Cuomo is not your COVID hero

July 16, 2020 By Alan Salzberg

Our dear leader in orange is clearly a villain with respect to COVID, whose response has ranged from nothing to blaming others.  So it is natural that we need heroes.  Anthony Fauci has proven worthy over and over, for decades, actually.  There are many other scientists who sounded the alarm, also.

When it comes to political leaders, Cuomo has gotten a lot of press recently.  This article today ( lauds New York's turnaround from "worst to first" and Cuomo says "this wasn't only about what government did. This was about what people did."  Cuomo put that false modesty aside when he created a ridiculous piece of self-congratulatory graphic art:

New York has won only this title thus far in the fight against COVID: Worst in the world.

The actual record of NY is not good.  In fact, NY is at this moment the biggest failure in the world, when compared to any other country, and when compared to all other states.  It's true that the South is failing badly enough (see my earlier post: that their infections and deaths might approach New York's, but no one is congratulating them.

In terms of deaths per million people, NY is at about 1,700 deaths per million (see  In other words, 0.17% of New York's population has died of COVID.  New York City is worse, with a death rate of 2,675 per million, or about 0.27% of New York City's population).  Both these rates are far worse than any country in the world (see ).  A good comparison city to NYC is Madrid, which suffered the worst outbreak of any large city in Europe.  Still Madrid, with a population only a little smaller than NYC (and a subway system like NYC), had a population fatality rate of 0.12%, less than half that of NYC.

Recent data on the infection fatality rate (called IFR and defined as the fraction of people who have COVID that die) indicates that the median IFR is 0.24% (see John Ioannidis' great survey paper here: ).  Initial high figures of closer to 1% held true only in places with the worst outbreaks.  Ioannidis estimates New York's IFR at 0.54% (and Brooklyn's at 0.34%).  Note that these IFR's are not too far from the proportion of the population that died.  This means that a significant percentage of New Yorkers were infected.  In other words, we did not successfully stave off COVID here.

[What percentage were infected in New York City? There are two good sources to estimate this.  First, the simple math of 23,000 deaths and a death rate of about 0.5% indicates that 4.6 million of NYC's 8.6 million were infected (i.e., more than half).  This number is likely too high, however, because people who are more susceptible to getting very sick or dying tend to get infected early.  The other good data we have is the level of antibodies found in a broad study in April.  This study (see here) found that as of the end of March, about 23% of adult NYC residents had been infected.  Given the course of the disease, this would imply one-third (about 3 million) or more of NYC residents have now been infected (given the continued increases in cases and deaths from April until now -- for details, see NYC's data pages). ]

Our initial failure practically guaranteed success now

But, you might say, now we're doing great.  Well, yes we are.  However, with perhaps 40% of NYC infected and a significant percentage of the state infected, we may be approaching herd immunity in NYC and may have seen the worst of COVID elsewhere in the state (see ).  Why?  Because there are fewer people left to infect, and those that have not been infected are either less susceptible, have fewer contacts that could infect them, or both.  So our current success is partly, or possibly mostly, due to our earlier colossal failure.

So why was the outbreak of COVID so severe in New York?

First, New York shut down too late.  Because of exponential growth of COVID infections, that mistake multiplied the cases and deaths in such a way that no amount of extreme shutdowns, mask wearing, or careful re-opening could fix it.  Cases (and deaths) were multiplying at a rate of 6 times per week before we shutdown, so even shutting down a week earlier might have saved nearly 20,000 lives in the New York City metro area alone (see, for example, this study: ).

The second big mistake was sending patients sick with COVID, who were recovering, from the hospital back to nursing homes (see, for example: ).  Perhaps 10,000 or more of the 32,000 NY deaths were residents of nursing homes (New York did not count those who lived at nursing homes but died in the hospital, so the exact count is unknown (see this article).

Neither Hero nor Villain

Though many scientists, including public health professionals in DeBlasio's administration, were calling for a shutdown in early March, it would have been a difficult and bold decision to shut down on, say March 8, when few cases had been identified and no deaths had occurred in New York.  I would even say that would have been a heroic political decision.  What Cuomo and DeBlasio did do was not.  They did what most politicians would have done: ignored the science until the political pressure was substantial and then called for a shutdown.  

The decision about the nursing homes, colossally stupid in retrospect, was not so idiotic at the time.  It was widely believed that hospitals would be overwhelmed, so recovering patients were sent home to make room.  

In conclusion, I'm not saying Cuomo, or even DeBlasio, should be put in the category of the bad guys.  They're just not heroes, no matter how many silly graphs Cuomo draws.