What to Know New York is beginning to see signs the curve is flattening, Gov. Andrew Cuomo said; he extended the statewide shutdown through April 29 to reinforce the social distancing measures he says have been working

New Jersey is the nation's second-most impacted state; Gov. Phil Murphy says its daily infection rate has also been slowing, but the state likely won't hit its peak until later this month

More than 178,000 in the tri-state area have now tested positive for COVID-19; nearly 6,000 have died, including first responders and children

Gov. Andrew Cuomo said Monday he would extend the statewide "PAUSE" order, along with school closures, through April 29 because, he says, there is evidence that social distancing is working. And now is not the time to let up.

The numbers continue to rise, but the rate of increase has slowed, Cuomo said. His aides said Monday the latest models show New York may have reached or neared its crisis apex, as the governor hinted in his briefing a day earlier.

Fewer than 8,700 new positives were added to New York's case total overnight, compared with the 10,000 daily increases the state has seen in recent days. The state saw a decline of daily deaths Saturday into Sunday, and despite averaging just under 600 deaths a day for the past four days — including a slight uptick Sunday into Monday — Cuomo described the current trend as hopeful. As of Monday, New York state had 130,689 total cases and 4,758 deaths. Intensive care admission rates are slowing; intubation rates are slowing.

"It would suggest an overall flattening of the curve," Cuomo said.

That makes the need for strict social distancing more urgent than ever, he added. And he raised the maximum fine for violating that protocol from $500 to $1,000 to drive home the point.

"If we are plateauing, we are plateauing at a very high level," Cuomo said Monday. "Now is not the time to be lax. Now is not the time to be playing Frisbee in the park. I want to be, frankly, more aggressive on the enforcement because all the anecdotal evidence is that people are violating it at a higher rate than before. If it's not about your life, you don't have the right to risk someone else's."

New York likely has the hospital bed capacity it needs at this point to manage the crisis. New projections put the number of beds the state will need at around 20,000 rather than the 110,000 predicted by earlier models, Cuomo said Monday. But, he added, "It is a monumental challenge to sustain this pace."

Early projections (in orange & blue) showed we would need 55K to 110K hospital beds.



The purple line shows where we are.



We are tracking better than the initial models, which is good news.



Social distancing appears to be working.



We must keep it up. pic.twitter.com/voCNzVv8do — Andrew Cuomo (@NYGovCuomo) April 6, 2020

The Gates Foundation-funded IHME model, which Cuomo has cited in several of his briefings, now predicts an earlier apex with lower morbidity for New York. At this point, that model projects resource use to peak in two days and deaths to peak in three days, with about 15,600 total lives potentially lost through the second week of May. That ultimate fatality projection, which presumes full adherence to social distancing, is about 1,000 lower than it was a week ago.

New York has tested more per capita than anywhere else in the globe, Cuomo has said. More than 40 percent of the 300,000-plus tested to date have been positive, which is well above the national average. Cuomo said two-thirds of the people who have been hospitalized since the start of the crisis have been discharged, but he noted places like Long Island and Westchester County are seeing a spike in hospitalizations as the curve trends out from NYC.

Overall, the number of new people entering hospitals daily has dropped, as has the number of critically ill patients needing ventilators, Cuomo said.

Still, New York City remains the nation's virus epicenter, with 72,181 total cases and at least 2,475 fatalities as of Monday. The five boroughs account for nearly 25 percent of the nation's still-surging death toll.

While there are contingency plans in place should the death rate exceed capacity, like "temporary internment" in city parks, the medical examiner's office says that measure is not currently under consideration. Mayor Bill de Blasio acknowledged the disaster plan scenario when asked about it during his media briefing Monday, but declined to discuss the issue further.

Meanwhile, the city has seen a shift in its case pattern. For the first time Sunday, most of the city's cases were people aged 50 or older (51 percent). The vast majority of fatalities have been people older than 65, though the city added a second child death to its tragic toll over the weekend. The exact age of the child wasn't known, but like the city's first minor to die of COVID-19, and like nearly 99 percent of all its COVID-19 fatalities, the victim had an underlying condition.

The city has seen a higher rolling hospitalization rate (22 percent of all cases to date) than the state (13 percent); half of its hospitalized patients are 75 or older and 9 percent are children.

Cuomo says the goal remains to not lose any lives that could have been saved. To that end, President Trump authorized the USNS Comfort pivoting to taking on COVID-19 patients as the Javits Center field hospital did. Both the Comfort and Javits had been intended to take non-virus patients to offload some of that burden, but as Cuomo has said for days, it's the virus patients, not the others, who have and continue to flood the hospital system. There could be more field hospital locations on the way as well, including at spacious locations such as the Cathedral of St. John the Divine in Morningside Heights, which has volunteered to house patients (likely non-COVID-19 patients) or as space for medical workers.

Providing reinforcements to those battling on the front lines continues to be an urgent need. Answering repeat calls from Cuomo and de Blasio for more federal help, hundreds of army medics arrived in the city over the weekend, as well as much-needed PPE, to help treat patients. The mayor said Monday the city still needs more military personnel and re-upped his calls for a national enlistment program. Tens of thousands of retirees and other professionals have volunteered to help on the front lines. Cuomo signed an executive order over the weekend allowing medical students to start practicing early; some colleges, including NYU and Rutgers, previously said they would graduate ahead of schedule.

We knew this coming week would be our hardest yet.

And we knew saving lives depended on getting more help in time.



We are far from out of the woods but some of that help is starting to come through. — Mayor Bill de Blasio (@NYCMayor) April 5, 2020

Securing enough ventilators has been the single greatest challenge. The machines are often the difference between life and death for critically ill COVID-19 patients, who stay on them for 20 to 30 days, much longer than the typical two-to-three day use for non-COVID-19 patients. Last week, Cuomo ordered the National Guard to take ventilators from institutions that don't need them immediately and redistribute them, on loan, to hospitals that do. De Blasio has authorized the NYPD to assist in those efforts.

One thousand more ventilators landed at JFK Airport from the Chinese government over the weekend, and Cuomo said Oregon sent 140 on loan. California said Monday it was loaning New York another 500.

Governor, words can’t express what this means to New Yorkers right now. We won’t forget this act of solidarity. Thank you. Our fellow Americans can count on New York City to pay it forward the moment we can. https://t.co/cnrUciwwqn — Mayor Bill de Blasio (@NYCMayor) April 6, 2020

De Blasio says the city has enough ventilators to get through the next few days -- about 4,000 NYC patients are on them and another 1,000 could need them by Wednesday, he said. The city has until April 12, he said Sunday, to shore up more medical supplies before it risks another serious, potentially deadly shortage.

Normally 35% of our patients in ICUs are on ventilators. Now it's 100% of patients. DR. STEVE CORWIN, PRESIDENT AND CEO OF NEW YORK-PRESBYTERIAN

Surgical gowns are an increasing area of concern, de Blasio said Monday. Speaking from the Brooklyn Navy Yard, which has turned into a wartime manufacturer of medical supplies, the mayor said the city's public hospitals have enough gowns to get through this week. Nursing homes and private hospitals are running low, he said. Last week, the city used 1.8 million surgical gowns. This week, anticipating a surge in cases, de Blasio said the city will use 2.5 million.

"Anything you can donate to help us continue this fight, we need you," the mayor said Monday. "We have an invisible enemy. We have a ferocious enemy. But this city is fighting back with everything we've got."

Next to New York, no other state in the nation has been as impacted by coronavirus as New Jersey. Gov. Phil Murphy says he thinks the Garden State is about a week behind New York in terms of the apex -- and the IHME model supports that. As of Monday, his state had 41,090 cases and 1,003 deaths.

There is good news: The rate of daily increase is going down in New Jersey as it has in New York, a sign the curve is beginning to flatten. At the end of March, the Garden State was seeing daily case increases of 24 percent, Murphy said. Today, that number stands around 12 percent.

The governor said social distancing is the reason for that. Murphy said a best-case scenario would be for New Jersey to hit its peak April 19 with 86,000 cases. Worst-case scenario? More than half a million cases with a peak in mid-May.

"We didn't pick social distancing because it might be a good idea to try. We picked it based on the facts," Murphy said Monday. "While we are not out of the woods yet, we are clearly on the right path to get there."

If we keep up with our current practices, we can get through the peak with the hospital beds that we’re preparing.



If we relax our social distancing, we will overwhelm the system to the point that ALL of our contingency plans, and then some, will need to go into effect. pic.twitter.com/6wgUrczC1I — Governor Phil Murphy (@GovMurphy) April 6, 2020

The federal government shipped another 500 ventilators to New Jersey over the weekend to help the state manage the wave of critically ill patients flooding its already strapped health care system. The field hospital at the Meadowlands was scheduled to open Monday, and Murphy said one in Edison would be next. He also said President Trump had granted his request to allocate some beds on the USNS Comfort, now docked in New York Harbor, to New Jersey patients.

Connecticut could be one of America's next hotspots, according to Dr. Deborah Birx, the White House Coronavirus Task Force response coordinator. As of Monday, Gov. Ned Lamont had reported 6,906 virus cases there and 206 deaths, including a 7-week-old girl.

Regionally, the three states have a combined 178,685 cases and 5,967 deaths. They represent nearly half of all cases in America, which NBC News estimates have surpassed 3,000, and 55 percent of its deaths, which are nearing 10,00. Nonessential business has been shut down for a month; the economic toll has been dizzying by any measure. Nationwide weekly jobless claims have spiked 10 times their previous record. Tens of millions have been isolated.

The ultimate toll on the American psyche, and its lingering impacts, are incalculable at this point. As Cuomo has said, this crisis will transform a generation -- and shape another.

The White House has projected up to 240,000 U.S. lives could be lost to the pandemic, even with mitigation efforts like social distancing. See how COVID-19 has spread across the country since March 1 using this interactive map.