Did Andrew Cuomo endanger NY nursing home residents?
I don't think so.
Image from Cuomo for Mayor of NYC
In most articles about former Governor Andrew Cuomo, we read about the many people who have accused him of inappropriate behavior and what they refer to as his dangerous and corrupt response to the COVID-19 pandemic. The comments are not complimentary.
As the AP puts it, “Cuomo was … damaged by allegations that his administration unintentionally contributed to a wave of COVID-19 deaths in nursing homes by initially barring them from refusing to readmit virus patients discharged from hospitals.”
I don’t live in NYC, so I won’t be able to vote for or against Mr. Cuomo, but I believe that it is important to try to look objectively at the accusations against him concerning his management of the COVID-19 pandemic.
There are two main accusations.
The governor has been accused of endangering the lives of NY nursing home residents by forcing nursing homes to accept recovering COVID-19 patients after hospitalization, regardless of the diagnosis, between March 25 and May 10, 2020. The order was rescinded in May after pushback from nursing home advocates, lawyers and other public health officials. It was claimed that the order contributed to 5000 deaths or more.
Then there was the accusation that the Governor’s staff held back or reduced the number of reported nursing home deaths, “out of concern that the Trump administration would use the information against the Cuomo administration and gain political advantage in the 2020 election.” The Daily News Editorial Board opined that, “The cover-up is always worse than the crime.”
There is one main problem with all the heated reporting and accusations leveled at the Governor. There was no crime! In retrospect, New York had fewer nursing home deaths and overall deaths from COVID-19 than 44 other states when the data is displayed per 1000 nursing home beds.
Remember, much of this hullabaloo came up in May of 2020. New York hospitals were still reeling from the effect of the pandemic. People were dying every day with a death toll reaching over 800 deaths per day in New York alone. Dead bodies filled morgues. Some bodies were being kept in refrigerator trucks on the street, “stacked like cord wood.” Hospitals were so overcrowded that even ICU patients were kept in hallways. The city commissioned extra emergency beds at the Javits Center and brought a hospital ship into the harbor to accommodate overflows. Nursing homes were not allowing anyone to come into their facilities other than patients and staff. Families could not visit their loved ones who sadly often died alone. Patients suffered from lack of socialization and even lack of care.
The number of COVID-19 cases and deaths was being tracked by the State of New York, by the CDC and John’s Hopkins University among others. I had bookmarked several of these pages and followed the numbers daily.
The Governor began to give daily briefings to New Yorkers which were followed intensely. Those briefings became must-see TV. The governor would give us the numbers, remind us to keep safe and be careful, remind us that we were “New York Tough” and keep hope alive. As we got to the other side of the epidemic curve, he told us that we could beat COVID. He got personal, telling stories about his family and caregivers. His briefings were watched all over the country.
Doctors and nurses were heroes! Remember? Hospital staff were working at first in Emergency Rooms with limited protective equipment caring for people with a disease that we knew little about. Doctors and nurses were also getting ill and dying! Staff would cheer when a patient left the ICU or the hospital, as they rolled down the hall in their wheelchairs.
Cuomo’s daily briefing ended in June of 2020 after over 100 days. Deaths were down to about 25 per day and the number of people hospitalized was just over a thousand, compared with 18,000 at the peak of the pandemic.
In June of 2020 we still had only partial knowledge about the disease, how it was transmitted, how to treat it and how to protect ourselves. There was no vaccine, no effective treatment. Ventilators were in short supply, and it took the supply chain way too long to get ventilators where they were needed. It was a breakthrough to discover that keeping a ventilator patient on their stomach increased survival. Wow! Is that modern medicine?
While New York City was imploding from the virus we had few cases in Central New York. I was working as a physician in a nursing home at the time. We had no cases, zero, as of May 2020. I thought that it was because we were doing such a great job. I wrote the article above just before the pandemic hit us. Within days we had a dozen cases. Frail elderly people seemed to survive the disease for a week, recover, and then die. Others were sent to the hospital when they were too sick for us to manage. They often died or returned to the nursing home in worse condition than when they left.
Our home created a special section walled off by plastic sheeting to keep patients who tested positive for COVID-19. We did our best to provide care while preventing the spread of the disease to other residents or staff.
The State of New York required nursing homes to report cases and deaths every week. Just the reporting requirements kept one member of the staff busy full time. Once tests became available, we had to test everyone repeatedly, staff and patients alike. If one patient on a floor tested positive, everyone on the floor had to be tested again, the patient isolated, their roommate watched closely and quarantined.
Staff were scared, wearing whatever protective equipment they could find in the beginning and trying to follow the ever-changing rules. Was it ok to reuse a mask, for how long, how many times? Do eye shields make a difference? Is handwashing a part of protection? Do I need to clean the stethoscope between patients? Maybe each room needs its own gear. How about trash? There were a thousand questions to answer, and it seemed like the answers changed every day. No one was an expert.
As we watched the pandemic develop from our vantage point in Syracuse, it became apparent that most of our cases came from the outside, from staff. We would go without any cases for a few days or a week, and then a staff member would test positive. We would have to run the entire fire drill, testing everyone they had contacted and begin isolation until we were sure who was infected and who wasn’t.
After a while, we wanted our patients to return to the nursing home from the hospital. It may sound strange, but we knew how to care for our patients. We knew our patients personally, as people, not cases; we cared for them. We knew how to feed them and protect their skin; how to talk with them and interact in a positive way. We knew their families. A COVID-19 patient in the nursing home was less likely to get skin breakdown than the same patient in the hospital. Hospital staff are just too busy, and skin care was not their primary concern.
The decisions Governor Cuomo made concerning COVID-19 during the first few months were made under these extraordinary circumstances. His decision to send COVID-19 patients to nursing homes to free up scarce and valuable hospital beds was not a reckless decision. He depended on nursing homes to figure out how to protect staff and patients from the virus, whether the virus came from outside staff or from hospital transfers. He trusted us and we rose to the occasion. Nursing home deaths in New York State were among the lowest in the nation. There were no excess deaths.
And, notice, most of those who have criticized Governor Cuomo, going back to May 2020 have been non-physicians, often politicians and armchair critics with no medical experience. Criticism was offered before the results were known.
I can’t comment on the allegations of a cover-up, except that there was nothing to cover up. New York had a huge number of deaths from COVID-19 in nursing homes and hospitals, but the numbers were consistent with the size of the population. The per-capita numbers were in the right range for COVID-19, as we learned.
If staff were afraid to release the real numbers, it was partly because it looked bad, and no one understood the meaning of those numbers. It was reasonable to assume that some observers and critics would raise the alarm, as they did anyway.
So, I give Andrew Cuomo a break, at least on the concerns about how New York handled COVID-19. Cuomo was a leader and a hero for us during those 100 days. He deserves credit for what he did, not blame for what he couldn’t know or prevent.
Jef Sneider, MD, FACP
Syracuse, NY
March 19, 2025