What to Know NYC has revised how it counts COVID-19 deaths -- and new numbers say more than 10,000 lives may have been lost in the five boroughs alone. Gov. Andrew Cuomo says the state will move to a similar system

Amid the tragedy, there are signs of a flattening curve; Cuomo is leading a new coalition of seven governors focused on developing a plan to reopen state economies while still prioritizing public health

To date, more than 299,000 people have been infected in NY, NJ and CT and nearly 20,000 have died

New York state will adjust its COVID-19 death toll reporting to include presumed or probable cases in accordance with new CDC guidelines, Gov. Andrew Cuomo said Wednesday. He said his team was contacting health facilities to get updated numbers, though it wasn't immediately clear when that data would be available.

As for confirmed deaths, New York state added another 752 overnight, bringing its official toll above 11,500 as of Wednesday. Amid the tragedy, there were more signs of optimism as total hospitalizations showed a net decrease for the second consecutive day. Also encouraging: Net intubations were down. Cuomo says 80 percent of people on ventilators never come off them.

"We are not out of the woods yet," the governor said Wednesday. "Coronavirus is still a monumental public health crisis and we are losing New Yorkers every day to this virus. Each New Yorker lost to COVID is a heartbreaking loss."

To help prevent more loss of life, Cuomo is now ordering all New Yorkers to wear a mask or cloth covering their noses and mouths when they are in public and not able to maintain a 6-foot distance from others. He, along with all local leaders and the nation's top health experts, have said social distancing is the key factor to slowing the spread of infection and, ultimately, preventing more death. Cuomo said he would leave enforcement up to local jurisdictions, and the order would go into effect April 17.

For example, if you are riding on public transit where it is impossible to maintain social distancing, or walking on a busy sidewalk, you must wear a face covering like a bandana or a mask. — Andrew Cuomo (@NYGovCuomo) April 15, 2020

Connecticut Gov. Ned Lamont stopped short of issuing an official order for now, but urged residents of the state that it's time to be "strict" with wearing masks, adding that an executive order could come in the next two days.

New Jersey Gov. Phil Murphy, whose state is the nation's second-most impacted next to New York, has issued a series of mandates requiring masks in stores and on public transit. He's been one of America's most fervent and frequent social-distancing preachers to date, and re-upped the urgency again Wednesday.

"Nothing trumps social distancing," an impassioned Murphy said. "Stay home. Stay apart. Keep your face covered. We will beat this damn virus."

New Jersey reported 351 new deaths Wednesday as its toll topped 3,000. It wasn't immediately clear if Murphy planned to try to include probable virus deaths in his state's COVID-19 toll going forward.

Casualties have been undercounted worldwide, experts say, due not only to limits in testing but the different ways nations count the dead. Acknowledging many may have died from COVID-19 without ever being officially diagnosed, the CDC recently issued new guidance saying deaths could be counted in the virus toll in cases where there was a "reasonable degree of certainty” they were connected.

New York City revised its reporting methods Tuesday to incorporate cases where death certificates list COVID-19 "or an equivalent" as the cause. The immediate spike in numbers was jarring. As of Wednesday, the five boroughs had 10,899 confirmed or probable COVID-19 deaths; 37 percent of those were "probable." That's nearly 2,500 more deaths than the most recent data from the state.

The change in the city’s accounting came after officials acknowledged that statistics based only on lab-confirmed tests were failing to account for many people dying at home before they reached a hospital or even sought treatment.

The FDNY has recorded as many as 200 daily deaths at home in recent weeks, far more than the average 25 deaths at home before the pandemic. It recorded nearly 2,200 "cardiac arrest" home deaths between March 20 and April 5 -- a 400 percent-spike over the same period a year ago.

The blunt truth, New York City Mayor Bill de Blasio said, is that "coronavirus is driving these tragic deaths." And he said it was critical to include them in the toll -- both to honor the lives lost and to better grasp the scope of the epidemic. That understanding will guide future decision-making as it relates to easing restrictions and other current standards implemented to control the spread.

De Blasio has focused on key three daily metrics -- the number of hospitalizations, the number of ICU admissions and the percentage of people testing positive -- that he wants to see all trend down in unison. When that happens for at least 10 days, he says, that will indicate the city can begin to think about entering the next phase of the crisis, which the mayor describes as low-level virus transmission.

On Monday, all three metrics dropped. By Tuesday, just one did -- the percentage of people who tested positive. It was the only of the three indicators to drop again Wednesday.

"Don't be discouraged. It's not going to be a perfect, clean line," de Blasio said. "This will be a day-by-day fight. We have to get to the point where we string together a bunch of good days. Hang tough with these restrictions because they're working."

According to the state's latest data, New York has nearly 214,000 COVID-19 cases and 11,586 deaths (NYC's share is more than 118,000 cases and 8,455 deaths, by the state's reckoning). That's a third of all cases in America, and nearly 40 percent of the country's deaths.

New Jersey had 71,030 cases and 3,156 dead as of Wednesday. Connecticut saw its largest single day jump in deaths Wednesday, bringing the state's total to 868, with 14,755 cases overall. In total, a virus unknown in this region 45 days ago has now killed more than 18,000 people locally.

While Cuomo says the worst may be behind us, he says the crisis itself likely won't be over until we have a vaccine, which could be anywhere from a year to 18 months out, if not longer. Worldwide, there are 70 vaccines in development. Barring a vaccine or effective virus treatment, Harvard researchers warn social distancing measures may need to remain in place into 2022.

Paving the Way to a New Normal

Though the curve of new COVID-19 cases is flattening, people are still getting sick, people are still being put into intensive care, and people are still dying. The death toll is a "lagging indicator," Cuomo has said, meaning it will continue to rise even as hospitalizations and intubations level off.

The question isn't so much when we'll get back to normal. It's how normal will change going forward.

President Trump has pitched a rollout approach to reopening the economy, a tactic he said could involve up to 20 lower-impact states opening up even before his hopeful May 1 date of a national reboot. Trump acknowledged that wouldn't be the case for the hardest-hit states like New York, saying he would support them reopening "piece by piece" as it was appropriate.

The president also said Wednesday that the U.S. had reached its peak of new COVID-19 cases. His press conference on Thursday is set to include guidelines for how and when states can reopen.

As Cuomo said Tuesday, "How you reopen is everything. We could lose all the progress we made in one week if we do it wrong."

He is at the helm of a new coalition of seven governors that plans to try to figure out how to do it right. So far, they all agree it most definitely won't happen all at once. It'll be incremental, a process of easing, not evaporating, restrictions. And it'll involve social distancing for another month at least, if not longer.

Cuomo offered a bit more insight on a "gradually phased" reopening Wednesday, saying it would be determined by two factors: the essentiality of each industry and the infection risk for each industry. He said the most essential and lowest risk industries would be opened first.

Reopening will also require expansive testing, testing to a capacity that Cuomo says the states don't have the ability to achieve on their own. Trump says it's up to them to get it done.

The single best tool to begin to safely reopen society is large-scaling testing.



The unvarnished truth is that we can’t yet test to scale.



And we can't get either diagnostic or antibody testing to scale without federal support. — Andrew Cuomo (@NYGovCuomo) April 15, 2020

Governors keep telling their citizens they will get through this crisis together. For an increasing number of Americans, reaching the other side is a tall order. Unemployment claims have spiked to record numbers. The federal coronavirus relief packages were seen as one route to get the economy going, but a key component -- individual relief checks -- may be further delayed after Trump issued the unprecedented demand that his name be put on the payouts.

Americans are growing more desperate. Concerns of alcoholism are on the rise. Nearly 40 percent of New Yorkers freely admit drinking while working at home. That number might be even higher -- if more still had jobs in the first place.

The surging unemployment crisis is making it more difficult for families to put food on the table as well. De Blasio says he believes that part of the problem will only worsen in the coming weeks. He is already providing free meals to all New Yorkers at more than 400 sites citywide and unveiled a new $170 million, four-pronged initiative Wednesday to ensure no one goes hungry.

The first element: provide 10 million meals in April and more in May. Second, hire more than 10,000 New Yorkers to deliver meals. Third, secure the supply with a $50 million investment in food reserves for the city. Fourth, protect grocery stores and workers. To that end, the mayor said Wednesday supermarkets should require customers to wear face coverings when they go inside.

"This will help everyone to remember when they're in that kind of place that it's so important to protect each other, to protect the community," de Blasio said. "Any customer who says, 'No, I refuse,' should not be allowed in. The city will back you. This is the smart thing to do."

The objective is simple: Protect people, save lives.

One of the most widely cited virus models, from the Gates Foundation-backed IHME, estimates that new deaths in the tri-state area will more or less end by the first week of May, assuming social distancing is maintained. The latest projections forecast virus-related deaths to peak around 14,500 in New York and 4,400 in New Jersey by May 1. Connecticut likely won't see its curve stabilize until early June, when it is expected to reach about 5,400 fatalities.

That same model predicts more than 68,000 deaths nationally by early June, which falls well below earlier projections -- a credit to mitigation efforts, officials say.

To date, the United States has seen more than 638,000 cases and more than 32,000 deaths, according to NBC News estimates. Globally, cases surpassed the 2 million-mark Wednesday, with 130,000-plus dead, according to Johns Hopkins data.