American Crisis

by Andrew Cuomo

  But the medical community was skeptical. Hydroxychloroquine had been on the market before and was used to treat malaria. Bona fide medical professionals raised questions about the risks and doubted its effectiveness to treat COVID. But the president and his supporters were 100 percent convinced. As usual, the president needed a villain, and he suggested that political forces were conspiring to keep the COVID virus alive to hurt him and his reelection and were therefore trying to discredit hydroxychloroquine. The president was so successful in communicating his message there was a run on the drug. Pharmacies and suppliers couldn’t keep up. Patients who normally use hydroxychloroquine to treat illnesses such as lupus couldn’t get it because the demand was so high from doctors prescribing it for their patients. New York had to pass a regulation limiting prescriptions for hydroxychloroquine to fourteen days so there was a supply for people who normally relied on it.

  At the same time, the president and the FDA wanted to expedite testing for the drug. Because New York had the highest number of cases, it was the obvious and best location to do it. Hydroxychloroquine’s potential was the one topic that Trump repeatedly raised in every conversation I had with him for weeks.

  Hospitals in New York began participating in a standard testing regiment with FDA protocols to see if the drug actually worked. The test took about five weeks, but the president was eager to get the results and communicated total certainty on what they would find. I had said publicly that I didn’t know whether hydroxychloroquine was effective for treating COVID. I’m not a doctor, scientist, or pharmacist. Obviously, everyone would love a cure and if it’s hydroxychloroquine, or any other drug, that would be great.

  Sometimes we see in others what we see in ourselves. Or we think other people are motivated the same way we are motivated. Trump and the White House assumed the Democrats, myself included, would not want hydroxychloroquine to work because we feared that the president would get credit for it. And if COVID was resolved, it would be good for the president. However absurd, I had heard this from enough Trump supporters to know that they were sincere. They believed Democrats would sabotage hydroxychloroquine for political purposes. How sick is that? People are dying, billions of dollars are being spent, how could anyone put politics above a cure? Maybe the White House could.

  I had been working very hard to keep our COVID efforts in New York nonpartisan, and I had even gone on Sean Hannity’s show to reach out to all New Yorkers, because if you’re not on Fox News, you’re missing the best platform to talk to conservatives in the state. To be clear, Hannity was perfectly cordial with me. Because I had no national agenda, I wasn’t a threat.

  However, hydroxychloroquine became the line in the sand for Fox; Hannity talked about it all the time. Dr. Oz was talking about it. But there was an undercurrent of doctors saying, “We’re not sure it works, and we think it may be causing harm.” And if you were against hydroxychloroquine or even unsure about it, you were the enemy.

  The White House was growing increasingly eager for the test results. State government had nothing to do with the timing of the tests, because it was all done by hospitals, with the data to go to the FDA for review, but that didn’t stop them from pressing to get the test results done faster.

  Mark Meadows, the White House chief of staff, called me. It was highly unusual for him to call me. When we did meet, he had a general air of negativity around him. When I picked up the phone, Meadows said that they wanted the results from the tests on hydroxychloroquine. I told him, as I told the president, that the tests were being done by the hospitals and when they were complete they would be sent to the FDA. I didn’t know how long they took, but no one had any interest in causing undue delay. Meadows then communicated to me that the federal government was about to send out funding for hospitals and strongly implied that if the tests weren’t completed, New York wouldn’t receive any funding.

  Now, I am a New Yorker, I am not a shrinking violet, and I am accustomed to dealing with all sorts of personalities. I have no problem dealing with tough guys—whether they are genuine tough guys, or really scared guys trying to act tough, or guys who think they need to act tough to impress me. I don’t mind exaggeration or expletives, but I draw the line at extortion. It is incredible to me that the chief of staff to the president of the United States would ever link the production of drug tests to federal government health-care funding. Government Ethics 101 tells you that’s a no-no. Meadows might not have had any federal executive experience, but he was a congressman and as such should’ve known that quid pro quos are no-bueno.

  I wondered if Meadows wanted the results because he was assuming they would be positive or if he already knew what they were. I assumed that the results must be positive or he would not have been as aggressive in wanting their release. I told Meadows that the state Department of Health would transfer the test results to the FDA as soon as they received them and that to threaten me with not funding the hospitals in my state was not a good tactic to take and would not prove productive for him.

  Then I spoke to Dr. Howard Zucker and asked him when the hospitals would finish the tests. Dr. Zucker said he didn’t know, that he had nothing to do with the tests, but that as soon as they were ready, the hospitals would send the results to the FDA. I asked Dr. Zucker to let the FDA know that as soon as the results were ready, they would receive them.

  At last, the results came in, and they were negative. Hydroxychloroquine is not effective in treating COVID, and the results actually raised possible health risks. At the same time, a number of doctors were publicly speaking out against hydroxychloroquine and the risks of using it. Remarkably, in June the FDA itself would conclude that hydroxychloroquine was of no beneficial effect and was in fact dangerous. This is just after President Trump announced that he was personally taking hydroxychloroquine as a preventative for COVID infection.

  I have two theories about what motivated the president and his minions. First, it was about money. Maybe someone had stock in a drug company related to hydroxychloroquine, or there was some financial scheme by which someone would financially benefit. The second theory is in some ways more troubling. The president was desperate to end this nightmare of coronavirus that was disrupting his reelection by disturbing the economy, and he desperately wanted to believe that there was a simple solution: There was one pill to make it all go away. Literally.

  MARCH 30 | 6,984 NEW CASES | 9,517 HOSPITALIZED | 253 DEATHS

  “This is a war, and let’s act that way, and let’s act that way now.”

  A LITTLE BOOST ONCE IN A while was helpful, and one of the great symbols of hope in this crisis was the recovery of Lawrence Garbuz, known as patient zero from New Rochelle. He had been quite sick, and the doctors did not expect him to make it. He had been put on a ventilator, and approximately 80 percent of people who are put on ventilators never come off. But he had survived and was out of the hospital. This was a reason to be hopeful.

  But so many others were dying. Early on, I had set a goal that no one would die simply due to the fact that they did not receive our best medical attention. COVID would kill people. I knew that, and it was hard to come to terms with. But no life should be lost because of our lack of organization, resources, or talent. I kept going back to images of people dying in Italian hospital corridors. There, infected individuals, including young people, were dying not from coronavirus alone but from lack of access to health-care services—lack of a ventilator, lack of medical attention. I refused to let that happen here.

  Meanwhile, I had received some more hope from a surprising source. In early March, Bill Clinton called me to touch base and see how I was doing. It meant a great deal to me that he took the time. He had been in the hot seat many times, as attorney general and governor of Arkansas and, obviously, as president. He knew what it was like to make hard decisions and live with the consequences. We had spent eight years working together, during which he had been enormously kind to me. I
was one of the youngest cabinet secretaries in history, and he had taken a big chance on me and he had also taken the time to counsel and advise me. I still appreciate it to this day. Bill Clinton is an extraordinary politician, and his ability to connect with people—to put his own self aside and actually appreciate where another person is coming from and respond on that level—is a true skill. He has a personal touch unlike anyone I have met.

  When we worked together, one of his objectives was to “reduce the New York in me.” New Yorkers are high-strung and can come off as intense. President Clinton took me on many presidential trips with him and would spend time talking to me on Air Force One about the event we had just attended, the people there, my observations and his. I remember one conversation early on when he suggested that I reach out to the House and Senate members on the HUD authorizing and appropriations committees to develop a relationship with them. He made the point it would be much more effective to visit them in their home districts than in their Washington offices. Visiting them in the district was a sign of respect and also showed constituents that their representation made a difference on the local level.

  HUD had a broad portfolio and was active in every district in the nation, so I could certainly find something that HUD was doing to justify the trip. The president simply said I should “go visit” them. I am a very literal person, so I wanted to make sure that I understood what he meant by “go visit.”

  “What do you think I should be talking with them about?” I asked him.

  The president repeated, “Just go visit.”

  As a New Yorker, I didn’t understand the concept of just visiting. I was goal oriented. Everything had to have a purpose.

  “Andrew, there is no purpose; the only purpose is to visit,” the president said.

  But I couldn’t take a hint. “But what do I want to accomplish?”

  “Nothing,” answered the president. “Just visit.”

  Eventually I understood. There did not always have to be an agenda. The personal connection was simply for the sake of the personal connection. This lesson has served me very well in later life. I would recall it when I was working through my briefings.

  President Clinton and I had another encounter that sticks with me. As HUD secretary, I was going to receive the Man of the Year Award from the Detroit NAACP. I often received these awards, which were really based on an organization’s desire to have a featured speaker. But HUD had been very aggressive on antidiscrimination work: We sued the Ku Klux Klan, and we dramatically advanced fair housing and home ownership opportunities for Black Americans.

  President Clinton called me a few days before the event to congratulate me. I didn’t think it was a big deal, and I was taken aback that he would have the time to call.

  “It’s the largest indoor sit-down dinner in the country with several thousand attendees,” he said. “I’m proud of you. I’d like to come along. You should bring Kerry. We’ll go on Air Force One.”

  “Mr. President, I’m really flattered, but that’s not necessary.”

  He insisted, and a few days later we were on Air Force One going to Detroit, and sure enough it was the largest dinner I had ever attended. The president spoke, and the crowd loved him. I spoke, but obviously no one was really that interested after hearing from the president.

  I had heard the advance people telling the president there was a shortcut to exit behind the stage so that he would not get caught by the crowd. I thought that was the plan. However, when it came time to leave, rather than exiting the stage through the back, the president walked right toward the crowd. Several thousand people surged the rope line to shake his hand. He must have stood there for two and a half hours shaking hands and taking pictures. I think he shook hands with everybody in the room. We got back on Air Force One at about one o’clock in the morning.

  I knew President Clinton could’ve just walked out the back of the hotel and saved hours, so I asked him why he stayed back. He made two points. First, he said this was a big thing for the people at the dinner and they deserved it. They would have a picture with the president, and it would be treasured. He also said, “Andrew, that’s the job. We are elected by the people to serve the people, and we must always take the time to honor and respect them and show them gratitude and humility.”

  It wasn’t as if the president had to win over anyone in that room; they all loved him before he showed up. They loved him even more after he showed up and spoke. Two hours of handshaking didn’t get him one additional fan or vote. He had them all. But he did it anyway. I’ve never forgotten that message, and I truly appreciate the human and emotional connection with the people I serve.

  One afternoon I was speaking with a young state assemblyman, and he asked me how I got people to connect with me during briefings. I said it can be simply stated. If you want people to open up to you, you open up to them first. Open your heart; show your emotion, your truth, your vulnerability, your humanity. I told my kids all their lives, “Give love, get love,” but you have to “give” it first. No one wants to go first. It risks rejection. But it’s the only way.

  The assemblyman then asked me, as he was just starting out, what advice I could give him. I had been in a reflective mood, so I gave him more than he expected. I said that government is actually a more substantive trade than many young people now appreciate. It’s not about just having an opinion or identifying a wrong that needs to be righted. Every student in a college-level political science course can do that. You must understand the issue from all dimensions, understand the complexities and the consequences. Too many opinions now are only “tweet deep.” You then need to know how to make change: how to get it done from the legislative perspective, but even more, how the change would then be implemented. How do you make it happen and how do you make it happen with no unintended consequences? Raising problems without effecting solutions is pointless, if not counterproductive. I said, look at the extraordinary baseball players: They are “complete players.” You must be a power hitter who can also bunt. A fielder who can also run bases. In government you must be a strong advocate but also know how to manage, execute, compromise, and forge consensus. Criticism is easy. Construction is hard.

  More than two decades later, President Clinton and I talked about the pressure and the consequences of my situation, and then he passed on a piece of information. He knew a lot of people in big pharma through his work to bring necessary drugs to Africa for many years. He told me that people whom he respected suggested that remdesivir was a drug that might be helpful against coronavirus and that our Department of Health should check it out.

  After the call, I phoned Dr. Zucker and told him what the president had said. Zucker had also heard about remdesivir and agreed it might be helpful. He said he would call the FDA and ask what they thought. I followed up a few days later, and he told me that the FDA was reviewing studies.

  Fast-forward approximately three and a half months. The HHS secretary, Alex Azar, says on national TV during the last week of June that the administration will be buying a drug that they recently discovered and that showed promise. What was the name of the drug? Remdesivir. All those weeks wasted obsessing over hydroxychloroquine, and there was an existing drug that actually worked which they knew about months before.

  MARCH 31 | 9,298 NEW CASES | 10,929 HOSPITALIZED | 332 DEATHS

  “The main battle is at the apex; we’re still going up the mountain.”

  WE WERE STILL TWO TO four weeks from the apex of this mountain we were climbing, and we were all tired. A month of bad news, our lifestyles disrupted, and nobody knew when it was going to get better, not even the president, who was harping on reopening the country by Easter, less than two weeks away.

  The nation was realizing the disparity in the infection rate between lower-income communities and higher-income communities. Luckily, in New York the disparity was much less than other states across the nat
ion. We were testing more people than any state in the country, even more per capita than China and South Korea. New York City had an infection rate of about 19 percent. The infection rate among the Black community and the Latino community was about 23 percent; in some states there was a nearly 50 percent differential. We wanted to ensure that every New Yorker was getting all the help they needed. We were increasing testing and services in Black and brown communities and made special efforts in public housing. Our greatest challenge was in New York City’s crowded public housing. In these areas special teams were going door to door to offer people testing and information on social distancing, masks, and precautions.

  The high-infection areas were what we called hot-spot zip codes. The highest infection rate hot spots had an infection rate of approximately 50 percent. Corona, Queens, which is served by Elmhurst Hospital, was one of those hot spots. Elmhurst made national news when it was overwhelmed with patients and suffered a severe shortage of supplies. It was an eye-opener on several levels. Elmhurst is a community that comprises many new immigrants and low-income people. It is a community that did not have as much access to health care and had many underlying illnesses. It was also a community suffering from a housing shortage, with many new immigrants living in tight quarters.

  Elmhurst is a public hospital as opposed to a private hospital. In downstate New York, there are approximately one hundred hospitals with about ninety “privately run” and eleven “public” hospitals operated by the City of New York. While we had understood that it would be a challenge to get the private hospitals to work together, we didn’t know that the eleven public hospitals, all owned by New York City, were not already coordinated as one system either. If Elmhurst was overwhelmed, why didn’t it coordinate with the other ten hospitals in the same system to shift patients, resources, and staff as necessary?