THE NEW REPUBLIC
"Turns Out Andrew Cuomo Isn’t America’s Governor After All - Under pressure for his coronavirus response, the former media darling of the crisis is sounding a bit like Donald Trump."
By Alex Shephard
April 30, 2020
Andrew Cuomo has been cast as the anti-Trump in the coronavirus crisis.
The governor of New York was widely praised in the national media for doing all the things that the president could or would not do.
In contrast to the president, he has been focused, informative.
He has shown his emotions, making it clear he understands the human cost of the pandemic.
While Trump uses his daily press conferences to spread conspiracy theories, Cuomo has alternated between delivering hard truths and offering a shoulder to cry on.
But in recent days, Cuomo has sounded an awful lot like Trump.
Faced with mounting criticism of his handling of the coronavirus — and unfavorable comparisons with his West Coast counterparts, who appear to have been more successful in containing the outbreak — Cuomo has lashed out in an attempt to deflect blame.
“Governors don’t do global pandemics,” Cuomo said at his press briefing on Tuesday.
“Where were all the experts?”
He also targeted the media, asking, “Where was The New York Times?"
"Where was The Wall Street Journal?”
Cuomo’s emergence as the media’s foil to Trump, as I argued last month, always had more to do with aesthetic differences than the governor’s actual performance.
With Joe Biden sidelined and West Coast Governors Gavin Newsom and Jay Inslee ceding the spotlight to public health experts, Cuomo was left to play a starring role.
But the spotlight has its drawbacks as well; in this case, highlighting Cuomo’s spotty record on the coronavirus and reminding many people why they didn’t like him in the first place.
Cuomo has accepted some responsibility for New York’s slow response to stop the spread of the coronavirus — a response that has made New York, by far, the hardest-hit state in the country.
“I wish someone stood up and blew the bugle,” Cuomo said in an interview with Axios’s Jonathan Swan that aired on HBO on Monday.
“And if no one was going to blow the bugle, I would feel much better if I was a bugle blower last December and January."
"Even though no one danced to the music, I would feel better.”
But he changed his tune the next day.
As The New York Times’ Albany bureau chief Jesse McKinley wrote, Cuomo “apparently decided on Tuesday that there was enough blame to spread far and wide,” attacking the media, the World Health Organization, and federal agencies.
The rant, which highlighted the mistakes that other leaders and institutions had made, came just when his own record was being newly scrutinized.
Reporting from the Times’ J. David Goodman in April revealed that delays caused by Cuomo and other leaders, most prominently New York City Mayor Bill de Blasio, contributed to the staggering rise of cases in New York.
“Excuse our arrogance as New Yorkers,” Cuomo said on March 2.
“We have the best health care system on the planet right here in New York.”
He added, “We don’t even think it’s going to be as bad as it was in other countries.”
Cuomo, like Trump, downplayed the risk of the coronavirus and resisted shutting down nonessential businesses, ultimately doing so three days after California, on March 22.
The decision to wait proved to be costly.
At least 18,015 New Yorkers have died from Covid-19, compared to at least 1,887 deaths in California and 800 in Washington state.
“You have to move really fast."
"Hours and days."
"Not weeks."
"Once it gets a head of steam, there is no way to stop it,” Dr. Thomas R. Frieden, a former commissioner of New York City’s Health Department, told the Times.
Frieden estimated that New York’s death toll would have been 50 to 80 percent lower if social distancing measures had been adopted just one or two weeks earlier — around the time that Cuomo was thumping his chest and touting “the best health care system on the planet.”
Cuomo’s public messages were a big part of the problem.
Like Trump, Cuomo spent much of late February and early March downplaying the pandemic.
“The city’s epidemiologists were horrified by the comforting messages that de Blasio and Cuomo kept giving,” reported The New Yorker’s Charles Duhigg.
Cuomo’s long-standing feud with de Blasio further hobbled the effectiveness of both executives and occasionally led to miscommunication and confusion.
Blame for New York’s lack of preparedness falls on many leaders and institutions, of course.
But Cuomo’s recent unwillingness to accept that blame and his eagerness to tar others, particularly media organizations, suggests both desperation and Trumpian narcissism.
Cuomo has hidden his famously thin skin for much of the past six weeks, but, with criticism mounting, it’s beginning to show through again.
As usual, Cuomo is aided by the fact that his rivals are incompetent.
President Trump’s buffoonery will continue to contrast with Cuomo’s more professional mien.
And then there is Bill de Blasio, whose instincts are so bad that he sometimes seems to be participating in a performance art piece about politics.
Cuomo’s anti-press rant was quickly overshadowed by a bit of idiocy from de Blasio, a tweet singling out New York’s “Jewish community” after law enforcement broke up a funeral for a Hasidic rabbi on Wednesday.
But even the endless circus that accompanies both Trump and de Blasio can’t overshadow a tough truth for Cuomo: He has fallen back down to earth.
Alex Shephard is a staff writer at The New Republic. @alex_shephard
https://newrepublic.com/article/157532/ ... s-governor
THE YOUNG ANDY CUOMO CHRONICLES
Re: THE YOUNG ANDY CUOMO CHRONICLES
NCBI
US National Library of Medicine
National Institutes of Health
Public Health Rep. 2010; 125(Suppl 3): 71–79.
doi: 10.1177/00333549101250S310
PMCID: PMC2862336
PMID: 20568569
The 1918 Influenza Epidemic in New York City: A Review of the Public Health Response
Francesco Aimone, MPHa
SYNOPSIS
New York City approached the 1918 influenza epidemic by making use of its existing robust public health infrastructure.
Health officials worked to prevent the spread of contagion by distancing healthy New Yorkers from those infected, increasing disease surveillance capacities, and mounting a large-scale health education campaign while regulating public spaces such as schools and theaters.
Control measures, such as those used for spitting, were implemented through a spectrum of mandatory and voluntary measures.
Most of New York City's public health responses to influenza were adapted from its previous campaigns against tuberculosis, suggesting that a city's existing public health infrastructure plays an important role in shaping its practices and policies during an epidemic.
The threat of a high-fatality influenza pandemic looms large on the public health horizon.
Driving the concerns of the international public health community is the fear that H1N1 could become as deadly as the 1918 influenza pandemic that killed between 50 and 100 million people worldwide 90 years ago. 1
The influenza pandemic that swept the globe in 1918 was the most acute crisis handled by public health officials in modern times.
When compared with other large U.S. cities, especially its two largest neighbors, Boston and Philadelphia, New York City did not fare poorly in its overall mortality burden.
During the pandemic, New York City's excess death rate per 1,000 was reportedly 4.7, compared with 6.5 in Boston and 7.3 in Philadelphia. 2
New York City emerged from the three waves of the influenza pandemic (September 1918 to February 1919) officially recording approximately 30,000 deaths out of a population of roughly 5.6 million due to influenza or pneumonia, 21,000 of them during the second fall wave (September 14 to November 16). 3,4
This article describes and examines the Department of Health's myriad policies and practices used to control the spread of influenza from August through December 1918.
New York City's proactive approach to controlling the influenza epidemic was a product of the city's existing public health infrastructure and employed a variety of tactics familiar to public health practice at the turn of the 20th century.
The most notable strategies to control the spread of influenza were changes in legal statutes that mandated staggered business hours to avoid rush-hour crowding and established more than 150 emergency health districts and centers to coordinate home care and case reporting.
The sick were cared for and counted in hospitals, at home, and in gymnasia and armories.
Even the Municipal Lodging House, Manhattan's first homeless shelter on East 25th Street, was temporarily converted for the duration of the epidemic. 5
State health officials used a modified maritime quarantine for New York City-bound ship traffic.
In fact, the harbor's maritime quarantine was in place for at least a month before the first confirmed cases of influenza were reported in the city by the press on August 14, 1918.
At the ports, traditional maritime quarantine usually carried out by New York state officials was abandoned in favor of a land-based quarantine strategy in part due to considerations for the war effort.
The city increased its capacities for disease surveillance through physician reporting and health inspection, while a massive public health education campaign persuaded New Yorkers to cover their coughs and sneezes and stop spitting.
Standard public health techniques were used to limit the exposure of the general population to influenza cases and attempted to distance New Yorkers from one another.
These techniques and interventions varied in their level of compulsion: the New York City response relied on a mix of mandatory as well as voluntary measures to curb the spread of the disease.
The Department of Health applied this framework to policies regarding schools and theaters, which stayed open throughout the epidemic, though under careful regulation.
Anti-spitting measures consisted of health education efforts backed by the threat of misdemeanor fines and watchful police officers.
LEGAL BASIS OF THE PUBLIC HEALTH RESPONSE
In the middle of September, the Board of Health began making changes to the Sanitary Code.
On September 17, it made influenza and pneumonia reportable for the first time in New York City's history and on October 4 officially resolved that an epidemic existed.
As reported in the Annual Report of the New York City Department of Health, for the two weeks between October 5 and October 19, influenza deaths mounted until cresting around October 21.
From October 26 onward, the number of deaths from both influenza and pneumonia quickly declined and by mid-November had returned to levels comparable to the previous year's influenza and pneumonia mortality rates.
After November 4, the only item left on the Board of Health's influenza docket was to process the glut of hiring and compensation forms in the wake of a dramatic emergency expansion of the public health workforce. 6
The Board of Health mandated a number of compulsory actions to slow the disease's spread.
By far, the action most felt by New Yorkers was their Board of Health's decision to establish a timetable to regulate the opening and closing hours of businesses.
Passed on October 4, this timetable staggered the hours of business opening and closing with the intention of easing congestion in the public transit system during the morning and afternoon rush.
It was hoped that reducing crowding both on subway and elevated train platforms and inside the train cars would slow the spread of influenza. 6
Health Commissioner Royal S. Copeland reasoned that more restrictive means, such as ordering all businesses and municipal offices closed, was unwarranted because of the low incidence and concentrated prevalence of the disease. 7
Though this order carried with it the full weight of the police powers of the Board of Health, it is not clear the degree to which it was enforced.
Media accounts paint a mixed picture of the city's reaction to the timetable.
It was initially greeted with confusion and criticism about its ineffectiveness at reducing crowding in the subways during its first week, and it is unclear how many New York businesses complied. 7–10
The mandatory timetable codified in the Sanitary Code was created with input from those most affected by it.
Before it was enacted, Copeland and other health officials met with representatives of New York City's business community, including large employers such as the Tobacco Products Corporation, to explain the logistics of the order and the reasons it was needed. 11
Business interests also had a voice in altering the timetable once it took effect.
In fact, Copeland proved very amenable to changing the specifics of the timetable for the sake of businesses and manufacturers.
In the wake of the numerous complaints lodged against the Board of Health's orders, Copeland negotiated new opening and closing hours with some large department stores, theaters, and banks and exempted municipal and federal offices from the order the day after it took effect. 6,12
Widely disbursed cases, along with an inadequate means of delivering nursing services, led the Department of Health to create a network of emergency health centers.
The “clearinghouse plan,” rolled out on October 7, divided the city into sub-units and established about 150 temporary emergency health centers.
Copeland described the centers as the clearing house through which all the local activities of the Department of Health will be carried. 13
Although some emergency district health centers acted as clinics and kept track of available hospital beds, their main purpose was to act as headquarters for nurses delivering home health care in their districts while operating as a base of operations for the health inspectors who often assisted them.
The Department of Health met the shortage of public health inspectors through new hires using emergency appropriations from the Board of Estimate and inspectors reassigned from the Tenement House Department. 13
Nursing care was coordinated through the Nurses' Emergency Council, created and chaired by Lillian D. Wald, who also served on the Emergency Advisory Committee created to help Commissioner Copeland manage the epidemic.
Nursing, in fact, was a major part of the public health response to the epidemic.
City health officials coordinated care with Lillian Wald and others to tend to the ill, survey tenement house districts, and care for those in isolation.
A covenant enacted on October 17 required all people “… to protect their nose or mouth while coughing or sneezing.”
Though this policy was not rigorously enforced, this amendment to the Sanitary Code provided the legal basis for any fines or other punitive measures issued by sanitarians and police officers. 6
On October 19, the Board of Health overhauled the administrative structure of the Department of Health.
Under this new organizational structure, more authority was granted to each borough's sanitary superintendants and assistant superintendants.
Under the new plan, the heads of each borough were given the power to regulate, order, and “… remove, abate, suspend, alter or otherwise improve” places that sell, store, or serve food and drink with the same authority as if their orders were issued by the Board of Health.
This plan intended to clarify the Department of Health's chain of command and increase each borough's autonomy to regulate local health matters. 6
Board of Health regulations were sometimes grim.
On October 30, Mayor John F. Hylan ordered 75 men dispatched to the Calvary Cemetery to help it meet a Board of Health deadline for interring unburied bodies that were stored in a two-level shed acting as an overflow area for the cemetery's receiving vault. 6,14
New York City did not shape its policies around bacteriological investigations of influenza despite furious attempts by the Department's laboratories to come to conclusive results about its etiology and transmissibility.
Rather, the Department of Health built its control plan around its experiences fighting tuberculosis at the beginning of the century.
By and large, New York City health officials responded to the influenza with the public health machinery that was the hallmark of 19th-century public health practice.
QUARANTINE AT THE PORT
Various techniques were used to distance influenza victims from the rest of the healthy population.
At the beginning of the century, infection-control measures included personal quarantine at home for the sick and their contacts, use of placards to identify places where the sick resided, keeping children at home, and isolations at the request of private physicians.
As is the case today, the ill were sometimes forcibly isolated on North Brothers Island in the East River or in other state-run facilities in New York Harbor.
Modified sanitary cordons, port closures, and travel restrictions at railway terminals were also identified as forms of quarantine.
As other authors have explained, quarantine, even before the influenza epidemic, was a complex concept with multiple meanings and uses. 15
Newspaper accounts identified the arrival of influenza in New York's port on August 14, 1918, a full month before influenza was made a reportable disease by the Department of Health.
According to the press, eight passengers were isolated by state inspectors at the Norwegian Hospital in Brooklyn after disembarking from a Norwegian steamship on fears they were infected with influenza. 16–18
The Norwegians who supposedly brought influenza to New York City's port were identified because New York (state) port officials had increased disease surveillance on inbound ship traffic to actively monitor for influenza since the beginning of July 1918 using modified quarantine measures to do so. 19–22
In typical cases of maritime quarantine, New York State port officials would hold ships at a quarantine station in the harbor for inspection and a waiting period before letting them land. 15,23
After bacteriological investigation became more prevalent in the late 1890s, cultures were collected from passengers who waited for days in quarantine while labs cultured their specimens.
However, this was not the case during the summer of 1918, perhaps due to the unknown etiology of influenza.
Media accounts suggest that port quarantine measures were modified in the summer of 1918 specifically to monitor for “Spanish” influenza coming from Europe.
Under the modified system of quarantine at the port, ships were boarded by port health officials, inspected, and then proceeded to immediately dock at port.
Once docked, passengers identified as having flu-like symptoms during the inspection were put in ambulances and driven to the hospital where they were isolated.
Statements made to the press indicate that isolation, as well as contact tracing, were carried out by the Department of Health once the sick were in quarantine. 19,21,24,25
This maritime quarantine may have continued into late September, well after native cases developed.
Although newspapers reported that the first cases of influenza in New York City came via the port on August 14, 1918, the cases from the Norwegian steamship were not the first to reach New York City's shores.
Roughly 180 cases of “active” influenza arrived on vessels bound for New York City between July 1 and mid-September.
Approximately 305 cases of suspected influenza were reported throughout the voyages of 32 ships' port health officers examined from July through September, including victims who died while at sea or recovered from their illness. 26
Health officials did not report any secondary outbreaks of influenza from the index cases that arrived through the harbor before August 14, 1918.
New York State health officials opted for a maritime quarantine in the case of influenza to ensure the uninterrupted movement of goods and supplies to Europe for the war effort.
America entered World War I on April 6, 1917, and New York City was the main point of embarkation for American doughboys heading to the European fronts. 27
Col. J. M. Kennedy, the army officer in charge of medical affairs for the district of New York, met with local health officials in the summer of 1918 to discuss the possibility of a quarantine measure for influenza and concluded that a typical maritime quarantine for influenza would not be appropriate or practical.
As Leland E. Cofer, the State of New York's Health Officer of the Port of New York City, explained:
“Before any of the vessels arrived with influenza on board, the matter of quarantining influenza was considered solely on account of its possible bearing on the military and naval situation…it was more advantageous for the public to face a possible infection with influenza than to hinder the movement of vessels by any quarantine method which would prove effective.” 26
VOLUNTARY ISOLATION AND HOME QUARANTINE
Due to practical concerns, isolation measures used during the 1918 epidemic took on a slightly different form than the protocols for quarantine and isolation used at the turn of the century for yellow fever, diphtheria, or smallpox.
Under typical public health protocols, a person would either be bound to their home for the duration of their illness and a placard placed on their door, or they would be removed from their home and isolated in a hospital or sanitarium.
Given the high number of cases in New York City, placard isolation for influenza was impractical and unenforceable.
State Commissioner of Health Herman M. Biggs summarized the dilemma of isolation and quarantine by explaining that such measures “… while theoretically desirable, are not practical in view of the highly contagious character and the widespread extent of the malady and the general susceptibility to it.” 28
Copeland's Health Department opted for a two-tiered approach to isolating cases of influenza.
As Copland explained to The New York Times on September 19, “When cases develop in private houses or apartments they will be kept in strict quarantine there."
"When they develop in boarding houses or tenements they will be promptly removed to city hospitals, and held under strict observation and treated there.” 29
Influenza cases found in tenement and boarding homes were to be removed to municipal hospitals.
All other cases were put under home quarantine without placards. 29,30
Placarded quarantine was not used because of the belief that there were no asymptomatic cases of influenza.
As Copeland explained in the press:
“The Health Department has not deemed it necessary to quarantine families in which there are cases of influenza because this disease is held not to be communicable by one who has not himself got influenza."
"It matters not that a person is exposed to the malady unless he himself is stricken with it."
"The danger of infection lies almost entirely, it is said, in the coughing and sneezing of one who actually has influenza." 31
The responsibility for ensuring compliance with the home isolation measure fell on the shoulders of attending physicians.
Doctors were required to report if they were assuming responsibility for isolating their patient when they reported cases to the Department of Health. 32,33
It seems unlikely that individual doctors were able to ensure their patients complied with their orders to stay home during a time when doctors in New York City's East Side neighborhood were reportedly “mobbed by women demanding their services.” 18
Without doctors or sanitarians rigorously enforcing isolation orders, isolation was a de facto voluntary measure.
Despite the obligation of physicians to enforce isolation orders and the ubiquitous presence of public health nursing efforts and inspectors, daily enforcement of isolation orders fell on the shoulders of the ill and their families.
The Bureau of Public Health Education's annual report contains no evidence that placards were printed for posting on dwellings.
SURVEILLANCE AND HEALTH EDUCATION
On September 28, the city's Board of Estimate approved the first emergency appropriation to the Department of Health to fight influenza.
The first and largest use of the appropriation went toward printing health education materials.
The second largest appropriation was used to hire nurses and health inspectors who could help the city count its sick.
The Board of Estimate's first appropriation is telling: when confronted with the prospect of an influenza epidemic, the city's first move was to increase its health education and surveillance capacities.
Tandem programs of health education and surveillance had been mainstays of the Department of Health's infectious disease control procedures since the late 19th century and were touted as two of the primary means of countering the spread of tuberculosis.
Surveillance measures were expanded in the 1890s, most notably through mandates that physicians report cases of tuberculosis to the Department of Health.
Health education also took on a prominent role, persuading the tubercular to act in ways that would lessen the risk of transmitting their disease.
Educational campaigns, compulsory notification of cases by public institutions and private physicians, and case follow-up were the most important efforts in New York City's tuberculosis control plan. 34
In its efforts to control the influenza epidemic, the Health Department heavily relied on these precedents.
As the eyes of the Health Department, physicians were the primary means of collecting health information.
The Board of Health's order on September 17 that made influenza and pneumonia reportable also required physicians to report the name, age, sex, and address of their patients.
Two weeks later, Copeland expanded the reporting requirements for physicians, requesting that they also report “the sanitary conditions of the home.” 33
To better coordinate care and treatment services, inspectors borrowed from the Tenement House Authority undertook a house-to-house canvas in which they attempted to find previously undocumented cases of flu and pneumonia and report on the needs of the families. 35
Just as the Department of Health had enlisted laypeople, specifically janitors and landlords, to report tuberculars beginning in 1902, Copeland appealed for help beyond the medical community to count cases of influenza. 34
In a move that The New York Times called “rather unusual,” Copeland appealed to Tammany Hall to use its “… party machinery to seek out influenza cases." 36
Five days later, the Tammany Hall Executive Committee obliged.
According to the Times, “… the entire organization, with its election district captains, was turned over to the Department of Health to aid Commissioner Copeland in the Spanish influenza epidemic.” 37
Along with case reporting, the Department of Health used health education to control the influenza epidemic.
By September 24, at least 10,000 posters had been placed around the city in railway stations, elevated train platforms, street cars, store windows, police precincts, hotels, and other public places.
At least three different health posters were distributed during the epidemic: one instructing people to cover their coughs and sneezes, one not to spit, and the last titled, “Help to Prevent the Return of the ‘Flu’ and Pneumonia!” 3,38
Compared to other local health departments, the New York City Department of Health had an unrivaled capacity for creating and disseminating health education materials.
Established in 1914, theirs was the first health department to formally incorporate health education into public health practice.
KEEPING SCHOOLS OPEN
In an October 5 New York Times story, Commissioner Copeland outlined the logic behind one of his most controversial decisions during the epidemic: the continued operation of New York's public schools.
“New York is a great cosmopolitan city and in some homes there is careless disregard for modern sanitation…"
"In schools the children are under the constant guardianship of the medical inspectors."
"This work is part of our system of disease control."
"If the schools were closed at least 1,000,000 would be sent to their homes and become 1,000,000 possibilities for the disease."
"Furthermore, there would be nobody to take special notice of their condition.” 7
In Copeland's mind, there was no real danger of influenza spreading in schools and during the epidemic, he repeatedly defended his decision not to close them.
Copeland's argument was three-fold.
First, he advocated for keeping children in schools where “… educational propaganda against influenza can be kept constantly before them.” 39
And it was.
At the end of September, the Department of Health distributed nearly one million circulars, one for every pupil in the public and parochial schools to take home. 40
Second, Copeland believed that the city could do a better job keeping the students healthy than could their families.
Last, Copeland made use of the existing school health and medical surveillance programs already in place in New York City schools, which at the time were perhaps the nation's best.
Copeland reasoned that schools were safer than many homes because in the schools children would be under the watchful eye of their teacher and subject to daily medical inspection.
As part of the school health and medical surveillance program, teachers were mandated to inspect their pupils daily and report symptomatic children to school medical authorities.
School nurses and medical inspectors were instructed to follow up on teacher inspections and conduct home visits on absentee students to determine whether “… they or members of their family are sick, that physical examinations be carefully made, and that dry sweeping [in their home] be discontinued and ventilation sufficient.” 3,41
The Board of Superintendents agreed with Copeland's assumption that most children's homes were unsanitary. 42
Numerous parties disagreed with the Department of Health's decision to keep the schools open, including the Red Cross of Long Island and former Health Commissioner Dr. S.S. Goldwater.
Goldwater did not criticize the Department of Health's parens patriae argument, but instead took issue with the “almost criminal laxity” the schools used in carrying out pupil inspections and case follow-up, the enforcement of which he described as “lamentably weak.” 43,44
THE SHOW MUST GO ON
Theaters presented a paradox for the Department of Health.
Theaters of all types were an opportunity to educate the public about ways to prevent the spread of influenza, but they also presented an immense risk for spreading the disease.
Throughout the city, theaters were not universally closed and instead were subject to increased regulation and inspection.
On October 11, the Board of Health issued regulations for theaters that included prohibiting children younger than age 12 from entering movies or shows.
Regulations also included bans on dry sweeping, overcrowding and, in a move truly ahead of its time, smoking.
Theaters were also required to ventilate during off-hours by opening all their windows and doors. 6
The Board of Health order was enforced through increased inspection, and non-compliant theaters were shut down.[/b][/color]
Of the greatest concern to Copeland was not the properly maintained, “well-ventilated, sanitary theatre,” but the “insanitary [sic], hole-in-the-wall theatre … the latter sort which our inspectors found was closed immediately …” 45
Despite the danger posed by theaters, these public places provided two potential benefits.
First, theaters presented an opportunity to educate the public about how not to transmit influenza.
Second, Copeland maintained that keeping sanitary theaters with a low risk of spreading contagion in operation would “… prevent the spread of panic and hysteria, and thus to protect the public from a condition of mind which would predispose it to physical ills.” 45
REGULATING “THE FILTHY HABIT”
The Department of Health began its anti-spitting campaign more than 20 years prior to the influenza epidemic in 1918.
The anti-spitting campaign waged under former Health Commissioner Herman Biggs was based on education, moral suasion, and police enforcement.
Pamphlets, with titles such as “Don't Spit,” were translated into English, Italian, German, and Yiddish and distributed in tenement houses from the turn of the century onward.
An extensive anti-spitting placarding campaign was evident in public buildings, rail platforms, and ferryboats at a time when preventing the spread of contagious respiratory disease took on a moral tone. 46
Biggs' spitting campaign also included fines and arrests for violation of the Sanitary Code.
In writing about the extent and efficacy of the Department of Health's anti-spitting campaign in 1908, Biggs wrote that arrests of spitters by the “sanitary police of the Department” were constant and, as a result, “spitting is much less prevalent than it was a few years ago, although still much remains to be desired.” 34
The anti-spitting campaign employed during the 1918 influenza epidemic reinforced the same message and used the same tactics.
Placards were posted in railway stations, ferries, and public places.
Nongovernmental organizations were involved in the Department of Health's suasion, too.
The New York Tribune reported that Boy Scouts handed out cards to people spitting on the sidewalk that read: “You are violating the Sanitary Code.” 47
Like the previous spitting campaign, education and persuasive efforts occurred in tandem with enforcement. 48
New Yorkers caught spitting were usually rounded up and brought before courts in large numbers and available records suggest that few taken to court escaped without fines.
On October 4, 134 men were fined $1 at Jefferson Market Court and another three at the Yorkville Court for spitting on subways, subway platforms, and elevated trains.
A few days later on October 7, more than 100 spitters were summoned to court; 128 paid a $1 fine and 11 cases were dropped. 41,49
Violating the spitting covenants of the Sanitary Code technically resulted in fines or jail time, although no records exist indicating that violators were punished with the latter. 36,49,50
CONCLUSIONS
New York City health officials used a combination of traditional public health practices, such as quarantine, isolation, and health information campaigns, in their attempt to control the influenza epidemic.
Along with isolation, quarantine, and regulation of public spaces, modifying personal behavior was essential to halt the disease's spread.
At the same time the Health Department was borrowing inspectors from other city agencies to complete block-by-block surveys for influenza cases, they recruited laypeople and nongovernmental organizations to increase their surveillance capacity.
When compulsory measures were impractical, Copeland's Department of Health turned to persuasive measures, such as posters and pamphlets, because health education was thought to be an appropriate and effective supplement to public health policies. 51
The city's health surveillance capacity increased through physician reporting and an expanded workforce of public health inspectors.
Health inspection played an important role in schools, too, as they remained open because of the belief that children would be healthier if kept in schools rather than sent home.
Schools were also an effective conduit for distributing health education materials to children and their families.
Likewise, theaters were subjected to increased regulation and inspection, but not closed because they were another effective venue for disseminating health educational information.
The mandated system of staggered business hours and theater regulations and the use of public health police powers to fine people caught violating the anti-spitting ordinances of the Sanitary Code were the most frequently used means of enforcing healthy practices.
In responding to the influenza epidemic, the Health Department scaled up and adapted the programs and practices that had been developed to address tuberculosis.
New York City's mixture of mandatory and voluntary measures was part of a broad continuum of public health activities used to stem disease throughout the 19th and early 20th centuries.
In an interview with The New York Times after the epidemic subsided, Copeland commented that New York City “escaped” with a low mortality rate because of the city's health efforts over the previous 20 years.
He referenced the consistent efforts of tuberculosis control to improve sanitary conditions, tenement house reform laws mandating good ventilation, and the constant effort to maintain clean streets and to keep the city clean and sanitary. 52
When confronted with the overwhelming task of controlling influenza, the New York City Department of Health turned to a variety of time-tested and adaptable regulatory and voluntary techniques already at its disposal.
Certainly, the importance of a robust public health infrastructure is instructive as we confront the possibility of a future influenza epidemic.
REFERENCES
1. Johnson N, Mueller J. Updating the accounts: global mortality of the 1918–1920 ‘Spanish’ influenza pandemic. Bull Hist Med. 2002;76:105–15.
2. Deaths from influenza and pneumonia in cities: 25 weeks, September 8, 1918 to March 1, 1919. Public Health Rep. 1919;34:505–8.
3. Department of Health of the City of New York. Annual report of Department of Health of the City of New York for the calendar year 1918. New York: William Bratler, Inc.; 1919.
4. Department of Health of the City of New York. Annual report of Department of Health of the City of New York for the calendar year 1919. New York: 1920. [publisher unknown]
5. New York City Police Department. New York Police Department annual report for the year 1918. New York: Bureau of Printing; 1919.
6. Book 31. New York: Municipal Archives of the City of New York; Minutes of the Board of Health of the City of New York, August 10, 1918, to December 31, 1918.
7. Drastic steps to fight influenza. New York Times. 1918 Oct;5:1.
8. Epidemic here checked hints Dr. Copeland. New York Tribune. 1918 Oct;7:16.
9. Influenza orders bring a flood of inquiries. New York Evening Post. 1918 Oct;5:1.
10. Cars are crowded despite new rules. New York Evening Post. 1918 Oct;7:6.
11. Copeland Royal S., Whalen Grover H. Mayoral Correspondence Collection, folder 795, box 072. New York: Municipal Archives of the City of New York; 1918. Oct 25,
12. Six hospitals here taken in influenza fight. New York Tribune. 1918 Oct;6:18.
13. Copeland Royal S., Hylan John F. Mayoral Correspondence Collection, folder 795, box 072. New York: Municipal Archives of the City of New York; 1918. Oct 18,
14. Hylan John F., Copeland Royal S. folder 795, box 072, Mayoral Correspondence Collection. New York: Municipal Archives of the City of New York; 1918. Oct 30,
15. Centers for Disease Control and Prevention (US) A commentary on the JAMA study's interpretation of the influenza experiences in New York City and Chicago, 1918–19. 2008. Jan 17, [cited 2009 Aug 1]. Available from: URL: http://www.cdc.gov/ncidod/dq/1918_commentary.htm.
16. Spanish influenza here, shipmen say. New York Times. 1918 Aug;14:1.
17. 8 Spanish grip suspects here; one victim dead. New York Tribune. 1918 Aug;14:12.
18. Price GM. Mobilizing social forces against influenza. The Survey. 1918;41:95–6.
19. Health head calls for influenza inquiry. New York Times. 1918 Aug;16:16.
20. 13 Spanish influenza cases come to port. New York Evening Post. 1918 Sep;16:1.
21. City has 85 cases of Spanish influenza. New York Evening Post. 1918 Sep;23:1.
22. Epidemic guard for port. New York Times. 1918 Aug;19:5.
23. Markel H. Baltimore: Johns Hopkins University Press; 1997. Quarantine! East European Jewish immigrants and the New York City epidemics of 1892.
24. Spanish influenza found in New York. New York Tribune. 1918 Aug;20:7.
25. Spanish influenza found in ‘mild form’ New York Times. 1918 Aug;20:20.
26. Influenza may be old-fashioned grip. New York Evening Post. 1918 Sep 19;
27. Ellis ER. The epic of New York City: a narrative history. New York: Carroll & Graf Publishers; 2004.
28. Influenza causes Crowder to cancel Oct. 7–11 draft call. New York Tribune. 1918 Sep;27:6.
29. New York prepared for influenza siege. New York Times. 1918 Sep;19:11.
30. Subway spreading influenza here. New York Tribune. 1918 Sep;29:10.
31. Vaccine for influenza. New York Evening Post. 1918 Oct;12:8.
32. Copeland Royal S. Mayoral Correspondence Collection, folder 793, box 071. New York: Municipal Archives of the City of New York; 1918. Sep 20, to unnamed New York City doctors.
33. Copeland Royal S. Mayoral Correspondence Collection, folder 795, box 072. New York: Municipal Archives of the City of New York; 1918. Oct 10, to unnamed New York City doctors.
34. Biggs HM. Brief history of the campaign against tuberculosis. New York: New York City Department of Health; 1908.
35. Emergency Advisory Committee. Lillian D. Wald Papers, folder 4.1, box 91. Columbia University, New York: Rare Book and Manuscript Library; 1918. Oct 24, Memo to the executives of the emergency health districts.
36. Fight stiffens here against influenza. New York Times. 1918 Oct;12:13.
37. Grip in the Y.M.C.A. checked by vaccine. New York Times. 1918 Oct;17:9.
38. Find 114 cases of influenza here. New York Times. 1918 Sep;24:9.
39. 142,000 draft men held up by influenza. New York Tribune. 1918 Sep;27:6.
40. New influenza cases in the city doubled. New York Times. 1918 Sep;28:10.
41. Has clearing house plan for influenza. New York Times. 1918 Oct;8:11.
42. Influenza lessens school attendance. New York Evening Post. 1918 Oct;15:2.
43. Asks experts' aid to check epidemic. New York Times. 1918 Oct;13:18.
44. Closing of schools will be discussed. New York Evening Post. 1918 Oct;19:1.
45. Copeland Royal S. Mayoral Correspondence Collection, folder 796, box 072. New York: Municipal Archives of the City of New York; 1918. Dec 17, to National Association of the Motion Picture Industry.
46. Tomes N. The gospel of germs: men, women, and the microbe in American life. Cambridge (MA): Harvard University Press; 1998.
47. Anti-influenza serum made in tests here. New York Tribune. 1918 Oct;2:14.
48. Tells of vaccine to stop influenza. New York Times. 1918 Oct;2:10.
49. Influenza cases increase. New York Evening Post. 1918 Oct;4:2.
50. Influenza cases still mounting. New York Evening Post. 1918 Oct;11:2.
51. Duffy J. A history of public health in New York City, 1866–1966. New York: Russell Sage Foundation; 1974.
52. Epidemic lessons for next time. New York Times. 1918 Nov;17:42.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862336/
US National Library of Medicine
National Institutes of Health
Public Health Rep. 2010; 125(Suppl 3): 71–79.
doi: 10.1177/00333549101250S310
PMCID: PMC2862336
PMID: 20568569
The 1918 Influenza Epidemic in New York City: A Review of the Public Health Response
Francesco Aimone, MPHa
SYNOPSIS
New York City approached the 1918 influenza epidemic by making use of its existing robust public health infrastructure.
Health officials worked to prevent the spread of contagion by distancing healthy New Yorkers from those infected, increasing disease surveillance capacities, and mounting a large-scale health education campaign while regulating public spaces such as schools and theaters.
Control measures, such as those used for spitting, were implemented through a spectrum of mandatory and voluntary measures.
Most of New York City's public health responses to influenza were adapted from its previous campaigns against tuberculosis, suggesting that a city's existing public health infrastructure plays an important role in shaping its practices and policies during an epidemic.
The threat of a high-fatality influenza pandemic looms large on the public health horizon.
Driving the concerns of the international public health community is the fear that H1N1 could become as deadly as the 1918 influenza pandemic that killed between 50 and 100 million people worldwide 90 years ago. 1
The influenza pandemic that swept the globe in 1918 was the most acute crisis handled by public health officials in modern times.
When compared with other large U.S. cities, especially its two largest neighbors, Boston and Philadelphia, New York City did not fare poorly in its overall mortality burden.
During the pandemic, New York City's excess death rate per 1,000 was reportedly 4.7, compared with 6.5 in Boston and 7.3 in Philadelphia. 2
New York City emerged from the three waves of the influenza pandemic (September 1918 to February 1919) officially recording approximately 30,000 deaths out of a population of roughly 5.6 million due to influenza or pneumonia, 21,000 of them during the second fall wave (September 14 to November 16). 3,4
This article describes and examines the Department of Health's myriad policies and practices used to control the spread of influenza from August through December 1918.
New York City's proactive approach to controlling the influenza epidemic was a product of the city's existing public health infrastructure and employed a variety of tactics familiar to public health practice at the turn of the 20th century.
The most notable strategies to control the spread of influenza were changes in legal statutes that mandated staggered business hours to avoid rush-hour crowding and established more than 150 emergency health districts and centers to coordinate home care and case reporting.
The sick were cared for and counted in hospitals, at home, and in gymnasia and armories.
Even the Municipal Lodging House, Manhattan's first homeless shelter on East 25th Street, was temporarily converted for the duration of the epidemic. 5
State health officials used a modified maritime quarantine for New York City-bound ship traffic.
In fact, the harbor's maritime quarantine was in place for at least a month before the first confirmed cases of influenza were reported in the city by the press on August 14, 1918.
At the ports, traditional maritime quarantine usually carried out by New York state officials was abandoned in favor of a land-based quarantine strategy in part due to considerations for the war effort.
The city increased its capacities for disease surveillance through physician reporting and health inspection, while a massive public health education campaign persuaded New Yorkers to cover their coughs and sneezes and stop spitting.
Standard public health techniques were used to limit the exposure of the general population to influenza cases and attempted to distance New Yorkers from one another.
These techniques and interventions varied in their level of compulsion: the New York City response relied on a mix of mandatory as well as voluntary measures to curb the spread of the disease.
The Department of Health applied this framework to policies regarding schools and theaters, which stayed open throughout the epidemic, though under careful regulation.
Anti-spitting measures consisted of health education efforts backed by the threat of misdemeanor fines and watchful police officers.
LEGAL BASIS OF THE PUBLIC HEALTH RESPONSE
In the middle of September, the Board of Health began making changes to the Sanitary Code.
On September 17, it made influenza and pneumonia reportable for the first time in New York City's history and on October 4 officially resolved that an epidemic existed.
As reported in the Annual Report of the New York City Department of Health, for the two weeks between October 5 and October 19, influenza deaths mounted until cresting around October 21.
From October 26 onward, the number of deaths from both influenza and pneumonia quickly declined and by mid-November had returned to levels comparable to the previous year's influenza and pneumonia mortality rates.
After November 4, the only item left on the Board of Health's influenza docket was to process the glut of hiring and compensation forms in the wake of a dramatic emergency expansion of the public health workforce. 6
The Board of Health mandated a number of compulsory actions to slow the disease's spread.
By far, the action most felt by New Yorkers was their Board of Health's decision to establish a timetable to regulate the opening and closing hours of businesses.
Passed on October 4, this timetable staggered the hours of business opening and closing with the intention of easing congestion in the public transit system during the morning and afternoon rush.
It was hoped that reducing crowding both on subway and elevated train platforms and inside the train cars would slow the spread of influenza. 6
Health Commissioner Royal S. Copeland reasoned that more restrictive means, such as ordering all businesses and municipal offices closed, was unwarranted because of the low incidence and concentrated prevalence of the disease. 7
Though this order carried with it the full weight of the police powers of the Board of Health, it is not clear the degree to which it was enforced.
Media accounts paint a mixed picture of the city's reaction to the timetable.
It was initially greeted with confusion and criticism about its ineffectiveness at reducing crowding in the subways during its first week, and it is unclear how many New York businesses complied. 7–10
The mandatory timetable codified in the Sanitary Code was created with input from those most affected by it.
Before it was enacted, Copeland and other health officials met with representatives of New York City's business community, including large employers such as the Tobacco Products Corporation, to explain the logistics of the order and the reasons it was needed. 11
Business interests also had a voice in altering the timetable once it took effect.
In fact, Copeland proved very amenable to changing the specifics of the timetable for the sake of businesses and manufacturers.
In the wake of the numerous complaints lodged against the Board of Health's orders, Copeland negotiated new opening and closing hours with some large department stores, theaters, and banks and exempted municipal and federal offices from the order the day after it took effect. 6,12
Widely disbursed cases, along with an inadequate means of delivering nursing services, led the Department of Health to create a network of emergency health centers.
The “clearinghouse plan,” rolled out on October 7, divided the city into sub-units and established about 150 temporary emergency health centers.
Copeland described the centers as the clearing house through which all the local activities of the Department of Health will be carried. 13
Although some emergency district health centers acted as clinics and kept track of available hospital beds, their main purpose was to act as headquarters for nurses delivering home health care in their districts while operating as a base of operations for the health inspectors who often assisted them.
The Department of Health met the shortage of public health inspectors through new hires using emergency appropriations from the Board of Estimate and inspectors reassigned from the Tenement House Department. 13
Nursing care was coordinated through the Nurses' Emergency Council, created and chaired by Lillian D. Wald, who also served on the Emergency Advisory Committee created to help Commissioner Copeland manage the epidemic.
Nursing, in fact, was a major part of the public health response to the epidemic.
City health officials coordinated care with Lillian Wald and others to tend to the ill, survey tenement house districts, and care for those in isolation.
A covenant enacted on October 17 required all people “… to protect their nose or mouth while coughing or sneezing.”
Though this policy was not rigorously enforced, this amendment to the Sanitary Code provided the legal basis for any fines or other punitive measures issued by sanitarians and police officers. 6
On October 19, the Board of Health overhauled the administrative structure of the Department of Health.
Under this new organizational structure, more authority was granted to each borough's sanitary superintendants and assistant superintendants.
Under the new plan, the heads of each borough were given the power to regulate, order, and “… remove, abate, suspend, alter or otherwise improve” places that sell, store, or serve food and drink with the same authority as if their orders were issued by the Board of Health.
This plan intended to clarify the Department of Health's chain of command and increase each borough's autonomy to regulate local health matters. 6
Board of Health regulations were sometimes grim.
On October 30, Mayor John F. Hylan ordered 75 men dispatched to the Calvary Cemetery to help it meet a Board of Health deadline for interring unburied bodies that were stored in a two-level shed acting as an overflow area for the cemetery's receiving vault. 6,14
New York City did not shape its policies around bacteriological investigations of influenza despite furious attempts by the Department's laboratories to come to conclusive results about its etiology and transmissibility.
Rather, the Department of Health built its control plan around its experiences fighting tuberculosis at the beginning of the century.
By and large, New York City health officials responded to the influenza with the public health machinery that was the hallmark of 19th-century public health practice.
QUARANTINE AT THE PORT
Various techniques were used to distance influenza victims from the rest of the healthy population.
At the beginning of the century, infection-control measures included personal quarantine at home for the sick and their contacts, use of placards to identify places where the sick resided, keeping children at home, and isolations at the request of private physicians.
As is the case today, the ill were sometimes forcibly isolated on North Brothers Island in the East River or in other state-run facilities in New York Harbor.
Modified sanitary cordons, port closures, and travel restrictions at railway terminals were also identified as forms of quarantine.
As other authors have explained, quarantine, even before the influenza epidemic, was a complex concept with multiple meanings and uses. 15
Newspaper accounts identified the arrival of influenza in New York's port on August 14, 1918, a full month before influenza was made a reportable disease by the Department of Health.
According to the press, eight passengers were isolated by state inspectors at the Norwegian Hospital in Brooklyn after disembarking from a Norwegian steamship on fears they were infected with influenza. 16–18
The Norwegians who supposedly brought influenza to New York City's port were identified because New York (state) port officials had increased disease surveillance on inbound ship traffic to actively monitor for influenza since the beginning of July 1918 using modified quarantine measures to do so. 19–22
In typical cases of maritime quarantine, New York State port officials would hold ships at a quarantine station in the harbor for inspection and a waiting period before letting them land. 15,23
After bacteriological investigation became more prevalent in the late 1890s, cultures were collected from passengers who waited for days in quarantine while labs cultured their specimens.
However, this was not the case during the summer of 1918, perhaps due to the unknown etiology of influenza.
Media accounts suggest that port quarantine measures were modified in the summer of 1918 specifically to monitor for “Spanish” influenza coming from Europe.
Under the modified system of quarantine at the port, ships were boarded by port health officials, inspected, and then proceeded to immediately dock at port.
Once docked, passengers identified as having flu-like symptoms during the inspection were put in ambulances and driven to the hospital where they were isolated.
Statements made to the press indicate that isolation, as well as contact tracing, were carried out by the Department of Health once the sick were in quarantine. 19,21,24,25
This maritime quarantine may have continued into late September, well after native cases developed.
Although newspapers reported that the first cases of influenza in New York City came via the port on August 14, 1918, the cases from the Norwegian steamship were not the first to reach New York City's shores.
Roughly 180 cases of “active” influenza arrived on vessels bound for New York City between July 1 and mid-September.
Approximately 305 cases of suspected influenza were reported throughout the voyages of 32 ships' port health officers examined from July through September, including victims who died while at sea or recovered from their illness. 26
Health officials did not report any secondary outbreaks of influenza from the index cases that arrived through the harbor before August 14, 1918.
New York State health officials opted for a maritime quarantine in the case of influenza to ensure the uninterrupted movement of goods and supplies to Europe for the war effort.
America entered World War I on April 6, 1917, and New York City was the main point of embarkation for American doughboys heading to the European fronts. 27
Col. J. M. Kennedy, the army officer in charge of medical affairs for the district of New York, met with local health officials in the summer of 1918 to discuss the possibility of a quarantine measure for influenza and concluded that a typical maritime quarantine for influenza would not be appropriate or practical.
As Leland E. Cofer, the State of New York's Health Officer of the Port of New York City, explained:
“Before any of the vessels arrived with influenza on board, the matter of quarantining influenza was considered solely on account of its possible bearing on the military and naval situation…it was more advantageous for the public to face a possible infection with influenza than to hinder the movement of vessels by any quarantine method which would prove effective.” 26
VOLUNTARY ISOLATION AND HOME QUARANTINE
Due to practical concerns, isolation measures used during the 1918 epidemic took on a slightly different form than the protocols for quarantine and isolation used at the turn of the century for yellow fever, diphtheria, or smallpox.
Under typical public health protocols, a person would either be bound to their home for the duration of their illness and a placard placed on their door, or they would be removed from their home and isolated in a hospital or sanitarium.
Given the high number of cases in New York City, placard isolation for influenza was impractical and unenforceable.
State Commissioner of Health Herman M. Biggs summarized the dilemma of isolation and quarantine by explaining that such measures “… while theoretically desirable, are not practical in view of the highly contagious character and the widespread extent of the malady and the general susceptibility to it.” 28
Copeland's Health Department opted for a two-tiered approach to isolating cases of influenza.
As Copland explained to The New York Times on September 19, “When cases develop in private houses or apartments they will be kept in strict quarantine there."
"When they develop in boarding houses or tenements they will be promptly removed to city hospitals, and held under strict observation and treated there.” 29
Influenza cases found in tenement and boarding homes were to be removed to municipal hospitals.
All other cases were put under home quarantine without placards. 29,30
Placarded quarantine was not used because of the belief that there were no asymptomatic cases of influenza.
As Copeland explained in the press:
“The Health Department has not deemed it necessary to quarantine families in which there are cases of influenza because this disease is held not to be communicable by one who has not himself got influenza."
"It matters not that a person is exposed to the malady unless he himself is stricken with it."
"The danger of infection lies almost entirely, it is said, in the coughing and sneezing of one who actually has influenza." 31
The responsibility for ensuring compliance with the home isolation measure fell on the shoulders of attending physicians.
Doctors were required to report if they were assuming responsibility for isolating their patient when they reported cases to the Department of Health. 32,33
It seems unlikely that individual doctors were able to ensure their patients complied with their orders to stay home during a time when doctors in New York City's East Side neighborhood were reportedly “mobbed by women demanding their services.” 18
Without doctors or sanitarians rigorously enforcing isolation orders, isolation was a de facto voluntary measure.
Despite the obligation of physicians to enforce isolation orders and the ubiquitous presence of public health nursing efforts and inspectors, daily enforcement of isolation orders fell on the shoulders of the ill and their families.
The Bureau of Public Health Education's annual report contains no evidence that placards were printed for posting on dwellings.
SURVEILLANCE AND HEALTH EDUCATION
On September 28, the city's Board of Estimate approved the first emergency appropriation to the Department of Health to fight influenza.
The first and largest use of the appropriation went toward printing health education materials.
The second largest appropriation was used to hire nurses and health inspectors who could help the city count its sick.
The Board of Estimate's first appropriation is telling: when confronted with the prospect of an influenza epidemic, the city's first move was to increase its health education and surveillance capacities.
Tandem programs of health education and surveillance had been mainstays of the Department of Health's infectious disease control procedures since the late 19th century and were touted as two of the primary means of countering the spread of tuberculosis.
Surveillance measures were expanded in the 1890s, most notably through mandates that physicians report cases of tuberculosis to the Department of Health.
Health education also took on a prominent role, persuading the tubercular to act in ways that would lessen the risk of transmitting their disease.
Educational campaigns, compulsory notification of cases by public institutions and private physicians, and case follow-up were the most important efforts in New York City's tuberculosis control plan. 34
In its efforts to control the influenza epidemic, the Health Department heavily relied on these precedents.
As the eyes of the Health Department, physicians were the primary means of collecting health information.
The Board of Health's order on September 17 that made influenza and pneumonia reportable also required physicians to report the name, age, sex, and address of their patients.
Two weeks later, Copeland expanded the reporting requirements for physicians, requesting that they also report “the sanitary conditions of the home.” 33
To better coordinate care and treatment services, inspectors borrowed from the Tenement House Authority undertook a house-to-house canvas in which they attempted to find previously undocumented cases of flu and pneumonia and report on the needs of the families. 35
Just as the Department of Health had enlisted laypeople, specifically janitors and landlords, to report tuberculars beginning in 1902, Copeland appealed for help beyond the medical community to count cases of influenza. 34
In a move that The New York Times called “rather unusual,” Copeland appealed to Tammany Hall to use its “… party machinery to seek out influenza cases." 36
Five days later, the Tammany Hall Executive Committee obliged.
According to the Times, “… the entire organization, with its election district captains, was turned over to the Department of Health to aid Commissioner Copeland in the Spanish influenza epidemic.” 37
Along with case reporting, the Department of Health used health education to control the influenza epidemic.
By September 24, at least 10,000 posters had been placed around the city in railway stations, elevated train platforms, street cars, store windows, police precincts, hotels, and other public places.
At least three different health posters were distributed during the epidemic: one instructing people to cover their coughs and sneezes, one not to spit, and the last titled, “Help to Prevent the Return of the ‘Flu’ and Pneumonia!” 3,38
Compared to other local health departments, the New York City Department of Health had an unrivaled capacity for creating and disseminating health education materials.
Established in 1914, theirs was the first health department to formally incorporate health education into public health practice.
KEEPING SCHOOLS OPEN
In an October 5 New York Times story, Commissioner Copeland outlined the logic behind one of his most controversial decisions during the epidemic: the continued operation of New York's public schools.
“New York is a great cosmopolitan city and in some homes there is careless disregard for modern sanitation…"
"In schools the children are under the constant guardianship of the medical inspectors."
"This work is part of our system of disease control."
"If the schools were closed at least 1,000,000 would be sent to their homes and become 1,000,000 possibilities for the disease."
"Furthermore, there would be nobody to take special notice of their condition.” 7
In Copeland's mind, there was no real danger of influenza spreading in schools and during the epidemic, he repeatedly defended his decision not to close them.
Copeland's argument was three-fold.
First, he advocated for keeping children in schools where “… educational propaganda against influenza can be kept constantly before them.” 39
And it was.
At the end of September, the Department of Health distributed nearly one million circulars, one for every pupil in the public and parochial schools to take home. 40
Second, Copeland believed that the city could do a better job keeping the students healthy than could their families.
Last, Copeland made use of the existing school health and medical surveillance programs already in place in New York City schools, which at the time were perhaps the nation's best.
Copeland reasoned that schools were safer than many homes because in the schools children would be under the watchful eye of their teacher and subject to daily medical inspection.
As part of the school health and medical surveillance program, teachers were mandated to inspect their pupils daily and report symptomatic children to school medical authorities.
School nurses and medical inspectors were instructed to follow up on teacher inspections and conduct home visits on absentee students to determine whether “… they or members of their family are sick, that physical examinations be carefully made, and that dry sweeping [in their home] be discontinued and ventilation sufficient.” 3,41
The Board of Superintendents agreed with Copeland's assumption that most children's homes were unsanitary. 42
Numerous parties disagreed with the Department of Health's decision to keep the schools open, including the Red Cross of Long Island and former Health Commissioner Dr. S.S. Goldwater.
Goldwater did not criticize the Department of Health's parens patriae argument, but instead took issue with the “almost criminal laxity” the schools used in carrying out pupil inspections and case follow-up, the enforcement of which he described as “lamentably weak.” 43,44
THE SHOW MUST GO ON
Theaters presented a paradox for the Department of Health.
Theaters of all types were an opportunity to educate the public about ways to prevent the spread of influenza, but they also presented an immense risk for spreading the disease.
Throughout the city, theaters were not universally closed and instead were subject to increased regulation and inspection.
On October 11, the Board of Health issued regulations for theaters that included prohibiting children younger than age 12 from entering movies or shows.
Regulations also included bans on dry sweeping, overcrowding and, in a move truly ahead of its time, smoking.
Theaters were also required to ventilate during off-hours by opening all their windows and doors. 6
The Board of Health order was enforced through increased inspection, and non-compliant theaters were shut down.[/b][/color]
Of the greatest concern to Copeland was not the properly maintained, “well-ventilated, sanitary theatre,” but the “insanitary [sic], hole-in-the-wall theatre … the latter sort which our inspectors found was closed immediately …” 45
Despite the danger posed by theaters, these public places provided two potential benefits.
First, theaters presented an opportunity to educate the public about how not to transmit influenza.
Second, Copeland maintained that keeping sanitary theaters with a low risk of spreading contagion in operation would “… prevent the spread of panic and hysteria, and thus to protect the public from a condition of mind which would predispose it to physical ills.” 45
REGULATING “THE FILTHY HABIT”
The Department of Health began its anti-spitting campaign more than 20 years prior to the influenza epidemic in 1918.
The anti-spitting campaign waged under former Health Commissioner Herman Biggs was based on education, moral suasion, and police enforcement.
Pamphlets, with titles such as “Don't Spit,” were translated into English, Italian, German, and Yiddish and distributed in tenement houses from the turn of the century onward.
An extensive anti-spitting placarding campaign was evident in public buildings, rail platforms, and ferryboats at a time when preventing the spread of contagious respiratory disease took on a moral tone. 46
Biggs' spitting campaign also included fines and arrests for violation of the Sanitary Code.
In writing about the extent and efficacy of the Department of Health's anti-spitting campaign in 1908, Biggs wrote that arrests of spitters by the “sanitary police of the Department” were constant and, as a result, “spitting is much less prevalent than it was a few years ago, although still much remains to be desired.” 34
The anti-spitting campaign employed during the 1918 influenza epidemic reinforced the same message and used the same tactics.
Placards were posted in railway stations, ferries, and public places.
Nongovernmental organizations were involved in the Department of Health's suasion, too.
The New York Tribune reported that Boy Scouts handed out cards to people spitting on the sidewalk that read: “You are violating the Sanitary Code.” 47
Like the previous spitting campaign, education and persuasive efforts occurred in tandem with enforcement. 48
New Yorkers caught spitting were usually rounded up and brought before courts in large numbers and available records suggest that few taken to court escaped without fines.
On October 4, 134 men were fined $1 at Jefferson Market Court and another three at the Yorkville Court for spitting on subways, subway platforms, and elevated trains.
A few days later on October 7, more than 100 spitters were summoned to court; 128 paid a $1 fine and 11 cases were dropped. 41,49
Violating the spitting covenants of the Sanitary Code technically resulted in fines or jail time, although no records exist indicating that violators were punished with the latter. 36,49,50
CONCLUSIONS
New York City health officials used a combination of traditional public health practices, such as quarantine, isolation, and health information campaigns, in their attempt to control the influenza epidemic.
Along with isolation, quarantine, and regulation of public spaces, modifying personal behavior was essential to halt the disease's spread.
At the same time the Health Department was borrowing inspectors from other city agencies to complete block-by-block surveys for influenza cases, they recruited laypeople and nongovernmental organizations to increase their surveillance capacity.
When compulsory measures were impractical, Copeland's Department of Health turned to persuasive measures, such as posters and pamphlets, because health education was thought to be an appropriate and effective supplement to public health policies. 51
The city's health surveillance capacity increased through physician reporting and an expanded workforce of public health inspectors.
Health inspection played an important role in schools, too, as they remained open because of the belief that children would be healthier if kept in schools rather than sent home.
Schools were also an effective conduit for distributing health education materials to children and their families.
Likewise, theaters were subjected to increased regulation and inspection, but not closed because they were another effective venue for disseminating health educational information.
The mandated system of staggered business hours and theater regulations and the use of public health police powers to fine people caught violating the anti-spitting ordinances of the Sanitary Code were the most frequently used means of enforcing healthy practices.
In responding to the influenza epidemic, the Health Department scaled up and adapted the programs and practices that had been developed to address tuberculosis.
New York City's mixture of mandatory and voluntary measures was part of a broad continuum of public health activities used to stem disease throughout the 19th and early 20th centuries.
In an interview with The New York Times after the epidemic subsided, Copeland commented that New York City “escaped” with a low mortality rate because of the city's health efforts over the previous 20 years.
He referenced the consistent efforts of tuberculosis control to improve sanitary conditions, tenement house reform laws mandating good ventilation, and the constant effort to maintain clean streets and to keep the city clean and sanitary. 52
When confronted with the overwhelming task of controlling influenza, the New York City Department of Health turned to a variety of time-tested and adaptable regulatory and voluntary techniques already at its disposal.
Certainly, the importance of a robust public health infrastructure is instructive as we confront the possibility of a future influenza epidemic.
REFERENCES
1. Johnson N, Mueller J. Updating the accounts: global mortality of the 1918–1920 ‘Spanish’ influenza pandemic. Bull Hist Med. 2002;76:105–15.
2. Deaths from influenza and pneumonia in cities: 25 weeks, September 8, 1918 to March 1, 1919. Public Health Rep. 1919;34:505–8.
3. Department of Health of the City of New York. Annual report of Department of Health of the City of New York for the calendar year 1918. New York: William Bratler, Inc.; 1919.
4. Department of Health of the City of New York. Annual report of Department of Health of the City of New York for the calendar year 1919. New York: 1920. [publisher unknown]
5. New York City Police Department. New York Police Department annual report for the year 1918. New York: Bureau of Printing; 1919.
6. Book 31. New York: Municipal Archives of the City of New York; Minutes of the Board of Health of the City of New York, August 10, 1918, to December 31, 1918.
7. Drastic steps to fight influenza. New York Times. 1918 Oct;5:1.
8. Epidemic here checked hints Dr. Copeland. New York Tribune. 1918 Oct;7:16.
9. Influenza orders bring a flood of inquiries. New York Evening Post. 1918 Oct;5:1.
10. Cars are crowded despite new rules. New York Evening Post. 1918 Oct;7:6.
11. Copeland Royal S., Whalen Grover H. Mayoral Correspondence Collection, folder 795, box 072. New York: Municipal Archives of the City of New York; 1918. Oct 25,
12. Six hospitals here taken in influenza fight. New York Tribune. 1918 Oct;6:18.
13. Copeland Royal S., Hylan John F. Mayoral Correspondence Collection, folder 795, box 072. New York: Municipal Archives of the City of New York; 1918. Oct 18,
14. Hylan John F., Copeland Royal S. folder 795, box 072, Mayoral Correspondence Collection. New York: Municipal Archives of the City of New York; 1918. Oct 30,
15. Centers for Disease Control and Prevention (US) A commentary on the JAMA study's interpretation of the influenza experiences in New York City and Chicago, 1918–19. 2008. Jan 17, [cited 2009 Aug 1]. Available from: URL: http://www.cdc.gov/ncidod/dq/1918_commentary.htm.
16. Spanish influenza here, shipmen say. New York Times. 1918 Aug;14:1.
17. 8 Spanish grip suspects here; one victim dead. New York Tribune. 1918 Aug;14:12.
18. Price GM. Mobilizing social forces against influenza. The Survey. 1918;41:95–6.
19. Health head calls for influenza inquiry. New York Times. 1918 Aug;16:16.
20. 13 Spanish influenza cases come to port. New York Evening Post. 1918 Sep;16:1.
21. City has 85 cases of Spanish influenza. New York Evening Post. 1918 Sep;23:1.
22. Epidemic guard for port. New York Times. 1918 Aug;19:5.
23. Markel H. Baltimore: Johns Hopkins University Press; 1997. Quarantine! East European Jewish immigrants and the New York City epidemics of 1892.
24. Spanish influenza found in New York. New York Tribune. 1918 Aug;20:7.
25. Spanish influenza found in ‘mild form’ New York Times. 1918 Aug;20:20.
26. Influenza may be old-fashioned grip. New York Evening Post. 1918 Sep 19;
27. Ellis ER. The epic of New York City: a narrative history. New York: Carroll & Graf Publishers; 2004.
28. Influenza causes Crowder to cancel Oct. 7–11 draft call. New York Tribune. 1918 Sep;27:6.
29. New York prepared for influenza siege. New York Times. 1918 Sep;19:11.
30. Subway spreading influenza here. New York Tribune. 1918 Sep;29:10.
31. Vaccine for influenza. New York Evening Post. 1918 Oct;12:8.
32. Copeland Royal S. Mayoral Correspondence Collection, folder 793, box 071. New York: Municipal Archives of the City of New York; 1918. Sep 20, to unnamed New York City doctors.
33. Copeland Royal S. Mayoral Correspondence Collection, folder 795, box 072. New York: Municipal Archives of the City of New York; 1918. Oct 10, to unnamed New York City doctors.
34. Biggs HM. Brief history of the campaign against tuberculosis. New York: New York City Department of Health; 1908.
35. Emergency Advisory Committee. Lillian D. Wald Papers, folder 4.1, box 91. Columbia University, New York: Rare Book and Manuscript Library; 1918. Oct 24, Memo to the executives of the emergency health districts.
36. Fight stiffens here against influenza. New York Times. 1918 Oct;12:13.
37. Grip in the Y.M.C.A. checked by vaccine. New York Times. 1918 Oct;17:9.
38. Find 114 cases of influenza here. New York Times. 1918 Sep;24:9.
39. 142,000 draft men held up by influenza. New York Tribune. 1918 Sep;27:6.
40. New influenza cases in the city doubled. New York Times. 1918 Sep;28:10.
41. Has clearing house plan for influenza. New York Times. 1918 Oct;8:11.
42. Influenza lessens school attendance. New York Evening Post. 1918 Oct;15:2.
43. Asks experts' aid to check epidemic. New York Times. 1918 Oct;13:18.
44. Closing of schools will be discussed. New York Evening Post. 1918 Oct;19:1.
45. Copeland Royal S. Mayoral Correspondence Collection, folder 796, box 072. New York: Municipal Archives of the City of New York; 1918. Dec 17, to National Association of the Motion Picture Industry.
46. Tomes N. The gospel of germs: men, women, and the microbe in American life. Cambridge (MA): Harvard University Press; 1998.
47. Anti-influenza serum made in tests here. New York Tribune. 1918 Oct;2:14.
48. Tells of vaccine to stop influenza. New York Times. 1918 Oct;2:10.
49. Influenza cases increase. New York Evening Post. 1918 Oct;4:2.
50. Influenza cases still mounting. New York Evening Post. 1918 Oct;11:2.
51. Duffy J. A history of public health in New York City, 1866–1966. New York: Russell Sage Foundation; 1974.
52. Epidemic lessons for next time. New York Times. 1918 Nov;17:42.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862336/
Re: THE YOUNG ANDY CUOMO CHRONICLES
NEWSDAY
"State nursing home directive complicated COVID-19 tracking, care"
By Mark Harrington, Michael Gormley and David M. Schwartz
mark.harrington@newsday.com @MHarringtonNews
Updated May 11, 2020 7:19 PM
March 18 marked the start of a most consequential week for nursing home residents across Long Island and New York State.
That was the week when the coronavirus epidemic began surging, the sick started pouring into hospitals and doctors began trying to make space by releasing patients to nursing home care.
At the start of the seven-day period, the Island’s hospitals tallied 59 COVID-19 admissions while the statewide total stood at 617.
By week’s end, the coronavirus count at Long Island’s medical centers had multiplied by 16 times to 983 and the state’s mark had soared to 5,327 — with many more virus-stricken patients still flooding into emergency rooms.
Against that backdrop, on March 25, the New York State Department of Health notified nursing homes that they must accept coronavirus patients who had been deemed “medically stable” for discharge from hospitals while still needing care.
This means a patient’s vital signs have stabilized, but it doesn’t reflect his or her actual condition as defined by the American Hospital Association as being either good, fair, serious or critical.
The order also barred nursing homes from requiring incoming patients “to be tested for COVID-19 prior to admission or readmission.”
“During this global health emergency, all [nursing homes] must comply with the expected receipt of residents returning from hospitals to nursing homes,” the memo read.
It underscored that “no resident shall be denied readmission or admission to the nursing home solely based on a confirmed or suspected diagnosis of COVID-19."
On Sunday, following calls for an independent investigation, Gov. Andrew M. Cuomo announced hospitals can no longer send a patient who has tested positive for COVID-19 to a nursing home.
A Cuomo aide insisted this was not a reversal, but a new policy based on increased hospital capacity and testing.
“We now have the capacity and the additional testing that we didn't have in March,” Cuomo spokesman Rich Azzopardi said.
“Positive (COVID-19) patients can also be released to the COVID-19-only facilities we set up.”
But the two initial directives have played critical roles in the state’s inability to accurately track the true number of COVID-19 fatalities and in families alleging that Cuomo placed their loves ones at greater risk of death.
They have forced Cuomo to face criticism that hastily enacted policies cost lives in a population composed primarily of chronically ill seniors with an average age of 83.
Wilfred Kleisler, 84, began showing symptoms of COVID-19, including weakness, diarrhea and fever, at the Sunrise Manor Center for Nursing and Rehabilitation facility in Bay Shore, where he’d lived for more than a year, said Diane Panizzo, Kleisler's daughter.
Kleisler died last week at Southside Hospital from COVID-19, Panizzo said, after a positive COVID-19 test.
Sunrise Manor did not return calls seeking comment.
While saying that she couldn't directly blame the state executive order for her father's sickness, Panizzo, of Farmingville, said, “You cannot mix vulnerable populations with COVID patients.”
Cuomo, who once stated that the virus could sweep through nursing homes “like fire through dry grass,” has responded both that the state-chartered facilities are paid to assist patients who need hospital aftercare and that nursing homes are obligated to notify the state if they cannot safely carry out their duties.
"Once again, this nursing home directive was based on CDC guidelines and is virtually identical to several other states and the clear policy is if a nursing home does not have the facilities, the staff nor the protective equipment to care for a resident, they must transfer them to a place that can — period," Azzopardi said.
"Throughout this pandemic, we have offered assistance in transporting, access to more than 95,000 volunteers to address staffing issues — which 400 of 600 nursing homes in the state used — and shipped more than 4 million pieces of protective equipment to nursing homes. ”
State officials, who asked not to be identified, explained the March 25 order as one born out of concern that nursing homes might not take patients who were treated in hospitals for the virus the way some HIV patients were discriminated against in the early days of the AIDS crisis in the 1980s.
The officials cited fear that elderly patients could be left to seek housing, which could worsen their condition and spread the virus.
The March 25 order states, "Residents are deemed appropriate for return to a [nursing home] upon a determination by the hospital physician or designee that the resident is medically stable for return."
The notification gives no specific definition of medically stable, though health experts assumed that those patients should have been assumed to be contagious.
John Dalli, an elder care attorney at Mineola-based Dalli & Marino, said the order sent sick people into facilities ill-equipped to care for them.
“There’s no way these facilities, understaffed to begin with, could handle an influx in cases,” he said.
New York has 101,518 residents in nursing homes, according to Cuomo, the highest total among the 50 states.
As of May 10, the Cuomo administration reported that 1,232 Long Island nursing home and adult care facility residents had died of confirmed or suspected COVID-19 illnesses since March 1.
The numbers don't include nursing home residents who died at hospitals.
The administration also revised its count of nursing home deaths across the state to more than 4,800 people, 1,700 greater than previously reported.
Nursing home advocates were quick to realize the potential implications of the Department of Health directive.
“This memo raised a tremendous concern and we raised all sorts of issues” with regulators, said Michael Balboni, a former state senator who is now executive director of the Greater New York Health Care Facilities Association, an industry lobbying group.
Balboni said he understood overwhelmed hospitals were in crisis.
While stopping short of faulting the governor or the state, he said the order should have accompanied a plan to make sure the nursing homes were equipped to face the onslaught, including with personal protective equipment for staff.
“In a perfect world everyone would have stopped and said, ‘Get all nursing homeowners on the phone.'"
"'Who has the capacity to isolate this [COVID] population?'"
"Who has PPE?'"
"'And who has the staff to be able to safely work with these patients before the patient is transferred?’” Balboni said.
The state’s order informed nursing homes: “Critical personal protective equipment (PPE) needs should be immediately communicated to your local Office of Emergency Management, with the appropriate information provided at the time of request.”
Four days later, state Health Commissioner Howard Zucker established protocols for separating residents into “positive, negative and unknown” regarding coronavirus infections, as well as creating specific staffing teams for coronavirus-positive patients.
Maria Torroella Carney, chief of geriatrics and palliative medicine and medical director of post-acute services at Northwell Health, which operates hospitals and three nursing homes across Long Island and the metro area, said nursing homes had clear guidelines from the state for separating COVID-19 patients and for assuming all COVID-19 transfers from hospitals were still COVID-19 positive, and thus contagious.
“The best practice is to assume that staff may be carriers, to test and monitor symptoms of staff on a regular basis,” she said.
“Assume patients are positive until you get the testing done.”
Gurwin Jewish Nursing and Rehabilitation, a 460-bed facility in Commack, used movable barriers in a dedicated wing of the facility to house COVID-19 patients from hospitals, along with a dedicated entrance to stop the spread, officials said.
“We try to keep things as segregated as possible,” said chief executive Stuart Almer, noting the facility has a 28-bed ventilator unit.
While he and family members of residents attempted to push back on the state order, there was also the understanding that the state was in crisis.
“Positive or not we take care of people,” he said.
The health commissioner also said the state would immediately enforce new rules that bar nursing home workers who contract and overcome the coronavirus workers from returning to work for 14 days after symptoms appeared.
The federal Centers for Disease Control recommends allowing coronavirus-positive workers back on the job at least three days since recovery from symptoms and seven days since symptoms first appeared.
The state officials who asked not to be identified said Cuomo enacted the 14-day cushion to provide more time for workers to recover than required under federal regulations.
To alleviate staffing shortages, nursing homes can turn to the administration's newly created database of 95,000 health care workers, many from out of state, who volunteered to work in hospitals and nursing homes.
About 400 nursing homes have since used the “portal” to replenish staffing, they say.
With lobbyists for nursing homes and other health care facilities raising alarms, Cuomo and the legislature passed a state budget on April 3 that granted immunity from “any liability, civil or criminal, for any harm or damages” resulting from health care services provided for COVID-19, except for lawsuits based on actions deemed criminally depraved or negligent.
The language covers “any health care facility or health care professional,” including hospitals, nursing homes and volunteer organizations.
The immunity was retroactive to March 7, according to the bill.
State officials said the impetus for the immunity clause was an influx of health care workers from other states operating without New York licenses.
In an effort to increase the capacity of hospitals, Cuomo issued a temporary order allowing these people to work in New York.
Without the immunity measure, any health care worker without a New York license and the hospital or nursing home in which they were working could potentially be sued for a mistake.
They called it a "good Samaritan" law.
Cuomo announced April 23 an investigation of nursing homes and their compliance with COVID-19 related executive orders, including a requirement they report COVID-19 test results and deaths to residents’ families.
The state said it would begin to inspect facilities for compliance with state directions, and violators faced fines of up to $10,000 and loss of their operating license.
For some of the biggest nursing homes on Long Island, alarms by family members went off after the Department of Health issued the March 25 directive.
“The immediate impact on the families was significant — they were outraged,” said Gurwin’s Almer.
“Everyone has been very, very vocal on this."
"We all are concerned for our residents in our facilities.”
Gurwin through early May had admitted 52 COVID-19-positive patients since the March 25 directive: 17 from Huntington Hospital, 10 from Stony Brook, eight from St. Catherine of Siena, five from Southside Hospital and two or three each from eight others.
To date, 46 people have died at Gurwin due to COVID-19, of which 40 were Gurwin residents and six were hospital admissions, according to data provided by Gurwin, which also reported 76 patients recovered from COVID in its care.
Hospital admissions rushed upward after March 25, ultimately peaking at 18,825 statewide on April 11 and 4,085 on the Island April 13.
In a statement, the health department wrote that “we are not using nursing homes as hospital surge capacity.”
However, the agency’s March 25 directive did state: “There is an urgent need to expand hospital capacity in New York State to be able to meet the demand for patients with COVID-19 requiring acute care.”
For hospitals overrun with COVID-19 patients by the end of March and continuing through April, the March 25 directive was a godsend.
“It was very important,” said Torroella Carney of Northwell.
The order was issued “near the peak of our bed-capacity issues,” she said.
COVID-related patient admissions at Northwell hospitals at that point had swelled to 3,425 at the height of the pandemic on April 7, a spokesman said.
Northwell has discharged more than 1,000 COVID-19 patients to nursing homes over the past two months, spokesman Terry Lynam said.
The directive freed hospitals from the prior requirement of two consecutive negative COVID-19 tests before discharging a patient, Torroella Carney said, which “is not easy to get.”
She added that “there are risks to keeping people in acute-care hospitals for a prolonged period.”
Some patients were stable but couldn’t go home because other family members were also sick and couldn’t care for them.
Sending them to nursing facilities “seemed at that point a necessary plan of care, to provide a safe health care environment for people not acute who could not go home.”
“I think there was a huge pressure to help the hospitals, and skilled nursing has always been part of the continuum of care,” she said.
Stephen Hanse, chief executive of the New York State Health Facilities Association, another industry lobbying group, said of the department’s directive:
“When you’re dealing in a state of emergency, when advisories are issued they are effective immediately."
"You have to adhere to them."
"So the concerns were raised but you’re in a pandemic emergency situation.”
With Yancey Roy
By Mark Harrington, Michael Gormley and David M. Schwartz
mark.harrington@newsday.com @MHarringtonNews
Mark Harrington, a Newsday reporter since 1999, covers energy, wineries, Indian affairs and fisheries.
https://www.newsday.com/news/health/cor ... con&stn=nf
"State nursing home directive complicated COVID-19 tracking, care"
By Mark Harrington, Michael Gormley and David M. Schwartz
mark.harrington@newsday.com @MHarringtonNews
Updated May 11, 2020 7:19 PM
March 18 marked the start of a most consequential week for nursing home residents across Long Island and New York State.
That was the week when the coronavirus epidemic began surging, the sick started pouring into hospitals and doctors began trying to make space by releasing patients to nursing home care.
At the start of the seven-day period, the Island’s hospitals tallied 59 COVID-19 admissions while the statewide total stood at 617.
By week’s end, the coronavirus count at Long Island’s medical centers had multiplied by 16 times to 983 and the state’s mark had soared to 5,327 — with many more virus-stricken patients still flooding into emergency rooms.
Against that backdrop, on March 25, the New York State Department of Health notified nursing homes that they must accept coronavirus patients who had been deemed “medically stable” for discharge from hospitals while still needing care.
This means a patient’s vital signs have stabilized, but it doesn’t reflect his or her actual condition as defined by the American Hospital Association as being either good, fair, serious or critical.
The order also barred nursing homes from requiring incoming patients “to be tested for COVID-19 prior to admission or readmission.”
“During this global health emergency, all [nursing homes] must comply with the expected receipt of residents returning from hospitals to nursing homes,” the memo read.
It underscored that “no resident shall be denied readmission or admission to the nursing home solely based on a confirmed or suspected diagnosis of COVID-19."
On Sunday, following calls for an independent investigation, Gov. Andrew M. Cuomo announced hospitals can no longer send a patient who has tested positive for COVID-19 to a nursing home.
A Cuomo aide insisted this was not a reversal, but a new policy based on increased hospital capacity and testing.
“We now have the capacity and the additional testing that we didn't have in March,” Cuomo spokesman Rich Azzopardi said.
“Positive (COVID-19) patients can also be released to the COVID-19-only facilities we set up.”
But the two initial directives have played critical roles in the state’s inability to accurately track the true number of COVID-19 fatalities and in families alleging that Cuomo placed their loves ones at greater risk of death.
They have forced Cuomo to face criticism that hastily enacted policies cost lives in a population composed primarily of chronically ill seniors with an average age of 83.
Wilfred Kleisler, 84, began showing symptoms of COVID-19, including weakness, diarrhea and fever, at the Sunrise Manor Center for Nursing and Rehabilitation facility in Bay Shore, where he’d lived for more than a year, said Diane Panizzo, Kleisler's daughter.
Kleisler died last week at Southside Hospital from COVID-19, Panizzo said, after a positive COVID-19 test.
Sunrise Manor did not return calls seeking comment.
While saying that she couldn't directly blame the state executive order for her father's sickness, Panizzo, of Farmingville, said, “You cannot mix vulnerable populations with COVID patients.”
Cuomo, who once stated that the virus could sweep through nursing homes “like fire through dry grass,” has responded both that the state-chartered facilities are paid to assist patients who need hospital aftercare and that nursing homes are obligated to notify the state if they cannot safely carry out their duties.
"Once again, this nursing home directive was based on CDC guidelines and is virtually identical to several other states and the clear policy is if a nursing home does not have the facilities, the staff nor the protective equipment to care for a resident, they must transfer them to a place that can — period," Azzopardi said.
"Throughout this pandemic, we have offered assistance in transporting, access to more than 95,000 volunteers to address staffing issues — which 400 of 600 nursing homes in the state used — and shipped more than 4 million pieces of protective equipment to nursing homes. ”
State officials, who asked not to be identified, explained the March 25 order as one born out of concern that nursing homes might not take patients who were treated in hospitals for the virus the way some HIV patients were discriminated against in the early days of the AIDS crisis in the 1980s.
The officials cited fear that elderly patients could be left to seek housing, which could worsen their condition and spread the virus.
The March 25 order states, "Residents are deemed appropriate for return to a [nursing home] upon a determination by the hospital physician or designee that the resident is medically stable for return."
The notification gives no specific definition of medically stable, though health experts assumed that those patients should have been assumed to be contagious.
John Dalli, an elder care attorney at Mineola-based Dalli & Marino, said the order sent sick people into facilities ill-equipped to care for them.
“There’s no way these facilities, understaffed to begin with, could handle an influx in cases,” he said.
New York has 101,518 residents in nursing homes, according to Cuomo, the highest total among the 50 states.
As of May 10, the Cuomo administration reported that 1,232 Long Island nursing home and adult care facility residents had died of confirmed or suspected COVID-19 illnesses since March 1.
The numbers don't include nursing home residents who died at hospitals.
The administration also revised its count of nursing home deaths across the state to more than 4,800 people, 1,700 greater than previously reported.
Nursing home advocates were quick to realize the potential implications of the Department of Health directive.
“This memo raised a tremendous concern and we raised all sorts of issues” with regulators, said Michael Balboni, a former state senator who is now executive director of the Greater New York Health Care Facilities Association, an industry lobbying group.
Balboni said he understood overwhelmed hospitals were in crisis.
While stopping short of faulting the governor or the state, he said the order should have accompanied a plan to make sure the nursing homes were equipped to face the onslaught, including with personal protective equipment for staff.
“In a perfect world everyone would have stopped and said, ‘Get all nursing homeowners on the phone.'"
"'Who has the capacity to isolate this [COVID] population?'"
"Who has PPE?'"
"'And who has the staff to be able to safely work with these patients before the patient is transferred?’” Balboni said.
The state’s order informed nursing homes: “Critical personal protective equipment (PPE) needs should be immediately communicated to your local Office of Emergency Management, with the appropriate information provided at the time of request.”
Four days later, state Health Commissioner Howard Zucker established protocols for separating residents into “positive, negative and unknown” regarding coronavirus infections, as well as creating specific staffing teams for coronavirus-positive patients.
Maria Torroella Carney, chief of geriatrics and palliative medicine and medical director of post-acute services at Northwell Health, which operates hospitals and three nursing homes across Long Island and the metro area, said nursing homes had clear guidelines from the state for separating COVID-19 patients and for assuming all COVID-19 transfers from hospitals were still COVID-19 positive, and thus contagious.
“The best practice is to assume that staff may be carriers, to test and monitor symptoms of staff on a regular basis,” she said.
“Assume patients are positive until you get the testing done.”
Gurwin Jewish Nursing and Rehabilitation, a 460-bed facility in Commack, used movable barriers in a dedicated wing of the facility to house COVID-19 patients from hospitals, along with a dedicated entrance to stop the spread, officials said.
“We try to keep things as segregated as possible,” said chief executive Stuart Almer, noting the facility has a 28-bed ventilator unit.
While he and family members of residents attempted to push back on the state order, there was also the understanding that the state was in crisis.
“Positive or not we take care of people,” he said.
The health commissioner also said the state would immediately enforce new rules that bar nursing home workers who contract and overcome the coronavirus workers from returning to work for 14 days after symptoms appeared.
The federal Centers for Disease Control recommends allowing coronavirus-positive workers back on the job at least three days since recovery from symptoms and seven days since symptoms first appeared.
The state officials who asked not to be identified said Cuomo enacted the 14-day cushion to provide more time for workers to recover than required under federal regulations.
To alleviate staffing shortages, nursing homes can turn to the administration's newly created database of 95,000 health care workers, many from out of state, who volunteered to work in hospitals and nursing homes.
About 400 nursing homes have since used the “portal” to replenish staffing, they say.
With lobbyists for nursing homes and other health care facilities raising alarms, Cuomo and the legislature passed a state budget on April 3 that granted immunity from “any liability, civil or criminal, for any harm or damages” resulting from health care services provided for COVID-19, except for lawsuits based on actions deemed criminally depraved or negligent.
The language covers “any health care facility or health care professional,” including hospitals, nursing homes and volunteer organizations.
The immunity was retroactive to March 7, according to the bill.
State officials said the impetus for the immunity clause was an influx of health care workers from other states operating without New York licenses.
In an effort to increase the capacity of hospitals, Cuomo issued a temporary order allowing these people to work in New York.
Without the immunity measure, any health care worker without a New York license and the hospital or nursing home in which they were working could potentially be sued for a mistake.
They called it a "good Samaritan" law.
Cuomo announced April 23 an investigation of nursing homes and their compliance with COVID-19 related executive orders, including a requirement they report COVID-19 test results and deaths to residents’ families.
The state said it would begin to inspect facilities for compliance with state directions, and violators faced fines of up to $10,000 and loss of their operating license.
For some of the biggest nursing homes on Long Island, alarms by family members went off after the Department of Health issued the March 25 directive.
“The immediate impact on the families was significant — they were outraged,” said Gurwin’s Almer.
“Everyone has been very, very vocal on this."
"We all are concerned for our residents in our facilities.”
Gurwin through early May had admitted 52 COVID-19-positive patients since the March 25 directive: 17 from Huntington Hospital, 10 from Stony Brook, eight from St. Catherine of Siena, five from Southside Hospital and two or three each from eight others.
To date, 46 people have died at Gurwin due to COVID-19, of which 40 were Gurwin residents and six were hospital admissions, according to data provided by Gurwin, which also reported 76 patients recovered from COVID in its care.
Hospital admissions rushed upward after March 25, ultimately peaking at 18,825 statewide on April 11 and 4,085 on the Island April 13.
In a statement, the health department wrote that “we are not using nursing homes as hospital surge capacity.”
However, the agency’s March 25 directive did state: “There is an urgent need to expand hospital capacity in New York State to be able to meet the demand for patients with COVID-19 requiring acute care.”
For hospitals overrun with COVID-19 patients by the end of March and continuing through April, the March 25 directive was a godsend.
“It was very important,” said Torroella Carney of Northwell.
The order was issued “near the peak of our bed-capacity issues,” she said.
COVID-related patient admissions at Northwell hospitals at that point had swelled to 3,425 at the height of the pandemic on April 7, a spokesman said.
Northwell has discharged more than 1,000 COVID-19 patients to nursing homes over the past two months, spokesman Terry Lynam said.
The directive freed hospitals from the prior requirement of two consecutive negative COVID-19 tests before discharging a patient, Torroella Carney said, which “is not easy to get.”
She added that “there are risks to keeping people in acute-care hospitals for a prolonged period.”
Some patients were stable but couldn’t go home because other family members were also sick and couldn’t care for them.
Sending them to nursing facilities “seemed at that point a necessary plan of care, to provide a safe health care environment for people not acute who could not go home.”
“I think there was a huge pressure to help the hospitals, and skilled nursing has always been part of the continuum of care,” she said.
Stephen Hanse, chief executive of the New York State Health Facilities Association, another industry lobbying group, said of the department’s directive:
“When you’re dealing in a state of emergency, when advisories are issued they are effective immediately."
"You have to adhere to them."
"So the concerns were raised but you’re in a pandemic emergency situation.”
With Yancey Roy
By Mark Harrington, Michael Gormley and David M. Schwartz
mark.harrington@newsday.com @MHarringtonNews
Mark Harrington, a Newsday reporter since 1999, covers energy, wineries, Indian affairs and fisheries.
https://www.newsday.com/news/health/cor ... con&stn=nf
Re: THE YOUNG ANDY CUOMO CHRONICLES
"Cuomo: Hospitals cannot discharge COVID-19 patients to nursing homes - Nursing home staffers will be tested for virus twice a week"
Cayla Harris, Albany, New York Times Union
May 10, 2020|Updated: May 10, 2020 6:57 p.m.
ALBANY – New York will no longer allow hospitals to discharge patients to nursing homes unless they test negative for COVID-19, and staffers in those facilities must also be tested for the virus twice a week, Gov. Andrew M. Cuomo announced Sunday.
The additional protocol comes as the Cuomo administration has faced severe backlash for its handling of the pandemic in nursing homes, where the governor has said the coronavirus spreads "like fire through dry grass."
If a nursing home cannot care for someone sick with the coronavirus for any reason – including a lack of supplies or an inability to maintain social distancing – they must transfer that person to another facility or hospital, or risk losing their license, Cuomo said.
"This virus uses nursing homes," the governor said at a Capitol press briefing.
"They are ground zero."
"They are the vulnerable population in the vulnerable location."
The state has been under fire for its policies relating to the spread of the coronavirus in nursing homes, for more than a month requiring the care facilities to continue accepting COVID-19 patients.
Officials had also implemented and then rescinded a policy allowing COVID-positive, but asymptomatic, employees to continue working in nursing homes.
New York has seen an increasing number of fatalities in nursing homes, even as the state's overall daily death toll declines, with 43 residents succumbing to the virus on Saturday.
The state also began reporting presumed coronavirus deaths in nursing homes and adult care facilities last week, disclosing 1,700 new fatalities in those facilities.
But Cuomo also noted on Sunday that New York has the highest nursing home population in the United States, with 101,518 residents – but has the nation's 34th-highest percentage of COVID-19 deaths in such facilities.
About 12 percent of all coronavirus deaths in New York have occurred in nursing homes, compared to states like West Virginia and Minnesota, where those facilities account for 81 and 80 percent of fatalities, respectively.
"If they cannot provide the appropriate care, they have to call the Department of Health, and let's get that resident into an appropriate facility," Cuomo said, adding that nursing homes have an obligation to keep their residents safe.
"We have the facilities."
"We have the beds."
"It's not like we're in a situation where there's no option."
All nursing home administrators must submit a certificate of compliance and a plan to the state by Friday detailing how they will abide by the testing requirement, the governor's office said in a prepared statement.
Any facility that does not adhere to the new mandates may have its operating certificate suspended or revoked, and it may also have to pay a $2,000 fine for each day there are violations.
The latest state data reports 43 deaths – both confirmed and presumed – at nursing homes and adult care facilities in the four central Capital Region counties.
The majority have occurred in Albany County, but six deaths were in Rensselaer, where County Executive Steve McLaughlin wrote on Twitter Saturday night that he has repeatedly asked state officials to transfer COVID-positive patients out of Diamond Hill Nursing and Rehabilitation Center but has not received a response.
Four deaths have occurred in the facility, according to state data, and McLaughlin said there were 17 new infections there on Saturday.
Cuomo senior adviser Rich Azzopardi quickly responded on Twitter with a note from Health Department Commissioner Howard Zucker, who said he had offered assistance to Diamond Hill, but facility leaders said they had enough supplies and no need to transfer patients.
"NYS DOH stands ready to assist with all of your patient and staffing needs, and please call me directly should you need any help whatsoever, including the need to move any residents out of the facility," Zucker wrote to the nursing home.
The total number of coronavirus hospitalizations and intubations declined on Saturday, as did new hospitalizations, which clocked in at 521 – about the same number it had been on March 20, near the start of the crisis.
Daily deaths dropped on Saturday to 207, the first significant drop in about a week, as deaths held steady in the low- to mid-200s for several days.
"All of this work, all of this progress of turning that tide, of reducing the rate of infection – that's all thanks to New Yorkers and what New Yorkers did," Cuomo said, promising an update Monday on reopening some regions of New York.
The governor also provided new information on Sunday on the state's investigation into a mysterious illness in children that may be related to the coronavirus.
The state Department of Health is investigating up to 85 cases of the illness, which presents symptoms similar to Kawasaki disease or toxic-shock syndrome.
Three children have died, and the department is investigating an additional two deaths.
New York is issuing a notice to all 49 other state health departments nationwide to advise them of the situation, he said.
Cuomo also said the state is looking into a new drug therapy, Remdesivir, that may help coronavirus patients recover more quickly.
New York is treating 2,900 people at 15 hospitals, he said, with guidance from the U.S. Department of Health and Human Services.
https://www.timesunion.com/news/article ... con&stn=nf
Cayla Harris, Albany, New York Times Union
May 10, 2020|Updated: May 10, 2020 6:57 p.m.
ALBANY – New York will no longer allow hospitals to discharge patients to nursing homes unless they test negative for COVID-19, and staffers in those facilities must also be tested for the virus twice a week, Gov. Andrew M. Cuomo announced Sunday.
The additional protocol comes as the Cuomo administration has faced severe backlash for its handling of the pandemic in nursing homes, where the governor has said the coronavirus spreads "like fire through dry grass."
If a nursing home cannot care for someone sick with the coronavirus for any reason – including a lack of supplies or an inability to maintain social distancing – they must transfer that person to another facility or hospital, or risk losing their license, Cuomo said.
"This virus uses nursing homes," the governor said at a Capitol press briefing.
"They are ground zero."
"They are the vulnerable population in the vulnerable location."
The state has been under fire for its policies relating to the spread of the coronavirus in nursing homes, for more than a month requiring the care facilities to continue accepting COVID-19 patients.
Officials had also implemented and then rescinded a policy allowing COVID-positive, but asymptomatic, employees to continue working in nursing homes.
New York has seen an increasing number of fatalities in nursing homes, even as the state's overall daily death toll declines, with 43 residents succumbing to the virus on Saturday.
The state also began reporting presumed coronavirus deaths in nursing homes and adult care facilities last week, disclosing 1,700 new fatalities in those facilities.
But Cuomo also noted on Sunday that New York has the highest nursing home population in the United States, with 101,518 residents – but has the nation's 34th-highest percentage of COVID-19 deaths in such facilities.
About 12 percent of all coronavirus deaths in New York have occurred in nursing homes, compared to states like West Virginia and Minnesota, where those facilities account for 81 and 80 percent of fatalities, respectively.
"If they cannot provide the appropriate care, they have to call the Department of Health, and let's get that resident into an appropriate facility," Cuomo said, adding that nursing homes have an obligation to keep their residents safe.
"We have the facilities."
"We have the beds."
"It's not like we're in a situation where there's no option."
All nursing home administrators must submit a certificate of compliance and a plan to the state by Friday detailing how they will abide by the testing requirement, the governor's office said in a prepared statement.
Any facility that does not adhere to the new mandates may have its operating certificate suspended or revoked, and it may also have to pay a $2,000 fine for each day there are violations.
The latest state data reports 43 deaths – both confirmed and presumed – at nursing homes and adult care facilities in the four central Capital Region counties.
The majority have occurred in Albany County, but six deaths were in Rensselaer, where County Executive Steve McLaughlin wrote on Twitter Saturday night that he has repeatedly asked state officials to transfer COVID-positive patients out of Diamond Hill Nursing and Rehabilitation Center but has not received a response.
Four deaths have occurred in the facility, according to state data, and McLaughlin said there were 17 new infections there on Saturday.
Cuomo senior adviser Rich Azzopardi quickly responded on Twitter with a note from Health Department Commissioner Howard Zucker, who said he had offered assistance to Diamond Hill, but facility leaders said they had enough supplies and no need to transfer patients.
"NYS DOH stands ready to assist with all of your patient and staffing needs, and please call me directly should you need any help whatsoever, including the need to move any residents out of the facility," Zucker wrote to the nursing home.
The total number of coronavirus hospitalizations and intubations declined on Saturday, as did new hospitalizations, which clocked in at 521 – about the same number it had been on March 20, near the start of the crisis.
Daily deaths dropped on Saturday to 207, the first significant drop in about a week, as deaths held steady in the low- to mid-200s for several days.
"All of this work, all of this progress of turning that tide, of reducing the rate of infection – that's all thanks to New Yorkers and what New Yorkers did," Cuomo said, promising an update Monday on reopening some regions of New York.
The governor also provided new information on Sunday on the state's investigation into a mysterious illness in children that may be related to the coronavirus.
The state Department of Health is investigating up to 85 cases of the illness, which presents symptoms similar to Kawasaki disease or toxic-shock syndrome.
Three children have died, and the department is investigating an additional two deaths.
New York is issuing a notice to all 49 other state health departments nationwide to advise them of the situation, he said.
Cuomo also said the state is looking into a new drug therapy, Remdesivir, that may help coronavirus patients recover more quickly.
New York is treating 2,900 people at 15 hospitals, he said, with guidance from the U.S. Department of Health and Human Services.
https://www.timesunion.com/news/article ... con&stn=nf
Re: THE YOUNG ANDY CUOMO CHRONICLES
THE NEW YORK POST
"Gov. Cuomo admits he was wrong to order nursing homes to accept coronavirus patients"
By Post Editorial Board
May 10, 2020 | 7:20pm | Updated May 11, 2020 | 5:47am
Gov. Andrew Cuomo has finally admitted — tacitly and partially, anyway — the mistake that was state health chief Howard Zucker’s order that nursing homes must admit coronavirus-positive patients.
On Sunday, Cuomo announced a new regulation: Such patients must now test negative for the virus before hospitals can return them to nursing homes.
Yet the gov also admitted that COVID-19 cases might still go to the facilities via other routes, and didn’t explicitly overrule Zucker’s March 25 mandate that homes must accept people despite their testing status — indeed, couldn’t even require a test pre-admission.
The gov’s people say that a home that simply can’t accommodate coronavirus patients never had to take them — though they are obliged to help those people find a place that will, with help available from the state if needed.
That is: Zucker’s mandate was never more than a “don’t discriminate” rule.
But Zucker publicly presented it as “must accept” — and Cuomo’s remarks regularly implied there must be something wrong with a home that couldn’t handle corona patients.
So, while the gov’s people imply that some homes simply misunderstood the rules, the real message to operators was that declaring themselves overwhelmed would put their licenses at risk.
Notably, the chief of one Cobble Hill facility not only had his request for PPE denied, he got turned down cold when he then asked to transfer patients.
Then, too, Zucker’s Department of Health has issued other heartless orders during this crisis — the now-rescinded “don’t even try to resuscitate” mandate to EMTs for cardiac-arrest cases, as well as telling at least one home it was OK to keep staffers on the job after they’d tested positive.
Also telling: The gov has ordered an investigation that’s plainly supposed to pin all the blame on nursing and adult-care facilities: It’s led by state Attorney General Tish James, who got her job with Cuomo’s crucial assistance — and it’s only looking at what homes did wrong.
We’re sure James will uncover plenty of real horrors: Everyone (who cared to know) has long been aware that many New York nursing homes leave a lot to be desired.
But that was all the more reason for Zucker & Co. to focus on policing and assisting these facilities from the start — rather than issuing edicts that led to repeated and needless tragedies.
https://nypost.com/2020/05/10/cuomo-was ... -patients/
"Gov. Cuomo admits he was wrong to order nursing homes to accept coronavirus patients"
By Post Editorial Board
May 10, 2020 | 7:20pm | Updated May 11, 2020 | 5:47am
Gov. Andrew Cuomo has finally admitted — tacitly and partially, anyway — the mistake that was state health chief Howard Zucker’s order that nursing homes must admit coronavirus-positive patients.
On Sunday, Cuomo announced a new regulation: Such patients must now test negative for the virus before hospitals can return them to nursing homes.
Yet the gov also admitted that COVID-19 cases might still go to the facilities via other routes, and didn’t explicitly overrule Zucker’s March 25 mandate that homes must accept people despite their testing status — indeed, couldn’t even require a test pre-admission.
The gov’s people say that a home that simply can’t accommodate coronavirus patients never had to take them — though they are obliged to help those people find a place that will, with help available from the state if needed.
That is: Zucker’s mandate was never more than a “don’t discriminate” rule.
But Zucker publicly presented it as “must accept” — and Cuomo’s remarks regularly implied there must be something wrong with a home that couldn’t handle corona patients.
So, while the gov’s people imply that some homes simply misunderstood the rules, the real message to operators was that declaring themselves overwhelmed would put their licenses at risk.
Notably, the chief of one Cobble Hill facility not only had his request for PPE denied, he got turned down cold when he then asked to transfer patients.
Then, too, Zucker’s Department of Health has issued other heartless orders during this crisis — the now-rescinded “don’t even try to resuscitate” mandate to EMTs for cardiac-arrest cases, as well as telling at least one home it was OK to keep staffers on the job after they’d tested positive.
Also telling: The gov has ordered an investigation that’s plainly supposed to pin all the blame on nursing and adult-care facilities: It’s led by state Attorney General Tish James, who got her job with Cuomo’s crucial assistance — and it’s only looking at what homes did wrong.
We’re sure James will uncover plenty of real horrors: Everyone (who cared to know) has long been aware that many New York nursing homes leave a lot to be desired.
But that was all the more reason for Zucker & Co. to focus on policing and assisting these facilities from the start — rather than issuing edicts that led to repeated and needless tragedies.
https://nypost.com/2020/05/10/cuomo-was ... -patients/
Re: THE YOUNG ANDY CUOMO CHRONICLES
THE NEW YORK POST
"Needed: Truly independent probe of coronavirus devastation in NY nursing homes"
By Post Editorial Board
May 9, 2020 | 8:45pm
Calls are rising for an independent investigation of the Cuomo administration’s handling of nursing homes amid the coronavirus crisis — and rightly so.
Gov. Andrew Cuomo’s own investigation, which he handpicked protégé Letitia James to lead, plainly won’t get to the bottom of many key issues: The gov and his team won’t even admit that forcing facilities to take in COVID-positive patients was a mistake.
That mandate is still in effect.
Back on March 10, Cuomo bragged of how the state was protecting residents of New York’s 1,100 nursing homes and adult-care facilities.
“You see that in the 22 deaths in Washington compared to New York with no deaths,” he said.
“Right?"
"Same number of cases, look how much higher Washington is."
"Because it’s about senior citizens.”
Yes, the elderly are the most virus-vulnerable, with those aged 60 and up accounting for 85 percent of Empire State corona deaths.
But Cuomo didn’t protect them: Washington state has fewer than 1,000 coronavirus deaths total, while New York lost 5,000 lives in nursing and adult-care homes alone.
And, two weeks after Cuomo’s big brag, Health Commissioner Howard Zucker ordered nursing homes to take in corona-positive patients.
Neither Zucker nor Cuomo explained that March 25 mandate.
The gov insists it’s in keeping with federal guidelines, yet they call for no such regulation.
The Centers for Disease Control and Prevention advised nursing homes: “Keep COVID-19 from entering your facility.”
How did his team even think up the rule?
Did the politically potent hospital lobby push for it?
The gov is disingenuous at best when he claims homes need merely tell the Health Department if they can’t handle coronavirus patients.
Donny Tuchman, CEO of Brooklyn’s Cobble Hill Health Center, asked about transferring out some of his COVID-positive patients back on April 10.
More than 50 of his residents have died.
Zucker’s order not only forbids nursing homes from rejecting the infected — it doesn’t even let them require testing for the disease before admission.
Only in late April, a month after the “must accept” order, did the state begin reaching out to check on homes’ ability to administer tests, officials in several counties told The Post.
Ulster County Executive Pat Ryan offered to pick test kits up in Albany himself — and never heard back.
The James investigation will focus on whether homes are “following the rules” — not on those deadly rules themselves.
An independent probe is a must.
https://nypost.com/2020/05/09/needed-in ... ing-homes/
"Needed: Truly independent probe of coronavirus devastation in NY nursing homes"
By Post Editorial Board
May 9, 2020 | 8:45pm
Calls are rising for an independent investigation of the Cuomo administration’s handling of nursing homes amid the coronavirus crisis — and rightly so.
Gov. Andrew Cuomo’s own investigation, which he handpicked protégé Letitia James to lead, plainly won’t get to the bottom of many key issues: The gov and his team won’t even admit that forcing facilities to take in COVID-positive patients was a mistake.
That mandate is still in effect.
Back on March 10, Cuomo bragged of how the state was protecting residents of New York’s 1,100 nursing homes and adult-care facilities.
“You see that in the 22 deaths in Washington compared to New York with no deaths,” he said.
“Right?"
"Same number of cases, look how much higher Washington is."
"Because it’s about senior citizens.”
Yes, the elderly are the most virus-vulnerable, with those aged 60 and up accounting for 85 percent of Empire State corona deaths.
But Cuomo didn’t protect them: Washington state has fewer than 1,000 coronavirus deaths total, while New York lost 5,000 lives in nursing and adult-care homes alone.
And, two weeks after Cuomo’s big brag, Health Commissioner Howard Zucker ordered nursing homes to take in corona-positive patients.
Neither Zucker nor Cuomo explained that March 25 mandate.
The gov insists it’s in keeping with federal guidelines, yet they call for no such regulation.
The Centers for Disease Control and Prevention advised nursing homes: “Keep COVID-19 from entering your facility.”
How did his team even think up the rule?
Did the politically potent hospital lobby push for it?
The gov is disingenuous at best when he claims homes need merely tell the Health Department if they can’t handle coronavirus patients.
Donny Tuchman, CEO of Brooklyn’s Cobble Hill Health Center, asked about transferring out some of his COVID-positive patients back on April 10.
More than 50 of his residents have died.
Zucker’s order not only forbids nursing homes from rejecting the infected — it doesn’t even let them require testing for the disease before admission.
Only in late April, a month after the “must accept” order, did the state begin reaching out to check on homes’ ability to administer tests, officials in several counties told The Post.
Ulster County Executive Pat Ryan offered to pick test kits up in Albany himself — and never heard back.
The James investigation will focus on whether homes are “following the rules” — not on those deadly rules themselves.
An independent probe is a must.
https://nypost.com/2020/05/09/needed-in ... ing-homes/
Re: THE YOUNG ANDY CUOMO CHRONICLES
"State antibody testing results murky as officials decline to release raw data - Questions remain about effectiveness and utility of tests as local leaders are left in the dark"
Cayla Harris and Amanda Fries, Albany, New York Times Union
May 7, 2020 | Updated: May 7, 2020 3:02 p.m.
ALBANY — New York has tested more than 1 million people for COVID-19, sharing detailed data about where the cases originated and who has been infected.
But when it comes to antibody testing, the state's latest endeavor to track the spread of the virus, officials have refused to release raw data on the samples collected.
They have tested more than 15,000 people for antibodies and reported results in percentages, but the methodology is unclear and comes with so many caveats that some medical experts and local government officials are questioning the utility of the results.
The state's lack of transparency and failure to coordinate with local officials on its antibody testing efforts has frustrated community leaders who believe the data, and how it’s being collected, could help inform their respective counties on the spread of the coronavirus, and also guide how some areas could move forward with a phased reopening of local economies.
The state has only reported results to individual counties in a few instances, instead reporting results on a regional basis through Gov. Andrew M. Cuomo’s daily coronavirus briefings.
“We don’t know how many residents were tested."
"We don’t know all of those results."
"We know a few, but we don’t know all of them,” said Rich Crist, Rensselaer County's operations director.
“We’d certainly like to see the results."
"One of the things about testing – it gets people who need treatment treated."
"It also helps map the road back to life.”
The state first announced its antibody testing plan about two weeks ago, when Cuomo said that New York would randomly test 3,000 New Yorkers for antibodies at grocery stores across the state.
The effort sought to identify how many individuals had contracted the virus and recovered from it, producing antibodies that may make them immune to the illness.
His top aide, Melissa DeRosa, said the testing would begin the next day.
But the testing began the same day Cuomo announced it, and patrons at some grocery stores in upstate New York passed by neon-yellow signs announcing “NYS DOH antibody screening: Find out if you have been exposed here!”
Shoppers were tested that Sunday at a supermarket in Schenectady County, where the local government had no idea testing would begin that day – or at all – and released a statement to the media that evening saying so.
In the days since, the state has not communicated the results of the tests to the county, and it has not coordinated testing sites with local officials, said county spokeswoman Erin Roberts.
She declined to comment on the consequences of not having access to the data, saying only: “Schenectady County appreciates any and all testing opportunities made available to our residents.”
Erin Silk, a spokeswoman for the state Department of Health, said the testing “is being performed by the state with notice to local counties.”
She repeatedly declined to say why the state is declining to release by-county data, referring instead to the governor’s plan to reopen the economy in regions.
She declined to say if there are counties where no one has been tested for antibodies.
Fulton County Public Health Director Laurel Headwell said she cannot provide answers to residents looking for details on how to access the tests, which occurred to some extent in the county, though officials do not have the full scope of results.
“I don’t know where they had the testing done or how they were able to get tested, so that information is very limited to us as a county,” she said.
“It just puts you in that hard spot of, ‘What do we do, and what do we tell our people in Fulton County?’”
The latest results, reported on Saturday, indicate that about 12.3 percent of the state population has COVID-19 antibodies.
That’s a slight drop from the first two surveys, which had estimated 13.9, and then 14.9, percent, with smaller sample sizes.
New York City, the epicenter of the pandemic in the United States, reported the highest positive test results at 19.9 percent of the population.
Western New York came in second, with 6 percent of participants testing positive.
The Capital District reported a 2.2 percent positive rate.
While the state did not provide data to Albany, Schenectady or Rensselaer counties, officials told local health leaders in Saratoga County that it had conducted 346 tests, 27 of which came back positive – roughly 7.8 percent, Saratoga County Director of Public Health Catherine Duncan said.
The state also reported weighted results for sex, age and race, though officials have refused to provide the number of individuals that have been tested, and their results, for each group.
For weeks, Cuomo touted antibody testing as key to reopening the economy and said results could allow some individuals to return to work sooner.
More recently, antibody testing has become a backburner item as officials question whether the results tell much more than how the virus has spread in the weeks when diagnostic testing was not yet up to scale.
"There was an initial thought that if you had gotten the virus and you had the antibodies that you would be immune to another infection," Cuomo said during a press briefing Wednesday.
"I think that's now being questioned."
Whether antibodies provide immunity remains unclear to scientists and the World Health Organization has said there has been no conclusive evidence that would indicate a person cannot fall ill with the coronavirus again after contracting and recovering from it.
State Department of Health Commissioner Howard Zucker said Wednesday that there are ongoing tests to see whether antibodies do provide immunity, and if so, for how long.
It's unclear what role antibody tests – which the state continues to ramp up, especially among health care workers – now play in Cuomo's reopening strategy.
A spokesman for the governor's office said antibody data continues to inform the state's public health response; meanwhile, in New York City, Mayor Bill de Blasio said on Thursday that the city will test 140,000 people for antibodies in the next month.
Experts also caution that testing hasn’t been sufficiently clinically validated and could show false positives by detecting antibodies present from exposure to other viruses.
“Antibody testing in general allows people to see if they’ve been in contact with the COVID virus,” said Rebecca Kaufman, the director of Broome County’s health department.
“The caveat to that is, at this point, we are not sure what it means toward their immunity, so even if you test positive … we are not positive if that means you are immune.”
Broome County was told ahead of time that the state would test about 100 people at two local grocery stores, Kaufman said, but officials have not been notified of the results.
In Rensselaer County, Crist said they have similar questions and concerns on immunity as well as whether there are other strains of the virus.
“I think there is a lot we don’t know about this disease, and antibody testing will probably give us a window into the precursors of COVID-19,” he said.
The effectiveness of the tests themselves is also an outstanding question, with accuracy rates varying depending on the type of test.
Silk said the state’s antibody tests are 97 percent accurate.
Natasha Chida, an associate professor of medicine in the division of infectious diseases at Johns Hopkins University, said there is only one strain of COVID-19, but uncertainty with current antibody tests at this time makes results unreliable.
"For that reason, I don't think it’s helpful to release (results) to the public," Chida said.
"I think there is a lot of testing that’s being developed, so I'm hopeful that we will have a good test soon."
Antibody testing is largely a state-only endeavor, with most counties taking a backseat as the state Department of Health samples people.
If a person calls their local health department in search of an antibody test, most health officials will refer them to their primary care provider, as some private practices also conduct tests.
In the random antibody tests conducted by the state health department, participants have been notified of their results in about a week, most receiving the information through text messages.
Chida said it's important for state and local health departments to work together when it comes to the testing, but data from testing at this point must be handled with care.
"I think it could give people a false sense of security," she said.
"They may think they’re immune and think they don’t have to social distance and avoid large groups."
"Because it’s not reliable, people may interpret it incorrectly, and that could have some detriments to public health measures."
Erie County has been an exception to the state-centered response, conducting its own tests through the county Public Health Lab.
Test results on both a local and state level are reported through ECLRS, a state electronic reporting system for lab results, county health department spokeswoman Kara Kane said.
For the week ending on May 2, a total of 8,223 residents had been tested for antibodies, with 679 coming back positive, for a return rate of 8.3 percent, she said.
With the county taking testing into its own hands, increased capacity has allowed government officials to offer more tests to the general public – unlike the state, which has generally limited tests to frontline workers and randomly sampled individuals.
Late last week, Erie began a pilot program to test county employees for antibodies, which has helped officials fine-tune scheduling, testing and reporting processes, Kane said.
“As soon as we have sufficient materials and supplies for these blood draws/sample collections, we will announce our schedule of testing locations throughout Erie County and the process for Erie County residents to make an appointment,” she said.
https://www.timesunion.com/news/article ... con&stn=nf
Cayla Harris and Amanda Fries, Albany, New York Times Union
May 7, 2020 | Updated: May 7, 2020 3:02 p.m.
ALBANY — New York has tested more than 1 million people for COVID-19, sharing detailed data about where the cases originated and who has been infected.
But when it comes to antibody testing, the state's latest endeavor to track the spread of the virus, officials have refused to release raw data on the samples collected.
They have tested more than 15,000 people for antibodies and reported results in percentages, but the methodology is unclear and comes with so many caveats that some medical experts and local government officials are questioning the utility of the results.
The state's lack of transparency and failure to coordinate with local officials on its antibody testing efforts has frustrated community leaders who believe the data, and how it’s being collected, could help inform their respective counties on the spread of the coronavirus, and also guide how some areas could move forward with a phased reopening of local economies.
The state has only reported results to individual counties in a few instances, instead reporting results on a regional basis through Gov. Andrew M. Cuomo’s daily coronavirus briefings.
“We don’t know how many residents were tested."
"We don’t know all of those results."
"We know a few, but we don’t know all of them,” said Rich Crist, Rensselaer County's operations director.
“We’d certainly like to see the results."
"One of the things about testing – it gets people who need treatment treated."
"It also helps map the road back to life.”
The state first announced its antibody testing plan about two weeks ago, when Cuomo said that New York would randomly test 3,000 New Yorkers for antibodies at grocery stores across the state.
The effort sought to identify how many individuals had contracted the virus and recovered from it, producing antibodies that may make them immune to the illness.
His top aide, Melissa DeRosa, said the testing would begin the next day.
But the testing began the same day Cuomo announced it, and patrons at some grocery stores in upstate New York passed by neon-yellow signs announcing “NYS DOH antibody screening: Find out if you have been exposed here!”
Shoppers were tested that Sunday at a supermarket in Schenectady County, where the local government had no idea testing would begin that day – or at all – and released a statement to the media that evening saying so.
In the days since, the state has not communicated the results of the tests to the county, and it has not coordinated testing sites with local officials, said county spokeswoman Erin Roberts.
She declined to comment on the consequences of not having access to the data, saying only: “Schenectady County appreciates any and all testing opportunities made available to our residents.”
Erin Silk, a spokeswoman for the state Department of Health, said the testing “is being performed by the state with notice to local counties.”
She repeatedly declined to say why the state is declining to release by-county data, referring instead to the governor’s plan to reopen the economy in regions.
She declined to say if there are counties where no one has been tested for antibodies.
Fulton County Public Health Director Laurel Headwell said she cannot provide answers to residents looking for details on how to access the tests, which occurred to some extent in the county, though officials do not have the full scope of results.
“I don’t know where they had the testing done or how they were able to get tested, so that information is very limited to us as a county,” she said.
“It just puts you in that hard spot of, ‘What do we do, and what do we tell our people in Fulton County?’”
The latest results, reported on Saturday, indicate that about 12.3 percent of the state population has COVID-19 antibodies.
That’s a slight drop from the first two surveys, which had estimated 13.9, and then 14.9, percent, with smaller sample sizes.
New York City, the epicenter of the pandemic in the United States, reported the highest positive test results at 19.9 percent of the population.
Western New York came in second, with 6 percent of participants testing positive.
The Capital District reported a 2.2 percent positive rate.
While the state did not provide data to Albany, Schenectady or Rensselaer counties, officials told local health leaders in Saratoga County that it had conducted 346 tests, 27 of which came back positive – roughly 7.8 percent, Saratoga County Director of Public Health Catherine Duncan said.
The state also reported weighted results for sex, age and race, though officials have refused to provide the number of individuals that have been tested, and their results, for each group.
For weeks, Cuomo touted antibody testing as key to reopening the economy and said results could allow some individuals to return to work sooner.
More recently, antibody testing has become a backburner item as officials question whether the results tell much more than how the virus has spread in the weeks when diagnostic testing was not yet up to scale.
"There was an initial thought that if you had gotten the virus and you had the antibodies that you would be immune to another infection," Cuomo said during a press briefing Wednesday.
"I think that's now being questioned."
Whether antibodies provide immunity remains unclear to scientists and the World Health Organization has said there has been no conclusive evidence that would indicate a person cannot fall ill with the coronavirus again after contracting and recovering from it.
State Department of Health Commissioner Howard Zucker said Wednesday that there are ongoing tests to see whether antibodies do provide immunity, and if so, for how long.
It's unclear what role antibody tests – which the state continues to ramp up, especially among health care workers – now play in Cuomo's reopening strategy.
A spokesman for the governor's office said antibody data continues to inform the state's public health response; meanwhile, in New York City, Mayor Bill de Blasio said on Thursday that the city will test 140,000 people for antibodies in the next month.
Experts also caution that testing hasn’t been sufficiently clinically validated and could show false positives by detecting antibodies present from exposure to other viruses.
“Antibody testing in general allows people to see if they’ve been in contact with the COVID virus,” said Rebecca Kaufman, the director of Broome County’s health department.
“The caveat to that is, at this point, we are not sure what it means toward their immunity, so even if you test positive … we are not positive if that means you are immune.”
Broome County was told ahead of time that the state would test about 100 people at two local grocery stores, Kaufman said, but officials have not been notified of the results.
In Rensselaer County, Crist said they have similar questions and concerns on immunity as well as whether there are other strains of the virus.
“I think there is a lot we don’t know about this disease, and antibody testing will probably give us a window into the precursors of COVID-19,” he said.
The effectiveness of the tests themselves is also an outstanding question, with accuracy rates varying depending on the type of test.
Silk said the state’s antibody tests are 97 percent accurate.
Natasha Chida, an associate professor of medicine in the division of infectious diseases at Johns Hopkins University, said there is only one strain of COVID-19, but uncertainty with current antibody tests at this time makes results unreliable.
"For that reason, I don't think it’s helpful to release (results) to the public," Chida said.
"I think there is a lot of testing that’s being developed, so I'm hopeful that we will have a good test soon."
Antibody testing is largely a state-only endeavor, with most counties taking a backseat as the state Department of Health samples people.
If a person calls their local health department in search of an antibody test, most health officials will refer them to their primary care provider, as some private practices also conduct tests.
In the random antibody tests conducted by the state health department, participants have been notified of their results in about a week, most receiving the information through text messages.
Chida said it's important for state and local health departments to work together when it comes to the testing, but data from testing at this point must be handled with care.
"I think it could give people a false sense of security," she said.
"They may think they’re immune and think they don’t have to social distance and avoid large groups."
"Because it’s not reliable, people may interpret it incorrectly, and that could have some detriments to public health measures."
Erie County has been an exception to the state-centered response, conducting its own tests through the county Public Health Lab.
Test results on both a local and state level are reported through ECLRS, a state electronic reporting system for lab results, county health department spokeswoman Kara Kane said.
For the week ending on May 2, a total of 8,223 residents had been tested for antibodies, with 679 coming back positive, for a return rate of 8.3 percent, she said.
With the county taking testing into its own hands, increased capacity has allowed government officials to offer more tests to the general public – unlike the state, which has generally limited tests to frontline workers and randomly sampled individuals.
Late last week, Erie began a pilot program to test county employees for antibodies, which has helped officials fine-tune scheduling, testing and reporting processes, Kane said.
“As soon as we have sufficient materials and supplies for these blood draws/sample collections, we will announce our schedule of testing locations throughout Erie County and the process for Erie County residents to make an appointment,” she said.
https://www.timesunion.com/news/article ... con&stn=nf
Re: THE YOUNG ANDY CUOMO CHRONICLES
THE DAILY GAZETTE
"Capital Region one step away from starting to reopen as COVID-19 eases - Eight counties can begin restarting local economies after further decline in daily death toll"
John Cropley
May 12, 2020
ALBANY — The Capital Region economy got one step closer to reopening Tuesday, as COVID-19 hospitalizations dropped below the state benchmark.
The eight-county region now has just one metric left out of the seven established by Gov. Andrew Cuomo as pre-conditions for reopening — number of hospital deaths.
Cuomo on Monday announced the rating system by which the state’s 10 economic development regions would be able to reopen after the New York on Pause order expires Friday.
Initially, the Finger Lakes, Mohawk Valley and Southern Tier regions met all seven criteria.
Central New York and the North Country were close behind with six of seven.
The Capital Region and three others met five conditions.
New York City was last with four.
The two metrics the Capital Region didn’t immediately meet were 1) a 14-day decline in net hospitalizations or fewer than 15 new hospitalizations on a three-day average and 2) a 14-day decline in hospital deaths or fewer than five deaths a day on a three-day average.
These two metrics are at once the best measures of the pandemic’s severity in a given region and the hardest to fix — if the thousands of government and health professionals fighting the pandemic had a way to keep people from dying, they would have long since used it.
REGIONAL REACTION
The importance of meeting the last two metrics and the difficulty of making that happen was not lost on the Capital Region leaders who sit on the regional “Control Room” that will monitor COVID-19 activity here so officials can take steps to increase countermeasures and/or slow down the economy’s reopening if more people start getting sick.
“There is a piece to it that is a waiting game,” said Schenectady County Manager Rory Fluman, a Control Room member.
The best strategy to keep the virus at bay is the one that’s been used so far: Keep people distant from each other and practicing good sanitation.
“It falls back on our normal mission of public health,” he said.
To varying degrees, the strategy has worked in individual counties.
Schenectady County saw a surge of infections and death in April, for example, reaching 506 confirmed positive cases and 28 deaths by May 2.
But since then the number of infections is up only about 10 percent and there have been no additional deaths.
Rensselaer County Executive Steven McLaughlin, also a member of the Control Room, said he’s had some frustrations with the entire shutdown and while it’s good to gain a measure of regional control over the reopening, some of the resources to implement it have been lacking.
For example, all the testing that Cuomo is ordering will exceed the number of test kits available and laboratory capacity for processing, he said.
The two metrics that stalled the Capital Region — hospitalization and death — are the hardest to influence, McLaughlin said.
“A lot of this is out of our hands — how do we control who winds up in a hospital?”
Like Albany County Executive Daniel McCoy, he thinks nursing home resident hospitalizations and deaths should not be counted toward the total, as the residents are not free-roaming members of society at this point.
“Just a bad day or two at Diamond Hill or Teresian House can throw off the entire region,” McLaughlin said, naming two facilities where a combined 30 residents have died.
“At the very very peak of this mess, Rensselaer County had 20 people in the hospital."
"We now have four, three of whom are nursing home residents,” McLaughlin said.
In a county of 160,000 people, he added, “four are in the hospital and our economy is at a standstill.”
Nonetheless, he’s optimistic about the region meeting that last metric.
“Our numbers are trending down."
"I feel great except that every county has a major problem with one nursing home each,” McLaughlin said.
“But yeah, I’m hopeful.”
Saratoga County Administrator Spencer Hellwig, another member of the Control Room, said the region has to remain closed, stay the course and continue its efforts until the daily death toll drops below the benchmark.
“Fortunately we’ve got six of the seven checked off,” he said.
“I would expect that the remaining one would be checked off in the near future.”
He said the work of public health nurses in tracing contacts of infected people has been invaluable in controlling the spread of COVID in Saratoga County.
“Once those positives have been confirmed, having them go out and track down everyone they’ve been in touch with … that is probably a big reason why it’s been manageable for the most part,” Hellwig said.
“In some cases it could be dozens of people.”
Since the pandemic reached the area, 2,040 people have been instructed to go into quarantine or isolation in Saratoga County, nearly 1 in 100 residents.
When the Capital Region meets the seventh metric and begins to reopen, Saratoga County officials will add a new role: Helping businesses get back on their feet.
The county Board of Supervisors on Tuesday announced its new reopening advisory group, a group of government and business leaders chaired by Waterford Supervisor Jack Lawler.
The county will become a sort of clearinghouse, Hellwig said.
“There’s been a lot of interest and questions from the business community."
"Part of the county’s role here is to provide as much assistance it can,” he said.
THE DETAILS
For purposes of reopening, the Capital Region is defined as Albany, Columbia, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington counties.
The Mohawk Valley is defined as Fulton, Herkimer, Montgomery, Oneida, Otsego and Schoharie counties.
The seven metrics that a region must meet to reopen are:
• A 14-day decline in net COVID hospitalizations or fewer than 15 new hospitalizations per day on a three-day average;
• A 14-day decline in hospital deaths or fewer than five deaths per day on a three day average;
• Fewer than two new hospitalizations per 100,000 residents per day;
• At least 30% of hospital beds must be vacant;
• At least 30% of ICU beds must be vacant;
• At least 30 out of each 1,000 residents must be tested each month;
• At least 30 infection contract tracers must be hired per 100,000 residents.
The Capital Region and four other regions are given conditional approval on this last metric — they are labeled “expected” because they have personnel in place or in training and are expected to meet the minimum number of tracers shortly.
Statewide, 1,225,113 people had been tested for COVID-19 infections as of Tuesday morning; 338,485 of them have been confirmed positive and 21,845 have died.
An additional number of New Yorkers has died but not been included in the death toll because of reporting errors and limitations.
In the Capital Region, two new deaths were reported Tuesday, both in Columbia County.
https://dailygazette.com/article/2020/0 ... d-19-eases
"Capital Region one step away from starting to reopen as COVID-19 eases - Eight counties can begin restarting local economies after further decline in daily death toll"
John Cropley
May 12, 2020
ALBANY — The Capital Region economy got one step closer to reopening Tuesday, as COVID-19 hospitalizations dropped below the state benchmark.
The eight-county region now has just one metric left out of the seven established by Gov. Andrew Cuomo as pre-conditions for reopening — number of hospital deaths.
Cuomo on Monday announced the rating system by which the state’s 10 economic development regions would be able to reopen after the New York on Pause order expires Friday.
Initially, the Finger Lakes, Mohawk Valley and Southern Tier regions met all seven criteria.
Central New York and the North Country were close behind with six of seven.
The Capital Region and three others met five conditions.
New York City was last with four.
The two metrics the Capital Region didn’t immediately meet were 1) a 14-day decline in net hospitalizations or fewer than 15 new hospitalizations on a three-day average and 2) a 14-day decline in hospital deaths or fewer than five deaths a day on a three-day average.
These two metrics are at once the best measures of the pandemic’s severity in a given region and the hardest to fix — if the thousands of government and health professionals fighting the pandemic had a way to keep people from dying, they would have long since used it.
REGIONAL REACTION
The importance of meeting the last two metrics and the difficulty of making that happen was not lost on the Capital Region leaders who sit on the regional “Control Room” that will monitor COVID-19 activity here so officials can take steps to increase countermeasures and/or slow down the economy’s reopening if more people start getting sick.
“There is a piece to it that is a waiting game,” said Schenectady County Manager Rory Fluman, a Control Room member.
The best strategy to keep the virus at bay is the one that’s been used so far: Keep people distant from each other and practicing good sanitation.
“It falls back on our normal mission of public health,” he said.
To varying degrees, the strategy has worked in individual counties.
Schenectady County saw a surge of infections and death in April, for example, reaching 506 confirmed positive cases and 28 deaths by May 2.
But since then the number of infections is up only about 10 percent and there have been no additional deaths.
Rensselaer County Executive Steven McLaughlin, also a member of the Control Room, said he’s had some frustrations with the entire shutdown and while it’s good to gain a measure of regional control over the reopening, some of the resources to implement it have been lacking.
For example, all the testing that Cuomo is ordering will exceed the number of test kits available and laboratory capacity for processing, he said.
The two metrics that stalled the Capital Region — hospitalization and death — are the hardest to influence, McLaughlin said.
“A lot of this is out of our hands — how do we control who winds up in a hospital?”
Like Albany County Executive Daniel McCoy, he thinks nursing home resident hospitalizations and deaths should not be counted toward the total, as the residents are not free-roaming members of society at this point.
“Just a bad day or two at Diamond Hill or Teresian House can throw off the entire region,” McLaughlin said, naming two facilities where a combined 30 residents have died.
“At the very very peak of this mess, Rensselaer County had 20 people in the hospital."
"We now have four, three of whom are nursing home residents,” McLaughlin said.
In a county of 160,000 people, he added, “four are in the hospital and our economy is at a standstill.”
Nonetheless, he’s optimistic about the region meeting that last metric.
“Our numbers are trending down."
"I feel great except that every county has a major problem with one nursing home each,” McLaughlin said.
“But yeah, I’m hopeful.”
Saratoga County Administrator Spencer Hellwig, another member of the Control Room, said the region has to remain closed, stay the course and continue its efforts until the daily death toll drops below the benchmark.
“Fortunately we’ve got six of the seven checked off,” he said.
“I would expect that the remaining one would be checked off in the near future.”
He said the work of public health nurses in tracing contacts of infected people has been invaluable in controlling the spread of COVID in Saratoga County.
“Once those positives have been confirmed, having them go out and track down everyone they’ve been in touch with … that is probably a big reason why it’s been manageable for the most part,” Hellwig said.
“In some cases it could be dozens of people.”
Since the pandemic reached the area, 2,040 people have been instructed to go into quarantine or isolation in Saratoga County, nearly 1 in 100 residents.
When the Capital Region meets the seventh metric and begins to reopen, Saratoga County officials will add a new role: Helping businesses get back on their feet.
The county Board of Supervisors on Tuesday announced its new reopening advisory group, a group of government and business leaders chaired by Waterford Supervisor Jack Lawler.
The county will become a sort of clearinghouse, Hellwig said.
“There’s been a lot of interest and questions from the business community."
"Part of the county’s role here is to provide as much assistance it can,” he said.
THE DETAILS
For purposes of reopening, the Capital Region is defined as Albany, Columbia, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington counties.
The Mohawk Valley is defined as Fulton, Herkimer, Montgomery, Oneida, Otsego and Schoharie counties.
The seven metrics that a region must meet to reopen are:
• A 14-day decline in net COVID hospitalizations or fewer than 15 new hospitalizations per day on a three-day average;
• A 14-day decline in hospital deaths or fewer than five deaths per day on a three day average;
• Fewer than two new hospitalizations per 100,000 residents per day;
• At least 30% of hospital beds must be vacant;
• At least 30% of ICU beds must be vacant;
• At least 30 out of each 1,000 residents must be tested each month;
• At least 30 infection contract tracers must be hired per 100,000 residents.
The Capital Region and four other regions are given conditional approval on this last metric — they are labeled “expected” because they have personnel in place or in training and are expected to meet the minimum number of tracers shortly.
Statewide, 1,225,113 people had been tested for COVID-19 infections as of Tuesday morning; 338,485 of them have been confirmed positive and 21,845 have died.
An additional number of New Yorkers has died but not been included in the death toll because of reporting errors and limitations.
In the Capital Region, two new deaths were reported Tuesday, both in Columbia County.
https://dailygazette.com/article/2020/0 ... d-19-eases
Re: THE YOUNG ANDY CUOMO CHRONICLES
15 May 2020
Maryfran Wachunas
Public Health Commissioner
Rensselaer County Department of Health
Ned Pattison Government Center
1600 7th Ave
2nd Floor
Troy, NY 12180
RE: "State antibody testing results murky as officials decline to release raw data - Questions remain about effectiveness and utility of tests as local leaders are left in the dark" by Cayla Harris and Amanda Fries, Albany Times Union, May 7, 2020; Inane and ignorant statements by Rensselaer County Director of Operations Richard Christ
Dear Commissioner Wachunas:
By way of review, and here I am speaking as a licensed professional engineer further qualified to practice at the associate level as a public health engineer who is quite familiar with the history of the Rensselaer County Health District and Health Department going back to 1946, according to the official record, on 8 January 2020, the CDC issued a health alert with respect to COVID-19 which was distributed to state and local health officers, state and local epidemiologists, state and local laboratory directors, public information officers, HAN coordinators, and clinician organizations, which distribution presumably included yourself as the local health officer in the Rensselaer County Health District.
Thereafter, despite that CDC alert to your office as Rensselaer County Health Commissioner concerning the very real threat of COVID-19, nothing happened in Rensselaer County for the next fifty-four (54) days, until 2 March 2020, at which time Rensselaer Couty put out a misleading and false press release entitled "Rensselaer County Officials Working with State and Federal Officials on Coronavirus Issue," wherein we Rensselaer County residents were informed as follows, to wit:
With confirmed cases of coronavirus in the nation and the state, Rensselaer County health officials took part in calls with the Centers for Disease Control and the New York State Department of Health regarding the issue.
At this time, there are no confirmed cases of coronavirus in the county.
Federal and state health officials have termed the spread of the illness nationally and in the state as “isolated” cases.
“We want residents to know that our team at the Health Department is monitoring this situation closely and working with state and federal officials to share information and get updates."
"However, there is no need for undue concern or worry,” said County Executive Steve McLaughlin.
“We have been informed that New York State remains at a low risk for coronavirus."
"While we are at a low risk, residents are advised to take simple but effective steps to reduce exposure to all communicable diseases,” said Public Health Director Maryfran Wachunas.
end quotes
As we now know, that glib information was in fact false, which raises the very serious question of incompetence and gross negligence or worse on your part as the Rensselaer County Health Commissioner, unless you wish us to believe that the state health department and the CDC were outright lying to you and the County Executive, himself having no role in the Rensselaer County Health District, given his total lack of public health education or training.
Absent proof of that, the assumption right now which is born out by the record, is that it was you and the County Executive who were lying to us when we were informed in that 2 March 2020 press release that there was no need for undue concern or worry about COVID-19, when obviously, there was, although for all those people who have died because of your incompetence or negligence and that lie, it is a bit late for them now, which raises the question of why are you still in office as the Rensselaer County Health Commissioner when you obviously cannot be trusted with the responsibility, which takes us to the May 7, 2020 Albany Times article entitled "State antibody testing results murky as officials decline to release raw data - Questions remain about effectiveness and utility of tests as local leaders are left in the dark" by Cayla Harris and Amanda Fries, where we county residents were treated to the following from Richard Christ, who also has no role to play in the Rensselaer County Health District because like the County Executive, Mr. Christ has no experience or training as a public health professional, to wit:
In Rensselaer County, Crist said they have similar questions and concerns on immunity as well as whether there are other strains of the virus.
“I think there is a lot we don’t know about this disease, and antibody testing will probably give us a window into the precursors of COVID-19,” he said.
end quotes
Given that on 1 May 2020, six (6) days before Mr. Christ made those public statements in the Times Union about Rensselaer County officials, presumably yourself, not knowing much if anything about COVID-19, an incredible statement given the plethora of technical information available on COVID-19, the Center for Disease Control and Prevention in its Morbidity and Mortality Weekly Report (MMWR), which you should have received as Rensselaer Coumnty Health Commissioner, entitled "Public Health Response to the Initiation and Spread of Pandemic COVID-19 in the United States, February 24–April 21, 2020" by Anne Schuchat, MD; CDC COVID-19 Response Team, gave a complete run-down as to what was then known about COVID-19, we can see that the 7 May 2020 public statements of Mr. Christ as a Rensselaer County Health Department spokesperson were both ignorant and uninformed, which seems to be a continuation of the ignorance broadcast in the 2 March 2020 press release about COVID-19 being nothing to worry about, to wit:
Genomic analysis of outbreak strains suggested an introduction from China to the state of Washington around February 1.
However, examination of strains collected from northern California during early February to mid-March indicated multiple introductions resulting from international travel (from China and Europe) as well as from interstate travel.
Sequencing of strains collected in the New York metropolitan area in March also suggested origins in Europe and other U.S. regions.
end quotes
Given the availability of this information to your office on 1 May 2020, why are we hearing ignorant drivel from Rich Christ in the Times Union six (6) days later where he implies or states that you are not competent enough to understand that information from the CDC, or you simply ignored it, like was the case with the 8 January 2020 HAN Alert about COVID?
Why are we still saddled in Rensselaer County with a health department that is a threat to our public health and well-being in Rensselaer County, just as it was in 1988?
Why are we hearing about COVID-19 from unqualified and ignorant persons like Richard Christ who knows nothing of public health?
As a life-long Rensselaer County resident who is a grandfather over the age of seventy, I would like to know.
Sincerely,
Paul Plante, PE
Maryfran Wachunas
Public Health Commissioner
Rensselaer County Department of Health
Ned Pattison Government Center
1600 7th Ave
2nd Floor
Troy, NY 12180
RE: "State antibody testing results murky as officials decline to release raw data - Questions remain about effectiveness and utility of tests as local leaders are left in the dark" by Cayla Harris and Amanda Fries, Albany Times Union, May 7, 2020; Inane and ignorant statements by Rensselaer County Director of Operations Richard Christ
Dear Commissioner Wachunas:
By way of review, and here I am speaking as a licensed professional engineer further qualified to practice at the associate level as a public health engineer who is quite familiar with the history of the Rensselaer County Health District and Health Department going back to 1946, according to the official record, on 8 January 2020, the CDC issued a health alert with respect to COVID-19 which was distributed to state and local health officers, state and local epidemiologists, state and local laboratory directors, public information officers, HAN coordinators, and clinician organizations, which distribution presumably included yourself as the local health officer in the Rensselaer County Health District.
Thereafter, despite that CDC alert to your office as Rensselaer County Health Commissioner concerning the very real threat of COVID-19, nothing happened in Rensselaer County for the next fifty-four (54) days, until 2 March 2020, at which time Rensselaer Couty put out a misleading and false press release entitled "Rensselaer County Officials Working with State and Federal Officials on Coronavirus Issue," wherein we Rensselaer County residents were informed as follows, to wit:
With confirmed cases of coronavirus in the nation and the state, Rensselaer County health officials took part in calls with the Centers for Disease Control and the New York State Department of Health regarding the issue.
At this time, there are no confirmed cases of coronavirus in the county.
Federal and state health officials have termed the spread of the illness nationally and in the state as “isolated” cases.
“We want residents to know that our team at the Health Department is monitoring this situation closely and working with state and federal officials to share information and get updates."
"However, there is no need for undue concern or worry,” said County Executive Steve McLaughlin.
“We have been informed that New York State remains at a low risk for coronavirus."
"While we are at a low risk, residents are advised to take simple but effective steps to reduce exposure to all communicable diseases,” said Public Health Director Maryfran Wachunas.
end quotes
As we now know, that glib information was in fact false, which raises the very serious question of incompetence and gross negligence or worse on your part as the Rensselaer County Health Commissioner, unless you wish us to believe that the state health department and the CDC were outright lying to you and the County Executive, himself having no role in the Rensselaer County Health District, given his total lack of public health education or training.
Absent proof of that, the assumption right now which is born out by the record, is that it was you and the County Executive who were lying to us when we were informed in that 2 March 2020 press release that there was no need for undue concern or worry about COVID-19, when obviously, there was, although for all those people who have died because of your incompetence or negligence and that lie, it is a bit late for them now, which raises the question of why are you still in office as the Rensselaer County Health Commissioner when you obviously cannot be trusted with the responsibility, which takes us to the May 7, 2020 Albany Times article entitled "State antibody testing results murky as officials decline to release raw data - Questions remain about effectiveness and utility of tests as local leaders are left in the dark" by Cayla Harris and Amanda Fries, where we county residents were treated to the following from Richard Christ, who also has no role to play in the Rensselaer County Health District because like the County Executive, Mr. Christ has no experience or training as a public health professional, to wit:
In Rensselaer County, Crist said they have similar questions and concerns on immunity as well as whether there are other strains of the virus.
“I think there is a lot we don’t know about this disease, and antibody testing will probably give us a window into the precursors of COVID-19,” he said.
end quotes
Given that on 1 May 2020, six (6) days before Mr. Christ made those public statements in the Times Union about Rensselaer County officials, presumably yourself, not knowing much if anything about COVID-19, an incredible statement given the plethora of technical information available on COVID-19, the Center for Disease Control and Prevention in its Morbidity and Mortality Weekly Report (MMWR), which you should have received as Rensselaer Coumnty Health Commissioner, entitled "Public Health Response to the Initiation and Spread of Pandemic COVID-19 in the United States, February 24–April 21, 2020" by Anne Schuchat, MD; CDC COVID-19 Response Team, gave a complete run-down as to what was then known about COVID-19, we can see that the 7 May 2020 public statements of Mr. Christ as a Rensselaer County Health Department spokesperson were both ignorant and uninformed, which seems to be a continuation of the ignorance broadcast in the 2 March 2020 press release about COVID-19 being nothing to worry about, to wit:
Genomic analysis of outbreak strains suggested an introduction from China to the state of Washington around February 1.
However, examination of strains collected from northern California during early February to mid-March indicated multiple introductions resulting from international travel (from China and Europe) as well as from interstate travel.
Sequencing of strains collected in the New York metropolitan area in March also suggested origins in Europe and other U.S. regions.
end quotes
Given the availability of this information to your office on 1 May 2020, why are we hearing ignorant drivel from Rich Christ in the Times Union six (6) days later where he implies or states that you are not competent enough to understand that information from the CDC, or you simply ignored it, like was the case with the 8 January 2020 HAN Alert about COVID?
Why are we still saddled in Rensselaer County with a health department that is a threat to our public health and well-being in Rensselaer County, just as it was in 1988?
Why are we hearing about COVID-19 from unqualified and ignorant persons like Richard Christ who knows nothing of public health?
As a life-long Rensselaer County resident who is a grandfather over the age of seventy, I would like to know.
Sincerely,
Paul Plante, PE
Re: THE YOUNG ANDY CUOMO CHRONICLES
MARKETWATCH
"Empire State index shows activity continued to decline sharply in May"
By Greg Robb
Published: May 15, 2020 at 9:58 a.m. ET
The numbers:
The New York Fed’s Empire State business conditions index rose 29.7 points to -48.5 in May, the regional Fed bank said Friday.
This is the second-lowest reading on record.
Economists had expected a reading of -65, according to a survey by Econoday.
Any reading below zero indicates deteriorating conditions.
What happened:
Fifteen percent of manufacturers reported that conditions were better in May than April.
New orders and shipments continued to decline though not as steeply as in April.
The new-orders index rose 23.9 points to -42.4 in May while shipments rose 29.1 points to -39.
Optimism about the six-month outlook did improve.
The index for future business conditions rose 22 points to 29.1.
Employment levels fell further in May but not at the sharp pace of April.
The index for number of employees rose almost 50 points to -6.1.
Hours worked continued to decline.
Big picture:
Some economists were saying the rebound showed that April was the bottom for manufacturing, while others said that was extrapolating too much from the data.
The latter economists pointed out that some of the improvement in May came from firms reporting that activity was unchanged at zero after reporting steep declines in April.
What are they saying?
“Manufacturers are holding on to their hopes of a turnaround, but we believe significant caution is warranted."
"Looking ahead, the road to recovery will be long, and uneven, with depressed demand, supply-chain disruptions and elevated uncertainty hindering the rebound we expect to take shape in the third quarter,” said Oren Klachkin, economist at Oxford Economics.
Market reaction:
U.S. equity benchmarks are slumping Friday as retail sales dropped sharply and there were signs of tensions with China.
The Dow Jones Industrial Average was down 132 points in morning trading.
https://www.marketwatch.com/story/empir ... cle_inline
"Empire State index shows activity continued to decline sharply in May"
By Greg Robb
Published: May 15, 2020 at 9:58 a.m. ET
The numbers:
The New York Fed’s Empire State business conditions index rose 29.7 points to -48.5 in May, the regional Fed bank said Friday.
This is the second-lowest reading on record.
Economists had expected a reading of -65, according to a survey by Econoday.
Any reading below zero indicates deteriorating conditions.
What happened:
Fifteen percent of manufacturers reported that conditions were better in May than April.
New orders and shipments continued to decline though not as steeply as in April.
The new-orders index rose 23.9 points to -42.4 in May while shipments rose 29.1 points to -39.
Optimism about the six-month outlook did improve.
The index for future business conditions rose 22 points to 29.1.
Employment levels fell further in May but not at the sharp pace of April.
The index for number of employees rose almost 50 points to -6.1.
Hours worked continued to decline.
Big picture:
Some economists were saying the rebound showed that April was the bottom for manufacturing, while others said that was extrapolating too much from the data.
The latter economists pointed out that some of the improvement in May came from firms reporting that activity was unchanged at zero after reporting steep declines in April.
What are they saying?
“Manufacturers are holding on to their hopes of a turnaround, but we believe significant caution is warranted."
"Looking ahead, the road to recovery will be long, and uneven, with depressed demand, supply-chain disruptions and elevated uncertainty hindering the rebound we expect to take shape in the third quarter,” said Oren Klachkin, economist at Oxford Economics.
Market reaction:
U.S. equity benchmarks are slumping Friday as retail sales dropped sharply and there were signs of tensions with China.
The Dow Jones Industrial Average was down 132 points in morning trading.
https://www.marketwatch.com/story/empir ... cle_inline