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New York’s Calm Before the Storm?

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eye on the news

New York’s Calm Before the Storm?

Covid-19 will test the capacity of the city’s health-care system. March 11, 2020
Covid-19
Health Care
New York

Mayor Bill de Blasio and his team of public-health professionals have been holding regular briefings on the coronavirus crisis in New York City, detailing the extent of its transmission in the community, updating the public on the progression of disease in infected persons, and offering guidelines about avoiding infection. The tone of the briefings is cautious concern, with an emphasis on prevention and readiness.

The city is doing an attentive and careful job of keeping New Yorkers informed about the number of people infected and the importance of hygiene and practicing social distancing, especially for people with health conditions. But certain details have emerged recently that suggest that the city is less prepared for a mass outbreak of Covid-19—the disease associated with the novel coronavirus—than officials suggest.

De Blasio and health commissioner Oxiris Barbot, a physician, have stressed that though the coronavirus is certainly contagious, the mechanics of transmission are relatively limited. “The virus can only transmit when bodily fluid, such as through a sneeze, cough, or spit, is transferred from a person who has the virus, directly into another person,” de Blasio stated in a press release. “Disease detectives”—the city’s term for epidemiologists—“have determined that the virus does not survive for more than two or three minutes in open air.”

The claim that coronavirus dies quickly upon exposure to the atmosphere is striking; it also seems to contradict information elsewhere. The World Health Organization (WHO) says that the novel coronavirus appears to behave similarly to related viruses, and “may persist on surfaces for a few hours or up to several days.” A recent article in the Journal of Hospital Infection suggests that the family of coronaviruses can persist on dry surfaces for long enough to permit transmission to the mouth, eyes, and nose. “On different types of materials,” the article says, “it can remain infectious for from 2 hours up to 9 days.”

If the novel coronavirus loses its potency after two or three minutes, then many intensive practices and precautions are unnecessary, such as constant deep cleaning of buses and subways. Closing schools for 24 hours after announcement of a local infection—as Governor Andrew Cuomo has announced that he would do—in order to sterilize buildings would also be unnecessary.

Asked how the Department of Health had concluded that the virus dies quickly in the open air, the mayor was unpersuasive. “There are studies, there are academic studies, there are global and national organizations providing the information they have,” he said. “But you know, the old saying, God bless the child who’s got his own or her own. . . . All information is valuable, but the information that we’re gleaning from our own direct experience is the most valuable to us.” When pressed, Barbot acknowledged that the finding is hypothetical. “This is a novel virus that we’re still learning a lot about,” she said, “and there is still science that’s coming out and you will find in the literature that in a lab setting you can have the virus live up to a couple of hours, but in everyday world scenarios, what we’re learning from our partners from around the globe is that typically it’s in a range of minutes.”

Since the virus’s surface-contamination properties remain in dispute, the city would have been better off not presenting its own findings as fact. That would make its broader instructions less contradictory, such as affirming that deep cleaning is a best practice but also insisting that balustrades, subway poles, and elevator buttons are generally safe to handle.

More troubling is the insistence that New York’s hospital system is fully capable of handling a widespread Covid-19 outbreak, which in extreme cases can cause total respiratory failure and necessitate intubation. De Blasio and Dr. Mitchell Katz, the head of NYC Health + Hospitals—the largest public-health network in the country—have said repeatedly that the hospital system has “1,200 beds that can be brought online immediately,” as a reserve stock.

As a public-health emergency, Covid-19 is a logistical crisis about capacity. As is widely accepted now, most people who get infected—perhaps 80 percent—are asymptomatic or suffer only lightly. Of the remainder, a fraction become seriously ill, and require the use of a ventilator. The disease appears to be spreading exponentially, with the total number of new cases outside of China increasing by a factor of ten every 14 to 16 days. Assuming this trend holds, then the 20 or so cases we see in New York City now could reach 2,000 by mid-April, 200,000 by mid-May, and even 2 million by June.

New York City’s entire hospital system—including public and private hospitals—currently has about 26,000 beds. If 10 percent of the city’s population becomes infected, and only 5 percent of those 850,000 people become seriously ill, that would still require 42,500 hospital beds—and nursing staff to tend to the patients, along with ventilators and other equipment. Katz offered an optimistic take on that prospect: “Our hospitals have tents that would allow us to turn a parking lot into an intensive care unit. . . . 80 percent of people are going to be fine. Only about 20 percent of people might have symptoms serious enough to be in the hospital. And it’s even a much smaller number, perhaps 4 or 5 percent that actually would require intensive care or intubation.”

It’s probably true that, even if 2 million New Yorkers are infected by June, and only 5 percent—100,000—need to be intubated, that it wouldn’t happen all at once. “Flattening the curve” of the infection rate through social distancing and hygiene will, it is hoped, attenuate a flood of sick people into the city’s hospitals. Nonetheless, the image of intensive-care parking lots is less than encouraging for anxious New Yorkers.

Photo by Jeenah Moon/Getty Images

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