The newly released study of New York’s coronavirus pandemic response falls far short of what Governor Hochul promised – and the state urgently needs – in the aftermath of its worst natural disaster in modern history.

Hochul had commissioned a $4.3 million after-action review of the crisis, saying she wanted it to cover “the good, the bad and the ugly” and bolster the state’s preparedness for future outbreaks. 

Yet the 262-page report from the Olson Group, a Virginia-based consulting firm, turns out to be thinly researched, poorly argued, ill-informed, sloppily presented and marred by obvious errors.

Although many of its findings ring true, it glosses over or ignores some of the state’s most questionable actions – such as ordering thousands of Covid-positive patients into nursing homes.

It looks especially weak in comparison to a similar review prepared for the state of New Jersey, which 648 pages longer – and far more detailed, authoritative and clearly written.

Hochul should declare the Olson Group’s work unacceptable, demand a refund and launch a real after-action review – by joining with Legislature to establish an independent pandemic response commission.

Thin research

The Olson Group study’s shortcomings start with its research. By the authors’ own account, their primary source of information was the commentary of stakeholders within New York, gathered through targeted surveys, interviews and “town hall-style listening sessions.” 

The firm also compiled thousands of documents issued by various state agencies, including “leadership intelligence reports” prepared on a daily basis by the governor’s office.

Anecdotes and official documents are necessary and useful, but the research is lacking on other fronts.

The authors could have consulted experts with a national or international perspective – but they make no mention of doing so.

They provide no new data or fresh analysis of existing data. They make little effort to compare New York’s performance with those of other states or countries. They do not identify the best practices that have emerged with the benefit of hindsight. 

The authors often give former Governor Andrew Cuomo and other officials credit for being proactive without carefully measuring the real-world impact of their decisions – a crucial step in weighing costs and benefits.

Another missing element is hard numbers. The report refers to various programs as being underfunded without giving the dollar amounts or putting their finances in context. It discusses school closures without quantifying the impact in terms of infection rates or lower test scores.

Instead, the report relies heavily on anonymous quotes – without always specifying the commenters’ roles or level of expertise.

The authors acknowledge that “a number of key officials were unwilling to participate” due to “concerns about possible litigation and other legal actions” which “has undoubtedly resulted in some gaps in the record.” These officials, too, are unnamed – making it unclear who Olson did and did not speak to.

Their choice of people to consult also raises questions. Why did they survey the Commission on Judicial Ethics but not the comptroller’s office or either house of the Legislature? Why did they hold just one town hall each for the hospital and nursing home industries, with a total of 20 participants, when the health and human services sector had three town halls with 112 participants?

A flawed narrative

The Olson Group’s account of New York’s first wave appears to be largely based on what officials thought was happening at the time – which we know in retrospect was wrong in important ways.

Although the state did not confirm its first Covid case until March 1, 2020, it’s now clear that the virus arrived in New York in late January or early February of that year and had been spreading for weeks undetected. 

 

 

Because testing was initially scarce and then ramped up quickly, it appeared that the state’s infection rate was surging through late March into early April. In fact, it likely peaked in mid-March.

The report fails to confront the implications of these revelations – which indicate that officials were too nonchalant in February, but overreacted in late March and April. Nor does the Olson Group lay out a clear plan for improving public health surveillance so that the state is not similarly blindsided in a future pandemic.

Sloppiness and mistakes

The report’s credibility is undermined by factual errors and other mistakes. Some appear to be the result of sloppiness, but others point to deeper misunderstanding of the subject matter.

For example:

  • On p. 11, the report refers to businesses seeking proof of vaccination as part of the reopening process in May of 2020 when vaccines did not become available until December 2020.
  • On p. 28, the report includes two charts that were copied from the Empire Center’s website without attribution.
  • On p. 36, a paragraph headed “Covid-19 mental wellness resources” – which actually talks about sewage testing – is printed twice in a row.
  • On p. 63, the report says the Health Department’s underreporting of nursing homes was the result of “adherence to state law requiring that deaths in NYS be reported based on where the decedent expires, not where they became ill or injured.” There is no law or requirement that would have prohibited the Health Department from tallying nursing home residents who died in hospitals.
  • On p. 67, the report asserts that the state comptroller’s office “is not required to consult with the agencies it is auditing” and failed to do so regarding an audit of Health Department nursing home policies. In fact, the audit in question included a 14-page response from the Health Department, and the comptroller’s office has detailed its extensive consultation with department officials.
  • From p. 241 to p. 257, the report devotes 16 pages to list the dates and file names of “leaders’ intelligence reports” that are of no value without links to the reports themselves.
  • On p. 260, a chart of “daily deaths” shows a spike in the fall of 2021 that does not show up in other publicly available data

Missing topics

The report passes over a number of seemingly relevant issues, including several high-profile scandals related to the pandemic response.

The authors do not explain these omissions, leaving the public to wonder whether they were the result of political interference or oversights by the Olson Group.

Among the topics left out:

  • The need to obtain FDA approval before state’s Wadsworth Laboratories could use their own test kits, which delayed the launch of widespread testing early in the crisis.
  • The discovery in April 2020 that turning critically ill patients on their stomachs, known as “proning,” was in some cases safer and more effective than putting them on ventilators.
  • Repeated instances in which Governor Cuomo publicly clashed with New York City Mayor Bill de Blasio over pandemic policy and sometimes overruled their orders.
  • The use of state resources and personnel to provide expedited Covid testing to friends and relatives of the governor and other high-ranking officials at a time when testing was otherwise scarce.
  • The neglected condition of the state’s pandemic stockpile, which was full of masks, gowns, ventilators and other supplies that were in many cases years beyond their expiration dates.
  • The altering of a July 2020 Health Department report on the pandemic in nursing homes, which was rewritten by the governor’s office to lower the number of reported deaths by almost 3,000, or 31 percent. 
  • The governor’s decision to publish a memoir in the midst of the crisis, which involved the use of state personnel and resources and brought him a fee of $5.2 million.
  • The Hochul administration’s award of a lucrative home-test contract to a company owned by campaign donors that was charging unusually high prices.

Questionable conclusions

Many of the report’s conclusions seem reasonable, but the authors fail to back them up with enough evidence and detail to provide a useful guide for policymakers.

In one of their central findings, for example, the authors fault Cuomo for taking an excessively top-down approach to managing the crisis and sidelining various state and local agencies that could have played a larger role: 

Governor Cuomo’s decision to center the State’s response in the Executive Chamber and, more specifically, in his office was a significant and unnecessary mistake. The structures developed through hard-won experience from events including 9/11 and Hurricane Sandy were largely ignored and the State’s chief executive office served as the central point of the response.

Yet this conclusion seems to be largely based on comments from other officials involved, some of whom were among those he sidelined. The report does not cite specific lessons from 9/11 or Hurricane Sandy that were being ignored.

Its main example of Cuomo failing to use available structures relates to the vaccine roll-out, which he assigned to hospitals rather than the county governments that had specially prepared for that task. The argument about over-centralized control would be more persuasive if the report went into more detail about its downsides.

Another weak point is the report’s analysis of the much-debated March 25, 2020, order mandating nursing homes to admit Covid-positive patients being discharged from hospitals.

The report gives a garbled, incomplete account of the events surrounding the order and comes to a generally supportive conclusion:

The State is required by virtue of the applicable federal standards to have planning and processes in place to execute medical surge strategies to preserve the capacity to provide life-saving clinical care. It is also obligated to ensure that people are not discriminated against due to their health conditions. The policy to admit or return COVID-19 patients to nursing homes following hospital admission was an attempt to accomplish both standard public health disaster practices. 

That analysis ignores key considerations:

  • The policy was based on exaggerated projections of hospital crowding that never came to pass.
  • Alternative sites were available, such as the temporary hospital at the Javits Convention Center, but they went largely unused.
  • Nursing homes received no warning before the March 25 mandate was issued.
  • Officials failed to emphasize the need for precautions in handling the admissions – or that facilities had the option of turning them down.
  • The policy applied statewide even though the crisis was concentrated in New York City.
  • The policy remained in place until early May even though hospital demand peaked in mid-April.

These are the type of details that a proper after-action review should itemize – not to shame past officials for mistakes, but to help future officials avoid repeating them.

Legislation to establish an independent pandemic response commission has been introduced in both the Assembly and Senate. Despite high-level negotiations in the closing days of the legislative session, it has not yet been approved by either house.

Lawmakers should pass that bill at their earliest opportunity – because the 83,000 New Yorkers who died deserve better from the state’s leadership than a shoddy consultant’s report.

 

About the Author

Bill Hammond

As the Empire Center’s senior fellow for health policy, Bill Hammond tracks fast-moving developments in New York’s massive health care industry, with a focus on how decisions made in Albany and Washington affect the well-being of patients, providers, taxpayers and the state’s economy.

Read more by Bill Hammond

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