Before the coronavirus pandemic had even reached some states, it was ripping through New York and Massachusetts. Both weathered a devastating spring, reaching peaks in April. New York was especially hard-hit; more than 32,000 residents have died of COVID-19 thus far, the vast majority in March and April.
While both states have charted remarkable roads to recovery, it is New York — the state with the highest total death count in the country — that has emerged as a national leader this summer. As many states have faced alarming surges and even Massachusetts has seen key metrics fluctuate, New York has managed to continue its steady progress in beating back the disease.
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Experts said that while it is difficult to determine exactly what has given New York an edge in surmounting COVID-19, a combination of extensive testing, cautious and region-based reopening, and vigilant enforcement of business safety guidelines have combined to create an impressive turnaround.
Some of this is a product of two governors’ contrasting leadership styles — the very aggressive, in-your-face approach taken by New York’s Governor Andrew Cuomo, compared to Massachusetts Governor Charlie Baker’s more detached and cautious approach, experts said. While Baker’s calm tenor drew praise during the pandemic’s more frightening days, some experts said guiding reopening may require a heavier hand.
“Comparatively with other states, [Massachusetts and New York] are both doing quite well,” said Jennifer Nuzzo, a Johns Hopkins epidemiologist. But, she said, New York still stands in a league of its own. “It’s not so much the absolute difference [in metrics], it’s also the trend. What’s encouraging about New York is that its trends have held for a long time.”
Johns Hopkins University’s coronavirus tracker reports that over the past month, Massachusetts has counted 10,189 new COVID-19 cases compared to New York’s 20,265. When accounting for the states’ populations, that means Massachusetts has seen nearly 1.4 times the number of new cases per capita.
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The number of cases per capita in New York is lower even though that state is testing more extensively than Massachusetts is — almost twice as many tests per capita in the week from Aug. 5 through Aug. 11.
The average rate of Massachusetts COVID-19 tests that come back positive also appears to show higher infection rates than in New York. Johns Hopkins puts that figure at 2.1 percent for Massachusetts over the past seven days versus 0.9 percent for New York, though Nuzzo noted that comparisons across states can be difficult since they report data differently. The Massachusetts Department of Public Health reported a lower figure, 1.4 percent, on Friday.
Though both states are in the latter stages of their four-phase reopening plans, New York has progressed through its phases on a regional basis, with Governor Andrew Cuomo moving each of 10 regions forward based on localized health metrics and risk factors.
This has resulted in a more fine-tuned approach for the state’s largest, densest, and highest-transmission region. New York City did not begin reopening until June 8, three weeks after some New York regions took their first steps to end their lockdowns and after some had already advanced to the second phase of Cuomo’s plan.
Boston, in comparison, has for the most part kept pace with the rest of Massachusetts, though the city has held off an additional week on some aspects of reopening.
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Experts also pointed to one significant difference in the two reopening plans: New York City still does not allow indoor dining, whereas Boston chose to allow inside eating as of June 22, when Massachusetts gave the green light for eateries statewide.
Indoor dining has been linked to 10 percent of new infections in other states, said Shan Soe-Lin, managing director of Pharos Global Health Advisors, a Boston nonprofit focused on global health matters. Disease experts in the state have also pointed to indoor dining as an area of concern, with some calling for a rollback of reopening.
New York has been especially tough on businesses that fail to adhere to social distancing guidelines. Cuomo on July 23 announced a task force led by state police and liquor authorities to help local officials monitor violations of coronavirus-related regulations. More than 700 establishments have received citations, and punishment can range from fines of $10,000 per violation to liquor license suspension and temporary closure.
Baker announced a similar statewide task force on Aug. 7, along with new guidelines for restaurant safety, so it is too soon to tell how it will affect the virus’s spread. Most enforcement of pandemic rules in Massachusetts, however, has been left to local boards of health.
Baker’s administration has adopted stricter travel restrictions than Cuomo’s has; travel to Rhode Island, for example, is currently restricted under Massachusetts rules but not New York’s.
Sarah Finlaw, a spokeswoman for the Massachusetts COVID-19 Command Center, said the Baker administration had also “launched a first-in-the-nation contact-tracing effort, and continues to report comprehensive public health data, including community-level data unveiled … to monitor cases in cities and towns so the administration can work with local officials to enforce reopening guidelines in order to slow the spread.”
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But Robert Hecht, an epidemiology professor at Yale University’s School of Public Health, said Cuomo’s leadership style of “showing teeth and passion and not being afraid of stepping on toes in the business community” may be more effective.
“I wish states had the time, bandwidth, and incentives to learn more from each other,” Hecht said. “Understanding New York’s tougher enforcement and the benefits of this should be critical information for us in Massachusetts.”
But experts warned that clamping down has a cost. Strict regulation can target the same communities of color already disproportionately impacted by the disease, said Allie Bohm, policy counsel for the New York Civil Liberties Union.
“Typically in New York, and I think around the country, it has often been harsher enforcement in communities of color,” Bohm said. “When you are using law enforcement discretion to enforce public health issues and you’ve got scarce resources, you’re going to end up with enforcement mirroring the preexisting biases in society.”
In May, the New York Police Department came under fire after reports showed that 91 percent of people arrested for coronavirus-related crimes were Black or Hispanic.
Though the task force charged with inspecting restaurants and bars has not faced the same criticism, some parts of New York City have seen more enforcement than others.
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Even when applied fairly, strict enforcement can hamper public health progress, Bohm said, as people may fear that cooperating in crucial efforts including contact tracing could lead to punishment or job loss for themselves or their neighbors.
“Enforcement may be an important tool, but you can also imagine some scenarios in which enforcement could backfire,” Nuzzo added.
She explained that public health officials must be careful of inadvertently driving people to socialize in private, difficult-to-regulate spaces if they act too quickly to shut down such venues as restaurants and bars.
One method of soft enforcement multiple experts said might help New York adhere to safety precautions and keep its COVID-19 transmission low: New Yorkers’ shared memory of a traumatic spring.
“One thing that sets New York apart from any other state at least at this point is just how hard-hit it was,” said Nuzzo.
She said the pandemic was “inescapable,” particularly in New York City, where relentless sirens, daily tributes to health care workers, and overrun hospitals and crematoriums sent shock waves through neighborhoods.
“New York City, as a whole, got rocked way harder than we did in Boston. The hospitals here didn’t get overrun,” said Soe-Lin. “That’s a good thing, but it’s hard when people need to remember to maintain their vigilance now.”
Dasia Moore can be reached at dasia.moore@globe.com. Follow her on Twitter @daijmoore Kay Lazar can be reached at kay.lazar@globe.com Follow her on Twitter @GlobeKayLazar.
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