March 26, 2020

New York is experiencing an "astronomical" number of COVID-19 cases—a surge that's straining the state's health care system, and now, experts are warning other states that they could meet a similar fate if they don't take action. 

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Nearly half of US COVID-19 cases are in NY

As of Thursday morning, New York had identified more than 33,000 cases of COVID-19 and had seen 325 deaths. New York City alone had upward of 19,000 active cases as of Thursday morning and had seen 280 deaths. Overall, the United States has seen nearly 70,000 cases of COVID-19.

Many of the cases are occurring just outside of New York City. Deborah Birx, White House Coronavirus Task Force response coordinator, in a tweet Tuesday said about half of the cases in the United States occurred in the New York City metropolitan area.

According to Birx, the state has a COVID-19 "attack rate close to one in 1,000," which is "five times what the other areas are seeing" and is more cases per capita than Italy.

Even at these numbers, the peak of the epidemic in the state isn't expected for another 14 to 21 days, according to New York Gov. Andrew Cuomo (D). "New York is going first," Cuomo said. "We have the highest and the fastest rate of infection."

Birx said population density, size, and mass transportation system have exacerbated the outbreak. New York City, with a population of 28,000 residents per square mile, is more densely populated than any other city in the United States, according to the New York Times.

"Density is really an enemy in a situation like this," said Steven Goodman, an epidemiologist at Stanford University. "With large population centers, where people are interacting with more people all the time, that's where it's going to spread the fastest."

Throughout the state, residents have been advised to stay home, and retail stores are closed. The situation is so severe that the White House on Tuesday advised people who had recently visited New York City to self-quarantine for 14 days.

Some experts have suggested that the state's coronavirus response might have been employed a bit too late, in part due to miscommunication between federal and local governments, Axios reports.

Just three weeks ago, officials told residents that they were safe to ride the subway. "Clearly, the virus had been circulating there for a number of weeks to have this level of penetrance into the general community," Birx said.

Surge of COVID-19 case strains state health care system

The growing COVID-19 case count is straining the state's health care system, which is growing "desperate" for ventilators and hospital beds, Cuomo said.

Before the epidemic, New York had 53,000 hospital beds, but now the state predicts it will need 140,000 to get through the crisis. The state has asked the National Guard and the Army Corps of Engineers to construct four emergency field hospitals, but that could take up to 10 weeks, NBC News reports.

Cuomo projects the state will soon need 30,000 ventilators "at a minimum," while 3,000 to 4,000 usually suffice. The federal government plans to provide 2,000 ventilators to New York City alone, but Cuomo said that wouldn't be enough. "That'll just get us to the first week of April," he said.

To conserve resources, the state is splitting ventilator tubes in half so one ventilator can treat two patients at a time. 

Is NY's experience a preview of what's to come?

Experts are questioning whether the epidemic in New York could foretell how an outbreak might play out in other parts of the country.

"We are your future," Cuomo said during a briefing on Tuesday. "What happens to New York is going to wind up happening to California, and Washington state, and Illinois. It's just a matter of time. We're just getting there first."

Some public health experts, however, said that while other parts of the United States may see many cases, there is hope that transmission of the virus will be slower in parts of the country that are less densely populated, Politico reports.

And even still, other large, dense cities may be spared New York City's fate. Michael Hendrix, director of state and local policy at the Manhattan Institute, said population density is not the sole determinant of whether a location will experience a major outbreak. "Hong Kong, Singapore, and Tokyo also have density and nowhere near the kinds of outbreaks we have," he said.

In addition, Joshua Epstein, a professor of epidemiology at New York University's school of global public health, said outbreaks of COVID-19 in other state's might not mirror New York's due to evidence that the virus might spread more easily in cooler, less humid climates.

Still, William Hanage, a professor of epidemiology at Harvard T.H. Chan School of Public Health, said the New York outbreak is indication that states should enforce social distancing now and begin to prepare for the worst. "Some places will be affected more than others and some places will be affected earlier than others. However, everywhere should be preparing for this," he said. "Look at it. And don't think that it won't happen to you" (Kingson, Axios, 3/25; Schreckinger/Eisenberg, Politico, 3/25; Silva, NBC News, 3/24; Rosenthal, New York Times, 3/23; CBS News, 3/24; Feuer, et al., CNBC, 3/24; Hellmann, The Hill, 3/24; Owens, Axios "Vitals," 3/25; Smith et al., New York Times, 3/26; Johns Hopkins tracker, accessed 3/26).

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