Mayor de Blasio during a recent coronavirus briefing (photo: Michael Appleton/Mayor's Office)
New York City’s response to the coronavirus outbreak has been a battle on shifting sands. As information about the disease and officials’ recognition of its threat evolved over time, so did the government approach, from initially continuing business as usual well after the first cases in the city were confirmed to a statewide shutdown of sorts and strict social distancing guidelines that have now been in place in New York City for over two months.
But adding to the uncertainty that has gripped the city during this crisis has been a lack of clear messaging from Mayor Bill de Blasio about how the city is doing on key coronavirus-related public health and recovery metrics set by the mayor himself, as well as those set by Governor Andrew Cuomo, who holds ultimate say over the city’s “reopening.”
On April 9, de Blasio announced three key infection and hospitalization “indicators” the city would be tracking to evaluate its progress on the downside of the COVID-19 curve, with goals he said the city would have to meet in order to begin reopening the economy and get people back to their daily lives.
“Now, what do we need to start to discuss moving to the next phase, that better phase and to start to discuss any change, any relaxing of restrictions?,” de Blasio said at the time. “We need to see all three of those indicators move in unison in the same direction. We cannot see two of them get better and one of them get worse. That doesn't work. All three have to move together down; all three have to move in a better direction together. They have to do that for at least 10 days to two weeks -- sustained, consistent. If one day gets good and the next day goes bad, that doesn't count. We need to see a clean, clear pattern that sustains itself for several weeks to then say it's time to even discuss some of the positive changes we'd all like to experience.”
To begin to even attempt to resume some normalcy, de Blasio said, there would have to be 10-14 days of consecutive reductions in hospital admissions for suspected COVID-19, number of people with coronavirus in the ICU in the municipal hospital system, and the percentage of people testing positive for the virus.
But those metrics did not account for the possibility of slight day-to-day upticks amid overall positive trendlines, and other than on Fridays the mayor was not showing any larger picture at his daily public briefings, where he focused only on the day-to-day change. De Blasio presented updates on whether the daily numbers on coronavirus hospitalizations, public hospital coronavirus ICU patients, and positive COVID-19 tests were up or down from the day before, talking about progress or regress and showing red or green arrows for each of the three metrics based on that day-to-day change, not presenting New Yorkers with the fuller picture.
Meanwhile, his health department posted its own version of the mayor’s metrics on its website, with thresholds shown relative to the three “milestones,” as the department calls them but the mayor doesn’t, and graphs with easy-to-understand labels like “We want to be below this line” and notes about “consecutive days” below such thresholds but not of consecutive day-to-day decline.
Adding to the confusion, de Blasio was using hospitalizations across all of the city’s roughly 66 hospitals, but ICU patients only in the city’s 11 public hospitals. And on the percentage of tests coming back positive, his indicators did not account for the fact that for some time the city was encouraging tests for only highly-symptomatic individuals or those who had been exposed to known coronavirus-positive people, then significantly widened the pool as testing capacity ramped up.
Well before Friday, when the mayor announced a shift in how he’d be presenting the metrics that will align him much more with his health department’s website, the city had been showing strong progress on two of the three metrics relative to the thresholds shown by the health department under its “milestones” tab on its widely-used coronavirus data page.
But even as he centered his daily briefings around his three indicators, only to shift them as the city got closer to beginning to “reopen,” de Blasio’s tallies matter less to the city’s future than seven metrics Governor Cuomo released in early May, which de Blasio has only discussed when asked by reporters.
Cuomo’s March 20 “New York on PAUSE” executive order was what placed New Yorkers under a semblance of stay-at-home restrictions and shut down or significantly limited many “non-essential” businesses, starting March 22. On May 4, Cuomo announced the state’s seven metrics that regions would have to meet to begin reopening, a process set to occur in four phases. Seven of 10 regions have already hit the metrics to enter phase one, with two more expected early this coming week, leaving only New York City remaining. The metrics to enter phase one include:
-Consistent decrease in the three-day rolling average of hospitalizations over 14 days, or keep the daily increase in hospitalizations under 15 over a three-day average.
-Consistent decline in daily deaths over 14 days, or keep the daily increase under five deaths over a three-day average.
-Fewer than 2 new hospitalizations per 100,000 residents over a three-day rolling average.
-A minimum of 30% availability of hospital beds.
-A minimum of 30% availability of ICU beds.
-A daily testing capacity of 30 tests per 1,000 residents per month.
-Hiring a minimum 30 contact tracers per 100,000 residents.
The first phase of reopening, as determined by the state, will allow manufacturing, construction, and wholesale and curbside-pickup retail to resume operation.
So far at his daily briefings, the mayor has not addressed each of the state’s metrics individually, even as the city approaches meeting them all. The city has met four metrics – on hospitalizations, deaths, and testing – and is close to meeting the rest. As of Friday, the city hospital bed availability was at 27% and ICU bed availability was at 28%, and it was on track to soon hire the requisite number of contact tracers, who will help execute the testing, tracing, and isolation program deemed necessary to reopening.
The mayor has expressed familiarity with the state’s metrics when asked about them by reporters, and indicated on Friday that he agrees with them and the reopening stages they allow regions to begin. “I think the state standards make a lot of sense,” de Blasio said. “They're careful. They go through stages. You have to prove each stage before you move to the next one.”
On Friday, the mayor announced the city’s shift to “thresholds” for its first phase of reopening, which he said is expected to happen by mid-June. The thresholds are a different way of looking at the mayor’s three indicators, he explained, saying that given the city’s progress it was time to take the longer view.
De Blasio said the daily hospital admissions for suspected COVID-19 will have to remain below 200; the daily number of people in municipal ICUs (now counting non-COVID-19 patients as well) will have to be under 375; and the city will have to stay under 15% of people testing positive for coronavirus each day.
“We want to move forward,” de Blasio said. “We want to get to that first phase of restart....What is clear is, for the first time I've seen these indicators stay consistently low and so it's time to talk about the indicators differently as we prepare for phase one,” the mayor said, apparently unaware that his health department had been showing such progress and thresholds for days. “The day-to-day changes, the small up-and-downs matter less. What matters more now is staying at a low level and keeping that way. And so, we're going to be about thresholds now. So, our indicators that we talked about before were trend lines, now we're going to talk about thresholds and that's going to be the focus going forward.”
On Friday, de Blasio showed that on Wednesday, May 20, there were 76 new hospital admissions of coronavirus patients, 451 patients in ICU, and 11% of positive COVID-19 tests. On Sunday, de Blasio did not hold a briefing but tweeted the latest data on his three metrics, attaching graphs and saying, “Hospital admissions and positive tests for COVID-19 are looking good — and the number of patients in @NYCHealthSystem ICUs continues to drop.” Data for Friday, May 22, showed just 53 new hospital admissions, 415 ICU patients, and a 7% positive test rate.
He continued, “The strategies are working. Social distancing is working. What you’re doing is working, New York City. Keep it up.”
Even between his Friday presentation and his Sunday tweet, de Blasio’s graphs had different labeling: whereas on Friday the three threshold graphs were labeled “indicator threshold,” on Sunday the graphs had the health department language of “we want to be below this line.”
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Asked to further explain his decision to focus on new metrics, de Blasio told reporters on Friday, “The trend lines were a great measure, because they said to us, we couldn't just, you know, make a little bit of progress. We have to make a lot of progress. We have to keep moving in the right direction...But we then realized in recent days that with two of the three indicators, we are below the threshold we would need to be at on a long-term basis…So, it got to the point of saying, hey, we need to look at our definition and see if it makes sense at this moment. We're going to always, always vary our approach according to new information and new realities. We're all learning together about this. So, it's this simple. The thresholds now make sense. This is a standard.”
De Blasio’s realization had already been apparent to his health department and anyone using its data web-page.
With de Blasio's new "thresholds" and as of the latest city and state numbers, the gaps for the city to hit both de Blasio's and Cuomo's metrics to begin "reopening" boiled down to: 40 fewer people in city's public hospital system ICUs (city metric); 4% more ICU beds available (state metric); 2% more of total hospital beds available (state metric); and hiring requisite contact-tracers (state metric the city is "expected" to meet soon).
But in the bigger picture part of any confusion around metrics and a possible reopening of New York City also stems from different messages being put out by the mayor and the governor, including where de Blasio has focused on his three indicators while Cuomo has presented his seven metrics.
At times during the crisis, the two Democrats seem to have continued their long-running feud, with the governor repeatedly making moves that appear to undermine or show up the mayor, and the mayor taking apparent steps to get ahead of the governor or establish his own authority.
When de Blasio said a stay-at-home order may need to be issued and told New Yorkers to prepare for it, Cuomo repeatedly shot down the idea just days before putting an order in place to effectively achieve the policy the mayor had said should be considered. After the mayor said schools will need to stay closed for the rest of the school year, Cuomo insisted that the mayor did not have the authority to make such a declaration, before declaring it himself a few days later. The two held separate events on the same morning to welcome the USS Comfort hospital ship to Manhattan’s west side.
Even now, the state and city have not come to an agreement on counting the number of deaths from COVID-19, the disease caused by the coronavirus. As of May 22, the city reported 16,333 confirmed deaths and 4,753 probable deaths, for a total of 21,086 deaths. The state, on the other hand, reported a total of 15,520 confirmed deaths in New York City as of May 22.
Yet Cuomo and de Blasio have both insisted that there is little to no daylight between the state and city. De Blasio said on Thursday, “The big story here now over three months is that the city and state have been very, very much on the same page. There's been a couple of times where there's been different perspectives. We've worked them through. But overwhelmingly...not only did everyone communicate all the time, but there's overwhelmingly a sense of common purpose, common strategic understanding.”
On May 15, de Blasio even indicated the city and state may work together to further shift the requirements for the city to begin reopening, saying, “Anything we do would be in close coordination with the state. And look, if conditions suddenly became more favorable, we'd have that conversation with the state and obviously we and they could make adjustments. But, right now, I think we're all aligned that the first half of June is the earliest opportunity for even some lessening of restrictions and we'll work together on that.”
At his own daily briefing on Friday, when asked about the different communications from the mayor on reopening, particularly on schools, Cuomo said, “I don't think we're on a different page at all on schools and reopening. My position is I don't have a position. I don't know whether or not they should reopen yet. We're getting more information. We're getting more data. And we'll make the decision on the fall reopening in a timely way. We're telling them, go ahead, do your plans. Tell me how you would take a classroom, reduce the density. Tell me how you would reduce density on a school bus. Tell me how you would reduce density in the cafeteria setting, etc. Give us those plans by July and then we have to make a decision about September. But I don't think there's a difference of opinion or position between the state in the city.”
Secretary to the Governor Melissa DeRosa added that there’s been close coordination with the mayor on key decisions, including on allowing small religious gatherings and on reopening beaches over the Memorial Day weekend with strict social distancing restrictions -- though while state beaches are open to swimming, city beaches are not.
“We speak to the city 17 times a day,” DeRosa said. “We've been in lockstep on everything. The indicators that they laid out initially line up almost identically with our indicators. And, you know, we did the religious ceremonies decision, which is something that they agreed with. On beaches, we wanted to take into account the local situations and that was something that I know Mayor de Blasio supported. And so we've been operating in lockstep with the city.”
by Samar Khurshid, senior reporter, Gotham Gazette
Ben Max contributed to this story.