Up to 2.7 Million in New York May Have Been Infected, Antibody Study Finds

Preliminary results from New York's first coronavirus antibody study show nearly 14 percent tested positive, meaning they had the virus at some point and recovered, Gov. Andrew Cuomo said Thursday. That equates to 2.7 million infections statewide -- more than 10 times the state's confirmed cases.

The study, part of Cuomo's "aggressive" antibody testing launched earlier this week, is based on 3,000 random samples from 40 locations in 19 counties. While the preliminary data suggests much more widespread infection, it means New York's mortality rate is much lower than previously thought.

As of Thursday, nearly 16,000 people in New York have died of virus-related complications. With 260,000-plus confirmed cases, the mortality rate would be as high as 6 percent. With 2.7 million cases, it would be around 0.5 percent -- much lower, though still much higher than the seasonal flu.

Cuomo was quick to caution, though, that the death toll was higher than even the state's own official report -- it counts deaths in hospitals and nursing homes, but not at-home deaths or other "probable" cases. In other words, the mortality rate is still hard to determine properly.

New York City had a higher rate of antibodies (21.2 percent) than anywhere else in the state and accounted for 43 percent of the total tested. Long Island had a 16.7 percent positivity rate, while Westchester and Rockland counties saw 11.7 percent of their samples come up with the antibody. The rest of the state, which accounted for about a third of those studied, had a 3.6 percent positivity rate. There were early variations by race/ethnicity and age as well.

Cuomo says further analysis of the antibody study findings is underway. The early estimates mirror findings from a study in Los Angeles County, California. Researchers there found COVID-19 could have been 55 times more prevalent than reported, which would mean a far lower morbidity rate than believed.

One prominent New York City doctor reacted to the results by saying they were plausible but by no means certain, and that even if 21 percent of NYC residents had antibodies, it didn't mean they were immune.

"It means a lot of us in NYC have been infected. But that's not surprising news - we've seen high levels of cases for over a month. It means the virus is STILL spreading in NYC. It means that the MAJORITY of us are still very susceptible! It means we still need to #StayHome," said Craig Spencer, a Manhattan emergency room doctor, Ebola survivor and prominent social media voice during the crisis.

Nursing Homes: COVID-19 'Ground Zero'

About a quarter of the state's total fatalities have been in long-term care facilities, which have been dubbed ground zero of the national crisis.

By law, nursing homes must provide personal protective equipment and temperature checks for staff. They must isolate COVID-19 residents, ensure separate staff for virus patients and notify all family members within 24 hours if any resident tests positive for COVID-19 or dies from infection.

That's not always happening. More families are finding themselves blindsided by a loved one's nursing home death before they were even told a particular facility had a virus problem. In some cases, that reflects a home's lack of awareness. In others, it's an absence of reporting.

Declaring nursing homes a "top priority since Day 1," Cuomo said the state would crack down on centers that don't comply with current regulations and executive orders. Attorney General Letitia James will lead that investigation in coordination with the state Department of Health, the governor said.

The federal government has pledged better tracking and information-sharing on nursing home outbreaks, which the Associated Press reports have been linked to at least 8,500 deaths across the country. The real toll is likely much higher; the virus is adept at killing, Cuomo has said, and the people in nursing homes, the frail and the elderly, are most vulnerable to its attack.

Experts say the outbreaks have been fueled by the industry's chronic challenges with controlling infections and staffing shortages. Many homes have not reported their deaths and state counts may not include those who die without ever being tested for COVID-19.

Cuomo has incorporated nursing home data into the New York state coronavirus tracker; it currently lists nursing homes and adult care centers that have reported fatalities by name and breaks out the total numbers by county. As of Wednesday, 22 percent of the state's 15,740 fatalities came from nursing homes or adult care centers. The state tracker does not list all the centers that have reported infections. Last week, the governor ordered nursing homes to begin supplying this information to the state. Noncompliance may lead to civil penalties.

Some of the nation's biggest outbreaks have been local, including 55 deaths at a nursing home in Brooklyn. The borough now has the highest virus death toll (3,540) of any county in America, per state and NBC News data, accounting for 7 percent of all U.S. deaths. Five homes in the outer boroughs have reported at least 40 deaths each. Part of the issue is the vulnerability of the population itself; part of it is reporting and access to testing. Supplies and personal protective equipment for staff have been problematic as well.

Earlier Thursday, New York City Mayor Bill de Blasio unveiled stepped-up efforts to fight that battle in the five boroughs. He says his administration has sent nearly 10 million N95 and surgical masks, gowns, gloves, face shields and other PPE to the city's 169 nursing homes in weekly distributions to date. On Thursday, he announced the city would increase its weekly shipment by at least 50 percent, adding to the over 40,000 N95s, 800,00 surgical face masks 40,000 face shields, 1.5 million gloves and 105,000 gowns or coveralls that went out last week.

To help with urgent staffing needs, de Blasio has sent 210 clinical staff volunteers to 40 NYC nursing homes and will double that, bringing the total number of personnel to more than 420, the mayor said Thursday. His administration has established a task force to work with about half the nursing homes citywide, collecting data on staffing, PPE, death management and other metrics to ensure nursing home needs are continually met through the crisis.

“Our city’s nursing homes are home to some of those most at risk for COVID-19,” de Blasio said Thursday. “They need our support more than ever, which is why we are stepping in and sending more staff and support to assist those who protect and care for our most vulnerable.”

New Jersey, which has seen about 40 percent of its total COVID-19 deaths come from nursing homes, launched a new webpage earlier this week that names all 446 long-term facilities where outbreaks have been reported and those where residents have died. One home in particular, a sprawling facility in Andover, came under fire after an anonymous tip led to the discovery of 17 bodies piled inside a makeshift morgue. According to the New York Times, they were moved there after being temporarily stored in a shed. Gov. Phil Murphy said he was outraged by the gruesome find and pledged a thorough investigation.

Current and former employees at the Andover home described vile conditions there even before the pandemic hit.

"There would be urine and fecal matter on the floor, in the hallway, in the bedroom, like it was just gross ... I have seen bedbugs in patient beds," one former employee said. "We have reported this a couple of times and nothing is being done about it. Nothing. And then with the virus happening ... things just got 10 times worse."

Path to Reopening: A Data-Driven Approach

Cuomo has said reopening states will be a gradual process -- and that can't really begin until the data supports it, meaning hospitalization and death rates are completely under control. The numbers have been trending in the right direction, but the volume is still high overall. Cuomo says it'll never be zero.

"The number will decline to a level that is basically a low constant. You can't stop all transmission of the virus," Cuomo said during an interview on The Daily Show late Wednesday. "When you get down to the lowest level you can, that's your low point. Once we hit that number, then we can talk about starting to reopen."

New projections from the widely watched Gates Foundation-backed IHME model, the one relied upon by infectious disease expert Anthony Fauci and often cited by Cuomo, suggest New York and New Jersey could relax restrictions after May 27, presuming strong containment strategies remain in place, including testing, contact tracing, isolation and crowd limitations. Connecticut's timeline would be a bit later, after June 9, the model says.

The new "nation-leading" contact tracing program Cuomo announced Wednesday will help with the containment part of the equation. The plan is still in its very early stages; former NYC Mayor Michael Bloomberg has committed $10.5 million to develop and implement it in partnership with Johns Hopkins researchers.

Cuomo said the plan would be regional in its approach, rolled out in coordination with New Jersey and Connecticut. Gov. Ned Lamont later said he was still evaluating it.

IHME revised its death forecasts upward for Connecticut again Wednesday night, for the third time in a week. The state could now see 3,006 deaths through June 2; it has reported about half that to date.

The new model slightly lowered projections for New York (23,232 deaths through May 23) and New Jersey (7,058 deaths through May 21), though those numbers are still higher than in the model's April 17 iteration.

The newer forecasts take into account New York City's reporting on probable fatalities (it has 5,121 of those to date) and data compiled by The New York Times.

"People are about to burst, on one level. On the other hand, we had 474 people die yesterday," Cuomo said Wednesday of reopening. "You tell me how many people go outside and touch other people, I'll tell you how many people go into a hospital three days from now. It's an impossible balance."

On Thursday, Cuomo added another 438 fatalities to New York's growing toll, it's lowest single-day toll in weeks and a fourth straight day below 500. The state now has 15,740 dead, not counting NYC's probable fatalities. New Jersey's toll has reached 5,368, while Connecticut has seen 1,639 lives lost.

Casewise, the tri-state area has reported more than 385,000 infections -- 263,460 in New York, 99,989 in New Jersey and 23,100 in Connecticut. New York City reported its first confirmed case on March 1. A new model from Northeastern University suggests nearly 11,000 people could already have been infected in the city by then, according to The New York Times. De Blasio said Thursday he still believes half of the entire city could ultimately become infected.

The stark numbers and the uncertainty have New Yorkers, tens of thousands of whom have lost their jobs amid this crisis, torn between their desire to get back to normal and their fear of what could happen when restrictions relax.

Evidence of the state easing some rules on construction can already be seen in the city. On the Upper West Side, work on a high rise is being allowed because it includes affordable housing — which is considered essential. So is work at a west side hotel project, which was newly designated as essential.

Mayor de Blasio admitted that seeing an apparent recent uptick in traffic on NYC streets and sidewalks gives him some cause for concern. He said that even though COVID-19 admissions at city hospitals has plunged — from 850 in late March to 227 on Wednesday — relaxing on social distancing would undo any progress that's been made.

"I've been seeing it personally and I am worried about it," the mayor said. "If it's folks starting to get too loose, that's a problem."

People may not look at a crowded subway train the same way again; they may be leery of walking into a Broadway theater. The New York area has endured debilitating hardships since the shutdown; hardships will linger when it lifts.

The stresses of this crisis -- physical, psychological, financial and otherwise -- are profound. Cuomo says they'll lead to lead to "PTSD for an entire generation."

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