American Crisis

by Andrew Cuomo

  It appeared at the time that young people were relatively unaffected. But I knew too well that we didn’t really have all the facts and the conventional wisdom was false comfort because it was constantly evolving. This was an emotional experience that we were all going to go through. There is comfort in knowing you are not alone in your emotions. You can validate emotions without validating the fear. Easier said than done, but that’s where I needed to bring myself to be able to help other people get through this.

  Luckily, the situation with Cara turned out fine. After several days of anxiety and fifty-seven telephone conversations, everyone was negative. Michaela had to call back her five friends, who then had to call back the dozens of people they contacted. The experience graphically illustrated for me how difficult this was going to be: the personal anxiety, the explosive expansion, the rush on testing, contact tracing, the anxiety of the unknown, the parental panic. For me, the lasting feeling was fear.

  MARCH 14 | 164 NEW CASES | 117 HOSPITALIZED | 2 DEATHS

  “Nobody believes there are only five hundred cases of coronavirus in New York today. We believe there are thousands of people who have coronavirus, maybe tens of thousands.”

  EXACTLY TWO WEEKS AFTER OUR first case, we reported our first death from COVID-19—an eighty-two-year-old woman in Brooklyn with emphysema. The situation felt urgent in a whole new way, especially because it came right on the heels of the scare with my family. This was also the same day we closed the state capitol, because members of the assembly tested positive, and that sent shock waves through the whole government.

  People around me were getting tested, and we were socially distanced from one another during meetings and in the Red Room. We changed the staffing around the governor’s suite. But the fear was everywhere. When someone handed me a document, I wondered, can I get COVID from paper?

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  MY FATHER ONCE said to me that it’s hard to find a person who can come up with new good ideas, and it’s also hard to find a person who can implement good ideas. But it’s impossible to find a person who can do both. After all those sad conversations on the couch with him recounting our failures, I knew the right formula, impossible or not. It was doing both: doing the briefings in the morning and management efficiency in the afternoon.

  Every day was developing the same rhythm, alternating between two main functions: communications and operations. Communications was preparing for the briefing, doing the presentation, answering the press questions. I had a great team, but not being able to gather all of the relevant people in a room and hold a proper face-to-face meeting was a real obstacle.

  The operational issues were also hampered by the fact that the line where state responsibility ended and federal responsibility began was very unclear. And the federal government was not saying. Later, I realized they just didn’t know.

  We were attempting to outline the entire system that would need to be in place to deal with the virus itself. Of course, there were secondary consequences driven by the economic fallout and social issues, but the first priority was to handle the pandemic. The medical response would start with intake facilities, testing facilities, quarantine facilities, hospital capacity, hospital equipment, and medical staff. Every element of the system posed a problem. Either the scale was nowhere near adequate, or it didn’t exist at all.

  There were so many questions: How large would the universe of infected people be? How many people could be infected, and how many people would we need to treat? The challenge was driven by quantity, and we needed a number.

  Several firms were doing projection models of the rate of infection. Models provided specific ranges and dates for the spread, the rate of transmission, the number of hospital beds needed, and the number of deaths anticipated. There were so many projections that we had hired the consulting firm McKinsey to review all the models and give us a workable range.

  Modeling the spread of the virus is a little less precise than modeling weather patterns; at least forecasters can point out the number of variables. In the coronavirus projections, the variable was human behavior. There is more data available on wind patterns than on possible human responses.

  The U.S. models had the advantage of being able to study the spread in the countries that went before us, like China, South Korea, Italy, and others in Europe, to get a sense of what was going to happen in the United States, and New York in particular. All the models were extrapolating out from the current viral transmission rate, and the main variable was how successful the closedown and social distancing policies would be. No one really knew, including me.

  Every society is different, and our success was wholly dependent on what people themselves, rather than governments, chose to do. If people took the threat seriously, it would be one situation. If people were dismissive, there would be an entirely different outcome. In many ways the operational needs would be linked to my success in communication, because the more people were persuaded to follow our policy prescriptions, the lower the infection rate and the smaller the scale of our operations.

  The White House Coronavirus Task Force had made a truly startling projection at the beginning of March, when the CDC suggested a minimum of 2.4 million Americans would be hospitalized and a maximum of 21 million. The tenfold range did not build confidence in the model, but even the minimum projection suggested catastrophe. Two million Americans hospitalized is staggering when you consider there were only 925,000 staffed hospital beds in the nation, and most of those beds were already used on a daily basis.

  Again, in retrospect it is easy to see how dysfunctional the federal situation was. Their own projections of potential hospitalizations would have panicked any rational federal official. The president was in denial about his own experts’ projections. On March 6, he said, “It’ll go away,” and later, after Dr. Fauci testified to Congress that the country was “failing” when it came to testing, Trump said of the virus, “We stopped it.”

  We needed to know the realistic range for New York so I could understand what we were really dealing with. The best estimates suggested that the state would need 110,000 to 140,000 total hospital beds in a day at the apex. I was shocked, because in total New York State has only 53,000 hospital beds and 3,000 ICU beds. The nightmare scenario was overwhelming the hospital system, and that’s what we were watching on the nightly news in Italy, where people were dying in the street unable to access medical care, morgues were overwhelmed, and coffins were stacked in churches awaiting lonely burials after funerals were declared illegal. I knew that once the hospital systems became overwhelmed, lives that could have been saved would be lost. Compounding this was the concern that if the hospital system was overwhelmed, people suffering normal health emergencies, such as heart attacks and strokes, could not be treated.

  There was no way that we could dramatically increase the number of hospital beds, although we were trying. I posed another option to the experts: What if we were more effective in changing human behavior? Could we reduce the number of those being hospitalized? But the experts did not believe it was possible to change social behavior quickly enough to make a real difference in the numbers. The news was so bad that it was almost inconceivable. I was stunned.

  I called the president and explained the scenario. He was pleasant enough, but he just didn’t want to hear it.

  The truth is, I didn’t want to hear it either, but I did. I met with my team every afternoon as soon as the briefings were over, and we went over dozens of what-if scenarios. It was clear we had to try to reduce the transmission rate, and at the same time we had to figure out a way to build hospitals in three weeks.

  I was beginning to understand that this conversation with the people of my state was different from any conversation had in generations. This was not about normal government issues of budgets, taxes, roads, and bridges. This was about life and death. This was as real as it gets. No one knew
the future, and no one knew how many would die.

  I had an interesting conversation with a woman who had been watching the briefings. She said she was taken with the fact that I was “unflappable.” “Unflappable” is a word that can mean totally different things to different people, so I asked what she meant. She said that I didn’t seem “scared” about COVID.

  “I don’t mean to disappoint you,” I said, “but you couldn’t be more wrong.”

  She was surprised.

  “I am more frightened about COVID than almost anything in my life,” I said. I once had a serious health scare with Mariah when she was severely burned as a toddler, but second to that I have never been more frightened.

  I had already been thinking about what dimension of the COVID crisis frightened me most. I think it was the “fear of the unknown known,” as the expression goes. There were existing facts about this virus that we just didn’t know yet, but I was sure that we would know in the future. Then, with the advantage of hindsight, we will say we should have made different decisions, such as asking people to wear masks sooner. A factor driving the fear for me was that the “facts” were already changing. The worst was the reversal on the belief that asymptomatic people couldn’t spread the virus. We would have operated much differently if we had known that earlier. What else will we find out six months down the road?

  The former defense secretary Robert McNamara talked about the “fog of war” in explaining his actions during Vietnam. What would the “fog of COVID” turn out to be? Will the antibodies have a secondary effect on people who were infected? Was there a drug that could have helped? Will the virus mutate and come back like the 1918 flu pandemic? Will a second wave be even worse?

  I had this conversation with my daughters one evening while sitting around the dinner table. They asked me how I seemed so calm at the briefings when they knew how anxious I was. I said to them, you can feel fear, but acting on fear is different. Even being governed by the fear is different. I think it is disingenuous when people say they weren’t afraid in a situation that would normally trigger fear. Fear is a normal and healthy response to the appropriate stimulus. If you don’t feel fear, you don’t appreciate the consequences of the circumstance. I told them to confront the worst-case scenario and make peace with it. Resolve the anxiety. I understood the projection models. I knew how bad it could be. The questions are what do you do with the fear and would you succumb to it. I also told my daughters that there are little things you can do to help with the fear when you are speaking in public. Control your breathing by taking long deep breaths. Fill your stomach when you inhale. Don’t drink coffee. I would not allow the fear to control me. The fear kept my adrenaline high and that was a positive. But I would not let the fear be a negative, and I would not spread it. Fear is a virus also.

  I think people are often stronger and more capable than they realize. Insecurity causes them to underestimate themselves and is self-limiting. It also prevents them from pushing hard enough to reach their full potential. Many people are more powerful than they are in their day-to-day lives. If you never push yourself to your limit, you don’t have to acknowledge your limit—that’s the good news. The bad news is that you don’t realize your full potential. For most people, this is a choice we make subconsciously.

  Sometimes life brings you to a point where you either give up or push harder and dig deeper to find an unrecognized strength in your character. My divorce, political loss, and public humiliation did that to me. It was terrible, and it all happened at once. My life was upended: no home, no job, no prospects, my reputation trashed, my family embarrassed. It felt at the time as if things couldn’t be any worse. It wasn’t just my perception; objectively, it was a very bad time for me. I knew I had a choice: I could either give up, or I could look inside and work through how to change.

  When I was starting to get stronger, after my darkest days, my father said to me, “What you went through was really brutal, and I told your mother I wouldn’t blame him”—me—“if he spent the rest of his life on a barstool.” He didn’t mean it literally, but was just communicating that he felt my pain and respected my resilience. He was not the most emotionally fluent man, but I heard him and I appreciated his sentiment.

  The adage “That which doesn’t kill you makes you stronger” is true, and many people are stronger than they know. They just need the reason to reach their true limits. I also believe we are better, kinder, and more loving than we realize. Showing love makes us vulnerable, and we don’t want to be vulnerable. We are also socialized to think showing love is showing weakness—especially men. I have gotten past that. I am an emotional person and I show it very openly in my personal life.

  After what I went through, I became much more emotionally expressive. I wanted to fully communicate how I felt and understand the feelings of others. I try to ask questions to understand what makes other people tick. But in politics, I have remained what I would call emotionally reserved. Politics can be nasty. Opponents seize on any weakness. The press is always looking for any controversial statement or action to exploit. They said Vice President Al Gore had no sense of humor. They were wrong. I know him and he is as smart as people think he is and as honorable, but he is also witty and funny. He is a respectable pool player, too, and I have lost money to him. So why doesn’t he show that side of himself in public? Because it is perilous. Emotion in politics is a risky proposition. It can always be misconstrued, and there are many forces looking to do just that.

  This crisis, and the briefings, communicated my genuine self publicly. The trauma we were dealing with was emotional. It was driven by fear, anxiety, loneliness, and doubt. Quarantine specifics and testing protocols were not the only major issues to be processed. People were on emotional overload. How do you help others deal with the sense of fear and vulnerability? Show your own vulnerability first. Discuss your emotions and fears. And that’s what I did in the briefings. It was authentic and real. I felt the same emotions so many people were feeling, and I would acknowledge them and show them. It was risky to do this, but I didn’t really have a choice. First, I am emotional, and the situation did not allow me control or reservation. Also, I needed to connect with people where they were. I had to go to them—they would not come to me. If I was going to succeed, I would have to try. If it didn’t work or backfired, I would fail. But if I didn’t try, I would fail anyway. It was an easy choice.

  That’s where I was. If I expressed vulnerability and emotion and got criticized or mocked, I could handle it. I had been mocked before and survived. My kids would still love me. But if I didn’t connect emotionally with the people, they would never have the trust and confidence in me to follow my proposals. To believe in me, they had to know me as a person and not as a government official. In the briefings I spoke the way I would speak to a close friend or to my daughters. I said the same words that I said to my mother and brother. Everything I communicated was true, unrehearsed, unscripted, and spontaneous. If people rejected me, so be it. That’s the only way I could do it. I gave my heart in the briefings and people gave me theirs. The letters, emails, smiles, and thumbs-up on the streets were them showing their love because I showed my love. And there is nothing better. I learned that even in the public arena vulnerability is always worth the risk, because without it there’s nothing. I learned that in the right circumstances people can reach a higher level of trust and goodness. Sometimes it just takes the other person to go first. So I’ll go.

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  GOOD QUARTERBACKS IN football can throw the ball brilliantly but can also take off and run the ball. I had always striven to be a “complete” government official. I worked to connect with people, motivate people, and drive a dialogue. But I also wanted to be a great executive with a government of extraordinary performance.

  It quickly became clear that the claim that we had fifty-three thousand hospital beds in the state was misleading.
The “state” had only a couple of thousand beds in public hospitals. The vast majority of beds in the state are owned and controlled by private hospitals, and each one is its own corporation with a board of directors or trustees, its own clientele. They had never been “controlled” by the state. The state government is their regulator, meaning the Department of Health promulgates regulations about safe operating conditions and also regulates certain financial aspects, but they are private entities in competition with one another.

  There was the additional complication that most of our cases were in downstate New York, and many of the hospital beds were in the suburbs and upstate. Planning for an available capacity of fifty-three thousand hospital beds assumed you would be controlling all the beds statewide and that a patient from any area of the state could be placed in an available bed anywhere in the state. That is not how the system worked. Patients picked their hospital. There had rarely been a situation where an individual showed up at one hospital and was sent to a hospital in another region of the state. But we had no choice. I couldn’t just sit there and pray, nor could I continue to ask the federal government for help that I couldn’t count on coming.

  I began calling the leaders of the major hospitals. Some of them had been with me during the first virus briefing on March 2. I have known many of the hospital administrators for years; once again, personal relationships are always most important. I explained the situation and the options. I wanted them to understand how dire the potential consequences were. For them to accept state control of the private health-care system would be a major hurdle. When they heard the numbers from the projection models, they understood why we needed to take such dramatic action. They didn’t like it at all, but they couldn’t deny the reality. We were all watching the collapse in Italy and the crushing impact on its health-care professionals. They did not want to be part of an international story of the failure of one of the greatest hospital systems in the world. Their bread and butter was people coming from all over the planet for treatment in their facilities. There were also significant financial concerns. I told them that we would need to agree to work together and get through the crisis and then they needed to trust me that we would work out the finances.