How New York’s Coronavirus Response Made the Pandemic Worse

The hasty expansion of medical facilities by state, city and hospital leaders led to grave mistakes, a Wall Street Journal investigation found; ‘wartime conditions’

By Shalini Ramachandran, Laura Kusisto and Katie Honan of The WSJ. Excerpts:

"In the first few days of March, Gov. Andrew Cuomo and Mayor Bill de Blasio assured New Yorkers things were under control. On March 2, Mr. de Blasio tweeted that people should go see a movie."

"• Improper patient transfers. Some patients were too sick to have been transferred between hospitals. Squabbling between the Cuomo and de Blasio administrations contributed to an uncoordinated effort.

• Insufficient isolation protocols. Hospitals often mixed infected patients with the uninfected early on, and the virus spread to non-Covid-19 units.

• Inadequate staff planning. Hospitals added hundreds of intensive-care beds but not always enough trained staff, leading to improper treatments and overlooked patients dying alone.

• Mixed messages. State, city government and hospital officials kept shifting guidelines about when exposed and ill front-line workers should return to work.

• Overreliance on government sources for key equipment. Hospitals turned to the state and federal government for hundreds of ventilators, but many were faulty or inadequate.

• Procurement-planning gaps. While leaders focused attention on procuring ventilators, hospitals didn’t always provide for adequate supplies of critical resources including oxygen, vital-signs monitors and dialysis machines.

• Incomplete staff-protection policies. Many hospitals provided staff with insufficient protective equipment and testing"

"One planning lapse showed up in improper patient transfers. More than 1,600 largely Covid-19 patients in two of the state’s largest hospital systems were moved from overloaded hospitals to ones less hit, according to spokespeople for those systems. Some patients arrived in worse condition than when they left, sometimes without names and treatment information, said doctors and nurses at several hospitals.

Under normal protocol, only stable patients typically would be transferred, but these people came in with “one foot in the grave,” said Dr. David Buziashvili, who worked many shifts at Bellevue hospital, part of the city’s public system, NYC Health + Hospitals. On one shift there, he was alarmed to see 10 new transfers in beds with little medical information,"

"Avery Cohen, a City Hall spokeswoman, blamed the state for denying a request from the city to establish a centralized hub, called a Healthcare Evacuation Call Center, that would have helped better coordinate transfers between hospitals"

"A contributing factor was New York leaders’ delayed reaction. Early signs of the virus’s arrival—including a rise in patients with flulike symptoms visiting hospitals—went largely uninvestigated by hospital, state and city officials. The city health department was limiting testing primarily to travelers from China, following the federal government’s lead. Throughout February in calls with hospitals, the city health department played down the possibility that the virus could spread through the air or by asymptomatic people."

"In early March . . . the city’s health department . . . rejected for testing even many patients who satisfied the criteria"

"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."

"Messrs. Cuomo and de Blasio delayed taking measures to close the state and city even as the number of cases swelled, despite warnings from doctors, nurses and schoolteachers."

"Even after New York announced its first coronavirus case on March 1, the city health department was advising New Yorkers they were more likely to get the flu."

"On March 23, Mr. Cuomo ordered hospitals to increase capacity to treat Covid-19 by 50%, anticipating the need for 140,000 new beds. When hospital executives asked where they would get staffing, beds and protective gear, state officials told them to “do your best,”"

"When New York City’s Office of Emergency Management realized massive mobilization would be needed to coordinate transferring hundreds of Covid-19 patients from overwhelmed hospitals, the mayor’s administration sought the state’s help to activate a centralized evacuation hub previously used for emergencies like superstorm Sandy, according to city officials.

Twice, the state’s department of health denied the request, the officials said. When the state gave the green light on March 26, the hub was used to transport patients only to Javits Center and the USNS Comfort Navy ship, the officials said—facilities set up with the federal government that ended up disappointing hospital executives because they weren’t initially built for critical care or to take Covid-19 patients and eventually took only mild to moderately ill Covid patients."


"Mr. Cuomo announced a state-run program on March 30 to coordinate beds, equipment and staff."

"But the system didn’t supervise the transfer of medical records about patients or follow up on their conditions once they were moved, he said. “You were trying to manage volume,” Mr. Malatras said, “not necessarily the individual patient need.”"

"Early on, most hospitals told staff to isolate suspected Covid-19 patients in rooms with negative air pressure to limit spread.

But as patients flooded in, hospitals including Maimonides Medical Center, Health + Hospitals' Bellevue and Harlem, and Northwell’s Staten Island University Hospital housed suspected Covid-19 patients together, sometimes side-by-side or in the same vicinity as confirmed Covid-19 patients, health-care workers there said. Sick patients likely infected some neighbors in the days it sometimes took to get test results, they said."

"It didn’t help that New York City, state government and hospital officials, often relying on CDC guidance, kept shifting guidelines about when sick and exposed front-line workers should return to work—and didn’t plan for thorough staff testing."

"The CDC on March 17 was advising that confirmed Covid-positive health-care workers shouldn’t return to work until they received a negative test and their symptoms had improved, according to a notice at the time from the Greater New York Hospital Association. On April 30, the CDC updated its guidance to say Covid-positive workers didn’t necessarily need a negative test to return and could wait 10 days after symptoms first appeared and 72 hours after they abated."