Why has NYC corona response been so mismanaged?

[FrugalSaver]

Seems there was already much learned long before their first case.

Now states are quaranteeijg people who enter their state from New York and things only seem to be getting worse

[Systems101]

Why are you surprised that it's still getting worse?  That situation is totally consistent with the known SARS-CoV-2 progression.

There is a significant lag between a stay-at-home order and the peak of new cases (because it takes a while for symptoms to appear)...

There is then even more lag between that and peak need in the hospitals (because it takes a while to recover)...

We should still be expecting it to get worse: The new cases we are seeing today include a lot of people infected before non-essential services were closed (a week ago)...

This is why reactions by other states not locking down now are so scary.  Their next 1-2 weeks of cases *are already established* (they just can't measure it yet)... the question isn't "where are we today", it's "where will we statistically be in 2 weeks, and what would that lead me to do, so I can take that action *today*".

https://covid19.healthdata.org/projections can give you a good view of what to expect going forward if nothing else changes... and it's consistent with the peak demand in NY hospitals still being 14 days out (consistent with news coming from NY - which is saying 14-21)

[StarBright]

Why are you surprised that it's still getting worse?  That situation is totally consistent with the known SARS-CoV-2 progression.

There is a significant lag between a stay-at-home order and the peak of new cases (because it takes a while for symptoms to appear)...

There is then even more lag between that and peak need in the hospitals (because it takes a while to recover)...

We should still be expecting it to get worse: The new cases we are seeing today include a lot of people infected before non-essential services were closed (a week ago)...

This is why reactions by other states not locking down now are so scary.  Their next 1-2 weeks of cases *are already established* (they just can't measure it yet)... the question isn't "where are we today", it's "where will we statistically be in 2 weeks, and what would that lead me to do, so I can take that action *today*".

https://covid19.healthdata.org/projections can give you a good view of what to expect going forward if nothing else changes... and it's consistent with the peak demand in NY hospitals still being 14 days out (consistent with news coming from NY - which is saying 14-21)

^ yep! My state basically locked down two weeks ago (cancelled schools, encouraged social distancing), and officially shut down one week ago (everything closed except essentials) and they said today they don't expect to hit the peak until mid-May. (*note that this is also considered good- because we have apparently managed to delay the peak from mid april to mid may- thus giving some time to secure supplies for hospitals).

NYC is incredibly populous and they basically initiated lockdowns as soon as they had testing to confirm the virus. I would actually say that Cuomo has done a the best job he can (and New  Yorkers certainly seem to think he is doing a great job).

[Apple_Tango]

I also don’t think the NYC response has been mismanaged. I’ve been watching the briefings that Cuimo gives and I think he’s doing an excellent job. (I am not a New Yorker.) It’s a very dense place with a lot of international travel. They’re doing the best they can but the virus is only gonna get worse. It’s taking an average of four days to get the test results. So the numbers we have today are actually the true numbers from four days ago.  New York is a state that actually has the resources to handle what they’ve been handling up till this point. I’m aware that they’re being overwhelmed, and that’s why federal aid is being put in place. I’m more concerned about the states that are not locking down because all they have to do is look at New York to see what their future is going to be in three weeks.

[Sibley]

The only thing that could have helped NY as far as I can tell is if they'd had the testing capability earlier. This disease is slow.

[tawyer]

https://covid19.healthdata.org/projections can give you a good view of what to expect going forward if nothing else changes... and it's consistent with the peak demand in NY hospitals still being 14 days out (consistent with news coming from NY - which is saying 14-21)

Solid link.

[FINate]

The fatal mistake NY and NYC made was failing to aggressively lockdown earlier. Epidemiologists saw it coming, saw what was happening in Italy, yet city and state leaders were unwilling to risk damage to the economy until it was too late. A week is an eternity on an exponential curve and so the die was cast at that fateful moment. Not much they can do at this point but ride out the wave as best as possible, but this will be very chaotic and tragic.

[jim555]

Lots of people are blaming Cuomo because they wanted business open and there weren't that many cases when the order to shut down was made.  If anything he was early.  NY has higher numbers because they test much more than anyone else. 

[zygote]

I live in NYC.

I agree we should have shut down more aggressively more quickly, but there are also inherent factors about life in NYC that make this tough to contain.

There are a ton of international travelers coming and going at all times (less so now, obviously). We're incredibly dense - staying 6 feet apart on the sidewalk is a joke. It is also basically impossible to carry out day to day life in isolation. Most people walk or take public transit to grocery stores, which means more interaction and more trips to the store because it's too heavy to carry it all back. (Grocery delivery is an option is normal times but is currently so slammed it's difficult to rely on, and it's also way more expensive). Almost no one has laundry in their apartment, and many (including me) don't have it in their building. Laundromat only. Even taking out the trash is a communal act - I have to go outside and put it in a bin shared by multiple buildings. There's only so much you can do to reduce interactions in that kind of environment.

On top of that, we're running more tests than any other state, so we're going to catch more cases.

Just some perspective on why the numbers may look as bad as they do. Frankly, I think it's a miracle the numbers aren't higher for a city of 8.5 million people with the lifestyle factors we have.

[bacchi]

Lots of people are blaming Cuomo because they wanted business open and there weren't that many cases when the order to shut down was made.  If anything he was early.  NY has higher numbers because they test much more than anyone else.

Troof.

Missouri has only ~800 cases and KC is a city of 2M (MSA). Is that likely? Hardly.

https://www.ksmu.org/post/parson-missouri-can-t-test-all-seniors-covid-19-affected-nursing-homes-due-test-shortage#stream/0

Governor Mike Parson said Thursday if he could prioritize the testing of all residents in nursing homes where there’s been a coronavirus outbreak, he would – but he says he cannot due to a shortage of tests.

They can't even test everyone in nursing homes that have outbreaks. That was on the 26th. We have a long way to go.

[kenmoremmm]

The fatal mistake NY and NYC made was failing to aggressively lockdown earlier. Epidemiologists saw it coming, saw what was happening in Italy, yet city and state leaders were unwilling to risk damage to the economy until it was too late. A week is an eternity on an exponential curve and so the die was cast at that fateful moment. Not much they can do at this point but ride out the wave as best as possible, but this will be very chaotic and tragic.

truth.

however, this should've come at the federal level. this has been know about for almost half a year now. a month ago, it was still a hoax at the federal level.

this is not something that you can expect state/local agencies to deal with. this is why you have federal agencies to deal with big decisions like this.

[Bettersafe]

@zygote: that sounds like a real challenge how things are set up and trying to social distance/quarentine at the same time. Good luck!

[AnnaGrowsAMustache]

I can tell you exactly why.

Example one: The NYC governor has been very vocal about working hard for his people/how awful the virus is..... but when Rhode Island wants to quarantine people out of NYC, governor threatens to sue??? Um, do you want to control this frickin thing or not???

Example two: Gun shops have been closed in some areas as part of a wider lockdown and the NRA wants to sue???? Um.... bigger issues much???

All of the problems with the USA can be summed up in those two examples. Absolutely no one is working together for a common outcome, and people are far more concerned with their rights than their responsibilities to others.

[jim555]

I can tell you exactly why.

Example one: The NYC governor has been very vocal about working hard for his people/how awful the virus is..... but when Rhode Island wants to quarantine people out of NYC, governor threatens to sue??? Um, do you want to control this frickin thing or not???

We still have a Constitution, states can't prohibit interstate travel.

[AnnaGrowsAMustache]

I can tell you exactly why.

Example one: The NYC governor has been very vocal about working hard for his people/how awful the virus is..... but when Rhode Island wants to quarantine people out of NYC, governor threatens to sue??? Um, do you want to control this frickin thing or not???

We still have a Constitution, states can't prohibit interstate travel.

Your nation is on fire. Your federal government has emergency powers. Someone take some frickin responsibility for actually solving the issue at hand ie you're all going to die of a virus inside a month, and stop blathering on about your rights. Your rights mean fuck all if you're dead. Idiots. Honestly!

[jim555]

I can tell you exactly why.

Example one: The NYC governor has been very vocal about working hard for his people/how awful the virus is..... but when Rhode Island wants to quarantine people out of NYC, governor threatens to sue??? Um, do you want to control this frickin thing or not???

We still have a Constitution, states can't prohibit interstate travel.

Your nation is on fire. Your federal government has emergency powers. Someone take some frickin responsibility for actually solving the issue at hand ie you're all going to die of a virus inside a month, and stop blathering on about your rights. Your rights mean fuck all if you're dead. Idiots. Honestly!

The horses have already left of the barn.  It is already in every state.  Locking everything will do nothing but collapse the economy and have no impact on the spread.  The Constitution has not been suspended.

[Schaefer Light]

The fatal mistake NY and NYC made was failing to aggressively lockdown earlier. Epidemiologists saw it coming, saw what was happening in Italy, yet city and state leaders were unwilling to risk damage to the economy until it was too late. A week is an eternity on an exponential curve and so the die was cast at that fateful moment. Not much they can do at this point but ride out the wave as best as possible, but this will be very chaotic and tragic.

truth.

however, this should've come at the federal level. this has been know about for almost half a year now. a month ago, it was still a hoax at the federal level.

this is not something that you can expect state/local agencies to deal with. this is why you have federal agencies to deal with big decisions like this.

The federal government doesn't have the right to order businesses to shut down.

[fasteddie911]

I'm not sure what you mean by mismanaged but in that case every country except a few Asian ones have been mismanaged. Few were ready for this ferocious virus.  Throw millions of humans together in a dense city like NYC and it'll be bad.  The Asian countries who are having success have experience and are prepared for pandemics and it has helped contain it but even they aren't immune. Taiwan apparently simply did not trust China and were aggressive early on with border control and quarantining.

[ltt]

People, at least here in the US, get extremely upset, irate, whatever you want to call it, when the mere thought is expressed of closing down flights coming into the US.  I've never understood it, but it is what it is.  Also, we are a highly mobile society.  People like their freedom to move about as they please.  It's a "well, it doesn't apply to me" mentality.

With that being said, I don't think that, given all that's occurred, the situation has been mismanaged.  I think Cuomo is working the best he can with the situation he's been given.  It has to be totally taxing on him and for others who are out there in this every single day.

No one could have seen this coming--maybe if they looked back at China much, much earlier, but I doubt it.

[bmjohnson35]

People inherently like to point fingers and lay blame.  Anyone who has managed people knows this all too well.  In addition, we live in a time where politics are extremely polarized and government policy is heavily influenced by industry. There are many reasons why this virus has been and will continue to be extremely difficult to manage. Years from now, this "event" will be one of those time's in history when people will remember how life changed as we know it.

BJ

[BECABECA]

...
No one could have seen this coming--maybe if they looked back at China much, much earlier, but I doubt it.

I get really frustrated when people say this. And I am hearing it more and more, when a new city or state starts to get overrun. We all could see this coming. NYC saw this coming, all they had to do was look at SF Bay Area. SF Bay Area saw this coming, they just had to look at Seattle. Seattle saw this coming, just looking at Lombardy.

Cuomo mismanaged the first few critical days of NYC’s community spread. The NYC mayor tried to get NYC to shelter in place 3 days before, but the governor smacked him down. When NYC’s exponential growth finally starts to taper off in a week or so, we can look at the last 3 days of new cases and directly attribute them to Cuomo’s obstruction. Then a couple weeks later when the deaths finally start to come out of exponential growth, we can attribute the last 3 days of deaths to him as well. All because he wanted to keep businesses making money for a few extra days.

Yes, he’s stepping up now, but a lot of comfort that gives to the families of the more than a thousand extra people who will die because of the delay.

 

On March 17, as the number of confirmed cases rose to 814 citywide, Mayor Bill de Blasio announced that the city was considering a similar shelter-in-place order within the next 48 hours. Across the boroughs of New York City, there were 277 confirmed cases in Manhattan, 248 in Queens, 157 in Brooklyn, 96 in the Bronx, and 36 in Staten Island. Seven city residents had died of the virus.[70]
Mayor Bill de Blasio's comments were quickly rebuked by New York Governor Andrew Cuomo's office, and again later by the governor himself in an interview with CNN's Jake Tapper.[71] Melissa DeRosa, secretary to the governor, issued a statement during the mayor’s briefing, clarifying state government is not considering shelter-in-place orders at the time.[70] Governor Andrew Cuomo said later Tuesday morning, "We hear 'New York City is going to quarantine itself.' That is not true. That cannot happen. It cannot happen legally. No city in the state can quarantine itself without state approval. And I have no interest whatsoever and no plan whatsoever to quarantine any city."[72]
On March 18, New York Governor Andrew Cuomo reaffirmed that he would not approve a “shelter-in-place” order for New York City. “That is not going to happen, shelter in place, for New York City,” Cuomo said, “For any city or county to take an emergency action, the state has to approve it. And I wouldn’t approve shelter in place.”[73]

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_New_York_(state)

[FINate]

I live in NYC.

I agree we should have shut down more aggressively more quickly, but there are also inherent factors about life in NYC that make this tough to contain.

There are a ton of international travelers coming and going at all times (less so now, obviously). We're incredibly dense - staying 6 feet apart on the sidewalk is a joke. It is also basically impossible to carry out day to day life in isolation. Most people walk or take public transit to grocery stores, which means more interaction and more trips to the store because it's too heavy to carry it all back. (Grocery delivery is an option is normal times but is currently so slammed it's difficult to rely on, and it's also way more expensive). Almost no one has laundry in their apartment, and many (including me) don't have it in their building. Laundromat only. Even taking out the trash is a communal act - I have to go outside and put it in a bin shared by multiple buildings. There's only so much you can do to reduce interactions in that kind of environment.

On top of that, we're running more tests than any other state, so we're going to catch more cases.

Just some perspective on why the numbers may look as bad as they do. Frankly, I think it's a miracle the numbers aren't higher for a city of 8.5 million people with the lifestyle factors we have.

These are all reasons to lock down earlier and more aggressively. Frankly, I don't give a damn about the official test numbers ... even NY is doing so few that it's a meaningless stat. Weeks ago it was clear that this thing was spreading within the community (confirmed cases that didn't fit the travel/contact profile). What matters now is the reality on the ground in the healthcare system, which is very likely going to collapse in NYC this week or next. Failing to act earlier put NYC on the same curve as Italy.

This didn't have to happen. Asian cities are *way* denser and more populated. And yet, South Korea, Japan, Taiwan, and Singapore went before us and showed us how to manged this virus. We weren't willing to listen.

[FINate]

The fatal mistake NY and NYC made was failing to aggressively lockdown earlier. Epidemiologists saw it coming, saw what was happening in Italy, yet city and state leaders were unwilling to risk damage to the economy until it was too late. A week is an eternity on an exponential curve and so the die was cast at that fateful moment. Not much they can do at this point but ride out the wave as best as possible, but this will be very chaotic and tragic.

truth.

however, this should've come at the federal level. this has been know about for almost half a year now. a month ago, it was still a hoax at the federal level.

this is not something that you can expect state/local agencies to deal with. this is why you have federal agencies to deal with big decisions like this.

The Feds, and the Trump Admin specifically, fumbled early on. Trump, to his credit, changed his stance, yet he's too arrogant to admit he made a mistake. Fine, whatever, I'm not interested in rubbing people's faces in it during the thick of a crisis.

But this doesn't excuse state and local leaders of their responsibility to act. If we can't expect state and local agencies to do the right thing within their jurisdictions then why do they even exist?

[FINate]

I can tell you exactly why.

Example one: The NYC governor has been very vocal about working hard for his people/how awful the virus is..... but when Rhode Island wants to quarantine people out of NYC, governor threatens to sue??? Um, do you want to control this frickin thing or not???

We still have a Constitution, states can't prohibit interstate travel.

Your nation is on fire. Your federal government has emergency powers. Someone take some frickin responsibility for actually solving the issue at hand ie you're all going to die of a virus inside a month, and stop blathering on about your rights. Your rights mean fuck all if you're dead. Idiots. Honestly!

The horses have already left of the barn.  It is already in every state. Locking everything will do nothing but collapse the economy and have no impact on the spread.  The Constitution has not been suspended.

Not true! Locking down will not stop the spread initially, and in places like NYC it's going to get way more awful before it gets better because they waited so long, but locking down will eventually slow the spread.

[jim555]

Everyone is a Monday morning quarterback.  Hindsight is 20/20.

[FINate]

...
No one could have seen this coming--maybe if they looked back at China much, much earlier, but I doubt it.

I get really frustrated when people say this. And I am hearing it more and more, when a new city or state starts to get overrun. We all could see this coming. NYC saw this coming, all they had to do was look at SF Bay Area. SF Bay Area saw this coming, they just had to look at Seattle. Seattle saw this coming, just looking at Lombardy.

Cuomo mismanaged the first few critical days of NYC’s community spread. The NYC mayor tried to get NYC to shelter in place 3 days before, but the governor smacked him down. When NYC’s exponential growth finally starts to taper off in a week or so, we can look at the last 3 days of new cases and directly attribute them to Cuomo’s obstruction. Then a couple weeks later when the deaths finally start to come out of exponential growth, we can attribute the last 3 days of deaths to him as well. All because he wanted to keep businesses making money for a few extra days.

Yes, he’s stepping up now, but a lot of comfort that gives to the families of the more than a thousand extra people who will die because of the delay.

 

On March 17, as the number of confirmed cases rose to 814 citywide, Mayor Bill de Blasio announced that the city was considering a similar shelter-in-place order within the next 48 hours. Across the boroughs of New York City, there were 277 confirmed cases in Manhattan, 248 in Queens, 157 in Brooklyn, 96 in the Bronx, and 36 in Staten Island. Seven city residents had died of the virus.[70]
Mayor Bill de Blasio's comments were quickly rebuked by New York Governor Andrew Cuomo's office, and again later by the governor himself in an interview with CNN's Jake Tapper.[71] Melissa DeRosa, secretary to the governor, issued a statement during the mayor’s briefing, clarifying state government is not considering shelter-in-place orders at the time.[70] Governor Andrew Cuomo said later Tuesday morning, "We hear 'New York City is going to quarantine itself.' That is not true. That cannot happen. It cannot happen legally. No city in the state can quarantine itself without state approval. And I have no interest whatsoever and no plan whatsoever to quarantine any city."[72]
On March 18, New York Governor Andrew Cuomo reaffirmed that he would not approve a “shelter-in-place” order for New York City. “That is not going to happen, shelter in place, for New York City,” Cuomo said, “For any city or county to take an emergency action, the state has to approve it. And I wouldn’t approve shelter in place.”[73]

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_New_York_(state)

^This. So much this. I also get frustrated by what happened in NY. On March 18 I wrote to my brother saying I hoped Cuomo would finally approve a shelter in place order for NYC...and it didn't come until the 22nd! I have former colleagues there, very worried for them.

By the time this really hit the US it wasn't a complete unknown. We had positive examples of how to deal with the virus in densely populated cities: South Korea, Japan, Taiwan, Singapore. And we had negative examples as well: Italy, Wuhan (the early response).

As far as I'm concerned, both Trump and Cuomo are working very hard to present themselves as heroes in a situation they helped create.   

[John Galt incarnate!]

[quote author=AnnaGrowsAMustache .

Your nation is on fire. Your federal government has emergency powers. Someone take some frickin responsibility for actually solving the issue at hand ie you're all going to die of a virus inside a month, and stop blathering on about your rights. Your rights mean fuck all if you're dead. Idiots. Honestly!
[/quote]



The Framers endeavored  to design a country of enduring, maximum liberty.

The Framers'  dread of  a concentration of power is the overarching reason they formed  a tripartite, check-and-balances  national government.
 
And  in keeping with their commitment to dispersion of power they granted  each State its own sovereignty under the Tenth Amendment's principle of federalism.

The result is an America   comprised of 51 sovereign powers, the federal government plus the 50 States.

The  federal government and the States, as well as the States'  political subdivisions,  do  have extra latitude in the exercise   of their existing power in times of extraordinary emergency, exercises of power that permissibly result in atypically restrictive regulations, orders, local ordinances, etc.

However,   "Emergency does not create [extraconstitutional] power."

Federal power, State power, and the power of political subdivisions "are not altered by emergency."

Untrammeled power is repugnant to the Constitution's undergirding principle of dispersion of power.

Home Building & Loan Assn. v. Blaisdell 1934

Emergency does not create power.

Emergency does not increase granted power or remove or diminish the restrictions imposed upon power granted or reserved.

The Constitution was adopted in a period of grave emergency.

Its grants of power to the Federal Government and its limitations of the power of the States were determined in the light of emergency, and they are not altered by emergency.

 What power was thus granted and what limitations were thus imposed are questions which have always been, and always will be, the subject of close examination under our constitutional system.

[obstinate]

Seems there was already much learned long before their first case.

Now states are quaranteeijg people who enter their state from New York and things only seem to be getting worse

NYC has been managing this horribly, but you're going to see in the not too distant future that many other states are managing it even worse. NYC is "ahead" of the curve, because it got infected earlier. But there are still many states with no lockdown at all and where schools are still open.

It seems humanity is cursed to believe "it can't happen here" despite all the evidence that it happens the same everywhere.

[former player]

Politicians mostly follow public opinion rather than lead it.  The sorts of extreme interventions that are needed to stop coronavirus don't become acceptable to most populations until the point of inevitability is past - or an authoritarian government can impose them at some earlier point.

[Buffaloski Boris]

A lot of this is Monday morning quarterbacking. I do think that the initial response was somewhat mismanaged in that the early days in that the early cities like Seattle and NYC were not shut down earlier. But I think those are relatively minor contributors compared to the gross long-term failures to prepare for contingencies.

Question 1: why is the US medical system so short on PPE? The SARS epidemic hit many years ago and we just managed to dodge the bullet. Why wasn’t there adequate PPE held in reserve? And I’m not thinking that there needs to be some central reserve of this stuff. Why don’t nurses, doctors, and other medical professionals have their own emergency supply? We can provide uniform allowances, why not for PPE?

Question 2: why is the US medical system so short on ventilators? We neither manufacture them in significant numbers nor have enough in reserve. Again, we had the advance warning of SARS.

Question 2A: why is the US dependent on 2 countries outside the US for most of its generic pharmaceuticals?

Question 3: why do businesses have such low levels of emergency funds available that they don’t have the resiliency to withstand a shut down of two weeks let alone a couple of months? I ask that question on the personal level as well.

Question 4: has there been any studies or modeling done of how long a shutdown of the economy can be endured? If not, how does anyone make a difficult choice between closing the economy down to save lives in the short term and preserving the economy to in effect save lives in the long term?

In the end, there will be a lot of finger pointing at who did or did not shut down what city in a timely manner. But the longer term questions will likely remain unanswered. Because what the real problems are here are a longer term failure of imagination, a lack of resiliency, and a failure of political leadership stretching over decades.

[maizefolk]

Politicians mostly follow public opinion rather than lead it.  The sorts of extreme interventions that are needed to stop coronavirus don't become acceptable to most populations until the point of inevitability is past - or an authoritarian government can impose them at some earlier point.

I think yours is the real answer. In democracies, particularly those lead by politicians hoping to win reelection, it is not possible to get too far out ahead of what sacrifices the public is worried enough to willing to accept.

Imagine if the US federal government blocked all foreign travel as soon as the size of the crisis in China became apparent, dumped $100B into developing and deploying a series of coronavirus tests starting with something that could be deployed in a couple of days but is slower and more expensive,* and in parallel doing crash development on faster/cheaper/scalable tests to get them into the field in a matter of weeks/months, another $100B into ramping up mask manufacturing domestically to the point that there were enough to mandate that every person in the USA wear one whenever going out, and maybe even cancelled domestic air travel.

Now imagine all of these efforts worked, and there was never a domestic outbreak in the USA, just some scattered cases of individuals who carried the virus back from China and a few clusters of close friends and family, and maybe one church or retirement home.

The impact in terms of loss of human life (and damage to the economy) would be far far less than than what we're living through today ... and the leaders who took those decisions would likely find themselves thrown out in the next election for panicking, over reacting, and needlessly disrupting people's lives and the US economy while spending hundreds of billions of dollars.

*qPCR based tests are just not that hard to make once you have a genome sequence to work with. They take expensive equipment and complicated reagents to run, which is why the USA is having trouble scaling those tests, but going from DNA/RNA sequence to a test that can be run on hundreds or thousands of samples (not millions) is something thousands of university and industry labs do on a regular basis all year long in non-diagnostic settings. (Getting through the paperwork to have them approved by the federal government for diagnostic use is slow.)

[ice_beard]

The CDC's failure to produce a test that worked was a huge failure early on.  The leadership at the federal level that failed to acknowledge this was a major problem in the making was also huge.  I don't want to sound partisian, but these failures at the highest levels put us way further behind the curve than we should have been.  We had multiple examples from overseas experiences of what was working and what certainly did not.  We learned very little from those examples. 

When it was apparent that the federal level was not going to provide guidance in a concise, proactive way, states and municipalities began putting together piecemeal strategies.   Even then, mayors and governors could not get on the same page.  New York, as others have pointed out, is going to suffer much worse than say a smaller city like Topeka, Kansas.  The density is magnitudes greater, there is much more interaction between people and far more international travelers.  In Topeka, you take a car everywhere, stores are massive and not that many people (comparatively speaking) are traveling internationally. 

As for the slow responses by cities and states.... The current administration doesn't believe they are responsible for dealing with issues like pandemics.  In their worldview, government should do less, not more, so they have been un-willing to provide guidance or make big decisions at an executive level.  At least any decisions that deal with the health aspect of this crisis.  The CDC botching the roll-out of testing?  That's because government can't do anything right, amiright?  That's the angle they'll be taking, not because they were inept from the start.  Not because they believed conspiracy theories over hard factual evidence up until the reality finally hit them square in the face. 

[FINate]

I think yours is the real answer. In democracies, particularly those lead by politicians hoping to win reelection, it is not possible to get too far out ahead of what sacrifices the public is worried enough to willing to accept.

...and yet, California was able to lock things down before the point of inevitability, and before it seemed like a problem to the general population. Or so it seems, we'll see in the weeks ahead. This took lots of communication from Gov. Newsom and local health departments. And it required leadership -- politicians willing to take risks and do the right thing even when doing so seemed like a silly over reaction.

To write this all off because "hindsight is 20/20" or as "Monday morning quarterbacking" is to give in to fatalism and, essentially, means leaders are rarely held accountable. Our leaders are doing what they can at this point, and I give them credit for that. But the difference between San Francisco and NYC will go down in the epidemiological history books as another case study similar to St Louis vs. Philadelphia in 1918.

[RetiredAt63]

Re democracies, both Justin Trudeau in Canada and Jacinda Ardern in New Zealand were relatively quick on the uptake and introduced measures that seemed overkill at the time (but not 3 days later).  New Zealand is small enough to not need the intermediate level of government, but in Canada the various provinces are also dealing with it.  The provinces are intimately involved because health is a Provincial jurisdiction, so this is a joint Provincial/Federal effort.

Just for comparison to New York, Toronto is over 6 million, Ontario as a total is about 14.5 million, so about 3/4 the size of New York State.  Ontario has 1,355 confirmed cases including 21 deaths, 8 recovered.  Toronto's international airport (Pearson, the busiest one in Canada) is one of the 4 allowed to receive foreign flights.  Toronto also had SARS cases.

[FINate]

Don't just take my word for it, here's a quote from a Dr on the front lines in NYC:

China warned Italy. Italy warned us. We didn’t listen. Now the onus is on the rest of America to listen to New York.
...
Social distancing, while still crucial, came too late in New York to prevent a crisis. Maybe, just maybe, extreme measures can prevent this from happening in other cities around the country.

The article is sobering and worth reading in whole: https://www.theatlantic.com/ideas/archive/2020/03/america-learn-new-york/608875/

[maizefolk]

To write this all off because "hindsight is 20/20" or as "Monday morning quarterbacking" is to give in to fatalism and, essentially, means leaders are rarely held accountable.

Despite you putting those statements in quotes, I did not say, nor am I arguing that hindsight was 20/20 nor was I accusing anyone of Monday morning quarterbacking. I was pointing out that politicians often have an incentive to avoid reacting in ways that will cause a lot of pain to their electorate and completely avoid a major crisis precisely because they are afraid of being held accountable for the costs of that reaction.

...and yet, California was able to lock things down before the point of inevitability, and before it seemed like a problem to the general population. Or so it seems, we'll see in the weeks ahead. This took lots of communication from Gov. Newsom and local health departments. And it required leadership -- politicians willing to take risks and do the right thing even when doing so seemed like a silly over reaction.

Newsom's shelter in place order for California was signed and went into effect March 19th. Cuomo's shelter in place order for New York was signed on March 20th and went into effect on 22nd.

I don't know what your personal experience of growing population awareness has been. My impression is that sometime is the first week of March is when the new coronavirus started "seeming like a problem to the general population." On Monday March 2nd I received an e-mail reaffirming an event the following week was still going to be held, despite the growing problems with the coronavirus. By Friday March 6th, the event was cancelled, universities were already starting to close down and send students home, and large businesses in my field were cancelling all travel and having their employees work from home.

However, shelter in place orders didn't start until March 15th (PR), and started picking up on March 19th. I give California complete credit for being on the leading edge of things by issuing a state wide lockdown order on the 19th. By all means, feel free to use it as an example of Newsom having more political course to run risks than Cuomo. But I don't think you can point to Newsom's order as an example of a politician acting before the general population thought there was a problem.

[FINate]

To write this all off because "hindsight is 20/20" or as "Monday morning quarterbacking" is to give in to fatalism and, essentially, means leaders are rarely held accountable.

Despite you putting those statements in quotes, I did not say, nor am I arguing that hindsight was 20/20 nor was I accusing anyone of Monday morning quarterbacking. I was pointing out that politicians often have an incentive to avoid reacting in ways that will cause a lot of pain to their electorate and completely avoid a major crisis precisely because they are afraid of being held accountable for the costs of that reaction.

Those quotes were not directed at you, they're referring to others up thread.

...and yet, California was able to lock things down before the point of inevitability, and before it seemed like a problem to the general population. Or so it seems, we'll see in the weeks ahead. This took lots of communication from Gov. Newsom and local health departments. And it required leadership -- politicians willing to take risks and do the right thing even when doing so seemed like a silly over reaction.

Newsom's shelter in place order for California was signed and went into effect March 19th. Cuomo's shelter in place order for New York was signed on March 20th and went into effect on 22nd.

I don't know what your personal experience of growing population awareness has been. My impression is that sometime is the first week of March is when the new coronavirus started "seeming like a problem to the general population." On Monday March 2nd I received an e-mail reaffirming an event the following week was still going to be held, despite the growing problems with the coronavirus. By Friday March 6th, the event was cancelled, universities were already starting to close down and send students home, and large businesses in my field were cancelling all travel and having their employees work from home.

However, shelter in place orders didn't start until March 15th (PR), and started picking up on March 19th. I give California complete credit for being on the leading edge of things by issuing a state wide lockdown order on the 19th. By all means, feel free to use it as an example of Newsom having more political course to run risks than Cuomo. But I don't think you can point to Newsom's order as an example of a politician acting before the general population thought there was a problem.

My county, which is more-or-less in lock step with the rest of the greater Bay Area, has been on full mandated shelter-in-place since March 16, and had limited gatherings of more than 50 and recommended social distancing the prior week (week of March 9). The statewide shelter-in-place came later, but the Bay Area was clearly a hot spot needing this earlier action. As I said up thread, a week makes a massive difference in cases of exponential spread. Every day is critical.

[maizefolk]

My county, which is more-or-less in lock step with the rest of the greater Bay Area, has been on full mandated shelter-in-place since March 16, and had limited gatherings of more than 50 and recommended social distancing the prior week (week of March 9). The statewide shelter-in-place came later, but the Bay Area was clearly a hot spot needing this earlier action. As I said up thread, a week makes a massive difference in cases of exponential spread. Every day is critical.

I don't think anyone is disagreeing with you on the bolded bit.

The three day delay between California's shutdown and New York's may ultimately translate into twice as many cases and more than twice as may deaths since NYC looks likely to exceed their total intensive care capacity, which means more people will die who could have been saved with the hospitals weren't overwhelmed. If California and New York had both shut down at the same time as the bay area did, we'd probably be looking at perhaps 1/2th the cases and deaths in CA and 1/4th the cases and deaths in NY.

But you responded to my post about how elected leaders in democracies are rarely if ever going to respond to crises like this one early enough to head them off entirely when that response is going to cost a lot of money and inconvenience a lot of people rather than waiting for obvious crises and hot spots to develop.

For the USA that opportunity to act would probably have been sometime in mid-February both in terms of when we've retroactively established that community spread was already going on in Washington state, and in terms of when it was clear this virus was going to spread around the globe and cause a lot of death and suffering anywhere it wasn't contained. At that point there was enough data to realize this was going to be really bad, a smaller intervention would have reduced suffering and death a lot more than the larger interventions we're now conducting, but no politician was going to put their career/reputation on the line.

I guess I'm not clear what you are actually disagreeing with from my post that you quoted?

[FINate]

And it's clear leaders in NY and NYC knew this crisis was building. This is from March 11!

But that likelihood grew increasingly remote as New York emerged as an epicenter of coronavirus infection in the United States, with most of its infections centered in Westchester County, north of New York City.

Mr. Cuomo declared a state of emergency in the state on Saturday and deployed the National Guard three days later to a “containment area” in New Rochelle, in Westchester County.

https://www.nytimes.com/2020/03/11/nyregion/new-york-st-patricks-day-parade-canceled.html

Again, not trying to rub people's faces in it, but we need to learn from this. If a deadly contagion with R0=2.5 is spreading in the community, and you don't have the capability to do wide-spread testing and contact tracing, then lock everything down RIGHT NOW! Don't wait a week. Don't wait a even a few days.

[FINate]

My county, which is more-or-less in lock step with the rest of the greater Bay Area, has been on full mandated shelter-in-place since March 16, and had limited gatherings of more than 50 and recommended social distancing the prior week (week of March 9). The statewide shelter-in-place came later, but the Bay Area was clearly a hot spot needing this earlier action. As I said up thread, a week makes a massive difference in cases of exponential spread. Every day is critical.

I don't think anyone is disagreeing with you on the bolded bit.

The three day delay between California's shutdown and New York's may ultimately translate into twice as many cases and more than twice as may deaths since NYC looks likely to exceed their total intensive care capacity, which means more people will die who could have been saved with the hospitals weren't overwhelmed. If California and New York had both shut down at the same time as the bay area did, we'd probably be looking at perhaps 1/2th the cases and deaths in CA and 1/4th the cases and deaths in NY.

But you responded to my post about how elected leaders in democracies are rarely if ever going to respond to crises like this one early enough to head them off entirely when that response is going to cost a lot of money and inconvenience a lot of people rather than waiting for obvious crises and hot spots to develop.

For the USA that opportunity to act would probably have been sometime in mid-February both in terms of when we've retroactively established that community spread was already going on in Washington state, and in terms of when it was clear this virus was going to spread around the globe and cause a lot of death and suffering anywhere it wasn't contained. At that point there was enough data to realize this was going to be really bad, a smaller intervention would have reduced suffering and death a lot more than the larger interventions we're now conducting, but no politician was going to put their career/reputation on the line.

I guess I'm not clear what you are actually disagreeing with from my post that you quoted?

It was more like a 7 day difference when you consider when the metro areas were locked down. But yes, even three days would make a huge difference.

I'm disagreeing with you that there's something inherent in democracies preventing action. I even provided California as a counter example, and others here have listed Canada and New Zealand as democracies that took early action. Rather than focusing on the form of government, I'd like to suggest that it was China's earlier experience with SARS that prompted their quick and aggressive action.

[SwordGuy]

The American government FLAT OUT KNEW it was going to be a huge problem back in February.   (And apparently the government had been informed a month before that as well.)

We know this because Senator Burr (R-NC) was caught on tape secretly briefing his wealthy donors about how bad it would be, specifically mentioning the 1918 Spanish Flu pandemic, shortly after he received a briefing on it.

The American PUBLIC wasn't told about this until much later and, in fact, was told by the highest levels of our government that it was all a hoax and it would just go away.

Don't try to serve us a shit pie and tell us it's chocolate.    Not going to swallow that.    There's plenty of blame to go around at the federal level and we already know some of the people to pin it on.

[FINate]

The American government FLAT OUT KNEW it was going to be a huge problem back in February.   (And apparently the government had been informed a month before that as well.)

We know this because Senator Burr (R-NC) was caught on tape secretly briefing his wealthy donors about how bad it would be, specifically mentioning the 1918 Spanish Flu pandemic, shortly after he received a briefing on it.

The American PUBLIC wasn't told about this until much later and, in fact, was told by the highest levels of our government that it was all a hoax and it would just go away.

Don't try to serve us a shit pie and tell us it's chocolate.    Not going to swallow that.    There's plenty of blame to go around at the federal level and we already know some of the people to pin it on.

There's plenty of blame to go around at multiple levels of government and across both parties, though clearly Trump bears a larger share of the blame. But congress also shares in it -- e.g. senators that sold off stock before this hit...from both parties. And especially state governors (again, from both parties) who in our system of government have an extremely important duty when it comes to outbreaks. Again, hopefully we learn from this instead of making it a partisan issue.

[Apple_Tango]

Politicians mostly follow public opinion rather than lead it.  The sorts of extreme interventions that are needed to stop coronavirus don't become acceptable to most populations until the point of inevitability is past - or an authoritarian government can impose them at some earlier point.

I think yours is the real answer. In democracies, particularly those lead by politicians hoping to win reelection, it is not possible to get too far out ahead of what sacrifices the public is worried enough to willing to accept...

Now imagine all of these efforts worked, and there was never a domestic outbreak in the USA, just some scattered cases of individuals who carried the virus back from China and a few clusters of close friends and family, and maybe one church or retirement home.

The impact in terms of loss of human life (and damage to the economy) would be far far less than than what we're living through today ... and the leaders who took those decisions would likely find themselves thrown out in the next election for panicking, over reacting, and needlessly disrupting people's lives and the US economy while spending hundreds of billions of dollars.

Exactly. It’s a paradox- if you actually do the right thing and control the spread of novel viruses, then there are no pandemics, standards get relaxed, and government pandemic offices get the ax because people start wondering why we are spending billions of dollars for “no reason”. Then a pandemic hits, and we start over from scratch. The circle of stupidity!

[lost_in_the_endless_aisle]

Almost no countries responded well to this and severity at the national level seems to be largely related to the timing and scope of early seeding events, as well as urban population density and hygiene practices. Are countries with universal BCG vaccinations doing better? Have cumulative infections in NYC already reached 5% and Lombardy is at 15%, implying a rather low death rate? No one knows for sure yet because much of the information is unreliable, messy, and/or missing. One thing this shows is on a meta-level we are unprepared for pandemics because our ability to aggregate actionable information within countries and across countries is miserable.

[Radagast]

The American government FLAT OUT KNEW it was going to be a huge problem back in February.   (And apparently the government had been informed a month before that as well.)

We know this because Senator Burr (R-NC) was caught on tape secretly briefing his wealthy donors about how bad it would be, specifically mentioning the 1918 Spanish Flu pandemic, shortly after he received a briefing on it.

The American PUBLIC wasn't told about this until much later and, in fact, was told by the highest levels of our government that it was all a hoax and it would just go away.

Don't try to serve us a shit pie and tell us it's chocolate.    Not going to swallow that.    There's plenty of blame to go around at the federal level and we already know some of the people to pin it on.

There's plenty of blame to go around at multiple levels of government and across both parties, though clearly Trump bears a larger share of the blame. But congress also shares in it -- e.g. senators that sold off stock before this hit...from both parties. And especially state governors (again, from both parties) who in our system of government have an extremely important duty when it comes to outbreaks. Again, hopefully we learn from this instead of making it a partisan issue.

Sorry, I can only agree with SwordGuy. This is not a partisan issue, this is an executive branch issue. States do not have control over borders, nor do they employ hundreds of experts whose sole job is to monitor the world for potential pandemics and prevent their spread in the US. State and local governments can mitigate the effects of a disease that has already arrived within their jurisdictions.

Which branch of government removed the pandemic response section of the National Security Council? Which decided not to fill the embedded job in the the Chinese CDC when the previous employee left in 2019? Which branch failed to test and monitor travelers returning from China and then other countries? Which ignored the ongoing reports from other countries on its spread an effects? Which sidelined and ignored experts on pandemics and continues to do so as recently as yesterday and no doubt still today? Which sent out faulty tests, and then refused to let any other agency develop its own? Which continuously downplayed the possible effects of the disease?

At all points throughout the first three months of this pandemic the US and its government had the resources to prevent this. There is exactly one branch of government in the entire United States that is charged with marshaling and directing the resources of the US in a time like this. It failed to execute on every level.

However, for state governments I would tend to agree that failure to act until three business days after the majority of their populations thought COVID was the most urgent concern of all is a perfectly fine excuse for inaction. Though kudos to those who sucked it up and did the right thing when they saw the evidence. A special shout-out to Sisolak in Nevada who closed all non-essential business on the 17th and asked everyone to stay home. Considering that almost the entire state economy is "non-essential" and cannot be done from home, and relative to the tiny number of in-state cases at the time, that was probably the ballsiest move of any governor.

[dodojojo]

It's happening in real time so the final assessment of Cuomo's performance is yet to come. I think he's done a good job in providing some semblance of leadership in place of the national void.  I do think he should have closed the state, or least, NYC earlier.  I know this has moved incredibly fast, but we saw what happened in China and what unfolded in Italy--so there were obvious examples.

I can't remember where I read this and hopefully someone else read it and can find the source--if China had closed Wuhan down 1 week earlier, there would have been a significant decrease in cases.  I can't remember the percentage.  If they had closed another week earlier (so 2 weeks earlier than the actual closed down date), the number of cases would have been cut by 95%. 

Taiwan, Hong Kong and Singapore moved quickly and used their SARs experience to deal with Covid-19.  And yes, they are much smaller than the USA but they're pretty comparable in size to NYC and NY.

[AnnaGrowsAMustache]

[quote author=AnnaGrowsAMustache .

Your nation is on fire. Your federal government has emergency powers. Someone take some frickin responsibility for actually solving the issue at hand ie you're all going to die of a virus inside a month, and stop blathering on about your rights. Your rights mean fuck all if you're dead. Idiots. Honestly!

The Framers endeavored  to design a country of enduring, maximum liberty.

The Framers'  dread of  a concentration of power is the overarching reason they formed  a tripartite, check-and-balances  national government.
 
And  in keeping with their commitment to dispersion of power they granted  each State its own sovereignty under the Tenth Amendment's principle of federalism.

The result is an America   comprised of 51 sovereign powers, the federal government plus the 50 States.

The  federal government and the States, as well as the States'  political subdivisions,  do  have extra latitude in the exercise   of their existing power in times of extraordinary emergency, exercises of power that permissibly result in atypically restrictive regulations, orders, local ordinances, etc.

However,   "Emergency does not create [extraconstitutional] power."

Federal power, State power, and the power of political subdivisions "are not altered by emergency."

Untrammeled power is repugnant to the Constitution's undergirding principle of dispersion of power.

Home Building & Loan Assn. v. Blaisdell 1934

Emergency does not create power.

Emergency does not increase granted power or remove or diminish the restrictions imposed upon power granted or reserved.

The Constitution was adopted in a period of grave emergency.

Its grants of power to the Federal Government and its limitations of the power of the States were determined in the light of emergency, and they are not altered by emergency.

 What power was thus granted and what limitations were thus imposed are questions which have always been, and always will be, the subject of close examination under our constitutional system.
[/quote]

Your constitution is an idiotic document. It was written for circumstances hundreds of years ago. Even if it had specifically addressed pandemic, it would be hundreds of years out of date. If this is what is really got your country to this point, and to the point it's going to end up, you guys need to take it out and burn it. You're basically in a burning house and arguing with the firefighters about whether or not you have the right to stay in it!

[FINate]

Sorry, I can only agree with SwordGuy. This is not a partisan issue, this is an executive branch issue. States do not have control over borders, nor do they employ hundreds of experts whose sole job is to monitor the world for potential pandemics and prevent their spread in the US. State and local governments can mitigate the effects of a disease that has already arrived within their jurisdictions.

Which branch of government removed the pandemic response section of the National Security Council? Which decided not to fill the embedded job in the the Chinese CDC when the previous employee left in 2019? Which branch failed to test and monitor travelers returning from China and then other countries? Which ignored the ongoing reports from other countries on its spread an effects? Which sidelined and ignored experts on pandemics and continues to do so as recently as yesterday and no doubt still today? Which sent out faulty tests, and then refused to let any other agency develop its own? Which continuously downplayed the possible effects of the disease?

At all points throughout the first three months of this pandemic the US and its government had the resources to prevent this. There is exactly one branch of government in the entire United States that is charged with marshaling and directing the resources of the US in a time like this. It failed to execute on every level.

However, for state governments I would tend to agree that failure to act until three business days after the majority of their populations thought COVID was the most urgent concern of all is a perfectly fine excuse for inaction. Though kudos to those who sucked it up and did the right thing when they saw the evidence. A special shout-out to Sisolak in Nevada who closed all non-essential business on the 17th and asked everyone to stay home. Considering that almost the entire state economy is "non-essential" and cannot be done from home, and relative to the tiny number of in-state cases at the time, that was probably the ballsiest move of any governor.

I don't disagree. Which is why I said the Trump admin bears most of the blame. And hopefully voters hold him accountable this Fall. But again, this doesn't absolve state and local governments of their part in this. Once spreading within their communities they bear a burden of responsibility. State governments pointing the finger at the feds is no better than Trump pointing his finger at China: both are piss poor examples of leadership.

To OP's point, and your example above, the difference between NV and NY is stark. This pandemic wasn't unavoidable at a world or national level, nor was the crisis now unfolding in NYC unavoidable. This virus could come in multiple waves, and it will not be the last novel virus the world sees. It is imperative that we learn from this. That means better worldwide cooperation, but also state and local governments taking action before it's too late. Once the number of infections explodes there's very little chance of orderly management.

[maizefolk]

I can't remember where I read this and hopefully someone else read it and can find the source--if China had closed Wuhan down 1 week earlier, there would have been a significant decrease in cases.  I can't remember the percentage.  If they had closed another week earlier (so 2 weeks earlier than the actual closed down date), the number of cases would have been cut by 95%. 

This makes sense. Doubling time for cases without social distancing seems to be on the order of 3-4 days. So putting the lockdown in place 14 days earlier could have meant 1/2^(14/3) = ~4% as many cases.

It's worth also keeping in mind that when the lockdown actually was announced and implemented many people outside of China saw it as a major over reaction and potentially counterproductive.

Here is a Washington Post article from the day after it was announced. It's worth reading to get a sense of what experts and government officials were saying here only two months ago about the ineffectiveness and infeasibility of large scale quarantines.

Taiwan, Hong Kong and Singapore moved quickly and used their SARs experience to deal with Covid-19.  And yes, they are much smaller than the USA but they're pretty comparable in size to NYC and NY.

Agreed. But I would argue it is a combination of governmental experience dealing with SARS as well as a population/electorate which had recent (in historical terms) experience from SARS with the types of disruption and fear which would come from failure to prevent the spread of a new disease. And it was that experience which made them much more supportive of their governments taking preemptive measures.

[Radagast]

Sorry, I can only agree with SwordGuy. This is not a partisan issue, this is an executive branch issue. States do not have control over borders, nor do they employ hundreds of experts whose sole job is to monitor the world for potential pandemics and prevent their spread in the US. State and local governments can mitigate the effects of a disease that has already arrived within their jurisdictions.

Which branch of government removed the pandemic response section of the National Security Council? Which decided not to fill the embedded job in the the Chinese CDC when the previous employee left in 2019? Which branch failed to test and monitor travelers returning from China and then other countries? Which ignored the ongoing reports from other countries on its spread an effects? Which sidelined and ignored experts on pandemics and continues to do so as recently as yesterday and no doubt still today? Which sent out faulty tests, and then refused to let any other agency develop its own? Which continuously downplayed the possible effects of the disease?

At all points throughout the first three months of this pandemic the US and its government had the resources to prevent this. There is exactly one branch of government in the entire United States that is charged with marshaling and directing the resources of the US in a time like this. It failed to execute on every level.

However, for state governments I would tend to agree that failure to act until three business days after the majority of their populations thought COVID was the most urgent concern of all is a perfectly fine excuse for inaction. Though kudos to those who sucked it up and did the right thing when they saw the evidence. A special shout-out to Sisolak in Nevada who closed all non-essential business on the 17th and asked everyone to stay home. Considering that almost the entire state economy is "non-essential" and cannot be done from home, and relative to the tiny number of in-state cases at the time, that was probably the ballsiest move of any governor.

I don't disagree. Which is why I said the Trump admin bears most of the blame. And hopefully voters hold him accountable this Fall. But again, this doesn't absolve state and local governments of their part in this. Once spreading within their communities they bear a burden of responsibility. State governments pointing the finger at the feds is no better than Trump pointing his finger at China: both are piss poor examples of leadership.

To OP's point, and your example above, the difference between NV and NY is stark. This pandemic wasn't unavoidable at a world or national level, nor was the crisis now unfolding in NYC unavoidable. This virus could come in multiple waves, and it will not be the last novel virus the world sees. It is imperative that we learn from this. That means better worldwide cooperation, but also state and local governments taking action before it's too late. Once the number of infections explodes there's very little chance of orderly management.

Fair. And to be honest I quoted you but was perhaps addressing more the thread in general.