New York’s scramble to brace for peak crisis is warning for rest of U.S.

NEW YORK - The Empire State Building blinked red this week as New York became ground zero in the international battle against the coronavirus - a siren not just for battered Manhattan but for state and local authorities across the country racing to avoid a similar fate.

New cases this week drove the state's total above 75,000, surpassing China's Hubei province, where the virus emerged in December. The grim milestone was recorded as Gov. Andrew Cuomo, a Democrat, acknowledged having underestimated how overwhelming the situation would become. "It's more dangerous than we expected," he said.

That miscalculation, made especially stark by the rapid rate of infection in densely populated New York City, has forced the state to transform itself. Officials have sought to outpace a mounting death toll by pooling resources, erecting field hospitals, coaxing health-care workers out of retirement, pleading for reinforcements and desperately angling to outbid other states for lifesaving breathing devices and other equipment.

But New York is running out of time, quickly approaching an expected apex of cases. Exactly when that peak will arrive is the "$64,000 question," Cuomo told reporters this week, saying the range of available models suggested that the state had seven to 21 days to prepare for the worst.

The tight window will be a critical test of how quickly the state can relieve its overwhelmed hospitals, which have already been directed to increase their capacity by 50% while being enlisted in an ambitious burden-sharing plan spanning the state's public and private systems. The small window will also accelerate efforts to screen volunteers to maximize health-care staffs; 78,000 in-state medical workers came forward to help.

"I am really nervous about possibly being called to work, actually, as I do have three kids at home, and my parents also live with me, and they are both in their 70s, but it feels like my duty as a nurse to be there in an emergency," Melissa Ferrara, a nurse practitioner from White Plains, New York, said, explaining why she offered her assistance.

The critical period will also test the supply chain for coveted medical equipments Cuomo said he was looking as far away as China to locate new ventilators, including 17,000 from the original epicenter of the virus.

The test, however, is not New York's alone. The travails are being closely watched across the country, as the escalating emergency in New York adds fuel to preparations in many states as well as scores of cities, especially those already buffeted by severe outbreaks.

In California, more than 25,000 health-care workers signed up in 24 hours to supplement hospital staffs, Gov. Gavin Newsom, a Democrat, said Tuesday. Maryanne Bombaugh, president of the Massachusetts Medical Society, said 24,000 volunteers had stepped up since the weekend.

The effort to certify their credentials illustrated how the pandemic was requiring improvisation on a massive scale.

Forty-two states have waived licensure requirements for physicians to practice across state lines. In New York, about 175 people were involved in running background checks and sorting volunteers by region and specialty, according to Jim Malatras, president of Empire State College and a member of the governor's coronavirus task force. He said in-state volunteers would be assigned to hospitals by Thursday.

"In normal life it can take months," Bombaugh said. "Hopefully it will be expedited to be much quicker than that. How fast? I don't know."

Nationally, there were additional hurdles, including to the construction of pop-up medical facilities. The owner of the shuttered Hahnemann Hospital in Philadelphia asked the city to pay market value for use of the location, said the city's managing director, Brian Abernathy. Instead, the city sought quarantine space at a Holiday Inn Express, and was in talks with five other hotels. It was also beginning to build a field hospital at Temple University's basketball arena.

"We're watching New York City's hospitals become overwhelmed by the number of cases that they're seeing, and they're standing up resources in the midst of a surge," Abernathy said. "Our hope is that those resources are stood up before a surge actually happens."

President Donald Trump on Tuesday praised Samaritan's Purse, an evangelical disaster-aid organization that erected tents for a 68-bed hospital in a meadow in Manhattan's Central Park. "They did it so fast," he remarked.

The site had eight ventilators and was staffed by more than 70 clinicians. These "Christian doctors and nurses" from across the country will administer intensive care for patients with respiratory problems and will also "pray for each patient," said Franklin Graham, the group's president and son of the influential minister Billy Graham. Samaritan's Purse workers must agree with a statement of faith that, among other things, disavows same-sex marriage.

Non-coronavirus patients will be cared for at the 1,000-bed USNS Comfort, which docked in New York this week, as well as the 2,500-bed site built at Manhattan's Javits Center convention hall. Construction of similar but smaller facilities is underway elsewhere throughout the metropolitan area, including a makeshift 350-bed facility at Billie Jean King National Tennis Center - home to the U.S. Open - that will receive patients from Queens's Elmhurst Hospital. Workers there were overwhelmed by coronavirus patients in late March.

Cuomo, in outlining the public-private hospital plan, said the objective is to distribute burdens over the state's web of medical systems.

When one of New York City's 11 public hospitals becomes "overrun," he said, patients will be transferred to another public hospital "immediately . . . on a daily basis." Hospitals that exceed a "load threshold" are eligible to transfer patients to hospitals with vacant beds, he said.

Private medical centers in New York will do the same, including the transfer of patients into hospitals owned by their competitors, easing people through a health-care system that the governor described as "Balkanized."

Coronavirus patients already have been moved upstate from New York City to Albany Medical Center, Cuomo said Wednesday.

"The distinction of private-public, that has to go out the window," Cuomo has said. "We are one health-care system." It is unclear whether other states may follow this radical model.

In addition to transferring patients to areas with vacant beds, officials said, the network will pool equipment and staff where needed across the state. The state has asked upstate New York facilities for volunteers to work in the coronavirus epicenter in the south. A main priority, officials said, is assisting Elmhurst Hospital and other hard-hit medical centers.

A "command center" overseen by the state's health department began operations Tuesday and will make the potentially life-or-death decisions about the transfer of supplies, ventilators and patients. Its duties will include setting patient thresholds, monitoring supplies and acting as a central purchaser.

Throughout the country, officials said they were aiming to move just as quickly as their counterparts in New York.

San Francisco, which has held off a rapid surge of cases, opened its emergency operations center on Jan. 24, according to Mary Ellen Carroll, executive director of the Department of Emergency Management. "What New York tells us to do is keep moving forward and be as prepared as we possibly can," she said.

The lesson was similar in Detroit, which recorded nearly two dozen additional deaths between Monday and Tuesday.

"We're anticipating similar demands here," said Charlene Babcock, an emergency physician who traveled to Washington last week to demonstrate to members of government how to split a ventilator among multiple patients, which recently became necessary in New York as resources grew thin.

Babcock predicted that Michigan, which had reported 9,334 cases as of Wednesday, was one to two weeks behind New York in the severity of the outbreak. The state's Democratic governor, Gretchen Whitmer, had already moved to relax scope-of-practice rules and accepted a recommendation from the U.S. Army Corps of Engineers to repurpose the TCF Center, home of Detroit's North American International Auto Show, as a field hospital.

Nationally, however, only seven alternative sites had been fully approved and contracted as of Tuesday, according to an Army Corps of Engineers planning document obtained by The Washington Post. They included four in New York and three in Illinois. Four would be equipped to treat patients sickened with covid-19, the disease caused by the novel coronavirus, while the remaining three would absorb patients with other illnesses to relieve traditional hospitals.

By Tuesday, more than 500 assessments had been requested across the country, and 421 of them had already been completed, according to the document. Eight sites were pending a contract.