What Does Reopening Look Like? New York Outlines Multi-Phase Strategy

Gov. Cuomo said Friday a decision on whether to extend the state's PAUSE directive, set to expire May 15, is about one week away; tied up in that executive order is the fate of New York schools

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What to Know

  • More than 24,000 tri-state lives have been lost to date, though NY reported its lowest single-day toll (367) since March 31 on Sunday
  • 13.9% of people in New York's first antibody study tested positive, meaning they had the virus and recovered; that means up to 2.7 million people could have been infected statewide
  • Nationally, deaths passed a grim 50,000 milestone Friday, by NBC News estimates; total U.S. cases have surpassed 900,000

When can states reopen and how do they do it safely? That's the question governors, mayors and newly created task forces are trying to answer.

Tri-state stay-at-home orders are still in place for a few weeks - and could be extended further - but the question on everyone's mind is when can businesses reopen and people return to daily life.

New York Gov. Andrew Cuomo says the state will abide by CDC's recommendation to hold major reopening until state and regional hospitalization rates see a decline for 14 days.

Upstate and downstate New York face different challenges, Cuomo points out, with downstate facing a majority of positive coronavirus cases. Reopening downstate New York will "need multi-state and regional coordination," he said Sunday.

"Downstate is obviously the most complicated situation; thats New York City, Westchester, Nassau, Suffolk, the surrounding suburbs. Multi-state coordination is vital there because the New Jersey, Connecticut, New York City area is basically very intermixed. People are going and coming, they live in one place, work in another, so that coordination is important," said Cuomo.

The first phase of a reopening strategy for New York will begin with construction and manufacturing workforces, the governor said. Before moving to the second phase, which is focused on additional essential workforces with low-risk of spread, Cuomo says two weeks will be needed between each phase to monitor its effects.

"One caveat is you can't do anything in any region that would increase the number of visitors to that region," Cuomo warned. "It's possible that you open something in Syracuse or you open something in the north country, where you now see license plates coming in from Connecticut, New Jersey, people from downstate all coming to that area because people they've been locked down and they're looking for an activity."

Cuomo did not provide any reopening timeline beyond suggesting upstate New York could begin reopening in slow phases as soon as May 15, the deadline for his "Pause" order, and will likely start reopening procedures ahead of downstate New York.

Downstate, in New York City, Mayor Bill de Blasio announced a different set of plans, but still focused on reopening businesses. De Blasio said the city's action will be determined by the daily health metrics.

In addition to expanding testing and growing a team of contact tracers, de Blasio is creating a handful of advisory councils as well as two task forces all focused, one way or another, one recovering and reopening efforts. Mayor de Blasio said e wants a roadmap by June 1 on how to rebuild New York City.

"I want to be clear, there's no on and off switch here," he said Sunday. "It's a series of careful smart moves and then you test each one along the way to make sure there's not that backfire. And then when you see things working, you take that next step."

At this point, New Jersey Gov. Phil Murphy said he's not in a position to even consider next steps, adding, "We need to see more progress, and more slowing, before we can begin those considerations."

On Sunday's Meet the Press, Murphy said when they do plan to reopen the state, they will analyze issues in each of the state's three regions. his administration has not decided if they will reopen based on region.

"While we haven't made a decision on that, we're going to move as one state, recognizing you've got density issues in the north that you just don't have in the south," Murphy offered up.

Murphy acknowledged three positive signs in New Jersey: the positive test curve has flattened, hospitalizations have started to come down and ICU and ventilator use has also decreased. "But we're not out of the woods yet," he cautioned.

Gov. Cuomo gives a broad outline of the plan to reopen New York.

Updated modeling from the widely watched Gates Foundation-backed IHME predicts the tri-state will ultimately see more fatalities over a longer period of time than previously projected. It now incorporates New York City's "probable" death reports (5,102) and data compiled by The New York Times.

The latest model run also has expedited the timeline by which New York and New Jersey could begin to relax social distancing restrictions. Presuming strong containment strategies, like contact tracing, isolation and crowd limitations remain in place, those states could ease restrictions after May 27. Connecticut, which has barely past its peak, according to IHME, looks a bit later, after June 9.

New York added another 367 people to the coronavirus death for a total of 16,966, not including presumptive deaths, Gov. Andrew Cuomo announced on Sunday.

The 367 deaths is a steep drop from the 437 daily deaths reported on Saturday. Cuomo says the amount of new people who have been hospitalized with the virus, another key metric, has also fallen to just above 1,000. 

More than 24,000 people in the region have died -- 16,966 in New York, 5,938 in New Jersey and 1,924 in Connecticut. Brooklyn may now be the deadliest county in America, based on the state's latest data. Murphy added another 75 fatalities to New Jersey's growing toll on Sunday.

Nationally, more than 900,000 coronavirus cases have been reported, while the tri-state crossed 400,000 cases on Saturday. The country passed a grim 50,000-death milestone on Friday, by NBC News estimates.

Contract tracing

A report summarized by NBC News said to track the virus, the U.S. could need as many as 100,000 contact tracers, a group of workers who call people who test positive and ask about their past travel and interactions with other people.

Tracing involves isolating everyone who tests positive and interviewing them about recent “close contacts,” which health officials define as people who spent 15 minutes or more within six feet of someone who was infectious.

While specific plans have not been outlined, the state and city plan to hire thousands of tracers in the coming weeks. The task will not be easy for the nation's epicenter of the coronavirus where more than 280,000 New Yorkers have already tested positive.

New York City already has a few hundred disease detectives, but those already in place stand outnumbered by the thousands of new daily cases reported by the state and city. De Blasio says an additional 5,000-10,000 tracers would be needed in the city to prove effective.

"You cannot really do contact tracing the way things are right now in New York City. We need to have the virus under much better control," said Dr. Bruce Farber, a doctor of infectious disease at Northwell Health.

Some experts have suggested using smartphone data to assist with contact tracing.

Antibody Testing Answers

Up to 2.7 million New Yorkers may have been infected with coronavirus -- more than 10 times the number of confirmed cases, according to preliminary results from the state's first antibody study. Less than two months ago, there were zero known cases here. How did the virus spread so dramatically so fast?

It was here well before New York City reported its "first" case on March 1, possibly as early as late January, researchers from Northeastern University say. They gave their model data to The New York Times, which reported nearly 11,000 may have been infected in the city by the time Gov. Andrew Cuomo and Mayor Bill de Blasio jointly announced our "patient zero."

"The horse had already left the barn" by the time the nation shut down, Cuomo said Friday. He cited research on the number of flights (13,000, carrying over 2 million people) from Europe, the globe's second hot zone after China, to New York and New Jersey between January and March.

Knowing that now, "It was like watching a horrible train wreck in slow motion," Cuomo said. "We closed the front door but left the back door wide open."

The study found 21 percent of NYC samples tested positive for the antibody, meaning they had COVID-19 at some point and recovered. That was the highest positivity rate of all regions tested in this initial round; Long Island had the second-highest positivity rate (16.7 percent). In total, of the 3,000 people randomly sampled from 40 locations in 19 counties, 13.9 percent had antibodies.

While the preliminary data suggests much more widespread infection, it means New York's mortality rate is much lower than previously thought.

Given the 271,000 cases confirmed by the state so far, the mortality rate would be as high as 6 percent. With 2.7 million cases, it would be around 0.5 percent -- much lower, though still much higher than the seasonal flu.

Cuomo was quick to caution, though, that the death toll was higher than even the state's own official report -- it counts deaths in hospitals and nursing homes, but not at-home deaths or other "probable" cases. In other words, the mortality rate is still hard to determine properly.

The sample size of the first antibody study was also relatively small. People were hastily recruited at shopping centers and grocery stores, meaning they were healthy enough to be out in public. Acknowledging some data points were inexact, Cuomo says more people will be tested over time.

“We’ll have a larger and larger sample. But I want to see snapshots of what is happening with that rate," the governor said. "Is it going up, is it flat, is it down? And it can really give us data to make decisions."

Preliminary results from the antibody survey revealed that fourteen percent of New Yorkers tested positive for the antibody. Sarah Wallace reports.

Knowing how many people have antibodies could potentially help set policy on when to reopen parts of the state, the governor said. He projects New York revenues to decline $13.3 billion in the next state budget forecast, largely because of the pandemic. With the state's "PAUSE" directive set to expire on May 15, Cuomo said Friday he'd decide in about a week whether to extend it further. Tied up in that executive order is the fate of New York schools.

Antibodies don't guarantee a safe return to work, or to the classroom, for that matter. Dr. Anthony Fauci, the nation's top infectious disease specialist, says it's reasonable to assume a person who has antibodies will be immune from reinfection, based on experiences with past viruses. It's unproven with respect to this novel coronavirus, however. Even if antibodies do grant that precious immunity, it's not clear how long it would last, Fauci says. Three months? Six months? The hunt for answers is underway in labs across the country and the globe.

Dr. Craig Spencer, a Manhattan emergency room doctor who famously survived Ebola and has been a prominent social media voice during this crisis, was quick to point out the limitations of Cuomo's initial study.

"It means a lot of us in NYC have been infected. But that's not surprising news - we've seen high levels of cases for over a month," Spencer tweeted. "It means the virus is STILL spreading in NYC. It means that the MAJORITY of us are still very susceptible! It means we still need to #StayHome."

For now, tri-state officials continue to drive home that last point. To date, New York, New Jersey and Connecticut have seen nearly 400,000 confirmed virus cases, with the Empire State accounting for the lion's share (271,590). New Jersey eclipsed the 100,000-mark Friday, hitting 102,196, while Connecticut, which saw a bit later curve, has reported nearly 24,000.

Neither New Jersey or Connecticut have yet attempted an antibody study like Cuomo's, which the New York governor previously described as the most "aggressive" in the nation. It's safe to assume, though, that their actual case totals are significantly higher than the reported numbers as well, given limitations on testing capacity and outreach in some hard-hit communities.

Cuomo's antibody study reflected higher positivity rates in communities of color, which mirrors racial disparities evident in overall case numbers in New York and across the country. Both the governor and de Blasio have extended outreach, opening up new central testing locations and funneling masks and other supplies into NYCHA facilities to equip people for self-protection. The mayor also wants the city to starting doing as many as 10,000 tests a week, and will open three more NYCHA testing sites next week.

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