The handwritten doctor’s order was just eight words long, but it solved a problem for Dundee Manor, a nursing home in rural South Carolina struggling to handle a new resident with severe dementia.
David Blakeney, 63, was restless and agitated. The home’s doctor wanted him on an antipsychotic medication called Haldol, a powerful sedative.
“Add Dx of schizophrenia for use of Haldol,” read the doctor’s order, using the medical shorthand for “diagnosis.”
But there was no evidence that Mr. Blakeney actually had schizophrenia.
Antipsychotic drugs — which for decades have faced criticism as “chemical straitjackets” — are dangerous for older people with dementia, nearly doubling their chance of death from heart problems, infections, falls and other ailments. But understaffed nursing homes have often used the sedatives so they don’t have to hire more staff to handle residents.
one in 150 people.
Schizophrenia, which often causes delusions, hallucinations and dampened emotions, is almost always diagnosed before the age of 40.
“People don’t just wake up with schizophrenia when they are elderly,” said Dr. Michael Wasserman, a geriatrician and former nursing home executive who has become a critic of the industry. “It’s used to skirt the rules.”
refuge of last resort for people with the disorder, after large psychiatric hospitals closed decades ago.
But unfounded diagnoses are also driving the increase. In May, a report by a federal oversight agency said nearly one-third of long-term nursing home residents with schizophrenia diagnoses in 2018 had no Medicare record of being treated for the condition.
hide serious problems — like inadequate staffing and haphazard care — from government audits and inspectors.
One result of the inaccurate diagnoses is that the government is understating how many of the country’s 1.1 million nursing home residents are on antipsychotic medications.
According to Medicare’s web page that tracks the effort to reduce the use of antipsychotics, fewer than 15 percent of nursing home residents are on such medications. But that figure excludes patients with schizophrenia diagnoses.
To determine the full number of residents being drugged nationally and at specific homes, The Times obtained unfiltered data that was posted on another, little-known Medicare web page, as well as facility-by-facility data that a patient advocacy group got from Medicare via an open records request and shared with The Times.
The figures showed that at least 21 percent of nursing home residents — about 225,000 people — are on antipsychotics.
The Centers for Medicare and Medicaid Services, which oversees nursing homes, is “concerned about this practice as a way to circumvent the protections these regulations afford,” said Catherine Howden, a spokeswoman for the agency, which is known as C.M.S.
“It is unacceptable for a facility to inappropriately classify a resident’s diagnosis to improve their performance measures,” she said. “We will continue to identify facilities which do so and hold them accountable.”
significant drop since 2012 in the share of residents on the drugs.
But when residents with diagnoses like schizophrenia are included, the decline is less than half what the government and industry claim. And when the pandemic hit in 2020, the trend reversed and antipsychotic drug use increased.
A Doubled Risk of Death
For decades, nursing homes have been using drugs to control dementia patients. For nearly as long, there have been calls for reform.
In 1987, President Ronald Reagan signed a law banning the use of drugs that serve the interest of the nursing home or its staff, not the patient.
But the practice persisted. In the early 2000s, studies found that antipsychotic drugs like Seroquel, Zyprexa and Abilify made older people drowsy and more likely to fall. The drugs were also linked to heart problems in people with dementia. More than a dozen clinical trials concluded that the drugs nearly doubled the risk of death for older dementia patients.
11 percent from less than 7 percent, records show.
The diagnoses rose even as nursing homes reported a decline in behaviors associated with the disorder. The number of residents experiencing delusions, for example, fell to 4 percent from 6 percent.
A Substitute for Staff
Caring for dementia patients is time- and labor-intensive. Workers need to be trained to handle challenging behaviors like wandering and aggression. But many nursing homes are chronically understaffed and do not pay enough to retain employees, especially the nursing assistants who provide the bulk of residents’ daily care.
Studies have found that the worse a home’s staffing situation, the greater its use of antipsychotic drugs. That suggests that some homes are using the powerful drugs to subdue patients and avoid having to hire extra staff. (Homes with staffing shortages are also the most likely to understate the number of residents on antipsychotics, according to the Times’s analysis of Medicare data.)
more than 200,000 since early last year and is at its lowest level since 1994.
As staffing dropped, the use of antipsychotics rose.
Even some of the country’s leading experts on elder care have been taken aback by the frequency of false diagnoses and the overuse of antipsychotics.
Barbara Coulter Edwards, a senior Medicaid official in the Obama administration, said she had discovered that her father was given an incorrect diagnosis of psychosis in the nursing home where he lived even though he had dementia.
“I just was shocked,” Ms. Edwards said. “And the first thing that flashed through my head was this covers a lot of ills for this nursing home if they want to give him drugs.”
Homes that violate the rules face few consequences.
In 2019 and 2021, Medicare said it planned to conduct targeted inspections to examine the issue of false schizophrenia diagnoses, but those plans were repeatedly put on hold because of the pandemic.
In an analysis of government inspection reports, The Times found about 5,600 instances of inspectors citing nursing homes for misusing antipsychotic medications. Nursing home officials told inspectors that they were dispensing the powerful drugs to frail patients for reasons that ranged from “health maintenance” to efforts to deal with residents who were “whining” or “asking for help.”
a state inspector cited Hialeah Shores for giving a false schizophrenia diagnosis to a woman. She was so heavily dosed with antipsychotics that the inspector was unable to rouse her on three consecutive days.
There was no evidence that the woman had been experiencing the delusions common in people with schizophrenia, the inspector found. Instead, staff at the nursing home said she had been “resistive and noncooperative with care.”
Dr. Jonathan Evans, a medical director for nursing homes in Virginia who reviewed the inspector’s findings for The Times, described the woman’s fear and resistance as “classic dementia behavior.”
“This wasn’t five-star care,” said Dr. Evans, who previously was president of a group that represents medical staff in nursing homes. He said he was alarmed that the inspector had decided the violation caused only “minimal harm or potential for harm” to the patient, despite her heavy sedation. As a result, he said, “there’s nothing about this that would deter this facility from doing this again.”
Representatives of Hialeah Shores declined to comment.
Seven of the 52 homes on the inspector general’s list were owned by a large Texas company, Daybreak Venture. At four of those homes, the official rate of antipsychotic drug use for long-term residents was zero, while the actual rate was much higher, according to the Times analysis comparing official C.M.S. figures with unpublished data obtained by the California advocacy group.
make people drowsy and increases the risk of falls. Peer-reviewed studies have shown that it does not help with dementia, and the government has not approved it for that use.
But prescriptions of Depakote and similar anti-seizure drugs have accelerated since the government started publicly reporting nursing homes’ use of antipsychotics.
Between 2015 and 2018, the most recent data available, the use of anti-seizure drugs rose 15 percent in nursing home residents with dementia, according to an analysis of Medicare insurance claims that researchers at the University of Michigan prepared for The Times.
in a “sprinkle” form that makes it easy to slip into food undetected.
“It’s a drug that’s tailor-made to chemically restrain residents without anybody knowing,” he said.
In the early 2000s, Depakote’s manufacturer, Abbott Laboratories, began falsely pitching the drug to nursing homes as a way to sidestep the 1987 law prohibiting facilities from using drugs as “chemical restraints,” according to a federal whistle-blower lawsuit filed by a former Abbott saleswoman.
According to the lawsuit, Abbott’s representatives told pharmacists and nurses that Depakote would “fly under the radar screen” of federal regulations.
Abbott settled the lawsuit in 2012, agreeing to pay the government $1.5 billion to resolve allegations that it had improperly marketed the drugs, including to nursing homes.
Nursing homes are required to report to federal regulators how many of their patients take a wide variety of psychotropic drugs — not just antipsychotics but also anti-anxiety medications, antidepressants and sleeping pills. But homes do not have to report Depakote or similar drugs to the federal government.
“It is like an arrow pointing to that class of medications, like ‘Use us, use us!’” Dr. Maust said. “No one is keeping track of this.”
published a brochure titled “Nursing Homes: Times have changed.”
“Nursing homes have replaced restraints and antipsychotic medications with robust activity programs, religious services, social workers and resident councils so that residents can be mentally, physically and socially engaged,” the colorful two-page leaflet boasted.
Last year, though, the industry teamed up with drug companies and others to push Congress and federal regulators to broaden the list of conditions under which antipsychotics don’t need to be publicly disclosed.
“There is specific and compelling evidence that psychotropics are underutilized in treating dementia and it is time for C.M.S. to re-evaluate its regulations,” wrote Jim Scott, the chairman of the Alliance for Aging Research, which is coordinating the campaign.
The lobbying was financed by drug companies including Avanir Pharmaceuticals and Acadia Pharmaceuticals. Both have tried — and so far failed — to get their drugs approved for treating patients with dementia. (In 2019, Avanir agreed to pay $108 million to settle charges that it had inappropriately marketed its drug for use in dementia patients in nursing homes.)
‘Hold His Haldol’
Ms. Blakeney said that only after hiring a lawyer to sue Dundee Manor for her husband’s death did she learn he had been on Haldol and other powerful drugs. (Dundee Manor has denied Ms. Blakeney’s claims in court filings.)
During her visits, though, Ms. Blakeney noticed that many residents were sleeping most of the time. A pair of women, in particular, always caught her attention. “There were two of them, laying in the same room, like they were dead,” she said.
In his first few months at Dundee Manor, Mr. Blakeney was in and out of the hospital, for bedsores, pneumonia and dehydration. During one hospital visit in December, a doctor noted that Mr. Blakeney was unable to communicate and could no longer walk.
“Hold the patient’s Ambien, trazodone and Zyprexa because of his mental status changes,” the doctor wrote. “Hold his Haldol.”
Mr. Blakeney continued to be prescribed the drugs after he returned to Dundee Manor. By April 2017, the bedsore on his right heel — a result, in part, of his rarely getting out of bed or his wheelchair — required the foot to be amputated.
In June, after weeks of fruitless searching for another nursing home, Ms. Blakeney found one and transferred him there. Later that month, he died.
“I tried to get him out — I tried and tried and tried,” his wife said. “But when I did get him out, it was too late.”
saying local officials expected “the possibility of flooding and even spinoff tornadoes in portions of Alabama.” In Mississippi, Gov. Tate Reeves also issued a state of emergency on Saturday, allowing for the use of state resources for response and recovery.
Research over the past decade has found that, on average, such rapid intensification of hurricanes is increasing, in part because the oceans, which provide the energy for hurricanes, are getting warmer as a result of human-caused emissions of greenhouse gases.But Ida will also strengthen quickly because the Gulf, as is usual at the end of the summer, is very warm.
The hurricane center defines rapid intensification as at least a 35-m.p.h. increase in sustained winds over 24 hours. In the extremely active 2020 season, Hurricane Laura intensified by 45 m.p.h. in the 24 hours before making landfall in Louisiana as a Category 4 storm in late August.
The National Hurricane Center said Ida was likely to produce heavy rainfall late Sunday into Monday from southeast Louisiana to coastal Mississippi and Alabama. Tropical storm force winds will arrive along the coast as early as Saturday night, according to the National Weather Service, before the storm makes landfall on Sunday afternoon or evening. After moving inland, the storm could contribute to flooding in Tennessee, where flash flooding killed 20 people last weekend.
“Based upon current track and strength of Ida, this storm will test our hurricane protection systems in a way they haven’t been tested before,” Chip Kline, executive assistant to the governor of Louisiana for coastal activities, said on Twitter. “It’s times like these that remind us of the importance of continuing to protect south Louisiana.”
Because of an editing error, an earlier version of this article misidentified the location of Tropical Storm Ida. It was in the Caribbean Sea early Friday, not the Gulf of Mexico.
Hurricane Ida will produce “life-threatening” weather conditions in Louisiana and batter parts of Mississippi, the National Weather Service said, urging people to evacuate inland.
Here is a breakdown of how various parts of the region could be affected when the hurricane makes landfall on Sunday afternoon or evening , according to the Weather Service.
Baton Rouge, La.
River Parishes and Northshore in Louisiana
Residents in the metro area can expect winds of 110 m.p.h. and, potentially, more than 20 inches of rain.
Inundation could reach as high as 11 feet. Residents can also expect winds of 74 m.p.h. and up to 12 inches of rain.
Tornadoes are possible in all of these areas, the Weather Service said.
Hurricane Ida is expected to make landfall Sunday, threatening to bring dangerous wind, storm surge and rain to the Gulf Coast exactly 16 years after the arrival of Hurricane Katrina, one of the most costly natural disasters in American history, which left more than 1,800 dead and produced more than $100 billion in damages.
The overall impact of storm surge from Ida is predicted to be less severe than during Katrina. Because that storm began as a Category 5 hurricane in the Gulf of Mexico before weakening as it approached landfall, it generated enormous storm surge, which brought over 20 feet of water to parts of the Mississippi coast. Current projections put the storm surge of Ida at 10 to 15 feet.
“Fifteen-foot sure can do a lot of damage,” said Barry Keim, a professor at Louisiana State University and Louisiana State Climatologist. “But it’s going to be nothing in comparison with Katrina’s surge.”
Improvements to the levee system following Katrina have better prepared the New Orleans metro area for the storm surge.
However, the areas likely to receive the most severe surge from Ida may be less equipped to handle it than the area hit by Katrina, said Dr. Keim.
Ida is expected to make landfall to the west of where Katrina struck, bringing the most severe storm surge impacts to the Louisiana coast west of the Mississippi River rather thaneast of the river along coastal Mississippi, as Katrina did.
“We are testing a different part of the flood protection in and around southeast Louisiana than we did in Katrina,” said Dr. Keim. “Some of the weak links in this area maybe haven’t been quite as exposed.”
While the impacts of Ida’s storm surge are expected to be less severe than Katrina’s, Ida’s winds and rain are predicted to exceed those that pummeled the Gulf Coast in 2005.
Ida is expected to make landfall on the Gulf Coast as a Category 4 storm with peak winds of 130 mph, while Katrina made landfall as a Category 3 with peak winds of 125 mph.
“It could be quite devastating — especially some of those high rise buildings are just not rated to sustain that wind load,” said Jamie Rhome, acting deputy director of the National Hurricane Center.
The severe damage from Hurricane Laura, which struck southwest Louisiana last year as a Category 4 storm, was caused primarily by high winds peaking at 150 mph. The storm caused 42 deaths and damage costing more than $19 billion.
Ida’s rainfall also threatens to exceed Katrina’s highs.
The National Hurricane Center estimates that Ida will drench the Gulf Coast with 8 to 16 inches of rain and perhaps as much as 20 inches in some places. Katrina brought 5-10 inches of rain with more than 12 inches in the most impacted areas.
“That is a lot of rainfall,” said Mr. Rhome. “Absolutely the flash flood potential in this case is high, very high.” Especially combined with storm surge, he said, such intense levels of rainfall could have a “huge and devastating impact to those local communities.”
NEW ORLEANS — When a hurricane comes roaring toward New Orleans out of the Gulf of Mexico, there is a discernible mood shift on Bourbon Street, the city’s famed strip of iniquity and conspicuous alcohol consumption.
It goes from tawdry to tawdry with a hint of apocalypse. On Friday afternoon, the street was half alive. Daiquiri bars were open and daiquiri bars were boarded up. The doors to Larry Flynt’s Hustler Club were locked. Nearby, a man lay on his back on the sidewalk, a plastic bag at his side, yelling the name “Laura.” Or maybe “Lord.”
Six happy women from New York ambled toward Canal Street in matching black T-shirts that said, “Birthday, beignets and booze.” The birthday girl declined to give her name. They went past the club called The Famous Door, where a listless bar band played “Fat Bottomed Girls.”
The riffs poured out into the street. A member of the birthday team raised a glass of something alcoholic and sugary and shouted out the chorus.
Another of the New York women, Jessika Edouard of Long Island, said that most of her group had been trying to get out of town before the storm’s arrival, to no avail. It was all cancellations and unresponsive airline customer service. “The flights are terrible,” she said.
What choice did they have but to keep the party going? Ms Edouard thought she and some of the others might be able to leave on Monday, after Ida hit.
In the meantime, she said, they had bought a ton of booze in the French Quarter. In the morning they had beignets. They had just met a crew from the Weather Channel. They seemed more excited than scared.
Ms. Edouard even had words for the storm, which she delivered like a threat from one pro wrestler to another.
“If Hurricane Ida thinks she is going to ruin my friend’s 30th birthday, then Ida has another thing coming,” she said.
NEW ORLEANS — With Hurricane Ida likely to bring powerful winds and heavy rain to their city, residents of New Orleans faced a familiar choice: flee or hunker down for the duration.
The storm was expected to make landfall by Sunday afternoon or evening and officials urged people who intended to evacuate to do so by Saturday. Residents came to a variety of decisions on the matter.
Lacy Duhe, 39, and Jeremy Housely, 42, opted to hunker down in their second-story apartment on Deslonde Street in New Orlean’s Lower Ninth Ward. If they evacuated and ended up in a shelter, they said, they worried about the risk of their unvaccinated children contracting Covid-19. They also had just paid their monthly bills and could not afford to go anywhere.
“It feels serious,” said the couple’s 11-year-old daughter, Ja-nyi. “I wasn’t born during Katrina time. But I know it knocked down a lot of places.”
Mary Picot, 71, walked out the door on Saturday afternoon carrying bags of snacks and medicine. She wasn’t worried about flooding and believed the levees would hold. It was the threat of power outages that convinced her to leave.
“My husband is diabetic,” she said. “We have to keep his medicine cold.”
Donald Lyons, 38, was packing up a silver Nissan sedan Saturday afternoon under a cloud-filled sky in Hollygrove, one of the traditionally Black working class neighborhoods that flooded badly when Katrina hit. The car, carrying his wife, three children and mother-in-law, was full of bags and bedding. They were heading to Sugar Land, Texas, 27 miles southwest of Houston, where they had family that had left after Katrina, 16 years ago, and never come back.
“I’m just trying to get somewhere safe,” Mr. Lyons said.
Down the block, Barbara Butler, 65, a housekeeper, said she thought the city was safer now with all of the new flood protection. She intended to ride out the storm at home.
“It gave us some relief,” she said. “It’s better than no relief.”
She was sitting on the porch with her husband, Curtis Duck, 63, and her brother, Ray Thomas, in a house that Ms. Butler said was flooded with eight feet of water after Katrina.
Mr. Duck said he was sick of evacuating time and again.
“We listen to the news,” he said. “People telling us to go, go, go.”
Victor Pizarro, a health advocate, and his husband decided to ride out the storm in their home in the Gentilly Terrace neighborhood, although they said they would leave town if they lost power for an extended period.
“It’s definitely triggering to even have to think about this and make these decisions,” Mr. Pizarro said in a telephone interview while he drove across town in search of a spare part for his generator. “It’s exhausting to be a New Orleanian and a Louisianian at this point.”
Andy Horowitz and his familydecided to vacate their home in the Algiers Point neighborhood, which sits directly across the Mississippi River from the French Quarter. Mr. Horowitz is the author of“Katrina: A History, 1915-2015,” and he is among those scholars and Louisiana residents who fear that the city’s new flood protection system, as massive as it is, may prove to be inadequate for a sinking city in the likely path of more frequent and powerful storms in the age of climate change.
“Every summer, New Orleans plays a game of Russian roulette, and every summer we pull the trigger,” Mr. Horowitz said.
NEW ORLEANS — With tracking maps for Hurricane Ida consistently showing an expected pathway toward southeast Louisiana, Mayor LaToya Cantrell of New Orleans issued a stern warning on Saturday that city residents who intend to leave should do so immediately.
“In no way will this storm be weakening, and there’s always an opportunity for the storm to strengthen,” Ms. Cantrell said at a news briefing. “Time is not on our side. It’s rapidly growing, it’s intensifying.”
City officials are asking that residents who plan to stay in the city prepare for extended power outages, limited emergency services and several days of high temperatures after the storm passes.
“The first 72 is on you,” said Collin Arnold, director of the New Orleans Office of Homeland Security and Emergency Preparedness. “The first three days of this will be difficult for responders to get to you.”
Forecasters are predicting that Hurricane Ida will be a Category 4 storm upon landfall on Sunday, the 16th anniversary of Hurricane Katrina, which left more than 1,800 dead.
“What we learned during Hurricane Katrina is we are all first-responders,” Ms. Cantrell said. “It’s about taking care of one another.”
— Chelsea Brasted
NEW ORLEANS — On Saturday afternoon, the Rev. Willie L. Calhoun Jr., a 71-year-old resident of the Lower Ninth Ward, was in his Lincoln Continental on the brink of getting out of town. He was not quite sure where. Somewhere in Alabama, he figured.
Rev. Calhoun remembers his father smashing a hole in the roof of his family’s home in the Lower Ninth in 1965, when Hurricane Betsy put 10 feet of water in his house. When Katrina came, he and his family made sure to get out of the neighborhood before the storm destroyed their homes — unlike many of his neighbors, some of whom perished when the levees failed.
The pain from Katrina was now an indelible fact of life in the neighborhood. He had hoped to take part in a 16th anniversary commemoration on Sunday, with a high school marching band and a theme, he said, of “healing, unifying and strengthening our communities.”
“The trauma, and the hurt that’s there,” he said. “I have one friend who lost his mother and his granddaughter in Katrina. For that trauma to be revisited every year is a tough thing.”
But his perspective on the neighborhood 16 years on was somewhat nuanced. He felt confident that the improvements to the city’s storm protection system — with its mammoth flood walls and new gates and levees — would keep the Ninth Ward safe. His worry, he said, was the damage from the wind that comes with a Category 4 hurricane.
And yet it was difficult not to be disappointed. The jobs for Black men seemed to have dried up in the city. A revamped post-Katrina educational system, heavily reliant on charter schools, did not seem, in Rev. Calhoun’s opinion, to have done much good. The neighborhood was in need of economic stimulus. Still full of empty lots, and ghostly foundations of homes, many of them owned by Black families, long washed away.
After $20 billion in infrastructure improvements, it felt, at best, like partial progress, and like survival with an asterisk.
LAKE CHARLES, La. — Not again. That was the widespread sentiment among residents of Lake Charles, a city of about 76,000 residents some 200 miles from New Orleans, on Saturday.
A year after Hurricane Laura left many here without power — and some without homes — for long periods of time, residents were preparing for perhaps yet another weather catastrophe.
When Laura, a powerful Category 4 storm, barreled through Lake Charles last August, it shattered the windows of the home that Juan Jose Galdames, 55, a construction worker, shared with his five children. On Saturday, he was at Home Depot, buying plywood to protect the windows and other vulnerable parts of his house ahead of the storm.
“Yes, I am a little afraid,” Mr. Galdames said. “I don’t want a repeat of that day. It was scary. I want my children to feel safe. I’m trying to get everything ready before nightfall.”
Water and bread were in short supply at an area Target store, and traffic stretched for miles as residents sought safety elsewhere.
Tracy Guillory, 57, a carpenter, tried to prepare by stocking up on supplies and staying on top of weather reports. She said she and her family were weary after a long year of weather crises that included Hurricane Delta and a winter storm that caused pipes to burst and knocked out water systems throughout the region.
Ms. Guillory said her neighborhood was still recovering from flooding in May, which left her SUV beyond repair. She plans to hunker down with her 83-year-old father and 21-year-old daughter.
Josue Espinal, 34, who also works in construction, was trying to reassure his 4-year-old son, Anderson, that everything would be all right. The boy sat on top of a generator box as his father loaded a cart with bottles of water at a Home Depot. Truth was, Mr. Espinal admitted, he too was worried. He and his family live in a mobile home near a lake, and he was looking for a better option to spend the next two nights.
In Louisiana, where daily deaths from Covid reached their highest levels this week, stretched hospitals are having to modify the intense preparations they would normally make ahead of an expected strike from Hurricane Ida.
Louisiana’s medical director, Dr. Joseph Kanter, asked residents on Friday to avoid unnecessary emergency room visits to preserve the state’s hospital capacity, which has been vastly diminished by its most severe Covid surge of the pandemic.
And while plans exist to transfer patients away from coastal areas to inland hospitals ahead of a hurricane, this time “evacuations are just not possible,” Gov. John Bel Edwards said at a news conference.
“The hospitals don’t have room,” he said. “We don’t have any place to bring those patients — not in state, not out of state.”
The governor said officials had asked hospitals to check generators and stockpile more water, oxygen and personal protective supplies than usual for a storm. The implications of a strike from a Category 4 hurricane while hospitals were full were “beyond what our normal plans are,” he added.
Mr. Edwards said he had told President Biden and Deanne Criswell, the administrator of the Federal Emergency Management Agency, to expect Covid-related emergency requests, including oxygen.
The state’s recent wave of Covid hospitalizations has exceeded its previous three peaks, and staffing shortages have necessitated support from federal and military medical teams. On Friday, 2,684 Covid patients were hospitalized in the state. This week Louisiana reported its highest ever single-day death toll from Covid — 139 people.
Oschner Health, one of the largest local medical systems, informed the state that it had limited capacity to accept storm-related transfers, especially from nursing homes, the group’s chief executive, Warner L. Thomas, said. Many of Oschner’s hospitals, which were caring for 836 Covid patients on Friday, had invested in backup power and water systems to reduce the need to evacuate, he said.
The pandemic also complicated efforts to discharge more patients than usual before the storm hits. For many Covid patients who require oxygen, “going home isn’t really an option,” said Stephanie Manson, chief operating officer of Our Lady of the Lake Regional Medical Center in Baton Rouge, which had 190 Covid inpatients on Friday, 79 of them in intensive care units.
The governor said he feared that the movement of tens or hundreds of thousands of evacuees in the state could cause it to lose gains made in recent days as the number of new coronavirus cases began to drop. Dr. Kanter urged residents who were on the move to wear masks and observe social distancing. Many of the state’s testing and vaccination sites were slated to close temporarily.
NEW ORLEANS — As Hurricane Ida heads toward a possible Sunday landfall on Louisiana’s coastline, the National Weather Service’s storm surge forecast has local officials warning about the potential for water to overtop some of the levees that protect parts of New Orleans.
Mayor LaToya Cantrell of New Orleans noted at a news briefing on Friday evening that water overtopping the levees “is as it was structured to do.” That reflects the updates to the local system of earthen and reinforced levees that protects much of southeast Louisiana in the years after Hurricane Katrina stretched it to a breaking point.
The system, officials said, was rebuilt to defend against a so-called “100-year-storm,” or a storm that has a 1 percent chance in happening every year, but to remain reinforced up to a 500-year-event. It includes armoring, splash pads — concrete areas designed to keep the ground behind an overtopped wall from being washed away — and pumps with backup generators, officials said.
Heath Jones, an emergency operation manager with the Army Corps of Engineers, said that some levees protecting New Orleans on the western side of the Mississippi River were at risk of overtopping in line with the Weather Service’s forecast calling for between 10 and 15 feet of storm surge. A federal levee database shows sections of levee there as low as 10 feet.
Levees in this part of the state have rarely been challenged since they were shored up in the years after Hurricane Katrina in 2005.
“The previous big tests were (hurricanes) Isaac and Gustav,” said Matt Roe, a public affairs specialist with the Army Corps of Engineers, which occurred in 2012 and 2008, “but it’s important to note that each storm is different.”
Ida’s strength, according to Chip Cline, chairman of the Coastal Protection and Restoration Authority, “will test our hurricane protection system in a way they haven’t been tested before.”
— Chelsea Brasted
Hurricane Ida threatens to be the first major storm to strike the Gulf Coast during the 2021 season, hitting a region in many ways still grappling with the physical and emotional toll of a punishing run of hurricanes last year.
The Atlantic hurricane season of 2020 was the busiest on record, with 30 named storms, 13 of which reached hurricane strength. There were so many storms that forecasters ran through the alphabet and had to take the rare step of calling storms by Greek letters.
Louisiana was dealt the harshest blow, barraged repeatedly by storms, including Hurricane Laura, which was one of the most powerful to hit the state, trailed six weeks later by Delta, which was weaker than Laura but followed a nearly identical path, inflicting considerable pain on communities still gripped by the devastation from the earlier storm.
The state is still struggling to claw its way back. Gov. John Bel Edwards of Louisiana said the state had $3 billion in unmet recovery needs. In Lake Charles, which was ravaged by direct hits from both hurricanes followed by a deadly winter storm and flooding in May, local officials recently renewed a plea for federal aid as the city has failed to regain its footing; much of it has yet to recover and many residents, unable to find adequate or affordable housing, have fled.
The looming impact of Ida underscores the persisting danger imperiling coastal communities as a changing climate stands to intensify the destructive force of the storms that have always been a seasonal part of life.
President Biden cited the growing danger in May when he announced a significant increase in funding to build and bolster infrastructure in communities most likely to face the wrath of extreme weather.
Hurricane Nora formed in the eastern Pacific on Saturday morning, threatening much of Mexico’s western coastline as the storm strengthens and barrels its way toward Puerto Vallarta, Jalisco and the tip of the Baja California Peninsula, forecasters said.
As of 10 a.m. on Saturday, Nora was about 425 miles from Cabo San Lucas, Mexico, and had maximum sustained winds of 80 miles per hour as it moved north, according to the National Hurricane Center.
A hurricane warning was in effect for parts of western Mexico.
Forecasters said the storm was expected to cause flooding, mudslides and perilous surf along much of Mexico’s central and northern Pacific Coast.
The remnants of the storm are expected to produce heavy rainfall in parts of the southwestern U.S. and central Rockies toward the middle of next week, forecasters said.
A forecast track from the National Hurricane Center showed Nora skirting close to Mexico’s coastline by Sunday morning before moving toward the Gulf of California a day later.
“Some additional strengthening is forecast through tonight if Nora’s center does not make landfall,” the National Hurricane Center said in an update. “Some gradual weakening is expected to begin by Sunday night or Monday, but Nora is forecast to remain as a hurricane through Tuesday.”
Nora is expected to produce rainfall totals of up to 12 inches this weekend along Mexico’s western coast.
It has been a dizzying few weeks for meteorologists who are monitoring Hurricane Ida this weekend after having monitored three named storms that formed in quick succession in the Atlantic, bringing stormy weather, flooding and damaging winds to different parts of the United States and the Caribbean.
The links between hurricanes and climate change are becoming more apparent. A warming planet can expect to see stronger hurricanes over time, and a higher incidence of the most powerful storms — though the overall number of storms could drop because factors like stronger wind shear could keep weaker storms from forming.
Hurricanes are also becoming wetter because of more water vapor in the warmer atmosphere; scientists have suggested that storms like Hurricane Harvey in 2017 produced far more rain than they would have without the human effects on climate. Also, rising sea levels are contributing to higher storm surges — the most destructive element of tropical cyclones.
LONDON — He suggested that a doctor inject him with the coronavirus live on television to play down the dangers to a nervous public. He modeled himself after the small-town mayor in the movie “Jaws,” who ignored warnings to close the beaches even though there was a marauding shark offshore. As the pandemic closed in on Britain, he was distracted by an unflattering story about his fiancée and her dog.
That was the portrait of Prime Minister Boris Johnson painted by his disaffected former chief adviser, Dominic Cummings, in parliamentary testimony on Wednesday. While Mr. Johnson flatly rejected several of the assertions in his own appearance in Parliament on Wednesday, they nevertheless landed with a thud in a country still struggling to understand how the early days of the pandemic were botched so badly.
“When the public needed us most, the government failed,” said Mr. Cummings, the political strategist who masterminded Britain’s campaign to leave the European Union and engineered Mr. Johnson’s rise to power before falling out bitterly with his boss and emerging as a self-styled whistle-blower.
a much-criticized road trip he made with his family that breached lockdown rules, saying he had fled London because of threats against his family. And he apologized for his failure to act sooner when he realized that Britain’s delay in imposing a lockdown last March was courting disaster.
“It’s true that I hit the panic button and said we’ve got to ditch the official plan,” Mr. Cummings said. “I think it’s a disaster that I acted too late. The fundamental reason was that I was really frightened of acting.”
testing 100,000 people a day. Mr. Cummings said he told Mr. Johnson to dismiss Mr. Hancock, as did the then-cabinet secretary, Mark Sedwill.
move patients from hospitals to nursing homes without testing them.
“Hancock told us that people were going to be tested before they went back to care homes, what the hell happened?” he said. “Quite the opposite of putting a shield round them, we sent people with Covid back to the care homes.”
A spokesman for Downing Street said on Wednesday that Mr. Johnson did not believe Mr. Hancock had lied to him.
reported by the BBC but denied by Downing Street.
Asked if Mr. Johnson was the right person to guide the country through the pandemic, Mr. Cummings responded simply: “No.”
The CNN prime-time host Chris Cuomo offered public-relations advice to his brother, Gov. Andrew M. Cuomo of New York, after a series of sexual harassment allegations threatened the governor’s political career earlier this year, an unusual breach of traditional barriers between lawmakers and journalists.
CNN said on Thursday that the conversations were “inappropriate” and that Chris Cuomo would refrain from any more similar discussions with the governor’s staff. But the network said it would take no disciplinary action against the anchor, whose program was CNN’s highest-rated show in the first quarter of the year.
The episode has — once again — raised questions about Chris Cuomo’s ability to host a flagship cable news program while his brother is a key figure in several major political stories. Besides the harassment allegations from several women who worked on his staff, Governor Cuomo has faced criticism for obscuring the number of coronavirus deaths in New York State nursing homes. Last year, before the scandals became news, Governor Cuomo commanded a national audience with his daily briefings on the pandemic.
Governor Cuomo’s office said on Thursday that Chris Cuomo had joined several strategy calls with the governor and some of his top advisers, confirming an earlier report by The Washington Post. Earlier this year, CNN barred Chris Cuomo from participating in its news coverage of the harassment allegations lodged against his brother, who has denied any wrongdoing.
he helped write speeches for Joseph R. Biden Jr., who was then a candidate for president.
Several of Fox News’s opinion hosts actively advised President Trump during his administration; Sean Hannity even appeared with Mr. Trump at a boisterous campaign rally. But CNN’s leadership often criticized Fox News for those blurred lines, with Jeff Zucker, the CNN president, describing the Rupert Murdoch-owned Fox as “state-run TV.”
After Chris Cuomo joined CNN in 2013, he mostly refrained from interviewing his brother on television. (One early exception led to some backlash.) That changed last year, after Governor Cuomo’s coronavirus updates became a national phenomenon. The brothers engaged in extended prime-time interviews about the emotional burdens of the pandemic. Viewers were riveted, especially after Chris Cuomo tested positive for the coronavirus and began speaking with his brother from isolation in a basement.
CNN leaned into the moment. “You get trust from authenticity and relatability and vulnerability,” Mr. Zucker told The New York Times last year. “That’s what the brothers Cuomo are giving us right now.”
who received special access to government-run coronavirus testing facilities, including a police escort for samples so that they could be quickly processed.
At the time, a CNN spokesman defended the host, arguing that Mr. Cuomo was sick with the virus and “turned to anyone he could for advice and assistance, as any human being would.”
Most government entities in Texas will soon be prohibited from requiring people to wear masks, Gov. Greg Abbott announced on Tuesday, days after federal health officials announced new guidance that encourages people who have been completely vaccinated to forego masks in most situations.
The executive order Mr. Abbott announced on Tuesday would prevent counties, cities, public health authorities and local government officials from requiring people to wear masks beginning on Friday. Violators could be fined $1,000.
Hospitals owned or operated by the government, state-supported living centers and jails and other criminal justice facilities are exempt from the order. Schools can continue their current mask policies until June 4, the end of the school year in some Texas districts, after which they will not be allowed to compel anyone to wear a mask. The C.D.C. also recommended that masks remain universally in use in K-12 schools until the end of the current school year.
Only a third of Texans are fully vaccinated, below the U.S. average of 37 percent, according to a New York Times database. No Covid-19 vaccines have been authorized yet for children under 12.
rescinded a statewide mask mandate and capacity restrictions on March 10, the new recommendations from the Centers for Disease Control and Prevention were less of a shock than they were in other states, where officials and business leaders scrambled to figure out how to safely accommodate residents and customers. Many states, and chains like Target, CVS and Best Buy, have since relaxed their mask mandates for vaccinated people.
Mr. Abbott’s mask rollback in March invigorated some individuals and business owners and alarmed others. But some local leaders chose to initially keep mask requirements in place, including the mayors of Texas’s biggest cities — Houston, Austin, San Antonio and Dallas — all of which are in counties won by President Biden.
Mayor Sylvester Turner of Houston, a Democrat, called the governor’s new order “a clear overreach,” and added, “His power is not absolute.”
Going forward, Mr. Turner said in a statement, “If you are a city employee or entering a city facility and you have not been fully vaccinated, you should wear your mask. We are not mandating it, but I strongly encourage everyone to get vaccinated to protect yourself, your family and your co-workers.”
Mayor Steve Adler of Austin and Travis County Judge Andy Brown, both Democrats, said in a statement that in the coming days, “we will be speaking with parts of our community most impacted by the governor’s order, including schools and nursing homes. Our community’s safety will continue to be our highest priority.”
New York Times database.
“Texans, not government, should decide their best health practices, which is why masks will not be mandated by public school districts or government entities,” Mr. Abbott said in a statement announcing the order. “We can continue to mitigate Covid-19 while defending Texans’ liberty to choose whether or not they mask up.”
The governor of New York said Monday that the state will lift some mask requirements in accordance with the new mask guidance for vaccinated people that the Centers for Disease Control and Prevention announced Thursday.
“No masks, no social distancing,” Gov. Andrew M. Cuomo, a Democrat, said of the policy that will go into effect for vaccinated people on Wednesday. Masks will still be required in nursing homes, schools, health care facilities and on public transit. Unvaccinated people should continue to wear a mask, he said in a news conference at Radio City Music Hall in Midtown Manhattan.
The move dovetails with the previously scheduled lifting of most capacity restrictions at offices, museums, restaurants and stores on Wednesday. It was significant, however, given the longstanding restrictions imposed on one of the hardest hit cities in the United States.
In addition, the city’s subway system returned to 24-hour service on Monday. There has been more than one year of overnight closings during the coronavirus pandemic to provide more time to clean and disinfect trains, stations and equipment. It was the longest planned shutdown since the subway opened in 1904.
no longer necessary for fully vaccinated people to mask or maintain social distance in many settings. The change set off public confusion and drew objections from some local officials and labor unions, including the country’s largest union of registered nurses. A number of major U.S. retailers have already lifted mask requirements, essentially turning to an honor system that relies on unvaccinated people to keep their masks on in public.
Businesses in New York can still set individual policies and some will still require masks.
The Centers for Disease Control and Prevention is finally catching up to the science.
For months, research about Covid-19 has pointed to two encouraging patterns. First, the underlying virus that causes Covid rarely spreads outdoors. Second — and even more important — fully vaccinated people are at virtually no risk of serious disease and only a minuscule risk of spreading the virus to others.
But the C.D.C., which has long been a cautious agency, has been unwilling to highlight these facts. It has instead focused on tiny risks — risks that are smaller than those from, say, taking a car trip. The C.D.C.’s intricate list of recommended Covid behavior has baffled many Americans and frightened others, making the guidance less helpful than it might have been.
Yesterday, the agency effectively acknowledged it had fallen behind the scientific evidence: Even though that evidence has not changed in months, the C.D.C. overhauled its guidelines. It said fully vaccinated people could stop wearing masks in most settings, including crowded indoor gatherings.
The change sends a message: Vaccination means the end of the Covid crisis, for individuals and ultimately for society.
long accepted without upending our lives, like riding in a car, taking a swim or exposing ourselves to the common cold.
‘Evidence-based’ and ‘bold’
The announcement also sends a message to the unvaccinated (who, the C.D.C. emphasized, should continue wearing masks in most settings): Life is starting to return to normal, and a vaccine shot is your best protection against a deadly virus. It is also the best way to protect your community and the rest of the world. And the long vaccine waits and difficult sign-up procedures are disappearing in most places.
Some experts praised the announcement. “Good move for the C.D.C. and our country,” Dr. Howard Forman, a Yale School of Medicine professor and former Senate staff member, wrote on Twitter. “They must stop making perfect the enemy of very good. And this is a step in that direction.”
Dr. Uché Blackstock, the C.E.O. of Advancing Health Equity, wrote: “I’m ecstatic about this news! It’s evidence-based and it’s bold. I hope that the updated guidelines incentivize more people to get vaccinated.”
Other experts worried that encouraging vaccinated people not to wear masks might cause unvaccinated people to shed them too — the so-called slippery-slope argument. It is a common concern whenever health authorities lift behavior restrictions. But history suggests it is often overblown. An absolutist message often fails, Julia Marcus of Harvard Medical School has noted, especially when it urges people to take steps that do not actually protect them.
criticized the C.D.C. during a hearing this week for not hewing to the data — and she argued that the change would lead to safer behavior. “This really matters because if people don’t have confidence in the C.D.C. guidance, if they believe it is driven more by politics than science, then they are likely to disregard the C.D.C. guidelines that we should be following,” Collins said.
will not fall to zero, and it is important to remember that. But zero is not a realistic goal, and the freezing of normal life has brought big costs of its own: children who are not learning; parents who cannot return to the work force; businesses that cannot rehire their workers; and millions of people who miss everyday forms of human companionship.
When Covid was raging out of control, these costs were nonetheless smaller than the alternative. With vaccines widely available, that’s no longer the case.
The C.D.C. has not fully shed its caution. It has not withdrawn its exaggeration of outdoor risks for the unvaccinated. And yesterday’s guidance continues to direct vaccinated people to wear masks and remain physically distant in some circumstances.
Some of those exceptions — like nursing homes, hospitals, homeless shelters and prisons — probably make sense. Many people in these settings are vulnerable, and masks can continue to provide protection, from both small Covid risks and other contagious diseases.
The rationale for other exceptions — like airplanes and public transportation, as well as airports and other travel hubs — is less clear, and the C.D.C. did not offer a public explanation for why vaccinated people need a mask on a bus but not in a bar.
in spreading the virus, a little extra caution is not beyond comprehension. It will not last forever, either. Yesterday’s about-face showed that while the C.D.C. may be slow, officials there take their mission seriously and do not enjoy being out of step with science.
“This is a watershed moment in the pandemic,” Dr. Lucy McBride, an internist, wrote on Twitter. “Next up: unmasking kids outdoors. Please, C.D.C.??”
“After a year of hard work and so much sacrifice, the rule is very simple: Get vaccinated, or wear a mask until you do,” President Biden said.
Biden and Republican senators meeting at the White House removed their masks. “Get vaccinated!” said Senator Joe Manchin of West Virginia, on a visit to his home state with Jill Biden. “We feel free.”
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Even before the pandemic began 14 months ago, nursing homes had become the source for rampant, antibiotic-resistant infections. The facilities also faced systemic problems like high turnover among nursing home staff and the gaming of the federal government’s rating system, which made it hard for families to judge the quality of homes.
For years, federal health officials and some insurers have tried to encourage more stay-at-home care, and the pandemic has created a sense of urgency.
“It’s really changed the paradigm on how older adults want to live,” said Dr. Sarita Mohanty, the chief executive of the SCAN Foundation, a nonprofit group focused on issues facing older adults. The vast majority of those adults would prefer to stay at home as they age, she said.
“What’s happened is a welcome sort of market correction for nursing homes,” said Tony Chicotel, a staff attorney for California Advocates for Nursing Home Reform in San Francisco. Some families, he said, “ended up agreeing to a nursing home without giving it a lot of deliberation.” But after trying home care during the pandemic, many families found keeping an older relative at home was a viable alternative, he said.
Nursing homes rose from the almshouses in England and America that cared for the poor. In the United States, passage of the Social Security Act in 1935 provided money for states to care for the elderly. Thirty years later, the Medicaid program expanded funding, making long-term care homes central to elder care, said Terry Fulmer, the president of the John A. Hartford Foundation, an advocacy group for older adults. “If you pay the nursing homes, that’s where you go,” Dr. Fulmer said.
It wasn’t until the 1970s that some programs began to pay for home care, and the number of nursing home residents nationwide started to slowly decline, with occupancy levels in recent years flattened to about 80 percent, according to data from the Kaiser Family Foundation.
Public health experts are praising President Biden’s announcement that his administration would create a federal stockpile of coronavirus vaccine doses and invest millions in community outreach, saying the moves would help immunize underserved communities and ensure doses would go where they’re most needed as demand falls.
Until now, vaccines had been allotted to states strictly on the basis of population, despite reports of wasted doses and pleas for more of them where the virus was surging, as in Michigan just weeks ago. In a reversal, the Biden administration is now trying to match supply with demand. Federal officials informed states on Tuesday that if they did not order their full allocation of doses in a given week, that vaccine would be considered part of a federal pool, available to other states that wanted to order more.
The administration had been unwilling to shift doses to states that were faster to administer them out of a concern that low-income communities would lose out to richer areas where residents were more willing to get shots.
the new coronavirus strategy that Mr. Biden announced on Tuesday at the White House: Pharmacies are to allow people to walk in for shots, and pop-up and mobile clinics will distribute vaccines, especially in rural areas. Federal officials also plan to enlist the help of family doctors and other emissaries who are trusted voices in their communities.
“We’ve got the product and we’ve vaccinated the very high-risk people, elderly people in nursing homes, people with diseases,” said Dr. Robert Murphy, executive director of Northwestern University’s Institute for Global Health. “Now we have to get the healthy ones and the younger ones and the ones that are being referred to as vaccine-hesitant.”
Allowing walk-ins at pharmacies would cut down on waste, he said, and funding for community outreach through trusted institutions like churches and schools could help reach people who are reluctant. That could offset the misinformation that has complicated efforts to vaccinate Black and Hispanic residents, who also face obstacles like language and technology barriers and less access to medical facilities.
Dr. Eric Topol, a professor of molecular medicine at Scripps Research in La Jolla, Calif., said he was “overjoyed” by the announcement. Dr. Topol pushed for loosening vaccine allocation limits last month, when Michigan was hit with a virus surge and unsuccessfully sought a boost in supply.
more than 106 million people in the United States were fully vaccinated and more than 56 percent of adults — or almost 148 million people — had received at least one shot. That has contributed to a steep decline in cases, hospitalizations and deaths across all age groups, federal officials said.
But despite a flood of available doses, the pace of vaccination has fallen considerably over the past two and a half weeks. Providers are now administering an average of about 2.19 million doses per day, about a 35 percent decrease from the peak of 3.38 million reported on April 13, according to data from the Centers for Disease Control and Prevention.
Officials across the country say they believe that despite falling demand, a substantial portion of Americans will get vaccinated if given more support and more information from trusted messengers, like personal doctors.
“We need to be in the community, asking the community what works for them and keeping that presence,” said Dr. Karen Landers, Alabama’s assistant state health officer. She added: “We are not giving up.”
Even in China, where propaganda has become increasingly pugnacious, the display was jarring: A photograph of a Chinese rocket poised to blast into space juxtaposed with a cremation pyre in India, which is overwhelmed by the coronavirus. “Chinese ignition versus Indian ignition,” the title read.
The image was quickly taken down by the Communist Party-run news service that posted it. But it has lingered as a provocative example of a broader theme running through China’s state-run media. Official channels and online outlets often celebrate the country’s success in curbing coronavirus infections, while highlighting the failings of others. Other comparisons in recent months include depicting crowds of shoppers or jubilant partygoers in China versus desolate streets and anti-lockdown protests abroad.
The example contrasting China with India was posted on Saturday on Weibo, a popular social media service, by a news service of the ruling party’s powerful law-and-order commission. The post drew a backlash from internet users who called it callous, and it was taken down on the same day.
But it has kindled debate in China about attitudes toward India, and the tensions between Beijing’s nationalist rhetoric at home and its efforts to promote a humbler, more humane image abroad.
one of his online responses to Mr. Hu. China, he suggested, should be more relaxed about flexing its political muscle. “Where can an 800-pound gorilla sleep?” he wrote. “Wherever it wants to.”
Mareike Ohlberg, a senior fellow in the Asia Program at the German Marshall Fund in Berlin who studies Chinese propaganda. “They have an increasing number of interests internationally, but ultimately what it boils down to is that your primary target audience still lives at home.”
the government’s draconian policies in the far western region of Xinjiang and the crackdown in Hong Kong. This combative style, widely described as “wolf warrior” diplomacy, has won praise at home, but drawn anger abroad.
In France, the Foreign Ministry summoned the Chinese ambassador to Paris in April last year after his embassy’s website wrote that French nurses had abandoned residents in nursing homes, a claim the government denied.
held a news conference late last year to demand an apology from China after Zhao Lijian, a Chinese foreign ministry spokesman, posted a doctored image on Twitter that depicted an Australian soldier holding a knife to the throat of an Afghan child.
Understand the Covid Crisis in India
India and China also exchanged bitter criticisms last year after their troops fought on a disputed border, leading to deaths of soldiers on both sides. But Mr. Xi and Prime Minister Narendra Modi of India quickly doused those tensions, and last week, Mr. Xi expressed condolences over India’s latest outbreak. China has recently offered to send medical support, including speeding up orders of oxygen equipment.
“wolf warrior” diplomats.
India’s image as a poorer, unruly country was sometimes used in China to “defend a more centralized and authoritarian rule,” he wrote by email. He added, “Many Chinese believe that India has joined the West to counter China’s rise in recent years.”
Under normal circumstances, the Chinese social media post would have provoked public anger in India. But many Indians are preoccupied with the crisis, said Madhurima Nundy, assistant director of the Institute of Chinese Studies in Delhi who is an expert on public health.
“There is too much happening now in India which is distressing, so the primary anger is directed towards the government” in Delhi, Dr. Nundy said. “The anger and distrust that emerged last year against China, because of Covid and compounded by border tensions, has dissipated in light of the present crisis.”