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The bombing has reportedly stunned Moscow’s political elite and raised many eyebrows among Kremlin watchers abroad. Russia has now blamed Ukraine for the bombing, while Kyiv has denied any involvement. Amid fears the bombing will spur Russia to escalate its war in Ukraine, speculation both in and outside Russia continues to run rampant about who was behind the plot and their motives. Below is what we know.
The bombing.
According to Russian authorities and media reports, on Saturday night, Dugina and Dugin attended a nationalist festival on the outskirts of Moscow. When they left the event to return to Moscow, Dugin made a last-minute decision to ride in another vehicle. At around 9 p.m. local time, the Toyota Land Cruiser Dugina was driving exploded on a highway near the village of Bolshiye Vyazyomy, some 12 miles west of Moscow. Dugina, who was apparently the sole occupant of the vehicle, was killed instantly.
Russian authorities said the cause of the blast was an explosive device that had been attached under the vehicle on the driver’s side. On Monday, a law-enforcement official told the state-run TASS media outlet that the bomb was detonated remotely. A friend of the family, Andrei Krasnov, told TASS that the Land Cruiser belonged to her father. “Dasha drives another car, but she drove his car today, and Aleksandr went separately,” he said, referring to Dugina and speculating that the bomb had been intended for Dugin or perhaps both him and his daughter.
A video of the immediate aftermath later shared on social media shows smoking vehicle parts strewn across the highway and the vehicle itself engulfed in flames on the side of the road.
Another video appears to show Dugin at the scene himself, watching in shock as the SUV is consumed by fire.
Russia has blamed the bombing on Ukraine, which denies any involvement.
On Monday, Russia’s intelligence service, the FSB, claimed that it had swiftly finished its investigation and concluded that Ukraine’s intelligence services were responsible. The FSB said the bomb had been planted by a Ukrainian woman who came to Moscow in late July and rented an apartment in the same building Dugina lived in “in order to organize the murder of Dugina and obtain information about her lifestyle.” The FSB said the woman also attended the nationalist festival Saturday, then later fled the country by car over the border with Estonia. It released purported security footage of the woman both in Moscow and at the Russian border.
Ukraine has denied any involvement in the bombing. “Ukraine definitely has nothing to do with this because we are not a criminal state, which the Russian Federation is, and even more so, we are not a terrorist state,” Mykhailo Podolyak, an adviser to President Volodymyr Zelenskyy, said Sunday in an interview on Ukrainian television. On Monday, he called the FSB allegation “propaganda” from a “fictional world.”
A former Russian lawmaker says an armed resistance group conducted the bombing.
On Sunday, a former member or Russia’s parliament now living in exile in Ukraine claimed that an armed Russian resistance group called the National Republican Army was responsible for the bombing. According to the ex-lawmaker, Ilya Ponomarev, the underground group is working inside Russia to target and topple Putin and his allies and wasn’t only behind the car bombing but “many other partisan actions carried out on the territory of Russia in recent months.” Both the Associated Press and The Guardian were unable to verify Ponomarev’s claims or, for that matter, that such a group even existed.
Ponomarev was the only member of the Duma to vote against Putin’s illegal annexation of Crimea in 2014. He later left the country and now lives in Kyiv, where he operates opposition YouTube and Telegram channels.
Who was Darya Dugina?
A nationalist journalist and television commentator who has been a staunch public advocate of Russian expansion and the war in Ukraine, Dugina was sanctioned by the U.S. in March. She has appeared as a pundit on RT, was a commentator and former editor at the nationalist TV channel Tsargrad, and was the chief editor of United World International, which the U.S. has called a source of disinformation.
Putin praised Dugina in a letter released Monday, calling her “a bright, talented person with a real Russian heart” whose life was ended by a “vile, cruel crime” — though he made no mention of who was behind it.
Who is Aleksandr Dugin?
Dugin is an anti-liberal and ultranationalist ideologue who has long advocated for Russia to rebuild its authoritarian Soviet-era strength and global influence. As the Washington Post explains:
Dugin built his reputation on the premise that Russia’s destiny was to lead a united “Eurasia” to thwart the global ambitions of the United States. He has often been credited with influencing the Kremlin’s thinking on Russian expansion and Ukraine. His 600-plus-page 1997 tome, Foundations of Geopolitics, in which he espouses his nationalist theories, has been described as required reading among Russian military and foreign policy elites.
His links to Russian President Vladimir Putin are the source of speculation and occasional overstatement, and the extent of their direct relationship, if any, is unclear. Although he does not hold an official government position, Dugin has long called for the reabsorption of Ukraine into Russia — and experts say his language and expansionist views of Russia’s place in the world have been echoed by the Kremlin and in recent speeches by Putin.
In that 1997 book, Dugin wrote that “Ukraine as a state has no geopolitical meaning” and that its ambitions to be a state posed a threat to Russia, a point which has been echoed in more recent arguments against Ukraine’s existence by Putin and others. As The Guardian’s Pjotr Sauer notes, many believe Dugin’s views formed an ideological blueprint for Russia’s theft of Crimea in 2014 and, this year, the full invasion of Ukraine.
Media coverage has often referred to Dugin as “Putin’s brain” or the Russian president’s “spiritual adviser” — but many Russia analysts have argued that his supposed influence on Putin is vastly overestimated and more a product of the otherwise fringe ideologue’s talent for self-promotion than anything else.
This year, Dugin has not only been a staunch advocate for the war against Ukraine but has repeatedly called for much more aggressive tactics in the war. He did so again Monday. In a statement attributed to Dugin, he called the bombing an “act of terror” by Ukraine and said, “Our hearts yearn for more than just revenge or retribution … We only need our victory. My daughter laid her maiden life on its altar. So win, please!”
Dugin, who has been a target of U.S. sanctions more than once, has also aligned himself with and supported anti-western and far-right movements abroad in China, Iran, and Turkey as well as in Austria, France, and Italy, according to the Financial Times’ Gideon Rachman.
RUSSIAN ELITES ARE NOT SAFE! DON'T BLAME UKRAINE FOR RUSSIAN OPPOSITION. PUTIN CAN SILENCE THE OPPOSITION, BUT NOT TERRORIST ACTS.
Donald Trump. (photo: Erin Schaff/NYT/Redux)
The National Archives found more than 150 sensitive documents when it got a first batch of material from the former president in January, helping to explain the Justice Department’s urgent response.
In total, the government has recovered more than 300 documents with classified markings from Mr. Trump since he left office, the people said: that first batch of documents returned in January, another set provided by Mr. Trump’s aides to the Justice Department in June and the material seized by the F.B.I. in the search this month.
The previously unreported volume of the sensitive material found in the former president’s possession in January helps explain why the Justice Department moved so urgently to hunt down any further classified materials he might have.
And the extent to which such a large number of highly sensitive documents remained at Mar-a-Lago for months, even as the department sought the return of all material that should have been left in government custody when Mr. Trump left office, suggested to officials that the former president or his aides had been cavalier in handling it, not fully forthcoming with investigators, or both.
The specific nature of the sensitive material that Mr. Trump took from the White House remains unclear. But the 15 boxes Mr. Trump turned over to the archives in January, nearly a year after he left office, included documents from the C.I.A., the National Security Agency and the F.B.I. spanning a variety of topics of national security interest, a person briefed on the matter said.
Mr. Trump went through the boxes himself in late 2021, according to multiple people briefed on his efforts, before turning them over.
The highly sensitive nature of some of the material in the boxes prompted archives officials to refer the matter to the Justice Department, which within months had convened a grand jury investigation.
Aides to Mr. Trump turned over a few dozen additional sensitive documents during a visit to Mar-a-Lago by Justice Department officials in early June. At the conclusion of the search this month, officials left with 26 boxes, including 11 sets of material marked as classified, comprising scores of additional documents. One set had the highest level of classification, top secret/sensitive compartmented information.
The Justice Department investigation is continuing, suggesting that officials are not certain whether they have recovered all the presidential records that Mr. Trump took with him from the White House.
Even after the extraordinary decision by the F.B.I. to execute a search warrant at Mar-a-Lago on Aug. 8, investigators have sought additional surveillance footage from the club, people familiar with the matter said.
Russian soldiers in Ukraine. (photo: Shutterstock)
Russian Ambassador Gennady Gatilov said there would be no direct talks between Putin and Ukraine's president Volodymyr Zelenskyy
Gennady Gatilov, Russia’s permanent representative to the U.N. in Geneva, told the Financial Times that the U.N. should be playing a bigger role in attempts to end the conflict and accused the U.S. and other NATO countries of pressing Ukraine to walk away from negotiations. There would be no direct talks between Putin and Ukraine’s president Volodymyr Zelenskyy, he said.
“Now, I do not see any possibility for diplomatic contacts,” Gatilov said. “And the more the conflict goes on, the more difficult it will be to have a diplomatic solution.”
His remarks, which come despite a flurry of shuttle diplomacy in recent weeks, are a blow to negotiators who had hoped that a recent agreement on grain exports from Ukraine’s Black Sea ports could form the basis for a broader deal.
The U.N. has become mired in “politicization” because of the war and that has “damaged the authority of the U.N. and its organizations,” Gatilov said. As a result, it is unable to act effectively as a mediator, he complained.
“We do not have any contacts with the western delegations,” he said of his day-to-day work in Geneva. “On the protocol side we do not see each other…Privately we do not have any contacts, unfortunately…we simply do not talk to each other.”
Global diplomacy was in the worst state he had experienced in his 50-year career, Gatilov added. “The world has changed and the U.N. will never be the same as it was before.”
Russia invaded on February 24, in what Putin called a “special military operation” to “denazify” Ukraine. It was condemned by western countries, which imposed crippling sanctions on Moscow and severed ties. An initial attempt to seize Kyiv in a lightning assault was thwarted, forcing Moscow’s army to regroup and focus on an artillery-led campaign in the east.
Bilateral ceasefire negotiations broke down after evidence was discovered of war crimes committed by occupying Russian troops in April. Moscow has denied the allegations.
The failure to restart peace talks, combined with continued western military support for Ukraine, meant it was impossible to forecast how long the conflict could last, Gatilov said: “And so they [Kyiv and its western supporters] will fight until the last Ukrainian.”
Gatilov, who served as deputy foreign minister before being posted to Geneva in 2018, claimed that Moscow and Kyiv had been “very close” to an agreement that could have paused the conflict in negotiations hosted by Turkey in April. People involved in the talks have refuted this.
The U.N. and Turkey have sought to act as intermediaries between Kyiv and Moscow, and had recent success in brokering the deal on Ukraine’s grain exports.
But Gatilov said it was “unfortunate” that the U.N. was not playing a larger role. “I think [the grain deal] is the only example that they played a practical role in trying to mediate,” he said. “It should be more than that.”
Gatilov accused western countries of using the situation “as a matter of pressure on Russia, as a tool of isolation of Russia…damaging our position, economically, politically”.
“They do not care about the Ukrainian people, the Ukrainian soldiers,” he said.
Ukraine’s defence has been boosted by more than $30-billion worth of weapons supplies pledged by the U.S., U.K. and other NATO allies. Zelenskyy has previously said that he saw direct talks with Putin as the only way to negotiate an end to the conflict, and only after a Russian withdrawal from all Ukrainian territory captured since February.
Mykhailo Podolyak, an adviser in Zelenskyy’s administration who participated in the failed peace talks, said on Friday that “negotiating with the Russian federation means…a fatal ending for everyone”.
Turkey’s president Recep Tayyip Erdoğan, who has maintained relations with Kyiv and Moscow since the invasion, visited Putin in Sochi this month and met Zelenskyy in Lviv last week alongside U.N. secretary-general António Guterres in an effort to act as a mediator.
Erdoğan said during his visit to Ukraine: “I continue to have faith that the war will end at the negotiating table. Mr Zelenskyy and Mr Putin are of the same opinion.”
But that statement did not refer to any new developments that could lead to negotiations, according to a person familiar with the discussions.
Gatilov praised Erdoğan for “trying his best” to facilitate dialogue but dismissed speculation of direct talks between Putin and Zelenskyy, saying there “was not any practical platform for having this meeting”.
He also accused Ukraine of “a clear provocation” at the Zaporizhzhia nuclear plant, which is occupied by Russian forces. Ukraine has blamed Russia for shelling the plant, while Nato has said Russia is using the nuclear site as a base from which to launch attacks.
“Russian troops are just guarding it. Just securing it. Why should we shell it?” Gatilov said. Russia has agreed to an urgent safety visit by the International Atomic Energy Agency to the plant.
Dr. Anthony Fauci. (photo: Greg Nash/Getty Images)
As of December, he will leave the position he's held for 38 years as the director of the National Institute of Allergy and Infectious Diseases, as well as his job as chief of the NIAID Laboratory of Immunoregulation, and his role as chief medical adviser to President Biden.
The straight-talking scientist and physician was the government's top infectious disease doctor for decades, and one of the few scientists that many Americans knew by name.
Fauci, 81, served under seven U.S. presidents and helped lead the country through numerous health crises. He was instrumental in combatting the AIDS epidemic, starting as the youthful director of NIAID in the early 1980s. He also took center stage in a politically fraught response to the nation's COVID-19 pandemic, and he was both praised and assailed for his tell-it-like-it-is philosophy.
Biden hailed him as a "dedicated public servant" in a statement issued Monday. "Because of Dr. Fauci's many contributions to public health, lives here in the United States and around the world have been saved," the president said.
Department of Health and Human Services Secretary Xavier Becerra, who took leadership of the agency a year into the COVID pandemic, said he relied on Fauci's counsel and praised him for "his ability to break down complex science in simple terms to the American people to save lives."
As AIDS crisis grew, he led by listening
Fauci's actions during the AIDS epidemic helped marshal a scientific and government response that saved millions of lives. His approach to engaging AIDS activists also transformed the way patients and activists interacted with medical science for many diseases.
"Tony Fauci is a really interesting character in the history of the AIDS epidemic," said Jon Cohen, a journalist at Science magazine who wrote a book about Fauci's passionate but ultimately unsuccessful effort to develop an AIDS vaccine. "He becomes the voice of science, he can translate science into English better than anyone, and he can speak to every president, every congressperson, every world leader, and he can speak to patients," Cohen said in an interview.
Those abilities emerged during the earliest days of the AIDS epidemic, when the Reagan administration tried to downplay or ignore the deadly disease afflicting particularly gay men and users of drugs by injection, as well as people with hemophilia who died because their medication was derived from contaminated blood products.
Part of Fauci's strategy was to engage the patients and activists who were demanding not only answers but a rapid federal response.
"He was one of the few [powerful people in Washington] that opened his doors early to us to listen and to hear us out," said Peter Staley, one of the founding members of Act Up New York, a prominent AIDS activist group. "And he was one of the few that wasn't afraid of us, and thought we had something to bring to the table."
Staley recalls regular dinners that Fauci held in the home of a gay man who worked in his office. Those dinners "would last for many hours over many bottles of wine, and we debated these issues, and it would sometimes get very heated," Staley said. They didn't always agree, "but I came to respect the man intensely during that period."
The AIDS activists pushed for being part of the research and having a seat at the table, as scientists and government officials figured out how to develop drugs and test vaccines to control the AIDS epidemic.
A gifted communicator
Fauci also oversaw a laboratory at the NIH and saw patients throughout his long career, keeping connected to the science as well as the human dimensions of infectious disease.
"Tony won the respect of the angriest, most frustrated people because they saw him as an ally and because he listened to them and he incorporated them — he made them part of finding solutions," Cohen said. And that approach "radically overhauled how we think about disease and research and patients, not just AIDS."
Breast cancer activists adopted this cooperative approach and many other disease advocates followed suit.
Fauci was also instrumental in an effort, undertaken by the George W. Bush administration, to make AIDS medicines available globally. The multibillion-dollar program, called the President's Emergency Plan for AIDS Relief, or PEPFAR, has saved millions of lives, primarily in Africa.
Fauci's gift for communication put him at the center of many public health crises, in Republican as well as Democratic administrations. Those included viral outbreaks ranging from Zika and West Nile disease to the annual flu. To help calm a jittery American public during the Ebola scare in 2014, Fauci stepped up to the cameras and embraced an Ebola patient — a nurse, Nina Pham — who had been treated at the NIH.
"I want to tell you what a great pleasure, and in many respects a privilege it has been for me and the staff here ... to have had the opportunity to treat and care for and get to know such an extraordinarily courageous and lovely person," he said in his distinctive Brooklyn accent.
His political acumen stood him in good stead with seven presidential administrations, starting with Ronald Reagan. No other leading federal scientist in modern times held a top position for as many years as Fauci did.
Fauci even got a shout-out from George H.W. Bush during a 1988 vice presidential debate. The candidates had been asked to name their heroes, and Bush included Fauci in his list. "You probably never heard of him," Bush said. "He's a very fine researcher, top doctor at the National Institute[s] of Health. Working hard, doing something about research on this disease of AIDS."
Diplomacy and politics in the early days of COVID
Fauci's biggest political challenge came during the Trump administration. Early in the COVID-19 pandemic, Trump frequently brought Fauci to the White House as a member of the Coronavirus Task Force, to participate in meetings and press conferences. But as the disease spiraled out of control, the president tired of Fauci's warnings. Fauci found diplomatic ways to correct the president's often errant statements about the coronavirus, for example when Trump wondered whether COVID-19 could be treated with bleach injections or by shining ultraviolet light into people.
The relationship hit a low point a few days before Election Day, 2020, when a crowd at a Trump campaign rally in Opa-Locka, Fla., started changing "Fire Fauci! Fire Fauci!"
Trump replied, "Don't tell anybody, but let me wait until a little bit after the election. I appreciate the advice. He's been wrong on a lot," Trump continued. "He's a nice man but he's been wrong on a lot."
Trump did not fire Fauci, who had made some missteps during the early days of the pandemic.
At first, scientists didn't fully understand how the virus spread or how to contain it. Fauci initially misjudged the degree to which the virus spread from people who had no symptoms of disease. He quickly changed his view as scientists learned more. Like many scientists, he was also uncertain about the value of masks early on.
But he never wavered in his view that people needed to stop gathering in large numbers, to wash their hands, isolate if ill and otherwise to take personal responsibility to avoid spreading the virus. Those positions earned him the ire of some Americans, who felt public health guidance infringed on their personal freedom. It was also inconsistent with Trump's false claim that the pandemic was being overblown.
Fauci had amassed a powerful following among people committed to a science-based response to COVID-19. His face popped up on T-shirts, coffee mugs and yard signs — and on Tony Fauci bobbleheads.
He was even invited to throw the ceremonial first pitch at the start of the Washington Nationals' 2020 home opener, five months short of his 80th birthday. Suffice it to say it was outside the strike zone, a fact which the president noted among his complaints about Fauci's performance. (He redeemed himself two years later throwing a cleaner pitch this month in game between the Seattle Mariners and the New York Yankees, in Seattle.)
With Biden's election, Fauci became the president's chief medical adviser. Fauci admitted in the administration's very first press briefing that it was a relief to work for a president who took the science seriously.
"I can tell you I take no pleasure at all in being in a situation of contradicting the president," he said. "So, it was really something that you really feel you couldn't say something and there wouldn't be any repercussions. The idea that you can get up here and talk about what you know, and what the science is and that's it. Let the science speak. It is somewhat of a liberating feeling."
Fauci's gift for communication made him a media star and a household name.
But his fame also made him a target for critics of the federal government's COVID response and even for death threats. In January, at a Senate hearing on COVID, Fauci blamed rhetoric from Sen. Rand Paul, R-Ky., for sparking death threats against him and his family.
Paul and other congressional Republicans have raised the idea of investigating Fauci after the midterm elections, if they win back control of the House or Senate.
A scientist 'in his very soul'
Throughout the COVID pandemic, and the nonstop media attention he received, Fauci continued to run one of the major institutes at the NIH.
"He in his very soul was a laboratorian, was a bench scientist," said Dr. Georges Benjamin, longtime head of the American Public Health Association. "Here was a guy who loved that kind of work. And while he handled the administration and the bureaucracy well, that wasn't necessarily what he got up for every morning to do."
Indeed, under Fauci's guidance, scientists at his institute aggressively pursued a vaccine for COVID-19. And, in an astonishing span of less than a year, they brought one into being, in partnership with the drug company Moderna. It was even more effective than Fauci had dared hope, achieving an efficacy of over 90%.
"He was giddy with laughter," Benjamin recalls. "I remember watching him on TV with the joy of a new parent who has something that's just precious, and understood just how valuable that vaccine was going to be."
In a statement, Fauci said it had been "the honor of a lifetime to have led the NIAID." He said he'll continue to work after departing from his current government positions.
"After more than 50 years of government service, I plan to pursue the next phase of my career while I still have so much energy and passion for my field," he said.
A doctor and patient. (photo: Rawpixel/Getty Images)
At my clinic in Illinois, so many are coming across state lines for care.
Everybody’s a little different, so we feel out the patient themselves. Some patients just are going to require more attention to make them feel more safe while doing this procedure. You have to read the room. One of our things we do is we talk food with patients. Patients who are coming in from out of state, first thing they want to go do after this is go get something good to eat. So they throw out their favorite food and then we run through recommendations of everywhere within like 25, 30 minutes that they can go find somewhere good to eat. Talking about animals, other siblings or family members. If they have any support back home. Open those up and then you have more avenues to travel down to get them to feel closer.
Volume increase is definitely the most predominant change since the Dobbs trial. We’ve also had patients bring us stuff because they know everything that’s going on. And they’re like, “We got to support you guys, because you’re supporting us.” While abortion access has changed, our patient care, what we’re doing for the patients has not changed. We’re not going to change that because Roe fell.
Some days are just extra exhausting, because you can never know what stories you’re going to have from patients. What led the patient here. That sometimes is very difficult for them to talk about. And it can be hard on the staff, depending on what kind of past trauma staff has as well.
Everybody’s a little tired. There’s no getting around that. We’re trying to find time to focus on ourselves and trying to make sure our employees are getting the therapy that they need. And they’re just being taken care of just as much as our patients. It’s not only hard on the patients, but the staff, because we went from a quarter of the patients we were seeing to what we’re seeing now. And not to mention, we brought on staff that needs to be trained. So it’s just, it’s a little wibbly-wobbly until we are able to, I guess, find a flow that works.
Mostly everybody’s trying to keep it as positive as we can. There are some days where it’s just gloomy. Everybody who comes in is just sad. And then it just brings the vibe down in the building, but as long as you just push through, it’ll get back.
And personally, it’s rewarding too because these people need this. It’s just so rewarding to know that these people are able to continue their lives. And these people who come in pregnant, can have procedures done and continue their lives, not pregnant. Nobody should have to carry a pregnancy just because they had a hiccup or a contraceptive failure or something along those lines.
A prisoner. (photo: Peter Macdiarmid/Getty Images)
Alvarez has heart trouble and he's struggled to take care of his four kids and his fiancé's daughter through their long separation. When Eva Cardoza returned from the federal correctional institution in Danbury, Conn., she shouldered a lot of burdens.
"She was doing everything at home. She was cooking, cleaning, taking care of the kids, helping them with homework," Alvarez said.
More than 11,000 people like Cardoza have been released from federal prison in the last couple of years, to ride out the pandemic at home, often with their families and loved ones. But that situation can be precarious.
In June 2021, Alvarez and Cardoza took a 90-minute cab ride into the Bronx, so she could meet with staffers in charge of her supervision. Cardoza, who had tested positive for marijuana, never came out of the building. Alvarez ended up forking out $433 to cover the hours the taxi meter ran as he waited in vain.
Cardoza's return to prison turned the family upside down. She's now been back at Danbury for 14 months. Alvarez said she never got the chance to explain herself or challenge that single positive drug test.
"That's just mind boggling to me," Alvarez said. "Where is the judicial system? Where is the fairness? Where is the 50-50? I don't see it."
Less than 0.2% of the people released committed new crimes while they were out
This week, the Bureau of Prisons told NPR that 442 people who were released during the pandemic have now returned to prison. Only 17 people out of more than 11,000 who were released committed new crimes, mostly drug related ones, while they were out. More than half, some 230 people including Eva Cardoza, got sent back for alleged alcohol or drug use. Other cases involved technical violations.
Sakira Cook of the racial justice group Color of Change explained what that means.
"It could be as simple as failing to answer the phone when your probation officer calls you. It could be as simple as the ankle monitor giving an incorrect signal about your location," Cook said.
Cook has personal experience with that last problem: a relative recently left federal prison on home confinement, only to get an ankle monitor that didn't work. Fortunately, she said, the probation officer understood the situation.
Kevin Ring advocates for people in prison and their families at the group FAMM, formerly known as Families Against Mandatory Minimums.
"In a normal circumstance, somebody who violates the terms of their home confinement is sent back to the halfway house or to prison, but the stakes are much lower," Ring said. "They're only going back for a month or two."
But some of the people released from prison under the bipartisan pandemic legislation called the CARES Act have years remaining on their prison terms.
"Is it really worth sending people back for years because they missed a phone call or they had alcohol in their urine?" Ring asked.
Hoping for due process as a judge rules the current procedures are unconstitutional
Most of the monitoring of people on home confinement is being done by private contractors, said Quinnipiac University School of Law professor Sarah Russell.
"There can be a lot of room for miscommunications and misunderstandings," Russell said.
Russell said that's all the more reason to ensure due process rights for people at risk of being sent back: the opportunity to see the evidence against them and to have a hearing before a neutral arbiter.
Last week, one of Russell's clients won those rights in court. The decision by Judge Omar Williams is the first in the nation to hold that the current process for returning people to federal prison after home confinement is unconstitutional.
Russell said her other clients — moms with young children — are still nervous about having to leave their lives behind unexpectedly.
"My real hope is that this gets addressed at the national level through the Bureau of Prisons and through the Department of Justice," Russell said. "They have a real opportunity to set clear procedures and criteria."
More lawsuits from people returned to prison are under way. The Bureau of Prisons said it can't talk about that pending litigation. But it is considering a new federal rule to make the process more clear.
For Eric Alvarez, 46, that can't come too soon. He's been diagnosed with colon cancer — the same disease that took his uncle years ago.
"And my heart is not up to par to take this kind of abuse and now I'm going through it on my own," he said. "It's just I'm afraid that I'm going to die alone."
Alvarez talks to his fiancé in prison on the phone, or with video calls. But he said it's not the same as having her home.
An estimated 25 million people in the United States have asthma. (photo: NOAA)
Most susceptible are communities of color, which are disproportionately burdened by poorer air quality and other environmental factors.
"I don't want to die," he told her.
When his father, Michael Brown, saw Kingston, the boy was pale, but his oxygen level was steady.
"That's the thing that scared me the most. Out of all of the times that I encountered him having one of these episodes," Brown said of Kingston, who had experienced an asthma attack and was hospitalized overnight at Augusta University Health, "he's never had one this bad and mentioned death."
An estimated 25 million people in the United States have asthma, but for those like Kingston, who is Black, their condition can be dire. Health data collected in recent years has indicated a growing imbalance along racial lines: Black people and Native Americans are diagnosed with asthma at higher rates; emergency department visits related to asthma are five times as high for Black patients as for white patients; and Black people are about three times more likely to die from asthma than white people.
The concern among doctors and patient advocates to ensure adequate treatment and access to care comes as the asthma death rate appears to be climbing.
Asthma deaths across the country rose by more than 17% from 3,524 in 2019 to 4,145 in 2020 — the first "statistically significant increase" in more than 20 years, according to federal data examined by the Asthma and Allergy Foundation of America, a nonprofit patient organization that tracks hospital visits and asthma-related mortality rates; it plans to include its findings in an annual report this fall.
For years, the asthma death rate has declined, in part because of better diagnosis and medications.
Kenneth Mendez, the foundation's president and chief executive, called the year-over-year jump "puzzling" for a disease that is largely manageable through an array of treatments, and said further studies are needed to understand why the number of deaths increased and if a lack of proper care or a severity in cases were to blame.
While Covid-19 may also be a likely factor in the recent increase, there's more to be studied as a warming climate and hotter days are only worsening the effects on people with asthma and allergy sensitivities, Mendez said.
"We need to connect the dots between climate change, allergies, asthma and the disproportionate burden of these experienced by Black, Hispanic and Indigenous populations," Mendez said. "Climate change is making allergy seasons longer and more intense. We must do more to reverse these trends."
Extreme heat a factor
Brown is unsure what directly triggered Kingston's latest bout of asthma, although he had experienced a milder attack earlier this year and had been given an inhaler to use twice a day. The family plans to have a lung doctor evaluate him further.
On the days surrounding the asthma attack, the temperatures in northern Georgia had been in the 80s and 90s, and Brown believes that extreme heat and weather are playing a part in his son's condition.
Punishing heat waves from coast to coast and stretching across the globe this summer — part of a pattern of consistently hotter years — can't be ignored, scientists and allergists say.
Rising temperatures elevate ozone levels in the air, which can aggravate asthma symptoms and irritate airways. Intense wildfires are burning more frequently, creating hazardous smoke and airborne particles that affect air quality. Meanwhile, record flooding and rains fueled by warmer temperatures and rising sea levels can spur mold and microbial growth, potentially inflaming a person's asthma.
"It's worse for me on days when it's really hot and humid," said Amanda Ernest, 27, of Boston, who spent several days in the hospital in late June for her asthma. Ernest, who is Black and Haitian American, said she's still unsure what led her to develop breathing problems later in life.
But people of color with a chronic respiratory condition may face added threats that make it harder to breathe.
Recent studies have shown people of color in the U.S., including Black, Latino and Asian populations, are subjected to more polluted air than white Americans, with exposure coming from industrial, agricultural and residential sources. In larger cities, communities of color are more likely to be located in neighborhoods historically overburdened by factories or near highways. And poorer-quality housing in urban areas can be home to asthma triggers, such as mold, cockroaches and mice.
Dr. Sydney Leibel, who treats children with severe asthma at the Rady Children's Hospital in San Diego, said most of his patients come from areas of the city that were historically segregated because of redlining — in which federal agencies in the 1930s allowed for unjust lending practices that disenfranchised Black and Latino home buyers. A study in March in the journal Environmental Science … Technology Letters found that air quality is still worse in cities where redlining was practiced.
"It is children from these areas that are already vulnerable for asthma development and exacerbations that I am most worried about with global warming and the changing climate," Leibel said.
Finding solutions
Leibel's hospital hosts a specialized clinic founded in 2015 with UC San Diego Health, and with financial assistance from the Asthma and Allergy Foundation of America.
Children who are referred to the clinic undergo a thorough evaluation by a pulmonologist, allergist and a clinical pharmacist to determine the severity of their asthma, and to also educate families and offer treatment options.
A study of the program published in 2020 found significant reductions in the number of emergency department visits and hospitalization days for patients who participated in the clinic.
Leibel said the coronavirus pandemic also led to a small reprieve in hospital visits, thanks in part to masking and social distancing.
More than half of the participants at Rady Children's Hospital's asthma clinic are insured by Medi-Cal, California's insurance program for low-income residents.
Giving these most susceptible families a place to go to for controlling their children's asthma is critical, Leibel said.
"Here's the reality: No one has to die from asthma," he said.
On the national level, a study published this year in the New England Journal of Medicine took an unusual approach by conducting a clinical trial involving 1,200 Black and Latino asthma patients in order to understand why there is a persistent racial gap in treatment. The study found that those participants who were also treated with an as-needed inhaled corticosteroid, an anti-inflammatory drug, had a better health outcome — which could ultimately help reduce hospital visits.
Mendez said he's hopeful that the recently passed federal Inflation Reduction Act, which includes hundreds of billions of dollars meant to reduce global warming and lower the cost of prescription drugs, will also be a benefit for asthma sufferers.
"We will continue to advocate for more of these kinds of changes to protect our community," he said, "especially ones that bear this unfair burden of higher hospitalizations and deaths."
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