Mar 1, 2020
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Coronavirus in N.Y.: Growing Anxiety as Doctors Prepare for an Epidemic

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In recent weeks, some hospitals in New York City have begun safeguarding their stockpiles of masks and other protective gear amid suspicions that employees were taking them home.

Administrators at one hospital are allowing pregnant employees to opt out of caring for anyone thought to have the new coronavirus. At another hospital, radiologists have been studying CT scans of coronavirus patients from China.

Although no one in New York has tested positive for the virus, doctors and public health officials in the city and state, amid growing anxiety, have been bracing for the possibility of an epidemic that could strain the health care system.

The pace of the preparations may increase after federal officials urged Americans on Tuesday to prepare for the spread of the virus in the United States, with the possibility that containment strategies could soon give way to mitigation plans.

New York State officials say they are ready, with a huge store of supplies hidden in three locations around the state, including a soaring, temperature-controlled warehouse near Albany.

The warehouse is stacked to its 40-foot ceilings with surgical masks, gowns and gloves, and more extreme protective gear like N95 respirators and enclosed Tyvek suits, which resemble hazmat suits. Officials have also stockpiled ventilators, a necessity for severe cases of this coronavirus, which causes high fever and respiratory problems.

Officials are also consulting state and federal playbooks for potential plans, including measures like closing schools, day care centers and businesses; canceling mass gatherings and curtailing mass transit, although they caution that taking such steps is only being considered in worst-case scenarios.

New York law already provides for emergency powers for the governor and health officials, but state lawyers are examining whether changes might be necessary to address this threat, officials said. The state is also asking federal officials to allow testing for the virus at a basement-level laboratory adjacent to the State Capitol, and at laboratories in New York City and elsewhere. The tests are currently being sent via FedEx to the federal Centers for Disease Control in Atlanta.

On Wednesday, Gov. Andrew M. Cuomo and Dr. Howard Zucker, the state health commissioner, announced a $40 million plan to fight the virus, promising the addition of more epidemiologists and other personnel to track potential patients, as well as more equipment to help treat the state’s first patients. New York City officials said on Wednesday that 1,200 hospital beds could be made available for coronavirus cases without affecting other patients.

  • Updated Feb. 29, 2020

    • At least 65 people in the U.S. have been infected with the virus, with some newer cases not believed to be connected to recent overseas travel or contact with a person known to be infected.
    • An outbreak would test the American education system. Few schools have detailed plans to teach online if schools were closed for long periods.
    • The Centers for Disease Control and Prevention warned that Americans should brace for the likelihood that the virus will spread in the U.S. Some lawmakers questioned whether the nation is prepared.
    • Can a state force a city to house coronavirus patients? A federal judge ruled that Costa Mesa, Calif., does not have to, at least for now.
    • The outbreak has left some Asian-Americans feeling an unsettling level of public scrutiny.
    • An Omaha hospital that drew attention for treating Ebola patients is now playing a key role again.
    • Most experts agree: To protect yourself wash your hands and avoid touching your face.
    • Mask hoarders may increase the risk of an outbreak in the U.S. Health care workers risk infection if they cannot get the protective gear.

Nobody knows quite what an outbreak in New York City or in the United States more broadly would look like.

But the effect on daily life in America’s most populous city could be dramatic: Staggering or limiting public transportation; a shutdown of the country’s largest school system would leave 1.1 million children at home; and a sharp drop in the nearly 70 million tourists who visit the city each year could put a financial strain on local businesses. (Tourism from China has already been restricted.)

Officials say that the virus’s arrival in New York seems inevitable, and on Thursday they identified a possible patient who was being tested for infection. Seven other people in New York City who were previously tested were found not to have the virus.

After originating in China, where entire cities were eventually placed on lockdown, the disease has spread to more than 40 countries. New hubs recently emerged in Iran, Italy, and South Korea. By Wednesday, nearly 3,000 people had been killed by the virus and more than 81,000 had been infected.

Emergency planners in New York, both the city and the state, note that they have been quietly preparing for a pandemic for years. Their plans offer a rough sketch of what might happen in an outbreak of the coronavirus — technically known as Covid-19.

Yet in interviews, doctors at several hospitals in the city described growing concern about the new illness and whether New York’s health care system was prepared for it. The doctors expressed a worry that too few people were currently being tested. One doctor said that she was watching YouTube videos to learn how to use protective equipment. At some hospitals, two doctors said, surgical masks had begun to disappear in noticeable numbers, leading administrators to conclude that staff members were probably bringing them home.

The New York Department of Health has been asking hospitals “to dust off the pandemic flu plans,” according to Dr. Zucker, the state health commissioner. He noted that the coronavirus was similar to influenza in its transmission and in its nature as a respiratory illness.

Dr. Zucker said the state planned to hold meetings with police and transit officials to work through various outbreak scenarios.

“Day 2, Day 4, who calls who?” Dr. Zucker said of the planning sessions. “What’s the supply chain? What do you do with transportation, what do you do with mass gatherings?”

One planning document from November 2014 prepared by the city’s Emergency Management Department, which examined the effect of a flu pandemic, said that in a severe pandemic, as many as 41,000 people might die in each wave of possibly two or three.

Among the areas the report identified as most at risk included the Southwest Bronx, Morningside Heights in Manhattan and the Brooklyn neighborhoods of Bedford-Stuyvesant, East New York, Crown Heights and Coney Island.

During the H1N1 “swine flu” pandemic in 2009, New York City closed a limited number of schools. Closing a large number of schools, or the entire school system, is not a move that public health officials would take lightly, and they are likely to wrestle with how aggressive their response should be.

If the first cases of infection in New York seem to be linked to a certain place, or if they are otherwise easily traced, the authorities would take limited steps: monitoring people who may have been exposed or asking some to quarantine at home. They could also close down a particular location associated with the virus’s spread.

But if people began getting sick from the virus without an apparent connection to earlier cases, public health officials would most likely institute so-called social-distancing measures that were more aggressive.

Complicating matters is that so much remains unknown about the new coronavirus, including how infectious it is and the fatality rate.

But there is danger in waiting too long before taking action and giving the virus time to spread unchecked, public health experts said. China did little initially to slow transmission. The government suppressed information about the virus and intimidated doctors who tried to raise concerns. After the illness began to spread widely, China imposed a quarantine on a scale that some public health officials deemed unprecedented.

Some public health experts say that past pandemics — in particular the deadly Spanish flu pandemic of 1918, which killed approximately 675,000 people in the United States, offer lessons, including the importance of imposing strict social-distancing measures early and keeping them in place.

In the 1918 pandemic, various cities took different tactics. Some continued to allow public gatherings in the weeks after the first cases appeared. Others acted more quickly.

A study that examined 17 American cities’ responses to the 1918 pandemic found that “early implementation of certain interventions, including closure of schools, churches, and theaters, was associated with lower peak death rates.”

In New York, there have been some recent efforts to plan for a pandemic on the scale of the one in 1918. The state, for instance, has been stockpiling ventilators, which are critical for treating coronavirus patients who have a severe form of the illness.

Across New York, there were 7,241 ventilators in acute care settings, and another 1,750 stockpiled for use in an emergency, according to a 2015 state report. The report noted that the supply of ventilators would be inadequate for a pandemic on the scale of the 1918 flu outbreak.

The task force that issued the report devised a formula, relying partially on medical criteria, to help hospitals decide who would get ventilators and who would not. It also envisioned a lottery system in some instances. And age could play a role, with children being given preference over adults.

Most of the preparations in New York City over the past month have been focused on how to confront a smaller scale crisis.

Michael Phillips, the chief hospital epidemiologist for the NYU Langone Health System, listed numerous preparations that had been made, including plans to essentially split the main hospital between patients who have respiratory illness and those who do not. He said that alternative sites within the system had been identified where doctors could start treating patients if the number of cases spiked.

Still, Dr. Phillips wondered about the broader plan in the event that the illness spread beyond what hospitals could handle. “Where would those patients go?” he said. “We’re not China, and we can’t build an isolation hospital in 10 days.”

It is a question that public health officials in New York City have so far been reluctant to address publicly.

“We can really keep this thing contained,” Mr. de Blasio said at a news conference on Wednesday.

Asked what would happen if the 1,200 hospital beds currently available for coronavirus patients filled up, he said, “We’ve got a long time to ramp up if we ever had anything like that.”

Christina Goldbaum contributed reporting.

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