I found his constant pandering to the Far Right alternately disingenuous and repugnant, but today was a different day, and New York needed the federal government. As a former cabinet secretary, I knew what it could do, and I knew we needed its assistance. My personal feelings and politics were irrelevant. I would do my best to make the relationship work.
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THE STATE’S WADSWORTH Laboratory had the capacity to do about four hundred tests per day. Now that we had permission from the federal government to conduct tests ourselves, we announced the ambitious goal of increasing capacity to a thousand per day within a week and said that tests would be free to the public. Given the current state of testing in the United States, this number was ridiculed as pie in the sky by some folks, and several of my own team thought I was crazy for setting such a high goal. What we didn’t know was that ultimately we would need to perform in excess of fifty thousand tests per day.
New Yorkers, some of whom can be a neurotic group, were quick to analyze the potential exposure risk. For months, we’d thought the risk was from the West Coast, where it seemed the virus first took root in late January. The CDC was allowing tests only for people with symptoms who had recently traveled from Wuhan, China. Of the few people who were being tested, the nasal swab was performed in New York, then mailed to Atlanta. I knew we were in trouble when four of my family members called asking how they could be tested. Meanwhile, the World Health Organization (WHO) declared a global emergency on January 30, and San Diego and then San Francisco declared states of emergency in February. But the CDC had claimed there were no cases in New York. An FDA press release on February 4 said, “At this time, federal health officials continue to believe that the threat to the general American population from this virus is relatively low.”
All through January and February, the Department of Health sent us updates of people under investigation, or PUIs, in New York. These were people who had traveled to Hubei Province in China or had had contact with a relative who had traveled and now had a temperature. All the tests went through the CDC in Atlanta. And every day, the New York State Department of Health would put out a press release saying, according to the CDC, there were no confirmed cases of COVID in New York. It gave people the sense that the situation was being well monitored, but it was completely false because there were so few tests and they were testing the wrong people! On top of that, they didn’t know that the enemy had already been arriving from another part of the world, probably earlier than the first week in February.
Given the density and crowding of New York City, once the virus had officially arrived, the possibility of coming in contact with a COVID-positive person was very real. If a positive person took the subway, people immediately wanted to know what train, at what time, and what car. Maybe they had held the same pole in a bus or train as a COVID-positive person. Maybe they rode in the same cab. Maybe they were in the same Uber. The possibilities were endless, so we quickly instituted new cleaning protocols for public transportation, schools, and so on.
For months the federal government told us the COVID spread was from symptomatic individuals, that transmission was from sneezing, coughing, and touching contaminated surfaces. However, that was a half-truth. We would later learn that the virus also spreads from asymptomatic individuals.
Yet as early as January 27, a doctor named Camilla Rothe, exploring Germany’s first coronavirus case, concluded that the patient was infected by a person from China. The doctor also found that the visitor from China exhibited no symptoms whatsoever. Thereafter there was a viral spread in French churches, Italian soccer stadiums, Austrian ski barns—all also apparently from asymptomatic or presymptomatic spreading. One of the first international outbreaks of the virus was on a cruise ship, the Diamond Princess. Interviews with the health professionals on the ship pointed to symptomless spread: Of the 454 people who tested positive, about 70 percent showed no symptoms whatsoever.
The health community debated the concept of asymptomatic spread for more than two months before they were willing to accept it. There were articles published in The New England Journal of Medicine as a caution to countries around the world. The World Health Organization noted in early February that patients might transmit the virus before showing symptoms, but also said patients with symptoms were the “main” cause of the spread of the epidemic. Chinese health authorities had also explicitly cautioned that patients were contagious before showing symptoms.
Why would federal health officials be hesitant to acknowledge symptomless spread? And why would the orientation not have been toward being overly cautious, assuming the worst, and acting accordingly? Because the ramifications were too colossal. If we assumed people must show symptoms if they were positive, it made the diagnosis and containment much easier. It also limited the population that required attention. If we assumed a person without any symptoms could be positive, massive amounts of testing would be required at extraordinary expense.
Too many federal officials were oblivious to the conversations about how the virus spreads. As is the case
