Tag Archives: New York City

One ventilator, two patients: New York hospitals shift to crisis mode

By Jonathan Allen and Nick Brown

NEW YORK (Reuters) – At least one New York hospital has begun putting two patients on a single ventilator machine, an experimental crisis-mode protocol some doctors worry is too risky but others deemed necessary as the coronavirus outbreak strains medical resources.

The coronavirus causes a respiratory illness called COVID-19 that in severe cases can ravage the lungs. It has killed at least 281 people over a few weeks in New York City, which is struggling with one of the largest caseloads in the world at nearly 22,000 confirmed cases.

A tool of last resort that involves threading a tube down a patient’s windpipe, a mechanical ventilator can sustain a person who can no longer breathe unaided. The city only has a few thousand and is trying to find tens of thousands more.

Dr. Craig Smith, surgeon-in-chief at New York-Presbyterian/Columbia University Medical Center in Manhattan, wrote in a newsletter to staff that anesthesiology and intensive care teams had worked “day and night” to get the split-ventilation experiment going.

By Wednesday, he wrote, there were “two patients being carefully managed on one ventilator.”

New York Governor Andrew Cuomo, who says his staff is struggling to find enough machines on the market, has touted the adaptation as a potential life-saver. “It’s not ideal,” he told reporters, “but we believe it’s workable.”

The U.S. Food & Drug Administration, which regulates medical device manufacturers, gave emergency authorization on Tuesday allowing ventilators to be modified using a splitter tube to serve multiple COVID-19 patients, though manufacturers still must share safety information with regulators.

Some medical associations oppose the unproven method.

On Thursday, the Society of Critical Care Medicine, the American Association for Respiratory Care and four other practitioner groups issued a joint statement saying the practice “should not be attempted because it cannot be done safely with current equipment.”

It is difficult enough to fine-tune a ventilator to keep alive even one patient with acute respiratory distress syndrome (ARDS), the statement said; sharing it across multiple patients would worsen outcomes for all. They proposed doctors instead choose the one patient per ventilator deemed most likely to survive.

At Columbia, Smith noted that they could not split a ventilator across just any two COVID-19 patients, but were only pairing patients with sufficiently similar respiratory needs.

Across Manhattan, Mount Sinai Hospital told staff in an email that officials were “working to figure out” whether they could split ventilators. The hospital has ordered the necessary adapters, a nurse there said in an interview on condition of anonymity because she was not authorized to speak to reporters.

Experts at Columbia pointed to a 2006 study where researchers, using lung simulators, concluded that a single ventilator could sustain four adults in an emergency scenario.

One author of that study, Dr. Greg Neyman, cautioned against the application in COVID-19 cases in part because the lungs themselves are infected. If one patient’s lungs were deteriorating faster, he said, it could cause imbalances in the closed system. One patient could starve for oxygen while the other patient’s lungs would get increased pressure.

“Unless they were very very closely monitored, such a set up may end up doing more harm than good,” Neyman wrote in an email to Reuters.

(Reporting by Jonathan Allen and Nick Brown; Editing by David Gregorio)

NYC hospitals 10 days from crisis as coronavirus cases explode: mayor

By Jonnelle Marte and Barbara Goldberg

NEW YORK (Reuters) – The mayor of New York City, the epicenter of the nation’s coronavirus epidemic, on Sunday described the outbreak as the biggest domestic crisis since the Great Depression and called for the U.S. military to mobilize to help keep the healthcare system from becoming overwhelmed.

“If we don’t get more ventilators in the next 10 days people will die who don’t have to die,” said Mayor Bill de Blasio, as the nation’s most populous city saw COVID-19 cases top 8,000 and deaths hit 60.

Nationwide, cases have topped 29,000 with at least 385 dead, according to a Reuters tally.  The number of cases of the highly contagious respiratory illness in the United States and Spain are exceeded only by China and Italy. Italy reported record numbers of daily coronavirus deaths last week.

“This is going to be the greatest crisis domestically since the Great Depression,” de Blasio told CNN, referring to the economic crisis of the 1930s. “This is why we need a full-scale mobilization of the American military.”

Nearly one in four Americans, or 80 million, were under orders to shelter at home as New York, California, Illinois, Connecticut and New Jersey instituted statewide lockdowns.

Around the globe, billions are adapting to a new reality, with countries like Italy, Spain and France on lockdown and several South American nations taking similar measures to try to stay ahead of the contagion, as global cases exceeded 300,000 and deaths top 13,000.

The lockdown affecting large segments of the American public to try to curb the spread of the coronavirus is likely to last 10 to 12 weeks, or until early June, U.S. Treasury Secretary Steven Mnuchin said on Sunday.

Lawmakers in Washington are nearing a deal that could pump a record $1 trillion into the economy to limit the economic damage from the coronavirus.

Speaking on “Fox News Sunday,” Mnuchin said the package would give an average U.S. family of four a one-time payment of $3,000.

MEDICAL CRISIS

De Blasio said the city is not getting needed medical supplies from the federal government to contend with the rapid spread of the sometimes deadly illness.

“If the president does not act, people will die who could have lived otherwise,” de Blasio told NBC.

Hospitals are scrambling for protective equipment for healthcare workers and for ventilators as they brace for a wave of patients who will need help breathing as severe cases often lead to pneumonia and decreased lung function.

New York Governor Andrew Cuomo urged the federal government to take over acquisition of medical supplies so states do not have to compete with each other for desperately needed resources. He also repeated a request for the Army Corps of Engineers to build temporary hospitals.

Over the past week, U.S. President Donald Trump’s administration has been pushing for aggressive steps to stem the economic hit, after Trump spent several weeks downplaying the virus’ risks.

Trump said on Twitter on Sunday that U.S. automakers Ford Motor Co, General Motors Co and Tesla Inc had been given the green light to produce ventilators and other items in short supply during the coronavirus outbreak.

Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, on Sunday said the White House recognized the urgency of New York’s situation.

“Not only is New York trying to get resources themselves, but we’re going to be pouring it in from the federal government,” he told CBS News.

U.S. drugmaker Merck & Co Inc said it delivered 500,000 donated masks to New York City on Sunday morning.

The help is not coming quickly enough, Cuomo said.

“Time matters, minutes count, and this is literally a matter of life and death,” he said.

He also chastised New York residents who were congregating in parks and other places and not practicing social distancing. He noted 53% of the cases in New York are between the ages of 18 and 49.

“It’s insensitive, arrogant, self-destructive…and it has to stop, and it has to stop now,” he said. “This is not a joke and I’m not kidding.”

(Reporting by Jonnelle Marte and Barbara Goldberg in New York; Additional reporting by Andrea Shalal and Susan Heavey in Washington; Writing by Lisa Shumaker; Editing by Bill Berkrot)

New York City ‘almost to point’ of recommending ‘shelter-in-place’ to Governor, NYC Mayor says

(Reuters) – New York City Mayor Bill de Blasio said on Wednesday that he was “almost to the point” of recommending to New York Governor Andrew Cuomo that the city implement a ‘shelter-in-place’ policy that would have people stay in their homes.

“We have a little bit more we have to make sense of — how we are going to get people food and medicine,” de Blasio told NBC’s “TODAY” morning show, adding that he would only make that decision in consultation with the state. “But I have to say it has to be considered seriously starting today.”

(reporting by Nathan Layne in Wilton, Connecticut, Editing by Franklin Paul)

Wall Street empties out as New York City declares state of emergency

Reuters
By Imani Moise and Elizabeth Dilts Marshall

NEW YORK (Reuters) – Working from home went from optional to mandatory across Wall Street this week as financial firms reported their first confirmed cases of coronavirus and the outbreak triggered a state of emergency in New York City.

JPMorgan Chase & Co <JPM.N>, Goldman Sachs Group Inc <GS.N> and Morgan Stanley <MS.N> each announced similar programs on Thursday for working remotely to stem the spread of the pandemic. JPMorgan and Goldman told employees the staff would be split roughly in two for a weekly rotation in which half the workers will work from home and half go to the office.

JPMorgan’s plan applies to New York-area employees while Goldman’s plan was for most staff across North America and Europe, excluding some sales, trading and critical staff.

JPMorgan, the largest U.S. lender, informed New York-area employees in an internal memo seen by Reuters. The bank later confirmed the program, set up in response to a request from the state government.

The bank plans that by the end of this month, only 25% to 50% of team members will work from home, the memo said.

The plan applies to most corporate employees based in Manhattan, Brooklyn and Jersey City, New Jersey, but not to branch workers or traders.

Goldman Sachs told employees that most staff across North America and Europe would start working from home or one of the bank’s business continuity centers on a rotating schedule starting Monday, according to another memo viewed by Reuters.

Morgan Stanley told all staff who do not have to work in the firm’s offices to work from home, apart from some sales and trading staff, who are working from secondary trading locations.

The bank also banned all travel, domestic or international, not deemed business critical.

Barclays PLC <BARC.L> and Credit Suisse Group AG <CSGN.S> also informed their investment bankers on Wednesday of a similar rotating schedule, sources said.

A spokesman for Credit Suisse declined to comment and a Barclays representative was not immediately available.

The banks also have ramped up other precautionary efforts like office deep-cleaning after firms like Barclays and BlackRock Inc <BLK.N> reported their first confirmed cases.

On Thursday a Manhattan-based Royal Bank of Canada <RY.TO> employee tested positive, a bank representative said. The Canadian bank has also reported two other confirmed cases in one of its offices near Toronto.

As of Thursday there were more than 129,000 cases of coronavirus globally and 4,750 people have died, according to a Reuters tally.

New York City Mayor Bill De Blasio declared a state of emergency in the city on Thursday as the number of confirmed cases climbed to 95, up from 12 at the beginning of the week.

Citigroup has put signs around its New York City headquarters asking visitors and employees not to sit on certain chairs to practice social distancing.

Another Wall Street investment bank ran overnight disaster tests on its remote working systems this week to prepare for having more bankers work from home.

“It’s not a matter of if, it’s when,” said a bank source familiar with the contingency planning efforts.

(Reporting by C Nivedita in Bengaluru and Imani Moise and Elizabeth Dilts Marshall in New York; Editing by David Gregorio and Matthew Lewis)

California declares emergency over coronavirus as death toll rises in U.S

By Steve Gorman and Dan Whitcomb

LOS ANGELES (Reuters) – The U.S. death toll from coronavirus infections rose to 11 on Wednesday as new cases emerged around New York City and Los Angeles, while Seattle-area health officials discouraged social gatherings amid the nation’s largest outbreak.

The first California death from the virus was an elderly person in Placer County, near Sacramento, health officials said. The person had underlying health problems and likely had been exposed on a cruise ship voyage between San Francisco and Mexico last month.

It was the first coronavirus fatality in the United States outside of Washington state, where 10 people have died in a cluster of at least 39 infections that have emerged through community transmission of the virus in two Seattle-area counties.

Although the Placer County patient who died was not believed to have contracted the virus locally, that case and a previous one from the San Francisco Bay Area linked to the same ocean liner have led health authorities to seek other cruise passengers who may have had close contact with those two individuals.

Hours after the person’s death was announced, California Governor Gavin Newsom declared a statewide emergency in response to the coronavirus, which he said has resulted in 53 cases across the nation’s most populous state.

“The State of California is deploying every level of government to help identify cases and slow the spread of this coronavirus,” Newsom said in a statement.

Newsom said the cruise ship, named the Grand Princess, had later sailed on to Hawaii and was returning to San Francisco, but would not be allowed into port until passengers had been tested for the virus.

“We are holding that ship off the coast,” Newsom said.

Six new coronavirus patients were confirmed in Los Angeles County, public health officials said on Wednesday. One was a federal contractor who may have been exposed while conducting medical screenings at Los Angeles International Airport, the U.S. Department of Homeland Security reported.

Three others likely were infected while traveling recently to northern Italy, one of the areas hardest hit in the global outbreak. Of the six in Los Angeles County, only one has been hospitalized. The other five are recovering in home isolation.

The greater Seattle region represents the biggest concentration of cases detected in the United States from a virus that has killed more than 3,000 people worldwide, mostly in China, where the epidemic originated in December.

With most of the Seattle-area cases not linked to travel or exposure to people who might have been infected abroad, that means the virus has gone from being an imported phenomenon to taking up residence in Washington state, health officials say.

At least 18 cases, including six deaths, were connected to a long-term nursing facility for the elderly, called LifeCare Center of Kirkland, in a Seattle suburb.

‘DISTANCING MEASURES’

Seattle health authorities urged a number of measures for curbing further spread of the disease, including recommendations for anyone aged 60 and older and individuals with underlying chronic health problems or compromised immunity to stay home and away from large gatherings and public places.

They also urged companies to allow their employees to work from home as much as possible, stagger shifts to ease commuter congestion on public transportation and avoid large work-related gatherings.

“The distancing measures that we’re recommending are essential because we need to slow the spread of the disease to the point where we are able to continue to handle the load,” said Patty Hayes, the public health director for Seattle and King County.

A growing number of U.S. companies are adopting such steps. On Wednesday Microsoft Corp asked its employees in the Seattle region near its headquarters and in the San Francisco Bay Area to work from home if possible until March 25.

In New York state, the number of cases rose to 10 on Wednesday. Three family members and a neighbor of a lawyer who was previously identified as infected tested positive. The neighbor’s wife and three of his children have also contracted the virus, Governor Andrew Cuomo said.

About 1,000 people in suburban Westchester County, where the two families live, were under self-quarantine orders because of possible exposure, Cuomo said.

“We are, if anything, being overcautious,” he said.

AIPAC, the pro-Israel lobby, said Wednesday that people in a group from New York that attended its 18,000-person policy conference in Washington, D.C., this week potentially had been in contact with an individual who contacted the coronavirus before the conference.

Dozens of Congress members attended the conference, as well as Vice President Mike Pence.

EMERGENCY FUNDS

U.S. lawmakers reached bipartisan agreement on an $8.3 billion emergency bill to help fund efforts to contain the virus. The bill garnered enough votes to pass in the House of Representatives.

More than $3 billion would be devoted to research and development of coronavirus vaccines, test kits and therapeutics. There are currently no approved vaccines or treatments for the fast-spreading illness.

The administration is working to allow laboratories to develop their own coronavirus tests without seeking regulatory approval first, U.S. Health Secretary Alex Azar said.

The latest data from the U.S. Centers for Disease Control and Prevention listed 129 confirmed and presumed cases in the United States, up from the previous 108. They were 80 reported by public health authorities in 13 states plus 49 among people repatriated from abroad, according to the CDC website.

Those figures do not necessarily reflect Wednesday’s updates from three states.

(Reporting by Steve Gorman in Los Angeles and Laila Kearney in New York; Additional reporting by Dan Whitcomb in Los Angeles, Maria Caspani and Hilary Russ in New York, David Morgan and Richard Cowan in Washington; writing by Grant McCool; Editing by Bill Berkrot, Lisa Shumaker, Cynthia Osterman, Leslie Adler and Lincoln Feast.)

Gunman wounds NYC police officer inside station hours after ambushing patrol officers

By Brendan O’Brien

(Reuters) – A gunman opened fire inside a New York City police station on Sunday, striking a lieutenant in the arm, some 12 hours after he had ambushed a patrol van in the same neighborhood, wounding an officer, police said.

The gunman was arrested at the police station. The two officers were being treated in hospital and were expected to fully recover from their wounds, officials said at a news conference.

“This was an attempt to assassinate two police officers … it was a premeditated effort to kill,” New York City Mayor Bill de Blasio said. “An attack on a police officer is an attack on all of us.”

The gunman, whose name has not yet been released by authorities, entered the 41st Precinct headquarters in the Bronx borough just before 8 a.m. (1300 GMT), pulled out a .9mm hand gun and started firing at the front desk where several officers stood, officials said.

He then walked into an area next to the desk and fired several rounds at point blank range at several more officers and a civilian staffer, Police Commissioner Dermot Shea said.

“It is only by the grace of God and heroic actions of those inside the building who took him into custody that we are not talking about police officers murdered,” he said.

“This coward immediately laid down but only after he ran out of bullets,” Shea said.

A lieutenant, who returned fire, was shot in the upper left arm.

On Saturday night a uniformed police officer who was sitting in his police van with his partner was shot by the same gunman, police said. He walked up to the vehicle and began a conversation with the two officers in the vehicle before suddenly opening fire, striking one policeman in the chin and neck, police said.

The officers did not return fire. The wounded officer’s partner got in the driver’s seat and drove him to the hospital.

(Reporting by Brendan O’Brien in Chicago; editing by Grant McCool)

New Jersey mayor sues New York City over moving homeless with ‘offer they can’t refuse’

NEW YORK (Reuters) – Newark Mayor Ras Baraka’s administration has sued New York Mayor Bill de Blasio, accusing the fellow Democrat of dumping his city’s population of homeless people on New Jersey’s biggest city.

The lawsuit naming the city of New York, its mayor and his homelessness czar, Steven Banks, accuses the de Blasio administration’s Special One-Time Assistance, or SOTA, program of using strong-arm tactics to send people across the Hudson River to find a place to live.

“This case concerns an unlawful program of ‘coerced’ migration,” Newark lawyers say in court documents filed in U.S. District Court in New Jersey on Monday.

New York City officials are accused of “forcing SOTA recipients to accept the proverbial ‘offer they can’t refuse,'” the documents said, explaining that the phrase from the 1972 American Mafia film “The Godfather” is “really a command, ‘Do what we say or else.'”

The lawsuit accuses New York of violating federal commerce laws. It cites several former New York shelter residents who were hustled through tours of New Jersey apartments and pressured to quickly commit to one, with the SOTA Program paying landlords a full year’s rent up front.

“She was told by case managers in her shelter that she should look in New Jersey, in the cities of Newark or Paterson, because New York landlords were leery of the SOTA program and because she would find something quicker in New Jersey,” Newark’s lawyers said in court filings.

The de Blasio administration did not immediately respond to a request for comment.

Baraka, Newark’s mayor since 2014 and the son of poet and African-American activist Amiri Baraka, and de Blasio, a former Democratic presidential candidate who touts himself as a progressive, appeared together in Newark last year to announce a tenant initiative aimed at keeping people in their homes, in part by ending illegal evictions. The New Jersey program was modeled after one in New York City and both mayors praised one another for pursuing the initiatives.

The vast majority of New Yorkers experiencing homelessness – over 63,000 homeless men, women and children – spend the night instead within the city’s shelter system where they remain unseen, according to The Bowery Mission nonprofit group. In a city of 8.5 million people, nearly one in every 121 New Yorkers is currently homeless.

(Reporting by Barbara Goldberg in New York; Editing by Scott Malone and Jonathan Oatis)

U.S. attorney general shakes up prisons bureau after Epstein death

FILE PHOTO: U.S. Attorney General William Barr is pictured after a farewell ceremony for Deputy Attorney General Rod Rosenstein at the U.S. Department of Justice in Washington, U.S., May 9, 2019. REUTERS/Leah Millis

WASHINGTON (Reuters) – U.S. Attorney General William Barr on Monday announced a new leadership team at the federal Bureau of Prisons in a shake-up of the agency in the wake of financier Jeffrey Epstein’s apparent suicide inside a federal jail in New York City.

Kathleen Hawk Sawyer, a veteran of the Bureau of Prisons, will return to the agency to serve as its director, Barr said. He named another former agency official, Thomas Kane, to serve as her deputy.

The Bureau of Prisons has about 37,000 employees and oversees 122 facilities, which house about 180,000 inmates.

Hugh Hurwitz, who has been serving as the bureau’s acting director – including when Epstein was found unresponsive over a week ago in a Manhattan jail cell – has been reassigned to his prior position within the agency.

Epstein had been arrested on July 6 and pleaded not guilty to federal charges of sex trafficking involving dozens of underage girls as young as 14.

An autopsy report released on Friday concluded he committed suicide by hanging.

His death at the age of 66 at the Metropolitan Correctional Center (MCC) in lower Manhattan triggered multiple investigations and had prompted Barr to criticize “serious irregularities” at the facility.

“During this critical juncture, I am confident Dr. Hawk Sawyer and Dr. Kane will lead BOP with the competence, skill, and resourcefulness they have embodied throughout their government careers,” Barr said in the statement.

Barr had previously ordered the reassignment of the warden at the MCC. Two corrections officers assigned to Epstein’s unit were placed on administrative leave pending investigations.

Lawyers for Epstein did not immediately respond to requests for comment on Monday.

His lawyers had said in a statement last week that they were “not satisfied” with the medical examiner’s conclusions and planned to carry out their own investigation, seeking prison videos taken around the time of his death.

Epstein had been on suicide watch at the jail but was taken off prior to his death, a source who was not authorized to speak on the matter previously told Reuters. Two jail guards are required to make separate checks on all prisoners every 30 minutes, but that procedure was not followed, the source added.

Epstein, a registered sex offender who once socialized with U.S. President Donald Trump and former President Bill Clinton, pleaded guilty in 2008 to Florida state charges of unlawfully paying a teenage girl for sex and was sentenced to 13 months in a county jail, a deal widely criticized as too lenient.

Senator Ben Sasse, the Republican chairman of the Senate Judiciary Oversight Subcommittee, has urged Barr to void the agreement and said “heads must roll” after Epstein’s death.

“This is a good start, but it’s not the end,” Sasse said of Barr’s announcement on Tuesday. “Jeffrey Epstein should still be in a padded cell and under constant surveillance, but the justice system has failed Epstein’s victims at every turn.”

(Reporting by Sarah N. Lynch; Writing by Tim Ahmann; Editing by Dan Grebler and Steve Orlofsky)

Kitchen devices resembling bombs cause havoc for New York commuters

New York City police officers are seen as police said they were investigating two suspicious packages at the Fulton St. subway station in Manhattan, New York, U.S. August 16, 2019. REUTERS/Catherine Koppel

By Peter Szekely

NEW YORK (Reuters) – Kitchen appliances resembling pressure cookers were left in two Manhattan locations on Friday, disrupting automobile and subway travel during the morning rush hour before police deemed them harmless and began investigating the possibility of a hoax.

The discoveries of the devices, which the city’s chief counterterrorism officer called “rice cookers that could be mistaken for pressure cookers,” raised concern because of the latter’s previous use as makeshift bombs in New York and Boston.

Surveillance video shows a dark-haired man in his 20s or 30s with a shopping cart placing the devices at two locations inside the busy downtown Fulton Street subway station, said John Miller, the New York Police Department’s deputy commissioner of intelligence and counterterrorism.

“Because of the timing and the placement and items we’re carrying this right now as a hoax device,” Miller told reporters at the scene. “That’s the investigative category.”

The unidentified man is “not a suspect but certainly someone we’d want to interview,” he said. Police posted two photographs on social media of the cookers at Fulton Street.

Officials said they had not determined whether the discovery about an hour later of a third implement resembling a pressure cooker next to a garbage can on a street corner in the borough’s Chelsea neighborhood was related, Miller said.

Miller noted that in September 2016 the so-called “Chelsea Bomber,” Ahmad Khan Rahimi, wounded 30 people using a device made from a pressure cooker and a cellphone timer that exploded on Manhattan’s West 23rd Street. Another pressure cooker bomb was left nearby but did not explode.

Rahimi was sentenced last year to life in prison.

There was also an explosion in Midtown Manhattan in December 2017 when a Bangladeshi man, Akayed Ullah, detonated a homemade bomb in a pedestrian tunnel connecting two subway lines and a bus terminal. Three people were wounded.

Pressure cookers were turned into bombs by a pair of ethnic Chechen brothers when they killed three people and injured more than 200 at the 2013 Boston Marathon.

The discoveries, which were first reported at about 7 a.m. EDT (1100 GMT) created havoc for thousands of motorists and commuters on the numerous subway lines that converge at Fulton Street as police and bomb squad vehicles swarmed to the scene.

Even after police deemed the devices harmless at the Fulton Street station complex, which is close to the World Trade Center, officials warned of residual delays for commuters.

(Reporting by Peter Szekely; Editing by Daniel Wallis and Steve Orlofsky)

New York coroner ‘confident’ Epstein’s death was suicide: New York Times

An exterior view of the Metropolitan Correctional Center jail where financier Jeffrey Epstein, who was found dead in the Manhattan borough of New York City, New York, U.S., August 10, 2019. REUTERS/Jeenah Moon

(Reuters) – New York City’s chief medical examiner is confident Jeffrey Epstein died by hanging himself in the jail cell where he was being held without bail on sex-trafficking charges, but is awaiting more information before releasing her determination, the New York Times reported on Sunday, citing a city official.

An autopsy was performed earlier in the day on the disgraced financier found unresponsive on Saturday in a New York City jail, chief medical examiner Dr. Barbara Sampson said. A private pathologist observed the autopsy on behalf of Epstein’s representatives, which she called “routine practice.”

A determination on the cause of death “is pending further information at this time,” Sampson said in a statement.

The suspicion in Epstein’s death was hanging, said a city official not authorized to speak on the record.

The Times did not say why it could not identify the source of information on the medical examiner’s likely determination of the cause of death.

Epstein, 66, was not on suicide watch at the time in his cell in the Special Housing Unit of the Metropolitan Correctional Center (MCC), a source said.

Epstein, a well-connected money manager, was found hanging by his neck, according to the source, who was not authorized to speak on the record.

The wealthy financier, who once counted Republican President Donald Trump and Democratic former President Bill Clinton as friends, was arrested on July 6 and pleaded not guilty to charges of sex trafficking involving dozens of underage girls as young as 14, from at least 2002 to 2005.

The FBI and the Department of Justice’s Inspector General opened investigations into his suicide while he was in federal custody.

Last month, Epstein was found unconscious on the floor of his jail cell with marks on his neck, and officials were investigating that incident as a possible suicide or assault.

Despite that incident, Epstein was not on suicide watch at the time of his death, and he was alone in a cell in the unit of the correctional center used to isolate vulnerable prisoners when his body was found.

It was not immediately clear why Epstein was taken off suicide watch, a special set of procedures for inmates who are deemed to be at risk of taking their own lives.

The Federal Bureau of Prisons, which operates the MCC, provided no explanation beyond its terse statement that Epstein was found dead in an apparent suicide.

His death touched off outrage from Attorney General William Barr, politicians and many of Epstein’s alleged victims, who fear that they may lose their day in court now that Epstein is dead.

That investigation into conduct described in the indictment, including the conspiracy count, will continue despite Epstein’s death, Geoffrey Berman, the U.S. Attorney in Manhattan, said on Saturday.

The indictment – which accused Epstein of knowingly recruiting underage women to engage in sex acts, sometimes over a period of years – came more than a decade after he pleaded guilty in Florida to state charges of solicitation of prostitution from a minor in a deal with prosecutors that has been widely criticized as too lenient.

(Reporting by Letitia Stein in Tampa, Florida; Editing by Frank McGurty and Bill Rigby)