'In search of the apex and the other side of the mountain': The coronavirus has killed more than 4,100 New Yorkers in just over a month, and the worst is still to come
- The coronavirus has wreaked havoc in New York, infecting more than 122,000 people - more than China's reported total - and killing over 4,100.
- Gov. Andrew Cuomo has shut down schools, put the city on pause, closed non-essential businesses, ramped up testing, and created makeshift hospitals.
- In the month since New York's first coronavirus case was reported, though, hospitals have been overrun. Morgues are filling to capacity, medical resources are falling short, and frontline healthcare workers are facing "apocalyptic" scenes.
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In New York City, officials have commandeered three iconic landmarks - Central Park, the Javits Convention Center, and the National Tennis Center - and erected medical tents and hospital cots in these spaces.
The symbolism couldn't be more unsettling: Places known for bringing throngs of people together have become triage sites as the city struggles with its rapidly escalating coronavirus case count and death toll.
The United States is the new epicenter of the coronavirus pandemic, with at least 312,400 cases - that's one in five of all COVID-19 cases worldwide - and over 8,500 deaths. New York state is one of the hardest-hit areas, with 122,000 patients - more than all of China has reported - and at least 4,159 deaths.
The state's hospitals are inundated, morgues are overflowing, and exhausted medical workers, forced to don trash bags due to a lack of protective gear, are testing positive for the coronavirus themselves. At least three nurses, a well-known pediatric neurosurgeon, and an ER doctor have died.
All this in just over a month.
The coronavirus is "truly vicious," New York Gov. Andrew Cuomo said at a press briefing on Sunday. He described the illness as an "effective killer."
Here's how COVID-19 ravaged New York so quickly.
An outbreak in the suburbs
The earliest reports of coronavirus cases emerged in China in late December, though experts think it had likely already been circulating there for about a month. The disease has since spread across Asia, Europe, and the US: More than 1.2 million people have been infected, and the death toll has crossed 65,700.
New York's first confirmed case, reported on March 1, was a healthcare worker in her 30s who'd returned from a trip to Iran. Its second was 50-year-old Westchester County man, Lawrence Garbuz, who works at a law firm with offices near Grand Central.
Garbuz, who fell ill around February 27 and tested positive on March 2, was New York's first case of community spread: He had neither traveled to any countries with severe outbreaks, nor had he been exposed to a coronavirus patient.
The town of New Rochelle, where he lives, became the state's first hotspot. Officials asked 1,000 people to quarantine themselves, and Gov. Andrew Cuomo imposed a 1-mile containment area around a synagogue where more than 100 families had come into contact with Garbuz.
Cuomo, however, has said neither of these patients were likely the true first in the state.
"I have no doubt that the virus was here much earlier than we even know," and before it reached any other state, he said.
When strengths became weaknesses
Many consider New York City's constant motion and high density to be among its greatest strengths, along with its residents' reliance on public transit.
At the same time, "that spatial closeness makes us vulnerable," as Cuomo said.
The coronavirus spreads easily from person to person when individuals come within 6 feet of each other - something hard to avoid in New York City, given that it houses 27,000 people per square mile. Infected people can transmit the virus for days before showing symptoms. Some carriers remain asymptomatic the whole time.
What's more, the virus can survive for 72 hours on metal railings and plastic seats like those in subways and buses.
After its first two confirmed cases, New York City's numbers shot up: There were 88 on March 12, then 464 by March 16. The total passed 2,000 on March 18, and by March 20, there were more than 5,600 cases. The 10,000-case threshold came less than two days later.
Cuomo declared a state of emergency on March 7, then banned gatherings of over 500 people five days later.
Restaurants, Broadway shows, the Metropolitan Museum of Art, and other Manhattan landmarks were shuttered to promote social distancing and slow the virus' spread to "flatten the curve" so healthcare systems wouldn't get overwhelmed.
But it all seems to have come too late.
'Four months, six months, nine months'
More mass closures soon followed.
New York state schools shut down on March 15; Cuomo put the whole city on pause a week later, shutting down non-essential businesses and issuing a stay-at-home order.
"This is not a short-term situation ... It is going to be four months, six months, nine months," he told reporters.
Subway stations became deserted. Bodega shelves were emptied. Children and parents in New York faced an unfamiliar situation: staying at home around the clock, indefinitely.
The lockdown is a "double whammy," Cuomo has said, because New York state is on track to lose $10 to $15 billion in revenue because of the costs of fighting the virus. But there's no other choice: Cuomo has projected that 40% to 80% of the state's residents will likely contract COVID-19.
"All we're trying to do is slow the spread. But it will spread - it is that contagious," he said.
On March 23, the city reported more than 13,000 cases. The number more than doubled in four days, to 26,700 on March 27. By March 30, more than 38,000 New Yorkers had gotten the virus, and 45,707 had been infected by April 1.
But those rapidly rising numbers are in part a reflection of New York's aggressive testing.
According to data collected by the COVID Tracking Project, a volunteer effort run by The Atlantic's Alexis Madrigal to tally tests in every state, New York had conducted more than 283,600 tests as of Friday. By comparison, New Jersey, the second-hardest-hit state, has completed over 75,300 tests as of Saturday.
Even so, thousands of sick people have been unable to get tested. Lingering test shortages have led New York, like California and Washington, to reserve tests for those who need it most: critically ill patients and symptomatic healthcare workers and first responders.
At least 1,400 New York Police Department employees have contracted the coronavirus, as have some 282 members of the New York Fire Department, more than 580 MTA workers, and 4,500 ambulance workers.
People presenting mild symptoms in New York are being asked to stay home.
On the whole, the US's diagnostic abilities have been riddled by errors and delays. The CDC at first designed a faulty test, and the ongoing test shortages still prevent officials from fully understanding the scale of the epidemic.
'Apocalyptic' scenes in New York's hospitals
Many of New York's wealthy seem to have fled the city. But most people are spending these early spring days cooped up in cramped apartments, relying on delivery and takeout at mealtimes. Some emerge briefly to walk their dogs or go for a run, warily giving a wide berth to anyone they pass.
Unable to handle the ceaseless flow of patients, hospitals are running out of space. A doctor at Elmhurst Hospital in Queens described the scene as "apocalyptic" to The New York Times, and said patients have died while awaiting treatment.
A nurse told Business Insider that people with coronavirus symptoms were showing up at the NYU Medical Center every three to five minutes on March 25. Dr. Jolion McGreevy, the medical director of Mount Sinai Hospital's emergency department, said because so many people are trying to ride out the illness in their homes, some hold out until their needs are dire, then arrive at hospitals in "impending respiratory failure." New York City's ambulance workers are now advised to leave cardiac arrest patients at home if they can't detect a pulse.
Elderly people and those with preexisting health conditions are more vulnerable to the worst effects of the coronavirus. But one in five patients admitted to New York hospitals are under 44, Bloomberg reported.
"So many patients are not fitting the picture that we've been told from China or Italy. This is not just elderly patients; it's anyone," Kaedrea Jackson, a doctor at Mount Sinai Morningside Hospital, told Bloomberg.
Like 'fighting a ghost'
Meanwhile, a severe shortage of medical supplies looms.
When the outbreak peaks, patients will require 30,000 more ventilators than the state currently has on hand, according to Cuomo. Officials also need to boost New York's capacity from 50,000 hospital beds and 3,000 ICU beds to 110,000 and 30,000, respectively, he said.
Personal protective equipment (PPE) for medical workers, including masks, medical gowns, face shields, and gloves, is already in short supply. As a result, #GetUsPPE, a rallying cry from doctors fighting COVID-19, has become a movement.
But New York City nurses have been reduced to using trash bags to ward off the virus, while one woman tweeted that she was given a Yankees rain poncho in lieu of a medical gown.
To shore up the collapsing healthcare system, the Javits Center was outfitted with 2,500 beds, Central Park with 68, and Flushing Meadows-Corona Park with 350. The USNS Comfort, a floating naval hospital, will hold 1,000 extra beds for non-coronavirus patients. As of Saturday evening, the newly christened Javits New York Medical Station was treating 40 people, according to The Washington Post, while the USNS Comfort was 2% full, with 20 patients, as of Friday.
Thousands of healthcare workers have been asked to dust off their scrubs, medical students have graduated early, and reinforcements are en route to Manhattan from all over the US. On Friday, New York officials sent out a mobile push alert asking "licensed healthcare workers" to support overwhelmed hospitals.
"It's like we're fighting a ghost," one doctor told Business Insider. His identity, while confirmed by Business Insider, is being kept anonymous because he hasn't been authorized by his hospital to speak to the press. "I know it's out there, but I have no idea where it's coming from, who it's affecting the hardest, and how to stop it."
'I don't know how many more bodies I can take'
The coronavirus is killing a person roughly every four minutes in New York State, and about every six minutes in New York City, based on the COVID Tracking Project and city data. The state experienced its deadliest day yet, Cuomo said on Saturday, with 630 more people succumbing to the disease over the past 24 hours.
Refrigerated semi-trailers and cooled tents are stationed outside hospitals to serve as makeshift morgues - nondescript portents of doom.
Patrick Marmo, a state-licensed funeral director and embalmer of 30 years, says his company, International Funeral Service of New York, typically handles about 40 cases at any given moment. On March 30, he was trying to manage more than 140.
"I don't know how many more bodies I can take," Marmo told Business Insider, explaining that frontline "deathcare" workers are struggling with their own limited capacity.
"We are working night and day," he said. "The integrity of everyone's loved one is our number-one priority. I've thought about putting a refrigerated trailer outside the funeral home. But that's horrendous. If I do that, what does it say? Do I put that in plain view?"
'We are still headed up the mountain'
On March 31, Cuomo estimated that the "apex" of the outbreak was still 21 days away.
"We're all in search of the apex and the other side of the mountain. But we are still headed up the mountain," he said.
He added, "this is a moment that is going to change this nation."
On Saturday, Cuomo projected an even bleaker outcome: New York's COVID-19 peak is now within a "seven-day" range, and the state isn't yet prepared.
"It feels like an entire lifetime," he told reporters in Albany. "I think we all feel the same, these stresses, this country, this state - like nothing I've experienced in my lifetime."
He amended this prediction on Sunday, saying that it remains unclear whether the "apex" represents a point on the curve of infections or a plateau. This makes it hard to tell if New York is nearing the worst or has already reached that stage in its outbreak. The number of hospitalizations and deaths dropped in the last 24 hours, he said, but it's simply "too early to tell" if this has any significance.
Cuomo has taken some criticism for a proposed $400-million cut in Medicaid funding to state hospitals - cuts suggested by a panel he convened. "It's a shot in the gut, " Dr. David Perlstein, the chief executive officer of St. Barnabas Hospital, told The New York Times. If the cuts are enacted however, they may not go through until after the pandemic is over, City and State New York reported.
Acknowledging that hospitals are scrambling to deal with the daily eruption in coronavirus cases, Cuomo said that they are expected to receive more than $150 billion in grants by way of the government's $2 trillion COVID-19 stimulus bill.
"The places that are getting the most funding now because of what the federal government did are the hospitals. They are doing better than anyone else," Cuomo said, per The Times.
New York is only the beginning
The governor has frequently been at loggerheads with President Donald Trump, with Cuomo bashing Trump's proclivity to play politics as "anti-American" and Trump pushing responsibility onto state authorities.
What's apparent, however, is that no community in New York can handle the virus by itself so officials are surging and flexing the capacity, staff, and resources of the entire healthcare system so so as to "balance the patient load" among all available hospitals, Cuomo said.
This wisdom needs to be applied nationwide, he said, because experts anticipate New York to be just the first hotspot of many. It should be viewed as a warning, not an outlier, they say.
Dr. Deborah Birx, the response coordinator on the White House coronavirus task force, expressed concern on Thursday that New Jersey is also in the throes of a serious outbreak. About 35% of all administered coronavirus tests there have come back positive - the same rate as in New York, according to Yahoo News.
Medical officials are also nervously eyeing Louisiana, where 26% of tests are coming back positive.
"Michigan, Connecticut, Indiana, Georgia, Illinois - so that should tell you where the next hot spots are coming - are at 15% of their tests positive, and then Colorado, DC, Rhode Island and Massachusetts are at 13%," Birx said.
She added that the limited data she has so far suggests "not every American is following" social-distancing rules.
"Today it is New York," Nirav Shah, a former New York state health commissioner, told Vox. "Tomorrow it will be somewhere else, and only by coming together as a nation will we get this under control."
Dave Mosher and Lydia Ramsey contributed to this report.
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