The rolling apex

Amid efforts to expand New York City’s hospital capacity before a peak in coronavirus cases is reached, other parts of the state have to prepare themselves to do the same as a “rolling apex” continues across the state, Gov. Andrew Cuomo told reporters at the state Capitol on Sunday.

“If you are not in a highly-affected health area now. that does not mean you won’t have a real situation to deal with,” he said. “High tide comes first in New York City and then the tide is on the way down and then it is high tide in upstate New York.”

Much of the governor’s Sunday press conference highlighted the state’s ongoing strategy for coordinating the disparate parts of the health care system. Upstate hospitals have to get ready to absorb some patients from downstate (who the governor has previously said would not be coronavirus patients). The governor said that he will speak tomorrow with private hospitals to urge them to better coordinate with their public counterparts. “No hospital is an island,” Cuomo asserted.

This idea of a “rolling apex” is one key reason why there was such a backlash Saturday to a suggestion by President Donald Trump (which he walked back last night) that he would impose a quarantine of New York, New Jersey and parts of Connecticut. The opportunity for confining the virus inside a few hot spots across the country has likely come and gone. 

Other states might want to keep in mind how their treatment of New York can provoke a reciprocal response, Cuomo said. “I could set up my borders and say I'm not letting anyone in until they take a test to see whether or not they have the virus,” Cuomo said on CNN last night of a now-rescinded policy in Rhode Island to set up checkpoints on its state border to identify any New Yorkers.

Thousands of deaths are expected in the coming weeks, according to New York State Department of Health Commissioner Howard Zucker, and projections suggest that the pandemic will reach its peak in the state around mid-April. Most of these cases will be in New York City, but other regions of the state, including populated areas like Long Island, Buffalo and Rochester, could reach their peaks later on. 

Once the apex is reached in a certain area, Cuomo said there is a possibility that some people could be allowed to work again outside the home if a cheap and easily-manufactured test can be developed for the virus. A new nasal diagnostic test could begin to be used “as soon as next week,” according to the governor. However, Cuomo emphasized that large gatherings will remain a source of concern and that state policies will not change for upcoming religious holidays like Passover and Easter. “Density is the enemy here,” Cuomo said.