I live in the middle of a large North American city; Toronto. I also lived through the SARS crisis in 2003 that killed several Torontonians before a major outbreak was prevented. So, I was concerned when Covid-19 cases were rising in Toronto and when numbers were exploding in New York City. Would we be next?
As it turns out, Toronto and many other big cities all over the world did not have a major disaster like New York. This made me wonder why the coronavirus pandemic affected New York City more than other urban centers.
Using newspaper reports, I constructed a time-line of events that help to understand what happened. The key factor that explains New York City’s fate is that health officials did not have tests to detect the spreading of the virus that occurred in the early weeks of March and possibly even in February. However, the lack of testing does not explain why other cities that were testing did not find more cases at the same time. Thus, the disaster in NY is the result of a combination of two factors. The virus arrived in NY earlier than in other cities and it was able to spread undetected because there were insufficient tests. While it is unclear why Covid-19 hit NYC earlier than other cities, the lack of tests can be explained by two problems. The US center for disease control was slow in developing and producing Covid-19 tests and the Food and Drug Administration did not allow private companies to carry out tests when the virus was already spreading in NYC. If tests had been available two weeks earlier, social distancing measures could have been introduced earlier to reduce the death toll considerably.
Covid-19 arrived early in the United States. The first outbreak with several deaths occurred in Washington State. The virus spread undetected for several weeks. Seattle is far away from NY city, but it takes only a few hours to fly from one city to the other. Flights also arrived daily from many international locations with confirmed Covid-19 cases. It was only a matter of time, till the first Covid-19 case would arrive in New York.
The NYT reported the first official case on March 1 (NYT.03.01). The article shows that officials believed to be in control of the situation, although it is likely that the virus was already spreading undetected in the city.
New York City’s Health Commissioner, Oxiris Barbot also assured New Yorkers that they had nothing to worry about.
Major de. Blasio also reassured NY residents that the situation was under control.
Similar reassurances were printed in other news outlets.
It is not clear whether officials were simply trying to be optimistic or to prevent a panic, but they had no way of knowing how bad the situation was because they had conducted only nine tests for the virus at that point.
Statisticians are trained to make a clear distinction between the absence of evidence and the evidence of absence, but it is a human fallacy to mistake the two. Apparently, officials in NY were also treating the absence of confirmed cases as evidence that Covid-19 was not in NYC, although it is obvious that no cases can be confirmed without testing. The need for positive evidence that was unattainable delayed school closures and other measures that could have slowed the spread of the virus in early March.
On March 4th the New York Times reports that Seattle introduced several measures to deal with the Covid-19 outbreak . The same NY records 9 positive cases (NYT.3.4).
Probably because tests were limited, health officials advised people not to get tested for Covid-19 even if they had symptoms.
The illusion was that officials still had control over the virus and could trace infections, while the virus was spreading undetected among NY residents.
More testing produced more positive results. The NYT reports that 89 positive cases, including an Uber driver in Queens (NYT.3.7). Governor Cuomo declares a state of emergency to prepare a response to the spread of the virus. At the same time, he aims to calm New Yorkers.
Another article also still sounds optimistic about the fate of NYC. “New York City, of course, has not faced the cataclysmic impact of the virus that has been visited upon areas of China or Iran or Italy, and government officials are scrambling to ensure it remains that way” (NYT.3.7.b).
Another article mentions that school closures are a last resort (NYT.3.7.c). The article also points to systematic problems that may explain why NYC was hit harder by Covid-19 than other big cities in the United States or in other countries.
In hindsight it becomes apparent that the attempt to protect vulnerable students endangered them and many more vulnerable New Yorkers even more.
False information may have further led to the fatal decision to keep things running. “The federal Centers for Disease Control and Prevention have advised that, so far, children have been less likely than adults to become infected.” Instead, they may have been asymptomatic carriers of the virus and passed it on to older family members. It is not clear whether the misinformation was on the linked website or a misunderstanding by the reporter.
And today, after everybody has learned in the most painful way possible about exponential growth, the comment by a math teach seems incredibly naive.
Cuomo publicly criticizes the Center for Disease Control for preventing private labs to start testing (NYT.3.8). The lack of testing is of course a main reason why the virus could spread unnoticed in NYC. However, even with the limited amount of testing, it was apparent that community transmission was happening.
On March 8, the testing situation seemed to be at least temporarily resolved because NY received a shipment of 23,000 tests.
Although aware of a crisis, officials seemed to be unable to foresee the exponential increase in cases, expecting only several hundred cases over a time span of several weeks.
It is not clear whether officials did not have access to models or whether models did not predict a dramatic increase in cases. It is clear, however, that they underestimated the severity of the situation on March 7 and did not enact drastic social distancing measures to slow the spread of the virus.
On March 10, the biggest news was that prisoners would produce hand sanitizer. The major of NYC, Mr. de Blasio, announced that there were still no plans to close schools.
On March 11, the World Health Organization (WHO) declares Covid-19 a pandemic (NYT.3.11).
That day, the New York Times reported 328 confirmed cases for NY state and 96 for NYC. These numbers may still seem reassuringly low, but are meaningless because testing was still very limited.
In response to the evolving situation, Governor Cuomo announced a ban of gatherings of more than 500 people. In hindsight, we may say that this was too little too late to prevent spreading of the virus in NYC.
Equally useless was Trump’s travel ban for flights from Europe. This might have worked several weeks earlier, but on March 11 the virus was already in North America. Banning flights out of NY to other parts of the US might have been a more rational response to the actual pandemic.
March 13 is the first day on the covid-tracking website that lists more than 1,000 tests for NY state. Out of 2,779 tests 421 results were positive. This means 15% produced a positive result. In comparison, South Korea or other countries that were able to get ahead of the virus like Australia or New Zealand have positive rates of 2%. Even today several US states in lock-down have lower positive rates. If NY needed positive evidence that the virus is out of control, here it was.
But March 13 was a Friday and not much happened in response to this information.
The Covid-Tracker recorded 4543 tests and 729 positive results. While testing increased by 63%, positive results increased by 73%. The positive rate rose to 16%. The CovidTracking also projects lists 3 deaths for this day, while a New York Times article reports 5 deaths (NYT.315c). As it takes several weeks from infection to deaths, these deaths indicate that the virus was spreading in NY at the beginning of the month.
New York’s major announced the closure of bars and restaurants (NYT.3.15).
The announcement was made at the end of the March 14/15 weekend. It is not clear how many people got infected because bars and restaurants were not closed earlier on Friday to prevent spreading of the virus over the weekend.
The NYT article also implies that this decision was not made on the basis of an assessment of the local situation in NY, but rather in response to general guidelines by the Center for Disease Control for the United States in general.
The article further suggests that de Blasio and Cuomo reacted to social pressure rather than in response to a situation that was already out of control.
The same day, it was announced that schools will be closed. Again, this decision was made in response to pressure from parents and teachers and not a proactive decision by the major (NYT.3.15b).
The New York Times conducted a very informative interview with Governor Cuomo (NYT.3.17).
I find this answer a bit difficult to interpret the answer. One-thousand cases is a lot, especially because there were only about 300 cases on March 11, implying that cases tripled in one week. However, this increase is partly due to more testing. According to the Covid-Tracking numbers, testing also increased from a few hundred to over 5,000 tests. Thus, the number of cases alone is a meaningless (symbolic) number, not an assessment of the situation in New York that explains a sudden shift in policies, closing of schools, and closing of restaurants. In the background are models and something must have changed in the modeling predictions.
It is not clear what the models’ predictions were on March 1 or on March 8 or whether the model was unable to make predictions because there were no testing data. What is clear is that the model predicted the disaster in NY when it was too late. As deaths follow infections with a lag, most of the 5,000 deaths by April 7 can be attributed to infections that occurred before March 17.
Despite the severity of the model predictions, Cuomo did not issue a stay at home order. The New York Times reports about disagreement between New York’s major and governor Cuomo, with Cuomo explicitly opposing more drastic measures (NYT.3.17.b).
The most important news was that positive results skyrocketed by more than 1,000 cases in one day, which implies that cases nearly doubled in one day (NYT.3.18).
However, the article implies that the governor did not think that this was an alarming finding.
However, even if there were 5,000 tests, finding 1,000 positives is not a good outcome. It implies a positive rate of 20%. If we assume that only people with flu-like symptoms were tested, it means that 1 out of 5 patients with flu-like symptoms were Covid-19 positive. Such high levels imply that there are many more people with and without symptoms who are infected by the virus. The alarm bells should be ringing. Instead Cuomo seems to make light of the result as if it is just a statistical blip.
Governor Cuomo introduced further measures, but did not issue a full stay-at-home order.
A New York Times article reports that parks and playgrounds remain open (NYT.3.18.b).
On March 20, governor Cuomo did what he said he would never do; he told New Yorker’s to stay at home and closed non-essential businesses (NYT.3. 20).
Cuomo explained that the new measures were put in place because the numbers were still going up. However, nobody could have expected that the numbers would stop increasing within a couple of days or even a week of the earlier measures. The numbers would be going up for a long time. The only question was how quickly they would be going up. And by issuing a stay at home order sooner than later, they would have increased slower.
With 20,875 cases and a positive rate of 36%, the number of cases in NYC is exploding. While nobody seemed to believe that Covid-19 was in NYC a couple of weeks ago, the positive evidence now made it seem logical and inevitable that Covid-19 was spreading in early March when no actions were taken (NYT.3.23).
One can only ask, why New York did not enact measures earlier, even without testing, if it was clear that an outbreak in New York was inevitable and that the virus would spread more quickly than in Seattle.
At this point, governor Cuomo had become a household name all over the United States (NYT.3.24).
He is able to get things done. He obtained the rights to do testing in state. New York became the leader in testing. As a result, he had a clear picture of the situation than anybody else in the United States. And yet, despite this information, he still underestimated the severity of the crisis.
Cuomo’s strength is apparent in the handling of the disaster, but questions can be raised about his ability to foresee the scale of the disaster and to avoid or at least mitigate it early on.
On March 26, the situation in NY was dire. The number of deaths had nearly doubled from 3,800 to 6,800 in one day. In contrast, numbers in other states were low and some states had not recorded a single Covid-19 death. Was New York simply the canary in the coalmine (after Washington) or was New York a unique hot-spot in North America? Experts were not sure (NYT.3.26).
One expert suggests that the virus arrived in NY as early as January and was able to multiply undetected.
If the virus arrived this early, there would have been Covid-19 related deaths in February, but no such deaths were recorded. Maybe the lack of testing made it impossible to identify Covid-19 as the cause of death.
Urban density is a salient feature of NY, but NY is not the only urban, dense city in the world. Yet, other urban cities especially in Asia did not become hot-spots like New York.
Maybe Asian urban cities were spared because Asian countries were very good at keeping Covid-19 out of their countries or in South Korea’s case control the outbreak before it reached Seoul. However, other big cities in North America like Chicago or Toronto have also not seen the same level of cases or deaths as New York.
At least on March 26, there were no clear answers.
However, the question is clear. Why did New York City have more cases than other big cities in the early weeks of March or even February? Undetected spread is not the answer because other big cities in the US also had no tests. For example, the entire state of Illinois had conducted less than 500 tests by March 13. Thus, there was ample time and opportunity for the virus to spread in Chicago, but it didn’t. Was New York just unlucky?
On April 15, Cuomo announces an executive order to wear a face mask in public, when it is impossible to maintain social distancing (NYT.3.15). This order follows a major reversal in recommendations that were given by the World Health Organization. Why people were not advised to cover their mouth in crowded places like subways is another important question. Maybe the wearing of face masks can explain how densely populated cities in Asia were able to avoid the spread of the virus. It is possible that an executive order to wear masks in early March could have saved a lot of lives, but at this point there is insufficient information about the transmission of the virus in public places to be sure. The fact that other cities with heavy use of public transport like Chicago or Berlin did not suffer the same fate as New York suggests that public transportation alone is not a key factor in the spread of the virus.
There is light at the end of the tunnel (NYT.4.16). The worst is over and the question is how and when NY will start coming back to life. The situation is now much more predictable and controllable, especially because testing makes it possible to track and trace cases. The lack of tests is clearly a big factor that contributed to the disaster. How much the death toll could have been reduced by earlier, more decisive actions in the beginning of March may be an academic question that will never get a satisfactory answer. The coming months will provide new data that may help to explain why New York lost so many more lives than other North American cities. Hopefully, the whole world will learn from mistakes that were made to avoid repeating them when the next virus comes.