Sunday, March 29, 2020

Governor Cuomo Announces NYS On Pause Functions Extended for the Next Two Weeks


  Earlier today, Governor Andrew M. Cuomo announced all NYS On Pause functions will be extended for the next two weeks. The Governor also directed the state nonessential workforce to continue to work from home for an additional two weeks through April 15th. The state will re-evaluate after this additional two-week period.


In-person workforce restrictions, which have been implemented through various Executive Orders —202.3 (restaurants and bars, gyms, fitness centers, movie theaters and casinos); 202.4 (local government workforces, school districts; village elections); 202.5 (malls, public amusement facilities); 202.6 (all non-essential reduce 50%); 202.7 (barber shops, salons, other personal care); 202.8 (DMV); 202.10 (non-essential gatherings of any size); 202.11 (extension of school district closure until April 15, 2020) — are also extended until April 15, 2020 to enable uniform extension and review of such restrictions, and any such restrictions may be extended by future executive orders.


Governor Cuomo also announced that New York State's Wadsworth Lab has developed a new, less intrusive test for COVID-19. The new test is done through a saliva sample and a self-administered short nasal swab in the presence of a health care professional. Additionally, health care professionals can self-administer the test without another health care professional present. This new test will help conserve personal protective equipment, or PPE, for healthcare workers, reduce potential exposure of the virus to health care workers and will allow the state to continue to test as many individuals as possible in New York amid the national shortage of the more intrusive nasopharyngeal, or NP, swabs. Self-collection of nasal swabs has been done before for other respiratory viruses such as flu and it has been shown to be effective and safe, and collection of a saliva sample is simple and non-invasive. This new testing will begin within a week.


The Governor also issued an executive order to allow schools to host day care free of charge.



After speaking with the state's major pharmacy chains, the Governor announced that pharmacies have agreed to offer free home delivery to help reduce long lines for prescriptions at their facilities.


Thank you for being here. Let us go through some updates for today, so everyone knows where we are and what we're experiencing. As you can see the increase on the trajectory of cases continues to climb, 7,681. Couple of updates that I would like to make to the local health providers. We want to anticipate this situation. We talked yesterday about planning forward, getting ahead of it, that we have been behind on this virus from day one. And rather than be reactive, be proactive, get ahead of it. Local health providers should be watching what is going on in different parts of the state and anticipating what's going to happen.
This is going to be a phenomenon of a rolling apex. We keep talking about the apex, the top of the curve. But the top of the curve will occur at different times in different places, right? The curve is a function of the rate of spread, the rate of density and when it started. So you'll see different curves, you see it all across the country. Started in Washington, State of Washington. Now you see New York, you see Chicago, you see New Orleans, you see parts of California. So that rolling apex is happening across the country. That rolling apex is also going to happen across the state of New York. The current projections all say New York City will face the first high water mark, if you will, high tide mark, the height of the curve, but then you'll see Westchester, you'll see Long Island, on a delay with their curve hitting a new height. Model projectors are not sure if it's Westchester first or Long Island first. Some suggest it's Westchester because we had that cluster in Westchester, if you remember, in New Rochelle. And then Upstate New York. We expect a curve in Upstate New York, also. It may not be as high, obviously, as New York City, Westchester, long island, but there will be a curve. So, if you are not in a highly affected health area now, that doesn't mean you're not going to have a real situation to deal with because these numbers are just going to continue to go up all across the state.

So for local health systems this is a new challenge. Most health systems have public hospitals and then they have private hospitals or volunteer, voluntary hospitals. And they basically exist on a day-to-day basis as two different systems. So you'll have public hospitals and then you have the private hospital system. And for all intents and purposes, in normal operating procedures, they operate as two systems, there's very little interaction. There's also very little interaction among individual hospitals, sometimes even within their own system. So you have public hospitals that are a part of a public hospital system, but each hospital basically operates on its own, right? Has its own identity. Certainly true on the private side where you have individual hospitals and they operate on their own. We have to change that mentality, and we have to change that mentality quickly. No hospital is an island. No hospital in this situation can exist unto themselves. We really have to have a new mentality, a new culture, of hospitals working with one another, both within the public system as well as the private system, and we need to think about the public system working with the private system in a way they never have before. There is an artificial wall almost between those two systems right now. That wall has to come down. That theory has to come down. This is going to be all hands on deck. This is everybody helping everyone else. One hospital gets overwhelmed. The other hospitals have to flex to help that hospital and vice versa.

We have Elmhurst Hospital for example in New York City that is under stress. The number of cases in that Elmhurst Hospital is high. When the number of cases is high, the stress on the staff is high. I was just speaking with Dr. Zucker about this. You do this for two, three, four weeks, the level of stress is very intense. Elmhurst Hospital is part of a public health system of about 11 hospitals in New York City. That system has to work together and those hospitals have to work together. The 11 health and hospitals in New York City, the public system. I'm going to ask Mayor de Blasio and Comptroller Stringer to take a look at the system and figure out how we can get that system to work better together as a unified system. This is not going to get better soon. Right? So Elmhurst is under stress now. That stress does not abate for the foreseeable short-term future. So how do we make that system work better together and what recommendations do we have to improve H&H? We'll also be meeting with the private hospitals in New York City that are organized through something called the Greater New York Hospital Association. I'm going to be meeting with them tomorrow to talk about having those hospitals also organize, act as one, get out of their silos, get out of their identities, to work together.

Overall, we have local health systems the states roll which we've never really done before is getting those health systems to work with one another. So we talked about if New York City gets overwhelmed we'll ask the upstate systems to be a relief valve for the downstate health systems, which has never happened before to any scale and also vice versa. There will be a time where the upstate hospitals will be struggling and when the upstate hospitals will be struggling then we want the down state hospitals to be able to takeover and relief those hospitals.
That's actually the advantage of the rolling curve that they're projecting. If it does happen that way, theoretically, I almost think of it as a high tide mark, right? High tide comes first in New York City. Then the tide is on the way down and then it's high tide in upstate New York. So if the tide is dropping downstate then you have some relief for the upstate hospitals.

We put in place the New York Pause program. Today I am going to extend it to April 15, the directive that non-essential work force continue to work at home. We're doing it in two-week intervals because every day is a new day and we'll see what happens day to day, but I think it's not even questionabe today that we're going to need two more weeks of non-essential workers.

Good news, Wadsworth, the New York Department State of Health, has developed a less intrusive saliva and short nasal swab test. I'm not sure what a short nasal swab test is but my guess is it wouldn't apply to me. It can be administered in the presence of health care workers. It requires less PPE, health care workers can self-administer it, kudos to the Department of Health on that. It also helps them limit exposure for health care workers and it should start as soon as next week.

People ask when is this over? I think the testing, you tell me when they come up with an inexpensive home test or point of care test that can be brought to volume, I think that's probably when you see a real return to normalcy in the workforce.
In other words, we're all talking about this curve, flatten the curve - at what point on the other side of the curve do you go back to work? Jesse asked this question the other day. There is no answer. I think the answer is going to be in in testing. Dr. Fauci who I think is - we're so blessed to have him here at this time, he talks about faster, easier testing. If you can test millions of people, if you could test today millions of people, you could send them to work tomorrow, right? So the development of these tests, I think, are very important and instructive. Tomorrow the USNS Comfort coming. That is about 1,000 bed capacity. It's staffed by federal officials, federal medical professionals. It is not for COVID patients but it is to take the back fill from hospitals.

Current stockpile, we're still working to purchase equipment all across the globe. We have a whole team working seven days a week. Unfortunately, we're competing against every other state in the United States for the same things. So it's very hard but we're making progress. In terms of finding staff, that's going very well. The volunteerism of New Yorkers, God bless them, we're up to 76,000 health care workers who have volunteered. 76,000. 76,000 people who volunteer to go into these hospitals at this time. Just think about that.

On the total people tested, we did 16,000, last night, total of 172,000 tested, that's the highest in the country. Positive cases 7,000 last night, total cases 59,000. The virus continues its march across the state of New York. Only two counties now that don't have cases. These are the overall numbers, 59,000 people tested positive. 8,000 currently hospitalized, 2,000 ICU patients, 3,500 patients discharged. We know - nobody really points to these numbers but this is good news. 846 people came out of hospitals yesterday, discharged after being treated for COVID, right? So yes, people get it, 80 percent have either self-resolved or have some symptoms at home. 20 percent go into the hospital - majority of those get treated and leave. It's the acutely ill by in large who are the vulnerable population and that's what we're seeing more and more. The deaths went from 728 to 965. What's happening now is as I mentioned yesterday, people are on the ventilator longer and longer. The longer you are on a ventilator, the less your chance of ever getting off that ventilator and that's what we're seeing. And we will continue to see the number of deaths increase. In terms of most impacted states, again, New York is still number one. Total new hospitalizations, these are the charts we look at every night. The number is up 1,175. It was 847 the night before.

These bounce night to night. Any one night's data could have a number of variables in it. What hospitals actually reported, when they reported it, how accurate they were? So more you look for a trend line, more than anything else, and there are trend lines. If you look early on, the hospitalization rate was doubling every two days, then it doubled every three days, then it doubled every four days - now it's doubling every six days. So you have almost a dichotomy: The doubling rate is slowing, and that is good news but the number of cases are still going up. So you're still going up towards an apex, but the rate of the doubling is slowing, which is good news.

Change in daily ICU admissions, you see a pickup in the ICU admissions, but again, you look for the trend line among those columns more than the individual columns. Change in daily intubations, we don't normally run this chart but these are the people most seriously affected and again, you see a trend line in that. You see some aberrations, March 26th the 290, but you see a trend line. And the trend line is what we're watching. You also see a trend line in people being discharged and this is a dramatic trend line. So people came in, they started to come in only March 18, right - so we're only talking about ten days. They started to get treated. A few of them got out early. A few more, a few more, a few more. And now you're seeing the discharge number trend way up because that's what's going to happen. People are going to the hospital, they get treated, they leave. Those that are acutely ill get put on a ventilator and then it's the inverse dynamic. The longer the longer they are intubated, the longer they are on the ventilator, the higher the mortality rate.

Again, perspective, these are the numbers from day 1 since China started. Also, we should all keep in mind we lost the first responders who go out there. I was talking about the 76,000 people who volunteered to help - medical professionals - being a first responder today, being a public health official, working in a hospital, working with senior citizens. This is really an act of love and courage. We lost Detective Cedric Nelson, 48-years-old, 32nd, 23-year veteran. He could've retired. So we wish him and his family peace.

We lost a nurse, we've lost a couple of other nurses. Kious Kelly 48-years-old who was the assistant nurse manager at Mount Sinai West. We wish his family the best. These public people - I don't even have the words to express my admiration for them.

FDR always had words: "Courage is not the absence of fear, but rather the assessment that something else is more important than fear."
To me, that says it all today. Everyone is afraid. Everyone is afraid. You think these police officers are not afraid to leave their house? You think these nurses are not afraid to go into the hospital? They're afraid. But, something is more important than their fear. Which is their passion, their commitment for public service and helping others. It's public service. That's all it is. Their passion and belief in helping others. And that overcomes their fear and that makes them, in my book, just truly amazing, outstanding human beings. I wish them and their families all the best.

The President and the CDC ordered a travel advisory for people of New York, New Jersey and Connecticut. This happened last night. This is not a lockdown, it is a travel advisory to be implemented by the states. In essence, it's nothing that we haven't been doing. Non-essential people should stay at home. So it's totally consistent with everything we're doing and I support what the President did because it affirms what we've been doing. It also affirms what New Jersey and Connecticut have been doing.

Also for New Yorkers, I know we feel under attack. I had a lot of phone calls yesterday when the President first suggested some form of quarantine. "What does that mean, quarantine? Am I going to be allowed to leave the house? My parents who are supposed to be coming back, and this one's here and this one's here." I know we feel under attack. "The Rhode Island -- you can't drive into Rhode Island. We'll pull you over with the police." Yes, New York is the epicenter and these are different times, and many people are frightened. Some of the reactions you get from individuals, even from governments, are frightening and suggesting that they'll take abrupt actions against New York. But look, this is New York and we are going to make it through this. We have made it through far greater things. We are going to be okay. We specialize in stamina, and strength, and stability, and that's just what we're doing now. We are strong. We have endurance and we have stability. And we know what we're doing. We have a plan. We're executing the plan. Anything, any obstacle that we come across we will manage that obstacle, and we have. I can't sit here and say to anyone you're not going to see people pass away. You will. That is the nature of what we're dealing with, and that's beyond any of our control. But, New York is going to have what it needs and no one is going to attack New York unfairly and no one is going to deprive New York of what it needs. That's why I'm here, that's why we have a state full of very talented, professional people. So a deep breath on all of that. And we are doing exactly what we need to do. There is no state in the nation in the nation that is better prepared or better mobilized than what we're doing. I feel that deeply and having studied everything that every other state has done. Federal officials have even remarked to me that they're surprised how quickly a state as big and complicated as New York has actually mobilized. So, feel good about that.

There are two great New York expressions that I use all the time. Anything I build in New York always has two expressions on it. One, "excelsior." It says it all. Ever upwards. Ever upwards. Aspirational. We can be better, we will be better. We're going aim higher, we're going to improve ourselves. Excelsior. State motto, it's on the seal behind me. Excelsior. And the other, "e pluribus Unum," out of many, one. Unity, unity. You put those two things together, it says it all. Aim high, do better, believe you can do better, be optimistic, and the way you get there is through unity and togetherness and cooperation. Through mutuality and community. Those two expressions. I say to my daughters, if you remember nothing else when I'm gone, if you walk up to the box and have nothing else to remember, excelsior - you can be better, it will be better, we can make it better - e pluribus Unum - we make it better together. That's it and that's what we're doing.

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