NY's regional plan for reopening discussed in Cuomo's press conference, yesterday (very long)
Thought their team did a great job of outlining the specifics of NY essentially trying to mimic South Korea's model for controlling outbreaks, i.e., aggressive testing, tracing, and isolating, combined with a mask-wearing culture and appropriate social distancing (with controls where that's not possible) and that Cuomo did a masterful job of presenting all the data/info - great leadership and understanding. I also liked that he made it clear that "I don't know" is ok to say and is, in fact, required when one doesn't know and there are many things we still don't know, but we prepare as best we can with what we do know. I included graphics from the presser below, too, as they're probably easier to read.
Requirements for Reopening in each region
- Regions must have at least 14 days of decline in total hospitalizations and deaths on a 3-day rolling average.
- In regions with few COVID cases, it cannot exceed 15 new total cases or 5 new deaths on a 3-day rolling average.
- In order to monitor the potential spread of infection in the region, a region must have fewer than two new COVID patients admitted per 100k residents per day.
- NY must make sure every region has the capacity to handle a potential surge in cases: Regions must have at least 30% total hospital and ICU beds available.
- This is coupled with the new requirement that hospitals have at least 90 days of PPE stockpile.
- As far as testing for viral infections, NY will follow the CDC guidance of having the capacity to perform 30 tests for every 1,000 residents in a region.
- Regions must have a baseline of 30 contact tracers for every 100,000 residents and additional tracers based on the projected number of cases in the region.
- NY is building an army of tracers in partnership with Mayor Bloomberg (head and financial sponsor of the task force on tracing), to meet statewide needs.
Phased Reopening Plan
Cuomo said that businesses that are most essential and pose the lowest risk will be the first to open, with less essential and riskier businesses opening later, as per the phases below. He also said that each phase will be followed by a pause to reassess whether flare-ups/outbreaks were being observed and, if so, controlled before moving to the next phase, so that an outbreak doesn't get way ahead of the response as occurred in the initial wave, obviously. And noted that businesses are going to need to reassess and reimagine the workplace with regard to people, places/facilities, and processes/procedures. I know where I work, every aspect of work has been reorganized to reduce COVID risks.
- Phase 1: Manufacturing, construction, curbside pickup etc.
- Phase 2: Professional services, retail, real estate
- Phase 3: Restaurants, food services etc.
- Phase 4: Arts, sports, education.
Cuomo also addressed the fact that NY Pause ends on May 15. "May 15th, regions can start to reopen and do their own analysis, but these are the facts that they have to have in place to do it. Start now. Don't wait until May 15th. Don't call me up on May 15th, and say, well, the pause order expired. I want to open. Because I'm going to ask you the questions I just asked." And he also mentioned that the Governors in the NE region working with each other (NY/NJ/CT/MA/RI/PA/DE) will also be unveiling similar plans. Given what's at stake in terms of potential deaths, as per the quoted post, including IHME doubling estimated deaths to 134K by August and the Wharton model showing scenarios with up to 950K dead over many months if we stop all interventions/social distancing, let's hope this works.
Slides from Press Conference
A few words on projected deaths/calcs
One more thought for skeptics. Unless NY is somehow "different" and I doubt it is, apart from the rate of deaths being greater due to the far greater undetected infection rates in late Feb/March that we simply didn't know about due to lack of testing (meaning it might take NY 6 months to reach herd immunity and a rural area 2 years, due to population density differences, which slow transmission rates, but the eventual endpoints should be the same, barring a cure/vaccine. .
But we know a ton more than we did before, so death calcs are not nearly as dependent on models any more, especially since we now know reasonably well the current infection fatality ratio, at least for a decent population (NY state), which has statewide antibody testing results. NY had about 23,000 deaths late last week while they were doing the antibody testing, which showed 12.3% infected (2.46MM infected with antibodies), which is an IFR of 0.9%. While the error bars on the IFR are moderately high, due to the errors on the antibody testing (denominator), I don't think we're going to find out we have 50% infected instead of 12.3% (would be fantastic if we did, though).
So if we take the 12.3% as correct and assume we have another 30-60% of NY left to infect to reach 42% to 72% infected (to come close to herd immunity of 54-82% - should slow down greatly near the herd immunity level - the range most think is herd immunity, depending on the transmission rate, which is still not known for sure; 54% is if R0 is 2.2 and 82% is if R0 is 5.7), that would mean another 30/12.3 x 23K or 56K deaths to go on the low side and another 60/12.3 x 23K or 112K deaths to go on the high side (in addition to the 23K dead).
The same calculation for the US, assuming a prevalence of 3% in the US (1/4 of NY - a guess based on cases, roughly), means probably 15-25X as many deaths as we've seen to date or 1.05-1.75MM total US deaths at herd immunity (depending on what that level is) and at an IFR of 0.9%. Perhaps NY's IFR truly is a bit higher than other areas for reasons I don't know yet (demographics? hospitals stressed?), but even if the US's IFR were only 0.5%, that's 580-970MM US deaths. The Wharton model is predicting 950K US deaths eventually, assuming current death rates and no controls/distancing and no cure/vaccine before herd immunity is reached.
I still believe convalescent plasma is going to save many lives in the next few months and then the engineered antibodies will save a lot more and I think we'll have a vaccine by the end of the year, but the path that Cuomo outlined, following South Korea's model, is what we need to do until we have a cure/vaccine, IMO. Flattening the curve isn't just about not overwhelming hospitals - it's also about buying time to develop cures/vaccines, so hundreds of thousands of lives can be saved, hopefully while reopening most of the economy (but in new ways).
