In late January, I was filling my bottle at the office water cooler when Lawrence Eisenstein, our county’s health commissioner, sidled up to fill his own. Everyone in the office calls Lawrence “Dr. Larry.” After medical school, he trained as an internist specializing in infectious diseases; afterward, he treated H.I.V. patients on Long Island. He became the county health commissioner in 2011. Three years later, when a man in New York City was diagnosed with Ebola, Dr. Larry made sure that our county, which is situated just east of Queens, had the right isolation and quarantine procedures in place. Even in normal times, he carries a tiny bottle of hand sanitizer in his jacket pocket.
“Doc,” I said. “How worried should we be about this novel coronavirus in China?”
“I’ll be honest with you,” he said. “I’ve never heard my contacts at the C.D.C. sound so concerned, and they’ve been through SARS, MERS, H1N1.” He paused. “That tells me they think it could have a significant global impact.”
In my office, I started thinking about how we could prepare. Nassau County, where I was elected the county executive, in 2017, is home to more than 1.3 million people. It covers four hundred and fifty square miles, stretching from the Gatsbyesque mansions on the north shore of Long Island to the middle-class neighborhoods of the south shore. Although it is mostly affluent, there are pockets of poverty and vulnerability. People who live in New York City often picture Nassau as a montage of beaches, porch swings, and shopping malls. My perspective is different: the government I run has a $3.3-billion budget and encompasses fifty-six independent school districts and a complex patchwork of cities, towns, villages, and hamlets. The county is more populous than Boston and Atlanta combined.
One way we plan for catastrophes is by running table-top exercises: department heads and regional partners meet in a classroom-type setting to walk through what they’ll do in case of a monster storm or a school shooting. I called Tatum Fox, my deputy for public safety, and asked her to organize such an exercise for the coronavirus. We settled on what we thought was an aggressive date: March 23rd. We didn’t know that, by then, the time for exercises would have passed, and we’d be fighting the coronavirus for real.
Months later, during the summer, Nassau County would progress through the stages of its reopening. As the fall began, we would be diagnosing between twenty and forty new coronavirus cases per day, or about one case per forty-five thousand residents—a rate of viral spread low enough for us to start school and move toward a more complete reopening of our economy. Today, we think we are as prepared as possible for the growing winter surge; we’re eyeing our numbers, which so far have ticked upward only modestly, with a full range of protocols and public-health options in place. But learning how to fight the virus hasn’t been easy. Before the pandemic, our county government was focussed on what we thought were big goals: revitalizing downtowns, fixing budget problems, building a new stadium for the Islanders. Suddenly, we were on conference calls planning the purchase of body bags and the leasing of refrigerator trucks as temporary morgues.
Along with other elected officials around the country, I found myself at the center of a kind of crisis I’d never experienced. In the beginning, it was like a dark storm, the sort you can hear even before you see the clouds roll in. Eventually, the clouds were all we could see. In such a crisis, every decision you make affects your constituents’s lives and livelihoods. You do your best to balance it all: you talk to the experts, examine the numbers and the models, and seek the best advice. But the virus moved with overwhelming speed. New York City became the worldwide center of the virus, and so it was bad in Nassau, too; our numbers were the highest outside of New York City. Since March, 52,897 Nassau County residents have tested positive for the virus, and 2,226 have died. In the early days, I’d catch myself thinking, Is this a dream?
Over the course of the spring and summer, Nassau managed to flatten its curve; we hope to keep it flat through the winter. But the virus is still circulating around the country, and, until scientists strike a definitive blow against it, with a vaccine or other treatments, all progress is provisional. Meanwhile, we are grappling with economic distress on an unprecedented scale. We need help for our businesses and citizens, many of whom have been thrown out of work. Our county government needs money for basic public functions—safety, transportation, paving roads, maintaining parks—but we also need money to continue fighting the virus: to fund more testing and contact tracing, and to maintain our ramped-up public-health infrastructure. We’re building a dam, and the water is rising on the other side.
The coronavirus seemed to arrive in slow motion. In February, a month after our water-cooler conversation, Dr. Larry and the health department began monitoring two hundred and fifty people for signs of the virus. Most of them were travellers from China who had been identified by the Centers for Disease Control and Prevention, which was relaying news of incoming travellers to local governments. As soon as they landed, we contacted them, so that we could place them in quarantine and test them if they developed symptoms. At the time, our health department employed only six disease investigators, to respond to illnesses such as hepatitis and E. coli. The C.D.C. hadn’t yet given local labs approval to process coronavirus tests, and so we had to send our test kits to its lab, in Atlanta. A hundred and sixty of the people we had contacted agreed to isolate themselves while we waited for the results. None of the tests came back positive.
On February 25th, Dr. Larry came by my office, where I was meeting with my top aides, Helena Williams and Mike Santeramo, discussing the county’s upcoming infrastructure projects. His expression told me that I should close the door.
“We may have a positive case,” he said. A teacher had returned from a winter break trip to Italy and developed a fever and cough; she’d tested negative for the flu. She worked at Elmont Memorial High School, where, the following week, I was planning to give my state-of-the-county speech. A few days before that, I was supposed to meet with journalists at the school, for a “pre-speech on site.” Without explaining why, I postponed it, in case the teacher’s test came back positive and the school had to shut down. But it, too, came back negative.
It wasn’t until March 5th that we got our first confirmed case, and its details couldn’t have been more alarming. A forty-two-year-old man from Uniondale, who worked at a local hospital and had a side job driving people to the airport, came down with a fever and cough; his doctor decided to give him a COVID-19 test. Our health department’s team of disease investigators got rolling. When was he last at work? How did he get there? Who lived with him? Had he been to any gatherings? Investigators discovered that he hadn’t travelled. This was unnerving news: it meant that the coronavirus was already spreading in the community, circulating unchecked.
It’s striking, after months of social distancing, to look back on my schedule then. Just a few days before, on March 2nd, I had travelled to Washington, D.C., to attend a of couple conventions; at one, the National Association of Counties, I sat with hundreds of other county officials in the ballroom of the Washington Hilton, while President Donald Trump briefed us on the coronavirus. (He spoke frankly and seemed to grasp that it was a serious issue. County governments would have an important role to play, he said, because they know so much about their residents.) My schedule on March 11th was similarly packed: after meeting with reporters from “Good Day New York,” for a live sunrise segment about the coronavirus, and visiting Northwell Health’s labs, in Lake Success, to see their new virus-testing equipment, I stopped by the St. Patrick’s Day luncheon hosted by the local Kiwanis club, at the Garden City Hotel. When I walked through the double doors and into the ballroom, the event looked pretty much like it had every year. I wove through the tables, where everyone sat wearing green ties and sweaters; I said hello to the people I knew and introduced myself to those I didn’t. Instead of shaking hands, I stuck out my elbow to bump—a wise move, I thought, given the viral threat. Still, I couldn’t imagine the scale of what was coming. I didn’t know that the luncheon would be my last non-coronavirus work commitment for months to come.
That afternoon, I met with Dr. Larry at a school administration building, in Garden City, for a conference with the superintendents of the county’s school districts. Sitting at the head of a boomerang-shaped table, I scanned the superintendents’ faces, which ranged in expression from worried to very worried. Since the first confirmed case, more had been found, including some in the schools. Two bus drivers had tested positive. Some districts, having discovered cases among teachers and staff, had closed individual schools; an entire district shut down for a week, after it found that all of its schools might have been exposed, through a teacher with school-aged kids.
The Nassau County government doesn’t control the schools—each district sets its own policies. Still, the superintendents seemed to be looking to me for guidance. I told them that I would support any decisions they made, including shutting down. “You know your schools and your communities better than anyone,” I said. “But I am following the C.D.C. protocols for flu pandemic.” I explained that, according to those protocols, closing schools is the last thing that a district should do in a flu-type pandemic: it’s easier to contain the virus when kids are in class, instead of hanging out with friends or being watched by their grandparents. Many children rely on schools for lunch, and many health-care workers and first responders depend on them for child care. By this logic, closing schools was a step to take only when viral cases were skyrocking.
In fact, we were already reaching that point. One morning, by the lockers at the gym, I took a phone call from Dr. Larry. He’d just been on a conference call with other regional health officials and learnt that the New York City department of health was so hard-pressed that it was only testing patients who were hospitalized. That meant that, because the coronavirus is so often asymptomatic, most infected people in the city were going untested, and their contacts were going untraced. In Nassau, we were ramping up our test-and-trace operations. Dozens of staffers from our health department, along with civilian members of the county police department, were being quickly retrained as contact tracers—putting their regular duties, such as clerical work, on hold. But our border with Queens is more than fifteen miles long; many of our residents commute to the city. I could hear the frustration in Dr. Larry’s voice. So many of the precautions we were taking wouldn’t really matter; with the virus spreading unchecked next door, all the work we’d been doing could be quickly undone. (Since then, New York City’s test-and-trace operation has expanded substantially.)
On Friday, March 13th—two days after my meeting with the school superintendents—I learned that declaring a state of emergency would allow me to close the schools myself. I decided it was the best option. On Saturday I took my phone outside—I try not to be on the phone too much when I’m around my family—and sat on my porch swing, my jacket zipped up against the cold, and spoke with Dr. Larry, school leaders, and Governor Andrew Cuomo about how the school closures would work. I announced them the following day, at a press conference. A few hours later, at his own press conference, Governor Cuomo announced that he would be closing schools statewide.
