American Crisis

test every nursing home employee before they go to work every day. But there are 158,000 nursing home employees. New York did not have enough testing capacity, even at our height, when we were doing 70,000 daily tests, to accomplish this feat. A more modest goal would be to test workers once a week. Even this was not achievable when COVID first came to New York, because the statewide testing capacity was only about five thousand per week, and again, there were 158,000 nursing home workers. Once our testing capacity increased, we mandated testing every nursing home worker once a week. We would do that again in the future. However, even this is imperfect. Some workers can get infected and bring in the virus between weekly tests. It could slow the number of infected people entering nursing homes, but it wouldn’t prevent the virus from entering entirely.

We also could have stopped family visitation earlier. Again, we didn’t know the virus had come to New York, or that there was asymptomatic spread. We stopped visitation on March 13. But even going forward, if at the first sign of a virus we stop all family visitation, that would be a harsh, dual-edged sword. I hear many recriminations about stopping people in nursing homes from having visits from their loved ones.

Theoretically, we could test all visitors and workers daily going into nursing homes. Again, theoretically, that could be applied to hospitals, group homes, and so on. But that would require a testing capacity that as of this writing is impossible to achieve. It would require serious federal participation.

The ideal scenario would be to hermetically seal off nursing homes. The closest model to this was done by a nursing home in France, where some workers volunteered to live in the facility and not go back to their own homes. They essentially quarantined in the facility. This is extraordinary: staff living in the facility for months and not seeing their families. This would have to be combined with no outside visitors. Theoretically, it would be the safest procedure but I don’t know that it is practical or replicable on a large scale. Legally, I could not force 158,000 workers to stay on site. If that is what we need in the future, we would need to be clear and hire workers willing to do that. We should then also consider that for hospitals, group homes, et cetera. It would be ideal but virtually impossible to implement.

I believe we need the best federal health experts to review international data and determine a national nursing home and congregate facility protocol to be implemented at the first sign of an outbreak. The key would be large-scale testing capacity, which only the federal government could provide.

Wisdom comes back to the same point: We control what we can, but we must accept that we cannot control everything.

As of this writing, six months after everything New York experienced, COVID is now devastating nursing homes in Florida, where nursing home patients and staff account for approximately 45 percent of all deaths in the state. To explain the increase in deaths, Governor DeSantis’s secretary of the Agency for Health Care Administration (AHCA) said, “Infected, asymptomatic health workers themselves are carrying the virus and transmitting to their own patients.” (That is what happened in New York five months ago without the notice Florida had.) On July 15, the AHCA issued Emergency Rule 59AER20-6, allowing nursing homes with healthy residents to accept COVID-positive patients. Following the order, it was reported that “many long-term care facilities throughout Florida quietly, quickly, and deliberately began bringing COVID-19-positive patients into places where healthy residents live.” COVID patients are being transferred from hospitals into Florida nursing homes with the express blessing of the DeSantis administration. Florida was having the problem we prepared for but which we avoided. Their hospitals were over capacity, and they had no choice but to send seniors back to nursing homes. They did not reduce the viral transmission rate the way New York State did, nor did they build the alternative additional beds we did. For New York, it was a worst-case-scenario plan that never materialized. For Florida, it was reality. Unsurprisingly, neither Donald Trump nor Fox News maligns Republican governor DeSantis for actually doing what they incorrectly accused New York of doing.

MAY 11 | 1,660 NEW CASES | 7,226 HOSPITALIZED | 161 DEATHS

  “We have been smart through this, and we have to continue to be smart.”

THE BUDGET IN THE FEDERAL government is not real. The numbers don’t add up, but then again they don’t have to. The federal government can print money, so theoretically it can solve any financial issue by turning on the printing press in the basement. States don’t have a printing press; however, I do have an old Xerox copier in the basement. A state must pass a balanced budget. By July, the COVID crisis had already caused a $14 billion budget shortfall in New York because of reduced tax revenue. That was an impossible number for me to deal with. If there was ever a day that it was not top of mind for me, I was joined at the daily briefings by my budget director, Robert Mujica, who made it his business to remind me.

We had to reopen, and we had to reopen smart. While every expert talked about an economic reopening plan that included testing and a data-driven approach, no such coherent methodology existed. No state had successfully done it yet. There was no template or blueprint. I assembled my team and said that I wanted to develop the most science-based reopening plan in the country.

I wanted the reopening plan to track specific metrics like infection rate, hospital capacity, and testing and tracing rates. I wanted two specific data thresholds: first, a series of metrics that had to be met—showing the virus is under control—that would be required before a region could begin reopening; second, a series of metrics that would monitor the