Quoting Sun Tzu, the ancient Chinese philosopher and military strategist, Governor Andrew Cuomo on Monday detailed his winter plan for battling COVID-19.

“Just as water retains no constant shape, so in warfare there were no constant conditions,” said Cuomo, quoting from Sun Tzu’s The Art of War. “He who can modify his tactics in relation to his opponent thereby succeeds in winning.”

“COVID is an enemy that we’re dealing with. It’s attacking people. It’s killing people,” said Cuomo.

After consulting with global experts and local governments, the state’s COVID Task Force developed five strategies to combat COVID-19 this winter as cases across the nation increase due to holiday travel, shopping, and gathering as well as cold weather, keeping people indoors.

Using a phrase recently coined by Anthony Fauci, the nation’s top infectious-disease expert, Cuomo said, “That’s Dr. Fauci’s surge on top of the surge … It’s going to be the entire holiday season, which is 37 days,” Cuomo said at a press conference in New York City on Monday morning.

The five strategies outlined in the winter plan are:

— Continuing the micro-cluster strategy while managing hospital capacity to enhance and equalize care;

— Increasing and balancing testing resources and availability;

— Keeping schools open safely;

— Preventing viral spread from small gatherings; and

— Operating an equitable and safe vaccination program.

Micro-clusters and hospitals

Cuomo started a micro-cluster strategy in October to control outbreaks of infection in targeted areas rather than shutting down regional economies. In the winter plan, hospital metrics are to provide a clearer picture of the spread of infection.

The state’s health department will use metrics based on bed and intensive-care-unit capacity, staffing ratios, and daily hospital admissions to determine which areas qualify as micro-cluster zones.

A fourth level will be added to the current yellow precautionary, orange warning, and red zones: An emergency-stop level will put severe areas under New York Pause guidelines — which dictated the statewide shutdown this spring — to preserve hospital capacity.

On Monday, the state’s health department began emergency measures to be prepared for a surge in admissions. This includes identifying retired nurses and doctors to bolster staff, balancing patient loads across facilities, planning emergency field hospitals, planning to increase bed capacity by 50 percent, and gauging stockpiles of supplies.

Hospitals in Erie County, where the infection rate is the highest in the state, must suspend elective surgeries to make beds available for COVID patients.

Cuomo noted that, when hospitalization rates were so high this spring in New York City, resources could be shifted from upstate to downstate. Currently, across the state, hospitalization rates are “going up at an alarming rate,” said Cuomo. “So, in the new battlefield, hospital capacity is the top concern, period. It’s about hospital beds, it’s about the ICU, and it’s about having enough staff and enough equipment.”

Reflecting on the surge in the spring, Cuomo said, “We learned this lesson the hard way. We have about 54,000 hospital beds in this state; we were told we would need about 120,000. We lived this nightmare. We learned from this nightmare, and we’re going to correct for the lessons we learned during this nightmare. It was the first time ever the hospital system, which is essentially a private hospital system, needed to be managed governmentally. And that was a very difficult transition, but we learned from it.”

Under the winter plan, Cuomo said, if a hospital gets overwhelmed, the state will investigate. “And if the result of that investigation is they did not distribute the patients, that will be malpractice on their part …,” he said. “I don’t mean to be difficult, but difficult is when people die because they didn’t get the right health care.”

Testing

During the winter, the state will increase available testing statewide in a way that ensures distribution is balanced.

Segments of the population that need sufficient testing include health-care workers, nursing homes, schools, essential workers, business professionals, people who supply personal services, and members of the general population such as travelers and returning students.

Local governments will coordinate this distribution, Cuomo said.

He also said New York has the highest amount of pro rata testing of any state.

“You can't do enough testing,” he said. “The more testing you do, the more you know, and the more you know, the better you do. It is just that simple. Local governments, the state, hospitals, have to work to increase the gross amount of testing. And we have to have a balanced distribution.”

Schools

As long as a school’s infection rate remains under the rate of the community at large, the school should stay open for in-person learning, the winter plan says. The plan focuses on keeping schools open that serve kindergartners through eighth-graders as well as schools that serve special-education students.

Schools in orange zones will need to test 20 percent of their students and staff over the course of a month, and schools in red zones need to test 30 percent.

While local districts can decide to close at levels under the state’s mandatory closure level, they are urged to keep schools for kindergartners through eighth-graders open when it is safe.

“We believe in keeping, especially K-8, open,” said Cuomo at Monday’s press conference. “The schools are safer than the surrounding community and children get an education and parents can work, et cetera. We understand local school district prerogative. They can close below our level.”

Small gatherings

According to the plan, small gatherings are the top spreader of coronavirus disease 2019 with at least 65 percent of all cases coming from such gatherings; New york is among 16 states that have limited gatherings to 10 or fewer people.

The state will launch a public-education campaign to get the word out since the government’s ability to monitor small gatherings is limited.

“The small gathering spread is now the number-one spreader. That is 65 percent of all cases. This is a dramatic shift,” said Cuomo.

Part of the increase, he said, is because of the holidays and another part is because usual gathering places, like bars and restaurants, are curtailed. So people are hosting gatherings, with outsiders, in their homes.

“I understand that people say, ‘I don’t like the restrictions, I have COVID fatigue. How can you say I shouldn’t have more than 10 people in your house?’ Look, the truth is the government doesn’t have an ability to monitor it. You want to know what is smart, what is reasonable, what is protective of other people and yourself? This is where the spread is coming from. It’s the small-gathering spread.”

The facts on the dangers of small gatherings are not political, said Cuomo. “This is probably the only issue President Trump’s people and Joe Biden’s people have agreed on. Both of their health advisors say small gatherings are the problem.”

Cuomo went on to relate a conversation he’d had over the weeknd with someone who told him he was going to invite whomever he wanted to his house; nobody could tell him who or how many.

Cuomo said he responded: “You do whatever you want in your house, invite whoever you want, but here’s the deal: If somebody gets sick from what you did, you handle it … Don’t call an ambulance and expose an ambulance driver. Don’t go to the hospital and expose a nurse and a doctor and an 1199 worker because you wanted to be reckless. You handle it.”

When the person wouldn’t agree to that deal, Cuomo said he responded, “I see, I see. So you want to be able to behave in a risky way and then, if you get sick, then other people have to risk their lives because you were risky. Is that fair?”

Vaccinations

The Food and Drug Administration is set this month to review applications for COVID-19 vaccines from Pfizer, which applied for a permit on Nov. 20, and from Moderna, which applied on Nov. 30. Both claim to be over 90-percent effective.

However, it will be months before a critical mass of vaccinations will be available to the general public.

The winter plan says the state’s distribution of vaccines will be based on three main pillars: fairness, equity, and safety.

“We’re going to have a very inclusive process,” said Cuomo at Monday’s press conference. “I’m reaching out with other governors to the federal government, which is now funding a Black, Brown, poor community outreach program for the vaccine.

“Blacks died at twice the rate that whites died. Browns died at one-and-a-half times the rate that whites died. They are less served by the health-care facilities. We need a special outreach effort. The federal government has provided no funding to do that.”

Raising another topic that he has stressed before, Cuomo said, “There are also concerns with the undocumented community that they’re not exposing themselves to legal action, so we’re working through that.”

Returning to his battle metaphor, Cuomo said that the vaccination “is going to be the weapon that will end the war. The only question is when.”

In the meantime, he said, “New York is doing better than almost any other state on the numbers …. This is all a function of human behavior and social action. It’s all a function of what we do …. I believe in New Yorkers. They did this before at a much harder level with less notice, and we’ll do it again. But we have to do it.”