Sandy's death toll rises as Northeast begins recovery

By Gary Strauss and Carolyn Pesce, USA TODAY

U.S. death toll rises to 74

Air traffic is resuming, but transit systems remain snarled

Flooding still prompts evacuations in New York, New Jersey

Much of the storm-battered Northeast is now in early recovery mode. But widespread devastation and ongoing fallout from Superstorm Sandy will likely prolong rescue and rebuilding efforts, hampering the lives of millions over a wide area for days.

With Sandy's U.S. death toll now at 74 and estimates of destruction and economic fallout running as high as $55 billion, several flood- and wind-ravaged states are restoring some semblance of normalcy as roads, schools and mass transit systems go back online.

President Obama, who toured hard-hit New Jersey on Wednesday, warned that relief efforts would take time, but promised that federal officials would cut through "red tape and bureaucracy" to provide swift relief.

"At this point, our main focus is on the state of New Jersey and New York," said Obama, flanked by New Jersey Gov. Chris Christie as they toured the state's battered shoreline. "But we're very concerned about some situations in Connecticut, and we're still monitoring West Virginia. Those four states are really bearing the brunt of this incredible storm."

Christie, an early supporter of Republican presidential contender Mitt Romney, has been a leading party critic of Obama during the campaign. But Christie's frequently blunt bombast was replaced by effusive praise for Obama's response to the crisis.

"I cannot thank the president enough for his personal concern and compassion for the people of our state,'' Christie said, as they met with storm victims.

Obama responded that Christie had put his "heart and soul" into response and recovery efforts.

While losing its early intensity, the 900-mile-wide storm, now heading into Canada, is expected to cause lingering problems across 17 states.

Flood-watch warnings remain for northern New England and the northern Mid-Atlantic; the National Weather Service has issued winter-storm warnings for the central Appalachians, along with gale-force-wind and flooding advisories across the lower Great Lakes.

The West Virginia mountains could get up to 10 inches of snow, bringing totals up to 3 feet in places. Surf conditions along the Atlantic, from Florida through New England, are expected to remain dangerous through Friday.

Sandy has been particularly destructive to New Jersey, where the storm ravaged coastal cities and towns Monday night after making landfall near Atlantic City. The latest storm-related deaths in the state came Wednesday night, when carbon monoxide leaking from a portable power generator apparently caused the deaths of two sisters, ages 18 and 19, at a Trenton apartment building. Residents say the generator was being used to provide electricity.

Much of Hoboken, N.J., remains underwater after being flooded by the Hudson River. An estimated 20,000 people were still stranded in their homes, encouraged by city officials to stay there and wait for supplies to reach them. Mayor Dawn Zimmer said floodwaters were receding late Wednesday night, but the city was still without power.

"We need more food, more water and more resources coming in,'' Zimmer said. "We need more volunteer teams coming in and checking on buildings.

Some New Jersey towns, such as Middletown, were experiencing gas shortages and shuttered service stations, forcing some motorists to wait hours to fill up cars and portable generators. But fears of widespread shortages and sharp price hikes have proved unfounded so far. The government is temporarily waiving some Clean Air Act requirements in 16 states and the District of Columbia to reduce storm-related fuel disruptions, which will allow conventional gasoline and blends to be sold instead of cleaner-burning reformulated fuel.

Nearly 6 million homes and businesses in at least 15 states and Washington, D.C., remain without power — down from Tuesday's 8.5 million — as an army of more than 50,000 utility workers from across the country and Canada arrived to make repairs. For power companies, the scale of the destruction was unmatched -- more widespread than any blizzard or ice storm and worse than the aftermath of Hurricane Katrina.

"It's unprecedented: fallen trees, debris, the roads, water, snow. It's a little bit of everything," said Brian Wolff, senior vice president of the Edison Electric Institute, a group that lobbies for utilities.

Air travel was rebounding after the storm caused more than 19,000 cancellations. Limited air service resumed Wednesday at New York's John F.Kennedy International Airport and Newark International. LaGuardia International was scheduled to open Thursday morning with limited service. Amtrak plans to restore some train service to New York City on Friday.

Trying to ease snarled post-storm traffic, Bloomberg said that cars entering Manhattan between 6 a.m. and midnight Thursday and Friday must have at least three people. Bloomberg announced the restriction partly in response to major traffic jams that developed Wednesday as motorists tried to cross the Manhattan, Brooklyn and Queensboro bridges to reach Manhattan.

National Guard troops and local police were evacuating the last of 700 patients from New York's flood-ravaged Bellevue Hospital to other hospitals and local shelters.

New York City schools remain closed through Friday.

More than 1.9 million New York customers remained without power, nearly all in the New York City and Long Island.

While Northeast power grids were being restored, backup batteries and generators for cellphone towers are running out of juice. One of every five towers was down Wednesday, according to the Federal Communications Commission.

That — plus more people relying on cellphones to stay connected — overwhelmed the system.

INTERACTIVE:Superstorm Sandy blasts eastern USA

IHS Global Insight predicted Sandy will end up causing about $20 billion in property damage and up to $30 billion in lost business. Another firm, AIR Worldwide, estimated losses up to $15 billion — big numbers probably offset by reconstruction and repairs that will contribute to longer-term growth.

Across the storm region:

— In Connecticut, where more than 500,000 Connecticut Light & Power

customers and 187,000 United Illuminating customers lost power at Sandy's peak, there were still 378,000 outages Wednesday evening. In New Haven, a 103-year-old oak tree that fell during the storm revealed a skeleton that may have been there since Colonial times. The tree was on the town green, in an area where thousands were buried in the Colonial era.

-- Police in suburban Philadelphia say an early morning electrical fire that killed two women is considered storm-related, bringing to 11 the number of statewide deaths linked to Sandy. About 600,000 residents were still without power, down from 1.2 million at the peak of the outages.

The Department of Environmental Protection, which regulates drinking water and wastewater plants, said problems because of flooding or power loss were widespread, particularly in eastern and central Pennsylvania. Advisories to boil water were issued for several counties.

— In West Virginia, utilities scrambled to restore power to hundreds of thousands of customers amid snow storms and freezing temperatures. Poor road conditions were hampering assessment efforts. The state's toll climbed to at least six, including state delegate candidate John Rose, killed by a falling tree limb as he was checking fences on his 100-acre farm near Philippi. Snow drifts as high as 5 feet were reported in Richwood. At least 36 state roads remain closed.

--- In Maine, the Port of Portland reopened, but ocean conditions remained dangerous with high winds. Amtrak's Downeaster resumed service. About 3,000 Central Main Power customers were without electricity Wednesday night, down from a 90,000 peak.

-- In northern Ohio, flood warnings remained for the Cleveland lakeshore area as power crews were attempting to restore power to thousands of homes and businesses.

— In Wisconsin, dangerously high waves and flooding were expected along Lake Michigan.

-- In Kentucky, as much as a foot of snow blanketed the Appalachians.

Contributing: Kevin McCoy, Elizabeth Weise, William Welch, The Associated Press, Asbury Park Press

Winter storm: Blizzard warnings as wind, snow hits Boston, Northeast

A powerful winter storm continued dumping snow on the Northeast on Saturday as near-hurricane force wind gusts contributed to snarled travel, more than 100,000 power outages and blizzard conditions near major cities.

Officials banned non-emergency travel in some areas and urged drivers to stay off roads. Meanwhile, thousands of flights were canceled as the storm hit, according to FlightAware. Newark Liberty International Airport in New Jersey said more than 85% of scheduled flights Saturday have been canceled due to the storm.

More than 100,000 customers in Massachusetts were already without power Saturday afternoon, according to poweroutage.us, with about 85,000 Cape Cod and Martha's Vineyard customers on Cape Cod and Martha's Vineyard without power as of 4:15 p.m.

Additional power outages are likely in southern and eastern New England — and elsewhere along the mid-Atlantic coast, AccuWeather said, encouraging people to be prepared for long outages and to have flashlights and blankets on hand.

Winter weather will spread from the mid-Atlantic coast to the Northeast coast throughout Saturday, according to the National Weather Service. The conditions are expected to taper off by Sunday as the storm moves into Canada, the NWS said.

Parts of 10 states were under blizzard warnings Saturday: Maine, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, Delaware, Maryland and Virginia. Major cities including Philadelphia, New York and Boston — as well as much of New England — are expected to bear the brunt of the storm, with wind gusts as high as 100 mph in some areas. Parts of New York and New Jersey confirmed blizzards Friday night and Saturday morning, according to local NWS reports.

The governors of Maryland, Virginia and Delaware declared states of emergency before the storm that began Friday night and had prepped National Guard members to join the cleanup. Only “essential personnel” were allowed to drive on Delaware roads in two of the state's three counties, under an order by Gov. John Carney.

Maryland State Police tweeted troopers had received more than 670 calls for service and responded to 92 crashes as of mid-morning Saturday. There were no immediate reports of storm-related deaths and power outages were minimal.

Wind gusts in eastern Maryland made it difficult for snowplows to keep roads clear, as blowing snow could cover them again in minutes, the state's highway administration said.

In videos posted to social media, storm chasers struggled to stand while walking against high winds that swirled snow into their faces. One storm chaser on Cape Cod filmed winds whipping against trees and dunes as sand and snow sprayed against him.

The Weather Service said the powerful nor'easter further developed overnight, calling the system a bomb cyclone — another name for the process known as bombogenesis.

The storm is "likely to be the strongest and most disruptive snowstorm and blizzard in several years for portions of New England and the immediate mid-Atlantic coast," AccuWeather said.

WHAT IS A NOR'EASTER:Storms can batter East Coast with snow, impact millions of people

People in the region woke up Saturday morning to snow accumulation already in the double digits, according to AccuWeather, and an additional 2 to 3 feet could fall in parts of New England.

Much of the Northeast coast will see snowfall accumulations of more than a foot, NWS said. Some regions will see as much as two to three inches of snowfall per hour, according to the weather service.

Cold temperatures and dangerous wind chills across the East following the storm may "exacerbate an already dangerous situation for those without power/heat," the NWS said.

Officials across the coast warned people to stay off roads as high winds and snow create potential whiteout conditions.

"Expect whiteout conditions and nearly impossible travel at times," the NWS said.

WHAT IS A BOMB CYCLONE?:A winter hurricane, explained.

The Massachusetts Department of Transportation warned on Twitter that already difficult travel will worsen throughout the day.

"Avoid travel if possible," the department said. "If you must go out, take it slow & let crews treat/clear roads safely."

Some coastal flooding and beach erosion is also possible as a result of the storm, according to the NWS. Waves battered parts of the southern Boston area, flooding streets with frigid water. In Newburyport, a seaside town near the New Hampshire border, officials urged residents near shores to move to higher ground.

WHAT IS WIND CHILL?:Understanding the wind chill index and how it's calculated

Storm may set record in Boston

While Boston is no stranger to snowstorms, this weekend's storm is forecast to be the city's first blizzard since 2018 and may even become one of the largest on record, AccuWeather said.

If Boston sees 20 inches or more of snow, the storm could break into the city's top 10 snowfall slots, the weather service said. More than 24.6 inches could put it into the number one spot, over the previous record from January 2015.

AccuWeather has forecast 18 to 24 inches of snow in Boston.

Past major blizzards in the city include the President's Day Storm of 2003, which buried some areas under 30 inches of snow as Boston faced 27.6 inches, according to AccuWeather.

Contributing: Doyle Rice, USA TODAY; The Associated Press

Contact News Now Reporter Christine Fernando at cfernando@usatoday.com or follow her on Twitter at @christinetfern.

Dangerous heat, unequal consequences in Arizona, Florida

By Sofia Moutinho and Elisabeth Gawthrop

This story was produced in collaboration with the Center for Public Integrity and Columbia Journalism Investigations. It was co-published in partnership with Mother Jones, The Arizona Republic and Orlando Sentinel. Regional stories based on the heat illness data analysis produced by CJI can be found in Orlando Sentinel and The Arizona Republic.

Mario Wilcox won’t set out in the summer without an emergency kit in his car trunk: a cooler with an ice pack and a blanket. He learned this improvised life saver from his time in the Iraq and Afghanistan wars; ice and a wet cloth can cool down an overheated body. Now he finds it vital in the intensifying heat of Fort Pierce, Florida, and especially his heat-stressed neighborhood.

More than 2,000 miles away in Phoenix, Arizona, Grace Salinas monitors the street outside her window in a public housing complex when summer temperatures reach triple digits. A community leader in the area southwest of downtown, Salinas stocks cold water bottles for anyone she sees struggling with the heat, a situation growing more common each year.

Heat-related illnesses are soaring in Arizona and Florida as the planet warms and temperatures rise. Among the hottest states in the country, none saw a sharper spike in summertime temperatures over the last century than these two. Already, Arizona is considered the hottest state in the U.S., and Phoenix the hottest city, with more than 140 days over 100 degrees Fahrenheit last year alone. In Florida, the combination of heat and humidity makes it one of the nation’s most dangerous places, according to a recent study.

Poor communities are bearing the brunt of sickening heat in these states, an analysis by Columbia Journalism Investigations and the Center for Public Integrity found. Federal data capturing most emergency room visits and hospitalizations in Arizona and Florida reveal higher rates of heat-related illnesses in areas with less income. The data, never before made public at the ZIP code level, also show that the highest rates of heat-related illnesses are in neighborhoods with a history of racial segregation. Experts say racist policies of the past created conditions, never corrected, that make heat more dangerous for people there today.

Winter has arrived in Arizona and Florida, attracting northerners eager to escape the cold. It seems easy to forget scorching temperatures now. But the warming planet will continue to make summers hotter and more deadly. And that means the problem requires attention year round.

“You would never decide not to heat your home because it is only useful in the winter,” said Howard Frumkin of the University of Washington School of Public Health, who headed the U.S. Centers for Disease Control and Prevention’s climate program in the mid-2000s. Likewise, the best solutions for extreme heat — planting more trees, creating buddy systems — must be implemented consistently to be effective. If “efforts lag for months at a time,” he said, “then you lose ground.”

The response to the problem in these hotspots is as disparate as the landscape itself. In the desert city of Phoenix, grassroots groups are partnering with government officials to protect low-income Black and Latino residents from the scorching sun, but targeted and long-term solutions have yet to come. In the beachfront city of Fort Pierce, by contrast, local authorities barely recognize the threat of heat and are doing little to nothing about it.

Adrienne Hollis, a researcher at the Union of Concerned Scientists, studies the effects of the changing climate on the health of historically disadvantaged populations. She notes that communities of color are often the hardest hit by extreme heat. According to her calculations, U.S. counties where African Americans or Latinos represent at least a quarter of the population — most in the South — have faced more days with temperatures above 100 degrees Fahrenheit over a three-decade period: an average of 18 and 13 days per year, respectively, as compared with roughly seven days a year for the rest of the country.

“ZIP codes do determine your health,” Hollis said, “and most of that is because of structural racism.”

Arizona’s 85007 ZIP code, which includes both the predominantly low-income Black and Latino area southwest of downtown and the more affluent, white neighborhood of Encanto Park, had in 2017 the highest rate of heat-related illness in that state. CJI’s analysis of the federal data shows per-capita ER visits and hospitalizations linked to problems such as heat stroke, heat exhaustion and dehydration in this 4.5-square-mile area were nearly 10 times the state’s average. In Florida’s 34950 ZIP code, the majority Black and low-income neighborhood of Lincoln Park where Wilcox lives, residents came to hospitals for these ailments nearly six times more often than the statewide average.

The situation in both places has been getting worse, county health data shows. In and around southwest of downtown Phoenix, the yearly number of heat-related ER visits for every 100,000 people has more than doubled since 2010, to 129. In Saint Lucie County, where Lincoln Park is located, the rate of such visits in recent years is almost double its mid-2000s level, while hospitalization rates in the same period have more than tripled.

Emergency calls to 911 in both places reveal the risks faced by residents during the summer and even well into the fall. Elderly people, overcome by heat, collapsed and injured themselves while walking outside. Heat exhaustion hit young adults as they biked or waited for a bus. Potentially deadly heat strokes snuck up on workers laboring in the sun.

Salinas, 70, who grew up in Phoenix’s 85007 ZIP code, is used to seeing people succumb to the baking sun. She lost a cousin who lived in the neighborhood to heat stroke and witnessed her adult son, sprawled on the ground outside her home, go to the ER for the same reason. She knows how to identify the danger signs. "We see people walking by looking like they need to breathe," she said. “If you’re not sweating anymore, you’re already in trouble.” During the summer, the tenant leader also checks on elderly people living in her public-housing complex, built in the 1940s to house Mexican Americans. She gives people tips on using the air conditioner in more economical ways.

That may sound like a constant battle. And it is.

“It’s just the way of life here,” Salinas said.

Unequal heat

What’s driving this problem is inequality. Salinas lives in an area largely populated by squat houses with dusty yards that rivals the hottest spots in Phoenix. Daytime temperatures here can be between four and seven degrees Fahrenheit higher than in the wealthier Encanto, located partly in the 85007 ZIP code just three miles north, according to separate experiments conducted by Arizona State University and The Arizona Republic.

While Encanto is an oasis full of parks, replete with trees that keep the air cooler, the area southwest of downtown, between West Harrison Street and the Maricopa Freeway, is marked by barren lots and heat-trapping cement. Mirage-like desert mountains on the horizon break up the urban landscape of highways, buildings and fences here. To make things worse, this area is one of the poorest in town, with residents who often can’t afford to run an air conditioner. Electricity bills can cost around $600 a month per family.

It’s a dangerous combination.

“That’s where the inequities show,” said Juan Barreto-Declet, a geographer researching environmental vulnerability to heat in Phoenix. “That is where the vulnerability is higher.”

And those inequities appear to be widening. State health data shows heat illnesses in this neighborhood and across central Phoenix have increased at a rate seven times the rest of the city since 2010. In Encanto, by contrast, the annual rate of heat illnesses has dipped.

CJI’s analysis shows 79 people who live in the 85007 ZIP code went to the hospital in 2017 because of life-threatening symptoms brought on by heat. Around half suffered from heat exhaustion, while another 20% succumbed to the more severe condition of heat stroke.

The risks facing residents in this area didn’t happen by chance. Investments here — in trees, parks, transit — have been historically lower than in higher-income areas of the city.

That history dates back at least as far as government-imposed “redlining” of the 1930s. The federal Home Owners’ Loan Corp. mapped neighborhoods in cities across the country and graded them according to perceived risk of lending there — with race as the key factor. Areas with people of color and immigrants were marked in red and judged high-risk for mortgage lenders, starving neighborhoods of investment.

The government’s red pen came for the south and west sides of Phoenix, among the city’s oldest regions and historically inhabited by Blacks, Mexican immigrants and Native Americans. Local decisions reinforced residential segregation: Zoning regulations forbade industrial land use in white neighborhoods, funneling that development and its pollution to places where people of color lived; race-restrictive covenants prevented anyone who wasn’t white from buying houses in affluent suburbs.

These policies resulted in “relegating minorities and low-income populations to the hottest areas of the city,” Barreto-Declet said.

A similar storyline has unfolded in many other places across the country — including Florida’s heat-illnesses hotspot, Lincoln Park in Fort Pierce.

The area’s first Black people were enslaved, brought by white settlers on the hunt for land along the Atlantic Coast in 1842. More African Americans moved to the region after the Civil War to work on pineapple farms and then railroads.

The Jim Crow era hardened this segregation. Lincoln Park residents couldn’t go to the same school or beach as white people. Celebrated writer Zora Neale Hurston, who spent her last years in the neighborhood, was buried in an all-Black cemetery, her grave unmarked for a dozen years. The now-shuttered African American-owned theater — one of just four in the country — stands on the main thoroughfare here, Avenue D. U.S. 1 was the literal dividing line: the “Colored Town” on one side, and on the other, the “White City.”

“Segregation in the county determined where a Black citizen could live, work, go to school, fish, eat, give birth, go to church, pee, walk and be buried,” said Jean Ellen Wilson, an 80-year-old historian who grew up in the white part of town. “Black people were not allowed to come out to White City.”

Today, most of the city’s Black residents still live in Lincoln Park, which remains “Fort Pierce’s most segregated community,” a 2016 city housing report states. The neighborhood is 91% African American, and a little more than half the residents live below the federal poverty line. In a county where the typical household makes about $43,000, the median income here is just $15,797. One aid agency fields 300 or so monthly requests from local residents seeking help to pay their electricity bills.

Wilcox sees the stark difference between his neighborhood and the rest of the city when driving in the area. Heading south on Indian River Drive, toward the Fort Pierce immortalized in paintings of exuberant sunrises and palm-lined beaches, he takes in solar panels, fountains, expensive houses. On the return trip north, he spots weathered homes and stores, their pastel colors faded, their windows boarded or covered in aluminum foil — a sign of no air conditioning or insulation. On a hot day, families keep doors open and sit outside to cool off. Friends play dominoes or catch ball on street corners. As he sees it, a systematic lack of resources explains why people here are sickened by heat.

“The south and the beachfront are the haves,” he said. “And the north of the city is the haves not.”

CJI’s data analysis shows that 33 people living in the ZIP code encompassing most of Lincoln Park went to the hospital for heat-related illnesses in 2017. Sixty percent were Black. That’s a lot of people for a small area of about 16,000 residents.

The legacy of racist policies on present-day heat vulnerability is widespread across the country. A study conducted by researchers at the Science Museum of Virginia, Virginia Commonwealth University and Portland State University looked at more than 108 cities to conclude that the hottest neighborhoods are those located in formerly redlined areas. Unpublished data from this research, calculated exclusively for CJI, shows that in Phoenix, for example, the current difference in temperature between redlined areas and other neighborhoods is more than eight degrees Fahrenheit during the summer.

In the city’s 85007 ZIP code, home to several shelters, people identified as homeless account for some of the patients sickened by heat. But even when this population is excluded from the data, the ZIP code remains the state’s hardest hit. And Black people are disproportionately represented among the heat-illness patients, CJI’s analysis shows: They’re three times more likely to go to the ER for that reason.

CJI analyzed statewide data in Arizona and Florida to see whether the ZIP codes with the highest heat-illness rates were also the hottest, but the results were inconclusive. Heat maps show Fort Pierce’s Lincoln Park and neighborhoods southwest of downtown Phoenix have elevated temperatures, but other similarly hot areas have experienced fewer heat illnesses. That suggests temperature isn’t the only reason so many people are sickened by heat in these neighborhoods.

Underlying health conditions that exacerbate heat illness may play a role. In both ZIPs, CJI’s analysis of hospital data found high numbers of patients diagnosed with conditions known to heighten risk for heat stress — diabetes, hypertension, heart disease. In Lincoln Park, nearly half of the 2017 heat-illness patients were also diagnosed with diabetes or hypertension. This too can be a consequence of decades of decisions that sapped neighborhood resources.

One 2017 community assessment found the diabetes rate is three times higher in Lincoln Park than in the rest of the county, a spike that its health department has worked to reduce. Most health experts recognize the link between poverty, chronic conditions and heat, but it doesn’t seem to be on county health officials’ radar.

Clint Sperber, who heads the Saint Lucie County Department of Health, declined to be interviewed for this article. In an email, he acknowledged that the agency wasn’t aware of the heat issue until a CJI reporter reached out. The agency had no answer about why it had not already made use of the data on heat illnesses that the Florida Department of Health collects so its county counterparts can develop public health interventions.

“The Department of Health in St. Lucie and our community partners have been informed, and as a community we will collaborate to address this issue,” Sperber wrote in a November 12 email.

The agency has taken the problem to the Fort Pierce city manager, he said. A spokesperson for that official, Nick Mimms, said in an email that the city is “looking forward … to collect as much data and information as possible in order to combat the heat illness and create a program that provides safety and protects the well-being of its citizens.” Mimms declined an interview request.

Gerald Newberry, 59, was born and raised in Lincoln Park and has always worked outdoors, starting as a teenager when he picked fruit with his father. He lost count of how many times he saw co-workers getting sick in the fields because of the baking sun. On the job, farmworkers with limited access to health care relied on a homemade treatment to beat the heat: a teaspoon of apple cider vinegar mixed with water. Now a landscaper, Newberry still carries a vinegar and water bottle with him. Often, he gets dizzy and feels ill under the sun.

“It feels like you did bump your head, it feels sore, and you know that you didn’t bump it,” he said. “And then another thing is the headaches, heavy headaches.”

He has never fainted but fears the day he will, like the locals say, be “bear-caught,” a heat stroke that takes you to the ground like a bear sneaking in from behind. Until he recently got health insurance, sporadic visits to Walgreens to check his blood pressure were his only form of health care.

Too slow or not at all

Cities can mitigate heat risk with steps such as planting trees, investing in new designs and cool materials, and opening cooling centers for residents without air conditioning. None of this has happened in Fort Pierce, the health department said. In one of the city’s few nods to the dangers, it prohibits residents from leaving dogs outside when the heat index is above 100°F. There’s no local law protecting people from heat.

A 2016 report from the county emergency-management division at the Department of Public Safety warned that the “probability of heat indexes within the range of causing health problems is moderate to high during the summer months.” But according to the division, the county has never declared a heat emergency and, unlike hurricanes and floods, the issue is not among its priorities.

County health officials also confirm that they don’t have any programs or policies for extreme heat. In a 2015 report, the Florida health department classified Fort Pierce’s county, Saint Lucie, at medium to high risk for heat hazards under different climate change scenarios. But the state’s actions to prevent heat illnesses are scant. Its “Beat the Heat” campaign is a 26-second video with tips for residents about how to stay safe.

State health officials have long overlooked climate-related health hazards. In 2016, the department shunted its federally funded climate and health program to Florida State University, where it has no policy-making power. The program serves three of the state’s 67 counties. Saint Lucie isn’t one of them.

Former Fort Pierce City Commissioner Reginald Sessions, a native of Lincoln Park who represented the area until December, said he’d like to see more effort by health officials to help Black and poor communities.

“We need to put a lot more emphasis on targeting them to improve their health,” he said. “I assure you that if we do that, we will have less African Americans suffering from heat strokes.”

In Phoenix, where local officials are keenly aware of heat’s dangers, efforts to protect residents are further along. But plans to address the long underinvestment in neighborhoods southwest of downtown have yet to bear fruit.

Efforts to save lives with heat-risk awareness campaigns date back to the summer of 2009, after eight local residents died of heat stroke.

Eva Olivas with the grassroots Phoenix Revitalization Corp. reached out to the city parks and aquatics departments. They organized information sessions at public pools and posted on social media.

“Sometimes people who live here get so used to the heat that they forget how dangerous it can be,” she said. “The idea was to remind them that the summers today are not like summers before.”

Mark Hartman, who heads the city’s Sustainability Office, said Phoenix is trying to be the first municipality to respond to extreme heat like other places prepare for storms. In 2018, he and other city officials launched a “Heat Ready” program that pulled together actions they had already adopted and plan to extend, including emergency relief such as cooling centers and long-term initiatives, like planting trees and using “cooling pavement” that doesn’t absorb as much heat. His office is testing this pavement in different districts across the city, including one location outside the 85007 ZIP code in the area southwest of downtown.

Phoenix has set a goal to cover 25% of its land area with trees by 2030. That would double the tree canopy and require planting 10,000 trees per year on average. But the city is off track: When Phoenix planted a record number of trees in 2019, it still amounted to less than half the annual requirement.

A CJI analysis of satellite data reveals a stark disparity in green space in ZIP code 85007: Forty-two percent of the wealthier Encanto neighborhood has leafy vegetation, including two golf courses. By contrast, just seven percent of the area southwest of downtown Phoenix is green. Residents have pushed city officials for years to plant more trees in vulnerable areas, and a city subcommittee recommended the appointment of a “tree administrator.”

City officials have yet to implement that recommendation. Hartman said the city is trying to map the areas most in danger from heat to target tree distribution and related actions.

“We originally thought that we needed to create shades throughout our whole city and trees everywhere, but actually, we just need them in certain places, like in vulnerable communities,” he said.

In the last three years, his cabinet has worked with researchers like David Hondula, a sustainability scientist at ASU and a member of the state’s climate and health team, to develop a more complete vulnerability index. It aims to take into account not only where the most heat-vulnerable people live, but also where they are most exposed.

“The traditional approaches to vulnerability don’t really reflect how people move around the city,” said Hondula, whose own research has identified ZIP code 85007 among the city’s top 10 neighborhoods most vulnerable to heat.

Advocates, scientists and county health officials have met multiple times with residents of Edison-Eastlake, a neighborhood just east of downtown Phoenix, to hear about problems contributing to heat risk. Among those they named: too few street trees and unshaded bus stops.

This shouldn’t come as news to city officials. A 2004 Phoenix urban design plan recommended the city “provide comfortable and convenient shaded bus stops.” But from her office window today, 16 years later, Olivas sees a bus stop that’s merely a sign in the sun. “Should this kind of ‘infrastructure’ be considered normal in a city where the temperatures get up to 117?” she asks.

That’s just one such example of a missed opportunity. In 2014, the city launched a streets plan that included guidelines for developers on shade and tree coverage. Four years later, seven of the project’s nine advisory board members quit, saying the city, lobbied by developers, was proposing a series of alterations to the street design guidelines that “watered them down” until they were meaningless. The project stalled.

“The city is really good at writing press releases and approving plans,” said Stacey Champion, who participated in a 2018 petition to Phoenix officials about local trees, “but not so good in making sure those plans actually get followed.”

Hartman, acknowledging some problems, blamed a lack of funding and personnel. He said the city still “has a long way” to go to be heat ready.

Mayor Kate Gallego, asked about criticism that the city has prioritized plans over action, declined to comment. Her office pointed to yet another plan: a climate-action strategy it’s developing after joining a network of 96 municipalities worldwide whose leaders have committed to combat global warming. It will include heat mitigation.

“Phoenix is uniquely experienced to share proven practices for building heat resilience,” Gallego said in a written statement. “We are still learning and have a lot of work to do, but our partnership with heat research powerhouse Arizona State University and our legacy of living with heat makes Phoenix a model for other cities who are grappling with this public health challenge.”

A hotter future

If officials don’t counteract the longstanding disinvestment that endangers people in communities like Lincoln Park and those southwest of downtown Phoenix, heat risks there will worsen. A report from the Union of Concerned Scientists predicts Florida will experience some of the most frequent periods of extreme heat in the nation by 2050 as climate change intensifies: as many as 105 days a year with a heat index over 100°F. The group expects Fort Pierce and the surrounding county will endure five times more extreme heat days a year than from the 1970s to 2000. In the greater Phoenix area, such days are projected to double.

The UCS’s Hollis, who grew up in hot and segregated Mobile, Alabama, warns that people of color will bear the brunt of this change. By midcentury, if nothing is done to stop climate change, counties where Black residents make up more than a quarter of the population will experience an additional month of extreme heat days each year compared with their counterparts, according to an analysis she conducted.

“If nothing is done,” she said, “we’re gonna have more health disparities, more people sick and more deaths.”

Back in Phoenix, Grace Salinas has tried to keep up her usual heat outreach. Amid the coronavirus pandemic, her block watch association had to abandon its plans for awareness campaigns and other activities. She sent information leaflets to neighbors instead.

The number of 911 heat-related calls in the city last year topped 1,400. In the last six years, those calls have jumped 80 percent.

MORE INFO: Heat is deadlier in rural Arizona, where help is scarce

How heat, wet or dry, affects the body

Extreme heat overwhelms our body’s ability to regulate its temperature by sweating. This can lead to heat stress, which has wide-ranging symptoms like cramps, headaches and nausea. The more severe condition of heat stroke occurs when our body temperature rises to 104 degrees. That can affect the brain and potentially cause fainting or death.

All that can happen in dry heat, but the combination of heat and humidity is worse. That’s because humidity prevents our sweat from evaporating enough to cool down. Scientists assess this combination using what’s known as “wet-bulb temperature.” Even when air temperatures are hovering around 80 degrees, humidity can threaten to overheat our bodies.

Climate scientists predict the heat-humidity combo will hit deadly thresholds as the planet warms. Such scenarios have more than doubled since 1979 across the southern United States, a recent study shows. Researchers found parts of Florida and Louisiana along the Gulf of Mexico have among the deadliest mixtures of hot air temperatures and humidity worldwide.

Children, seniors and people with chronic conditions are most at risk for heat-related illnesses. Those experiencing heat-stress symptoms should find a cool place to rest, hydrate and let someone know they’re not feeling well. If symptoms worsen, cover your body in cold, wet towels or ice packs. This can save lives. And, of course, call 911.

Sofia Moutinho and Elisabeth Gawthrop are reporting fellows for Columbia Journalism Investigations, an investigative reporting unit at the Columbia Journalism School. Funding for CJI comes from the school’s Investigative Reporting Resource and the Energy Foundation. The Center for Public Integrity provided editing, fact-checking and other support. The Arizona Republic provided photography.

US heat wave: Oppressive heat will bake much of the US this ...

CNN —

Relentless, oppressive heat will grip much of the US this weekend, with the Northeast region expected to bear the brunt amid forecasts for near-record temperatures across the region.

More than 85 million Americans from the central US to the Northeast are under heat warnings or advisories Saturday morning as officials across the country urge people to take precautions when outdoors.

“Sweltering heat over the Northeast US this weekend may lead 30+ stations to approach or exceed their record high temps by Sunday, w/ high humidity driving triple-digit heat indices along the I-95 corridor,” the Weather Prediction Center warned Friday.

“In terms of actual high temps, look for daytime max temps to eclipse the century mark in the Central Plains and record breaking high temps from the Central Plains to the Northeast today (Saturday).”

Heat index values – what the air feels like – may reach at least 105 degrees Fahrenheit this weekend in parts of the Northeast and mid-Atlantic, aided by the suffocating humidity, the prediction center noted.

The dangerous temperatures – which experts note are becoming more common across the globe due to climate change– have led state and local leaders to take steps to help their residents cope with the oppressive conditions.

“Temperatures at night will struggle to drop below 80 degrees, especially in the highly urbanized areas such as Center City Philadelphia,” the National Weather Service office in nearby Mount Holly said.

In New York, the governor is urging people to take advantage of cooling centers and check on particularly vulnerable communities.

“We need everyone to be on alert this weekend, keeping an eye out for any signs of heat-related illness and looking after one another,” Gov. Kathy Hochul said in a news release.

In Philadelphia – where the air is forecast to feel as hot as 107 degrees Fahrenheit Sunday – officials extended a heat health emergency. Cooling centers, home visits by special teams and enhanced daytime outreach to people experiencing homelessness are available through Sunday.

A heat emergency is in effect in Washington, DC, until at least Monday morning as temperatures are expected to be 95 degrees or higher, the mayor announced. Shelters and cooling centers have also opened to serve those who need them, the mayor said.

Sylvia Carrasquillo reacts as she sits in front of an open fire hydrant Friday in The Bronx neighborhood of New York City. Seth Wenig/AP

This week saw at least 2 heat-related deaths in US

The extreme heat claimed at least two lives so far this week.

In Dallas, a 66-year-old woman who had underlying health conditions died due to heat-related issues, a county official said Thursday.

And on Wednesday, a 22-year-old hiker died due to possible dehydration and exposure in a South Dakota national park, the Pennington County Sheriff’s Office said in a news release.

The hiker was flown to a hospital after running out of water while hiking on an unmarked trail in Badlands National Park.

Highs in the area this week have been in the upper 90s, according to the National Weather Service. Typically, highs are 92 degrees in July.

In Arizona, officials in Maricopa County reported at least 29 people died from heat-related issues since March – the majority of whom were outdoors. Last year, 16 heat-related deaths during the same period in 2021, the county’s public health department said. In the meantime, dozens of other deaths are under investigation in the county for heat-related causes.

Excessive heat is the leading cause of weather-related deaths in the US. The conditions climate change imposes have been making extreme weather events more deadly and more common.

In fact, heat deaths have outpaced hurricane deaths by more than 15-to-1 over the past decade, according to data tracked by the National Weather Service.

Meanwhile in New Mexico, two women died Thursday after flash flooding in San Miguel County, the sheriff said in a statement.

First-responders there found the bodies of the two women in a creek channel after seeing a car had capsized, Sheriff Chris Lopez said. A man was also reported missing in the flooding, he added.

85% of US will see high temperatures next week

About 85% of the US population – or 273 million people – could see high temperatures above 90 degrees over the next week. And about 55 million people could see high temperatures at or above 100 degrees over the next seven days.

On Saturday, “sizzling temperatures” will take hold of the Middle Mississippi Valley and Central Plains with temperatures forecast to surpass 100 degrees, the weather prediction center said.

Saturday's heat index forecast CNN Weather

Daytime temperatures could top 100 degrees across much of the Southwest, with some areas exceeding 110 degrees, according to the center.

The south-central region can expect to see high temperatures in the triple digits every day between Sunday and Thursday, the prediction center noted.

“There is some good news in the medium range (after the weekend) as an approaching cold front brings a brief injection of cooler temps to the Midwest and Northeast, but the core of the intense heat shifts to the South Central US and Pacific Northwest early next week,” the prediction center wrote.

Winter storm brings rain, snow, havoc to Southeast

A winter storm that has brought havoc to airline and highway traffic across much of the nation crawled east Sunday, pummeling the Southeast with snow and sleet.

Almost 300,000 homes and businesses were without power in North and South Carolina, Tennessee, Georgia and Alabama early Sunday. Thousands of flights were cancelled or delayed from Texas to the Carolinas.

In North Carolina, more than 1,000 flights were cancelled in and out of Charlotte Douglas International Airport alone. Parts of North Carolina could see snow measured in feet rather than inches before the storm finally rolls out to sea, a forecast that compelled Gov. Roy Cooper to declare a state of emergency.

In the western part of the state, the city of Boone already had 10 inches of snow early Sunday.

“This is a snow storm, not a snowfall – it’s serious,” Gov. Cooper said. “In the Piedmont to western parts of our state, we’re preparing for days of impact, not hours.”

Cooper warned that utility companies projected widespread power outages affecting over half a million homes and businesses. In some areas, power could be out for days, he said.

Virginia Gov. Ralph Northam also declared a state of emergency, urging state residents to "take all necessary precautions to ensure they are prepared" for the storm.

The storm dumped heavy rains on Los Angeles more than a week ago before slamming across the southern Plains into the Southeast, leaving a swath of power outages, delayed and canceled flights and dangerous road conditions in its wake. The Southeast was next in line before the storm was expected to move northeastward over the Atlantic Ocean, the National Weather Service said.

Asheville, N.C., is expected to bear a large brunt of the storm, with up to two feet falling around much of the region this weekend, followed by treacherous and icy conditions early next week.

Emergency officials were bringing in extra staff and cautiously monitoring whether ice accumulates under all the snow, making travel increasingly dangerous.

"If we do, that’s going to make it treacherous to get around," said Jerry VeHaun, director of Buncombe County Emergency Services, which covers Asheville. "But we're just watching the weather and making sure we’re ready to react whichever way we need to.”

More:Wintry storm brings rain, snow, havoc across USA

More:American Airlines cancels nearly 1,000 Sunday flights due to weather

The storm has already taken a heavy toll on Texas, where Lubbock was blasted with more than 9 inches of snow. Hundreds of miles to the southeast, the storm brought heavy rains and flooding to Houston. In scenes eerily reminiscent of the deadly floods following Hurricane Harvey last year, motorists across the city abandoned cars that had been submerged by high-rising floodwaters Saturday.

Six Houston-area bayous had overflowed their banks and parts of Houston and Harris County got more than 6 inches of rain over the past two days. College Station, Texas, also reported 4 inches of rain, shattering a record set in 1931, according to the National Weather Service.

Much of the wet stuff moved out of Texas by Saturday night as the storm continued moving east. High school championship and playoff football games were postponed in Arkansas, and and Christmas parades in Oklahoma and South Carolina faced a similar fate.

Appalachian Power, headquartered in Charleston, W. Va., began moving crews from Indiana, Ohio, and Michigan to areas expected to be affected by the storm. Additional crews will be ready on Monday to assist if needed.

"We continue to monitor the weather closely and will adjust plans as forecasts warrant," Appalachian Power said in a statement.

Duke Energy, an electric power company headquartered in Charlotte, estimated that half a million customers will lose service across the Carolinas. Duke Energy is bringing crews in from Florida, Kentucky, Ohio and Virginia to respond to power outages.

Contributing: USA TODAY's Jessica Guynn and Doyle Rice and The Citizen Times.

COVID-19 relief deal, winter storm, vaccine, Trump: Wednesday's ...

It's raining money and snowing flakes in the nation's capital. (Well, coronavirus aid checks are *almost* sorted, and the East Coast got quite a few inches of snow.)

It's Ashley with the news you need to know.

But first, did COVID-19 create a new kind of Dad? A vaccine means more Americans could soon return to work. Dads who got more time with kids may want more job flexibility and a new routine. 👨👧👦

The Short List is a snappy USA TODAY news roundup. Subscribe here!

Checks and balances

Lawmakers closed in on a roughly $900 billion COVID-19 relief deal Wednesday that may include another round of aid checks and other much-needed financial benefits, according to a source familiar with negotiations. Sen. John Thune, the second-ranking Senate Republican, said Wednesday he believed checks of $600 or $700 were part of discussions, and the unemployment benefit was about $300 per week. Senate leaders seemed optimistic about the prospects of a deal Wednesday morning. Majority Leader Mitch McConnell, R-Ky., said lawmakers made "major headway" on closing a deal that could pass the House and Senate, and Minority Leader Chuck Schumer, D-N.Y., said they were on the "precipice" of an agreement.

Let it snow

As my East Coast colleagues have been discussing jubilantly all day: The big storm is here at last. After several days of buildup, what promises to be the most significant winter storm in years hit much of the East Coast on Wednesday. Snow is likely to fall all the way from Georgia to Maine, threatening very dangerous travel conditions and isolated power outages, the National Weather Service warned. A wide swath of the region was forecast to see a foot of snowfall, and some spots could see up to 2 feet, the Weather Service said. More than 50 million people were under a winter storm warning, including the New York City metro area, where more than a foot of snow was possible.

How often should I start my car and let it idle in cold weather? Answer: Don't.

What everyone’s talking about

Calling all health care heroes: Have you received a vaccine?

When Dr. Steven Roumpf received the long-awaited COVID-19 vaccine Wednesday, he didn't flinch, but the significance of the moment did not escape him. "It's a ray of hope," Roumpf said. "I've lost my perception of time. January feels like yesterday. Everything that's happened since March feels like years." Roumpf and emergency room nurse Joe Majchrowicz were the first two Indianapolis health care workers to receive the vaccine. But they aren't alone: The rollout of the first doses of the COVID-19 vaccine has gone smoothly, and 2 million more are set to be delivered next week, the leaders of the government’s Operation Warp Speed said in an update Wednesday.

As health care workers get the COVID-19 vaccine, we want to hear your stories – and see your selfies. Email me at TheShortList@usatoday.com to share yours.

Thousands of international adoptees lack US citizenship. They’re trying to change that

Paperwork was lost. Parents were told children would automatically become citizens. Thousands of international adoptees came into the USA legally as children, grew up believing they were American citizens, worked, married and raised families only to find out they are not U.S. citizens. The National Council for Adoption and other organizations estimate that 15,000 to 18,000 adults who were adopted as children by U.S. citizens do not have citizenship. "You love this country, and it's taken from you," Michael Libberton, an adoptee from Colombia, told USA TODAY. "Every right you thought you had, you don't have."

Real quick

Suspected al-Shabaab operative charged in 9/11 style hijacking plot

A Kenyan man has been charged with plotting a Sept. 11-style hijacking attack in the U.S., federal prosecutors said in court documents unsealed Wednesday. Cholo Abdi Abdullah, a suspected operative of the al-Qaeda affiliate al-Shabaab, faces six terror-related offenses and was set to make his first court appearance Wednesday in New York. Acting Manhattan U.S. attorney Audrey Strauss called the alleged scheme a "chilling callback to the horrific attacks" nearly two decades ago that killed almost 3,000 people in New York, Washington and Pennsylvania.

A break from the news

Flu and RSV hit hard and early; now, Covid-19 is starting to rise | CNN

CNN —

Just when you thought it was safe for a holiday visit with your Auntie Mary and her fragile health, RSV and the flu reared their heads – and now Covid-19 numbers are creeping up again.

Health officials are emphasizing the availability of the protective measures, tests and treatments that they say will be key to preventing a repeat of the Covid-19 surges of the past two winters.

Case numbers are now below those of earlier waves, but about 14% of the US population is in an area that meets the US Centers for Disease Control and Prevention’s criteria for a “high” Covid-19 community level, up from less than 5% last week. New York City, Los Angeles County and Phoenix’s Maricopa County are among those areas.

Covid-19 hospitalizations have been on the rise since early November, and older people are bearing the brunt of these serious illnesses. Hospitalization rates are four times higher for seniors than for any other age group.

In the first week of December, the US had the most Covid-19-related deaths in months. Even with vaccines and treatments widely available, the CDC reported nearly 3,000 deaths for that week.

As it stands, there have been at least 99.2 million Covid-19 cases and more than 1.08 million deaths in the US, according to the CDC.

The White House said Thursday that this Covid-19 season does not have to be like last winter’s, when there was a large spike in cases with the rise of the Omicron coronavirus variant.

“We have the tools, we have the infrastructure, and we have the know-how to manage this moment,” White House Covid-19 response coordinator Dr. Ashish Jha said at a briefing.

The Biden administration has been in daily contact with state and local public health leaders, monitoring hospital levels, he said. And the federal government has medical personnel, supplies and other resources ready if states and communities need them.

The government is also reopening Covidtests.gov for a limited time so more Americans can get access to free tests. Each household in the US can order up to four at home tests that ship as early as next week.

Jha added that although “Covid isn’t the disruptive force it once was,” the country is prepared “no matter what the virus throws at us.”

Push for more vaccinations

However, more people still need to get boosted and vaccinated.

Only about 14% of eligible Americans have gotten an updated Covid-19 booster, and 1 in 5 people in the US remain completely unvaccinated, according to the CDC.

Survey data published Friday by the Kaiser Family Foundation found less than half of adults in the US are worried that Covid-19 cases and hospitalizations will increase this winter, and even fewer – only about a third – are worried that they will get seriously sick from the virus. These findings are based on KFF’s ongoing COVID-19 Vaccine Monitor project, and the latest survey was conducted from November 29 to December 8.

Only about 4 in 10 adults say they have gotten the updated booster or plan to do so as soon as possible, although federal data shows that the risk of Covid-19-related hospitalization is four times lower for adults who are up to date on their Covid-19 vaccines than for those who are unvaccinated.

Democrats are nearly four times more likely than Republicans to say they have gotten the updated booster shot or plan to. Among Republicans, skepticism is the driving factor. Even among those who have gotten their initial Covid-19 vaccine series, more than 60% said they “don’t think they need the new booster” or “don’t think the benefit is worth it.” Democrats were most likely to say they haven’t gotten the new booster because they are “too busy or have not had the time.” But even a quarter of Democrats surveyed say that they don’t think they need the new booster.

As at other times in the pandemic, groups who have been disproportionately affected by severe outcomes from Covid-19 – including seniors, as well as Black and Hispanic adults – were more likely than others to worry about rising cases and hospitalizations.

Public health officials have specifically stressed the importance of seniors being up to date on their vaccinations. Seniors were more likely than any other age group in the survey to say they have gotten the updated booster or plan to – the only age group with more than 50% expected uptake – but more than a third of seniors say they don’t think they need the new booster or don’t think the benefit is worth it.

Most parents in the survey do not plan to have their children get the updated Covid-19 booster shot. Only 30% of parents of children 5 to 11 and 42% of parents of adolescents 12 to 17 say they have gotten the booster or plan to do so.

About half of parents are worried that their child will get seriously ill from the flu, RSV or Covid-19 this season – but flu and RSV slightly outrank Covid-19.

Prevention and treatment

Jha said on CNN on Thursday that people who test positive for Covid-19 should “be evaluated for treatment,” especially those 50 and older and anyone with chronic conditions.

Treatments can reduce a person’s risk of being hospitalized or dying from Covid-19, but Paxlovid works best if started within days of when symptoms appear.

“We want to encourage people to use those tools, and given how widespread and how available those tools are, I think if people did that, we could get through” the Covid-19 season, Jha said.

Public health officials are beginning to recommend a return to one of those tools: masking in public places.

In Philadelphia, when schoolchildren come back from the winter break, they will be required to wear masks for 10 days as a “proactive measure” to reduce the spread of Covid-19 and other respiratory illnesses, a district spokesperson said.

Get CNN Health's weekly newsletter Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team.

The CDC recommends masking for anyone who’s on public transportation. It also suggests wearing one in other public settings in communities with high Covid-19 community levels. People who are at high risk of severe illness are urged to wear masks even in areas with only medium community levels.

Other basic prevention measures still apply: Keep hands clean, and if you’re sick, stay home and do a video call with your elderly relatives.

3M documents show company knew of PFAS dangers for decades

A 3M environmental specialist, in a scathing resignation letter, accused company officials of being "unethical" and more "concerned with markets, legal defensibility and image over environmental safety" when it came to PFAS, the emerging contaminant causing a potential crisis throughout Michigan and the country.

PFOS, one of 3M's chief PFAS products, "is the most insidious pollutant since PCB," Richard Purdy stated in his March 28, 1999, resignation letter, referring to a compound used in 3M's ScotchGard stain-protection product line, among other uses.

"It is probably more damaging than PCB because it does not degrade, whereas PCB does; it is more toxic to wildlife," he stated, adding that PFOS's end point in the environment appeared to be plants and animals, not soil and sediment like PCB.

"I have worked within the system to learn more about this chemical and to make the company aware of the dangers associated with its continued use," Purdy stated in the letter, saying he was resigning effective April 6, 1999. "But I have continually met roadblocks, delays, and indecision. For weeks on end, I have received assurances that my samples would be analyzed soon — never to see results. There are always excuses and little is accomplished."

Purdy's explosive resignation letter is just one of a large cache of internal 3M memos and documents obtained by the Free Press through public records law from the Minnesota Attorney General’s Office. Then-Minnesota Attorney General Lori Swanson obtained the internal documents from the Minnesota-based company after suing 3M in 2010 over its environmental contamination in the state. The company settled the suit last year for $850 million.

Per- and polyfluoroalkyl substances — PFAS — is the biggest emerging contaminant problem in Michigan. The nonstick compounds were used for decades, from the 1950s to the 2000s, in aqueous firefighting foam, industrial processes and a host of popular consumer products: Teflon nonstick pots and pans, ScotchGard stain protectants on carpets and upholstery; Gore-Tex water-resistant shoes and clothing, and more.

But the same qualities that made PFAS compounds so useful also makes them almost indestructible in the environment, giving them the ominous nickname "the forever chemicals."

Two of the most common and most studied PFAS compounds, known as PFOS and PFOA, have been linked to cancer; conditions affecting the liver, thyroid and pancreas; ulcerative colitis; hormone and immune system interference; high cholesterol; pre-eclampsia in pregnant women, and negative effects on growth, learning and behavior in infants and children.

PFAS can now be found in the blood of nearly 99% of Americans. It has even been found in polar bears in the Arctic Circle, as the chemicals have worked their way up the food chain from fish and seals.

Some 46 sites in Michigan are known to have groundwater with PFAS levels above the U.S. Environmental Protection Agency's lifetime health advisory guideline of 70 parts per trillion, a level above which a person consuming the water for a lifetime might expect health problems. And state officials have identified more than 11,000 sites in Michigan where PFAS was used and contamination may be an issue.

And it's not just the Great Lakes State's problem. In a new study, citing updated federal government data, the Washington-based nonprofit Environmental Working Group identified 610 sites in 43 U.S. states or territories known contaminated with PFAS, including drinking water systems serving 19 million people.

More:

PFAS contamination: Michigan's biggest environmental crisis in 40 years

Castellanos, 24 Tigers minor leaguers exposed to harmful PFAS chemicals in past

PFAS in Michigan: What to know about contaminant, exposure risk, drinking water concerns

The documents obtained from the Minnesota Attorney General's office outline 3M's own research showing its PFAS compounds were not breaking down in the environment, were having negative health effects in laboratory rats and other animals — and that the blood of employees, and the public, had become contaminated with the compounds.

As these revelations occurred within the company, 3M continued to sell PFAS compounds for use in products worldwide: in ScotchGard stain protection, Teflon coating on cookware and other products, Gore-Tex water resistant shoes and clothing, sandwich wrapping paper and microwave popcorn bags, aqueous firefighting foam and other industrial uses.

For generations, 3M kept much of what it knew to itself, not informing the U.S. Environmental Protection Agency — or the public — until the late 1990s, when the EPA began taking notice of the rising research outside of 3M showing PFAS's persistence in the environment. The company in 2000 announced an agreement with the EPA to voluntarily phase out its use of PFOS by 2003. It also halted its manufacture of another popular PFAS compound, PFOA, in 2000, but other manufacturers, including DuPont in its Teflon products, continued utilizing PFOA until a subsequent agreement with the EPA to phase out its use by 2015.

Nicholas Coulson, an environmental class-action attorney from Detroit, is using the 3M internal documents from Minnesota in his own lawsuit. Coulson represents current and former residents of the city of Parchment, in Kalamazoo County, in a lawsuit against 3M and Georgia-Pacific, final owner of a long-standing paper mill in the city that made food-wrap paper coated with 3M's PFAS. The mill left a toxic mess in its nearby landfill, and PFAS compounds leached from it into Parchment's municipal water supply. Thousands in the city have been exposed to high levels of the compounds in their drinking water for an unknown number of years.

"What we’re alleging that 3M did is really a crime against humanity," Coulson said.

"It’s an absolute outrage that, in the name of profit, for decades they suppressed this information, and they continued to pump these chemicals out in incredible quantities into the natural environment," Coulson said. "And the terrible result of that is that some communities, like Parchment, have had to bear the brunt of it."

Some 46 Michigan locations have PFAS compounds in groundwater that exceed the EPA's 70 parts-per-trillion health advisory level. The Michigan Department of Environment, Great Lakes and Energy has estimated PFAS could be found at more than 11,300 sites in Michigan — fire stations, municipal airports, military sites, refineries and bulk petroleum stations, wastewater treatment plants, old landfills, and various industrial sites.

Seventeen rivers, lakes, streams and ponds throughout Michigan have "do not eat" fish advisories, or limitations on consumption of fish, because of PFOS contamination, including Saginaw Bay, Lake St. Clair and portions of the Au Sable, Huron, Flint, Saginaw and St. Joseph rivers.

Letter cites delays, unkept promises

Purdy, in his resignation letter to 3M, listed repeated instances when his urgency on PFOS was met with delays and unkept promises that the company would conduct further, clarifying studies. He referenced an "8e report" 3M had made to the EPA in May 1998. Under the federal Toxic Substances Control Act, Section 8e, a chemical manufacturer who discovers its chemical poses "a substantial risk of injury to health or the environment shall immediately inform the (EPA) Administrator of such information."

"There is tremendous concern within EPA, the country, and the world about persistent bioaccumulative chemicals such as PFOS," Purdy stated in the letter.

"Just before that submission we found PFOS in the blood of eaglets — eaglets still young enough that their only food consisted of fish caught in remote lakes by their parents. This finding indicates a widespread environmental contamination and food chain transfer and probable bioaccumulation and bio-magnification. This is a very significant finding that the 8e reporting rule was created to collect.

"3M chose to report simply that PFOS had been found in the blood of animals, which is true but omits the most significant information."

Purdy later in his resignation letter added that "3M waited too long to tell customers about the widespread dispersal of PFOS in people and the environment."

"3M continues to make and sell these chemicals, though the company knows of an ecological risk assessment I did that indicates there is a better than 100% probability that perfluorooctansulfonate (PFOS) is biomagnifying in the food chain and harming sea mammals. This chemical is more stable than many rocks. ...

"3M told those of us working on the fluorochemical project not to write down our thoughts or have email discussions on issues because of how our speculations could be viewed in a legal discovery process. This has stymied intellectual development on the issue, and stifled discussion on the serious ethical implications of decisions."

Purdy concluded his resignation letter with this paragraph:

"I have worked to the best of my ability within the system to see that the right actions are taken on behalf of the environment. At almost every step, I have been assured that action will be taken — yet I see slow or no results. I am told the company is concerned, but their actions speak to different concerns than mine. I can no longer participate in the process that 3M has established for the management of PFOS and precursors. For me it is unethical to be concerned with markets, legal defensibility and image over environmental safety."

Free Press attempts to reach Purdy for comment were unsuccessful.

Company's deception spanned decades

Dr. William Guy, at the University of Florida College of Medicine, was puzzled.

It was 1975, and he and colleagues at other universities had discovered unusual levels of fluorine in human blood — blood bank contributions from donors in both Texas and New York had it in sample after sample. It couldn’t be explained by naturally occurring fluorine, or by the fluoridation of water.

Guy reached out to 3M, maker of fluorinated compounds that had become ubiquitous in waterproofing, stain-guarding and nonstick consumer products, to see what the company thought.

In a confidential, internal company message between 3M officials, one, G.H. Crawford, suggested to “plead ignorance,” and wondered whether they could spin it as a helpful health benefit.

“On the positive side — if it is confirmed to our satisfaction that everybody is going around with fluorocarbon surfactants in their bloodstreams with no apparent ill effects, are there some medical possibilities that would bear looking into?,” such as whether the slippery substances improved arterial sclerosis or kidney blockage, he asked.

Crawford further suggested conducting animal studies along those lines that could later prove useful “from a defensive point of view.”

The internal company documents show that as evidence mounted of PFAS compounds persisting in the environment and causing health problems in animal studies, company officials took no action to inform the EPA or the public:

A document showed PFAS compounds were found to cause toxicity in lab rats all the way back in a company study in 1950.

Studies of fish, rats and monkeys indicating health concerns dated to the mid-1970s. Later, company officials found PFAS compounds in their employees' blood, and a tie to increased testicular cancer.

A 1978 study showed one of 3M’s commonly used PFAS compounds “was found to be completely resistant to biodegradation.”

It wasn’t until the late 1990s that 3M shared those concerns with the EPA. The EPA in 2006 cited 3M for 244 violations of the Toxic Substances Control Act, accusing 3M of failing to notify the agency about new chemicals and of late reporting of "substantial risk information." 3M’s fine was $1.52 million — about 0.3% of its annual sales revenues from PFAS compounds.

"3M had really, really sufficient notice to know that, one, these things don’t go away, they build up and build up and build up, both in the environment and the body, and two, that they cause really harmful effects," Coulson said.

"3M continued to make and sell (PFAS) for all of these purposes, while ignoring — or even actively suppressing — the risks."

3M responded to Free Press requests for an interview with an emailed statement: "3M has dedicated substantial time and resources to researching PFAS and, to that end, we have invested more than $600 million on research, technology, and clean-up efforts related to PFAS. As a responsible steward of our community, we have a record of sharing information we learn with government regulators, the scientific community, as well as local and federal officials.

"The small set of documents from the Minnesota litigation portrays an incomplete and misleading story that distorts the full record regarding 3M’s actions with respect to PFOA and PFOS, as well as who we are as a company. 3M acted responsibly in connection with products containing PFAS and we will vigorously defend our environmental stewardship."

Though 3M's 2000 agreement with the EPA to phase out PFOS meant the loss of its popular ScotchGard products — a $300 million a year revenue-maker — that still represented only 2% of the chemical giant's total sales. The company in the fourth quarter of 2018 reported $7.9 billion in sales, its products include Scotch tape and Post-It Notes.

Study after study signaled toxicity

A confidential 3M interoffice memo dated May 10, 1978, described a meeting that occurred two days earlier, in which company officials discussed the results of studies in which laboratory rats were exposed to three different PFAS compounds over 90 days.

"Results indicate that FC-95, FM-3422 and FC-143 are toxic," the memo states.

But then company officials decided not to report the finding to the EPA.

"After a review of the data and a review of the March 16, 1978, EPA guidelines for reporting substantial risk under the Toxic Substances Control Act, it was decided that the toxicity of FC-95, FM-3422 and FC-143 does not constitute a substantial risk and should not be reported at this time," the memo states.

Other 3M documents show FC-95 and FC-143 were PFOA-containing industrial surfactants sold by the company under the Fluorad brand. How the third compound was sold and used is unclear.

A year later, in a 3M memo dated July 6, 1979, an employee named M.T. Case sounded an alarm to colleagues.

"I believe it is paramount to begin now an assessment of the potential (if any) of long term (carcinogenic) effects for these compounds, which are known to persist for a long time in the body and thereby give long-term chronic exposure," he stated.

In a 2005 study, Marvin T. Case was listed as being with 3M's medical department in Corporate Toxicology and Regulatory Services.

In 1981, citing internal research showing PFAS compounds were causing birth defects in rats, 3M moved 25 female employees "of childbearing potential" off production lines at its Decatur, Alabama, plant "as a precautionary measure."

Another document describes a crisis between 3M and one of its principal clients, DuPont, which used 3M's PFOA in the manufacturing of DuPont's Teflon products, including nonstick cookware.

DuPont was worried that because of internal research findings of increased incidences of tumors in rats fed the PFAS compound FC-143 — PFOA — over 24 months, "they may be obliged under their policy to call FC-143 a carcinogen in animals."

Though a 3M researcher identified as "Dr. King" acknowledged "the increased incidence of mammary and testicular tumors under these particular experimental conditions," he maintained his conclusion that "FC-143 is not considered to be carcinogenic."

A large-scale health study of people exposed to PFOA from long-term releases from a DuPont Teflon factory in West Virginia, done as part of a $671 million lawsuit settlement between DuPont and spin-off company Chemours and thousands of class-action litigants, concluded in 2012 "that there is a probable link between exposure to C8 (also known as PFOA) and testicular cancer and kidney cancer."

Another, undated, document, "Draft Memorandum on Fluorochemicals in Human Blood," described how 3M employees were documented to have PFOS, a PFAS compound, in their blood serum — even employees who were not exposed to the compound on the job. Company researchers then examined blood from 21 different U.S. blood banks, including one in Grand Rapids, and again found PFOS.

The researchers then expanded the scope, looking at blood samples taken earlier in the 1990s, and in the '80s, '70s, '60s, from places such as Sweden and the rural provinces of China. The compounds showed up in the blood again and again. The only sample groups to come up with no detection of PFOS: 10 vials of blood taken from U.S. military recruits during the Korean War era, from 1948 to 1951.

"Organic fluorine has been noted in human serum since the late 1960s. We have now identified PFOS as a part of this organic fluorine fraction," the memo states.

"PFOS related materials were not produced commercially prior to 1948, and only in small quantities for several years thereafter. It is not surprising that samples from 1948 to 1951 show undetectable levels. There was clearly an increase 20 years later."

Despite these revelations, 3M pressed on with its production and sale of PFAS compounds.

In a March 29, 2008, slideshow presentation, John Butenhoff of 3M's medical division outlined the value in the company continuing to study the toxicological effects of its legacy fluorochemicals One of the bullet items was "Defensive Barriers to Litigation."

Jennifer Field, a professor of environmental and molecular toxicology at Oregon State University, served on the science advisory board for former Gov. Rick Snyder's Michigan PFAS Action Response Team. She has been a leading researcher on PFAS since the late 1990s, as 3M revealed much more of its findings on the compounds' environmental persistence and health effects to the EPA, and agreed to phase out PFOS and PFOA.

Field noted that much of her research is funded by taxpayers, through the federal or state governments.

"We have to spend a lot of taxpayer dollars to learn what a chemical company knows," she said.

Questions about toxic firefighting foam

One of 3M's popular uses of PFAS compounds was Light Water, an aqueous firefighting foam, or AFFF. It is use of that product that has led to PFAS groundwater contamination at hundreds of military installations across the U.S., and perhaps thousands of other locations — fire stations, municipal airports, even the locations of long-ago fires where the foam was used only once.

In the 3M internal documents is a June 3, 1988, letter to a 3M official from Boots & Coots Fire & Protective Equipment Inc., based in Oakland, California. Officials blasted the company after learning what they'd been told for years in 3M literature and manufacturer presentations — that firefighting foam breaks down in nature — wasn't true.

A Sacramento fire protection unit had learned 3M's fire foam wasn't biodegradable in a phone call with a "'PhD scientist chemist' by the name of Eric Reimer (his last name is actually Reiner) at the 3M company," Boots & Coots executives Jim Devonshire and Bill Walton stated in the letter.

After this information was revealed, the Sacramento District of the U.S. Army Corps of Engineers then required Boots & Coots employees filling a foam tank to wear protective gear, as the firefighting foam was now considered "a dangerous, harmful liquid," the men stated.

"This statement was based upon information given by Eric (Reiner) and data sheets supplied by the 3M Company to the Corps of Engineers."

The men asked 3M for "a full and complete disclosure of the toxic, chemical and biodegradability effects of the 3M AFFF concentrates."

In an email to 3M colleagues that Dec. 30, Reiner, who worked in the company's Environmental Engineering and Pollution Control division, sounded further alarms on the company's firefighting foam.

"I don’t think it is in 3M’s long-term interest to perpetuate the myth that these fluorochemical surfactants are biodegradable," Reiner stated. "It is probable that this misconception will eventually be discovered, and when that happens, 3M will likely be embarrassed, and we and our customers may be fined and forced to immediately withdraw products from the market."

A response from Don Ricker in 3M's Specialty Chemical Division stated that any additional experiments on the biodegradability of the firefighting foam needed to have samples submitted through him.

"BY MEANS OF THIS MEMO I AM NOTIFYING E. REINER THAT MIKE KILLIAN, JON CHASMAN ARE THE RESPONSIBLE PARTIES FOR THE SURFACTANT LINE OF PRODUCTS," Ricker's email states.

The pressure to phase out PFAS

By the late 1990s, as scientific knowledge continued to expand on PFAS compounds' persistence, and under intensifying pressure from the EPA, 3M officials prepared to announce they would voluntarily phase out and find substitutes for PFOS and their lucrative ScotchGard stain protectant lines. The company would also largely stop manufacturing PFOA compounds, but sold the rights to DuPont to continue using it in the making of its Teflon products. DuPont would continue to use PFOA until 2015.

In a Feb. 26, 1998, document entitled "FDA Communications Plan," 3M officials discussed their rollout of information to the U.S. Food and Drug Administration's Center for Food Safety and Applied Nutrition and the EPA. The document illustrates what federal officials hadn't yet been told about what 3M knew.

"Intent to have orderly exit from the market," is one of the bullet points in the plan.

"Disclose metabolism study and general finding of PFOS in sera," or human blood.

"Provide summary of existing tox testing and planned tox testing."

"Provide summary of 3M plant worker studies"

"Address pending microwave popcorn petition."

This was an apparent reference to a late-1990s petition to the FDA by 3M to allow PFOS as a grease-resistant component of microwave popcorn bags. It was not until 2011 that the FDA worked out with chemical manufacturers a voluntary phaseout of PFOA in food contact paper.

Later in the document, they discuss when to do their "8e disclosure" to the EPA, the requirement under the Toxic Substances Control Act to report serious environmental or health problems associated with one of their chemicals "immediately."

"TSCA 8(e) submission completed. Describes only metabolism study and finding of FC (fluorocarbons) in sera (human blood)," the plan states.

"Plan:

- File 8(e) on or before 3/6/98

- Call EPA in advance of submission

- Arrange meeting for full disclosure — late March, early April."

Under a heading, "Issues associated with 8e filing," 3M officials listed, "Public disclosure (environmental activist, regulatory newsletters)."

Sandy Wynn-Stelt learned in 2017 that the well water in her home in Belmont contained up to 76,000 parts per trillion of PFAS compounds, emanating in groundwater from an old Wolverine World Wide shoe and leather company landfill across the street. The EPA has a health advisory limit for PFOS and PFOA in water of 70 parts per trillion.

3M provided Wolverine's ScotchGard waterproofing chemicals.

Wynn-Stelt lost her husband to liver cancer in 2016, and has PFAS compounds in her blood at 750 times the level of the average American.

She reflected on the proof that 3M knew about the persistence and harms of PFAS for years before it made that information available to regulators and the public.

"None of us would raise our kids to be that way," she said. "If you make something, and it turns out that it’s dangerous, then I think you have a responsibility to own that, and to do what you can to protect people from that."

In the Kent County city of Rockford, Jill Osbeck also learned her home's well water has PFAS compounds at levels hundreds of times higher than the EPA guidelines, also from a Wolverine World Wide landfill groundwater plume. She reacted with outrage when she learned of 3M's foreknowledge of problems associated with PFAS.

"Why would you put people’s lives at stake like that?" she said. "It’s incomprehensible to me that you would, for a dollar."

Contact Keith Matheny: 313-222-5021 or kmatheny@freepress.com. Follow on Twitter @keithmatheny.

Polar Vortex arrives but its 2nd wave may be even more brutal

Doyle Rice

USA TODAY

Thanks to another unwelcome visit from the Polar Vortex, dangerous, life-threatening cold temperatures and fierce winds will spread across much of the Midwest and Northeast over the next several days.

A snowstorm will also add to the wintry misery for parts of the northern U.S. with blizzard conditions possible in some areas.

The cold will come in two waves, the first Wednesday and Thursday and the second — which could be even more brutal — over the weekend.

Some locations could experience their coldest December temperatures in several years, the Weather Channel said, and a few record lows may be threatened.

The beleaguered northern Plains and Upper Midwest will again bear the brunt of the icy onslaught: "Dangerous to life-threatening" wind chill temperatures to 45 below zero are forecast Friday night through Sunday morning in parts of the Dakotas, the National Weather Service said.

Wind chills this cold can cause frostbite in less than 10 minutes, the weather service said.

The fierce cold is thanks to the Polar Vortex, which is seeping down from its rightful place in the Arctic. Though the vortex has been around for a few billion years and understood by scientists for several decades, it only entered the popular lexicon as a synonym for miserably cold weather a few years ago.

First blast

The first assault is spreading across the northern Plains and Midwest on Wednesday, where temperatures by Thursday morning will dip below zero in cities such as Minneapolis and Milwaukee.

A wind chill temperature of 38 degrees below zero was recorded Wednesday morning in Langdon, N.D., according to the weather service.

The weather service issued a wind chill advisory Wednesday for all of North Dakota, Minnesota and Wisconsin, and parts of Montana, Wyoming, South Dakota, Iowa, Illinois, Indiana, Ohio and Pennsylvania.

Below-zero wind chills are likely for most of those areas for much of Wednesday and into Thursday.

The cold will finally make it to the Northeast and Mid-Atlantic by Thursday. Temperatures will not rise out of the 20s along the Interstate 95 corridor, from Boston to Washington D.C., on Thursday and Friday, the Weather Channel predicts.

Second blast

A second round of hideous cold, perhaps even more intense than the first blast, will dive into the central U.S. on Saturday and Sunday.

Below-normal temperatures are likely this weekend and into Monday across the entire northern half of the country, from the Pacific Northwest to Maine and as far south as Texas, Arkansas and Virginia, the Climate Prediction Center said.

Afternoon readings won't rise above zero in the northern Plains, upper Midwest and western Great Lakes both weekend days, including Minneapolis and Fargo, N.D.

Chilly temperatures will reach down all the way to Texas. After seeing temperatures near 70 degrees on Saturday, the high temperature in Dallas on Sunday will only be near freezing.

The Northeast and Mid-Atlantic will be dealt a glancing blow from this cold blast by early next week.

The good news is that moderating temperatures are forecast for much of the central and eastern U.S. just before Christmas, AccuWeather said.

Snow too!

Along with the cold, a sprawling storm will deliver a messy mix of snow and ice Thursday to Saturday along a 1,200 swath from the Rockies to the Mid-Atlantic states.

Cities such as Denver, Minneapolis, Chicago, Detroit, Cleveland, Buffalo and Syracuse will all have to deal with shovel-able snow, as much as a half-foot in spots.

Blizzard conditions could develop in major hubs such as Denver and Chicago, AccuWeather said.

Lake-effect snow will also bury the typical snow-belt regions of the Great Lakes. As much as three feet is forecast for portions of New York State near Watertown.

Light snow and freezing rain will also create travel headaches for the big cities of the Northeast and Mid-Atlantic by Saturday.

Why Jacob Trouba's hits are a part of the game that we love and hate

So you love big hits but hate seeing players get hurt?

You’re not alone.

For many hockey fans, an open-ice collision is one of the most exciting parts of the game. And few players in the NHL are more adept at executing a momentum-building, bone-crunching check as New York Rangers defenseman Jacob Trouba.

We’ve seen it in each of his past two games, with Chicago’s Jujhar Khaira and Colorado’s Nathan MacKinnon bearing the brunt of the blows.

MacKinnon briefly exited Wednesday’s contest, a 7-3 win for the Avalanche, but returned for the third period and is presumably healthy.

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A much more alarming scene came Tuesday in Chicago, with Khaira laying motionless on the ice before being taken away on a stretcher and rushed to the hospital.

"Very scary," Trouba said. "I exchanged text messages with him after and checked in. He was telling me he's doing okay, so that's good to see. But obviously no one wants to see that. No one plays the game to see guys get injured or injure guys. And that was very unfortunate. It's a tough situation for everyone. I hope he recovers fast."

The league took no issue with either hit, which comes as no surprise. Neither hit clearly violated any rules.

For it to be considered charging, Trouba would have had to leave his feet in a jumping motion or traveled an excessive distance to deliver the blow, which he did not.

He also didn’t extend his elbow or check from behind. He led with his shoulder and hit both players straight on.

The primary concern is contact to the head. On the hit against Khaira, in particular, there did appear to be incidental contact with the chin as Trouba drove toward his chest. But the rulebook states that an illegal check occurs when "the head was the main point of contact and such contact to the head was avoidable."

It's a stretch to portray what Trouba was doing as head-hunting. A look at the unsettling replay shows that Khaira lost control of the puck at his feet, which caused him to look down and lower his head in the process. At the same time, Trouba was bending his knees and lowering his shoulder to administer the hit.

Those simultaneous movements created the perfect storm for a dangerous collision, but multiple league sources told lohud.com, part of the USA TODAY Network, that they believe Trouba's technique was textbook.

"I don't think it was malicious," Trouba said. "I don't think I jumped. I stayed on my feet, tried to tuck my shoulder and put it in their chest. That's how I was taught how to hit. That’s the cleanest way I know how to hit, and that's what I try to do."

The old adage is to keep your head up, because looking down leaves you in a vulnerable position. Players are instructed to use their body when fighting for possession, which means removing your opponent from the puck with brute force.

As Trouba pointed out, "It's a fast-paced game," which makes adjusting in the extremely short time it takes an opponent to drop their head nearly impossible.

"It's easy to slow down and let your brain think when it's going half speed," he added. "But you're in the middle of the game."

Even if the opponent has their head up, those type of hits have the potential for disaster. Whiplash can cause their head to smack into the ice, which can lead to a concussion — or worse.

Knowing what we know now about head trauma and the life-altering effects it can cause, the question needs to be asked: Is the risk worth the reward?

Placing the burden on players to calculate the odds of an injury in a fraction of a second is unfair and unreasonable. The truth is, the only way to ensure fewer head injuries would be to eliminate open-ice hits altogether.

Of course, that would completely change the way the sport is played. And as someone who loves the game — including the physicality of it — that's a difficult sell.

It would also feel hypocritical for a league that allows players to literally punch each other in the head. Fighting is part of hockey, too — except, unlike hitting, it does not occur within the flow of the game.

How can we ask players not to throw checks while continuing to allow them to throw punches? Again, a very tough sell.

Following Trouba's hits on both Khaira and MacKinnon, he was challenged to drop the gloves and engaged. The ironic response to what the NHL Department of Player Safety considered a clean hit was to risk further injury by fighting.

For Trouba — and countless others — it's an accepted reality.

"I don't have an issue with it," he said. "Do I think you have to defend yourself if the hit is deemed clean? No. Do I have a problem standing up for myself if someone wants to stand up for the teammate? No. I also don't have an issue with that. It is what it is."

If there's a good solution out there, I haven't heard it.

There's little doubt that Trouba's hits were executed within the rules, but even less doubt that they put his opponents in danger. Unfortunately, the players accept those risks when they step onto the ice and are mostly left to police it themselves.

"I don't think I have a reputation as a dirty hitter," Trouba said. "I think I play the game hard. I play pretty close to the edge, but I try not to go over the edge. It's unfortunate to see and something that nobody ever wants to see."

Vincent Z. Mercogliano is the New York Rangers beat reporter for the USA TODAY Network. Read more of his work at lohud.com/sports/rangers/ and follow him on Twitter @vzmercogliano.