The number of people hospitalized with COVID-19 is expected to rise across the state in the coming weeks as an anticipated post-Thanksgiving wave gives way to another wave of new infections after the upcoming holidays. Gov. Andrew Cuomo announced on Monday that if a region’s hospitals become overwhelmed, that region will see mass industry shutdowns again.

“In life, there are certain absolutes,” Cuomo told reporters. “What is the absolute here? You cannot overwhelm your hospitals. If you are at a rate that’s going to overwhelm your hospitals, you must shut down. Not just indoor dining. Shut down — only essential businesses. ‘Oh, we don’t want to do that again.’ Then change your behavior. If you don’t change your behavior, that is the absolute reality of the situation.”

The state will also impose new restrictions on indoor dining if hospitalizations don’t stabilize within the next five days, Cuomo said. Restaurants outside of New York City may be asked to reduce indoor dining capacity to 25%, down from 50% currently.

Cuomo told reporters that restaurants would be given “a couple of days to reorient” before the restrictions would be put in place, and if the state decides to implement the new restrictions, they would likely go into effect on Monday.

The governor announced the state’s new hospitalization-based metrics — or “surge and flex plan” — during his daily COVID-19 briefing on Monday. The restaurant-specific restrictions were announced after the U.S. Centers for Disease Control and Prevention issued new guidance last week that pointed to indoor dining as a “high-risk” activity.

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Hospital capacity

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Under the state’s new metrics, if the seven-day average hospitalization rates indicate that North Country hospitals could hit “critical” capacity within three weeks, then the North Country region will return to an economic shutdown similar to what was seen this spring before Phase 1 reopening, with only businesses deemed essential authorized to operate, according to Cuomo.

The state has defined “critical capacity” as 90% of beds occupied. When asked how many hospital beds exist across the North Country region, the state Department of Health and Cuomo’s office did not answer the question, but the DOH did say that the current hospital bed capacity in the North Country is approximately 46% occupied.

As of Monday, New York hospitals had a total capacity of about 54,000 beds at its 215 hospitals. More than 64% of those beds are currently occupied, according to Cuomo.

Cuomo said that the state is looking at hospitalization metrics for this period — which could last until April — before a vaccine is widely available.

“Between now and then, we need to slow the rate of spread, slow the hospitalizations,” he said.

Overwhelming hospitals means “people die on a gurney in the hallway” and lives are lost unnecessarily, Cuomo said.

The DOH can order hospitals to increase their capacity by 50% and to cancel elective surgeries, and the state can build field hospitals, according to Cuomo. Altogether, implementing those measures would bring the state’s hospital bed capacity to 75,000.

The DOH on Monday directed hospitals to increase bed capacity by 25%.

Cuomo also issued a call to retired nurses and doctors on Monday, asking that they return to service to help with the anticipated surge of COVID-19 patients. Cuomo said the state would “automatically” renew required registrations.

Across the North Country region, 38 people were hospitalized as of Monday, according to the DOH.

As of Monday, there were three COVID-positive patients hospitalized at Alice Hyde Medical Center in Malone, plus three “patients under investigation” — meaning patients who are exhibiting symptoms but haven’t received test results yet, according to hospital spokesman Phillip Rau.

There was one COVID-positive patient hospitalized at Adirondack Medical Center in Saranac Lake on Monday, according to hospital spokesman Matt Scollin, plus four “patients under investigation” who aren’t exhibiting symptoms but are awaiting test results under the hospital’s current admission policy. The hospital currently requires patients being admitted to the hospital to be tested for COVID-19.

At Elizabethtown Community Hospital there was one person hospitalized with COVID-19 as of Monday, according to spokeswoman Elizabeth Rogers.

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“Surge upon a surge”

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Dr. Anthony Fauci, the federal government’s top infectious disease expert, joined Cuomo during the governor’s daily briefing on Monday. Fauci warned New Yorkers about a “surge upon a surge” — a new wave of infections that could happen after the post-Thanksgiving wave. That’s if families and friends gather for the holidays and if public health measures aren’t followed.

“In regard to the issue of the holiday spread and the peaks, they are going to be superimposed on each other,” Fauci told Cuomo. “So you would expect the full brunt of the travel and family setting gatherings with friends that you alluded to as a problem, you would expect the effect of the Thanksgiving surge in probably another week-and-a-half from now. It’s usually two weeks from the time of the event. The problem is, that’s going to come right up to the beginning of the Christmas and Hanukkah potential surge. So you have a surge upon a surge, and then before you can handle that, more people are going to travel over Christmas. They’re going to have more of those family and friend gatherings that you accurately said are an issue.

“So if those two things happen and we don’t mitigate well and we don’t listen to the public health measures that we need to follow, then we could start seeing things get really get bad in the middle of January,” he said.

It’s not necessarily the number of people who gather in one place, he added — it has more to do with the intermingling of households and travel.

“You want to make sure you don’t get people who just got off an airport or a plane or a train and came in from Florida or came in from wherever. That’s even more risky than the absolute number,” he said. “Not only the number of 10 seems reasonable, but make sure that when people come in, that they’re not people who have no idea where they’ve been or who they’ve been exposed to. You want to be friendly, you want to be collegial, but you really got to be careful about that.”

Cuomo estimated that about 70% of the state’s coronavirus spread is coming from small gatherings.