The City of New York launched one of its largest most expensive operations in history to contain a “100-nanometer-wide bubble of genes.”1 The Coronavirus disease 2019, “also known as the coronavirus, or COVID19, is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first identified in 2019 in Wuhan, China.2 The bill for NYC was of $ 14,023,275,837.94 in 2020 alone and as of this writing (December 1st, 2021), according to John Hopkins University, this tiny threat had killed 5.2 million people worldwide and infected 263 million3. Unbelievable as it may sound, it could have been worse, much worse. Initial estimates reported similar death numbers but for the US in 2020 alone4. Several initiatives were put in place in an attempt to reduce the loss of lives, and though the public was constantly receiving counts of infections, hospitalizations and deaths, via the media; not such a close count was being kept of the thousands of hours worked by the armies of men and women serving in the front lines during such times. This document will study the Human Resources deployed by the NYC Department of Health & Mental Hygiene dedicated to the emergency response during the year 2020 to reveal how many assignments were given, dates and hours worked, number of employees, strategies used, and types of talents most needed during the crisis of 2020. This is an X-Ray of the Covid19 emergency response in NYC.
This research will harness the opportunity of the fact that the author has been working with, granted access to, and been allowed to publish inside data about human resources deployment, hours worked, and expenditures made in combating the spread of the virus. Through this analysis, we hope to discover useful markers of performance in DOHMH and other city agencies. In addition, this study includes financial information that can give us an understanding of how much was directed to the Department of Health as a whole, under the Covid19 nomenclature relative to other agencies. To achieve this, I will be using the COVID-19 Expenditures Report presented by the Mayor’s Office of Management and Budget (OMB).
This analysis can serve local taxpayers have a better view of where their contributions went, what worked and what did not, what processes should be repeated in case a similar emergency occurs. It can also help inform voters of how their politicians delivered in times of crisis to make better informed decisions in the future. In time and ideally, these results could be compared with other operations in other cities and countries to see which ones worked best and serve as a framework for facing similar crises in the future.
It all started in February 2020. Word was heard rather faintly from the other side of the globe. A new virus had appeared. It sounded like a rumor given the contradicting messages arriving to the office. Scary videos of very sick doctors were surfacing while authorities overseas kept reassuring us it was nothing relevant. Was it deadly? How deadly? Was this even real? We had so many questions, and upon receiving the same answer, we kept asking. We are the Department of Health after all, so we kept investigating. My direct supervisor erred on the side of caution. He visited my desk to bring the news “Elmer, apparently it is nothing to worry about, but remember that training you were very unlikely to ever use? I just want you to refresh on it a bit”. The visits to my desk then became more frequent. He seemed hastier every time. He had first decided to manage it all by himself, as he is used to during other health crises, but this time it was different. I guess he was hesitant of getting me involved. I was a young new hire. It took only one week for him to be overwhelmed by the number of requests for personnel across the city. The City of New York was already preparing for the worst. By February 29th we got our lab results, along with our own answers to our questions: Yes, the virus is real, deadly, very contagious and is here in New York City1. He approached my cubicle one more time and said: “Elmer, I need your help, you are hereby being Activated”
My first mission was to find a Mandarin translator for patients who were contracting the virus and could not communicate their symptoms or needs to the medical personnel. It was a life-saving position. This would have been an easy task under any other circumstance but Hospitals and DOHMH were already using all their translators, this would require thinking outside the box. Then it occurred to me with little hope to ask an unlikely candidate: A financial analyst who works on the same floor with us to take the role. She had every reason to say no. She was not hired nor trained for that kind of work. There was panic, nobody knew how to treat the virus, there were no medications, and vaccines or treatments were not available. Who would dare to go talk face to face with patients who are provenly infected? I told her the job description; and before I even finished explaining how necessary the role was, she asked: “can I start today?”. I was impressed and moved by how resolute she was. I felt responsible, and worried for her but at the same time happy and proud. To this day I remember that response. I realized then that it would take people like her to win this fight, hundreds of them, and it was my job to find them. This mission had become personal.
Here we can see the total of activations that were given that year. Next to it is the total number of translators activated for comparison. It not only shows how massive the operation was, but it also shows how unique the translator task was. Every one of them was activated by me, so there was a sense of personal worry that came with every activation of such a potential danger. This was a time when the virus was mostly of unknown nature, its mortality and contagion rate were to be calculated, protective measures were not clear, and treatment was indetermined. I could not help but feel concerned about receiving a notice saying, “remember that employee you sent there? She got sick”. Every one of them shares a story similar to the one presented above of an individual willing to take that risk far apart from their regular work.
NYC Department of Health and Mental Hygiene (DOHMH) employees have official titles known as Civil Service Titles. During emergencies, DOHMH employees can be mobilized out of their official roles to attend an emergency, this is called an Activation. Once activated, their titles may change depending on the new assignments received, this is their Incident Command System Title (ICS). The duration of the new title will depend on the job at hand. It could last from one day, to the entire duration of the emergency or beyond. Since my activation in February 2020, me and my supervisor have been working as ICS Resources Unit Managers. Said title can be found at the very bottom right corner of the graph below since there are only two of us.
When the crisis was at its peak, me and my supervisor were constantly on the phone discussing the needs of staff across the city and strategies to resolve them. Then I noticed his voice was changing and he increasingly needed to apologize to cough. We were so absorbed by our task that we did not want to accept it: He had Covid19. There was a point where his body simply could not take it and he had no choice but to leave the unexperienced me leading the operation. He went through severe complications and various near-death experiences. He was not returning anytime soon. This became even more personal. I had one more reason not to fail and was not planning to drop the ball.
The resulting data serves to show what titles are in highest demand during the time of a Pandemic. A notable first place is Lab Helper. They occupy this place because they were and are the ones transferring in a safe manner all the tests that are being collected citywide and delivering them to the laboratory8. The total number of activations can be simplified by breaking them down even further into the types of work each employee was involved in upon activation. This way we can know how many employees were working within the medical field in general or mental health related tasks for example.
In the graph below, all titles were rearranged into broader categories, thus we can see here in a simpler view the top four categories of skills most used:
Second are Contact Tracers and as their name suggest, their work became primordial in investigating positive patients who may have potentially infected others, thus their numbers increased dramatically. Following closely in third place is a title that makes me feel specially identified: Data Analysts. Not only because it is my field of study, but because numerous sleepless nights were spent trying to find qualified candidates to fill these high demand roles. They became the eagle eyes that provided the feedback on how things were going on every front. Cases, hospitalizations, deaths, spending, percentage of workforce deployed, money spent, vaccines needed and a large etcetera. It all required up to date information that needed to be collected and presented in a way that leadership and the public would understand.
One additional consideration we needed to keep in mind while designing our staffing strategies was the balance required in the flow of personnel. We had to be careful of not taking too many people from one Division as to not affect the most essential operations and services DOHMH normally provides. As the emergency progressed, disagreements with Division Managers were common, as every employee Activation resulted in an increase in the workload for that Division. Employees were torn between wanting to help the city with the emergency and helping their supervisors. On various occasions, some employees were outstandingly efficient or had a particular skillset that made them essential for both work units. This made it part of our tasks to mediate between the ICS Supervisors, the regular Supervisors, and the employee so they could come to an agreement on a work schedule where the employee would work part time on both or even three areas simultaneously, all while trying not to burn out our personnel. Above is a detailed visualization of the flow of employees from their regular work Division to the ICS Branch they were sent to upon Activation.
The graph above shows the highest number of activations is concentrated in the middle of the year, between May and September. Cases, hospitalizations and deaths were lowest between May and October.
Notice that death rate never rose again to the initial levels. This illustrates the fact that though there was a second increase in people getting infected, there were not that many people hospitalized or dying. This study reveals that NYC had learned by then how to save the lives of its citizens.
First, where did it come from? Once the city declared the state of emergency, it was granted funding from several sources. The graph below allows us to easily take a look at the spending over time even per day, along with the funding source and its totals. Notice how the beginning and end of 2020 show smaller numbers. According to DOHMH, the first cases were seen back on February 29th of 2020. This is the date that DOHMH classifies as the beginning of the outbreak in NYC as well as the date of the first laboratory-confirmed COVID-19 case. Then there is a concentration of spending throughout the middle of the year and a decline towards the end. The main funding source is FEMA which transferred funds through the Emergency Declaration in 2020.
In 2020, according to documentation provided by the Mayor’s Office in a dataset that includes “every expenditure transaction incurred by a city agency under a “CV” (for Covid) budget code” which is “taken directly from the City’s Financial Management System (FMS) with very few alterations”5 a total $ 14,023,275,837.94 was distributed as shown in the graph below. These 4 buildings represent the top four agencies responsible for most of that spending and the orange windows represent the percentage spent:
Included in this tiny city of building is CUNY, which is 28th place in spending, here for comparison and because it could be of special interest for CUNY students or staff reading this material.
Speaking of buildings, DCAS is the grand building located at 1 Center Street (right). Just as its address suggests, it is at the center of the administration of all city resources. It is the agency overseeing all other agencies and as such, it is also in charge of most of the spending. Health and Hospitals Corporation is in charge of treatment of patients via its 70 locations, making it the largest healthcare system in the United States6, thus occupying the second place in this list with a total of over 2 billion dollars in spending in a single year. The Department of Education (DOE) ranks 4th among the agencies with most money spent. This is mainly because testing and then vaccination sites provided by the city were located in schools. This caused a series of needs in terms of logistics, security, transportation, equipment, personnel, and vaccines to be redirected to said facilities. A total of 1,552 testing sites were opened across the city.
The Department of Homeless Services spent more than the NYPD and the Department of Health and Mental Hygiene (DOHMH). Let’s not forget that these numbers specifically reflect what was spent under the Covid19 budget. DOHMH which is in charge of testing, laboratories, contact tracing, vaccination, research, guidelines development, public health education, restaurant/hotels safety, births certificates, pets and more.
The graph above not only shows the entire list of agencies, but it also serves to demonstrates the stark contrast between the categories of spending. To put it simply, this study reveals that 93% of the money was spent rather than invested. Invested in this context, as in any other, means that the money was used to acquire an asset that is be usable for the long term such as construction and real state (as opposed to masks or gloves which are disposable).
Let us investigate this even further. The graph above shows more specifically the object in which the money was used. The objects are numerous, but the filter and tooltip allow to examine them in greater detail. Medical supplies are first as expected, given the massive need for these, worsened by the long series of varying recommendations regarding masks until in February 2021 the CDC suggested double masks7.
In the middle of those sudden changes, the city continued to use unheard amounts of medical supplies and to employ qualified medical personnel. That is one of the reasons why payments to the Health and Hospitals Corporation are third on this list. The city was covering for the care of patients, paying medical personnel, and medical equipment.
Note how overtime expenses for uniformed forces (EMS, Police, Nurses) almost doubled those of general personnel. That is a great contributor for which the Police Department enters the top ten agencies as there was a drastic need for law enforcement during this time. Overtime had to be paid to cover for officers that were falling ill with the virus while having to protect businesses and neighborhoods, often overnight during the violent summer crisis. What seems to be counter intuitive, on the other hand, is the fact that the Department of Homeless Services spent more than the NYPD and the Department of Health during such times. Let’s not forget that these figures only reflect what was spent under the Covid budget. It raises questions as to how this agency could spend more money than the Department of Health during the worst health crisis in history. DOHMH is in charge of testing, laboratories, contact tracing, guidelines development, public health education, restaurant/hotels safety, births certificates, pets, research and more. Further break down of these objects into more general categories in the graphs below highlights the most important ways in which the money was used and allows for simpler comparison.
Homeless Services category stand out as it almost equals that of Transportation, Fuel, Advertising, Construction and Overtime categories combined. In an effort to get a better understanding of how the spending of DHS compares to that of other agencies such as DOHMH the following graph was created:
Despite having broken down the spending to the smallest expression made public by the city government, which is the object of expenditure, it is not possible to know exactly what resulted in the massive spending of DHS compared to other agencies, since almost all the funding is lumped under the single object Individual Homeless Services. That one object is larger than all 52 objects of expenditure from DOHMH combined.
It would be interesting to know how exactly that occurred but that would be the subject of another paper. This paper focuses on DOHMH, which brings us to the next step of our analysis.
This study has gone through a citywide analysis, then agencywide, then per object, then per title, and now the following graph shows the last the deepest level of profundity in our analysis: the individual. It shows how many hours per day every DOHMH employee dedicated to the fight against the pandemic.
This study has revealed how many employees were deployed, the tasks they performed, the days and shifts they worked, funding sources, money spent, agencies involved, and even the objects that were bought. This can serve as a precedent for the city and can be used as an integral part of the creation of an Emergency Preparedness Plan for the future. The city can use this data to prepare resources to fast-track the hiring of qualified Data Analyst, or Lab Helpers, for instance. It provides tools to determine whether certain funds were applied efficiently, if purchases were proper, if the providers delivered as expected, if an object should have been rented, bought or built. It allows for the projection of needs given a hospitalization, contagion and mortality rates. The objectives of this research project were met and surpassed, but despite the enormous amount of data presented and analyzed here, there are many things that cannot be known within the one year covered. The result of some of the strategies applied are still being revealed and their effectiveness still to be measured. This project gives us a notion of how massive the data required to cover the full length of the pandemic is. It has also served us to know analysis strategies and has readied the data that is to be compared with other cities and with the years to come. Among all the discoveries, maybe the most important one is that of the human element, which is why we saved “The Individual” for last as a reminder to the city of the talent that it has, and that within its ranks, there are people who are willing to stop whatever they are doing, even when it means facing an unknown risk of death, if it is in order to help save someone else’s life.
- Zimmer C (26 February 2021). “The Secret Life of a Coronavirus – An oily, 100-nanometer-wide bubble of genes has killed more than two million people and reshaped the world. Scientists don’t quite know what to make of it”. Retrieved 28 February 2021.
- Page J, Hinshaw D, McKay B (26 February 2021). “In Hunt for Covid-19 Origin, Patient Zero Points to Second Wuhan Market – The man with the first confirmed infection of the new coronavirus told the WHO team that his parents had shopped there”. The Wall Street Journal. Retrieved 27 February 2021.
- John Hopkins University and Medicine, Coronavirus Resource Center, https://coronavirus.jhu.edu/map.html. Accessed Dec 1st, 2021.
- Neil M Ferguson, Daniel Laydon, Gemma Nedjati-Gilani et al. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. Imperial College London (16-03-2020), doi: https://doi.org/10.25561/77482. Accessed May 21, 2021.
- COVID-19 Expenditures Report, NYC Open Data, COVID-19 Expenditures Report | NYC Open Data (cityofnewyork.us), accessed December 1, 2021
- NYC Health + Hospitals, About NYC Health + Hospitals | NYC Health + Hospitals (nychealthandhospitals.org), accessed December 1, 2021
- John T. Brooks, MD1; Donald H. Beezhold, PhD2; John D. Noti, PhD2; Jayme P. Coyle, PhD2; Raymond C. Derk, MS2; Francoise M. Blachere, MS2; William G. Lindsley, PhD2 Maximizing Fit for Cloth and Medical Procedure Masks to Improve Performance and Reduce SARS-CoV-2 Transmission and Exposure, 2021. CDC Weekly / February 19, 2021 / 70(7);254–257
- NYC DOHMH Website https://www1.nyc.gov/site/doh/providers/reporting-and-services/public-health-lab.page. Accessed December 23, 2021