COVID-19 Devastated Far Rockaway. Andrew Cuomo Closed One of Their Hospitals.

Over loud community opposition, Cuomo shuttered Peninsula Hospital in 2012.

This week, New York City finally released data on the COVID-19 death toll by zip code. The city’s stark inequality was laid bare. In the zip code encompassing Battery Park City, one of New York’s wealthiest enclaves, there were zero fatalities logged. Poorer, nonwhite communities, meanwhile, were devastated. Starrett City in East New York lost 76 tenants. Immigrant-heavy areas in northern Queens were ravaged.

One of the hardest hit areas of the city has been Far Rockaway in Queens, a close-knit neighborhood with a high concentration of public housing and nursing homes. The east end of the racially segregated Rockaway Peninsula, Far Rockaway is overwhelmingly black, with an Orthodox Jewish community mixed in. Their death rate is staggering: 340 deaths per 100,000 people — nearly twice the citywide average of 175.

In an interview with the excellent news website The City, Donovan Richards, the local councilmember, broke down in tears. “There’s a lot more we could have done earlier,” Richards said.

Many factors contributed to Far Rockaway’s high death rate. Nursing homes and public housing have been particularly hard hit. Lower income residents with preexisting conditions can be more vulnerable to the virus. The poorer you are, the harder it is to social distance—NYCHA residents don’t have backyards, large extra rooms, or Hamptons homes to escape to.

But another factor looms, one that may get more attention in the coming months as more journalists, elected officials, and investigators begin to understand exactly why New York became the global epicenter for the COVID-19 pandemic. In 2012, Governor Andrew Cuomo closed down Peninsula Hospital, one of two hospitals serving Far Rockaway. Today, there is only one: St. John’s Episcopal Hospital.

To date, almost 30,000 people have likely died from coronavirus in New York State. More than 20,000 have died in New York City. As I’ve written before, this death toll is extreme and should not be treated as an inevitability. Less than 100 people, total, have died from COVID-19 in America’s second densest city, San Francisco. New York’s death toll rivals that of entire nations, including Italy and Spain. There is no single, satisfying explanation for this carnage. But Cuomo and New York City Mayor Bill de Blasio, who were tragically slow to impose social distancing measures as the virus spread unabated in New York, deserve blame. In February and March, the crucial months when Cuomo and de Blasio could have planned to contain COVID-19 with earlier shutdown orders, coordination among hospitals, and consistent, science-based messaging, each man failed miserably. New York’s nightmare began with their mismanagement.

Hospital closures have gotten renewed attention in this environment. For the last 20 years, New York State government has been on a crusade to shutter hospitals, which serve as valuable lifelines for low income communities but also cost a lot of money to operate. Beginning with Republican Governor George Pataki in the 2000s, New York closed money-losing hospitals across the state, almost always over vociferous community protest. Pataki appointed an investment banker named Stephen Berger to lead his hospital closure commission. Berger would later join the Cuomo administration, advocating for hospital closures and serving on Cuomo’s first Medicaid-cutting task force. Though they belonged to different parties, Cuomo and Pataki’s approach to healthcare was remarkably similar: shut down expensive, money-losing hospitals to save the state money, even if they were among the only healthcare options for working class and poor neighborhoods.

More hospitals alone could not have staved off mass death in New York City. Once the virus was loose and Cuomo was dithering on whether to impose a shelter in place order—the first COVID-19 case was confirmed on March 1 and the shelter in place order didn’t come until March 22—people were going to die. The question was always: how many? How many lives could have been saved?

New York City was hitting its intensive care unit limit in March. A lack of ICU beds led to deadly crowding at city hospitals. Corpses quickly piled up in trucks outside. New York City, per capita, has among the worst ICU capacities in America. Chicago, Detroit, Fort Lauderdale, Baltimore, Nashville and Las Vegas all have more ICU beds per capita. Across the world, excess hospital capacity likely saved lives. In Germany, where politicians would rail against the high number of hospital beds, the sheer number of hospitals allowed officials to efficiently isolate and treat the infected. “In contrast to Spain, France and Italy, we have a very high density of hospitals and beds, and this has emerged as a big advantage in this crisis,” Uwe Janssens, head of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), told the Financial Times.

Back to Peninsula Hospital: in 2012, Cuomo’s Department of Health approved the closure of the cash-strapped hospital, leaving the entire Rockaway Peninsula with only one hospital, St. John’s Episcopal. At the time, the 173-bed Peninsula had filed for bankruptcy and its lab failed a state exam. The State Department of Health rejected Peninsula’s plan to fix their lab. Without a functioning lab, Peninsula was effectively hamstrung, unable to perform a vast majority of services like blood tests or transfusions. Given that it served a poor, Medicaid-dependent populace, Peninsula did not make money. Under Cuomo, it was doomed.

Though the hospital had a mixed reputation locally, residents aggressively rallied to its defense as the Department of Health readied to shut it down. “As a child, I was raised by my grandma and she’d always take me there when I needed care,” local Iris Delgado told the Queens Chronicle in 2011. “That’s where my children went to the emergency room when they broke their arms and needed stitches. When I was diagnosed with cancer, I had my chemo and surgery there. They were so good to me, holding my hand, making me feel at home.”

What we won’t know is how many lives could have been saved if Peninsula remained open to handle the onslaught of COVID-19 patients in 2020. On March 31, Richards, the local councilmember, warned that the 257-bed St. John’s Episcopal—the Rockaway Peninsula’s lone hospital—was “overwhelmed” and in need of at least 30 ventilators to treat patients. The emergency room at St. John’s, which was last renovated in the 1960s, was designed to serve 15,000 patients a year, but it usually treats double that number, according to the New York Times. In April, St. John’s Episcopal boasted that they had discharged more than 120 coronavirus patients. It’s unclear, though, how many patients died over a lack of capacity—ICU beds or ventilators.

What we can argue, with enough plausibility, is that another hospital on the Rockaway Peninsula would have helped manage the crisis. Municipalities with more hospital beds had more options for treatment, more ways to isolate patients, more chances to offer for the critically ill to survive. Queens itself has lost four hospitals in the last 15 years. Three closed before Cuomo took office. It’s true that hospitals are expensive to operate. It’s true that letting empty, open hospitals sit in a neighborhood can seem counterintuitive in peacetime, when there isn’t a pandemic. But New York City has already weathered a superstorm and a terrorist attack. Catastrophes happen. Cuomo wasn’t ready for this one. We can only hope we are better prepared for whatever comes next.