Friday, April 24, 2020

Governor Cuomo Update on COBID-19 - April 23, 2020


The hospitalization rate is down again, so that is good news. The overall, if you project the curve, everybody's looking at curves nowadays. If you look at the curve, the curve continues to go down. And that's also in the total hospitalization number, bounces up and down a little bit, but it's clearly down. Number of intubations bounces a little bit, but it's also clearly down. The number of new COVID cases walking in the door or being diagnosed is relatively flat. That is not great news. We would like to see that going down but it's not going up either. Number of lives lost is still breathtakingly tragic - 438. That number is not coming down as fast as we would like to see that number come down.

The numbers are trending down. Do they continue to trend down or do they pop back up? If they continue to trend down, how fast is the decline and how low will the decline go? In other words, if 1,300 people or about that number keep walking in the door, then you're going to have a hospitalization rate proportionate with the number of people walking in the door. So we want to see the number of people walking in the door reduced, the number of new infections reduced, so we hit a low plateau, if you will. It's been remarkably flat for the past several days. So that's the best indicator of how containment is working and how the close-down policies are working. And over the past few days, we've basically flattened at 1,300 new cases a day. We would like to see those new cases reducing even more and we'd like to see them reducing faster.

You then have other long-term questions. Is there a second wave of the virus? We talk about the 1918 pandemic. It came in three waves. Is there a second wave? Does the virus mutate and come back? The federal officials are starting to talk about the fall and potential issues in the fall. They're worried about the virus waning somewhat during the summer. Remember, will it go away when the weather gets warm? No one is really saying it will go away when the weather gets warm in the summer. But there's still a theory that the virus could slow during the summer but then come back in the fall. If it comes back in the fall, then it comes back with the normal flu season. That's then problematic because you are then quote/unquote testing for the flu and you're testing for covid on top of all the other tests you do. That could be a possible overwhelming of the testing system.
If people could have the flu or could have COVID in the fall and they don't know which it is they could get nervous and start going into the health care system which could then bring back a capacity issue in the health care system. So that's something we have to worry about and watch. 

Nursing homes are our top priority. They are private facilities. They get paid to provide a service. They get regulated by the State government. There are certain rules and regulations that they must follow and we put in additional rules and regulations on nursing homes in the midst of this crisis. Staff must have appropriate PPE. They must have their temperatures checked before they come into the facility. There are no visitors who are coming into the facility which is a tremendous hardship but it's necessary to protect public health. If they have a COVID-positive person in the facility that person has to be in quarantine. They have to have several staff for the COVID residents versus the non-COVID residents.

The nursing home is responsible for providing appropriate care. If they cannot provide that care then they have to transfer the person to another facility. They have to notify residents and family members within 24 hours if any resident tests positive for COVID or if any resident suffers a COVID-related death. That is a regulation they have to follow and they have to readmit COVID-positive residents but only if they have the ability to provide the adequate level of care under Department of Health and CDC guidelines.

We're going to undertake an investigation of nursing homes now to make sure they're following the rules. It's going to be a joint Department of Health and Attorney General investigation, but those are the rules. The State Department of Health and the Attorney General are going to be commencing an investigation to make sure all of those policies are in place and being followed. If they're not being followed, they can be subjected to a fine or they can lose their license. It's that simple.

Testing is going to be a major operation that happens from now until the situation is over. It's new, it's technical, it's complex, it's a political football, but testing does a number of things for us. Number one, it reduces the spread of the virus by finding people who are positive, tracing their contacts and isolating them. That's a function of testing.

Testing also - what they call anti-body testing - you test people to find out if they have the antibodies. Why? Because if they have the antibodies they can donate blood for convalescent plasma which is one of the therapeutic treatments. So you want to find people who had it so you can identify them to donate for convalescent plasma. The testing also can tell you the infection rate in the population, where it's higher, where it's lower, to inform you on a reopening strategy and then when you start reopening, you can watch that infection rate to see if it's going up. If it's going up, slow down on the reopening strategy. 

We have undertaken the largest, most comprehensive study of New York State to find out what is the infection rate. That, we started a few days ago. Sample size so far, 3,000 people statewide. Let's find out what the infection rate is. We have preliminary data on phase one and this is going to be ongoing. We're going to continue this testing on a rolling basis. I want to see snapshots of that is happening with that rate. Is it going up? It is flat? Is it going down? It can really give us data to make decisions.

We did 3,000 surveys in about 19 counties, 40 localities across the state. The surveys were collected at grocery stores, box stores, et cetera. That's important. It means you're testing people who, by definition, are out of the home and not at work. These are people who are out and about shopping. They were not people who are in their home. They are not people who are isolated. They are not people who are quarantined who could argue probably had a lower rate of infection because they wouldn't come out of the house. These are people who were outside. These are people who were not at work so they're probably not essential workers. So that has to be calibrated.

What we found so far is the statewide number is 13.9 percent tested positive for having the antibodies. What does that mean? It means these are people who were infected and developed the anti-bodies to fight the infection. So they were infected 3 weeks ago, 4 weeks ago, 5 weeks ago, 6 weeks ago, but they had the virus, they developed the antibodies and they are now quote, unquote recovered, 13.9 percent, just about 14 percent.

Breakdown, Female 12 percent positive, males close to 16 percent, 15.9 percent positive. Regionally, Long Island at 16.7, New York City at 21.2, Westchester, Rockland 11.7 and rest of state, 3.6. This basically quantifies what we've been seeing anecdotally and what we have known, but it puts numbers to it. Rest of the state is basically upstate New York, 3.6. It's been about 7-8 percent of the cases that we've had in the state. Westchester, Rockland we had an initial significant problem. Remember Westchester had the largest, hottest cluster in the country at one time. Eleven percent, so it's literally somewhere in between. New York City 21, which again, supports what we knew anecdotally. Long Island, 16.7 so it's not that far behind New York City and it is significantly worse than Westchester, Rockland. We've been talking about Westchester, Rockland and Nassau, Suffolk basically as one. But there is a variation with the Long Island numbers. 

By race, Asians about 11.7 percent, African-American, 22 percent, Latino, Hispanic, 22 percent, multi none other, 22 percent, white 9.1 percent. This reflects more the regional breakdown, African-American and Latinos are in this survey, disproportionately from New York City, and New York City is at 21 percent. So, the African-American number, Latino number is 22 percent. Upstate, whites, they're talking about more upstate, which is 9, but it's 3.6 in the survey. By age, nothing extraordinary here. We did not survey anyone under 18. So it starts with 18 years old. 18 to 24, 8 percent. 45 to 54, 16. 75 plus, 13.

But it's a small percent of the total. Again, how many 75-year-olds were out shopping and about? That is the group that's supposed to be isolating because they are the most vulnerable. 65 to 74 also. But that's the distribution. Again, the sample was by definition, people who were outside the home, so we have to analyze that. What does that do to the numbers? But that is a factor that has to be taken into consideration. If the infection rate is 13.9 percent, then it changes the theories of what the death rate is if you get infected. 13 percent of the population is about 2.7 million people who have been infected. If you look at what we have now as a death total, which is 15,500, that would be about .5 percent death rate. But, two big caveats. First, it's preliminary data, it's only 3,000. Well, 3,000 is a significant data set, but, it's still preliminary.

But there's a second complicating factor, because there always is. What you do in a region still has to be coordinated because you have a pent up demand in the whole tristate area where one region opens up for business - you could see people come in, literally, from the tristate area and overwhelm that region. We try to rationalize with Connecticut and New Jersey because there have been facilities in Connecticut that were open and you have all sorts of New York license plates there. 

Also, you have more people in the New York City area. More people getting on subways, getting on buses. More people dealing with that density. We know that's where it communicates. But, New York City Housing Authority - we're starting more testing today at New York City Housing Authority facilities. You talk about public housing. I was a HUD secretary. I worked in public housing all across this nation. That is some of the densest housing in the United States of America. People crammed into elevators, crammed through small lobbies, overcrowding in their apartment. So, public housing does pose a special issue and it should be addressed.

It also makes no sense that the entire nation is dependent on what the governors do to reopen. We've established that it's up this governor, it's up to this governor. But then you're not going to fund the state government? You think I am going to do it alone? How do you think this is going to work? And then to suggest we're concerned about the economy? States should declare bankruptcy? That's how you're going to bring this national economy back, by states declaring bankruptcy? You want to see that market fall through the cellar? Let New York state declare bankruptcy, let Michigan declare bankruptcy, let Illinois declare bankruptcy, California declare bankruptcy. You will see a collapse of this national economy. 
So, if you fund states that are suffering from the coronavirus, the Democratic states, don't help New York state because it is a Democratic state. How ugly a thought -- I mean just think of what he's saying. People died, 15,000 people died in New York, but they were predominantly Democrats, so why should we help them?

That's why look, our rule has been very simple from day one. There is no red and blue. When we talk about New York tough, we are all New York tough, Democrats and Republicans. We're all smart, we're all disciplined, and we're all unified, and we're all in this together and we understand that and that's how we operate. We operate with love and we're strong enough to say love. Say love is not a weakness. It is a strength and New Yorkers are that strong. 

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