As Death Toll Nears 100,000, Some in White House Question the Math – The New York Times

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ImageDr. Deborah Birx, the White House coronavirus response coordinator, briefed reporters on Friday.
Credit…Anna Moneymaker/The New York Times

As the United States continues its advance toward 100,000 coronavirus deaths, a grim milestone the country is expected to reach in the coming days, President Trump and members of his administration have begun questioning the official coronavirus death toll, suggesting the numbers are inflated.

Last Friday, Mr. Trump told reporters that he accepted the current death toll, but that the figures could be “lower than” the official count, which now totals more than 95,000.

Most statisticians and public health experts say he is wrong; the death toll is probably far higher than what is publicly known. People are dying at their houses and nursing homes without ever being tested, they say, and deaths early this year were likely misidentified as influenza or described only as pneumonia.

Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, has said publicly that the American health care system incorporates a generous definition of a death caused by Covid-19.

“There are other countries that if you had a pre-existing condition, and let’s say the virus caused you to go to the I.C.U., and then have a heart or kidney problem — some countries are recording that as a heart issue or a kidney issue and not a Covid-19 death,” she said at a White House news conference last month.

In a brief interview on Thursday, Dr. Birx stressed that there had been no pressure to alter data. But concerns about official statistics are not limited to the death toll, or to administration officials.

Epidemiologists said they were stunned to learn that the C.D.C. is combining tests that detect active infection with those that detect recovery from Covid-19 — a system that muddies the picture of the pandemic but raises the percentage of Americans tested as President Trump boasts about testing.

Experts said that data from antibody tests and active virus tests should never be mixed.

“It just doesn’t make any sense,” said Natalie Dean, a biostatistician at the University of Florida. “All of us are really baffled.”

Epidemiologists, state health officials and a spokeswoman for the C.D.C. said there was no ill intent; they attributed the flawed reporting system to confusion and fatigue in overworked state and local health departments that typically track infections — not tests — during outbreaks.



‘We Need More Prayer,’ Trump Says, Calling Houses of Worship ‘Essential’

President Trump urged governors to reopen houses of worship immediately, saying he would override them if they did not. His authority to do so is unclear.

Today, I’m identifying houses of worship, churches, synagogues and mosques as essential places that provide essential services. Some governors have deemed liquor stores and abortion clinics as essential, but have left out churches and other houses of worship. It’s not right. So I’m correcting this injustice, and calling houses of worship “essential.” I call upon governors to allow our churches and places of worship to open right now. These are places that hold our society together, and keep our people united. The people are demanding to go to church and synagogue, go to their mosque. Many millions of Americans embrace worship as an essential part of life. The ministers, pastors, rabbis, imams and other faith leaders will make sure that their congregations are safe as they gather and pray. I know them well, they love their congregations. They love their people. They don’t want anything bad to happen to them or to anybody else. The governors need to do the right thing, and allow these very important essential places of faith to open right now, for this weekend. If they don’t do it, I will override the governors. In America, we need more prayer, not less.

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President Trump urged governors to reopen houses of worship immediately, saying he would override them if they did not. His authority to do so is unclear.CreditCredit…Anna Moneymaker/The New York Times

President Trump stepped into the culture wars again on Friday, taking the side of some religious leaders against governors who have moved slowly in reopening places of worship amid the pandemic.

Without any clear authority to do so, Mr. Trump said that he was calling houses of faith, including churches, synagogues, and mosques, “essential services” and urged governors to reopen them “right now.”

“Today I am identifying houses of worship — churches, synagogue and mosques — as essential places that provide essential services,” Mr. Trump said at a hastily scheduled briefing at the White House on Friday. “Some governors have deemed liquor stores and abortion clinics as essential but have left out churches and other houses of worship. It’s not right.”

After he spoke, the Centers for Disease Control and Prevention issued a number of long-delayed guidelines with suggestions for steps that houses of worship can take to curb the spread of the virus. Among them was a recommendation that religious officials defer to the directive of state and local governments.

Still, the president threatened to “override” the governors if they did not follow his order, though it was not immediately clear what powers he was claiming. “I call upon governors to allow our churches and places of worship to open right now,” he said. “If there’s any question, they’re going to have to call me, but they’re not going to be successful in that call.”

When the C.D.C. recently released a set of guidelines for reopening, its report largely mirrored an earlier draft version that the White House had rejected because Trump administration officials worried that the suggestions infringed on religious rights.

On Friday the C.D.C.’s new guidelines for religious communities suggested that they consider a number of limitations to keep congregations safe. Among them:

  • “Take steps to limit the size of gatherings in accordance with the guidance and directives of state and local authorities.”

  • “Consider suspending or at least decreasing use of a choir/musical ensembles and congregant singing, chanting, or reciting during services or other programming, if appropriate within the faith tradition. The act of singing may contribute to transmission of Covid-19, possibly through emission of aerosols.”

  • “Consider temporarily limiting the sharing of frequently touched objects that cannot be easily cleaned between persons, such as worship aids, prayer rugs, prayer books, hymnals, religious texts and other bulletins, books, shared cups, or other items received, passed or shared among congregants.”

Mr. Trump said Friday at the White House that the nation needs religion. “In America, we need more prayer, not less,” he said. He left without taking questions.

David Postman, the chief of staff for Gov. Jay Inslee of Washington, said the state didn’t know what the president’s comments meant and noted the state had not seen any formal order. “We don’t believe the president has the ability to dictate what states can and cannot open,” Mr. Postman said.

“We’re not ready,” she said. “Honestly, that would be reckless. It’s Friday. They’re not ready.”

Credit…Paul Ratje/Agence France-Presse — Getty Images

It was not clear what authority President Trump was invoking on Friday when he called for governors “to allow our churches and places of worship to open right now,” and threatened to “override” them if they did not. Soon after he spoke, though, the C.D.C. issued guidelines urging faith leaders to “take steps to limit the size of gatherings in accordance with the guidance and directives of state and local authorities.”

States and localities have been taking a variety of approaches to religious services since the outbreak began.

Houses of worship were already allowed to operate in more than half of the states, though many remain under social distancing instructions and many individual churches, synagogues and mosques have decided to remain closed for safety.

There have been tensions in places that still have restrictions in place. In California, more than 1,200 pastors signed a declaration protesting the state’s restrictions on in-person services and pledged to reopen their churches by May 31 even if the restrictions are not lifted. Gov. Gavin Newsom, a Democrat, said Friday that the state was working with faith leaders on guidelines to reopen in “a safe and responsible manner” that would be released by Monday at the latest.

The state’s guidelines, which will distinguish between megachurches and smaller venues, deal with the configuration of pews and “sanitation protocols,” the governor said.

In Illinois, Gov. J.B. Pritzker said on Friday that he would “continue to operate on the basis of science and data” in deciding when it was safe for houses of worship to open.

“I’m as anxious as anybody to make sure that our churches, our mosques, our synagogues open back to where they were before Covid-19 came along,” Mr. Pritzker said. “We’re gradually moving in that direction. But there’s no doubt the most important thing is, we do not want parishioners to get ill because their faith leaders bring them together.”

The president’s call to let in-person services resume came just before one of the biggest Muslim holidays of the year, Eid al-Fitr, which starts Saturday night.

Washington State currently allows drive-in services, where congregants remain in their vehicles, and allows houses of worship to bring in personnel to broadcast and stream videos of services. Officials there have been working with an interfaith group to develop guidelines on how religious institutions can safely open up for more in-person activities.

And in some states, houses of worships were never required to close. In Pennsylvania, religious institutions were exempt from a stay-at-home order, though Gov. Tom Wolf has advised religious leaders not to hold in-person services or large gatherings to protect people from the virus.

Gov. Gretchen Whitmer of Michigan, who on Friday extended the state’s stay-at-home order through June 12, has banned large gatherings but also said that houses of worship would not be subject to penalties, leaving the decision in the hands of religious leaders. Many churches, synagogues and mosques there decided to remain closed anyway, and those that are reopening often remain under strict guidelines, including limiting the number of congregants who could enter.

In hard-hit New York, Gov. Andrew M. Cuomo moved this week to allow religious gatherings of up to 10 people to resume as long as attendees wear masks and maintain social distance. The announcement was particularly significant for Jewish congregations, where a minyan, defined as 10 people over 13, is required for a worship service.

Credit…Ryan Young for The New York Times

One testing measure shows that coronavirus cases are persisting at worrisome rates in three major metropolitan areas — Los Angeles, Chicago and Washington, D.C. — that are still under stay-at-home orders, a top White House official said on Friday.

“We have concerns of where cities have remained closed and metros that have remained closed but have still persistent high number of cases,” Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, told reporters at a news conference. She said officials from the Centers for Disease Control and Prevention were working with local officials in the three cities “to really understand where these new cases coming from, and what do we need to do to prevent them in the future.”

Dr. Birx’s concern did not suggest that the case rates in the three regions were spiking to alarming new levels, but rather that they were not dropping at the same rate as in many other cities.

Dr. Birx singled out the Washington area — which includes the district as well as parts of Maryland and Virginia — and said it led the country in the percentage of positive test results, a measure different from total coronavirus cases. Among those who have tested positive is the former N.B.A. all-star Patrick Ewing, now the men’s basketball coach at Georgetown University in Washington, who announced on Twitter on Friday that he had the virus.

Unlike New York, the Washington area has seen no “dramatic decline” in positive test rates or emergency room visits, Dr. Birx said.

Further complicating the picture, Mayor Muriel E. Bowser of Washington said on Thursday that the city could begin a phased reopening as early as May 29, pointing to figures that showed a downward trend in spread of the virus for almost two weeks. Yet on the same day, Washington, D.C., and Virginia announced single-day highs in cases.

The Washington region’s high positive-test percentage comes despite reassuring news in most states: 42 have a rate under 10 percent of positive test results as part of a rolling, seven-day average, Dr. Birx said.

The New York area, which includes Jersey City and Newark, is seeing steeper declines by that test result measure, Dr. Birx said. And cities that have been especially hard hit, such as Detroit, Boston and Miami, now have more promising daily case counts.

Credit…Al Bello/Getty Images

In the Hamptons, the locals have put up barricades to limit parking and deployed enforcement officers to ticket outsiders. Jersey Shore towns have banned short-term leases and Airbnb rentals. And on Long Island, the Suffolk County executive’s office taunted Mayor Bill de Blasio of New York City: “Do your job. Figure out a plan to safely reopen your beaches.”

Since the pandemic began, tensions have flared over whether too many New York City residents have decamped to outlying vacation areas, potentially taking the virus with them. But now the region appears on the brink of a full-fledged (and nasty) battle over beaches, touched off by the city’s decision to keep its shoreline closed.

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In normal times, start of beach season on Memorial Day weekend incites a mass migration from New York to Long Island, the Jersey Shore and, to a lesser extent, Connecticut. But the extension of beach closings in New York City has led to a backlash from local officials in those areas, who say they fear that their shorelines will be overwhelmed by an exodus of sun-starved New Yorkers blocked from their own beaches, which can in normal times attract a million people a day.

To maintain social distancing, beaches across the region are moving to limit access to everyone, and special rules have also been adopted to keep outsiders away.

The Justice Department on Friday backed an Illinois Republican’s effort to invalidate the state’s stay-at-home order, the latest effort by the federal government to undermine governors’ coronavirus measures.

The U.S. attorney for the Southern District of Illinois argued in a legal brief that Gov. J. B. Pritzker, a Democrat, had exceeded his authority by extending his executive order for more than 30 days.

The brief came in response to a directive from Attorney General William P. Barr that department lawyers review stay-at-home orders around the country “to ensure that civil liberties are protected.”

Since Mr. Barr’s request, the Justice Department has increasingly asserted itself in arguing over the legality of states’ sweeping orders in response to the coronavirus pandemic.

“Under our system, all public officials, including governors, must comply with the law, especially during times of crisis,” Eric Dreiband, the head of the department’s civil rights division, said in a statement. On Friday, Mr. Dreiband also warned in a letter to Mayor Eric Garcetti of Los Angeles that a “long-term lockdown” could be illegal.

The move in Illinois came in a lawsuit that was filed by Darren Bailey, a Republican state representative whose fellow lawmakers kicked him out of the building in which they had gathered because he refused to wear a mask. Mr. Bailey had asked an Illinois court to declare the governor’s order invalid. The governor this week sought to have the case transferred to federal court, a move the Justice Department also said was wrong.

Credit…Jim Wilson/The New York Times

The Transportation Department said late Friday that it would tentatively allow 15 airlines to stop flights to about 60 mostly small and midsize cities, though none of the destinations stand to lose service entirely.

American Airlines would be allowed to stop flying to airports in Worcester, Mass., and Aspen, Colo. Delta Air Lines would be able to stop service to Erie, Pa., and Flint, Mich. United Airlines would be able to stop flights to Fairbanks, Alaska; Kalamazoo, Mich.; and Myrtle Beach, S.C., among other locations.

None of the cities would be left without service, the agency said, because it granted exemptions only if other airlines still flew there. Some of the affected regions are also served by other airports.

The decision is rooted in the federal stimulus act passed in late March. Under that law, any airline that received federal assistance is required to maintain a minimum number of flights to locations that it had served before the pandemic. But the law also allowed the Transportation Department to grant exceptions, which it has done regularly for weeks.

The Department of Homeland Security late Friday provided exemptions for certain professional athletes from its travel restrictions that Trump administration officials have said are crucial to preventing the spread of the coronavirus.

The department said in a statement that foreign baseball, basketball, golf, hockey and tennis players, as well as their families and essential staff members, would be allowed to enter the United States. In his push to reopen the economy, President Trump has encouraged sports commissioners to resume play.

“Professional sporting events provide much-needed economic benefits, but equally important, they provide community pride and national unity,” said Chad F. Wolf, the acting secretary of the Department of Homeland Security. “In today’s environment, Americans need their sports.”

In late January, the administration prohibited foreign travelers who had been in China within the previous 14 days from coming to the United States. The administration later put similar restrictions in place for those from Iran and many European countries, including Britain.

The order on Friday said that allowing the athletes into the United States was within the “national interest.” But homeland security officials have defended using health authorities granted to the surgeon general to rapidly turn away asylum-seeking migrants at the southwestern border.

Credit…Luke Sharrett for The New York Times

When she found out in mid-March that she had landed an internship with an education nonprofit in Washington, Lydia Burns, a senior at the University of Louisville, called her mother to celebrate.

The euphoria lasted all of a week. As she worked on a paper the next Tuesday, Ms. Burns got an email from the nonprofit: The internship was canceled because of the coronavirus pandemic. She burst into tears.

“I feel like I had such a strong plan,” she said. “I knew what I was going to do — I had been working for it all of college. Now I don’t know what I’m going to do.”

For millions of college students, internships can be a steppingstone to full-time work, a vital source of income and even a graduation requirement.

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  • Frequently Asked Questions and Advice

    Updated May 20, 2020

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      Over 38 million people have filed for unemployment since March. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • Is ‘Covid toe’ a symptom of the disease?

      There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • How can I help?

      Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.

But like so much else, summer internships have been upended by the pandemic, with a wide range of major companies, including tech firms like Yelp and entertainment behemoths like the Walt Disney Company, canceling programs and rescinding offers. Instead, students who had hoped to experience an office setting for the first time are instead looking for work at fast-food restaurants.

The early-stage trial, published in the Lancet, was conducted by researchers at several laboratories and included 108 participants. Subjects who got the vaccine mounted a moderate immune response to the virus, which peaked 28 days after the inoculation, the researchers found.

A vaccine to the new coronavirus is considered to be the best long-term solution to ending the pandemic and helping countries reopen their societies. Nearly 100 teams worldwide are racing to test various candidates.

On Monday, Moderna announced that its RNA vaccine appears to be safe and effective, based on results from eight people in its trial. On Wednesday, researchers in Boston said a prototype vaccine protected monkeys from coronavirus infection.

The vaccine reported today was created with another virus, an adenovirus called Ad5 that easily enters human cells.

But the virus is one that many people already have been exposed to, and some experts have worried that too many already have antibodies to Ad5, limiting its usefulness as a way to deliver a vaccine.

Although the vaccine did elicit some immune response, the results are based on data from just a short period. It is not clear how long-lasting the protection might be.

Apart from pain at the injection site, close to half of the participants also reported fever, fatigue and headaches, and about one in five had muscle pain.

The participants knew whether they were receiving a low, medium or high dose, however, which may have influenced their perceptions of the side effects.

Credit…Arshad Arbab/EPA, via Shutterstock

The widespread interruption of routine immunization programs around the world during the coronavirus pandemic is putting 80 million children under 1 year old at risk of contracting deadly, vaccine-preventable diseases, according to a report Friday by the World Health Organization, UNICEF and Gavi, the Vaccine Alliance.

The groups surveyed 129 poor and middle-income countries and found that 68 had some degree of disruption of vaccine services through clinics and through large inoculation campaigns.

Many public health experts say they are worried that deaths from diseases including cholera, rotavirus and diphtheria could far outstrip those from Covid-19 itself.

But officials are now moving toward a cautious risk-benefit analysis.

Credit…Bridget Bennett for The New York Times

As the country reopens, employers are looking into how to safely bring back their workers. One recurring question: Should they be tested for the new coronavirus?

Some businesses are moving ahead. Amazon plans to spend as much as $1 billion this year to regularly test its work force, while laying the groundwork to build its own lab near the Cincinnati airport.

Las Vegas casinos are testing thousands of employees as they prepare to return to work, collecting nasal samples in convention halls. Gov. Steve Sisolak of Nevada is hoping to reopen the state’s gambling industry by June 4, he said on Friday.

And Major League Baseball, eager to begin its season, is proposing a detailed regimen that involves testing players and critical staff members multiple times a week.

While public health experts and government officials have emphasized that widespread testing will be critical to reopening, state and federal agencies have given little clear guidance on the role employers should play in detecting and tracking the virus.

Despite rapid advancements in testing, many limitations remain. Diagnostic tests, for example, only detect infections during a certain period. And antibody tests alone should not be used to make decisions about when people can return to work, the Association of Public Health Laboratories and Council of State and Territorial Epidemiologists warned.

Some public health officials also said that broad-based testing might have unintended consequences.

“We don’t want people to get a false sense of security,” said Karen Landers, a district medical officer with the Alabama Department of Public Health, which is not recommending that employers test all workers.

Guidelines from the C.D.C. making the rounds online this week are clarifying what we know about the spread of the virus.

The virus does not spread easily via contaminated surfaces, according to the agency. For those who were worried about wiping down grocery bags or disinfecting mailed packages, the news headlines highlighting this guidance in recent days might have brought some relief.

But this information is not new; the agency has been using similar language for months. If anything, the headlines have pulled into sharper focus what we already know. The virus is thought to spread mainly from one person to another, typically through droplets when an infected person sneezes, coughs or talks at close range — even if that person is not showing symptoms.

The C.D.C.’s website also says that “touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes” is a possible way for people to become infected. But those are “not thought to be the main way the virus spreads.”

Credit…Dan Busey/The Decatur Daily, via Associated Press

As all 50 states begin to open back up in some way, some epidemiologists are seeing warning signs of a possible resurgence in the South, including Montgomery, Ala., where Mayor Steven L. Reed raised alarms going into the holiday weekend.

Mr. Reed, who earlier this week said there was just one I.C.U. bed remaining at certain area hospitals, said he spoke out after hearing from hospital leaders that the situation was becoming unsustainable.

“We are in a very dangerous predicament,” he said on MSNBC on Thursday night.

Mr. Reed, a Democrat whose position is officially nonpartisan, attributed an uptick in cases in Montgomery to changes in people’s behavior amid an early decision by Gov. Kay Ivey, a Republican, to relax restrictions across Alabama, including the reopening of entertainment venues on Friday.

“It has sent a message that the battle with Covid-19 is over and it has been won,” he said. “We are still in this battle. We can’t afford to relax now.”

Mia Mothershed, a spokeswoman for Jackson Hospital in Montgomery, said on Friday that the hospital had reached capacity in its 30 I.C.U. beds because of a combination of the virus and other patients. “We have absolutely no beds available here,” she said.

The last thing you need right now is a spotty Wi-Fi signal interrupting your workday. Good news! There are some simple steps you can take to improve that. And, while you’re at it, take a look at the rest of your computer setup and see what may be slowing you down. A little tweak can make working from home less miserable.

Parting with years of precedent, China on Friday abandoned an annual growth target for 2020, in an acknowledgment that restarting its economy after the outbreak will be a slow and difficult process. In his annual report to lawmakers meeting in Beijing, Premier Li Keqiang said that the country had made major achievements in its response to the epidemic and that economic development was a top priority. But while he set goals to limit inflation and unemployment, he did not announce a target for economic growth for the year.

Reporting was contributed by Mike Baker, Karen Barrow, Alan Blinder, Julie Bosman, Keith Bradsher, Nicholas Bogel-Burroughs, Kassie Bracken, Chris Buckley, Niraj Chokshi, Michael Cooper, Elizabeth Dias, Steve Eder, Christopher Flavelle, Ellen Gabler, Bianca Giaever, Michael Gold, Joseph Goldstein, Abby Goodnough, Denise Grady, Maggie Haberman, Mohammed Hadi, Jan Hoffman, Zolan Kanno-Youngs, Sheila Kaplan, Annie Karni, Corey Kilgannon, Sarah Kliff, Apoorva Mandavilli, Patricia Mazzei, Jesse McKinley, Sarah Mervosh, Heather Murphy, Robin Pogrebin, Alan Rappeport, Emily Rhyne, Dana Rubinstein, Marc Santora, Jeanna Smialek, Farah Stockman, Sheryl Gay Stolberg, Eileen Sullivan, Noah Weiland and David Yaffe-Bellany.

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