American Crisis

by Andrew Cuomo

  MARCH 21 | 3,254 NEW CASES | 1,406 HOSPITALIZED | 12 DEATHS

  “I don’t believe this is going to be a matter of weeks. How long and how well it takes to get through this is up to us.”

  THERE WERE NO DAYS OF the week—one day just blending into the next. One crisis blending into the next. But these days were also so extraordinary on so many levels. They really pushed people to the brink and gave them a glimpse of their souls. It’s relatively easy for people to be nice and functional when things are going well. But when the pressure is on, you really get to see what people are made of. It’s like a piece of marble that has a fine crack in it. It’s almost invisible and blends into the pattern. But when that marble is under pressure, that crack can explode.

  I was operating on multiple tracks. One, communicating with the public to keep them informed and calm. Two, revamping the government to functionally perform the incredible tasks of building hospitals, creating testing capacity, and finding medical staff, ventilators, and PPE. Three, dealing with the federal government—not an easy task. And four, personally confronting the stress, pain, and death all around me.

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  FOR THE FIRST TIME in a long time, all three of my daughters were in Albany with me. Michaela would finish her classes online and, like so many other seniors, miss out on graduation festivities. My daughters are young, tech savvy, and cool and often tease me about being out of date. They would tell me, Dad, this tweet could be better, or give me advice about how to communicate with people their age. They would say, “This picture would be a great ‘latergram.’ ” I still do not know what that means. So I asked Mimi Reisner, my social media and messaging guru, to make them part of the social media effort, helping to communicate the information and connect with people who don’t normally engage with government. Having them around grounded me and gave me comfort, reminding me what’s important in life and how meaningless so many things become when faced with grave danger. At dinner each night, I’d ask them what they did that day, but what I meant was, what did they think of the day’s briefing?

  As anyone watching the briefings knew, Mariah wouldn’t come to Albany without him: the Boyfriend. I begrudgingly agreed that the Boyfriend could come. The Executive Mansion has twelve bedrooms, and he got the one on the top floor with the twin bed everyone says is haunted. I assure you, that was a coincidence. The Boyfriend, who shall remain nameless unless and until the relationship proceeds to an impending formal status, is a genuinely nice and talented fellow. He is a gentleman, which I cannot say for all boyfriends. Luckily, my daughters have an overprotective dad. They don’t always believe that it is lucky for them. But sometimes dads just know best.

  Cara worked on finding PPE to purchase for the state, calling all over the world. Michaela worked on organizing mental health providers and setting up a hotline that provided mental health counseling and support services. Mariah worked on social media and video advertising to encourage wearing masks and social distancing.

  In the normal course of life, my girls would never have spent weeks with their old man in Albany. After this crisis I am sure they never will again. They are birds who have flown from the nest with much to do. I see myself in them all the time. It seems life repeats itself.

  What I wouldn’t give to be able to sit at home with my old man for just one more day. To have him back, hear his voice, touch his face, and hold his hand. We lost him six years ago. He was ill and debilitated, and his quality of life had degenerated. In many ways he just didn’t want to go on. I told him how important it was for him to stay alive and how much we all needed him, and he scoffed at my argument. So I resorted to making it personal. I told him I was several weeks away from Inauguration Day for my second term and I needed him to help me work on the speech. But he was too smart for me, and he rejected that, saying that he would be there for his son, to hear my inauguration speech. I looked at him and I said, do you promise? He looked at me and he said he promised. My father never broke a promise to me, nor I to him. January 1 was the day of my inauguration. I gave the speech, and he heard it over the telephone. One hour after the speech he passed away. True to his promise, always.

  Since he died, when I have a special or difficult day, I wear my father’s shoes: literally! It sounds ridiculous I know. My father wasn’t a material person and we didn’t have many objects to remember him by after his death, but he loved shoes and I wear the same size as he did. My mother gave me my pick. My father’s love of his shoes stemmed from his growing up during the Great Depression era, when shoes were precious, so he bought quality shoes and took excellent care of them. I once heard my father talking to Harry Belafonte about how they shined their shoes, and the method was so intricate that it sounded absurd. My father shined his own shoes on a weekly basis. As a kid, I would help him. He would explain the process to me: saddle soap first, then mink oil, then regular polish, and then neutral polish; brushed and buffed and only cedar shoe trees, of course. Plastic shoe forms were for amateurs. My daughters were particularly fascinated with the “filling your father’s shoes” psychological angle, but I wanted them to know how important he was to me and how much comfort I still take in feeling that he is with me. I only hope that my daughters can get that sense of comfort from me when I’m gone. It’s said that “the spirit” lives. I believe it does. I am not sure my father would support everything I do in his shoes, but he would appreciate what they mean to me, and he would love that I still shine them the same way he taught me. Brushed and buffed and cedar shoe trees, of course.

  MARCH 22 | 4,812 NEW CASES | 2,043 HOSPITALIZED | 38 DEATHS

  “We will overcome this and America will be greater for it, and my hope is that New York is going to lead the way forward—and together, we will.”

  NOTHING WAS EASY, AND THERE wasn’t a moment to breathe. Even if we had some good news to share in the briefing in the morning—where I had found some sliver of light in the grim statistics to share—as soon as I got back to the operational table, the ugly reality of our situation would slap me in the face once again. To avoid the tidal wave crashing on our hospital system in a few weeks, we had to get the viral transmission rate down, but none of the experts thought we’d be able to get it to a manageable level. We had to double—if not triple—testing capacity to have any shot at controlling the virus and quickly create tens of thousands of new hospital beds. All of which would be a feat to rival Jesus’s loaves and fishes.

  And then there was the issue of ventilators. I had never heard so much about ventilators and never wish to again. They are complicated pieces of technology and cost about $15,000 each, pre-COVID. Every hospital had some, but no hospital had many. In the normal course of business, they are not used that often. In total, statewide we normally have approximately four thousand ventilators, and by this point in the crisis, due to our purchasing efforts, we had between five thousand and six thousand.

  It didn’t take long for me to figure out that this was not just a New York problem. Every state in the country needed ventilators, but New York needed them the most urgently. The American companies that made ventilators were overwhelmed and could not increase supply quickly enough to come close to meeting the demand.

  The main manufacturer of ventilators is China, but obviously China also had a tremendous need for ventilators. Besides that, every country and every state was trying to buy ventilators from China. The cost for a ventilator ran as high as $50,000. Competing states were bidding against one another to acquire the scarce resources. I had conversations with other governors about the situation, which we all agreed was ridiculous, but we had no choice.

  Experts estimated that we would need at least an additional thirty thousand for the ICU beds. The federal government theoretically had an emergency stockpile of medical supplies including ventilators, and so the states, especially those with the worst caseloads, deluged the federal government with requests for ventilators. But, as we soo
n figured out, the federal stockpile had only about ten thousand ventilators—for the entire nation.

  On this point, President Trump got very defensive once again. He took the request for ventilators as a personal attack. In this hyper-partisan environment, the blame game was in full swing. In reality no one was to blame for not having an ample supply of ventilators. No one could have predicted this virus and its particular effect on the respiratory system that would require the specific type of equipment.

  Trump mocked my request for thirty thousand ventilators during a phone interview with Sean Hannity. Never mind that we were both using the same projection models and therefore had the same numbers. I could sense the president’s position was hardening. He saw this as a no-win situation and more and more took to denying the problem. COVID was “just like the flu.” COVID would “magically disappear.” The “warm weather will kill the virus.” The president responded as if these requests for ventilators, hospital beds, and testing were all political attacks.

  When the NBC White House correspondent Peter Alexander asked him what he would say to Americans who were scared, he shot back, “I say that you’re a terrible reporter…I think that’s a very nasty question.”

  For me the situation was simple. Either we could provide hospital beds with ventilators, or more people would die. Either we could persuade people to stay home and reduce the viral transmission rate, or more people would die.

  I called everyone I knew with contacts in China to help us buy more ventilators. At the same time, I asked engineers and medical technology experts to figure out other options. Northwell Health designed a conversion of BiPAP machines, which are normally attached to a mask that goes over the face to provide oxygen, so that they could be used as ventilators. This would increase our capacity by about six thousand.

  One design firm created modifications so that one ventilator could serve two patients. An emergency physician in Detroit named Dr. Charlene Babcock had posted a video on YouTube that showed how to split ventilators so that they could serve four patients instead of just one, so my team tracked her down at the hospital where she worked, and I called her. We were getting messages from people saying, “I’ve got a guy who has a guy who has ventilators.” We chased down every lead and dealt with anyone who would talk to us, including the Chinese and Qatari governments.

  In the worst-case scenario we would have to use manually operated rubber bags. This is what you would see in the old movies: patients in beds with plastic covering over their noses and mouths attached to rubber bags being squeezed by people sitting next to the beds to assist inhalation and exhalation. We purchased six thousand of the bags, and we explored training members of the National Guard to manually operate them, which is harder to do than you might think. We tested it and it was too difficult for one person to squeeze for more than an hour, so next we talked to people about making machines that could squeeze them automatically. I tried to squeeze the bag for a period of time and thought, this is never going to work. We were desperate. I was desperate. Here we were in the greatest country in the world talking about squeezing rubber bags to keep people alive.

  Another complication was that hospitals across the state would need to share excess ventilators on an as-needed basis. Most of the hospitals in the state agreed. One hospital system in western New York refused, saying they might need them. It was an unkind gesture and threatened the spirit of cooperation. Some upstate politicians were also quick to seize the moment as an opportunity to divide New Yorker’s upstate from downstate. Several upstate politicians started a campaign saying, “Upstate lives matter.” It was totally contrary to the sense of sharing and community we’d been trying to build from the beginning; it was straight out of the Trump playbook.

  But the positive reactions in people overwhelmed the negative. When the news of the perceived “selfishness” was publicized, I received a call from a nursing home in the upstate town of Niskayuna outside Albany offering thirty-five ventilators to help. How great! A nursing home, one of the most vulnerable places, made a gesture to say, “I hear your negativity, and I respond with love.” I returned the ventilators myself to the nursing home on Easter to say thank you, and the staff and patients all came to the windows. The episode was a little litmus test of what would win, the devil or the angel. You have the devil on your shoulder, you have an angel on the other shoulder, and the devil is generally easier to motivate. I had been trying to talk to the angels, and the angels were winning; then some politicians saw an opportunity to get the devil all fired up. The devil lost at the end of the day.

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  MORE THAN EVER, I was getting the growing sense of being on our own in New York. Trump never pretended to be a leader who could bring the country together in a moment of national crisis. In fact, I believe he relished his role as “divider in chief.” It fit his personality. He was angry and resentful, and he communicated it. Nor did Trump ever suggest he believed in government capacity or that he himself could provide government stewardship. In many ways his response to COVID was predictable. At the same time, we still needed federal help whether he liked it or not.

  With Trump, it’s always about his ego. When one accepts that is when one knows how to deal with him. While he has no patience for the operations of government, he does like the bright lights and big stage and enjoys the optics of associating himself with the military.

  I had met with the Army Corps of Engineers in Albany on the eighteenth, and we sketched out a simple plan. The state would identify sites and coordinate with existing health-care facilities to provide staff, and the Army Corps of Engineers would manage construction of temporary field hospitals. We took an aerial tour identifying large sites near existing hospitals. We identified four locations where the Army Corps of Engineers could construct thousands of temporary beds: SUNY Stony Brook in Suffolk County, SUNY Old Westbury in Nassau County, and the Westchester County Center—a regional balance that together with the Jacob K. Javits Convention Center in Manhattan would cover the entire downstate area, with each facility being able to treat at least a thousand patients. In the end, the military also agreed to provide a thousand medical personnel to help staff the Javits Center, which would be the largest facility.

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  NEXT I SPOKE to the Federal Emergency Management Agency (FEMA) administrator, Peter Gaynor. I had worked with FEMA extensively when I was in the federal government in the 1990s. When FEMA is well operated, it is a beautiful thing, but when FEMA fails, it is a catastrophe. They show up either immediately before or immediately after a disaster. They have to be prepared for the unexpected, and they have to be able to deal with whatever peculiar circumstances develop.

  In many ways FEMA is the antidote to a dangerously slow federal bureaucracy. They can mobilize quickly, command other agencies, be the central point of contact for local governments, and expedite procurement mechanisms. FEMA and the Army Corps of Engineers are the one-two punch for the federal government in an emergency.

  The COVID crisis exposed the good, the bad, and the ugly in so many ways. Pressure tends to do that. And when the pressure was on during COVID, FEMA crumbled. The ventilator issue was a pure procurement and supply chain issue. It was a unique and unexpected challenge, but in an emergency you must expect the unexpected. FEMA was dreadful. Not only that, but on PPE procurement, personnel deployment, and ground transportation FEMA was incompetent.

  As for the White House, the most productive person I could find there was Jared Kushner. He had a difficult time with the press. As the president’s son-in-law, he was a natural target; the arrangement was peculiar and open to criticism of nepotism. In his position, he inherited all of the president’s enemies, and the media had reported that he was resented by many of the president’s staff.

  Jared was from the private sector, so his natural orientation was the “end justifies the means.” He was focuse
d on production, and by definition he would run afoul of the bureaucracy. When I went to work for my father as special assistant during his first year as governor, I faced many of the same dynamics. Jared needed to get things done in the federal bureaucracy, but he didn’t know how. He knew if they failed to produce, it would be blamed on the president. On the other hand, if he bumped heads with the bureaucracy to accelerate production, the bureaucracy would bite back. It was a no-win situation for him and he knew it, but he pushed anyway.

  I saw him as the key to New York getting anything from the federal government, because we weren’t getting anything from FEMA or HHS, the agencies that should have been helping. What’s right is right. He was attentive and he delivered. Jared was the person who eventually produced the PPE, ventilators, and military personnel for New Yorkers, and I am grateful on their behalf.

  MARCH 25 | 5,145 NEW CASES | 4,079 HOSPITALIZED | 75 DEATHS

  “It is that closeness, that concept of family, of community. That’s what makes New York ‘New York.’ And that’s what makes us vulnerable here.”

  THE PRESIDENT SEEMED TO BE even more firmly planted in denial. His problem was obvious: The number of cases kept rising, as well as the number of deaths. I believe he didn’t know what to do, but he really didn’t want to do anything anyway.

  His credibility was also falling at a faster and faster rate. On March 24, the president had proclaimed that he wanted to have the country opened up and the economy “raring to go by Easter,” which was less than three weeks away. He also said, “We are beginning to see the light at the end of the tunnel.” I was still amazed at his disconnection. How could he say these things, and how could his staff let him say them? I was watching the numbers and knew the facts better than anyone and was stunned by his statements. I asked myself, “Does he know something that I don’t know? Does he have inside scientific knowledge? Or can he really be that dangerous?” As time went on it became clear that indeed he did not know anything that I didn’t know.