American Crisis

by Andrew Cuomo

  The individual phone calls to the biggest players laid the groundwork for their buy-in so that when we brought in the leaders of other hospitals around the state on group conference calls, every hospital knew its competitors and colleagues were in the same situation.

  My first specific request bordered on the insane: Every hospital had to increase its capacity by 50 percent and stop elective surgeries to free up existing bed capacity. The 50 percent increase in capacity would take the entire system from about fifty-three thousand beds to seventy-five thousand beds. Even seventy-five thousand beds was only about 60 percent of the projected need.

  The challenge to the individual hospitals was overwhelming. A hospital with two hundred beds would need to create an additional one hundred beds. Hospitals are normally highly regulated with specific requirements as to room size, staffing ratios, and so on. Now we were telling them to double the number of beds in some rooms, convert cafeterias to congregate areas, and find space wherever they could. For them it was an earthshaking proposition.

  The second component, ending elective surgery, would begin to reduce the current hospital population to make room for the COVID patients who were just days or weeks away. Elective surgery is also the primary source of income for hospitals. I explained that our plan assumed we had fifty-three thousand beds, all empty, so we had no alternative but to start creating capacity.

  While many of the people I talked to said such an increase was impossible, I told them that impossible wasn’t an option. After much discussion, we had consensus support. It was a relief to see that even large institutions, when they understood the consequences, were willing to accept major change. This was critical because if they had sued to stop me, they probably would have been successful, at least in the short run, and that’s all we had—the short run.

  MARCH 15 | 131 NEW CASES | 137 HOSPITALIZED | 1 DEATH

  “The curve is not a curve, the curve is a wave, and the wave could break on the hospital system.”

  THERE ARE SEVERAL MAJOR FACTORS to consider when you close schools. You stop providing food for many students who rely on school lunches. The teachers in the school have concerns for their own health separate and apart from the students’. The teachers’ union is very strong and influential with state and local politicians. At first, the unions were allied with local school districts and the state education department in saying, “You are out of your mind; you cannot close the schools.” Children staying at home for long periods of time raises socialization and mental health issues. School districts are proudly locally run, and when the state or federal government makes a decision concerning schools, they often organize the parents in opposition.

  As usual, some people wanted schools open and some wanted schools closed tomorrow. It wasn’t that easy. My grandfather had a great expression: “When you don’t know what you’re talking about, it always seems simple.” Here’s a question that illustrates how complicated the decision is: If the governor concludes that in the middle of a pandemic safety dictates he must close the schools, who does the most pivotal conversation include?

  The local politician

  The local teachers’ union head

  The local PTA

  The local health commissioner

  The local school board

  The local hospital staff

  The answer is F.

  The most essential conversation around closing schools in the midst of a pandemic is, will the hospital staff show up for work if their children are at home? All other issues involve levels of political opposition, but the availability of hospital staff means life or death. In the situation we were facing, one needed to conclude that the politics and press coverage were irrelevant, as any disruption would cause opposition. To me there were only two relevant factors. Was it the right decision for the safety of the children and the school staff? And, if schools were closed and students were at home, would the nurses, doctors, and hospital staff need to stay home and take care of their children and therefore disrupt the operations of the hospitals and health-care facilities?

  The majority of health-care workers are in working families without significant resources. Many earn near-minimum-wage salaries. Nurses are often mothers who are also working to manage households. If the health-care staff needed to stay home to care for their children and families, it would be a major problem. By definition, the intensity of the health issues driving the closing of the schools would be creating unprecedented demand on the local health-care system.

  The same situation was presented for many of the essential workers. Police, firefighters, truck drivers, blue-collar workers operating vital systems—how did they take care of their children who would now be home?

  That was the riddle that we had to solve. Where could we find large-scale childcare facilities to provide for the children of essential workers so we were sure they would show up for work? If we were going to close the schools immediately, we would need to set up large-scale childcare operations for the children of these essential workers. To do that, some schools would need to serve as safe childcare centers, and some teachers would have to staff them. In some cases, we would bring childcare workers to hospitals, so workers didn’t have to go out of their way to drop their children off. We would need to open them on a regional basis and make sure the essential workers in that region understood their availability and were comfortable with the arrangement before we could actually close the schools. This all had to happen very quickly.

  The teachers’ and health-care unions have great reach and credibility with their members. If I could fashion a solution with them, they could quickly communicate to the membership and serve as credible validators of the system’s safety. Many of the other essential workers also were members of powerful unions. As always, relationships matter. There would be no contracts or documentation, this would all have to be done on a handshake. We would need to understand that the situation would change going forward, that issues would pop up that we did not anticipate, and that we must deal with one another in good faith.

  Sometimes, but not often, there is an advantage to being old. I had worked with the leadership of the major unions for many years. We knew one another well and trusted one another on a personal level. And this would have to be personal. Normally, a small change in work rules would be negotiated for weeks. In this case we would be setting up an entirely new system overnight. The relevant teachers’ unions are run by Randi Weingarten, Andy Pallotta, and Michael Mulgrew. The main health-care union is 1199 and is run by George Gresham. I had worked with all of them on many issues. Recently, we had all gone to Puerto Rico to volunteer to help the island deal with Hurricane Maria.

  I had a series of frantic phone calls over two days, most ending with the same phrase: “Don’t worry, we will figure it out.” As a result, New York State had a new system of childcare facilities managed by teachers and day-care providers that could provide for the children of classified “essential workers.” In a normal situation, what we did could take literally years to complete; we did it in three days.

  People can rise to the occasion. If they understand the issue and the consequences, they can step up. We tend to assume people will be self-interested, exploitive, selfish, and difficult. Maybe it doesn’t have to be that way. If one person lets their guard down first, it makes it easier for others to respond in kind. Maybe we can establish a precedent in which each of us operates from a place of decency and mutuality.

  Two weeks after I started doing my daily briefings, with three COVID deaths, on March 15, we announced the closing of schools in New York City and Westchester, Nassau, and Suffolk counties. The following day, we announced the closing of schools in the entire state. Even though the action was highly disruptive, people accepted it because they had been following the information I’d been sharing every morning. Many of the districts’ officials did not want to close, and they did not appreciate my
newfound control over them. But the people of the state understood the necessity and supported my decision. I also ordered nonessential New York State workers to work from home. As with the closing of colleges, government action would set a precedent for policies that I hoped private companies would follow.

  Never in modern history has government ordered businesses, schools, and private institutions to close. State government has never issued stay-at-home orders, not even during the 1918 flu pandemic, when schools and theaters were allowed to stay open. With each state determining its own path, the inevitable incongruous decisions would lead only to confusion and decreased support from the people. If the federal government established a national standard, it could ease the burden on state leadership and increase popular support. The federal mandate could have easily set an infection rate, hospitalization rate, or death rate by percentage of population that would’ve triggered a state to shut down. The federal government has the expertise in global health pandemics. State and local health departments do not.

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  WE CONTINUED TO watch what was going on in California and Seattle, and what we saw was disturbing. Even more disturbing was watching China and Europe. Italy was in the worst situation, with an overwhelmed hospital system that prompted officials to lock down much of the northern part of the country, including Milan and Venice. Even China—where government control is total—was having trouble executing coherent procedures to safeguard the population. Imagine how hard it would be in our situation where you must actively persuade people to follow the policy rather than simply dictate it. I had been speaking to every expert I could get on the phone. Would we have to do something like Italy and China were doing? The answer was yes, but the drastic measures that they said may be required seemed almost impossible. How do you “close down” society? What does that even mean?

  It turns out that when people say close down, they don’t really mean close down. They mean closing down “unnecessary” economic and social activities. “Unnecessary” is defined as any functions not required for basic social stability. Again, there was no existing blueprint, but when we started discussing the list of “basic” activities, the list actually got quite long. Society still had to be stable and functioning. Public transportation would need to continue. Grocery stores and pharmacies would need to remain open. Doctors’ offices and the health-care system would be essential. Delivery services, utility services, emergency home repair services, stores that sell home goods, police, firefighters, some government workers but not all. It was a substantial list.

  Discussing the ramifications of the closures, I became deeply troubled. Talk about a tale of two cities: This would be a tale of two economies and two types of workers. The phrase for the employees of the basic services is “essential workers.” An essential worker may sound like a nice title, but it is really anything but glamorous. The essential workers are the structural framework for the service economy. They are the backbone of New York. They are the blue-collar working folks we too often take for granted. In New York City, they are not the fancy Manhattan residents or the Wall Street bankers. They are Queens, Brooklyn, the Bronx, and Staten Island residents, outer-borough Latino, Asian, Black. They are the hardworking, struggling families. Why is it that the poorest among us are always asked to pay the highest price? These are the people our society always seems to forget. They are working, so they are not on public assistance or Medicaid. But they are barely making it. The last national “disaster” was the 2007 housing collapse and mortgage fraud scandal, when these people lost the equity in their homes while the federal government bailed out the big banks with their tax dollars. I am from Queens. I grew up feeling that I was from a different class from the Manhattan elite. As attorney general, I had brought actions against companies like AIG and Bank of America, which took the federal bailout funds and paid million-dollar bonuses to the same executives who created the scandal in the first place. No one bailed out the working families in the outer boroughs who saw their home values depleted.

  My father’s voice rang in my ears. The system was rigged. One set of rules for the rich and powerful and another set of rules for everyone else. Whatever the situation, it seems working families get the short end of the stick. The powerful institutions work together to protect themselves and their friends, and the government is their unwitting or, even worse, conscious ally.

  But in many ways this situation would be more devastating than the Great Recession of 2008. This was not just about unfair economic gain or loss. We would be asking one group of workers to put their lives at risk so that another group, the “nonessential workers,” would be able to stay safe at home. It is a gross injustice and manifestation of the inequality in society. I couldn’t get past the feeling that this was just unfair.

  How could I even explain this when the time came, and it seemed certain that it would soon. I would need to tell the people of the state that the situation was incredibly dangerous and would require drastic action that was without precedent. We would need to close down business and social activity because it was unsafe. However, essential workers still needed to go to work because we needed them to do their jobs. They would have to deal with the risk that they might get sick and bring the virus home to their families. There was no alternative. If the essential workers didn’t show up, there would be anarchy. Imagine a situation with no police, no food, no public transportation. What if I asked the essential workers to continue working and they determined it was too dangerous? The ethical, moral, and practical issues continued to multiply. I struggled with these questions night after night when I reviewed the decisions I’d made that day and considered the decisions that awaited me the next. I talked to any number of people, and everyone had a different opinion. In bed when the phone was finally silent, I would rerun the whole day one more time in my mind like a video replay. It came down to judgment calls about life and death, and every one of those calls could be second-guessed. The only certainty was that I had to make decisions now and move.

  MARCH 16 | 294 NEW CASES | 158 HOSPITALIZED | 6 DEATHS

  “When we say these facilities close down at 8:00 P.M. tonight, they will then remain closed until further notice.”

  WE REACHED OUT TO THE governors of the surrounding states, most notably Phil Murphy of New Jersey and Ned Lamont of Connecticut, who joined me at the day’s briefing. Melissa spoke to their respective chiefs of staff numerous times a day, and I spoke with both men directly. It was helpful to have leaders from the neighboring states to bounce things off, because they were facing the same challenges we were. It also gave me comfort to talk to people in a similar position. We could commiserate. Many people in New Jersey and Connecticut commuted to New York for work, and their infection rates were spiking in tandem with ours. If the federal government wouldn’t come up with a national policy, then we would come up with our own regional policy. This would do two things. First, it would give people a sense of comfort that they were not alone because their neighbors were taking the same actions. Second, it would avoid people traveling from one state to another state to “shop” for activities, goods, or services they might need. Together, we took the most dramatic action to date, instituting uniform closures to take effect that night: The restaurants, bars, movie theaters, gyms, and casinos in all three states were closing at the same time, and all gatherings would be capped at fifty people.

  I do a lot of work with Governor Murphy and Governor Lamont, and they are both good men. Last year I invited Lamont to go salmon fishing with me on Lake Ontario. In addition to the opportunity to spend some time together away from meetings, the trip was meant to highlight the great fishing in upstate New York. We chartered a boat, and we planned a brief chat with the press when we got back to the dock.

  It was getting close to the time that we were supposed to return, but we had a major problem: We hadn’t caught any fish. And there was no way I was going back to face the p
ress on the dock without fish. I told the captain showing up empty-handed would be bad news for the state of New York, and he knew that it would not be great for his business either. I was ready to jump overboard and dive down to see what I could find. Luckily, we landed a fish before I had to do that. But one fish isn’t really enough for two fishermen. We needed another one. The press was already waiting on the dock, but I was committed to that second fish.

  Miraculously, as we were pulling in to harbor, we saw the pole bend and the line take off; we caught our second fish. The poor charter boat captain was so relieved I thought he was going to cry.

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  WHILE WE WERE making this progress at the state level, we were still operating in the absence of federal leadership and coordination, and that day Trump went as far as to tweet, “Just had a very good tele-conference with Nation’s Governors. Went very well. Cuomo of New York has to ‘do more.’ ” I tweeted right back, “I have to do more? No—YOU have to do something! You’re supposed to be the President.”

  The president had finally instituted a partial European travel ban on March 12. But it was too little, too late. The virus had been silently circulating in the New York region for weeks, if not months. If the federal authorities had realized this basic reality—that the virus would have traveled from China over the course of weeks—we could have screened or stopped European travel much earlier and saved thousands of lives.