COVID-19 Part 4: New York Cases Plateau, Massachusetts Surges, the Rest of the U.S. Is Relatively Flat
COVID-19 updates from a Harvard physician.
By Anthony Lee, MD
Faculty, Harvard Medical School
As we make our way through this pandemic, the large number of cases in the United States has caught our attention and prompted much discussion. In Part 4 of this series, we examine the latest trends in cases and deaths in the 10 locations we've been following.
Much of the media continues to report absolute number of cases by location, which is misleading because a location's population matters in terms of what's known as local severity.
This is better described as case density, or the number of cases per capita. For example, if 10 out of 50 people were infected on a small grass field, the case density would be 20%. If 25 out of 500 people were infected on a larger grass field, the case density would be 5% even though there are more cases.
Therefore, even though 2.5 times more people were infected on a larger grass field, the case density would be 4 times less, and therefore the local severity would be less critical. The same is true for deaths per capita. With that in mind, here are the updated charts.
Figure 1: On a per 100,000 population basis, the rises for New York City and New York State are quite steep. When plotted with other locations, the plots of the other locations are squashed significantly and misrepresent the actual condition. Therefore, the plots of NYC and NYS have been removed for the sake of clarity. However, for the rates of change chart, NYC and NYS plots remain as they don't obscure the other plots significantly.
On the left of Figure 1, we see that Massachusetts is experiencing the largest surge in cases so far. It is said that Massachusetts may soon become the new epicenter of case growth in the US.
But to maintain perspective, NYS still carries 31% of all cases in the US and 9.9% of all cases in the world. By contrast, Massachusetts carries 5.2% of all cases in the US and 1.7% of all cases in the world. However, case density in Massachusetts has surpassed that of "The Rest of the US" (US-NYS) by more than a factor of 3, but less than half of NYS.
On the right of Figure 1, the number of daily new cases in Italy peaked on March 21st, 12 days after their lockdown with daily cases continuing to fall over the last 33 days. For NYS and NYC, the number of daily new cases peaked on April 9th, 23 days after social distancing began, and has continued to fall over the last 2 weeks.
For the UK, the number of daily new cases peaked on April 11th, 15 days after lockdown but 19 days since increasingly stringent social distancing began. This downward trend has been ongoing over the last 12 days.
For Ireland, the number of new cases peaked on April 11th but is currently escalating again. Belgium's number of new cases peaked on April 16th, but it's too early to tell if it will increase again. It looked as if Belgium was on a downward trajectory in terms of rates of change, but the country experienced a subsequent surge. The same holds true for Northern Ireland.
Sweden, like Massachusetts, is on a surge, but with much less magnitude.
Figure 2 illustrates the relative lag times between the peak of new cases and the peak of daily deaths. The arrows correlate to when the daily peak cases occurred (not the peak of deaths, although they may coincide by chance).
In general, deaths follow cases. One would expect that the peak of daily deaths for any location would arrive after the peak of daily new cases. This is true for Italy, where the peak of daily deaths occurred 7 days after the peak of daily new cases, which in turn occurred 12 days after lockdown. 19 days of lockdown were required to lessen Italy's death rate.
The UK needed 15 days of lockdown to simultaneously reduce both the number of daily new cases and the death rate. This could be because the UK may be under-testing, resulting in a delay of the peak of daily new cases.
It's also conceivable that the peak of new daily cases can arrive after the peak of the daily death rate. Further support for this notion is the fact that Ireland has a higher case density than the UK, yet the UK has a higher number of deaths per capita.
NYS required 24 days of social distancing to reduce the death rate; a reduction which occurred 1 day after the peak of daily new cases. Again, this could be due to the lack of testing. In NYC, deaths are on the rise again but to an unknown extent. The same is true for Massachusetts, Northern Ireland, Belgium, and Sweden. It's too early to tell what will happen in Ireland.
For "The Rest of the US," the death rate peaked 8 days ago, 29 days after social distancing was instigated.
Sources of data: Worldometer.com, Spectrum News NY1, New York State Department of Health, Massachusetts Department of Public Health, HSC Public Health Agency
The very small window of opportunity to close down the country
By Anthony Lee, MD
Faculty, Harvard Medical School
As we make our way through this pandemic, the large number of cases in the United States has caught our attention and prompted much discussion. In Part 3 of this series, we will delineate the events that have thus far unfolded for the United States.
In Parts 1 and 2 of this series, we plotted cases and deaths on a per 100,000 population basis. In Part 2 we added "The rest of the US" as a location, represented by "US-NYS" to illustrate that outside of New York State, the US is doing relatively well compared to NYS and other parts of the world.
One notices, however, that in Figure 1 for NYC and NYS, a low and flat trajectory is seen from early February and continues until March 16th, when suddenly the trajectory begins to steepen. This is called the inflection point of the curve and will be described in Figure 2.
In Figure 2, locations other than NYC, NYS, and US-NYS (US minus NYS) have been removed. Social distancing began on March 17th. Note that in prior charts, social distancing for the US was lumped with that of the UK. But, after reviewing history, the US actually began social distancing a week earlier. (This has been corrected on subsequent charts.)
Figure 2 presents milestones that show when certain measures were enacted and what the number of cases and deaths were at that time, on a per 100,000 population basis by location. The inflection point represents a small window of opportunity to make a quick decision on mitigation.
Here are the events leading up to and around the inflection point:
2/2/20: Travel ban from China
2/29/20: Travel ban from Iran, Italy, and South Korea
3/11/20: World Health Organization declares COVID-19 a pandemic
3/12/20: Travel ban from Schengen European Countries*
3/14/20: Travel ban from UK and Ireland
3/17/20: Social distancing and restrictions start
3/19/20: Travel restrictions from Japan (not shown in Figure 2)
3/19/20: Increased testing in New York (not shown in Figure 2)
As far as the other locations seen in Figure 1, we can see that Italy continues to decrease in daily new cases, Ireland and Belgium have seen spikes in new cases. Massachusetts and NY continue to see waves of new cases that overall seem to be increasing in magnitude, while the rest of the locations continue on low and flat trajectories.
New York State continues to be the epicenter of the world, with 33% of all US cases and 10% of all cases globally.
Sources of data: Worldometer.com, Spectrum News NY1, Massachusetts Department of Public Health, HSC Public Health Agency
*The Schengen Area is composed of 26 European states that have officially abolished passports and all other types of border control at their mutual borders.
How do we contextualize an unprecedented moment in American history?
As a healthcare worker with more than three decades of training and clinical work under my belt, I have a few thoughts about this moment in American history:
The Metaphor of War is Inaccurate
This is an undeclared war against the coronavirus. What healthcare workers are going through is war. With such strictly limited resources, we must apply wartime strategies to care for as many people as possible.
As our Mayor, Bill De Blasio, said in today's briefing, "this is a war with many-many fronts. The only way to get through it is to use our military, all HCP (Health Care Personnel). [To create] a national enlistment of all doctors and nurses and move them to areas of need as it arises around the country."
De Blasio is urging the president to enlist all doctors and nurses across America. Indeed, we're not only at war, we are on a battlefield.
In wartime, people hunker down together - especially those most vulnerable. Not so with this virus. Social distancing causes even the sick to care for themselves in isolation, as they check in with others by phone.
The "mask or no mask" question
On the streets and in grocery shops, neighbors in self protection mode aggressively condemn each other for not standing the mandatory 6 feet apart. After close to three weeks of social distancing, why only now are we being asked to wear non-medical masks when going outside.
As a nurse, when I hear the word droplets, I follow precautions, I wear a mask. Any health care worker who doesn't receive the flu vaccine is required by law to wear a mask from the beginning of flu season in October through May or June in all patient areas in the hospital - elevators, patient rooms, hallways, and in clinic.
However, during these perilous times and with supplies stretched thin, the medical field is our first priority. The public has been repeatedly asked to spare PPE (Personal Protective Equipment) for medical people.
Healthcare Workers Are To COVID-19 as Fireman and Police Were To 9/11
Doctors and nurses working frontline without proper PPE is like rushing into a burning building in a tee-shirt, jeans, and bare feet. Are we being asked to do something that was not asked of our firefighters on 9/11?
But every evening at 7pm in NYC, #Clappingforcarers erupts in a massive round of global applause. What a profoundly glorious acknowledgement of Health Care and Essential Workers. Walking home from my ten hour shift at an Upper East Side hospital, I stand on 3rd Ave overwhelmed with this outpouring of gratitude that brings tears to my eyes. I am in awe of how life affirming this is. And how many beautiful people are recognizing our bravery and duty to care.
We Don't Know What We Don't Know
We don't know. We don't know how this virus works in the body . . . how long it takes an individual to fully recover and no longer shed it. We don't know when it will be safe to socialize again.
On Monday, the US Navy hospital ship Comfort sailed into the west side docks with 1,000 beds. As of Thursday, they've only filled 20 beds due to a tangle of military protocols and bureaucratic hurdles. Frustration is growing because this isn't relieving our overburdened hospitals at all.
But here's the don't-know-what-we-don't-know of it, the world's top researchers do not fully understand how this pathogen works although we're months into the existence of this virus.
The 16-year-old will take to Foley Square to spearhead a global strike on September 20.
Teen activist Greta Thunberg touched down on the shores of New York today after a two-week journey at sea, but her real journey has just begun.
The Swedish teenager rose to prominence last year with her "School Strikes for Climate," which have since sparked a worldwide movement. She's since become one of the leading faces in climate activism, representing young people's refusal to tolerate the ignorance of their elders.
Sixteen-year-old Thunberg has spent the past two weeks traveling to New York City via solar-powered yacht, which was chosen in order to avoid a carbon-heavy airplane flight. The journey—which was obsessively followed by activists and European media and much-maligned by critics—culminated with a landing on the shores of Coney Island, Brooklyn, and her final destination was a port off Lower Manhattan. She was welcomed by excited crowds of activists and fans.
Thunberg has a packed itinerary, which includes high-profile meetings with some of the world's most powerful officials. On Friday, September 20, she'll be leading a worldwide Climate Strike, and millions of people will be taking to the streets to call for aggressive global action on climate change. Find your local strike (or start your own) using this website.
Thunberg will be attending New York City's strike, which begins with a march in Foley Square and ends with a rally in Battery Park, where speakers, performers, and Thunberg herself will take the stage. If you want to be more involved in this event, NYC is having an art build on August 30 and 31, and the group Fridays for Future will be organizing other logistical actions in preparation for the strike. Also for NYC folks: Ethical Culture is hosting strike planning meetings every Wednesday from 6-8pm, and Greta herself will be striking each Friday, starting with a strike on Friday, 8/30 at Ralph Bunche Park outside of the United Nations from 11-2pm.
Participants hope that mass action will influence several important upcoming climate meetings, which will be attended by Thunberg. The first will be the Youth Climate Summit at the United Nations in Manhattan on September 23rd. The next is the COP25 summit in Santiago, Chile, which takes place in December.
The young activist recently announced that she's taking a year-long sabbatical from school to focus on her activism. Her actions manifest the emotions and thoughts of many students who are asking, "What's the point in going to school and working towards our future if there is no future?"
As Thunberg put it in 2018, "We cannot solve the crisis without treating it as a crisis. You say you love your children above all else, and yet you're stealing their future in front of their very eyes."
Yet she's also resolutely hopeful. "It is still not too late to act," she reminded the European Parliament in a recent speech. "It will take a far-reaching vision, it will take courage, it will take fierce, fierce determination to act now, to lay the foundations where we may not know all the details about how to shape the ceiling. In other words, it will take cathedral thinking. I ask you to please wake up and make changes required possible."
Thunberg was nominated for a Nobel Peace Prize in 2018 for her work. She has mobilized millions of strikers around the world, and she's given hope and a sense of urgency to countless others. She also has been heavily criticized, mostly by conservative outlets and European nationalists. One British businessman even went as far as to Tweet, "Freak yachting accidents do happen in August…" She was also described as a "teenage puppet" by a member of Trump's transition team and a "prophetess in shorts" by a conservative French politician.
Many of these criticisms have taken on a misogynistic undertone, resembling those lobbed at another young, powerful female activist—Alexandria Ocasio-Cortez. This may not be incidental, since the kind of global structural overhaul that human survival requires necessitates a revamp of many patriarchal and conservative ideas based in traditional ways of doing things. "For climate skeptics … it was not the environment that was threatened, it was a certain kind of modern industrial society built and dominated by their form of masculinity," proposed one study that linked misogynistic comments about Thunberg and Ocasio-Cortez to toxic masculinity.
Thunberg, however, is not advocating for any particular shift in gender dynamics, nor any politician's agenda. Instead, she's all about ensuring human survival by adjusting our actions based on scientific fact.
As the Malitzia II sailed towards the New York City skyline, a banner reading "Unite Behind the Science" waved proudly above it. Unfortunately, the scientific consensus about the dire consequences of climate change hasn't been enough to mobilize humanity into acting. That has required one particularly outspoken teen activist, and New York City is lucky to have her here.
On Valentine's Day, Amazon pulled out of its plan to build a second headquarters in Queens, citing the efforts of citizen protestors and politicians who opposed its imminent arrival.
The moment Amazon announced that it would be building its second headquarters in NYC's Long Island City, people took to the streets.
On November 26th, a coalition of immigrant advocates and anti-HQ2 groups gathered to protest Amazon's involvement with ICE, Paladir, and other organizations responsible for deportations. Citizens marched again on Cyber Monday, launching a " day of action" and flooding an Amazon Bookstore in Manhattan, holding signs aloft and chanting sing-song rhymes about Jeff Bezos. Together, over two dozen community groups organized these protests, including local unions and nonprofits. Following the protests in Manhattan, Amazon workers employed in warehouses in Staten Island made the decision to unionize, citing low pay and impossible performance quotas, and leveraging Amazon's impending move to Queens to draw attention to their case.
Image via The New York Times
Their protests attracted the attention of some of New York City's political officials, such as City Council Speaker Corey Johnson, who initially supported Amazon's entry but denounced it after learning more about the circumstances surrounding the deal. He began to stand with the protestors, complaining that a general lack of transparency and the fact that Amazon bypassed NYC's standard review process mandated further investigation.
In December, a public hearing was held at City Hall, and protestors gathered outside while council members grilled economists and officials who had been instrumental in making the deal with the world's most profitable corporation. "We are not in the business of corporate welfare here at city council," said Johnson.
It was this so-called corporate welfare—the $3 billion in government and tax incentives that Amazon was promised, in exchange for the 25,000 jobs it promised to create—that became the foundations of the anger stewing around the sales conglomerate's impending arrival, anger which resulted in Amazon's decision to pull out of its promise to develop a huge corporate campus in Queens.
Image via Vox.com
The people's anger came from different places, and their protests were haphazard efforts, but their rage had been brewing for a long time, and Amazon's imminent arrival fed a variety of fears about corporate greed and pervasive gentrification, which opponents feared would tear apart places like Long Island City, sucking it clean of culture and community. Amazon's arrival was predicted to catalyze a wave of homelessness; the announcement that it was setting up shop in Long Island City was instantly followed by dizzying spikes in rent—chilling lower-income residents in a city already plagued by stretches of empty storefronts.
Long Island CityImage via AM NY
Protestors cited Amazon's effects on Seattle, Amazon's first home city, as reasons why the conglomerate shouldn't move on with its plan. Some people argue that Amazon made Seattle into a hull, a kind of paper city that existed only to facilitate its metallic corporate heart; and Seattle's homeless corporation did rise in tandem with rising housing prices, making it home to the
third-highest number of homeless people in the country, after New York and Los Angeles.
HQ2 opposition united a great deal of unlikely allies—including an unlikely ally in the Wall Street Journal's Editorial Board, who argued that the deal was "crony capitalism at its worst." Their article continued, "Amazon's case is aboveboard, but it still amounts to a company with a market capitalization of nearly $800 billion getting paid to create jobs it would have created somewhere anyway."
Alexandria Ocasio-Cortez was the most visible face of a group of politicians who protested Amazon's HQ2 establishment, and her resistance might have been one of the central reasons for its decision to abandon ship. "It was that the environment over the course of the past three months had not got any better," said Joni Seth, Amazon's head of policy communications. "There were some local and state elected officials who refused to meet with Amazon and criticized us day in and day out about the plan."
Ocasio-Cortez had long denounced Amazon's plans to move into Queens, and she celebrated Amazon's retraction on Twitter. So did other political figures, including Cynthia Nixon. Following the company's Valentine's Day breakup announcement, the actress-turned politician triumphantly tweeted, "The fight against Amazon laid bare their union-busting, corporate welfare, ICE-abetting practices and shows why we need to break up monopolies like Amazon."
In addition to its ties to law enforcement giants, Amazon had also been accused of developing facial recognition technologies to gain information about customers without them knowing; and many protests have cropped up among its warehouse workers, especially in Europe, where employees have staged walkouts against low wages and poor working conditions.
A protestor stops an Amazon truck in Spain.Image via apnews.com
Despite Amazon's shady ethics, many people were not as enthusiastic about the company's foiled New York City dreams, arguing that the demise of HQ2 will compromise what could've been an economic boom for the city, criticizing Ocasio-Cortez's decision to favor ideology over economics. Amazon may have hiked up rents, but rents are high anyway; and its arrival would have created thousands of jobs, including consistent positions for lower-level staff members and service workers.
Plus polls showed that 56% of New Yorkers approved Amazon's arrival, which was initially billed as a triumph by Mayor Bill de Blasio and Governor Andrew Cuomo—both central players in the deal's initial success who believed that the arrival would help NYC solidify its position as a worldwide hub of tech and industry. Bill DeBlasio's tweets following Amazon's decision resembled those of a spurned ex. He also lashed out at Ocasio-Cortez, stating that "a small group of politicians put their own narrow political interests above their community—which poll after poll showed overwhelmingly supported bringing Amazon to Long Island City—the state's economic future and the best interests of the people of this state," the governor said in a statement.
But even so, a great deal of major political figures opposed the deal, including Senator Michael Gianaris of Queens, who initially supported Amazon's arrival but, like Johnson, changed his mind after learning about its policies. Still, Amazon in Long Island City's demise all started with those first street protests, which erupted directly after De Blasio's announcement as politicians remained silent. Ultimately, community members and citizen organizers catalyzed the start of the resistance that led to the downfall of Amazon's Queens campus.
Image via Marketwatch
There's something deeply satisfying about the image of the world's richest man and his behemothic corporation getting kicked out of New York by impassioned Queens residents, ready to unite and fight for the integrity of their home borough. Still, Amazon's departure won't stop gentrification, won't fill up empty stores, and won't bring back the days when young artists could gallivant around Greenwich Village with pennies in their pockets and working-class families could call Manhattan home.
In a way, Amazon's departure is a symbolic victory for its opposition, a tantalizing promise that the people can triumph over corporations. Of course, this move will not deter Amazon from building its global empire, and America's supermassive wealth gap will remain. It just won't be as tangibly visible in New York.
Eden Arielle Gordon is a writer and musician from New York. Follow her on Twitter at @edenarielmusic.
A history of stalled construction, deferred maintenance and funding problems have left the subway with a seemingly hopeless future
The subway system, winding beneath, through and over the streets of New York City, moves almost six million people every day. The system stretches over 665 miles of track from Manhattan to Brooklyn, Queens, the Bronx, and Staten Island. The subway opened in 1904 with 28 stations in Manhattan, and though it now connects the five boroughs through 472 stations, many regular riders complain that not much else has changed in the last 114 years. Some trains are more often delayed than not. And while the city's population is, again, rising and overcrowding on subway platforms continues to cause problems, the city has basically stopped building new subways. Why? And why can't the MTA keep its trains running smoothly and on-time?