We can say with the certainty of hindsight that, yes, we should have shut New York City down quicker. I think all of us were slow in reacting to this threat in one way or another. I may have been a little earlier than others to call for a shutdown, but now I’m mostly focused on the ongoing crisis and the ways we’re not ready for the next step.
I’m not spending as much time looking backward.
At the moment, we are probably at the apex of the pandemic in New York City, though the data’s somewhat mixed. It took us a long time to get up to the apex, and it’s going to take us a long time to get down. But it’s not too soon to start building for the next phase. When we can get the number of cases down to a point at which we can start to identify every single one, trace contacts, offer to quarantine when helpful, and contain this — then we can begin to reopen the broader economy.
This is going to require an unprecedented new public health system that will expand testing all over the city, with a focus on low-income communities of color, which have not had equal access to testing until now. It will require thousands of people to work on contact tracing. It’ll require offering hotels to people who can’t remain safely at home and a new system to transport people with symptoms because they can’t ride mass transit safely. It will require a new system of telemedicine due to people quarantining at home. This is an enormous and expensive undertaking, and we’re going to need federal help to do it.
I certainly hope the federal government will fulfill its role at a time of national crisis and do what only it can do: organizing mass production of shortage materials — what we didn’t succeed in doing for ventilators or protective gear. New York City can’t work this out alone. We need the federal government.
Testing for the virus is the kind of thing you have to do on an ongoing basis. You could potentially test many people regularly — possibly even, in the case of health care workers, daily — because people can get infected at any point. We probably need to increase testing for the virus by 10 or 20 times where it is today. Even at today’s relatively low level of testing, we are running out of supplies.
There’s also a lot of promise in testing for antibodies, first and foremost because of an emerging treatment which is showing great promise. People who have recovered can donate blood plasma to people who are still in the hospital to help speed their recovery. If someone has the antibodies, then they’re eligible. We’re starting this in New York and it needs to be ramped up.
We want to be cautious about saying people have immunity if they’ve gotten sick because the science on this is not firm; there do appear to be cases of people who have gotten sick again. Understanding who has antibodies will be really important to reopening our economy. So we need to scale all of this up; we’re nowhere near where we need to be.
We desperately need more testing facilities in communities of color in New York City. We want to get to the point where any time people visit a doctor anywhere in the city, they can get a test. Certainly if they’re symptomatic, but maybe even if they’re not. We want to get to the point where everybody in sensitive professions like health care and transit can get testing regularly. Add it all up and this potentially could be 100,000 to 200,000 tests per day. We’re at 10,000 tests per day.
April’s going to continue to be brutal. We hope May will be somewhat better. It’ll be difficult, but potentially by as early as June we are going to be in a position to start some of these containment strategies. We have a lot of work to do between now and then. You’re going to have to retool manufacturing to produce swabs and reagents for testing. This can’t happen overnight, and the order still hasn’t come from the White House. We have to hire and train people to do contact tracing and build out the technology. There’s a long list of difficult work we have to do and time is really running short.
Reopening New York is not going to be like flipping a switch. This is going to be extremely measured and gradual and we’ll only take a step forward, even a baby step forward when we see progress in the health data. Until we have a vaccine — which certainly is not going to happen this calendar year and might still be a full 12 months away — we are going to have some measures in place that will be very different from life pre-pandemic.
If we can build the kind of system I described, and make progress in reducing new infections, we can take steps forward. This might include opening up beaches for the summer so that there is something of a safety valve at a time when we can’t do things like street fairs and summer camps. Currently, playgrounds are closed; they could open again based on where the data goes. Restaurants could potentially open in a limited, controlled fashion, where there are really strict rules around limiting the number of people and how closely they can be together. Some things — like a Celine Dion concert in Madison Square Garden — are pretty hard to imagine for the foreseeable future.
I do think it’s appropriate to begin to prepare people. This will not be quick. It will be slow, it will be measured, and it will probably be a long time till we return to the kind of life we had before this pandemic.
In cases where it’s not possible to physically distance, then we will likely be requiring — or at a minimum, suggesting — face-covering for the foreseeable future. Getting PPE to people in health care, obviously, but also people in supermarkets and laundromats and everyone doing essential work.
Mass transit is going to be a huge challenge. There’ll probably be a push to keep some folks telecommuting, if they can, in order to reduce pressure on transit. And we’re going to need a new system to transport people who have symptoms of the virus. A new system to move people around who have to get to a doctor’s appointment or who are being relocated to a shelter or somewhere else, a hotel where they can be protected from their family or to allow their family to be protected. We can’t have those folks on mass transit.
We’re going to have to resist the temptation, even though we’re in an absolutely brutal fiscal environment, to cut back on transit service because that means you’re going to have more people per bus or per train car. We understand the system is losing a huge amount of money and probably incurring extra expenses because of the virus.
This will not be quick. It will be slow, it will be measured, and it will probably be a long time till we return to the kind of life we had before this pandemic.
The real number of deaths in the city at this point is probably more like 15,000 — if you count those who are dying at home undiagnosed or who couldn’t access normal medical care. The number of people who have caught this virus in New York is probably 10 times the official positive test count, which today [Friday] stands at, I think, 117,000. So, I wouldn’t be surprised if we had 1.2 million people who have or have had this virus in New York City. This would give us a death rate of about a little under 1.5%. Death rates lag infection rates. The people who are passing away today probably got infected two, three, four weeks ago. So it seems like we may be at about a 1.5% fatality rate, which is not out of line with other countries.
If we do our job in containing in the next phase, then we are through the worst of it. But we have seen other parts of the world have had a round two. And there’s also the big unknown about how weather and climate impact this.
We need to take seriously the threat there could be a rebound of this virus if we don’t put measures in place to keep people safe. This is why we’re going to have to be extremely slow and cautious in reopening because if you do it too fast, the virus could come roaring back. I’m sorry to be a downer.
We expect antibody testing will be part of the strategy for reopening the economy. I caution everybody: Don’t think you have superpowers and can run around with no protection. There have been a limited number of cases, we believe, of people getting reinfected. People who have had Covid-19 probably have immunity and it probably will last for a fairly long time, one to three years. But we don’t know that for sure. And so, people like you and me are going to still have to wear face coverings in public and at least until we understand the science better.
As hellish as it has been and continues to be in New York, we may look back and feel like having gone through it earlier was an advantage. First, because there might be even more severe resource shortages in the future. And secondly, because we’re building immunity here. And other parts of the country which have largely been spared at this stage might be more vulnerable in a round two or, God forbid, round three.
It’s already an extraordinary economic shock to people’s personal livelihood, but also to the finances of the city and state. This is going to be equivalent to the Great Depression; this is not the 2009 financial crisis. We have no hope of pulling out of this without federal help. Both to individuals and small businesses who are suffering economically, but also to our state and city government, which are facing multi-billion-dollar shortfalls. We don’t have the ability to borrow to close this shortfall, nor should we. The federal government needs to do this.