It seems like NYC is finally getting around to surveillance. We did some work for the state earlier in April but they were unconvinced by our data which showed that based in ILI reported in hospitals (3x normal March rates) and rates among routine testing for women delivering in hospitals in early March, the prevalence was much higher than officials had thought when we went into lockdown. We also have some pretty compelling data from NYC that, because we had significant prevalence already, lockdown likely exacerbated the spike (e.g. spiked rather than flattened the curve) by putting shedding asymptotic or mildly symptomatic with people with vulnerabilities in multigenerational housing. The reaction by the Governor’s office COVID task force lead, Mike Schmidt, was “compelling but what if we release lockdown and someone dies?” Hard to move forward if no-death ever is is the endpoint. But that is very much the US and how we view health. Finally, we know that the case fatality rate (CFR) can be an indicator of the strength of health systems. It seems ours in NYC is even weaker than we had understood previously and at least in part why CFR has been so high. Perhaps even bleaker than how we have responded to COVID is the reality of how many people have lost their jobs. As a city, we were on the brink of bankruptcy before COVID and it does not seem like most businesses small and large will be able to recover. So the social determinants of poor health will kick in soon with a vengeance. As will lack of utilization of other services.