With New York in a race against the "bullet train" of the coronavirus sweeping across it, public health experts warned of the challenges ahead to prevent the state from becoming the next Italy.
Gov. Andrew Cuomo painted a dire forecast for the outbreak Tuesday morning, saying that the spread of COVID-19, the disease caused by the virus, was accelerating and that the state was in "desperate" need of ventilators and more hospital beds with the projected apex just 14 to 21 days away.
With cases soaring to more than 25,000, and more than 200 dead as of Tuesday evening, New York is the center of the coronavirus in the country as officials try to slow its spread by setting up field hospitals, calling on hospitals to increase their capacity and urging residents to stay home.
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"We are not slowing it, and it is accelerating on its own," Cuomo said during a news conference at the Jacob K. Javits Convention Center in New York City. "One of the forecasters said to me we were looking at a freight train coming across the country. We're now looking at a bullet train, because the numbers are going up that quickly."
Cuomo said that there was a "critical and desperate need" for ventilators — at least 30,000. The state's hospital system typically has 3,000 to 4,000 ventilators and has so far managed to procure about 7,000 more, he said.
The governor strongly urged the Trump administration to provide its 20,000 reserve ventilators to New York and invoke the Defense Production Act to direct companies to make the much-needed machines.
Later Tuesday, Vice President Mike Pence said in an interview with Fox News that the federal government was preparing to send 4,000 ventilators within the next two days.
Cuomo said the projected need for hospital beds could be as high as 140,000 in a state that has only 53,000.
Dr. Deborah Birx, the White House's coronavirus response coordinator, said that population density could account for part of the spread in New York and that another part could be the spread as people take the subway and touch metal surfaces.
Dr. William Schaffner, an infectious diseases specialist at Vanderbilt University, said there were certainly concerns that New York could become the next Italy, where the virus quickly spread to more than 60,000 people and more people have died than in China.
There have been 6,820 deaths in Italy, compared to just over 3,000 in China. In some areas, hospitals have been so overwhelmed that they have not been able to accept new patients as the death toll continues at an alarming rate, with 743 deaths in the last day. While Italy now has some of the strictest public measures in response to the crisis, the country's initial incremental measures, such as establishing containment zones, proved to be too little to stop the sweeping outbreak.
"Because you have such a concentrated population in New York City, the virus can spread very readily," Schaffner said.
Despite a strong hospital system in the state, facilities "could easily get swamped and just be stretched beyond what their capacity would be," he added.
Another concern is "the exhaustion of health care workers," he said, adding: "We have a finite number of health care workers."
Schaffner added that bringing in retired workers quickly is not always easy, given potential licensing or insurance issues.
The state has asked for four field hospitals, including one at the Javits Center, where Cuomo spoke Tuesday in front of supplies. The three others would be on Long Island and in Westchester County outside the city. Members of the National Guard were helping to convert the center in a process Cuomo has said could take a week to 10 days.
Mayor Bill de Blasio starkly warned Tuesday that New York City was "just trying to get through March right now," especially in terms of its health care system.
Even with new supplies coming in, de Blasio warned of shortages, especially in terms of ventilators, as the crisis could continue in the city for months. The federal government is giving 2,000 ventilators to the city, on top of 400 more that were given, but the city is asking for 15,000.
"That'll just get us to the first week of April," he said at a news conference. "Even with this new supply, it doesn't guarantee we'll get through that first week."
Schaffner urged New Yorkers to practice good hygiene habits, take social distancing very seriously and stay home whenever possible.
"Keeping us all very separate, I think, that is the key thing we can do at the present time to try to dampen the curve," he said.
Dr. Nikita Desai, a pulmonary and critical care physician at the Cleveland Clinic, said that although the U.S. is in "an unprecedented time," previous outbreaks show how important social distancing is to slow the spread of a disease in populous places like New York.
Desai said slowing the spread would leave the health care system better equipped to deal with ongoing cases. She said hospital systems tended to hundreds of thousands of patients for the flu in the last year and were able to handle them because "we need them to not all happen in the same week."
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On Sunday, President Donald Trump announced that he had approved requests to federally fund the National Guard to assist Washington, California and New York, three of the hardest-hit states.
He also said large quantities of masks, respirators, gowns, face shields and other items were due to arrive in the three states within days. He said he had ordered the government to set up large federal medical stations in each of the states.
Katherine Baicker, dean of the University of Chicago's Harris School of Public Policy, said social distancing and closing businesses in the short term were essential for the economy to bounce back when the crisis is over.
"Clearly, in the short term, everything we can do to stem the spread of the disease is of vital importance," she said, adding that the country and companies would need to figure out how to keep necessary production going as safely as possible, such as production of food and medical supplies.
Baicker, a former member of the Council of Economic Advisers under President George W. Bush, said it was also important for the government to provide social insurance and relief for businesses and families in need in order to invest in the economy in the long term.
Such investments and social distancing would eventually pay off both in public health and in "allowing the ramping up of economic activity sooner" once it is safe, she said.
"The health epidemic is a major crisis, but if that were to go away, we could resume economic activity," she said. "The more effective we can be in slowing the spread of the disease, the faster we can get it under control, the faster we can return to normal economic activity."