New York has always been two cities: those who have enough, those who do not.  It is densely populated, so at the onset of the Covid19 pandemic in the U.S., New York became the epicenter;  in effect, the nation’s petri dish.

At New York’s peak, the lab data roughed out a picture of disparity.  Manhattan did not sustain the number of infections and fatalities being registered in Bronx, Brooklyn, and Queens.  Manhattan is dominated by private hospitals, and the outer boroughs, particularly for indigent patients, are served by public hospitals.

Public and private hospitals are distinguished in part by the ratio of staff to patient.  Public hospitals are government-funded. The government cannot afford the staff size of private hospitals, funded by philanthropy, and capital  markets and other for-profit practices.

The New York Times recently published the results of its reporting on the pandemic in New York during March and April.  The report described the situation in a public hospital such as Elmhurst, one of those hit hardest .  There were more Covid19 patients than could be handled adequately by staffing.   A nursing ratio in a private hospital might by 4 patients to a nurse. In the public hospital, the ratio could be as high as 9 to 1.  Doctors, nurses and aides were overwhelmed by the sheer volume of patients.  It turned out that ventilators were not the answer. As understanding of the disease increased, patient monitoring and care became  crucial factors in treatment and life-saving measures.

The Big Apple has come a long way in its battle of Covid19.  For the moment, the infection rate in New York has dropped. The 11th of July was  the first day since March that no Covid-related deaths were reported in New York. At the same time, the virus is raging in the south and southwest, with infection rates and deaths topping records almost every day.  When the data is compiled, a similar story like will unfold.

A person’s chances of survival depend on the type of medical care received. Even under universal care, there is no expectation that care will be equal.  Power and wealth equate with better care, whatever the economic system.  Covid19 has cast a light on how precise are those differences  in care and how those differences can mean life or death.

No matter how much some of us may argue for equality of care, the better marker is adequacy of care. As a nation, we are building toward a consensus about universal care but it is meaningless without establishing a baseline. Overcrowded and understaffed hospitals may mean no care at all. New York has demonstrated exemplary public service in managing the rate of infection.  At the same time, the state and city have  failed a stress test on managing  shortfalls of public healthcare.

If the national government can break the gridlock on the healthcare debate, the establishment of meaningful benchmarks  must be part of the discussion. If we decide to accept public systems that cannot meet those benchmarks, then we must incorporate rational, temporary backup systems to carry us through, rather than down, in a crisis.