Ken Britten and Sandra Aamodt followed a familiar routine after learning about a wildfire burning four miles from their Northern California home. As with past fires in the parched hills outside the rural town of Winters, west of Sacramento, he scanned weather and news websites as she tracked social media for more details. The couple found little information that evening, yet while concerned, they judged the threat relatively low given their distance from the blaze and the lack of wind.

Around midnight, two hours after they went to bed, their pit bull mix, Tierra, began to stir. Mr. Britten, a retired neurobiology professor, stood up to let her outside the darkened A-frame house he bought in 1997. Opening the front door, he realized the dog’s anxious behavior had served as a warning – much of the night sky now glowed a furious orange.

He rushed up a slope on the eight-acre property and saw flames advancing down a hillside about a mile away. A stiff wind had kicked up, and the roaring inferno sounded to him like an enormous blast furnace. He hurried back to the house to rouse his wife. “We’re going,” he said.

A steep, sinuous gravel road links their neighborhood’s 10 large-lot homes, and residents – most of them middle-aged or seniors, some with functional needs – stay connected during emergencies through a group text thread. That night, Aug. 19, the thread blinked to life as neighbors alerted each other, the fifth time in six years that wildfire has forced them to evacuate.

Martin Kuz/The Christian Science Monitor

Ken Britten is shown with his pit bull mix, Tierra, outside his home in Winters, Calif., on Aug. 29, 2020. Mr. Britten credits the dog with waking up him and his wife as a massive wildfire approached their home Aug. 19.

The texts proved vital, possibly life-saving. A technical glitch in the emergency alert system for Yolo County prevented automated evacuation calls from reaching residents in imperiled areas, including the Winters neighborhood where Mr. Britten and Ms. Aamodt live. The county further waited until almost 4 a.m. to send evacuation texts and emails to residents, more than three hours after the couple fled the approaching fire.

The counties of Napa and Solano, both adjacent to Yolo, and several others endured similar emergency alert problems after dry-lightning strikes ignited hundreds of fast-moving wildfires in mid-August.

The failures and delays pose particular risk for elderly residents and people with access and functional needs who may require more time to escape. In the past month – with the eruption of the second-, third-, and fourth-largest wildfires in state history – pressure has intensified on public agencies to improve crisis planning for and evacuation of California’s most vulnerable residents.

“We have a lot of work to do,” says Don Saylor, a member of the Yolo County Board of Supervisors, who has pushed the county to fortify its disaster preparedness. “The bottom line is, we need to be far more attentive to the needs of seniors, people with limited mobility, or those who might live alone.”

Unreliable warning systems and erratic cooperation between California’s 58 counties have hampered swift evacuation of residents as the state confronts the dawning era of megafires. The infernos that flared last month and new fires that sparked over Labor Day weekend amid a withering heat wave have destroyed in excess of 3,300 homes and other structures, forced at least 120,000 people to evacuate, and claimed eight lives. In one dramatic nighttime rescue, helicopter crews airlifted more than 200 people trapped by a fire that exploded in forestland northeast of Fresno.

Tierra’s early warning enabled Mr. Britten and Ms. Aamodt to load up their two vehicles with essential possessions – laptops, documents, two cats – and for Mr. Britten to switch on a gas-powered sprinkler system connected to a 2,500-gallon water tank. Sometime after they drove to safety, the flames died in the wet grass within a few feet of the A-frame, sparing it the fate of three nearby homes that burned to the ground.

“If not for the dog, we might’ve lost the house,” says Mr. Britten, who installed the sprinklers and tank after a wildfire in 2016. He stood on his wooden deck looking down at hills charred the color of coal. “Who knows, we might’ve lost our lives.”

No silver bullet

A state audit last year examined the evacuation readiness and response of three counties ravaged by recent wildfires. The report concluded that deep deficiencies persist at the local and state level in aiding seniors, people with disabilities, and non-English speakers before, during, and after natural disasters. Counties neglected to identify vulnerable residents as part of emergency planning, assess the extra assistance they might require to evacuate, or devote sufficient resources to provide them with transportation and shelter.

The state’s review emphasized the inordinate impact of natural disasters on elderly residents. Two years ago in the Sierra Nevada foothills of Butte County, California’s deadliest wildfire on record killed 85 people in and around the town of Paradise, where some neighborhoods never received evacuation orders. More than three-fourths of the victims were age 65 or older.

Elder care advocates regard the missteps of counties this summer as worrisome evidence that vulnerable residents remain an afterthought in crisis preparations. “Is California getting better with each disaster? Yes. We’re learning from our mistakes,” says Debbie Toth, president and CEO of Choice in Aging. The Bay Area nonprofit group offers supportive services to seniors to help them preserve their independence. “But are we fully prepared? No. Not even close.”

The graying of California will accelerate over the next decade as the seniors population climbs from 5.8 million to an estimated 8.6 million by 2030, with more than 1 million requiring support to live at home.

The expanding cohort will age in a state beset by an increase in the number, magnitude, and severity of wildfires arising from climate change, overgrown forests, and sprawling development. As massive “fire clouds” obscure the sun and nearly 15,000 firefighters battle the flames, more than 2.2 million acres have burned already this year, eclipsing California’s single-year record of 1.85 million in 2018.

Democratic state Sen. Bill Dodd represents a district north of San Francisco that stretches across all or part of Napa, Solano, Sonoma, and Yolo counties. He joined emergency officials last month to tour areas scorched by fires, and they described the frantic door-to-door efforts of first responders to warn residents as ferocious winds propelled flames into neighborhoods. Faulty disaster alert systems compounded the chaos.

“They were successful in getting people out,” he says. “But that also underscored that the loss of life could have been far higher.”

The state audit found that the prevailing “opt-in” model for notification networks has excluded as many as 40% of a county’s residents from receiving evacuation calls, texts, and emails. Even if seniors sign up, a lack of tech literacy, a bout of confusion, or physical or cognitive impairment can leave them susceptible to impending danger.

California lawmakers approved a measure last week that authorizes use of two-tone, “high-low” sirens common in Europe on emergency vehicles, giving public safety agencies another method for reaching residents during natural disasters.

“None of these things is the silver bullet,” says Senator Dodd, who authored the bill. “But we have a lot of seniors and people with disabilities living on their own, and we have to make them aware every way we can.”

In the early hours of Aug. 19, a wildfire ripped through Vacaville, a city of 100,000 people in his district. Around 1:45 a.m., Ailene Klotz, a retired high school teacher, received an automated call from Solano County informing her of an evacuation advisory. She flipped on the lights in the ranch-style house where she has lived alone since her husband died 20 years ago and began to gather medications, clothes, jewelry, and photo albums.

A second call at 2:30 a.m. delivered an evacuation order. Ms. Klotz, who is 81, steered her Prius through smoke-choked darkness as she and her shih tzu, Molly, fled to a nearby seniors center converted into a temporary emergency shelter.

Her house survived unscathed, unlike hundreds of others in the area, and she recognizes her good fortune – and the complicated decision that emergency officials faced on sending alerts as winds shifted and swirled. Still, after so many destructive infernos in California the past three years, she suggests that counties notify residents sooner rather than later.

“Forty-five minutes isn’t enough time,” she says. “The alerts have to be earlier and faster because the fires are getting worse. At this age, you want as much warning as you can get.”

Martin Kuz/The Christian Science Monitor

Ken Britten and Sandra Aamodt's home in Winters, Calif., is shown on Aug. 29, 2020. The couple fled the house on Aug. 19 as a wildfire approached. Mr. Britten switched on an emergency sprinkler system before leaving, likely saving the house from burning.

The key to survival

The same morning, 15 miles away in Winters, acrid smoke seeped into Cynthia Rodriguez’s home. The haze unsettled her adult daughter, Libby, who was born deaf and diagnosed with Down syndrome. Ms. Rodriguez and her husband searched news sites, watched TV, and called 911 as they tried in vain to learn details about nearby fires.

As they weighed whether to leave, she received a call at 10:30 a.m. from a caseworker with the Yolo County health services agency that assists with Libby’s care. The person told her the agency was alerting clients in the couple’s neighborhood that the county had ordered an evacuation of their area an hour earlier.

“That’s not an ideal way to find out,” says Ms. Rodriguez, a retired attorney, whose son drove to Winters to pick up Libby and bring her to his home near Oakland.

“We have to exercise judgment not just for ourselves but those we’re caring for,” she says. Packing adaptive equipment or loading a person with disabilities into a vehicle can slow an individual’s or family’s escape, as appears to have occurred with an older couple who lived outside Winters and died in the fires.

“Advance warning is the key to survival,” Ms. Rodriguez adds. “You need time to plan and gather your resources and your energy so you can get out the door.”

State law mandates that cities and counties take into account people with access and functional needs as part of emergency readiness – a directive that covers alerts, evacuations, and post-disaster shelter – and to include members of vulnerable groups in the planning process.

Last year’s audit of evacuation practices criticized county agencies for failing to fulfill either obligation, and faulted California’s office of emergency services for dedicating inadequate resources and guidance to counties to aid vulnerable residents. Vance Taylor, who heads the office of access and functional needs within that state agency, advocates a broader, more collaborative approach at the county level to strengthen the emergency net.

“What’s happened historically with disaster preparedness is you have good people trying to do good things, but they operate from a somewhat limited perspective,” Mr. Taylor says. He was diagnosed with muscular dystrophy as a child and uses a wheelchair. “When you bring people with access and functional needs into the discussion, the reaction shifts from ‘Your plan left us out’ to ‘Our plan has some gaps – let’s fix them.’”

Kate Laddish lives in Winters and belongs to an advisory committee on disaster readiness that last week presented a slate of recommendations to the county board of supervisors. The committee called for a thorough census of residents with access and functional needs and sending more alerts during emergencies to help them better prepare for a potential evacuation.

When flames reached the outskirts of Winters three weeks ago, Ms. Laddish, in the absence of county updates, listened to scanner apps tuned to fire and police channels. She found herself fielding calls and texts from other residents in the city seeking information that night.

“When you don’t get any notifications but you know there’s a fire,” she says, “you’re left wondering if you’re not under an evacuation order or the system failed or something else.”

Ms. Laddish, a former geology professor and park ranger whose diagnoses of muscular and neurological disorders qualify her for disability assistance, lives in an affordable housing complex for seniors and people with functional needs. During those fraught hours, she feared what might happen to vulnerable residents like those in her building if the high winds brought the fire barreling into town.

“Without getting enough notice to evacuate,” she says, “there would have been catastrophic loss of life.” She contends that the county relies too much on neighbors helping each other when disasters hit. “Fantastic community spirit isn’t an evacuation plan.”

Gov. Gavin Newsom launched an initiative last year called Listos California – Spanish for “ready” – that has funneled $50 million to nonprofit and community groups statewide to promote disaster preparedness among seniors, people with functional needs, non-English speakers, and low-income residents. The program holds emergency training sessions, distributes “go kits,” and works with vulnerable populations to create evacuation plans.

The campaign also urges people to sign up for county and state disaster alerts. Emergency officials in Yolo County, following the failure of the automated call system, fixed the technical snafu and tested the network last week. The good results encouraged Mr. Saylor, the board supervisor, who wants Yolo to emulate nearby counties that send more warnings to residents.

“We’re past the time when we can withhold giving notice because some people might be annoyed about receiving too many alerts,” he says. “The risks of not notifying are too great. Fires are still burning.”

Peter Dejong/AP/File

The International Criminal Court, or ICC, is seen in The Hague, Netherlands on Nov. 7, 2019. President Donald Trump has lobbed a broadside attack against the International Criminal Court. He's authorizing economic sanctions and travel restrictions against court workers directly involved in investigating American troops and intelligence officials for possible war crimes in Afghanistan without U.S. consent.

Under a different administration, and despite its lack of membership in the court, the United States might be assisting the International Criminal Court in its investigation of an alleged genocide of Myanmar’s Rohingya minority at the hands of the country’s military in 2017.

The George W. Bush administration assisted the Hague-based court – created in 1998 to try cases of international war crimes and crimes against humanity – in investigating the genocide in Darfur, providing among other things satellite imagery to help locate suspected mass graves.

The Obama administration deployed special forces to Uganda in 2011 to help track down a leader of the Lord’s Resistance Army, wanted by the court for suspected crimes against humanity, and shared intelligence of interest for other investigations.

But that past cooperation has turned into virulent antagonism under President Donald Trump. Last week the U.S. went so far as to impose sanctions on two ICC officials, the court’s lead prosecutor and her chief of staff, over the international court’s willingness to investigate alleged war crimes committed by belligerents in Afghanistan – including potentially the U.S.

The financial sanctions cite ICC Prosecutor Fatou Bensouda for her “effort to investigate US personnel,” and ICC division chief Phakiso Mochochoko, for assisting the prosecutor.

Trump administration officials describe the imposition of sanctions most often used against terrorists, drug cartel leaders, and officials of hostile governments as a no-other-choice step aimed at preserving U.S. sovereignty and protecting American citizens from prosecution by a politicized global court answerable to no one.

“The United States is a strong advocate for justice around the world, but … [the U.S. has never] accepted” the ICC’s “jurisdiction over our personnel,” said Secretary of State Mike Pompeo last week in announcing the sanctions. “The ICC’s recklessness has forced us to this point and … cannot be allowed to follow through with its politically driven targeting of U.S. personnel.”

Moreover, Mr. Pompeo said he was acting to thwart the danger posed by the court to “our allies” – assumed to mean Israel, which has also drawn the attention of the ICC over alleged “war crimes” in the occupied West Bank and in Gaza.

Cooperation, in part

But for many experts in international criminal justice, the U.S. action is the work of a superpower bully that will do nothing to deter the ICC from pursuing the investigations it deems important – including of the U.S. Instead, they add, it will only alienate U.S. allies and major ICC funding members, like the Europeans and Japan, who could have been recruited to help steer the court from focusing on the U.S.

Some experts see the U.S. action in terms of international equity that predate the Trump administration. Despite longstanding issues with the ICC and never having joined the court and its 123 members, the U.S. has repeatedly been willing to cooperate with it and offer material support – as long, some U.S. critics say, as it was investigating weak, primarily African governments. But when the ICC decided it might add the U.S. to its docket – well, then, not so much.

Some nevertheless lament seeing the global power that established and led the postwar international justice system with adjudication of the Nuremberg and Tokyo war crimes trials now acting in ways they say risk encouraging bad behavior by despots and human rights violators.

“The U.S. has historically supported and even spearheaded international justice, from the Nuremberg and Tokyo tribunals [to] the war-crimes cases involving the former Yugoslavia and the Rwanda and Cambodia tribunals – but none of those cases ever risked that an American would be tried,” says Jennifer Trahan, a clinical professor of international law and human rights at New York University’s Center for Global Affairs.

“It’s extraordinarily hypocritical for us to take action like [the sanctions] as soon as that international justice system considers looking at U.S. actions. If the U.S. believes in international justice,” she adds, “then it can’t be immune from it.”

The U.S. has never been a big fan of the ICC, but Washington started developing a working relationship with the court once the White House decided the ICC could in some cases serve its interests.

John Bolton’s stance

Led by the anti-ICC fervor of John Bolton – who rose to become ambassador to the United Nations – the George W. Bush administration initially took steps to weaken and threaten the court. But the genocide in Darfur, and pressure from U.S. evangelicals to do something about it, prompted President Bush in his second term to see the ICC in a new light.

“In the Bush first term we even talked of invading The Hague if any Americans were ever jailed there” by the ICC, says William Burke-White, an expert on international law and institutions at the University of Pennsylvania in Philadelphia. “But then the administration comes under political pressure from the religious right to do something about the Darfur genocide, and it realizes the ICC can be a useful tool without putting American lives at risk” on the ground in Sudan, he adds.

That cooperation continued under the Obama administration. “There was very much a sense that, if the U.S. engaged with the court, we could shape its development and direction, even if still from the outside,” Professor Burke-White says.

At the same time, he adds, the court realized it couldn’t do its work without national governments – particularly wealthy ones like the U.S., with the intelligence, satellite, and technology capabilities the court lacks but needs to undertake complex investigations.

But that growing cooperation came to a screeching halt when two things happened, Professor Burke-White says: John Bolton joined the Trump administration in 2018 as President Trump’s national security adviser, bringing with him his goal of killing the ICC; and the ICC moved to investigate war crimes in Afghanistan, including those allegedly committed by the U.S.

“The court was coming under a lot of pressure to show that it didn’t just investigate weak governments in Africa, but was able to take on the powerful as well,” he says.

Christopher Ankersen, a former U.N. assistant to the Khmer Rouge trials in Cambodia, notes that the ICC was starting to be dismissed by weaker nations and frequent targets of the court, particularly in Africa, as a tool of Western powers more than a champion of true international justice.

“Countries within the African Union started equating the ICC with ‘northern justice,’” he says, “and this gave growing credence to the view that the ICC was a hypocritical institution,” says Professor Ankersen, now at NYU’s Center for Global Affairs.

Sanctions “counterproductive”

Even some experts in international law who agree with the U.S. position that the ICC’s case against the U.S. is “illegitimate” say they believe the Trump administration would have been much better off holding the sanctions fire.

Better for the U.S. to have instead made its case among its key allies who hold the ICC purse strings and influence ICC policy and focus, they say.

“My view is that the ICC investigations into the U.S. and Israel are illegitimate – and it’s a view shared by former Obama administration officials as well as hundreds of members of Congress,” says Orde Kittrie, a senior fellow of foreign policy at the Foundation for the Defense of Democracies and a professor of international law at Arizona State University’s Washington program. The U.S. has been “willing and able to investigate itself,” which he says by the ICC’s own rules precludes any ICC investigation.

But the sanctions have been “counterproductive,” he maintains, as they have alienated key U.S. allies who “share our concerns about the ICC’s operations and failures.”

“What we should have done is reached out to U.S. allies that provide more than 50% of ICC funding,” Professor Kittrie says, “and worked with them to encourage the court to return to its core mission.”

But instead, many experts worry that the Trump administration’s sanctions will only further tarnish the U.S. image as a beacon of international justice.

Noting that the U.S. singled out the ICC’s two senior African officials, NYU’s Professor Trahan says, “The racial optics are terrible given everything that’s going on in our country. Why did the administration go after [them],” she adds, “when there are other high-level people of other nationalities” in the prosecutor’s office?

“This is not the first time we’ve seen this tension between America’s international relations and international law,” says Professor Ankersen. “But to the extent this kind of action from the U.S. encourages others to follow the U.S. lead and disregard international law, it can only weaken U.S. interests.”

Something extraordinary is happening in the worldwide fight against the coronavirus pandemic: Some governments have been telling people that it’s fine not to wear face masks.

That’s not because they’ve suddenly changed their minds about the value of masks in preventing new outbreaks. It’s a response to another global health and safety challenge: global warming.

Amid record-high temperatures in the United States, Europe, the Middle East, and Asia, officials in some countries have decided that the immediate risk of overheating must be weighed alongside the danger of catching COVID-19.

The calculation underscores a deeper policy tension. That’s between the drive to get national economies restarted as soon as possible, and the hope among climate experts that world leaders’ efforts to tackle one great natural challenge – the pandemic – will lend new urgency to facing another one: reducing carbon emissions.

The signs of whether that will happen remain mixed, despite some high-profile new commitments, especially by European Union countries.

Yet the signs of climate change are getting stronger. Two new studies have charted the hugely accelerating loss of the world’s ice sheets.

The first revealed that in the far northern reaches of Canada, the country’s last intact ice shelf has fractured. A mass of ice nearly the size of Manhattan has collapsed into the Arctic Ocean. The second report, late last month, found that the Greenland ice sheet had lost a record amount of ice in the summer of 2019: more than twice the yearly average and enough to inundate the state of California under four feet of water.

Not all of this is due to global warming. Annual climate patterns play a role as well. But the trend since the turn of the century – rising carbon emissions, rising temperatures, and larger melts – is unmistakable. “Not only is the ice sheet melting,” said the lead author of the Greenland study. “It’s melting at a faster and faster pace.”

Neither of these climate reports received much international attention. That’s perhaps not surprising. News about climate change, like nearly everything else, has been crowded out by the pandemic.

But another sign of climate change has been impossible to ignore in the past few weeks: soaring temperatures in a number of countries around the globe.

In the U.S., Californians are facing the twin challenge of wildfires and searing heat, well over 100 degrees Fahrenheit. The state weather service has warned of “dangerous to potentially deadly” temperatures.

European countries including Britain and France have been hit by extreme temperatures over the summer, and the heat is now targeting southern and eastern areas of the continent.

But it’s been even more intense in the Middle East. Earlier in the summer, the Iraqi capital of Baghdad was hit by temperatures over 125 degrees Fahrenheit. In recent days, Israel has also experienced its hottest days on record, up to 120 degrees in the Red Sea resort of Eilat.

Israeli health authorities were among those easing their face mask guidance. They advised people who are distanced from others at a park or on a beach that they can remove their masks.

In Japan, where temperatures climbed last month to a record 106 degrees Fahrenheit, the national tourist organization was more explicit. Urging people to “remove your mask” when socially distanced outdoors, it warned that “wearing a mask … with high temperature and humidity may cause heat stroke.”

But climate scientists and activists want to see the pandemic spark longer-term adjustments. They point out that when COVID-19 first hit many countries, the resulting economic shutdowns, though unwelcome, did provide clear evidence of humankind’s impact on the environment and of the potential benefits of altering our behavior. Carbon emissions fell. The air became dramatically clearer.

Ahn Young-joon/AP

A woman wearing a face mask to help curb the spread of the coronavirus holds a fan to counteract sweltering heat at a service at the Chogyesa temple in Seoul, South Korea, Aug. 26, 2020.

The other pandemic lesson they hope politicians will take on board is that the effects of climate change – like COVID-19 – do not stop at national borders, and that this means they require a concerted international response. With governments spending unheard-of sums to rescue and resuscitate their countries’ economies, climate activists want more of that money to create and support low-carbon businesses.

A number of countries worldwide have announced cleaner-energy targets as part of their economic reconstruction plans. But the 27-nation European Union has led the way, with a nearly $900 billion recovery package, of which 30% is earmarked for less carbon-intensive energy generation.

The EU aims to become carbon-neutral by 2050, but that is a target it set for itself a year ago, and an alliance of thousands of climate scientists and policy advocates, including the teenage Swedish activist Greta Thunberg, has criticized the new EU plan as too cautious and vague.

The recovery plan receiving the warmest welcome from climate activists has, in fact, come from someone who does not hold office: U.S. Democratic Party presidential hopeful Joe Biden. He has announced a $2-trillion blueprint, pledging to ratchet up government support for electric vehicles, carbon-free power and energy efficiency – with a carbon-neutral target of 2045. Nearly half of the investment would go to minority and disadvantaged communities.

The hope of Ms. Thunberg and fellow campaigners is that the EU and other countries will add fresh detail and greater ambition to their plans as the economic recovery takes root. The key, they say, is that nations should summon the same sense of urgency – the sense of “emergency,” in Ms. Thunberg’s phrase – that they have brought to battling the pandemic.

Wilfredo Lee/AP

Frances Reaves paid a drive-by visit to her friend Margaret Choinacki, foreground, in July at Miami Jewish Health nursing home in Miami, Florida. Florida Gov. Ron DeSantis announced Sept. 1 that nursing homes could start a partial reopening after nearly six months of lockdown.

When Mildred Brown arrived for physical therapy at a North Carolina nursing home in February, the octogenarian who had been living independently until then could pace about 150 feet with her walker without sitting down. Now, six months after she and thousands of other nursing home residents nationwide were placed in lockdowns designed to protect them from COVID-19, Mildred appears depressed and can barely get out of bed, says her daughter Laura Brown. 

“Her spirits were great in February. Since the isolation and lockdown, she’s just deteriorated,” says Laura, who echoes a growing sentiment among experts on aging that some long-term care residents experience health decline not because of COVID-19, but lack of human contact.  

Since a family visit on Mother’s Day – allowed because it appeared for over a week that Mildred was so ill she might die – she has gone four months without a loved one’s embrace.

When Laura eagerly arrived for a half-hour visit in the facility’s courtyard July 30, her mother wept. But Mildred’s wheelchair was parked a few feet beyond her daughter’s reach. As the women strained to hear each other behind their masks, their natural urge to touch was crushed by staff warnings that future visits would be barred if they did.

“It was torture,” says Laura. “They watched us just like we were in jail.”

Mildred cried even harder when the visit ended.         

Nursing homes closed their doors to most visitors in March in an attempt to shield vulnerable residents from the virus, which has killed more than 75,000 residents and staff in long-term care this year, according to early-September Kaiser Family Foundation data. But cautionary confinement has meant a second affliction for residents, and not just for those who missed final goodbyes.

Courtesy of Laura Brown

When Laura Brown snapped this photo of her mother, Mildred Brown, at her North Carolina nursing home on July 30, it was at the wrenching distance of six feet required by health regulations. She believes the lack of human connection in lockdown has led to a decline in her mother's overall health.

“There are many instances where we’ve seen that our patients are not declining because of COVID, but they’re declining because of lack of interaction with family members,” says Grace Jenq, associate clinical professor of geriatric and palliative care medicine at the University of Michigan in Ann Arbor.

Some experts on aging say isolation can lead to depression, anxiety, and overall health decline.  

Desperate for connection, relatives of the country’s more than 1 million nursing home residents have scrambled for creative workarounds – from strained video calls to bucket truck-assisted window visits.

And now, care facilities face high-stakes decisions about how to reopen safely. That means most reunions will come for the foreseeable future at a wrenching 6-foot distance.

In Colorado, for example, where until Sept. 3 only outdoor visits had been permitted, many locals have complained that reopening residential care facilities has been too slow, says Randy Kuykendall, director of the health facilities and emergency medical services division for the state Department of Public Health and Environment. 

“My heart breaks for them, because I understand,” says Mr. Kuykendall. “But again: Lives are on the line here.”

Similarly safety-conscious, Evan Lubline, CEO of Hooverwood Living in Indianapolis, which only offers outdoor visits, says: “The inside visits are something we’re definitely wanting to explore. But the question goes back to: Is it safe? ... I feel really bad for those families. This isn’t fair to them.”

Uneven regulation 

Since early June more than half of states have allowed long-term care facilities to reopen gradually to visitors, though it’s unclear how many families have been able to visit.

Federal guidance leaves wide room for interpretation, making for a piecemeal rollout. Several states have permitted only outdoor visitation because the risk of the virus’s transmission is considered lower outside. Facilities have found creative ways to support these connections, including one Virginia nursing home whose glass barrier set up outside allowed for handholding through plastic gloves. Underscoring the uneven process, the Monitor encountered four cases of long-term care facilities that offered outdoor visits before their states issued guidelines on resuming visitation. 

While the pandemic continues to course through much of the country, some industry watchers say there are risks in reopening too soon, especially with ongoing shortages of staff and personal protective equipment.

“I’m deeply concerned with the lack of transparency, the lack of consistency, the lack of commitment by nursing homes and assisted living facilities in ensuring that basic health and safety standards are being met to allow for safe visitation,” says Elaine Ryan, vice president for state advocacy and strategy at AARP. “Death counts cannot be our measure of how well we’re doing.”  

Only seven states had required ongoing testing of residents, staff, or both in long-term care as of mid-July, Stateline reported. And the federal government began requiring regular COVID-19 testing for nursing home staff on Aug. 25, six months after the pandemic’s first nursing home deaths in Washington state. 

Supporters of controlled visitation argue that infection risks should be weighed against the physical and emotional well-being of residents. Dr. Jenq says lack of social interaction has even caused some nursing home residents to lose their abilities to perform simple activities of daily living, like walking or eating. 

“The benefits [of visits] are really enormous,” says Peter Lichtenberg, director of Wayne State University’s Institute of Gerontology in Detroit, who also speaks from personal experience. After weeks of isolation, he visited his own father for an end-of-life exception visit at a Pennsylvania facility this spring. 

“My dad died without anxiety,” says Dr. Lichtenberg. “I thought in large part that was because I was there.”  

The federal Centers for Medicare and Medicaid Services (CMS), which oversees nursing homes, first published reopening recommendations in May. The agency urges facilities to prolong visitor bans until at least 28 days have passed without a new COVID-19 case originating on-site. Additional considerations include adequate staffing and personal protective equipment (PPE), along with COVID-19 testing for residents and staff. Compassionate care visits (such as an end-of-life visit) remain an acceptable exception, according to CMS.

The federal guidance, however, is nonbinding, and protocols differ from state to state, facility to facility, on when and how visits can resume, frustrating families nationwide.

Florida, for example, with about 650,000 known cases of COVID-19, lifted a long-term care visitor ban Sept. 1. Facilities can start indoor or outdoor visits if they’ve gone at least 14 days without a new case, and no minors are allowed.

Massachusetts, reportedly the first state to publish parameters for outdoor visitation, adopted a plan on June 3 that includes mandatory masks, social distancing, and screening visitors for symptoms upon arrival. The state encourages facilities to continue virtual communication between residents and visitors “as much as possible.” 

Sherrill House, a nonprofit skilled nursing and rehabilitation center in Boston, has a courtyard that accommodates up to four families at a time. And, says Jeannie Doyle, day scheduler and supervisor at Sherrill House, “The first visit that we had with many of the families, there were tears in their eyes. … The hard part was not being able to hug.”

Getting visitation right    

Resumed visitation may help with contact tracing as facilities keep track of who visits, but industry experts still warn of community spread of infection.

“Testing is paramount,” says Janine Finck-Boyle, vice president of regulatory affairs at LeadingAge, an advocacy group for nonprofit aging-services providers. “We know that nursing homes were not at the top of the list when their PPE was being doled out. Nursing homes are not at the top when it comes to getting access to testing.”    

Sherrill House, which according to Massachusetts data has had 32 resident deaths from COVID-19, relies on local Beth Israel Deaconess Medical Center to process tests. Results come back within 24 hours.

Providers and officials stress the need for families to have patience with the process – especially as monitored visits mean added duties for staff in cash-strapped facilities. Hooverwood Living, the skilled nursing and assisted living facility in Indianapolis where state data shows 19 residents have died from the virus, has hired a part-time visitation coordinator. That extra expense, along with PPE costs and fewer new residents, has caused losses of $300,000 to $350,000 monthly for the nonprofit during the pandemic.

Some nursing homes remain closed to visitors in states that have already relaxed restrictions.  

In Westlake, Ohio, Amy Kullik’s plan to visit her mother on July 20 after 19 weeks apart was canceled when the facility sent a letter that announced two COVID-19 cases and the delay of outdoor visits.

Ms. Kullik says it took time to empathize with the facility’s decision. She says she was disappointed, “but I understand.” She’d agreed with staff that window visits would be more confusing than beneficial due to her mother’s diagnosis of Alzheimer’s, but the isolation appears to have taken a toll. During their strained virtual chats over FaceTime, her mother stares speechless at the screen. 

“Occasionally you might get a smile from her,” she says. 

Ms. Kullik eagerly awaits their reunion next weekend after a series of delays, the latest of which was a scheduled outdoor visit on Labor Day canceled due to bad weather.

She bought a see-through vinyl mask for the occasion so that her mother can see most of her face: “The first thing I’m going to look for is recognition in her eyes that she knows who I am.” 

Staff writer Simon Montlake contributed to this report. 

Editor’s note: As a public service, we have removed our paywall for all pandemic-related stories.

AP

Maria Kolesnikova, one of Belarus' opposition leaders, gestures to a crowd in Minsk Aug. 27.

It was a scene out of a Cold War novel. On Monday, KGB agents in Minsk pushed Maria Kolesnikova, one of three women behind the pro-democracy protests in Belarus, into a car. Then the security agents drove her to a checkpoint at the border with Ukraine and tried to forcibly expel her. Instead, she tore up her passport, climbed out a car window, and walked back toward her own country with head high.

By clinging to her right as a citizen, Ms. Kolesnikova showed in action what she had been advising people during two months of protests in Belarus. Rather than plead for dignity from authorities, she acted on her inherent dignity. In fact, in helping organize the protests against dictator Alexander Lukashenko after a rigged election Aug. 9, she has ensured protesters were inclusive, respectful, and peaceful.

“There has never been a plan other than reminding people of their own dignity,” she said. The result has been a civic awakening with demonstrators being largely leaderless and fearless.

In many countries, the key to either creating a democracy or improving one has been to recognize the dignity of all. Ms. Kolesnikova says the Lukashenko regime has shown “disrespect, humiliation, and intimidation” to the people. The best response, she says, is for Belarusians to act with freedom and dignity. “That can't be broken with police batons,” she says. Ms. Kolesnikova was detained again on Monday after her escape. Yet her example no doubt has left a mark in Belarus.

Reminders of this approach can be found in recently liberated countries. Each Jan. 14, Tunisia celebrates the “Dignity Revolution” in 2011 that ousted a dictator and led to democracy. Ukraine is building a “Dignity Revolution” museum in the capital Kyiv to honor its pro-democracy revolts in 2005 and 2014. In Sudan, where democracy is still a work in progress, the civilian leader, Prime Minister Abdalla Hamdok, often justifies each new reform as preserving the “dignity of the Sudanese people.”

Neither government nor politicians can bestow dignity. Nor do social or material circumstances determine its expression. This point was made clear after World War II when all countries joined in signing a “universal” declaration that states: “All human beings are born free and equal in dignity and rights.”

Dignity is also marked by an innate capacity to distinguish what is good. “Most people know in their innermost being that they have dignity and that this imposes upon others the duty of respect,” said Justice Anthony Kennedy, a former Supreme Court justice.

In many countries, a feeling of humiliation is commonly heard these days. Politicians often revel in stoking that feeling.  Yet when dignity kicks in, individuals can move entire countries. Belarus may be next to show how.