Top aides to Gov. Andrew Cuomo were alarmed: A report written by state health officials had just landed, and it included a count of how many nursing home residents in New York had died in the pandemic.
The number - more than 9,000 by that point in June - was not public, and the governor's most senior aides wanted to keep it that way. They rewrote the report to take it out, according to interviews and documents reviewed by The New York Times.
The extraordinary intervention, which came just as Cuomo was starting to write a book on his pandemic achievements, was the earliest act yet known in what critics have called a monthslong effort by the governor and his aides to obscure the full scope of nursing home deaths.
After the state attorney general revealed this year that thousands of deaths of nursing home residents had been undercounted, Cuomo finally released the complete data, saying he had withheld it out of concern that the Trump administration might pursue a politically motivated inquiry into the state's handling of the outbreak in nursing homes.
But Cuomo and his aides actually began concealing the numbers months earlier, as his aides were battling their own top health officials, and well before requests for data arrived from federal authorities, according to documents and interviews with six people with direct knowledge of the discussions, who requested anonymity to describe the closed-door debates.
The central role played by the governor's top aides reflected the lengths to which Cuomo had gone in the middle of a deadly pandemic to control data, brush aside public health expertise and bolster his position as a national leader in the fight against the coronavirus.
As the nursing home report was being written, the New York State Health Department's data - contained in a chart reviewed by The Times that was included in a draft - put the death toll roughly 50% higher than the figure then being cited publicly by the Cuomo administration.
The Health Department worked on the report with McKinsey, a consulting firm hired by Cuomo to help with the pandemic response. The chart they created compared nursing home deaths in New York with other states. New York's total of 9,250 deaths far exceeded that of the next-highest state, New Jersey, which had 6,150 at the time.
The changes sought by the governor's aides fueled bitter exchanges with health officials working on the report. The conflict punctuated an already tense and devolving relationship between Cuomo and his Health Department, one that would fuel an exodus of the state's top public health officials.
In the past week, Cuomo's once seemingly unshakable grip on power has been buffeted by a wave of scandal. Three women have accused the governor of inappropriate conduct, including workplace sexual harassment. On Wednesday, he publicly apologized for his actions, which are soon to be subjected to an independent investigation overseen by the state attorney general.
The crisis over Cuomo's behavior with women came just as his administration had been dealing with political turmoil over nursing homes. Lawmakers moved to strip him of the emergency powers he had been granted during the pandemic, and federal prosecutors in Brooklyn have opened a separate investigation.
An outside lawyer hired by the state has begun interviewing officials about the handling of nursing homes during the pandemic, according to a person with knowledge of the discussions.
The aides who were involved in changing the report included Melissa DeRosa, the governor's top aide; Linda Lacewell, the head of the state's Department of Financial Services; and Jim Malatras, a former top adviser to Cuomo brought back to work on the pandemic. None had public health expertise.
In response to a detailed list of questions from The Times sent Tuesday, the governor's office responded with a statement Thursday night from Beth Garvey, a special counsel, who said "the out-of-facility data was omitted after D.O.H. could not confirm it had been adequately verified." She added that the additional data did not change the conclusion of the report.
The tension over the death count dated to the early weeks of the pandemic when Cuomo issued an order preventing nursing homes from turning away people discharged from the hospital after being treated for COVID-19. The order was similar to ones issued in other states aimed at preventing hospitals from becoming overwhelmed.
But by late spring, Republicans were suggesting that the order had caused a deadly spread of the virus in nursing homes. Cuomo disputed that it had. Still, critics and others seized on the way the state was publicly reporting deaths: Unlike other states, New York excluded residents who had been transferred to hospitals and died there, effectively cloaking how many nursing home residents had died of COVID-19.
The 33-page report, which was issued in July by the state Health Department, found the governor's policies were not to blame, but it became a turning point in the Albany debate over the governor's policies.
The day after it was published, legislators began calling for hearings and requesting complete data. Public health officials criticized its approach. A think tank began seeking for the data the next month, as did the Justice Department.
Health officials, nursing home operators and even some of Cuomo's aides expressed bafflement at the governor's apparent insistence on delaying the release of the data for so long, as none of the information released so far has changed the overall number of COVID-19 deaths in New York - now more than 47,000, including more than 15,000 nursing home residents.
But the July report allowed Cuomo to treat the nursing home issue as resolved last year, paving the way for him to focus on touting New York's success in controlling the virus.
"I am now thinking about writing a book about what we went through," Cuomo said four days after the report's release, his first public comments about a possible book.
By that point, he was already seeking formal approval from a state ethics agency to earn outside income from book sales, according to a person with knowledge of his planning at the time.
The governor's policy to direct nursing homes to accept and readmit patients who had tested positive for the coronavirus remains a subject of intense debate. An investigation by the attorney general's office, released in January, said that Cuomo's memo to nursing homes was consistent with federal guidance, but it "may have put residents at increased risk of harm in some facilities."
Garvey said in her statement that the governor's order did not drive nursing home deaths, a conclusion that was also reached in the Health Department report.
At the time, when the report was being prepared, Cuomo, a third-term Democrat, still enjoyed broad popularity for his televised news briefings.
For its report, the Health Department had drawn on data submitted by the state's more than 600 nursing homes, which were particularly hard hit in March and early April, as New York became a global epicenter.
"To us, it was clear: that you've got to report cases and deaths by all categories - case in nursing home, case in hospital," said Stuart Almer, chief executive of Gurwin Health Care System, which runs a 460-bed nursing facility on Long Island that has recorded 65 resident deaths from COVID-19. "We always had confidence, and still do, in our numbers."
State health officials could see from the data that a significant number of residents died after being transferred to hospitals. The state health commissioner, Dr. Howard Zucker, had been aware as early as June that officials in his department believed the data was good enough to include in the report, according to two people with knowledge of the discussions.
But Zucker testified to lawmakers in early August that the department was still auditing the numbers and could not release them. State Sen. Gustavo Rivera, the chair of the health committee, suggested during the hearing that the data was being withheld to improve the governor's image.
"That's a problem, bro," Rivera told Zucker. "It seems, sir, that, in this case, you are choosing to define it differently so that you can look better."
In a statement issued Thursday, Gary Holmes, a spokesperson for the Health Department, echoed Garvey's words, disputing that the numbers had been ready in time for the report and saying said that, regardless, they would not have changed its conclusions.
Dr. Eleanor Adams was the Health Department's lead on the report, but her draft was substantially rewritten by Malatras, now the chancellor of the State University of New York system. He was among a number of officials and former advisers temporarily recruited by Cuomo to assist with the pandemic response.
The back-and-forth went well beyond the usual process of the governor's office suggesting edits to an agency report, and became "intense" at times, according to two people with knowledge of the discussions.
Health officials felt the governor's office, whose opinion was conveyed by Malatras, wanted to simplify too much. They worried it was no longer a true scientific report but feared for their jobs if they did not go along.
Even so, an edited version prepared by Malatras did not remove the higher death toll.
That occurred later, after DeRosa and Lacewell became aware of its inclusion. It was taken out soon after.
This article originally appeared in The New York Times.
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