March 2, 2020
Mayor Bill de Blasio: Thank you, everyone, for being here. We just finished an exercise with our emergency response teams. Heads of all major city agencies were here to run through scenarios related to the coronavirus. This is a process that we undertake on a regular basis on a variety of different fronts. We do a counter-terrorism tabletop exercises, we do a tabletop exercises around major weather events. This is something the City does on a regular basis led by our colleagues here at Emergency Management. Today, we ran a scenario involving a quickly escalating a coronavirus spread and all agencies participated in determining their actions to address the situation. We are going to continue to do a number of these exercises of greater and greater levels of difficulty and challenge in the coming days to prepare. I want to remind everyone, a number of you were here back on January 24th, and now it's March already.
So, on January 24th was the first time that I said on behalf of the City of New York that it was not a question of if, but when we would have a coronavirus case test positive here in New York City. So, in that is the good news that the City of New York now for almost seven weeks has been in a state of high readiness and preparation. The confirmed case we received last night since we anticipated it is something that was handled properly, as you heard this morning. And I want to certainly commend the health care worker who is the individual with the disease for having done everything right in that situation.
I want to thank all of the members of my administration who are here, all their agencies that are working hard to address this issue and get ahead of it to inform the public, to inform their employees of all the things we have to do. And also want to thank the many, many elected officials and community leaders, community organizations that we have been working with constantly. And I want to say again, New Yorkers are really doing the right thing here and all of the organizations and leaders are doing the right thing. There's not been a single moment of denial over these last six or seven weeks. Everyone is taking it seriously. Everyone has spread the word of what people need to do. New Yorkers are clearly responding when they have symptoms, they’re are acting on it, which is exactly what we want. We want people getting to health care. When in doubt, get to health care, go to your individual doctor, go to a community clinic, go to Urgent Care, go to whatever you can, but get to health care. And again, anyone who is unclear about where to turn or how to get to the health care they need can 3-1-1.
We do know, because our Department of Health has been down this road many times, has the ability to track the exact interactions that anyone has had with who contracts the disease. We do know from the disease detectives at the Department of Health that the individual in question had very, very limited contact with others, only serious contact with her husband who we are waiting the test results on, and handled her visits to the hospital exactly right with the prior notice and all things were handled properly there. We also have now, today – literally, today, for the first time an advantage we have not had over the last six or seven weeks, which is the ability to test here in New York City. Literally this morning, based on the information we had at the beginning of the day, we thought it would take until Friday and we wanted to be cautious in guaranteeing when testing would begin here in New York City. I'm pleased to tell you now, it will begin later on today. So, we will be up and running with testing through our Health Department later on today. That testing will take a matter of hours for each individual case. So, we're basically saying on any given day, we'll know the same day whether someone tests positive or not.
Right now, we have two outstanding cases we're awaiting –
Mayor: One – I'm sorry, one outstanding case we're waiting results on. I mentioned earlier, I want to reiterate that we're launching this week an early detection system. This is a structure through the Department of Health, working with hospital systems to constantly glean information from patient visits. So, we're talking about thousands of health care professionals encountering thousands and thousands of patients each week. We'll be getting a constant flow of information from that system, indicating if there's any trend lines that need to be addressed. And obviously, if any individual is found through that process, who needs coronavirus testing, they will get it.
The bottom line, as always, is we will remain in a state of high vigilance. We don't have a timeline for this crisis. I think people should assume it will be with us for months and we're going to be in a high state of readiness as long as it is here. But what we do know for sure is that those basic precautions really, really matter. It's stunning that we have a global health care crisis and the best way to address it individually is to wash your hands, to use hand sanitizer, to cover your mouth when you cough and sneeze – those basics really, really matter here – and to be quick to come forward if you have symptoms. And look, right now, that means particularly if you have a nexus to travel to the countries have been most affected, whether that means you, yourself or someone you've been in close contact with has been in one of those countries recently. But we know community spread is likely, so even if you don't have that nexus, but you have the symptoms, it's important to get to health care right away. We'd rather have many people quickly find out they do not have coronavirus than people holding back who might have it and not getting the health care they need and maximizing the chance of a dangerous spread.
Again, any questions whatsoever – please, everyone in the media spread this news – if people have questions that call 3-1-1. There's no one out there – if they can't reach their own health care provider, they don't have one, there's no one who should suffer in silence. Any questions, any concerns, call 3-1-1.
With that, let me just say a few words in Spanish before turning to my colleagues.
[Mayor de Blasio speaks in Spanish]
With that, thank you again to all my colleagues and all the agencies, all their personnel for all they're doing. And I want you now to hear from our Health Commissioner, Dr. Oxiris Barbot.
Commissioner Oxiris Barbot, Department of Health and Mental Hygiene: Good afternoon. As the Mayor has said, we have our first individual that has been confirmed to have the coronavirus. This is has been anticipated because we know that viruses don't respect borders. And the patient is doing well clinically and has received the proper isolation protocol in their home. We will be continuing to monitor the individual for the next 14 days on a daily basis. And we have, through our disease detectives, done all of the necessary tracing of potential contacts that the individual may have come in contact with and we're pleased to report that there is only one additional individual who was a contact with prolonged exposure. And so, those individuals are currently, as I mentioned, under the proper level of isolation.
The other thing I want to just note is that with the ability to do on-site testing here in the city, we will be obviously increasing the capacity of our testing. But before I get to that, I want to just sort of remind New Yorkers that hearing this news of our first case, even though it was anticipated could create a bit of anxiety for folks. And I want to just remind individuals that we are encouraging New Yorkers to go about their every-day lives and to practice the precautions that the Mayor said with regards to hand-washing to regards to covering your nose and mouth when you sneeze or cough, and that if you are feeling ill and you have traveled to one of the countries that are now hotspots, if you will, across the globe, to call your doctor as quickly as possible – don't delay. And, at the end of the day, our risk remains low and our preparedness remains high. And in terms of the height of our preparedness with having city capacity to do our own lab testing, we are now going to be increasing the number of tests that we do. And one of the things that we will be kicking off today is in collaboration with three health systems – H + H, New York Presbyterian and NYU – we will be starting what we're calling an early detection system for individuals who could potentially have a coronavirus, because the idea is, as the Mayor have has already said before, we don't want people to go undetected. And this is an opportunity for us to take a deeper dive, leave no stone unturned in terms of identifying individuals who may have coronavirus. So, again, it's an opportunity for us to leave no stone unturned.
The other thing I want to remind New Yorkers is, we're in the middle of a very rough flu season. I don't want New Yorkers to be in a situation where they may develop flu-like symptoms and they go through the anxiety of wondering, do I have the flu or could I possibly have coronavirus? This is a reminder, it's not too late to get your flu vaccine. We've been looking at data across the city and I'm seeing roughly a 5 percent increase over last year in terms of the number of children that have received the flu vaccine, and that's good, but we can do better. And with regards to adults on an average annual basis, less than half of New Yorkers get immunized against the flu. This is a time where you don't want to be caught in a situation, again, thinking, do I have the flu or could I possibly have coronavirus? The other thing I want to remind New Yorkers, and, again, we are in a scenario where the risk to New Yorkers remains low. Our preparedness is high. We want New Yorkers to be prepared. So, you know, this is not the time to sort of delay on filling your prescriptions. We want to make sure that if you've got a prescription that needs to be refilled, you do it sooner rather than later.
And then lastly, I want to also sort of draw special attention to the fact that what we have learned from the experience we're seeing across the globe is that 80 percent of the individuals who do develop coronavirus, COVID-19 have very mild symptoms. And that those who tend to have severe symptoms are the elderly and those with chronic underlying diseases. And so, this is an opportunity for us to remind the seniors that we have in our lives that if they are feeling symptomatic, and, by all means, if they've had a connection to travel, they should reach out to their doctors. But even without that connection to travel, we want to make sure that all of these routes are open and that there is no delay in care for them. And then lastly to remind individuals in terms of having a chronic underlying illness. These can include asthma, diabetes, heart disease, but it also incorporates those individuals who may be smokers. So we want the folks who fall into these categories to pay special attention. And again, if you've got meds that need to be refilled, this is the time to do it.
I guess the last thing that I will say is that the messages that we've been giving in terms of hand-washing continue to apply. You know, this might be an opportunity to make alcohol-based hand sanitizer your new best friend if you don't have easy ongoing access to a water supply. And it may also be an opportunity to start practicing fist bumps, handshakes or elbow handshakes.
So, thank you very much. We can model that.
Mayor: There you go. All right.
We modeled good behavior. Thank you, doctor. Our Emergency Management Commissioner, Deanne Criswell.
Commissioner Deanne Criswell, Office of Emergency Management: All right, thank you Mr. Mayor. You know, as you've heard today, we do have this first case of coronavirus, but this is something that we have prepared for and the city is ready to tackle this virus head on. New York City Emergency Management, along with the Department of Health has been working very closely since this first hit the scene in early January and we're working with our State and federal partners in all of our preparedness efforts as well as in response to this first confirmed case. Today's tabletop exercise really brought together all of our leading experts across the city as well as the officials from a dozen City agencies and our partners such as MTA and the Port Authority to continue our planning – planning that has been ongoing long before this even arrived – and continue our response to prevent the spread of this virus. As the Mayor stated, these efforts are going to continue and we will be having escalating exercises that increasing complexity as the weeks go on.
Building off the work that has been ongoing for some time now we also will be working to improve and expand on our long history of pandemic planning that New York City has already done. We have established several inter-agency crisis planning working groups. They started meeting yesterday – or, last week and they will be focusing on containing the spread of the virus in the future. Plans are also in place for City agencies to maintain essential services, continuity of operations. What do we need to do to make sure our workforce can come to work and what do we do if they can't? Emergency Management and the Health Department have also conducted multiple calls with our private sector partners to address any concerns about the potential impacts of this virus. Additionally, we have engaged close to 800 organizations that are the City's partners in preparedness that focus on supporting organizations in preparing their employees, services, and facilities for emergencies.
One of the big questions that we've had continually through this as our impacts to the supply chain, and so we have also been closely monitoring those impacts across the city. Right now, we've been tracking any resource concerns from City agencies, and, as of right now we have not received any concerns about current disruptions to the supply chain, but we are monitoring this very closely. Because we do have concerns over this, New York City Emergency Management is working very closely with the Department of Health, as well as our State and federal officials to prioritize and coordinate the distribution of those high priority commodities, such as N95 masks that we've heard so much about an additional personal protective equipment. We also have a direct line of communication with our state and federal partners, so as we find that we may be reaching critical levels of our resources we can reach out to them to make sure New York City has what it needs. People should also go about – and as you've heard – in closing here, people should go about their daily lives, remembering that the precautions that you would take during cold and flu season are the precautions that we would expect you to take today. As we continue to work through this first case and potentially future cases, the City is going to continue to work together to enhance our existing plans to make sure we're monitoring our stockpile and making sure that New Yorkers have what they need in order to respond to this.
Mayor: Thank you, Commissioner. Finally, want us to hear from the Speaker of City Council. I want to thank Speaker Johnson and the whole City Council for partnership during this crisis. Also, a reminder, he used to be Chair of the Health Committee, so this is something he knows about and cares about a lot, how we all have to work together to address a situation like this. Speaker Cory Johnson –
Mayor: Thank you very much, Speaker. And amplifying that point, discrimination is illegal in New York City. So, people who practice discrimination – there's a number of potential sanctions and consequences. And I want to really emphasize that we mean business. I'm very disturbed, as the Speaker is, with some of the specific discrimination that's been directed towards the Chinese community. It's unacceptable and we will use every tool we have to stop it.
With that, I want to take questions on this topic. Yes?
Question: The Health Commissioner [inaudible] why do you believe that? And a second question is the low infection rate a function of low testing rates? With more testing, do you expect there to be an increase in the number of diagnosis [inaudible]?
Commissioner Barbot: So, there's a lot in there. Let me just unpack that. The risk to New Yorkers remains low because we only have one case and there is no indication that casual contact was a driver of ongoing person-to-person transmission. The other thing is that we have been focused on ensuring that we are in close communication with all of our health care providers so that when they see individuals who have traveled to any of the affected countries, they're incorporating a travel history into that history and physical. And then lastly, you know, we've been fighting long and hard, led by the Mayor's advocacy, to make sure that we have the testing capacity here in the city. So, even though we hadn't had the capacity here in the city, you know, it didn't delay diagnosing folks. But now, with the increase in person-to-person transmission that we're seeing in Washington State, California, Oregon – I think, you know, it's to be expected that we will have person-to-person transmission here. And so, all of our efforts are directed at cutting that off as quickly as possible.
Did I get all your questions?
Question: The second question is, is the low infection rate of function of low testing and since you’re going to be testing more [inaudible]?
Commissioner Barbot: I think that the low numbers are a result of a number of different things that include the travel restrictions that took place, that include all of the protective measures that we have put in place. I wouldn't ascribe it to low testing.
Mayor: I want to thank also Council Members Steve Levin and Ydanis Rodriguez for joining us. Thank you very much. Go ahead.
Question: Your administration has been working to connect immigrants, particularly undocumented immigrants to care. How does that kind of play into this when we're looking at public charge? We’re looking at ICE coming to hospitals. How are you addressing immigrants who might be too afraid to be able [inaudible] facility?
Mayor: First of all, thank you – excellent and very important question. Please, everyone, report the truth – we do not ask documentation status in our public hospitals and clinics. We never have. We never will. Folks who need health care should be absolutely comfortable coming to get it. In fact, we are trying to ensure that they have ongoing health care – any undocumented New Yorker has ongoing health care through our guaranteed health care plan through NYC Care. And I think, you know, without getting into the bigger issues of the day, this is an object lesson. As a nation, as a city, would we be more comfortable with folks who happen to be undocumented having regular health care and having their needs addressed quickly and well – isn't that better for all of us, for our families too, and our neighborhoods too? Or, do we think it's somehow better, more moral, more practical to have hundreds of thousands of people with nowhere to turn for health care? That's what it comes down to. So, for anyone who contests why we provide health care to undocumented people, it's not only the morally right thing to do, it is absolutely the practical right thing to do because exactly in cases like this it maximizes the chance that people will get care when they need it and we can deal with a crisis before it gets out of control.
Question: [Inaudible] specifically, like any sort of like specific actions?
Mayor: Sure, a huge amount of outreach. My conscience is here, come over here Bitta. A huge amount of outreach is being done right now through community organizations, community based health care providers, etcetera, with a constant message to people that if you have symptoms get to health care and that it will be available to you regardless of your status, regardless of your availability – ability to pay, I should say. And that's why, again, the central message, whoever you are, call 3-1-1 if you're not sure what to do. Our Immigrant Affairs Commissioner, Bitta Mostofi –
Commissioner Bitta Mostofi, Office of Immigrant Affairs: Thank you. And, of course, I underscore everything that the Mayor said and would just add, in terms of what we've been doing to respond to public charge and to this particular crisis. We have a large network of community providers that we work with. We partner with community-based organizations to do specific engagement around NYC Care in communities and ensuring that people are connected to that service and know what's available. We've also trained our legal services providers on connection to NYC Care and, of course, have had a wide – city-wide systematic response to public charge with that same messaging. We don't care about your immigration status, we don't care about what language you speak, we want to make sure you get the care that you need and that you're informed to do so. We're taking additional steps with the particularly impacted communities that we work with who may have some of the travel history as well.
Mayor: Gloria – hold on, Gloria?
Question: I think the last time we were here we talked about how – the difficulty of testing for the virus. What has changed since and can you walk us through what this testing looks like that will become available [inaudible] –
Mayor: Can I just make sure we're all speaking the same language? When we were first here, we didn't have the ability to test ourselves. So, that's what you get into, right?
Mayor: Right. Okay, go ahead. And obviously, Deputy Mayor, join in whenever.
Commissioner Barbot: So, the easy answer is, the CDC shipped us the reagents that they needed to and we're doing the same test that they were doing, but just doing it here.
Question: What does the test look like? If someone's showing symptoms and they want to come in and be tested, what should they expect?
Commissioner Barbot: So, the procedure is when you go to your doctor, you present symptoms. They'll do a nasal swab, they'll test for the 26 most common viruses that may be accounting for your symptoms, because, remember, the likelihood of you having the flu is way higher than the likelihood of you having coronavirus. And so, we want to rule that out first. Then, we would take a similar sample – that swab – and send it to the public health lab for it to be run. So, there's no blood work that needs to be done, nothing separate to what is currently done with regards to nasal swabs.
Question: This is a two-part question. There's a private school here in the city that has – is asking students who traveled to some of the affected countries over the February break to self-quarantine for 14 days. [Inaudible] would the Department of Education consider that for students who may travel during February break, or then even in the future, the upcoming spring break? And then the second part I guess is the admissions and that if it becomes an issue when you consider, especially for specialized schools, would you consider not using the attendance just to encourage people to actually stay home?
Mayor: Fair questions. I think we're going to do this, as with everything in life, in stages. We – the exact reason we have this exercise today is to start running different scenarios, and, again, there'll be higher and higher levels of difficulty in the coming days. Right now, how we would address school attendance issues and admissions and all, that's over the horizon and we're not there yet. We’re obviously going to take into account aberrant realities if we get there. The question of whether the kids who had traveled overseas should be handled differently. I think it's a fair question. That's an assessment we'll make in the next day or two. We have obviously not done that yet, but I think it is a fair question and we'll come back to you on that.
Question: Can you talk about what is being done specifically at the city school? I know that they - you talked about at this point about your safe – cleaning protocols [inaudible].
Mayor: Look, I'll start and if the Chancellor wants to jump in, feel free. I want to emphasize that, again every time I attempt as a non-doctor to talk about coronavirus, I'll acknowledge not only am I a non-doctor, even the doctors don't fully understand coronavirus. It is a new thing in the human experience. We do see so far noticeable dynamic that does not seem to affect children in a meaningful way. So that's a very good sign. But you know, we will not make an assumption, we have to see more play out, but so far so good on that front. The guidance to the schools has been to intensify cleaning efforts. The guidance to all school personnel is to look out for children with symptoms and advise their families to get care, but obviously for our personnel as well, if they have symptoms to make sure they get care.
But what you're going to see on all these fronts is we're going to keep amplifying those messages and keep ensuring that there's follow through because the real difference here, I think there's a common sense point that it bears saying publicly that the difference between finding someone the first day that it might be clear they have coronavirus and testing them and getting them the help they need and isolating them versus, you know, the third day, the fifth day. Obviously the more someone's out there, the more they could be in a position to expose others. Again, from what we know right now, it takes prolonged contact to transmit the disease, but the perfect world is find everyone the first available day and isolate them. So we want all of our city employees to be a part of that, that if they themselves or anyone they come across might need that testing, that we're getting that done at the first available moment. Chancellor do you want to add anything?
Chancellor Carranza: So I want to emphasize what the Mayor has said is absolutely true. What we've been focusing on is working very closely with the Department of Health. In fact, we've backpacked home already a letter by Dr. Barbot that gives very specific guidance to parents. Since January we have issued guidance to all of our facilities crews in terms of cleaning protocols, we've also sent guidance with principals on what protocols they should be aware of. We've also communicated directly with parents through backpack letters – electronic communication. And we've also worked with our nurses, our school nurses, following protocols at Department of Health has developed. So we want to over communicate and again, we want to emphasize if a child is sick, do not worry about admissions and all of those things. If the child is sick, stay home and get some attention. If our employees are sick, we want them to stay home, get some medical attention as well. And we will continue to work very, very closely with the Department of Health.
Question: You mentioned - actually the city's official Twitter account mentioned cleaning protocols for public transportation. What would that look like for subways or buses? What does mean in actuality?
Mayor: Again, I think everyone's familiar with the fact that the subways and buses are run by the State of New York, but the fact is that the basics here apply and other experts can speak to it more eloquently than me, but it means thorough, consistent cleaning. It’s the, you know, I'm going to make it really simple to the point that Dr. Barbot has said about alcohol based hand sanitizer for people. It's using, as the Governor said earlier, using cleaning agents, using bleach, etcetera on public facilities. So, that's just going to be done very systematically. I want to defer to the MTA about how they're doing it in their case. But that's the basic concept.
Question: Yes, I was wondering when the Chancellor if schools are requiring the parents to advise schools if they travel abroad at anytime [inaudible] having a family member visiting one of the affected countries [inaudible]?
Chancellor Carranza: [Chancellor Carranza speaks in Spanish].
I just want to reemphasize that we're working very closely with the Department of Health under the leadership of Dr. Barbot. We do not have that specific guidance in place yet. I want to reemphasize there is one case so far but our guidance is all focused around having a heightened sense of alert, having a heightened sense of being – monitoring what's happening with our students and as time goes and circumstances change, we're constantly revisiting what that looks like.
Question: Right, you said earlier that New Yorkers are doing the right thing here, that there hasn’t been a single moment of denial and then New Yorkers are responding, I guess my question is how do we know that and which are the communities that are at risk for failing to respond or distrusting you and how do you reach those people? And is there a -
Mayor: Okay, wait, wait, dude, this is becoming a 12 part question. Henry, Henry, respectfully, Henry, Henry, Henry, please. When I'm asking you guys – when I'm saying you're asking so many things, I can't follow it and answer it. It would really be dignified and decent and human, if you'd recognize - I'm speaking to you as a human being who's trying to communicate. If I can't follow your question, I can't answer your question. When I ask you to separate your questions and I loyally come back to you for the rest of your question, it is to get you a good answer. Please work with me.
Question: You said that New Yorkers are responding and that there is no denial.
Question: How do we know this?
Mayor: Facts. Outcomes. Product. That's how I'm judging. We've gone this whole way with consistent reporting of people going and getting health care, coming in with their symptoms, not holding back. The folks who came in for testing previously, those folks came forward. So now our grand total since day one of people under investigation is –
Commissioner Barbot: 11.
Mayor: 11. Those 11 folks didn't hold back. They came forward. We have seen extraordinary outreach efforts. I've seen with my own eyes in communities. I particularly commend all of our colleagues in community organizations, in Asian communities who have done a great job getting the word out, demystifying, telling people where they can get care. The proof is simply in the pudding here, Henry. We have seen a tremendous amount of information flowing. We have seen people responding to the information doing what we have asked them to do. I'm not saying it's perfect by any stretch of the imagination. What I'm saying is when there's public messaging and then you see follow through on the public messaging, that's very, very affirming that New Yorkers are taking it seriously and further that when we specifically offer guidance you see it being spread intensely by lots and lots of other sources. So I'm very satisfied by what I see. Go ahead.
Question: Which are the communities that would be at risk for resisting this mess?
Mayor: I don’t see resistance. That's my point. I literally do this for a living. I pay attention to communities and what they're going through and I've been doing it my entire life. I talked to community leaders, I talked to elected officials. I'm listening for denial. I'm listening for resistance. I'm listening for disconnect. I'm not seeing any. I'm sure there's some somewhere, but if we thought there was a systematic problem, we would want to be all over it. So in other words, your question's a great question, if we saw it, we would be doubling down, but we're not seeing it. We're not seeing a place where there's some pushback or minimization or resistance.
Unknown: Last two.
Mayor: No we'll do a few more.
Question: Commissioner Barbot mentioned an early detection system. Can she elaborate a little more about what that means and how it works?
Commissioner Barbot: So the early detections system builds on our existing flu monitoring systems so that when a patient goes to a doctor and they have symptoms consistent with flu and the provider does a flu test, then those samples will also be tested for coronavirus.
Question: Can you, I’m sorry, can [inaudible] can you talk about whether that system will have [inaudible] places that [inaudible] talk about, including hospitals to make sure you separate people from the rest of the population of the hospitals. If you could talk about it in Spanish too about the system?
Commissioner Barbot: So the early detection system that we're talking about has only to do with the lab samples. It's not a part of the overall process that happens in hospitals.
[Commissioner Barbot speaks in Spanish].
Question: In terms of the early detection system, the Governor mentioned [inaudible]. Is that part of this?
Mayor: No, the early detection effort is city-based. I think the Governor is absolutely right to aspire to that level of testing and it looks like the stars are aligning. We want to have maximum testing capacity, but he was referring to the State's testing capacity as well as the city. So the point is we want to keep maximizing that for everyone
Question: Just a follow up, [inaudible] I know you’ve been very critical of the CDC and the federal government’s response, I wonder if Dr. Barbot can tell us a little bit about when the city first got warning signs about the virus and if she could talk from a medical perspective about the federal response?
Commissioner Barbot: So coronavirus activity picked up in China in late December and I think that we're – there are many outlets through which we pay attention to what's going on in the world. We have sort of the graduate level of disease detectives that are on the lookout for what's happening globally. So we were already paying attention. I don't have the exact dates that the CDC first contacted us, but I think the point is here that we don't necessarily wait for CDC to sound the alarm. We're always looking out for what's happening globally, especially being an international city.
Question: A couple of sets of clarifying questions. The flu tests, are those done in the hospitals and then if they test negative for flu, does it go to the public health facility for additional tests? Can you sort of walk through the logistics of that a little bit more?
Commissioner Barbot: That's correct.
Question: And those tests are done at Bellevue or they're done in Long Island city or where are they at?
Commissioner Barbot: At the Public Health Lab is where we do the coronavirus testing and that's on First Avenue.
Question: All right. Secondly, with regard to the case of coronavirus, can you provide any more details about the timeline she got back in the country on Tuesday? When did she go to Mount Sinai for the testing and how long did it take to get the test results back? And do we know exactly how she got back from Iran? Did she come back from London or Paris or is – there aren't any nonstop flights between here and there?
Mayor: I don't know if we have all that, that last part, but do we have the part about the –
Deputy Commissioner Demetre Daskalakis, Department of Health and Mental Hygiene: So we do actually just the details - I'm sorry, I’m Demetre Daskalakis, the Deputy Commissioner for Disease Control at the Department of Health. The individual that you're talking about landed as you said around Tuesday asymptomatic for several days, became symptomatic and sought care on Saturday. Testing was done and we got results on Sunday.
Mayor: Who has not gone, oh, I'm sorry. Yeah.
Question: If you would, this was a question I was going to ask you earlier. Can you talk a little bit more about the disease detectives? Who are they and how does this process -
Mayor: Do they have a cape?
Question: What challenges might be facing them –
Commissioner Barbot: So no joke. I think these folks are the unsung heroes of public health because they do their work behind the scenes. And they are Health Department staff that have been trained in the most sensitive interview techniques to be able to get clinical information that sometimes can be very sensitive, get that information from people who are - who have a particular illness that we want to make sure that no one else has. And so these were the same detectives that we deployed when we had measles. These were the same detectives that we deploy, you know, when we've got any kind of outbreak. And so they're very well versed and toggling between things that may be incredibly sensitive. And, you know, we feel good about their ability to get important actionable information from patients that we're trying to treat.
Mayor: Hold on, hold on. Guys, just time out. We’re going to finish you and then going to anyone who was not gone and then we'll go to anybody else a little bit longer.
Question: If this expands as we were anticipating and hoping not, what's the greater challenge for the detectives, the disease detectives?
Commissioner Barbot: So I think the best way to answer that is during the measles outbreak, we track down over 20,000 people.
Mayor: Right, just volume.
Commissioner Barbot: Yeah.
Question: The one case pending [inaudible] is that the husband? The spouse –
Question: Okay, so if the turnaround is pretty quickly [inaudible].
Mayor: The Governor said and I agree with him. We expect that there'll be a positive.
Question: Do you know how soon we can expect those results?
Mayor: Today we think, tomorrow, hopefully later today.
Mayor: Thank you. Way back. Yup.
Question: I wonder whether there's any thought about some kind of enhanced screening or protocols of nursing homes and assisted livings in light of the situation going on in [inaudible].
Mayor: Yes. I'll start and if any of my colleagues or Aging Commissioner wants to speak or anyone else. The Governor indicated earlier, there will definitely be a focus on assisted living, nursing homes, senior centers, there's obviously a strong nexus there. So a lot information has flown already, but we're going to be doing constant work with each of those institutions to make sure if there's any kind of follow-up, any kind of assistance they need, that they will get it. Anyone want to add anything there. Not from there. Not from there. Come on, dude. You've been, you've done this for a while. You got to get to the microphone.
Commissioner Lorraine Cortés-Vázquez, Department for the Aging: I just want to remind everyone that the nursing homes and assisted living facilities are under the jurisdiction of the state.
Mayor: You didn’t say who you were.
Commissioner Cortés-Vázquez, Department for the Aging: I'm sorry, I am Lorraine Cortés-Vázquez. I'm the Commissioner for the Department for the Aging. The other thing is that we have been giving information to the older adult centers that we have throughout the city as well as to the workers that work in those facilities.
Mayor: Okay. Who has not gone? First call. Not gone at all? Nolan, your hands up, you've gone. Who? Who? You haven't gone. Good.
Question: What do you guys - what's the plan for the population of street homeless who already very, very not interested in authority and how can you even like make sure that those people will get care if they're already like, you know, not trying to like -
Mayor: Right, good question. The two - it fits actually with two things we do already. And I'll start and Steve, if you feel free, jump in. One is because we are now, unlike in the past, we're in an incessant outreach effort through HOME-STAT. If our outreach workers who really get to know each individual on the streets, I mean that's the whole concept is really getting to build a personal relationship. If they see someone with symptoms, obviously they're going to know to act on that. And second is, you know, we have the code blue concept during, for example, a blizzard. Obviously if we think anyone is in physical danger, we have the ability to bring them in willingly or unwillingly. Now this is, as you've heard, this is a disease that manifests different ways and for a lot of people it is like having the flu and nothing worse. But if someone had, for example, obvious medical conditions already and vulnerability and had symptoms that would be the kind of situation I'm extrapolating. I don't know if this a scenario you've dealt with before and I'm looking to Jim as well, but I think this is a case where if someone had clear medical distress and symptoms consistent with coronavirus, that we would want to be aggressive about bringing them in to help.
Commissioner Steven Banks, Department of Social Services: I think you're quite right that we do encounter individuals who do not want to on the first interaction accept services. But that doesn't mean we don't know who they are. And one of the important new tools that we've developed over the last several years is the by-name list which enables our outreach teams to actually, as the Mayor said, meet people where they are. And so part of evaluating what their needs are - are going to be taking into account whether we're seeing any potential concerns in this area. And if we see that we will be very aggressive in making sure that people get the help that they need so that we all can be safe.
Mayor: All right. Last call and anyone who has not gone at all.
Question: All right. You spoke last week [inaudible].
Mayor: We had an extensive conversation about masks during the tabletop exercise. It comes down this way. Our current stockpile is strong, but in an escalating crisis, we would absolutely need federal assistance. We have an outstanding request, as you know, for 300,000 masks. The federal government is finally playing a more decisive role. And I think they're right to try and figure out where the need is greatest first. But, so I'd say right now in New York City is good today, but we might need help very soon if we had a bigger situation. Okay. Last chance I'm going to do this one more time. Anyone who was not gone at all, not gone at all. Yes.
Question: Has there been any discussion in expanding the list of countries from which people are [inaudible] China [inaudible] JFK?
Mayor: Again, I want to be careful on this one because I'm not the perfect expert on all this. We've called for a very aggressive approach. In terms of screening, I think it's more than that already. Go ahead Raul.
Deputy Mayor Dr. Raul Perea-Henze, Health and Human Service: Right now the travel restrictions are four countries, China, Iran, Italy and South Korea. Japan has a lower level of restrictions and Hong Kong follows. We expect that in the coming weeks we'll probably going to see this number of countries increase.
Questions: So those are people coming into the country. All of those flights, anyone coming –
Deputy Mayor Perea-Henze: The U.S. has actually plays advisory, very strong advisories for travel back and forth from those four countries. Basically saying restrict to only essential travel.
Mayor: And again, on the further on, that would be for the federal government. Okay. Now guys, we're going to do a few more. We're not going to go on forever here – so, go ahead.
Question: Dr. Barbot actually, one of the things that's really unique about – there’s 86 cases in the U.S. but in Manhattan where this case is, population density, people live on top of each other. You mentioned earlier at the Governor's press conference [inaudible] about casual contact, so there isn't an immediate concern, but at some point when we expect more cases, people living in apartment buildings, what is the risk – people start wondering, if someone in my neighbor in my building has coronavirus, what are the concerns if you live in a building with ventilation, apartments, common space, things like that that are unique, especially to the [inaudible]?
Commissioner Barbot: You know, I think the important thing to remember is that this is not an illness that can be easily spread through casual contact. We want New Yorkers to go about their everyday lives, use the subway, take the bus, et cetera. The other thing that we have working in our favor here is that we have been very aggressive in identifying potential cases and not necessarily waiting for the final test results before doing all of the contact tracing that needed to be done to ensure that if indeed someone did turn out to be positive, we would have already done that important legwork with regards to limiting the mobility of potential contacts. So, all of that put together puts us in a really strong position. Now that to say, in spite of those efforts and you know what I said before, viruses don't respect borders. So, we do anticipate seeing additional cases, but we will treat each of them as aggressively as we have these.
Question: In the case of the woman who tested –
Mayor: Hold on, I'm sorry, I'm just going to stop you for one second. To clarify on your question, because I think this is, I got this earlier when I was on the radio. You're the doctor for New York City. Here's the question. Can I get it through the ventilation system based on what we know today?
Commissioner Barbot: On what we know today? No.
Mayor: No. So, there’s a simple answer.
Question: Just to follow up just because I, this is something people are asking. This woman is somewhere in Manhattan isolated in her home. When the disease detectives are identifying others who may have been in contact you know, the plane, you mentioned the car that that's not necessarily prolonged, was her building, you know, people in common space. Is that something that was identified? Where those people notified?
Mayor: I don’t think that qualifies as prolonged?
Commissioner Barbot: No. That's casual at best. So, no.
Mayor: So, let me try and you'll – here, you stay here for a second and then you're going to assess whether what I say – As a layman, I'm going try this. I believe it means you're in the same apartment with someone. You're like prolonged contact, you're breathing the same air for like a meaningful amount of time or you're working really closely with someone at work over hours, days, not, you know, I was in a car with someone for a half an hour or an hour. I was on a subway. I walked through the lobby. No, you actually have to be in regular contact in a meaningful way.
Commissioner Barbot: Correct.
Mayor: Correct. Okay, go ahead. Yeah.
Question: Commissioner could you please say that in Spanish?
[Commissioner Barbot speaks in Spanish]
Question: There was a man in Miami who thought he had coronavirus. He went to the hospital, insisted he get a flu test just to make sure and rule it out. He wound up having the flu. They made him, the hospital charged him like $3,000 to get that test done. So what I wanted to know was for people who, you know, with ACA going up to the Supreme Court, there’s concern –
Mayor: You're blending here. What's your bottom-line question?
Question: My bottom-line question is, what are you doing with the hospitals to ensure that the cost isn’t being shifted onto the people?
Mayor: I think this is a, I'm going to try and Oxiris or Raul, Mitch, anyone who wants to get in this. Look, if anyone comes to one of our facilities, everyone understands the ground rules. You know, we're going to get people care no matter what. If people have insurance, we're going to use their insurance. But no one's being turned away. No one's being gouged. So if anyone is in doubt, they can always go to a public health care facility. But in terms of regular health care, I don't know about that case. I think it's fair to say that the, the healthcare community in the city, and you saw a lot of people at the press conference earlier, Greater New York Hospital Association, they're not trying to gouge people in the middle of a crisis. Someone comes in for a test, they're going to be treated the way they would for any other tests. So it's a valid concern, but I don't see the health care community here doing something immoral like that.
Question: Just a quick follow up since you are working with two other hospitals beyond Health + Hospitals. What, how'd you come to that conclusion to work with New York Presbyterian [inaudible] and are there other hospitals that are coming into the mix?
Commissioner Barbot: So that constellation of hospitals gives us a fairly comprehensive footprint of the city, and we will continue working with other hospital systems to bring them on board as well.
Question: Mr. Mayor, if I may. Commissioner –
[Reporter speaks in Spanish]
[Commissioner Barbot speaks in Spanish]
[Commissioner Cortez-Vasquez speaks in Spanish]
Question: What day did the infected woman become symptomatic? Is her husband currently symptomatic?
Question: Okay. The second, would people sharing the same subway air be at risk and how would the disease detective track them down?
Mayor: I'm going to try again as the layman and I'm looking to the doctor to grade me. No sharing subway air is not close contact. So, again, enclosed spaces –
Question: If you were on a subway car for an hour you wouldn’t –
Mayor: Again, we’re going by what we know. You’ve got to have prolonged contact with someone that would typically align to, for example, a family member in an apartment, not open context for a limited period of time. That’s what we know today.
Question: So, the doctor mentioned that smoking is actually one of the preexisting conditions. Is vaping also in that category, if you're vaping electronic cigarettes or marijuana use? Like, is that something that's also going to make you more predisposed to get this?
Commissioner Barbot: So, before I answer that, I want to go back to the question about the subway air. This is not transmitted like measles where, you know, someone with measles is in the room, 10 people who come into that room an hour after that person left can get measles. This is totally different, right? This is, someone is ill and they have symptoms having prolonged exposure to – not to be too graphic, but their secretions. So, it's a very different scenario. In terms of the question that you just asked me, can you, I'm sorry, can you ask me one more time?
Mayor: Vaping –
Commissioner Barbot: Vaping, oh yeah – you know, it's unclear. And the risk factor of smoking is the same risk factor that we call out when we advise individuals about the flu.
Mayor: But can I bring you back? I'm going add to the question, what do we say if someone is vaping, they should beware even though we don't know, it's unclear, but does it add caution or not?
Commissioner Barbot: Absolutely. That's a good idea to add caution. Yes.
Question: For everyone has been reading about it in the papers and knows that there's worldwide concern about the spread of this disease, can you explain to me a little bit how you guys make the determination that self-quarantine at home is sufficient and how do you make sure people are actually respecting self-quarantine?
Mayor: Right, fair questions. I'll start, and, Oxiris, join in. Okay, so, as the non-doctor, my understanding is this is the global health standard that given that this behaves for the vast majority of people somewhere in the neighborhood of like a flu, it's understandable that the way you deal with that as you ride it out and that the self-quarantine is the right way to ride it out without infecting other people. So, we're not making that up, we're basing it on the global standard. On the question of other folks, it's an excellent question. And, again, as we're saying about the husband in the case we already have where it's likely he will test positive. Yes, if the rest of your family stays there, there is the risk of them contracting the disease, which means we would like to see the rest of the family not be in the same place with the person who quarantining. And that could be done – by the way, you can do that within a single home or a single apartment. You can create separation. Either – doctor, or anyone wants speak to that?
Commissioner Barbot: I think what the Mayor said was right on in terms of the appropriate level of isolation depends on the apartment situation. I want to also just add that we have been working very closely with our sister agencies, the Office of Tenant Protections, the Commission on Human Rights. And we haven't come up against these issues yet, but we are, as the Mayor said before, deploying all City agencies to contribute so that there isn't anyone who has any hesitation about coming forward. We will do anything and everything possible to make appropriate home isolation be as minimally painful as it is. Because, you know, the reality of it is that any of us would have challenges staying in our apartments for 14 days. And so, as part of our response, we're looking at the mental health needs of individuals, we're looking at a whole host of areas that we can provide support to make it as easy as possible for them to follow the instructions.
Question: [Inaudible] taking care of themselves –
Mayor: So, wait, let me go back on the previous and then we'll follow-up on your question. So, to all my colleagues and just want to give an order of the day here – 3-1-1 is central to this whole reality. If folks don't know how to properly self-quarantine, I want to make sure they can get that information through 3-1-1. If a family doesn't have a context where they can create separation and we need to find a way to find other family members a place temporarily, you should be able to do that through 3-1-1. Whatever the outstanding issue, I want to make sure – so, I'm saying this both to tell New Yorkers, call 3-1-1, but I'm also telling the rest of the government, make sure 3-1-1 is up to this capacity immediately and whatever we have to add in terms of personnel or training or follow-through mechanisms, we need to do that immediately because the best way to see this through is if people can very easily get the support and facilitation they need. Now, your question?
Question: I was just wondering about [inaudible] the couple that's been [inaudible]?
Mayor: Right. I want to – again, I think guys – I want to – just listen carefully on the part about what it is and what it isn't. So, this couple is in their 30s, they happen to be health care professionals. If you had the flu, you yourself had the flu. We wouldn't have a nurse there with you to see you through the flu. You would stay home and take some meds and you’d get through it. So, the people who are in danger are the folks with those underlying medical conditions. For those folks, obviously, we're talking about in some cases a higher level support, but in a lot of cases being in a hospital setting, obviously. So, I think to really help people – anyone who's worried has every right to be worried. Anyone who's scared of this could turn into something much bigger, has every right to be. But what we know essentially is, the vast majority of people on earth who get this, they have it, they get through it, it's over. For a much, much smaller number of people, it is a greater danger, a greater problem. For a very small number of people, it can be fatal. We take that very, very seriously. So, I think it's fair to say, if you're in home isolation, it means you're dealing with the lesser version and you can see it through on your own if you need to.
Mayor: Yeah. And Chief Monahan, Chief Sudnik participated, if either of you want to come forward, feel free. Chief Monahan is very shy, he may not want to speak.
He's a – we're trying to get him to go one of those courses to be able to feel comfortable in public. The – what there has been information given out to all our first responders. They are taking additional precautions already. And there is, right now, all the equipment we need to accommodate. But as we said, over the horizon, in a bigger crisis, we're going to need more equipment, but we have what we need now.
Chief of Department Terence Monahan, NYPD: All right. We have a stockpile of masks, disinfectant gloves that we gave out to all our PSA transit housing facilities. They're out there. We've given some protocol and conditions to our personnel when they respond to jobs, working with the Fire Department, EMS, if it's a sick job, a potential for coronavirus, our personnel will wait outside, EMS will respond, they will go up and we will provide whatever assistance that EMS needs.
Chief of Department John Sudnik, FDNY: So, as a matter of protocol, our EMT’s, our paramedics, our firefighters already follow universal precautions. So, they're already trained and equipped to deal with any exposure that they would have for anybody, including people with the flu. Right now, we have a response protocol where if somebody calls 9-1-1 and reports either a fever or a cough and they have traveled to one of the countries that we're talking about that are the at-risk countries, our EMT’s, our paramedics, our firefighters will be notified that it's a potential fever, cough, travel incident and they would take additional precautions, and that includes wearing N95 respirators wearing gowns, if necessary, and eye protection.
Mayor: Okay. We’re going to do two or three more and be done. Yes, Jeff?
Mayor: That’s the only one. It's the only one right now. Again, we predict a positive on that.
Question: Can you give a sense of how much it costs for each test?
Mayor: I'll certainly have – anyone who has the answer – but again, I'm going to have a blanket answer on everything cost, going forward. The President of the United States said in his press conference that not only states but localities would be reimbursed. Take him at his word, glad to hear him say it proactively. We are going to do whatever it takes to protect New Yorkers. That will be an ever-changing situation. So, anytime we can give you a cost update, a cost estimate, we will. But bluntly, we're in the middle of dealing with things, we're not totaling up the dollar figures each day. When we get to the end of line, we'll go for the appropriate federal reimbursement.
Question: Health care professional is kind of a wonky term. Can you give us any more idea of what they do? Are they surgeons? Are they –
Mayor: That’s all I’ve got for you right now. Go ahead, last call –
Question: Just wondering [inaudible] showed symptoms Saturday and was tested Saturday?
Mayor: That’s what we understand, right?
Unknown: That’s correct.
Mayor: Yes and yes.
Okay. Thanks, everyone.