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BEFORE DAWN every morning, the queue begins to form outside Elmhurst hospital in New York City. It snakes along the pavement as multitudes of people, bundled against the cold and wearing face-masks, wait to be tested for covid-19. Staff are emotional as they walk in for their next shift, reporting shortages of masks, gowns, gloves and, most urgently, ventilators. This public hospital in Queens, one of the city’s outer boroughs, is what President Donald Trump calls the “epicentre of the epicentre” of America’s coronavirus crisis. It is operating at 125% capacity; refrigerated trucks have been brought in to store the bodies. In a single day on March 25th, thirteen people died of covid-19.
The head of the city’s hospital system says that Elmhurst is a harbinger of what is to come elsewhere in America. More than 123,000 cases have been recorded in the country—more than in China, where the epidemic started—and more than 2,100 people have died. Twenty states have at least 1,000 cases each. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, a prominent figure in America’s response to covid-19, warned on March 29th that between 100,000 and 200,000 Americans could die of the disease.
Right now, New York stands apart. The state saw its first case just four weeks ago, and plunged rapidly into crisis. On March 29th New York reported 965 deaths and 59,513 confirmed cases, accounting for more than 40% of America’s cases and 7% of the world’s. The majority of these—678 deaths and 33,768 cases—are in New York City itself. The peak is expected to come by mid-April.
The coming weeks represent the biggest, most urgent test of America’s ability to contain the damage of covid-19. New York’s agony is not only a trial of public-health policy but also of political leadership in the federal, state and city governments. The crisis is being overseen by three New Yorkers—Mr Trump; Andrew Cuomo, New York’s governor; and Bill de Blasio, the city’s mayor—who display varying degrees of competence and little mutual trust.
Mr Trump has been erratic, as ever: first playing down the gravity of the pandemic, then blaming China for it, then musing on and off about placing New York and neighbouring states under quarantine. Mr Cuomo has earned praise for his cogent daily press conferences, delivered in his strong Queens accent. He has clashed with Mr Trump over the need for faster, more forceful assistance from Washington. In local papers and on Twitter, commentators muse that the governor looks strikingly presidential. Mr de Blasio, in contrast, dithered too long in deciding to close schools, Broadway shows, bars and restaurants. Hours after Mr Cuomo announced that all gyms in the state must shut, Mr de Blasio was spotted exercising in one in Brooklyn.
Their most pressing tasks are the same as those facing leaders around the world: limit the transmission of covid-19 and ensure proper treatment for those suffering from the disease. This is proving difficult. Covid-19 spread though America’s biggest, densest metropolis when testing was still sparse. New York, like other American cities, relies on both public and private hospitals, making it trickier at first to mount a consistent and co-ordinated response.
Social-distancing orders now mean the usually bustling city is mostly barren. Non-essential businesses are closed. The 1.1m children in the city’s school system, America’s biggest, are at home. The number of people on New York’s subways is down by 90%. Yellow cabs have all but disappeared from Manhattan’s streets, though some can be seen parked in Queens driveways. In city parks, staff are removing basketball hoop rims to discourage even small gatherings.
Yet covid-19 cases continue to climb. Mr Cuomo says the state needs 30,000 more ventilators, beyond the 10,000 it is in the process of acquiring. Elmhurst, a public hospital, is particularly overwhelmed, but the city’s private institutions are scrambling to treat patients, too. The state has authorised New York Presbyterian Hospital to hook up two people to a single ventilator. Gary Terrinoni, chief executive of Brooklyn Hospital System, an independent hospital, says he has heard of a method whereby nine people could be connected to a ventilator.
Worryingly, essential health and safety workers are falling ill, too. At least one nurse has died. Health staff use social media to beg for proper equipment and protection. A photograph of nurses from Mount Sinai West in Manhattan wearing bin bags as protection gear went viral. More than 500 members of the city’s police department have tested positive, including the deputy commissioner. Three have died, including a detective and a janitor.
Help is on the way. On March 27th Mr Trump signed a $2trn stimulus bill and invoked rarely used powers to compel General Motors, a carmaker, to produce ventilators. The Army Corps of Engineers are creating temporary hospitals, including one at the city’s convention centre. A naval hospital ship is due to dock in New York’s harbour on March 30th. Samaritan’s Purse, a charity that set up a temporary hospital in Italy, is erecting a field hospital in Manhattan’s Central Park.The city and state have asked retired and private health-care workers to help. Some 62,000 have volunteered so far. Mr Cuomo has ordered that public and private hospitals work as a single system, so staff and patients can be transferred as needed. Elmhurst will receive more resources, too. On March 27th Mr de Blasio tweeted that more ventilators and staff are on the way to the beleaguered hospital, which will become a covid-only facility and increase capacity by 50%.
However it is not clear that this is enough. For instance, GM may not produce ventilators immediately. Its factories are not yet designed to make them. On March 29th Mr de Blasio said the city needed several hundred ventilators quickly; he expected a “sharp escalation” in cases and warned that medical supplies would run out in a week. He and Mr Cuomo both object to the scant aid that the stimulus provides to New York. Mr de Blasio calls it “immoral”.
As New York’s cases mount, its residents are finding it harder to leave. On March 28th Mr Trump said that he was considering imposing a quarantine on New York and its neighbouring states, New Jersey and Connecticut—without consulting their respective governors. A few hours later he declared it would not be necessary. Instead, the national Centres for Disease Control and Prevention (CDC) issued a rare travel advisory calling on residents of the three states to “refrain from non-essential domestic travel”. The governor of Rhode Island has already dispatched police and National Guard to stop cars with New York licence plates, and to go door to door to order New Yorkers in their Rhode Island holiday homes to quarantine themselves. Florida is setting up highway checkpoints to screen New Yorkers fleeing the outbreak. Other states may impose similar restrictions, desperate to ensure that New York’s crisis does not become their own.