What to Know New York's single-day death toll fell below 500 (474) for a third straight day Wednesday; the ultimate cost -- more than 15k lives -- is staggering

Former NYC Mayor Michael Bloomberg has volunteered to help develop and implement a regionally coordinated contact tracing program

Nearly 22,000 lives have been lost to coronavirus in the tri-state area to date; more than 375,000 people have been infected -- and those are just the ones we know about

Gov. Andrew Cuomo has pounded the importance of testing more fervently than anyone in America. He went to Washington, D.C. to nail down a federal-state partnership with President Donald Trump and said the meeting was productive. But once you've tested hundreds of thousands of people, how do you trace their contacts to prevent a future surge of infections?

Former New York City Mayor Michael Bloomberg has volunteered to help develop and implement a regional contact tracing program, a "massive undertaking" that will propel the tri-state area toward reopening, Cuomo announced Wednesday.

He said the program, which will be supported by $10.5 million from Bloomberg and developed in partnership with Johns Hopkins' researchers, will be regional in its approach because "the virus doesn't stop at jurisdictional boundaries."

The effort will require an "army," Cuomo said. While planning is still in the works, he says about 35,000 SUNY and CUNY medical students will be called upon to help. New York City Mayor Bill de Blasio spoke earlier Wednesday about a city plan for tracing; Cuomo says any NYC approach will be coordinated with the rest of the state, along with New Jersey and Connecticut, where Gov. Ned Lamont said he will evaluate whether he wants the state to participate and that no formal agreement had yet been reached.

"You cannot trace somebody within the boundaries of New York City," the governor said. "We'll coordinate everyone. This is a monumental undertaking."

And it's a critical one, particularly to prepare for the possibility of a second wave of the virus, which happened with the influenza epidemic of 1918.

"If you're not ready for the second wave, that's the wave that's going to knock you down," Cuomo said Wednesday. Acknowledging some local officials feel pressure to reopen faster than others, the governor said he won't allow that in New York.

"We're not going to have people lose their life because we acted imprudently. I'm not going to do that," Cuomo said. "I'm not going to have the obituary of this period be, 'Well, they got nervous so they acted imprudently.'"

Cuomo said a reopening timeline can't really begin until the data supports it, meaning hospitality and death rates are completely under control.

"The number will decline to a level that is basically a low constant. You can't stop all transmission of the virus, we're never going to get down to zero," Cuomo said during an interview on The Daily Show 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."

Acting too soon is not something any state can afford, least of all the ones in this region. One of the nation's most widely watched virus projection models, the one relied upon by infectious disease expert Dr. Anthony Fauci and often cited by Cuomo, revised its local death projections upward Tuesday for the second time in a week.

More people will die in the tri-state area, and the country, than previously thought before the pandemic ebbs -- and the fatalities won't level off for a longer period of time, according to the Gates Foundation-backed IHME model.

In its updated model, IHME projected New York's ultimate death toll to be 64 percent higher than it modeled just a week ago -- driven, in part, by a new effort to count New York City's "probable" deaths on top of the state's confirmed cases.

Last week, it projected New York would see more than 14,000 total fatalities by early-to-mid May. Now it says the Empire State could see up to 23,741 deaths through May 22.

The current IHME model assumes New York will have a triple-digit death toll every day through May 4, and a double-digit toll daily through May 13. As of Wednesday, the state had 15,302 fatalities, as Cuomo added another 474 names to the mounting toll.

The model also registered higher fatality projections for New Jersey and Connecticut, at 7,116 and 2,884, respectively. Their timelines now extend later as well, to May 20 and May 30. Nationally, projected fatalities increased slightly.

According to IHME's website, it primarily relies on data aggregated by Johns Hopkins, which has been the most commonly cited source for real-time numbers, down to a county level, on total cases and deaths globally and nationally. It uses data from New York City's health department and data compiled by the New York Times to calculate the "probable" death count for the city.

Notably, the model also revised its projected dates after which states could begin to relax social distancing restrictions. Presuming strong containment strategies remain in place, including testing, contact tracing, isolation and crowd limitations, IHME now says New York and New Jersey could begin to ease social distancing -- paving the way to reopen nonessential business -- after May 27. In its previous model run, IHME projected that date to be June 1. (While it moved up that timeline for New York and New Jersey, it pushed it back for Connecticut, from June 1 to June 7.)

"People are about to burst, on one level. On the other hand, we had 474 people die yesterday," Cuomo said of when measures could be relaxed. "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."

The three states to date have reported more than 21,900 deaths related to COVID-19. In New York, the recent daily tolls have been lower than in previous weeks. New Jersey reported its highest single-day death toll Tuesday (379), but Gov. Phil Murphy has said Tuesday numbers may at times reflect a delay in weekend reporting. On Wednesday, he added another 314 fatalities as the Garden State's toll climbed over 5,000. Connecticut added 121 deaths as well.

Death is a lagging indicator, meaning the toll may very well continue to rise even as other key indicators, like total hospitalizations, net intubations and new hospitalizations, decline. There were 1,308 new virus patients hospitalized in New York on Monday and a similar number on Tuesday, which further solidifies a downward turn. Five days ago that metric was averaging 2,000 or higher.

"We are going down -- how fast we'll find out but we're going down," Cuomo said Wednesday. "This is a profound moment in history. Our actions shape our future. If we get reckless today, we’ll suffer the consequences tomorrow."

The governor said New York could see its hospitalization numbers reverse and start to climb again within days if social distancing isn't aggressively maintained.

New Jersey and Connecticut, with 5,063 and 1,544 virus deaths as of their last reports, have also seen some positive movement on key metrics. Murphy has cited a decline in the number of new hospitalizations, which he attributes to a slowing infection rate, as well as hospitals seeing more COVID-19 patients discharged than admitted. He also says the number of patients in critical or intensive care has stabilized, which has protected NJ's ventilator supply.

Murphy says he wants to see those numbers decrease, but that they're not increasing at the moment is an encouraging sign. Also potentially good news: For the first time, New Jersey's health commissioner said more hospitals in the central region of the state were diverting patients than hospitals in the northern portion — meaning the pandemic could be shifting away from areas that have been hardest hit.

IMPORTANT: The overall number of patients in critical or intensive care remains STABLE, as does the numbers of ventilators in use.



We need these numbers to begin to decrease before we can move to our next phase. But, not seeing any significant increases is a good starting point. pic.twitter.com/9mX9YISZil — Governor Phil Murphy (@GovMurphy) April 22, 2020

Despite the good signs, the governor toured two hospitals that are getting additions to house more patients, including East Orange General Hospital and Bergen New Bridge Medical Center — the state's largest capacity hospital that got help from the Army Corps of Engineers to bring 130 new beds there.

Right now, it's difficult to imagine any of these three hard-hit states relaxing restrictions in a meaningful way by May 27, as the IHME suggests they could do. Thousands of new cases are still being reported every day -- the tri-state area has seen more than 375,000 COVID-19 cases to date (257,216 in New York; 95,865 in New Jersey; 22,469 in Connecticut). That's about half of the more than 833,000 cases reported in the United States, by NBC News estimates.

New York City is uniquely impacted, impaired by the density that makes it one of the world's most vibrant places. The five boroughs have seen more than 140,000 virus cases to date, with at least 10,977 deaths, by the state's reckoning. The city health department reports another 5,052 probable lives lost to COVID-19, which, if added to the state count, would bring NYC's ultimate toll to 16,000.

The stark numbers 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 if the city tries to do that too quickly. Cuomo said that the stresses caused physically, emotionally, mentally, financially and any other way is going to lead to "PTSD for an entire generation" once it is all over.

"The pressure that people are under is phenomenal, it is traumatic. You have no paycheck, but meanwhile they're still sending you the bills," Cuomo said. "You've been in the house with the family for a month. It sounds romantic for the first seven days, and then it gets highly stressful."

Mayor de Blasio has said repeatedly New York City's reopening will be incremental, mindful of the excruciating blow a viral resurgence would deal the public. The city will also be reopening six more testing sites before the end of April at NYCHA complexes, which have been some of the hardest-hit communities.

"The density is what created this issue. NYC is one of the more dense places on the globe, that's why you can't compare any other place to it," Cuomo said Tuesday. "People are going to be very wary before they walk into a Broadway theater or onto a crowded subway car."

Cuomo, in coordination with the other states, has extended New York's shutdown through at least May 15. Murphy said his public schools would remain closed at least through that time, in line with the regional approach to reopening, but indicated Tuesday the closures could go on longer.

"We are not going to open our schools back up until we are convinced by scientists and medical professionals that doing so would be safe for students and staff – and their families," Murphy said. "I will not rush this. I cannot."

Reopening strategies will vary by state and by region. Look at New York -- the upstate curve has been far different from the one downstate, Cuomo says. One thing he did say would be among the last businesses to return: barbershops and hair salons. The governor said that they are not essential (while admitting some might argue otherwise) and are very high-risk for spreading the virus, given the close quarters in which barbers and stylists work.

While components of reopening may slightly differ, they will be part of a multi-state strategy. Without uniform standards, it would be challenging if not impossible to protect the progress individual states and even counties have made in beating back the virus.

Ultimately, all three tri-state governors, as well as the nation's top experts, say a robust testing infrastructure is critical to economic revitalization.

"Tests can monitor the spread of the virus. That is the single most important thing," said Cuomo. "As you're opening the reopening valve and increasing the flow, what you need to know is how many people are getting infected, and that testing can do that for you."

They need a fuller picture of where we are to determine the optimal path forward. States have worked to maximize testing capacity to the best of their abilities, their governors say. They're constantly looking to do more, too.

On Wednesday, prosecutors in New Jersey announced FEMA testing sites at PNC Bank Arts Center in Holmdel and Bergen Community College in Paramus would be open to any state resident, regardless of symptoms. Testing at the center was initially capped at 500 people a day, but Murphy later admitted that the state may have jumped the gun a bit. Federal permission is still needed to operate the FEMA-run facilities.

Gov. Cuomo Goes to Washington

Cuomo met with President Trump in Washington, D.C., Tuesday, primarily to discuss testing, which has been a key point of the governor's criticism of the commander-in-chief. Both described the conversation as a productive and honest one, even as the governor later said that "The president doesn't like me. It is unambiguous, it is open. He doesn't like my politics."

Essentially, Cuomo and Trump agreed on roles that states and the federal government can play. While each state will be responsible for the actual testing in labs — including tests for COVID-19 antibodies — as well as tracing virus cases, the feds will maintain testing kit supply chains.

"I give them credit because its hard to sit down with someone you have differences with and say, 'Put that all aside, let's just do our jobs here because it's bigger than we are.' And that's what yesterday was," Cuomo said on the Daily Show. "Forget everything else, were talking about life and death. We're talking about the profound moment of our history that we will experience and we have a job to do."

Cuomo said he wants to work with the feds to achieve his "very aggressive goal" of doubling the state's current daily infection and antibody testing capacity — from 20,000 per day to 40,000 — which he said will take at least "several weeks" to accomplish. The governor also said that they have asked private labs in the state to do 50 times what they would normally do.

"It may not be possible to get there," Cuomo said Wednesday. "But I want to set the bar high. You set the bar high and then we get what we get."

He and Trump also discussed the need for states to get billions in federal aid. As vice chair of the Republican-led National Governors Association, Cuomo has led bipartisan efforts to try to secure that -- and has thus far come up empty.

The $484 billion interim relief package the Senate agreed upon Tuesday didn't account for the astounding revenue shortfalls and virus-related expenditures impacting states. Cuomo said Trump is open to funneling more direct aid to states in the next piece of legislation, though there's no clear timeline at this point for a follow-up bill. Helping financial matters, the president agreed to waive New York's FEMA match responsibilities, which Cuomo said would amount to hundreds of millions of dollars. It helps, he said Wednesday, but it's not enough.

Joining Cuomo in frustration over funding for states was Phil Murphy, who during his Wednesday press conference went on an impassioned diatribe blasting Senate Majority Leader Mitch McConnell's rejection of what he called "blue state bailouts" — that is, giving money to states that have been hardest hit by the COVID-19 pandemic.

"I'm jaw-dropped, I'm taken aback, my breath is taken away, I have almost nothing to say," a stunned Murphy said. "I would say two things in reaction to Senator (McConnell): Number one, come on man. That is completely and utterly irresponsible ... I don't care what party you're in — encouraging, engendering explicitly, almost hoping for bankruptcies of American states in the midst of the biggest health care crisis this country has ever faced, is completely and utterly irresponsible. Secondly, as usual, he's dead wrong."

Instead of giving relief money to the states, McConnell said during a radio interview that the states should be able to declare bankruptcy instead. While cities and municipalities are allowed to do so, states are not allowed to declare bankruptcy.

"We won't go bankrupt. But you know what will happen? We will gut the living daylights in every state of America of the exact services our citizens need right now," Murphy continued, explaining what could happen without federal funding. "We will leave our citizens in the lurch at their most profound hour of need ... That is what will happen in New Jersey, and I might add Senator, without having spoken to your governor, that will happen in Kentucky. You have my word. So watch your words, sir."

For his part, Gov Cuomo called McConnell's comments "one of the dumbest statements of all time."

Later Wednesday, Sen. Chuck Schumer announced that New York hospitals and providers would receive $4.4 billion of a new $10 billion allocation designated for hotspots like those across the New York City area and Long Island. Schumer said the money was secured as part of the CARES Act; and that New York would get billions more in the months ahead.