Day 132: Making it Worse

The world has accumulated 7.5 million coronavirus cases, with nearly 423,000 deaths. The US (over 2 million cases) is slowly creeping upwards at a rate of 20,000 cases or so a day. Second-place Brazil has topped 800,000 cases and 40,000 deaths. Russia (#3) has exceeded 500,000 cases, and today India jumped past both the UK and Spain to hit fourth place just shy of 300,000 cases. Massachusetts cases are up half a percent today.

The Wall Street Journal has put together a scathing overview of the state's delayed and counterproductive reaction to the coronavirus: How New York’s Coronavirus Response Made the Pandemic Worse. PlagueBlog did not find most of it all that damning; it's not clear that a few days' delay in closing schools and other "slow" reactions really made much of a difference compared to the CDC's only-ex-China testing policies (for which New York is also unfairly blamed):

In early March at Health + Hospitals' Elmhurst, Dr. Chad Meyers and his colleagues in the emergency room worried they were missing community spread of Covid-19. But when they called the city’s health department to get patients tested, it rejected for testing even many patients who satisfied the criteria, Dr. Meyers said, leading to “often protracted and unproductive calls” with the department.

Hospital, city and state officials said they were relying on the federal government for testing capability and were limited by criteria set by the Centers for Disease Control and Prevention on whom they could test. Jason McDonald, a CDC spokesman, said: “CDC testing guidance has always allowed for clinical discretion. So, while we set guidelines, states and health-care providers have had the flexibility to determine who to test.”

I'd blame the CDC for that one, although it does sound suspiciously like Governor Cuomo's argument that the nursing homes never had to take the COVID-19 patients he forced on them.

The state's called for a 50% increase in beds with little provision for a corresponding increase in staffing, though to what extent that was a true "misstep" is unclear from the anecdotal nature of the evidence. Statistics of ventilator deaths from lack of training or substandard equipment should not be taken too much to heart, considering the generally low rate of survival of COVID-19 patients on ventilation.

The article becomes quite torn on the topic of equipment and oxygen shortages; the anecdotes say there weren't enough, and the administrators and spokespeople say there were no shortages. There's also a question of how healthy and well-documented the patients who were transferred between hospitals were. A spokeswoman blamed the generally unstable condition of COVID-19 patients for the nearly-dead-on-arrival transfer phenomenon.

Perhaps most damningly, there was a policy of neither testing nor furloughing exposed and/or asymptomatic staff, due in part to the shortage of tests (not to mention the shortage of staff). The most dangerous choice of all, however, merits only an aside in an anecdotal story about PPE: an executive committed suicide over PPE procurement "among other issues nursing homes faced," such as the flood of COVID-19 cases forced on them by the state.