A civil rights leader was escorted by police out of a North Carolina movie theater after he insisted on using his own chair for medical reasons, prompting an apology from the nation’s largest movie theater chain.

The incident occurred Tuesday in Greenville during a showing of “The Color Purple.” The Rev. William Barber II said he needs the chair because he suffers from ankylosing spondylitis, a disabling bone disease.

Barber, 60, leads a nonprofit called Repairers of the Breach, which focuses on issues including voter suppression and poverty. He also co-chairs the national Poor People’s Campaign, which is modeled after an initiative launched in 1968 by the late Rev. Martin Luther King Jr.

During an hourlong news conference on Friday, Barber spoke in support of people with disabilities and the need for businesses to provide the accommodations required under the Americans with Disabilities Act.

“I know that if I cannot sit in my chair in a theater in Greenville, North Carolina …. that there are thousands of other people who will be excluded from public spaces in this nation,” Barber said.

Barber said managers at the AMC theater asked an armed security guard and local police officers to remove him after he stood firm on using the chair. Barber said he agreed to be escorted out after officers said they’d have to close down the theater and arrest him.

Barber said he left his 90-year-old mother behind with an assistant to watch the film. Video of the incident shows Barber talking to an officer before walking out of the theater.

“This is not about me personally,” he said. “Though it happened to me personally, this is about what systemic changes, policy changes (and) training needs to be done to ensure this happens to no one.”

Greenville police said in a statement that a caller from the theater said a customer was arguing with employees and the theater wanted him removed. After a brief conversation with a responding police officer, “Barber agreed to leave the theater voluntarily,” police said. No charges were filed.

AMC apologized in a written statement, saying it welcomes and works hard to accommodate guests with disabilities, WRAL reported.

“We are also reviewing our policies with our theater teams to help ensure situations like this do not occur again,” the statement said.

Barber said he’ll meet next week with the chairman of AMC Entertainment Holdings, Adam Aron, after Aron reached out to him. Barber said he is “hopeful it will lead to just and good things for those with disabilities.”

Barber previously served as president of the North Carolina NAACP, leading protests over voter access at the Statehouse that got him and more than 1,000 people arrested for civil disobedience. He stepped down from that role in 2017.

Barber is now a professor at Yale Divinity School. He said Friday that he tells his students they must care about people.

“There’s no way to follow Jesus without learning to pay attention to whoever is broken and vulnerable in society,” Barber said. “Because that’s where God shows up.”

DENVER (AP) — First, Colorado’s Supreme Court ruled that former President Donald Trump wasn’t eligible to run for his old job in that state. Then, Maine’s Democratic secretary of state ruled the same for her state. Who’s next?

Both decisions are historic. The Colorado court was the first court to apply to a presidential candidate a rarely used constitutional ban against those who “engaged in insurrection.” Maine’s secretary of state was the first top election official to unilaterally strike a presidential candidate from the ballot under that provision.

But both decisions are on hold while the legal process plays out.

That means that Trump remains on the ballot in Colorado and Maine and that his political fate is now in the hands of the U.S. Supreme Court. The Maine ruling will likely never take effect on its own. Its central impact is increasing pressure on the nation’s highest court to say clearly: Can Trump still run for president after the Jan. 6, 2021, attack on the U.S. Capitol?

WHAT’S THE LEGAL ISSUE?

After the Civil War, the U.S. ratified the 14th Amendment to guarantee rights to former slaves and more. It also included a two-sentence clause called Section 3, designed to keep former Confederates from regaining government power after the war.

The measure reads:

“No person shall be a Senator or Representative in Congress, or elector of President and Vice-President, or hold any office, civil or military, under the United States, or under any State, who, having previously taken an oath, as a member of Congress, or as an officer of the United States, or as a member of any State legislature, or as an executive or judicial officer of any State, to support the Constitution of the United States, shall have engaged in insurrection or rebellion against the same, or given aid or comfort to the enemies thereof. But Congress may by a vote of two-thirds of each House, remove such disability.”

Congress did remove that disability from most Confederates in 1872, and the provision fell into disuse. But it was rediscovered after Jan. 6.

HOW DOES THIS APPLY TO TRUMP?

Trump is already being prosecuted for the attempt to overturn his 2020 loss that culminated with Jan. 6, but Section 3 doesn’t require a criminal conviction to take effect. Dozens of lawsuits have been filed to disqualify Trump, claiming he engaged in insurrection on Jan. 6 and is no longer qualified to run for office.

All the suits failed until the Colorado ruling. And dozens of secretaries of state have been asked to remove him from the ballot. All said they didn’t have the authority to do so without a court order — until Maine Secretary of State Shenna Bellows’ decision.

The Supreme Court has never ruled on Section 3. It’s likely to do so in considering appeals of the Colorado decision — the state Republican Party has already appealed, and Trump is expected to file his own shortly. Bellows’ ruling cannot be appealed straight to the U.S. Supreme Court — it has to be appealed up the judicial chain first, starting with a trial court in Maine.

The Maine decision does force the high court’s hand, though. It was already highly likely the justices would hear the Colorado case, but Maine removes any doubt.

Trump lost Colorado in 2020, and he doesn’t need to win it again to garner an Electoral College majority next year. But he won one of Maine’s four Electoral College votes in 2020 by winning the state’s 2nd Congressional District, so Bellows’ decision would have a direct impact on his odds next November.

Until the high court rules, any state could adopt its own standard on whether Trump, or anyone else, can be on the ballot. That’s the sort of legal chaos the court is supposed to prevent.

WHAT ARE THE ARGUMENTS IN THE CASE?

Trump’s lawyers have several arguments against the push to disqualify him. First, it’s not clear Section 3 applies to the president — an early draft mentioned the office, but it was taken out, and the language “an officer of the United States” elsewhere in the Constitution doesn’t mean the president, they contend.

Second, even if it does apply to the presidency, they say, this is a “political” question best decided by voters, not unelected judges. Third, if judges do want to get involved, the lawyers assert, they’re violating Trump’s rights to a fair legal procedure by flatly ruling he’s ineligible without some sort of fact-finding process like a lengthy criminal trial. Fourth, they argue, Jan. 6 wasn’t an insurrection under the meaning of Section 3 — it was more like a riot. Finally, even if it was an insurrection, they say, Trump wasn’t involved in it — he was merely using his free speech rights.

Of course, the lawyers who want to disqualify Trump have arguments, too. The main one is that the case is actually very simple: Jan. 6 was an insurrection, Trump incited it, and he’s disqualified.

WHAT’S TAKEN SO LONG?

The attack was three years ago, but the challenges weren’t “ripe,” to use the legal term, until Trump petitioned to get onto state ballots this fall.

But the length of time also gets at another issue — no one has really wanted to rule on the merits of the case. Most judges have dismissed the lawsuits because of technical issues, including that courts don’t have the authority to tell parties whom to put on their primary ballots. Secretaries of state have dodged, too, usually telling those who ask them to ban Trump that they don’t have the authority to do so unless ordered by a court.

No one can dodge anymore. Legal experts have cautioned that, if the Supreme Court doesn’t clearly resolve the issue, it could lead to chaos in November — or in January 2025, if Trump wins the election. Imagine, they say, if the high court ducks the issue or says it’s not a decision for the courts to make, and Democrats win a narrow majority in Congress. Would they seat Trump or declare he’s ineligible under Section 3?

WHY DID MAINE DO THIS?

Maine has an unusual process in which a secretary of state is required to hold a public hearing on challenges to politicians’ spots on the ballot and then issue a ruling. Multiple groups of Maine voters, including a bipartisan clutch of former state lawmakers, filed such a challenge, triggering Bellows’ decision.

Bellows is a Democrat, the former head of the Maine chapter of the American Civil Liberties Union, and has a long trail of criticism of Trump on social media. Trump’s attorneys asked her to recuse herself from the case, citing posts calling Jan. 6 an “insurrection” and bemoaning Trump’s acquittal in his impeachment trial over the attack.

She refused, saying she wasn’t ruling based on personal opinions. But the precedent she sets is notable, critics say. In theory, election officials in every state could decide a candidate is ineligible based on a novel legal theory about Section 3 and end their candidacies.

Conservatives argue that Section 3 could apply to Vice President Kamala Harris, for example — it was used to block from office even those who donated small sums to individual Confederates. Couldn’t it be used against Harris, they say, because she raised money for those arrested in the unrest after the murder of George Floyd by Minneapolis police in 2020?

IS THIS A PARTISAN ISSUE?

Well, of course it is. Bellows is a Democrat, and all the justices on the Colorado Supreme Court were appointed by Democrats. Six of the 9 U.S. Supreme Court justices were appointed by Republicans, three by Trump himself.

But courts don’t always split on predictable partisan lines. The Colorado ruling was 4-3 — so three Democratic appointees disagreed with barring Trump. Several prominent legal conservatives have championed the use of Section 3 against the former president.

Now we’ll see how the high court handles it.

More about the 2024 election:

• Americans sour on primary election process and major political parties, poll says
• Map: See where redistricting challenges continue across the US
• Who’s running for president? A list of 2024 candidates

ATLANTA (AP) — For election officials preparing for the 2024 presidential election, the list of security challenges just keeps growing.

Many of the concerns from four years ago persist: the potential for cyberattacks targeting voter registration systems or websites that report unofficial results, and equipment problems or human errors being amplified by those seeking to undermine confidence in the outcome.

Add to that the fresh risks that have developed since the 2020 election and the false claims of widespread fraud being spread by former President Donald Trump and his Republican allies. Death threats directed at election workers and breaches of voting equipment inside election offices have raised questions about safety and security. Some states have altered their voting and election laws, expanded legislative control of local elections and added penalties for election workers who violate rules.

The turmoil has contributed to a wave of retirements and resignations among election staff, creating a vacuum of institutional knowledge in some local election offices.

With Trump running again and already warning that the 2024 vote is “on its way to being another rigged election,” election workers are bracing for a difficult year that will have no margin for error.

FOREIGN THREATS

National security experts have warned for years that foreign governments — primarily Russia, China and Iran — want to undermine the U.S. and see elections as a pathway to do it.

In 2016, Russia sought to interfere with a multi-pronged effort that included accessing and releasing Democratic emails and scanning state voter registration systems for vulnerabilities. Four years later, Iranian hackers obtained voter data and used it to send misleading emails.

In 2022, there were multiple instances in which hackers linked to Iran, China and Russia connected to election infrastructure, scanned state government websites and copied voter information, according to a recent declassified report.

While there has been no evidence of any compromises affecting the integrity of U.S. elections, experts say those countries are more motivated than ever given tensions across the globe.

“Election 2024 may be the first presidential election during which multiple authoritarian actors simultaneously attempt to interfere with and influence an election outcome,” Microsoft warned in a November threat assessment.

The company said it was unlikely that Russia, China and Iran would sit out next year’s contest because the “stakes are simply too high.” The report said Russia remains “the most committed and capable threat to the 2024 election,” with the Kremlin seeing next year’s vote as a “must-win political warfare battle” that could determine the outcome of its war against Ukraine.

Michigan Secretary of State Jocelyn Benson, a Democrat, said she believes foreign adversaries have a “greater incentive than ever before” to get involved in the upcoming elections.

“We’re going to do everything we can to be prepared, but we are facing well-funded, serious adversaries, and that requires all of us to be clear-eyed about those challenges — and for voters to also know that there are foreign actors that want to influence their vote to further their own goals and not America’s,” she said.

ELECTION SYSTEM VULNERABILITIES

Many of the conspiracy theories that have persisted since Trump lost the 2020 presidential election to Democrat Joe Biden relate to voting technology and claims that equipment was manipulated to steal the vote. There is no evidence of manipulation, and the systems have safeguards to detect problems.

An intensive effort has been underway for several years to build defenses around voting machines and tabulators and develop plans to recover if tampering occurs. Experts are particularly concerned about non-voting systems such as voter registration databases, electronic poll books and websites that report results because they rely on internet connections.

Experts have warned that a well-timed attack, perhaps using ransomware that locks up computers until payments are made or systems are restored from backups, could disrupt election operations.

Many local election offices have been moving their systems off countywide networks to protect them, but not all have. In early September, election officials in Hinds County, Mississippi, were preparing for statewide elections when everything came to an abrupt halt.

Workers in the election office were unable to access their computers for about three weeks. The breach of the county’s computers caused a slight delay in processing voter registration forms and pushed back training for poll workers.

Local election offices, particularly in rural areas, often struggle to secure enough funding, personnel and cybersecurity expertise. Hinds County Election Commissioner Shirley Varnado said it was a “wonderful idea” to have their election office networks separated from the county but would take money they don’t have.

“That should be done, but we’re in a building without heat or air,” she said.

Election integrity groups say more needs to be done and point to a series of voting system breaches since the 2020 election that have resulted in proprietary software being distributed among various Trump allies. They want a federal investigation and for authorities to force anyone with copies to hand them over.

They also worry about technical failures, noting an incident last November in which some votes in a Pennsylvania judicial race were flipped. The prevalence of false election claims has made it difficult to raise valid criticisms, said Susan Greenhalgh, a senior adviser on election security with Free Speech For People, a left-leaning nonprofit focused on election and campaign finance reforms.

“Our election system is not perfect,” Greenhalgh said. “There are a lot of things that need to be and should be improved.”

INCREASED PROTECTIONS

Improvements since the 2016 election, in which Trump beat Democrat Hillary Clinton, include replacing outdated and vulnerable voting machines that lacked paper records of every vote cast. In 2020, an estimated 93% of ballots cast nationwide produced a paper record, up from 82% four years earlier.

After 2016, election systems were added to the list of critical infrastructure in the U.S. that also includes dams, banks and nuclear power plants.

In 2018, Congress established the U.S. Cybersecurity and Infrastructure Security Agency, which provides security reviews. CISA Director Jen Easterly launched a cyber defense initiative in 2021 and last summer said 10 new regional election security advisers would be hired to work directly with local election offices.

“There’s just been so much that has transformed the face of election infrastructure security over the past seven years,” Easterly said in an interview last August. “In a space where people can sometimes get pretty down, I think we should be optimistic.”

Larry Norden, an election expert with the Brennan Center for Justice, said he sees “massive progress” but also said turnover in local election offices has diminished institutional knowledge.

Just 29% of local election officials surveyed this year for the Brennan Center were aware of CISA routine vulnerability scans, and just 31% were aware of the agency’s physical security assessments.

“There was not nearly as much awareness of the services that are offered as I think there should be,” Norden said. “It’s not surprising, but it means there’s work to do.”

‘PERFECT STORM’

Staffing has long been a challenge for local election offices, which rely on both permanent and temporary workers, including those who staff some 80,000 polling locations nationally on Election Day.

But 2020 was a tipping point, with coronavirus pandemic-related challenges before the presidential vote and everything that followed: death threats, a flood of information requests from election skeptics, hostile county boards and new laws that impose fines or criminal penalties on election officials for violating rules. That contributed to a wave of retirements and resignations among election officials. Utah Lt. Gov. Deidre Henderson said two-thirds of county clerks there are new since the 2020 election.

“This all combines into this perfect storm,” said Henderson, a Republican. “It’s a real challenge.”

Insider threats — the possibility that someone working in an election office could tamper with systems or provide access to them — poses another concern. To address this, election officials have been boosting security around key equipment by limiting access and adding surveillance cameras.

Meanwhile, the threats and harassment have continued. Georgia’s Fulton County, a target of various 2020 election conspiracy theories, was one of several election offices in November sent envelopes containing a powdery substance that in some cases tested positive for fentanyl.

The letters are another reminder of the charged environment surrounding U.S. elections heading into 2024. Despite all the challenges, Henderson said election officials are doing everything they can to prepare.

“When you have a human-run system, there will be human error. That’s just part of it,” she said. “But we’re working hard to make sure that we mitigate those human errors and mitigate the risks and continually improve our processes so that people can have the confidence that when they vote, only eligible voters are voting, and when they vote, their votes count accurately.”

PORTLAND, Maine (AP) — Maine’s Democratic secretary of state on Thursday removed former President Donald Trump from the state’s presidential primary ballot under the Constitution’s insurrection clause, becoming the first election official to take action unilaterally as the U.S. Supreme Court is poised to decide whether Trump remains eligible to return to the White House.

The decision by Secretary of State Shenna Bellows follows a ruling earlier this month by the Colorado Supreme Court that booted Trump from the ballot there under Section 3 of the 14th Amendment. That decision has been stayed until the U.S. Supreme Court decides whether Trump is barred by the Civil War-era provision, which prohibits those who “engaged in insurrection” from holding office.

The Trump campaign said it would appeal Bellows’ decision to Maine’s state courts, and Bellows suspended her ruling until that court system rules on the case. In the end, it is likely that the nation’s highest court will have the final say on whether Trump appears on the ballot in Maine and in the other states.

Bellows found that Trump could no longer run for his prior job because his role in the Jan. 6, 2021, attack on the U.S. Capitol violated Section 3, which bans from office those who “engaged in insurrection.” Bellows made the ruling after some state residents, including a bipartisan group of former lawmakers, challenged Trump’s position on the ballot.

“I do not reach this conclusion lightly,” Bellows wrote in her 34-page decision. “I am mindful that no Secretary of State has ever deprived a presidential candidate of ballot access based on Section 3 of the Fourteenth Amendment. I am also mindful, however, that no presidential candidate has ever before engaged in insurrection.”

The Trump campaign immediately slammed the ruling. “We are witnessing, in real-time, the attempted theft of an election and the disenfranchisement of the American voter,” campaign spokesman Steven Cheung said in a statement.

Legal experts said that Thursday’s ruling demonstrates the need for the nation’s highest court, which has never ruled on Section 3, to clarify what states can do.

“It is clear that these decisions are going to keep popping up, and inconsistent decisions reached (like the many states keeping Trump on the ballot over challenges) until there is final and decisive guidance from the U.S. Supreme Court,” Rick Hasen, a law professor at the University of California-Los Angeles, wrote in response to the Maine decision. “It seems a certainty that SCOTUS will have to address the merits sooner or later.”

While Maine has just four electoral votes, it’s one of two states to split them. Trump won one of Maine’s electors in 2020, so having him off the ballot there, should he emerge as the Republican general election candidate, could have outsized implications in a race that is expected to be narrowly decided.

That’s in contrast to Colorado, which Trump lost by 13 percentage points in 2020 and where he wasn’t expected to compete in November if he wins the Republican presidential nomination.

In her decision, Bellows acknowledged that the U.S. Supreme Court will probably have the final word but said it was important she did her official duty.

That won her praise from the former state lawmakers who filed one of the petitions forcing her to consider the case.

“Secretary Bellows showed great courage in her ruling, and we look forward to helping her defend her judicious and correct decision in court. No elected official is above the law or our constitution, and today’s ruling reaffirms this most important of American principles,” Republican Kimberley Rosen, independent Thomas Saviello and Democrat Ethan Strimling said in a statement.

But other Republicans in the state were outraged.

“The Secretary of State’s decision would deny thousands of Mainers the opportunity to vote for the candidate of their choice, and it should be overturned,” U.S. Sen. Susan Collins wrote on the social media site X.

“This is a sham decision that mimics Third World dictatorships,” Maine’s House Republican leader, Billy Bob Faulkingham, said in a statement. “It will not stand legal scrutiny. People have a right to choose their leaders devoid of mindless decisions by partisan hacks.”

The criticism wasn’t just along normal partisan lines, though. Rep. Jared Golden, a Democrat who represents Maine’s 2nd congressional district that Trump won in 2020, noted on X that he’d voted to impeach Trump for the Jan. 6 attack and doesn’t believe he should win next year’s election.

“However, we are a nation of laws, and therefore until he is actually found guilty of the crime of insurrection, he should be allowed on the ballot,” Golden wrote.

The Trump campaign on Tuesday requested that Bellows disqualify herself from the case because she’d previously tweeted that Jan. 6 was an “insurrection” and bemoaned that Trump was acquitted in his impeachment trial in the U.S. Senate after the capitol attack. She refused to step aside.

“My decision was based exclusively on the record presented to me at the hearing and was in no way influenced by my political affiliation or personal views about the events of Jan. 6, 2021,” Bellows told the Associated Press Thursday night.

Bellows is a former head of the Maine chapter of the American Civil Liberties Union. All seven of the justices of the Colorado Supreme Court, which split 4-3 on whether to become the first court in history to declare a presidential candidate ineligible under Section 3, were appointed by Democrats. Two Washington, D.C.-based liberal groups have launched the most serious prior challenges to Trump, in Colorado and a handful of other states.

That’s led Trump to contend the dozens of lawsuits nationwide seeking to remove him from the ballot under Section 3 are a Democratic plot to end his campaign. But some of the most prominent advocates have been conservative legal theorists who argue that the text of the Constitution makes the former president ineligible to run again, just as if he failed to clear the document’s age threshold — 35 years old — for the office.

Likewise, until Bellows’ decision, every top state election official, whether Democrat or Republican, had rejected requests to bar Trump from the ballot, saying they didn’t have the power to remove him unless ordered to do so by a court.

In California, which has the largest trove of delegates in the 2024 presidential contest, Trump was included on the certified list of candidates released Thursday for the state’s March 5 primary.

Secretary of State Shirley Weber faced political pressure to reject Trump’s candidacy in the state, including from Lt. Gov. Eleni Kounalakis, a fellow Democrat who urged her in a Dec. 20 letter to “explore every legal option” to remove the former president from the California ballot. Weber later responded that she was guided by “the rule of law,” and indicated the proper venue to resolve ballot challenges was in the courts.

The timing on the U.S. Supreme Court’s decision is unclear, but both sides want it fast. Colorado’s Republican Party appealed the Colorado high court decision on Wednesday, urging an expedited schedule, and Trump is also expected to file an appeal within the week. The petitioners in the Colorado case on Thursday urged the nation’s highest court to adopt an even faster schedule so it could rule before March 5, known as Super Tuesday, when 16 states, including Colorado and Maine, are scheduled to vote in the Republican presidential nominating process.

The high court needs to formally accept the case first, but legal experts consider that a certainty. The Section 3 cases seem tailor-made for the Supreme Court, addressing an area of U.S. governance where there’s scant judicial guidance.

The clause was added in 1868 to keep defeated Confederates from returning to their former positions of power in local and federal government. It prohibits anyone who broke an oath to “support” the Constitution from holding office. The provision was used to bar a wide range of ex-Confederates from positions ranging from local sheriff to Congress, but fell into disuse after an 1872 congressional amnesty for most former Confederates.

Legal historians believe the only time the provision was used in the 20th Century was in 1919, when it was cited to deny a House seat to a socialist who had opposed U.S. involvement in World War I. But since the Jan. 6 attack, it has been revived.

Last year, it was cited by a court to remove a rural New Mexico County Commissioner who had entered the Capitol on Jan. 6. One liberal group tried to remove Republican Reps. Madison Cawthorn and Marjorie Taylor Greene from the 2022 ballot under the provision, but Cawthorn lost his primary so his case was thrown out, and a judge ruled for Greene.

Associated Press writer Michael R. Blood in Los Angeles contributed to this report.

More about the 2024 election:

• Americans sour on primary election process and major political parties, poll says
• Map: See where redistricting challenges continue across the US
• Who’s running for president? A list of 2024 candidates

The documents provide insight into the unusual secrecy in the case of Samuel Lazar, who had been released from federal custody in September after completing his sentence in his Capitol riot case. His case remained under seal even after his release, so there was no public record of a conviction or sentence.

The records unsealed this week show that Lazar, of Ephrata, Lancaster County, admitted to spraying a chemical irritant at police officers who were trying to defend the Capitol and to using a bullhorn to encourage other rioters to take officers’ weapons as he yelled, “Let’s get their guns!” He pleaded guilty to assaulting officers using a dangerous weapon and was sentenced to 30 months in prison during a sealed hearing last March.

More than 1,200 people have been charged with Jan. 6-related crimes, and hundreds of them have pleaded guilty. But it is rare for records of a guilty plea and sentence to be sealed, even in cases involving a defendant’s cooperation. Court hearings and records are supposed to be open and available to the public unless there’s a compelling need for secrecy.

The documents show that prosecutors asked the judge last year to sentence Lazar to a prison term below the federal guidelines range, citing Lazar’s “fulsome” cooperation with the government. That included providing “valuable information” to authorities investigating the Jan. 6 attack, prosecutors said in court papers.

An attorney for Lazar declined to comment Thursday. She told the judge that her client’s behavior Jan. 6 “was completely out of character for him as he is extremely respectful, law-abiding citizen who has deep respect and appreciation for law enforcement.”

“He blindly followed President Trump’s cry to ‘fight like hell to take back the country,’ ” lawyer Hope Lefeber wrote in a court filing.

The documents were unsealed Wednesday after a coalition of news outlets, including The Associated Press, moved to publicly release records in his case. The documents, however, were then removed from the court docket after lawyers said they objected to the release of all of the documents and wanted the court to post only blacked-out versions.

Richer reported from Boston.

Three years after more than 3,600 health workers died of COVID-19, occupational safety experts warn that those on the front lines may once again be at risk if the Centers for Disease Control and Prevention takes its committee’s advice on infection control guidelines in health care settings, including hospitals, nursing homes, and jails. In early November, the committee released a controversial set of recommendations the CDC is considering, which would update those established some 16 years ago.

The pandemic illustrated how a rift between the CDC and workplace safety officials can have serious repercussions. Most recently, the giant hospital system Sutter Health in California appealed a citation from the state’s Division of Occupational Safety and Health, known as Cal/OSHA, by pointing to the CDC’s shifting advice on when and whether N95 masks were needed at the start of the pandemic. By contrast, Cal/OSHA requires employers in high-risk settings like hospitals to improve ventilation, use air filtration, and provide N95s to all staff exposed to diseases that are — or may be — airborne.

The agencies are once again at odds. The CDC’s advisory committee prescribes varying degrees of protection based on ill-defined categories, such as whether a virus or bacteria is considered common or how far it seems to travel in the air. As a result, occupational safety experts warn that choices on how to categorize COVID, influenza, and other airborne diseases — and the corresponding levels of protection — may once again be left to administrators at hospitals, nursing homes, and jails or prisons.

Eric Berg, deputy chief of health at Cal/OSHA, warned the CDC in November that, if it accepted its committee’s recommendations, the guidelines would “create confusion and result in workers being not adequately protected.”

Also called respirators, N95 masks filter out far more particles than looser-fitting surgical masks but cost roughly 10 times as much, and were in short supply in 2020. Black, Hispanic, and Asian health workers more often went without N95 masks than white staffers, which helped explain why members of racial and ethnic minorities tested positive for COVID nearly five times as often as the general population in the early months of the pandemic. (Hispanic people can be of any race or combination of races.)

Cal/OSHA issued dozens of citations to health care facilities that failed to provide N95 masks and take other measures to protect workers in 2020 and 2021. Many appealed, and some cases are ongoing. In October, the agency declined Sutter’s appeal against a $6,750 citation for not giving its medical assistants N95 masks in 2020 when they accompanied patients who appeared to have COVID through clinics. Sutter pointed to the CDC’s advice early in the pandemic, according to court testimony. It noted that the CDC called surgical masks an “acceptable alternative” in March 2020, “seemed to recommend droplet precautions rather than airborne precautions,” and suggested that individuals were unlikely to be infected if they were farther than 6 feet away from a person with COVID.

This is a loose interpretation of the CDC’s 2020 advice, which was partly made for reasons of practicality. Respirators were in short supply, for example, and physical distancing beyond 6 feet is complicated in places where people must congregate. Scientifically, there were clear indications that the coronavirus SARS-CoV-2 spread through the air, leading Cal/OSHA to enact its straightforward rules created after the 2009 swine flu pandemic. Workers need stiffer protection than the general population, said Jordan Barab, a former official at the federal Occupational Safety and Health Administration: “Health workers are exposed for eight, 10, 12 hours a day.”

The CDC’s advisory committee offers a weaker approach in certain cases, suggesting that health workers wear surgical masks for “common, often endemic respiratory pathogens” that “spread predominantly over short distances.” The draft guidance pays little attention to ventilation and air filtration, and advises N95 masks only for “new or emerging” diseases and those that spread “efficiently over long distances.” Viruses, bacteria, and other pathogens that spread through the air don’t neatly fit into such categories.

“Guidelines that are incomplete, weak, and without scientific basis will greatly undermine CDC’s credibility,” said a former OSHA director, David Michaels, in minutes from an October meeting where he and others urged CDC Director Mandy Cohen to reconsider advice from the committee before it issues final guidance next year.

Although occupational safety agencies — not the CDC — have the power to make rules, enforcement often occurs long after the damage is done, if ever. Cal/OSHA began to investigate Sutter only after a nurse at its main Oakland hospital died from COVID and health workers complained they weren’t allowed to wear N95 masks in hallways shared with COVID patients. And more than a dozen citations from Cal/OSHA against Kaiser Permanente, Sharp HealthCare, and other health systems lagged months and years behind health worker complaints and protests.

Outside California, OSHA faces higher enforcement obstacles. A dwindling budget left the agency with fewer workplace inspectors than it had in 45 years, at the peak of the pandemic. Plus, the Trump and Biden administrations stalled the agency’s ongoing efforts to pass regulations specific to airborne infections. As a result, the agency followed up on only about 1 in 5 COVID-related complaints that employees and labor representatives officially filed with the group from January 2020 to February 2022 — and just 4% of those made informally through media reports, phone calls, and emails. Many deaths among health care workers weren’t reported to the agency in the first place.

Michaels, who is now on the faculty at the George Washington University School of Public Health, said the CDC would further curtail OSHA’s authority to punish employers who expose staff members to airborne diseases, if its final guidelines follow the committee’s recommendations. Such advice would leave many hospitals, correctional facilities, and nursing homes as unprepared as they were before the pandemic, said Deborah Gold, a former deputy chief of health at Cal/OSHA. Strict standards prompt employers to stockpile N95 masks and improve air filtration and ventilation to avoid citations. But if the CDC’s guidance leaves room for interpretation, she said, they can justify cutting corners on costly preparation.

Although the CDC committee and OSHA both claim to follow the science, researchers arrived at contradictory conclusions because the committee relied on explicitly flawed trials comparing health workers who wore surgical masks with those using N95s. Cal/OSHA based its standards on a variety of studies, including reviews of hospital infections and engineering research on how airborne particles spread.

In decades past, the CDC’s process for developing guidelines included labor representatives and experts focused on hazards at work. Barab was a health researcher at a trade union for public sector employees when he helped the CDC develop HIV-related recommendations in the 1980s.

“I remember asking about how to protect health care workers and correction officers who get urine or feces thrown at them,” Barab said. Infectious disease researchers on the CDC’s committee initially scoffed at the idea, he recalled, but still considered his input as someone who understood the conditions employees faced. “A lot of these folks hadn’t been on hospital floors in years, if not decades.”

The largest organization for nurses in the United States, National Nurses United, made the same observation. It’s now collecting signatures for an online petition urging the CDC to scrap the committee’s guidelines and develop new recommendations that include insights from health care workers, many of whom risked their lives in the pandemic.

Barab attributed the lack of labor representation in the CDC’s current process to the growing corporate influence of large health systems. Hospital administrators prefer not to be told what to do, particularly when it requires spending money, he said.

In an email, CDC communications officer Dave Daigle stressed that before the guidelines are finalized, the CDC will “review the makeup of the workgroups and solicit participation to ensure that the appropriate expertise is included.”

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

Oscoda, Michigan, has the distinction as the first community where “forever chemicals” were found seeping from a military installation into the surrounding community. Beginning in 2010, state officials and later residents who lived near the former Wurtsmith Air Force Base were horrified to learn that the chemicals, collectively called PFAS, had leached into their rivers, lakes, and drinking water.

Thirteen years later, the community is still waiting on whatever it will take to clean its water. As a result of dogged activism and pressure from government officials, the Air Force has finally taken initial steps simply to contain the chemicals.

Wurtsmith is just one of hundreds of contaminated U.S. military sites. Under congressional pressure, the Defense Department has acknowledged it has a big mess to clean up. It has spent years trying to grasp the scale of the contamination and assess the costs U.S. taxpayers will shoulder to clean it all up. Further, there’s no clear scientific agreement on how to destroy the chemicals, even as companies pitch their scientists’ best solutions in a bid for a share of billions of dollars in looming government contracts.

“We’re really at the forefront,” said Tony Spaniola, a lawyer turned activist whose family owns a home across Van Etten Lake from the former base. “There has been gross mismanagement of this entire program — a lot of stonewalling, a lot of foot-dragging.” He added: “In the meantime, this stuff is continuing to spew into groundwater continuously, into lakes, rivers.”

PFAS chemicals have been linked to increased cholesterol levels, preeclampsia in pregnant women, decreased birth weights, and decreased immune response to vaccines, as well as certain types of cancer. A federal study of U.S. military personnel published in July was the first to show a direct connection between PFAS and testicular cancer, and the chemicals have been linked to increased risk of kidney cancer.

Pentagon has lacked ‘urgency’

Despite rising concerns over the potential effects of these substances, Pentagon officials have defended their use as a matter of national security, asserting in a report to Congress in August that banning them would undermine military readiness.

As many as 600 active or former military installations and adjacent communities are or may be contaminated with per- and polyfluoroalkyl substances, or PFAS. The chemicals are found in a bevy of products used by the U.S. military for decades, including industrial solvents, stain retardants, waterproofing compounds, and firefighting foam.

While the Pentagon was aware of the potential health effects of PFAS as early as the 1970s, the individual military services didn’t begin responding to PFAS pollution at bases until 2014. More than nine years into the Defense Department’s work to analyze its contamination problem and plan for cleanup, frustrated advocates and community residents continue to worry about the safety of their drinking water.

“There hasn’t been an urgency from the DOD that we’ve seen to actually clean up their mess,” said Jared Hayes, a senior policy analyst with the Environmental Working Group, an advocacy organization that focuses on pollution issues nationwide.

The Defense Department did not respond to questions about the pace of the cleanup or provide updated cost estimates.

A spokesperson said the Pentagon is committed to addressing its PFAS contamination. “The Department recognizes the importance of this issue and is committed to addressing PFAS in a deliberative, holistic, and transparent manner,” Jeff Jurgensen wrote in an email to KFF Health News.

Cleanup costs balloon

By June 30, the Defense Department had determined that 359 of 714 active and former bases and National Guard facilities were polluted with PFAS and 107 didn’t meet a threshold for action. Investigations are underway at the remaining 248 sites, with nearly all results expected by year’s end, according to Defense Department records.

Cleanup cost assessments have ballooned as the list of contaminated installations grows and researchers work to develop technologies to remove or destroy the toxic compounds. The Defense Department estimated in 2016 that the “total cleanup liability” — only a portion of which applies to PFAS cleanup — was $27.3 billion.

But according to a Sept. 21 letter from 52 members of Congress, that estimate climbed to $38.7 billion by 2022.

The House version of the Pentagon’s fiscal year 2024 funding bill includes more than $1.1 billion for cleanup of PFAS and contaminants such as PCBs, dioxins, and radiation at active and former installations, while the Senate’s version would boost the military’s PFAS-specific $250 million funding request by more than $67 million to address water contamination. The legislation has yet to pass, mired in congressional debate over the fiscal 2024 appropriations process.

“DOD has a massive backlog of cleanup at their sites and the funding just wasn’t adding up. … The amount of funding that they are putting toward cleaning up the problem isn’t matching the need of the problem,” Hayes said, referring to an analysis conducted by EWG.

A November analysis of Pentagon data found that the extent of the contamination may even be broader, with tests showing thousands of samples from private wells near military installations contained levels of PFAS that the Environmental Protection Agency considers unsafe.

The EPA has proposed stringent limits on multiple types of PFAS, including PFOA and PFOS, in drinking water. The new standard, expected to take effect by the end of the year, would set a cap of 4 parts per trillion for those two compounds. Meanwhile, the Pentagon has been evaluating its sites using a 2016 EPA health advisory of 70 parts per trillion.

If the EPA limit becomes the standard, the Defense Department will need to incorporate it into the review, planning, and cleanup process, Jurgensen said.

But activists, including Spaniola, are pushing the Biden administration to start the cleanup process even while investigations are ongoing. In a July memorandum, Brendan Owens, assistant secretary of defense for energy, installations, and environment, directed the Defense Department to find locations near current and former bases where PFAS can be extracted from groundwater and soil while a cleanup plan is developed.

At Wurtsmith — the first military site where contamination was discovered — officials started by installing two groundwater treatment systems, adding to a handful of other pumps installed over the years.

The two systems won’t destroy the chemicals, but they will stop some of the flow of contaminated groundwater into Van Etten Lake from a landfill and a repository that once held discarded or unused equipment, according to Air Force officials.

As for completely ridding the environment of PFAS chemicals, a long, bumpy road remains.

‘Multiple decades of cleanup’

For years, the Defense Department had disposed of the chemicals by burning them in incinerators. In 2018, the Defense Department paid contractors to begin work to incinerate more than 2 million gallons of stockpiled firefighting foam. In 2021, Congress ordered the Pentagon to stop the practice in anticipation of new EPA guidelines for PFAS disposal and destruction, which the agency says it expects to update this winter, but the Pentagon lifted its moratorium on incineration on July 11.

Studies have shown burning the chemicals can release toxic gases into the air.

In suspending the moratorium, the Defense Department said it had found four commercially available options for effectively burning PFAS.

EPA spokesperson Tim Carroll said in a statement the agency understands the Pentagon needed to provide guidance to its personnel regarding destruction and disposal of PFAS.

But communities already affected by PFAS contamination should be protected when making decisions about how to dispose of the chemicals, according to the statement.

“EPA understands that DoD considers high temperature incinerators to be an effective destruction option,” Carroll said. “EPA notes that, at this time, it is difficult to determine whether high temperature incinerators are an effective PFAS destruction option because data on PFAS releases from incinerators are generally lacking.”

Besides incinerating waste, injecting it deep into the earth, and putting it in landfills, a number of companies are testing technologies they hope will work to destroy PFAS. Among those methods is supercritical water oxidation, known as SCWO, which oxidizes organic compounds at high temperatures.

Conventional incineration plants are “nowhere close to being able to destroy PFAS,” said Zhuoyan Cai, director of Denmark-based Aquarden Technologies, which he said is currently in talks with U.S. companies about its SCWO technology. “The PFAS is used in firefighting foam, so it’s highly thermally resistant, so it’s very difficult to just burn it away in a traditional plant.”

Supercritical water is essentially a fourth state of water under extremely high pressure and temperature — different from ice, liquid water, and steam — with special characteristics that dissolve oil and other organic compounds, including PFAS and pesticides.

When wastewater is under those conditions, the salts fall away and the oils and pesticides blend into the supercritical water. Mix in oxygen and it reacts aggressively and rips the PFAS carbon bonds apart, with greater than 99.999% destruction, Cai said. A study from EPA scientists said the method “could be a permanent solution for PFAS-laden wastewaters.”

A handful of companies are working with the Pentagon to bring mobile SCWO technology to widespread use, including Revive Environmental, a spinoff of the Ohio-based nonprofit Battelle, and 374Water, which originated from research at Duke University in North Carolina.

“Unfortunately, we as a society are still manufacturing and selling [PFAS] into the market. So I think the first thing we need to do is stop putting it in our ecosystem,” 374Water’s board chairman, Kobe Nagar, said. “It’s multiple decades of cleanup.”

Other companies are developing and testing their own approaches, using everything from ultraviolet light to plasma.

Dallas-based AECOM, a consulting firm that handles PFAS response work for the U.S. military, uses electrodes to break down the chemicals by removing electrons.

But Rosa Gwinn, global PFAS technical lead at AECOM, cautioned that none of these emerging technologies is a perfect response to the cleanup predicament. “There is not going to be a single solution, no matter what somebody says,” she said.

But as industry chases billions of dollars in government contracts, towns like Oscoda linger under a cloud of health concerns with little action.

Well over a decade after the discovery of the chemicals surrounding Wurtsmith, a bounty of public health warnings about PFAS exposure remain, including for drinking water, fish and wildlife, and the chemical-laced foam that still washes ashore. One site now finally being targeted is a beach with a YMCA camp for children, Spaniola said.

“Am I concerned for my health? Yes,” he said. “Am I concerned for my family’s health? Yes.”

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

Authorities said Wednesday that the 47-year-old Masterson has been admitted to North Kern State Prison, and they released his first prison mug shot. The photo shows him wearing orange prison attire, with long hair and a beard.

In June, Masterson was convicted of raping two women in his Los Angeles home in 2003. In September, a judge sentenced him to 30 years to life in prison. His wife, actor Bijou Phillips, filed for divorce in the weeks that followed after a marriage of nearly 12 years.

He had been held in Los Angeles County jail in the months since while post-sentencing hearings were held and issues resolved, including the turnover of all the guns Masterson owned, some of which had to be located.

It will be more than 25 years before Masterson will be eligible for parole.

Tom Smothers, half of the Smothers Brothers and the co-host of one of the most socially conscious and groundbreaking television shows in the history of the medium, has died at 86.

The National Comedy Center, on behalf of his family, said in a statement Wednesday that Smothers died Tuesday at home in Santa Rosa, California, following a cancer battle.

“I’m just devastated,” his brother and the duo’s other half, Dick Smothers, told The Associated Press in an interview Wednesday. “Every breath I’ve taken, my brother’s been around.”

When “The Smothers Brothers Comedy Hour” debuted on CBS in early 1967 it was an immediate hit, to the surprise of many who had assumed the network’s expectations were so low it positioned their show opposite the top-rated “Bonanza.”

But the Smothers Brothers would prove a turning point in television history, with its sharp eye for pop culture trends and young rock stars such as the Who and Buffalo Springfield, and its daring sketches — ridiculing the Establishment, railing against the Vietnam War and portraying members of the era’s hippie counterculture as gentle, fun-loving spirits — found an immediate audience with young baby boomers.

“We were moderate. We were never out there,” Dick Smothers said. “But we were the first people through that door. It just sort of crept in as the ’60s crept in. We were part of that generation.”

The show reached No. 16 in the ratings in its first season. It also drew the ire of network censors. After years of battling with the brothers over the show’s creative content, the network abruptly canceled the program in 1969, accusing the siblings of failing to submit an episode in time for the censors to review.

Nearly 40 years later, when Smothers was awarded an honorary Emmy for his work on the show, he jokingly thanked the writers he said had gotten him fired. He also showed that the years had not dulled his outspokenness.

“It’s hard for me to stay silent when I keep hearing that peace is only attainable through war,” Smothers said at the 2008 Emmy Awards as his brother sat in the audience, beaming. He dedicated his award to those “who feel compelled to speak out and are not afraid to speak to power and won’t shut up.”

During the three years the show was on television, the brothers constantly battled with CBS censors and occasionally outraged viewers as well, particularly when Smothers joked that Easter “is when Jesus comes out of his tomb and if he sees his shadow, he goes back in and we get six more weeks of winter.” At Christmas, when other hosts were sending best wishes to soldiers fighting overseas, Smothers offered his to draft dodgers who had moved to Canada.

In still another episode, the brothers returned blacklisted folk singer Pete Seeger to television for the first time in years. He performed his song “Waist Deep in the Big Muddy,” widely viewed as ridiculing President Lyndon Johnson. When CBS refused to air the segment, the brothers brought Seeger back for another episode and he sang it again. This time, it made the air.

After the show was canceled, the brothers sued CBS for $31 million and were awarded $775,000. Their battles with the network were chronicled in the 2002 documentary “Smothered: The Censorship Struggles of the Smothers Brothers Comedy Hour.”

“Tom Smothers was not only an extraordinary comedic talent, who, together with his brother Dick, became the most enduring comedy duo in history, entertaining the world for over six decades — but was a true champion for freedom of speech,” National Comedy Center Executive Director Journey Gunderson said in a statement.

Thomas Bolyn Smothers III was born Feb. 2, 1937, on Governors Island, New York, where his father, an Army major, was stationed. His brother was born two years later. In 1940 their father was transferred to the Philippines, and his wife, two sons and their sister, Sherry, accompanied him.

When the Japanese bombed Pearl Harbor, the family was sent home and Maj. Smothers remained. He was captured by the Japanese during the war and died in captivity. The family eventually moved to the Los Angeles suburb of Redondo Beach, where Smothers helped his mother take care of his brother and sister while she worked.

“Tommy was the greatest older brother. He took care of me,” Dick Smothers said. “His maturity was amazing. Sometimes you lose part of your childhood.”

The brothers had seemed unlikely to make television history. They had spent several years on the nightclub and college circuits and doing TV guest appearances, honing an offbeat comedy routine that mixed folk music with a healthy dose of sibling rivalry.

They would come on stage, Tom with a guitar in hand and Dick toting an upright bass. They would quickly break into a traditional folk song — perhaps “John Henry” or “Pretoria.” After playing several bars, Tom, positioned as the dumb one despite being older, would mess up, then quickly claim he had meant to do that. As Dick, the serious, short-tempered one, berated him for failing to acknowledge his error, he would scream in exasperation, “Mom always liked you best!”

“It was the childlike enthusiasm through ignorance, and me, the teacher, correcting him — sometimes I’d correct him even if I was wrong,” Dick Smothers said. “I was the perfect straight man for my brother. I was the only straight man for my brother.”

They continued that shtick on their show but also surrounded themselves with a talented cast of newcomers, both writers and performers.

Future actor-filmmaker Rob Reiner was among those on the crack writing crew the brothers assembled.

“Tommy was funny, smart, and a fighter,” Reiner said on social media Wednesday. “He created a ground breaking show that celebrated all that was good about American Democracy.”

Other writers included musician Mason Williams and comedian Steve Martin, who presented Smothers with the lifetime Emmy. Regular musical guests included John Hartford, Glen Campbell and Jennifer Warnes.

The brothers had begun their own act when Tom, then a student at San Jose State College, formed a music group called the Casual Quintet and encouraged his younger brother to learn the bass and join. The brothers continued on as a duo after the other musicians dropped out, but began interspersing comedy with their limited folk music repertoire.

“We never wrote anything, we just made it up, and tried to remember what we made up,” Dick Smothers said. “I just responded to Tom, if he said something that wasn’t in the bit, I wouldn’t stick to the script, I would listen.”

The brothers’ big break came in 1959 when they appeared at San Francisco’s Purple Onion, then a hot spot for new talent. Booked for two weeks, they stayed a record 36. They had a similar run at New York’s Blue Angel. But to their disappointment, they couldn’t get on “The Tonight Show,” then hosted by Jack Paar.

“Paar kept telling our agent he didn’t like folk singers — except for Burl Ives,” Smothers told the AP in 1964. “But one night he had a cancellation, and we went on. Everything worked right that night.”

Dick Smothers said Wednesday that “we weren’t that good when we were on ‘The Tonight Show.’ We were just charmingly different.”

The brothers went on to appear on the TV shows of Ed Sullivan, Jack Benny and Judy Garland, among others. Their comedy albums were big sellers and they toured the country, especially colleges.

Before their more vaunted show, the duo got a sitcom in 1965. “The Smothers Brothers Show” was about a businessman (Dick) haunted by his late brother (Tom), a fledgling guardian angel. It lasted just one season.

Shortly after CBS canceled the “Comedy Hour,” ABC picked it up as a summer replacement, but the network didn’t bring it back in the fall. NBC gave them a show in 1975 but it failed to find an audience and lasted only a season. The brothers went their separate ways for a time. Among other endeavors, Smothers got into the wine business, launching Remick Ridge Vineyards in Northern California’s wine country.

“Originally the winery was called Smothers Brothers, but I changed the name to Remick Ridge because when people heard Smothers Brothers wine, they thought something like Milton Berle Fine Wine or Larry, Curly and Mo Vineyards,” Smothers once said.

They eventually reunited to star in the musical comedy “I Love My Wife,” a hit that ran on Broadway for two years. After that they went back on the road, playing casinos, performing arts centers and corporate gatherings around the country, remaining popular for decades.

“We just keep resurfacing,” Smothers commented in 1997. “We’re just not in everyone’s face long enough to really get old.”

After a successful 20th anniversary “Smothers Brothers Comedy Hour” in 1988, CBS buried the hatchet and brought them back.

The show was quickly canceled, though it stayed on the air long enough for Smothers to introduce the “Yo-Yo Man,” a bit allowing him to demonstrate his considerable skills with a yo-yo while he and his brother kept up a steady patter of comedy. The bit remained in their act for years.

“It was like a great marriage, you go through some rough spots, but you still don’t lose that focus,” Dick Smothers said.

They retired in 2010, but returned for a series of shows in 2021 that would be their last before Tom Smothers’ illness left him unable to continue.

“The audience exploded,” Dick Smothers said of those shows. “It was like a clap of thunder. They were young again.”

Smothers married three times and had three children. He is survived by his wife Marcy, children Bo and Riley Rose, and brother Dick, in addition to other relatives. He was predeceased by his son Tom and sister Sherry.

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This story has been updated to correct that Smothers’ father was in the Army, not the Navy, and that his wife’s name is Marcy, not Marie. “The Smothers Brothers Comedy Hour” debuted in early 1967, not fall, and was canceled in 1969, not 1970.

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Dalton reported from Los Angeles. Moore, a longtime Associated Press television writer, retired in 2017. Former Associated Press journalists John Rogers and the late Bob Thomas contributed to this report.

NEW YORK (AP) — Nearly three years after rioters stormed the U.S. Capitol, the false election conspiracy theories that drove the violent attack remain prevalent on social media and cable news: suitcases filled with ballots, late-night ballot dumps, dead people voting.

Experts warn it will likely be worse in the coming presidential election contest. The safeguards that attempted to counter the bogus claims the last time are eroding, while the tools and systems that create and spread them are only getting stronger.

Many Americans, egged on by former President Donald Trump, have continued to push the unsupported idea that elections throughout the U.S. can’t be trusted. A majority of Republicans (57%) believe Democrat Joe Biden was not legitimately elected president.

Meanwhile, generative artificial intelligence tools have made it far cheaper and easier to spread the kind of misinformation that can mislead voters and potentially influence elections. And social media companies that once invested heavily in correcting the record have shifted their priorities.

“I expect a tsunami of misinformation,” said Oren Etzioni, an artificial intelligence expert and professor emeritus at the University of Washington. “I hope to be proven wrong. But the ingredients are there, and I am completely terrified.”

Manipulated images and videos surrounding elections are nothing new, but 2024 will be the first U.S. presidential election in which sophisticated AI tools that can produce convincing fakes in seconds are just a few clicks away.

The fabricated images, videos and audio clips known as deepfakes have started making their way into experimental presidential campaign ads. More sinister versions could easily spread without labels and fool people days before an election, Etzioni said.

“You could see a political candidate like President Biden being rushed to a hospital,” he said. “You could see a candidate saying things that he or she never actually said.”

Faced with content that is made to look and sound real, “everything that we’ve been wired to do through evolution is going to come into play to have us believe in the fabrication rather than the actual reality,” said misinformation scholar Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania.

The Federal Election Commission and Republicans and Democrats in Congress are exploring steps to regulate the technology, but they haven’t finalized any rules or legislation.

A handful of states have passed laws requiring deepfakes to be labeled or banning those that misrepresent candidates. Some social media companies, including YouTube and Meta, which owns Facebook and Instagram, have introduced AI labeling policies. It remains to be seen whether they will be able to consistently catch violators.

It was just over a year ago that Elon Musk bought Twitter and began firing its executives, dismantling some of its core features and reshaping the social media platform into what’s now known as X.

Since then, he has upended its verification system, leaving public officials vulnerable to impersonators. He has gutted the teams that once fought misinformation on the platform, leaving the community of users to moderate itself. And he has restored the accounts of conspiracy theorists and extremists who were previously banned.

The changes have been applauded by many conservatives who say Twitter’s previous moderation attempts amounted to censorship of their views. But pro-democracy advocates argue the takeover has shifted what once was a flawed but useful resource for news and election information into a largely unregulated echo chamber that amplifies hate speech and misinformation.

In the run-up to 2024, X, Meta and YouTube have together removed 17 policies that protected against hate and misinformation, according to a report from Free Press, a nonprofit that advocates for civil rights in tech and media.

In June, YouTube announced that while it would still regulate content that misleads about current or upcoming elections, it would stop removing content that falsely claims the 2020 election or other previous U.S. elections were marred by “widespread fraud, errors or glitches.” The platform said the policy was an attempt to protect the ability to “openly debate political ideas, even those that are controversial or based on disproven assumptions.”

X, Meta and YouTube also have laid off thousands of employees and contractors since 2020, some of whom have included content moderators.

The shrinking of such teams “sets the stage for things to be worse in 2024 than in 2020,” said Kate Starbird, a misinformation expert at the University of Washington.

Meta explains on its website that it has some 40,000 people devoted to safety and security. It also frequently takes down networks of fake social media accounts that aim to sow discord.

Ivy Choi, a YouTube spokesperson, said the platform has recommendation and information panels, which provide users with reliable election news.

The rise of TikTok and other, less regulated platforms such as Telegram, Truth Social and Gab, also has created more information silos online where baseless claims can spread. Some apps such as WhatsApp and WeChat, rely on private chats, making it hard for outside groups to see the misinformation that may spread.

“I’m worried that in 2024, we’re going to see similar recycled, ingrained false narratives but more sophisticated tactics,” said Roberta Braga, founder and executive director of the Digital Democracy Institute of the Americas. “But on the positive side, I am hopeful there is more social resilience to those things.”

Trump’s front-runner status in the Republican presidential primary is top of mind for misinformation researchers who worry that it will exacerbate election misinformation and potentially lead to election vigilantism or violence.

The former president still falsely claims to have won the 2020 election.

Without evidence, Trump has already primed his supporters to expect fraud in the 2024 election, urging them to intervene to “ guard the vote ” to prevent vote rigging in diverse Democratic cities. Trump has a long history of suggesting elections are rigged if he doesn’t win and did so before the voting in 2016 and 2020.

That continued wearing away of voter trust in democracy can lead to violence, said Bret Schafer, a senior fellow at the nonpartisan Alliance for Securing Democracy, which tracks misinformation.

“If people don’t ultimately trust information related to an election, democracy just stops working,” he said.

Election officials have spent the years since 2020 preparing for the expected resurgence of election denial narratives.

In Colorado, Secretary of State Jena Griswold said informative paid social media and TV campaigns that humanize election workers have helped inoculate voters against misinformation.

“This is an uphill battle, but we have to be proactive,” she said. “Misinformation is one of the biggest threats to American democracy we see today.”

Minnesota Secretary of State Steve Simon’s office is spearheading #TrustedInfo2024, a new online public education effort by the National Association of Secretaries of State to promote election officials as a trusted source of election information in 2024.

His office also is planning meetings with county and city election officials and will update a “Fact and Fiction” information page on its website as false claims emerge. A new law in Minnesota will protect election workers from threats and harassment, bar people from knowingly distributing misinformation ahead of elections and criminalize people who non-consensually share deepfake images to hurt a political candidate or influence an election.

In a rural Wisconsin county north of Green Bay, Oconto County Clerk Kim Pytleski has traveled the region giving talks and presentations to small groups about voting and elections to boost voters’ trust.

“Being able to talk directly with your elections officials makes all the difference,” she said. “Being able to see that there are real people behind these processes who are committed to their jobs and want to do good work helps people understand we are here to serve them.”

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Fernando reported from Chicago. Associated Press writer Christina A. Cassidy in Atlanta contributed to this report.

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