Unexpectedly Intriguing!
12 May 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....

Image credit: unsplash-logoMartin Sanchez


Update 23 March 2021: The explosion of Cuomo scandal news has prompted us to launch a new blog to host the timeline we had been updating regularly in this space! We officially launched the new site nearly a week ago. If you haven't yet seen it, may we introduce A Timeline of New York Governor Andrew Cuomo's Nursing Home Scandals.

The Governor Who Kills Grandmas?

Now serving all your Cuomo nursing home scandal news needs!

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