Tl;dr:

Analysis strongly suggests that the NYC metro area has 5–10 days to quarantine the city or face dramatically overwhelmed hospitals, extremely high death rates, and a ruined economy.

The outlook for NYC and COVID-19 is bleak. The policy response is far too slow and too weak to meet the needs of the moment.

This note started as a twitter post on Wednesday March 11.

I’ve attached updated charts with two additional days of data to this note.

The Analysis

The NYC region has approximately 400 cases reported as of Friday Mar 13. That number is obviously an underestimate. After accounting for undercounting of asymptomatic cases and failing to detect cases due to under testing, we estimate that between 1,281 and 2,280 people are infected as of yesterday.

Using an SIR Epidemiology Model (described in greater detail in my previous Medium post), we can use the Low and High estimates for infections on 3/13 to project #COVID19 growth through March. Then using those projections for infections, we can use a conservative 10% severity rate to get the number of people who are infected on that day that will require hospitalization (severe & critical cases).

The NYC region has between 1,200 and 3,000 open hospital beds. This analysis suggests that enough people will become infected by March 23 and March 25 that NYC’s hospitals will be fully at capacity approximately 7 days later. (Infected people who will become severely ill do not immediately need medical care upon being infected. There is approximately a 5–7 day incubation period. After which, most severe cases present to the hospital within 2–3 days.)

The Obvious Choice

NYC must implement more severe social distancing measures and potentially fully shut down no later than a week from now in order to avoid overwhelming its hospital system.

Think about the choices here:

The Status Quo: The governor and the mayor continue to allow the virus to spread at schools, subways, restaurants, cafes, and workplaces. This is the exact same approach Italy took at the beginning of its outbreak. Seriously take a look at this article from two and a half weeks ago when Italy only had 160 cases (vs NYC’s 500+).

“Strict emergency measures were put in place over the weekend, including a ban on public events in at least 10 municipalities, after a spike in confirmed cases in the northern regions of Lombardy and Veneto. Italy’s Health Minister Roberto Speranza announced severe restrictions in the affected regions, which included the closure of public buildings, limited transport, and the surveillance and quarantine of individuals who may have been exposed to the virus. “We are asking basically that everyone who has come from areas stricken by the epidemic to remain under a mandatory house stay,” Speranza said at a Saturday press conference.” — CNN, Feb 24 2020

Sound familiar? It’s the exact same thing New York is trying now. It won’t work here either.

After that fails here too, we will wind up with the Italian situation. Overflowing hospitals. Demand at two, three, five times the capacity of the hospitals’ ability to deliver care. What’s worse is that their capacity will decline as cases overflow. Their doctors and nurses will be exposed and have to be quarantined, reducing an already strained workforce. Soon after, chaos in the hospitals will lead to fear in the whole city. You will see reports of people dying in their apartments because there isn’t capacity for them in hospitals. This fear alone will shut down the city. The economy will be ruined and tens, if not hundreds, of thousands of New Yorkers will die this year. This could all start at the beginning of April, if we don’t act within the next 5–10 days.

The Better Alternative: Shut down the city this week. Close everything but grocery stores, banks, and pharmacies. Convert schools into food distribution centers. Bring in the National Guard to provide essential services like food and augment police and emergency services. Issue checks to all New Yorkers for the length of the quarantine for at least $500 per person per month. Limit travel outside of the region. Slow the growth of the virus to a crawl immediately.

We know quarantines work. It did in Italy and Wuhan. It looks like France and Spain are convinced it will work too. The economy will be wrecked, but depending on when you do it, you might keep deaths in NYC under 5,000. Many times fewer deaths than the status quo approach. And, it will cost less. The economy will rebound more quickly and trust will be maintained in the ability of the government to protect the public.

This is an easy decision. We need Gov. Andrew Cuomo to take action now.

Appendix