COVID-19 pandemic in New York City

Although the first case of COVID-19 was confirmed in New York State on March 1, 2020, it is likely the virus was present in New York during mid-February, weeks prior to the first confirmed cases, and that the proximate origin of the virus was Europe rather than Asia.[1][2] The 39-year-old health care worker, a resident of Manhattan, had returned from Iran on February 25.[10]

NYPD taping off One Grand Central Place during the early afternoon of March 3, 2020, in response to New York's first confirmed case of COVID-19 person-to-person spread.

New York City Subway passengers on March 9, when there were 16 confirmed cases of COVID-19 in New York City, with NYC Transit Interim President Sarah Feinberg on the right.

On March 3, New York Governor Andrew Cuomo announced that the first recorded case of person-to-person spread in New York State had been confirmed via a New Rochelle man who was working at a law firm within One Grand Central Place in Midtown Manhattan.[11] Six days later, on March 9, Mayor Bill de Blasio announced that there were 16 confirmed cases of COVID-19 in New York City.[12]

The virus then grew exponentially: by March 25, over 17,800 cases had been confirmed in New York City, with 199 deaths.[13] At the time, the city's infection rate was five times higher than the rest of the country, and its cases and were one-third of total confirmed US cases.[14] The reasons for the high infection rate continue to be discussed.[15] On March 27, infection in New York City surpassed 23,000, with 365 deaths. Queens was the worst-affected borough by number of deaths, with over a third of total deaths; the majority of the deceased had underlying health issues.[16] Between March 28 and 29, the number of deaths in New York City tripled from the previous 24-hour period; 222 people died of the virus bringing the city's fatalities to 672, with 30,765 confirmed cases.[17]

Refrigerated trucks filled with COVID-19 victims outside a hospital

The USNS Comfort hospital ship arrived in New York Harbor on March 30.[18] Field hospitals were also set up in several places citywide.[19][20] Refrigerator trucks were set up on city streets outside hospitals to accommodate the overflow of bodies of the deceased.[21] On March 31, the first death of a child from COVID-19 in New York City was recorded.[22]

On April 4, Governor Cuomo announced that the Chinese government had arranged for a donation of 1,000 ventilators to be sent to New York through foundations run by Jack Ma and Joseph Tsai.[23] The state of Oregon was reported to be sending 140 ventilators.[24] Trump announced that 1,000 additional federal medical soldiers would be deployed to New York City.[25] It was reported that "Urban Area Medical Task Forces" made up of army reservists would be working in the New York City field hospitals and other parts of the country.[26] As of April 4, there were 1,200 medical military personnel serving on the USNS Comfort. 2,700 New York State National Guard forces had also been deployed.[23]

Closed non-essential retailers in Morris Park, the Bronx, during the COVID-19 pandemic

Masks for sale in June, South Bronx

On April 5, it was reported that a tiger at the Bronx Zoo had contracted COVID-19, the first known case of a tiger anywhere being infected with the disease. Several other "big cats" were found to have COVID-19, the first of which had started showing symptoms on March 27; they were believed to have contracted COVID-19 from an infected zookeeper who was not yet showing symptoms.[27] This was also the first known case of an animal contracting the disease from human contact in the US.[28] On April 22 it was reported that four additional tigers plus three lions had tested positive.[29]

On April 6 there were 72,181 confirmed cases, with at least 2,475 deaths. NYC accounted for 25% of COVID-19 deaths in the United States.[30] The next day Gothamist reported that the death toll in New York City was undercounted.[31] It was estimated that 1,125 people had died at home or on the street in NYC in the first five days of April, an eight-fold increase compared with FDNY figures for 2019. Due to the large increase, many of the deaths were presumed to be caused by COVID-19, but only residents with confirmed infections had been recorded in the official count. Due to the crisis circumstances of the pandemic, the real death toll was unknown. Bodies of those who had died at home, around 280 per day, were being picked up by the US Army, National Guard, and Air National Guard.[32]

As of April 8, at least 80% of New York City virus patients put on ventilators had died.[33] Some of the communities most affected by the pandemic included densely-populated neighborhoods in north-central Queens with high immigrant populations, including Corona, East Elmhurst, Elmhurst, and Jackson Heights. As of April 8, these communities, with a cumulative 600,000 residents, had recorded 7,260 COVID-19 cases.[34] On April 23, state officials said that based on preliminary antibody testing results, they estimated around 21.2% of city residents had contracted COVID-19.[35]

On May 10, de Blasio said 38 children were known to be affected by an inflammatory syndrome believed to be linked to an immune response to COVID-19. Known as pediatric multisystem inflammatory syndrome, the condition resembles Kawasaki disease. Symptoms include high fevers that can last for days, rash, racing heart beat, changes in skin color, redness of the tongue, and severe abdominal pain.[36] At least one child has died in New York City, and two additional deaths have been reported statewide. The link with COVID-19 has not yet been proven, but at least 85 cases are being investigated statewide.[37] On May 19, Cuomo confirmed 137 cases of the illness, stating it was "the tip of the iceberg" with 90% of the cases testing positive for the virus or antibodies.[38]

A survey conducted May 5-12 and reported in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report found that 42% of 286 respondents residing in the New York City metropolitan area knew someone who had tested positive for COVID-19, and 23.1% knew someone who had died.[39] These figures were considerably higher than those reported by respondents from Los Angeles (10.8% and 7.3%, respectively) and from across the United States (16.8% and 5.9%, respectively).

During May, COVID-19 cases started to decline.[40] After the George Floyd protests in New York City started in late May, public officials expressed concern about the spread of COVID-19 via the crowded events. The gatherings had led to fears about another wave of illness but no COVID-19 spikes have been recorded to date.[41]

On June 8, the city partially reopened after meeting seven conditions of the PAUSE order, which had been put in place three months earlier.[42]

On March 14, before the PAUSE order was put in place, all New York Public Library branches in the Bronx, Manhattan, and Staten Island were temporarily closed. The Queens Public Library and Brooklyn Public Library were also closed.[48][49][50] Theaters, concert venues, and nightclubs in NYC have been shut down since March 17, and restaurants were restricted to take-out and delivery only. Schools were closed until at least April 20.[51] Gyms were closed as well.[52]

On March 17, despite de Blasio's message to New Yorkers that they should be "prepared right now" for the possibility of "shelter in place" orders, Cuomo expressed doubts about whether the policy would be effective. The governor's office issued a statement that the shelter in place order could only be put in place by the governor's office; the Mayor's office agreed.[52][53]

On March 20, with 5,683 confirmed cases in NYC, the governor's office issued an executive order that shelter in place restrictions would go into effect on March 22 at 8 PM. The order put in place the following restrictions:[54]

1. Anyone with underlying conditions, a compromised immune system, or who is over the age of 70 should wear a mask.
2. Healthy persons should limit their outdoor activities to getting groceries and medicine.
3. Exercising and walking outdoors is permitted as long as social distancing is observed and participants stay at least six feet away from each other.
4. No non-essential gatherings of any size.
5. Mass transit should not be used unless absolutely necessary. Roads remain open.
6. Non-essential workers must stay home.

The governor said the provisions would be enforced. Businesses that violate the order face fines and closure.[54][55] Businesses that qualify as "essential businesses" under the shelter in place order include:[54]

On April 6, the statewide PAUSE order was extended through April 29. The rate of increase had slowed from 10,000 new confirmed cases daily to 8,700. Intubation and ICU admission rates were slowing. Fines for violating social distancing protocols were increased from $500 to $1000.[30] On April 16, the statewide PAUSE order was extended through May 15, in coordination with "a multi-state council".[56] On May 14, Governor Cuomo issued an executive order to extend the PAUSE order through May 28 for New York City and other regions that did not meet the state's requirements to begin Phase 1 of reopening.[57][58] A week later, it still had only met four of seven reopening conditions.[59]

Phase 1 of reopening in New York City began on June 8, allowing some nonessential businesses to reopen for curbside pickup, as well as allowing construction and manufacturing to resume.[42][60][61] On June 17, Governor Cuomo announced that New York City is on track to enter Phase 2 of reopening on June 22, which allows commercial building management, hair service businesses, outdoor food services, offices (at no more than 50 percent occupancy), real estate, non essential retail stores, among others to begin to re-operate.[62][63]

On June 22, the region moved to Phase 2 with an expected 300,000 returning to work.[64]

Temperature screening of Metropolitan Transportation Authority workers at Grand Avenue Depot, Queens

New York City issued new commuter guidelines following the start of the outbreak, asking sick individuals to stay off public transit, encouraging citizens to avoid densely packed buses, subways, and trains.[65] Beginning March 25, service on buses, subways, and commuter rail was reduced due to decreased ridership.[66][67] Ridership had decreased by 92% on April 8, when 41 Metropolitan Transportation Authority (MTA) workers had died.[68] By April 22, 2020, COVID-19 had killed 83 agency employees; the agency announced that their families would be eligible for $500,000 in death benefits.[69][70]

On April 20 four City Council members requested that subway service be temporarily suspended, saying that reduced service had resulted in crowding on the subway and that entire cars had been taken over by homeless people. The request was to shut down the subway was initially rejected by the governor's office[71] and criticized by interim New York City Transit President Sarah Feinberg.[72][73] Starting in May 2020, stations were closed overnight for cleaning; the overnight closures would be a temporary measure that would be suspended once the pandemic was over.[74] Of the approximately 800 homeless people on the subway system, about half have been willing to accept offers of assistance from the city government.[75] On June 8, 2020, regular subway and bus service resumed with Phase 1 of the city's reopening, though the overnight subway closure remained in place.[76][77]

Jeffrey E. Harris, a member of the economics faculty at MIT, has said the service cuts "most likely accelerated the spread of coronavirus." In his study published on April 15 he argues that public transportation was a "major disseminator" of novel coronavirus in New York City. The MTA has said the study was "flawed – period."[78] The advice to continue taking public transportation given by city officials during the early stages of the pandemic is now believed to have contributed to the intensity of the outbreak in New York City.[79]

Bowne Playground in Flushing, Queens, seen on April 2, 2020, was closed due to the pandemic.

On March 8, all NYC school trips were canceled.[80] On March 13, de Blasio stated that he would keep the schools open, citing the need for school meal programs and child care to continue.[81] On March 15, all schools in the New York City Department of Education (NYCDOE) system closed until at least mid-April.[82]

On April 11, de Blasio ordered all schools to remain closed for the rest of the academic year, while Cuomo insisted that the authority to close and reopen schools throughout the state belonged to himself as the governor, not to de Blasio or any other mayor.[83][84] On May 1, Governor Cuomo announced that all schools would be closed for the academic year and continue to provide distance education.[85]

On April 1, Cuomo ordered all playgrounds in the city to be shut in order to promote social distancing. Parks will remain open.[86] The exceptions were Fort Totten in Queens, which was closed to provide a staging area for first responders, and the High Line, which was closed because it is a linear park with few means to spread out. Sports fields and facilities were also closed, as were the historic-house museums operated by the New York City Department of Parks and Recreation.[87]

On May 7, de Blasio said that entry to public parks may be limited to prevent overcrowding and to promote social distancing.[88] It was later announced that access might also be limited within parts of parks, such as Sheep Meadow at Central Park.[89]

On April 6, the New York Times reported that the city's overall death rate had tripled and that morgues were overwhelmed. After councilman Mark D. Levine tweeted that temporary internment "likely will be done by using a NYC park for burials", NYC officials said they were not considering temporary burials in city parks.[90][91]

The mayor's press secretary said that a next resort could be to store or bury bodies on Hart Island off the coast of the Bronx in the Long Island Sound.[92] Following reports that mass burials had begun there,[93][94] the mayor clarified that Hart Island was only being used for unclaimed bodies or for those who chose it as a burial place.[95] Bodies are ordinarily held at the city's morgues anywhere from 30 to 60 days, but to make room for the influx of deceased individuals during the pandemic, the city's medical examiner's office announced a new policy of holding unclaimed bodies for only up to 15 days before they are transferred to the island.[96]

On April 29, authorities discovered dozens of decomposing bodies in two trucks parked outside a funeral home in Brooklyn.[97]

Line at Costco in Brooklyn on March 19, 2020

On March 30, the mayor announced that most religious buildings had shut down in accordance with quarantine regulations. However, he warned that some churches and synagogues were not in compliance and would be shut down by authorities if they remained open.[105] Several summonses and arrests were made for violating social distancing rules. On March 28, a Brooklyn bar owner was arrested for defying Cuomo's ban on bars and restaurants.[106] On April 3, the NYPD broke up a party in the Bronx where several dozen people had gathered in violation of social distancing rules.[107] On April 7 NBC News reported violations of the statewide PAUSE order throughout the city, and de Blasio said violations of the order could be reported to 311.[108]

One epidemiologist at Columbia University noted "Social distancing is a privilege that not everybody has equal opportunity to practice." Of the five boroughs, Manhattan had reported the lowest number of confirmed cases. Epidemiologists have observed that low income communities were being disproportionately affected. Many residents of these neighborhoods work in essential jobs where it may not be possible to work from home.[109]

After some arrests for violations of social distancing protocols turned violent, the city relaxed enforcement. As the weather warmed large groups began gathering at parks and beaches. Some non-compliant bars and restaurants, limited to take out service during the pandemic, continued to allowing customers to dine in or to gather outside bars with drinks. De Blasio said non-compliant establishments risk closure.[110]

During May and June 2020, there were mass arrests due to the George Floyd protests, and due to the nature of the arrests, the probability of a second wave of COVID-19 increased significantly.[111][112] Several outlets criticized police working the events for failing to wear face masks as required by policy and by order of the governor.[113] As the number of arrests during the protests increased, many people were detained for longer periods and, as of June 5, hundreds were still waiting to see a judge, being held in close quarters in the meantime.[114] Some of the arrested also had inadequate access to water to wash their hands.[115]

At the beginning of March, prior to the confirmation of the first case of COVID-19, and the onset of the coronavirus pandemic in New York City, a 20 percent spike in crime for the first two months of 2020 was reported.[116] After movement in the city became restricted, New York City Police Commissioner Dermot Shea stated that the pandemic had curtailed crime.[117] At the end of March, Shea said that crime had decreased sharply during the epidemic (other than car theft, which increased markedly), though there is concern that domestic violence was not being reported.[118][119]

By the end of the month, 911 calls were at a record high, and 1,048 officers and 145 civilian employees had tested positive for COVID-19. 5,657 uniformed officers, or more than 15% of the force, called out sick on March 31.[120] The percentage of officers out sick rose to nearly 20 percent, as reported on April 6.[121] By April 30, 4,959 members of the NYPD had tested positive for the virus, and 37 had died.[122]

Xenophobia and racism against Asians in the city increased due to the pandemic. Police investigated 11 anti-Asian hate crimes between January 1 and March 29, 2020, up from three during the same time period in the previous year.[123]

Several prominent restaurant owners and chefs have died of COVID-19 including Indian chef Floyd Cardoz[124] and Andreas Koutsoudakis (who opened the Gee Whiz diner in Tribeca in 1989).[125] Maria Mercader, a news producer at CBS, died on March 29.[126][127][128] Musician Alan Merrill died on March 29 at Mount Sinai Hospital.[129]

As of April 17, the death toll included 63 employees of the NYCDOE, including 25 teachers.[130] Nursing homes have had high fatality rates, accounting for at least 2,056 deaths in the city as of April 20. New York State Health Commissioner Howard Zucker stated that the policy was for nursing home residents who test positive back to be readmitted to nursing homes.[131]

Between March 11 and May 2 there were 32,107 deaths in the city; based on past data, this number was higher than expected by 24,172. According to official figures, COVID-19 is linked with 18,879 of the excess deaths (including probable cases that were not confirmed with testing).[132]

New York City usually has about 20,000 hospital beds and 5,000 ventilators, many of which are routinely in use to keep ICU patients alive. Social distancing measures were implemented to slow the spread of the virus and prevent the hospital system from collapsing.[133] In the early days of the crisis, on March 14, the Health and Hospitals Corporation and New York-Presbyterian cancelled non-emergency surgeries. Northwell Health put out a call for retired nurses to return. The Tisch Hospital of NYU Langone converted a pediatric emergency ward into a respiratory ward. Personal protective equipment (PPE) was rationed due to shortages.[133] By March 25 the situation at Elmhurst Hospital, one of the worst-affected hospitals in the city, had deteriorated to the point that staff described it as "apocalyptic."[134] Dr. David Reich, President and COO of Mount Sinai Hospital, announced in March that the hospital was converting its lobbies into extra patient rooms to "meet the growing volume of patients" suffering from coronavirus.[135][136]

The "Javits New York Medical Station" is a field hospital set up in the Javits Center

In response to the increasing number of COVID-19 cases at the end of March 2020, several temporary field hospitals were built or proposed, including the Javits Center in Manhattan,[20] USTA Billie Jean King National Tennis Center in Queens (350 beds),[137] and in Central Park in Manhattan (68-bed COVID respiratory care unit).[138][139] Field hospitals were also proposed at the New York Expo Center in the Bronx, Aqueduct Racetrack in Queens, the Brooklyn Cruise Terminal, and the College of Staten Island.[140] At the request of the Mayor, veterinary clinics sent their ventilators to human hospitals.[141]

According to projections in April 2020, taking into account the effects of the PAUSE order, the city would only need 20,000 hospital beds instead of 111,000.[30] Although the number of new patients admitted to the hospitals started to slow in early April, Cuomo stated that social distancing protocols would continue to be enforced to prevent a rise in these figures that could overwhelm the strained healthcare system.[142] The USNS Comfort was originally intended to take non-COVID patients to ease the burden on city hospitals, but most New Yorkers remained isolated in their homes and non-COVID admissions decreased dramatically; the admission processes for patients who did present at the emergency room was cumbersome.[143] On April 21, when Cuomo told Trump that the Comfort was no longer needed, the ship had treated 179 patients.[144] Another field hospital, built in Brooklyn for $21 million during April, was closed the next month without ever seeing any patients.[145][146]

The New York City healthcare system continued to experience major shortages with its COVID-19 testing capacity. An alert sent out on April 11, 2020, by the city's Department of Health and Mental Hygiene stated that the city's hospitals are close to running out of cotton swabs used for COVID-19 testing. The same alert reminded the providers that only those patients admitted for hospitalization should be given COVID-19 tests.[147]

Some doctors have been trying to crowdsource tablets so patients can say goodbye to loved ones. The last contact patients have with their families was when they were dropped off at the hospital or taken by ambulance.[148]

Field hospital in Central Park

Due to the demand from the pandemic on New York City hospitals, emergency medical services (EMS) personnel were ordered not to transport adult cardiac arrest cases to the hospital, if the EMS personnel were unable to restart the patient's heart at the scene.[149] On April 21 this order was modified to "do not resuscitate", meaning EMS should no longer try to revive persons on scene.[150]

On April 5 a state Health Department official confirmed that seriously ill patients were being treated with hydroxychloroquine. The effects are being observed by the University of Albany's School of Public Health.[151] On April 23, Cuomo said that one based on one study the drug "didn't really have much on an effect on the recovery rate." Although studies are still ongoing, hospitals have stopped using the drug as treatment.[152]

On May 1, 2020, the New York State Department of Health issued fresh COVID-19 guidelines for the Medicaid providers who are serving low-income families, nursing homes (including adult care facilities), and physically disabled individuals.[153] These guidelines were directed towards the providers of the following home and community-based services  — social daycare (SDC) services which also included the elderly (PACE) organizations and providers of Consumer Directed Personal Assistance Program (CDPAP).[154][155] However, just a month ago, New York State signed a 2021 fiscal budget to cap Medicaid long-term care (LTC) enrollment at 3% under the managed long-term care (MLTC) plans.[156] In the long run, the 3% capping will gradually reduce the number of individuals served by current Medicaid LTC plans, and also reduce the number of provider organizations able to contract with MLTC plans. However, the LTC recipients are a substantial population at risk for COVID-19 and there are cost involved to make sure the LTC facilities are adequately staffed and that infection control protocols are closely followed.[157]

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