As a Black trans woman, Elle Halo has experienced sexual violence from partners, family, people she called her friends, and people in the community throughout her life. 

Most of the assaults were by people Halo, 34, knew and trusted. 

When asked if she feels safe, the LGBTQIA+ advocate said: “I never feel safe. Most trans people of color never feel safe.” 

Isolation is a crucial contributor to violence, and too often, people in the trans community feel like they have no safe place to go or anyone to turn to. 

“When you are isolated and poor, you don’t have many options, and that’s when you are willing to accept things that compromise your safety,” Halo said. 

Transgender people are four times more likely than cisgender people to experience violence. Still, Halo said the numbers fail to tell the complete story of violence, rape, sexual assaults, aggravated and simple assaults that go unreported or underreported against the Black trans community. 

While the news doesn’t talk much about the sexual assaults transgender people experience, the media does report on transgender deaths.

But that’s where Halo has a problem. When it comes to telling stories about trans people of color, the media struggles to see “trans people as people.”  

“We are more than just an obituary. We have lives, too. We come from families. We have friends who care about us, but those stories are never told,” Halo said. 

By mainly focusing on the death of trans people and not telling fuller stories about trans people, Halo said the media creates a trust problem. 

What Halo is referring to is what many African Americans and other communities of color say is a larger problem with the media. Journalists “helicopter” in when something terrible happens, like the death of a trans woman, tell the narrow story of the death, then leave. This approach offers no solution to the violence and transphobia, and does little to help people understand the community enduring — but not defined by — a given tragedy. 

Even in death, Halo said, the media often causes harm to family and friends when the person is misgendered after death. 

“When the media misidentifies a trans woman or man in death, what it says to our community is that we don’t matter,” Halo said. 

As journalists, we must incorporate transgender people into our health reporting, and tell more complete stories about them as well. While we will continue to report on transgender people who are killed, we also need to tell stories of other disparities the trans community faces: homelessness, unemployment, discrimination, and the unjust treatment they often meet when seeking help from law enforcement.  

Many transgender people are bullied 

In November, a Milwaukee man was charged in the killing death of Chyna Long, a black transgender woman. 

Chyna, 31, is the fourth identified Black transgender woman to die by homicide in Milwaukee since June 2022.  

Antonio S. Currin allegedly shot and killed Long the morning of Oct. 8. According to the criminal complaint, Currin was seen standing outside a car talking to someone in the vehicle when a series of gunshots were heard. When police arrived at the scene, they found Chyna lying in the street with several gunshot wounds. She died at the scene.

No motive was given for the shooting. Currin is a convicted felon and should not have had a gun.

Chyna, a resident of Chicago, was visiting Milwaukee to provide comfort to her father, Jonathan Long, who was dealing with the death of his brother.

Jonathan said Chyna told him she was gay at the age of 18. By 23, Chyna identified as transgender.   

Jonathan said he knew his child, born Jaquez Long in March 1992, was queer at an early age.   

When Jaquez said he wanted to be referred to as Chyna, Jonathan said instead of being upset, he educated himself on the trans community so his child could live her best life. 

Jonathan said his daughter shared his sense of humor, loved dancing, and had many of his traits. He described her as hilarious and a gifted dancer.  

Growing up was difficult for Chyna. She was bullied in school, called homophobic slurs, and often forced to fight to defend herself. People even threw trash at her out of their cars. Once, when Chyna fell asleep on a train in Chicago, she woke up to men urinating on her.  

The violence and transphobia against trans people is at a crisis level, according to a 2021 study in the American Journal of Public Health. Transgender people aged 16 or over are victimized over four times more often than cisgender people, the study found. One in four transgender women who were victimized thought the incident was a hate crime, compared to less than one in 10 cisgender women. And these numbers are almost certainly an undercount, since half of all violent victimizations were not reported to police. 

“The results underscore the urgent need for effective policies and interventions that consider high rates of victimization experienced by transgender people,” said IIan H. Meyer, the study’s author. 

Most trans deaths in 2022 were people of color 

Halo said no matter how bad the numbers are for the trans community when it comes to violent crime and health disparities, the numbers are worse if you are Black. 

In 2022, a record 41 transgender people were shot or killed nationwide, according to the Human Rights Campaign, a gay rights advocacy group. 

The disparity is stark: Of the 41 transgender people killed in 2022, 83% were people of color, and 54% were Black transgender women. 

Transgender people, and particularly trans women of color, are disproportionately affected by hate, and they don’t go to the police or family members because of stigma.  

Halo said reporters can play a vital role in reducing stigma. 

“There are a lot of stereotypes out there about trans women that are perpetuated by the media,” Halo said. 

For years, transsexual people have been stereotyped as being “mentally ill” or “confused” about their sexuality. Trans women have been objectified as sex workers or only looking for sex. As a result, they are far more likely to be victims or sexual assault and rape. 

 Halo is working to change these stereotypical images. She is a member of SHEBA (Sisters Helping Each Other Battle Aids), a group of 20 African American transgender women that seeks to battle the isolation the women often face. 

“If you are isolated from your family and friends, and you know you can’t turn to the police because they may not believe you were the victim of abuse, who do you turn to?” Halo asked. 

The Human Rights Campaign report “An Epidemic of Violence 2021” found that between 2013 and 2021, nearly two-thirds of transgender and gender non-conforming people with known killers had their lives taken by an acquaintance, friend, family member, or intimate partner. Intimate partners specifically accounted for over a fifth of all known perpetrators — and this may likely be an undercount.  

Halo also warned people against believing that most of the violence against transgender people comes from a result of trans people lying about who they are or trying to “fool” a man.  

“Most of the men who date or go out with a trans woman know who he is going out with,” she said. 

There are ways to include the trans community in news coverage 

Journalists and media organizations should have beat reporters covering the gay community in the same way most cover crime, politics, government, business, and sports, Halo said. 

While having a dedicated reporter to cover the gay community might be difficult for most news organizations due to our dwindling staff numbers, other things can be done to increase gay and trans visibility in the news.  

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WASHINGTON (AP) — COVID-19 drove a dramatic increase in the number of women who died from pregnancy or childbirth complications in the U.S. last year, a crisis that has disproportionately claimed Black and Hispanic women as victims, according to a government report released Wednesday.

The report lays out grim trends across the country for expectant mothers and their newborn babies.

It finds that pregnancy-related deaths have spiked nearly 80% since 2018, with COVID-19 being a factor in a quarter of the 1,178 deaths reported last year. The percentage of preterm and low birthweight babies also went up last year, after holding steady for years. And more pregnant or postpartum women are reporting symptoms of depression.

“We were already in the middle of a crisis with maternal mortality in our country,” said Karen Tabb Dina, a maternal health researcher at the University of Illinois at Urbana-Champaign. “This really shows that COVID-19 has exacerbated that crisis to rates that we, as a country, are not able to handle.”

The nonpartisan U.S. Government Accountability Office, which authored the report, analyzed pregnancy-related deaths after Congress mandated that it review maternal health outcomes in the 2020 coronavirus relief bill.

The maternal death rate in the U.S. is higher than many other developed nations and had been on the rise in the years leading up to the pandemic, but COVID-19 has only worsened conditions here for pregnant women.

Women who contract the virus while pregnant face elevated health risks. Staffing shortages and COVID-19 restrictions created more hurdles for expecting mothers to get in-person health care; And pandemic stress has intensified depression, a common condition during pregnancy.

Mental health issues likely contributed to the increase in pregnancy-related deaths, Tabb Dina said. Many women who experience depression and anxiety during or after their pregnancy struggle to get the care they need.

“Mental health is the greatest complication in pregnancy that we don’t understand,” she said.

The biggest spike in deaths came during July through December of last year, as the COVID-19 delta variant infected millions, noted Carolyn Yocom, a director at the Government Accountability Office.

“It’s really clear from the data that the time in which the delta variant spread seemed to correspond to a huge increase in deaths,” Yocom said.

The maternal death rate is particularly stark for Black women, who have long faced worse maternal outcomes than their peers.

Pregnancy-related deaths for every 100,000 births climbed from 44 in 2019 to 68.9 among Black women last year. White women had death rates of 26.1 last year, a jump from 17.9 in 2019.

Death rates among Hispanics had been on the decline, but they swelled again during the pandemic from 12.6 per 100,000 in 2019 to 27.5 last year.

Black and Hispanic people have also died at higher rates from COVID-19, in part because they have less access to medical care and often work essential jobs that exposed them to the virus.

Long before COVID-19 began spreading, the stage was set for Black, low-income and rural women to receive subpar pregnancy care — putting them at further risk for their pregnancies to go wrong, according to a separate GAO report.

Hospitals have been shedding their obstetric services in rural areas, low-income and majority Black communities, that report said.

More than half of rural counties didn’t have a hospital offering pregnancy care as of 2018, the review found.

“The loss of hospital-based obstetric services in rural areas is associated with increases in out-of-hospital births and pre-term births, which may contribute to poor maternal and infant outcomes,” the report found.

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GENEVA (AP) — The head of the World Health Organization said Wednesday that the number of coronavirus deaths worldwide last week was the lowest reported in the pandemic since March 2020, marking what could be a turning point in the years-long global outbreak.

At a press briefing in Geneva, WHO Director-General Tedros Adhanom Ghebreyesus said the world has never been in a better position to stop COVID-19.

“We are not there yet, but the end is in sight,” he said, comparing the effort to that made by a marathon runner nearing the finish line. “Now is the worst time to stop running,” he said. “Now is the time to run harder and make sure we cross the line and reap all the rewards of our hard work.”

In its weekly report on the pandemic, the U.N. health agency said deaths fell by 22% in the past week, at just over 11,000 reported worldwide. There were 3.1 million new cases, a drop of 28%, continuing a weeks-long decline in the disease in every part of the world.

Still, the WHO warned that relaxed COVID testing and surveillance in many countries means that many cases are going unnoticed. The agency issued a set of policy briefs for governments to strengthen their efforts against the coronavirus ahead of the expected winter surge of COVID-19, warning that new variants could yet undo the progress made to date.

“If we don’t take this opportunity now, we run the risk of more variants, more deaths, more disruption, and more uncertainty,” Tedros said.

The WHO reported that the omicron subvariant BA.5 continues to dominate globally and comprised nearly 90% of virus samples shared with the world’s biggest public database. In recent weeks, regulatory authorities in Europe, the U.S. and elsewhere have cleared tweaked vaccines that target both the original coronavirus and later variants including BA.5.

Maria Van Kerkhove, the WHO’s technical lead on COVID-19, said the organization expected future waves of the disease, but was hopeful those would not cause many deaths.

Meanwhile in China, residents of a city in the country’s far western Xinjiang region have said they are experiencing hunger, forced quarantines and dwindling supplies of medicine and daily necessities after more than 40 days in a lockdown prompted by COVID-19.

Hundreds of posts from Ghulja riveted users of Chinese social media last week, with residents sharing videos of empty refrigerators, feverish children and people shouting from their windows.

On Monday, local police announced the arrests of six people for “spreading rumors” about the lockdown, including posts about a dead child and an alleged suicide, which they said “incited opposition” and “disrupted social order.”

Leaked directives from government offices show that workers are being ordered to avoid negative information and spread “positive energy” instead. One directed state media to film “smiling seniors” and “children having fun” in neighborhoods emerging from the lockdown.

The government has ordered mass testing and district lockdowns in cities across China in recent weeks, from Sanya on tropical Hainan island to southwest Chengdu, to the northern port city of Dalian.

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NEW YORK (AP) — An estimated 100,000 Americans died of drug overdoses in one year, a never-before-seen milestone that health officials say is tied to the COVID-19 pandemic and a more dangerous drug supply.

Overdose deaths have been rising for more than two decades, accelerated in the past two years and, according to new data posted Wednesday, jumped nearly 30% in the latest year.

President Joe Biden called it “a tragic milestone” in a statement, as administration officials pressed Congress to devote billions of dollars more to address the problem.

“This is unacceptable and it requites an unprecedented response,” said Dr. Rahul Gupta, director of National Drug Control Policy.

Experts believe the top drivers of overdose deaths are the growing prevalence of deadly fentanyl in the illicit drug supply and the COVID-19 pandemic, which left many drug users socially isolated and unable to get treatment or other support.

The number is “devastating,” said Katherine Keyes, a Columbia University expert on drug abuse issues. “It’s a magnitude of overdose death that we haven’t seen in this country.”

Drug overdoses now surpass deaths from car crashes, guns and even flu and pneumonia. The total is close to that for diabetes, the nation’s No. 7 cause of death.

Drawing from the latest available death certificate data, the Centers for Disease Control and Prevention estimated that 100,300 Americans died of drug overdoses from May 2020 to April 2021. It’s not an official count. It can take many months for death investigations involving drug fatalities to become final, so the agency made the estimate based on 98,000 reports it has received so far.

The CDC previously reported there were about 93,000 overdose deaths in 2020, the highest number recorded in a calendar year. Robert Anderson, the CDC’s chief of mortality statistics, said the 2021 tally is likely to surpass 100,000.

“2021 is going to be terrible,” agreed Dr. Daniel Ciccarone, a drug policy expert at the University of California, San Francisco.

The new data shows many of the deaths involve illicit fentanyl, a highly lethal opioid that five years ago surpassed heroin as the type of drug involved in the most overdose deaths. Dealers have mixed fentanyl with other drugs — one reason that deaths from methamphetamines and cocaine also are rising.

Drug cartels in Mexico are using chemicals from China to mass produce and distribute fentanyl and meth across America, said Anne Milgram, administrator of the Drug Enforcement Administration.

This year, the DEA has seized 12,000 pounds of fentanyl, a record amount, Milgram said. But public health experts and even police officials say that law enforcement measures will not stop the epidemic, and more needs to be done to dampen demand and prevent deaths.

The CDC has not yet calculated racial and ethnic breakdowns of the overdose victims.

It found the estimated death toll rose in all but four states — Delaware, New Hampshire, New Jersey and South Dakota — compared with the same period a year earlier. The states with largest increases were Vermont (70%), West Virginia (62%) and Kentucky (55%).

Minnesota saw an increase of about 39%, with estimated overdose deaths rising to 1,188 in May 2020 through April 2021 from 858 in the previous 12-month period.

The area around the city of Mankato has seen its count of overdose deaths rise from two in 2019, to six last year to 16 so far this year, said police Lt. Jeff Wersal, who leads a regional drug task force.

“I honestly don’t see it getting better, not soon,” he said.

Among the year’s victims was Travis Gustavson, who died in February at the age of 21 in Mankato. His blood was found to show signs of fentanyl, heroin, marijuana and the sedative Xanax, Wersal said.

Gustavson was close to his mother, two brothers and the rest of his family, said his grandmother, Nancy Sack.

He was known for his easy smile, she said. “He could be crying when he was a little guy, but if someone smiled at him, he immediately stopped crying and smiled back,” she recalled.

Gustavson first tried drugs as kid and had been to drug treatment as a teenager, Sack said. He struggled with anxiety and depression, but mainly used marijuana and different kinds of pills, she said.

The morning of the day he died, Travis had a tooth pulled, but he wasn’t prescribed strong painkillers because of his drug history, Sack said. He told his mother he would just stay home and ride out the pain with ibuprofen. He was expecting a visit from his girlfriend that night to watch a movie, she said.

But Gustavson contacted Max Leo Miller, also 21, who provided him a bag containing heroin and fentanyl, according to police.

Some details of what happened are in dispute, but all accounts suggest Gustavson was new to heroin and fentanyl.

Police say Gustavson and Miller exchanged messages on social media. At one point, Gustavson sent a photo of a line of a white substance on a brown table and asked if he was taking the right amount and then wrote “Or bigger?”

According to a police report, Miller responded: “Smaller bro” and “Be careful plz!”

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UNDATED — The resurgence of COVID-19 this summer and the national debate over vaccine requirements have created a fraught situation for the United States’ first responders, who are dying in larger numbers but pushing back against mandates.

It’s a stark contrast from the beginning of the vaccine rollout when first responders were prioritized for shots.

The mandates affect tens of thousands of police officers, firefighters and others on the front lines across the country, many of whom are spurning the vaccine. That is happening despite mandates’ consequences that range from weekly testing to suspension to termination — even though the virus is now the leading cause of U.S. law enforcement line-of-duty deaths.

According to the Officer Down Memorial Page, 132 members of law enforcement agencies are known to have died of COVID-19 in 2021. In Florida alone last month, six people affiliated with law enforcement died over a 10-day period.

Despite the deaths, police officers and other first responders are among those most hesitant to get the vaccine and their cases continue to grow. No national statistics show the vaccination rate for America’s entire population of first responders but individual police and fire departments across the country report figures far below the national rate of 74% of adults who have had at least one dose.

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MORE ON THE PANDEMIC:

— European Union regulator pondering whether to recommend Pfizer booster shots for 16 and older

— Two anchors of COVID safety net ending, affecting millions in US

— Volunteers help poorest survive Thailand’s worst COVID surge yet

— Hospitals in crisis in Mississippi, the least-vaccinated US state

— Want to attend Hamilton? Not unless you meet virus protocols

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— Find more AP coverage at https://apnews.com/hub/coronavirus-pandemic and https://apnews.com/hub/coronvirus-vaccine

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HERE’S WHAT ELSE IS HAPPENING:

AMSTERDAM — The European Medicines Agency says it has started an expedited evaluation on whether to recommend use of a booster dose of the coronavirus vaccine made by Pfizer-BioNTech.

In a statement Monday, the EU drug regulator says it is considering whether a third dose of the vaccine should be given six months after people over age 16 have received two doses “to restore protection after it has waned.”

EMA’s experts are carrying out an “accelerated assessment” of data submitted by Pfizer and BioNTech, including results from an ongoing research trial in which about 300 healthy adults received a booster dose about six months after their second dose.

Pfizer has already submitted an application to the U.S. Food and Drug Administer for authorization of a third dose and the U.S. government said last month boosters would likely be available in late September. Israel has already started administering booster doses and the plan is under consideration in other countries for vulnerable populations, including France and Germany.

The Amsterdam-based agency said it expects to make a decision in the next few weeks.

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DETROIT — Five federal courthouses in eastern Michigan will fully reopen Tuesday for the first time since COVID-19 restrictions were put in place in March 2020.

Lawyers, news reporters, jurors and court spectators will be required to answer questions about their health and have their temperature checked at courthouse entrances. Masks will be required.

Courthouse employees who have not been vaccinated will be required to share the results of two weekly COVID-19 tests at their own expense.

“The court is doing everything in its power to make sure that everyone who uses our facilities are protected,” said Chief U.S. District Judge Denise Page Hood.

The main courthouse is in downtown Detroit, but there are other federal courthouses in Flint, Bay City, Ann Arbor and Port Huron. Remote video access will be provided for some hearings in civil lawsuits. But nearly all criminal cases will be conducted in person at the courthouses.

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SANTIAGO, Chile — Chile’s Public Health Institute has approved the Chinese-developed Sinovac COVID-19 vaccine for children older than 6, though the health minister must approve the plan before shots enter arms.

The panel of senior physicians, including presidents of the associations of pediatrics and infectology, analyzed a Chinese study of 500 children aged 3 to 17, all of whom produced antibodies. A similar study of 4,000 children is being organized in Chile.

Brazil’s health regulatory agency, however, recently rejected a similar request by Sinovac, and asked for data involving a larger study.

Chile already had authorized vaccinations for children as young as 12, though only with the Pfizer vaccine. Supply shortages have stalled that effort.

Chilean officials plan to vaccinate 15.2 million of the country’s 19 million people. So far they have given a full double dose regimen to 86% of those now eligible. The country last month also began giving AstraZeneca booster shots to fully vaccinated people people older than 55.

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ROME — Life expectancy for men in some of Italy’s worst-hit provinces in the pandemic dropped by more than four years.

ISTAT, Italy’s national statistics bureau, in a report on Monday said that compared with 2019, nationwide life expectancy for those born in 2020 dropped by 1.2 years.

“In 2020, the spread of the COVID-19 pandemic and the sharp increase in the risk of mortality that derived from it abruptly interrupted the increase of life expectancy at birth that had marked a trend up to 2019,” ISTAT said.

The pandemic first erupted outside Asia in northern Italy, and much of the north reeled with confirmed COVID-19 deaths in the initial wave of cases. In the northern provinces of Bergamo, Cremona and Lodi, life expectancy for men decreased by some 4.3 to 4.5 years. For women in those provinces, the reduced expectancy ranged from 3.2 to 2.9 years.

For a child born in 2020, male life expectancy nationwide is 79.7 and female life expectancy is 84.4, ISTAT said.

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PHOENIX — A program announced by Arizona’s Republican governor last month giving private school vouchers to students whose parents object to school mask requirements has seen a surge of applications.

More than 2,700 applications have been started or completed in less than two weeks. That’s twice as many as can be funded with the $10 million in federal coronavirus relief cash earmarked for the program.

Gov. Doug Ducey’s plan will give $7,000 a year to each student to pay for private school tuition.

School voucher opponents worry they will permanently get vouchers and some Republican lawmakers say they hope that’s the case.

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ROME — Italy’s health minister says a two-day meeting of his G-20 counterparts yielded resolve to help poor nations obtain more COVID-19 vaccines.

Minister Roberto Speranza told reporters in Rome on Monday that achieving that includes vaccine production in less developed nations. The goal is “to bring vaccines to every corner of the world,” said Speranza. He described the meeting’s unanimous final document as a “departure point.”

Stronger nations, starting with the G-20, are committing to more resources and to sending vaccines to the more vulnerable countries, he said, adding that efforts like COVAX need to be strengthened.

“We want to build on conditions so that production can be brought to the countries. It’s not enough merely to transfer doses,” Speranza said.

COVAX is an international mechanism created in part to share vaccines so that poorer wouldn’t have to rely on donations. But in some cases, wealthy nations have received doses through COVAX.

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COPENHAGEN, Denmark — Danish health authorities say they are offering jabs in supermarkets as they are aware of differences in the vaccination pattern even though more than 80% of people over 12 have had two shots of vaccine.

”It is especially young people who have not received the first jab,” said Soeren Brostroem, head of the Danish Health Agency.”

On Saturday, vaccines will be offered in two of Denmark’s largest supermarket chains, Bilka and Foetex, No appointments are needed.

“We want to ensure that the offer of vaccination is as accessible as possible, so that, for example, it is possible to get a shot while shopping,” Brostroem said, adding there are many young people working in retail.

Denmark has a target of reaching 90% of people above the age of 12 by Oct. 1.

As of Sept. 10, the digital pass — a proof of vaccination or a negative test which was required to enter nightclubs — becomes the last COVID-19 safeguard to fall.

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PRISTINA, Kosovo — Kosovo’s Health Ministry said it has received half a million Pfizer vaccines Monday sent from the United States.

Kosovo’s 1.8 million people have faced a surge in new infections during the last month. On Monday there were 28 deaths and 489 new cases.

The ministry said it had received 503,100 Pfizer shots from the United States through the COVAX program. It strongly called on people older than 16 years old to take the jabs as the only way to prevent further spread of the coronavirus.

About 17% of Kosovo’s people have gotten both shots of the vaccine so far.

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SEOUL, South Korea — South Korea’s daily increase in coronavirus infections has exceeded 1,000 for the 62nd consecutive day as officials are raising concerns about another viral spike during this month’s Chuseok holidays, the Korean version of Thanksgiving.

The Korea Disease Control and Prevention Agency said more than 940 of the 1,375 new cases reported Monday were from Seoul and the nearby metropolitan region, where a rise in infections have been linked to the reopening of schools and people returning from summer vacations.

While the virus has slowed outside the capital area in recent weeks, KDCA official Kim Ki-nam said transmissions could worsen nationwide during the Chuseok break, which starts on Sept. 20, a time when millions usually travel across the country to meet relatives.

Officials are enforcing the country’s strongest social distancing rules in the greater capital area, where private social gatherings of three or more are banned after 6 p.m. unless all are fully vaccinated.

A slow vaccine rollout has left less than 35% of South Koreans fully vaccinated as of Monday.

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HANOI — About 23 million Vietnamese students have started a new school year, most of them in virtual classrooms, amid a COVID-19 lockdown to contain a virus surge in the country.

Since April, when the latest wave of the virus spread in the country, Vietnam closed down schools and education institutes in pandemic areas and move learning activities to online platforms.

Millions of students spent their summer break at home as more than half of the country is in lockdown. In hard-hit provinces, schools have been converted into quarantine facilities and field hospitals.

In Ho Chi Minh city, the epicenter of Vietnam’s worst virus outbreak, teachers and students observed a minute of silence to pay tribute to those who died of COVID-19 and honor front-liners before opening classes Monday.

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WELLINGTON, New Zealand — Most of New Zealand will move out of lockdown Tuesday except for the largest city of Auckland, which will remain in the strictest type of lockdown until at least next week, the government announced Monday.

The nation has been battling an outbreak of the delta variant of the coronavirus since last month. All recent cases have been found in Auckland, including 20 that were found on Monday.

There have been a total of 821 cases found in the outbreak. The government is pursuing an unusual strategy of trying to eliminate the virus entirely.

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JERUSALEM — Israel says it will soon reopen its gates to foreign tour groups — even as it battles one of the world’s highest rates of coronavirus infections.

The country’s Tourism Ministry on Sunday said it will begin allowing organized tour groups into the country beginning Sept. 19.

Tourists will have to be vaccinated against the coronavirus, present a negative PCR test before their flight and undergo both PCR and serological testing upon arrival. Visitors would have to quarantine in their hotels until the test results come back — a process expected to take no more than 24 hours.

Tourists from a handful of “red” countries with high infection rates — including Turkey and Brazil — will not be permitted to visit for the time being.

Israel launched a similar program in May after vaccinating most of its population early this year. But the program was suspended in August as the delta variant began to spread.

In recent weeks, the country has begun administering booster shots to anyone who was vaccinated over five months ago.

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WASHINGTON (AP) — Deaths among Medicare patients in nursing homes soared by 32% last year, with two devastating spikes eight months apart, a government watchdog reported Tuesday in the most comprehensive look yet at the ravages of COVID-19 among its most vulnerable victims.

The report from the inspector general of the Department of Health and Human Services found that about 4 in 10 Medicare recipients in nursing homes had or likely had COVID-19 in 2020, and that deaths overall jumped by 169,291 from the previous year, before the coronavirus appeared.

“We knew this was going to be bad, but I don’t think even those of us who work in this area thought it was going to be this bad,” said Harvard health policy professor David Grabowski, a nationally recognized expert on long-term care, who reviewed the report for The Associated Press.

“This was not individuals who were going to die anyway,” Grabowski added. “We are talking about a really big number of excess deaths.”

Investigators used a generally accepted method of estimating “excess” deaths in a group of people after a calamitous event. It did not involve examining individual death certificates of Medicare patients but comparing overall deaths among those in nursing homes to levels recorded the previous year. The technique was used to estimate deaths in Puerto Rico after Hurricane Maria in 2017 and in New York City after the first coronavirus surge last spring. It does not attribute a cause of death but is seen as a barometer of impact.

Death rates were higher in every month last year when compared with 2019. The report documented two spikes with particular implications for government policy and for protecting the most vulnerable in future outbreaks of life-threatening illnesses. In April of last year, a total of 81,484 Medicare patients in nursing homes died. Then eight months later, after lockdowns and frantic efforts to expand testing — but before vaccines became widely available — nursing home patients accounted for a staggering 74,299 deaths in December.

“This is happening long after it was clear that nursing homes were particularly vulnerable,” said Nancy Harrison, a deputy regional inspector general who worked on the report. “We really have to look at that. Why did they remain so vulnerable?” Federal investigators are still drilling down to try to document the chain of causes and effects.

Responding to the report, the Centers for Medicare and Medicaid Services said that nearly 80% of nursing home residents and more than 55% of staff are now vaccinated, and the agency is working to protect health and safety. CMS sets standards for nursing homes.

The two main nursing industry groups, the American Health Care Association and LeadingAge, said the grim statistics reflect the consequences of society and government not placing a high enough priority on the needs of frail elders. That “showed once again how ageism can result in policies that treat older people as expendable,” said Katie Smith Sloan, president of LeadingAge, which represents nonprofit homes.

Tuesday’s report was the most comprehensive yet from the government because it included statistics for the early part of last year, during the initial coronavirus surge. Medicare did not require nursing homes to report COVID-19 cases and deaths occurring before May 8, more than four months into the pandemic year.

In another new finding, the report showed that cases and deaths among Asian American patients tracked with the more severe impacts seen among Blacks and Latinos. Indeed, Asian Medicare enrollees in nursing homes saw the highest increase in death rates, with 27% dying in 2020 compared to 17% the previous year. For whites, the death rate grew to 24% in 2020 from 18% in 2019, a significant increase but not as pronounced.

Death rates for Hispanic and Black patients were 23% last year, up from 15% in 2019.

The inspector general’s office based its analysis on Medicare billing data. It also included patients in Medicare Advantage plans sold by private insurers. Although Medicare does not cover long-term care, the vast majority of nursing home patients are elderly, and Medicare does cover their medical needs. The report included both patients who live in nursing homes as well as those temporarily at a facility for rehabilitation.

Health economist Tamara Konetzka of the University of Chicago, who also reviewed the report for AP, said building an estimate from individual death certificates would have faced another set of challenges. Especially in the first wave of the pandemic, many who died would not necessarily have been tested for COVID-19, for example.

“By looking at excess deaths you can get away from some of the measurement issues and say how much worse things were in 2020 than in 2019,” explained Konetzka, who has testified before Congress on the impact of COVID-19 in nursing homes.

The inspector general’s findings about Asians highlight a riddle for researchers, said Konetzka. The reasons for higher cases and deaths among Blacks, Hispanics and Asians may not necessarily be tied to race and ethnicity. Instead, minority patients may be clustered in homes located in communities with more severe outbreaks.

The report also found that low-income nursing home patients covered by Medicare and Medicaid together were much more likely to have gotten COVID-19. The infection rate for that group reached 56%, and 26% died.

Some states suffered worse impacts. By the end of December more than half of the Medicare patients in nursing homes in Connecticut, Illinois, Louisiana and New Jersey had or likely had COVID-19.

Although nursing homes locked down in March of last year, government efforts to help were haphazard. The industry complained of chronic shortages of protective gear, including basics like masks and gowns.

The Trump administration initially delegated responsibility for testing to states before belatedly marshaling more federal resources. HHS later laid the groundwork for vaccinations under the Trump administration, and the Biden administration followed through. As vaccination rates rose, nursing home cases plummeted, allowing facilities to again permit family visits.

The country can’t move on yet, said deputy inspector general Harrison. “Hopefully, COVID will go away,” she said. “But once that happens, there will always be infectious diseases, and we all need to ask ourselves what we can do to protect vulnerable nursing home residents going forward.”

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NEW YORK (AP) — Coronavirus deaths are rising in nearly two-thirds of American states as a winter surge pushes the overall toll toward 400,000 amid warnings that a new, highly contagious variant is taking hold.

As Americans observed a national holiday Monday, New York Gov. Andrew Cuomo pleaded with federal authorities to curtail travel from countries where new variants are spreading.

Referring to new versions detected in Britain, South Africa and Brazil, Cuomo said: “Stop those people from coming here…. Why are you allowing people to fly into this country and then it’s too late?”

The U.S. government has already curbed travel from some of the places where the new variants are spreading — such as Britain and Brazil — and recently it announced that it would require proof of a negative COVID-19 test for anyone flying into the country.

But the new variant seen in Britain is already spreading in the U.S., and the Centers for Disease Control and Protection has warned that it will probably become the dominant version in the country by March. The CDC said the variant is about 50% more contagious than the virus that is causing the bulk of cases in the U.S.

While the variant does not cause more severe illness, it can cause more hospitalizations and deaths simply because it spreads more easily. In Britain, it has aggravated a severe outbreak that has swamped hospitals, and it has been blamed for sharp leaps in cases in some other European countries.

As things stand, many U.S. states are already under tremendous strain. The seven-day rolling average of daily deaths is rising in 30 states and the District of Columbia, and on Monday the U.S. death toll surpassed 398,000, according to data collected by Johns Hopkins University — by far the highest recorded death toll of any country in the world.

Ellie Murray, an assistant professor of epidemiology at the Boston University School of Public Health, said cases have proliferated in part because of gatherings for Christmas and New Year — and compounded previous surges from Thanksgiving and the return of students to schools and universities in the fall.

The pace of any further spread will depend on whether those who did gather with family and friends quarantined afterward or went back to school or work in person, she said.

One of the states hardest hit during the recent surge is Arizona, where the rolling average has risen over the past two weeks from about 90 deaths per day to about 160 per day on Jan. 17.

“It’s kind of hard to imagine it getting a lot faster than it is right now, because it is transmitting really fast right now,” said Dr. Joshua LaBaer, director of the Biodesign Institute research center at Arizona State University. “But there is some evidence that Thanksgiving didn’t help things.”

Rural Yuma County — known as the winter lettuce capital of the U.S. — is now one of the state’s hot spots. Exhausted nurses there are now regularly sending COVID-19 patients on a long helicopter ride to hospitals in Phoenix when they don’t have enough staff. The county has lagged on coronavirus testing in heavily Hispanic neighborhoods and just ran out of vaccines.

But some support is coming from military nurses and a new wave of free tests for farmworkers and the elderly in Yuma County.

Amid the rise in cases, a vast effort is underway to get Americans vaccinated — what Cuomo called “a footrace” between the vaccination rate and the infection rate. But the campaign is off to an uneven start. According to the latest federal data, about 31.2 million doses of vaccine have been distributed, but only about 10.6 million people have received at least one dose.

In some cases, vaccine supplies thus far do not meet demand. More than 172,000 people in Missouri’s St. Louis County have registered for the vaccine, but the local health department so far has only received 975 doses, said County Executive Sam Page.

In California, the most populous state, counties are pleading for more vaccine as the state tries to reduce a high rate of infection that has led to record numbers of hospitalizations and deaths.

Although the state last week said anyone age 65 and older can start receiving the vaccine, Los Angeles County and some others have said they don’t have enough to immunize so many people. They are concentrating on protecting health care workers and the most vulnerable elderly in care homes first.

On Monday, the superintendent of the Los Angeles Unified School District sent a letter asking for state and county authorization to provide vaccinations at schools for staff, local community members — and for students once a vaccine for children has been approved.

The death rate from COVID-19 in Los Angeles County — an epicenter of the U.S. pandemic — works out to about one person every six minutes. On Sunday, the South Coast Air Quality Management District suspended some pollution-control limits on the number of cremations for at least 10 days in order to deal with a backlog of bodies at hospitals and funeral homes.

In other areas of the country, officials are working to ensure that people take the vaccine once they’re offered it amid concerns that many people are hesitant. Maryland Gov. Larry Hogan, in a livestreamed event on Martin Luther King Jr. Day, received a shot, and urged other Marylanders to do likewise.

“We’re all looking forward to the day we can take off and throw away our masks,” Hogan said. “The only way we are going to return to a sense of normalcy is by these COVID-19 vaccines.”

But challenges to the vaccine campaign are surfacing worldwide.

The World Health Organization chief on Monday lambasted drugmakers’ profits and vaccine inequalities, saying it’s “not right” that younger, healthier adults in some wealthy countries get vaccinated against COVID-19 before older people or health care workers in poorer countries.

Director-General Tedros Adhanom Ghebreyesus lamented that one country received a mere 25 doses while over 39 million doses have been administered in nearly 50 richer nations.

“Just 25 doses have been given in one lowest income country — not 25 million, not 25,000 — just 25. I need to be blunt: The world is on the brink of a catastrophic moral failure,” Tedros said. He did not specify the country, but a WHO spokeswoman identified it as Guinea.

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As 2020 came to a close, health officials remember the lives lost during the pandemic and remind residents that, collectively, everyone contributes to slowing the spread of the virus. Coronavirus caused or contributed to the deaths of hundreds of Riverside County residents, including two children under the age of 18.

The first coronavirus-related death in Riverside County was reported March 15 – an Indio resident in his late 70s. The two youngest deaths include a 12-year-old from Western Riverside County and a 15-year-old from Central Riverside County. The oldest deaths were found in three 104-year-old Riverside County residents, including a man from Corona, a man from Riverside and a female from Mecca.

Four county employees have died from the virus, including two deputies, one probation officer and one engineer.

“This disease doesn’t discriminate. We’ve seen deaths in the young and old. We’ve seen couples, family members and healthcare workers die from this disease,” said Kim Saruwatari, director of the Riverside University Health System-Public Health. “These deaths, combined with mental health impacts and economic losses, are painful reminders of how this disease has cost all of us.”

After nine months of the pandemic, the county is reporting a total of 1,985 deaths related to coronavirus. Deaths among racial and ethnic minorities are disproportionately higher, including among Native Hawaiian/Pacific Islander, Latino, Black and African American residents.

“Our hearts are with families, friends and neighbors who are grieving the loss of an important and special person in their lives,” said Riverside County Board Chair and Fourth District Supervisor V. Manuel Perez. “After a year of tragedy and hardship, we have hope for a better 2021. We remember and honor all Riverside County residents who have passed away from coronavirus this year, and thank all the front line workers and all who are doing their part to help overcome this pandemic.”

In addition to COVID-19 deaths, the number of fatal overdoses is up by 26.6 percent compared to last year. The unemployment rate has also risen to nine percent, representing approximately 107,000 job losses.

Taking simple actions like wearing a mask, stop gathering with others outside the household and getting the vaccine will protect yourself and others from the virus. The number of confirmed coronavirus cases is more than 180,550 in Riverside County and more than 118,800 have recovered from the virus.

Riverside County is also experiencing a surge of cases requiring hospitalization and intensive care unit treatment (ICU). COVID-19 patients requiring hospitalization is at 1,464, of which 296 are in an ICU. The positivity rate in Riverside County is 22.6 percent and the daily case rate is 140.5 new cases per 100,000 residents.

Jose Arballo Jr. • Contributed

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PHOENIX (AP) — A project that maps the bodies of border-crossers recovered from Arizona’s inhospitable deserts, valleys and mountains said it documented 227 deaths in 2020, the highest in a decade after the hottest, driest summer in state history.

The previous annual high mapped by the Pima County Medical Examiner’s Office in Tucson and the nonprofit Humane Borders was 224 migrant deaths in 2010.

Enforcement efforts in California and Texas over the years have pushed migrants into dangerous terrain in Arizona without easy access to food and water. Humanitarian groups like No More Deaths leave water jugs and other provisions in remote parts of southern Arizona in hopes of saving lives in a region where nearly 3,400 migrant deaths have been documented since 2004.

Despite the increase in deaths, U.S. Border Patrol apprehension figures suggest that the number of migrants crossing the U.S.-Mexico border illegally in Arizona has actually fallen by almost 50% over 10 years.

There were 131,759 migrants apprehended between Oct. 1, 2018, and Sept. 30, 2019, in the Border Patrol’s Yuma and Tucson sectors, which cover the entire Arizona border, compared with more than 248,624 in the same 12 months from 2008 to 2009.

Immigration scholars say they expect a wave of people from Guatemala, Honduras and El Salvador to try to cross the U.S.-Mexico border this year following a pair of disastrous hurricanes in Central America and with a Joe Biden administration after four years of hardline policies under President Donald Trump.

“Heading north will continue to be seen as an option,” Andrew Selee, president of the nonpartisan Migration Policy Institute, wrote in November in Americas Quarterly magazine. “President-elect Joe Biden has promised to do things differently, treating migrants and asylum-seekers with dignity.”

Selee warned that sudden policy changes could encourage would-be border-crossers to flood north.

Dr. Greg Hess, Pima County’s medical examiner, and Michael Kreyche, mapping project coordinator with Humane Borders, have said they believe the summer’s record heat and dry weather were the main causes of the unprecedented number of deaths in 2020.

The National Weather Service in Phoenix says the average high temperature was nearly 110 degrees (43 degrees Celsius) in July and nearly 111 in August, helping make it the hottest summer in history. Phoenix’s highs tend to be similar to those in Arizona’s Sonoran Desert north of Mexico, forecasters say.

The weather service said July and August also were the state’s driest summer months on record.

While many remains recovered last year were weathered, partial skeletons that indicated older deaths, there were considerably more recent deaths in 2020 than in previous years, said Dr. Bruce Anderson, forensic anthropologist with the Pima County medical examiner’s office.

Some officials and activists working near the Arizona border, including recently retired Santa Cruz County Sheriff Tony Estrada, have said they believe border wall construction also pushed migrants into riskier places to avoid workers.

The Border Patrol keeps its own border death statistics, counting the remains of suspected migrants it learns about in the course of its duties, according to its parent agency, Customs and Border Protection.

From January to September 2020, the Border Patrol listed 43 deaths in the Arizona border area. The mapping project tracked 181 deaths over the same nine-month period.

The Border Patrol, which operates on a federal fiscal calendar that ends Sept. 30, has not yet released figures for the last quarter of the 2020 calendar year.

Arizona is not the only place with fluctuations in border deaths over the years.

While migrant deaths are now down in South Texas, eight years ago, the mass graves of border-crossers were being discovered after people began trekking through isolated ranches to avoid the official checkpoint by the small town of Falfurrias.

The Brooks County sheriff’s office said this week that migrant deaths in its jurisdiction fell to 34 last year from 45 in 2019.

In Arizona, a passer-by discovered the last migrant remains of 2020 in the remote southeast corner of the state near New Mexico.

Hess, the medical examiner, said nothing is known so far about the person, whose skeleton was discovered in the uninhabited area east of Douglas, a few miles from Guadalupe Canyon. Work crews there are rushing to complete as much of Trump’s signature border wall as possible before he leaves office.

Hess said autopsy results aren’t expected for several weeks but that the person probably won’t be identified — just like a third of the human remains that turn up in Arizona’s borderlands.

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LOS ANGELES (AP) — Los Angeles County surpassed 10,000 deaths from the coronavirus Wednesday as California also hit a record high number of fatalities. The governor also announced the first detected case of the new and apparently more contagious variant of the coronavirus in a San Diego man.

LA County Health Director Dr. Barbara Ferrer called the 10,056 deaths there a “terrible milestone.” She noted that more than 7,400 people remain hospitalized with coronavirus in the county, with 20% of them in intensive care units.

“Most heartbreaking is that if we had done a better job of reducing transmission of the virus, many of these deaths would not have happened,” Ferrer said.

The milestone came the same day Gov. Gavin Newsom announced an “unprecedented” high of 432 reported deaths, a figure that was likely elevated due to a lag in reporting over the holidays. He said during a briefing with Dr. Anthony Fauci, the nation’s leading infectious disease expert, that he had just learned that the new strain of the virus had been detected, the second reported case in the nation.

“I don’t think Californians should think that this is odd; it’s to be expected,” Fauci said of the virus variant.

San Diego County officials said the infected man is a 30-year-old with no history of travel.

“The patient became symptomatic on the 27th. He was tested yesterday and the new strain was detected early (Wednesday),” said Eric McDonald, the county’s medical director for epidemiology. Another person in the man’s household was being tested, he said.

The Colorado and California cases have triggered a host of questions about how the variant circulating in England arrived in the U.S. and whether it is too late to stop it now, with top experts saying it is probably already spreading elsewhere in the United States. One San Diego supervisor said the detection means it is already circulating there.

Hours after the new variant was detected, San Diego Mayor Todd Gloria signed an executive order directing stricter enforcement of state and local public health rules. He said he’s asked police and the city attorney to pursue fines “and potentially other enforcement actions” against those who are “blatantly and egregiously” defying health orders.

Gloria praised residents who follow the rules, stay home as much as possible and wear masks when outside.

“Many have sacrificed their social lives for the greater good. Others have treated this with a sickening level of apathy as their neighbors died,” he said.

Hospitals are increasingly stretched by soaring infections that are expected to grow in the coming weeks. Southern California and the agricultural San Joaquin Valley have what is considered no intensive care capacity to treat patients suffering from the coronavirus. And state health officials remain worried about gatherings tied to New Year’s Eve.

But hope is on the horizon as vaccines roll out.

The statewide transmission rate has also fallen to the point where one infected person is in turn infecting just one other individual, a development that Newsom called encouraging while warning that rates in central and Southern California remain much higher and the trend could reverse from holiday gatherings.

Despite the still-soaring infections, Newsom also released a plan for schools to resume in-person teaching next spring, starting with the youngest students and those who have struggled most with distance learning. He also promised $2 billion in state aid for coronavirus testing, increased classroom ventilation and personal protective equipment.

Many schools have already reopened and there have not been virus outbreaks “even in places with high rates of transmission,” California School Board President Linda Darling-Hammond said.

Officials said schools in districts that have not already reopened with stringent plans in place would not reopen for in-person instruction until the overall transmission rate declines in California.

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