TOPLINE
New York’s most recent coronavirus patients are mainly people who were staying at home, according to a new survey Gov. Andrew Cuomo revealed last week, a finding that he called “shocking”—and that sparked questions and fear about how that could be possible; public health experts have a few theories as to how the virus may still be transmitted even as people stay home:
New York has the country’s biggest COVID-19 outbreak, with over 355,000 cases and 28,000 deaths.
Photo by Roy Rochlin/Getty Images
KEY FACTS
Cuomo said about 1,200 patients were surveyed across 113 state hospitals, with results showing 66% of patients were at home before being admitted and more likely to be over 51 years old, Hispanic, or African American; about 96% of patients surveyed had comorbidities (which means they had a pre-existing medical condition prior to being infected with COVID-19).
Two public health experts told Forbes that the data, though seemingly surprising, could have a few explanations that would help it make sense, including the fact that patients may live with others who are traveling outside the home or are essential workers, and that living in crowded apartment buildings could increase exposure.
Dr. Ashish Jha, Director of Harvard Global Health Institute, was first surprised by the survey’s results, but realized that “older and sicker people are less likely to go out and travel, and much more likely to get infected and to need hospital care.”
Dr. Ashwin Vasan, Columbia University Medical Center professor and CEO of nonprofit Fountain House, wanted to know more about the patients: “Even though these people are older, do they live with essential workers? Did they live in multi-generational households?”
According to Vasan, who also once served as an executive director for the NYC Department of Health, older people either living with essential workers or in multi-generational households are more common in low income and African American communities.
What New York did not account for, Vasan said, was transmission inside apartment buildings—”particularly in densely-populated communities, which seems to track with the [survey’s] results.”
Ideally, both doctors said, people who develop coronavirus symptoms at home should have the opportunity to isolate themselves in a separate facility, in order to prevent further transmission to family or community members.
Crucial quote
Jha called for Cuomo to release the full survey results: “Without having a full splay of the data, it’s very hard to know what this analysis tells you.” Cuomo’s office did not respond to multiple requests for comment by Forbes.
Chief critics
Social media users questioned the survey’s results, saying that because patients were coming from their homes, it meant that stay-at-home orders were flawed or an outright failure. Jha disagreed, saying other studies have shown that reducing people’s mobility flattens the curve, and that’s what has taken place in New York’s outbreak. “I don’t have a question in my mind whether ‘stay at home’ worked,” Jha said.
What we don’t know
How long it could take to break what Vasan called “transmission chains,” a term that refers to the spread of disease among people. Both Vasan and Jha said the type of lockdown seen in Wuhan, where COVID-19 was first detected, was much more stringent than what New York and other U.S. states have been under—meaning the virus could be transmitting more easily here. “It’s hard to know whether people are asymptomatic, and the virus transmits so easily,” Vasan said. “It’s hard to say whether [healthcare and essential workers] who are exposing themselves are the main chain of transmission.”
Big number
New York has the country’s biggest COVID-19 outbreak, with over 355,000 cases and 28,000 deaths, according to data from the New York Times. Statewide stay-at-home orders began to be lifted Saturday, as five New York regions met strict criteria set by Cuomo. Regions will be reopening in four phases, and the infection rate will be monitored closely. Officials can slow or pause reopening phases if the number of cases passes a certain threshold.
Key background
New York conducted the patient survey to learn where individuals were coming from prior to being hospitalized for coronavirus, and because the rate at which they were hospitalized was not declining quickly enough, according to Cuomo. A Centers for Disease Control and Prevention study of hospitalized coronavirus patients released April 8 showed that older people and African Americans were more likely to have the virus—findings that seem to match parts of the New York survey.
Further reading
Majority Of New Coronavirus Cases In New York Are From People Staying At Home—Not Traveling Or Working (Forbes)
Social distancing works. The earlier the better, California and Washington data show. (Washington Post)
You Can Help Break the Chain of Transmission (New York Times)
Cuomo: Five New York Regions To Begin Reopening Today (Forbes)
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