Russia has turned to Gen. Alexander Dvornikov, 60, one of Russia’s most experienced military officers and — according to U.S. officials — a general with a record of brutality against civilians in Syria and other war theaters. The senior official who identified the new commander was not authorized to be identified and spoke on condition of anonymity.

But the White House national security adviser, Jake Sullivan, said “no appointment of any general can erase the fact that Russia has already faced a strategic failure in Ukraine.”

“This general will just be another author of crimes and brutality against Ukrainian civilians,” Sullivan told CNN’s “State of the Union.” “And the United States, as I said before, is determined to do all that we can to support Ukrainians as they resist him and they resist the forces that he commands.”

The decision to establish new battlefield leadership comes as Russia gears up for what is expected to be a large and more focused push to expand Russian control in the Donbas and follows a failed opening bid to conquer Kyiv, the capital.

Dvornikov gained prominence while leading the Russian group of forces in Syria, where Moscow has waged a military campaign since 2015 to shore up President Bashar Assad’s regime during a devastating civil war.

Dvornikov is a career military officer and has steadily risen through the ranks after starting as a platoon commander in 1982. He fought during the second war in Chechnya and took several top positions before being placed in charge of the Russian troops in Syria in 2015.

In 2016, Putin awarded Dvornikov the Hero of Russia medal, one of the country’s highest awards. Dvornikov has served as the commander of the Southern Military District since 2016.

Sullivan described the general as having a record of brutality against civilians in Syria and said “we can expect more of the same in this theater.” But he stressed that the U.S. strategy remains the same in providing Ukraine the military and logistical support it needs.

“It is unfair to expect accountability from the nearly 400,000 VA employees and not demand the same from its top executive. It is clear that Secretary Robert Wilkie failed to meet the standard that the veteran who came forward with the complaint deserved,” the American Legion’s national commander, James W. “Bill” Oxford, said in a statement. He urged Wilkie and several other top VA officials cited in the report to resign because of their “violation of trust” of the agency’s commitment to not “tolerate harassment of any kind.”

Pelosi, D-Calif., said Wilkie “has lost the trust and confidence to serve, and he must immediately resign.” She said Wilkie “has not only been derelict in his duty to combat sexual harassment, but has been complicit in the continuation of a VA culture that tolerates this epidemic.”

On Saturday, the VA said Wilkie, who has denied wrongdoing, doesn’t intend to resign. “He will continue to lead the department,” said spokeswoman Christina Noel.

The demands for Wilkie’s resignation came a day after numerous veterans groups expressed similar outrage and sought Wilkie’s dismissal in the final weeks of the Trump administration. Those organizations include Veterans of Foreign Wars, Iraq and Afghanistan Veterans of America, Disabled American Veterans, AMVETS, Paralyzed Veterans of America and the Modern Military Association of America, and they said they had lost confidence that Wilkie could effectively lead the department, which is responsible for the care of 9 million veterans.

An investigation by the Veterans Affairs’ inspector general on Thursday concluded that Wilkie repeatedly sought to discredit Andrea Goldstein, a senior policy adviser to Democratic Rep. Mark Takano, chairman of the House Veterans’ Affairs Committee, after she alleged in September 2019 that a man at the VA medical center in Washington, D.C., had physically assaulted her.

The inspector general found that Wilkie’s disparaging comments about Goldstein, a Navy veteran, as a repeat complainer as well as the overall “tone” he set influenced his staff to spread negative information about her while ignoring known problems of harassment at the facility.

Wilkie and other senior officials had declined to fully cooperate with the investigation by VA Inspector General Michael Missal. For that reason, Missal said he could not conclude whether Wilkie had violated government policies or laws, allegedly by personally digging into the woman’s past. Wilkie has denied that he improperly investigated Goldstein.

“We’ve had our concerns about Wilkie’s leadership throughout the pandemic and this IG report really cements the fact that the VA is not being led with integrity,” said Jeremy Butler, chief executive of Iraq and Afghanistan Veterans of America. “That calls for an immediate change.”

The report on Thursday drew widespread concern from lawmakers from both parties about VA’s leadership, with Takano the first to call for Wilkie’s resignation. Concerned Veterans for America, a conservative group who supported Wilkie when he became VA secretary in 2018, chided Wilkie and his team, stressing that “VA leaders should always put the veteran and the integrity of the institution ahead of themselves.”

AMVETS national commander Jan Brown said she found it unacceptable that VA would dismiss known problems facing women who receive care at its facilities.

“Women veterans already hesitate to use VA services for a number of reasons and we need a Secretary who will make our community feel welcomed,” she said. “We strongly disapprove of any VA official that took part in the scheme to wreck the credibility of a victim.”

The case of Goldstein, who agreed to be publicly identified, was ultimately closed by the inspector general’s office and Justice Department earlier this year due to a lack of enough evidence to bring charges.

Wilkie is Trump’s second VA secretary after David Shulkin was fired in 2018. A former Pentagon undersecretary, he presided over the nation’s largest hospital system that has seen continuing improvement and veterans’ satisfaction since a 2014 scandal involving lengthy waiting times for medical appointments.

President-elect Joe Biden has pledged to rebuild trust in the VA when he takes office on Jan. 20. He has selected Denis McDonough, who served as President Barack Obama’s White House chief of staff, to be VA secretary.

In a letter Friday, the 31 senators take aim at new Postmaster General Louis DeJoy, a GOP fundraiser who took the post in June and has since imposed several operational changes that have led to mail backlogs across the United States. His cost-cutting measures have come as President Donald Trump rails against increases in mail-in voting and says he may hold up postal funding to impede the balloting in November.

The senators say they’ve heard from hundreds of veterans, as well as Department of Veterans Affairs staff, who cited weekslong mail delays, “causing veterans to miss doses of vital medications.”

The VA website offers assurances that prescriptions typically arrive within three to five days.

The lawmakers called on DeJoy to reassess the impact of the postal changes on veterans and urged him to work with VA Secretary Robert Wilkie to reduce delays. Veterans are an important constituency for Trump, broadly supporting him in 2016 and during his presidency.

“Access to prescription medications is especially integral during the COVID-19 pandemic when routine health care appointments may be delayed or cancelled,” according to the letter, which was led by Montana Sen. Jon Tester, the top Democrat on the Senate Veterans Affairs Committee. “No veteran should have to wonder when their antidepressant or blood pressure medication may arrive — and the effects can be devastating if doses are missed.”

In a statement, VA disputed the notion that mail-order prescriptions were arriving weeks late and pointed to guidance on its website encouraging veterans to request refills at least 10 days before they need it.

“VA always encourages veterans to order routine prescriptions in advance,” said VA spokeswoman Christina Noel. “When it comes to emergent prescriptions, VA either fills them onsite or uses commercial carriers to ensure timely delivery.” She said prescriptions delivered by the Postal Service are averaging less than three days for delivery, while 95% of those sent by UPS next-day service have been on time.

VA fills about 80% of veteran prescriptions by mail. That translates to almost 120 million prescriptions a year, with deliveries arriving daily to about 330,000 veterans across the country.

Michigan Sen. Gary Peters, the top Democrat on the Senate Homeland Security Committee, has been investigating the postal delays after he said DeJoy failed to provide answers about why they were happening. Peters is asking a dozen veterans organizations to provide him with information about wait times for mail-order prescriptions or other problems. He says some veterans have reported to him financial harm caused by late fees after their bills and payments took much longer to arrive in July and August.

Memos from post office leadership, obtained earlier this month by The Associated Press, detailed an elimination of overtime and a halting of late delivery trips that are sometimes needed to make sure deliveries arrive on time. One document said if distribution centers are running behind, “they will keep the mail for the next day.” Another said: “One aspect of these changes that may be difficult for employees is that — temporarily — we may see mail left behind or mail on the workroom floor or docks.”

Additional records obtained by the AP outline upcoming reductions of hours at post offices, including closures during lunch and on Saturdays.

“Those who gave so much to serve this country should be able to count on the nation’s Postal Service to deliver their medications in a timely manner,” the lawmakers wrote Friday.

Known as REACH, the government campaign is the core part of a $53 million, two-year effort announced by President Donald Trump to reduce suicide, particularly among veterans.

Starting Wednesday, digital ads will hit the internet with the key message that “suicide is preventable” and that collective action not only by government but also by businesses, schools, nonprofits and faith-based organizations can overcome the stigma of discussing mental health and empower people to understand risk factors, stay connected with others and talk openly about problems.

“Working together, we can implement this road map and end this national tragedy of suicide,” said Vice President Mike Pence’s wife, Karen Pence, a lead spokesperson for the government effort. She called it an opportune time, noting increased social distancing because of the coronavirus.

“All of us have been facing anxieties and isolation,” she said. “It’s OK to not be OK. … The best thing is to talk about it more, not less.”

“No one should be afraid to ask for help,” she added.

Trump established a federal task force last year to develop a way to lower veterans’ suicides. Currently, about 20 veterans, guardsmen and reservists die by suicide each day, about 1.5 times higher than those who have not served in the military. The government says about 14 of those 20 were not under the care of the Department of Veterans Affairs, pointing to a need for improved community outreach.

With the coronavirus still raging across communities, officials expressed hope that the message of suicide prevention can aid the public more widely, not just veterans.

Surgeon General Jerome Adams, who is helping the effort, stressed the need to stay connected by texting, emailing or, in the case of his kids, writing “old-fashioned letters to grandma and grandpa.” He described stigma against getting help as a much bigger public health threat than cigarettes or COVID-19.

“When we feel comfortable seeking help, and unless more people feel comfortable offering help without judgment, we’ll never reach those who need it the most,” he said.

Acknowledging the impact of the broader pandemic, Adams also offered a separate public service message: Wear a mask.

His public admonition comes as many governors are pushing for a national mandate on wearing masks. Trump has repeatedly declined to wear masks in public and recently held campaign-style events in Tulsa, Oklahoma, Mount Rushmore in South Dakota and the White House on the Fourth of July where he and many attendees went bare-faced.

“It’s not an impingement on your freedom,” Adams said, calling masks the No. 1 way to stem spread of COVID-19. “It actually increases your freedom and your choices because it lowers spread of the disease and increases the chances we will be able to open and stay open.”

“It actually will decrease that hopelessness. It will actually lower suicide rates,” he said.

Public health experts urged people to go to the website wearewithinreach.net and take a pledge “to reach and be part of the solution” to stem suicide. The website offers information on risk factors for suicide and ways people can get help.

“By having this conversation, we will save lives,” said Dr. Barbara Van Dahlen, executive director of the suicide prevention effort.

At a House hearing, he defended initial use of hydroxychloroquine on coronavirus patients as justified “to give them hope,” given few treatment options at the time. But Wilkie said that government-run VA hospitals have “ratcheted it down” — to just three prescriptions in the last week — as studies pointed to possible dangers and other possible treatments were brought online. “I expect that trend to continue in the future,” he added.

President Donald Trump has heavily pitched the drug — even saying in recent days he had been taking it to prevent coronavirus infection — without scientific evidence of its effectiveness.

“We are all learning as we go in this crisis,” Wilkie told a House appropriations subcommittee. “Our mission is to preserve and protect life.”

The department, which is the nation’s largest hospital system, has recently been turning to remdesivir. Preliminary results from a major study found reduced recovery time, as well as convalescent plasma.

According to the VA’s website, 13,657 veterans have been infected with the coronavirus, and 1,200 have died.

Major veterans organizations had called on the VA to explain its use of hydroxychloroquine after an analysis of VA hospital data was published month showing hundreds of veterans who took the drug saw no benefit for COVID-19. About 28% of veterans who were given hydroxychloroquine plus usual care died, versus 11% of those getting routine care alone.

VA data provided Thursday to Congress show that weekly prescriptions for hydroxychloroquine surged from about two in mid-March to a peak of 404 about two weeks later as Trump began promoting its use. They remained at higher levels before tapering off in late April amid backlash over results of the VA hospital analysis and as remdesivir emerged as a form of treatment. In all, 1,370 veterans were prescribed hydroxychloroquine for COVID-19.

Wilkie said Thursday that he expected the VA to continue using the drug in limited forms such as clinical trials, based in part on the guidance of Dr. Anthony Fauci, the nation’s top infectious-diseases expert and a member of the White House coronavirus task force.

That answer drew a rebuke from Rep. Nita Lowey, D-N.Y., chair of the appropriations committee, who said the VA should have been listening to Fauci’s counsel urging caution on the drug from the start.

“I hope VA will respond to the science that is clearly coming from Dr. Fauci, rather than some wishful thinking coming from the president,” Lowey said.

No large, rigorous studies have found hydroxychloroquine safe or effective for COVID-19, and it can cause heart rhythm problems and other serious side effects. The Food and Drug Administration has warned against the drug and said hydroxychloroquine should only be used for the coronavirus in formal studies.

The VA has said it prescribed the drug only when medically appropriate, after full discussion between doctor and patient about the risks.

In responses provided to Congress and obtained by The Associated Press, the VA said it never “encouraged or discouraged” its government-run hospitals to use hydroxychloroquine on patients even as President Donald Trump heavily promoted the drug for months without scientific evidence of its effectiveness.

Still, it acknowledged that VA Secretary Robert Wilkie had wrongly asserted publicly without evidence that the drug had been shown to benefit younger veterans. The VA, the nation’s largest hospital system, also agreed more study was needed on the drug and suggested its use was now limited to extenuating circumstances, such as last-ditch efforts to save a coronavirus patient’s life.

In the first week of May, 17 patients had received the drug for COVID-19, according to VA data obtained by the AP. The department declined to say how many patients had been treated with hydroxychloroquine for the coronavirus since January, but a recent analysis of VA hospital data showed that hundreds of veterans had taken it by early April.

“VA has not endorsed nor discouraged the use of hydroxychloroquine in COVID-19 patients and has left those decisions to providers and their patients,” the VA said. “While all drugs have the potential for adverse events and some drugs in particular, like hydroxychloroquine, are known to have specific risks, when they are used carefully and judiciously, they can be managed safely.”

As of Friday, 11,883 veterans had been confirmed to be infected with the virus and 985 had died, according to VA statistics.

Responding to written questions from Sen. Jon Tester, the top Democrat on the Senate Veterans Affairs Committee, the department admitted it had no studies or evidence to back up Wilkie’s claim that hydroxychloroquine had shown effectiveness in younger veterans in particular.

“The use of hydroxychloroquine for COVID has dropped off dramatically,” the VA said.

Trump repeatedly has pushed the malaria drug hydroxychloroquine with or without the antibiotic azithromycin, but no large, rigorous studies have found them safe or effective for COVID-19, and they can cause heart rhythm problems and other side effects. The Food and Drug Administration has warned against the drug combination and said hydroxychloroquine should only be used for the coronavirus in formal studies.

Two large observational studies, each involving around 1,400 patients in New York, recently found no benefit from hydroxychloroquine. Two new ones published Thursday in the journal BMJ, one by French researchers and the other from China, reached the same conclusion.

Tester, who received VA’s responses this week, said he remained concerned about the drug’s safety.

“Any drug used to treat patients with COVID-19, especially veterans living with debilitating preexisting conditions, must be proven safe and effective before it’s administered,” he said. “Given recent studies from both VA and other hospitals, hydroxychloroquine seems to fall short of those requirements.”

Major veterans organizations and Democrats, including Senate Minority Leader Chuck Schumer, had called on the VA to explain why it allowed the use of an unproven drug on vets. Last week, a whistleblower complaint by former Health and Human Services official Rick Bright alleged that the Trump administration wanted to “flood” hot spots in New York and New Jersey with the drug.

Jeremy Butler, CEO of Iraq and Afghanistan Veterans of America, said Friday that his group was heartened by the VA’s preliminary explanations and called it imperative that it release additional details. “It remains concerning that it took this long to begin to get answers to basic questions,” he said.

The analysis of VA hospital data, done by independent researchers at two universities with VA approval, was not a rigorous experiment. Researchers analyzed medical records of 368 older male veterans hospitalized with confirmed coronavirus infection at VA medical centers who died or were discharged by April 11.

About 28% of veterans who were given hydroxychloroquine plus usual care died, versus 11% of those getting routine care alone.

In its response to Congress, the department provided copies of some of its guidance issued to VA physicians on hydroxychloroquine from March to May. It made clear that hydroxychloroquine should be considered mostly for use in clinical trials or when medically appropriate after a full discussion with the patient about risks.

The VA did not explain the circumstances in which veterans in the recent analysis of hospital data were given the drug, only suggesting that “it is possible” they were prescribed as part of last efforts to save a patient’s life.

“Based on the principles of patient-centric care, it would be inappropriate to deny patients access to hydroxychloroquine under these dire circumstances,” VA wrote. It said it had followed the approach of the National Institute of Allergy and Infectious Diseases by “summarizing the medical literature regarding unapproved treatments for COVID-19 and making that available to VA clinicians in their shared decision-making with patients.” That guidance now includes preliminary studies on remdesivir, which has been federally approved for emergency use to treat COVID-19.

One VA document dated March 25 notes a few “very small cohort studies” showing possible “beneficial effects” but adds “these data have NOT been verified in randomized controlled trials and are extremely preliminary.”

The VA acknowledged to Congress that it had placed bulk orders for hydroxychloroquine from Feb. 1 to April 23 for 6.3 million tablets worth $208,000 in anticipation of a possible shortage of the drug, but that most of it was being used for approved uses, such as treating lupus and rheumatoid arthritis. It said it did not have breakdowns.

The department also said it planned further studies and clinical trials on hydroxychloroquine, including whether it could help prevent infection in veterans who were potentially exposed to COVID-19. It is in discussions with Novartis to have some VA facilities participate in a national clinical trial that will look at the effectiveness of hydroxychloroquine in combination with azithromycin in patients with moderate and severe disease.

AP Chief Medical Writer Marilynn Marchione in Milwaukee contributed to this report.

He had been trained as a forward observer — the person who spots a target and gives coordinates to artillery — but when he got to Iraq, the then 19-year-old instead found himself photographing dead bodies for intelligence gathering. A suicide attempt before his second deployment triggered a less than honorable discharge and a long fight to gain honorable status after being diagnosed with PTSD.

Goldsmith credits the U.S. Department of Veterans Affairs medical staff with saving his life.

The VA and its partner mental health providers have kept thousands of veterans in treatment during the coronavirus pandemic through telehealth appointments. But as job losses and increased social isolation take an extended toll, some veterans’ advocates worry the already understaffed VA medical facilities can’t keep up and that telehealth isn’t enough.

“After years of self-imposed isolation … I was really in need of person-to-person contact,” said Goldsmith, now the assistant director of policy at Vietnam Veterans of America. “Flash forward almost 13 years now since I got out, and telehealth is right for me.”

The VA on Friday kicked off a “Now is the Time” campaign aimed at alerting veterans and their families to the mental health resources that are available to them.

But veterans advocates still are waiting for a report by a White House task force established by President Donald Trump last year that was charged with developing a national roadmap to boost mental health care and stem persistently high suicide numbers among veterans, who have been hard hit in the pandemic.

Release of the task force report had been scheduled in March but was abruptly shelved due to the outbreak.

“We are not happy about this decision because we understand that there are partnerships and financial resources tied to this plan that we’d like to see implemented immediately,” said Chanin Nuntavong, executive director of The American Legion’s Washington office.

VA Secretary Robert Wilkie told veterans groups in a call last week that the draft report was being finalized but declined to give a release date.

An administration official, who requested anonymity to reveal internal deliberations, told The Associated Press that officials planned to unveil the plan around Memorial Day. Karen Pence, wife of the vice president, will help launch the effort.

VA officials said telehealth medical appointments jumped from 20,000 in February to nearly 154,000 in April. Many of the department’s partners have moved most or all of their mental health appointments to telehealth, including the Cohen Veterans Network which transitioned 98% of patients at its 15 clinics.

The VA has provided some veterans with tablets, phones and affordable data rates through several private partnerships. Dr. Matt Miller, acting director of the VA’s suicide prevention program, said veterans aren’t waiting long for telehealth sessions, but only wait times for in-person appointments are tracked.

Sherman Gillums Jr., the chief advocacy officer for AMVETS, said telemedicine is likely saving lives, but it is also likely missing some older or less tech savvy veterans. He wants the VA to move veterans with canceled appointments to the front of the line when things reopen and make more inpatient beds immediately available.

“I just don’t want them to oversell telemedicine. We had it before when veteran suicide became an issue, and it wasn’t a fix,” Gillums said.

Gillums said a suicide prevention tool created by AMVETS to train family members to spot signs of suicidal thoughts before a veteran gets to a crisis could help families during stay-at-home orders.

For years, the government reported that 20 veterans die by suicide each day, about 1.5 times higher than non-veterans. Last fall, the VA adjusted the methodology to remove from the count some active-duty service members and former members of the National Guard and Reserve, updating the veteran suicide rate to 17 a day based on 2017 data, the most recent available. There were 6,139 suicide deaths in 2017, which is up 129 from the previous year, even as the total veteran population declined.

The government says about two-thirds of those were not under VA care, pointing to a need for improved outreach.

“We have been very busy during the COVID crisis — with our efforts focused on getting in front of the mental health crisis that we know is coming,” Barbara Van Dahlen, executive director of the task force, told the AP. The group has boosted social media efforts during the pandemic.

At Cohen Veterans Network, website traffic has increased, including a spike between midnight and 4 a.m. Saturdays when people are alone or experiencing insomnia.

Anthony Hassan, the president and chief executive officer of Cohen, said he doesn’t believe the country’s mental health system is prepared for the surge likely to happen from the pandemic. Cohen is opening 10 new centers by the end of next year and hiring more staff.

“The one thing I don’t want to be is too late… We need to be talking now about how we can make sure we are ahead of this,” Hassan said.

Staff have set up online groups— yoga classes, mindfulness training, sessions about unemployment — to help veterans and families cope.

Chad Sneary was only a few hours into his shift at a Mooresville, North Carolina, manufacturing plant when he was laid off in early April. The 43-year-old, who served six years in the Marine Corps and two in the Ohio National Guard, insisted on working his full shift.

Sneary and his family are surviving on pantry items and hoping he is approved for unemployment soon.

“Financial skills is not something the military ever taught you. Most of us live paycheck to paycheck,” he said.

New government statistics released Friday show the unemployment rate among veterans in April was 11.7%, up from 2.3% a year earlier. The overall unemployment last month was 14.7%.

The Independence Fund, a nonprofit that helps critically wounded service members, has received hundreds of financial requests and is struggling to meet a nearly 600% increase in need.

Meanwhile, the Iraq and Afghanistan Veterans of America has seen an almost 25% increase in the hundreds of calls to its rapid response hotline for veterans in crisis. Jeremy Butler, the group’s chief executive officer, said the largest increases are requests for financial, housing or mental health referrals.

Goldsmith, who has spent years advocating for other veterans, worries about the trauma that national guard members, first responders and others are experiencing and whether they will get care.

“There is going to be a lot of survivors’ guilt,” he said. “People don’t die from PTSD in the midst of war. When they sit with these new fresh raw memories, that’s when PTSD takes lives.”

Lauer reported from Philadelphia, and Yen reported from Washington. AP Economics Writer Christopher Rugaber contributed to this report.

Sen. Charles Schumer of New York said the VA needs to provide Congress more information about a recent bulk order for $208,000 worth of hydroxychloroquine. President Donald Trump has heavily promoted the malaria drug, without evidence, as a treatment for COVID-19.

Schumer’s request comes after a whistleblower complaint filed this past week by former Health and Human Services official Rick Bright alleged that the Trump administration, eager for a quick fix to the onslaught of the coronavirus, wanted to “flood” hot spots in New York and New Jersey with the drug. Major veterans organizations have urged VA to explain under what circumstances VA doctors initiate discussion of hydroxychloroquine with veterans as a treatment option.

“There are concerns that they are using this drug when the medical evidence says it doesn’t help and could hurt,” Schumer, D-N.Y., said in an interview with The Associated Press.

He said given the fact the malaria drug, despite being untested, had been repeatedly pushed publicly by Trump, VA Secretary Robert Wilkie must address whether anyone at the department was pressured by the White House or the administration to use hydroxychloroquine for COVID-19.

Schumer said Wilkie also should answer questions about a recent analysis of VA hospital data that showed there were more deaths among patients given hydroxychloroquine versus standard care, including how much patients knew about the drug’s risks before taking it.

Wilkie in recent weeks has denied that veterans were used as test subjects for the drug and that it was instead administered at government-run VA hospitals only when medically appropriate, with mutual consent between doctor and patient.

Still, Wilkie has repeatedly declined to say how widely the drug was being used for COVID-19 and whether the department had issued broad guidance to doctors and patients on the use of the drug.

In a weekly call with veterans’ groups this past week, Wilkie continued to defend VA’s use of hydroxychloroquine. He said the recent analysis of VA hospital data showing no benefits to patients involved cases of older, very sick veterans. He has not said whether the department will continue to use the drug.

“Use of this medication for treatment of COVID-19 is considered ‘off label’ — perfectly legal and not rare,” he wrote in an April 29 letter to veterans’ groups.

The analysis of hospital data, done by independent researchers at two universities with VA approval, was not a rigorous experiment. Researchers analyzed medical records of 368 older male veterans hospitalized with confirmed coronavirus infection at VA medical centers who died or were discharged by April 11.

About 28% of veterans who were given hydroxychloroquine plus usual care died, versus 11% of those getting routine care alone.

The VA recently said most of its recent bulk order for hydroxychloroquine was being used for approved uses, such as treating lupus and rheumatoid arthritis, but it didn’t provide breakdowns.

Wilkie in recent weeks took advocacy of the drug even further than Trump by claiming without evidence that it has been effective for young and middle-aged veterans in particular. In fact, there is no published evidence showing that.

Veterans are “very concerned that we still do not have clarity on the VA’s past and present use of hydroxychloroquine in treating veterans with COVID-19,” Jeremy Butler, chief executive officer of Iraq and Afghanistan Veterans of America, told the AP.

“Now that the federal government issued an emergency use authorization for remdesivir to treat COVID-19, we need answers to these questions as well as the VA’s plans for administering, or not administering, remdesivir,” he said.

Schumer said his main concern is determining whether the VA had conducted any “clandestine studies to determine whether hydroxychloroquine was effective without their permission.” He said there’s also concern that the department won’t address specifically where the drug was sent or how it’s being used.

“These are people who risked their lives for us,” Schumer said. “They should be treated only with the utmost dignity, respect and high standards of care.”

The drug has long been used to treat malaria and other ailments. A few, very small preliminary studies suggested it might help prevent the coronavirus from entering cells and possibly help patients clear the virus sooner. But the Food and Drug Administration last month warned doctors against prescribing the drug for COVID-19 outside hospitals because of the risks of serious side effects and death.

In a letter and call with major veterans organizations, Wilkie said the malaria drug hydroxychloroquine was being administered in government-run VA hospitals to virus-stricken patients only in conjunction with a physician’s advice.

But Wilkie declined to say how widely the drug was being used at VA for COVID-19 and whether the department had issued broad guidance to doctors and patients on the use of the drug, which has been heavily touted by President Donald Trump without scientific evidence.

The Food and Drug Administration has warned doctors against prescribing the drug for COVID-19 outside hospitals because of the risks of serious side effects and death.

“Our number one priority is keeping veterans, their families, and our staff safe and healthy,” Wilkie said in the letter, which was obtained by The Associated Press.

He stressed without elaborating that the VA, the nation’s largest health care system, was adhering to FDA guidance allowing prescriptions of the drug for COVID-19 in hospitals.

Asked about the letter, the VA issued a separate statement saying it “permits use of the drug after ensuring veterans and caretakers are aware of potential risks associated with it, as we do with any other drug or treatment.”

Major veterans organizations are calling on VA to explain under what circumstances VA doctors initiate discussion of hydroxychloroquine with veterans as a treatment option after an analysis of VA hospital data was published last week showing hundreds of veterans who took the drug saw no benefit for COVID-19.

The analysis, done by independent researchers at two universities with VA approval, was not a rigorous experiment. Researchers analyzed medical records of 368 older male veterans hospitalized with confirmed coronavirus infection at VA medical centers who died or were discharged by April 11. The analysis was the largest look so far at hydroxychloroquine for COVID-19.

About 28% of veterans who were given hydroxychloroquine plus usual care died, versus 11% of those getting routine care alone.

“Why were veterans who were receiving treatment from a federal agency being treated with an unproven and speculative drug?” asked Jeremy Butler, chief executive officer of Iraq and Afghanistan Veterans of America. “At what point did the VA know that the results were this dire and when did they act upon those results?”

“We are concerned that VA still has not addressed any of these questions or provided any information about the issue of hydroxychloroquine’s safety and the results they have seen from it,” Butler added.

Terrence Hayes, a spokesman for Veterans of Foreign Wars, urged the VA to limit its use of the drug for COVID-19. “It still hasn’t been proven if the drugs help or not for COVID-19,” he said.

The VA has sent conflicting public messages on use of the drug. Last week, Wilkie took advocacy of the drug even further than Trump by claiming without evidence that it has been effective for young and middle-aged veterans in particular. In fact, there is no published evidence showing that.

In March, as Trump promoted the drug, the VA placed two emergency orders for $208,000 worth of hydroxychloroquine for use at its hospitals. The department later said the bulk of that order was being used for its approved uses, such as treating lupus and rheumatoid arthritis.

The drug has long been used to treat malaria and those ailments. A few, very small preliminary studies suggested it might help prevent the coronavirus from entering cells and possibly help patients clear the virus sooner. But the FDA said last week that they are investigating life-threatening side effects reported to poison control centers and other health authorities.

Based on a “worst case” scenario that up to 1 in 5 of its mostly elderly population of veterans will need coronavirus care, the government-run hospital system is seeking $16.6 billion in emergency money, according to a VA document submitted to Congress and obtained by The Associated Press.

The money would be used over six months to ramp up COVID-19 testing, cover hospital care and protective masks for 4,500 more veterans, add medical ventilators, boost online telehealth options as Americans continue to hunker at home and pay for 40,000 more urgent care visits. About $170.74 would be allocated per VA employee in certain divisions for hand sanitizer, disinfecting wipes and antiviral face tissue for the rest of the budget year that ends Sept. 30.

“All that gives is an added safety boost,” Dr. Richard Stone, the agency’s top health official, said in an AP interview.

During national emergencies such as the one declared by President Donald Trump last week, the VA not only serves 9 million veterans but also acts as a backup health care system to the broader public.

If called upon by states and the Health and Human Services Department, the VA network of 170 hospitals, 1,074 outpatient sites and more than 350,000 employees could provide care to first responders and civilians in hard-hit communities.

It could be an unprecedented task for the VA, which has faced past criticism for staff shortages, management disarray and long patient wait times.

Since January, the department has run drills and checked stockpiles of medical equipment. As coronavirus spread in the U.S., the VA locked down visitation at its 134 nursing homes and 24 spinal cord injury centers to protect elderly and vulnerable patients and screened patients for symptoms of the virus before they entered facilities.

To increase capacity, the VA has cut back on routine appointments, limiting dental work and canceling elective surgeries, according to Secretary Robert Wilkie, who was belatedly added to the White House coronavirus task force this month.

In the U.S., there are more than 10,000 confirmed coronavirus cases.

For most people, the coronavirus causes only mild or moderate symptoms, such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia. The vast majority of people recover from the new virus.

At the VA, officials said they were tracking at least 83 cases of veterans who showed signs of the virus. One patient in their 70s died late last week at a VA facility in Portland, Oregon, of complications from COVID-19. The department currently has 1,200 coronavirus test kits from the Centers for Disease Control and Prevention and 2,000 VA-developed tests. More than 800 veterans have been tested so far.

A group of Democratic senators and the House Veterans’ Affairs Committee have pressed the VA to provide regular updates on its preparedness and available resources to address the pandemic.

“VA must be properly prepared to respond to the unique needs of our nation’s veterans, and ready to activate its critical Fourth Mission to support all Americans if it becomes necessary,” said Montana Sen. Jon Tester, the top Democrat on the Senate Veterans’ Affairs Committee.

He urged the agency, which currently has more than 44,000 vacancies, to work aggressively “to determine both immediate and projected needs for health care workers and first responders on the frontlines — including beds and personal protective equipment.”

Joe Chenelly, executive director of American Veterans, or AMVETS, said veterans were anxious and uncertain about their health care amid the outbreak, with information from the VA often slow in coming.

“We understand that the VA has a crucial role in a public health crisis, and we’re ready for whatever that means,” he said.

At the same time, Chenelly said, more than half of veterans are older and face a higher risk from the virus and younger veterans have chronic health conditions related to their military work. “There is perhaps no segment of the American population more at risk of being decimated,” he said.

Asked this week at what point VA hospitals or Defense Department medical facilities might be tapped by federal health officials to help relieve an overburdened private health care system, Trump pointed to pockets of the U.S. where medical personnel are showing strain.

“Some areas — like New York, California, State of Washington — they’re going to have some difficulty. And when we see that coming, we’re going to be in there,” Trump said.

The VA has played a role in national emergencies before, such as the 2017 hurricane in Puerto Rico.

The VA system currently has 13,000 acute care beds, including 1,800 intensive care beds and 1,100 negative air flow rooms, which control the air flow around patients with airborne contagious diseases to protect other patients and medical personnel.

Over the past two weeks, the VA has expanded hospital capacity, dropping occupancy in acute care beds from about 80% to over 60% to make room for possible civilian patients, Stone said. He added that VA also is working to add negative air flow beds should they be needed to help treat the civilian population.

“We are the buttress force in case” HHS or the Federal Emergency Management Agency “calls upon us to deploy medical professionals across the country to meet crises,” Wilkie said this week at a White House briefing of the coronavirus task force. “We are gaming out emergency preparedness scenarios. And we stand ready, when the president needs us, to expand our mission.”

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