Unexpectedly Intriguing!
May 12, 2020
COVID-19 - Martin Sanchez via Unsplash: https://unsplash.com/photos/Tzoe6VCvQYg

We're fascinated with how politicians use data and models in setting the policies they pursue, where knowing both what they knew and when they knew it can explain a lot about why they made the choices they did at the time they made them.

To that end, we've been paying attention to how Governor Andrew Cuomo has been managing the difficult task of coping with the coronavirus epidemic in New York, and in New York City in particular, which has been the focal point for both the number of cases and the spread of the SARS-CoV-2 coronavirus across the United States. We've assembled a timeline of Governor Cuomo discussing the predictive models for how fast the coronavirus infection would spread within New York, which provides insight into how that information affected his decisions for how to allocate the limited health care resources over which he had influence during the worst part of the epidemic in his state.

We're going to pick up the action shortly after 7 March 2020, the date Governor Cuomo declared a state of emergency because of the coronavirus epidemic in New York, when the number of coronavirus cases within the state had 'soared' to 89. The following article is the earliest in which we find a reference to coronavirus modeling projections for New York City, which had been put together by New York City Mayor Bill de Blasio's staff:

9 March 2020: Coronavirus Cases in New York State Rise to 105:

Mayor Bill de Blasio said Sunday that the city had 13 confirmed cases, including a new case of a man in the Bronx. Based on modeling, his team estimated there could be 100 cases in the next two or three weeks, but for most people, the illness would result in very mild symptoms.

Three days later, New York City had nearly reached that total and was set to blast through it, prompting Governor Cuomo to ban all public events with more than 500 people in attendance and to require gatherings with fewer than 500 people to cut capacity by 50%. The faster than previously projected growth in the number of COVID-19 infections drove a change in public policy.

Four days after that, Governor Cuomo had clearly been presented with projections that showed the exponential growth in the number of cases that had gotten underway in New York.

16 March 2020 - Audio & Rush Transcript: Governor Cuomo is a Guest on CNN's Cuomo Prime Time:

"I see a wave and the wave is going to break on the health care system ... You take any numerical projections on any of the models and our health care system has no capacity to deal with it."...

"Yeah. I think you look at that trajectory, just go dot, dot, dot, dot, connect the dots with a pencil. You look at that arc, we're up to about 900 cases in New York. It's doubling on a weekly basis. You draw that arc, you understand we only have 53,000 hospital beds total, 3,000 ICU beds, we go over the top very soon."

At this point, Governor Cuomo was beginning to appreciate that the thousands of hospital beds across the state of New York were really a scarce resource. He expanded on that realization the next day after an overnight surge in the number of reported cases:

17 March 2020 - Video, Audio, Photos & Rush Transcript: Governor Cuomo Announces Three-Way Agreement with Legislature on Paid Sick Leave Bill to Provide Immediate Assistance for New Yorkers Impacted By COVID-19:

"There is a curve, everyone's talked about the curve, everyone's talked about the height and the speed of the curve and flattening the curve. I've said that curve is going to turn into a wave and the wave is going to crash on the hospital system.

I've said that from day one because that's what the numbers would dictate and this is about numbers and this is about facts. This is not about prophecies or science fiction movies. We have months and moths of data as to how this virus operates. You can go back to China. That's now five, six months of experience. So just project from what you know. You don't have to guess.

We have 53,000 hospital beds in the State of New York. We have 3,000 ICU beds. Right now the hospitalization rate is running between 15 and 19 percent from our sample of the tests we take. We have 19.5 million people in the State of New York. We have spent much time with many experts projecting what the virus could actually do, going back, getting the China numbers, the South Korea numbers, the Italy numbers, looking at our rate of spread because we're trying to determine what is the apex of that curve, what is the consequence so we can match it to the capacity of the health care system. Match it to the capacity of the health care system. That is the entire exercise.

The, quote on quote, experts, and by the way there are no phenomenal experts in this area. They're all using the same data that the virus has shown over the past few months in other countries, but there are extrapolating from that data.

The expected peak is around 45 days. That can be plus or minus depending on what we do. They are expecting as many as 55,000 to 110,000 hospital beds will be needed at that point. That my friends is the problem that we have been talking about since we began this exercise. You take the 55,000 to 110,000 hospital beds and compare it to a capacity of 53,000 beds and you understand the challenge."

Faced with the potential shortage of needing 110,000 beds and only having 53,000 to provide care to coronavirus patients in New York, Governor Cuomo lobbied President Trump for support, which resulted in President Trump ordering the U.S. Navy's hospital ship USNS Comfort to sail to New York City the next day, and also lobbied for the U.S. Army's Corps of Engineers to begin identifying public facilities in New York City to be converted for use as temporary hospitals to handle the projected overflow of coronavirus patients from regular hospitals.

USNS Comfort would arrive in New York City on 30 March 2020, and the Army Corps of Engineers would have 1,000 beds ready at New York City's Javits Center ready on 27 March 2020, and were working to expand it to a 2,500 bed temporary hospital facility by 1 April 2020. But during the time in between, the updated projections of the coronavirus models led Governor Cuomo to panic.

24 March 2020: Andrew Cuomo: Apex of coronavirus outbreak in NY two or three weeks away:

Cuomo, speaking at his daily COVD-19 briefing in Manhattan, said the state's projection models now suggest the apex of the coronavirus crisis could hit New York within 14 to 21 days, rather than the 45 days the state projected late last week.

He likened it to a "bullet train" headed for New York, urging the federal government to deploy as many ventilators and as much protective medical gear it can to the state as quickly as possible.

"Where are they?" Cuomo said. "Where are the ventilators? Where are the masks? Where are the gowns? Where are they?”

At this point, we should show what one of the more influential coronavirus models that Governor Cuomo was using looked like. The following chart is taken from the Institute for Health Metrics and Evaluation (IHME)'s 25 March 2020 projections showing its estimates of the minimum, likely, and maximum number of additional hospital beds that would be needed in the state of New York to care for the model's expected surge of coronavirus patients.

IHME Forecast of All Hospital Beds Required for COVID-19 Care Beyond Available Capacity in New York State, Projection from 25 March 2020

This is just one of several coronavirus models whose projections were being combined and presented to Governor Cuomo by consultants from McKinsey & Co., where the IHME's coronavirus model's projections for New York are consistent with the figures and timing of a peak cited by Governor Cuomo in the days preceding his panic.

Faced with what appeared to be an imminent shortage of hospital beds and other medical resources, the Cuomo administration appears to have adopted an emergency triage strategy, one that would have devastatingly deadly consequences. Here, to free up as many beds as possible in New York's near-capacity hospitals, the Cuomo administration would try to move as many patients infected with the SARS-CoV-2 coronavirus as they could out of these facilities into others, even though they could still be contagious and present the risk of spreading infections within the facilities to which they would be transferred.

25 March 2020: The facilities in which they chose to place them were predominantly privately run nursing homes, where a directive issued by the state's Department of Health on 25 March 2020 mandated they must admit them into their facilities, where refusals could mean the loss of their New York state-issued licenses to operate.

New York Department Of Health Directive to Nursing Homes Mandating Admission of Coronavirus-Infected Patients, 25 March 2020

Flashing forward to the end of March 2020, the coronavirus epidemic forecast models Governor Cuomo was using in making his decisions were pointing to the peak still being ahead:

Cuomo said various predictive models being used by New York indicate the apex of the surge for hospitals will come anywhere from 7 to 21 days from now.

“The virus is more powerful, more dangerous than we expected,” Cuomo said. “We’re still going up the mountain. The main battle is on top of the mountain.”

Four days later, the coronavirus models were predicting the peak was almost upon New York:

While giving an update Saturday on the frantic work to ready New York hospitals for the most intense period of the coronavirus (COVID-19) crisis, Gov. Andrew Cuomo said that the state’s models put the so-called apex about four-to-eight days out.

“By the numbers, we’re not yet at the apex. We’re getting closer,” he said at his daily press briefing. “Depending on whose model you look at, they’ll say four, five, six, seven, days, some people go out 14 days. But our reading of the projections is that we’re somewhere in the seven-day range. Four, five, six, seven, eight-day range.”

“Part of me would like to be at the apex, and just, let’s do it,” Cuomo continued. “But there’s part of me that says it’s good that we’re not at the apex because we’re not yet ready for the apex, either. We’re not yet ready for the high point...the more time we have to improve the capacity, the better.”

But on 6 April 2020, the IHME model revised its estimates for New York and the U.S. downward, indicating the peak Governor Cuomo feared would overwhelm New York's hospitals was not going to come anywhere close to what it had previously projected. On 8 April 2020, it indicated New York had already passed its peak in number of daily new cases.

Ordinarily, that would be a good thing. Except, Governor Cuomo had taken an action by which he intended to avoid the spectacle of having pictures of sick New Yorkers not able to get medical treatment in the media, but instead ensured the state's death toll from its coronavirus epidemic would no longer be small. That part of the story has its own special timeline, which we've moved here from the bottom of the article where we had previously been piecing together this part of the story of COVID-19 in New York....

The Governor Who Kills Grandmas?

There's a series of extremely disturbing stories coming out from the state of New York related to Governor Cuomo's and his administration's handling of the coronavirus epidemic within the state's nursing homes for the elderly, where the administration's deliberate negligence appear to have greatly amplified the state's death toll from COVID-19. Here is a timeline of significant events related to the implementation of the state's deadly policy of placing sick COVID-19 patients in private nursing homes:

7 March 2020: Cuomo declares state of emergency in New York as state coronavirus cases soar to 89 - This article outlines one of the earliest actions Governor Cuomo took in addressing New York's coronavirus epidemic. In the following excerpt, he clearly knew that nursing home patients were uniquely at risk from coronavirus infections and was taking action to reduce their risks of exposure:

Nursing homes and senior living facilities in the New Rochelle area will be asked to suspend outside visitors, he said.

“Nursing homes are the most problematic setting for us,” given that the virus is most deadly for elderly and medically compromised patients, Cuomo said.

This article confirms Governor Cuomo has known the risks of coronavirus infection to nursing home patients from the very beginning of the coronavirus epidemic in the state of New York.

12 March 2020: Cuomo ends visitation at nursing homes to fight coronavirus - Governor Cuomo expanded his actions to protect nursing home patients to cover the entire state of New York. Note his statement:

Gov. Andrew M. Cuomo on Thursday suspended all visits to nursing homes as the spread of the coronavirus worsens statewide.

“This means no visitors in a nursing home,” Cuomo said. “If you care for someone in a nursing home, the last thing you want to do is endanger them.”...

“That is the most vulnerable population,” Cuomo said earlier this week. “It is the most dangerous situation faced by the virus … that’s my nightmare. You are going to see pain and damage from this in nursing homes.”

Indeed, that risk was also communicated in the official directive New York's Department of Health issued to nursing homes the next day. And the very last thing you would want to do is purposefully introduce the coronavirus infection into a nursing home. And yet, less than two weeks later....

25 March 2020: Governor Cuomo failed to protect the most vulnerable of our citizens by prohibiting Nursing Homes from denying re-admission or admission to patients that have tested positive COVID-19. - This 22 April 2020 tweet includes a copy of the 25 March 2020 directive the state of New York's Department of Health Services sent to nursing homes requiring them to admit patients infected with the SARS-CoV-2 coronavirus.

In retrospect, the 12 March 2020 order blocking the family members of nursing home patients from visiting them made what came later possible, because it blocked the consequences of the 25 March 2020 policy from becoming known to the public as quickly as it would have otherwise been, which enabled it to last longer than it might have otherwise.

26 March 2020: New York Mandates Nursing Homes Take Covid-19 Patients Discharged From Hospitals - The pushback from nursing homes fearing harm to their resident patients was immediate, as this article confirms. Here's a short excerpt:

A group representing doctors who work in nursing homes, known as AMDA, the Society for Post-Acute and Long-Term Care Medicine, said in a recent resolution that “admitting patients with suspected or documented Covid-19 infection represents a clear and present danger to all of the residents of a nursing home.”

“We’ve got an extraordinarily vulnerable population on our hands,” said Christopher Laxton, executive director of the group. Nursing homes’ older, often frail residents are particularly susceptible to the virus. Many nursing homes have also long struggled with infection control, according to federal inspection records and researchers.

The Cuomo administration cannot say they were not warned of the danger of their policy from the very time it was implemented.

29 March 2020: Cuomo says virus and nursing homes a ‘toxic mix’; 8,519 cases in Westchester - This is one of the earliest reports confirming that Governor Cuomo and his administration's public health officials were very well aware of the risk of their policy from a very early date. Note that this report came just 9 days after Governor Cuomo ordered New Yorkers to stay-at-home and business closures statewide. Also note that he was fighting President Trump's proposed quarantine of New York City and the surrounding counties (including in New Jersey and Connecticut) that have seen the highest rates of coronavirus-related infections and deaths in the U.S.

Here's a key quote from the article confirming Governor Cuomo knew what the consequences of placing contagious coronavirus patients in nursing homes were:

“This virus preys on the vulnerable. It preys on seniors. It preys on people with compromised immune systems and underlying illnesses. And coronavirus in a nursing home can be like fire in dry grass,” Cuomo said.

And so it was. It's not like this information wasn't known by the state of New York's top officials responsible for managing the state's epidemic response. They knowingly chose to do it anyway.

14 April 2020: Cuomo Raises Concern Over Growing Number Of Nursing Home Deaths - just a little over two weeks after the previous report, confirming the situation at nursing homes in New York was getting far worse, not better.

20 April 2020: Cuomo didn’t know coronavirus patients are being sent back to nursing homes - This is the first report where New York's media began actively challenging Governor Cuomo's and his administration on the actions they were taking during the epidemic in the state.

New York’s health commissioner on Monday defended a directive that requires nursing homes to readmit residents who’ve tested positive for the coronavirus — as Gov. Andrew Cuomo revealed he didn’t know the policy was in place.

Cuomo was asked about the state’s policy on admitting or readmitting to nursing homes people who’d tested positive for COVID-19.

“That’s a good question, I don’t know,” the governor said.

Cuomo’s startling admission came days after the state revealed last week that at least 3,316 people in nursing homes and adult care facilities had died of coronavirus at their residences or in hospitals across the state.

Based on the timeline of events and news reporting, our view is that Governor Cuomo's claim is almost certainly false. We also think it is highly unlikely that New York's public health officials would implement such an obviously high risk policy that so contradicted their previous policy and statements made by the governor on their own without the governor's tacit, if not explicit, approval.

21 April 2020: Andrew Cuomo’s coronavirus nursing home policy proves tragic: Goodwin - Michael Goodwin's column explores how Governor Cuomo and his administration's policies of deliberate neglect cost the life of a grandmother, providing a human anecdote to go along with the cold, hard data.

22 April 2020: Gov. Cuomo says ‘it’s not our job’ to provide PPE to nursing homes - This article reveals Governor Cuomo's apparent contempt for elderly New Yorkers and confirms his administration saw no problem with diverting resources like protective personal equipment from the nursing home facilities the state regulates and which they knew were at very high risk to directly benefit state and local government employees. If you want to know what life would be like under a Medicare for All single-payer health care system, this should tell you everything you need to know about how the people who would run such a system would choose to allocate resources within it in making life-and-death decisions.

23 April 2020: Coronavirus patients admitted to Queens nursing home — with body bags - This is easily the most disturbing report to come out of New York with respect to Governor Cuomo's and his administration's coronavirus epidemic policies. Here's the introduction:

The first coronavirus patients admitted to a Queens nursing home under a controversial state mandate arrived along with some grim accessories — a supply of body bags, The Post has learned.

An executive at the facility — which was previously free of the deadly disease — said the bags were in the shipment of personal protective equipment received the same day the home was forced to begin treating two people discharged from hospitals with COVID-19.

“My colleague noticed that one of the boxes was extremely heavy. Curious as to what could possibly be making that particular box so much heavier than the rest, he opened it,” the exec told The Post Thursday.

“The first two coronavirus patients were accompanied by five body bags.”

That's quite an indication what state officials expected would happen from the implementation of the Cuomo administration's policy. If that is indeed how the policy was implemented, it's no wonder Governor Cuomo is seeking to deflect attention away from it, which perhaps explains the next headline....

23 April 2020: N.Y. Gov. Cuomo says state nursing homes will be investigated - But only privately-run nursing homes. Nursing homes run by the state of New York will not be investigated. Oddly enough, Governor Cuomo also did not initiate an investigation of his administration or its policies.

24 April 2020: Cuomo: 'Nobody's to blame' for NY nursing home COVID-19 deaths - Phrased differently, Governor Cuomo denies personal responsibility for himself and his administration for any COVID-19 nursing home deaths. Also, what does this say about Governor Cuomo's 'investigation' when the governor has conveniently pre-determined its outcome?

25 April 2020: Coronavirus spreads in a New York nursing home forced to take recovering patients - This article directly links coronavirus deaths in New York's nursing homes to the policy the state implemented a month earlier prohibiting the nursing homes from denying admission to contagious patients. The policy is described as "reckless and careless" by a health care worker.

26 April 2020: Cuomo doubles down on ordering nursing homes to admit coronavirus patients - this article reveals how Governor Cuomo refuses to allow challenges to the state government's authority in requiring nursing homes to admit coronavirus-infected patients.

The governor — who himself has described nursing homes as a “feeding frenzy’’ for the deadly coronavirus — said that the facilities can’t challenge a state regulation forcing them to admit patients with the contagion.

But he insisted that nursing homes could transfer those ill with the virus to another facility if the centers lacked such things as quarantine space, proper protective equipment and staff.

Asked by a reporter at his daily briefing Sunday if there was anything contradictory about his statements, the governor replied, “No.”

How did that work in practice?

The CEO of a hard-hit Brooklyn nursing home, where 55 patients have died from the coronavirus, told The Post last week that he’d been warning state Health Department officials for weeks he had staffing and equipment issues — yet received little help.

“There is no way for us to prevent the spread under these conditions,’’ the head of the Cobble Hill Health Center, Donny Tuchman, wrote in an e-mail to the department on April 8.

He said he asked to move some patients to the makeshift wards at Manhattan’s Javits Center and aboard the city-docked USNS Comfort amid the pandemic, only to be told those two spots were receiving only patients from hospitals.

“I made specific requests to transfer patients, and it didn’t happen,’’ Tuchman told The Post. “There weren’t options.”

The article also reports that state health officials "conducted a focus study" of the facility and determined it had sufficient resources in their view to justify rejecting the nursing home's CEO's requests to transfer patients, finding they had plenty of masks and gloves. The article doesn't indicate what they thought of the staffing or other issues cited by the facility in their requests.

There's enough information here to indicate New York's top health officials were effectively implementing a triage strategy with the primary objective of reducing what they anticipated would be the peak load of coronavirus patients on hospitals directly at the expense of privately-run nursing homes, as confirmed by the transfers of patients known to be carriers of the coronavirus from hospitals to nursing homes, along with body bags. That the facilities they designated to take on overflow patients from hospitals went almost completely unused confirms they badly misjudged what the peak load would be.

27 April 2020: Cuomo blames his refusal to help coronavirus-hit nursing home on Navy protocol - Why didn't Governor Cuomo send uninfected nursing home patients to the U.S.S. Comfort, the naval hospital ship sent by the U.S. Navy to take the load off New York City's nursing homes? This article shows his attempt to deflect personal culpability and blame the Navy's policies along with the management of the non-profit nursing home that was overloaded with coronavirus patients because of his administration's policies.

28 April 2020: Cuomo Claims He Didn’t Know About New York Rule Forcing Nursing Homes To Accept Elderly With COVID-19 - There's not much new information on Governor Cuomo's COVID-19 nursing home scandal in this article, but it indicates that both California and New Jersey implemented similar rules as New York's to force nursing homes to accept coronavirus patients. Separately, over 3,000 coronavirus infection-related deaths have occurred at nursing homes in New York.

29 April 2020: Requiring NY Nursing Homes to Accept COVID Patients Caused Deaths - In addition to revealing a potential motive for why Governor Cuomo's administration put nursing home patients at risk with its reckless policy (fearing a surge in COVID-19 patients that could overwhelm hospitals predicted by the IHME model, which is proving to be far from accurate, the Cuomo administration effected a 'triage' policy, with nursing homes the designated losers), this article also reveals the state had fined several of the nursing homes at which it place infected coronavirus patients for unsanitary conditions as recently as earlier this year.

In other words, New York's state regulators already knew these facilities would place nursing home patients at extremely high risk because they had already faulted them for conditions that would be conducive to spreading a viral infection. Then New York state officials required these facilities to accept patients infected with the coronavirus. Then the same New York state officials refused to transfer patients the nursing homes, lacking the resources and environment needed to provide proper care, requested be moved to facilities that could.

29 April 2020: New York let coronavirus-infected nurses work in upstate nursing home - This may be the second most disturbing news story to come out from New York. Here's the introduction:

The state Health Department allowed nurses and other staff who tested positive for the coronavirus to continue treating COVID-19 patients at an upstate nursing home, The Post has learned.

State officials signed off on the move during an April 10 conference call that excluded local officials from Steuben County, who protested the move, according to a document provided by the county government’s top administrator, Jack Wheeler.

At least 15 people have died at the Hornell Gardens nursing home in the tiny town of Hornell since the outbreak, according to county tallies. State records show just seven deaths across the county and include no data about this home.

Allowing staff known to have tested positive for carrying the deadly coronavirus and at high risk of being contagious continue working to provide care to nursing home patients is the equivalent of knowingly allowing a serial killer the freedom to move from victim to victim. This isn't just a reckless policy, it may qualify as either manslaughter or criminally negligent homicide on the part of those who gave the green light to make this happen.

29 April 2020: State Ends Policy Allowing COVID-Positive Nursing Home Staffers to Work - It didn't take long for New York's public health officials to rescind their policy of allowing health care by coronavirus-infected nursing home staff after it was exposed. Meanwhile, the state's policy of requiring nursing homes to admit coronavirus-infected patients remains in force.

1 May 2020: States ordered nursing homes to take COVID-19 residents. Thousands died. Here’s what happened - New York wasn't the only state that forced nursing homes to admit known coronavirus-infected patients without ensuring they were equipped to handle them. This article counts up the associated deaths and describes a large number of actions now being taken that should have been implemented from the beginning.

3 May 2020: Faced with 20,000 dead, care homes seek shield from lawsuits - This article looks at the lobbying effort nursing homes have launched to protect themselves from lawsuits related to the coronavirus deaths they have incurred, which total nearly a third of all deaths attributed to COVID-19 in the U.S. The portions of the article that address New York are telling:

At least 15 states have enacted laws or governors’ orders that explicitly or apparently provide nursing homes and long-term care facilities some protection from lawsuits arising from the crisis. And in the case of New York, which leads the nation in deaths in such facilities, a lobbying group wrote the first draft of a measure that apparently makes it the only state with specific protection from both civil lawsuits and criminal prosecution.

Why is New York so different in protecting nursing homes from criminal prosecution? The article goes on to describe Governor Cuomo's relationship with the nursing home industry after describing the efforts of the industry to gain immunity protections in recent years, which looks like the industry's lobbyists have been actively engaged in providing funds to support the governor's political priorities:

Nowhere have the industry’s efforts played out more starkly than in New York, which has a fifth of the nation’s known nursing home and long-term care deaths and has had at least seven facilities with outbreaks of 40 deaths or more, including one home in Manhattan that reported 98.

New York's immunity law signed by Democratic Gov. Andrew Cuomo was drafted by the Greater New York Hospital Association, an influential lobbying group for both hospitals and nursing homes that donated more than $1 million to the state Democratic Party in 2018 and has pumped more than $7 million into lobbying over the past three years.

New York's immunity law, the Emergency Disaster Treatment Protection Act (EDTPA), was enacted on 20 April 2020, just as New York's coronavirus nursing home scandal began blowing up in the news. Since New York is uniquely alone in the nation at this point in shielding nursing home operators from prosecution for coronavirus-related deaths resulting from criminal negligence, it looks like the industry lobbyists have successfully used the additional leverage that the Cuomo administration's scandalous actions have provided them to get something they haven't been able to get elsewhere. Since New York wasn't the only state that allowed the practice, it will be interesting to see what happens on this count in the others, such as New Jersey and California.

4 May 2020: Pataki slams Cuomo, calls for investigation into nursing home deaths amid coronavirus - The former governor is calling for an independent investigation of the scandal, the Cuomo administration is resisting.

5 May 2020: Another 1,700 Virus Deaths Reported in NY Nursing Homes - according to this article, 4,813 nursing home residents have died from COVID-19 in New York overall since 1 March 2020, or about a quarter of the 19,415 deaths in the state at this point.

5 May 2020: Coronavirus Toll: ‘Absolutely Horrifying’ Surge Of 98 Dead At NYC Nursing Home - this article puts paid to Governor Cuomo's claim (see 26 April 2020) that state officials only put coronavirus-infected patients into nursing homes filled with high-mortality risk elderly patients if they had sufficient resources to care for them and could protect patients from exposure to the coronavirus. Here's an excerpt:

“Isabella, like all other nursing homes in New York City, initially had limited access to widespread and consistent in-house testing to quickly diagnose our residents and staff,” Audrey Waters, a spokeswoman for the nursing home, wrote in an email. “This hampered our ability to identify those who were infected and asymptomatic, despite our efforts to swiftly separate anyone who presented symptoms.”

Isabella also encountered staffing shortages, prompting it to hire from outside agencies and early challenges securing personal protective equipment for employees. Waters said the home finally is “getting more access to testing” now.

Apparently, nursing homes needed more than a week's supply of masks and gloves that state officials would seem to have believed was all that was necessary to care for the COVID-19 patients the state mandated they admit into their facilities.

6 May 2020: SEE IT: At least 20 bodies removed from Harlem nursing home during coronavirus pandemic, though state data only shows five COVID-19 deaths - This article (and video) suggests the death toll in New York's nursing homes is being greatly understated by state officials. It also points out that many deaths being reported in hospitals may be traced to infections that occurred in the state's nursing homes, which would also understate the extent to which nursing home patients are contributing to the state's coronavirus death toll.

7 May 2020: Cuomo's Nursing Home Investigation May Present "Conflict Of Interest" - This article discusses the inherent conflict of interest that exists in how Governor Cuomo's investigation of nursing homes has been set up as a joint affair between the state attorney general, a member of Governor Cuomo's political party, and the state's Department of Health, which oversees and regulates the state's nursing homes, and which is being exempted from being a target the investigation, even though its role in forcing nursing homes to admit contagious coronavirus patients and in allowing infected nursing home staff to remain on the job contributed to the large and growing death tool at the state's nursing home facilities.

9 May 2020: NY’s Cuomo criticized over highest nursing home death toll - This PBS News Hour article provides some damning figures, which to put into perspective, we'll note that Johns Hopkins is reporting a total 77,180 deaths for the entire United States through 8 May 2020, with 26,243 of them in the state of New York. Here's an excerpt:

Of the nation’s more than 25,000 coronavirus deaths in nursing homes and long-term care facilities, more than a fifth of them — about 5,300 — are in New York, according to a count by The Associated Press, and the toll has been increasing by an average of 20 to 25 deaths a day for the past few weeks.

“The numbers, the deaths keep ticking up,” said MaryDel Wypych, an advocate for older adults in the Rochester area. “It’s just very frustrating.”

Across the U.S., the 25,000+ deaths attributed to COVID-19 that have occurred in nursing homes and other long-term care facilities represent at least 32% of the nation's total death count, with deaths in the state of New York's nursing homes resulting from Governor Cuomo's policies alone contributing nearly 7% of the national total.

These figures are almost certainly underestimates, where we suspect they do not fully reflect deaths that occurred among New York's nursing home patients who became infected thanks to the Cuomo administration's policies, who were subsequently transferred to hospitals where they passed away. One nurse describes Governor Cuomo's policies as "irresponsible, negligent, and stupid".

Meanwhile, at least 38% of all 9,116 lab-confirmed COVID-19 deaths in New Jersey occurred in that state's nursing homes and long term care facilities. Having followed the Cuomo administration's lead in forcing the state's nursing homes to admit infected patients beginning on 31 March 2020, the state has seen 97% of its coronavirus-confirmed deaths in the period since. Following Governor Cuomo's lead in exposing high-mortality risk patients to the coronavirus is proving especially deadly.

10 May 2020: Cuomo orders biweekly coronavirus tests for nursing home workers - This article reveals that Governor Cuomo has finally acted to make COVID-19 testing of nursing home staff a regular practice. Wait, what? Why wasn't this done in any of the 64 days that have elapsed since the governor declared a state of emergency for the coronavirus epidemic in New York and began block family members from visiting nursing home patients?

10 May 2020: Andrew Cuomo FINALLY Reverses Order Forcing Nursing Homes To Take COVID Patients, Demands Testing For Care Workers - Meanwhile, 46 days after the Cuomo administration's infamous order was issued, which proved to be the equivalent of throwing lit matches on "dry grass", Governor Cuomo has decided to stop it. Governor Cuomo has officially overruled the state's Department of Health 25 March 2020 directive by executive order, though the Department of Health has not yet issued its own new directive or guidance for nursing homes to follow it, we presume state officials will comply with it.

10 May 2020: Gov. Cuomo admits he was wrong to order nursing homes to accept coronavirus patients - If you've followed the links above, the New York Post has largely owned the story on the Cuomo administration's coronavirus nursing home scandal. In this editorial, they recap the coverage that forced Governor Cuomo to end his deadly policy. They've left one question unasked as yet: What compelled Governor Cuomo and his administration to completely contradict their previous statements and adopt it knowing the likely consequences of it in the first place? Our working hypothesis for answering that question is presented above.

11 May 2020: The Real Center of the Pandemic - This article reveals nursing homes to be the true 'ground zero' of the pandemic in the state of New York, accounting for 22% of confirmed cases despite representing less than 1% of the state's population.

Update 12 May 2020: Here's an annotated chart showing the rolling 7-day total of confirmed cases and deaths attributed to COVID-19 in the state of New York. Here is the source for the referenced data for nursing homes cases and deaths.

New York Rolling 7-Day Total Number of Newly Confirmed Cases and Deaths Attributed to COVID-19, 17 March 2020 through 12 May 2020

Why a rolling 7-day total? The daily data shows a cyclical pattern, with the numbers dipping every seven days, coinciding with weekends when many state and local government officials aren't working. Presenting the rolling 7-day counts smooths out that source of day-to-day volatility in the reported data.

Meanwhile, there are new calls for an independent investigation of the Cuomo administration's policies by state legislators, including calls for a federal investigation, which would resolve the conflict of interest issues inherent in the state attorney general's limited investigation.

Finally, we've also updated the second entry for 10 May 2020 to add a minor clarification and to improve its overall readability.

Update 15 May 2020: EXCLUSIVE: New York Admits Knowingly Undercounting Nursing Home Deaths After Quietly Changing Reporting Rules - There is no longer any question of whether New York has been deliberately understating the number of deaths related to the Cuomo administration's coronavirus nursing home scandal:

New York’s coronavirus tracker “currently does not include out of facility deaths,” NYSDOH spokeswoman Jill Montag told the DCNF. “Deaths of nursing home and adult care facility residents that occurred at hospitals is accounted for in the overall fatality data on our COVID-19 tracker.”

In other words, New York’s nursing home and adult care facility coronavirus deaths tracker omits any individuals who contracted coronavirus while living at a long-term care facility but died in a hospital.

The DCNF has confirmed our observation from 9 May 2020 (see above). Or if you don't want to scroll up that far, check out the chart with 12 May 2020's entry. Based on what other states in the northeast are reporting for the infection rate within their nursing homes and long term care facilities, we think New York's count for the number of confirmed coronavirus cases within its elderly care facilities are off by a factor of about 5.

Update 17 May 2020: Cuomo says "nobody" should be prosecuted in N.Y. for deaths caused by coronavirus. Here's the video from CBS News:

Perhaps by "nobody", he's referring to himself, his administration, and the state's public health officials, who he already effectively exempted from investigation back on 7 May 2020. On the other hand, if he's wondering what state law might apply to the people involved, we would suggest New York Penal Law Section 125.10, for criminally negligent homicide, might be somewhat relevant, if not Section 125.20 (manslaughter in the first degree).

A deadly coronavirus infestation of New York's nursing homes certainly wasn't "inevitable". Not until the Cuomo administration's policy went into effect.

Update 19 May 2020: NY didn’t count nursing home coronavirus victims for weeks; then, a stumbling rush for a death toll - there's an old saying among quality engineers: "What gets measured gets done". This article reveals that New York's public health officials weren't measuring COVID-19 infection at nursing homes and other long term care facilities in the state, which is to say they were blind to their plight (because they weren't even asking until 17 April 2020) and to the deadly crisis they had unleashed within them. Bureaucracy kills through negligence.

The article also presents a chart showing New York's coronavirus deaths by age group. Here's our adaptation of the chart:

20 May 2020: Gov. Cuomo: ‘Ask President Trump’ about nursing home deaths - This article reports on Governor Cuomo's attempt to blame President Trump for nursing home deaths that occurred as a direct result of his state's policy. He claims the guidance the CDC issued is at fault, but if that were true, we would have seen COVID-19 infected patients transferred from hospitals to nursing homes in all states, instead of just a handful, like New York, New Jersey, Minnesota, Michigan, Pennsylvania, and Illinois, to name the worst offenders. Meanwhile other states following the exact same CDC guidelines adopted effective safeguards to prevent the contagion from spreading into nursing homes. New York Representative Elise Stefanik provided a rather complete refutation of Governor Cuomo's claim.

22 May 2020: AP count: Over 4,500 virus patients sent to NY nursing homes - This article delves into just how many contagious patients New York officials transferred from hospitals to nursing homes, where they would infect staff members, and subsequently, highly vulnerable patients.

23 May 2020: Cuomo still defends policy of filling nursing homes with coronavirus patients - This article details Governor Cuomo's continued attempts to avoid taking personal responsibility for the deadly order mandating nursing homes admit patients known to be infected with the coronavirus by blaming both President Trump and guidance provided by the CDC for his administration's actions.

25 May 2020: “We All Failed”— The Real Reason Behind NY Governor Andrew Cuomo’s Surprising Confession - It took until Memorial Day for Governor Cuomo to acknowledge the models he and other public officials relied upon in setting policy was wrong. Here are excerpts from Cuomo's comments at the news briefing that took place on the U.S.S. Intrepid museum in New York City (emphasis ours):

"Now, people can speculate. People can guess. I think next week, I think two weeks, I think a month. I'm out of that business because we all failed at that business. Right? All the early national experts. Here's my projection model. Here's my projection model. They were all wrong. They were all wrong.

"There are a lot of variables. I understand that. We didn't know what the social distancing would actually amount to. I get it, but we were all wrong. So, I'm sort of out of the guessing business, right?”

Unfortunately, much of Governor Cuomo's more recent actions are consistent with his seeking to muddy the waters in a deliberate efforts to avoid personal responsibility for costing the lives of thousands of elderly New Yorkers, where a full accounting of nursing home residents impacted by his decisions based on the models would cover over 10% of the names listed on the front page of the 24 May 2020 Sunday edition of the New York Times to represent all the COVID-19 deaths in all the U.S.

26 May 2020: Order Forcing Nursing Homes to Take Covid Patients Scrubbed from N.Y. State Website - This report reveals New York's Department of Health has removed its deadly order mandating nursing homes admit coronavirus-infected patients from its web site (it was linked here). Fortunately, others made a point of preserving multiple copies of the order at the Internet Archive.

26 May 2020: Betsy McCaughey: Cuomo nursing home scandal – Deaths likely closer to 10,000 and it gets worse - The former lieutenant governor of New York and the current chair of Committee to Reduce Infectious Diseases, a public advocacy group who seeks to reduce the incidence of preventable infections at U.S. hospitals, who has been serving in that role for several years, estimates the death toll from New York's deadly coronavirus nursing home scandal could be around double the state's current figures if the number of patients who were transferred from nursing homes to hospitals before dying were correctly added to the state's official death toll from nursing homes.

27 May 2020: New Yorkers disapprove of Gov. Cuomo’s handling of nursing homes: poll - News detailing Governor Cuomo's delinquency in addressing the spread of the coronavirus epidemic in New York and is recent attempts to deflect responsibility for his state's policy forcing nursing homes to admit contagious coronavirus patients by blaming both President Trump and the CDC for it is starting to hurt his standing in public opinion polls.

27 May 2020: Andrew Cuomo gave immunity to nursing home execs after big campaign donations - This article from the Guardian, a left-wing UK newspaper, connects the dots between campaign contributions from the state's government-regulated nursing home industry and the immunity from law suits for coronavirus deaths they were awarded just prior to the growing number of coronavirus deaths directly resulting from Governor Cuomo's deadly policies became a major scandal.

27 May 2020: How is Gov. Cuomo Not Guilty of Involuntary Manslaughter? - This analysis considers what federal laws Governor Cuomo and New York's chief public health officer, Howard Zucker, may have violated in New York's coronavirus nursing home scandal. Here's the conclusion:

Given the state of knowledge on March 25, when Cuomo and Zucker enacted their policy, it is fair to say that New York’s policy amounted to a death sentence for many nursing home residents — deaths that would not have occurred but for this policy. And it is fair to say that both Cuomo and Zucker knew it. It is also textbook involuntary manslaughter. 18 U.S. Code § 1112, defines the federal crime of Manslaughter as the commission, “without due caution and circumspection, of a lawful act which might produce death.” The President should invite the AG to begin an appropriate investigation.

There's also the matter of how long the policy was allowed to continue after New York passed its peak in hospital resources being consumed because of the coronavirus epidemic, when the faulty reasoning that prompted state officials to initiate the policy no longer applied, which also appears to satisfy the federal legal definition for manslaughter. The sooner a federal investigation is mounted, the better.

28 May 2020: The Most Important COVID-19 Statistic: 43% Of U.S. Deaths Are From 0.6% Of The Population - The "0.6%" of the population referred to in this headline is the percentage of Americans who live in nursing homes and other assisted-living facilities. This article features some of the better analysis we've seen on the topic and contrasts the approaches taken by the governors of Florida and New York in following the CDC's guidelines as respective examples of what to do and what not to do in protecting residents of nursing homes from viral infections. The authors note that the "43%" figure in the headline would be considerably higher if New York's public officials were more honest about where patients who were counted as dying in hospitals from COVID-19 were exposed to the virus.

29 May 2020 States Are Copying and Pasting Immunity Laws for Nursing Home Executives - This article is not directly about New York but discusses the pay-for-play politics the nursing home industry used to secure its "get out of jail" pass from Governor Cuomo as the coronavirus epidemic raged in New York, where New York's law exempting nursing homes from lawsuits for fatally exposing residents to the viral infection has become the template for similar laws in other states. Corruption, it seems, spreads like a virus.

Image credit: unsplash-logoMartin Sanchez

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