THENEWYORKER,M AY4, 2020 21
to persuade people to stay home and
follow the scientists’ advice; New York’s
leaders, despite having a highly esteemed
public-health department, moved more
slowly, offered more muddied messages,
and let politicians’ voices dominate.
New York’s mayor, Bill de Blasio, has
long had a fraught relationship with the
city’s Department of Health and Men-
tal Hygiene, which, though technically
under his control, seeks to function in-
dependently and avoid political fights.
“There’s always a bit of a split between
the political appointees, whose jobs are
to make a mayor look good, and public-
health professionals, who sometimes have
to make unpopular recommendations,”
a former head of the Department of
Health told me. “But, with the de Bla-
sio people, that antagonism is ten times
worse. They are so much more impos-
sible to work with than other adminis-
trations.” In 2015, when Legionnaires’
disease sickened at least a hundred and
thirty New Yorkers and killed at least
twelve, tensions between de Blasio and
the Health Department came to a head.
After de Blasio ordered health officials
to force their way into buildings in the
Bronx to test cooling towers for contam-
ination, even though the outbreak’s source
had already been identified, the officials
complained that the Mayor was wasting
their time in order to brag to reporters
that he’d done everything possible to
stamp out the disease. When the deputy
commissioner for environmental health,
Daniel Kass, refused City Hall’s demands,
one of the city’s deputy mayors urged
the commissioner of health, Mary Bas-
sett, to fire Kass. She ignored the sug-
gestion, but Kass eventually resigned. He
later told colleagues he felt that his re-
bellion had made coöperation with City
Hall impossible.
“Dan Kass is one of the best envi-
ronmental-health experts in the coun-
try,” Bassett, who now teaches at Har-
vard, said. “New York has one of the
best health departments in the United
States, possibly the world. We’d all be
better off if we were listening really
closely to them right now.”
In early March, as Dow Constantine
was asking Microsoft to close its offices
and putting scientists in front of news
cameras, de Blasio and New York’s gov-
ernor, Andrew Cuomo, were giving
speeches that deëmphasized the risks of
the pandemic, even as the city was an-
nouncing its first official cases. De Bla-
sio initially voiced caution, saying that
“no one should take the coronavirus sit-
uation lightly,” but soon told residents
to keep helping the city’s economy. “Go
on with your lives + get out on the town
despite Coronavirus,” he tweeted on
March 2nd—one day after the first
COVID-19 diagnosis in New York. He
urged people to see a movie
at Lincoln Center. On the
day that Seattle schools
closed, de Blasio said at a
press conference that “if you
are not sick, if you are not
in the vulnerable category,
you should be going about
your life.” Cuomo, mean-
while, had told reporters
that “we should relax.” He
said that most infected peo-
ple would recover with few problems,
adding, “We don’t even think it’s going
to be as bad as it was in other countries.”
De Blasio’s and Cuomo’s instincts
are understandable. A political leader’s
job, in most situations, is to ease citi-
zens’ fears and buoy the economy. During
a pandemic, however, all those impera-
tives are reversed: a politician’s job is to
inflame our paranoia, because waiting
until we can see the danger means hold-
ing off until it’s too late. The city’s ep-
idemiologists were horrified by the com-
forting messages that de Blasio and
Cuomo kept giving. Jeffrey Shaman, a
disease modeller at Columbia, said, “All
you had to do was look at the West
Coast, and you knew it was coming for
us. That’s why Seattle and San Fran-
cisco and Portland were shutting things
down.” But New York “dithered instead
of telling people to stay home.”
By early March, the city’s Depart-
ment of Health had sent the Mayor nu-
merous proposals on fighting the virus’s
spread. Since there weren’t enough di-
agnostic kits to conduct extensive test-
ing, public-health officials proposed “sen-
tinel surveillance”: asking local hospitals
to provide the Department of Health
with swabs collected from people who
had flulike symptoms and had tested
negative for influenza. By testing a se-
lection of those swabs, the department
could estimate how rapidly and widely
the coronavirus was moving through the
city. In previous outbreaks, such studieshad been tremendously useful in guid-
ing governmental responses—and this
spring Los Angeles effectively deployed
the strategy, as did Santa Clara County,
in California, and the state of Hawaii.
In New York City, the Health Depart-
ment began collecting swabs, but the ini-
tiative met swift resistance. Under fed-
eral health laws, such swabs have to be
anonymized for patients who haven’t
consented to a coronavirus
test. This meant that, even
if city officials learned that
many people were infected,
officials wouldn’t be able to
identify, let alone warn, any
of them. The Mayor’s office
refused to authorize testing
the swabs. “They didn’t want
to have to say, ‘There are
hundreds, maybe thousands,
of you who are positive for
coronavirus, but we don’t know who,’ ” a
Department of Health official told me,
adding, “It was a real opportunity to com-
municate to New Yorkers that this is
serious—you have to stay home.” The
effort was blocked over fears that it might
create a panic, but such alarm might have
proved useful. After all, the official told
me, panic is pretty effective at getting
people to change their behavior. Instead,
the Mayor’s office informed the Health
Department that the city would sponsor
a job fair to find a few new “disease de-
tectives.” That event was held on March
12th, in Long Island City. The Depart-
ment of Health official said, “We’re in
the middle of a catastrophe, and their
solution is to make us waste time inter-
viewing and onboarding people!” (The
Mayor’s office eventually relented on the
sentinel-surveillance samples, and testing
began on March 23rd—almost a month
after samples were first collected. By then,
the outbreak was well under way.)
As New York City schools, bars, and
restaurants remained open, relations be-
tween the Department of Health and
City Hall devolved. Health supervi-
sors were “very, very angry,” one official
told me. In particular, health officials
were furious that de Blasio kept telling
New Yorkers to go out and get a test if
they suspected they were infected. On
March 4th, he tweeted, “If you feel flu-
like symptoms (fever, cough and short-
ness of breath), and recently traveled to
an area affected by coronavirus... go to