“New York officials have given up on eradicating this virus.”

Sean Petty is a pediatric emergency room nurse at Jacobi Medical Center in the Bronx and the southern regional director for the New York State Nurses Association (NYSNA). In a March interview with The Indypendent’s Danny Katch, he predicted that the coming coronavirus spike would overwhelm a public hospital system that had been decimated by budget cuts and closures. In a May follow-up interview, he described how he and his fellow nurses had sounded the alarm about the dire conditions inside hospitals by organizing some of the first workplace actions demanding more personal protective equipment (PPE).

Now Petty talks to Katch again to explain how the refusal of New York’s political leaders to increase taxes on the wealthy caused them to squander the summer lull and leave working people and our health care system unprepared for the second wave that’s starting to build up across the city. This interview has been lightly edited for clarity and concision.

Danny Katch: COVID cases are rising in New York around the country. Are we heading for another wave? 

Sean Petty: In New York, infection rates are starting to ratchet up again in pockets around the city. The second wave will happen, and it’s just a question of how bad it’s going to be. 

In my hospital, we’re starting to see our volume of patients recover from pre-COVID times– people were rightfully wary of the hospital and who knows how many people’s chronic diseases have been getting worse because of their fear of getting care. 

We’re seeing in the last two weeks a small uptick in COVID cases coming to the ER. Some of the cases we had over summer were incidental cases — people coming in for something else and we’d test them and they’d test positive for COVID kind of randomly. Now we’re starting to see some people with respiratory problems. These are people who are actually ill from the disease. But it’s a small uptick right now. 

This gets at a broader point about the way the city has been managing this outbreak, which is that it’s hard to ascertain the trajectory of the virus based on snapshots. What we now know is that the virus was spreading long before the first case was diagnosed. So the problem is the lag time. The city has now identified infection clusters emerging across the city, but the picture it presents is basically a picture of several weeks behind in terms of what the actual danger is-—and that mirrors what happened this spring.

This lag time seems relevant to the current headlines that reopening schools hasn’t led to many infections. 

Right. It’s the methodology danger of relying on snapshots. These numbers can’t tell the full story.

The problems are because of the lag time in testing. It can take up to nine days to get results depending on where you get tested—and because while the tracing is getting better, they’re only doing what’s called forward tracing, which means tracing only who the positive patient had contact with. 

What they really need to do is both forward and backward tracing, which is tracing the infection to a patient zero that introduced that virus into the cluster by tracing who your contacts had contact with back in time, and their contacts, etc. Viruses spread like branches and they’re only hitting one branch instead of finding the roots. 

Countries like South Korea and Japan have largely eradicated the virus by having mass rapid testing—tests that come back in one or two hours, and backward tracing. So they can actually get to the root cause of the cluster, quarantine everyone involved, and even lock down those sectors if the virus has spread faster than they can trace it. They have been able to be on top of almost every cluster and contain it.

Why is our testing and tracing program more limited than it needs to be? Is it a resources question? 

I think the public health strategists in New York City have essentially given up on eradicating the virus because they don’t feel that there’s the political and economic will to do what’s necessary to eradicate it. So they’ve settled on strategies that contain it as best they can at lower levels, and they’ve been a little too self-satisfied with their results during the lull over the last several months. 

And because there hasn’t been a sufficient amount of public aid for people who have not been able to work and people who have had to shut down their business, there’s been a tremendous amount of pressure to continue to open up the economy despite how dangerous that is in terms of allowing this virus to spread. 

In our last interview we talked about Governor Andrew Cuomo’s $400 million cuts to health. What has been the impact from that? 

The $400 million ended up being $2.2 billion in Medicaid cuts  in last year’s finalized budget from the state. But the impact has been largely obscured by the influx in federal funding through the stimulus programs  and the direct aid to hospital programs, so it hasn’t had an immediate impact on health care delivery at the present time. 

There are places where there is that fiscal pressure. For instance, in Brooklyn, the bigger problem is Cuomo’s long term strategy of reducing hospital beds which, as we talked about last time, resulted in 20,000 fewer beds in New York State. Well, a few more of those beds just recently got eliminated from Central Brooklyn, one of the hardest hit areas of the city, with the consolidation of health care services that eliminated almost 100 staffed beds, mostly from Kingsbrook Jewish Medical Center. 

One of the scandals of this virus is that top recipients of CARES ACT money from the federal government are large private academic medical center hospitals and not public hospitals that saw more COVID patients. For instance, Elmhurst Hospital and Queens Hospital were the most overwhelmed and saw the most patients. They don’t even make the top 10 recipients of that federal CARES money. 

So as of now, there hasn’t been significant overall downsizing of the system. But in the wake of COVID what you should have seen was a massive expansion of our hospital system: significant increases in permanent hirings, opening up closed units, and an expansion of primary care in a rapid and systematic way. Health care infrastructure should have been the number one priority. 

But because of the state cuts and the disparate way that federal funding was implemented, there’s still an incredible amount of financial nervousness in the hospital sector and none of that expansion really happened. It’s basically the status quo, with pockets like Central Brooklyn that have seen some declines. 

It also sounds like stable state funding has been replaced with temporary infusions of federal cash, which makes hospital budgets more precarious. 

One hundred percent. And one thing I forgot to mention is that, at both the city and state level, they’ve kicked a lot of the can down the road. They have money from reserves from when the economy was doing better that they’re completely using up this time around. They made a lot of threats—Cuomo threatened 20% cuts of every public institution and Mayor de Blasio threatened 22,000 layoffs—but they backed off after realizing the consequences for the second wave of COVID. 

But they haven’t resolved anything in terms of the fiscal cliff that’s awaiting in next year’s fiscal year budget. So come April and come July of next year at the state and city level, you’re going to see the real pitched battle. If there’s no redistribution of wealth, if there’s no additional federal money coming in with these temporary infusions of stimulus, then you’re going to see the real austerity show up.

Where should that distribution of wealth should come from? 

The billionaire class nationwide has increased their wealth to over three quarters of a trillion dollars just during the pandemic. This is the result of not just their savvy marketing skills but the fact that they’ve systematically avoided taxation at every level, city state and federally. So corporate profits are running rampant at the same time as one of the largest economic crises for working people is ravaging communities across New York City and the country. 

New York State already taxes financial transactions to the tune of $10 to $20 billion a year. They collect that money and then they refund it back to Wall Street. A stroke of a pen by the legislature and Cuomo can keep those billions in our budget.  Additional taxes can be levied on corporations and wealth taxes on billionaires can raise that revenue in a heartbeat to allow health care systems to implement the solutions and keep the economy regulated so that the virus can be defeated. 

Thanks to the Trump administration, there’s now a lot of talk about “herd immunity”. What do you think about this as a public health strategy? 

It’s not a strategy at all. It’s homicidal neglect. Herd immunity doesn’t really exist as a strategy for thinking about how you contain a pandemic. It’s largely used in epidemiology to describe a point at which the population has been vaccinated enough so that there’s enough immunity so that some people who don’t get vaccinated won’t get infected because there’s not enough people for that pathogen to get a foothold. So the idea of herd immunity under our current conditions, and being paired with the question of letting the economy stay open, is not something that’s really recognized among serious public health strategists.

You said earlier that public health officials in New York City have given up on trying to eradicate COVID-19, which means the local policy is somewhere in between lockdown and “herd immunity”. Has this lowering of public health expectations contributed to what we think of as  “quarantine fatigue” as we enter a second wave this winter? 

There is a level of resignation and betrayal that people feel in terms of the leadership at all levels: federal, state, and city. No matter how much evidence gets presented about how to stop the spread of this virus, the political and economic imperative seem to win the day. I think quarantine fatigue is just one part of a generalized fatigue due to the apathy coming from our political leadership. 

Cuomo and de Blasio are giving dire warnings about the seriousness of the second wave when it comes to individual behavior, even as they continue to open up business that could never be called essential, such as movie theaters and ski resorts. Why is there a disconnect between their approach to regulating individual behavior and the commercial environments where the virus can spread? 

If your imperative is to avoid taxing the rich, you have to open up elements of the economy to salvage people’s economic well being. That means there’s going to be an increase in the virus, but you can’t be blamed for that, so you need to ideologically shift the terrain and provide a scapegoat for what is going to be the cause of this second wave. 

The narrative that de Blasio and Cuomo are trying to  construct is that this is all the fault of people who don’t wear masks and people in religious communities having indoor gatherings—in particular the focus has been on Hasidic communities in Brooklyn and upstate. There’s all kinds of programs that can be implemented with vetted public health strategies in culturally competent ways, but what they’re doing is taking an ideological bludgeon to that process and scapegoating not just religious communities, but everybody who doesn’t wear a mask for whatever reason as the cause. 

Mask wearing is incredibly important and we should figure out ways to implement universal mask wearing wherever we can. But we cannot let this blatant hypocrisy of our political establishment go unchecked because it’s allowing for policies that are doing far greater damage to go unnoticed. People are desperate to get their kids back in school, to have entertainment, to have jobs. So they’ve constructed this process. They refuse to tax the rich, they starve people of resources and support so they’ve pushed people into being desperate to get back into situations and then set things up to blame a very small source of what are the beginnings of a second wave. 

What do you think of the way that Cuomo in particular has framed stopping COVID as a police enforcement issue? 

It exposes the hollowness of Governor Cuomo support for the Black Lives Matter movement. He’s tried to be publicly sympathetic to the movement’s demands related to individual instances of police aggression, while implementing a policy that ratchets up the likelihood for those interactions to continue. 

Anyone who saw the videos from the initial wave of mask enforcement that the NYPD were called on to implement could see swaths of people unmasked in largely white affluent communities with no police, or there were park rangers handing out masks. And then you cut to parts of Brooklyn and the Bronx where they’re going around shoving teenagers in the streets. And then we of course saw the brutality of the murders of George Floyd, Breonna Taylor, and a number of other instances where we know that the more police are given impunity to interact in aggressive ways in terms of enforcement, the higher chance there is of Black and Brown people getting murdered.

Also, if you want to talk about a community known for not wearing masks, it’s police officers in New York City. The idea that you would call on known mask avoiders to enforce mask wearing is the height of hypocrisy. 

Is it possible at this point to have a public health response that wins people’s faith that we can beat this? 

Yes. You get attention and resources—emotional resources, physical resources, time resources—from people that are invested in a project that has some hope. 

If we were able to have marshaled a successful campaign in the first wave to fundamentally restructure health care and social services towards ending this virus, people were there for that. The amount of solidarity and self-sacrifice that people made in the early days of the pandemic was truly remarkable, and that could have lasted longer if there were a serious plan to actually end this virus. 

But because there wasn’t, there is now a tremendous amount of demoralization that exists. They talk about quarantine fatigue in terms of mask wearing, and that exists, because people don’t have that same level of collective investment that they did in March and April. 

But I don’t think all is lost on that front. I think that can be reclaimed. This process has spiraled into a number of other crises that will sharply impact people’s lives. If anything, it has exposed a number of blatant hypocrisies and conflicts of interest that exist within our political and economic systems, which I think will compel people to unify and fight back in various ways. I pointed to one earlier which is the fiscal cliff that the city and state is about to fall off next spring and summer. 

Some others can come earlier in terms of how the virus plays out and how people’s lives are handled throughout the second wave. Any one of those can compel a response that turns some of that demoralization into unity and into action in a collective and productive way to alter the priorities that are currently being implemented. That’s where I see real hope.

Published at The Indypendent November 9, 2020