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When Will N.Y.C. Reach the Peak of the Outbreak? Here’s What We Know When Will N.Y.C. Reach the Peak of the Outbreak? Here’s What We Know
(3 days later)
Gov. Andrew M. Cuomo has said in the past week that he believes the number of coronavirus cases in New York will hit its high point this week, and then hopefully begin to drop.Gov. Andrew M. Cuomo has said in the past week that he believes the number of coronavirus cases in New York will hit its high point this week, and then hopefully begin to drop.
But even he acknowledges the uncertainty of that prediction.But even he acknowledges the uncertainty of that prediction.
“The projection models have a number of alternatives,” he said at a news conference on Monday. “Some suggest basically the curve goes up and then drops precipitously. Some suggest a slight pause at the top. Some suggest there’s a longer pause at the top, which is effectively a plateau effect, or again the straight up and straight down precipitous drop, which is the peak effect. No one can tell you which will occur.”“The projection models have a number of alternatives,” he said at a news conference on Monday. “Some suggest basically the curve goes up and then drops precipitously. Some suggest a slight pause at the top. Some suggest there’s a longer pause at the top, which is effectively a plateau effect, or again the straight up and straight down precipitous drop, which is the peak effect. No one can tell you which will occur.”
Others say the worst is still a little further off. Mayor Bill de Blasio has said he fears “May could be worse than April,” and his health commissioner, Dr. Oxiris Barbot, has predicted the peak will come in late April or early May.Others say the worst is still a little further off. Mayor Bill de Blasio has said he fears “May could be worse than April,” and his health commissioner, Dr. Oxiris Barbot, has predicted the peak will come in late April or early May.
Steve Corwin, the chief executive of NewYork-Presbyterian Hospital, said he predicts the peak will happen “on or around April 15th.”Steve Corwin, the chief executive of NewYork-Presbyterian Hospital, said he predicts the peak will happen “on or around April 15th.”
So who is right? Let’s examine what the terminology means, what we can expect and how much we should trust these predictions.So who is right? Let’s examine what the terminology means, what we can expect and how much we should trust these predictions.
The peak is the high point on an epidemic curve, which charts the number of cases over time.The peak is the high point on an epidemic curve, which charts the number of cases over time.
You can track the number of new cases detected, or the number of deaths. Epidemic curves have been around for a long time. The Times ran one in 1918, amid the Spanish flu pandemic. (Spanish flu deaths in New York City peaked five weeks into the epidemic.)You can track the number of new cases detected, or the number of deaths. Epidemic curves have been around for a long time. The Times ran one in 1918, amid the Spanish flu pandemic. (Spanish flu deaths in New York City peaked five weeks into the epidemic.)
Public health officials have expressed hope that by closing schools and instructing families to isolate themselves, they are flattening the epidemic curve. Instead of a steep increase and a sharp spike, the curve will hopefully be a more gentle hump, with a lower peak that takes longer to reach.Public health officials have expressed hope that by closing schools and instructing families to isolate themselves, they are flattening the epidemic curve. Instead of a steep increase and a sharp spike, the curve will hopefully be a more gentle hump, with a lower peak that takes longer to reach.
Even if the overall number of cases were the same in the end, a “flattened curve” would avoid a sudden surge of patients that could overwhelm hospitals and cause more people to die from lack of care.Even if the overall number of cases were the same in the end, a “flattened curve” would avoid a sudden surge of patients that could overwhelm hospitals and cause more people to die from lack of care.
There are several. In New York City, the number of hospitalizations has been relatively flat for more than a week. The daily death toll has dropped in recent days after reaching 262 deaths on March 31, according to the Department of Health. “There are signs we are hitting a plateau,” Mark Levine, who heads the City Council’s health committee, said on Twitter on Monday.There are several. In New York City, the number of hospitalizations has been relatively flat for more than a week. The daily death toll has dropped in recent days after reaching 262 deaths on March 31, according to the Department of Health. “There are signs we are hitting a plateau,” Mark Levine, who heads the City Council’s health committee, said on Twitter on Monday.
At NewYork-Presbyterian Hospital, the chief of surgery, Dr. Craig R. Smith, wrote in a memo that was released by the hospital, “We are hurtling into weeks predicted to be our worst.” But he also offered a small dose of optimism. “Scanning the daily statistics for the NYP system I can squint, angulate the page, and see the hint of a suggestion that the new-case curve has flattened slightly over the past few days.”At NewYork-Presbyterian Hospital, the chief of surgery, Dr. Craig R. Smith, wrote in a memo that was released by the hospital, “We are hurtling into weeks predicted to be our worst.” But he also offered a small dose of optimism. “Scanning the daily statistics for the NYP system I can squint, angulate the page, and see the hint of a suggestion that the new-case curve has flattened slightly over the past few days.”
Dr. Jim Malatras, the president of SUNY Empire State College who previously served in Mr. Cuomo’s administration as director of state operations, appeared with the governor on Monday and said New York officials had been looking at projections that listed a possible peak to occur anywhere within 7 to 30 days.Dr. Jim Malatras, the president of SUNY Empire State College who previously served in Mr. Cuomo’s administration as director of state operations, appeared with the governor on Monday and said New York officials had been looking at projections that listed a possible peak to occur anywhere within 7 to 30 days.
“It looks like we’re at toward the earlier side of that time frame based on the current projections and modeling that we’ve been looking at,” Dr. Malatras said.“It looks like we’re at toward the earlier side of that time frame based on the current projections and modeling that we’ve been looking at,” Dr. Malatras said.
There are reasons to treat the data with caution.There are reasons to treat the data with caution.
The number of hospitalizations, for instance, depends not only on the number of new arrivals but also on hospital admission standards. As hospitals have teetered on the brink of being overwhelmed, they have sent home people whom they would have admitted just a few weeks earlier, several New York doctors said in interviews.The number of hospitalizations, for instance, depends not only on the number of new arrivals but also on hospital admission standards. As hospitals have teetered on the brink of being overwhelmed, they have sent home people whom they would have admitted just a few weeks earlier, several New York doctors said in interviews.
So even if the number of hospitalizations appears to have plateaued, that could be because the number of sick people turning up has lessened, or it may have to do with changing hospital admissions standards — or both.So even if the number of hospitalizations appears to have plateaued, that could be because the number of sick people turning up has lessened, or it may have to do with changing hospital admissions standards — or both.
And it’s difficult to know what to make of the slight dip in deaths in recent days. There are indications that deaths related to the coronavirus are being undercounted — especially those who die of the illness at home.And it’s difficult to know what to make of the slight dip in deaths in recent days. There are indications that deaths related to the coronavirus are being undercounted — especially those who die of the illness at home.
Patients can die of the illness several weeks after they were infected — some after a lengthy period of time in a medically induced coma while a mechanical ventilator breathes for them.Patients can die of the illness several weeks after they were infected — some after a lengthy period of time in a medically induced coma while a mechanical ventilator breathes for them.
For now, doctors expect that many of those placed on ventilators will die.For now, doctors expect that many of those placed on ventilators will die.
There are thousands of Covid patients currently on ventilators in New York, officials have said. We may yet see a rise in deaths as these patients possibly succumb to their illness.There are thousands of Covid patients currently on ventilators in New York, officials have said. We may yet see a rise in deaths as these patients possibly succumb to their illness.
The number of patients dying now in hospitals might offer information about the spread of the virus in the first weeks of March — but it says little about the rate of new infections.The number of patients dying now in hospitals might offer information about the spread of the virus in the first weeks of March — but it says little about the rate of new infections.
“In reality, we don’t know,” said Prof. Howard Markel, a doctor and historian of medicine at the University of Michigan, when asked if New York was nearing the peak. “It’s very hard to separate the hopeful side of our brain from the scientific side.”“In reality, we don’t know,” said Prof. Howard Markel, a doctor and historian of medicine at the University of Michigan, when asked if New York was nearing the peak. “It’s very hard to separate the hopeful side of our brain from the scientific side.”
Mr. Cuomo has referred to predictions by the Institute for Health Metrics and Evaluation at the University of Washington, known as IHME, as well as predictions generated by McKinsey & Company and Weill Cornell Medicine.Mr. Cuomo has referred to predictions by the Institute for Health Metrics and Evaluation at the University of Washington, known as IHME, as well as predictions generated by McKinsey & Company and Weill Cornell Medicine.
The models serve a purpose, and Governor Cuomo has spoken of their importance to leaders amid a pandemic. “I follow data,” he has said. “I don’t have instinct. I don’t have a gut. It’s not about emotion.”The models serve a purpose, and Governor Cuomo has spoken of their importance to leaders amid a pandemic. “I follow data,” he has said. “I don’t have instinct. I don’t have a gut. It’s not about emotion.”
Updated June 12, 2020Updated June 12, 2020
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
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.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.
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.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.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
The accuracy of these models remains to be seen.The accuracy of these models remains to be seen.
The IHME model has in recent days been revised, and its updated projections are generally less dire than earlier ones. It predicts New York State will hit its peak number of hospitalizations on April 8.The IHME model has in recent days been revised, and its updated projections are generally less dire than earlier ones. It predicts New York State will hit its peak number of hospitalizations on April 8.
“Modeling is just one piece of data among a mosaic of data spread out on the floor that has not yet been put into place,” said Professor Markel, who has written about past epidemics in New York City. “They’re simply based on assumptions that may or may not be wrong, and they’re created by people who don’t take care of patients — and may not be in the thick of the epidemic, and may not be asking the right questions.”“Modeling is just one piece of data among a mosaic of data spread out on the floor that has not yet been put into place,” said Professor Markel, who has written about past epidemics in New York City. “They’re simply based on assumptions that may or may not be wrong, and they’re created by people who don’t take care of patients — and may not be in the thick of the epidemic, and may not be asking the right questions.”
And the data about the coronavirus in New York is uncertain at best. Nobody quite knows when the virus began circulating in New York. Nor is there any consensus of how many people are infected, given that public health officials have repeatedly changed the eligibility criteria for testing. More recently, in New York City, public health officials have discouraged testing except for the sickest patients.And the data about the coronavirus in New York is uncertain at best. Nobody quite knows when the virus began circulating in New York. Nor is there any consensus of how many people are infected, given that public health officials have repeatedly changed the eligibility criteria for testing. More recently, in New York City, public health officials have discouraged testing except for the sickest patients.
It’s too early to tell, some public health officials say. As time passes, and more data comes in, the shape of New York’s curve will become clearer.It’s too early to tell, some public health officials say. As time passes, and more data comes in, the shape of New York’s curve will become clearer.
But there is a growing sense that New York City should have begun social-distancing measures earlier.But there is a growing sense that New York City should have begun social-distancing measures earlier.
“New York’s curve may not have been flattened, because they were kind of late to do things, closing schools for example,” Professor Markel said. “If you’re late, what our data shows, you may not achieve that flattening.”“New York’s curve may not have been flattened, because they were kind of late to do things, closing schools for example,” Professor Markel said. “If you’re late, what our data shows, you may not achieve that flattening.”
It’s possible that New York’s epidemic curve in 2020 becomes a cautionary tale to other cities about the importance of strict social distancing early on — just as Philadelphia’s initial response to the 1918 pandemic became a reference point for public health officials on what not to do.It’s possible that New York’s epidemic curve in 2020 becomes a cautionary tale to other cities about the importance of strict social distancing early on — just as Philadelphia’s initial response to the 1918 pandemic became a reference point for public health officials on what not to do.
“I hope that the rest of the country sees that these lockdowns are essential,” Dr. Corwin, the president of NewYork-Presbyterian, said. “Because you don’t want to get into the situation that we find ourselves in now in New York City.”“I hope that the rest of the country sees that these lockdowns are essential,” Dr. Corwin, the president of NewYork-Presbyterian, said. “Because you don’t want to get into the situation that we find ourselves in now in New York City.”
Professor Markel warned that letting up on social distancing measures too quickly following the peak would be a major mistake, noting that cities that did that during the pandemic of 1918 faced a second surge of cases.Professor Markel warned that letting up on social distancing measures too quickly following the peak would be a major mistake, noting that cities that did that during the pandemic of 1918 faced a second surge of cases.
“We saw that a lot in 1918, we called them double-humped curves — they were not generally as bad as the first hump, but they were pretty bad,” Professor Markel said.“We saw that a lot in 1918, we called them double-humped curves — they were not generally as bad as the first hump, but they were pretty bad,” Professor Markel said.
Jesse McKinley contributed reporting.Jesse McKinley contributed reporting.