Leaked Border Patrol Memo Tells Agents to Send Migrants Back Immediately — Ignoring Asylum Law

2 Apr

by Dara Lind

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For the first time since the enactment of the Refugee Act in 1980, people who come to the U.S. saying they fear persecution in their home countries are being turned away by Border Patrol agents with no chance to make a legal case for asylum.

The shift, confirmed in internal Border Patrol guidance obtained by ProPublica, is the upshot of the Trump administration’s hasty emergency action to largely shut down the U.S.-Mexico border over coronavirus fears. It’s the biggest step the administration has taken to limit humanitarian protection for people entering the U.S. without papers.

The Trump administration has created numerous obstacles over recent years for migrants to claim asylum and stay in the United States. But it had not — until now — allowed Border Patrol agents to simply expel migrants with no process whatsoever for hearing their claims.

The administration gave the Border Patrol unchallengeable authority over migrants seeking asylum by invoking a little-known power given to the Centers for Disease Control and Prevention, the U.S. public health agency, to ban the entry of people or things that might spread “infectious disease” in the U.S. The CDC on March 20 barred entry of people without proper documentation, on the logic that they could be unexamined carriers of the disease and out of concern about the effects if the novel coronavirus swept through Customs and Border Protection holding facilities.

U.S. immigration law requires the government to allow people expressing a “well-founded” fear of persecution or torture to be allowed to pursue legal status in the United States. The law also requires the government to grant status to anyone who shows they likely face persecution if returned to their homeland.

“The Trump administration’s new rule and CDC order do not trump U.S. laws passed by Congress and U.S. legal obligations under refugee and human rights treaties,” Eleanor Acer, of the legal advocacy group Human Rights First, told ProPublica. “But the Trump administration is wielding them as the ultimate tool to shut the border to people seeking refuge.”

Two weeks ago, the Trump administration hastily put in place a policy, which the internal guidance calls Operation Capio, to push the overwhelming majority of unauthorized migrants into Mexico within hours of their apprehension in the U.S.

The Trump administration has been publicly vague on what happens under the new policy to migrants expressing a fear of persecution or torture, the grounds for asylum. But the guidance provided to Border Patrol agents makes clear that asylum-seekers are being turned away unless they can persuade both a Border Patrol agent — as well as a higher-ranking Border Patrol official — that they will be tortured if sent home. There is no exception for those who seek protection on the basis of their identities, such as race or religion.

Over 7,000 people have been expelled to Mexico under the order, according to sources briefed by Customs and Border Protection officials.

The guidance, shared with ProPublica by a source within the Border Patrol, instructs agents that any migrant caught entering without documentation must be processed for “expulsion,” citing the CDC order. When possible, migrants are to be driven to the nearest official border crossing and “expelled” into Mexico or Canada. (The Mexican government has agreed to allow the U.S. to push back not only Mexican migrants, but also those from Guatemala, Honduras and El Salvador; the four countries account for about 85% of all unauthorized border crossings.)

Under the Refugee Convention, which the U.S. signed onto in 1968, countries are barred from sending someone back to a country in which they could be persecuted based on their identity (specifically, their race, nationality, religion, political opinion or membership in a “particular social group”).

The Trump administration has taken several steps to restrict the ability of migrants to seek asylum, a form of legal status that allows someone to eventually become a permanent U.S. resident. Until now, however, it has acknowledged that U.S. and international law prevents the U.S. from sending people back to a place where they will be harmed. And it has still allowed people who claim a fear of persecution to seek a less permanent form of legal status in the U.S. (In the last two weeks of February, 2,915 people were screened for humanitarian protection, according to the most recent statistics provided by U.S. Citizenship and Immigration Services.)

The Border Patrol guidance provided to ProPublica shows that the U.S. is acting as if that obligation no longer applies.

Customs and Border Protection, the agency that oversees the Border Patrol, said it would not comment on the document provided to ProPublica. Asked whether any guidance had been provided regarding people who expressed a fear of persecution of torture, an agency spokesperson said in a statement, “The order does not apply where a CBP officer determines, based on consideration of significant law enforcement, officer and public safety, humanitarian, or public health interests, that the order should not be applied to a particular person.”

That language does not appear in the guidance ProPublica received. Instead, it specifies that any exception must be approved by the chief patrol agent of a given Border Patrol sector. One former senior CBP official, who reviewed the guidance at ProPublica’s request, said that because there are so many levels of hierarchy between a chief patrol agent and a line agent, agents would be unlikely to ask for an exemption to be made.

The guidance offers some details of exceptions that Border Patrol should make on public-safety grounds — people with felony convictions, for example, are to be held in detention rather than being sent back — but none on health grounds.

In fact, the guidance provides no instructions on medical screening or care for migrants, making it impossible to know how such an exception would be made. (One source briefed by CBP on the policy said the agency said migrants would not be expelled if they showed symptoms of illness or claimed a medical issue, but there is no mention of this in the guidance ProPublica received.)

The guidance makes a single humanitarian exception: If a migrant, before expulsion, tells the Border Patrol agent that they fear torture in their home country, they can be kept in the U.S. and referred to U.S. Citizenship and Immigration Services, which evaluates claims for humanitarian protection, to see if they qualify for protection under the Convention Against Torture. But agents are not instructed to ask; the migrant has to volunteer the information “spontaneously.” Then, the Border Patrol agent is instructed to analyze whether the claim is “reasonably believable” — something they haven’t been trained to do.

As recently as last fall, the Trump administration acknowledged in court filings that it’s bound both to protect victims of torture under the Convention Against Torture and to protect victims of persecution under the Refugee Convention.

Even as it has erected bars to asylum — most notably, preventing anyone who crosses through Mexico from receiving asylum in the U.S. — it has continued to allow anyone entering the U.S. to seek a lesser form of legal status called “withholding of removal,” which allows an immigrant to stay in the U.S. but does not allow them to become a permanent resident. (Since the passage of the 1980 Refugee Act, federal law requires the executive branch to grant this status to anyone who can show it’s more likely than not they’ll be persecuted.)

The Operation Capio guidance does not mention the possibility that someone could be eligible for lesser protections instead of expulsion. Two sources briefed on the new policy confirmed that neither asylum nor withholding of removal is available to anyone subject to the CDC order.

In that briefing, CBP officials claimed that a migrant expressing any sort of fear is referred for screening to the U.S. Citizenship and Immigration Services, but that migrants will only pass that screening if they claim torture. However, the guidance doesn’t instruct Border Patrol agents to refer other types of claims to USCIS (and instructs them only to refer torture claims when they are “reasonably believable”).

In lawsuits challenging the administration’s asylum policies, Department of Justice lawyers have described withholding of removal as a “mandatory” form of protection — something it’s required to provide — while asylum is “discretionary.” In a brief filed last fall with the 9th U.S. Circuit Court of Appeals, the government wrote that “The United States has implemented its non-refoulement obligations” — the obligation not to send people back to danger — “by providing withholding of removal and CAT (Convention Against Torture) protection.”

Now, the U.S. is only providing one of the two — and only at the discretion of Border Patrol.

“If you read between the lines,” one congressional staff member briefed on the operation told ProPublica, “they’re saying that Title 42 (the chapter of the U.S. Code that includes the CDC’s quarantine power) supersedes Title 8 (which covers immigration law).” Title 42 doesn’t clearly state that the administration may suspend its obligations under immigration law, and the Trump administration hasn’t published any legal opinions or memos that make its case.

No legal challenges have yet been filed against the new policy. Lawyers told ProPublica that the secrecy of the policy has made it harder to compile a case against it.

The administration has argued that the risk of coronavirus spreading through Customs and Border Protection holding facilities — which aren’t equipped to deal with medical needs — justifies the mass-expulsion policy. Since putting the policy in place, the number of people crossing into the U.S. has dropped drastically, according to official CBP statistics circulated internally and provided to ProPublica, and there are only 330 people in CBP custody at last count, down from over 1,300 as of March 25.

The new guidance instructs agents to wear personal protective equipment at all times and not to use any Border Patrol vehicle to transport migrants that isn’t specifically designated for Operation Capio.

However, because the Operation Capio process doesn’t include medical screening, it will be impossible to know whether any migrants who are being expelled just in case they have the novel coronavirus are actually infected.

Meet the Pastors Holding In-Person Services During Coronavirus

2 Apr

by Kiah Collier, Vianna Davila and Perla Trevizo

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

This article is co-published with The Texas Tribune, as part of an investigative partnership.

HOUSTON — At least 25 parishioners filed into a beige-brick church here Wednesday evening and were handed rubber gloves at the door. A handwritten sign directed them to designated areas with seats that had been spaced 6 feet apart. Another sign laid out five things people should do to keep from spreading the new strain of coronavirus, including staying away if they felt sick.

The founding pastor of City on a Hill, Juan Bustamante, was in a particularly good mood. A day earlier, Texas Gov. Greg Abbott joined 30-plus other governors around the country in issuing a statewide stay-at-home order — though he declined to refer to it as such — that also designated religious services as essential. Under the order, Texans must stay home unless they work in certain business sectors or are grocery shopping, running must-do errands or exercising outdoors. Or going to church.

Abbott’s order came the same day the country’s top health experts estimated the deadly virus could kill between 100,000 to 240,000 Americans, and that’s assuming people across the country adhere to social distancing guidelines. Otherwise, the numbers could climb much higher, to more than 2 million dead.

Amid the rapid spread of COVID-19 in Texas — with nearly 4,700 confirmed cases and 70 deaths as of Thursday — many congregations across the state, large and small and of a variety of faiths, closed their doors of their own accord weeks ago and moved all services online.

But there are some religious groups in Texas — it’s unclear just how many — who say it’s their right to remain open because they believe they provide an essential service to their communities at a time of great need. And on Wednesday night, several houses of worship across the state welcomed parishioners.

Top scientists and public health experts have warned that religious services appear to be particularly conducive to COVID-19 transmission, with multiple documented cases of spread in houses of worship across the globe.

Harvard University epidemiologist Bill Hanage ticked off examples of virus transmission in houses of worship in London, South Korea, Singapore and the state of Georgia and said exempting religious services from shelter-in-place orders is “an incredibly bad idea.” Nearly four dozen people also were hospitalized in Washington state last week after they met for a two-and-a-half-hour choir practice in a church. Two members have died.

Vice President Mike Pence chimed in on Wednesday, saying in-person religious services — which have been deemed essential by more than a dozen states — should be limited to 10 people and held online if at all possible.

For Bustamante, closing the doors of the church he opened almost a decade ago was never an option.

That’s partly because half of his 100-plus parishioners don’t have internet access at home, he said, but more so because there’s no true replacement for in-person worship, particularly during a time of crisis.

“I truly believe the churches are first responders,” he said Wednesday before the evening service. “I have a deep conviction to keep going and keep standing for what we believe in.”

To him, people are more likely to catch and spread the virus at grocery or liquor stores, which are also exempt.

Bustamante was among three Houston-area pastors named in a petition filed on Monday with the Texas Supreme Court, along with conservative activist Steven Hotze, that asked the justices to strike down an order enacted by Harris County Judge Lina Hidalgo. The order, similar to others enacted by large Texas counties and cities, doesn’t consider religious services — or firearm sales — as essential, which the petition alleges is a constitutional violation.

Jared Woodfill, the attorney for Hotze and the pastors, said on Wednesday that he’s now getting calls “left and right” from churches that want to join the lawsuit — most are evangelical Christian, though a few are Catholic — and plan to continue, or resume, in-person services. At least five more had come on board in addition to the three that signed the petition, he said.

“All of the folks I work with are moving forward with services,” he said, noting the Easter holiday is coming up.

Hidalgo’s order is now seemingly moot, superseded by Abbott’s, though local officials have scrambled to figure out how exactly to interpret the governor’s directive. Some have said they take issue with the religious exemption and are still ordering religious leaders to cease in-person services while they assess the order.

San Antonio Mayor Ron Nirenberg called the governor’s exemption for religious services “concerning.” The order’s wording is confusing, he said, and seemed to conflict with advice from the Centers for Disease Control and Prevention, as well as his city’s orders.

“If we want to keep people alive, we’ve got to do services remotely,” particularly now, Nirenberg told ProPublica and The Texas Tribune. “We’re entering a very dangerous phase of community spread.”

The cities of Dallas and Fort Worth said they are also assessing the legality of Abbott’s order, with Fort Worth telling houses of worship they can’t hold in-person services.

But some conservative communities in the greater Dallas and Fort Worth region, like McKinney and Frisco, have already changed their regulations after a local religious liberties law firm encouraged them to.

McKinney Mayor George Fuller said he didn’t know of any churches that planned to hold in-person services and that the city is telling them to avoid it, but also that he supported “religious liberty and freedom.”

Later Wednesday, Abbott’s office released joint guidance with Texas Attorney General Ken Paxton that said houses of worship must be given special consideration for constitutional reasons and are indeed “essential services.” However, they must conduct activities online or at home “whenever possible” and some should avoid large gatherings, namely those located in areas with rapid community spread.

As for the 10-person gathering limit Abbott had previously imposed, it appears only to apply to churches located in areas with rapid community spread though Abbott’s office did not respond to a request for clarity.

“Houses of worship should work with counties and municipalities to evaluate the rate of local community spread and determine the appropriate level of mitigation strategies to implement,” the guidance said.

But Harvard’s Hanage said gatherings of any size are problematic. And the way people interact in churches, synagogues, mosques and other religious facilities — shaking hands, hugging, singing — appears conducive to what epidemiologists call “super-spreading events,” he said.

“We know that church services are places where this gets spread,” he said. “People need to understand that it’s a risk.”

Hanage said that congregations could possibly protect themselves by gathering outdoors — say, in a field — and ensuring parishioners keep their distance, but that “it’s hard to do it correctly.”

In Sacramento County, public health experts said on Wednesday that about a third of the 300-plus cases there can be linked to religious gatherings. That led to a special advisory banning worship services even though they already were not allowed under state shelter-in-place orders.

Beyond Christians, different faith groups in the Houston and San Antonio area continue to abide by the stricter guidelines, despite Abbott’s directive.

Some members of the Muslim, Christian, Jewish and Catholic communities consulted with one another and all came to the same conclusion, said Shariq Abdul Ghani, director of the Minaret Foundation, a Houston-based organization that focuses on building relationships through interfaith and civic engagement.

“Everyone has a feeling that for us, the faithful, our responsibility to our congregants is to keep them safe first and foremost,” he said. Many had adapted and moved services online using Facebook Live, Zoom and Google Hangouts.

The mosques will continue to offer services for the elderly and underprivileged, considered essential, he said, but even that will be abiding by social distancing guidelines and only with the most essential volunteers.

Rabbi Mara Nathan, of San Antonio’s Temple Beth-El synagogue, said the congregation had been holding services in the sanctuary with just clergy and no members, until the mayor issued the city’s March 23 stay home order. Services have been held on Zoom since then, because it’s important “that we’re modeling the most careful kind of behavior we can,” Nathan said. In a way, that has provided members with a more intimate setting than watching services held in an empty sanctuary. “At the end of every service, we make sure to say, ‘We miss you,’ but we’re together,” she said.

Texas is far from the only state to deem religious services essential — more than a dozen others have done so, according to the National Governors Association. That includes states like New York, Massachusetts and Kansas that are led by Democratic governors. But those states still appear to be cracking down on churches that have services with zero social distancing guidelines, at least at the local level.

In states such as Florida and neighboring Louisiana, pastors have been arrested by local authorities after holding services with large groups of people.

Matt Woodfill, the younger brother of Jared, is one of the pastors that petitioned against Montgomery County Judge Mark Keough’s stay-at-home order, similar to Harris County’s.

Woodfill’s congregation, The Way Church, defied the county’s order last Sunday, when it held regular services, though he said they tried to spread people apart. Attendance was still down significantly, from a high of 200 to no more than 50 parishioners this past Sunday.

The church plans to hold drive-in services in their parking lot for Palm Sunday this weekend. He will stand on an outdoor stage, set up with a PA system and a band, while people can listen in their vehicles. This is a high season for churches, with Easter in another week, so Woodfill wants families to feel safe enough to attend services.

Oakwood Church in New Braunfels, a growing community along Interstate 35 between San Antonio and Austin, moved all services online for its 6,000 congregants two weeks ago, in response to orders from the city, according to Pastor Ray Still.

Coronavirus has already affected his congregation directly: parishioner T.J. Mendez died March 26 from COVID-19 at the age of 44. Mendez’s family was very active in the church; one of his daughters was an Oakwood staff member.

On Tuesday, Still drove to the Mendez home, where the rest of the family remains in quarantine. He stood outside his car and prayed with them.

The governor’s new order doesn’t change their plans to keep holding services online, he said.

“As Christian people, we’re taught to be respectful and respect authorities, and our authorities aren’t doing that because they want to hurt us, they’re doing that because they want to protect us,” Still said.

Alex Samuels of The Texas Tribune contributed reporting.

COVID-19 crisis fast-tracks safe drug supply

2 Apr

Local lives filled with risk have gotten a lot riskier lately. In the Cowichan region, the COVID-19 pandemic is a triple whammy for people who use drugs and don’t have secure housing. Already dealing with the opioid overdose crisis and the affordable housing crisis, they are particularly vulnerable to contracting the coronavirus. They can’t stay […]

The post COVID-19 crisis fast-tracks safe drug supply appeared first on The Discourse..

Now That Coronavirus Is Inside This Adult Home for the Elderly or Mentally Ill, It May Be Impossible to Stop

2 Apr

by Joaquin Sapien

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

Over the years, Elmhurst residents have learned to mostly ignore the bedraggled and destitute residents who quarrel over cigarettes and beg for change outside the Queens Adult Care Center.

But now, inside the worn brick building, are all the elements of an epidemiologist’s nightmare.

On March 22 came proof that the deadly coronavirus had made its way into the home when one of its residents, an 82-year-old former nurse, succumbed to COVID-19. Now, staffers say, another may have died and as many as a dozen more residents have been sent to the hospital for treatment. At least 20 are in some form of isolation within the center. Up to a dozen of its 100 or more workers are out sick with coronavirus symptoms, workers say, and the numbers seem to be changing all the time.

Since the coronavirus hit the U.S., most of the attention has been on nursing homes. But there are hundreds of adult homes like the one in Queens across the state. Many pack in a combustible mix of the sick, elderly patients alongside those with mental illness. They are free to come and go, with little understanding of the risks of infectious disease.

Now that the virus is inside the Queens home, it may be impossible to stop.

First there is the center’s location, just one block from the now-notorious Elmhurst Hospital, where 13 patients died from the coronavirus in a single day last week and dozens more wear masks and cough as they wait for hours in a line that trails down the sidewalk. The surrounding neighborhood has one of the highest rates of infection in New York City, according to data released by the city this week.

Then there are the residents. As many as 352 mentally ill or aging New Yorkers live in the home. Their ailments and age put them in the crosshairs of the coronavirus. Chronic obstructive pulmonary disease, which constricts airflow to the lungs, is rampant. So are diabetes and heart disease.

Inside there’s no escape from the roommate with a cough or fever. The residents, mostly poor with nowhere else to go, live side-by-side, cramped two to a bedroom — the sick, old and bedridden next to the mentally ill. Bathrooms are shared by groups of four. Every day there are at least three more opportunities for community spread, the center’s staffers say. Residents say they only began to eat their meals in their own rooms on Wednesday. Before that they were gathering to eat in groups of 50 or even 100 or more.

Many residents have cognitive limitations, making it difficult for them to absorb the severity of the coronavirus and the importance of staying indoors. Some residents, who staffers suspect are infected, wander freely through the center’s three floors and recreational rooms. They congregate in communal rooms thick with cigarette smoke. Others can be seen in the surrounding neighborhood, panhandling and picking through the trash. They can ask for masks at the front desk, but few bother.

Leon Hofman, the owner of the Queens Adult Care Center, and his lawyer said the center is following all guidelines from the New York Department of Health, which oversees the home, and they are “working tirelessly to address this challenging situation.”

One longtime resident, Robert Schettino, 70, said he tested positive for the disease this week. He said he self-quarantined in his room, just down the hall from the former nurse who died.

He said keeping the infection from spreading among his fellow residents may be impossible. “They don’t even wear shoes and socks, let alone gloves and masks,” he said.

Roughly half of the residents routinely shuffle down the street for appointments at a mental health clinic, potentially bringing or leaving with the virus.

“It’s an incubator,” said Jill Twohig, a mental health counselor who works with center residents at the clinic. “I don’t feel that the home is doing a good job controlling the residents, and I am terrified.”

Some frightened workers, dependent on the job and critical for the residents, said in interviews that they are flying blind. The home’s administration, the workers said, either doesn’t know or won’t tell them which residents are sick and which are not. Janitors and home health aides take a gamble each time they enter a room. Then they take that risk home to their families on public transportation or bring it back with them when they return.

“I think it’s out of everyone’s hands already,” said one worker, who now worries she has symptoms of the disease and has shared it with her family.

Denis Nash, a professor of epidemiology at the CUNY Graduate School of Public Health and Health Policy, called the circumstances at the home “really horrifying.”

The risk of viral conflagration at the Queens center, he said, “is likely no longer containable.”

Richard Mollot, the executive director of the Long Term Care Community Coalition, a New York-based elder care watchdog, was equally alarmed: “That is really, strikingly, frightening. I don’t know how else to put it. It’s hard to find a way to articulate how vulnerable residents are in this situation.”

One of the earliest outbreaks started at a nursing home in Kirkland, Washington, and spread in the community. But Mollot said adult homes like the Queens center are probably at more risk. They house people who are often medically frail enough to live in a nursing home, but with more freedom, less government oversight and, typically, less qualified staff.

“These homes can be very dangerous on a good day,” Mollot said. “And the good days are behind us for the time being. If I was a resident, I would be very concerned. If I were a family member, I would be very concerned. And if I were a member of that community, I would be very concerned.”

“The risk,” he said, “is enormous.”

In recent years, ProPublica has written extensively about conditions inside adult homes and their alternatives, including the Queens Adult Care Center. So when the pandemic arrived in New York, and Elmhurst became its epicenter, we began to call people who live and work in or near the facility.

When first contacted on March 25, Hofman said none of his workers were sick and only one resident was being treated for the virus at Elmhurst Hospital. At that point, ProPublica later learned, the first resident had already died.

Hofman then stopped returning calls, instead responding through emails sent by his lawyer, Kurt Bratten. The pair have defended the center’s response to the virus and suggested that the workers are exaggerating the danger.

On March 31, they said that only six residents, but no workers, had tested positive for COVID-19.

When ProPublica reminded Hofman and Bratten that many sick people can’t get tested, they said they did not have time to respond to additional questions.

In an email, they said the information gathered by ProPublica was “categorically false” and an article that contains it “will perpetuate fear and panic.”

At this point it may be impossible to capture current reality at the home, or at similar facilities across the country. Information that seems reliable and up-to-date one minute changes the next, usually for the worse.

In the last week, ProPublica interviewed three residents, four of Hofman’s employees and three current and former workers from a nearby mental health clinic.

Last Friday, workers said, five of their colleagues were out sick. By this Wednesday, they put that number at 12, though they acknowledged that some might just be steering clear of the home for their own safety. More show symptoms by the day, but none has been immediately tested, the workers said.

In wrenching terms, the workers discussed mounting fear and shame that they may have already infected their families with the virus. They said the home’s administration is not doing enough to protect them from infection and has been dishonest about the severity of the problem.

“These people don’t give a shit about us,” said one worker, who like all quoted in this story asked for their names not to be used for fear of losing their jobs.

Jonah Bruno, a spokesman for the New York Department of Health, which regulates the group home, would not say how many residents or workers are sick at the home or how many have died, citing patient privacy restrictions.

Perhaps even more chilling, Nash, the CUNY epidemiologist, said the crisis in Queens could easily unfold elsewhere. There are more than 500 adult care facilities scattered throughout New York state. In New York City alone, there are nearly two dozen, tucked away in low-rent neighborhoods that each house some 200 mentally ill and elderly residents. An infection in any one of them would be equally difficult to contain, Nash said.

Bruno said that across the state there are currently 399 COVID-19 positive cases in 106 facilities and 71 “associated deaths.”

On Monday, The Wall Street Journal reported that 15% of coronavirus deaths in New York state had occurred inside nursing homes. On Saturday, a neighborhood blog reported that an Upper West Side residence for seniors was being evacuated.

“These percolating situations are nightmare scenarios,” Nash said.

At the New York Psychotherapy and Counseling Center down the street from the group home, Twohig, 47, can trace the arc of her fear.

For nearly three years, she has worked in a windowless office inside the rundown clinic, where she helps 56 residents of the center. But over the past two weeks, she said her job has shifted from therapist to public health educator.

Usually she counsels patients on their troubles — helping them cope with medication side effects, disputes with roommates, loneliness and depression. But as concerns over the virus mounted, she began teaching them how to properly wash their hands, sneeze and cough into their elbows, stay away from others and use hand sanitizer.

On March 18, she said, it became clear her efforts were not enough. That afternoon, her supervisor, Kam Ng, gathered the staff to deliver some grim news.

The roommate of one of the clinic’s clients had tested positive for the coronavirus and was in the hospital. Twohig and her co-workers sat with their mouths agape. “It’s here,” she remembered thinking. After a pause, the group let loose a flurry of questions: Had the roommate been tested? Would they have to continue to come to work? The residents are supposed to come in for one session per week. What if the staff already had it?

Ng, Twohig said, didn’t have many answers.

She said Ng told them that his superiors said there would be no immediate changes to their policy: Residents would continue to come in for their regularly scheduled therapy sessions. They would use hand sanitizer before they entered the office and would keep the sessions short.

“We were in disbelief,” Twohig said. She went back into her office, shut the door and began to panic. “What the hell is going on?” she thought. “What are they not telling us?”

When she walked past the home that evening on her way back to the subway, several of the residents were still sitting outside, sitting next to each other, smoking cigarettes. None wore masks or gloves.

“The concept of the virus seems beyond the realm of their comprehension,” she said. “It’s just something they see on TV.”

On the train, its cars nearly empty, her heart rate quickened and reality sank in: She was now considered an “essential worker” in the middle of a pandemic.

Twohig avoided the clinic for the next three days, handling her sessions by phone. She spent the weekend inside her East Village apartment, watching cat videos and talking to friends on FaceTime.

The following Monday morning, she said Ng called to say that his bosses would allow her and the staff to work two days a week from home, but they’d need to come in for the other three.

Confoundingly, she said he reassured her that she would still do her sessions by phone, even from inside the clinic. The patients would come in, enter a separate room, and speak to her over a speaker phone.

Why, Twohig asked, couldn’t she just call her patients from home and avoid the risk of exposure on her 45-minute train commute?

She said Ng said his bosses believed her patients would be more likely to engage in the sessions knowing she was in the building. If the patients didn’t show, he said she could go into the group home and physically find them — a prospect she refuses to entertain.

Neither Ng nor Elliott Klein, the chief executive officer of New York Psychotherapy and Counseling Center, responded to calls and emails for this story.

In response to questions on Twohig’s situation, the New York Office of Mental Health, which regulates the clinic, said in a statement that “it had waived some regulations to make it easier for providers to serve their clients by phone.”

On her way to work Friday morning, Twohig said she saw one of her patients wandering to a bodega with a surgical mask dangling from his wrist. She called out to him, “Show me how you put it on.” He fumbled with a demonstration, then ambled off toward Broadway, the thoroughfare that cuts through Queens.

Later that day, Ng told her and the other staff that the patient in the hospital had died and that his roommate, their client, was still refusing medical attention because he insisted he had no symptoms.

Twohig could feel a pit form in her stomach. She asked if their client was being quarantined. Ng said no, and the pit in her stomach rose to her throat.

ProPublica separately learned that Shamshudin Karmali, an 82-year-old resident of the home, died on March 22. A relative confirmed the cause was the coronavirus. A worker at the home said Karmali had scarcely left the facility in the months before his death.

Reached by phone, Karmali’s former roommate, a 61-year-old man with paranoid schizophrenia, said he’d been told Karmali died because of the virus.

The man said he hadn’t changed his behavior after the coronavirus had hit the facility and killed his roommate. He said he’d watched the film “Son of Kong” that day with 15 other patients inside a TV room.

“They take my temperature,” he said of the staff. “I’m not worried.”

But just down the hall on the same floor, Schettino is. Five days after Karmali’s death, he spiked a fever that scared him into braving Elmhurst Hospital. A doctor there, he said, jammed a swab so far up his nose he started bleeding. “It’s like they hit your brain,” he said. Two days later, he said he learned he was positive for the coronavirus. Now isolated in his room, he said he is mostly worried about the workers.

He and one other resident said that the staff only recently started delivering meals directly to the residents’ rooms. Before that, every meal was a jostling opportunity to spread COVID-19.

“They stand outside the dining room within inches of each other like they never got fed before,” he said. “They tell them, ‘When you get in line, stay 6 feet apart.’ But I don’t know if they know what 6 feet means.’”

Crowded with people in poor health who receive scant services, adult homes have long been prime targets for highly infectious disease.

The Queens Adult Care Center is one of nearly two dozen homes with a long and troubled history in New York City. It is also one of the biggest.

In the 1970s, the homes were envisioned as a more humane alternative to the state’s notoriously abusive state psychiatric hospitals. But in the ensuing decades, they, too, devolved into centers of misery and neglect.

In 2002, The New York Times found that more than 1,000 people died inside the homes over a six-year period. Some threw themselves from rooftops. Others died of heat exposure in rooms with no air conditioning. Residents were warehoused and exploited for profit. The Queens Adult Care Center, then called Leben Home, was singled out as one of the worst.

The stories prompted a class-action lawsuit. After 10 years of litigation, a federal judge ordered the state to give adult home residents with mental illness a chance to live independently in their own apartments. But as ProPublica reported last year, the state also brokered a quiet deal with the adult homes. It gave them a second chance with a new, more lucrative population in the form of the elderly and infirm. The Queens Adult Care Center was one of more than a dozen facilities that took advantage of the offer. Now the two vulnerable groups live together in the facility.

Along the way, Hofman, the owner and operator of the center, positioned himself as a kind of adult home reformer. He took over the facility following the Times investigation, having earned praise from the state for improving other homes. He renamed it, made renovations, added rehabilitation rooms and increased staffing.

But now, some workers complain that the coronavirus is exposing gaps in the home’s care for patients, protections for workers and consideration for the surrounding community.

In interviews this week, four workers, who help feed, medicate and oversee the residents, said that the home’s managers appear primarily concerned with protecting themselves. Since the virus began to take hold in New York, the administrators have sequestered themselves in their offices, the workers said. They also use the more expensive and increasingly rare N95 masks, which offer more protection than the disposable, loose-fitting surgical masks distributed to staff.

Home health aides and cleaning staff only get one surgical mask per day, according to the workers. The workers have gloves but not protective gowns. Only residents who ask for masks receive them, and one worker estimated that maybe 2% bother to do so.

Hofman and his lawyer said the home has plenty of masks and everyone can get as many as they need. They said some staffers prefer the surgical masks over the N95s.

The workers said reliable information on who might be infected is difficult to come by, but last week they noted that kitchen workers were preparing separate meals for roughly 20 people who are not allowed to dine with the rest of the residents in the communal dining room

One worker believes that number should have been larger.

Early last week, one resident was coughing so heavily in a dining hall that he was struggling to breathe, according to a worker watching him. The worker tried to alert a supervisor repeatedly, but the supervisor ignored the man.

“I said this guy is sick, please remove him from the dining room. I have seen him here three times. He is coughing and sneezing in everyone’s face. He can’t even breathe,” the worker said. “And they just said, ‘OK, thank you for letting us know.’”

The worker said the man continued to show up in the dining hall afterward. And now several residents and workers are sick.

“There are no precautions in the building,” the worker said. “It’s going to spread throughout the whole building.”

Last week, two workers estimated that as many as eight residents were admitted to a hospital for coronavirus symptoms and five workers have stayed home with symptoms. Now one of those workers puts that estimate at a dozen each, though they note that historically residents are often sent to the hospital for a variety of reasons.

ProPublica spoke to one of the sick workers Saturday.

The worker had been home for nearly a week with a fever that rose to 101 degrees and throat pain that made it impossible to swallow. The worker relies on a wage of roughly $17 an hour but said the company was not paying for sick leave. In an email, the center’s lawyer said it was paying for sick time.

“The company treats us like we are nothing,” the worker said. “Like we are not even human beings.”

One worker has allegedly quit because she did not want to get her elderly parents sick. Another said that more workers might have the coronavirus but do not want to disclose their symptoms, because they are worried they won’t get their jobs back if they take time off.

“We are poor people,” the worker said. “We live on a salary of $15 or $16 an hour. We can’t afford to lose our jobs.”

All of them worry for the surrounding community.

“Why isn’t this door shut?” said one worker. “Why are these residents still able to go out into the community?”

The staff is also concerned that they are becoming vectors for the virus themselves. One clinic worker said she has to take two buses and two trains to get to work each day. She then goes home to her husband, children and mother.

“There is a risk for us and our families,” she said. “We don’t know exactly what to do. … Can you help us?”

Nash, the CUNY epidemiologist, grew increasingly concerned about the conditions at the Queens center as ProPublica shared the deteriorating conditions with him.

“The risk that there could be a substantial amount of serious illness, hospitalization and deaths due to COVID among the residents in this setting seems very high, given the age profile and what could be a high prevalence of underlying health conditions and smoking,” he said.

“We have seen a few very sad examples of what this could look like in New York state and around the country.”

Initially, he recommended ways to contain the virus: Quarantine anyone with a confirmed case or anyone who had close contact with a confirmed case. Communicate regularly with the Department of Health. Give residents and staff regular health checks and protective equipment. Limit movement between floors and rooms.

But by Sunday, Nash urged ProPublica to report the situation to the state and city departments of health. He said the government should intervene as soon as possible.

ProPublica forwarded Nash’s concerns to the state Health Department. In a statement, spokesman Bruno said, “All New Yorkers, including those who live in Adult Homes, should follow the state directions to limit exposure to COVID-19 by avoiding contact with others.”

The department, the statement said, was working with homes to make sure residents understood social distancing and the need to stay indoors, but it acknowledged that “Adult Home residents maintain a level of independence and are free to come and go like anyone else in the community.” Those who test positive or exposed to COVID-19 “must follow all state-issued quarantine guidance.”

In his sole conversation with ProPublica on March 25, Hofman, the center’s owner, gave a much different impression of his facility’s preparedness and conditions than those who work for him.

Hofman said he “got lucky’’ and he bought personal protective equipment for his staff before the crisis hit, and that “knock on wood” none of his workers were sick. He said many of his workers live in the neighborhood and didn’t have to rely on public transportation.

Hofman said he is following guidelines from the state Health Department, which recommend that in “areas of high concentrations of positive coronavirus cases, residents should be encouraged to remain at home” and that the home “must have staff available to screen residents for symptoms or potential exposure to someone with COVID-19.”

According to Bratten’s emails, only one resident was currently receiving medical treatment for COVID-19 at Elmhurst Hospital and no workers had tested positive. They would not say how many workers had called out sick with symptoms, nor how many residents had already received treatment at Elmhurst and come back or were sent to any other hospital.

A staff member, they wrote, takes the temperatures of workers before they start their shifts and residents who appear symptomatic. But Hofman said that he can’t prevent residents from leaving the facility if they want to.

“The home,” they wrote, “is doing an excellent job of maintaining a healthy and safe environment for its residents and staff.”

Katie Zavadski contributed reporting.