How New York Gov. Andrew Cuomo failed, then succeeded, on Covid-19

“Cuomo and other New York leaders were initially slow to react to the coronavirus, letting the pathogen spread rapidly through the population before the state closed down. Some of that was due to a lack of understanding of the disease early on, but there were also steps Cuomo and others, experts argued, should have known to take even back then.

But once New York’s leaders and the public acted, they did a lot of things right, from social distancing to testing to masking.”…
“nursing homes. A New York State Department of Health advisory memo was widely interpreted by the facilities as forcing them to take Covid-19 patients from hospitals, potentially worsening the spread of the disease.

Cuomo’s office has rebuked the criticisms, arguing that it acted on the best evidence and expert advice it had at the time. To the extent the state was slow to recognize the threat of Covid-19, officials claim it was due to federal missteps and inaction that hindered testing early on in the crisis, leaving the state, one adviser said, “flying blind” and unable to detect its full epidemic before it was too late.”

“The state’s late success as much of the country continues to struggle with a second coronavirus wave offers a lesson to the rest of the US and world: Covid-19 is not something that can simply be vanquished in a matter of weeks or months. It requires continued and sustained vigilance.

Unfortunately, it’s a lesson that only came about after Cuomo and state leaders oversaw and learned from the worst Covid-19 outbreak in the country and one of the worst in the world.”

“On March 1, New York state reported its first Covid-19 case. On March 2, Cuomo acknowledged that community transmission within the state “is inevitable.” By March 3, the state confirmed the first case of community transmission. At that point, the state’s first big outbreak took off in New Rochelle. On March 5, New York City Mayor Bill de Blasio said that “you have to assume [the virus] could be anywhere in the city.” Each of these events could have served as early red flags for aggressive action.

It became increasingly clear, too, that the coronavirus was spreading not just in far-flung places like China and Iran, but in the West too. Italy was struck hard first by March, leading to haunting stories of overflowing hospital wards, patients turned away, and a growing death toll. Spain, Belgium, and France soon followed with big outbreaks and climbing death tolls.

Cuomo and other New York leaders started to mobilize. They began holding regular news conferences, warning of the virus and threats. They started to close down parts of the state, including in-person teaching at schools and large gatherings, while recommending people work from home if possible.

 Even then, the messaging was muddled. Cuomo on March 2 told reporters, “We have been ahead of this from Day 1.” De Blasio on the same day tweeted that he was “encouraging New Yorkers to go on with your lives” and “get out on the town despite Coronavirus” — offering a movie recommendation for The Traitor.”

 “Cuomo was vocally skeptical of a stay-at-home order. Asked about de Blasio’s comments advocating for a “shelter-in-place” order, Cuomo on March 19 suggested such a move was unnecessary, arguing, “I’m as afraid of the fear and the panic as I am of the virus, and I think that the fear is more contagious than the virus right now.” Behind the scenes, the mayor and governor reportedly bickered about the order, with Cuomo remaining resistant.

Meanwhile, the San Francisco Bay Area issued the country’s first regional stay-at-home order on March 16, which went into effect the next day, and California issued an order on March 19 that went into effect the same day.

On March 20, Cuomo acquiesced — issuing a stay-at-home order for the whole state that would take effect two days later.

A few days of delayed action may not seem like a long time. But exponential growth means cases of Covid-19 can double in a couple of days, quickly spiraling out of control — making early action key to nipping the problem in the bud before it explodes out of control. Tom Frieden, who served as the director of the Centers for Disease Control and Prevention under President Barack Obama, told the New York Times that the state could have reduced its death toll by 50 to 80 percent if it locked down a week or two earlier.”…
“Cuomo’s office questioned whether the state could have acted quicker. A week before Cuomo issued a stay-at-home order, the state had reported around 50 Covid-19 cases a day and zero deaths. By the time of the order, there were nearly 1,000 cases and 10 deaths a day. Without that level of spread, the public may have been skeptical of drastic measures.” 

“New York may have gotten unlucky, too. Its position as a major international hub, its density, and its widespread dependence on public transportation made it uniquely vulnerable to Covid-19. These factors — considered upsides to New York in most other situations — were out of Cuomo’s control.

The virus also initially spread when we simply knew less about it. We didn’t know what parts of lockdowns would be effective, or that outdoor spaces, for example, were comparatively safer. We had much less research on the benefits of masks. And it was still unclear how this virus would affect the US in particular.”…
“Cuomo’s second big mistake came after the state started treating Covid-19 as a serious threat. On March 25, his administration issued an advisory that effectively forced nursing homes to take in Covid-19 patients from hospitals after they supposedly recovered. The rules barred nursing homes from demanding a coronavirus test prior to the transfer. In general, nursing homes interpreted the rules to force them to take in Covid-19 patients.

The idea was to limit hospital occupancy — a huge point of concern, as the coronavirus strained hospitals worldwide, including in New York. But critics say the advisory pushed Covid-19 into some of the most vulnerable places in the state.”

“Cuomo and the New York State Health Department have pushed back against the claims. Cuomo has described the criticisms as “political.” The New York State Health Department released a report suggesting Covid-19 was spreading in nursing homes prior to the advisory and largely due to infections among staff, not formerly hospitalized patients.

But experts have been highly critical of the state’s report, arguing its shoddy methodology wouldn’t make it into a reputable scientific journal. 

Experts told me that, overall, New York’s nursing homes were likely to suffer Covid-19 deaths once there was a big outbreak in the state, even if Cuomo’s administration hadn’t issued the advisory — a reflection of longstanding problems with infection control in these facilities.

Still, they argued that the advisory likely made things worse. Even the state’s report admits that some patients who were transferred back to nursing homes were infectious, although it’s not clear how many and which led to more infections.”

“While New York did some things very wrong, it was also true that Trump and the federal government often didn’t help — and, with their own failures and inaction, actually made it much harder for New York and other state and local governments to respond to the coronavirus pandemic.” 

“The situation has improved dramatically in New York since the spring. Today, the state is in the bottom three for daily new cases, with a rate of 3 per 100,000 people. Its test positive rate is the third lowest in the country at less than 1 percent — an indication of a controlled outbreak.

Experts say Cuomo and other leaders in the state deserve a lot of credit for such outcomes. New York dramatically scaled up testing — with the third-highest testing rate, when controlling for population, among all states. It built up a contact tracing system. It imposed a masking mandate. It has, in general, adhered closely to expert advice and empirical data as it’s evolved and shifted.

Perhaps most importantly, Cuomo resisted what many other states did not: reopening too quickly. The state imposed strict regional metrics that localities have to meet to reopen, and it’s stuck with them. New York City still hasn’t allowed indoor dining or bars, both of which present a huge risk for Covid-19 transmission.

It’s a sharp contrast to California Gov. Gavin Newsom (D). He was the first in the country to close down his state but, under pressure from local and private actors, allowed counties to reopen more quickly, getting waivers that effectively allowed them to ignore the standards the state previously set. That allowed indoor dining, bars, and other risky indoor spaces to reopen — until cases exploded in California, forcing Newsom to eventually reel back.”

“There are factors beyond policy that have helped New York. Because the state suffered a massive outbreak in the spring, there’s likely some element of population immunity making it more difficult for cases to spread too widely as long as people follow some precautions. The public has helped, too, remaining cautious even as the state has reopened; a New York Times analysis, for example, found New York had some of the highest rates of mask-wearing in public of any state.

“Once we did [act], it’s truly an incredible testament to New Yorkers that we have been able to do what was needed to get where we are today,” Nash, of the City University of New York, said.

New York’s success in the aftermath of a deadly outbreak shows the need for continued and sustained vigilance. It’s not enough to merely push down cases and test positive rates — as many states did early in the summer — people also need to stay cautious and keep the spread of the virus from getting out of control again. Resisting temptation, such as with reopening risky indoor spaces like bars, is crucial.

The unfortunate reality is Covid-19 won’t go away until a vaccine or similar treatment is widely available.”

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