saturday, april 4 , 2020. the washington post ez re A
the coronavirus pandemic
BY BEN GUARINO
AND TIM CRAIGNEW YORK — As the novel
coronavirus crisis deepens on
Long Island, even the paramed-
ics are starting to wonder if they
can handle the next shift.
for much o f the past month, as
calls for “shortness of breath” or
“trouble breathing” s tarted spik-
ing in Nassau County, medics
and technicians had been step-
ping up to fill overtime requests.
Kris Kalender, who heads the
union representing about 150
county paramedics, said his
members saw the extra work as a
gesture of community pride and
a chance for some extra money
amid the spate of gloomy news.
But as march dragged on, the
call volume kept growing. The
patients also got sicker and sick-
er. Nassau paramedics now re-
spond to about 450 emergency
calls each day — nearly double
their usual volume — and more
than 60 percent of them are
related to the coronavirus pan-
demic, he said.
Then Kalender saw something
he doesn’t recall ever seeing
before: on Sunday, no one re-
sponded to a request for extra
manpower. It’s “mental stress,”
he said, adding, “They just n eed a
day off, and time to recuperate to
regain their composure, and just
one day where they are not
responding to such sick people.”
The strain on Nassau County’s
police medic force — its main
ambulance service — reflects the
next phase in New York’s strug-
gle against the virus. The num-
ber of cases on Long Island has
begun to surge, testing the
health-care and emergency-re-
sponse systems even in some of
the state’s wealthiest communi-
ties.
In recent days, as New York
City has remained the center of
attention amid a national re-
sponse to the pandemic, state
and local officials have been
shocked at h ow quickly t he c asel-
oad is also rising Nassau and
Suffolk counties, the two coun-
ties that make up suburban Long
Island — with a combined esti-
mated population of almost 3
million.
for the second consecutive
day, New York Gov. Andrew m.
Cuomo (D) announced friday
that both N assau and Suffolk had
confirmed 1,000 additional coro-
navirus cases. Combined, they
now have more than 22,000,
meaning about one of out every
12 coronavirus case in the United
States is located there.
“Long Island does not have as
an elaborate of health-care sys-
tem as New York City,” Cuomo
said. “... And that has us veryconcerned.”
The spike comes after New
York’s worst infection rates had
initially been confined to
Westchester County, a northern
suburb of New York City. But
after the virus quickly spread
throughout the metropolitan
area, Long Island officials said
they had been bracing for their
caseload to also surge.
Nassau County Executive Lau-
ra Curran (D) characterized it
like this: “It’s as if you are on a
roller coaster that is going up a
hill, and it’s just slowly getting
higher and higher.”
With the disaster’s full impact
expected to hit in the coming
days, she and other leaders
across Long Island are r ushing t o
try to shore up their strained
emergency-response and health-
care system. Curran is request-
ing that the federal Emergency
management Agency quickly de-
ploy a disaster-assistance tent
city, a nd s he wants fEmA t o send
25 out-of-state ambulances to
buttress the county force.
As of friday afternoon, Curran
said there were about 1,620 pa-
tients hospitalized in her county,
an increase of about 200 over the
day before. About 325 were on
ventilators, a device that helps
critically ill patients breathe.
Curran has requested an addi-
tional 100 ventilators, but so far
only five had arrived.
In neighboring Suffolk Coun-
ty, County Executive Steve Bel-
lone (D) said 1,300 patients werehospitalized as of friday after-
noon, an increase of 244 in 24
hours. T here were only 648 unoc-
cupied hospital beds in the coun-
ty, including just 43 in intensive
care units, Bellone said.
“This is where the battle is
happening, and this is where we
need supplies,” Bellone said at a
news conference.
To help address the needs on
Long Island, Cuomo took the
extraordinary step friday of
signing an executive order that
allows the state to seize ventila-
tors from public and private
hospitals in Upstate New York
that so far have fewer coronavi-
rus patients. Cuomo dispatched
the National Guard to retrieve
them.
At Northwell Health, which
operates 11 hospitals on Long
Island, 70 percent of coronavirus
tests administered on patients
now come back positive, said
Te rry Lynam, a spokesman.
Northwell’s hospitals have
reached such capacity that pa-
tients are being placed in audito-
riums, conference r ooms, lobbies
and tents, he said.
“Every hospital in the ‘hot
zone’ i s feeling the p ressure,” s aid
Joseph Greco, operations chief
for NYU Winthrop Hospital in
Nassau County, which set up a
triage tent in its parking lot and
an intensive c are unit in a former
conference room.
Kalender said EmS units in
Nassau are also overwhelmed.
About 100 of Nassau County’s4,000-member police force have
been diagnosed with the corona-
virus, and another 172 are quar-
antined due to possible expo-
sure.
matthew Chase, executive di-
rector of the National Associa-
tion of Counties, said the strains
on resources now facing Nassau
and Suffolk counties offer a pre-
view of the challenges counties
across the nation face.
Nationwide, county govern-
ments operate over 1,900 public
health departments, nearly 1 ,
hospitals, over 80 0 long-term
care facilities and 3,000 police
and sheriffs’ departments, Chase
said.
“They are absolutely stressed
to the max,” Chase said. “We get
pleas every day from our state
association in New York calling
out t o peers across the c ountry t o
send ventilators and personal
protective equipment.”
Before the pandemic, Nassau
County medics were doing intu-
bations — opening an airway to
help a patient breathe — about
once every two days, Kalender
said.
County medics now perform
the procedure up to five times a
day, he added.
“Some of them are so very sick,
to the point where you can just
look at them and you can imme-
diately know what’s coming for
them,” Kalender said. “other pa-
tients, they look like they’re okay
— they are talking perfectly fine
— but then you measure theiroxygen saturation... and it’s
like, ‘oh, you are going to be
going down soon, too.’ ”
So far, the coronavirus has
lead to the deaths of 138 people
in Nassau County and another 9 6
in Suffolk County. As the death
toll mounts, Kalender said the
number of county medics need-
ing grief counseling and other
mental health services will fur-
ther hamper staffing plans.
“There is going to be a lot of
PTSD,” said Kalender, referring
to post-traumatic s tress disorder.
“We’re only three weeks into this,
and I anticipate things are going
to get a lot worse and I don’t
really see the county having a
backup plan.”
Curran, the Nassau County
executive, concedes that emer-
gency medical resources are r eal-
ly stretched, with “so many am-
bulances now on the street.”
While s he waits to see i f fEmA
will respond to her request for
more ambulances, Curran noted
some villages and towns in Nas-
sau County maintain their own
volunteer ambulance services.
Some volunteers, Curran said,
are keeping vigil at the firehouse
because they know it won’t be
long before they are needed to
respond to a call.
“We need you,” Curran said of
the volunteers. “We need you
now more than ever.”
[email protected]
[email protected]Craig reported from Washington.Crisis expands on Long Island, straining emergency-response systems
With 22,000 people sick,
about 1 out of 12 cases in
the U.S. are located theretions in addition to mexican na-
tionals, CBP officials say. T he four
countries account for more than
85 percent of unlawful border-
crossers into the United States.
U.S. and mexican border au-
thorities also have limited the
traffic at the international bridg-
es to essential travelers and com-
merce. Humanitarian groups
have been urging migrants to
leave border camps and relocate
to areas with better sanitary and
health conditions.
mexican nationals and those
expelled from the United States in
recent days have been quickly
loaded onto buses and taken to
other mexican states, advocates
and attorneys say. It is unclear
whether the people were encour-
aged or forced to board the buses,
but Sister Norma Pimentel of
Catholic Charities said it is part of
a broader campaign by mexican
immigration officials to clear the
border.
“There is an interest from the
mexican government to encour-
age people to leave and tell them
it’s best they go,” Pimentel said.
migrants said they are worried
about the coronavirus outbreak
but do not feel like they have
many options. They do not want
to leave the border area and miss
appointments once U.S. immigra-
tion courts resume operations —
whenever that happens. They
said they fear mexican authori-
ties will coerce primarily Central
American migrants to board bus-
es without knowing where they
are headed.
In Ciudad Juárez, migrants en-
rolled in the migrant Protection
Protocols program — known as
“remain in mexico” — are con-
tinuing to arrive at U.S. ports of
entry in the wee hours of the
morning, unaware that their
hearing dates have been resched-
uled because court has been sus-
pended.
rivas, of El Paso’s L as Americas
Immigrant Advocacy Center, said
migrants are risking exposure
waiting on bridges, where social
distancing is impossible. Asylum
seekers cannot be assured of a
new hearing without walking to
the bridge because authorities
have not collected addresses or
created a system to serve legal
documents or notices to migrants
waiting in mexico, she said.
“That’s absurd,” rivas said.
“They’re given a piece of paper
and told to go away.”
Everyone — sick children, asy-
lum seekers with disabilities, and
migrants in protected groups
who are entitled to relief — is
being rejected at ports of entry
after the federal government ef-
fectively shut down the border to
immigrants, rivas said.
J uárez’s shelters are at high
risk for spreading the coronavi-
rus, she said, and attorneys are
having to navigate life-or-death
decisions with their clients.
“We are going in blindfolded as
we try to advocate because Border
Patrol is unclear about their crite-
ria,” rivas said.
[email protected]
[email protected]Miroff reported from Washington.less than 1 percent of the number
in the United States, but testing
there is not widely available.
many countries have seen major
spikes in coronavirus cases just
weeks after discovering their first
few, as has happened in the Unit-
ed States.
“Every week, our border agents
encounter thousands of un-
screened, unvetted and unau-
thorized entries from dozens of
countries. And we’ve had this
problem for decades,” Trump
said. “In normal times, these mas-
sive flows place a vast burden on
our health-care system, but dur-
ing a global pandemic, they
threaten to create a perfect storm
that would spread the infection to
our border agents, migrants and
to the public at large. Left un-
checked, this would cripple our
immigration system, overwhelm
our health-care system, and se-
verely damage our national secu-
rity.”
Despite the recent drop in
crossings, CBP officials and bor-
der agents say they fear a rush on
the border if mexican hospitals
are overwhelmed, especially in
the large border cities such as
Ciudad Juárez and Tijuana.encouraged to leave
U.S. and mexican authorities
say they are cooperating closely to
secure the border. In an extraor-
dinary step, mexico is accepting
the return of adults and families
from Guatemala, Honduras and
El Salvador who are “expelled.”
The mexican government said
it will accept those returns on a
case-by-case basis, but in prac-
tice, it is t aking back virtually
everyone from those three na-facility, according to the new
rules, dubbed “operation Capio.”
Selee said the administration
might be slow to lift the emergen-
cy measures even after the pan-
demic subsides. Governments
around the world that have strug-
gled with a surge of asylum claims
could use the pandemic as a “back
door” to toughen immigration
laws and implement other re-
strictions, he said, “because it’s
harder to question a health ratio-
nale.”
When he announced the new
restrictions last month, Trump
cited the threat of “mass global
migration that would badly de-
plete the health-care resources
needed for our people.” mexico
has confirmed fewer than 1,
positive cases of the virus so far,formation would be used to by-
pass the nation’s immigration en-
forcement efforts.
“If specific circumstances
guaranteeing exemptions from
Title 42 expulsion were to be
made public, they would be ex-
ploited by human smugglers,”
said matthew Dyman, a CBP
spokesman.
According to an internal memo
obtained by ProPublica, migrants
would be ineligible for the expul-
sion orders if they “make an affir-
mative, spontaneous and reason-
ably believable claim they fear
being tortured in the country they
are sent back to.”
In t hose instances, agents must
seek the approval of their supervi-
sors before taking an asylum
seeker back to a Border PatrolUnder normal circumstances,
underage migrants who arrive
without a parent receive protec-
tion under U.S. anti-trafficking
laws; they are typically routed to
Department of Health and Hu-
man Services shelters until they
can be safely placed with family
members or guardians. Under
Trump’s emergency orders, mi-
nors are being swiftly removed
from the country, some of them
flown back to Central America.
Those who arrive with a grand-
parent or adult sibling are deport-
ed as part of a family group,
despite the U.S. government’s in-
sisting for years on a strict defini-
tion of family that is limited to
biological parents and their mi-
nor children.
on Thursday, C BP did not refer
any children to shelters overseen
by HHS’s office of refugee reset-
tlement, the first time in recent
memory that has occurred, ac-
cording to the orr.
Asylum seekers — those who
say they are fleeing persecution in
other countries — would normal-
ly get to make their case in court.
Some of them would be allowed to
stay in the United States, some
would wait in mexico, and some
would be sent to other countries
to claim asylum there. It was this
category of migrants that drove a
historic surge at the border last
year, and there is now an even
greater likelihood that these mi-
grants will be deported back to
the countries they are fleeing, or
turned away w ithout due process.
Asked to clarify the circum-
stances under which the emer-
gency health orders — known as
Title 42 — are applied, CBP de-
clined to respond, saying the in-the pandemic, Trump has repeat-
edly brought up his border wall
project, unprompted, and has
touted construction progress,
overstating the number of miles
crews have completed as he says
he is fulfilling his 2016 campaign
promise.
Trump has for years assailed
U.S. immigration laws as too le-
nient, and the global pandemic
has allowed the president to drop
many of the policies and legal
protections he calls the “worst
immigration laws ever.” In their
place, he has created a pilot test
for the impact of the more draco-
nian measures he has long advo-
cated.
The most immediate impacts
are that migrants who illegally
cross the U.S. border are no lon-
ger taken to border stations
where they would have the
chance to file a claim for humani-
tarian protection and access to
U.S. immigration courts, and
some unaccompanied minors
who typically would receive pro-
tection and shelter also are being
turned away.
“We are appalled at the way
things are being handled,” said
Linda rivas, director of the Las
Americas Immigrant Advocacy
Center in El Paso.
Some migrant advocates say
they worry Trump will be slow to
lift the emergency measures once
the coronavirus outbreak is no
longer a crisis.
“The border has always been a
symbol in his larger worldview
about dangers coming from the
outside,” said Andrew Selee, di-
rector of the migration Policy
Institute in Washington. “The
coronavirus may go away, but
there’s a chance you could see
these measures stay in place long
after epidemic begins to recede.”
Illegal crossings plunge
In the past 10 days, illegal
crossings along the mexico bor-
der have plunged nearly 40 per-
cent, returning to the lowest lev-
els of Trump’s presidency, accord-
ing to preliminary tallies by
s enior Customs and Border Pro-
tection officials, who spoke on the
condition of anonymity because
they were not authorized to dis-
cuss the trends publicly.
Citing the emergency declara-
tion from the Centers for Disease
Control and Prevention, Home-
land Security officials have by-
passed court-ordered due process
protections for minors, asylum
seekers and others as they return
border-crossers to mexico as
quickly as possible. The migrants
taken into custody now are tallied
as “encounters” rather than “ap-
prehensions,” and they are “ex-
pelled” from the country rather
than formally deported.
CBP officials say their march-
ing orders are to turn migrants
around as fast as possible to mini-
mize the risk of exposure to the
virus. After running quick back-
ground checks on criminal re-
cords, agents gather the migrants’
biometric info at open-air field
stations before loading them into
vans and taking them to mexico.
border from A
Blaming virus, Trump suspends some migrant protections
Photos by Jose luis Gonzalez/reuters
A volunteer disinfects the Paso del Norte border bridge, which connects Ciudad Juárez, Mexico, to el Paso.The U.S. flag flies over the Cordova Americas border bridge, where
new travel restrictions have decreased the flow of people.