The Coronavirus Outbreak

By J. David Goodman and Michael Rothfeld

The factors that made the city one of the hardest hit on the planet — its density, mass transit and tourism — complicate a return to normalcy.

ImageA coronavirus testing site at Gotham Health in Brooklyn last month. Opening more such sites will be an important element in the city’s ability to limit virus cases.
A coronavirus testing site at Gotham Health in Brooklyn last month. Opening more such sites will be an important element in the city’s ability to limit virus cases.Credit...Dave Sanders for The New York Times

Nearly 190,000 people were tested for the coronavirus in New York City over the past two weeks, a record number. The increase in testing, crucial for curbing the outbreak, came as Mayor Bill de Blasio announced plans to hire a small army of 1,000 disease detectives to track down the contacts of every infected New Yorker.

The city is also paying for hotels to house people who cannot quarantine in their cramped apartments, and it may use the USTA Billie Jean King National Tennis Center in Queens for the same purpose.

From the State Capitol, Gov. Andrew M. Cuomo has established a framework for reopening the state, based on seven concrete, health-related milestones, and he has asked Bill Gates, the restaurateur Danny Meyer, the New York Knicks owner James L. Dolan and dozens of other outside advisers from the upper echelons of New York’s business world to help guide him on how best to restart the economy and, possibly, reimagine public education.

Still, despite all the plans and initiatives, the reopening of New York City remains a long way off.

The factors that made the city the U.S. epicenter of the pandemic — its density, tourism and dependence on mass transit — complicate a return to any semblance of normalcy. The city is still far from meeting the public health metrics necessary to reopen, from available critical-care beds to new hospital admissions for the virus.

While states like Colorado, Georgia and Texas have let the stay-at-home orders lapse and businesses like nail salons and retail stores reopen, New York State is moving cautiously, anticipating a partial reopening later this month, mostly in rural areas.

The factors that made New York City the U.S. epicenter of the pandemic — its density, tourism and dependence on mass transit dependence — will complicate the effort to restart its economy.Credit...Brittainy Newman/The New York Times

How long might it take to restart New York City’s economy?

“Nobody can tell you,” Mr. Cuomo said last week.

The virus has killed more than 19,000 people in New York City, a death toll that exceeds those in all but a small number of countries, or in California, Illinois, Massachusetts, Michigan and Texas combined. While the outbreak is receding in the city, more than 1,000 new positive cases were reported on at least three days last week, for a total that now tops 181,000.

The key to reopening is containing the virus, and that will take a vast infrastructure of testing and contact tracing unlike anything the United States has ever seen, public health experts say.

Even when the new public health apparatus is fully staffed and running, it will merely lay a foundation for businesses and residents to feel safe returning to work and play. Many may choose to stay home.

The decision about when to reopen involves a balancing act: The longer New York is shut down, the more the pandemic will abate, reducing the need for testing and contact tracing while allowing officials more time to expand those efforts. But the economic damage to the city and the state will continue to grow.

More than 830,000 people have filed for unemployment in New York City alone since mid-March, when the shutdown began, according to state data.

Mr. Cuomo said his metrics, in line with recommendations from the federal Centers for Disease Control and Prevention, would guide the state’s reopening, region by region, with the city almost certainly among the last to return.

More than 830,000 people have filed for unemployment in the city since mid-March.Credit...Brittainy Newman/The New York Times

A true reopening of the city, Mr. de Blasio said this month, remained “a few months away at minimum.”

Plans for how to get there are still being created. A task force convened by the mayor held its first session via conference call late last month and it was a sobering “dose of realism,” according to Jennifer Jones Austin of the Federation of Protestant Welfare Agencies, who was on the call.

Exactly two hotels are being used exclusively for isolation so far, though the city has said it could expand to as many as 11,000 beds. The 1,000 new contact tracers that are to be part of the effort will not be hired for weeks, and 1,500 more will be needed to meet Mr. Cuomo’s milestones. Testing capacity will not reach 50,000 a day until August at least, officials said. That number still may not be sufficient.

On Wednesday, when Mr. Cuomo’s panel of outside advisers held its first video meeting, it included no chief executives, little in the way of advice and no talk of how New York City would get back on its feet.

A task force on reopening the city, convened by Mayor Bill de Blasio, held its first session via conference call last week.Credit...Dave Sanders for The New York Times

Mr. de Blasio works from a mostly empty City Hall in Lower Manhattan with a skeleton staff, speaking to top officials in an endless series of teleconferences and secure video chats. Each day, the mayor has an early call on small decisions — how long to extend a moratorium on alternate-side-of-the-street parking rules, for example — and, later, one or two big discussions about the city’s future.

But some of the most urgent questions, such as how to handle the normal load of nearly six million daily subway riders, or how 1.1 million school children might actually return to classrooms, have yet to be answered by either the city or the state.

Schools have been canceled for the rest of the academic year, and the city’s powerful teachers’ union, the United Federation of Teachers, has already said it would expect a system of widely available testing, contact tracing and cleaning to be ready and working before it would support reopening. The union has proposed experimenting with having school in split shifts, morning and afternoon.

“Until the schools are open, a good subset of working New Yorkers cannot leave their homes,” said Alison Hirsh, a top adviser to Mr. de Blasio and one of several city officials, including deputy mayors Dean Fuleihan and Vicki Been, coordinating the reopening plans.

“There’s an argument to be made that one of the reasons to keep the schools closed is to continue to force anyone who can work from home to continue to work from home,” Ms. Hirsh said. “That’s one way that you can slow down the reopening and help maintain a flatter curve.”

Mr. de Blasio has said he is planning to reopen schools in September.

Schools were included as part of the governor’s fourth and final phase of any region’s reopening, after restaurants and hotels.

Reopening schools was included in the final phase of Gov. Andrew M. Cuomo’s plans for returning New York to something like normal.Credit...Brittainy Newman/The New York Times

Restaurants are an easier problem to solve than schools because the state can rely on occupancy limits, said Jim Malatras, an adviser to the governor on the virus response. Whether restaurants can survive with those limits is an open question.

When it comes to schools, Mr. Malatras said, the state had not “figured it out yet.”

“This is a potential source of infection,” he said, citing the City University of New York as an example. “How do you do a lecture hall in CUNY? You can’t.”

At the State Capitol in Albany, Mr. Cuomo still holds his coronavirus meetings in person with a small group of close advisers, including Mr. Malatras, the president of SUNY Empire State College; Melissa DeRosa, the governor’s top aide; and the budget director, Robert Mujica.

Much of Mr. Cuomo’s reopening planning for New York City has been led by two former top aides: Steven M. Cohen, general counsel at the investment firm MacAndrews & Forbes and William Mulrow, who now works at the private equity firm Blackstone.

Mr. Cohen and Mr. Mulrow have had dozens of one-on-one calls with business and real estate leaders, and they have been particularly interested in hearing from companies with operations in Asia, to learn how operations restarted there, according to two people who requested anonymity to discuss private conversations.

City and state officials speak frequently, but Mr. Cuomo appears interested in maintaining an upper hand, according to three people with knowledge of the communications. Most recently, his office did not alert City Hall about Mr. Cuomo’s reopening metrics before he detailed them publicly, though the benchmarks could determine the city’s near future.

Mr. Cuomo has said the state’s regional approach to reopening would depend on an area’s ability to meet specified metrics.Credit...Victor J. Blue for The New York Times

The metrics, which included keeping new hospital admissions for virus infections under two per 100,000 residents on average over three days, do not bode well for New York City in the short term. As of early May, the city had more than twice that number.

The city has achieved its own stated milestone for hospital admissions, seeing fewer than 200 new admissions for illness resembling Covid-19, the disease caused by the virus, for 10 straight days. But other goals, including reducing the number of patients in critical care and the percentage of positive coronavirus tests, have remained out of reach.

“I can’t help but feel the challenge is more intense here than anywhere else in the United States,” said Dr. James Crawford, the senior vice president for laboratory services at Northwell Health, New York’s largest hospital system, who has led discussions about state efforts to vastly expand testing for virus antibodies.

Far from reopening, the virus is still closing parts of New York as the summer months arrive. Pools. Beaches. Block parties. Concerts.

Mr. de Blasio is working to close up 100 miles of city streets to make it easier for residents to practice social distancing. Mr. Cuomo ordered that city subways cease round-the-clock service, a practical change to clean cars and remove those sleeping in them, but one that struck at the very heart of New York’s up-all-night identity.

The subway, a 24/7 icon of New York City, has started to shut down for four hours a night so the whole system could be thoroughly disinfected.Credit...Todd Heisler/The New York Times

Top state and city officials are already contemplating the need for radically different routines, including transit systems with limits on occupancy for trains and buses. That could require staggered shifts for millions of workers.

“I don’t know that it’s going to be possible to have rush hours,” said Rick Cotton, the executive director of the Port Authority of New York and New Jersey, which operates commuter trains to and from Manhattan.

By June 1, the city may need the capacity to test as many 40,000 people a day for the virus, by one estimate.Credit...James Estrin/The New York Times

To reopen New York City in the months and, possibly, years before a vaccine is available will require monitoring and stamping out the virus wherever it appears.

The approach itself is not overly complicated, and it has long been used for diseases like tuberculosis and H.I.V. The city has, for example, done similar work to contain the few thousand cases of H.I.V. that now emerge every year.

But to rein in the virus and reopen, even partially, the city may need to handle thousands of new cases a day once it expands the criteria for who can be tested.

The Harvard Global Health Institute conducted an analysis for The New York Times that assumed all symptomatic people would be tested and that each positive result would lead to tests of 10 contacts.

Under such a scenario, Harvard considered one model that projected 4,180 new cases a day in New York City on June 1; that number of cases would call for 35,415 New Yorkers to be tested daily, more than twice as many as are now being tested.

Under a more favorable model that projected the city having 2,233 new daily cases by June 1, New York would still need about 19,352 tests a day, according to the Harvard analysis. That is 26 percent more than were tested on one recent day.

Mr. Malatras said that the city was already meeting the state’s testing metric of roughly 8,300 a day, a threshold he said was based on federal guidance.

But the models assume that social distancing will continue. When people begin to return to work, the numbers could be far higher.

Some parts of New York City, like this parking lot of a shuttered Sears in Brooklyn, are more conducive to drive-through testing centers than places like Manhattan.Credit...Dave Sanders for The New York Times

“Ideally you would take the test every day,” said Dr. Melissa Cushing, the director of the clinical laboratories at NewYork-Presbyterian/Weill Cornell Medicine. “That really answers the question: Should you be going out in society today?”

By slowing the virus’s spread, the shutdown in New York City has freed up some testing capacity, and some private hospitals have begun to test a broader range of people, not just health care workers with symptoms but also some without, and some emergency services workers.

Much more is needed.

“Testing doesn’t control the spread of the virus,” said Dr. Joshua M. Sharfstein, a vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health. “It is testing and then the action that testing makes possible that really matters.”

To move to the next phase, which involves tracing every contact, the number of new positive cases would need to come down sharply.

In New York City, that could mean as few as 100 to 300 new cases a day, said Dr. Thomas Frieden, a former director of the C.D.C. and onetime New York City health commissioner. City data shows that while new cases have come down, they still range from 600 to 1,200 a day.

Mr. de Blasio on Friday moved the city’s contact-tracing program from the Health Department, which has long performed handled it, to the city’s public hospital system.Credit...Hiroko Masuike/The New York Times

At the start of the outbreak, the city had 50 people to do the work known as contact tracing. Now it has 200. The city is hiring at least 1,000 people for its tracing program, and on Friday Mr. de Blasio added a new complication, moving the work from the Health Department, which has long done it, to the city’s public hospital system.

The need could be many times greater. Mr. Cuomo’s metrics called for more than 2,500 tracers for New York City. Mr. de Blasio vowed to reach that threshold in June.

Officials acknowledged that many more than that could be needed. In Wuhan, China, the first city brought down by the virus, officials eventually deployed an army of 9,000 contact tracers.

The contacts being traced under a state-run program would not include people such as strangers on the subway, only those with whom an infected person spent 30 minutes or more within 48 hours of the onset of illness.

“You have to prioritize, at least at the beginning,” said Dr. Kelly Henning, an epidemiologist who leads the public health program at Bloomberg Philanthropies, which is helping the state to hire contact tracers.

The job is challenging, in part, because it can mean asking someone not to go out for two weeks, and, if they can’t isolate at home, to do so in a hotel or, even a sports complex set up for that purpose.

Mr. de Blasio has said that the tennis center in Queens, when it is no longer needed as an emergency hospital, would become an isolation facility, in the way stadiums in China served that role.

The Billie Jean King National Tennis Center in Queens, which was turned into a hospital for Covid-19 patients, may eventually be used to quarantine patients who test positive.Credit...Hilary Swift for The New York Times

Officials said that New York was not contemplating potentially invasive measures employed elsewhere, such as so-called proximity tracing using cellphone data, something South Korea has tried.

But to be truly effective at containing the virus, experts said, asymptomatic contacts would also need to be tested, because they can pass on the virus. That testing strategy has been seen as effective in South Korea, Taiwan and Singapore.

New York officials have not yet proposed taking that step.

The construction industry is already taking precautions with its workers, like temperature checks outside building sites.Credit...Gregg Vigliotti for The New York Times

Businesses large and small will have to figure out new ways of working in a world where the virus may still lurk in every human interaction. Where do people do their jobs and how do they work together? When do they work? Who goes into the office and who stays at home? Can people be made to go to work if schools do not open first?

The first answers may emerge when restrictions begin to ease in some parts of New York State for two industries — construction and manufacturing — that have remained partially open through the shutdown. The experiences of those businesses provide a useful, if incomplete, road map for the challenges ahead.

Three shifts instead of one. Temperature checks. No large meetings. Shields and face guards between employees working near each other. Salt and pepper shakers removed from cafeterias. Reusable water bottles banned. Stern words for co-workers who stand too close when they talk.

At Gear Motions, a manufacturer based in Syracuse that was deemed essential and has stayed open through the shutdown, managers found that they had to deal with a very human concern: fear.

“That’s what we learned early on,” Dean Burrows, the company’s president, said. “Everyone is scared.”

To combat the fear, Mr. Burrows said his company had been sharing information about the virus broadly and quickly, creating a system for sending text messages to every employee. So far, no one at Gear Motions’ factories had tested positive, he said.

Other companies have been exploring the use of wearable devices for employees that buzz as a reminder to maintain social distancing, and track employees’ locations to help with contact tracing should anyone become infected.

At La Guardia Airport, where a huge rebuilding effort has continued amid the outbreak, roughly 20 workers tested positive for the virus in the last half of March, said Gary LaBarbera, the president of the Building and Construction Trades Council of Greater New York. That prompted the Port Authority, which runs the site, the developer and labor groups to come up with a new safety plan.

Now face masks are required at all times on the site; turnstiles were removed in favor of contact-free entry points. And if a person tests positive for the virus, construction stops in the area where he or she was working, the area is disinfected, and those working with that person must stay home for 14 days.

Since the new system was adopted, the number of positive tests at the site has dropped to “the low single digits” each week, said Mr. Cotton, the Port Authority leader.

“It’s very difficult to require self-quarantine,” Mr. LaBarbera said. “But to my knowledge the workers are taking it very seriously and are following the guidance.”

Jeffery C. Mays and Jesse McKinley contributed reporting.

  • Updated April 11, 2020

    • If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • This is a difficult question, because a lot depends on how well the virus is contained. A better question might be: “How will we know when to reopen the country?” In an American Enterprise Institute report, Scott Gottlieb, Caitlin Rivers, Mark B. McClellan, Lauren Silvis and Crystal Watson staked out four goal posts for recovery: Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care; the state needs to be able to at least test everyone who has symptoms; the state is able to conduct monitoring of confirmed cases and contacts; and there must be a sustained reduction in cases for at least 14 days.

    • The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • It seems to spread very easily from person to person, especially in homes, hospitals and other confined spaces. The pathogen can be carried on tiny respiratory droplets that fall as they are coughed or sneezed out. It may also be transmitted when we touch a contaminated surface and then touch our face.

    • No. Clinical trials are underway in the United States, China and Europe. But American officials and pharmaceutical executives have said that a vaccine remains at least 12 to 18 months away.

    • Unlike the flu, there is no known treatment or vaccine, and little is known about this particular virus so far. It seems to be more lethal than the flu, but the numbers are still uncertain. And it hits the elderly and those with underlying conditions — not just those with respiratory diseases — particularly hard.

    • If the family member doesn’t need hospitalization and can be cared for at home, you should help him or her with basic needs and monitor the symptoms, while also keeping as much distance as possible, according to guidelines issued by the C.D.C. If there’s space, the sick family member should stay in a separate room and use a separate bathroom. If masks are available, both the sick person and the caregiver should wear them when the caregiver enters the room. Make sure not to share any dishes or other household items and to regularly clean surfaces like counters, doorknobs, toilets and tables. Don’t forget to wash your hands frequently.

    • Plan two weeks of meals if possible. But people should not hoard food or supplies. Despite the empty shelves, the supply chain remains strong. And remember to wipe the handle of the grocery cart with a disinfecting wipe and wash your hands as soon as you get home.

    • That’s not a good idea. Even if you’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.