By Karen Rubin, News-Photos-Features.com

New York State Governor Andrew Cuomo has extended the lockdown through at least May 15 while at the same time unveiling a strategy for phased reopening of the economy and society. What is clear is that what happens next will involve a “new normal” rather than a return to the way things have been, in everything from the health care system to workplaces and transportation systems to schools. “Nothing short of a transformation of society,” Cuomo said in his April 16 press briefing.

Cuomo also raised the alarm that New York and every other state is being bankrupted by the costs of bolstering health care while shutting down their economy, cutting off revenue streams, and chastised the federal government for passing legislation that is counterproductive because it did not provide adequate funding for states. He said that the state’s federal representatives should not pass “bad legislation” that doesn’t help states and localities, and do it based on need, not politics.

“Now that we’ve shown we can flatten the curve and our efforts to control the spread of the virus are working, we must focus on a smart, effective plan to un-pause New York,” Governor Cuomo said. “The first part of the plan is to do no harm – don’t let that infection rate go up to the best of your ability and don’t lose the progress that we have made. Second, now that we have some stability in our health care system after a weeks-long overdrive, we continue to strengthen that system and ramp up testing and contact tracing to identify those who are sick and isolate them so they don’t transmit the virus to others. Then we can focus on phasing an economic return to the new normal – but we need all those activities going on at the same time for our plan to un-pause New York to work.”

While the curve in infections and hospitalizations has leveled off, numbers of dead – 606 yesterday, down from the mid-700s of previous days – continue at “horrific” levels. New York State has had more coronavirus cases than any country, and accounts for about one-third of the nation’s total.

Indeed, the Governor confirmed 8,505 additional cases of novel coronavirus, bringing the statewide total to 222,284 confirmed cases in New York State.

But Cuomo also noted that the numbers of “positives” are not an accurate reflection of infection since they only count people who are sick enough to get tested or have access to testing. Many many more can be infected who remain home. Indeed the death rate, now exceeding 30,000 in the US (nearly half of the entire country), may not account for those who have died at home. The CDC has only recently issued guidelines for a new list of “probable”  COVID-19 deaths- people who have died of symptoms that mimic COVID-19.

Still, the worst seems to be over – indeed, the only reason that the Trump Administration can even contemplate a reopening of the economy is because of the outsized impact of New York State that disguises even the uptick in other states. But Cuomo emphasized that the numbers have only leveled off as a result of the lockdown and social distancing measures that have been imposed, and because of the cooperation of New Yorkers.

The Governor said that the threat coronavirus poses will not truly be over until there is a vaccine – which is not likely for 12 to 18 months – or if there are medical treatments so that even if someone is sickened, their life can be saved.

“How do we accelerate that, expedite that? New York is ready, willing and able to work with the FDA,”  Cuomo said, noting that the state is working with many companies to develop treatments and testing in hospitals, “but that is a medical R&D function, beyond us.”

Absent that, the strategy has to be “do no harm,” he said. “Control the rate of infection – don’t let the infection rate go up or we will lose the progress made.”

The strategy of “surge and flex” to strengthen the healthcare system, by which the state increased the capacity of hospitals by 50 percent and mandated sharing and redistribution of patients, equipment and staffing worked to get through “this horrific period.” Now that the crush is over – at levels at a fraction of what the models predicted the onslaught could have been had the state not imposed a lockdown – “we have a chance to be more intelligent about handling the health care system.”

Now a chance to be more intelligent about handling health care system.”

Reopening society will necessitate wide use of testing and tracing for which, he said, “we need federal partnership” because no state has the resources to handle the amount of testing and tracing necessary. Tracing contacts once a person has tested positive will require “an army” of people he said.

(Our suggestion: hire an army of people from among the 22 million newly unemployed; the job can be done by telephone with little risk.)

Testing and tracing is necessary to determine how much the “spigot” of economic activity can be opened.

Cuomo showed how this depends on determining how many people one infected person can infect.

Once infection rates and hospitalization rates have gone down phased reopening will come by analyzing businesses based on their degree of “essential” against their level of risk of infection.

“How do do you restart the machine after stopping everything? In a coordinated way that doesn’t drive up infection. What businesses reopen is a nuanced question. There is no light switch.

“Are there more ‘essential businesses’, and what risks do they pose and what changes can they make in their businesses to make them safe?”  (But this will raise the question whether the new requirements enable them to still operate economically, such as if restaurants are required to operate at half capacity if they are to reopen.)

“In a new normal, new reality, tell us how they can adjust to it.

 “We now have an economy working with ‘essential workers’ – public transit, groceries, pharmacies.  Now as we start to bring the economy up, we move up one tranche on what is defined as essential. Are there ‘safer’ businesses that can be reopened, or can be safer? How do they reopen and operate? Where should they open first (or last)? When?

“There is a matrix based on how important the enterprise is to society and how risky is that business to the rate of infection. The lower the risk and the more a priority, the sooner they can reopen. We will do it in phases of priority, then phase up, the way phased down, by percentages.

“This will be an ongoing process, in coordination with other states. This is regional. Coordinating doesn’t mean we will always be in lockstep, but we will talk through first and hopefully not do something contradictory to other states.”

The analysis is underway, he said.

But just determining what enterprises can open based on how important and how risky is not enough.

“We must reimagine the workplace,” Cuomo said. “The private sector now has to think about what they do, how they do it, and what they need to do differently.”

That might mean determining which workers can continue to telecommute; how people can maintain social distance in the workplace.

“Businesses must strategize. There will be a new normal precaution and practice.”

Mass transportation is critical before workers can be sent back to their workplaces, so there need to be guarantees for workers and commuters to have safe transport – public-interacting employees will need necessary protective supplies and transit-goers will need to wear masks.

“Our goal is that the ‘new normal’ will be a better New York,” Cuomo said. “This will be a moment of transformation for society. And we paid a high price for it.”

But to build the “bridge” to the “new normal” requires first and foremost testing. “It is the best tool to inform decisions, to calibrate progress of risk/reward,” Cuomo said. “This is a new frontier for all of us.”

New York State tests more than any other state (which is one reason why the numbers are so much higher than any other stte). We were very aggressive and set an ambitious goal and reached it – 500,00 tests in 30 days, more than California, Florida and Michigan combined.

“This is all about figuring it out first and creating a system that didn’t exist before. But we have 19 million people, 9 million workers; 500,000 tests in one month doesn’t sound so big.”

So testing has to be much more widely available, but there are logistical and practical problems: how to set up sites and have the personnel, obtaining the supplies including swabs and vials, laboratory capacity and the acquisition of chemical reagents.

Here the problem becomes coordination of the demand for testing, with all 50 states and the federal government competing for the same materials, posing the same “e-bay” problem of bidding up the cost, interfering with orders, as happened with the ventilators.

Testing is one part of the equation; tracing contacts is also critical. “We need to create a tracing army” because every person who tests positive, all their prior contacts have to be investigated, then all of them need to be tested.  “We need to assembling an army that does not now exist,” Cuomo said, who added that he spoke to the White House again this morning.

 “We are looking forward to working with the federal government. We need federal help. Period.”

Reopening also requires strengthening the health care system, and continuing the “surge & flex.”

“Every hospital system has been an independent enterprise until now.” Now the strategy has to continue to be sharing resources “like was never understood before.” This means building out the strategic PPE and equipment stockpile; sharing among states. (New York is sending 100 ventilators to New Jersey and has sent 100 to Michigan and 50 to Maryland.)

“The key is not to increase the infection rate. We need people to understand, we can’t allow the infection rate to go up.”

So far, the infection rate has been determined by the hospitalization rate, but people are only hospitalized after they are infected and severely ill. Advanced testing will help determine the actual infection rate.

Advanced testing will determine how quickly the virus is spreading. “As we bring people out of their homes, we have to be able to measure how fast is the virus is spreading and how quickly the infection rate is rising because as Dr. Fauci noted, COVID-19 is a virus that is quite good at transmitting from one person to another. “We learned that the hard way.”

 “The rate of infection is everything,” Cuomo said. “All those early projection models assumed a higher rate of infection.

Why were all projection models higher than actualized – so far? – controlled the beast, brought rate of spread down. But if rate of spread actually happened, we would have been in much much worse situation, in a really bad placed.

Early projection models were based on modeling without lockdown measures:  the CDC on March 13 projected 160 million to 214 million Americans would be infected, or half to 2/3 the population – and 2.4 million to 21 million hospitalizations which would mean 925,000 staffed hospital beds or twice as many beds as there are; while the White House coronavirus Task Force on March 12 projected 1.5 million to 2 million deaths, or, in the best case scenario “if everything went perfectly,” 100,000 to 240,000 deaths.

All the models projected higher infection rates.

But, Cuomo said, that these projections have not materialized is proof that the actions taken in New York and other places have worked (and because New York accounts for the majority of cases, slowing the rate of infection here accounts for the flattening of the curve for the country).

The projected spread of the virus depends on how many people one infected person infects. If one person infects fewer than one person, the disease is under control; if one person infects just one more person, the rate is stabilized. But the infection is out of control if one person infects two or more people. “The number increases exponentially, like a fire through dry grass.”

 “This is what we have to control as we start to reopen the economy – if we turn the valve on the  economy a bit and watch the meter – the meter is hospitalization rate, or even better, the virus spread rate determined by testing and tracing– so as we start to turn on the valve, and people come out of homes and businesses reopen, if the infection rate goes up, we can turn back the valve right away.”

We have already seen this in action: on the Diamond Princess ship, one person infected on average 2.2 persons;

In Wuhan, one person infected an average of 2 to 3 people

During the Spanish Flu of 1918, one person infected an average of 1.4-2.8 people.

Here is New York State, at the severe spread,  one person infected 1.4-1.8 others, while as the rate moderated, the level was brought down to 1.2-1.45 people.

 “After mitigation – social distancing, stay at home – we brought that rate of infection to one person  to less than one other, .9. this compares to Wuhan, which locked up everything, and brought down the infection rate to .3.

So at the current infection rate of .9 there is only a margin of  of .3 before you get to 1.2, which would trigger new increases in hospitalizations.

“That doesn’t leave you a lot of wiggle room. So we start to phase reopening. We are at .9 now after an entire lockdown, if go back up to 1.2, we will have a problem.

“New York Pause has worked – the close down has worked. But we are not there yet: .9 is not enough. New York Pause will be continued with other states in the region to May 15. (That is New Jersey, Connecticut, Pennsylvania, Rhode Island, Delaware, Massachusetts.)

The new shutdown will continue through May 15. “We don’t want to project beyond that – that’s one month, a long time. People need certainty, clarity to plan. We need a coordinated action plan with other states. “

After May 15, he said, “we don’t know. We will see, depending upon what the data shows. Tell me what the infection rate is, is it .9?  then experts will tell us the best course of conduct based on that. There are not political decisions.”

Cuomo has issued an executive order requiring everyone to wear a mask when in public.

 “As relatively simple but annoying as it seems, wearing a mask is one of the best things we can do.” He said he is well aware that people are not happy about it. I am sorry if it makes people unhappy, but I don’t consider it a major burden and is a simple measure that can save lives (and reopen economy). Understand, it is not just about you. I have rights, my kids and yours have rights also – we have a right for another to take reasonable safeguard not to infect.”

People will be required to wear masks on public transportation systems and private transportation carriers and for-hire vehicles, and the operators will also be required to wear masks at all times.

 “It’s inconvenient, yes, but in a closed environment, where you are not socially distancing, this is a precaution for everyone. It balances individual liberties with social conscience. After all, what determines infection rate spread? You!”

Cuomo made a big plea to emphasize that he has limited ability to enforce the measure, that it has to come down to people understanding the facts, believing in the urgency, and acting responsibly.

“It’s not about government, it’s about what people decide to do wand what people have decided to do. They have brought infection rate down. It’s about your behavior, your discipline, your education of your children, your consideration of others.

 “Wear a mask, wash your hands, maintain social distance, educate your children on what to do/not, use hand sanitizer  – make smart choices. That makes all the difference in the world.”

Cuomo reflected, “Of all the unique aspects of this crisis, the most positive and surprising to me is how New Yorkers, how Americans rose to the challenge. The policies I communicated aren’t worth the paper they are presented on unless people decide to follow them.

“I can say as governor we must do this or that, these are the most life-changing policies government has ever issued – this isn’t government saying this is your tax rate, or how to vote – this is government saying ‘Stay in house, don’t touch, wear mask’.  I don’t have the ability to enforce these measures on any scale if people are not willing to do it.

“The policies are difficult, life changing are being implemented by people because people are choosing to do the right thing. It’s that simple.

“I trust that if the facts are presented, New Yorkers will do the right thing.

“What is the right thing? The appropriate path that is socially and morally correct. New Yorkers have very strong ‘right thing’ quotient. They know what the right thing is. What I must do is give the facts, the information to explain why I am suggesting these actions. They decide. I can’t put a mask on 17 million people. 17 million people will decide, but they have done it. They understand the facts, risks, rewards, consequences.

“We brought this state forward, and will bring the nation forward.”

Meanwhile, Cuomo chided Congress for passing stimulus measures that did nothing to aid states and localities drowning under astronomical health care expenses as revenue streams have dried up.

The Congress is presently preparing a fourth stimulus bill that so far again focuses on bailing out businesses, but not states.

As counties and cities throughout the state plead for more funding, he said, “I’m not in a position to help counties, cities. I’m in the hole,” he said, pointing to the ballooning $10-15 billion deficit as a result of the coronavirus. Congress “passed major legislation to protect the economy and move the economy forward but not fund state and local governments? Then state and local government has to turn around and cut everyone that relies on them (like police, teachers, transportation). That’s not smart, not right, and is counterproductive.

“They don’t get the same political credit if they fund New York State, New York City , Nassau County or Suffolk, because that doesn’t benefit their voters. I get that politically they want to pass legislation where they can call up their people at home and say, ‘Hey, I got money for you.’ How can you even pretend you are addressing the crisis when you are starving state and local governments? This is not Democratic or Republican. The National Governors Association, headed by Chairman Hogan of Maryland, a Republican and myself as vice chairman, sent a letter to the administration.  I say to our Democratic Congressional members- Senators Schumer and Gillibrand — you passed legislation that starved state and local governments; you’re not helping the country. Well, they say, we have to get to ‘yes.’ But I say, it doesn’t matter to get to yes if the bill doesn’t do what the purpose is.”

He said rejecting a new stimulus bill would be better than passing a piece of irresponsible legislation. “We are at a point financially where we have a $10-15 billion deficit. I hope and believe the federal government should have more inclusive policy.”

As Cuomo laid out in fairly meticulous fashion the strategy to phase in reopening of the metropolitan region’s economy, the Trump administration was getting set to issue its own guidelines. Trump had initially declared he had “total authority” to order states to reopen, but then retreated after an outpouring of objections.

The economic pain for the country became clear as unemployment numbers swelled a further 5 million, to bring the number of people filing for unemployment to 22 million in just four weeks. Economic data documented the sharpest drop in retail activity in history.

Significantly, though, though New York has been the hardest hit by the coronavirus and has seen a 783% increase in unemployment claims from the beginning of the year, the increase being the 21^st smallest among the states, according to Wallethub.

 “This is better than the average increase of 1,709%,” said Jill Gonzalez, WalletHub analyst.

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