What to Know New York, New Jersey and Connecticut are on "pause," shutting down all non-essential businesses and enacting new density control measures; NJ says day care centers can only stay open if they care solely for essential workers' children

As of Wednesday, more than 38,000 people in the three states had tested positive for COVID-19; at least 447 have died; NYC has more than 20,000 cases alone and three-quarters of the 366 deaths statewide

The doctor coordinating response for the White House Coronavirus Task Force says 50% of all new U.S. cases and nearly 1/3 of U.S. deaths are coming from the NYC metro area right now

UPDATE: NY Cases Near 40K, 385 Dead; 'Almost Any Scenario' Will Overwhelm Health Care System, Cuomo Says

Gov. Andrew Cuomo blasted the feds' $2 trillion proposed economic relief package Wednesday, saying it would be "terrible" for New York, which faces an accelerating rate of infection that doubles case count every few days and an economic shortfall worsened by each day of response to the crisis.

"We have 15 times the problem of the next state. Every state will have a different apex with this virus. New York is first," Cuomo said Wednesday. The Senate plan, which still needs a vote before it goes to President Trump, would give New York $3.8 billion, a "drop in the bucket" compared with the up to $15 billion Cuomo says the state needs for the crisis. He's already spent $1 billion.

"How do you plug a $15 billion hole with $3.8 billion? You don't," Cuomo said. "The House bill would give us $17 billion. That's a dramatic difference."

The rapid infection spread has hastened the approach of the "apex" of the crisis in New York, Cuomo said. The wave, now more like a tsunami, could crash on the health care system in three weeks rather than 45 days -- and with life-saving supplies already heavily depleted, New York is increasingly desperate for resources to get through just the immediate future. Mayor Bill de Blasio has said he expects the crisis to be worse in April than in March, potentially even worse come May — and no one should get their hopes up that everything will be back to normal by Easter.

De Blasio also vented his frustration with the stimulus bill, saying in a Twitter thread that the bill is "nowhere close to what we need to fight this epidemic," and the city getting "$1 billion out of a $150 billion pot does not reflect reality."

The predicament is such that the Columbia ER doctor who famously survived Ebola a few years ago, and now finds himself on the front lines of the COVID-19 war, says he's more fearful of the new virus than of the one that nearly killed him.

As of Wednesday night, nearly 33,000 cases had been confirmed in New York, an increase of more than 7,000 from the day before. At least 366 people have died. The city, impaired by the density that makes it one of the world's most vibrant places, bears the brunt of the impact, with more than 20,000 cases across the five boroughs as of Wednesday night. The mayor's office said the death toll had soared to 280, the biggest increase in deaths the city had seen so far.

One hospital in the city, Elmhurst Hospital in Queens, had 13 patients being treated for COVID-19 die over the span of 24 hours, according to NYC Health & Hospitals. In a statement, the hospital group said the number was "consistent with the number of ICU patients being treated there," with Elmhurst being "at the center of this crisis."

Faced with mounting deaths, the city medical examiner is building a makeshift morgue in Manhattan, City Hall said. The measure, which has been used in the past during mass casualty events like 9/11, falls within the purview of the city emergency declaration that de Blasio signed weeks ago, a spokesperson for the mayor's office said. To date, more than half (52 percent) of NYC fatalities have been people 75 and older; 3 percent of victims are younger than 45, according to the city's data. But most of the total cases (56 percent) are impacting people younger than 50; 2 percent of NYC cases as of Wednesday are people no older than 17.

New Jersey has endured growing tragedy as well. A day after announcing the state's highest single-day fatality increase, Gov. Phil Murphy said Wednesday the state had another new high: 18 deaths in one day, bringing its total to 62. New Jersey now has the second-highest case total (4,402) in America. New York is the only state with more.

Also in New Jersey, the mayor Newark issued stringent shelter-in-place order for the entire city, mandating residents stay inside their homes unless it was an emergency, necessary trips to the grocery store, or for a brief time for fresh air and/or to walk a dog. Essential employees would also be allowed to leave. Police would be "aggressively" enforcing the measure.

New York City is still the epicenter of the nation's outbreak, with an "attack rate" of COVID-19 five times higher than anywhere else. The White House said Tuesday that anyone who visited NYC should self-quarantine for 14 days because of exposure risk, a measure that de Blasio said he disagreed with. It was just a few weeks ago that suggestion applied only to people who had visited five countries on the other side of the world.

New York state's health commissioner said Wednesday people should not follow the federal government's self-quarantine suggestion, though. Instead, Dr. Howard Zucker said, they should heed social distancing guidelines.

The city has implemented extensive measures to control density, most recently a pilot plan to close some NYC streets to car traffic to help people spread out.

There is evidence the efforts may be working, Cuomo said. On Sunday, hospitalizations were doubling every two days. On Monday, that number rose to 3.4 days. By Tuesday, hospitalizations were doubling every 4.7 days. Cuomo said Wednesday those numbers are encouraging, but time will tell if they can hold.

Though the vast majority of New York cases self-resolve, actual hospitalizations have moved at a higher rate than the projected models, Cuomo said Wednesday. He initially projected the state would need 110,000 hospital beds at the peak of the crisis. Now he believes New York will need up to 140,000 beds. That's more than double current capacity. The intensive care situation is worse; the state has 3,000 ICU units and may need up to 40,000, Cuomo said.

About 16 percent of the city's cases to date have required hospitalization, around the same as the state's percentage, the mayor's office said. Twenty-three percent of the currently hospitalized patients are in ICUs. ICUs need ventilators.

Ventilators are so critical, and in such short supply, the governor said he is experimenting with having patients share a single machine. Cuomo said Wednesday the state has 11,000 ventilators, including 7,000 newly state-procured ones. But New York needs 30,000, the governor said, adding that acquiring the life-saving machines is "our single biggest challenge."

"I told the White House, send us the equipment we need. Then we will deploy it to the states that come after us," Cuomo said. "I personally guarantee it."

FEMA sent an initial shipment of 400 ventilators earlier this week and another 2,000 Tuesday. Another 2,000 were expected to be sent Wednesday, and de Blasio said the city would get half of the 4,000 total. The mayor said on Wednesday that the goal is to have 15,000 ventilators for the city alone, a number the city isn't even remotely close to right now.

I am working very hard to help New York City & State. Dealing with both Mayor & Governor and producing tremendously for them, including four new medical centers and four new hospitals. Fake News that I won’t help them because I don’t like Cuomo (I do). Just sent 4000 ventilators! — Donald J. Trump (@realDonaldTrump) March 25, 2020

The head of FEMA also said the Trump administration would use, for the first time amid the pandemic, the Defense Production Act, which lets the federal government order private companies to manufacture needed supplies. FEMA Administrator Peter Gaynor said it would be used to secure tens of thousands of COVID-19 test kits and hundreds of millions of masks -- only for the White House to say hours later that it had not been necessary after all for the kits in particular.

States have been begging for that lifeline -- and while local leaders acknowledged the step in activating the DPA, they want it fully leveraged. More people will die, and many of them could be saved if hospitals had the fundamental resources to help them, officials say.

First Priority — Health Care

The economic impact of COVID-19, and its rampant spread, has been devastating on every economic level. Trump said Tuesday he hoped to have the country reopened and "just raring to go" by Easter — a notion that de Blasio called "absolutely inconceivable" given the current situation in New York.

Cuomo says the first order of business has to be saving lives, period. But he said the government can look at ways to restart the economy, thinking about which people can begin to go back to work, while still prioritizing public health.

Job-seekers have not been hard to find. Some areas of the state have seen a 1,000 percent increase in unemployment claims, according to the latest labor statistics. But the number of those out of work has been outpacing the number of open opportunities, particularly in states that have shut down all non-essential business. New Jersey Gov. Murphy said his state has 12,000 jobs available now; according to the state's page, 88,000 people are looking for them.

REMINDER: We’ve launched a jobs portal to help residents who have lost their jobs as a result of #COVID19 find and apply for a new job at one of our essential workplaces.



Looking for work? Visit: https://t.co/ausEjYkWtx

Looking to hire? Visit: https://t.co/HbfbmqcrOu pic.twitter.com/iEpNTen1Ca — Governor Phil Murphy (@GovMurphy) March 24, 2020

States have announced extreme cuts on non-COVID-19 spending, and face devastating budget shortfalls as coronavirus spending spikes. Temporary hospitals are being built, and while the feds are footing the bill for some -- like four 250-bed, fully staffed facilities within the Javits Center to treat non-virus patients, individual states are saddled with the brunt of the financial burden.

They're also looking, on a daily basis, for more sites to convert to temporary medical facilities. Cuomo has a number of projects in the works, including on Long Island and in Westchester in addition to the Manhattan facility. He also says he's been speaking with hotel owners about using their rooms. Some have already responded: Ty Warner Hotels and Resorts said Wednesday it would open the Four Seasons New York to nurses, doctors, and medical personnel working on COVID-19 in the city; the workers can stay for free.

Murphy has said he is also looking into hotels as an option for medical personnel. To help with patient capacity, he says FEMA is building four temporary field hospitals in New Jersey, including one at the sprawling Meadowlands complex, to provide about 1,000 additional beds for non-virus patients.

A coronavirus testing site at Temple University's Ambler campus in Montgomery County expanded its criteria to include people dealing with stomach issues or a loss of smell and taste. It comes after doctors revealed new symptoms associated with COVID-19. NBC10's Aaron Baskerville has the details.

More medical professionals are needed, too, not just to give weary health care workers their much-needed breaks, but to shore up defenses before the floodgates open further. Legions of retirees have stepped up across the tri-state area - Cuomo said Wednesday 40,000 people from physicians to RNs to respiratory therapists have responded to the call to date. NYU says it will graduate its medical students early to help shoulder the load.

New York has also launched a free mental health hotline (844-863-9314) for COVID-19 patients. Cuomo says more than 6,000 professionals signed up to field calls. Murphy, meanwhile, announced a new executive order requiring all childcare centers still operating to certify that they would only care for the kids of essential workers. If they can't agree to that, they are ordered to close by April 1.

"A lack of childcare cannot be a barrier for them or our response," Murphy said. "While these workers commit to protecting us and our families, we will commit to helping their families."

Murphy also said he had been in touch with Vice President Mike Pence, requesting again the Trump administration issue a major disaster declaration for his state as it did for New York, opening up billions in urgently needed funding. He said he was hopeful for a positive outcome; it's not clear when he may get it.

Grave Reality, Growing Desperation

Numbers will continue to rise as more people are tested, officials have said. To date, the state of New York has accounted for 28 percent of all COVID-19 testing in America, Cuomo said Wednesday.

New Jersey and Connecticut have seen their case totals rise, now at 4,402 and 875, respectively, along with their death tolls (62 in NJ, 19 in CT to date). On Wednesday, Murphy added 727 cases and 18 coronavirus deaths, the highest one-day fatality increase his state has seen since the pandemic struck America.

Regionally, tri-state cases have surpassed 38,000; at least 447 people have died.

All three states are scrambling to develop their own mobile testing centers and drive-thru stations. But there have been bumps, as the number of people desperate to get tested flood the capacity of the new facilities. New Jersey's largest testing center in Paramus has had to shut down within minutes of opening each day because it hits capacity; newly opened stations face similar plights.

The three tri-state governors have already taken unprecedented joint action to help slow the pandemic. New Jersey followed New York's lead on the stay-at-home order, and Connecticut enacted its version Monday night.

Governors are working to accelerate action on the drug front as well. New York launched a clinical trial for an experimental treatment Tuesday and plans to be the nation's first state to try to heal critically ill patients using recovered people's plasma — a process called convalescent plasma that was used during the flu epidemic of 1918. Right now, everything is on the table.

Mount Sinai's Chief Medical Officer Michael Del Moro urgently called for those who recovered from COVID-19 to donate antibody-rich plasma to give to the sick, telling staff in a letter he posted to Twitter that "this is the humanitarian mission of our lifetimes."

Where Do We Go From Here?

The depths of the outbreak — and its impact — are incomprehensible at this point but most definitely catastrophic: Billions upon billions of dollars have been lost and more will be lost; many have died, far more have been sickened. The grim totals will rise — and it may be months before we see the curve flatten out.

The World Health Organization declared the novel coronavirus a pandemic, the first coronavirus to ever earn the dubious distinction. It's novel — that means it's new and no one has immunity to it.

Nationally, NBC News estimates more than 64,000 have been infected with the novel coronavirus and around 900 people have died. The numbers are far more stark globally. WHO offered a somber outlook in a recent situation paper: It took three months to get to the first 100,000 cases. It took 12 days to get to the next 100,000, and just five days to get the next 100,000 after that.