Rare syndrome tied to COVID-19 kills three children in New York, Cuomo says

By Nathan Layne

(Reuters) – Three children in New York have died from a rare inflammatory syndrome believed to be linked to the novel coronavirus, Governor Andrew Cuomo said on Saturday, a development that may augur a pandemic risk for the very young.

Both Cuomo and his counterpart in the neighboring state of New Jersey also spoke on Saturday about the pandemic’s growing toll on mental health, another factor on the minds of governors as they weigh the impact of mounting job losses against health risks in moving to loosen restrictions on daily life.

Nearly all of the 50 U.S. states will have taken steps to relax lockdown measures by this weekend, including states like Arizona and Mississippi, which are reporting increasing infections of COVID-19, the disease caused by the virus, highlighting the risk of a new wave of outbreaks.

Cuomo told a daily briefing that he was increasingly worried about a syndrome that shares symptoms with toxic shock and Kawasaki disease, which he said included inflammation of the blood vessels and potentially fatal damage to the heart.

He said three children – including a five-year old disclosed on Friday – have died from such symptoms while also testing positive for COVID-19 or related antibodies, suggesting a link that was still not fully understood.

Cuomo, who has emerged as a leading national voice on states’ response to the coronavirus crisis, said state health officials were reviewing 73 similar cases, which have rattled a prior assumption that children were largely not susceptible to the novel coronavirus.

“We are not so sure that is the fact anymore. Toddler, elementary school children are presenting symptoms similar to Kawasaki disease or toxic shock-like syndrome,” Cuomo said. “It’s very possible that this has been going on for several weeks and it hasn’t been diagnosed as related to COVID.”

Cuomo said state health officials had partnered with the New York Genome Center and the Rockefeller University to look at whether there is a genetic basis for the syndrome and have been asked by the federal Centers for Disease Control and Prevention to develop national criteria for identifying and treating cases.

The syndrome shares symptoms with toxic shock and Kawasaki disease, which is associated with fever, skin rashes, swelling of the glands, and in severe cases, inflammation of arteries of the heart. Scientists are still trying to determine whether the syndrome is linked with the new coronavirus because not all children with it have tested positive for the virus.

At a separate briefing, New Jersey Governor Phil Murphy said the death of a four-year old disclosed on Friday was not related to the syndrome. “This is a very specific situation with this blessed little kid and we are going to leave it at that.”

‘TOXIC MIX’

New York and New Jersey are at the epicenter of the pandemic in the United States, accounting for nearly half of the 77,737 American deaths from COVID-19, according to a Reuters tally, and the two states have among the strictest lockdown rules still in place.

They are also at the center of a devastating economic toll underscored in government data released on Friday showing the U.S. unemployment rate rose to 14.7% last month, up from 3.5% in February and shattering the post-World War Two record of 10.8% set in November 1982.

Cuomo said his state has seen increasing reports of mental health issues, substance abuse and domestic violence, all tied to the economic stress and isolation of the lockdowns.

On Friday a study released by the Well Being Trust and the American Academy of Family Physicians estimated an additional 75,000 people could lose their lives to suicide, drugs and other contributors to “deaths of despair” stemming from the crisis.

Murphy echoed those concerns.

“The cure for the health crisis is keeping people isolated,” Murphy told his briefing. “You add to that job loss, small businesses that have been crushed. It’s a toxic mix.”

Cuomo said 226 New Yorkers died from COVID-19 on Friday, up from 216 a day earlier, but less than half the levels recorded two weeks ago. He said hospitalizations and intubations continued their downward trend, further evidence the state has gained a measure of control over the virus.

Murphy said an additional 166 residents of his state had died over the past 24 hours from COVID-19, bringing its total fatalities to 9,116, while total cases rose by 1,759 to 137,085.

On a positive note, Murphy said the number of people hospitalized for the disease continued to fall, with the 422 patients discharged over the past 24 hours outpacing the 364 newly admitted for treatment.

Yet Murphy warned against complacency and said his constituents should continue to practice social distancing.

“We are not out of the woods, folks. Let’s not forget that,” he said.

(Reporting by Nathan Layne in Wilton, Connecticut; Editing by Daniel Wallis and Dan Grebler)

Your COVID-19 questions, answered

There is a lot of misinformation circulating about the coronavirus, so we took to Instagram, Twitter and Reddit to see what questions have been bugging you, our readers.Below are answers from several healthcare experts who have been following the outbreak. Please note that there is much we still don’t know about the new virus, and you should reach out to your own healthcare provider with any personal health concerns.

LIVING UNDER LOCKDOWN

What are good ways to maintain your mental health?

I would recommend the following:

1. Maintain a normal schedule if possible

2. Exercise (go for walk or run, do an online video)

3. Maintain social connections via FaceTime, Skype or phone calls

4. Limit time spent on the Internet and connected to the news

5. Have “virtual” dates with family and friends.

— Dr. Krutika Kuppalli, infectious disease researcher

Here’s how it’s affecting young minds  and how millennials are adjusting to isolation.

How long will the U.S. really have to be on lockdown to successfully flatten the curve?

We’re still learning on a daily basis what the case count looks like in the U.S. We also need to consider that there could be a resurgence of cases once public health measures are loosened up.

— Dr. Krutika Kuppalli, infectious disease researcher

I defer to the epidemiologists here, but National Institute of Allergy and Infectious Diseases Director Anthony Fauci recently said that he’s confident in a range of four to six weeks to 3 months.

— Dr. Angela Rasmussen, virologist at Columbia University

Do I actually need to wear a mask?

The WHO advises that if you’re healthy, you need to wear a mask only when caring for an infected person or if you’re coughing, sneezing or showing symptoms. More here

TRANSMISSION

Is it fair to assume every American will be exposed to the coronavirus this year?

No, which is one of the reasons we have these current public health measures in place. We are trying to prevent further onward transmission of the disease.

— Dr. Krutika Kuppalli, infectious disease researcher

Almost 100,000 cases have been reported in the U.S. and its territories, according to a Reuters tally of state and local government sources, mapped .

Is the coronavirus airborne in normal settings and if so, for how long?

According to our knowledge, it does not stay in the air in normal settings. Most evidence directs us to droplet transmission. Airborne precautions are required only for healthcare workers when undertaking aerosol producing procedures such as bronchoscopy/intubation.

— Dr. Muge Cevik, infectious diseases researcher at the University of St. Andrews

Is there potential exposure in elevators?

Coronavirus guidelines by the CDC are based on the fact that the virus is transmitted primarily via respiratory droplets, like a cough or sneeze. In droplet form, it’s airborne for a few seconds, but is only able to travel a short distance. In elevators, social distancing measures should be implemented with a max number of people inside at a time.

— Infectious Diseases Society of America

How worried should we be about fomite transmission?

We are still learning about fomite transmission. We know from an article in the New England Journal of Medicine that the virus is viable up to four hours on copper, 24 hours on cardboard, and two to three days on plastic and stainless steel.

— Dr. Krutika Kuppalli, infectious disease researcher

Can you spread the virus if you’re asymptomatic?

Yes, but it isn’t the main driver of transmission. This is also why it is extremely important to ensure you have washed hands before touching your face.

— Dr. Krutika Kuppalli, infectious disease researcher

What’s the typical timeline of symptoms?

From the time of exposure to symptoms it may take on average three to six days, which may be longer/shorter in some patients. Typically it starts with fever, dry cough, myalgia and flu-like illness, then progresses to shortness of breath and pneumonia in some patients.

— Dr. Muge Cevik, infectious diseases researcher at the University of St. Andrews

Is it possible that an infected person only has a mild cold before recovering?

Yes. The most common symptoms a person will have are fever, dry cough and muscle aches/fatigue.

— Dr. Krutika Kuppalli, infectious disease researcher

Should people be more concerned about eye protection?

We certainly use face shields to protect our eyes when in contact with patients.

— Dr. Isaac Bogoch, infectious disease researcher and scientist

Does getting vaccines increase your risk?

Getting any vaccines would not increase your risk for COVID-19. We’re recommending getting needed vaccines. We want people to get their influenza vaccines so they don’t end up with the flu and in the hospital.

— Dr. Krutika Kuppalli, infectious disease researcher

Do people have a natural immunity to this virus?

I am not aware of “natural immunity” since it is a new virus. We might find as serology testing is rolled out that people have been exposed and developed antibodies without having symptoms.

— Dr. Krutika Kuppalli, infectious disease researcher

Is it possible to get reinfected?

We’re not sure how immunity works or how long it lasts. The best guess is that people who are infected are likely to be protected over the short-to-medium term. We don’t know about longer yet.

— Dr. Eric Rubin, editor-in-chief, New England Journal of Medicine

There are a handful of cases of possible “reinfection” in recovered patients. But most scientists believe those are more likely to have been relapses.

TREATMENT

Is there a team working on an antibody test for the virus? If so, when might it be ready?

There are teams working on serological tests. Rolling out on a population scale will be an essential part of the long-term answer, but we need to get through the next month.

— Bill Hanage, associate professor at the Harvard T. H. Chan School of Public Health

When will a vaccine be ready?

Vaccine trials may take as long as 12 months. There are multiple clinical trials looking at different treatment options, but we currently don’t know whether this combination is effective and safe for patients.

— Dr. Muge Cevik, infectious diseases researcher at the University of St. Andrews

Scientists in Singapore are trying to fast-track the process.

What impact will warmer weather have on the spread?

I have yet to see convincing evidence on this, one way or the other. We are all hoping transmission will slow down with warmer weather in the northern hemisphere, and that warmer countries will be spared the worst. Not enough data yet to conclude.

— Dr. Suerie Moon, director of research at the Global Health Centre

Here’s what we know about seasonal features of disease outbreaks.

I’ve seen several news sources report that experts from Johns Hopkins and other medical colleges are saying the virus can become less deadly as it spreads. Can you explain this phenomenon?

Yes, one theory for why many viruses become weaker over time is that viruses that kill their host don’t get very far. This pattern of weakening is seen with flu viruses, and many others, but not all. We’re not there yet with the current outbreak. Whether it’s weaker three or 10 years from now doesn’t change anything about today’s situation.

— Christine Soares, medical editor at Reuters

(Reporting by Lauren Young, Jenna Zucker, Beatrix Lockwood, Nancy Lapid, Christine Soares)

Trump says he will push to close background check loopholes for gun buys

FILE PHOTO: A prospective buyer examines an AR-15 at the "Ready Gunner" gun store In Provo, Utah, U.S. in Provo, Utah, U.S., June 21, 2016. REUTERS/George Frey/File Photo

WASHINGTON (Reuters) – U.S. President Donald Trump said on Wednesday his administration would seek to close background check loopholes for gun purchases after Democrats accused him of reversing course on gun control measures.

Trump spoke with the leader of the National Rifle Association lobbying group, Wayne LaPierre, on Tuesday, a White House official said. Speaking to reporters outside the White House, Trump said he did not tell LaPierre, whose group strongly opposes increased gun restrictions, that he would avoid pursuing measures on background checks.

Trump, who was endorsed by the NRA in the 2016 presidential race, said he views the number of U.S. gun deaths as a public health emergency and reiterated his belief that people who are mentally ill should not be allowed to buy guns.

“We’re working on background checks. There are things we can do. But we already have very serious background checks. We have strong background checks. We can close up the gaps. We can do things that are very good and things that frankly gun owners want to have done,” Trump said.

“We have background checks but there are loopholes in the background checks. And that’s what I spoke to the NRA about yesterday. They want to get rid of the loopholes as well as I do. At the same time, I don’t want to take away people’s Second Amendment rights,” Trump added later.

On Tuesday, Trump, a Republican, said his administration was engaged in meaningful talks with Democrats, who control the U.S. House of Representatives, about gun legislation after gunmen in El Paso, Texas, and Dayton, Ohio, killed 31 people using semi-automatic rifles and high-volume magazines earlier this month.

Congressional aides, however, said the discussions have been low-level and generally unproductive.

(Reporting by Jeff Mason; Writing by Makini Brice; Editing by Jonathan Oatis and Paul Simao)

Man accused of throwing boy at Minnesota mall first sought to kill an adult: prosecutors

FILE PHOTO: Emmanuel Deshawn Aranda, charged with attempted homicide of a 5-year-old boy thrown or pushed from a third-floor balcony at Minnesota's Mall of America, is seen in this combination photo from police released pictures in Bloomington, Minnesota, U.S., on April 12, 2019. Courtesy City of Bloomington Police Department/Handout via REUTERS

(Reuters) – The man accused of seriously injuring a 5-year-old boy by throwing him from a balcony at Minnesota’s Mall of America last week told investigators he had initially intended to kill an adult, but it did not “work out,” prosecutors said on Monday.

Emmanuel Aranda, who police said has a history of mental issues and arrests on relatively minor charges, went to the mall last Thursday and left without following through on his plan, the Hennepin County Attorney’s office said.

Aranda told investigators he returned to the mall on Friday still intending to kill an adult, but picked the boy instead, and admitted throwing him from the building’s third tier, the attorney’s office said in a complaint.

“(Aranda) acknowledged repeatedly in his interview that he had planned and intended to kill someone at the mall that day and that he was aware that what he was doing was wrong,” prosecutors said in a complaint filed with Hennepin County District Court.

Aranda said years of coming to the mall to try talk to women only to be rejected “caused him to lash out and be aggressive,” according to the complaint.

Police have not identified the boy, but said he suffered life-threatening injuries after falling nearly 40 feet (12 meters) at the Bloomington mall, a major tourist attraction in the state. Prosecutors said he remained in critical condition on Monday.

MORE THAN $600,000 RAISED

In a GoFundMe post that raised $617,000 for the child’s medical expenses by Monday afternoon, a family friend identified as Noah Hanneman of Woodbury, Minnesota, said the boy’s first name is Landen.

Aranda, 24, of Minneapolis, will face attempted premeditated first-degree murder charges when he appears in court on Tuesday, and prosecutors will ask that bail be set at $2 million, the complaint said.

“We charged Mr. Aranda with the most severe crime that the evidence allowed,” Hennepin County Attorney Mike Freeman said in a statement.

After throwing the boy from the balcony, Aranda fled the scene but was arrested elsewhere at the mall a short time later, Bloomington Police Chief Jeff Potts said on Friday.

Aranda had been arrested by Bloomington police three times in 2015, including once after he threw an object from the third level at the mall, Potts told reporters on Saturday.

Some of Aranda’s previous arrests were heard in mental health court, Potts added.

(Reporting by Peter Szekely in New York; Editing by Matthew Lewis)

U.S. ‘model soldier’ to be sentenced for Islamic State support

FILE PHOTO: A photograph with a redacted date, and entered into federal court as an exhibit to support the government's motion to keep U.S. Army Sergeant Ikaika Erik Kang in detention without bond, shows what is described as Kang holding the Islamic State Flag after pledging allegiance to the Islamic State. Kang is charged with trying to provide material support to Islamic State extremists. U.S. District Court for the District of Hawaii/Handout via REUTERS

(Reuters) – A U.S. Army sergeant described by former colleagues as a one-time “model soldier” is due to be sentenced in a Hawaii federal court on Tuesday after pleading guilty to providing material support to the Islamic State militant group.

Ikaika Erik Kang, 35, agreed to a plea deal in August on four counts of breaking anti-terrorism laws in which he accepted a proposed sentence of 25 years in prison.

Kang had begun expressing support for Islamic State, designated by the United States as a foreign terrorist organization, by early 2016, according to the U.S. Department of Justice.

Undercover agents from the Federal Bureau of Investigation began meeting with Kang earlier this year, some of them posing as members of the militant group.

Kang gave them military gear and classified documents and agreed to teach them hand-to-hand combat in a video-recorded session he thought would be used to train other Islamic State fighters, according to federal prosecutors.

Lawyers for Kang filed three letters of support in court on Monday that described him as a diligent but withdrawn soldier who struggled with his mental health.

Kang’s older sister, Erika Takahashi, wrote that Kang grew up in a “very abusive household.”

“I do not know when things got like this for my brother but I know he is a good person on the inside,” she wrote.

Two soldiers who worked with Kang in air-traffic control at Alabama’s Fort Rucker military post wrote to Judge Susan Oki Mollway, urging her to help Kang get counseling.

Thomas Maia, who was Kang’s first supervisor at Fort Rucker, called Kang a “model soldier” but said he had worried about Kang’s odd behavior. This included staring at a wall for hours on end, saying he was trying to listen to the sound of his blood running through his veins, Maia wrote.

Maia wrote that his efforts to secure a mental health evaluation for Kang were rebuffed.

“He didn’t seek out ISIS on his own, he was approached and socially engineered by the FBI at the Army’s request,” Maia wrote, using an acronym to refer to the Islamic State. “If he would have been given adequate mental treatment back when I asked for it, none of this would have happened.”

Federal prosecutors say Kang agreed to swear an oath of loyalty to Islamic State in a pseudo-ceremony organized by the undercover FBI agents. After the ceremony, Kang told the agents he was ready to take his rifle to downtown Honolulu and start shooting, whereupon he was arrested.

(Reporting by Jonathan Allen in New York; Editing by Scott Malone and Bernadette Baum)

Toronto gunman a puzzle to his own tight-knit immigrant community

FILE PHOTO: Police are seen near the scene of a mass shooting in Toronto, Canada, July 22, 2018. REUTERS/Chris Helgr

By Anna Mehler Paperny and Danya Hajjaji

TORONTO (Reuters) – A close-knit vibrant immigrant community of Toronto’s Thorncliffe Park neighborhood, where Faisal Hussain grew up and went to school, is struggling to square the image of the quiet, skinny boy they knew with the man who went on a shooting spree late on Sunday, killing two and wounding 13.

Hussain would never talk to anybody, said resident Saira Ahmed, who would see him going out for a walk. He worked in a grocery store but spent much of his time at home, according to one neighbor, and attended high school at nearby Marc Garneau Collegiate Institute, another neighbor said.

However, Hussain, 29, struggled with severe mental illness, battled depression and psychosis, his parents, Farooq and Fakhara Hussain, wrote in a statement Monday evening.

Treatments could not fix his mental illness, his parents added. “While we did our best to seek help for him throughout his life of struggle and pain, we could never imagine that this would be his devastating and destructive end.”

On Sunday night, police say, Hussain shot dead an 18-year-old woman and a 10-year-old girl and injured 13 others using a handgun on the bustling Danforth Avenue before he fled an altercation with police and was later found dead.

Eighteen-year-old Reese Fallon had just graduated high school and was looking forward to studying nursing. Police have not identified the 10-year-old.

“Our hearts are in pieces for the victims and for our city as we all come to grips with this terrible tragedy,” Hussain’s parents said. “We will mourn those who were lost for the rest of our lives.”

The Hussains are no strangers to heartbreak, neighbors told Reuters. Their only daughter died following a car accident years ago, and one of their sons has been in a coma for some time. The family, originally from Pakistan, is known to have lived in the apartment for more than 25 years, neighbors said, though Reuters was not able to independently verify it.

Farooq Hussain, known by neighbors to walk the area no matter the season, has had health problems of his own and recently underwent surgery, two neighbors said.

Thorncliffe Park is a community with a high immigrant population, a large part of it South Asian.

(Reporting by Anna Mehler Paperny and Danya Hajjaji; Additional reporting by David Ljunggren in Ottawa; Editing by Steve Orlofsky)

Special Report: In Louisiana jail, deaths mount as mental health pleas unheeded

The outside of the East Baton Rouge Parish Prison is seen in Baton Rouge, Louisiana March 5, 2018. REUTERS/Shannon Stapleton

By Melissa Fares and Charles Levinson

EAST BATON ROUGE, La. (Reuters) – The East Baton Rouge Parish Prison, a squat brick building with low-slung ceilings and walls sometimes smeared with feces, is the face of a paradigm shift: penitentiaries as mental health care providers. Across the United States thousands of jails are sheltering a wave of inmates accused of crimes and serving time while suffering from illnesses ranging from depression to schizophrenia.

The shift is a byproduct of the plunging numbers housed in psychiatric inpatient treatment centers, a total that fell from 471,000 in 1970 to 170,000 by 2014. In Louisiana, the fallout exacerbated after a former governor shuttered or privatized a network of public hospitals that provided medical and psychiatric care to the accused.

East Baton Rouge Parish Prison is where Louis Jonathan Fano, afflicted with bipolar disorder and haunted by demons, found himself on Halloween Eve 2016 after fleeing a Greyhound Bus and wandering city streets naked and crazed.

Booked into the jail on six misdemeanor charges, Fano, 27, slit his wrists hours later. Then he was sent to solitary confinement, where he spent 92 of his 94 days imprisoned with his thoughts.

Midway through his jail ordeal, the parish handed responsibility for inmate medical care to a for-profit firm that decided Fano was “exaggerating his condition.” On January 18, 2017, it ordered him taken off his antipsychotic medication.

Two weeks later, the onetime veterinary student, who crafted letters to his mother in longhand, hanged himself.

His family rushed from California to find him unconscious in a hospital intensive care unit, where he lay until his death.

“We touched his cold hands. I talked to him but he had no life – it was just machines,” said his mother, Maria Olga Zavala. “Even with all that, they had him there handcuffed with a guard.”

Replaying that image inside her Southern California home, she asked: “Why wasn’t that guard in the jail, looking after my son before he took his own life?”

It’s a question asked often of the parish jail, where 25 inmates died from 2012-2016, at least five of whom were diagnosed with a serious mental illness or showed signs of one, jail and court records show. Fano became the sixth inmate since 2012 to die amid a mental health crisis; none had been convicted of the charges that jailed them.

From 2012 to 2016, the jail’s rate of death was 2.5 times above the national prison average, a Reuters analysis found. The East Baton Rouge Sheriff’s Office, which oversees the jail, blamed most deaths on drug use, “poor health and pre-existing conditions,” and noted Louisiana has long ranked low on public health metrics.

A private consultant hired to assess treatment found the jail was substantially understaffed, with 61 percent of the psychiatric staff hours found in comparable jails. Isolation units, transformed into de facto inpatient mental health wards, were “woefully inadequate physical environments for the most unstable mentally ill.”

Men on suicide watch were given paper gowns and no sheets or blankets, but the unit was kept so cold some inmates risked hypothermia. One sought warmth by squeezing himself inside the plastic covering of his mattress.

The East Baton Rouge Parish Prison is a vivid example of how local jails struggle to treat the masses of mentally ill filling their dank cells.

MENTALLY ILL AND INCARCERATED

Had a naked and hallucinating Fano stumbled off the Greyhound Bus a few years earlier, he likely would have received treatment at Baton Rouge’s Earl K. Long charity hospital. In the two years before its closure in April 2013, police brought 1,800 mentally disturbed detainees there for treatment, said Jan Kasofsky, Baton Rouge’s top mental health official.

Earl K. Long was part of Louisiana’s network of 10 public charity hospitals that provided medical and psychiatric care to the poor and the imprisoned. It cost the state $76 million a year to treat prisoners in these hospitals. In the spring of 2013, former Governor Bobby Jindal began privatizing or closing nine of the 10 and that $76 million cost has since been cut by two-thirds, said Raman Singh, until recently the corrections department’s medical director.

Jindal declined interview requests. Timmy Teepell, chief of staff during much of the Republican’s first term, said the system was closed for good reason.

“It was outdated, underfunded, and produced the nation’s worst healthcare results,” Teepell said. “I am surprised it lasted as long as it did into the 21st Century.”

But the shutting of the hospitals left local governments struggling to provide medical care behind bars. Cat Roule, who spent 12 years as a nurse supervisor at the East Baton Rouge Parish Prison, told Reuters, “Once Earl K. Long shut down, everything got much worse. There were people piling up in the intake unit. It was just madness.”

Dennis Grimes, the current warden, acknowledged the jail can’t properly treat those in need in a facility where some 800-900 of 1,500 inmates are currently on mental health medication.

“The prison is equipped to deal with disciplinary behavior, not mental health patients. It doesn’t have the things that it really needs in order to function for those who have a mental health problem.”

Medical staff, he said, “burn out, they don’t know what to do, they need some relief – and there are no mental health hospitals out there.”

FIVE MEN IN CRISIS WHO DIED IN JAIL

On February 13, 2013, as operations at Earl K. Long wound down, David O’Quin, a 41-year-old paranoid schizophrenic, was picked up by police after his father reported he was off his medications and behaving erratically. He was booked into East Baton Rouge jail on charges of disturbing the peace. Per jail policy for the mentally ill, he was placed in isolation, where inmates have little access to visitors and spend 23½ hours a day, court records show.

When O’Quin disobeyed orders, guards strapped him to a chair by his ankles and wrists and left him caked in feces and urine, the family alleged in a lawsuit. A jail nurse noted he suffered “serious psychosis” and needed to see a doctor. He didn’t see one for six days, the family said. Guards found him nude in his cell, ignoring orders and spitting, and stormed the cell with shields and mace, records say.

A day later, the jail’s psychiatrist diagnosed him suffering from serious psychosis. O’Quin spent much of the next seven days restrained to a chair in isolation. He died in that chair February 26.

An autopsy found he had died from a pulmonary embolism from a blood clot that developed in his lower legs, likely due to the prolonged period of restraint, as well as from bacterial infection likely from contact between his open wounds and feces. O’Quin’s family has reached an undisclosed lawsuit settlement with the sheriff’s office.

After his death, the sheriff’s office reviewed policies and procedures, said Casey Hicks, a spokeswoman for the East Baton Rouge Sheriff’s Office. Among the changes: new guidelines for using the restraint chair. “It is still used when necessary, though it now requires approval directly from the Warden or designee,” she wrote.

Howell Andrews, a Senior Special Assistant to the Parish Attorney of East Baton Rouge, which was responsible for jail medical care at the time, pointed to a review panel’s findings: “The personnel of the Prison Medical Services acted within the standard of care within the regulations and restrictions in place in this environment.”

In July 2014, Antwoin Harden, 28, was picked up by police for trespassing on the grounds of the Drury Inn, telling officers he was homeless and would rather be in jail than on the streets. In jail, Harden refused to take his medication for bipolar disorder and sickle cell anemia, said his mother, Angelo Moses. He died that month from a blood clot in his lung, related to not taking his medications, she said.

Citing confidentiality restrictions, Andrews said he could not discuss Harden’s case. But he noted: “We are unable to forcibly medicate the individuals.”

Months later, on September 19, 2014, 72-year-old Paul Cleveland was arrested after verbally threatening a court clerk and booked into the jail. On his intake forms, the nurse noted he was bipolar and on antipsychotic medications, and suffered maladies including diabetes, heart pain and rheumatoid arthritis.

Once inside, Cleveland was unable to stand in the hours-long line for patient medications due to his arthritis. His doctor sent a note to the jail saying Cleveland needed a wheelchair, and his family brought one to the front gates. But jailers never let it inside, according to court filings in a family lawsuit against the city, jail and sheriff.

Cleveland filed eight emergency medical request forms, complaining of chest pain, trouble walking to get medication, and suicidal thoughts. When he felt the requests went unheeded, he filed three formal grievances.

Once, a doctor refused to see him because he was behaving belligerently, his medical records show. Other pleas were dismissed as the ranting of a madman. “Banging on window,” said a nurse, who assigned him to a lockdown cell “for his own safety.”

Cleveland’s prescribed daily medications included the antipsychotic Seroquel, Metformin for diabetes, and Cardura for blood pressure. When he was unable to rise and walk to receive them, a jail nurse told him to “stop playing and come get your medication,” a guard testified as part of the family’s ongoing lawsuit.

“Look, they killin’ me,” Cleveland told his family, in his last jailhouse call. “I can’t hardly stand no more.”

At 2:32 the morning of November 12, deputies found Cleveland naked on the floor of his cell, covered in feces. He said he was too weak to shower. A nurse told guards Cleveland was faking “because he wants to get back to the infirmary,” a guard testified in a deposition. Two hours later, at 4:05 a.m., he was found dead in his cell. An autopsy found extensive gastrointestinal bleeding likely caused by cardiovascular disease.

“If he had been transported to the emergency room and received a very simple blood transfusion, he would have survived,” said his lawyer, Amy Newsom.

Hicks said the sheriff’s office took “appropriate action” in dealing with each of Cleveland’s medical requests.

East Baton Rouge city attorneys dispute the family’s allegations, saying Cleveland was treated by medical personnel between 15-17 times during his 50-day stay. His wheelchair was denied because there was no necessary medical approval, said the city, which disputed allegations he was too weak to take his medication.

On May 25, 2015, Lamar Johnson, 27, was pulled over by police because the windows of his Honda Accord were illegally tinted. It was a minor infraction, but Johnson had an outstanding warrant in a neighboring parish, a four-year-old charge for passing a bad $900 check.

He was booked into East Baton Rouge. When guards refused his request for a blanket, he cursed them, according to deposition testimony by two inmates in the family’s lawsuit against the city, parish, warden, sheriff and others. The guards beat Johnson, handcuffed him and pepper-sprayed him, the inmates testified.

Johnson had never been previously diagnosed with a mental illness, his family said. But in jail, his mental health took a turn. Eyewitnesses described him pacing and paranoid, muttering, “I don’t want to live.” The guards moved him to the jail’s isolation wing. “The further back you go, the worse it is, with the smell and the noise,” another inmate testified.

At 10:22 a.m. on May 30, Johnson was found hanging from cell bars. He died days later.

When his father, Karl Franks, sought answers, he said Warden Grimes had little to say. “Well, Mr. Franks, it is what it is,” Franks recounted.

The sheriff disputes allegations in the family’s lawsuit, Hicks said, finding “no evidence” Johnson expressed suicidal thoughts or had been beaten by guards.

Prison Medical Services, the city-run entity responsible for jail health care, said it was “never notified of his presence prior to being called to respond to his suicide,” Andrews said. An inmate log form, he said, showed Johnson’s name had been struck through and marked as “released.”

‘A TICKING TIME BOMB’

Johnson’s death was the fourth involving a mentally disturbed inmate since the closure of East Baton Rouge’s charity hospital. Political pressure was mounting. In August, jail medical personnel testified before council members at a public hearing.

A jail nurse, Sharon Allen, told the council the jail was filling up with mentally ill inmates and described how a nurse had to leave early because an inmate foisted feces at her. “These are mentally unstable people and there’s not enough nurses,” she said.

“We do have a ticking time bomb,” said Dr. Rani Whitfield, a top medical official at the jail.

In response, the council hired Chicago-based consultants Health Management Associates to conduct a $95,000 study of the jail’s medical services.

Before the consulting firm could finish its study, the death toll rose. This time, it was 17-year-old Tyrin Colbert, arrested in November 2015 at his high school for an alleged sexual assault of two younger boys. The waifish teen – standing 5’11” and weighing 129 pounds – reported feeling suicidal soon after he was booked.

Placed in isolation, Colbert said he was hearing voices and told medical staff he needed help, court records show. Dr. Robert Blanche, a psychiatrist contracted to work part time at the jail, assessed Colbert through the bars of his cell. “He is not suicidal; not depressed; he was manipulating,” Blanche noted in the jail’s electronic record-keeping system. He ordered the suicide watch discontinued.

Blanche did not respond to requests for comment. He, Sheriff Sid J. Gautreaux III and Warden Grimes are among defendants in the family’s lawsuit.

Four days later, another deputy said he found Colbert rocking back and forth and talking to a wall. Colbert said he had an imaginary friend named Jimmy. This time, Blanche concluded Colbert “may be psychotic (or he is malingering),” he wrote.

Hicks said Colbert requested to be taken off suicide watch. He returned to the general population and into a cell with another inmate, also 17, who choked him to death with a blanket on February 17, 2016. “Colbert did not report any threats or complaints concerning his cellmate,” said Hicks.

The private consulting firm’s findings, submitted to the Metro Council four months after this latest death, were damning.

Warden Dennis Grimes opens the doors to holding cells of the East Baton Rouge Parish Prison in Baton Rouge, Louisiana March 5, 2018. Picture taken March 5, 2018. REUTERS/Shannon Stapleton

Warden Dennis Grimes opens the doors to holding cells of the East Baton Rouge Parish Prison in Baton Rouge, Louisiana March 5, 2018. Picture taken March 5, 2018. REUTERS/Shannon Stapleton

PRIVATE FOR-PROFIT PRISON CARE

The jail had just 36 percent of the physician staff hours found in comparable facilities. Jail staff failed to distribute prescribed medications nearly 20 percent of the time. A powerful anti-psychotic was being used widely to treat routine insomnia and keep inmates docile.

HMA concluded East Baton Rouge would need to double its $5 million annual budget to meet the minimal standard of inmate medical and psychiatric care.

That didn’t happen.

Instead, on January 1, 2017, the city hired CorrectHealth LLC, a private for-profit firm specializing in prison health care. The Atlanta-based firm promised to bring the jail’s medical care up to standard for $5.2 million a year, half of what the consultant cited.

CorrectHealth is among at least a dozen U.S. firms specializing in for-profit medical care behind bars. Today, it holds contracts to provide inmate healthcare at more than 40 facilities in the southeast, a spokesman said.

When it took over medical care in East Baton Rouge, Fano had been there two months.

Jonathan Fano, who committed suicide while in custody at East Baton Rouge Parish Prison is pictured in this undated handout photo obtained by Reuters May 15, 2018. Vanessa Fano/Handout via REUTERS

Jonathan Fano, who committed suicide while in custody at East Baton Rouge Parish Prison is pictured in this undated handout photo obtained by Reuters May 15, 2018. Vanessa Fano/Handout via REUTERS

His jail journey began as the Greyhound Bus idled at the Baton Rouge depot, amid a cross country journey from Miami to his California home. Sitting on the bus, he grew deeply paranoid.

“He said that all the people on the bus knew what he was thinking, that they were judging him, and that he felt sick,” recalled his mother. Fano, showing signs of schizophrenia, sometimes cleared his mind by walking the streets so long his bare feet blistered.

“‘Just focus your mind on coming home, don’t look at anyone, stay calm,’” Zavala told her son.

He fled the bus. Hours later, Baton Rouge police found him wandering the streets “naked and running around … hollering and cussing at imaginary people” and tearing down mailboxes, an arresting officer wrote.

Locked up, he begged for help. He filled out a medical request form November 25, 2016, complaining of anxiety and saying his antipsychotic meds weren’t working. “Feels as if the walls are closing in,” he wrote in December. Soon, a guard noted in all-caps that Fano “NEEDS TO SEE PSYCH.”

CorrectHealth took over New Year’s Day 2017. On January 11, an employee wrote Fano was “faking bad or exaggerating his condition.” Psychiatrist Blanche assessed Fano through the bars of his cell, concluding he “doubts serious mental illness, will begin tapering meds.” He ordered Fano’s anti-psychotic medicine reduced to 5mg and then discontinued after a week.

On February 2, Fano was found hanging from a torn mattress cover knotted to the bars of his cell. Under jail policy, the warden said, guards are supposed to check on inmates on suicide watch every 15 minutes and document what they see. But such checks didn’t come for Fano in the 11 hours before he hanged himself, video reviewed by Reuters shows. The reason: The warden said medical staff had months earlier taken Fano off suicide watch.

He died three days later. His mother now visits his grave every week.

John Ritter, a spokesman for CorrectHealth, said the company could not comment on pending litigation. He said company-run facilities “have been successfully audited against national correctional healthcare standards on numerous occasions.”

Warden Grimes defended the jail’s policy of placing inmates in isolation. But he said he had no easy answers to the jail’s challenges.

“The only way you’re going to stop someone from killing themselves is if there’s an officer there monitoring them 24/7,” the warden said. “And that’s just not possible.”

REFORM THAT LIVES AND DIES WITH POLITICS

As the deaths mounted, some city leaders began to feel pressure. O’Quin, whose last breaths came in a restraint chair, was from a prominent philanthropic Baton Rouge family. His father, Bill O’Quin, former president of a financial services publishing firm, mobilized business interests who joined the city’s first African-American mayor, Kip Holden, to push for a solution.

They drafted a plan to build a new mental health treatment center that would take in mentally ill people picked up by police. The center was modeled after one in Bexar County, Texas, where the sheriff said the facility saved the county $50 million over five years thanks in part to a sharp drop in incarceration rates of the mentally ill.

In Baton Rouge, winning approval for a tax to fund the center required support of the 12-member East Baton Rouge Parish Metro Council. To muster support in the district, backers sought the endorsement of one of the parish’s most powerful forces: Sheriff Sid Gautreaux, who runs the East Baton Rouge Parish Prison. “If he didn’t support it, then our prospects were zero,” said William Daniel, former chief of staff to then-Mayor Holden.

Gautreaux is a tough-talking career lawman who had long pushed the city to bankroll a new jail. “The plan was, let’s give the sheriff a new jail, and we’ll get our mental health center,” said John Davies, CEO of the Baton Rouge Area Foundation, a philanthropic development fund that was among the driving forces for the mental health center.

Negotiations took place in Gautreaux’s office, adorned with taxidermied hunting trophies, animal skin rugs, and crossed rifles inmates had carved from wood, said those present.

The sheriff wanted the largest parish jail in Louisiana, a 3,500 bed facility, more than double the current size, attendees said. Mental health center supporters pushed back. Crime had been on the decline in Baton Rouge, they argued. Plus, the mental health center would divert many inmates from jail, citing the Texas example.

In Louisiana, sometimes dubbed the “world’s prison capital,” filling jailhouse beds means big money for sheriff’s offices. Any Louisiana sheriff with capacity to spare can house state prisoners and receive a fee of about $24 a day per inmate. Over 50 percent of Louisiana state prisoners are held in local jails, far more than in other states. Sheriffs boost their budgets by hiring out inmates as cafeteria workers at the statehouse, for instance.

“In Louisiana, anytime you want to pass a law moderating the drive to imprison people, you have this almost insurmountable opposition from the sheriffs,” said Jon Wool, with the Vera Institute for Justice, a nonprofit opposing mass incarceration.

Hicks said Gautreaux backed the mental health center from the start, and that the new jail size was determined by outside consultants. “The sheriff did not demand any particular size of the jail,” she said.

In the end, the package that went to the 12-member council for a vote in January 2015 included a 2,500-bed jail and package of new criminal justice facilities.

Advocates thought they had wrangled just enough support from the council’s tax-wary Republicans to endorse a $330 million bond measure. But at the last minute came defections from key Democrats. “This was just difficult to swallow with such a large prison component,” said council member Tara Wicker.

A mental health center was put again to a standalone citywide vote in 2016. It narrowly lost.

(Additional reporting by Ned Parker, Linda So and Grant Smith. Editing by Ronnie Greene)

Texas leaders want more screening and more guns to prevent more shootings

Ten roses are left in memory of the victims killed in a shooting at the Santa Fe High School in Santa Fe, Texas, U.S., May 20, 2018. REUTERS/Jonathan Bachman

By Jon Herskovitz

AUSTIN, Texas (Reuters) – Texas political leaders are considering installing airport-style security at public schools and screening students for mental health issues as alternatives to gun control to thwart a repeat of last week’s deadly shooting at a Houston-area high school.

The focus on school security and mental health has emerged since the shooting because Republican Governor Greg Abbott is facing few calls to overhaul gun laws in a state where the majority of the electorate backs gun ownership. The governor’s office said he would hold roundtable discussions from Tuesday to focus on the best options.

Eight students and two teachers were killed when a 17-year-old student opened fire at Santa Fe High School last week in the latest mass shooting at a U.S. school.

Craig Bessent, an assistant superintendent of the Wylie Independent School District in Abilene, said in an interview that he will take part in the roundtable and that he favored more police or security officers and more screening of students as they entered school campuses.

He also supports arming some teachers as “a good first line of defense,” a position that President Donald Trump has advocated.

“There’s not just the one thing you can do that will stop this and be a cure-all,” Bessent said. “There’s not a single answer.”

The shooting at Santa Fe High School occurred about three months after 17 teenagers and staff were shot dead at Marjory Stoneman Douglas High School in Parkland, Florida, stoking the national debate over gun control.

About two-thirds of Texas Republicans believe if more people carried guns, the state would be safer, according to a statewide survey in late 2017 from the University of Texas and Texas Tribune.

The shooting rampage in Florida sparked a gun control campaign by students and parents that has piled on pressure nationwide for lawmakers to enact gun control legislation.

“Texas Republicans look at this tragedy and they do not see the gun as the problem,” said Mark Jones, a political science professor at Rice University in Houston. “They see the person as the problem and security as the second problem.”

One of the state’s most prominent Republican leaders, Lieutenant Governor Dan Patrick, said he wanted to limit entrances to schools and stagger class starting times to allow for searches. He acknowledged that such airport-style screening would carry a high cost for the thousands of school districts in the state.

The Republican-controlled legislature is out of session until January 2019, making it nearly impossible for the state to implement and fund any major changes that come out of this week’s three roundtable discussions.

“The roundtables are more political theater than anything else,” Jones said.

The governor has said he sees the roundtables as an essential step in coming up with a consensus approach to enhance school safety. He did not respond to a request for comment.

Political analysts said if Abbott wanted to implement changes already floated, such as adding more metal detectors in schools and allowing for court orders to remove firearms from a person who presents a danger, he would call for a special legislative session. Abbott has given no indication that he would do so.

Texas has 5.4 million students enrolled in its public schools and any changes it made statewide would be costly.

One program being run out of Texas Tech University in Lubbock to screen students who could harm themselves or others has Abbott’s attention. He said after the shooting that he wanted to use it across the state.

The program trains people, using FBI threat-assessment criteria, to go to schools and screen students, according to Billy Philips, an epidemiologist and director of the Office of Rural Health at the Texas Tech University Health Sciences Center.

About 42,000 students have been screened through the program, according to data provided by Texas Tech. About 1 percent of them were referred to licensed counselors.

“Roughly about a third of those that were triaged were for suicidal intention, and they’re mostly female; females act in, males act out,” Phillips said.

Before the shooting at Santa Fe High School, Texas Democrats had filed about 15 bills related to gun violence, almost all of which died when the legislative session ended last year. They included measures to buy back guns, improve gun safety education and create a lethal violence protective order to stop a potentially dangerous person from buying or possessing a firearm.

(Reporting by Jon Herskovitz in Austin, Texas; Additional reporting by Jonathan Allen in New York, Rich McKay in Atlanta, Liz Hampton and Erwin Seba in Santa Fe, Texas; Writing by Jon Herskovitz; Editing by Frank McGurty)

FBI was warned about Florida man accused of killing 17 at school

By Bernie Woodall and Zachary Fagenson

PARKLAND, Fla. (Reuters) – The Federal Bureau of Investigation was warned in September about an ominous online comment by the 19-year-old man accused of killing 17 people at his former high school but was unable to locate him, an agent said on Thursday.

Authorities said the ex-student, identified as Nikolas Cruz, walked into the Marjory Stoneman Douglas High School in Parkland, near Miami, on Wednesday and opened fire with an AR-15-style assault rifle in the second-deadliest shooting at a public school in U.S. history.

Students from Marjory Stoneman Douglas High School attend a memorial following a school shooting in Parkland, Florida, U.S., February 15, 2018. REUTERS/Thom Bau

Students from Marjory Stoneman Douglas High School attend a memorial following a school shooting in Parkland, Florida, U.S., February 15, 2018. REUTERS/Thom Baur

Cruz may have left warning signs on social media in the form of a comment on a YouTube video that read “I’m going to be a professional school shooter.” That comment troubled the person whose video Cruz commented on, Mississippi bail bondsman Ben Bennight, who passed it on to the FBI, according to a video he posted online late Wednesday.

“No other information was included with that comment which would indicate a time, location or the true identity of the person who made the comment,” FBI Special Agent in Charge Robert Lasky told reporters. Investigators were unable to find the commenter, he added.

The FBI is conducting an extensive review of how it handled that tip to see if mistakes were made, a federal law enforcement official told Reuters.

Wednesday’s shooting was the 18th in a U.S. school this year, according to gun control group Everytown for Gun Safety. It stirred the long-simmering U.S. debate on the right to bear arms, which is protected by the Second Amendment of the U.S. Constitution.

President Donald Trump addressed the shooting in a White House speech that emphasized school safety and mental health while avoiding any mention of gun policy.

“It is not enough to simply take actions that make us feel like we are making a difference,” Trump said at the White House. “We must actually make that difference.”

Broward County schools superintendent Robert Runcie called for action on gun laws.

“Now is the time for this country to have a real conversation on sensible gun control laws,” Runcie told a news conference.

Democrats in the U.S. House of Representatives criticized the Republican leadership for refusing to take up legislation on tightening background checks for prospective gun buyers.

Mourners react during a community prayer vigil for victims of yesterday's shooting at nearby Marjory Stoneman Douglas High School in Parkland, at Parkridge Church in Pompano Beach, Florida, U.S., February 15, 2018. REUTERS/Jonathan Drake

Mourners react during a community prayer vigil for victims of yesterday’s shooting at nearby Marjory Stoneman Douglas High School in Parkland, at Parkridge Church in Pompano Beach, Florida, U.S., February 15, 2018. REUTERS/Jonathan Drake

“It’s appalling,” Representative Mike Thompson told reporters. “Thirty people every day are killed by someone using a gun, and the best we can do is say we need more information?”

The Republican-controlled Congress last year revoked Obama-era regulations meant to make it harder for those with severe mental illness to pass FBI background checks for guns, saying the rule deprived the mentally ill of their gun rights.

At least one member of Trump’s cabinet called for action.

“Personally I think the gun violence, it’s a tragedy what we’ve seen yesterday, and I urge Congress to look at these issues,” Treasury Secretary Steven Mnuchin told lawmakers.

Fifteen people were injured in Wednesday’s shooting, according to local hospital officials.

‘BROKEN HUMAN BEING’

Cruz’s court-appointed lawyer said he had expressed remorse for his crimes.

“He’s a broken human being,” public defender Melisa McNeill told reporters. “He’s sad, he’s mournful he’s remorseful.”

Nikolas Cruz (C) appears via video monitor with Melisa McNeill (R), his public defender, at a bond court hearing after being charged with 17 counts of premeditated murder, in Fort Lauderdale, Florida, U.S., February 15, 2018. REUTERS/Susan Stocker/Pool

Nikolas Cruz (C) appears via video monitor with Melisa McNeill (R), his public defender, at a bond court hearing after being charged with 17 counts of premeditated murder, in Fort Lauderdale, Florida, U.S., February 15, 2018. REUTERS/Susan Stocker/Pool

Cruz had done paramilitary training with a white nationalist militia called the Republic of Florida, a leader of the group said.

“He had some involvement with the Clearwater Republic of Florida cell at some point,” Jordan Jereb said in a telephone interview. Reuters could not immediately verify the claim.

Cruz loved guns and had been expelled from high school for disciplinary reasons, police and former classmates said.

Authorities said he marched into the school wearing a gas mask and tossed smoke grenades, as well as pulling a fire alarm that sent students and staff pouring from classrooms as he began his rampage, according to Florida’s two U.S. senators, who were briefed by federal authorities.

In a brief court appearance, Cruz spoke only two words, “Yes ma’am,” when a judge asked him to confirm his name. He was ordered held without bond.

Cruz had recently moved in with another family after his mother’s death in November, according to Jim Lewis, a lawyer representing the family and local media, bringing his AR-15 along with his other belongings.

The family believed Cruz was depressed, but attributed that to his mother’s death, not mental illness.

Victims included an assistant football coach who sheltered students, a social science teacher and multiple students.

People who live on same street as Cruz said he alarmed them by shooting squirrels and rabbits in the neighborhood as well as chickens being raised in a nearby backyard. Several times a year, they observed law enforcement officials at his house.

“Killing animals was no problem for this young man,” said Rhoda Roxburgh, 45, who lived on the block for several years and whose parents continue to live there.

(Additional reporting by Jonathan Allen and Peter Szekely in New York, David Alexander, Lindsay Dunsmuir, Mark Hosenball and Susan Heavey in Washington, Jon Herskovitz in Austin and Brendan O’Brien in Milwaukee; Writing by Scott Malone; Editing by Jeffrey Benkoe and Tom Brown)

Australia police say don’t suspect terrorism after car plows into pedestrians

Australian police stand near a crashed vehicle after they arrested the driver of a vehicle that had ploughed into pedestrians at a crowded intersection near the Flinders Street train station in central Melbourne, Australia December 21, 2017.

By Melanie Burton and Byron Kaye

MELBOURNE (Reuters) – An Australian man of Afghan descent with a history of mental health issues drove a car into Christmas shoppers in the city of Melbourne on Thursday, injuring 19 people, but police said they did not believe the attack was terror-related.

In January, four people were killed and more than 20 injured when a man drove into pedestrians just a few hundred meters away from Thursday’s attack. That too was not a terror attack.

Jim Stoupas, the owner of a donut shop at the scene, told Reuters the vehicle was traveling up to 100 kph (62 mph) when it drove into the intersection packed with people, hitting one person after another.

“All you could hear was just ‘bang bang bang bang bang’ and screams,” Stoupas said in a telephone interview, adding the car came to rest by a tram stop.

Police said they detained the 32-year-old driver, an Australian of Afghan descent with a history of assault, drug use and mental health issues.

“At this time, we don’t have any evidence or intelligence to indicate a connection with terrorism,” said the acting chief commissioner of Victoria State, Shane Patton.

Four of the injured were in critical condition, including a pre-school aged boy who suffered a head injury.

Police also detained a 24-year-old man at the scene who was filming the incident and had a bag with knifes.

Patton said it was “quite probable” the 24-year-old was not involved.

The men had not been charged and their names have not been released by police.

The attack took place on Flinders Street, a major road that runs alongside the Yarra River, in the central business district of Australia’s second-biggest city.

Melbourne has installed about 140 concrete bollards in the city center to stop vehicle attacks by militants similar to recent attacks in Europe and the United States.

“We’ve seen an horrific act, an evil act, an act of cowardice perpetrated against innocent bystanders,” said the state premier, Daniel Andrews.

Sydney, Australia’s biggest city, has also installed concrete barricades in main pedestrian thoroughfares.

“Our thoughts and prayers are with the victims and the emergency health workers who are treating them,” Prime Minister Malcolm Turnbull said in a post on his official Twitter account.

Australia has been on a “high” national threat level since 2015, citing the likelihood of attacks by Australians radicalized in Iraq and Syria.

Two hostages were killed during a 17-hour siege by a “lone wolf” gunman, inspired by Islamic State militants, in a cafe in Sydney in December 2014.

 

(Reporting by Melanie Burton in MELBOURNE and Byron Kaye in SYDNEY; additional reporting by Sonali Paul and Paulina Duran; writing by Jonathan Barrett; Editing by Nick Macfie, Robert Birsel)