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.

---

The Beginning

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 29^th 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”

The Stories

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. 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. She had every reason to say no. She 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 as 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.

The translator title was so unique and deemed so risky that only twelve such activations occurred that year. Every one of them was critical.

The Context

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. 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:

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.

The Money

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:

Given the nature of this emergency, it stands to reason that the Police Department enters the top agencies as there was a drastic need for law enforcement during this time, especially during the violent summer crisis, in addition to officer falling ill.

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 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, spent less than the Department of Homeless Services during the worst health crisis in history.

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.

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. Still, Homeless Individual Services stand out as its expenses almost tripled those of Uniformed Forces Overtime. 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.

Still, the 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.

The Individual

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.

Bibliography

1. 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.
2. 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.
3. John Hopkins University and Medicine, Coronavirus Resource Center, https://coronavirus.jhu.edu/map.html. Accessed Dec 1st, 2021.
4. 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.
5. COVID-19 Expenditures Report, NYC Open Data, COVID-19 Expenditures Report | NYC Open Data (cityofnewyork.us), accessed December 1, 2021
6. NYC Health + Hospitals, About NYC Health + Hospitals | NYC Health + Hospitals (nychealthandhospitals.org), accessed December 1, 2021
7. 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
8. NYC DOHMH Website https://www1.nyc.gov/site/doh/providers/reporting-and-services/public-health-lab.page. Accessed December 23, 2021