From time to time, until the crisis has passed, the HEPL blog series authors will be given the opportunity to provide short updates on their country/region’s continuing response to this worldwide catastrophe and their further reflections on those responses. Each update will be labelled accordingly with the original response at the bottom of each post.

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HEPL blog series: Country Responses to the Covid19 Pandemic

New York’s Response to the Coronavirus Pandemic – the August update (2020)
Shirley Johnson-Lans

Things have changed dramatically since I wrote my last update at the beginning of May.  New York State is no longer the epicenter of the pandemic within the United States, and New York City is no longer the epicenter within the state.  Three other states, California, Florida, and Texas, now exceed New York in total number of cases, and many regions of the country are experiencing large surges.  By contrast, the average daily case numbers (now in the 650s) have continued to fall in New York State. The infection rate remains low, around 1% of those tested, with the transmission rate generally less than 1. The infection rate on August 1 was down by 11% from its level two weeks ago. Fortunately, there was no surge in Covid-19 cases despite  protests throughout the state, some still continuing, following the killing of George Floyd in Minneapolis on May 25^th.  The rest of the nation is now looking to New York as a model.

At the beginning of August, the United States is still the country with the most confirmed Covid-19 cases, totaling 4,749,000. The number of confirmed cases in the country is now nearly four times its level at the beginning of May. By contrast, New York State has about 423,000 confirmed cases (compared with 325,000 at the beginning of May) and NYC has 223,000 cases (compared with 180,000 cases on May 1).

The detailed requirements for moving the various sections of the state through the four phases of the reopening process have helped to avoid the surges accompanying reopening (or never closing down) elsewhere. Although New York City reached Phase 4 on May 20^th, indoor service at bars and restaurants has not yet been allowed to resume. Throughout the state, and particularly in the greater New York City area, summonses are being issued to business establishments that do not observe the rules and that allow crowds to congregate within or on sidewalks outside. Liquor licenses are revoked, and in some cases business are shut down. However, 9,000 restaurants have reopened in New York City and some 80,000 jobs have returned within the area.

It appears that New York’s response in terms of re-opening, and of social distancing, mask wearing, and testing, has been far more effective than measures taken in many other states. New York has the largest test and tracing structure of any state in the U.S. By August l, New York  had performed 6 million diagnostic tests.

Remaining Problems

The three-tiered (national, state, and local) governmental system in this large and diverse country can result in inefficiency, and almost certainly contributed to a lack of communication in the early stages of the Covid-19 pandemic. It still seems to be a factor in the failure to bring the pandemic under control nationwide, but coordination has also been greatly hampered by the President’s failure to provide coherent leadership. Although there are some disagreements within New York State between the governor’s office and local officials and between health authorities and local governments, New York has managed to prevent any major Covid-19 surge since descending from the peak in mid-April.

However, both New York State and many municipalities, including New York City, are facing serious financial difficulties. The projected 2020 deficit for the State is estimated at $13.3 billion with about $6 billion for New York City. Already the City has made a $2 billion cut in services. At present, relief from the Federal government for states and cities is still not forthcoming, with the U.S. Senate deadlocked in negotiations over enacting a bill that would not only extend the relief programs for individual families that expired on July 31st but would also provide direct aid to state and local governments. If this continues, services will have to be cut and/or taxes increased at both state and local levels in New York at a time when their economies are already suffering greatly. This is particularly worrying since Congress is about to begin its long summer recess.

In the United States, control of school systems is largely in the hands of localities, with some state regulations. Schools throughout New York State are now required to meet state-level health requirements before reopening in September.  In most cases this will result in a mixture of on-site in-class learning and virtual meetings. Many children will be attending school, not learning from home, but only for a few days per week. This means that the continuing problems of providing childcare and having the necessary equipment at home for on-line learning remain. This, of course, contributes to huge inequality in educational opportunity between lower and higher income households, and to the accompanying racial disparities.

New York’s Response to the Coronavirus Pandemic – Update (May 2020)

Shirley Johnson-Lans

Background Information on State of the Pandemic

It is now known that some early January Covid-19 cases in California were not correctly diagnosed (including two who had visited Wuhan, China) and that outbreaks on the East Coast were more related to travelers arriving from Europe. The latter are a different strain of the virus from that observed on the West Coast.  Whether this has implications for treatment or immunity is not yet known.

U.S. confirmed cases at the beginning of May exceed 1.2 million with more than 69,000 recorded deaths. New York State has more than 326,000 confirmed cases and deaths exceed 25,000.   New York City alone reports more than 180,000 confirmed cases and approximately 19,000 deaths. New York State seems to have passed a peak that occurred in mid-April.  The rate of new infections and hospitalizations are declining. Deaths per day have decreased from 799 to around 230, but the greater New York City area is still the epicenter of the pandemic. The proportion of those tested and found positive for Covid-19 hovers around 20 percent and has even risen slightly since the beginning of May.

These figures also underrepresent the true state of affairs since some non-hospital deaths have not been attributed to Covid-19, and many asymptomatic cases will never be recorded until there is more extensive testing.

Roughly 2/3 of the coronavirus deaths in New York occur in patients >75 years of age. A high incidence of infection in nursing homes contributes.  Despite improvements in diagnosis and isolation of cases within these institutions in New York State, continuing high incidence of Covid-19 is still a problem as is the high rate of infection among prison inmates.

There are significant racial disparities in the incidence of Covid-19.  One reason is that communities of color are overrepresented in high-risk essential occupations: workers in grocery stores, the transit system, health care, and emergency responders.  Crowded living conditions are a further contributing factor.

Surges are now occurring in many other U.S. localities, with clusters of cases in heartland communities with large meat processing plants. Many large metropolitan areas also have not yet experienced their Covid-19 peaks.  This is important as the nationwide stay-at-home directive expired on April 30^th and, despite not having met CDC guidelines, many states have begun to re-open.

Economic Consequences of the Pandemic

Unemployment in the United States has soared, with 30 million unemployment insurance applications filed in the last six weeks.  A bill allocating $484 billion in relief funds was passed by Congress April 24^th.   $320 billion is allocated to small businesses to continue to pay their workers; the Economic Injury Disaster Program provides $60 billion in loans and grants, $75 billion for hospitals, and $25 billion for virus testing.  Unfortunately, there is no allocation for state and local governments who are responsible for paying the wages of first responders, health care workers, police, and teachers.

Throughout New York many people are suffering from loss of income. The distribution of federal relief checks has been slow and uneven. New York City is expanding its program distributing food at schools to both children and adults. Throughout the State food pantries are straining to meet increasing demand.

Response of New York State to the Pandemic

The North East, under New York’s leadership, has formed a consortium of states (New York, New Jersey, Connecticut, Pennsylvania, Delaware, Massachusetts and Rhode Island) to coordinate their gradual re-opening and the provision of goods needed for health care and testing. Stay-at-home policies remain in effect until May 15^th after which restrictions in the greater New York City area may differ from those in areas experiencing a lower incidence of Covid-19. New York State guidelines require that restrictions remain in place until area hospitals are at no more than 70% of full capacity and the number of Covid-19 cases have declined for 14 days. Schools and colleges will remain closed throughout this school year.

Guidelines for re-opening emphasize the importance of continuing social distancing and state that re-opening of schools and workplaces requires more widespread testing, contact tracing, and isolation of those who test positive. Former Governor Michael Bloomberg has offered to oversee the tracing process for the New York area.  He will hire and train the “army” necessary to accomplish this task and develop the necessary software.  Johns Hopkins School of Public Health and CUNY and SUNY will assist. Mayor de Blasio has announced that NYC will partner with local companies to produce its own supply of nasal swabs (in short supply as they are mostly produced in Italy).

Governor Cuomo and Mayor de Blasio announce daily that the lessening in severity of the region’s pandemic has resulted from New Yorkers observing stay-at-home and social distancing rules, and that progress will be reversed if these restrictions are too quickly relaxed.

New York’s Response to the Covid-19 Pandemic – Original post (April 2020)

Shirley Johnson-Lans,
Prof. of Economics Emerita
Vassar College, Poughkeepsie, NY

Background: The Pandemic in the U.S. and New York State

The first confirmed case of Covid-19 was in Washington State (January 19^th) in a man returned from Wuhan, China.  It was widely believed that if travel to and from China were restricted, and those returning quarantined, the epidemic could be contained much as in the case of SARS.

Shortly thereafter, a nursing home in Kirkland, Washington had 4 coronavirus deaths, originally mistaken as influenza. Visitors and nursing home staff spread corona virus to the community.  Almost immediately, isolation, particularly of the elderly, was strongly recommended by county and state officials. At the beginning of March, Microsoft encouraged its workers to work from home.

On February 25^th, the mayor of San Francisco declared a state of emergency.  In early March, the San Francisco Bay Area began a shelter in place regime after two cases surfaced there on March 5^th.  A six-county lockdown was ordered on March 16^th.  All of California had strict stay–at-home orders by March 19^th.

In late February, a man employed in New York City and living in New Rochelle came down with Covid-19, diagnosed on March 3^rd. This was one of the first U.S. cases of community spread with source of first infection unknown. Over 1,000 people in New Rochelle were quarantined; a one-square mile area was cordoned off. The National Guard were called in to sterilize the area and distribute food.  This was the first quarantine of an area in the U.S.

On March 7^th, Governor Cuomo issued an executive order declaring a State of Emergency for the whole state.  On March 18^th amusement parks, bowling alleys, and shopping malls closed and all but essential businesses were ordered to reduce their work force by 50%.  On March 20^th the Governor issued a stay-at-home order, effective March 22^nd for the entire state and all non-essential businesses. Pharmacies, grocery stores, gas stations and restaurants limited to take-out-orders remained open. Social distancing required staying 6 feet away from others when outside one’s home; no assemblies including religious services were allowed. Schools closed on March 23^rd with remote learning beginning on March 30^th.  Schools became centers for food distribution to children. (As of April 2^nd, food is distributed to any adult showing up at a distribution center.) Computers were supplied to children needing one. Centers for children whose homes had no internet and daycare centers for children of essential workers were opened.

New York is presently the epicenter of the pandemic in the United States with 122,000 confirmed cases in the State and deaths approaching 4,000. New York City has 63,307 confirmed cases (2,254 deaths). The national count (evening, April 5^th) is around 330,000 confirmed cases, with 9,500 deaths.

There are surges in other states including New Jersey, Michigan, California, Massachusetts, Louisiana, and Florida, all with more than 10,000 cases.  In Louisiana the epicenter is New Orleans. Mardi Gras crowds undoubtedly contributed. Florida’s surge was probably related to its March Spring Break beach crowds.

The Health Care Response

Health care for Covid-19 patients has been handled primarily by the states, under the direction of their governors, with assistance from the federal government of funds and equipment supplied by FEMA and help from the U.S. military.

Gov. Cuomo has organized New York State’s public and private hospitals into one integrated system. Emergency hospital facilities have been rapidly built, greatly assisted by the Army Corps of Engineers. A two-thousand-five-hundred bed facility was created in the NYC Javits Convention Center. Medically equipped tents in Central Park and in such venues as the Tennis Center in Queens have been opened.  A U.S. Navy hospital ship sent from Maryland to help with hospital overflow is now docked in the Hudson River.

Although New York State has done more testing than most other states, there is still a shortage of diagnostic tests, testing equipment, and locations where people can be tested.

As New York City nears the estimated peak of the epidemic, supplies of equipment and medical personnel are dangerously low. Masks, face shields and gowns are in short supply for health care workers and first responders.  Some masks and ventilators are now being provided by the Federal government, states not yet facing crisis proportions, and charitable donations. However, it is anticipated that within days, all ventilators in the New York City area will be in use, and there will be a shortage of doctors and nurses, despite the addition of retirees, physicians with other specialties (dermatology, etc)  nursing and medical students, and out-of-state medical volunteers. There is also a serious shortage of first responders and ambulances, with many personnel out sick.

Economic Impact and Response

The economic impact is great throughout the United States. Unemployment rates are projected to be higher than at any time since the 1930s. The BLS reported that 3,300,000 people filed for unemployment benefits during the last week of March.

Congress has just passed two relief bills, one for $2.2 trillion, that provides an initial $1,200 per adult and $500 per child for all households with incomes up to $75,000. Unemployment benefits are expanded to cover more workers and provide an extra $600 per recipient. Help is provided to small businesses and vulnerable industries like airlines and to cities, states, and hospitals.

Evaluation of the Response to the Pandemic

There have been wide differences between states in stay-at-home and other directives, and lack of coordination in moving equipment and health care personnel around as different areas reach peaks of infection.  Nine states still have no statewide stay-at-home orders. Five have no orders in place even in major cities. The President has not issued a country-wide stay-at-home order despite the advice of Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases.

There is a major shortage in diagnostic tests, both those indicating Covid-19 positives and those indicating whether one has developed antibodies, essential if the stay-at-home orders are to be relaxed.  Essential equipment from N-95 masks to ventilators has been difficult to obtain. China has been a major source but orders are often delayed or cancelled, with the situation aggravated by price wars.  The overriding problem is lack of direction and coordination by the Federal government; in fact, there is competition between FEMA’s orders and those of individual states.

From the perspective of New York State, the response of the Federal government has been too little too late, with the President reluctantly coming to the conclusion that the U.S. faced a pandemic of epic proportions and even then being slow to act. He delayed invoking the Defense Production Act to order firms to produce the goods needed in this emergency.

The real heroes are the health care workers and first responders; governors of states like California, Washington, and New York; and experts like Dr. Fauci and Dr. Ezekiel Emanuel, University of Pennsylvania, who have spoken out to the American people giving them the scientific facts in plain language.

In retrospect, President Trump’s order to shut down the National Security Council’s entire Global Health Security Unit in 2018 was a disastrous error. The prescient message of Bill Gates’ 2015 Ted Talk, and his subsequent NEJM article, that preparedness for threats from disease pandemics is even more critical  to National Security than preparedness for possible military threats, now rings true.

Health Economics, Policy and Law serves as a forum for scholarship on health and social care policy issues from these perspectives, and is of use to academics, policy makers and practitioners. HEPL is international in scope and publishes both theoretical and applied work.