The situation was becoming more and more clear in my mind. We needed him to do more than he wanted to do. The president didn’t understand the federal-state relationship and the true capacity of an engaged federal government. He didn’t see this as his problem. I was tempted to say to him that if the federal government was not responsible for a national crisis affecting all fifty states, what was it responsible for? What was the federal government’s role if not the interests of the states? It was all absurd to me. But I had promised myself I would bite my tongue. The president had agreed that they would help us with the testing supply chain, and that would be an accomplishment for the state. I would hold him to it. It was also becoming increasingly clear to me that while I knew COVID would be a fifty-state problem, the White House still believed COVID would be only a blue-state problem. That was the disconnect.
Six days later, he would make a statement in the Rose Garden promising to help states with the reagents.
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IN ADDITION TO diagnostic testing, which tells you if a person is positive or negative at that moment, we had started antibody testing in early April all across the state, and the results were very interesting. Antibody testing tells you if the person had the virus in the past. Our April antibody survey showed that in New York City 19.9 percent of those tested had antibodies, meaning they were infected at one point in time. On Long Island, 11.4 percent; in upstate New York, 3 percent.
We also aggressively tested all the essential workers. I had never gotten over the philosophical issue of having the essential workers show up so that other people could stay home safe. I wanted to make sure they were okay. Every death of an essential worker resonated with me. Expert opinion and common sense assumed essential workers were exposed to greater risk. Testing would tell us. We decided to do thousands of antibody tests of essential workers to find out what was going on. We tested police officers, nurses, doctors, and transportation workers all across the state. If essential workers had a higher infection rate, we would know.
We did the police departments first, both state and local. The New York City Police Department had an infection rate of 10.5 percent. Amazingly, New York City itself had an infection rate of 19.9 percent. That meant the NYPD actually had a lower infection rate than the general population. How was that even possible? We tested nurses and doctors next. These were people who worked in emergency rooms and were obviously exposed to COVID-positive people in the most dangerous circumstances. The infection rate for New York City doctors and nurses was 12 percent. That was even lower than the infection rate in the general geographic area.
Two thoughts came to mind. First, what a relief. It was the best news that I had personally received since this began. Yes, I asked essential workers to step up to the plate, but by the grace of God they were at no more risk than people within their community. A major weight was lifted from my chest. Knowing the low infection rate of essential workers lifted the morale of my whole team. The second thought was, how could this even be possible? How could people working in an emergency room have a lower infection rate than the general population? It became my new obsession to find out.
The global experts were somewhat surprised, but they had also seen lower infection rates among health-care workers in other countries compared with the general population. The only explanation was that the PPE worked. Of the PPE, the face shields and gowns were helpful no doubt, but the masks were the most critical piece of equipment.
Early on, disease experts warned of surface transmission. We took significant precautions to minimize surface exposure. However, as time went on and the experts had more data, emphasis turned to airborne transmission. Medical professionals stressed that the masks were helpful to stop positive people from transmitting it in their breath. But some experts had been telling me that the masks might also help prevent the particles from being inhaled.
This antibody testing data confirmed their theory. Many of the positive people coming into an emergency room didn’t have masks. The health-care professionals did. The masks were stopping people from inhaling the virus. Health-care professionals were equipped with N95 masks. These are different from surgical masks. N95 is a designation referring to the size of the particulate matter stopped by the filter in the mask. N95s are the highest-level masks in general use. Interestingly, they are used not just by health-care professionals but for industry applications as well, including applying fertilizers, paints, and other potentially dangerous chemicals that could be airborne. The N95 mask has two straps, and it had to be molded to the nose, cheeks, and chin to make sure there were no air pockets. Any gaps would reduce their effectiveness.
The run on N95 masks was so significant that they were hard to get even for health-care workers. I would venture to say that health-care experts would have recommended everyone in the general public wear N95 masks if they were not afraid of worsening the scarcity. There is also an argument to be made that an N95 mask is overkill for a member of the general public. They are uncomfortable and hot. Pictures of the health-care workers who wear them sometimes show marks on their faces from the tightness of the masks. They originally cost about seventy cents per mask before the price gouging began. In an ideal world there would be enough supply for all Americans. Again, health-care professionals might disagree and say they should be prioritized for health-care workers.
Masks became a political statement. President Trump would not encourage mask wearing, nor would he wear
