What to Know
- New York has reported more COVID-19 cases than China's Hubei province, where the pandemic started more than three months ago; many on the front lines are getting infected, some have already died
- The CDC says there's more evidence seemingly healthy people can transmit the virus and that anyone can be considered a carrier
- More than 121,000 in the tri-state area have now tested positive for COVID-19; more than 3,100 have died, including first responders
Cover up before heading out: That's the new message New York City Mayor Bill de Blasio has for all city residents, whether you feel sick or not.
De Blasio announced Thursday that all city residents are advised to wear face masks anytime when going out in public. However, the mayor discouraged purchasing surgical or professional masks, instead encouraged using items already available or making them at home from different materials.
Anything such as scarves or bandannas would work, de Blasio said, strictly specifying that "it does not need to be a professional surgical mask. In fact, we don't want you to use the masks our first responders use." He said he hopes people will not go out and try to buy masks that medical workers and first responders desperately need.
But he took to TV Friday morning to lay out in stark terms what the city was facing next week, either way.
"What next week is going to look like is, we're going to see a surge in the number of cases, we're going to see easily -- could be at this point 5,000 or more people in NYC who need to be intubated, who need to be in ICUs with ventilators … we have enough ventilators just to get to Sunday/Monday, we don't have enough yet for next week," he said on MSNBC Friday.
"Studies are showing asymptomatic individuals are transmitting this disease," de Blasio said, admitting that the new precaution "doesn't conform with the initial information" the city was given, hence the change in directive. He, along with the city's top doctor, Oxiris Barbot, stressed that the mask isn't necessarily for the wearer, but rather for everyone else.
Dr. Barbot noted that the masks do not undo the six-foot social distancing guidelines, but rather reinforce it. She added that the homemade masks should cover the wearers nose and mouth, and can be cleaned daily by hand simply with soap and warm water, and being completely dried before wearing again.
The mayor is not anticipating a need for police to enforce the new measure, which the White House appeared to support and offered its own direction for all Americans to wear masks outside. When asked why the mask advisement was not instituted earlier, de Blasio said "there just wasn't evidence," to make such a call, and didn't want the city to trigger a run on the items.
As for medical supplies for those battling the virus, the mayor gave a grim warning: New York City has less than four days to acquire enough to last hospitals another week, as the five boroughs face a crisis that claims hundreds of lives every 24 hours.
If millions of additional N95 and surgical masks, along with 400 more ventilators don't come through by April 5, de Blasio says hospitals could lose more people, simply because they lack the fundamental equipment to save them. He said the city "will make it through Sunday," but after that the situation becomes more dire.
Gov. Andrew Cuomo said Thursday the state sent another 600 ventilators to NYC, Long Island and Westchester the previous evening. He has 2,200 in the stockpile, which he says could empty in just six days "at the current burn rate" of 350 new patients a night. De Blasio said the city itself needs 2,500-3,000 ventilators to make it through next week.
Asked if he expected more ventilators from the U.S. government, Cuomo says he doesn't think the feds even have enough in the national stockpile to meet states' needs over the coming weeks. "Our attitude here is we're on our own," he said.
Critically ill COVID-19 patients need ventilators — some stay on the machines for 20 to 30 days, far more than the typical two-to-three-day average for non-COVID-19 patients. There's less turnover, and increasing need. A quarter of the state's hospitalized coronavirus patients are in ICUs. Cuomo has procured thousands of the life-saving machines over the last weeks and said Thursday he knows "where every ventilator is in the state." He's still trying to buy more, saying, "we are taking extraordinary measures to move ventilators to meet the need."
Tracking Coronavirus in Tri-State
New York's principal medical group told hospitals Thursday to be ready to make quick rationing decisions -- and warned that having to choose who lives and dies will intensify the burnout among doctors that already exists.
"At this point, the most difficult decisions facing physicians will have to be made. Already, some emergency physicians are reporting being told the equivalent of ‘Use your best judgment. You’re on your own," the Medical Society of the State of New York said in a statement.
Hoping to help lighten the load on hospitals themselves, Cuomo later announced that the field hospital at the Javits Center, which was initially intended for non-COVID-19 patients, would now be used to treat individuals with the virus.
Nowhere in America is the crisis more profound than in New York City right now. The city, impaired by the density that makes it one of the world's most vibrant places, had 51,809 cases and 1,562 dead as of Thursday. Statewide, New York has seen 92,381 cases -- more than China ever reported -- and 3,187 deaths.
Mayor de Blasio said that half of all New Yorkers could contract the virus, and many will not even know it.
The next battlefront, the apex, could be catastrophic. All of the current plans and efforts currently in place are designed with that in mind. If we wait to prepare until the storm hits, Cuomo says, it will be too late. Already, he says, "We have been behind this virus from Day 1. I'm tired of playing catch-up. You never win when you're playing catch-up."
State consultants say New York will need 75,000-110,000 COVID-only beds when the apex hits. Estimates vary as to when that will happen. Some models predict it could hit in seven days; others have it in six weeks. Cuomo's team evaluates all the models to develop moderate projections and plan for need. On Thursday, he said the latest projections have the apex hitting in seven to 30 days; he said his team is planning for the shorter end of that nearly month-long range.
"By any estimate, we don't have enough beds," Cuomo said. The state has 53,000 COVID-19 beds now, about 36,000 of which are in the New York City area. Hospitals have been ordered to boost capacity by 50 percent at minimum (Cuomo would like to see 100 percent).
About 21 percent of all NYC cases to date have required hospitalization, slightly higher than the rolling statewide average (14 percent). Half of those patients are 75 and older, but 10 percent are children, according to the city's latest data. The vast majority of fatalities, though, are people older than 65; nearly 99 percent of all victims had prior conditions or conditions under investigation.
The five boroughs account for a quarter of the nation's surging death toll and nearly the same share of its overall cases. One projection from the Gates Foundation-funded IHME suggests New York could lose a total 16,000 people through the second week of May.
There is some evidence social distancing efforts are working or at least mitigating the spread of infection. New York has seen hospital rates take longer to double, from about every two days a week ago to every six days now. New Jersey Gov. Phil Murphy says models show his state would already have hit ICU capacity and max out on beds next week if not for social distancing.
But without scaleable testing, it's hard to tell how many people are really infected. The CDC has warned anyone can be considered a carrier, symptoms or not. Social distancing, while physically and emotionally isolating, is critically important. No one is immune.
"How many people have to die before the people ignoring social distancing get that they have a responsibility?" Cuomo asked Wednesday. "One person sneezes — another person gets intubated. We all have to look out for each other."
Health officials say they're already seeing a surge in northern New Jersey; four hospitals are now on "divert" status. Murphy said Thursday the state added nearly 3,500 more COVID-19 cases overnight, bringing its total to 25,590. Nearly 200 more lives were lost, including a "front-line hero," as the death toll climbed to 537. New Jersey is the nation's second-most impacted state behind New York.
"If you don't need to be out, please God stay at home," Murphy pleaded Thursday.
In Connecticut, 3,854 cases have been reported and at least 112 people have died, including a 7-week-old baby in Hartford, Gov. Ned Lamont said Wednesday. The newborn is likely one of the youngest-ever victims of COVID-19, Lamont said.
Playgrounds in New York City have been entirely shut down to help slow the spread. Fines and summonses for noncompliance are being issued across all three states, which have seen a combined 121,825 cases and 3,187 deaths.
All of the unprecedented joint measures Cuomo, Murphy and Lamont have implemented mean nothing if people do not adhere to the most critical advice: Stay home. And when you go out, stay apart.
"Too much is at stake," Cuomo said. "We have to get this right."
The White House's move to extend federal guidelines through the end of April underscores the point. Even Dr. Anthony Fauci, the nation's top infectious disease expert, said Thursday the guidelines are essentially a national stay-at-home order.
"That is our major weapon against this virus right now. We don't have a vaccine that's deployable. This is the only thing we have," Fauci said on "TODAY."
How Coronavirus Has Grown in Each State — in 1 Chart
New York has quickly become the epicenter of the American coronavirus outbreak. This chart shows the cumulative number of cases per state by number of days since the 10th case.
Source: Johns Hopkins University
Credit: Amy O’Kruk/NBC
Bracing for the Apex, Battle for Fed Help
To better track the spread of COVID-19 in NYC and funnel resources where they're most needed, a team of data scientists, physicians, and engineers across the Mount Sinai Health System has launched STOP COVID NYC, a web-based app. They are asking everyone to enroll; a team leader describes it as "a survey about New Yorkers, for New Yorkers." Text COVID to 64722 to get it.
De Blasio says the city alone needs at least 65,000 beds by the end of April to meet the patient volume he expects will hit hospitals when infections peak. Field hospitals at locations like Central Park, USTA tennis center and the Brooklyn Cruise Terminal will be able to house thousands of non-virus patients. At least 20 hotels in NYC, which have seen business grind to a halt since the outbreak began, have been leased out by city hospitals to house 10,000 beds. The city hopes that in the next phase of leasing hotels and converting large venues, as many as 39,000 beds could be created, in addition to on-site and off-site hospital facilities.
Cuomo has already created a Central Coordinating Team, led by the state's Department of Health. That team will organize upstate-to-downstate staffing needs, patient transfers between hospitals and transfers to the USNS Comfort.
In the city, de Blasio has put an old friend and colleague in charge of managing the supply chains for all NYC hospitals, private or public: Former NYPD Commissioner James O'Neill.
"He's answered the city's call before, and he's answering it again," de Blasio said.
O'Neill was based in San Francisco for his new job with Visa when that city implemented its shelter-in-place order, and had been updating de Blasio on how those measures were working there. The former top cop said he wants to build a "system of accountability" to ensure hospitals are getting what they need to fight COVID-19, including N95 face masks, face shields and gowns.
O'Neill acknowledged the challenges ahead of him in an MSNBC interview Thursday, but said New Yorkers should be confident we'll get through the crisis.
"Now is the time for everybody to work together," O'Neill said. "This is about saving lives and there's nothing more important than that. If we can't do this at this point, we'll never be able to do it."
De Blasio has called for the White House to send military medical personnel to New York City by April 5 to help do just that; he says he's awaiting a response. To further centralize the supply chain, Sen. Chuck Schumer says he wants the Trump administration to appoint a "czar," a "military man," to manage production and distribution under the Defense Production Act. That law lets the feds order private companies to manufacture needed supplies like ventilators, which companies like GM are already doing.
The federal government has shipped thousands of those machines and millions of personal protective equipment (PPE) items from its national stockpile to date to help states prepare -- but President Trump has questioned the volume requested at each turn, most recently on Thursday.
Cuomo has said he doesn't think the president gets that the surge in patients, particularly the very sick ones, has fueled exponential PPE use. De Blasio has flat out said the president's continued claims about supply misuse is nonsensical.
Lamont weighed in Thursday, telling MSNBC, "The message I'm trying to take to Washington, D.C., every day you've got to put your foot on the accelerator. We're not exaggerating the case we need right now."
As much as hospitals are taxed, those fighting the wars within them are increasingly exhausted and fearful -- weary of the 12- and even 24-hour daily battles, concerned about infecting themselves and others. Five hundred nurses arrived in the city last week, and another 5,000 are on the way; some colleges are also graduating medical students early to provide reinforcements.
One Manhattan ER doctor, a former medic in Iraq, said New York City feels like an "inescapable warzone." The situation has become so dire that a regional EMT group has issued new guidelines telling paramedics not to take cardiac arrest patients to emergency rooms if they can't be revived in the field.
In New Jersey, Murphy signed an executive order authorizing the Division of Consumer Affairs to temporarily reactivate the licenses of recently retired health care professionals and grant temporary licenses to foreign doctors. That should usher in a new flood of medical personnel, the governor said. On Thursday, he signed another executive order -- this one authorizing state police to commandeer supplies and equipment needed for COVID-19 response.
Earlier in the day, Murphy toured one of New Jersey's new field hospitals, the station at the sprawling Meadowlands complex. That 250-bed facility should be ready for a "soft opening" on Monday, he said. Several other field hospitals are in development, which he said will in total add 1,000 beds.
Test More, Reboot Economy
Numbers will continue to rise as more people are tested, officials say. New York has accounted for about 25 percent of all COVID-19 testing in America to date, Cuomo has said. That is an accomplishment, he noted: Find the cases, isolate the positives and treat them.
That, in conjunction with the social distancing and business restrictions in place, will slow the spread of infection, the governor says.
The economic impact has been dizzying at all levels. The number of people filing first-time claims for unemployment doubled last week to 6.6 million, nearly 10 times the pre-pandemic record. Before this crisis, weekly unemployment claims had never topped 700,000 in U.S. history.
Trump signed three stimulus bills in three weeks, the latest worth $2.2 trillion with a promise to send millions of Americans virus relief checks. But those checks may not come for months, a new government memo to Congress reveals. A fourth bill is in the works, House Speaker Nancy Pelosi said -- one that would focus on recovery from the crisis. By the time it comes to fruition, though, it may be too late to save many small businesses. A new survey says a third of them can't last another three months under the current pressure.
Public health and the economy aren't mutually exclusive priorities, Cuomo has said. Bring testing up to scale quickly -- make it faster, easier, home-based and able to test millions -- he says, and you will identify hundreds of thousands of people who "can go back to work tomorrow."
Fauci says more scaleable testing is in the works nationally. In the meantime, rapid testing is becoming available locally.
Last week, the FDA granted Abbott Laboratories emergency use for its rapid COVID-19 test for doctor's offices and urgent care centers. The test delivers positive results in as little as 5 minutes and negative results in 13 minutes. Three Long Island locations of American Family Care say they'll start using the test Wednesday, becoming the nation's first health care providers to do so.
New Jersey's testing capacity also got a boon Wednesday. Rutgers says its RUCDR Infinite Biologics launched a genetic test for the novel coronavirus and is using its automation experience and infrastructure to test up to tens of thousands of samples daily.
It has also submitted an emergency use authorization request for a saliva collection method to broaden population screening. The project will help curb the spread by identifying more positives and allow infected front-line personnel to get back to work faster after recovering and testing negative, Rutgers says.
Governors are working to accelerate action on the drug front as well. New York launched a clinical trial for an experimental treatment and plans to be the nation's first state to try to heal critically ill patients using recovered people's plasma — a process called convalescent plasma that was used during the flu epidemic of 1918. FDA Commissioner Stephen Hahn said on CBS News Radio that the agency planned to announce its first serologic test approval Thursday, which will let labs determine exposure in antibodies. Right now, everything is on the table.
Where Do We Go From Here?
How will we know when we've turned a corner? Recent research from Columbia University offers some curve-based projections that suggest new cases will need to decline for at least 10 straight days. But it's still too early to tell.
The depths of the outbreak — and its impact — are incomprehensible at this point but most definitely catastrophic: Billions upon billions of dollars have been lost and more will be lost; many have died, far more have been sickened.
The World Health Organization declared the novel coronavirus a pandemic, the first coronavirus to ever earn the dubious distinction. It's novel — that means it's new and no one has immunity to it.
Nationally, NBC News estimates that more than 243,000 people have been infected and more than 5,800 have died. New projections from the White House suggest up to 240,000 Americans could die by the time the pandemic ebbs even if social distancing guidelines are followed.