How hidden cases, blunder tests and political missteps condemned New York’s COVID-19 response

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When the first cases of COVID-19 in New York were announced in early March, attention turned to China as the source of the threat.

But preliminary research now suggests that dozens of patients with genetic markers of the virus who can be traced back to Europe may have spread it across town by the end of January. a key factor that led New York to become the epicenter of the epidemic in the United States.

The first identified case of spread in the community in New York, a lawyer in the suburbs of Westchester, is linked to more than 100 other COVID-19 cases. So the likely spread of dozens of other unknown cases has put New York behind the ball from the start, said Dr. Eric Cioe-Pena, director of global health for Northwell Health, a nonprofit network that manages hospitals and research and testing. facilities in the state.

“It became a kind of losing match. We were already on the wrong side and time was no longer our friend, “said Cioe-Pena, noting that scientists are still investigating the source of the cases, including how Westchester’s lawyer contracted the virus.

“By the time we learned about this virus, how it was transmitted, the asymptomatic ones, it was already raging in New York. “

Travelers in protective gear pass through John F. Kennedy New York Airport on April 16 as it is largely empty due to continued reductions in travel due to the COVID-19 pandemic. (Spencer Platt / Getty Images)

Experts say lack of available tests, poor screening at city’s international airports and dense urban area have combined to bring New York to its knees, forcing millions of people into isolation and pushing hospitals to edge of the abyss.

With more than 15,000 probable and confirmed deaths from COVID-19, New York has the fifth highest death toll in the world, behind Italy, Spain, France and the United Kingdom.

Early disadvantage

The fact that such a high number of probable cases went unnoticed put New York City at a disadvantage compared to cities on the West Coast, which had fewer initial cases and were closed earlier, said George Rutherford, manager of infectious diseases and global epidemiology at the University of California, San Francisco.

“When New York started, there were over 200 transmission chains going on, while here in the West we had six, seven, eight, something like that,” he said. .

In California, health officials have determined that the earliest death they could trace to COVID-19 occurred on February 6, indicating that the virus was likely in the region in January.

Study from Mount Sinai Hospital in New York links early city cases to Europe and other parts of the United States – not China, where the virus originated – and suggests that the virus was probably circulating late January. The research is what is called a preprint study, which means that it has not yet been peer reviewed by independent experts.

“Basically, the virus was already in the population and there was already a community transmission before we even realized that we had to do this social distancing,” said Elodie Ghedin, professor of biology and global public health at the University of New York.

Medical staff conducts COVID-19 tests in the parking lot of their clinic in the Staten Island neighborhood of New York. Test sites continue to open across the city. (David Dee Delgado / Getty Images)

An estimate from researchers at Northeastern University, shared with the New York Times, suggests that as of March 1, New York City may have had more than 10,000 cases.

“It goes without saying that there was a community transmission in New York that we didn’t know about,” said virologist Dr. Angela Rasmussen of Columbia University. “Because New York is so densely populated, it is possible to really amplify that and get it out of control. “

Failed tests

Cioe-Pena said the initial lack of testing infrastructure meant that health officials were unable to keep up with the spread, contributing to New York’s inability to control the epidemic.

The early failures of the U.S. Centers for Disease Control and Prevention meant that states and city officials did not have access to a large number of tests, so they limited themselves to testing only the sickest patients, and it would take days to get results.

“It was already too late to step up the tests. We already missed the boat on it, ”said Cioe-Pena.

On March 5, the city was monitoring 2,773 lonely people and Mayor Bill de Blasio called on the federal government to get help with the tests. It would take more than two weeks for Governor Andrew Cuomo to issue the shelter order on site.

New York Mayor Bill de Blasio visits Union Square to broadcast information on the coronavirus on March 9. At the time, there were 20 confirmed cases of COVID-19 in the city, out of a total of 142 cases in the state. (Jeenah Moon / Getty Images)

Rasmussen said such an order could have happened sooner if the city had had the opportunity to more proactively test COVID-19, as well as antibody tests to detect those who had previously had the disease.

“I think it was definitely a missed opportunity,” she said.

Officials said on Thursday that there were more than 138,000 confirmed cases of COVID-19 in New York, but that number is missing the mark because people with mild symptoms have been told from the start not to get tested.

“It would not surprise me if, at this point, we probably have close to a million New Yorkers who have been exposed to COVID-19,” said Dr. Oxiris Barbot, New York health commissioner.

Political missteps

Not knowing the true imprint of the virus may have given elected officials a misplaced level of confidence from the start. In early March, New York State and local authorities sought to reassure the public even as the virus apparently spread quietly among people.

On March 11, the mayor of Blasio still advised healthy residents of the city to continue socializing.

“People should go out and continue living, should go to restaurants,” he said.

City and state officials also clashed over everything from closing the schools to postponing the St. Patrick’s Day parade in New York. Containment measures focused on the suburbs, not the city.

A statewide home stay order was announced on March 20 and came into effect two days later. California, as a result of previous measures implemented by some of its jurisdictions, closed its doors on March 19.

“I still think the response has been too slow at the federal level, at the state level, at the city level,” said Ghedin.

Governor Andrew Cuomo, now widely praised for his consistent behavior during the crisis, also issued a confident note on March 5, saying, “We have the best health care system in the world here. “

Cuomo reacted to recent research on Friday, saying it offers a valuable lesson for future pandemics, that an epidemic on the other side of the world can and will travel quickly.

“When you look back, does anyone think the virus was still in China until we act two months later? Said Cuomo.

New York Governor Andrew Cuomo, seen last month, has received high praise for his handling of the COVID-19 crisis. He ordered a statewide home stay order that began on March 22. But by then, the coronavirus could have spread for almost two months, according to research. (John Minchillo / The Associated Press)

He noted that between January and the state’s closure in March, there had been 13,000 flights between Europe and New York, bringing in 2.2 million people.

Cuomo said the travel ban from China to the United States on January 31 was appropriate, but European travel restrictions on March 14 came too late.

“We closed the front door with a travel ban to China … but we left the back door open. “

No easy choices

Nevertheless, New York officials were faced with difficult choices, said Ghedin. She points out, for example, that the mayor and the governor clashed over when to close the schools, in part because of the large number of students who depend on the school system for free or subsidized meals.

“As a virologist and epidemiologist, of course, my first thought was,” You have to close the schools. ” But it’s difficult when you start to weigh all these other important things in a society. “

Dr. Tom Frieden, former head of the US Centers for Disease Control and former New York health commissioner, told the New York Times that tougher quarantine measures a week or two earlier could have reduced the number 50-80% dead.

However, as Cioe-Pena points out, closing New York City was simply not an idea that people could buckle up at the time.

“It was something that was conceptually inconceivable in February, for an American city the size of New York to close. “

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