Andrew Cuomo’s mixed Covid-19 record in New York, explained

New York Gov. Andrew Cuomo is now widely seen by Democrats and the left as a hero in the fight against Covid-19.

In the spring, his daily news conferences about the coronavirus became the liberal counterbalance to President Donald Trump’s rambling, bizarre press briefings. At the Democratic National Convention, Cuomo claimed New Yorkers “climbed the impossible mountain, and right now we are on the other side.” He’s now writing a book about New York’s response to the pandemic, in which he seems poised to portray himself in a positive light.

Cuomo might seem like an unlikely hero, given that New York suffered the worst Covid-19 outbreak in the US, with only neighboring New Jersey coming close in terms of deaths after accounting for population. Its death toll of more than 32,000 is by far the highest in the country, amounting to more than 18 percent of Covid-19 deaths in the US even though New York only has about 6 percent of the country’s population. New Yorkers recall the sound of sirens echoing on empty streets throughout the spring — a constant reminder of the horror the state was going through.

But it’s also true New York is now doing better than almost any other state at containing the epidemic. It has the third least daily new cases out of any state, with its case count of 3 per 100,000 people coming in at one-third the national average. It has a low test positive rate, a common measure of gauging an outbreak and testing capacity, of less than 1 percent — far below both the recommended maximum (5 percent) and the national average (6 percent).

So did Cuomo succeed, fail, or both?

According to experts, Cuomo and other New York leaders were initially slow to react to the coronavirus, letting the pathogen spread rapidly through the population before the state closed down. Some of that was due to a lack of understanding of the disease early on, but there were also steps Cuomo and others, experts argued, should have known to take even back then.

But once New York’s leaders and the public acted, they did a lot of things right, from social distancing to testing to masking.

“Early on, there were a lot of stages that could have been the canary in the coal mine for them — to start creating mitigation or containment strategies — that I think were missed,” Makeda Robinson, an infectious diseases expert at Stanford, told me. “But I do think once they got the fire lit under them, they did an excellent job implementing all these strategies.”

One notable exception: nursing homes. A New York State Department of Health advisory memo was widely interpreted by the facilities as forcing them to take Covid-19 patients from hospitals, potentially worsening the spread of the disease.

Cuomo’s office has rebuked the criticisms, arguing that it acted on the best evidence and expert advice it had at the time. To the extent the state was slow to recognize the threat of Covid-19, officials claim it was due to federal missteps and inaction that hindered testing early on in the crisis, leaving the state, one adviser said, “flying blind” and unable to detect its full epidemic before it was too late.

Experts widely agree Trump was slow to acknowledge the crisis and moved far too slowly, contradicting expert advice even after it was clear that coronavirus was a real and present threat. His actions made things harder for New York — adding another reason that the state initially struggled with the coronavirus, and many other states continue to do so.

Still, New York also shows that action is possible even under Trump’s flailing. Cuomo could and did issue a stay-at-home order and mask mandate without federal intervention.

And despite initial mistakes, New York and its leaders have by and large remained vigilant. They’ve been slow to open back up, especially when it comes to risky indoor environments. They’ve encouraged the public to continue taking steps, like social distancing and masking, seriously. And the public has been, at least anecdotally, relatively receptive to the necessary precautions, having already gone through a major Covid-19 outbreak.

The state’s late success as much of the country continues to struggle with a second coronavirus wave offers a lesson to the rest of the US and world: Covid-19 is not something that can simply be vanquished in a matter of weeks or months. It requires continued and sustained vigilance.

Unfortunately, it’s a lesson that only came about after Cuomo and state leaders oversaw and learned from the worst Covid-19 outbreak in the country and one of the worst in the world.

New York closed too slowly

Cuomo’s first big mistake: He was too slow to take serious action.

On March 1, New York state reported its first Covid-19 case. On March 2, Cuomo acknowledged that community transmission within the state “is inevitable.” By March 3, the state confirmed the first case of community transmission. At that point, the state’s first big outbreak took off in New Rochelle. On March 5, New York City Mayor Bill de Blasio said that “you have to assume [the virus] could be anywhere in the city.” Each of these events could have served as early red flags for aggressive action.

It became increasingly clear, too, that the coronavirus was spreading not just in far-flung places like China and Iran, but in the West too. Italy was struck hard first by March, leading to haunting stories of overflowing hospital wards, patients turned away, and a growing death toll. Spain, Belgium, and France soon followed with big outbreaks and climbing death tolls.

Cuomo and other New York leaders started to mobilize. They began holding regular news conferences, warning of the virus and threats. They started to close down parts of the state, including in-person teaching at schools and large gatherings, while recommending people work from home if possible.

Even then, the messaging was muddled. Cuomo on March 2 told reporters, “We have been ahead of this from Day 1.” De Blasio on the same day tweeted that he was “encouraging New Yorkers to go on with your lives” and “get out on the town despite Coronavirus” — offering a movie recommendation for The Traitor.

At this point, experts said, the state just moved too slowly, particularly with a stay-at-home order.

“It did take us a while to focus on the strategies that we really needed to implement, given the threats that we faced in New York,” Denis Nash, an epidemiologist at the City University of New York, told me. “It’s hard to expect our elected officials to get everything right from the beginning in such an unprecedented situation. But I still think that some of our elected officials in New York — I’m thinking of Gov. Cuomo and Mayor de Blasio — really waited a little bit too long to make some hard decisions.”

Cuomo was vocally skeptical of a stay-at-home order. Asked about de Blasio’s comments advocating for a “shelter-in-place” order, Cuomo on March 19 suggested such a move was unnecessary, arguing, “I’m as afraid of the fear and the panic as I am of the virus, and I think that the fear is more contagious than the virus right now.” Behind the scenes, the mayor and governor reportedly bickered about the order, with Cuomo remaining resistant.

Meanwhile, the San Francisco Bay Area issued the country’s first regional stay-at-home order on March 16, which went into effect the next day, and California issued an order on March 19 that went into effect the same day.

On March 20, Cuomo acquiesced — issuing a stay-at-home order for the whole state that would take effect two days later.

A few days of delayed action may not seem like a long time. But exponential growth means cases of Covid-19 can double in a couple of days, quickly spiraling out of control — making early action key to nipping the problem in the bud before it explodes out of control. Tom Frieden, who served as the director of the Centers for Disease Control and Prevention under President Barack Obama, told the New York Times that the state could have reduced its death toll by 50 to 80 percent if it locked down a week or two earlier.

“I don’t think we would have averted an outbreak,” Nash said. “We could have averted a surge. It could have been less of a surge. I also think it would have bought time for the rest of the country, because, no doubt, a lot of the cases that went on to occur around the US originated in New York.”

Cuomo’s office questioned whether the state could have acted quicker. A week before Cuomo issued a stay-at-home order, the state had reported around 50 Covid-19 cases a day and zero deaths. By the time of the order, there were nearly 1,000 cases and 10 deaths a day. Without that level of spread, the public may have been skeptical of drastic measures.

“You can’t really enforce some of these policies. You have a state of 20 million people. You don’t have enough law enforcement to effectively enforce them. You have to have public buy-in,” Gareth Rhodes, a member of Cuomo’s Covid-19 Task Force, told me. “If we started shutting down any gathering or closing schools in February, when there wasn’t a confirmed case, it’s arguable people simply would not have listened at all.”

New York wasn’t alone in acting slowly. The CDC and Food and Drug Administration took weeks to fix problems that hindered testing in February and March, making it hard to detect the virus as it spread. And New York, despite the delay, was still one of the first states to shut down.

New York may have gotten unlucky, too. Its position as a major international hub, its density, and its widespread dependence on public transportation made it uniquely vulnerable to Covid-19. These factors — considered upsides to New York in most other situations — were out of Cuomo’s control.

The virus also initially spread when we simply knew less about it. We didn’t know what parts of lockdowns would be effective, or that outdoor spaces, for example, were comparatively safer. We had much less research on the benefits of masks. And it was still unclear how this virus would affect the US in particular.

“It was very early on in the pandemic, when we were still learning about Covid — a lot was unknown still,” Sandra Albrecht, an epidemiologist at Columbia University, told me. “It was a learning experience.”

A nursing home advisory likely made things worse

Cuomo’s second big mistake came after the state started treating Covid-19 as a serious threat. On March 25, his administration issued an advisory that effectively forced nursing homes to take in Covid-19 patients from hospitals after they supposedly recovered. The rules barred nursing homes from demanding a coronavirus test prior to the transfer. In general, nursing homes interpreted the rules to force them to take in Covid-19 patients.

The idea was to limit hospital occupancy — a huge point of concern, as the coronavirus strained hospitals worldwide, including in New York. But critics say the advisory pushed Covid-19 into some of the most vulnerable places in the state.

According to the Covid Tracking Project, more than 6,600 people have died in nursing homes and other long-term care facilities in New York, comprising about 26 percent of Covid-19 deaths. (It’s hard to compare how bad New York’s nursing home outbreaks were versus other states’ due to differences in how such cases are counted.)

Republicans and conservatives have seized on the advisory to criticize Cuomo, especially after he spoke at the Democratic convention. Michael Caputo, a spokesperson for Trump’s Department of Health and Human Services, tweeted, “Does the #DemConvention know @NYGovCuomo forced nursing homes across NY to take in COVID positive patients and planted the seeds of infection that killed thousands of grandmothers and grandfathers?”

Cuomo and the New York State Health Department have pushed back against the claims. Cuomo has described the criticisms as “political.” The New York State Health Department released a report suggesting Covid was spreading in nursing homes prior to the advisory and largely due to infections among staff, not formerly hospitalized patients.

But experts have been highly critical of the state’s report, arguing its shoddy methodology wouldn’t make it into a reputable scientific journal.

Experts told me that, overall, New York’s nursing homes were likely to suffer Covid-19 deaths once there was a big outbreak in the state, even if Cuomo’s administration hadn’t issued the advisory — a reflection of longstanding problems with infection control in these facilities.

Still, they argued that the advisory likely made things worse. Even the state’s report admits that some patients who were transferred back to nursing homes were infectious, although it’s not clear how many and which led to more infections.

“It didn’t help,” Albrecht said. The advisory “probably worsened the situation.”

But we can’t say with certainty how many of the thousands of Covid-19 deaths in New York nursing homes are linked back to the advisory.

Some of that comes down to how the state tracks these deaths. New York only counts a death as linked to a nursing home if a patient dies in one of these facilities. Since patients could contract the virus in a nursing home, then get transferred to a hospital and die there, New York’s tally almost certainly undercounts deaths linked to outbreaks in nursing homes.

Cuomo has repeatedly said he isn’t to blame, dismissing criticisms about the nursing home advisory as politically motivated. Still, his administration updated the advisory in May, requiring that patients test negative for the coronavirus before they’re sent to nursing homes.

The federal government didn’t help much

While New York did some things very wrong, it was also true that Trump and the federal government often didn’t help — and, with their own failures and inaction, actually made it much harder for New York and other state and local governments to respond to the coronavirus pandemic.

“One of the real problems is that our entire strategy, nationally and even globally, was really backward,” Stephen Morse, an epidemiologist at Columbia, told me, pointing to the state-by-state, country-by-country efforts over a truly national or global response. “I was stunned by the total lack of coordination.”

As experts called for federal leadership and a national plan, the Trump administration actively abdicated its duties to state and local governments. It claimed that when it came to procuring badly needed tests, for example, the federal government was merely a “supplier of last resort” — leaving cash-strapped states to bid against one another, and other nations, for test kits and other equipment.

When the federal government recommended that people social distance in March, and as experts said the pandemic would be a months-long battle, Trump suggested people could get back to normal by April in time for Easter. After federal agencies released a phased plan for reopening, Trump called on states to reopen faster and “LIBERATE” them from economic calamity.

As experts pushed for more testing, Trump said that he told his people to “slow the testing down, please.” After the CDC recommended people wear masks in public, Trump said it was a personal choice, refused for months to wear a mask in public, and even suggested people who were wearing masks were doing so to spite him (though he’s recently changed his tone).

While federal agencies and scientists diligently look for treatments for Covid-19, Trump has advocated for ineffective and even dangerous approaches — from repeatedly hyping the malaria drug hydroxychloroquine, which hasn’t been shown to be useful, to musing about injecting bleach.

Taken together, it’s Trump’s record — of magical thinking, lies, and incompetence — that sets the US apart, as it’s suffered a massive surge of Covid-19 cases and deaths that other developed nations (with the exception of Spain) have avoided.

“It begins in many ways, and you could argue it ends in many ways, with the Trump administration,” Ashish Jha, faculty director of the Harvard Global Health Institute, told me. “If George W. Bush had been president, if John McCain had been president, if Mitt Romney had been president, this would have looked very different.”

None of this absolves Cuomo for New York’s early missteps. He still could have issued a stay-at-home order earlier. He could have instituted a mask mandate before mid-April. His administration didn’t need to issue the nursing home advisory and then take weeks to correct it.

But federal inaction certainly didn’t help. By failing to build up a testing and tracing system, failing to encourage the widespread use of masks, and refusing to use the full powers of the federal government to boost production of equipment for health care workers, Trump put more work on cities, counties, and states that simply have fewer resources and less reach than the federal government.

New York officials point to issues with testing as a particularly damaging federal failure. When the CDC botched its tests in February and the FDA was slow to allow other tests, the federal government left what the New York Times called a “lost month” in terms of testing.

“There was this entire month that we were basically flying blind through no fault of our own,” Rhodes, of Cuomo’s task force, said. “We should have been testing much more.” He added, “Failing to recognize [Covid] earlier is not a state failure. It’s a failure of the federal government.”

New York is a relatively wealthy state with the resources to buy a lot of tests. But if testing problems are originating in other states — a swab factory in Maine, for example — there’s only so much that New York can do. That forced New York, as well as other states, to engage in a bidding war for limited supplies, slowing how quickly any state could build up its testing capacity even if it was fully committed to the cause.

Trump’s failure to act even applies to the travel restrictions he often boasts about. While Trump focused on restricting travel from China in February and early March, New York’s infections largely originated in Europe. Only weeks after community spread likely began in the Northeast of the US did Trump restrict travel from Europe — and only partially. That was simply too little, too late.

So while states, including New York, made plenty of mistakes that led to worse Covid-19 outbreaks, Trump and the rest of the federal government made things much worse too.

New York is now doing the right things — and needs to keep doing them

The situation has improved dramatically in New York since the spring. Today, the state is in the bottom three for daily new cases, with a rate of 3 per 100,000 people. Its test positive rate is the third lowest in the country at less than 1 percent — an indication of a controlled outbreak.

Experts say Cuomo and other leaders in the state deserve a lot of credit for such outcomes. New York dramatically scaled up testing — with the third-highest testing rate, when controlling for population, among all states. It built up a contact tracing system. It imposed a masking mandate. It has, in general, adhered closely to expert advice and empirical data as it’s evolved and shifted.

Perhaps most importantly, Cuomo resisted what many other states did not: reopening too quickly. The state imposed strict regional metrics that localities have to meet to reopen, and it’s stuck with them. New York City still hasn’t allowed indoor dining or bars, both of which present a huge risk for Covid-19 transmission.

It’s a sharp contrast to California Gov. Gavin Newsom (D). He was the first in the country to close down his state but, under pressure from local and private actors, allowed counties to reopen more quickly, getting waivers that effectively allowed them to ignore the standards the state previously set. That allowed indoor dining, bars, and other risky indoor spaces to reopen — until cases exploded in California, forcing Newsom to eventually reel back.

“California was very aggressive early on,” Robinson, of Stanford, said. “But during the time that we were sheltering in place, we often didn’t ramp up as much testing and contact tracing — so that when people started to come back outside, there wasn’t a definite plan with how we were doing that.” She added, “People felt like we paid our penance, let’s go back to life as normal, not realizing that this is something we’re going to be dealing with for years.”

Cuomo, at least, hasn’t faced similar problems so far (though that could change if the state starts to reopen aggressively, experts warned).

There are factors beyond policy that have helped New York. Because the state suffered a massive outbreak in the spring, there’s likely some element of population immunity making it more difficult for cases to spread too widely as long as people follow some precautions. The public has helped, too, remaining cautious even as the state has reopened; a New York Times analysis, for example, found New York had some of the highest rates of mask-wearing in public of any state.

“Once we did [act], it’s truly an incredible testament to New Yorkers that we have been able to do what was needed to get where we are today,” Nash, of the City University of New York, said.

New York’s success in the aftermath of a deadly outbreak shows the need for continued and sustained vigilance. It’s not enough to merely push down cases and test positive rates — as many states did early in the summer — people also need to stay cautious and keep the spread of the virus from getting out of control again. Resisting temptation, such as with reopening risky indoor spaces like bars, is crucial.

The unfortunate reality is Covid-19 won’t go away until a vaccine or similar treatment is widely available. The fall and winter could be even worse as schools reopen, the cold pushes more Americans indoors, the holidays bring family and friends together around the country, and another flu season looms — all of which could warrant more vigilance, not less.

Covid-19, then, remains a constant threat. And if states want to avoid outbreaks as bad as New York’s, they could learn from what it did in the aftermath.

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