COVID-19

Cuomo Sets New Standard for Closing Indoor Dining; Fauci Expects Mid-January Surge Peak

Meanwhile, NYC public schools reopen in-person learning this week for students at 3K, pre-K and K-5 levels along with special education after a two-week shutdown; parents must sign testing consent forms

NBC Universal, Inc.

What to Know

  • New York state hit a recent high in daily deaths (80) Monday, Gov. Andrew Cuomo said; he unveiled a new standard that ties regional hospitalization rates to indoor dining availability
  • Dr. Anthony Fauci, who joined Cuomo at his briefing Monday, said he expects the post-holiday effect to fully materialize by mid-January. Without substantial mitigation, he says times could turn really dark
  • New Jersey is also seeing an alarming spike, and topped 6K new daily cases for the first time Sunday just two days after it first topped 5k new cases; outdoor gatherings are limited to 25 as of Monday

Gov. Andrew Cuomo unveiled new rules Monday that inextricably tie each of the state's 10 regions' hospitalization rates to the availability of indoor dining, though the level of potential clampdown is harshest in New York City.

Citing new CDC guidance that identifies indoor dining as a key COVID spreader, the governor said dine-in would shut down completely in New York City, where it is currently open at 25 percent capacity, if the citywide hospitalization rate doesn't stabilize over the next five days. There's no singular hospitalization rate threshold, Cuomo says. It's simply a matter of avoiding further increase.

"Stabilization is stabilization," the governor explained. "Where you are now -- stabilize, instead of going up. If your hospitalization rate is 4 percent, instead of going from 4 to 5, you have to stay at 4 and stabilize. Right now it's increasing."

Cuomo expects it to continue to increase between now and mid-January. If current trends hold, indoor dining could be closed in the five boroughs as early as next Monday. Should that happen, there's no timetable to reopen it at this time. Melissa Fleischut, president and CEO of the New York State Restaurant Association, said that any closures would mean many businesses would have to close for good.

"With the looming limits on indoor dining and outdoor dining no longer practical, many of our members will be forced to shut their doors, and for some it may be their final service," she said. "Based on today’s news, many restaurants will have no other choice, and hundreds of thousands of restaurant employees will be laid off during the holidays."

For the rest of the state, indoor dining would be reduced to 50 percent or 25 percent capacity if the regional hospitalization rates are unstable for more than five days. All that excludes orange cluster zones, where indoor dining is closed.

Right now, the story is markedly reversed from what it was in the spring. New York City and Long Island both have lower hospitalization rates than upstate regions.

Hospitalizations have been on a steady rise for weeks now, both in the city and statewide, trends reflective of a national crisis that shows no signs of abating. As of Monday, New York state had 4,602 total hospitalizations, its highest total since May 22 but a mere fraction of the 19,000 or so admitted at the peak of the crisis.

The state's rate of transmission is about 1.2 right now, Cuomo said Monday, meaning every infected person infects more than one other person. The governor has long said that defines an active outbreak. He also reported 80 new deaths statewide, the highest single-day toll in months. Like hospitalizations, deaths are a lagging indicator -- and will likely ebb and flow with critical hospitalizations.

While hospitals are not as taxed by any means at this point as they were in April, they are stretched in each of the state's 10 regions. Cuomo wants to ensure the flexibility to "surge and flex" resources as needed between upstate and downstate. He triggered emergency hospital protocol late last month to ensure facilities had the PPE and resource stockpiles necessary to adapt as needed, and hospitals across the state were ordered to add 25 percent more beds to handle growing numbers of coronavirus patients. Worried about potential hospital staffing shortages, Cuomo also urged retired health care workers to volunteer to help provide as many as 20,000 extra nurses and doctors.

Daily Percentage of Positive Tests by New York Region

Gov. Andrew Cuomo breaks the state into 10 regions for testing purposes and tracks positivity rates to identify potential hotspots. Here's the latest tracking data by region and for the five boroughs. For the latest county-level results statewide, click here

Source: ny.gov

The problem in the spring, Cuomo said, wasn't that the entire hospital system was overwhelmed. It was that individual hospitals were overwhelmed. The flex component of his hospital strategy allows for the balancing of patient load. If it can't be, other measures, like suspending elective surgeries, may be needed.

“I think that’s the ultimate bottom line: Can your hospitals handle the increase until you start to see a reduction from the vaccinations?” Cuomo said at a briefing. The governor also said the state would shut down schools, nonessential businesses and all restaurant table service in regions that are on track to hit 90 percent of hospital capacity within three weeks, based on a seven-day average.

Amid the rising numbers, New York City Mayor Bill de Blasio debuted new daily health indicators, including the rolling hospitalization rate per 100,000 residents, on Monday as part of an effort to provide a more complete picture of the city's standing in its ongoing war against coronavirus. As of Monday, that metric by his data was 2.28. His goal is to keep it below 2.00.

The mayor also added probable daily COVID cases to the overall new cases toll. As of Monday, de Blasio reported 616 "probable" COVID cases to the 2,180 confirmed (based on a seven-day rolling average). He and his health commissioner, Dr. Dave Chokski, say incorporating antigen data is more accurate than including PCR diagnostic tests alone, which the city had done in the past.

"Data is the lifeblood of our COVID response. But data is also at the center of New Yorkers' response," Chokshi said in explaining the metrics shift. "In order to act on this data, people must know the data."

nyc probable cases
NYC is now incorporating probable new daily COVID cases, which it says stem from antigen tests. Previously the daily case report included only PCR tests.

Previously, the daily cases reported were based solely on PCR tests, which are molecular. They didn't include results from antigen tests, which check for a virus protein and are being used more frequently as a screening test for COVID-19. Going forward, those will account for the probable cases added to the daily tally.

The mayor also said he will no longer include the daily positivity rate in his daily indicators' report, opting exclusively instead for the seven-day rolling average. That was 4.98 percent as of Monday. It was less than three weeks ago that that rate hit his controversial 3 percent benchmark to move schools all remote.

Students in lower grade levels, including pre-K, can return to in-person learning in NYC Monday after a two-week hiatus, though parental consent for COVID testing is required. Katherine Creag reports.

The nation's largest public school district welcomed back 3K, pre-K and K-5 students to in-person learning Monday (and will do the same for special education students Thursday) after a two-week shutdown. Middle and high school students will have to wait to return at least into next year, part of a by-design phased reopening that de Blasio and education officials hope will protect the long-term viability of in-person learning amid the pandemic.

"This is a good day for New York City, even against a tough backdrop," de Blasio said Monday.

No timeline has been given for the older kids' return to school. Pressed about that Monday, de Blasio says he anticipates middle school students will return to in-person learning at some point in January, while high schoolers will delay longer.

All of the reopening schools have been told to pivot from a hybrid schedule to five-day-a-week in-person instruction, though a number of the larger ones say they can't accommodate that. De Blasio insists most schools have the capacity to move to that schedule at some point in January if not earlier. Schools Chancellor Richard Carranza says early data shows about 150 schools made the five-day-a-week move starting this week, but expects more complete data by Tuesday.

Parents sending their kids back to school this week also must submit a consent form to have their children tested for COVID. The reopening strategy includes mandatory weekly randomized testing of students and staff.

All public schools have been closed to in-person learning since Nov. 19, a day after the city's rolling seven-day positivity rate hit de Blasio's oft-criticized 3 percent threshold for closure. That controversial mark is no longer part of the equation to keep schools open, with the citywide positivity rate now well topped 5 percent, according to the latest data, and no significant spread traced to schools.

Some New York City school kids return to school on Monday but parents are still split on whether they want their kids to return to in-person learning as COVID-19 cases rise. NBC New York's Ida Siegal reports.

Up to 190,000 students are returning to the classroom this week at 850 school buildings across the five boroughs, de Blasio says. That includes orange zone cluster schools on Staten Island with additional testing requirements.

Keeping schools open for in-person instruction is a core tenet of the mayor's and governor's separate but parallel battle plans for managing the ongoing pandemic through the dreaded winter months. Winter means more indoor activity, which is linked to higher COVID exposure risk. It means more travel, more socializing.

No state has been untouched by the latest U.S. surge. Across the river, New Jersey is also seeing stark increases in new cases and hospitalizations. Gov. Phil Murphy's suspension of indoor youth and adult winter sports took effect over the weekend and outdoor gatherings are limited to just 25 people starting Monday. That's a 95 percent reduction from the 500-person limit in place through summer.

The new restrictions come as New Jersey's state health department recorded more than 6,000 new positive cases on Sunday, another record-breaker just two days after the state reported more than 5,000 new daily cases for the first time. The daily case number, which relies on PCR tests, dipped back down to around 3,500 on Monday, likely a product of typically lower weekend testing numbers.

Asked about the future of indoor dining in the wake of Cuomo's announcement Monday, Murphy said he learned of the New York governor's plan minutes before his own daily briefing began. He firmly defended keeping restaurants open to indoor diners in his state, saying any closure would be a measure of last resort.

"If you shutter something completely, you're driving this into underground activity, behind closed doors, private settings. We already have an issue with that," Murphy said. "If we think we can control that manageable risk in an enforceable space, such as a restaurant as opposed to Ed's living room, then that is our preference."

Controlling manageable risk would be much easier, Murphy added, if New Jerseyeans did their collective part assisting with contact tracing efforts. As of Monday, he said the rate of noncooperation is up to an "unacceptable" 74 percent.

"This is not a witch hunt," the governor pleaded. "We’re only trying to stop the spread of this virus. Work with our contact tracers."

While acknowledging record daily case totals in recent days, Murphy and other officials believe their states and others likely would have hit such peaks earlier if spring testing capacity and public acceptance of it had been up to current levels.

The key metrics states are monitoring this time around are hospitalizations and deaths, both of which lag increases in cases. Murphy told CNN Monday that hospitalization is a metric his team will review "very carefully" a week or two from now for any potential early impacts of the post-Thanksgiving effect.

Dr. Anthony Fauci, who joined Cuomo at the governor's Monday briefing, said the Thanksgiving impact would likely start to become evident in the next 10 days.

"The problem is, that's going to come right up to the beginning of the Christmas/Hannukah potential surge -- so you have a surge upon a surge and then before you can handle that, more people are going to travel over Christmas, they're going to have more of those family and friends gatherings," Fauci said, noting that after upticks in cases, it can take over two weeks for hospitalizations to increase. "If those two things happen and we don't mitigate well, we could start to see things really start to get bad in the middle of January. Without substantial mitigation, the middle of January can be a very dark time for us."

The numbers were alarming even before the dreaded holiday surge. Last week, the United States set new records on both total hospitalizations and daily deaths -- and promptly broke those records. And given the latest trends in cases, it is expected to set new records again soon.

The desperation is growing. A new stay-at-home order that applies to millions of people in California took effect Sunday night. Asked on CNN Monday whether he might consider such a measure for New Jersey, Murphy issued his oft-repeated phrase of "everything is on the table" but said he didn't anticipate that scenario.

Like officials at every level of government and public health across the country, Murphy is urging his people to continue with proven mitigation measures through the distribution and administration of a vaccine. Multiple states, including New York and New Jersey, are expected to receive initial doses of Pfizer and Moderna vaccines pending federal emergency use authorization within the next two weeks. High-risk healthcare workers and nursing home staff will get first priority.

Hospitalizations have increased in New Jersey to the highest number in nearly seven months. NBC New York's Brian Thompson reports.

Larger-scale distribution to the public is not expected until well into 2021. Mitigation efforts like masks and social distancing may be necessary well beyond that, health experts like Dr. Anthony Fauci have cautioned. Even with a 95 percent vaccine efficacy rate, some people will get COVID despite getting vaccinated.

Cuomo says experts say 75 percent to 85 percent of people need to be vaccinated in order for the economy to return to some semblance of normalcy. That in and of itself is a tall order, given heightened public skepticism of this particular vaccine. According to a new union survey, fewer than half of FDNY firefighters -- first responders who face heightened risk as part of their jobs -- would take the vaccine once it becomes available to them in a few weeks.

Copyright NBC New York
Contact Us