COVID-19 nearly overran New York's health care system. How it's bracing for second hit

David Robinson
New York State Team

COVID-19 killed tens of thousands in the Northeast, caused massive unemployment and wrecked the economy. In an ongoing series of stories, the USA TODAY Network Atlantic Group examines what the government got wrong in its response to the virus, what policies eventually worked — and why we remain vulnerable if the coronavirus strikes harder in the fall.

The threat of a new spike of coronavirus infections looms large after New York’s health care system nearly collapsed last spring under the burden of treating thousands of COVID-19 patients.

From scrambles to obtain life-saving breathing machines and protective masks to overrun hospitals storing the dead in freezer trucks, New York’s initial pandemic response was filled with traumatic missteps that unfolded daily on a national stage.

Yet as dozens of other states that seemed to ignore the hard-earned lessons in New York now face COVID-19 surges, the Empire State's infection rate remains at record lows.

Authorities and health officials are devising plans to avoid going backwards.

“We have the luxury of time right now, and need to keep things going to sustain low numbers and buy ourselves more time to prepare for a second wave,” said Dr. Michael Mendoza, Monroe County health commissioner.

“And if we do this right, we may never see a second wave.”

Sam Kaitharath, 29, of Yonkers, N.Y. volunteered to have his photo taken while getting a COVID-19 test administered by Catherine Hopkins, a nurse practitioner at St. Joseph's Medical Center in Yonkers April 22, 2020. Hopkins, whose regular job at the hospital involves community outreach and school health, has been pressed into duty in other areas of the hospital due to the coronavirus pandemic. She now splits her time between the screening tent, the emergency room, and filling in as nursing supervisor for the entire hospital.

Many promising developments since spring hinge on New York’s robust COVID-19 testing infrastructure, which improved from several hundred tests per day in early March to more than 50,000 tests daily in recent weeks.

Breakthroughs in medical treatments for COVID-19, the respiratory disease caused by the virus, further fueled hope that New York could weather the coronavirus storm ravaging states like Florida, Texas and Arizona.

Further, all New York hospitals must now stockpile at least 90 days of medical masks, gowns and other personal protective equipment (PPE) under new state orders. It came after reports of doctors and nurses being infected while donning garbage bags and reusing masks amid shortages this spring. 

Disparities in COVID-19 deaths related to income and race, however, underscored fundamental flaws in health care access and affordability in New York and across the country that remain unresolved in many ways.

But experts and health care leaders emphasized New York’s pandemic preparedness overall is vastly improved from the chaotic early days that contributed to its nation-leading death toll of more than 25,000.

“Every day, we better understand how COVID-19 spreads, how the virus manifests and the most effective treatments for it,” said Bea Grause, president of the Healthcare Association of New York State, the Albany-based group that represents hospitals and nursing homes.

State officials and health care providers “are working hard to prepare for a second wave of COVID-19, including stockpiling PPE,” she added, citing challenges like the renewed strain on testing and medical supplies due to cases hitting record highs nationally.

More: New York to out-of-state travelers: Provide contact information or face a fine

More: What we know (and don't know) about NY COVID-19 nursing home deaths after DOH report

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What failed during NY’s COVID-19 response

Gov. Andrew Cuomo showed a slide Friday, May 8, 2020, on how the federal government didn't shut down flights from Europe soon enough.

Earlier this year, coronavirus spread unchecked in New York for months due to gaps in the complex web of measures intended to identify and contain infectious-disease outbreaks early.

The failures spanned from federal government improperly monitoring the initial novel coronavirus outbreak last fall in Wuhan, China to health officials and hospitals failing to catch its arrival in the U.S.

“That led to this being a teeny little fire in a city that most Americans had never heard of to a global pandemic that has infected millions and killed hundreds of thousands,” said Dr. Gregory Poland, a Mayo Clinic and Infectious Diseases Society of America expert.

Gov. Andrew Cuomo noted New York’s outbreak was seeded by millions of European travelers, who arrived prior to a federal travel ban on March 16. It also goes to the debate over whether New York was too late to act in closing down businesses until March 22, when the state already had 114 deaths and 15,000 cases.

During that period, authorities and scientists also had limited understanding about the degree of community and asymptomatic spread, which contributed to delays in promoting mask wearing in public and complicated contact tracing.

“Like an airplane crash, when you dissect this backwards, it’s a series of missteps that collectively lead to a bigger impact than it need have,” Poland said.

This undated photo provided by U.S. Centers for Disease Control and Prevention shows CDC's laboratory test kit for the new coronavirus. (CDC via AP)

Further, the U.S. Centers for Disease Control and Prevention distributed faulty test kits to states, which delayed efforts to track and contain the virus in January and February.

New York launched its own test on Feb. 29 and didn’t truly begin ramping up to scale until late March, leaving hospitals and local health officials in the dark as to virus risks.

“We did not know what the local prevalence was in our community,” said Mendoza, whose county includes the city of Rochester. “Not knowing that meant that we had to make a lot of decisions with incomplete information.”

Statewide, suffering was most acute in many low-income and minority communities devastated by COVID-19 deaths linked to poor access to health care, including some of the 41 neighborhoods to have a hospital closed since 2003.

Black and Hispanic New Yorkers, excluding New York City, represent 31% of the state’s COVID-19 deaths, and just 21% of the population.

Yet the scope of COVID-19 disparities came to light only after state officials began publicly releasing race and ethnicity data on April 8, under pressure from advocates and media outlets, including the USA TODAY Network.

More: Why George Floyd's death, COVID-19 inequality sparked protests: 'We're witnessing history'

More:Coronavirus in New York: As deaths and cases soar, should NY leaders have acted sooner?

Similarly, state officials did not start releasing many details about coronavirus spreading in nursing homes until April 17, long after a controversial March 25 state order directing the facilities to accept COVID-19 patients from hospitals.

Today, at least 6,300 people have died inside New York nursing homes in connection to COVID-19, or about 25% of the state's overall deaths, igniting calls for an independent investigation of the matter.

Gloria Wilburn's husband, Ray LaRussa, died May 14, 2020, of COVID-19 at a nursing home in Westchester County

Amid the early pandemic chaos, state officials also raced to create nearly 90,000 additional hospital beds, converting massive convention centers into temporary hospitals and receiving a floating U.S. Navy hospital.

Much of the excess capacity went unused as infections fell short of initial projections, a result of the delayed understanding of the effectiveness of social-distancing and public mask wearing.

In many ways, New York politicians and hospital leaders in general “were trying to do the right thing, and they were getting bad advice” from the Centers for Disease Control and Prevention and the World Health Organization, Poland said.

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More:Coronavirus in NY: COVID-19 race, ethnicity data show black, Hispanic population at higher risk

What worked during New York’s COVID-19 response

New York Gov. Andrew Cuomo arrives wearing a face mask for his daily briefing about the the state's coronavirus reopening process May 29, 2020 at Iona College in New Rochelle.

New York’s pandemic battle truly started to turn after Cuomo on April 15 ordered masks or cloth face coverings must be worn in public, research shows.

The directive required face coverings when people can't maintain at least six feet of space between themselves and others in public. It came after COVID-19 cases continued to rise in New York, despite Cuomo issuing stay-at-home orders on March 20.

In fact, researchers found that face mask use reduced the number of COVID-19 infections by more than 66,000 in New York City from April 17 to May 9, according to a Texas A&M University-led study.

Poland described the turnaround in New York City as nearly unbelievable considering how the virus was spreading among the densely packed metropolis of about 8.6 million people.

“To have that level of wildfire raging and control it is remarkable. It is a real-time study of the power of these simple…non-pharmaceutical interventions,” he said.

Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, said New York's ability to control the virus can serve as a model for other states.

“We know that, when you do it properly, you bring down those cases. We have done it. We have done it in New York,” Fauci said in an interview on PBS NewsHour.

More: COVID-19 testing in New York: If you want a test, you can get a test

Some other states have followed New York’s lead in recent weeks.

New Jersey, for instance, mandated face coverings be worn in public groups on July 8, citing a slight uptick in COVID-19 infections and concerns about surges in other states without mask requirements.

Further, New York’s race this spring to obtain up to 30,000 ventilators, which help severely ill COVID-19 patients to breath, underscored gaps in the state and national networks of emergency medical equipment stockpiles.

New York’s health system started the outbreak with about 5,000 ventilators, and state officials scoured the globe to buy thousands more.

Yet the international rush on the breathing machines drove prices higher and deepened shortages. Cuomo said ventilator prices spiked from $25,000 to $45,000 in part due to interstate competition.

While New York ultimately ended up with excess ventilators, the saga prompted federal officials to pay nine companies $2.9 billion for 187,000 of the breathing machines to boost national stockpiles during the pandemic.

Vincenzo Russo, a research and development associate, monitors the health of cells being used in effort to create antibodies to treat people exposed to the novel coronavirus outbreak that originated in China, at Regeneron in Tarrytown, New York Feb. 10, 2020. The process involves injecting pseudo-coronavirus into genetically altered mice that produce human-like antibodies.

Meanwhile, the medical community has raced to improve treatments for COVID-19 until an effective vaccine arrives.

More: How NY scientists are using mice as the secret weapon against the outbreak

Studies involving doctors and patients in New York have contributed to an abundance of international medical discoveries, spanning from improved use of supplemental oxygen to re-purposed antiviral drugs.

“This canvas we call COVID-19 was blank 25 weeks ago…and it is nothing short of a miracle the amount of knowledge that has been learned,” Poland said.

Monroe’s health chief Mendoza expanded on the progress since spring, citing strides made towards creating and deploying an army of contact tracers needed to isolate COVID-19 infected New Yorkers and quarantine contacts.

“Now that we have more testing, if we can trace effectively and people cooperate with us, which has been variable, we can move forward and contain any surges,” he said.

More:NY hasn't named nursing homes that accepted COVID-19 patients. But testing data offers new details

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David Robinson is the state health care reporter for the USA TODAY Network New York. He can be reached and followed on Twitter:@DrobinsonLoHud