This article is from the source 'nytimes' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.

You can find the current article at its original source at https://www.nytimes.com/2020/04/10/nyregion/new-york-coronavirus-hospitals.html

The article has changed 33 times. There is an RSS feed of changes available.

Version 21 Version 22
Virus Deaths Mount, but N.Y. Avoids Predicted Surge at Hospitals So Far Virus Deaths Mount, but N.Y. Avoids Predicted Surge at Hospitals So Far
(5 days later)
On March 24 Gov. Andrew M. Cuomo appeared at the Jacob K. Javits Center in Manhattan and, as soldiers scrambled to transform it into a hospital, he offered the public a dire assessment.On March 24 Gov. Andrew M. Cuomo appeared at the Jacob K. Javits Center in Manhattan and, as soldiers scrambled to transform it into a hospital, he offered the public a dire assessment.
Sophisticated scientists, Mr. Cuomo said, had studied the coming coronavirus outbreak and their projections were alarming. Infections were doubling nearly every three days and the state would soon require an unthinkable expansion of its health care system. To stave off a catastrophe, New York might need up to 140,000 hospital beds and as many as 40,000 intensive care units with ventilators.Sophisticated scientists, Mr. Cuomo said, had studied the coming coronavirus outbreak and their projections were alarming. Infections were doubling nearly every three days and the state would soon require an unthinkable expansion of its health care system. To stave off a catastrophe, New York might need up to 140,000 hospital beds and as many as 40,000 intensive care units with ventilators.
“One of the forecasters said to me we were looking at a freight train coming across the country,” Mr. Cuomo said.“One of the forecasters said to me we were looking at a freight train coming across the country,” Mr. Cuomo said.
Two weeks later, however, with an unprecedented shutdown of public schools, countless businesses and most of outdoor life, New York has managed to avoid the apocalyptic vision that some of the forecasters predicted.Two weeks later, however, with an unprecedented shutdown of public schools, countless businesses and most of outdoor life, New York has managed to avoid the apocalyptic vision that some of the forecasters predicted.
The daily death toll has still been staggering, approaching 800 for a third straight day on Friday, and some hospitals continue to teeter on the brink of chaos.The daily death toll has still been staggering, approaching 800 for a third straight day on Friday, and some hospitals continue to teeter on the brink of chaos.
But the number of intensive care beds being used declined for the first time in the crisis, to 4,908, according to daily figures released on Friday. And the total number hospitalized with the virus, 18,569, was far lower than the darkest expectations.But the number of intensive care beds being used declined for the first time in the crisis, to 4,908, according to daily figures released on Friday. And the total number hospitalized with the virus, 18,569, was far lower than the darkest expectations.
In yet another sign that the worst of the predictions had not yet come to pass, the Javits Center, the convention center where Mr. Cuomo offered his worrisome assessment, was treating only 300 patients. The rest of its roughly 2,500 beds were empty.In yet another sign that the worst of the predictions had not yet come to pass, the Javits Center, the convention center where Mr. Cuomo offered his worrisome assessment, was treating only 300 patients. The rest of its roughly 2,500 beds were empty.
Whether used to analyze the weather or the stock market, statistical models are often an uneasy mix of guesswork and science, and they have proved to be of variable use in predicting the virus outbreak, a calamity that has no precedent in the past 100 years. Perhaps the biggest unknown was how people would react when told to stay at home and keep six feet apart from one another whenever they went out.Whether used to analyze the weather or the stock market, statistical models are often an uneasy mix of guesswork and science, and they have proved to be of variable use in predicting the virus outbreak, a calamity that has no precedent in the past 100 years. Perhaps the biggest unknown was how people would react when told to stay at home and keep six feet apart from one another whenever they went out.
Mr. Cuomo has relied on several models in making his decisions, and while each is slightly different, they all convinced him that the wisest course of action was to plan for the worst while hoping for the best.Mr. Cuomo has relied on several models in making his decisions, and while each is slightly different, they all convinced him that the wisest course of action was to plan for the worst while hoping for the best.
The models also helped Mr. Cuomo and other governors project an air of confidence amid the crisis and to come up with the cover they required to place their states under crippling restrictions that have damaged economies and brought most aspects of life to a halt.The models also helped Mr. Cuomo and other governors project an air of confidence amid the crisis and to come up with the cover they required to place their states under crippling restrictions that have damaged economies and brought most aspects of life to a halt.
When asked on Friday at his daily news briefing whether he feared losing credibility for trusting some models that had proven to be less than accurate, Mr. Cuomo said no.When asked on Friday at his daily news briefing whether he feared losing credibility for trusting some models that had proven to be less than accurate, Mr. Cuomo said no.
“I think my credibility would be affected if I didn’t ask experts for their opinion,” he said.“I think my credibility would be affected if I didn’t ask experts for their opinion,” he said.
The governor also said that the discrepancy between the predictions and the actual statistics was because of the behavior of New Yorkers themselves. With some exceptions, New Yorkers have managed to follow the restrictions on movement and socializing.The governor also said that the discrepancy between the predictions and the actual statistics was because of the behavior of New Yorkers themselves. With some exceptions, New Yorkers have managed to follow the restrictions on movement and socializing.
Dr. Deborah Birx, the White House coronavirus response coordinator, seemed to agree and congratulated Mr. Cuomo and his counterparts on Friday for having slowed the tide of infections in their states.Dr. Deborah Birx, the White House coronavirus response coordinator, seemed to agree and congratulated Mr. Cuomo and his counterparts on Friday for having slowed the tide of infections in their states.
“That has dramatically changed because of the impact of what the citizens of New York and New Jersey and across Connecticut and now Rhode Island are doing to really change the course of this pandemic,” Dr. Birx said.“That has dramatically changed because of the impact of what the citizens of New York and New Jersey and across Connecticut and now Rhode Island are doing to really change the course of this pandemic,” Dr. Birx said.
It is, of course, prudent politically and for public health reasons that elected leaders over-plan, not under-plan, for disasters. During hurricanes, for instance, governors are much more likely to save their constituents’ lives, and their own jobs, by ordering evacuations early rather than banking on the chance that a storm will peter out.It is, of course, prudent politically and for public health reasons that elected leaders over-plan, not under-plan, for disasters. During hurricanes, for instance, governors are much more likely to save their constituents’ lives, and their own jobs, by ordering evacuations early rather than banking on the chance that a storm will peter out.
The main objective in “flattening the curve” of the outbreak, apart from keeping people from dying, is to slow the spread enough to keep hospitals functioning.The main objective in “flattening the curve” of the outbreak, apart from keeping people from dying, is to slow the spread enough to keep hospitals functioning.
And from the start of the coronavirus emergency, Mr. Cuomo has repeatedly taken the position that he would rather be prepared for a dire scenario that never came to pass than to blithely put his faith in optimistic forecasts. Ironically, his doomsday attitude may complicate his efforts to keep the state on course as New Yorkers start to realize that the worst has not happened and eventually get itchy to go out.And from the start of the coronavirus emergency, Mr. Cuomo has repeatedly taken the position that he would rather be prepared for a dire scenario that never came to pass than to blithely put his faith in optimistic forecasts. Ironically, his doomsday attitude may complicate his efforts to keep the state on course as New Yorkers start to realize that the worst has not happened and eventually get itchy to go out.
Conservative pundits, like John Cardillo of Newsmax.com and Bill Mitchell, the host of the online talk show “YourVoice America,” have already seized on the gap between the grimmest models and the upward-trending facts to criticize social-distancing measures and to argue that the national economy should be reopened quickly.Conservative pundits, like John Cardillo of Newsmax.com and Bill Mitchell, the host of the online talk show “YourVoice America,” have already seized on the gap between the grimmest models and the upward-trending facts to criticize social-distancing measures and to argue that the national economy should be reopened quickly.
President Trump, after initially playing down the outbreak, has finally seemed to take the models seriously. But Mr. Trump has also used them to revise expectations about his handling of the pandemic, saying he will consider himself to have succeeded if he holds the total death count to under the current predictions of around 100,000.President Trump, after initially playing down the outbreak, has finally seemed to take the models seriously. But Mr. Trump has also used them to revise expectations about his handling of the pandemic, saying he will consider himself to have succeeded if he holds the total death count to under the current predictions of around 100,000.
The models that Mr. Cuomo has used to justify the restrictive measures in New York did not fully take into account the effect those measures might have had.The models that Mr. Cuomo has used to justify the restrictive measures in New York did not fully take into account the effect those measures might have had.
One of the models, created by the Institute for Health Metrics and Evaluation at the University of Washington, which is supported by the Bill and Melinda Gates Foundation, was initially based mainly on data from the epidemic in Wuhan, China, which many experts now consider unreliable. Outbreaks in Italy and Spain peaked more recently and provide a fuller picture of how quickly infections can be brought under control.One of the models, created by the Institute for Health Metrics and Evaluation at the University of Washington, which is supported by the Bill and Melinda Gates Foundation, was initially based mainly on data from the epidemic in Wuhan, China, which many experts now consider unreliable. Outbreaks in Italy and Spain peaked more recently and provide a fuller picture of how quickly infections can be brought under control.
The institute’s statistics from April 1 projected that by Friday, more than 70,000 New Yorkers would be hospitalized with the virus, more than four times the number that actually were.The institute’s statistics from April 1 projected that by Friday, more than 70,000 New Yorkers would be hospitalized with the virus, more than four times the number that actually were.
Ali H. Mokdad, a professor of health metrics sciences at the institute, said that in general, projections of how many hospital beds would be needed have been revised downward continually to reflect new data.Ali H. Mokdad, a professor of health metrics sciences at the institute, said that in general, projections of how many hospital beds would be needed have been revised downward continually to reflect new data.
Updated July 23, 2020 Updated July 27, 2020
The institute’s predictions issued on Wednesday were much closer to reality, indicating a need for 21,000 beds in New York by Friday.The institute’s predictions issued on Wednesday were much closer to reality, indicating a need for 21,000 beds in New York by Friday.
The institute’s earlier nationwide models also overestimated the number of days that patients who were not admitted to intensive care units would spend in the hospital. The original prediction had been 15 days, but on April 5, the institute reported it was actually only eight days. Patients who died were doing so faster than initially estimated.The institute’s earlier nationwide models also overestimated the number of days that patients who were not admitted to intensive care units would spend in the hospital. The original prediction had been 15 days, but on April 5, the institute reported it was actually only eight days. Patients who died were doing so faster than initially estimated.
“It is possible that people who were sicker came first and were more likely to die,” Mr. Mokdad said. (The institute’s predictions related to the number of deaths in New York have been more consistent and closer to the actual statistics.)“It is possible that people who were sicker came first and were more likely to die,” Mr. Mokdad said. (The institute’s predictions related to the number of deaths in New York have been more consistent and closer to the actual statistics.)
Some hospitals have also noticed sharp drops in the number of people seeking hospital care for ailments unrelated to the coronavirus. With much of normal life paused, there are fewer violent crimes and far fewer car accidents.Some hospitals have also noticed sharp drops in the number of people seeking hospital care for ailments unrelated to the coronavirus. With much of normal life paused, there are fewer violent crimes and far fewer car accidents.
Doctors believe that some New Yorkers are avoiding the hospital out of fear that a visit could get them sick. Around the country, doctors have also noticed a worrisome drop in cardiac admissions.Doctors believe that some New Yorkers are avoiding the hospital out of fear that a visit could get them sick. Around the country, doctors have also noticed a worrisome drop in cardiac admissions.
“We’ve been seeing much lower rates of some other sorts of emergencies,” said Dr. Andrew Bauerschmidt, a critical care physician at Lenox Hill Hospital in Manhattan. “I was covering stroke calls from the emergency department last week, and the volume was far lower than usual.”“We’ve been seeing much lower rates of some other sorts of emergencies,” said Dr. Andrew Bauerschmidt, a critical care physician at Lenox Hill Hospital in Manhattan. “I was covering stroke calls from the emergency department last week, and the volume was far lower than usual.”
“What the public needs to know is that if you are really sick with something that’s not Covid, you should still call 911 or come to the hospital,” he said. “What we don’t want is for people to not seek medical attention just because they are not having something related to Covid.”“What the public needs to know is that if you are really sick with something that’s not Covid, you should still call 911 or come to the hospital,” he said. “What we don’t want is for people to not seek medical attention just because they are not having something related to Covid.”
For some of these reasons, or perhaps for all of them, New York’s hospitals have been able to scale back some of their most serious and unusual contingency plans.For some of these reasons, or perhaps for all of them, New York’s hospitals have been able to scale back some of their most serious and unusual contingency plans.
Only weeks ago, there were grave concerns that the hospitals, confronting a flood of gasping patients, would run short of lifesaving ventilators. But by Friday, doctors had largely abandoned the experimental practice of ventilator sharing, in which one machine was used to support several patients.Only weeks ago, there were grave concerns that the hospitals, confronting a flood of gasping patients, would run short of lifesaving ventilators. But by Friday, doctors had largely abandoned the experimental practice of ventilator sharing, in which one machine was used to support several patients.
On Friday, Mr. Cuomo still seemed to be balancing optimism with caution and trying to understand how the projections he received had not yet squared with the realities he was seeing.On Friday, Mr. Cuomo still seemed to be balancing optimism with caution and trying to understand how the projections he received had not yet squared with the realities he was seeing.
“How do you come up with an actual curve that is so much different than what those experts predicted?” he asked.“How do you come up with an actual curve that is so much different than what those experts predicted?” he asked.
Part of the answer, he reasoned, was that it remained unclear whether the statewide shutdown he ordered last month would continue to be followed and effective.Part of the answer, he reasoned, was that it remained unclear whether the statewide shutdown he ordered last month would continue to be followed and effective.
But even more unclear, he said, was the situation itself.But even more unclear, he said, was the situation itself.
“In fairness to the experts, nobody has been here before,” Mr. Cuomo said. “Nobody. So, everyone is trying to figure it out the best they can.”“In fairness to the experts, nobody has been here before,” Mr. Cuomo said. “Nobody. So, everyone is trying to figure it out the best they can.”
Reporting was contributed by James Glanz, Brian M. Rosenthal and Margot Sanger-Katz.Reporting was contributed by James Glanz, Brian M. Rosenthal and Margot Sanger-Katz.