“That religious stigma weighs against you,” Ms. Cerón said.

As far as the murals go, she says they look beautiful but have done little to make her feel safer.

“It does nothing for me to have a very pretty painted street if three blocks away, they’re robbing or murdering people,” she said.

Alejandra Atrisco Amilpas, an artist who has painted some 300 murals across Iztapalapa, believes they can make residents prouder of where they live, but she admits they can only go so far.

“Paint helps a lot, but sadly it can’t change the reality of social problems,” she said.“A mural isn’t going to change whether you care about the woman being beat up on the corner.”

Ms. Atrisco, who is gay, said she had come up against conservative attitudes during the project, whether from male artists doubting her abilities or local officials barring her from painting L.G.B.T.Q.-themed murals.

“Violence against women, yes, but lesbians, no,” she said, smiling ruefully.

Still, Ms. Atrisco believes her work can affect residents’ lives by representing the characters of Iztapalapa in full color.

“Every day you confront a new challenge, every day a new wall and a new story,” she said. “You make dreams come true a little bit — you become a dream maker.”

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Phony Diagnoses Hide High Rates of Drugging at Nursing Homes

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.

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.

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.)

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.”

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Collapse: Inside Lebanon’s Worst Economic Meltdown in More Than a Century

TRIPOLI, Lebanon — Rania Mustafa’s living room recalls a not-so-distant past, when the modest salary of a security guard in Lebanon could buy an air-conditioner, plush furniture and a flat-screen TV.

But as the country’s economic crisis worsened, she lost her job and watched her savings evaporate. Now, she plans to sell her furniture to pay the rent and struggles to afford food, much less electricity or a dentist to fix her 10-year-old daughter’s broken molar.

For dinner on a recent night, lit by a single cellphone, the family shared thin potato sandwiches donated by a neighbor. The girl chewed gingerly on one side of her mouth to avoid her damaged tooth.

“I have no idea how we’ll continue,” said Ms. Mustafa, 40, at home in Tripoli, Lebanon’s second-largest city, after Beirut.

The huge explosion one year ago in the port of Beirut, which killed more than 200 people and left a large swath of the capital in shambles, only added to the desperation.

and the central bank unable to keep propping up the currency, as it had for decades, because of a drop in foreign cash flows into the country. Now, the bottom has fallen out of the economy, leaving shortages of food, fuel and medicine.

All but the wealthiest Lebanese have cut meat from their diets and wait in long lines to fuel their cars, sweating through sweltering summer nights because of extended power cuts.

long lines at gas stations, where drivers wait for hours to buy only a few gallons, or none at all if the station runs out.

hampered the investigation into the port explosion, and a billionaire telecoms tycoon, Najib Mikati, is currently the third politician to try to form a government since the last cabinet resigned after the blast.

Mustafa Allouch, the deputy head of the Future Movement, a prominent political party, said, like many other Lebanese, that he feared that the political system, intended to share power between a range of sects, was incapable of addressing the country’s problems.

“I don’t think it will work anymore,” he said. “We have to look for another system, but I don’t know what it is.”

His greatest fear was “blind violence” born out of desperation and rage.

“Looting, shooting, assaults on homes and small shops,” he said. “Why it hasn’t happened by now, I don’t know.”

The crisis has hit the poor hardest.

Five days a week, scores of people line up for free meals from a charity kitchen in Tripoli, some equipped with cut off shampoo bottles to carry their food because they can’t afford regular containers.

Robert Ayoub, the project’s head, said demand is going up, donations from inside Lebanon are going down, and the newcomers represent a new kind of poor: soldiers, bank employees and civil servants whose salaries have lost the bulk of their value.

In line on a recent day were a laborer who had walked an hour from home because he couldn’t afford transportation; a brick layer whose work had dried up; and Dunia Shehadeh, an unemployed housekeeper who picked up a tub of pasta and lentil soup for her husband and three children.

“This will hardly be enough for them,” she said.

The country’s downward spiral has set off a new wave of migration, as Lebanese with foreign passports and marketable skills seek better fortune abroad.

“I can’t live in this place, and I don’t want to live in this place,” said Layal Azzam, 39, before catching a flight to Saudi Arabia from Beirut’s international airport.

She and her husband had returned to Lebanon from abroad a few years ago and invested $50,000 in a business. But she said that it had failed and that she worried they would struggle to find care if their children got sick.

“There’s no electricity. They could cut the water. Prices are high. Even if someone sends you money from abroad, it doesn’t last,” she said. “There are too many crises.”

Drone footage by David Enders and Bryan Denton. Hwaida Saad contributed reporting.

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‘We’re Living in Hell’: Inside Fresnillo, Mexico’s Most Terrified City

FRESNILLO, Mexico — The violence was already terrifying, she said, when grenades exploded outside her church in broad daylight some five years ago. Then children in town were kidnapped, disappearing without a trace. Then the bodies of the executed were dumped in city streets.

And then came the day last month when armed men burst into her home, dragged her 15-year-old son and two of his friends outside and shot them to death, leaving Guadalupe — who didn’t want her full name published out of fear of the men — too terrified to leave the house.

“I do not want the night to come,” she said, through tears. “Living with fear is no life at all.”

For most of the population of Fresnillo, a mining city in central Mexico, a fearful existence is the only one they know; 96 percent of residents say they feel unsafe, the highest percentage of any city in Mexico, according to a recent survey from Mexico’s national statistics agency.

the Mexican government. Lately, it has become a national horror show, with cadavers found dangling from bridges, stuffed into plastic bags or even tied to a cross.

Across Mexico, murders have dropped less than 1 percent since Mr. López Obrador took office, according to the country’s statistics agency. That was enough for the president to claim, in a speech last month, that there had been an improvement on a problem his administration inherited. “There is peace and calm,” he said in June.

Many in Fresnillo disagree.

“‘Hugs not bullets’ doesn’t work,” said Javier Torres Rodríguez, whose brother was shot and killed in 2018. “We’re losing the ability to be shocked.”

the authorities said they had frozen 1,352 bank accounts linked to 14 criminal groups, including powerful drug cartels.

But the collection of programs and law-enforcement actions never coalesced into a clear public policy, critics said.

There is “an unstoppable situation of violence and a tragic deterioration of public security in Mexico,” said Angelica Duran-Martinez, an associate professor of political science at the University of Massachusetts Lowell. “There’s not a clear security policy.”

has also doubled down on his support for the armed forces, embracing the militarization that also marked previous administrations.

One central pillar of his approach to fighting crime has been the creation of the National Guard, a 100,000-strong federal security force deployed across some 180 regional barracks nationwide. Last week Mr. López Obrador announced that the guard would receive an additional $2.5 billion in funding.

102 people killed during the campaign, yet another sign of the country’s unraveling security.

His family is politically powerful. His brother, David, is governor-elect of Zacatecas. Another brother, Ricardo, leads the Morena party in the Senate and has said he intends to run for president in 2024. But not even the family’s political prominence has managed to rescue the city or the state.

central to the drug trade, a crossroads between the Pacific, where narcotics and drugmaking products are shipped in, and northern states along the United States border. Fresnillo, which sits in the center of important roads and highways, is strategically vital.

But for much of its recent history, residents say they were largely left alone. That began changing around 2007 and 2008 as the government’s assault on the cartels led them to splinter, evolve and spread.

In the last few years, the region has become embroiled in a battle between two of the country’s most powerful organized crime groups: the Sinaloa Cartel and the Jalisco New Generation Cartel.

Caught in the middle of the fighting are residents like Guadalupe. She can remember sitting on the stoop with neighbors until midnight as a young girl. Now, the city lies desolate after dark.

Guadalupe does not let her children play outside unsupervised, but even that couldn’t stop the violence from tearing her family apart. On the night her son was killed, in mid-July, four armed men stormed into her home, dragging out her son, Henry, and two friends who were sleeping over. There was a burst of gunfire, and then the assailants were gone.

It was Guadalupe who found the teenagers’ bodies.

Now she and her family live in terror. Too scared to stay in the same house, they moved in with Guadalupe’s parents in a different part of town. But the fear remained. Her 10-year-old daughter can barely sleep, she said, and Guadalupe keeps dreaming of her son’s killing. The motive, and the identity of the killers, remain unknown.

Guadalupe has thought about leaving town or even taking her own life. But for now, she sits in her parents’ small, cinder-block house, the curtains drawn, the shadows broken by the candles of a little altar to Henry and his fallen friends.

“There’s nothing here,” she said. “The fear has overwhelmed us.”

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1+1=4? Latin America Confronts a Pandemic Education Crisis.

SOACHA, Colombia — Already, two of Gloria Vásquez’s children had dropped out of school during the pandemic, including her 8-year-old, Ximena, who had fallen so far behind that she struggled with the most basic arithmetic.

“One plus one?” Ms. Vásquez quizzed her daughter one afternoon.

“Four?” the little girl guessed helplessly.

Now, Ms. Vásquez, a 33-year-old single mother and motel housekeeper who had never made it past the fifth grade, told herself she couldn’t let a third child leave school.

“Where’s Maicol?” she asked her children, calling home one night during another long shift scrubbing floors. “Is he studying?”

have returned to the classroom, 100 million children in Latin America are still in full or partial distance learning — or, as in Maicol’s case, some distant approximation of it.

The consequences are alarming, officials and education experts say: With economies in the region pummeled by the pandemic and connections to the classroom so badly frayed, children in primary and secondary school are dropping out in large numbers, sometimes to work wherever they can.

1.8 million children and young people abandoned their educations this school year because of the pandemic or economic hardship, according to the national statistics agency.

Ecuador lost an estimated 90,000 primary and secondary school students. Peru says it lost 170,000. And officials worry that the real losses are far higher because countless children, like Maicol, are technically still enrolled but struggling to hang on. More than five million children in Brazil have had no access to education during the pandemic, a level not seen in more than 20 years, Unicef says.

Increased access to education was one of the great accomplishments of the last half century in Latin America, with enrollment soaring for girls, poor students and members of ethnic and racial minorities, lifting many toward the middle class. Now, an onslaught of dropouts threatens to peel back years of hard-won progress, sharpening inequality and possibly shaping the region for decades to come.

some of the world’s worst outbreaks, yet several South American nations are now experiencing their highest daily death tolls of the crisis, even after more than a year of relentless loss. For some governments, there is little end in sight.

But unless lockdowns end and students get back into the classroom soon, “many children may never return,” the World Bank warns. And “those who do go back to school will have lost months or even years of education.” Some analysts fear the region could be facing a generation of lost children, not unlike places that suffer years of war.

Even before the pandemic, graduating from high school in Ms. Vásquez’s neighborhood was no small feat.

She and her children live at the end of a dirt road, just beyond Bogotá, Colombia’s sprawling, mountain-flanked capital, a deeply unequal city in one of the most unequal regions in the world. Violence and crime are as common here as the ice cream cart that circles the block each afternoon. For some children, the pandemic has been yet another trauma in a seemingly endless succession.

Many parents in the neighborhood make their living as recyclers, traversing the city with wooden wheelbarrows hitched to their backs. And many of their children don’t have computers, internet or family members who can help with class work. Often there is one cellphone for the family, leaving students scrambling for any connection to school.

Ms. Vásquez dropped out at 14 to help raise her siblings, and it has been her greatest regret. The motel she cleans is far from home, sometimes forcing her to leave her children for more than a day — 24 hours for her shift, with at least four hours of commuting. Even so, she rarely makes the country’s monthly minimum wage.

She had hoped her children — Ximena, 8, Emanuel, 12, Maicol, 13, and Karen, 15 — whom she calls “the motor of my life,” would leave the neighborhood, if only they could get through this never-ending pandemic with their schooling intact.

“I’ve always said that we have been dealt a difficult hand,” but “they have a lot of desire to learn,” she said.

Before the virus arrived, her children attended public schools nearby, wearing the colorful uniforms typical for Colombian pupils. Karen wanted to be a doctor. Maicol, a performer. Emanuel, a police officer. Ximena was still deciding.

By late May, the two boys were still officially enrolled in school, but barely keeping up, trying to fill out the work sheets their teachers sent via WhatsApp each week. They have no computer, and it costs Ms. Vásquez 15 cents a page to print the assignments, some of which are dozens of pages long. Sometimes, she has the money. Sometimes not.

Both girls had dropped out altogether. Ximena lost her spot at school just before the pandemic last year because she had missed classes, a not-so uncommon occurrence in Colombia’s overburdened schools. Then, with administrators working from home, Ms. Vásquez said she couldn’t figure out how to get her daughter back in.

Karen said she had lost contact with her instructors when the country went into lockdown in March 2020. Now, she wanted to return, but her family had accidentally broken a tablet lent to her by the school. She was terrified that if she tried to re-enroll, she would be hit with a fine her mother had no money to pay.

The family was already reeling because Ms. Vásquez’s hours at the motel had been cut during the crisis. Now they were four months behind on rent.

Ms. Vásquez was particularly worried about Maicol, who struggled to make sense of work sheets about periodic tables and literary devices, each day more frustrating than the last.

Lately, when he wasn’t recycling, he’d go looking for scrap metal to sell. To him, the nights out with his uncle were a welcome reprieve, like a pirate’s adventure: meeting new people, searching for treasure — toys, shoes, food, money.

But Ms. Vásquez, who had forbidden these jaunts, grew incensed when she heard he was working. The more time Maicol spent with the recycling cart, she feared, the smaller his world would become.

She respected the people who gathered trash for a living. She’d done it when she was pregnant with Emanuel. But she didn’t want Maicol to be satisfied with that life. During her shifts at the motel, cleaning bathrooms, she imagined her children in the future, sitting behind computers, running businesses.

“‘Look,’ people would say, ‘those are Gloria’s kids,’” she said. “They don’t have to bear the same destiny as their mother.”

Over the last year, school began in earnest only after she came home from work. One afternoon, she pulled out a study guide from Emanuel’s teacher, and began dictating a spelling and grammar exercise.

“Once upon a time,” she read.

“Once upon a time,” wrote Emanuel, 12.

“There was a white and gray duck —”

“Gray?” he asked.

When it came to Maicol’s more advanced lessons, Ms. Vásquez was often lost herself. She didn’t know how to use email, much less calculate the area of a square or teach her son about planetary rotations.

“I try to help them with what I understand,” she said. “It’s not enough.”

Lately, she’d become consumed by the question of how her children would catch up when — or if? — they ever returned to class.

The full educational toll of the pandemic will not be known until governments bring children back to school, experts warn. Ms. Di Gropello, of the World Bank, said she feared that many more children, especially poorer ones without computers or internet connections, would abandon their educations once they realize how far behind they’ve fallen.

By mid-June, Colombia’s education ministry announced that all schools would return to in-person courses after a July vacation. Though the country is enduring a record number of daily deaths from the virus, officials have determined that the cost of staying closed is too great.

But as school principals scramble to prepare for the return, some wonder how many students and teachers will show up. At Carlos Albán Holguín, one of the schools in Ms. Vásquez’s neighborhood, the principal said some instructors were so afraid of infection that they had refused to come to the school to pick up the completed assignments their pupils had dropped off.

One recent morning, Karen woke before dawn, as she often does, to help her mother get ready for her shift at the motel. Since leaving school last year, Karen had increasingly taken on the role of parent, cooking and cleaning for the family, and trying to protect her siblings while their mother was at work.

At one point, the responsibility got to be so much that Karen ran away. Her flight lasted just a few hours, until Ms. Vásquez found her.

“I told my mother that she had to support me more,” Karen said. “That she couldn’t leave me alone, that I was an adolescent and I needed her help.”

In their shared bedroom, while Ms. Vásquez applied makeup, Karen packed her mother’s blue backpack, slipping in pink Crocs, a fanny pack, headphones and a change of clothes.

Ms. Vásquez had gone out to march one day, too, blowing a plastic horn in the crowd and calling on the authorities to guarantee what she called a “dignified education.”

But she hadn’t returned to the streets. If something happened to her at the marches, who would support her children?

“Do you want me to braid your hair?” Karen asked her mother.

At the door, she kissed Ms. Vásquez goodbye.

Then, after months of hardship, came a victory.

Ms. Vásquez received messages from Maicol’s and Emanuel’s teachers: Both schools would bring students back, in person, in just a few weeks. And she finally found a spot for Ximena, who had been out of school entirely for more than a year.

“A new start,” Ms. Vásquez said, giddy with excitement.

Karen’s future was less certain. She had worked up the courage to return the broken tablet. Administrators did not fine her — and she applied to a new school.

Now, she was waiting to hear if there was space for her, trying to push away the worry that her education was over.

“I’ve been told that education is everything, and without education there is nothing,” she said. “And, well, it’s true — I’ve seen it with my own eyes.”

Reporting was contributed by Sofía Villamil in Bogotá and Soacha, Colombia; José María León Cabrera in Quito, Ecuador; Miriam Castillo in Mexico City; Mitra Taj in Lima, Peru; and Ana Ionova in Rio de Janeiro.

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What It’s Like to Be in India’s Covid-19 Crisis

Infections are soaring. So are deaths. Whole cities are under lockdown. And the government seems powerless to help.

India is in the grip of a coronavirus crisis. Experts agree that the spread is probably even worse than the official statistics suggest. In many parts of the country, hospital beds, supplemental oxygen and other vital supplies are running short.

As Western countries roll out mass vaccination campaigns, only about 3 percent of India’s population is fully inoculated. Though conditions are slowly improving in New Delhi and Mumbai, the virus appears to be spreading largely unchecked through the rest of the country.

The New York Times asked readers in India to describe their lives in the midst of the pandemic with words and photos. They wrote about fear and loss, anxiety and boredom. Some wrote about their anger at the stumbling response by India’s government under Prime Minister Narendra Modi. But they also wrote about family and friends who have helped them cope, and efforts they have made to help neighbors and strangers alike.

“A lot of people my age have been helping people find resources like hospital beds, oxygen cylinders, medication, etc., through social media by verifying whatever leads are floating around on the internet and sending them to whoever needs them. I’ve been working with one such group. I realize that it is a necessary job in these times, but it’s also incredibly draining. It is the sign of a completely broken system that teenagers have to band together and work themselves to exhaustion trying to answer all these desperate pleas all over Twitter. And it’s getting harder to do by the day as things worsen because resources get exhausted very quickly. Most of the time we just end up calling a lot of numbers and get no response, and when we do it’s usually people saying there’s nothing they can do for us. It’s heartbreaking when people around are just suffering and dying and there’s so little you can do to help. We’re all terrified and burnt out and this is a very unsustainable system of getting people access to health care. You can’t leave it to the citizens to bear the brunt of a health care system that’s crumbling.” — Arunima Tiwari, New Delhi

“I miss spontaneity. I hate that I now have to plan everything out and even when I do, the plans feel like they can just disappear. I’m trying not to focus on what could have been. Instead, I’m determined to stay focused on what I can do. I have reactivated my long-dormant social media accounts to amplify what I can, and I now volunteer at a response center that offers assistance to Covid-positive patients. I don’t have a choice but to help because elected authorities have made it loud and clear that they aren’t going to.” — Anindita Nayak, Bangalore

“Life in Delhi at the moment feels like you’re having an out-of-body experience. It’s hard to imagine this is actually real and happening. Every social media feed, every WhatsApp group is full of requests from people looking for oxygen, hospital beds, critical lifesaving medicines. The worst part: There’s almost nothing you can do to help anyone immediately. It takes hours of verifying, calling, begging for help to actually find some solutions, if that even happens. By that time, you feel almost too scared to call back and find out if help is still needed for fear of hearing the inevitable — that the person has died without getting adequate care. Indians are dying not because of Covid but because they’re not receiving treatment and care.” — Shweta Bahri, Delhi

“Both my parents got Covid. I lost my mother yesterday. Father is on ventilator support. The reason I lost my mother is because she didn’t get treatment. I live in Bangalore, and there is no way you can get a bed in any hospital. The help line numbers never work. If they do, then they just take details or transfer your call with no help. Being completely helpless, I took my mother to a hospital that I’m not sure is even legitimate. They just wanted money from me. They did not have trained staff. Oxygen was always in short supply. I felt helpless that I could not take her anywhere. I knew that if I kept her there she would not survive. I had to bring my father there, and his condition deteriorated due to lack of oxygen. I managed to take him to a different hospital, but it was too late. Now he is on a ventilator.” — Paresh Patil, Bangalore

Rahul Patil died on May 17, Paresh Patil said, after this submission was received.

“It has been challenging, but I maintain a mood log throughout the day and encourage my family to do the same. I also post a mood meter on social media so people can reply with how they are feeling using an emoji and we can talk about it. I also help my parents with their medicines, food, oximeter and temperature readings. Since both have different sets of medications, it’s really important we keep a record of the medicines along with a chart of the vitals. My extended family has been very helpful during this time. They remain connected through calls and texts and remind us not to lose faith.” — Rachita Ramya, Delhi

“Since I have been going to work every day, I have not really experienced the lockdown in terms of staying inside. But it has been a very stressful year when it comes to working. When the lockdown lifted last year, people immediately rushed into the bank where I work. It has been very difficult and almost impossible here, in a rural part of India, to make people understand the importance of masks and social distancing.”

“The government has done little to make people aware of the situation. Also, the lockdowns initially were more of a television ratings stunt rather than a precautionary measure. A lot of workers in banks have died on duty, and some have been denied leave even when they were sick. The precautionary measures on paper are nowhere close to reality. In the past few months, we played dumb to something which we clearly saw coming.” — Shweta Beniwal, Kolar

“As I type this out, four doors lay ajar or wide open in my home. Three of us have now developed Covid symptoms. My old dad has been taking care of cooking, cleaning, medicating and sanitizing all day. My dad sleeps in fits through the day and night, interrupted by calls for food, tea, hoarse coughing, and groans of pain and frustration. How do I cope? Each night, as a 21-year-old, lying wide-awake — the weather is unbearably hot, and my fever rarely subsides — I make up positive scenarios in my mind. Getting a job and earning enough to secure my family’s well-being in this cruel dog-eat-dog world. Being more bold, less hesitant, in fighting people who didn’t see the warning signs of a corrupt, inept distribution of resources. Slapping each of those complacent idiots who voted into power a ruthless demagogue who wins elections by stoking fear and resentment but is a dud when it comes to long-term policymaking, tough decision-making and leadership.” — Harmandeep Khera, Chandigarh

Since sending his submission, Mr. Khera said, he and his family have recovered.

“Many friends have been infected, and we call each other every day to share a joke and to stay positive and make plans to meet in the future. Still frightening, but we are coping. I also try to help people overcome disinformation and keep telling people that most of us who are infected will recover. I ask people to avoid panic buying and seeking unvalidated cures. Since last year I have exercised regularly and continue to do so even while infected and isolated. I am also a pistol shooter for my state of Maharashtra, so mental conditioning has been an important part of my training. I meditate for 10 minutes each day to stay positive.” — Raj Khalid, Mumbai

“It is very frightening. Half of the people I know have been tested positive or have been previously infected. We haven’t stepped out of the house for the past two weeks, and it has taken a greater toll on our physical and mental health. The only rule is to avoid contact. If you want to keep your close ones safe, then you need to keep them away for a while. My mother is an essential worker, and I have seen her doing grocery shopping for many needy people who are quarantined. It’s something I’m proud of. In times like these, we need to hold on to humanity and have faith in whatever you believe in. Being an atheist, I have faith in science and myself.” — Akash Helia, Mumbai

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New Zealanders Are Flooding Home. Will the Old Problems Push Them Back Out?

WELLINGTON, New Zealand — Like many New Zealanders before her, Cat Moody chased the broader horizons of life abroad, unsure if she would ever return to a homeland she saw as remote and limiting.

But when the pandemic arrived, it “changed the calculus” of what she valued, she said. Suddenly, fresh air, natural splendor and a sparse population sounded more appealing, as did the sense of security in a country whose strict measures have all but vanquished Covid-19.

In February, Ms. Moody, 42, left her house and the life she had built in Princeton, N.J., and moved back to New Zealand with her husband, a U.S. citizen. She is among more than 50,000 New Zealanders who have flocked home during the pandemic, offering the country a rare opportunity to win back some of its best and brightest.

The unexpected influx of international experience and connections has led to local news reports heralding a societal and industrial renaissance. Policymakers are exhorting businesses to capitalize on the “fundamental competitive advantage” offered by the country’s success against the coronavirus.

have received both doses of a Covid-19 vaccine, and Australians and residents of the Cook Islands are the only non-New Zealanders who can visit.

“Shifting into how we take advantage of the way things have changed, I think having a government that is risk-averse is actually going to be damaging to New Zealand,” Ms. Moody said.

Ms. Imam, who worked in communications for the computer company Dell in the United States, said that New Zealand’s reputation abroad was better than it deserved.

Still, she said that new government policies, such as paid leave for women who have miscarriages, had convinced her that the “project that is New Zealand” was worth returning for.

“At least we’re doing something right,” she said. “I want to be part of that.”

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Germany to Ban Most Travel from U.K. Over Covid Variant Concerns

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Germany is banning most travel from Britain starting on Sunday amid concerns about the spread of a coronavirus variant first discovered in India, the German authorities said on Friday.

German citizens and residents of Germany will still be allowed to enter the country from Britain but will be required to self-isolate for two weeks upon arrival, Germany’s public health institution said as it classified Britain as an area of concern because of the variant.

The move came just days after Britain reopened its museums and cinemas and resumed allowing indoor service in pubs and restaurants. Many people in Britain have been looking forward to traveling abroad in the coming months, and Spain is set to welcome visitors arriving from Britain without a coronavirus test starting on Monday.

serve as an early warning for other European countries that have relaxed restrictions. This month, the World Health Organization declared the mutation a “variant of concern,” and although scientists’ knowledge about it remains limited, it is believed to be more transmissible than the virus’s initial form.

dozen or so other countries that Germany considers areas of concern because of variants. As of Thursday, Britain had 3,424 cases of the variant first discovered in India, according to government data, up from 1,313 cases the previous week.

Dozens of nations, including European countries and the United States, suspended travel from Britain or imposed strict restrictions earlier in the pandemic amid concerns about the spread of a variant first detected in England.

Britain’s Office for National Statistics said on Friday that the percentage of people testing positive for the coronavirus in England had showed “early signs of a potential increase” in the week ending May 15, although it said rates remained low compared with earlier this year. At its peak in late December, Britain recorded more than active 81,000 cases, compared with about 2,000 this month.

The country’s inoculation campaign is continuing apace, with an increased focus on second doses in an effort to thwart the sort of spikes that led to restrictions imposed earlier this year.

said on Saturday that people over 32 could now book an appointment.

Prime Minister Boris Johnson has vowed to proceed with a plan to lift all restrictions by June 21, although scientists have warned that the spread of the B.1.617 variant could delay such plans. Most cases of the variant have been found in northwestern England, with some in London.

In Germany, the restrictions on travel from Britain come as outdoor service resumed on Friday in cafes, restaurants and beer gardens after months of closure. Chancellor Angela Merkel urged people to “treat these opportunities very responsibly.”

“The virus,” she said, “has not disappeared.”

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Virus Deaths Likely Higher Than Official Toll, W.H.O. Says

GENEVA — Deaths from Covid-19 and Covid-related causes are likely to be two to three times the number that countries have recorded in their official data, the World Health Organization said on Friday.

Some six to eight million people may have now died from Covid-19 or its effects since the start of the pandemic, compared with 3.4 million deaths recorded in countries’ official reporting, Dr. Samira Asma, assistant director of the W.H.O.’s data division, told reporters.

The W.H.O. also estimates that at least three million people may have died from Covid-19 in 2020, compared with 1.8 million recorded in official data, the W.H.O. reported in annual statistics released on Friday.

The W.H.O. based its assessment on a statistical model that estimates the excess deaths attributable to Covid-19. The technique involves taking the total number of officially recorded deaths and then subtracting the number of deaths that would have been expected on the basis of previous mortality trends if the pandemic had not occurred.

On that basis, the W.H.O. said it estimated that 1.1 million to 1.3 million people in 53 European countries died from Covid-19 in 2020, roughly double the number recorded in official data. The organization also calculates that, over the same period, 1.3 million to 1.5 million people died in 35 countries in the Americas, compared with the 900,000 deaths officially recorded.

The huge discrepancy between the W.H.O.’s estimates and official data underscores the limited capacity of many countries to test their populations for the coronavirus and other weaknesses in official health data. For example, some Covid victims had died before being tested and their deaths did not appear in official reporting, William Msemburi, a W.H.O. data analyst said.

The W.H.O. will present its statistics to the annual meeting of its policymaking assembly in Geneva next week. The numbers will help make the case for countries to invest urgently in bolstering data systems and their capacity to monitor and report health developments.

“We can only be better prepared with better data,” Dr. Asma said.

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Stocks Rebound as Wall Street Shakes Off Inflation Worries: Live Updates

manufacturing activity in the United States and Europe showed a rapid pickup, as did retail sales data from Britain.

The Stoxx Europe 600 rose 0.6 percent led by gains in consumer companies. One of the biggest gainers was Richemont, the Swiss luxury goods company that owns brands including Cartier and Montblanc. Richemont shares rose after the company reported its full-year results with strong growth in sales in Asia especially for its jewelry and watch brands.

Oil prices rose. Futures of West Texas Intermediate, the U.S. crude benchmark, rose 1.4 percent to $63.48 a barrel.

There are many ways to measure how much the economy has reopened after pandemic lockdowns. One offbeat way is to compare the share prices of Clorox to Dave & Buster’s.

Nick Mazing, the director of research at the data provider Sentieo, came up with this metric to gauge shifts in postpandemic activity. The higher Clorox’s share price rises relative to Dave & Buster’s, the more people appear to be staying home and disinfecting everything than going out to crowded bars.

By this measure, the DealBook newsletter reports, conditions have nearly returned to prepandemic levels — indeed, Dave & Buster’s recently lifted its sales forecast, as nearly all of its beer-and-arcade bars have reopened.

Two more ratios that Mr. Mazing suggest comparing are Netflix versus Live Nation and Peloton versus Planet Fitness.

The first is also nearly back to where it was before the pandemic: Live Nation is preparing for a packed concert schedule, selling tickets to people who may have already binge-watched all of “Below Deck.”

The second, however, suggests that people aren’t as eager to get back to huffing and puffing at the gym as they are content to exercise at home. As restrictions lift and people feel safer in crowds, drinking and dancing appear to be higher priorities.

George Greenfield, the founder of CreativeWell, a literary agency in Montclair, N.J., applied for a loan in March with Biz2Credit. The initial amount he was offered was less than a quarter of what he was eligible for.
Credit…Ed Kashi for The New York Times

The government’s $788 billion relief effort for small businesses ravaged by the coronavirus pandemic, the Paycheck Protection Program, is ending as it began, with the initiative’s final days mired in chaos and confusion.

Millions of applicants are seeking money from the scant handful of lenders still making the government-backed loans. Hundreds of thousands of people are stuck in limbo, waiting to find out if they will receive their approved loans — some of which have been stalled for months because of errors or glitches. Lenders are overwhelmed, and borrowers are panicking, The New York Times’s Stacy Cowley reports.

The relief program had been scheduled to keep taking applications until May 31. But two weeks ago, its manager, the Small Business Administration, announced that the program’s $292 billion in financing for forgivable loans this year had nearly run out and that it would immediately stop processing most new applications.

Then the government threw another curveball: The Small Business Administration decided that the remaining money, around $9 billion, would be available only through community financial institutions, a small group of specially designated institutions that focus on underserved communities.

A roll of steel is packaged and labeled.
Credit…Taylor Glascock for The New York Times

The American steel industry is experiencing a comeback that few would have predicted even months ago.

Steel prices are at record highs and demand is surging as businesses step up production amid an easing of pandemic restrictions. Steel makers have consolidated in the past year, allowing them to exert more control over supply. Tariffs on foreign steel imposed by the Trump administration have kept cheaper imports out. And steel companies are hiring again, The New York Times’s Matt Phillips reports.

It’s not clear how long the boom will last. This week, the Biden administration began discussions with European Union trade officials about global steel markets. Some steel workers and executives believe that could lead to an eventual pullback of the Trump-era tariffs, which are widely credited for spurring the turnaround in the steel industry.

Record prices for steel are not going to reverse decades of job losses. Since the early 1960s, employment in the steel industry has fallen more than 75 percent. More than 400,000 jobs disappeared as foreign competition grew and as the industry shifted toward production processes that required fewer workers. But the price surge is delivering some optimism to steel towns across the country, especially after job losses during the pandemic pushed American steel employment to the lowest level on record.

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