Why has NYC corona response been so mismanaged?

[beastykato_revived]

The amount of blame being placed on all sides is kind of ridiculous and misplaced. 

Even Korea has admitted their numbers mean nothing and there is almost no way to stop the spread of this.  In Korea all of their academies remain open and people are spreading it like wildfire.  30% of their cases are people in their 20's and 30's.  They still go to clubs and internet cafes just like everyone is doing in the U.S. who doesn't care about this or take it seriously. 

They also flat out said that only reason some countries show good numbers is that they are either lying, implementing draconian measures (China), or simply don't have the ability to even test.

Those statements were made by some of the top officials in Asia who I've seen referenced here as being able to "control" this outbreak.  So, if you tout their success then you must also agree with their statements.   Maizeman is 100% that their prior experience in Asia countries with SARS and MERS is one of their main reasons for being more prepared, but that's exactly what the officials there said.  The other primary factor was people wearing masks, which everyone in the U.S. was told not to do.

If there are any blames to be placed in the U.S. it certainly is a shared blame that dates back well into previous administrations.   

[Radagast]

In general one reason I have for not blaming states for being unprepared is that there has not been a pandemic in the US since 1918, when the world was very different. The states and municipalities have no experience in these things and so cannot be expected to expect. However, there have been a number of pandemics which affected other parts of the world and the US government played a role in suppressing those. Sure, I wonder why there are not state laws requiring healthcare facilities to maintain 12 months of "average use rate" PPE on hand, to be used first in first out. I wonder why there was not more pressure from states for more testing. But then, how would the states have known to do something that was outside their experience? The executive branch of the US government had the knowledge and experience necessary, it simply failed to employ it.

[Systems101]

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.

I do hope we learn something from this.  Certainly, Germany, Singapore, S Korea compared to US, Italy, Spain would be interesting.

Also travel is more significant and rapid now than in 1918.  This just shows how much and it makes containment a lot harder: https://www.youtube.com/watch?v=cq2zuE3ISYU

[slappy]

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

We don't need hindsight. We saw it coming from China in December/January and chose to ignore it.

[beastykato_revived]

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

We don't need hindsight. We saw it coming from China in December/January and chose to ignore it.

Not even China closed off the border of the first city, Wuhan, until the end of January,  January 23rd to be exact.   The Trump administration had closed off air travel to China by January 31st.   Hardly seems like they were ignoring it.   No one on this forum would have achieved any greater results.

[lost_in_the_endless_aisle]

In general one reason I have for not blaming states for being unprepared is that there has not been a pandemic in the US since 1918, when the world was very different. The states and municipalities have no experience in these things and so cannot be expected to expect. However, there have been a number of pandemics which affected other parts of the world and the US government played a role in suppressing those. Sure, I wonder why there are not state laws requiring healthcare facilities to maintain 12 months of "average use rate" PPE on hand, to be used first in first out. I wonder why there was not more pressure from states for more testing. But then, how would the states have known to do something that was outside their experience? The executive branch of the US government had the knowledge and experience necessary, it simply failed to employ it.

You are forgetting some pandemics:
H2N2, H3N2, HIV, H1N1

[Adam Zapple]

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

We don't need hindsight. We saw it coming from China in December/January and chose to ignore it.

Not even China closed off the border of the first city, Wuhan, until the end of January,  January 23rd to be exact.   The Trump administration had closed off air travel to China by January 31st.   Hardly seems like they were ignoring it.   No one on this forum would have achieved any greater results.

I agree.  I also think faulting states for not shutting down for two or three days is nitpicking.  It's not like you just say "CLOSE" and everything just happens.  There are incredibly complex decisions that have to be made in regards to legality, logistics, safety, unintended consequences, vital workers etc etc etc.  It's like Pandora's box but in reverse.

[Duke03]

I still think a lot of the up roar is just grand standing.  You see a lot of Governors claiming they need xyz and it's really just a money grab and them making sure their state gets theirs.  I understand people are freaking out, but to claim New York city needs 30,000 ventilators right now or people will die just does a huge disservice to everyone.  Not even in Italy did they need 30,000 ventilators.  Also I saw a report that bodies are starting to pile up due to 1,000 deaths in the past 3 weeks.... The only issue I have with that is before this virus ever existed on average 420 people died every day in New York.  So a city that used to process 12600 dead people every month now can't process an extra 1,000 bodies spread out over 3 weeks come on I was born at night but it wasn't last night.  The bodies pilling up has nothing to do with the shelter in place order or the entire city shut down....Rolls eyes.  Or what about the Governor of California that claimed within 8 weeks 25 million people in California would have the virus.  This is crazy talk.  One thing I do agree and see it happening is more effort needs to be spent on making testing available and we need the proper PPE for all health care workers.  I think the Federal Government is actually doing a good job at that.  People think you just snap your fingers and create everything you need at a moments notice.   It takes up to two weeks to ramp up production and we are starting to see that now.  Flame away!!!

[Abe]

If there’s one thing I’ve learned in medicine after all these years, it’s that biology is king. Obviously we can do some things to mitigate bad outcomes, but that ability is very limited. Here are my thoughts on some of these issues, from the medicine/hospital side:

Why didn’t we have ___ stores of PPE? Because they take up a ton of space and have a certain regulatory (not necessarily physical) shelf life. Same with ventilators, which are also quite expensive ($10k+). Our hospital, and several other California hospitals in ramped up orders of PPE in January so we won’t have as bad a shortage now. Most of it is made in China for cost reasons, so that was an unfortunate monkey wrench. Other hospitals should’ve prepared like we did, but did not probably due to cost constraints.

I agree that the number of ventilators needed are probably not going to be that high, and Cuomo is definitely trying to CYA. This is because survival for ventilated patients is poor and turnover will be high. Approximately 2-5% of infected patients end up on a ventilator (https://www.nejm.org/doi/full/10.1056/NEJMoa2002032), so we’d have to have 600,000 to 1.5 million patients (10-20% of the entire state) simultaneously having symptoms for that to be needed. If that scenario were to occur, our main issue will be enough healthcare personnel, not ventilators. There will not be people to run them as the entire healthcare system will have collapsed.


Lastly, time to lockdown probably is an issue and neither Cuomo or de Blasio were helpful in this matter. Both of them should have realized that NYC, being the densest city in the country, is at special risk of an outbreak and should’ve taken measures sooner. That was an oversight on their parts, and neither is taking responsibility.

[Wrenchturner]

If there’s one thing I’ve learned in medicine after all these years, it’s that biology is king. Obviously we can do some things to mitigate bad outcomes, but that ability is very limited. Here are my thoughts on some of these issues, from the medicine/hospital side:

Why didn’t we have ___ stores of PPE? Because they take up a ton of space and have a certain regulatory (not necessarily physical) shelf life. Same with ventilators, which are also quite expensive ($10k+). Our hospital, and several other California hospitals in ramped up orders of PPE in January so we won’t have as bad a shortage now. Most of it is made in China for cost reasons, so that was an unfortunate monkey wrench. Other hospitals should’ve prepared like we did, but did not probably due to cost constraints.

That's a good point.  What if this or the next pandemic were bacterial?  Or parasitic?  Or it required dialysis?  We'd be talking about different shortages and they can't all be stockpiled, really.  But I think we can develop strategies for quickly adapting infrastructure in the future for the sudden needs of a given outbreak.

[lost_in_the_endless_aisle]

I agree that the number of ventilators needed are probably not going to be that high, and Cuomo is definitely trying to CYA. This is because survival for ventilated patients is poor and turnover will be high. Approximately 2-5% of infected patients end up on a ventilator (https://www.nejm.org/doi/full/10.1056/NEJMoa2002032), so we’d have to have 600,000 to 1.5 million patients (10-20% of the entire state) simultaneously having symptoms for that to be needed. If that scenario were to occur, our main issue will be enough healthcare personnel, not ventilators. There will not be people to run them as the entire healthcare system will have collapsed.

This is squarely filed under stuff I can't completely verify but apparently the total US inventory contains half of all the medical ventilators that exist in the world. The US count is ~160K (or higher depending on info source) which is about 1 per 2,000 people. The NHS has 1 per 8,000 people while Germany has 1 per 3,300 people & France 1 per 13,000(!) people. I couldn't find credible numbers for Italy but some sources too ghetto to bother linking suggest ~1 per 12,000 people.

Note the amusing headlines in those articles, by the way: the US has way too few ventilators but the Germans have so many they should be sharing them!

[FINate]

Lastly, time to lockdown probably is an issue and neither Cuomo or de Blasio were helpful in this matter. Both of them should have realized that NYC, being the densest city in the country, is at special risk of an outbreak and should’ve taken measures sooner. That was an oversight on their parts, and neither is taking responsibility.

I'm afraid they still don't get it. This quote from de Blasio is shocking (https://www.politico.com/news/2020/03/29/new-york-leaders-look-ahead-harrowing-week-154706):

Earlier on Sunday, de Blasio said travel restrictions were not helpful, but added that the issue was not his primary concern.

“We’ve got to be mindful of families that at this crucial moment want to reunite, whether that means families coming back to New York or leaving New York to go to another place where they’re based,” he said on CNN’s “State of the Union.” “Families have a right to be together and this is going to be a long crisis.”

So dumb. We really don't want families traveling across the country to reunite, potentially spreading the virus to other communities and clusters of people already sheltering in place. Don't decamp to a second home in some other community, don't try to meet up with family elsewhere. Just stay home.

[obstinate]

The most shocking thing to me about all of this is the insane selfishness of some folks. "How long can we be expected to live like this??" "I can't live without taking a walk!" " If this goes on for more than a month there will be riots!"

These are statements I've seen more or less verbatim on the internet. Almost invariably posted by Americans. I guess a lot of people have never experienced real hardship. Staying in your house, clean, safe, and reasonably well fed and entertained, is not so bad. Hundreds of millions of people in the world have it worse as their baseline level of existence. You can get used to anything and I suggest that people in this camp get used to the idea of being in their house for the next two or three months. Because although it will not be a popular decision, killing off every everyone's parents or grandparents would end up being a whole hell of a lot less popular.

[slappy]

The most shocking thing to me about all of this is the insane selfishness of some folks. "How long can we be expected to live like this??" "I can't live without taking a walk!" " If this goes on for more than a month there will be riots!"

These are statements I've seen more or less verbatim on the internet. Almost invariably posted by Americans. I guess a lot of people have never experienced real hardship. Staying in your house, clean, safe, and reasonably well fed and entertained, is not so bad. Hundreds of millions of people in the world have it worse as their baseline level of existence. You can get used to anything and I suggest that people in this camp get used to the idea of being in their house for the next two or three months. Because although it will not be a popular decision, killing off every everyone's parents or grandparents would end up being a whole hell of a lot less popular.

I've seen a bunch of memes saying something to the effect of "it's not stuck at home, it's safe at home". In my experience, people in general have a hard time looking at things from other angles or applying critical thinking to situations. The walk is a perfect example. Of course you can go outside, or go for a walk. What would not be advised is to swarm your local hiking areas, which is what is happening in my states. Being is outside is fine if you are on your own, with your immediate family. Having 100+ cars lined up at the local mountain tells me there can't be much social distancing going on there.

[FINate]

For the data nerds out there, here's a lovely dashboard from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington: https://covid19.healthdata.org/projections

These graphs show how the shape of the curve dictates what's happening on the ground. For example, from the drop-down menu compare the shape of the curve between CA and NY, and note the fixed lines for number of beds and ICU beds. Realistically, we had one weapon going into this war, which was stopping or slowing the rate of transmission. What appears as mismanaged today is, in actuality, the result of decisions made (or not made) weeks ago.

[AnnaGrowsAMustache]

For the data nerds out there, here's a lovely dashboard from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington: https://covid19.healthdata.org/projections

These graphs show how the shape of the curve dictates what's happening on the ground. For example, from the drop-down menu compare the shape of the curve between CA and NY, and note the fixed lines for number of beds and ICU beds. Realistically, we had one weapon going into this war, which was stopping or slowing the rate of transmission. What appears as mismanaged today is, in actuality, the result of decisions made (or not made) weeks ago.

That weapon is still available. Self isolate.

[FINate]

For the data nerds out there, here's a lovely dashboard from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington: https://covid19.healthdata.org/projections

These graphs show how the shape of the curve dictates what's happening on the ground. For example, from the drop-down menu compare the shape of the curve between CA and NY, and note the fixed lines for number of beds and ICU beds. Realistically, we had one weapon going into this war, which was stopping or slowing the rate of transmission. What appears as mismanaged today is, in actuality, the result of decisions made (or not made) weeks ago.

That weapon is still available. Self isolate.

Agreed.

[wenchsenior]

The most shocking thing to me about all of this is the insane selfishness of some folks. "How long can we be expected to live like this??" "I can't live without taking a walk!" " If this goes on for more than a month there will be riots!"

These are statements I've seen more or less verbatim on the internet. Almost invariably posted by Americans. I guess a lot of people have never experienced real hardship. Staying in your house, clean, safe, and reasonably well fed and entertained, is not so bad. Hundreds of millions of people in the world have it worse as their baseline level of existence. You can get used to anything and I suggest that people in this camp get used to the idea of being in their house for the next two or three months. Because although it will not be a popular decision, killing off every everyone's parents or grandparents would end up being a whole hell of a lot less popular.

So are New Yorkers actually forbidden from going outside for exercise?  I don't think anyone else in U.S. is...  I can social distance relatively easily for months if need be without much problem, but not being able to take a walk outdoors really would be very bad for me, psychologically speaking. 

I'm a regular walker, and have been self isolating for close to 3 weeks at this point apart from walking and one trip to the grocery store, and I'm actually kind of pleased at how my neighborhood has transformed from 'barely a person on the street or in the park; one can hardly tell thousands of people live here' (its default state) to lots of people out walking nearly every day.  Granted, some of them are not correctly observing social distancing, but most are.  I have learned to avoid the park on weekends, b/c it sometimes gets so busy that walking on the sidewalk becomes virtually impossible. I've lived in this place for 20 years and have never seen anything like this amount of people getting outdoor exercise.   I think it's a good thing; too bad it took a life-threatening pandemic to spur people off their couches.

[jim555]

So are New Yorkers actually forbidden from going outside for exercise?  I don't think anyone else in U.S. is...  I can social distance relatively easily for months if need be without much problem, but not being able to take a walk outdoors really would be very bad for me, psychologically speaking. 

New Yorkers can go out to the store or exercise.

[Radagast]

Why didn’t we have ___ stores of PPE? Because they take up a ton of space and have a certain regulatory (not necessarily physical) shelf life.

I'm guessing this was based on something I said, so I'll reply though it is not a major issue to me.

All places in the US which provide the public with water, be they public or private, are required to keep surplus water available at all times. There are formulas for it that may vary a bit but are something like <greater of: 2X average day use, or maximum historic day use, or enough to extinguish a fire in the largest building.> Plus requirements for redundancy in pumping and power supplies. Water definitely has a shelf life of a few days. You can bet that all this costs a lot of money, yet pretty much every community is trying to push the upper limits of their water shelf life or pumping capacity because we all know that running out of water in an emergency is bad.

Relatively speaking PPE is cheap and easy to store and has a long shelf life. I am actually a little surprised there is not a simple national code specifying a minimum amount. It would be pretty easy to have something that was straight forward and yet brought the bottom 80% of places up to a higher standard, which would help greatly if a future crisis occurred because there would not be as much emergency price bidding in addition to safety. Something like population served multiplied by a density factor, for either in patient or out patient, but not less than X months maximum historical use. As with water federal grants could help get things rolling in poorer places. This is fairly easy to implement and would make a lot of sense to me.

[Radagast]

In general one reason I have for not blaming states for being unprepared is that there has not been a pandemic in the US since 1918, when the world was very different. The states and municipalities have no experience in these things and so cannot be expected to expect. However, there have been a number of pandemics which affected other parts of the world and the US government played a role in suppressing those. Sure, I wonder why there are not state laws requiring healthcare facilities to maintain 12 months of "average use rate" PPE on hand, to be used first in first out. I wonder why there was not more pressure from states for more testing. But then, how would the states have known to do something that was outside their experience? The executive branch of the US government had the knowledge and experience necessary, it simply failed to employ it.

You are forgetting some pandemics:
H2N2, H3N2, HIV, H1N1

Of those, HIV spread at a tiny fraction of the rate, and the others were a lot less impactful.