(CNN) – There were more than 74,000 cases of coronavirus in U.S until Thursday at noon. About half in New York, almost 10 times more than in any other state.
Why has the outbreak affected New York more strongly than in other parts of the country?
Health experts say the answers lie largely in the New York metropolitan area – primarily its density and population – but they are also a warning to other states that they think they can be saved.
New York is the epicenter for now, but the covid-19 will not stop there.
“The notion that everything is written about how it will unfold in the country is dangerous,” said Dr. Kent Sepkowitz, a CNN medical analyst and professor of Medicine and Infectious Diseases at Weill Cornell Medical College in New York City. “We are seeing New Orleans going up now, Detroit. (In) the next few weeks, many cities will have a history similar to New York’s. ”
High density and size
The first and most obvious explanation for the severity of the outbreak in the area is that New York is the largest and most densely populated city in the United States, and the coronavirus tends to spread in dense locations.
“That spatial closeness makes us vulnerable,” New York Governor Andrew Cuomo said Wednesday.
New York City averaged just over 27,000 people per square mile, according to the 2010 Census. That’s more than double the density of Chicago and Philadelphia and more than triple the density of Los Angeles.
At all times of the day, New Yorkers huddle on the subway, bump into each other on the sidewalks, and hit their knees in bars and restaurants, all of which are potentially contagious. They live in crowded apartment buildings, climbing stairs, or in elevators with neighbors. The transit system connects people in all five boroughs, so most do not own cars that could otherwise keep them separate.
“We are used to crowds,” said New York City Mayor Bill de Blasio. “We are used to the ranks. We are used to being together. ”
With more than 8 million people, New York City is also the largest in the country. So the high number of coronavirus cases there is also a reflection of its size. The state will likely lead the country in coronavirus cases even if its infection rate per person is not the highest, Sepkowitz said.
High testing rate
Another reason why New York has so many confirmed cases of coronavirus is because it is looking for them.
The United States has lagged behind other countries in identifying suspected cases, and people across the country have told CNN that they have been unable to get tested.
New York, however, has made a great effort to accelerate testing in hospitals, laboratories, and transit centers specifically established in the densest areas. With FDA approval, New York State authorized 28 public and private laboratories to begin testing for the coronavirus on March 13, being the first state to do so.
Cuomo said more than 100,000 people have been tested for coronavirus in New York. The mayor said Thursday that about 25% of all tests across the country have been conducted by New York State.
“We are looking for positive things,” said Cuomo. “We are looking for positive aspects to be able to isolate them and reduce the spread.”
Widespread testing can make the numbers look bad, of course, but health officials say it’s vital to slow the spread of the virus. The more you test, the more you can isolate people who have the virus and prevent it from spreading.
Still, the tests are only part of the explanation for the grand totals, according to Dr. Arthur Caplan, a CNN medical analyst and chief of the NYU School of Medicine’s Division of Medical Ethics.
“I think it’s true that we have a worse outbreak here just because of admissions to intensive care units as they start to grow. It’s not just about testing, ”he said.
Slow early response
Cuomo has received rave reviews for his daily press conferences during the crisis. But both he and De Blasio were slow to close schools and suspend events and social gatherings in the early days of the outbreak.
“Social distancing is not going to stop transmission, but it slows it down and that makes it easier to treat people,” Caplan explained. “The well-known‘ flattens the curve. ” I think they were too slow. I think the whole country was too slow. “
New York State had its first case of community spread, meaning its origin was unknown, on March 2 in New Rochelle, a suburb of New York City. As of March 11, there were 216 confirmed cases in the state, and that number increased to 613 by March 14.
Cuomo and de Blasio limited the gatherings of more than 500 people on March 12, but resisted interrupting life excessively.
“We are going to quickly present a guide on the need to reduce crowds and the public while still having a certain amount of activity,” de Blasio said at the time.
As coronavirus cases continued to increase exponentially, that activity no longer became sustainable. New York ordered the closure of all schools before March 18, when it already had 2,300 cases. Cuomo ordered non-essential workers to stay home from March 22, when there were more than 15,000 cases.
In contrast, California also had an early outbreak but took more aggressive measures to limit social life. On March 16, San Francisco Bay area leaders instituted a home shelter order for people to stay home when there were 500 cases across the state. Governor Gavin Newsom issued a state order to stay home on March 19, when the state had 900 positive cases.
Because the virus spreads exponentially, a delay of even a few days can lead to huge differences.
“It is important to isolate and exercise an early distance because that makes it difficult for the virus to jump from person to person quickly,” Caplan said. “When it spreads more slowly, then there are enough hospital beds, intensive care units and ventilators to care for the sick.”
Main tourist destination
The big Apple! The city that never sleeps! Concrete jungle where dreams come true!
New York City is a world-renowned tourist site and the most visited destination in the United States. As such, Cuomo said that people infected with countries that had coronavirus outbreaks earlier traveled to the city and spread the virus.
“We have international travelers who were in China and Italy and Korea and who came here,” Cuomo said Wednesday. “And I have no doubt that the virus was here much earlier than we know. And I have no doubt that the virus was here much earlier than in any other state. Because those people come here first. “
President Donald Trump implemented a series of travel restrictions to try to stop that spread. On February 2, the United States implemented strict travel restrictions for those who had recently been to China. And on March 11, Trump said he was suspending travel to two dozen European countries, including Italy.
Still, those measures came too late to prevent the virus from reaching New York due to its heavy tourism, Caplan said.
The large number of trips to New York “made the virus come earlier,” he said. “It started here faster.”
The first but not the last
For all those reasons, New York City has always been destined to be a rapidly spreading case center. But it is far from being the last.
“We arrived early. We will see waves elsewhere, ”said Caplan.
“It is like a rock thrown into a pond and generating waves,” he added. “It goes to cities, then to suburbs, then to rural areas because of population density.”
Cuomo has warned that New York is the “canary in the coal mine” for the country.
“It’s higher in New York because it started here first, because we have global travelers who come here first, because we are denser than most places, but they will see it in cities across the country. And they will see it in suburbs and counties across the country, ”he said. “We are just a test case.”
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