Is NYC destined to become the next Milan?

Like Milan before it, New York City’s number of coronavirus cases is skyrocketing. Just 17 days ago, New York City confirmed its first case of coronavirus. Now, New York state has at least 1,374 cases, with the vast majority of those in New York City and its surrounding suburbs. Italy detected its first coronavirus case on Jan. 29. Within 20 days, the country had more than 12,000 confirmed cases and now has more than 31,000. Since the progression of the coronavirus in Italy is about 10 days ahead of where it is in the U.S., it is possible to analyze how the country’s hardest hit region, Lombardy, and its capital, Milan, have been impacted by the virus and what could happen in the weeks ahead in New York.

Much like Milan and the rest of the Lombardy region, New York City has implemented increasingly stricter restrictions to curtail the spread of COVID-19, which is highly contagious and easily spread. If the city moves quickly enough and seriously enforces social distancing, restrictions that limit contact between people, there’s a chance it could avoid some of the same mistakes Milan (and Italy as a whole) have made during this global crisis.

After Italy’s first detected COVID-19 cases on Jan. 29, it wasn’t until Feb. 21 that additional cases of coronavirus were detected in the Lombardy region that surrounds Milan. And on Feb. 23, two cases were detected in Milan. This led the Italian government to close all schools and universities, museums, libraries and theaters in Lombardy.

But the governor of Lombardy referred to the virus as “just a little more than normal flu” on Feb. 25, and the next day relaxed restrictions on bars and restaurants. Some felt that the region was overreacting to the outbreak initially and making things out to be far worse than they appeared by enacting these strict measures. Many Milanese continued to go about their lives as usual, despite the closures. And on March 5, museums reopened in Milan – as they are one of the city’s major attractions – with the guidance that all museum-goers stand at least one meter apart.

On March 7, the Italian government shut down the entire Lombardy region, restricting its residents’ ability to travel and encouraging people to self-isolate as much as possible. On March 9, the entire country went into lockdown in an effort to combat the spread of the virus.

While the Lombardy region did respond to the outbreak quickly, it did not begin implementing strict social distancing rules until about three weeks after its first coronavirus patient was confirmed. Although medical experts had no idea how contagious COVID-19 was when Italy’s first cases were discovered. “The only thing we could have done is introducing the current lockdown on Jan. 30, a decision that was impossible and unthinkable at the time,” Stefano Rusconi, an associate professor of infectious diseases at the University of Milan, told Wired.

However, some cities located within the Lombardy region, such as Lodi and Bergamo, implemented social distancing before other cities, which resulted in far fewer positive COVID-19 cases.

Lodi began enforcing social distancing rules on Feb. 23, while Bergamo began enforcing them on March 8, and Lodi’s number of positive cases were far lower than Bergamo’s.

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Lodi adopted strict social distancing on Feb. 23. Bergamo waited until Mar. 8.

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On March 1, New York City confirmed its first coronavirus patient. After the news broke, the city encouraged its residents to stay home if they felt sick, wash their hands more vigorously and to cover their mouths when they coughed or sneezed.

“We want New Yorkers to go about their daily lives, ride the subway, take the bus, go see your neighbors,” New York City Health Commissioner Oxiris Barbot said at a press conference the next day. “The important thing, as both the mayor and the governor have said, we want New Yorkers to lean even more into frequent hand-washing and covering their mouths and their noses.”

The city and state’s initial reaction to the emergence of positive COVID-19 cases were similar to the mayor of Milan. But things shifted considerably once a cluster of cases were detected in New Rochelle, a Westchester County suburb, soon after. Most private universities in the city, as well as SUNY and CUNY schools, began moving their classes online. And on March 12, Gov. Andrew Cuomo instituted a rule across the state on prohibiting gatherings of over 500 people, causing the city’s biggest cultural attractions to shutter.

On Sunday, New York City Mayor Bill de Blasio announced that all city public schools will be closed until April 20. The mayor also signed an executive order on Monday limiting restaurants, bars and cafes to take-out and delivery only, and nightclubs, theaters, gyms and concert venues will also be forced to close. Gatherings of more than 50 people were also banned on Monday in New York, New Jersey and Connecticut.

While strict measures are now in place to encourage social distancing throughout New York City, not everyone is convinced that the mayor moved swiftly enough. De Blasio also came under fire on Monday after he spent the morning at his gym in Brooklyn, hours before his new executive order was to go into effect. “He has been slow to act, not realizing the seriousness of the situation,” a former de Blasio staffer told City & State.

The next front against the coronavirus in New York City is ensuring that area hospitals don’t become overwhelmed. In northern Italy, more than 80% of the region’s 1,123 acute-care beds are dedicated to coronavirus patients, according to Bloomberg. Doctors there have also had to manage a shortage of ventilators, which are critical for the roughly 10% of coronavirus patients who may need help breathing to stay alive.

On Monday, Cuomo issued an executive order allowing hospitals to increase their capacity. He also announced that the National Guard, building unions and private developers would work with the state to “find existing facilities – such as dormitories and former nursing homes – that can most easily be converted to medical facilities.” The goal: creating 9,000 more hospital beds across the state.

The city is similarly scrambling to add more hospital beds and hopes to have an additional 1,200 within the next two weeks, after a nursing home and hospital are converted to facilitate coronavirus patients. Public and private hospitals are also hoping to add 7,000 new beds by pitching tents in parking lots and converting cafeterias into wards. The city has also rented 250 hotel rooms to house people who need to be quarantined.

“We’re going to need massive medical capacity on a scale we have never seen in the history of New York City,” de Blasio said at a press conference on Monday. “This will be a race against time.”

However, in an op-ed for The New York Times, Cuomo explained that only the U.S. military has the ability to significantly ramp up the state’s hospital capacity, and without their assistance, things could quickly get worse.

As of Tuesday, Cuomo expects the virus will peak in about 45 days, threatening to overwhelm the state’s public health care centers. According to Cuomo, the state would need 55,000-110,000 hospital beds and 18,600-37,000 intensive care beds, if that were to happen. But the state only has about 53,000 hospital beds and 3,000 intensive care beds, of which 80% are already occupied, according to Cuomo. The state may also need as many as 18,600 ventilators, according to a 2015 state task force study, but it only has a little over 2,000 ventilators available, not counting the ones already in use.

In Italy, the widespread outbreak of COVID-19 is endangering the country’s health care system. “The numbers have continued to grow. We’re close to the moment where we will have no more intensive care beds,” Lombardy governor Attilio Fontana told SkyTG24 television.

It is a bleak projection of what New York City and state might face in the weeks ahead.