What to Know Signs show the curve of infections is flattening; Gov. Andrew Cuomo warns the death toll could keep rising, describing it as a "lagging indicator"

NYC Mayor Bill de Blasio said for the first time Thursday May not be as difficult as he feared but restrictions could remain in place into June

NJ eclipsed 50k COVID-19 cases Thursday; nearly 220,000 in the tri-state area have now tested positive and more than 9,000 have died

Four days ago, the nation's top doctor, U.S. Surgeon General Jerome Adams, warned America this would be the "saddest week" of the pandemic. He was right.

New York saw its daily death toll spike to a new record Thursday for the third straight day, while New York City's coronavirus toll surged well past 5,000 — more than the number killed on 9/11. The widely cited Gates Foundation-funded IHME model projects New York's daily death rate to decrease going forward; it has sharply lowered its ultimate projections for fatalities in the state.

That doesn't mean the tragedy will end. New York posted its lowest number of hospitalizations in weeks Thursday, but Gov. Andrew Cuomo warned the death toll will continue to rise. It's a “lagging indicator,” reflecting people who had been hospitalized before this week, he says. The fatalities have overwhelmingly been the most vulnerable patients, the ones on ventilators.

Cuomo has said the longer people stay on ventilators, the more unlikely they are to ever come off them. Experts say up to 50 percent of patients with severe respiratory distress die while on the machines. The link is so compelling that some doctors are trying to move away from using them when they can.

To date, more than 9,000 tri-state residents have lost their lives to COVID-19 and nearly 220,000 have been infected. After recording more than 500 deaths a day since late last week, New York state recorded its biggest one-day jump Thursday (799), for a statewide toll of more than 7,000, Cuomo said. New Jersey set daily death records twice this week as well but saw a lower increase (198) Thursday as its toll hit 1,700. The personal tragedy is relentless and heartbreaking.

"Today we can say we lost our brothers and sisters. There are no words that can express our grief and heartbreak. But the way I sleep at night is we didn't lose anyone we could have saved," Cuomo said. He, along with the governors of New Jersey and Connecticut, has ordered all state flags lowered to half-staff, a constant and visible tribute to the lives lost and the lives that will be lost.

Those working on the front lines of the crisis, doctors and nurses at hospitals, are feeling the exhaustion from working day-in, day-out in such relentless conditions — with one doctor saying there is a clear physical, mental and emotional exhaustion among medical workers.

"I'm seeing the physical exhaustion in my colleagues. I'm seeing the indentation of the goggles deep in their face. I'm seeing people just sort of worn out from day after day of doing this," said Columbia University Medical Center's Craig Spencer, who also worked in West Africa during the Ebola crisis. "But you're starting to see a lot more of that mental exhaustion."

New York's death toll alone is 44 percent of America's, based on NBC News estimates. A bad flu season in New York state kills about 1,900 people a year. COVID-19 has done that in just the last three days. Stark racial disparities have been apparent, and new outreach efforts are underway in communities of color. Five new testing facilities are opening in those areas, Cuomo said.

As of Thursday, New York state had 7,067 deaths and 159,937 total cases; that caseload is more than any country in the world has reported to date, according to Johns Hopkins. New York City itself had 87,028 total cases and 5,280 fatalities.

Mayor Bill de Blasio acknowledged the real toll was likely higher, saying only COVID-19 could explain a recent massive spike in home deaths. Both he and Cuomo, as well as federal officials, are looking at ways to include probable or presumed cases in the overall death tolls.

While the tragedy may continue to mount, there have been hopeful signs. About two-thirds of New York's hospitalized patients have been discharged; hundreds of NYPD and FDNY members have been cleared to return to work. Johns Hopkins data shows that more than 300,000 people worldwide have recovered from COVID-19 out of 1.5 million positive cases.

Cuomo lauded New Yorkers for complying with social distancing Thursday, saying they were doing their part to flatten the curve -- and the guidelines were working better than projected because of their commitment to compliance.

But now is not the time to relax, he said. "If we stop acting the way we're acting you will see those numbers go up. We can't handle the worst-case scenarios. We can't even handle the moderate-case scenarios with all we've done," said Cuomo, "The moment you stop following the policies, we will shoot through the roof."

The 1918 Spanish flu hit in 3 waves.



We are only in the first wave.



We can’t assume that because we are seeing some positive signs this will be over soon or that additional waves won’t hit.



NYS will not underestimate this enemy. — Andrew Cuomo (@NYGovCuomo) April 9, 2020

Mayor de Blasio echoed those sentiments earlier Thursday, saying the last thing we can afford is to let down our guard. He acknowledged the progress that had been made -- and for the first time Thursday said there's a chance May won't be as difficult a month as he thought it would be just a week ago. He says April will still be challenging.

"All 8.6 million of us have to earn our way out of this. We didn't deserve this. But we're in it," the mayor said. "We are one team. We need to win our way to the next phase ... I think if we really work hard we have a chance of seeing change in May or June."

De Blasio said he wouldn't relax any restrictions until there is sustained evidence of improvement. That sustained evidence involves three key metrics -- hospital admissions for suspected COVID-19, ICU admissions for suspected COVID-19 and the percentage of people testing positive -- trending down in unison. Those numbers all have to decline for at least 10 days before the city can move to the next phase, which de Blasio described as low-level virus transmission.

Even when we reach that next phase, current guidelines will not evaporate overnight, the mayor said. Slowly, they will ease, and slowly, life in New York City will start to look more normalized, as they mayor displayed a chart showing a plan for graded social distancing. That chart suggested some gatherings could return, but de Blasio declined to get into specifics about what restrictions could be eased, instead just saying "you may relax some and not the other."

That is months away, de Blasio said -- it might not happen until late May or June. The mayor said Thursday "serious discussions" are being held on the fate of NYC public schools and a decision on whether they might be able to reopen in time to salvage any part of the academic year is likely a few days away. Previously, he expressed serious doubt schools would reopen before the fall. Pennsylvania's governor Thursday extended his state's closures for the rest of the school year.

De Blasio said he wants the maximum number of people working from home "for a long time" because strict adherence to social distancing is how we'll get to the next phase. "If you see something, say something," was a collective call to action born out of terror. Today, the virus is the enemy -- and de Blasio said the same message applies. Call 311 to report violations.

New Jersey Gov. Phil Murphy, who has asserted the life-changing impact of social distancing perhaps more forcefully and frequently than any governor, says that single factor could be a difference of 420,000 COVID-19 cases for his state. Murphy also enacted a new executive order requiring face coverings in all grocery stores statewide.

Overall, New Jersey remains the nation's second most-impacted state, reporting 51,027 cases and 1,700 deaths as of Thursday. Connecticut could be an emerging hot spot as well, standing at 9,784 cases with 380 dead as of Thursday evening.

Look at this map: Social distancing is slowing the rate in which the numbers are doubling.



We need you to stay home whenever possible.



This isn’t about you, or me. It’s about all nine million of us.



This is not a time for selfishness. This is a time for selflessness. pic.twitter.com/ndltBSQJ7e — Governor Phil Murphy (@GovMurphy) April 9, 2020

Where Do We Go From Here?

The International Monetary Fund said Thursday it expects the pandemic to bring about the worst economic fallout since the Great Depression while urging governments around the world to prioritize containment and healthcare measures before shifting their focus to the economy.

Up to 50 million jobs are vulnerable to coronavirus-related layoffs, economists say. Roughly one in 10 workers has lost a job in the last 21 days; a record 16.8 million Americans have filed for unemployment since the outbreak started. President Trump plans to unveil a second White House virus task force, this one focused on the economy, a senior administration official confirmed.

New York alone has seen 810,000 unemployment claims since March 9. It has processed 600,000 of them. With hundreds of thousands still in limbo, the state is launching a new unemployment site that won't require a phone call.

Public health and the economy aren't mutually exclusive priorities, Cuomo has said. He has had preliminary discussions with Murphy and Lamont about developing a uniform regional approach to rebooting their economies, just as they did several weeks ago in shutting them down.

What might that look like? Cuomo offered no immediate specifics, saying we're not quite there yet. But he did suggest a key path to get there: Testing. And more testing. The governor is talking about more than typical COVID-19 tests -- he's talking about newly FDA-approved antibody testing. And bringing that to scale.

Cuomo says antibody testing, which identifies people who have recovered from COVID-19, will hasten a return to the workforce. He, along with some of the nation's top experts, say it's unlikely someone who has had the novel coronavirus will get re-infected because their course with it may grant them the precious immunity no one in the globe had before becoming infected with it themselves. If testing gets to the point where people can be tested for antibodies even without a prior COVID-19 test, many more could get back to work even sooner.

As for New Jersey residents who are eager to reopen the economy, Murphy said on MSNBC Thursday that he understands their financial strain but that the social mitigation efforts are "akin to ripping the band-aid off now" in exchange for what could have been "much deeper and longer-term economic misery."

Though experts say it's unlikely someone who has had COVID-19 will get it again this season, they acknowledge it's far from impossible. Murphy said he, Cuomo and Lamont have discussed a possible uniform approach to mobilizing resources for when COVID-19 comes back, which the nation's top infectious disease expert, Dr. Anthony Fauci, has said could happen in the fall.

All three tri-state governors have pledged to help out other states when their times of need come as the nation has stepped up to help theirs. Their states have a combined 220,748 cases and 9,147 deaths, representing nearly half of all cases in America, which NBC News estimates have surpassed 462,000, and nearly 60 percent of its deaths, which have topped 16,600.

The ultimate toll on the American psyche from this job- and soul-crushing pandemic is incalculable at this point. As Cuomo has said, this crisis will transform a generation -- and shape another.

The White House has projected anywhere from 100,000 to 240,000 U.S. lives could be lost to the pandemic. Fauci said Thursday he's hopeful America's death toll will come in well in under the lower end of those projections -- more like 60,000 -- because of how seriously people are taking mitigation. See how COVID-19 has spread across the U.S. since March 1 using this interactive map.