Missed Opportunities: How NYC’s Health Department Failed to Detect COVID-19 Early

The COVID-19 pandemic exposed significant gaps in the preparedness and response of public health systems worldwide. In New York City, one of the hardest-hit places in the world, the failure to detect the virus early enough may have cost countless lives. According to Don Weiss, a former surveillance director at the NYC Department of Health, the city’s Health Department missed critical opportunities to identify and contain the spread of COVID-19 in its early stages. Weiss, who monitored the situation closely from the ground, attributes this failure to the department’s strict adherence to rigid testing guidelines set by the Centers for Disease Control and Prevention (CDC). By following these guidelines, the city delayed confirming the presence and transmission of the virus by over a month, allowing the infection to spread unchecked.

The CDC’s Narrow Testing Criteria: A Barrier to Early Detection

In early 2020, the CDC’s testing criteria were overly restrictive, limiting COVID-19 tests to individuals who had recently traveled to Wuhan, China, or other overseas hotspots, exhibited severe lower respiratory symptoms, or had direct exposure to a confirmed case. Weiss, who directed the city’s surveillance unit for 22 years, explains that these criteria excluded many New Yorkers who were experiencing mild, flu-like symptoms from being tested. As a result, countless individuals who were infected with COVID-19 but did not meet the CDC’s strict criteria went undiagnosed. This meant they were not only unaware of their infection but also continued to spread the virus to others, including vulnerable populations such as the elderly, immunocompromised individuals, and those with pre-existing conditions.

The Consequences of Delayed Testing

The delay in testing had dire consequences. By the time the first COVID-19 case was officially confirmed in NYC on March 1, 2020, the virus had already been circulating in the city for over a month. Weiss estimates that nearly 240 suspected cases were reported to the Health Department before this official confirmation, but many of these were not tested due to the CDC’s narrow criteria. The lack of early detection impaired the public health response, allowing community transmission to establish itself before measures such as quarantine, mask-wearing, and contact tracing could be effectively implemented. Weiss fears that this delay may have cost lives, as earlier intervention could have prevented the virus from spreading so rapidly and overwhelmingly.

Frustration and Inaction: The Experience of Health Officials

Weiss and his team were acutely aware of the risks of not expanding testing to include individuals with mild symptoms. They pushed for a more inclusive testing strategy that would allow the city to identify cases earlier and launch a public health campaign to contain the spread. However, their efforts were met with resistance from higher-ups in the Health Department, who insisted on sticking to the CDC’s guidelines. Weiss describes the frustration of being “wedged between the suspicion of cases and the inability to test them.” He recalls sending emails to colleagues urging a departure from the CDC’s rigid criteria, but these appeals fell on deaf ears. The inaction was particularly galling given the growing evidence that the virus was spreading in the city.

The Human Cost of Missed Detection

One particularly poignant example of the consequences of delayed testing was the case of a Brooklyn ride-share driver who fell ill in late January 2020. The man, who was in his late 40s and had underlying health conditions, was hospitalized and placed on a ventilator after testing negative for influenza and RSV. Despite his exposure to travelers, he was not tested for COVID-19 because he did not meet the CDC’s criteria at the time. Weiss was among those who advocated for testing the patient, but his efforts were overruled. The man later tested positive for COVID-19 and tragically died in May 2021 due to complications from the virus. His case highlights the human cost of the Health Department’s failure to act decisively in the early days of the pandemic.

A Critical Reflection on Leadership and Response

Weiss’s book also offers a scathing critique of the leadership of then-Mayor Bill de Blasio and the broader public health response in NYC. He expresses outrage over de Blasio’s handling of a COVID-19 case involving a child in the Bronx, where the mayor revealed enough personal details about the child to identify them. The child subsequently faced abuse from classmates and the community, prompting health officials to vow greater discretion in the future. Weiss also criticizes the city’s contact tracing efforts, calling them ineffective and arguing that the resources devoted to screening students in schools were misused. He acknowledges that experimenting with different strategies during a pandemic is reasonable, but he faults the city for clinging to ineffective approaches long after their limitations became clear.

Learning From the Past: A Call for Balance

Weiss’s account is not just a critique of the past but also a call to action for the future. He emphasizes the need for a more balanced approach to public health crises, one that protects individual freedoms while safeguarding the community. This includes being more flexible in response to emerging threats and willing to challenge rigid guidelines when they no longer serve the public interest. As the city continues to grapple with the aftermath of the pandemic, with over 46,000 deaths and millions of cases recorded, Weiss’s reflections serve as a reminder of the importance of preparedness, adaptability, and leadership in times of crisis. His story is a sobering reminder of the human cost of inaction and the need for a more nuanced approach to public health.