Another record shattering single-day of new coronavirus cases in New Jersey, aided by the third-highest day in New York, brought the tri-state past 1.3 million cases of the virus this weekend.
The continued rise in cases hasn't slowed much despite renewed restrictions from governors eager to turn the tide; governors are now juggling efforts to stop the spread while the first shipments of vaccine are expected to reach states starting Monday.
As cases rise and more of the sick are admitted to hospitals across the region, the number of deaths related to the virus having slowly climbed too. New York, on Saturday, reported 95 deaths. It's the closest the state has come to breaking 100 in months.
The number of New Yorkers admitted to hospitals has been on a steady rise for the past several months, crossing 5,000 on Dec. 10 for the first time since the spring. That number reached 5,359 by Saturday.
The number hospitalized in New York City concerned the governor enough to reinstitute a closure of indoor dining starting Monday, he announced Friday. More shutdowns could be coming to the city or rest of the state depending on worsening conditions, he warned.
Mitigating increases in the state's hospitalization rate has become Cuomo's top priority -- and he recalibrated the state's micro-cluster model as part of a revised overarching post-holiday plan he unveiled Friday. That plan includes new standards for red, orange and yellow cluster zones and adjusted focus metrics.
If any region in the state is projected to hit 90 percent hospital capacity within 21 days, the governor will impose a red zone shutdown. That means nonessential businesses, schools and restaurant table service close in a given region for an indefinite period of time, a measure reminiscent of strict lockdowns from spring.
“If we don’t slow the spread and we overwhelm the hospital system — we get to a red zone... then every restaurant goes to zero indoor, outdoor zero. That’s the worst-case scenario,” he added.
The changes announced Friday are the core of Cuomo's revised winter plan, which prioritizes hospital capacity and acutely focuses on positivity rates, density, risk level of economic activity and rate of transmission. It's an interwoven strategy.
"We cannot relax until COVID relaxes — and COVID is not relaxing," Cuomo said.
New York City has a lower hospitalization rate than 3/4 of the state's regions and most major U.S. cities, but its density is a heightened risk factor. The new restrictions set to take effect Monday ensure that risk isn't underestimated.
The city also happens to have the least bed availability of the state's 10 regions after Long Island (18 percent and 19 percent, respectively). Cuomo said Friday that all statewide hospitals must remain below 85 percent capacity. They can reach that goal either by adding an extra 25 percent capacity, suspending elective surgeries or both. They have the flexibility, he said.
While statewide hospitalizations today pale in comparison to the 19,000 admitted at the peak of the crisis in April, they are at their highest since May 19, and mark a steep increase over recent months for freshly beleaguered hospital staff and facilities. Cuomo has attributed part of the surge to Thanksgiving gatherings.
Household and small gatherings account for 74 percent of viral spread, based on contact tracing data. Restaurants and bars account for significantly less -- around 1.43 percent of exposures in September -- but the concern is magnified in an area as dense as New York City given the increasing numbers across the board.
The Race to Shore Up Hospitals in NJ
Hospitalizations have also become the core metric in neighboring New Jersey, which has seen sharp increases on that measure as well over the last 14 days. As of Friday, state hospitalizations stood at 3,571, the highest total since May 14.
Cases have been substantially rising too, but the hospitalization number is more important to Gov. Phil Murphy, as it is to Cuomo in New York.
"The one third rail we cannot touch is hospitals and hospital capacity," Murphy said Friday. Earlier this week, he said those are the numbers that come to determining the next steps he needs to take for the state.
Right now, those next steps do not include any plans to limit indoor dining anew. Asked yet again about the issue Friday, given Cuomo's announcement in New York and a new indoor dining ban in Pennsylvania, Murphy held tight.
"We're staying with what we got," the governor said. "We are trying to be as surgical as we can be."
While New Jersey is the densest state in the country, Murphy likens it overall more to Westchester County or Long Island, where indoor dining remains open at reduced capacity for now, than the high-density mecca that is New York City. Dine-in remains capped at 25 percent capacity in the Garden State, and its governor says there's no major evidence indoor dining is fueling the surge.
The governor has taken steps to improve compliance, including imposing a 10 p.m. curfew on bars and restaurants statewide. Those late-night hours were when usually compliant spaces turned into unmasked, crowded spaces, Murphy said.
On Friday, he announced varying crackdowns on nearly a dozen New Jersey bars and restaurants over repeat infractions. At least one could be shut for 70 days.
"Let these charges send a perfectly clear signal to any bar or restaurant owner who thinks that the rules don't apply to them. This will happen to you," Murphy said. "Our job is to protect both public health and our economy. We will not tolerate knucklehead behavior and we will not hesitate to shut you down."
Compliance -- both on the part and business and the public -- can't be underestimated as a weapon in the COVID fight. The worst-case and moderate projection models New Jersey debuted earlier this week underscore the point.
Under the nightmare scenario, which presumes no change in public behavior, daily case totals could double in a month and hospitalizations could climb to peaks not seen in April by mid-January. That level of strain could overwhelm the system.
Under the moderate outcome scenario, which presumes some increased level of public compliance with masks, social distancing and avoidance of gatherings, new daily cases would still climb but hospital levels would remain manageable.