The Pennsylvania Supreme Court on Tuesday released a sweeping grand jury report on sex abuse in the Catholic Church, listing more than 300 accused clergy and detailing a “systematic” cover-up effort by church leaders over 70 years.

State Attorney General Josh Shapiro said at a news conference Tuesday that more than 1,000 child victims were identified in the report, but the grand jury believes there are more.

The investigation is the most comprehensive yet on Catholic Church sex abuse in the United States. The 18-month probe, led by Shapiro, of six of the state’s eight dioceses — Harrisburg, Pittsburgh, Allentown, Scranton, Erie and Greensburg — follows other state grand jury reports that revealed abuse and cover-ups in two other dioceses.

Shapiro said that the report details a “systematic cover-up by senior church officials in Pennsylvania and at the Vatican.”

The nearly 1,400-page report’s introduction makes clear that few criminal cases may result from the massive investigation.

“As a consequence of the cover-up, almost every instance of abuse we found is too old to be prosecuted,” it reads.

“We subpoenaed, and reviewed, half a million pages of internal diocesan documents. They contained credible allegations against over 300 predator priests. Over 1,000 child victims were identifiable, from the church’s own records. We believe that the real number — of children whose records were lost, or who were afraid ever to come forward — is in the thousands.”

Some details and names that might reveal the clergy listed have been redacted from the report. Legal challenges by clergy delayed the report’s release, after some said it is a violation of their constitutional rights. Shapiro said they will work to remove every redaction.

The report has helped renew a crisis many in the church thought and hoped had ended nearly 20 years ago after the scandal erupted in Boston. But recent abuse-related scandals, from Chile to Australia, have reopened wounding questions about accountability and whether church officials are still covering up crimes at the highest levels.

The new wave of allegations has called Pope Francis’ handling of abuse into question as many Catholics look to him to help the church regain its credibility. The pope’s track record has been mixed, something some outsiders attribute to his learning curve or shortcomings and others chalk up to resistance from a notoriously change-averse institution.

The Pennsylvania grand jury report follows the resignation last month of Cardinal Theodore McCarrick, a towering figure in the U.S. church. The former archbishop of Washington, D.C., was accused of sexually abusing minors and adults for decades. Both have further polarized the church on homosexuality, celibacy and whether laypeople should have more power. It has also triggered debate about whether statutes of limitations should be expanded.

“We’re dealing with a long-term struggle not only about the meaning of justice, but about the meaning of memory,” said Jason Berry, a reporter and author who has covered the sexual abuse crisis for decades. “And how honest the church has been about this crisis. Most bishops, besides apologies, have not been on the cutting edge of change.”

Church officials have already begun bracing for the aftermath of the report. On Monday, Washington Archbishop Cardinal Donald Wuerl, former longtime leader of the Diocese of Pittsburgh, warned his priests in a letter that the probe will be “profoundly disturbing.”

Harrisburg’s bishop Ronald Gainer said earlier this month that he’d remove the names of all accused bishops from diocesan buildings and rooms. Erie Bishop Lawrence Persico last month told PennLive.com, a digital news site based in central Pennsylvania, that the report will be “sobering” and “is rather graphic.”

“While I expect that this report will be critical of some of my actions” in Pittsburgh, “I believe the report also confirms that I acted with diligence,” Wuerl wrote to Washington’s clergy. Wuerl is one of Pope Francis’ closest U.S. advisers and sits on the Vatican’s bishop oversight committee. The bishop is expected to retire in the next few years.

The investigation took about two years. The report’s length is expected to be from 8oo to 1,000 pages, the Post-Gazette reported. It covers all dioceses except the two already studied — Philadelphia and Altoona-Johnstown. Pennsylvania is believed to have done more investigations of institutional child sex abuse than any other state.

Berry said the report — coupled with the McCarrick scandal and others — shows the church needs a major overhaul in how it polices itself. He said the church needs a “separation of powers, an independent oversight.”

“Canon law is not equipped for this kind of thing,” Berry said. “It’s an enormous criminal sexual underground. It’s been surfacing like jagged parts of an iceberg for 30 years.”

Yet others fear the progress made by the church since the early 2000s is being overlooked. The number of new allegations is down, and the vast majority took place decades ago.

“The church has done things right since 2002 — Dallas was a game-changer,” said Nick Cafardi, former dean of Duquesne University School of Law, a Catholic school in Pittsburgh, referring to the city where the church passed its crackdown rules on child sex abusers in 2002. “But what was done before Dallas is indefensible.”

Yet the fact that such a small number of high-level clerics — as opposed to parish-level priests — have been held responsible is glaring to many Catholics.

The question of whether the church’s sins have been confronted remains raw. Wuerl in an interview earlier this month with the Catholic station Salt & Light said he doesn’t think “this is some massive, massive crisis.” He then suggested the creation of an oversight board of bishops. Some critics saw his comments as tone-deaf.

That same week, Albany Bishop Edward Scharfenberger said the slew of recent scandals signals a new phase.

“While I am heartened by my brother bishops proposing ways for our church to take action in light of recent revelations . . . I think we have reached a point where bishops alone investigating bishops is not the answer,” he wrote.

Worldwide, the Vatican is dealing with law enforcement targeting abuse with in the church. In Chile, prosecutors and police are staging raids on church offices, confiscating documents and looking for evidence of crimes that went unreported to police. On Tuesday, The Associated Press reported a prosecutor said authorities were raiding the headquarters of Chile’s Catholic Episcopal Conference.

As part of the probe, a prosecutor’s office has summoned the archbishop of Santiago, Cardinal Ricardo Ezzati, to testify amid accusations that he was involved in the cover-up of abuse.

“People are basically revolting against what had been these sacred cows,” said Juan Carlos Cruz, a Chilean abuse victim who earlier this year spent several days with the pope. “In the 1970s and 1980s, the church was a lighthouse for the country. And it’s incredible to see this 180-degree turn. People who venerated the church, now they actually despise what they’re doing.”

The crisis in Chile is just one case in a new wave of abuse-related revelations that have raised pressure on Pope Francis to deal more forcefully with abuse. In France, Cardinal Philippe Barbarin is facing an upcoming trial on criminal charges for not reporting sexual abuse. In Australia, one archbishop was recently convicted in a criminal court for concealing sexual abuse, and a top Francis lieutenant, Cardinal George Pell, will soon stand trial on charges related to sexual offenses.

“Accountability from inside the church is not happening,” said Anne Barrett Doyle, co-director of BishopAccountability.org, which that tracks sexual abuse cases. “But secular society is beginning to affect the most change.”

Doyle said the Pennsylvania grand jury report could also lead the way for the state to reform statute of limitations laws related to abuse.

Todd Frey, 50, who says he was abused when he was 13 by a priest in Lancaster County, spoke to the grand jury. He said he told church and law enforcement officials through the years, but nothing was done. The report will be his first opportunity to see if the priest is accused of abusing others, and who in the church knew.

“Who else did he pick?” Frey said Monday, as his lawyer David Inscho listened in. Survivors like Frey, who is unable to work, “know their little part,” Inscho said on the phone call, “what they saw through eyes of a 12- or 13-year-old and now they can see everything. And that is really, really important — the validation of it. The having been heard by law enforcement. Actually caring makes a big difference instead of saying, ‘We can’t do anything.’”