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Health

A New Alzheimer’s Drug Gives Extra Questions Than Solutions

“It puts us in a bad place,” agreed Dr. Karina Bishop, a geriatrician at the University of Nebraska Medical Center. Ethically, she added, “if this drug was available right now, I would not feel able to prescribe it.”

Even as individual doctors grapple with advising patients, hospitals and health systems are devising protocols for when Aduhelm becomes available, probably within weeks.

At the Mayo Clinic, said Dr. Ronald Petersen, a neurologist who directs the Alzheimer’s Disease Research Center there, “we’re going to stick pretty close to the inclusion and exclusion criteria used in the trial.”

That means only patients with mild cognitive impairment or early Alzheimer’s disease would qualify, after an M.R.I. to rule out certain conditions and risks, and a P.E.T. scan or lumbar puncture to confirm the presence of amyloid. The Mayo protocols, like the clinical trials, would exclude people taking blood thinners like Warfarin or Eliquis.

“It’s not like you come in and say, ‘I’m a little forgetful,’ and we say, ‘Here’s this drug,’” said Dr. Petersen. But not every provider, he acknowledged, will employ such safeguards.

Dr. Eric Widera, a geriatrician at the University of California, San Francisco, expressed a similar concern: “If doctors were extremely cautious and limited this drug to the very specific population included in the study, with very careful monitoring, it would be the first time in medicine that was ever done.”

He pointed out another consequence of federal approval: a rift between some doctors and the Alzheimer’s Association, the national advocacy group, which this spring mounted a campaign it called More Time. Intended to demonstrate public support for approval of aducanumab, the effort included newspaper ads and social media posts.

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Politics

North Dakota Sues the Biden Administration Over Oil and Gasoline Leases

The state of North Dakota has sued the Biden government for suspending new state and waterway oil and gas leases, claiming that doing so has cost the state nearly $ 5 billion in lost revenue and more than half a billion barrels of oil in the ground will hold.

President Biden ordered the suspension days after he took office as part of his climate change agenda – but the move was blocked in federal court in June so states can proceed with new leases.

North Dakota joins 14 other states with Republican attorneys general who have filed lawsuits over the moratorium on new leases.

The Interior Ministry, the federal agency that oversees oil and gas leases, declined to comment.

In the lawsuit filed Wednesday in the US District Court for the North Dakota County, the state called the moratorium illegal and said the Home Office had exceeded its powers to suspend the sale of leases.

It also alleged that the suspension of two North Dakota leases, originally scheduled for March and June, has already cost the state tens of millions in lost revenue.

North Dakota is the second largest producer of oil and gas in the United States, and more than half of the state government’s revenue comes from oil and gas taxes.

“This significant damage to North Dakota will increase rapidly,” the lawsuit said, as the “illegal federal government moratorium may continue”.

If the moratorium continues next year, the lawsuit said, leases on nearly 150,000 acres of North Dakota would be blocked, preventing the construction of more than 1,000 oil and gas wells and the production of 555 million barrels of oil. The estimated total loss of revenue is $ 4.77 billion.

“I took these steps to protect the North Dakota economy, the jobs of our hardworking citizens, and North Dakota’s right to control its own natural resources,” said Wayne Stenehjem, the North Dakota attorney general, in a Explanation.

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World News

Inventory futures are flat after market sell-off

Traders on the floor of the New York Stock Exchange.

Source: NYSE

Stock futures were flat in overnight trading on Thursday after major indices fell on concerns over slowing economic growth.

Futures on the Dow Jones Industrial Average lost 25 points, or 0.07%. S&P 500 futures and Nasdaq futures were each down 0.10%.

Thursday’s losses came as the spread of the highly contagious Delta-Covid variant also fueled concerns over the global economic recovery. The Olympics announced a ban on spectators for the Tokyo Summer Games when Japan declared a state of emergency to curb the spread of the coronavirus.

The Dow closed Thursday’s regular session 259.86 points, or 0.75% lower. The S&P 500 lost 0.86% while the Nasdaq broke its four-day winning streak, down 0.72%.

All three major averages are on track to close lower for the week.

Stocks of companies tied to the economic comeback weighed on the market on Thursday. Large cruise lines, airlines, and home improvement stocks plummeted. Chip stocks also fell, and big tech names fell after rising in previous sessions.

“[T]The market continues to consider what to do after spikes in growth and the Fed will turn the tap (which has not necessarily happened yet) and ahead of a profitable season in Q221 starting next Tuesday, “Goldman Sachs’ Chris Hussey said in a statement on Thursday .

The latest unemployment claims report, released Thursday, also indicated a potential slowdown in the labor sector as first-time applicants for unemployment benefits unexpectedly rose to 373,000 in the week ending July 3. According to the Dow Jones, economists wanted 350,000 initial applications.

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Health

Pfizer says it’s growing a Covid booster shot to focus on the extremely transmissible delta variant

Pfizer and BioNTech announced Thursday that they are developing a Covid-19 booster vaccine that will target the Delta variant amid concerns about the highly communicable strain that is already the predominant form of the disease in the United States.

The companies said that while they believe a third vaccination of their current two-dose vaccine has the potential to maintain the “highest level of protection” against all currently known variants, including Delta, they are “vigilant” and are developing an updated version of the Vaccine.

“As evidenced by real evidence from the Israeli Ministry of Health, the effectiveness of the vaccine has declined six months after vaccination, while at the same time the Delta variant is becoming the dominant variant in the country,” the companies said in a written statement.

“These results are consistent with an ongoing analysis of the companies’ Phase 3 study,” they said. “This is why we have said, and continue to believe, that all of the data we have, it is likely that a third dose may be required within 6 to 12 months of full vaccination.”

Clinical trials could begin as early as August, subject to regulatory approvals, the companies said.

The announcement comes on the same day the Olympic Games organizers said they would be banning all viewers from the Games this year after Japan declared a state of emergency designed to stem a wave of new Covid-19 infections that are partly due to the Delta variant is due.

Delta is estimated by the World Health Organization to be about 55% more transmissible than Alpha, the variant first found in the UK that once dominated the US, didn’t do as well at protecting against mild illnesses and the spread of the disease to others, scientists say.

On Monday, Israeli officials reported a decrease in the effectiveness of the Pfizer BioNTech vaccine in preventing infections and symptomatic diseases, but said it remained highly effective in preventing serious diseases.

In the US, health officials are urging all eligible Americans to get vaccinated as soon as possible, especially before the fall season when Delta is expected to lead to a further surge in new coronavirus cases, especially in places with the lowest vaccination rates.

There are about 1,000 counties in the U.S. with a Covid vaccination rate of less than 30%, mostly located in the Southeast and Midwest, said CDC Director Dr. Rochelle Walensky recently. In these areas, the authority already sees increasing infection rates due to the further spread of the delta variant.

Pfizer and BioNtech executives have repeatedly said that people will likely need a booster vaccination or a third dose within 12 months of full vaccination, as they expect vaccine-induced immunity to wear off over time. They also said that people are likely to have to take extra shots every year.

Pfizer and BioNTech are developing booster vaccines and are expected to apply for US approval for a third dose of their vaccine shortly.

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Politics

Western warmth wave just about not possible with out local weather change, researchers say

People sleep at a cooling shelter set up during an unprecedented heat wave in Portland, Oregon, U.S. June 27, 2021.

Maranie Staab | Reuters

SANTA MONICA, Calif. — The deadly heat wave that brought triple-digit temperatures to the Pacific Northwest and western Canada and killed hundreds of people was virtually impossible without human-caused climate change, according to a new analysis by an international team of 27 scientists.

The temperature records were so extreme — 116 degrees Fahrenheit in Portland, Oregon, and 121 degrees Fahrenheit in Canada’s British Columbia — that researchers said it was difficult to quantify just how rare the heat wave was. The team, working under the umbrella of Oxford University-based World Weather Attribution, estimated it was a once-in-a-millennium event.

The scientists, who are based in the U.S., Canada, the U.K., the Netherlands, France, Germany and Switzerland, estimated that human-caused climate change increased the likelihood of such a heat wave by at least 150 times.

“An event such as the Pacific Northwest 2021 heatwave is still rare or extremely rare in today’s climate, yet would be virtually impossible without human-caused climate change,” the team of scientists wrote. “As warming continues, it will become a lot less rare.”

The researchers urged adaptation measures that account for the rising risk of heat waves, including action plans that incorporate early warning systems for high temperatures, as well as more ambitious targets to drastically reduce planet-warming greenhouse gas emissions.

Researchers also found that in a world with 2 degrees Celsius of warming, which could happen this century unless there are significant cuts to greenhouse gas emissions, such a heat event would occur about every five to 10 years.

The Earth has already heated up more than 1 degree Celsius compared with preindustrial levels, according to the World Meteorological Organization.

The analysis by World Weather Attribution, which conducts quick analyses to determine if there is a link between climate change and specific extreme weather events, has not yet been peer-reviewed. However, it uses processes that have been peer-reviewed in the past 10 years.

Scientists used computer simulations that compared a hypothetical world without greenhouse gas emissions to the existing world in order to assess the impact of climate change on weather events. The research will later be published in peer-reviewed journals.

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The study, published on Wednesday, is in line with previous research on the impact climate change has on the frequency and severity of heat waves and drought.

The recent historic heat wave, which started at the end of June, fueled wildfires, threatened water shortages and was linked to hundreds of deaths in Oregon, Washington and British Columbia. The official death count is expected to rise.

More than one-third of global heat-related deaths during warm seasons can be attributed to climate change, experts have said. Heat also kills more people than any other weather-related disaster in the U.S.

“Our results provide a strong warning: our rapidly warming climate is bringing us into uncharted territory that has significant consequences for health, well-being and livelihoods,” the scientists wrote.

North America just recorded its hottest June on record, according to scientists with the Copernicus Climate Change Service, with 2021 virtually certain to be among the 10 hottest years on record.

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Health

In a Reversal, F.D.A. Requires Limits on Who Will get Alzheimer’s Drug

When the FDA approved Aduhelm a month ago, the original label said the drug was “for the treatment of Alzheimer’s disease.” The surprisingly broad label caused a storm of concern among many Alzheimer’s experts, even those who had supported the drug’s approval.

At a forum sponsored by the Alzheimer’s Association last month that urged Aduhelm to be approved, a panel of Alzheimer’s clinics with differing views agreed on whether the drug should have been approved that its use was strong should be restricted.

Many experts say the drug’s label should not only restrict Aduhelm’s use to mild disease stages, but also require two more stringent clinical trial conditions: that suitable patients have evidence of high levels of a key protein, amyloid, in their brain, and that people with certain diseases (so-called “contraindications”) should be prevented from taking the drug or at least classified as a high-risk group, as this can lead to brain swelling and bleeding.

At the forum, Dr. Stephen Selloway, director of the Memory and Aging Program at Butler Hospital in Providence, RI, who helped conduct the Aduhelm studies and is one of the drug’s most ardent medical advocates, when he saw the label had no contraindications to his The reaction was “oy”.

On Thursday, Dr. Lon Schneider, director of the California Alzheimer’s Disease Center at the University of Southern California, who also worked on one of the Aduhelm studies and spoke out against the approval of the drug, saying that the new labeling was neglected.

The label should have said, among other things, that people with diabetes, high blood pressure and people who take blood thinners are not allowed to take part in the clinical trials and therefore “no extent is known”. of increased risk ”for these patients.

Dr. Jason Karlawish, a co-director of the University of Pennsylvania’s Penn Memory Center, said the new label was based more on what he and other Alzheimer’s experts believe should originally have been written. But the abrupt revision of the label so soon after a much criticized approval decision was worrying, he said.

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Entertainment

Your Subsequent Summer time Learn Primarily based on Your Favourite Summer time Cocktail

I can’t think of a better way to spend a summer day than by the pool with a captivating beach read and my favorite cocktail. I only have one (big) problem: I can stand in front of my bookshelf for the better half of the day and try to choose which book to read next. It’s basically the equivalent of scrolling through Netflix for two hours before settling on an hour and a half movie. From thrillers to new releases to intimate stories full of romance, I often have to close my eyes and randomly pick a novel, which isn’t a bad way, I might add. So this time I tried something different. I’ve chosen a book that goes with my summer cocktail. After all, drinks and books go hand in hand – what better way to choose my next reading than my favorite drink? Join me and find your next summer book and cocktail combo!

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World News

Haiti President’s Assassination: Dwell Updates

Here’s what you need to know:

Credit…Valerie Baeriswyl/Agence France-Presse — Getty Images

Nearly 24 hours after the assassination of President Jovenel Moïse of Haiti in the bedroom of his home, gunfire erupted in the capital, Port-au-Prince, late Wednesday as the security forces engaged in a chaotic shootout with a group they described as suspected assailants, killing four and taking two into custody.

The interim prime minister, Claude Joseph, has placed the country under a “state of siege.” He said the authorities were continuing to hunt down the “mercenaries” who carried out the attack.

“This death will not go unpunished,” Mr. Joseph said in an address to the nation on Wednesday.

But the authorities did not identify those killed or in custody, and offered no evidence of their involvement in Mr. Moïse’s death.

The rapidly evolving crisis deepened the turmoil and violence that has gripped Haiti for months, threatening to tip one of the world’s most troubled nations further into lawlessness.

Haiti’s police chief, Leon Charles, said that the security forces were in control of the situation even as he acknowledged that other suspected members of the hit squad remained at large.

Even as questions swirled about who might have been behind such a brazen attack and how they eluded the president’s security detail to carry it out, the uncertain political landscape added to the deep unease that gripped the Caribbean nation of 11 million.

While Mr. Joseph — the nation’s sixth prime minister in the last four years — declared that he was now in charge, his hold on power is tenuous given that a new prime minister, Ariel Henry, was scheduled to be sworn in this week.

Mr. Henry said that Mr. Joseph was “no longer prime minister” and contended that the office belonged to him. The country currently has no functioning Parliament, and it is uncertain when or even whether elections slated for the fall will take place.

An emergency meeting of the United Nations Security Council on the crisis was set for Thursday afternoon. In a statement, members unanimously called for “all parties to remain calm, exercise restraint” and avoid “any act that could contribute to further instability.”

President Biden called the assassination “horrific” and pledged U.S. assistance.

With rumors rife, some details of the attack started to come into focus.

Haiti’s ambassador to the United States, Bocchit Edmond, said at a news conference that the killing of the country’s president had been carried out “by well-trained professionals, killers, commandos.”

Carl Henry Destin, a Haitian judge, told the Nouvelliste newspaper that the assailants had posed as agents of the U.S. Drug Enforcement Administration — both U.S. and Haitian officials said that they were not associated with the D.E.A. — when they burst into the president’s private home on the outskirts of the capital around 1 a.m. on Wednesday.

Judge Destin said that a maid and another member of the household staff had been tied up by the attackers as they made their way to the president’s bedroom.

The president was shot at least 12 times, he said.

“The offices and the president’s bedroom were ransacked,” Mr. Destin said. “We found him lying on his back, blue pants, white shirt stained with blood, mouth open, left eye blown out.”

He said Mr. Moise appeared to have been shot with both large-caliber guns and smaller 9-millimeter weapons.

The president’s wife, Martine Moïse, was injured in the assault and was rushed by air ambulance to the Ryder Trauma Center in Miami, where Mr. Joseph said she was “out of danger” and in stable condition.

Mr. Destin said that the couple’s daughter, Jomarlie, was also at home during the attack but had hid in a bedroom and escaped unharmed.

The late President Jovenel Moïse of Haiti, center, with his wife, Martine Moise, and interim Prime Minister Claude Joseph, right, at a ceremony in Port-au-Prince in May.Credit…Joseph Odelyn/Associated Press

An already turbulent political landscape in Haiti threatened to descend into further turmoil on Thursday as a power struggle between two competing prime ministers stoked tensions after the assassination of President Jovenel Moïse.

The country’s interim prime minister, Claude Joseph, has said he is in charge and declared a “state of siege” for 15 days, essentially putting the country under martial law. But even constitutional experts are unsure whether he has the legal authority to impose it and whether he can stay in power.

Mr. Joseph was supposed to be replaced this week by Ariel Henry, who had been appointed prime minister by Mr. Moïse in recent days. But hours after the killing, Mr. Joseph assumed leadership of Haiti, taking command of the police and army in what he said was an effort to ensure order and stability. Secretary of State Antony J. Blinken spoke with Mr. Joseph, offering condolences, the State Department said on Wednesday.

Mr. Henry, in an interview with the Nouvelliste newspaper, said that Mr. Joseph was “no longer prime minister” and instead claimed his right to run the government.

“I am a prime minister with a decree that was passed in my favor,” Mr. Henry said, adding that he had been in the process of forming his government, of which Mr. Joseph was expected to be a member.

Mr. Henry said that he “did not want to add fuel to the fire,” but he criticized Mr. Joseph’s decision to impose a state of siege and called for a dialogue that could ensure a smooth political transition.

Lilas Desquiron, a Haitian writer who was culture minister from 2001 to 2004, said the situation was deeply confused since Mr. Moise had “left behind a prime minister that he had dismissed and another that he had not yet installed.”

Today’s Haiti is a parliamentary democracy without a functioning Parliament. Before his death, Mr. Moïse had been ruling by decree, and the president’s office is traditionally vested with most of the executive powers. It also appoints the prime minister. Long-planned elections were scheduled for later this year, but it was unclear on Thursday when or whether they will take place.

Haiti has a long history of political instability. The country has been rocked by a series of coups in the 20th and 21st centuries, often backed by Western powers, and has been marked by frequent leadership crises that have driven Haitians into the streets in protest.

It is unclear whether the political implications of this week’s assassination will follow a similar pattern.

Ms. Desquiron said that “no one understands” what is happening at the political level and that most Haitian political and intellectual actors were currently in a “wait-and-see and powerless position.”

A few hours after the assassination, Mr. Joseph called for calm and told the Haitian public that the situation was under control. He also declared a 15-day period of national mourning, starting on Thursday.

“During these 15 days of national mourning, the national flag will be flown at half-mast, nightclubs and other similar establishments will remain closed, and radio and television stations are invited to program circumstantial programs and music,” read the order, which was published in the official government journal, Le Moniteur.

A police officer standing guard outside the presidential residence in Port-au-Prince on Wednesday.Credit…Valerie Baeriswyl/Agence France-Presse — Getty Images

Not long after Haiti’s president was shot to death by assassins who burst into his home early Wednesday, the country’s interim prime minister announced that he had declared an “état de siège” — a state of siege.

To many people around the world watching with alarm as events unfold in Haiti, the term was unfamiliar, even baffling.

But things grew a little clearer when the interim prime minister, Claude Joseph, published details of the order in the official government journal, Le Moniteur.

Haiti is now basically under martial law. For 15 days, the police and members of the security forces can enter homes, control traffic and take special security measures and “all general measures that permit the arrest of the assassins” of President Jovenel Moïse. It also forbids meetings meant to excite or prepare for disorder.

There is one wrinkle. Or two, really.

Only Parliament has the power to declare a state of siege, said Georges Michel, a Haitian historian and constitutional expert. But Haiti at this moment has no functional Parliament. The terms of the entire lower house expired more than a year ago, and only 10 of Haiti’s 30 Senate seats are currently filled.

“Legally, he can’t do this,” Mr. Michel said. “We are in a state of necessity.”

There are actually a few other wrinkles.

Mr. Joseph’s term as interim prime minister is about to end and, in fact, President Moïse had already appointed a replacement, his sixth since taking office.

“We are in total confusion,” said Jacky Lumarque, rector of Quisqueya Universty, a large private university in Port-au-Prince. “We have two prime ministers. We can’t say which is more legitimate than the other.”

It gets worse.

Haiti also appears to have two Constitutions, and the dueling documents say different things about what to do if a president dies in office.

The 1987 version — published in both national languages, Creole and French — deems that if the presidency is vacant for any reason, the country’s most senior judge should step in.

In 2012, however, the Constitution was amended, and the new one directed that the president should be replaced by a council of ministers, under the guidance of the prime minister. Except if, as was Mr. Moïse’s situation, the president was in the fourth year of office. In that case, Parliament would vote for a provisional president. If, of course, there were a Parliament.

Unfortunately, that Constitution was amended in French, but not in Creole. So as it stands, the country has two Constitutions.

“Things are unclear,” said Mr. Michel, who helped write the 1987 Constitution. “It’s a very grave situation.”

Mr. Lumarque lamented the state of his country.

“This is the first time where we’ve seen that the state is so weak,” he said. “There is no Parliament. A dysfunctional Senate. The head of the Supreme Court just died. Jovenel Moïse was the last legitimate power in the country’s governance.”

News Analysis

U.S. soldiers delivering aid from the World Food Program to Jabouin, Haiti, after Hurricane Matthew destroyed dozens of villages in 2016.Credit…Meridith Kohut for The New York Times

Haiti’s morass has for decades put it near the top of a list of nations that have captured the world’s imagination for their levels of despair. But the failures have not occurred in a vacuum: They have been assisted by the international community, which has pumped $13 billion of aid into the country over the last decade.

Instead of the nation-building that the money was supposed to achieve, Haiti’s institutions have become further hollowed out.

Haiti is less a failed state than what an analyst called an “aid state” — eking out an existence by relying on billions of dollars from the international community. Foreign governments have been unwilling to turn off the spigots, afraid to let Haiti fail.

Yet the money has served as a complicating lifeline — leaving the government with few incentives to carry out the institutional reforms necessary to rebuild the country, as it bets that every time the situation worsens, international governments will open their coffers, analysts and Haitian activists say.

The aid has propped up the country and its leaders, providing vital services and supplies. It has also allowed corruption, violence and political paralysis to go unchecked.

Instead of helping create a system that works, Haitian civil society leaders contend, the United States has propped up strongmen and tied the fate of the nation to them.

“Since 2018, we have been asking for accountability,” Emmanuela Douyon, a Haitian policy expert who gave testimony to the U.S. Congress this year, said in an interview. “We need the international community to stop imposing what they think is correct and instead think about the long term and stability.”

Members of Montreal’s Haitian diaspora holding an anti-Moïse demonstration outside the Haitian consulate in March.Credit…Nasuna Stuart-Ulin for The New York Times

Many Haitians in the diaspora are fearing the worst after the assassination of the country’s president, Jovenel Moïse, an act of violence that many consider a potent symbol of the mayhem experienced in the Caribbean nation in recent months.

Rodney Saint-Éloi, a Haitian-Canadian poet and publisher in Montreal, said the assassination of Mr. Moïse was a blow to democracy in Haiti. “It turns all Haitians into assassins, because he was, like it or not, the president of all Haitians,” he said. “It is the failure of a society and of an elite who helped get us to this point.”

Mr. Moïse, killed in an attack early Wednesday on the outskirts of the capital, Port-au-Prince, had presided over a country buffeted by instability, endemic corruption and gang violence. His refusal to cede power had angered Haitians the world over, and many in the diaspora had put off trips home for the past year as kidnappings and other acts of violence became more commonplace.

Because of its chronic instability, Haiti has a large diaspora, with some of the largest communities based in the United States, Canada, France and the Dominican Republic. About 1.2 million Haitians or people of Haitian origin live in the United States, according to 2018 data from the U.S. Census Bureau. But the figure is thought to be higher because of a sizable number of immigrants who are in the country without documentation.

Frantz André, a leading Haitian rights advocate in Montreal, organized a protest in March in which dozens of Haitians demonstrated against what they called Mr. Moise’s political repression. He described Mr. Moïse as a deeply polarizing figure and said that other Haitians abroad were feeling mixed emotions about the president’s killing.

“I don’t think it would be wise to scream victory at his assassination, because we don’t know what will come after and the situation could be even more precarious,” Mr. André said. “Educated people saw him as a threat to democracy, and others have been protesting against him because they have nothing to eat.”

Mr. André added that a sizable minority had supported Mr. Moïse and saw him as a catalyst for change, because he had promoted the idea of giving Haitians outside the country the right to vote and was pushing to change the Constitution.

The Haitian security forces are engaged in what the authorities described as a sweeping manhunt for suspects in the killing of President Jovenel Moïse. Four people were killed, and two more taken into custody after a shootout late Wednesday.

Brazilian soldiers with a U.N. mission in Port-au-Prince in 2007.Credit…Ruth Fremson/The New York Times

The United Nations once deployed thousands of peacekeeping troops and police officers in Haiti as part of a coordinated international effort to rescue the country from its chronic bouts of political violence and instability. But the cholera epidemic that followed the 2010 earthquake — spread by infected peacekeepers — indelibly tainted the global organization in the eyes of many Haitians.

Even the U.N. secretary-general who presided during that period, Ban Ki-moon, admitted in a memoir published last month that the cholera disaster “forever destroyed the United Nations’ reputation in Haiti.”

A peacekeeping force authorized by the Security Council in 2004, known as the United Nations Stabilization Mission in Haiti, or by its French acronym Minustah, was empowered to send as many as 6,700 troops of all ranks and more than 1,600 civilian police officers to Haiti.

Ninety-six members of the peacekeeping mission were among those killed in the 2010 earthquake, which by some estimates left more than 300,000 people dead. The crisis led the Security Council to strengthen Minustah’s size to as many as 8,940 soldiers and 3,711 police officers.

But many Haitians came to regard the peacekeepers as an occupying force, and one that did not necessarily protect them. The force’s reputation was further impaired by reports that a Nepalese contingent may have introduced cholera to the country through poor sanitation — reports that were later confirmed by independent investigations.

Mr. Ban eventually acknowledged some responsibility, but the U.N. successfully rejected claims for compensation sought by aggrieved Haitians. A U.N. trust fund established under Mr. Ban to help Haiti cope with the cholera epidemic’s aftermath, which was supposed to total $400 million, has only a fraction of that sum.

Minustah’s mandate was terminated in 2017 with a transition to a much smaller mission, known as the United Nations Integrated Office in Haiti or its French acronym, Binuh. But the mission, which is confined to the capital, Port-au-Prince, has struggled.

None of its aspirations — helping Haiti achieve good governance, the rule of law, a stable environment and promotion of human rights — have shown any significant progress.

Helen La Lime, a former American diplomat and Binuh’s chief, summarized the worsening conditions afflicting the country in a report last month to the Security Council:

“The deep-rooted political crisis which has gripped the country for the better part of the last four years shows no sign of abating,” she said. “A political agreement remains elusive, as the rhetoric used by some political leaders grows increasingly acrimonious.”

Stéphane Dujarric, a U.N. spokesman, said on Wednesday that Ms. La Lime was in “constant contact” with the interim prime minister, Claude Joseph, and that she was calling “on the Haitian people to ensure calm.”

Mr. Dujarric said Binuh was in the process of accounting for its 1,200 staff members in Haiti, which includes about 200 from other countries, and he was advising them to “stay in place and in a safe place.”

Correction: July 8, 2021

An earlier version of this article misstated the amount that had been intended for a trust fund established by the United Nations to help Haiti in the aftermath of the cholera epidemic. It was $400 million, not $400,000.

An ambulance carrying the body of President Jovenel Moise in Port-au-Prince, Haiti, on Wednesday.Credit…Reuters

With security forces still hunting for the killers and investigators combing through the evidence from the scene of his assassination, the body of Haiti’s slain president, Jovenel Moïse, was loaded onto an ambulance on Wednesday, bound for a morgue.

A procession of cars was seen speeding away from the presidential residence, but things apparently did not go as planned: Encountering a highway blocked by tires, and hearing gunfire, observers said, the drivers made a quick turnaround.

They needed another route.

The same could be said for Haiti itself on Thursday, a day after its president was shot by a team of assassins described as “well-trained professionals” who had stormed his home on the outskirts of the capital, Port-au-Prince, and then disappeared into the night.

Now, an interim prime minister whose legitimacy was already under question — a replacement was named before the assassination — has declared himself in charge, and put the country under a Haitian version of martial law.

Parliament is riddled with vacancies and inactive. And a country steeped in violence is poised for things to get worse. Late Wednesday, prolonged gunfire could be heard in Port-au-Prince.

“It’s a very grave situation,” said Georges Michel, a Haitian historian and constitutional expert.

The interim prime minister, Claude Joseph, appealed for calm. “Let’s search for harmony to advance together, so the country doesn’t fall into chaos,” he said in a televised address to the nation.

But the country has learned the hard way over the decades, through earthquake and disease, poverty and political turbulence, that chaos feels always near at hand.

“I don’t know what’s going to happen now,” one man said as neighbors gathered to exchange news. “Everything is possible.”

Andre Paultre contributed reporting.

Haiti’s capital, Port-au-Prince, in 2017.Credit…Daniel Berehulak for The New York Times

Haiti has been thwarted by outside interests from its very foundation as a country.

For decades, European powers, and later the United States, refused to recognize it as an independent republic.

The Caribbean nation became the world’s first Black-led republic when it declared its independence from France on New Year’s Day 1804. That day, Saint-Domingue, once France’s richest colony, known as the “Pearl of the Antilles,” became Haiti.

It was a land long coveted for its riches of sugar, coffee and cotton, brought to market by enslaved people. Its declaration of independence meant that, for the first time, a brutally enslaved people had wrenched their freedom from colonial masters. But it came only after decades of bloody war.

In 1825, more than two decades after independence, the king of France, Charles X, sent warships to the capital, Port-au-Prince, and forced Haiti to compensate former French colonists for their lost property.

Haiti, unable to pay the hefty sum, was forced into a debt that it had to shoulder for nearly a century. Throughout the 19th century, a period marked by political and economic instability, the country invested little in its infrastructure or education.

In 1915, U.S. troops invaded after a mob killed the Haitian president.

The United States later justified its occupation as an attempt to restore order and prevent what it said was a looming invasion by French or German forces. But U.S. troops reintroduced forced labor on road-construction projects and were later accused of extrajudicial killings.

The widely unpopular occupation ended in 1934, but U.S. control over Haiti’s finances lasted until 1947.

After a series of midcentury coups, the Duvalier family, father-and-son dictators, reigned over Haiti with brute force until the 1980s. Their regime plunged Haiti deeper into debt, and introduced the so-called Tontons Macoutes, an infamous secret police force that terrorized the country.

In the early 1990s, Jean-Bertrand Aristide, a former Roman Catholic priest, was elected president. He was then ousted twice from power over the next 15 years.

Mr. Aristide preached liberation theology, and threatened the establishment by promising economic reforms. After a first coup, he was restored to power. But he left the presidency for good after a second coup in 2004, which was supported by the United States and France. He was exiled to the Central African Republic and, later, to South Africa.

Haiti, with a population of 11 million, is considered the poorest country in the Western Hemisphere.

In 2010, it suffered a devastating earthquake that claimed the lives of about 300,000 people. The country never really recovered, and it has remained mired in economic underdevelopment and insecurity. A cholera outbreak in 2016, linked to U.N. peacekeepers, killed at least 10,000 Haitians and sickened another 800,000.

Then early Wednesday, Jovenel Moïse, who became president in 2017, was assassinated at his residence.

A street market in Port-au-Prince, Haiti, last month.Credit…Joseph Odelyn/Associated Press

The assassination of President Jovenel Moïse of Haiti on Wednesday could complicate efforts to contain the Covid-19 pandemic in the Caribbean nation, which has yet to begin vaccinating its citizens, officials from the World Health Organization warned.

Carissa Etienne, the director of the Pan American Health Organization, which is part of the W.H.O., said her organization had made Haiti a priority in recent weeks as reported cases have surged.

“I am hopeful that the arrival of vaccines in the country can start to turn the tide of the pandemic and bring some relief to the Haitian people during these very difficult times,” Dr. Etienne said. “We continue to stand with them now and will redouble our efforts.”

Haiti did not experience the kind of surge early in the pandemic that many experts feared could devastate the country, the poorest in the Western Hemisphere. But the pandemic has grown worse in recent weeks, with a rise in reported cases that experts say is almost certainly an undercount, considering the country’s limited testing capacity.

Last month, Covid-19 claimed the life of René Sylvestre, the president of Haiti’s Supreme Court — a leading figure who might have helped to establish order in the wake of an assassination that has plunged the country into even deeper political uncertainty.

Dr. Etienne’s organization said in an email that while it was too soon to evaluate the impact of the assassination, “further deterioration of the security situation in Haiti could have a negative impact on the work that has been done to curtail Covid-19 infections,” as well as on vaccination plans.

VideoVideo player loadingPresident Jovenel Moïse of Haiti was killed in an attack at his private residence on the outskirts of the capital, Port-au-Prince.CreditCredit…Andres Martinez Casares/Reuters

The organization said that Haiti was also facing challenges from the start of hurricane season and the recent detection of the Alpha and Gamma virus variants on the island. Though “vaccines are expected to arrive shortly” in Haiti, the organization said it did not have a specific delivery date.

In June, Dr. Etienne urged the global community to do more to help Haiti cope with rising coronavirus cases and deaths. “The situation we’re seeing in Haiti is a cautionary tale in just how quickly things can change with this virus,” she said.

Haiti is an extreme example of the “stark inequities on vaccine access,” Dr. Etienne said. “For every success, there are several countries that have been unable to reach even the most vulnerable in their population.”

Across Latin America and the Caribbean, there are millions of people who “still don’t know when they will have a chance to be immunized,” she said.

She said the inequitable distribution of vaccines posed practical and moral problems.

“If we don’t ensure that countries in the South have the ability to vaccinate as much as countries in the North, this virus will keep circulating in the poorest nations for years to come,” Dr. Etienne said. “Hundreds of millions will remain at risk while the wealthier nations go back to normal. Obviously, this should not happen.”

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Health

U.S. heading for ‘harmful fall’ with surge in delta Covid instances and return of indoor masks mandates

People wearing protective masks shop at a Walmart store in Hallandale Beach, Florida on May 18, 2021.

Joe Raedle | Getty Images

With the highly transmittable Delta-Covid variant continuing to spread rapidly in the United States and elsewhere around the world, scientists and other health experts are warning that indoor mask regulations and other public health measures in the US are likely to return this fall.

The country, which just celebrated July 4th with some of its first major gatherings in more than a year, is heading for a “dangerous” fall season, with Delta expected to cause another surge in new coronavirus cases, health experts say. Delta is already the predominant variant in the US and will hit the states with the lowest vaccination rates the hardest – unless those states and companies reintroduce mask rules, capacity limits, and other public health measures, which they largely withdrew in recent months have, say experts.

With new mutations discovered every few weeks, many scientists are now predicting that Covid will circulate around the world for at least the next two to three years, obliging nations to adopt ad hoc public health measures for the foreseeable future. Authorities in Australia, South Africa and Asia recently reinstated curfews or other measures to contain rising delta outbreaks. Japan has just declared a coronavirus emergency in Tokyo and banned spectators from the Olympic Games. High vaccination rates in the US and the warm summer months have bought the country a little more time, but outbreaks around the world are giving Americans a preview of what could come this fall.

Health workers chats near an ambulance in the parking lot of the Steve Biko Academic Hospital amid a coronavirus disease (COVID-19) nationwide lockdown in Pretoria, South Africa, Jan. 11, 2021.

Siphiwe Sibeko | Reuters

“I could foresee that in certain parts of the country mask requirements, distance and occupancy restrictions for indoor areas would be reintroduced in the coming months,” said Lawrence Gostin, director of the World Health Organization’s Cooperation Center for National and Global Health Law.

He fears there will be “major outbreaks” in the US this fall, especially in states with low vaccination rates.

“We are heading for a very dangerous fall, with large parts of the country still unvaccinated, a swelling Delta variant and people taking off their masks,” added Gostin.

The warning from scientists and other health professionals comes as many U.S. companies and offices have largely phased out mask requirements, social distancing, and other pandemic-related restrictions.

Almost immediately after the Centers for Disease Control and Prevention declared in mid-May that fully vaccinated people would not need to wear masks in most indoor spaces, Walmart and Costco followed suit, allowing fully vaccinated customers and employees without state or local laws. Similarly, the Detroit automakers and the United Auto Workers union agreed late last month to make face masks optional for fully vaccinated employees.

A General Motors assembly worker loads engine block castings onto the assembly line at the GM Romulus Powertrain plant in Romulus, Michigan, the United States, August 21, 2019.

Rebecca Cook | Reuters

Other companies like Apple and Amazon are urging most of their employees to return to the office in some capacity this fall as more Americans get vaccinated against the virus. Goldman Sachs employees returned to the office last month, while Citigroup and JPMorgan expect their employees to return on a rotation basis this month.

Confirmed Covid infections in the US have dropped to their lowest level since the pandemic began, averaging about 15,000 new cases per day for the past seven days from a high of about 251,000 average new cases per day in January, according to Johns Hopkins University. Hospital stays and deaths have also declined, with Covid deaths averaging around 225 per day – up from a high of an average of more than 3,400 deaths per day in January.

Should daily Covid cases pick up again in the fall, as expected by health professionals, some employers in states with low Covid vaccination rates may face the difficult decision to make public health measures such as wearing masks and social distancing capacities to reintroduce limits or send office workers home entirely.

There will be “two Americas,” said Dr. Paul Offit, a pediatrician and vaccine advocate who served on advisory boards for both the Centers for Disease Control and Prevention and the Food and Drug Administration. “There’s vaccinated America and unvaccinated America, and I think unvaccinated America will pay a price for that.”

There are about 1,000 counties in the U.S. with a Covid vaccination rate of less than 30%, mostly located in the Southeast and Midwest, said CDC Director Dr. Rochelle Walensky recently. In these areas, the authority already sees increasing infection rates due to the further spread of the delta variant.

This has led some state and local health authorities to reintroduce previously abandoned public health measures.

Patricia Cole receives a shot of the Moderna Covid-19 vaccination from a medical worker at a pop-up clinic operated by the Delta Health Center in that rural Delta community on April 27, 2021 in Hollandale, Mississippi.

Spencer Platt | Getty Images

For example, in Mississippi, where less than a third of the state’s eligible population is fully vaccinated, officials last week recommended that all residents continue to wear masks indoors as Delta becomes the predominant variety in the state. About 96% of the new Covid cases in Mississippi are unvaccinated, state health officials said when they called reporters.

White House senior medical advisor Dr. Anthony Fauci said that people in states like Mississippi, where transmission are high and vaccinations are low, may want to consider wearing masks even if they are fully vaccinated.

“Depending on your personal situation, that could be,” said Fauci in an interview that was held on Friday with SiriusXM’s “Doctor Radio Reports” with Dr. Marc Siegel is to be broadcast. “For example, someone who is an elderly person who may not have full robust protection even though the protection is very, very high, or someone with an underlying medical condition,” still wants to wear a mask, he said.

Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases at the National Institutes of Health (NIH) testifies ahead of a Senate hearing on Health, Education, Labor and Pensions to receive an update from federal officials on efforts to fight COVID 19 to be examined in the Dirksen Senate Office Building on May 11, 2021 in Washington, DC.

Jim Lo Scalzo | Getty Images

Officials in Los Angeles County, California last week also recommended that “everyone, regardless of vaccination status,” wear masks as a precaution in public places indoors.

Offit, who advises the FDA on Covid vaccines, said he expected several more states to reintroduce indoor mask requirements this fall.

The United States is still “undervaccinated” and states with low vaccination rates are likely to be hit the worst, Offit said. Less than half of the United States, about 158 ​​million people, have been fully vaccinated, with more than a dozen states having fully immunized less than 40% of their population, according to CDC data. In Texas, the second most populous state after California, only 42% of residents are fully vaccinated, the data shows.

Even people who are fully protected have cause for concern when it comes to variants of Covid, Offit said. While the vaccines are good at protecting against serious illness and death, they may not protect as well against minor illness or the spread of Covid to others, he said. No vaccine is 100% effective, he noted.

“It is not a bold prediction to believe that SARS-CoV-2 will be circulating in two or three years. I mean, there are 195 countries out there, most of which haven’t received a single dose of vaccine. ”“ Offit said. “Will it still be circulating in the United States? I think that would be very, very likely.”

Dr. Christopher JL Murray, director of the Institute for Health Metrics and Evaluation, agreed that more states will need to re-implement mask mandates this fall. More vulnerable Americans may even have to wear masks every year during the peak covid and flu transmission season: November through April, he said. However, he noted that getting some Americans to wear face covers could be difficult now that the pandemic has subsided.

“Given the pandemic fatigue, getting most Americans to follow guidelines on mask use and social distancing will be more difficult. As cases and hospitalizations pick up again, maybe not until fall or winter, it might be easier to convince some. ” Take steps to be careful, “he said.

People crowd to eat at an outdoor restaurant as coronavirus disease (COVID-19) restrictions are eased on April 4, 2021 in Ann Arbor, Michigan, United States.

Emily Elconin | Reuters

Dr. Vin Gupta, a Harvard-trained lung specialist and NBC employee, said mask requirements should be reintroduced this fall, but should be enforced at the local level and with Covid vaccination rates and transmissions depending on events in the surrounding community.

“There has to be some specifics and multiple local jurisdictions have to make their own decisions, especially when the seasons shift and get back into cold, dry air,” he said.

Meanwhile, the federal government’s mask mandate for public transportation, including airplanes, commuter buses, and rail systems, is set to expire on September 13, unless the CDC renews it.

Whether the CDC does this is an open question, scientists said. Walensky and the White House have both advised there is no desire to reinstate the lockdowns and will leave much of the decisions about public health measures to the states.

“A lot of it isn’t science. It’s political science,” said Dr. Isaac Bogoch, professor of infectious diseases at the University of Toronto. “If you have a high rate of Covid-19 transmission in the community and you have a high rate of unvaccinated people, then from a scientific point of view it makes sense to mask indoor spaces. Whether or not this will go into policy is another question. “

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Politics

Tony Podesta Weighs Return to Lobbying and Democratic Politics

Although Mr Podesta’s law firm had disclosed to clients under less detailed lobbying rules of Congress and retrospectively registered with the Justice Department, this did not prevent the special investigator’s office from accessing the records and staff of his law firm and others who had worked with Mr Manafort, summons Mr. Gates.

Mr Podesta questioned the motives and methods behind the special investigator’s investigation. He referred to one of the lead prosecutors in the investigation, Andrew Weismann, as “Inspector Javert,” the police figure at Les Misérables obsessed with ensuring the arrest and punishment of a probation officer convicted of stealing bread to feed his family.

“I didn’t even steal a loaf of bread,” said Podesta, claiming that it was at least partially targeted because the special investigator “clearly thought it was a good idea to have a Democrat”.

Mr Podesta said his firm’s finances were few and far between, partly because it paid up to $ 5 million in legal fees for employees summoned by prosecutors and partly because the investigation frightened customers who were leaving the company.

Mr. Manafort and Mr. Gates were charged in October 2017 with unregistered foreign lobbying, tax fraud and other crimes. The indictment identified the Podesta Group and a company it worked with on the Ukraine effort, Mercury Public Affairs, but not by name. worked as part of a “scheme” with Mr. Manafort and Mr. Gates to gain support for Mr. Yanukovych while circumventing disclosure requirements for foreign lobbyists.

Within one day, the Podesta Group’s bank terminated its line of credit, citing the special investigator’s investigation and the emptying of the company’s accounts to pay employees’ legal fees, rendering the company illiquid, Podesta said.

He told employees at a staff meeting that he was stepping down from the company and cited attacks by Mr. Trump and his allies in the conservative media who, according to those in attendance, “made it impossible to run a public affairs store.”