“ The initial coronavirus outbreaks in New York City emerged at roughly the same time as those in Seattle. But the cities’ experiences with the disease have markedly differed. By the second week of April, Washington State had roughly one recorded fatality per fourteen thousand residents. New York’s rate of death was nearly six times higher.
There are many explanations for this divergence. New York is denser than Seattle and relies more heavily on public transportation, which forces commuters into close contact. In Seattle, efforts at social distancing may have been aided by local attitudes—newcomers are warned of the Seattle Freeze, which one local columnist compared to the popular girl in high school who “always smiles and says hello” but “doesn’t know your name and doesn’t care to.” New Yorkers are in your face, whether you like it or not. (“Stand back at least six feet, playa,” a sign in the window of a Bronx bodega cautioned. “covid-19 is some real excrement!”) New York also has more poverty and inequality than Seattle, and more international travellers. Moreover, as Mike Famulare, a senior research scientist at the Institute for Disease Modeling, put it to me, “There’s always some element of good luck and bad luck in a pandemic.”
It’s also true, however, that the cities’ leaders acted and communicated very differently in the early stages of the pandemic. Seattle’s leaders moved fast to persuade people to stay home and follow the scientists’ advice; New York’s leaders, despite having a highly esteemed public-health department, moved more slowly, offered more muddied messages, and let politicians’ voices dominate.
New York’s mayor, Bill de Blasio, has long had a fraught relationship with the city’s Department of Health and Mental Hygiene, which, though technically under his control, seeks to function independently and avoid political fights. “There’s always a bit of a split between the political appointees, whose jobs are to make a mayor look good, and public-health professionals, who sometimes have to make unpopular recommendations,” a former head of the Department of Health told me. “But, with the de Blasio people, that antagonism is ten times worse. They are so much more impossible to work with than other administrations.” In 2015, when Legionnaires’ disease sickened at least a hundred and thirty New Yorkers and killed at least twelve, tensions between de Blasio and the Health Department came to a head. After de Blasio ordered health officials to force their way into buildings in the Bronx to test cooling towers for contamination, even though the outbreak’s source had already been identified, the officials complained that the Mayor was wasting their time in order to brag to reporters that he’d done everything possible to stamp out the disease. When the deputy commissioner for environmental health, Daniel Kass, refused City Hall’s demands, one of the city’s deputy mayors urged the commissioner of health, Mary Bassett, to fire Kass. She ignored the suggestion, but Kass eventually resigned. He later told colleagues he felt that his rebellion had made coöperation with City Hall impossible.
“Dan Kass is one of the best environmental-health experts in the country,” Bassett, who now teaches at Harvard, said. “New York has one of the best health departments in the United States, possibly the world. We’d all be better off if we were listening really closely to them right now.”
In early March, as Dow Constantine was asking Microsoft to close its offices and putting scientists in front of news cameras, de Blasio and New York’s governor, Andrew Cuomo, were giving speeches that deëmphasized the risks of the pandemic, even as the city was announcing its first official cases. De Blasio initially voiced caution, saying that “no one should take the coronavirus situation lightly,” but soon told residents to keep helping the city’s economy. “Go on with your lives + get out on the town despite Coronavirus,” he tweeted on March 2nd—one day after the first covid-19 diagnosis in New York. He urged people to see a movie at Lincoln Center. On the day that Seattle schools closed, de Blasio said at a press conference that “if you are not sick, if you are not in the vulnerable category, you should be going about your life.” Cuomo, meanwhile, had told reporters that “we should relax.” He said that most infected people would recover with few problems, adding, “We don’t even think it’s going to be as bad as it was in other countries.”
De Blasio’s and Cuomo’s instincts are understandable. A political leader’s job, in most situations, is to ease citizens’ fears and buoy the economy. During a pandemic, however, all those imperatives are reversed: a politician’s job is to inflame our paranoia, because waiting until we can see the danger means holding off until it’s too late. The city’s epidemiologists were horrified by the comforting messages that de Blasio and Cuomo kept giving. Jeffrey Shaman, a disease modeller at Columbia, said, “All you had to do was look at the West Coast, and you knew it was coming for us. That’s why Seattle and San Francisco and Portland were shutting things down.” But New York “dithered instead of telling people to stay home.”
By early March, the city’s Department of Health had sent the Mayor numerous proposals on fighting the virus’s spread. Since there weren’t enough diagnostic kits to conduct extensive testing, public-health officials proposed “sentinel surveillance”: asking local hospitals to provide the Department of Health with swabs collected from people who had flulike symptoms and had tested negative for influenza. By testing a selection of those swabs, the department could estimate how rapidly and widely the coronavirus was moving through the city. In previous outbreaks, such studies had been tremendously useful in guiding governmental responses—and this spring Los Angeles effectively deployed the strategy, as did Santa Clara County, in California, and the state of Hawaii.
In New York City, the Health Department began collecting swabs, but the initiative met swift resistance. Under federal health laws, such swabs have to be anonymized for patients who haven’t consented to a coronavirus test. This meant that, even if city officials learned that many people were infected, officials wouldn’t be able to identify, let alone warn, any of them. The Mayor’s office refused to authorize testing the swabs. “They didn’t want to have to say, ‘There are hundreds, maybe thousands, of you who are positive for coronavirus, but we don’t know who,’ ” a Department of Health official told me, adding, “It was a real opportunity to communicate to New Yorkers that this is serious—you have to stay home.” The effort was blocked over fears that it might create a panic, but such alarm might have proved useful. After all, the official told me, panic is pretty effective at getting people to change their behavior. Instead, the Mayor’s office informed the Health Department that the city would sponsor a job fair to find a few new “disease detectives.” That event was held on March 12th, in Long Island City. The Department of Health official said, “We’re in the middle of a catastrophe, and their solution is to make us waste time interviewing and onboarding people!” (The Mayor’s office eventually relented on the sentinel-surveillance samples, and testing began on March 23rd—almost a month after samples were first collected. By then, the outbreak was well under way.)
As New York City schools, bars, and restaurants remained open, relations between the Department of Health and City Hall devolved. Health supervisors were “very, very angry,” one official told me. In particular, health officials were furious that de Blasio kept telling New Yorkers to go out and get a test if they suspected they were infected. On March 4th, he tweeted, “If you feel flu-like symptoms (fever, cough and shortness of breath), and recently traveled to an area affected by coronavirus . . . go to your doctor.” This was the opposite of what city health supervisors were advising: people needed to stay inside and call their doctor if they felt sick. Making trips to doctors’ offices or emergency rooms only increased the odds that the virus would spread, and the city’s limited supply of tests needed to be saved for people with life-threatening conditions. De Blasio’s staff, however, had started micromanaging the department’s communications, including on Twitter. Finally, on March 15th, the Department of Health was allowed to post a thread: “If you are sick, stay home. If you do not feel better in 3 to 4 days, consult with your health care provider”; “Testing should only be used for people who need to be hospitalized”; “Everyone in NYC should act as if they have been exposed to coronavirus. . . . New Yorkers who are not sick should also stay home as much as possible.” One City Council member told me that health officials “had been trying to say that publicly for weeks, but this mayor refuses to trust the experts—it’s mind-boggling.”
As the city’s scientists offered plans for more aggressive action and provided data showing that time was running out, the Mayor’s staff responded that the health officials were politically naïve. At one point, Dr. Marcelle Layton, the city’s assistant commissioner of communicable diseases, and an E.I.S. alum who is revered by health officials across the nation for her inventiveness and dedication, was ordered to City Hall, in case she was needed to help the Mayor answer questions from the press. She sat on a bench in a hallway for three hours, away from her team, while politicians spoke to the media. (Layton declined interview requests.) At press conferences, Layton and other physicians played minimal roles while de Blasio and Cuomo, longtime rivals, each attempted to take center stage. The two men even began publicly feuding—arguing in the press, and through aides, about who had authority over schools and workplace closures.
Eventually, three of the top leaders of the city’s Department of Health met with de Blasio and demanded that he quickly instate social-distancing rules and begin sending clear messages to the public to stay indoors. Layton and a deputy health commissioner, Dr. Demetre Daskalakis, indicated to de Blasio’s staff that if the Mayor didn’t act promptly they would resign. (The next day, Layton’s staff greeted her with applause, and at least one employee offered to give her some money if she had to make good on the ultimatum.) De Blasio was in a corner: he had long positioned himself as a champion of the underclass, and closing schools would disproportionately hurt the poor and vulnerable. What’s more, unions representing health-care workers had threatened that nurses, orderlies, and others might stay home unless there was a plan to provide child care.
Nevertheless, de Blasio finally acceded to the health officials’ demands. On March 16th, after a compromise was reached with the health-care unions, city schools were closed, and Cuomo ordered all gyms and similar facilities to shut down. The messaging remained jumbled, however. Right before the gym closure was set to take effect, de Blasio asked his driver to take him to the Y.M.C.A. in Park Slope, near his old home, for a final workout. Even de Blasio’s allies were outraged. A former adviser tweeted, “The mayor’s actions today are inexcusable and reckless.” Another former consultant tweeted that the gym visit was “Pathetic. Self-involved. Inexcusable.”
De Blasio and Cuomo kept bickering. On March 17th, de Blasio told residents to “be prepared right now for the possibility of a shelter-in-place order.” The same day, Cuomo told a reporter, “There’s not going to be any ‘you must stay in your house’ rule.” Cuomo’s staff quietly told reporters that de Blasio was acting “psychotic.” Three days later, though, Cuomo announced an executive order putting the state on “pause”—which was essentially indistinguishable from stay-at-home orders issued by cities in Washington State, California, and elsewhere. (A spokesperson for de Blasio said that City Hall’s “messaging changed as the situation and the science changed” and that there was “no dithering.” A spokesperson for Cuomo said that “the Governor communicated clearly the seriousness of this pandemic” and that “the Governor has been laser focused on communicating his actions in a way that doesn’t scare people.”)
