Tuesday, March 24, 2020

Washinton Post on NYC and our Governor Today

NEW YORK — Gov. Andrew M. Cuomo berated the Trump administration's response to the coronavirus pandemic on Tuesday, saying his state will be overwhelmed with tens of thousands of critically ill patients in a matter of days and the U.S. government is just about out of time to prevent a public health disaster.

After portraying himself in recent weeks as a voice of relative calm in this anxious city, Cuomo's tone shifted to one of anger and unease as he announced that the rate of new cases in New York City and its suburbs now doubles every three days. As a result, New York health experts predict the state will need about 140,000 hospital beds to handle the crisis, exceeding last week's estimate by 30,000. Cuomo said Tuesday that the state has 53,000 existing beds.
The dramatic surge of new cases here prompted the White House on Tuesday to advise that anyone who has been in New York City recently should self-quarantine for 14 days if they travel elsewhere — even to the suburbs. Anthony S. Fauci, among those leading the Trump administration's response to the pandemic, said that 1 out of every 1,000 people in New York now have the coronavirus.

Cuomo (D) said the rate of new cases in New York — one of the first major American cities to close businesses and restaurants in a desperate attempt to slow the global contagion's spread — foreshadows the crippling influx of patients that cities across the country will also soon experience amid signs containment efforts did not begin soon enough.

"We are not slowing, and it is accelerating on its own," Cuomo said at a news conference at the Jacob K. Javits Convention Center in Manhattan, which is being converted into an urban field hospital. "One of the forecasters said to me, 'We were looking at a freight train coming across the country. We're now looking at a bullet train' because the numbers are going up that quickly."

Even as the number of coronavirus cases nationwide surpassed 50,000, President Trump and some conservative politicians and commentators have grown more anxious about the painful economic toll inflicted by the extreme social distancing measures public health officials have advised to try to slow the spread of the virus. For the second consecutive day, Trump suggested Tuesday that it's time to prepare for people to return to normal.

"We lose thousands and thousands of people every year to the flu," Trump said during a midafternoon town hall hosted by Fox News. "We don't turn the country off."

But Cuomo, whose visible response to the crisis has made him a leading voice for the nation's governors, made it clear Tuesday that he believes the United States is still a long way from ordering the widespread reopening of businesses, restaurants and entertainment venues.

"I understand restarting the economy . . . but focus on the crisis at hand," Cuomo said. "Focus on the looming wave of cases about to break in 14 days. . . . And to communities all across the country, [New York] is just the test case. Where we are today, you will be in three weeks, four weeks or six weeks. We are your future."

New York now has more than 25,000 coronavirus cases, including more than 15,000 in New York City. The state has added about 5,000 new cases per day, and Cuomo said he expects those trends to accelerate at least for the next 14 to 21 days.
At that point, New York health officials expect, hospitals in the state will need 40,000 beds for critically ill patients, including an additional 30,000 ventilators. The coronavirus causes covid-19, a respiratory illness, and some patients quickly deteriorate as they struggle to breathe.

For nearly a week, Cuomo and other governors have been urging the federal government to supply states with additional ventilators, saying the devices can keep critically ill patients from dying.

The federal government is estimated to have more than 10,000 machines in a reserve stockpile of ventilators, but governors have also urged the president to compel private businesses to manufacture the devices. Trump has appeared reluctant to fully utilize the powers afforded to him under the Defense Production Act, a Korean War-era initiative that allows the president to order companies to produce military and emergency supplies.

Even if private companies started producing the ventilators today, Cuomo said, it could take three to five weeks for them to arrive at New York hospitals.

"We need the ventilators in 14 days, and if we don't have ventilators in 14 days, it does us no good," Cuomo said.

Cuomo said the state has so far acquired about 7,000 ventilators from other sources. And on Tuesday morning, he said, the Federal Emergency Management Agency offered him 400.

"What am I going to do with 400 ventilators when I need 30,000?" the governor said. "You pick the 26,000 people who are going to do die because you sent only 400 ventilators?"

The president responded during his Fox News town hall, saying Cuomo and other officials in New York should have better prepared years ago for the possibility of a pandemic.

"He's supposed to be buying his own ventilators," Trump said. "We're going to help, but you know, if you think about — if you think about Governor Cuomo, we're building him four hospitals, we're building him four mobile medical centers, we're working very, very hard for the people of New York."

At the White House later, Vice President Pence said the federal government would "surge resources" to New York, including 4,000 additional ventilators, within the next 24 hours.
The day of escalating tension between Cuomo and the White House came as hospitals throughout the New York City region experienced an influx of covid-19 patients as essential equipment and protective gear remain in short supply.

Northwell Health, a hospital network with facilities throughout the city, had 700 covid-19 patients Tuesday, up from 40 a week ago, said Chethan Sathya, a pediatric surgeon.

"This is expected. This is what we're preparing for. As we test more and more people, more people will be positive, and more and more people will be hospitalized," said Sathya, adding the hospital is now testing about 4,000 per day.

At Maimonides Medical Center in Brooklyn, which has more than 700 beds, clinicians have prepared by setting up tents: two outside the emergency department for screening and a much larger tent on a city street where the hospital will add extra beds. Officials anticipate doubling capacity in the coming days, said Maimonides head of surgery Patrick Borgen. Beds at its cancer center, inpatient care and long-term nursing facility can also be used.

"We're almost seeing double the number of either suspected or proven patients every two to three days," Borgen said. He did not give specific numbers but said the hospital saw "dozens" of new cases in recent days.

"Right now, we are absolutely safe. We absolutely have the PPE, the personal protective equipment, that we need," Borgen said, referring to supplies such as masks, gloves and gowns. "We're planning for four days, five days, six days from now."

At the Javits Center, Cuomo announced the state was rushing the distribution of about 900,000 surgical masks, 350,000 gloves, 200,000 face shields and 145,000 protective gowns to hospitals throughout the state.

But Henry Garrido, director of District Council 37, the New York City municipal workers union that includes 40,000 first responders and 30,000 health-care workers, said those on the front lines continue to cobble together needed supplies — calling the situation "a travesty."

Because of the shortage of protective masks, Garrido said, social workers have been asked not to wear them in hospitals when interviewing patients, even if those patients had confirmed positive tests.

"We were told that they have to prioritize the masks for first responders and health-care workers," Garrido said.

About 150 first responders he represents are already sick and unable to work, Garrido said. City health-care workers, he added, have been told to keep working unless they develop symptoms, even if they've had contact with a person who is positive for the illness.

"This is, for me, bringing a lot of memories from September 11," Garrido said, when officials assured front-line workers the environmental hazards were minimal.

The surge in coronavirus cases in New York has extended into neighboring New Jersey, where Gov. Phil Murphy (D) announced an additional 831 cases and 17 deaths on Tuesday.

Maria Refinski, president of the New Jersey Nurses Union local in the outer New York suburbs, said her 1,500 members are "trying their best" to care for patients, but they understand "the surge is still coming."

"It's basically getting into a wartime mentality," said Refinski, whose members work in Essex and Ocean counties. "We are just trying to keep ahead of it, but we are already in it, and the government needs to get us supplies."

In recent days, health-care workers at local hospitals are using surgical masks and not N95 respirator masks for patients who do not have a confirmed coronavirus case, Refinski said. She said that puts workers at risk because patients still are unaware if they have the coronavirus when they arrive at hospitals.

"You are going to start to see more health-care workers getting sick," Refinski said.

New York Mayor Bill de Blasio also braced the city's residents for many difficult weeks ahead and joined Cuomo in pushing back at Trump's suggestion that life would start returning to normal by mid-April.

"April will unquestionably be worse than March," de Blasio said at an afternoon news conference. "And right now, my fear is that May could be worse than April. That is the reality we are facing."

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