronavirus spreads readily in gyms when masks aren’t worn

The Centers for Disease Control and Prevention is urging stricter precautions for gym-goers after tracing coronavirus outbreaks to fitness centers in Hawaii and Chicago that left dozens of patrons with COVID-19.

The findings, detailed in two papers published this week in the CDC’s Morbidity and Mortality Weekly Report, highlight the risks of indoor fitness activities, particularly when guidelines about mask-wearing and social distancing are not enforced.

But even when worn properly, face masks may not do enough to mitigate the risk of indoor group classes, said Dr. Larry William Chang, an infectious diseases specialist at the Johns Hopkins University School of Medicine, who was not involved in the research.

“I personally would never join a group class in an enclosed space with poor ventilation,” Chang said. “I think that’s just a recipe for disaster.”

The first of the two outbreak cases took place in Hawaii and began in late June after two fitness instructors — one apparently infected by the other — transmitted the virus to patrons before developing any symptoms of COVID-19.

A total of 20 of 21 people who were exposed to either of the instructors in the 24-period before they showed signs of illness wound up becoming infected after attending a class or personal training session. Another eight patrons were exposed in the 24-hour period before that, and one of them contracted the coronavirus as well.

Out of those 21 infections traced to the instructors, 20 patients (including the second instructor) went on to develop COVID-19, and two of them were hospitalized.

At the time of the outbreak, mask use was not required in fitness facilities, the authors wrote.

Some of the classes seemed designed to spread the virus. For instance, there was a high-intensity cycling class where the infected instructor faced a group of 10 maskless participants and shouted instructions at them. Three large floor fans blew air toward the patrons for cooling; doors and windows remained shut.

“They essentially created an ideal environment for transmitting coronavirus,” Chang said. “I mean, you had enclosed spaces, inadequate ventilation, masks were often not used or required, and people were vigorously exercising. That’s essentially a recipe for a super-spreader event.”

The outbreak in Chicago took place around two months later. There, mask use, temperature checks and symptom screenings were required upon entry. Patrons brought their own mats and weights, and were positioned at stations at least six feet apart. However, they were allowed to remove their masks during exercise.

“I think in Chicago they did some things which we sometimes call public health theater,” Chang said. Asking if people have symptoms doesn’t catch people who are asymptomatic transmitters or who don’t tell the truth. Temperature checks are insufficient because not every contagious person will be running a fever. “None of that really probably has a huge effect on decreasing your risk of transmitting coronavirus in your facility,” he said.

Indeed, 55 out of 81 people who attended high-intensity indoor classes at the Chicago gym sometime between Aug. 24 and Sept. 1 became infected and developed COVID-19.

What’s more, 43 attendees with COVID-19 participated in multiple classes while they were potentially infectious. And 22 attendees with COVID-19 attended those classes on — or after — the day they started feeling symptoms.

Class participants were interviewed about their behavior in the gym. Out of 38 attendees who had COVID-19, 32 (84%) reported infrequent mask use. (So did 12 out of 20 — 60% — people who did not become sick.) Three of those with COVID-19 attended the gym on the same day — or after — they received a positive coronavirus test result.

Ultimately, two of the 55 people visited an emergency department and one was hospitalized for eight days.

Both research teams suggested ways of reducing the risk of working out in a gym, such as significantly improving ventilation, enforcing consistent and correct mask use and physical distancing, reminding all patrons and staff to stay home if they’re ill, and increasing hand-hygiene opportunities.

“Conducting exercise activities entirely outdoors or virtually could further reduce SARS-CoV-2 transmission risk,” both research teams added.

Chang said the safest place to exercise would probably be at home or outdoors. But not everyone is able to do so, which is where gyms come in.

“Gyms are a social and public health good,” he said. “it’s important for people to exercise and some people aren’t able to exercise at home or outdoors. So I do think many gyms can stay open — but they really need to have some vigorous policies and adjustments in place.”

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Fealty to Trump is the one litmus test at conservative conference

Among GOP elected officials and operatives, intense disagreements rage over the future of their party. But no sign of dissent will be visible this weekend when conservatives gather for an annual conference that has long showcased Republicans’ internal debates.

Instead, one theme will rule them all — fealty to Trump.

The former president plans to use Sunday, the final day of the Conservative Political Action Conference, for his first public speech since leaving the White House just over a month ago. Throughout the weekend, loyalty tests will be everywhere — panels touting Trump’s false claims of election fraud, speeches from Republican hopefuls who will compete to praise him, and a straw poll designed to show him as the favorite for the party’s 2024 presidential nomination.

“He’s not done with politics,” said Matt Schlapp, the American Conservative Union chairman and organizer of the annual conference known as CPAC. “Does he run again? That’s to be determined. But he is going to mess around in the political environment every day of this cycle.”

The four-day convention, moved this year from the Washington, D.C., area to Orlando, Fla., to take advantage of looser COVID restrictions, has always featured partisan red meat more than detailed policy discussions, said Matt Gorman, a Republican strategist.

“CPAC knows what will resonate with its members, and it’s always been the wedge issues that pit the base against Democrats or, in some cases, other Republicans,” he said.

What makes this year’s gathering stand out is the intense focus on an individual and his grievances. Trump’s relative quiet since he left the White House and, almost simultaneously, lost his platform on Twitter has added to the anticipation.

“It sets up perfectly for Trump,” Gorman said. “It’s his coming out party.”

Schlapp, who is in frequent contact with Trump, said the former president was “raring to go.” The annual conference was the scene of some memorable Trump speeches when he was president, including a two-hour epic in 2019 just after his failed summit in Hanoi with North Korean leader Kim Jong Un.

A rundown of the conference’s topic list makes clear its focus:

Protecting Elections Parts 1-4 — “Why We Must Protect Elections”; “Why Judges & Media Refused to Look at the Evidence”; “The Left Pulled the Strings, Covered it Up, and Even Admits It”; and “Failed States (Pennsylvania, Georgia, Nevada, Oh My!)” — will vie with more traditional conservative fare such as attacks on the rising power of China (and California), denunciations of the tech industry, and warnings against Democratic plans to promote low-emission cars, regulate guns and advance the rights of LGBTQ Americans.

“We picked panels that conservatives care about,” Schlapp said. “If the schedule seems Trump-heavy, it’s because the conservative movement and what Trump got done as president converged.”

In all, at least nine sessions will focus on the former president’s unhappiness over the 2020 outcome and try to amplify his false claims to be the rightful winner.

All of that poses a sharp contrast with the last time CPAC convened just after a Democratic president took office, said Republican strategist Alex Conant.

In the winter of 2009, after President Obama’s inauguration, Rush Limbaugh keynoted the conference, exhorting conservatives to pick themselves up and look to the future, Conant said.

That conference “was memorable because of how forward-looking it was,” he said. “What’s striking is how different this one will be. It appears this one will be very backward-looking — a defense of what a lot of voters rejected in the election.”

For Republicans, an emphasis on relitigating 2020 already has proved costly. As President Biden’s $1.9 trillion COVID relief package steams toward passage, with polls showing a quarter or more of Republican voters supporting it, the party has had difficulty mounting an effective attack, in part because GOP elected officials have spent much of their time attacking each other.

This week, for example, House Republican leaders called a news conference to criticize the bill. It was largely overshadowed when, in response to a reporter’s question, two of the leaders disagreed about whether Trump should speak at CPAC.

“Yes, he should,” said Rep. Kevin McCarthy of Bakersfield, the Republican leader in the House.

Rep. Liz Cheney (R-Wyo.), the third-ranking member of the leadership, demurred.

“That’s up to CPAC,” she said, but added, “I’ve been clear on my views about President Trump.”

“I don’t believe that he should be playing a role in the future of the party or the country,” she said.

Thursday, in an interview on Fox News, McCarthy criticized Cheney: “The idea that a Republican would join with cancel culture is beyond wrong,” he said.

Needless to say, Cheney will not be appearing at CPAC. Nor will Sen. Mitt Romney of Utah, the 2012 Republican presidential nominee who won the CPAC presidential straw poll that year.

At a conference this week sponsored by the New York Times, Romney said, referring to Trump: “I don’t know if he’s planning to run in 2024 or not, but if he does, I’m pretty sure he would win the nomination.” That would not be his preference, he made clear.

“I would be getting behind somebody in the tiny wing of the Republican Party that I represent.”

Also not on the CPAC agenda are Trump supporters who have failed to meet his threshold for absolute loyalty, including former Vice President Mike Pence and former United Nations Ambassador Nikki Haley. She ran afoul of Trump by criticizing him after his supporters stormed the Capitol on Jan. 6.

“I think he’s lost any sort of political viability he was going to have,” she said in an interview with Politico. “I don’t think he’s going to be in the picture.”

So far, that prediction of Haley’s appears wrong. Republicans had “a mini Arab Spring” in the immediate aftermath of Jan. 6, with many elected officials openly criticizing Trump for stoking his supporters’ anger before the attack and failing to call off the rioters when the violence began, said Charlie Sykes, a prominent conservative radio host from Wisconsin turned Trump critic.

But that faded quickly after Republican voters made clear their continued loyalty to the former president, he said.

“You had this sense that perhaps this was the moment the Republican Party sobered up,” Sykes said. “But it didn’t take.”

The Jan. 6 attack “isn’t going to come up much,” predicted former Rep. Jason Chaffetz, a Utah Republican who is now a Fox News contributor and is scheduled to speak Friday.

People who broke the law on that “horrific day” are being investigated and “should be prosecuted,” Chaffetz said. But he added, “I don’t blame the president for other people breaking the law.”

Rep. Ken Buck (R-Colo.), another CPAC panelist, said the heavy focus on Trump is understandable, but not a sign the party can’t move on.

“I think we’ll move on — with Donald Trump,” he said. “The president has a unifying impact on the base, but whoever is the nominee in 2024 is going to have a job to reach out to others outside the base.”

The conference agenda includes several leading Republicans who all hope to succeed Trump as the party’s presidential nominee — but dare not say so out loud.

Sens. Ted Cruz of Texas, Josh Hawley of Missouri, Tom Cotton of Arkansas and Rick Scott of Florida, as well as the state’s governor, Ron DeSantis, and former Secretary of State Michael R. Pompeo each have prominent speaking slots and probably will laud Trump while avoiding much acknowledgment of the election loss.

That simply reflects the reality of where the party’s voters stand, Chaffetz said.

“I don’t think you can be a successful Republican without embracing the ‘Make America Great Again’ core message into your justification for running for office,” he said.

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COVID-19 vaccine websites violate disability laws

Many COVID vaccination registration and information websites at the federal, state and local levels violate disability rights laws, hindering the ability of blind people to sign up for a potentially lifesaving vaccine, a Kaiser Health News investigation has found.

Across the country, people who use special software to make the web accessible have been unable to sign up for the vaccines or obtain vital information about COVID-19 because many government websites lack required accessibility features. At least 7.6 million people in the U.S. over age 16 have a visual disability.

WebAIM, a nonprofit web accessibility organization, checked COVID vaccine websites gathered by KHN from all 50 states and the District of Columbia. On Jan. 27, it found accessibility issues on nearly all of 94 webpages, which included general vaccine information, lists of vaccine providers and registration forms.

In at least seven states, blind residents said they were unable to register for the vaccine through their state or local governments without help. Phone alternatives, when available, have been beset with their own issues, such as long hold times and not being available at all hours like websites.

Even the federal Centers for Disease Control and Prevention’s Vaccine Administration Management System, which a small number of states and counties opted to use after its rocky rollout, has been inaccessible for blind users.

Those problems violate the Rehabilitation Act of 1973, which established the right to communications in an accessible format, multiple legal experts and disability advocates said. The federal Americans with Disabilities Act, a civil rights law that prohibits governments and private businesses from discriminating based on disability, further enshrined this protection in 1990.

Doris Ray, 72, who is blind and has a significant hearing impairment, ran into such issues when she tried to sign up for a vaccine last month with the CDC’s system, used by Arlington County in Virginia. As the outreach director for the ENDependence Center of Northern Virginia, an advocacy center run by and for people with disabilities, she had qualified for the vaccine because of her in-person work with clients.

When she used screen-reading technology, which reads a website’s text aloud, the drop-down field to identify her county did not work. She was unable to register for over two weeks, until a colleague helped her.

“This is outrageous in the time of a public health emergency, that blind people aren’t able to access something to get vaccinated,” Ray said.

Mark Riccobono, president of the National Federation of the Blind, wrote to the U.S. Health and Human Services Department in early December, laying out his concerns on vaccine accessibility.

“A national emergency does not exempt federal, state, and local governments from providing equal access,” he wrote.

Dr. Robert Redfield, who was then leading the CDC, responded that the interim vaccine playbook for health departments included a reminder of the legal requirements for accessible information.

CDC spokesperson Jasmine Reed said in an email that the Vaccine Administration Management System is compliant with federal accessibility laws and that the agency requires testing of its services.

But more than two months into a national vaccine campaign, those on the ground report problems at all levels.

Some local officials who use VAMS are aware of the ongoing problems and blame the federal government. Arlington Assistant County Manager Bryna Helfer said that because VAMS is run by the federal government the county cannot access the internal workings to troubleshoot the system for blind residents.

Connecticut Department of Public Health spokesperson Maura Fitzgerald said the state was aware of “many accessibility issues” with VAMS. She said it had staffed up its call center to handle the problems and was working with the federal government “to improve VAMS and enable the functionality that was promised.”

Deanna O’Brien, president of the National Federation of the Blind of New Hampshire, said she had heard from blind people unable to use the system. New Hampshire’s health department did not answer KHN questions about the problems.

Blind people are particularly vulnerable to contracting the coronavirus because they often cannot physically distance themselves from others.

“When I go to the grocery store, I do not have the option of walking around and not being near a person,” said Albert Elia, a blind attorney who works with the San Francisco-based TRE Legal Practice on accessibility cases. “I need a person at the store to assist me in shopping.”

There is no standardized way to register for a COVID vaccine nationwide — or fix the online accessibility problems. Some states use VAMS; some states have centralized online vaccination registration sites; others have a mix of state-run and locally run websites, or leave it all to local health departments or hospitals. Ultimately, state and local governments are responsible for making their vaccination systems accessible, whether they use the VAMS system or not.

“Once those portals open, it’s a race to see who can click the fastest,” Riccobono said. “We don’t have time to do things like file a lawsuit, because, at the end of the day, we need to fix it today.”

Common programming failures that make sites hard to use for the visually impaired included text without enough contrast to distinguish words from the page’s background and images without alternative text explaining what they showed, the WebAIM survey showed. Even worse, portions of the forms on 19 states’ pages were built so that screen readers couldn’t decipher what information a user should enter on search bars or vaccine registration forms.

The new vaccine pages had more errors than states’ main coronavirus pages but slightly fewer than state government websites in general, said WebAIM Associate Director Jared Smith.

When Bryan Bashin, 65, who is blind and chief executive of the LightHouse for the Blind and Visually Impaired in San Francisco, tried to sign up on Feb. 9 for his vaccine appointment, he encountered multiple hurdles. The appointments slipped away. That night the Alameda County resident received an email from the city of Berkeley offering vaccinations. But after two hours struggling with its inaccessible website, all the slots were again taken, he said in an email.

He was only able to get an appointment after his sighted sister signed him up and has since received his first shot.

“It’s an awful bit of discrimination, one as stinging as anything I’ve experienced,” Bashin said.

Susan Jones, a blind 69-year-old in Indianapolis, had to rely on the Aira app, which allows a sighted person to operate her computer remotely, when she tried to register for her vaccine appointment.

“I resent that the assumption is that a sighted fairy godmother ought to be there at all times,” said Sheela Gunn-Cushman, a 49-year-old also in Alameda County, who also had to rely on Aira to complete preregistration for a vaccine.

Emily Creasy, 23, a visually impaired woman in Polk County, Ore., said she tried unsuccessfully for a month to make the scheduling apparatus work with her screen reader. She finally received her first shot after her mother and roommate helped her.

Even Sachin Dev Pavithran, 43, who is blind and executive director of the U.S. Access Board, an independent agency of the federal government that works to increase accessibility, said he struggled to access vaccine registration information in Logan, Utah.

The Indiana Health Department, Public Health Division of Berkeley and Oregon’s Polk County Public Health did not respond to requests for comment. Utah’s Bear River Health Department did not answer questions on the issue.

After Alameda County received complaints from users that its site was not compatible with screen readers, officials decided to move away from its preregistration technology, Health Department spokesperson Neetu Balram said in mid-February. The county has since switched to a new form.

If vaccine accessibility issues are not fixed across the country, though, lawsuits could come next, Elia said. Members of the blind community recently won landmark lawsuits against Domino’s Pizza and the Winn-Dixie grocery chain after being unable to order online.

And, Elia said, “this is not ordering a pizza — this is being able to get a potentially lifesaving vaccine.”

KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation) that is not affiliated with Kaiser Permanente.

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Pfizer’s vaccine trial data holds up in the real world, according to large-scale study in Israel

In clinical trials conducted last fall, the vaccine developed by Pfizer and BioNTech proved 95% effective in preventing symptoms of COVID-19.

The question remained whether it and other vaccines would perform as well once they went into widespread use.

A new study involving more than a half million people who were vaccinated in Israel strongly suggests the answer is yes.

Compared with people who did not receive the Pfizer-BioNTech vaccine, those who were inoculated were 94% less likely to become ill, according to the study published Wednesday in the New England Journal of Medicine. They also had far lower rates of death, hospitalization and — among those who were tested for the virus — infection.

Josh Michaud, a global health expert at the Kaiser Family Foundation who wasn’t involved in the study, called it an “important milestone.”

“Up until now we’ve had to rely on scattered small-scale reports and non-peer-reviewed findings for a glimpse of how effective COVID-19 vaccines are in the real world,” he said.

The research did not address the critical question of whether vaccination prevents a person from transmitting the virus.

Clinical trials of various vaccines have focused on whether participants developed symptoms, leaving open the possibility that even those protected from illness could still become infected and unknowingly infect others.

The new study did not systematically test people for the virus, so there was no way of measuring how many people without symptoms may have been infected.

However, among those who were tested — either because they got sick or they wanted to ensure that they were not infected — those who had received both doses of the vaccine were 92% less likely to get a positive result than members of a control group who had not been vaccinated.

Dr. Noam Barda, one of the authors, said research is now underway to rigorously test people who have been vaccinated to definitively determine whether vaccination prevents infection and transmission.

For now, Dr. Carlos del Rio, an infectious disease researcher at Emory University who was not involved in the study, said seeing the high efficacy data carry over from clinical trials to the real world was “very encouraging.”

While controlled clinical trials are the best way to test the effectiveness of a new vaccine, they are far from a perfect predictor of how a rollout will go — particularly one so urgent and fraught with challenges.

Vaccine recipients sometimes fail to adhere to the proscribed timelines for getting their shots. Vaccines must be shipped long distances and kept cold. Lots of things can go wrong and undermine effectiveness.

The new study used data on 596,618 people who received the Pfizer-BioNTech vaccine between Dec. 20 and Feb. 1. Another 596,618 who were not vaccinated were selected for a control group based on age, sex, neighborhood, pre-existing conditions and other factors that could influence a person’s likelihood of contracting the virus or becoming ill.

All participants were members of Clalit Health Services, Israel’s largest healthcare organization.

Even after just one dose, the vaccinated group fared far better than their unvaccinated peers. They were 57% less likely to get sick and 74% less likely to be hospitalized. After the second and final dose, those figures rose to 94% and 87%.

Two to three weeks after the first shot, the vaccine was 72% effective at preventing death.

Jennifer Nuzzo, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, said the findings “should give us good hope that we can use vaccines to prevent hospitalizations and death, which would effectively defang the virus.”

The vaccine worked similarly well across all age groups.

Nicholas Davies, an epidemiologist at the London School of Hygiene and Tropical Medicine who was not involved in the study, said a high degree of protection for the elderly — and only slightly lower protection for people with multiple chronic health problems — “gives reason to be optimistic about vaccine effectiveness in the most vulnerable populations.”

The study’s authors said they were also encouraged that the emergence of coronavirus variants did not seem to have a major impact on the effectiveness of the vaccine.

The clinical trials were conducted when most of the viruses in circulation were a close match to the one used to design the Pfizer-BioNTech vaccine. The new study did not look at which variants were most common among the participants, but B.1.1.7 — the so-called U.K. variant — made up a large share of overall cases in Israel by the end of the study period.

Israel is far ahead of most other countries in its vaccination campaign, with more than half the population inoculated.

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Coronavirus infection immunity comparable to COVID vaccine

One of the enduring questions of the COVID-19 pandemic is how much immunity people are left with after recovering from a coronavirus infection. New research suggests the level of protection is comparable to getting a vaccine — at least for a few months.

Among a group of hundreds of thousands of Americans who tested positive for a SARS-CoV-2 infection, the risk of developing a subsequent infection more than three months later was about 90% lower than for people who had not been previously infected and therefore had no immunity to the virus, according to researchers from the National Cancer Institute.

For the sake of comparison, when the vaccines made by Pfizer-BioNTech and Moderna were tested in Phase 3 clinical trials, they reduced the risk of developing COVID-19 by at least 94%.

The findings, published Wednesday in JAMA Internal Medicine, could help inform plans for returning workers to their offices, sending students and teachers back to school campuses and allowing more of the economy to reopen.

“I think we knew this, that immunity [after natural infection] lasts a long time,” said Dr. Monica Gandhi, an infectious-disease specialist at UC San Francisco who was not involved in the new research. “But it’s still very exciting.”

There are three important things scientists need to know to understand the biological value of coronavirus antibodies, said Dr. Mitchell H. Katz, who leads NYC Health and Hospitals. They are: Do antibodies protect against infection? Can they be reliably detected with current tests? And, if they do offer some protection, how long does it last?

The new study “provides reassuring answers to the first and second questions,” Katz wrote in an editor’s note that accompanied the study.

To investigate coronavirus immunity, the cancer researchers examined the results of more than 3 million blood tests administered to Americans between the start of the pandemic and Aug. 23. A total of 378,606 of those tests were positive for SARS-CoV-2 antibodies — a sign that the person who provided the sample had an active coronavirus infection.

Among the millions of people who were tested, some — about 11% of those who tested positive and 9.5% of those who tested negative — later took a different test to look for evidence of the coronavirus’ genetic material in patient samples, which are typically gathered via the nose, throat or from saliva.

The researchers used these results to see whether people who’d had a coronavirus infection were any less likely than their uninfected counterparts to have SARS-CoV-2 particles in their system. For their analysis, they sorted the results into four groups based on the gap between the antibody test and the genetic test.

After running the numbers, the researchers found that between 3% and 4% of those who originally tested negative for coronavirus antibodies later tested positive with the genetic test. This was true across all four time intervals: 0 to 30 days, 31 to 60 days, 61 to 90 days and more than 90 days. The consistency was probably a reflection of the relatively stable rate at which people in their communities were being infected at the time, the researchers said.

Contrast that to the people who originally tested positive for coronavirus antibodies. Their genetic test results were positive at very high rates in the first 30 days (11.3%), which the researchers said was probably a sign that leftover viral particles were still being flushed from their systems.

However, the positivity rate for the genetic test plunged to 2.7% in the second month after infection, then fell to 1.1% in the third month. And after those 90 days, only 0.3% of people with a past coronavirus infection had another infection that was detected with a genetic test.

That coronavirus infection rate was 10 times lower than for the people who presumably had not been previously infected.

That level of protection appears to be comparable to the benefits offered by the Pfizer and Moderna vaccines in their clinical trials, the study authors pointed out.

“Of course, protection induced by a safe vaccine is clearly preferable,” they were quick to add, “as the population-wide risk of a serious outcome from an authorized or approved vaccine is expected to be orders of magnitude lower than that from natural infection.”

Though the findings may be of great interest to scientists, it’s unlikely they’ll make much practical difference at this stage of the pandemic, Gandhi said. That’s because vaccines appear to be at least as protective as a past infection, and they’re already being rolled out.

These findings “could have been used two months ago,” she added.

While this study didn’t gauge how long the benefits of a prior infection last beyond 90 days, other lines of evidence suggest it takes a while to wane. For instance, Gandhi pointed to a paper in Science that found that immune cells triggered by SARS-CoV-2 remained in the body for at least eight months.

The findings may help explain why new infections have been falling in Los Angeles County in the wake of a devastating holiday surge. Dr. Roger Lewis, director of COVID-19 hospital demand modeling for the L.A. County Department of Health Services, estimated that about 1 out of 3 people in the county now has immunity to the coronavirus.

Still, the study authors said more research would be necessary to get a clearer picture about natural immunity to the coronavirus.

“Factors that influence reinfection risk — such as varying viral strains, patients’ immune status, or other patient-level characteristics — should be evaluated in subsequent studies that include follow-up beyond 90 days,” they wrote.

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Joe Manchin drives Democrats crazy. Here’s why they need him

Sen. Joe Manchin, the self-styled conservative Democrat from West Virginia, is driving progressives crazy — and he doesn’t seem to mind.

Manchin says President Biden’s $1.9-trillion COVID relief bill is too big, and he wants to cut it. He says he strongly opposes a $15 federal minimum wage, one of Biden’s top campaign promises. He announced last week that he won’t vote to confirm Biden’s nominee to head the Office of Management and Budget, Neera Tanden, because her campaign-year tweets struck him as too partisan. He hasn’t decided whether to support Biden’s choice for Interior secretary, Deb Haaland, because she has advocated tough regulation of coal and natural gas, two important industries in West Virginia.

His refusal to back Tanden, an Indian American, and Haaland, a Native American, drew fury from progressives, who pointed out that both are women of color.
Rep. Alexandria Ocasio-Cortez (D-N.Y.) complained on Twitter that Manchin voted to confirm many of then-President Trump’s controversial nominees, “yet the first Native woman to be Cabinet Sec is where [he] finds unease?”

But the Senate’s Democratic leaders are staying out of the fray, giving Manchin a great deal of deference for a simple, practical reason: He’s their 50th vote.

Without Manchin, they don’t have a working majority. Even with Manchin on their side, they still need Vice President Kamala Harris to break tie votes.

Asked if his party has a Joe Manchin problem, Senate Democratic Whip Richard J. Durbin of Illinois told a television interviewer: “We have a 50-50 problem.”

Manchin is an unusual character in the increasingly polarized Senate: a Democrat who voted in favor of Trump’s position on legislation more than half the time, and who seeks to split almost every issue down the middle.

He’s a throwback to the age when Southern Democrats like his predecessor Robert C. Byrd became power brokers precisely because their votes were unpredictable.

“This place doesn’t work the way it’s supposed to anymore,” Manchin told me in December, referring to the Senate. “We’re generally disgusted with not getting anything done.”

He has urged Biden to build bipartisan coalitions with Republicans, and offered himself as a mediator. “Let me know what you’d like to accomplish, and I can help,” he said, quoting one of his conversations with the president.

He’s disappointed that Biden, in pursuit of quick passage for his COVID-19 relief bill, has largely ignored his advice.

It’s hard to avoid the impression that Manchin enjoys being the man in the middle — the senator both sides want to woo.

But his split-the-difference positions also reflect who he is and where he’s from: a culturally conservative, anti-abortion, pro-business Democrat from a desperately poor coal state.

His greatest passion in the Senate has nothing to do with ideology; it’s making sure West Virginia gets as much federal spending as possible.

In pursuit of that goal, he has been willing to evolve. Long a dogged defender of coal mining — as governor of West Virginia, he sued the Environmental Protection Agency over its ban on mountaintop removal — he has seemingly come to accept that coal jobs will never come back and now focuses on attracting clean energy jobs to his state.

His success at that kind of old-fashioned politics is what has enabled him to keep his Senate seat for 10 years, during which West Virginia, like other rural states, has turned solidly Republican.

In 2016, Donald Trump won West Virginia by a 42-percentage-point margin, the second-largest of any state (Wyoming came in first). In 2020, Trump won the state by 39 points.

Running against that red tide, Manchin won reelection in 2018 by only 3 points. No other Democrat won statewide office in West Virginia that year.

And that’s why Joe Manchin isn’t the Democrats’ problem; he’s part of their solution.

He’s an example of how Democrats can win Senate seats in states where they need to begin winning again: in rural states that, thanks to the Constitution, hold a share of seats in the Senate wildly disproportionate to their populations.

The 25 most rural states elect 50 of the Senate’s 100 members — and 40 of those 50 are currently Republicans.

“For Democrats to build a sustainable governing majority, you can’t do that as a bunch of large blue islands surrounded by an ocean of red,” said David Axelrod, the former advisor to then-President Obama. “That’s not going to work.”

To solve their 50-50 problem in the Senate, Democrats need to compete more effectively in states such as Iowa, Montana and Alaska, places they hoped to win in 2020 but lost.

That means recruiting and supporting candidates attuned to the problems of farmers, ranchers and miners — rural populists, not urban progressives.

What they need, like it or not, is more Joe Manchins.

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Mexico’s ruling party is divided as president stands by a candidate accused of rape

As it became clear last fall that Mexican Sen. Félix Salgado Macedonio would be running for governor of Guerrero state, Basilia Castañeda decided to go public with her accusation of rape.

She told police that back in 1998, when she was a 17-year-old political activist, she found herself alone with him at his Acapulco home.

“Without saying anything he started attacking me,” she explained to Milenio newspaper, adding that when it was over he threw a 100-peso bill — about $10 at the time — in her face.

Four other women have also come forward to accuse Salgado of sexual assault, including one who told police she was drugged and raped by the politician in 2016.

Those allegations didn’t stop Mexico’s ruling political party from officially making Salgado its gubernatorial candidate this month.

In the face of feminist opposition, Salgado’s candidacy has become a major political liability for President Andrés Manuel López Obrador, who has stood by his longtime friend and political ally.

The accusations have bitterly divided Morena — the center-left party López Obrador founded in 2011 — with hundreds of members, including many of its highest-profile women, demanding the party withdraw its support and Salgado be removed from the ballot.

“Side with history, side with the victims, side with women,” a coalition of female party leaders said in a statement last week.

But López Obrador has refused to budge, repeating Salgado’s claim that the accusations are nothing more than partisan political attacks.

“When there are elections … it’s about discrediting the opponent in one way or another,” the president, widely known by his initials, AMLO, said at a recent news conference, describing Salgado as the victim of “media lynching.”

Asked about the rape accusations during another news conference, López Obrador grew angry, shouting, “Enough already!”

His quick dismissal of the women’s sexual assault claims has enraged members of Mexico’s ever-more visible feminist movement.

The president has a habit of rejecting any criticism as an unwarranted attack from his political enemies. But that sort of response falls flat when the critique comes from women complaining of violence, political analyst Denise Dresser recently wrote in Americas Quarterly.

The growing number of women calling for an end to gender-based violence in Mexico represents “the one true thorn in AMLO’s side: a singular political movement that he does not seem to understand, cannot control and will be unable to suppress,” she wrote.

Carlos Bravo Regidor, a professor at the public research center CIDE in Mexico City, said that the president is under increasing pressure to recognize their grievances and heed their demands.

“Feminists within and outside of Morena are fighting to make the president feel that if he doesn’t back down, he will have to pay a price,” Bravo said.

Many feminists had high hopes for López Obrador. The long embattled leftist, who ran for president two times before winning election in 2018, vowed complete gender parity in his Cabinet — a promise he fulfilled.

But months after taking office, he angered activists by shuttering shelters for domestic violence victims and closing public day-care centers, part of a broader austerity plan.

Then a series of gruesome incidents in Mexico City thrust the issue of violence against women into the national spotlight.

A teenage girl said she had been raped by four police officers. A man apparently killed and skinned his 25-year-old girlfriend. And then the body of a 7-year-old named Fatima who had gone missing was discovered disemboweled in a garbage bag.

López Obrador blamed the crimes on the “neoliberal” governing model of his predecessors.

Failing to acknowledge the national crisis — an average of 11 women are killed each day in Mexico — he also downplayed a surge in calls to a government hotline for female victims of violence, saying 90% of such calls “are false.”

In response, hundreds of thousands of women from across the political spectrum demonstrated in Mexico City in March. The following day, women across the country skipped work in a national strike, with some of Mexico’s largest companies showing their support by giving female employees the day off.

After female protesters seized control of Mexico’s National Human Rights Commission in the fall, ripping paintings of revolutionary heroes off the walls and declaring that building would become a shelter for female victims of violence, López Obrador was incensed.

“Of course I don’t like it,” he said of the protest, highlighting the protesters’ defacement of a particular painting.

The activists said the president’s focus on property destruction rather than on their demands simply proved their point.

Protesters say they have taken increasingly militant actions because they have yet to see real change. While the #MeToo movement in the United States spurred many women here to denounce men in positions of power for alleged assaults, few of those cases resulted in dismissals or other major consequences.

An investigation by the news site Animal Politico found that from 2014 to 2018 just 5% of rape and sexual assault allegations resulted in a criminal sentence.

Salgado has not been charged with any crime. The accusations against him started coming to light at the end of last year, just as he prepared to accept the nomination as Morena’s gubernatorial candidate in Guerrero.

Born in a notoriously lawless region of the state known as the Tierra Caliente, or Hot Lands, Salgado is a flamboyant character, known for driving a Harley-Davidson and for dabbling in music — he famously recorded a cumbia in 2012 for López Obrador.

In a 2017 radio interview, Salgado described himself as a “womanizer, partier, gambler [and] drunk,” saying he was too old to change: “A tree that grows crooked never straightens its trunk.”

During his more than 30-year political career, he served as mayor of Acapulco, a state representative, a congressman and a senator.

Basilia, the woman who said Salgado raped her in 1998, said that she tried to report the assault at the time but that a clerk at the prosecutor’s office advised against it.

“This person is very influential, very powerful,” she said the man told her, according to her interview with Milenio. “Go home, live quietly and forget about this.”

She went on to become a prominent leftist activist in Guerrero, eventually helping López Obrador establish his party as a powerful political force there. Salgado joined the party in 2018 and won a seat in the Senate once again.

In fall last year, once it became clear that Salgado would seek the governorship, Basilia went to police. By then, newspapers had started carrying stories about another rape accusation against Salgado.

A woman who worked for Salgado when he briefly ran a newspaper in Acapulco had gone to police in 2016 to say that he had drugged and raped her. She said Salgado recorded a video of the first attack and used it as blackmail to rape her on at least two more occasions.

The investigation went nowhere. The top prosecutor in the state at the time, Xavier Olea, recently told journalists that his office dropped the case after the governor of the state asked him to not arrest Salgado. The prosecutor’s office has since reopened the case.

Other allegations have also become public in recent months, including a sexual harassment claim filed by a woman who worked for Salgado while he was mayor of Acapulco in 2007.

The well-known Guerrero writer Marxitania Ortega wrote a Facebook post that Salgado assaulted her at a book event several years ago.

“He was drunk, and when he approached me he did it in the worst way, lewd and with an improper hug, to say the least,” she said. She said she saw Salgado do the same thing to a friend on another occasion.

As the accusations against Salgado mounted, anger rose within Morena about Salgado’s nomination.

The party “cannot remain silent in the face of possible cases of rape,” said Citlalli Hernandez, Morena’s secretary general.

The decision even came under criticism from López Obrador’s interior secretary, Olga Sánchez Cordero, who is known for being fiercely loyal.

“Unrestricted respect for the right of women to live without violence is a necessary condition for an elected official,” she said.

Women play a growing role in Mexican politics. Thanks to a 2014 constitutional reform calling for parity in the legislature, just under 50% of elected leaders in the Senate and Chamber of Deputies are now women.

Paola Zavala Saeb, a human rights attorney and feminist activist, said that representation means that for the first time women are being heard.

“Before we couldn’t do it because we didn’t have these microphones,” she said.

Aimee Vega Montiel, a researcher at the Autonomous University of Mexico, said that after decades of activism — spurred in part by the slayings of hundreds of women in the border city of Juarez beginning in the 1990s — Mexico’s feminists have finally shown “that violations of women’s rights are not normal and are not natural.”

For Basilia’s part, she said she hopes that López Obrador will drop support for Salgado. She, too, has been a loyal supporter to López Obrador throughout his political career.

“I hope the president … can understand that this is not a lie,” she said.

Then she made a direct plea: “Mr. President, don’t protect a rapist.”

Women take part in a protest during a march to demand justice for femicide victims in Mexico City on Nov. 1, 2020.

(Claudio Cruz / AFP/Getty Images)

Cecilia Sanchez in The Times’ Mexico City bureau contributed to this report.

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Faulty intelligence blamed for Capitol riots response

Former security officials told Congress on Tuesday that faulty intelligence was to blame for failing to properly prepare for last month’s bloody insurrection at the U.S. Capitol, testifying in dramatic detail about their shock at confronting a violent insurrection and not the manageable protest they had been expecting.

“The events I witnessed on Jan. 6 was the worst attack on law enforcement and our democracy that I’ve seen in my entire career,” former Capitol Police Chief Steven Sund, who resigned in the days after the attack, testified before a joint hearing of the Senate Homeland Security and Rules committees.

“None of the intelligence we received predicted what actually occurred,” he said. “We properly planned for mass demonstrations, with possible violence. What we got was a military-style coordinated assault on my officers and a violent takeover of the Capitol.”

Sund was joined by two former Capitol security officials, as well as acting Washington, D.C., Police Chief Robert Contee III, at the hearing, the first to examine the Jan. 6 insurrection by a marauding pro-President Trump mob that left five people, including a police officer, dead. The hearing came just 10 days after the Senate voted to acquit the former president at his second impeachment trial on allegations he incited his supporters to storm Congress to stop it from counting electoral college votes that would cement Joe Biden’s victory.

All four security officials testified that federal law enforcement and intelligence agencies did not provide them with specific warnings that the Capitol might come under attack. They had planned, they testified, to confront a peaceful protest similar to the mostly peaceful ones by die-hard Trump supporters upset about the results of the November election.

Lawmakers have expressed dismay that Capitol police and federal agencies were caught so off guard, especially because media reports had indicated Trump supporters might try to prevent Congress from counting the electoral votes. Senators said they would continue holding such hearings, including one next week featuring testimony from federal law enforcement and military officials.

“We are here today to better understand what was known in advance, what steps were taken to secure the Capitol and what occurred that day, because we want to ensure nothing like this happens again,” said Sen. Amy Klobuchar (D-Minn.), chairwoman of the Rules Committee.

In addition to several congressional inquiries, the Justice Department has launched a wide-ranging investigation into the assault and has charged more than 250 people on allegations they stormed the building, destroyed property and threatened the lives of those there, including lawmakers, staffers, the public, reporters and police. The Justice Department has said that more than 130 law enforcement officers were injured in the insurrection.

While Sund and Contee have spoken publicly about the attack, Tuesday was the first time the public has heard from two key Capitol security officials: former Senate Sergeant at Arms Michael Stenger and former House Sergeant at Arms Paul Irving, who served as Sund’s bosses and resigned in the wake of the attack. They testified they had no indication there would be an insurrection.

“The intelligence was not that there would be a coordinated assault on the Capitol, nor was that contemplated in any of the interagency discussions that I attended in the days before the attack,” Irving testified.

Sen. Gary Peters (D-Mich.), chairman of the Senate Homeland Security Committee, quizzed Sund about intelligence reports generated by the FBI and his own department that indicated potential danger. Sund testified that his agency on Jan. 5 received a report from the FBI’s Norfolk, Va., office warning that Trump supporters were calling for violence. But the Capitol police officer who received the warning didn’t share it with him or commanders. Sund said he saw it for the first time on Monday.

Even if they had read it before Jan. 6, Sund said, it’s unclear whether the warning would have changed his agency’s security posture. “It would have been helpful to have been aware of,” he said, though “it is strictly raw data, it’s raw intelligence.”

Contee testified that the FBI report came in a run-of-the-mill email and was not flagged as a high-priority alert.

“I would think that something of that nature would rise to the level of more than just an email,” he said.

Lawmakers spent considerable time questioning the security officials about delays in getting help from the National Guard. Contee testified that he was on a phone call with Army leaders during the insurrection and was frustrated that they didn’t sense the urgency.

He listened as Sund pleaded with the Army brass to send troops and concluded military officials seemed to be going through a “check the boxes” exercise while expressing concerns it might look bad to have troops on the Capitol grounds.

“I was just stunned because I have officers out there fighting for their lives,” Contee said.

Three hours after the Capitol police chief pleaded with the Army brass to send the National Guard, the first batch of such soldiers mustered on the Capitol grounds, Sund testified.

The hearing started off dramatically when Capitol Police Capt. Carneysha C. Mendoza testified about engaging in four hours of hand-to-hand fighting with rioters in the Capitol. Insurrectionists nearly broke her arm, and she also suffered chemical burns to her face from tear gas deployed by the insurrectionists. Those burns have not fully healed, she testified.

Mendoza said she spent the day after the attack at a hospital, comforting the family of Officer Brian Sicknick as he died from injuries sustained in the assault.

“We could have had 10 times the amount of people working with us, and I still believe the battle would have been just as devastating,” Mendoza testified. “As an American and Army veteran, it’s sad to see us attacked by our fellow citizens. I’m sad to see the unnecessary loss of life.”

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The global journey of a COVID-19 body bag

In a factory not far from a holy river, sewing machines hum in the morning light. Spindles whir and women feed fabric toward needles. Unlike most products this Thailand business churns out — shower caps, ponchos and aprons — what the women are stitching together on the second floor will be used only once.

Siriphon Chakpangchaluem keeps an eye on it all. Her hair bunched under a white cap and her arms crossed against her smock, she has been at the Winbest Industrial plant for more than 13 years, ascending from assembly line to deputy manager. She has watched as designs have been improved and knows that high-density polyethylene can be woven to be leak-resistant.

The women under her charge work in pairs. They maneuver 94-inch strips of tarp. They cut and fold. They weld edges together with radio waves. Spools yank in rackety spin. Hands move swift as bird wings, and toward the end, when what they are making takes shape, the women fasten on long, curved zippers and fold their handiwork into neat rows of black, white and blue.

Siriphon Chakpangchaluem, 39, deputy manager of Winbest Industrial factory in Thailand, oversees a production line.

One of them will be delivered 8,545 miles away to Wanda Mathis-Conner’s house, but the Michigan mother doesn’t yet know this.

At Winbest Industrial in Thailand, employees sew long, curved zippers onto the bags.

At Winbest Industrial in Thailand, employees sew long, curved zippers onto the bags. The white paint on the sewing needle plates chips away with all the pounding.

When the seamstresses are done, dozens of men carry what they have made downstairs and pile it in cases stacked six feet tall. Forklifts wedge the cases into 40-foot shipping containers, like the one marked THAF48823 that on Sept. 26, 2019, is driven 42 miles south: across the Bang Pakong River, along the eastern coast of the gulf, and into Laem Chabang Port’s Terminal C.

The container sits for days waiting for freighter. It holds 37,000 pounds of Manufacturer Product #11-224.

Body bags.

Winbest Industrial factory workers in Thailand.

Factory workers at Winbest Industrial in Thailand inspect and package the “disaster pouches” for shipment to the United States


The COVID-19 pandemic was months away from sweeping the world on Oct. 4, 2019, when, eight minutes after noon, the MOL Premium, a Panamanian cargo ship that stretched three football fields long, set sail, wrapping east around the tip of Vietnam and bound for America.

At that moment, an ocean and a half a continent away, Wanda Mathis-Conner was driving through downtown Detroit, her black van cluttered with backpacks and artwork, along with knick-knacks her eldest brother, Warren, had picked out for her on a recent trip to Veterans Affairs.

It was her 55th birthday, and “Ma,” as her daughters Riann and Raven called her, had spent it at a funeral.

Wanda Mathis-Conner, or "Ma," with her daughters Riann, left, and Raven, circa 1989.

Wanda Mathis-Conner, or “Ma,” with her daughters Riann, left, and Raven, circa 1989.

(Courtesy of the family)

The girls’ Aunt Lisa on their dad’s side had died after years of battling a drug addiction. Ma knew all about that. Riann and Raven’s father had struggled with drug abuse and was largely absent for years when they were in elementary school.

Ma raised Riann, 33, and Raven, 31, mostly alone, working as a delivery truck driver for Frito-Lay chips and taking customer calls for Comcast. She later became caregiver for the elderly, including dementia patients. She and her girls lived in a small brick house that held four generations of her family stretching from Riann and Raven’s children to Ma’s mother, who everyone called Granny.

Ma and her daughters

Ma, left, poses in a photo booth with her daughters Raven, center, and Riann at their church’s biannual dinner dance on Sept. 21, 2018.

(Courtesy of the family)

Ma — who had hoped of riding on a Harley one day along the Detroit River — was the center of things. She had been in the operating room when Riann, who would earn a law degree, needed a C-section to deliver her son, Kaden. Every afternoon, she picked Raven’s daughter, London, up at school while Raven started up as a hairstylist. Ma paid the bills when the girls hit hard times, her van crisscrossing the city as she tended what needed to be done.

When Ma returned from Aunt Lisa’s funeral, Riann surprised her with HopCat fries and cheese sauce for her birthday. The next morning, Ma went to Mass at St. Charles, chatting with parishioners afterward until Brother Ray started locking doors. She piled Kaden, 11, and London, 6, into the van to go taste-test food samples at Costco.

As she did, the MOL Premium, was fresh into its weeks-long journey across the Pacific. The voyage would be at least the sixth body bag shipment to arrive on U.S. shores by sea that month.


On Friday, Oct. 25, 2019, the MOL Premium pulled into the Port of Long Beach at 3:45 a.m. About the same time, Ma, three hours ahead in Detroit, texted her daughters on their “Gossip Girls” group chat: “Are you people up?” She made breakfast and headed to work.

The ship berthed at Pier G, just south of the Queen Mary, its hundreds of containers stacked like Jenga blocks across its deck. Crews checked the seal and offloaded container THAF48823 with cranes. It was locked onto a truck bed and driven 33 miles southeast to the Laguna Hills warehouse of Salam International, owned by Abdul Salam, who came to the United States from Karachi, Pakistan, nearly a half-century ago.

One of the nation’s busiest mortuary suppliers, Salam’s company distributes autopsy tools including stainless-steel skull-breakers, toe tags, jaw spreaders and oscillating electric saws, complete with a bone dust collector. The top sellers, by far, are their “disaster pouches.”

The warehouse stocks body bags of every variation: infant, pediatric, adult, and jumbo; with and without handles; environmentally friendly bags and heavy-duty water-recovery ones.

A meticulous and sober man, Salam doubled his order of body bags when he learned of the coronavirus in January 2020.

By February, his phone never stopped ringing. By March, walk-ins were showing up at his warehouse. By April, its inventory of 100,000 bags was depleted.

The same month, FEMA requested 100,000 bags from suppliers. The virus was killing so many New Yorkers — more than 33 each hour — that first responders there were fashioning makeshift pouches out of trash bags and tape. Things would only get worse: In June alone, the United States would import 726,176 pounds of body bags — more than seven times the amount it imported during the same period of 2019, according to the trade database Import Genius.

Abdul Salam, president of Salam International, with body bags at the company warehouse.

Abdul Salam, president of Salam International, with body bags at the company warehouse in Laguna Hills, Calif., on Jan. 5.

(Allen J. Schaben / Los Angeles Times)

Body bag distributors turned for help to companies that made tents, boat sails and children’s bounce houses. Those that made waterbed mattress bladders, well-versed in sealing vinyl to lock in fluids, were “the perfect fit,” one distributor said.

The virus by late spring had infected 300,000 and killed more than 8,100 Americans. Lost jobs equated to those of the Great Depression and Great Recession combined. President Trump, under fire for initially downplaying the virus, declared that there would be “a lot of death.”

Salam International

David Cameron, executive vice president of Salam International, looks through the company’s product book in the warehouse in Laguna Hills, Calif. By April 2020, its inventory of 100,000 bags was depleted.

(Allen J. Schaben / Los Angeles Times)

Fresh graves multiplied and even those accustomed to such things, like Salam, were overwhelmed.

“I sent bags for September 11th. I sent bags for Hurricane Katrina,” he said. “I had a sixth sense that this one would be more bothersome. We ran out of everything, and the virus didn’t care — it wore on.”

Soon after the container from Thailand arrived at Salam International, 15 cases of product #11-224 were loaded onto pallets and shipped 2,300 miles to the medical examiner’s office in Macomb County, Mich., 25 miles northeast of Detroit. The body bags were expected to last through the following spring.


The pandemic spread like a flame through Detroit’s predominately Black population. Already battered by poverty and scarred by abandoned houses, the city, the largest in the U.S. to ever file for bankruptcy, became a landscape of ferried corpses, overburdened hospitals and final goodbyes spoken into phones.

The news was full of reports of ventilators and body counts. Few knew what to do. Infections spread from house to house. It was Granny, Ma’s mom, who appeared sickest on Saturday, April 4. She had diarrhea and couldn’t keep food down. Ma and her daughters held a three-way conference to talk about what to do.

Riann had heard local advisories asking people not to visit emergency rooms “unless it was serious, serious.”

They would wait and see if Granny’s condition took a bad turn. But that night, when Ma came home from work, she was winded just walking from her van to the cement porch of the family’s one-story brick ranch. Raven asked if it might be coronavirus. Ma looked up from the couch and waved her off.

“If it goes left, it goes left,” she joked. “I’ve made my peace with God.”

They joked that she had to keep her voice to sing “Jessie’s Girl” at karaoke.

Column One

A showcase for compelling storytelling from the Los Angeles Times.

By Sunday, Ma couldn’t sleep well; it was painful to lie down. Raven texted Riann: “Ma’s not being honest.”

A day later on April 6, Riann drove over, stopping to pick up some broth at a Thai place. Riann asked Ma to come stay at her house, promising Raven would look after the rest of the family. For once, Ma obliged, shuffling around her bedroom to pack some toiletries and change her clothes.

As they waited, Riann and Raven turned on the “Real Housewives of Miami;” the kids played on their iPads. The volume in the living room was a notch too high: No one heard Ma fall.

At 9:50 p.m., Raven went to the bedroom. She couldn’t open the door; Ma was lying against it, only her legs visible through the crack. Raven called out. Riann came running. She squeezed through the door, her left shoe popping off into the hallway.

“No,” she screamed.

“It was like I went back to being a baby,” Riann said, “Calling out to Ma, hoping she’d answer me.”

Raven rolled Ma onto her back and gave her chest compressions.

Kaden called 911. Medics arrived.

It happened like it happened to a lot of others.

Ma was pronounced dead at 10:22 p.m.

Riann and Raven Conner

Riann Conner, left, 33, and her sister, Raven Conner, 31, hold their mother’s cremains in front of the four-generation home where she lived and died in St. Clair Shores, Mich.

(Sylvia Jarrus / For The Times)


Gretchen Terebesi, a forensic investigator for Macomb County, got a 10:30 p.m. call from the St. Clair Shores Police Department. She climbed into her department’s Ford Edge and, with a blue body bag in a Rubbermaid storage bin in the cargo space, headed south toward Detroit.

Gretchen Terebesi

Gretchen Terebesi stands in front of the department’s car at the Macomb County Medical Examiner’s Office in Mount Clemens, Mich.

(Sylvia Jarrus / For The Times)

Terebesi, 44, had a long history in criminal justice: first as a correctional officer, then as a crime scene technician, a 911 dispatcher and — for the past 15 years — a death investigator.

House calls were rising steadily that spring. But the virus’ assault on Detroit was only just beginning; sometimes, she would handle multiple cases from the same household, only days apart. Ma would be the first case of Terebesi’s overnight shift.

One of the blue body bags

A body bag, red zipper lock, and ankle ID band at the Macomb County Medical Examiner’s Office in Mount Clemens, Mich.

(Sylvia Jarrus / For The Times)

Terebesi was soft-spoken, with an Alabama accent and auburn hair that brushed her shoulders. She, too, was the mother of two girls. And at 11:25 p.m., she donned a mask and gloves and walked up to the white metal awning of the ranch home.

By then, Riann had kissed her sister and left. Raven was waiting, a friend by her side. Granny kept uttering that her daughter was gone.

“When the medical examiner comes to your home, it’s the worst day of your life,” Terebesi said. “I could see these girls had lost their foundation — their glue.”

Terebesi’s is a job one wants to be quiet, quick and done. She looked over the scene and took photographs. She placed Ma in the blue bag with a label on the outside: Case #1418-20. At 11:50, she called for her transport team, and at 12:55 a.m., Ma arrived at the medical examiner’s office.

Riann Conner shows a tattoo in memory of her mother.

Riann Conner shows a tattoo in memory of her mother, Wanda Mathis-Conner, who passed away from COVID-19 in April.

(Sylvia Jarrus / For The Times)

She was signed into a log and placed on the examination docket for the next morning. The death certificate was signed on Good Friday: 55-year-old; non-smoker; no prescription medications; good health. Cause of death: COVID-19 infection and related complications.

The bag was zipped up once more. It would hold Ma until she was cremated.

Family voices rose and met in the days after. Whispered things that make a life. Ma had grown up riding bikes with friends over the Detroit River — from Dorchester Street on the East Side to Belle Isle. Her girls decided that, though Ma would never own a pickup truck, ride on the back of a Harley, or visit Seattle — all unfulfilled dreams — they might one day be ready to grant her final wish: to have her remains scattered on the river.

Anything Ma had ever told them “was Bible,” Riann said.

“And Detroit flowed through her like the river itself.”


Nearly 11 months later, tourists no longer flock to the Buddhist temples along the holy river known as Bang Pakong. Now, only grieving families visit to see monks bathe their deceased before cremation.

But every dawn, Winbest Industrial’s floors vibrate under machinery; lighting turns everything blue. The white paint on the sewing needle plates chips away with all the pounding. The handiwork is stacked, crated and shipped. Demand is as high as ever.

Chakpangchaluem, the deputy manager, commutes to the factory from Chonburi, a neighboring province where coronavirus cases are climbing. As a Buddhist, she tries to “put myself into a Zen state” and not think about what’s driving the company’s profit.

Still, she said, even a small cough lifting from the base of her throat brings panic. She walks the floor, her charges stay busy. It will go on this way for some time; the sealing of polyethylene, the fastening of curved zippers and the neat, waiting rows of black, white and blue — and all the hands they’ll pass through on their journeys.

Caleb Quinley in Thailand contributed to this report.