Video, Audio, Photos & Rush Transcript: Governor Cuomo Directs State Department of Health to Begin Implementing 'Surge & Flex' Hospital Protocol

Governor Andrew M. Cuomo today directed the New York State Department of Health to begin implementing the state's "surge and flex" protocol and mandate all hospitals begin expanding their bed capacity by 25 percent to further prepare hospitals for a future COVID-19 surge. Hospitals had previously been preparing plans for this action as part of New York's Winter COVID Plan. Additionally, the Governor issued a call to all retired doctors and nurses urging them to return to service if they are able to do so. A registration will be renewed at no cost for an individual who completes the questionnaire through the volunteer portal, set up by the state Department of Health.

The Governor also announced that regions that reach critical hospital capacity will be designated as a Red Zone under New York's micro-cluster strategy. Specifically, following the implementation of the state's "surge and flex" program, if a region's 7-day average hospitalization growth rate shows that the region will reach 90 percent within the next three weeks, the region will become a Red Zone.

Finally, following updated guidance from the CDC, the Governor announced that if a region's hospitalization rate does not stabilize in the next five days, additional restrictions will be applied to indoor dining. If the hospitalization rate does not stabilize in New York City in the next five days, indoor dining will be suspended; if the rate does not stabilize in regions outside New York City, capacity restrictions will be reduced to 25 percent.

VIDEO of the Governor's remarks is available on YouTube here and in TV quality (h.264, mp4) format here.

AUDIO of today's remarks is available here.

PHOTOS are available on the Governor's Flickr page.

A rush transcript of the Governor's remarks is available below:

Good morning, everybody. I hope everybody had a good weekend or as good of a weekend as you can have in these circumstances. Today is only day 282. Think of it that way, "Well this has been going on a long time." It's only been going on 282. Glass half full, glass half empty.

I want to thank New Yorkers and all the people who gave me great birthday wishes. My birthday was yesterday. People were curious. I'm 39 years old, again, I'm just going to repeat that number 39. I like it so I'm going to sit on that for a while, but I had as great a birthday as you can have in this new normal. My daughters came up, it was all great. The dog gave me a bone.

We have a special guest with us today, Dr. Anthony Fauci. Dr. Fauci who I like to call America's doctor. He was probably the singular voice, in my opinion, as a medical professional who offered guidance and facts and clarity to people all through this, countrywide and worldwide. He always stuck to the science. He always stuck to the facts. He was clear when it was difficult news. He offered the facts. He did it in a way that was calming, but was truthful, and that's a hard balance, but he did that extraordinarily well. He's also been very kind to me. I've spoken to the doctor many, many times throughout this situation and he's given me great advice and great guidance. He was also very helpful to New Yorkers on a personal level. He was very helpful to my brother Chris when he got COVID early on. He gave him good advice, but the doctor has been a great, great friend to New York. I'm just worried about when the doctor sends us the bill for all the consultation that he gave us, but you know what doctor maybe you could take - just to ease bookkeeping - you take the Cuomo consultations, me and my brother, put them together on Chris's bill. Send Chris the bill, he's a very generous person my brother Chris. So I'm sure that will be fine with him, doctor.

Let me give you a sense of where we are and give you the facts today and then I'd like to ask you a couple of questions to get your advice on where we go forward as this situation changes. Our positivity rate today without what we call micro-clusters, micro-clusters are the high problem areas in our state, which we have localized, and we have special strategies in them. And they have a higher percentage rate than the rest of the state. They're small zones, but there are intense positivities. Statewide, without those zones, we're at 4.2. If you add those zones in, we're at 4.7. The positivity in those high intensity zones is 6.5.

We did 152,000 tests yesterday. Sunday tends to be our lower testing day, but we still did 152,000 tests. Eighty New Yorkers passed away. They're in our thoughts and prayers. 160 additional hospitalizations, 22 ICUl, and 13 intubations. Our rate of transmission, we estimate at about 1.2 now. When you look across the state, you see a very varied picture. This is the number of people who are hospitalized and we look at the percent of the population that is hospitalized.

For example, the highest percent of hospitalization is actually upstate. Finger Lakes, that's Monroe, Rochester area. Buffalo, Western New York, Central New York - you come down to New York City, Long Island, we actually have a lower rate hospitalized than upstate, which is an exact flip of where we were in the spring. Spring, we had a largely downstate situation and upstate the situation was much better.

New York State, we've done a couple of things that are different than other states. In New York, the state sets all the policies on close down. The state keeps numbers that are determinative of the policies. We don't do it on a county or a city level. This, to me, avoids what I call the hodgepodge effect. Hodgepodge is a technical, medical term that we have here in New York. We also apply it to government. Hodgepodge, just a dis-coordinated mess. It also reduces forum shopping.

When you see states where one county is open, one county is closed, you want to go to dinner, you go to the neighboring county. You want to go get a haircut, you go to the neighboring county, which only increases the number of people traveling which is exactly what you don't want to do. It reduces the confusion. We're also then taking it to the next level. We try to coordinate with surrounding states. If I'm going to close restaurants, I try to coordinate it with New Jersey and Connecticut, et cetera. If I close a restaurant, but you live in Brooklyn and you can drive to New Jersey, then all I did was increase the traffic in New Jersey. It's not a perfect coordination, but in lieu of a national set of firm guidelines, which is frankly what I would have liked to see, we have come up with a regional compact of guidelines.

We have been very transparent with New Yorkers. We have websites, I give them numbers every day. I wanted them to hear the facts. If anything, I've been accused of being overly communicative, especially at home. But, the more facts people know, I think, the better. And we have been religious about following the data and the science. We do more testing than any state in the United States by far. We have more data points by far, and we rely on the data, and it's not anecdotal, it's not political, it's not an opinion. And we also started something called the Surge and Flex public health system management, which is something we're going to be implementing in an increased way today. Surge and Flex is not the most creative name, but what it says is we "surge" and we "flex" the hospital system in this state. We start with 54,000 hospital beds statewide. We can then mandate by the Department of Health, Dr. Howard Zucker to my left, Jim Malatras to his left, Gareth Rhodes to my far right, Melissa DeRosa to my right. You know Dr. Zucker and Melissa, you've worked with them, but Dr. Zucker can order a 50 percent increase in beds, which we've done before. Dr. Zucker can order no elective surgeries, which we have done before. And we can create field hospital beds, which we've done before and we can create several thousand field hospital beds. So, when you look at our hospital capacity, we start with 54,000 beds and you can increase it by 50 percent, it takes you to 75,000 total bed capacity. Roughly 35,000 of those beds are now occupied. If you cancel elective surgery, we estimate that you reduce the number of occupied beds by about half. That takes us to a total system capacity of about 58,000 beds for COVID patients. Today, we have 4,600 hospitalized, so that gives you a range of the capacity for the system. We can also add 5,000 additional field hospital beds. That would be, from my point of view, the last resource. We did that, the Jacob Javits Center for example, we did 2,000 beds. Dr. Fauci, it looked like a field hospital and an army. You just saw an ocean of cots. And I just hope we never have to get to that point.

Today, the Department of Health is going to issue an order saying hospitals have to increase their bed capacity 25 percent. They can, we can issue up to 50 percent, they can do that physically, but we're only going to go to 25 percent because we don't have a capacity criticality at this moment. We are aware of staff resources. The staff comes into this stressed, right. They had, you want to talk about a long year, nurses, doctors, hospital workers, 1199, they had the longest year of anyone. So they come into this stressed. We're going to ask retired doctors and nurses to sign up and we will automatically reregister them in the state without cost. We believe we can get about another 20,000 nurses and doctors from this mechanism.

And then the flex on the surge and flex is we have 215 hospitals. What happened in the Spring, interestingly, was not that the system was overwhelmed, individual hospitals got overwhelmed. And the individual hospitals did not have the capacity to balance patients. Frankly, this was an education for me. So you have public hospital systems. And let's say you have a public hospital system that had 10 hospitals. One hospital gets overwhelmed. They did not have the capacity to balance those patients among their other nine hospitals, right. So even in the public systems, before somebody walked into one hospital that was already overburdened, they didn't' say "hold on, I'm going to put you in an ambulance and drive you to my sister hospital that has less volume."

What our flex says is, those hospitals have to flex patient load and share it first within their system. We also shift patient load among private hospitals, which was, frankly, more unorthodox, right? You could go to NYU Langone, you think you're going to NYU Langone, what we say in the flex is, if NYU Langone is filled or at capacity, we're going to transfer you to Mount Sinai or another hospital. And then we actually have the capacity to shift between public and private systems. None of this has been done before. It was highly disruptive for the hospital management system, but we started it in the spring, it went fine enough, and we now have had more experience in it. We've started the Flex management system, where every night we get an inventory from every hospital doctor, how many patients do you have, how many ICU beds do you have, what capacity do you have, and we do that on a daily basis.

If our hospital capacity becomes critical we're going to close down that region, period. We call closedown a red zone. What is critical hospital capacity? Our formula is if your seven-day average shows that within three weeks you will hit critical hospital capacity, we close you down. So if your seven-day average says if that continues for three weeks, you're going to hit critical capacity, we close you down. We want that three-week buffer and then we call critical 90 percent of your hospital capacity, so a little complicated. If your seven-day average says if it continues for three weeks, you're going to hit 90 percent of your hospital capacity, close down.

CDC changed their guidance on Friday. Some have been critical about the changing guidance from CDC. I'm not. I believe as the facts change your opinion changes. As the facts change your strategy should change. I don't have a problem with that but they offered additional guidance on indoor dining especially and we're going to follow their guidance. If after five days we haven't seen a stabilization in a region's hospital rate, we're going to clamp down on indoor dining. Five days, if the hospitalization rate doesn't stabilize in New York City, we're going to close indoor dining. We're now at 25 percent in New York City. In the rest of the state, any region where the hospitalization rate doesn't stabilize - they're now at 50 percent capacity indoor dining - we're going to go to 25 percent. We have zones that are called orange zones where it's already closed. That wouldn't apply here. Bottom line for us: I see it as hospital capacity versus vaccination critical mass. I think that's the ultimate bottom line. Can your hospitals handle the increase until you start to see a reduction from the vaccinations? On the hospital capacity, do everything you can do to slow the spread and then at the same time, accelerate the vaccines. The frustrations we're seeing here — we estimate over 70 percent of the spread is coming from small gatherings and that's a problem. We're going to go through the holiday season. I think there's going to be more small gatherings. I've been talking until I'm blue in the face about the apparent safety of being at home, the apparent safety of being with your family, but that can be misleading. Your brother, your sister, your mother can love you, but they can still infect you. I know you think you're sitting in your living room and you're safe, but your living room is not really a safe zone. This isn't a political question. Trump's CDC and the Biden advisors all agree on the small gathering guidance, but it's about personal responsibility and community concern and I'm telling you, compliance is a major issue for us here. I'm also frustrated that we see polls that suggest a high percent of Americans are not ready to take this vaccine, 49 percent nationwide. Bigger problem in the black community: 57 percent say they're not ready to take the vaccine, but 75 percent to 80 percent needs to be vaccinated to hit critical mass on the vaccination and that's a problem. If you have 50 percent saying "I'm not taking it," but we have to hit 75 to 80.

The good news is New York still has one of the lowest positivity rates in the nation. Only Maine, Vermont, Hawaii are lower than we are and Maine, Vermont, Hawaii — beautiful states — but different than New York. They don't have the cities, they don't have the density, et cetera. So, for us to be down that low, is really good news. As a matter of fact, our worst region — our highest region in terms of positivity — is still lower than 41 states, so it's tricky because relative to everyone else, we're doing well. But the real question is, it's not a relative contest at the end of the day, it's how you're doing in your state.

So to recap, we're going to monitor the hospital capacity, if it doesn't stabilize, we're going to reduce the indoor dining restrictions, we go to zero New York [City], 25 percent everywhere else.

We close down if you hit critical hospital capacity. We're implementing the Surge and Flex. We're going to add 25 percent additional hospital beds. We'll renew the registration for nurses and doctors to get us a backup staff pool, continue to caution on the small spread and at the same time, we are gearing up to have the most efficient, most effective, most fair vaccination program in the country, reaching out to the black community, Latinos, undocumented, to make sure that it's fair.

So, a couple of questions for you Dr. Fauci. That's what we're doing in general, your opinion has always been valuable to us. The holiday spread, I think it continues through Christmas, Hanukkah, et cetera. I'm trying to guess, and I know it is a guess, when we could see the peak of this holiday spread? Is it after New Year's? Is it mid-January? Do you have any guess, an educated point about that? And again, thank you very, very much for being with us.

Dr. Fauci: Thank you very much for giving me the opportunity to listen to what I found to be a very interesting plan that you have for New York. It seems really sound, and you have a lot of backup contingencies, which I like so you're not going to get caught shorthanded on this, I'm certain. So, thank you for that.

In regard to the issue of the holiday spread and the peaks, they are going to be superimposed on each other. So, you would expect the full brunt of the travel and family setting gatherings with friends that you alluded to as a problem, you would expect the effect of the Thanksgiving surge in probably another week and a half from now. It's usually two weeks from the time of the event. The problem is, that's going to come right up to the beginning of the Christmas and Hanukkah potential surge. So, you have a surge upon a surge, and then before you can handle that, more people are going to travel over Christmas, they're going to have more of those family and friend gatherings that you accurately said are an issue.

So, if those two things happen and we don't mitigate well and we don't listen to the public health measures that we need to follow, then we could start the seeing things get really get bad in the middle of January. So, I think not only for New York State but for any state or city that is facing similar problems, without substantial mitigation, the middle of January can be a really dark time for us, but as you said in your presentation coming up there were some things that we can do to mitigate against that. I think particularly the appreciation that it's such a natural thing to think when I have family over, eating and drinking and you don't realize that there may be somebody that you know, that you love, that's a friend, that's a family member, who is perfectly well with no symptoms and yet they got infected in the community and brought it into that small gathering that you're now having in your home. So, that's the reason why I want to underscore what you said, that's one of the issues, but bottom line for your first question, mid-January is probably going to be a bad time.

Governor Cuomo: The small spread, family spread, living room spread - we call it living room spread here - like 16 states have done an order of no more than 10 in a home. The CDC guidance, that's President Trump's CDC, says no more than 10. Some states have gone to no more than 8. Compliance is very low on that. Do you think that is a sound rule, the no more than 10 in a home?

Dr. Fauci:Governor, I think that's a very sound rule and I feel 10 may even be a bit too much. It's not only the number, Governor, but it's the people that may be coming in from out of town. You mentioned in your presentation that you don't want somebody who's from New York who wants to go to a restaurant that's closed in New York, they go to New Jersey and then they come back. They travel back and forth in addition to the number of people in a home for a gathering or a social setting.

You want to make sure you don't get people who just got off an airport or a plane or a train and came in from Florida or came in from wherever. That's even more risky than the absolute number. Not only the number of 10 seems reasonable, but make sure that when people come in, that they're not people who have no idea where they've been or who they've been exposed to. You want to be friendly, you want to be collegial, but you really got to be careful about that.

Governor Cuomo:You're so right, doctor. The practical implications are so difficult. As I mentioned, I had a birthday yesterday. One of my daughters who wasn't with me wanted to come up. She had to quarantine before she could come to my birthday. So, you want to go travel and see someone, it's not just that weekend, it's the whole quarantining process before. In this state, we have very strict regulations of when you come in and what you have to do.

On the vaccinations, looking ahead, 75-80 percent is going to be very hard to reach. New Yorkers are tuned in and we're going to be very aggressive on public education, outreach, et cetera. But what does your crystal ball say? When is 75-80 even feasible? You know, I hear anywhere from May, June, July, August, September. What would you guess there? Which is when it's really over, right, when the vaccination hits critical mass.

Dr. Fauci: Yeah, when you have 75 to 80 percent of the people vaccinated, you have an umbrella of protection over the community that the level of community spread will be really, really very low. The virus will not have any place to go. It's almost metaphorically, if you think the virus is looking for some victims, when most of the people are protected the virus has a hard time latching on to someone. When that happens, Governor, is going to be entirely dependent upon how well we do, how well I do, you do, your health officials, in getting the message out of why it's so important for people to get vaccinated, because if 50 percent of the people get vaccinated, then we don't have that umbrella of immunity over us.

But let's say it works out well, let me answer your question specifically, and we do a really good job of convincing people between now and the end of December, you'd likely get a substantial proportion of healthcare providers and people in your nursing homes. As you get into January, you'll get the second level, and then February, the third. I would think by the time you get to the beginning of April, you'll start getting people who have no high priority, just a normal man and woman New Yorker on the street who's well, has no underlying conditions. If we get them vaccinated in a full court press, get them really going, and you do that through April, May and June, by the time you get to the summer - because remember it's a prime boost, which means you get vaccinated today, you get a boost 28 days from now, and then seven to 10 days following that, you're optimally protected. Even though you could get some protection even after the first shot, but optimally it's within seven to 10 days following the second shot. If we do that well, by the time we get into the core of the summer and get to the end of the summer and into the start of the third quarter of 2021, we should be in good shape. That's what I'm hoping for, and that's the reason why it's so important to extend ourselves out to the community, particularly to the Black, African-American, Latino, the people who are undocumented, the people who we really need to get vaccinated.

Governor Cuomo: Well doctor, I couldn't agree with you more on that. I'm pushing the Congress right now. New York, look, I think it would be discriminatory not to understand the situation that exists with the Black and Latino population, who, by the way, had- Blacks had twice the death rate of whites, Latinos had one and a half times the death rate of whites. Higher infection rate, higher percentage of essential workers. We're going to need a whole effort just to educate, and outreach, and get into public housing, and communicate with their communities, because otherwise, they're not going to flock to the local Walmart or K-Mart or Walgreens to take this vaccine. I think we're going to need an affirmative effort to do that.

Let me ask you this, our school positivity rate is amazingly low. Even in communities that have higher spread, we're seeing much, much lower infection rates in schools. It's almost a universal statement that the school is the safest place to be in the community. Does that surprise you?

Dr. Fauci: You know, it originally did surprise me because we were always concerned, if you look at the influenza model, the issue is the kids are in school, they get infected, they come home and they infect their parents and their relatives. We're not finding that with this coronavirus. In fact, to our, I think, real positive spinoff of this is the realization that schools appear to be a place where the positivity rate just like you all are seeing it in New York, the whole state including New York City, you're not alone. We're seeing that in other parts of the country that the test positivity rate is actually really low which is really a good thing which is one of the reasons why when we were talking about what the best strategy would be we would say something like close the bars, keep the schools open is the best thing to do, so long as you subsidize and help the restauranteurs and the bar owners so that they don't go down and essentially crash because of the economic strain. But if we can keep those things under control, subsidize those people, as well as keep the schools open, we'd be in good shape.

Governor Cuomo: And I think you're exactly right. The CDC says more restrictions on indoor dining which I understand, and again, changing positions when facts change is intelligent. People say, well, remain consistent. I'm not going to be consistent when the facts are inconsistent and if I see a different situation I'm going to change my opinion. But the Congress, Washington, also has to understand those bars, those restaurants, they need financial assistance because this has been a long year and they have bills to pay so you can't tell them we have to close you down without saying here is the economic reality and we're going to help.

Dr. Fauci: Absolutely.

Governor Cuomo: On the question of this state's infection rate versus other states, we're lower than all states besides Vermont, Maine, Hawaii - does that surprise you and how do you explain that?

Dr. Fauci: You know, I have to say, being a New Yorker, Governor, it doesn't surprise me. You guys, as you and I have discussed on many phone calls that we've had, you got hit with a sucker punch right from the beginning when the cases came in from Europe and the Northeastern corridor, particularly New York State, particularly the metropolitan area got hit really, really badly. You recovered from that - was after you got hit badly, your baseline level went way, way down and very, very low, and then you did things which were the appropriate way to avoid getting, resurging. So the bad news and it's painful for me to see it from a distance to my place of birth, but you guys got really slammed and then you rebounded. And you rebounded in a way that you kept your test positivity low because you did the prudent things that you need to do. I was following it from here in Washington and I was seeing that whenever it looked like things were getting a little out of hand, you'd tighten the rope a little bit and then when things went back, you eased up a little bit. So I'm not surprised that your infection rate is really low because I think you were doing the right things after you had a really serious hit in the beginning when you were there in the late-winter, early-spring.

Governor Cuomo: Doctor, on this education of the population — on both the small spreads and even more the vaccine, take the vaccine it's safe — I think that's going to be difficult to do. I think you have tremendous credibility, not just across the country but across this state and I think your voice on saying that the vaccines are safe would be important. I said that as soon as the vaccine is deemed ready and safe, I'll be the first one to take a vaccine. Maybe we enlist you, I'll do it with you — we'll do an ad telling New Yorkers it's safe to take the vaccine, to you know, put us together. We're like the modern-day DeNiro and Pacino. You can be whichever one you want. You can be the De Niro or Pacino. Fauci and Cuomo. Who do you want to be: De Niro or Pacino? Which one do you want to be?

Dr. Fauci: I love them both. I love them both. I don't want to insult one or the other. If I say one, I don't want to hurt the feelings of the other, so either one.

Governor Cuomo: Yeah. Who's the politician? Alright, last question. I know you're down in Washington, you're doing great duty, but I know you miss New York. What — we want to figure out what to send you for Christmas — what food do you miss the most that you can't get down there that you could get if you were back here in New York in Brooklyn?

Dr. Fauci: You know, Governor. Whenever I need some comfort food and I dream back on my days in the Bensonhurst section of Brooklyn, the thing that comes to my mind are two things: a nice Nathan's hot dog and a really steaming pastrami sandwich. That would be really great.

Governor Cuomo: Alright, so no cannoli, no meatballs? Nathan's hot dog.

Dr. Fauci: I don't want to overdo it. I don't want to overstay my welcome. I'll take them all.

Governor Cuomo: Alright done. Doctor, thank you so much for everything you've done for this country. God bless you. God bless you.

Dr. Fauci: Thank you very much, Governor.

Governor Cuomo: You know, this was a moment we really got to see what people were made of. When the pressure's on, you see the weaknesses and you see the strength — and the pressure was on and it forged you into a rock that really stabilized this nation, so God bless you for what you did, doctor. And I know what to get you for Christmas. Send the bill to Christopher. Thank you very much. God bless you, doctor. Be safe.

Dr. Fauci: You too, Governor, and thanks an awful lot. Appreciate it.