New York's governor, Andrew Cuomo, has said officials are seeing very early signs that physical distancing may be starting to slow the spread of coronavirus in his state, but cautioned that the number of cases is still rising significantly and hospitals would soon be overwhelmed.
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The New York City metro area accounts for 60% of new Covid-19 cases in the US. Despite that, Cuomo said it was encouraging that hospitalizations were projected to double every 4.7 days on Tuesday, compared with Monday, when the number was doubling every 3.4 days, and Sunday, when the figure was every two days.
"The arrows are headed in the right direction, and that is always better than the arrows headed in the wrong direction," Cuomo said at a press conference Wednesday.
But the virus still continues to spread quickly, and Cuomo said the "single greatest challenge" New York faces right now is a severe lack of ventilators, essential equipment for patients with potentially fatal Covid-19 infections. He said New York needs 30,000 ventilators but only has 4,000 in the current system.
Cuomo said the state has purchased 7,000, and the federal government has now provided 4,000 as high-tier officials start to recognize New York's crisis. Cuomo has said doctors would start trialling the use of one ventilator for two patients.
New York City on Wednesday took further steps to decrease the density of people, announcing that some roads would be shut to cars to allow pedestrians to use them, and encouraging social and physical distancing to be observed in playgrounds. Sports that involve "close contact" such as basketball should also be avoided.
Cuomo warned that if these measures to reduce the density did not work on a voluntary basis, then the city would make the guidelines mandatory.
The moves came after Dr Deborah Birx, part of the White House coronavirus taskforce, said on Tuesday that about 56% of all the cases in the US, and 60% of new cases, are in the New York metro area. Mike Pence called on people who have recently left New York for other parts of the country to self-quarantine for 14 days.
The vice-president said: "We have to deal with the New York City metropolitan area as a high-risk area."
Donald Trump tweeted on Wednesday that he had a good conversation with Cuomo, who later thanked Trump and his team for their cooperation. The tone was a considerable change from Tuesday, when Cuomo had fiercely criticized the federal government's response to the pandemic and balked at Trump's suggestion that restarting the economy superseded public health concerns.
While Trump has said he would like to see parts of the US economy reopening for business by April, and see churches packed by Easter Sunday, on 12 April, New York officials have implemented extreme social distancing measures, having non-essential employees work from home, shuttering schools and only allowing restaurants to provide takeout and delivery.
Still, more than one in every thousand New York residents has tested positive for the virus. The state confirmed 30,811 cases and 285 deaths as of Wednesday morning; 12% of cases have required hospitalization.
New York's mayor, Bill de Blasio, said: "The world we knew is gone. And it's not coming back, not for the next few months. That's the blunt truth. We're gonna lose some people."
New York state accounts for roughly 7% of all confirmed coronavirus cases worldwide, and De Blasio said it was likely more than half of all New Yorkers will get Covid-19. New York City alone tallied 17,856 cases and 199 deaths. The large number of cases could be attributed to New York's large testing numbers - it is testing more people per capita than South Korea.
New York officials are scrambling to equip hospitals with basic necessities to combat the virus. The hospital system has been given a mandate to increase capacity by at least 50%, but even if all hospitals doubled their capacity, the state would still be 34,000 beds short to accommodate projected numbers once the outbreak reaches its peak in the coming weeks.
There is also a severe shortage of space in intensive care units, where the most critical patients access ventilators. Right now, New York can support 3,000 ICU beds, but Cuomo said the hospitals will need 40,000 ICU beds - a more than 1,200% increase.
The Jacob Javits Center - a landmark convention center in midtown Manhattan - is being repurposed as a temporary hospital for Covid-19, along with four other sites selected by the army corps of engineers. But those new facilities will only inject a few thousand hospital beds into the wider network.
"The inescapable conclusion is that the rate of infection is going up," Cuomo said at a press conference a day earlier, on Tuesday. "It is spiking. The apex is higher than we thought, and the apex is sooner than we thought. That is a bad combination of facts."
Scott Weisenberg, an infectious diseases expert at NYU Langone, said hospitals are trying to create additional capacity with more beds and increased staffing. But he cautioned that a return to normalcy in a few weeks' time would be completely inappropriate, at least in New York.
"I would just say I would be very cautious about trying to reopen society too soon," he said. "Or you'll end up paying for it with a lot more cases and more deaths that could have been prevented."