Google Casts a Big Shadow on Smaller Web Sites


Annie Tritt for The New York Times


Jeffrey G. Katz, the chief executive of Wize Commerce, seen with employees. He says that about 60 percent of the traffic for the company’s Nextag comparison-shopping site comes from Google.





In a geeky fire drill, engineers and outside consultants at Nextag scrambled to see if the problem was its own fault. Maybe some inadvertent change had prompted Google’s algorithm to demote Nextag when a person typed in shopping-related search terms like “kitchen table” or “lawn mower.”


But no, the engineers determined. And traffic from Google’s search engine continued to decline, by half.


Nextag’s response? It doubled its spending on Google paid search advertising in the last five months.


The move was costly but necessary to retain shoppers, Mr. Katz says, because an estimated 60 percent of Nextag’s traffic comes from Google, both from free search and paid search ads, which are ads that are related to search results and appear next to them. “We had to do it,” says Mr. Katz, chief executive of Wize Commerce, owner of Nextag. “We’re living in Google’s world.”


Regulators in the United States and Europe are conducting sweeping inquiries of Google, the dominant Internet search and advertising company. Google rose by technological innovation and business acumen; in the United States, it has 67 percent of the search market and collects 75 percent of search ad dollars. Being big is no crime, but if a powerful company uses market muscle to stifle competition, that is an antitrust violation.


So the government is focusing on life in Google’s world for the sprawling economic ecosystem of Web sites that depend on their ranking in search results. What is it like to live this way, in a giant’s shadow? The experience of its inhabitants is nuanced and complex, a blend of admiration and fear.


The relationship between Google and Web sites, publishers and advertisers often seems lopsided, if not unfair. Yet Google has also provided and nurtured a landscape of opportunity. Its ecosystem generates $80 billion a year in revenue for 1.8 million businesses, Web sites and nonprofit organizations in the United States alone, it estimates.


The government’s scrutiny of Google is the most exhaustive investigation of a major corporation since the pursuit of Microsoft in the late 1990s.


The staff of the Federal Trade Commission has recommended preparing an antitrust suit against Google, according to people briefed on the inquiry, who spoke on the condition they not be identified. But the commissioners must vote to proceed. Even if they do, the government and Google could settle.


Google has drawn the attention of antitrust officials as it has moved aggressively beyond its dominant product — search and search advertising — into fields like online commerce and local reviews. The antitrust issue is whether Google uses its search engine to favor its offerings like Google Shopping and Google Plus Local over rivals.


For policy makers, Google is a tough call.


“What to do with an attractive monopolist, like Google, is a really challenging issue for antitrust,” says Tim Wu, a professor at Columbia Law School and a former senior adviser to the F.T.C. “The goal is to encourage them to stay in power by continuing to innovate instead of excluding competitors.”


SPEAKING at a Google Zeitgeist conference in Arizona last month, Larry Page, the company’s co-founder and chief executive, said he understood the government scrutiny of his company, given Google’s size and reach. “There’s very many decisions we make that really impact a lot of people,” he acknowledged.


The main reason is that Google is continually adjusting its search algorithm — the smart software that determines the relevance, ranking and presentation of search results, typically links to other Web sites.


Google says it makes the changes to improve its service, and has long maintained that its algorithm weeds out low-quality sites and shows the most useful results, whether or not they link to Google products.


“Our first and highest goal has to be to get the user the information they want as quickly and easily as possible,” says Matt Cutts, leader of the Web spam team at Google.


But Google’s algorithm is secret, and changes can leave Web sites scrambling.


Consider Vote-USA.org, a nonprofit group started in 2003. It provides online information for voters to avoid the frustration of arriving at a polling booth and barely recognizing half the names on the ballot. The site posts free sample ballots for federal, state and local elections with candidates’ pictures, biographies and views on issues.


In the 2004 and 2006 elections, users created tens of thousands of sample ballots. By 2008, traffic had fallen sharply, says Ron Kahlow, who runs Vote-USA.org, because “we dropped off the face of the map on Google.”


As founder of a search-engine optimization company and a recipient of grants that Google gives nonprofits to advertise free, Mr. Kahlow knows a thing or two about how to operate in Google’s world. He pored over Google’s guidelines for Web sites, made changes and e-mailed Google. Yet he received no response.


“I lost all donations to support the operation,” he said. “It was very, very painful.”


A breakthrough came through a personal connection. A friend of Mr. Kahlow knew Ed Black, chief executive of the Computer & Communications Industry Association, whose members include Google. Mr. Black made an inquiry on Mr. Kahlow’s behalf, and a Google engineer investigated.


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Hardship Strains Emotions in New York


Mike Segar/Reuters


Emilio Langilotti of Staten Island, who broke his wrist during Hurricane Sandy, received food Friday at a disaster relief station. More Photos »







Emotions, frayed after almost a week of desperation, darkness and cold, approached a breaking point on Friday as the collective spirit that buoyed New York in the first few days after Hurricane Sandy gave way to angry complaints of neglect and unequal treatment.




Mayor Michael R. Bloomberg, facing criticism that he was favoring marathon runners arriving from around the world over people in devastated neighborhoods, reversed himself and canceled the New York City Marathon.


The move was historic — the marathon has taken place every year since 1970, including the race in 2001 held two months after the Sept. 11 terrorist attacks, and was projected to bring in $340 million.


For days, the mayor, who is often reluctant to abandon a position of his, insisted on going ahead with the race, saying it would signal that the city was back to normal.


He changed his mind as opposition became nearly unanimous. Critics said that it would be in poor taste to hold a foot race through the five boroughs while so many people in the area were still dealing with damage from the hurricane, and that city services should focus on storm relief, not the marathon. A petition from some marathoners called on other runners to skip the race and do volunteer work in hard-hit areas.


But the mayor liked the parallel to Sept. 11 and saw the marathon as a symbol of the city’s comeback. He talked to former Mayor Rudolph W. Giuliani on Friday morning; Mr. Giuliani said to stick with his original plan.


Within the mayor’s inner circle, though, there were concerns. Some advisers worried that the criticism could steal the focus from Mr. Bloomberg’s well-received performance during and after the storm, and could damage his legacy in the way that the city’s botched response to a blizzard had done in 2010.


Behind the scenes, there were also concerns about what the world would see: images of runners so close to neighborhoods that had been battered by the storm, at a time when gasoline remained in short supply and mass transit was still not fully functioning.


Police Commissioner Raymond W. Kelly and Deputy Mayors Howard Wolfson and Patricia E. Harris all argued for calling off the event.


The mayor, virtually alone in saying the race should go on, finally relented and canceled it after a conversation with Mary Wittenberg, the marathon director, late Friday. “This isn’t the year or the time to run it,” she said.


Patience also wore thin in other parts of the New York area amid lines that were once again painfully long — lines for free meals, lines for buses to take people where crippled subways could not, lines for gasoline that stretched 30 blocks in Brooklyn.


Hand-lettered signs in hard-hit areas struck a plaintive note: “FEMA please help us,” read one in Broad Channel, Queens. In Hoboken, N.J., one was addressed to Gov. Chris Christie: “Gov. Chris — where is the help $$$$”


Ethel Liebeskind of Merrick, N.Y., echoed that idea as she stood in the storm-tossed ruins of the house she had lived in for 26 years. “This is as bad as Katrina,” she said, “and they got global attention. The South Shore of Long Island should be treated the same way. Don’t forget us on the South Shore of Long Island. We need help.”


There was more grim news on Staten Island, where rescuers pulled two bodies from another house in the Midland Beach neighborhood, about two miles from the Verrazano-Narrows Bridge. Neighbors who had been hauling their ruined furniture and trash to the street watched as two body bags were taken out of a house on Olympia Boulevard.


The two victims were not immediately identified. They brought to 41 the official count of people who died as rampaging wind drove a wall of water into the city on Monday night.


On Staten Island, which even in good times is often referred to as the city’s forgotten borough, desperation and anger were especially intense.


David Sylvester, 50, returned to his house in Midland Beach — he had left it after the mayor issued evacuation orders for low-lying areas, and it burned down when a power line shorted out during the storm — and criticized the government and relief agencies for not arriving fast enough.


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Songs offer messages of hope at Sandy benefit show

NEW YORK (AP) — From "Livin' on a Prayer" to "The Living Proof," every song Friday at NBC's benefit concert for superstorm Sandy victims became a message song.

New Jersey's Jon Bon Jovi gave extra meaning to "Who Says You Can't Go Home." Billy Joel worked in a reference to Staten Island, the decimated New York City borough. The hourlong event, hosted by Matt Lauer, was heavy on stars and lyrics identified with New Jersey and the New York metropolitan area, which took the brunt of this week's deadly storm. The telethon was a mix of music, storm footage and calls for donations from Jon Stewart, Tina Fey, Whoopi Goldberg and others.

The mood was somber but hopeful, from Christina Aguilera's "Beautiful" to Bon Jovi's "Livin' on a Prayer" and a tearful Mary J. Blige's "The Living Proof," her ballad of resilience with the timely declaration that "the worst is over/I can start living now." Joel rocked out with "Miami 2017 (Seen the Lights Go Out on Broadway)," a song born from crisis, New York City's near bankruptcy in the 1970s, while Jimmy Fallon endured a faulty microphone and gamely led an all-star performance of the Drifters' "Under the Boardwalk" that featured Joel, Bruce Springsteen and Steven Tyler. The Aerosmith frontman then sat behind a piano and gave his all on a strained but deeply emotional "Dream On." Sting was equally passionate during an acoustic, muscular version of The Police hit "Message In a Bottle" and its promise to "send an SOS to the world."

The show ended, as it only could, with Springsteen and the E Street Band, tearing into "Land Of Hope and Dreams."

"God bless New York," Springsteen, New Jersey's ageless native son, said in conclusion. "God bless the Jersey shore."

The stable of NBC Universal networks, including USA, CNBC, MSNBC, E! Entertainment, The Weather Channel and Bravo, aired the concert live from the NBC studios in Rockefeller Center in midtown Manhattan, several blocks north of where the city went days without power. Millions of people for whom the benefit was organized couldn't watch the event because they had no electricity.

NBC Universal invited other networks to televise the event, but not everyone signed on.

That might have something to do with network rivalries.

In the wake of the Sept. 11 terrorist attacks, the networks organized a benefit together behind the scenes and it was televised on more than 30 networks simultaneously, including all the big broadcasters.

After Hurricane Katrina, NBC televised its own benefit before the other broadcasters, one that became best known for Kanye West's off-script declaration that "George Bush doesn't care about black people." The other broadcasters cooperated on their own telethon a week later, and NBC televised that one, too.

Also this year, NBC organized and scheduled a telethon and gave others the chance to air it.

Others declined to televise Friday's telethon, even though ABC parent Walt Disney Co. said it would donate $2 million to the American Red Cross and various ABC shows will promote a "Day of Giving" on Monday. The CBS Corp., Viacom Inc., parent of "Jersey Shore" network MTV, Fox network owner News Corp. also announced big donations to the Red Cross.

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Second Illness Infects Meningitis Sufferers





Just when they might have thought they were in the clear, people recovering from meningitis in an outbreak caused by a contaminated steroid drug have been struck by a second illness.




The new problem, called an epidural abscess, is an infection near the spine at the site where the drug — contaminated by a fungus — was injected to treat back or neck pain. The abscesses are a localized infection, different from meningitis, which affects the membranes covering the brain and spinal cord. But in some cases, an untreated abscess can cause meningitis. The abscesses have formed even while patients were taking powerful antifungal medicines, putting them back in the hospital for more treatment, often with surgery.


The problem has just begun to emerge, so far mostly in Michigan, which has had more people sickened by the drug — 112 out of 404 nationwide — than any other state.


“We’re hearing about it in Michigan and other locations as well,” said Dr. Tom M. Chiller, the deputy chief of the mycotic diseases branch of the Centers for Disease Control and Prevention. “We don’t have a good handle on how many people are coming back.”


He added, “We are just learning about this and trying to assess how best to manage these patients. They’re very complicated.”


In the last few days, about a third of the 53 patients treated for meningitis at St. Joseph Mercy Hospital in Ann Arbor, Mich., have returned with abscesses, said Dr. Lakshmi K. Halasyamani, the chief medical officer.


“This is a significant shift in the presentation of this fungal infection, and quite concerning,” she said. “An epidural abscess is very serious. It’s not something we expected.”


She and other experts said they were especially puzzled that the infections could occur even though patients were taking drugs that, at least in tests, appeared to work against the fungus causing the infection, a type of black mold called Exserohilum.


The main symptom is severe pain near the injection site. But the abscesses are internal, with no visible signs on the skin, so it takes an M.R.I. scan to make the diagnosis. Some patients have more than one abscess. In some cases, the infection can be drained or cleaned out by a neurosurgeon.


But sometimes fungal strands and abnormal tissue are wrapped around nerves and cannot be surgically removed, said Dr. Carol A. Kauffman, an expert on fungal diseases at the University of Michigan. In such cases, all doctors can do is give a combination of antifungal drugs and hope for the best. They have very little experience with this type of infection.


Some patients have had epidural abscesses without meningitis; St. Joseph Mercy Hospital has had 34 such cases.


A spokesman for the health department in Tennessee, which has had 78 meningitis cases, said that a few cases of epidural abscess had also occurred there, and that the state was trying to assess the extent of the problem.


Dr. Chiller said doctors were also reporting that some patients exposed to the tainted drug had arachnoiditis, a nerve inflammation near the spine that can cause intense pain, bladder problems and numbness.


“Unfortunately, we know from the rare cases of fungal meningitis that occur, that you can have complicated courses for this disease, and it requires prolonged therapy and can have some devastating consequences,” he said.


The meningitis outbreak, first recognized in late September, is one of the worst public health disasters ever caused by a contaminated drug. So far, 29 people have died, often from strokes caused by the infection. The case count is continuing to rise. The drug was a steroid, methylprednisolone acetate, made by the New England Compounding Center in Framingham, Mass. Three contaminated lots of the drug, more than 17,000 vials, were shipped around the country, and about 14,000 people were injected with the drug, mostly for neck and back pain. But some received injections for arthritic joints and have developed joint infections.


Inspections of the compounding center have revealed extensive contamination. It has been shut down, as has another Massachusetts company, Ameridose, with some of the same owners. Both companies have had their products recalled.


Compounding pharmacies, which mix their own drugs, have had little regulation from either states or the federal government, and several others have been shut down recently after inspections found sanitation problems.


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Live Coverage: Increments of Progress, and New Struggles, After Storm




  • Full Coverage

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State-by-State Guide


A look at the devastation caused in the aftermath of Hurricane Sandy from North Carolina to New England.










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Apple rolls out iPad mini in Asia to shorter lines

SYDNEY (Reuters) - Apple fans lined up in several Asian cities to get their hands on the iPad mini on Friday, but the device, priced above rival gadgets from Google and Amazon.com, attracted smaller crowds than at the company's previous global rollouts.


Apple Inc's global gadget rollouts are typically high-energy affairs drawing droves of buyers who stand in line for hours. But a proliferation of comparable rival devices may have sapped some interest.


About 50 people waited for the Apple store in Sydney, Australia, to open, where in the past the line had stretched for several blocks when the company debuted new iPhones.


At the head of Friday's line was Patrick Li, who had been waiting since 4:30 am and was keen to get his hands on the 7.9-inch slate.


"It's light, easy to handle, and I'll use it to read books. It's better than the original iPad," Li said.


There were queues of 100 or more outside Apple stores in Tokyo and Seoul when the device went on sale, but when the company's flagship Hong Kong store opened staff appeared to outnumber those waiting in line.


The iPad mini marks Apple's first foray into the smaller-tablet segment, and the latest salvo in a global mobile-device war that has engulfed combatants from Internet search leader Google Inc to Web retailer Amazon.com Inc and software giant Microsoft Corp.


Microsoft's 10-inch Surface tablet, powered by the just-launched Windows 8 software, went on sale in October, while Google and Amazon now dominate sales of smaller, 7-inch multimedia tablets.


POSITIVE REVIEWS


Unveiled last week, the iPad mini has won mostly positive reviews, with criticism centering on a screen considered inferior to rivals' and a lofty price tag. The new tablet essentially replicates most of the features of its full-sized sibling, but in a smaller package.


"Well, first of all it's so thin and light and very cute - so cute!" said iPad mini customer Ten Ebihara at the Apple store in Tokyo's upscale Ginza district.


At $329 for a Wi-Fi only model, the iPad mini is a little costlier than predicted but some analysts see that as Apple's attempt to retain premium positioning.


Some investors fear the gadget will lure buyers away from Apple's $499 flagship 9.7-inch iPad, while proving ineffective in combating the threat of Amazon's $199 Kindle Fire and Google's Nexus 7, both of which are sold at or near cost.


Also on Friday, Apple rolled out its fourth-generation iPad, with the same 9.7-inch display as the previous version but with a faster A6X processor and better Wi-Fi. Both devices were going on sale in more than 30 countries.


Apple will likely sell between 1 million and 1.5 million iPad minis in the first weekend, far short of the 3 million third-generation iPads sold last March in their first weekend, according to Piper Jaffray analyst Gene Munster.


"The reason we expect fewer iPad minis compared to the 3rd Gen is because of the lack of the wireless option and newness of the smaller form factor for consumers," Munster said in a note to clients. "We believe that over time that will change."


Reviewers have applauded Apple for squeezing most of the iPad's features into a smaller package that can be comfortably manipulated with one hand.


James Vohradsky, a 20 year-old student who previously queued for 17 hours at the Sydney store to buy the iPhone 5, only stood in line for an hour and a half this time.


"I had an iPad 1 before, I kind of miss it because I sold it about a year ago. It's just more practical to have the mini because I found it a bit too big. The image is really good and it's got the fast A5 chip too," Vohradsky said.


The iPad was launched in 2010 by late Apple boss Steve Jobs and since then it has taken a big chunk out of PC sales, upending the industry and reinventing mobile computing with its apps-based ecosystem.


A smaller tablet is the first device to be added to Apple's compact portfolio under Cook, who took over from Jobs just before his death a year ago. Analysts credit Google and Amazon for influencing the decision.


Some investors worry that Apple might have lost its chief visionary with Jobs, and that new management might not be able to stay ahead of the pack as rivals innovate and encroach on its market share.


(Additional reporting by Mariko Lochridge in Tokyo, Stefanie McIntyre in Hong Kong and Miyoung Kim in Seoul; Writing by Noel Randewich and Edwin Chan in San Francisco; Editing by Phil Berlowitz and Alex Richardson)


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Blake Shelton pulls off surprise win at CMAs

NASHVILLE, Tenn. (AP) — Winning the Country Music Association Awards' entertainer of the year is a top honor and always counted as a career high point. But for Blake Shelton it wasn't even the most memorable moment of an amazing Thursday night.

"The Voice" star took home three trophies, including his third straight male vocalist victory, but nothing compared to sharing song of the year with wife Miranda Lambert. The pair wrote "Over You," about the death of Shelton's brother Richie in a car wreck 15 years ago. He said that trophy will always have a special place in their Oklahoma home.

"For me as a songwriter that is as personal as I can get," Shelton said. "So that songwriter award, song of the year award, it will have its own shelf. It will have spotlights on it and an alarm and everything. Trip wires and there will be a land mine if you walk towards it. It is a real big deal to Miranda and I."

Shelton's entertainer win was the biggest surprise of a night full of them. Even he couldn't believe he'd won the award in a field that included Taylor Swift, Jason Aldean, Kenny Chesney and Brad Paisley.

"I didn't think about that tonight. I was thinking there's Taylor Swift right there," he said of the two-time entertainer of the year. "Really, this is pretty dumb that there's anyone else even nominated."

The reality, though, is Shelton capped one of the most impressive career reboots in country music history with the win. About three years ago, he was searching for a hit or a gimmick that might return him to the top of the charts, without much luck. He scored a novelty hit with Trace Adkins called "Hillbilly Bone," began a run of hits and then joined "The Voice" in a move that made him an instant celebrity outside the country world.

He hasn't sold as many records as Swift, whose "Red" just moved 1.2 million copies in its first week, or as many concert tickets as Chesney or Aldean. But his leading-man looks, wicked sense of humor, Twitter presence and mellow baritone have made him one of country's top stars.

While Shelton didn't give himself much of a shot, Lambert — who also won her third straight female vocalist of the year award — thought he fit the definition of entertainer of the year after doing a little research.

"I realized that it just meant not only touring numbers, not only ticket sales or how much production you have, but the way that you represent country music within a year," Lambert said. "The media that you do and the work that you do and the TV shows that you are on and how you represent yourself and how you speak out about country music. When you think about it that way, Blake Shelton deserved to win that trophy tonight."

Shelton's victory was just one of many surprises during the awards. Quartet Little Big Town joined Lambert with two wins apiece, taking home vocal group and single of the year for "Pontoon." And Thompson Square's Shawna and Keifer Thompson won vocal duo of the year, ending Sugarland's five-year run in that category.

"Y'all, this has been a 13-year journey," Karen Fairchild said as members of the group fist-pumped, jumped up and down and shouted on stage. "We're living proof that if you work really hard and chase your dream, all the good stuff happens and it follows you. Nashville, you made us your band. Thank you for letting us do this."

Like fellow outsiders LBT, Eric Church felt the love from the CMA's voters for the first time. He won the prestigious album of the year for his breakthrough record "Chief," signaling the North Carolina native's complete acceptance by the country music community.

"I spent a lot of my career wondering where I fit in — too country, too rock," Church told the crowd. "I want to thank you guys for giving me somewhere to hang my hat tonight."

The awards went off-script early, and not just for Little Big Town. Thompson Square won in a category that's been locked up by either Sugarland or Brooks & Dunn 19 of the last 20 years.

"Ever since I was 5 years old, I used to practice in the kitchen with one of my Meemaw's Mason jars for this moment here," Shawna Thompson said.

Hunter Hayes won new artist of the year, while Chesney and Tim McGraw won musical event of the year for "Party Like a Rock Star" and Toby Keith won video of the year for "Red Solo Cup."

Church helped kick off the show by combining forces with Aldean and Luke Bryan. Playing with a large American flag behind them, the trio of performers teamed up on Aldean's new single "The Only Way I Know" from his new album "Night Train" and earned a standing ovation. Each returned later to play singles, showing how large a market share they now own in country music.

Most of country's top stars were on hand at Nashville's Bridgestone Arena for the celebration, with many slated to perform. Swift performed her somber new single "Begin Again" on a set with a picture of the Eiffel Tower and falling leaves in the background. She received an ovation of her own.

Shelton, McGraw and wife Faith Hill, Lady Antebellum and Keith Urban joined together to salute lifetime achievement winner Willie Nelson, ending with a group sing-along of his iconic "On the Road Again."

Little Big Town performed their winner "Pontoon," a song that was something of a departure for Fairchild, Kimberly Schlapman, Jimi Westbrook and Phillip Sweet. Produced by Jay Joyce, the song has a sharper groove than LBT's previous efforts.

In a coincidence, Joyce also produced Church's "Chief." The hard edge he brought to both paid off all around.

Church said album of the year, arguably the CMA's second most prestigious award, was a win that fit right in with his and Joyce's philosophy.

"I still think in this day and time the only way to really get a fan base is you've got to give them more than one chapter of a book," Church said. "They've got to read the whole book."

___

AP writer Kristin M. Hall in Nashville contributed to this report.

___

Online:

http://cmaworld.com

http://abc.go.com/shows/cma-awards

___

For the latest country music news from the Associated Press: http://twitter.com. Follow AP Music Writer Chris Talbott: http://twitter.com/Chris_Talbott.

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At Bellevue, a Desperate Fight to Ensure the Patients’ Safety





From the moment the water lapped above street level in Lower Manhattan, the doctors and nurses of Bellevue Hospital Center began a desperate struggle to keep patients safe. By 9 p.m. Monday, the hospital was on backup power, and an hour later, the basement was flooded.







Karsten Moran for The New York Times

Outside Bellevue Hospital Center, a line of ambulances lined up to evacuate patients on Wednesday after fuel pumps for the hospital’s backup generators failed.







Officials rushed to move the most critically ill patients closer to an emergency generator. After midnight, doctors heard shouts in the hallway. The basement fuel pumps had stopped working, and medical residents, nurses and administrators formed a bucket brigade to ferry fuel up 13 flights to the main backup generators.


By Tuesday, the elevator shafts at Bellevue, the country’s oldest public hospital, had flooded, so all 32 elevators stopped working. There was limited compressed air to run ventilators, so oxygen tanks were placed next to the beds of patients who needed them. Water faucets went dry, food ran low, and buckets of water had to be carried up to flush toilets.


Some doctors began urging evacuations, and on Tuesday, at least two dozen ambulances lined up around the block to pick up many of the 725 patients housed there. People carried babies down flights of stairs. The National Guard was called in to help. On Thursday afternoon, the last two patients were waiting to be taken out.


The evacuation went quickly only because Bellevue had planned for such a possibility before Hurricane Irene hit last year, several doctors said. But the city, which had evacuated two nearby hospitals before that storm, decided not to clear out Bellevue. In the wake of Hurricane Sandy, the consequences of bad calls, bad luck and equipment failures cascaded through the region’s health care system, as sleep-deprived health care workers and patients were confronted by a new kind of disarray.


A patient recovering from a triple bypass operation at Bellevue walked down 10 flights of stairs to a waiting ambulance, one of the dozens provided through the Federal Emergency Management Agency to speed patients across the metropolitan region.


Mount Sinai Medical Center, already dealing with the 2 a.m. arrival of a dozen psychiatric patients who spoke only Chinese, was struggling to identify the relatives of brain-injured traffic victims from Bellevue who arrived three hours later with only rudimentary medical records.


Maimonides Medical Center in Brooklyn was straining to meet a rising need for emergency dialysis for hundreds of people shut out of storm-crippled private dialysis centers. Patients who would normally get three hours of dialysis were getting only two, to ensure the maximum number of people received at least a minimal amount of care.


“The catastrophe is growing by the minute,” said Eileen Tynion, a Maimonides spokeswoman. “Here we thought we’d reached a quiet point after the storm.”


Every hospital maintains an elaborate disaster plan, but after Hurricane Sandy, the fact that many health care facilities are in low-lying areas proved to be something of an Achilles’ heel. Bellevue became the third hospital in the city to evacuate after the storm’s landfall, after NYU Langone Medical Center, just north of Bellevue, and Coney Island Hospital, another public hospital.


New York Downtown Hospital, the only hospital south of 14th Street in Manhattan, and the Veterans Affairs Hospital, just below Bellevue, had evacuated before the storm.


Hospital executives were reluctant to criticize their colleagues or city officials. But the sequence of events left them with many questions.


“All hospitals are required to do disaster planning and disaster drills,” Pamela Brier, the chief executive of Maimonides, noted. “All hospitals are required as a condition of being accredited, to have generators, backup generators.”


City health department and emergency officials have been particularly fervent about citywide disaster drills, she added, but “as prepared as we think we are we’ve never had a mock disaster drill where we carried patients downstairs. I’m shocked that we didn’t do that. Now we’re going to.”


The city’s health commissioner, Dr. Thomas Farley, defended the decision not to require evacuations of Bellevue, Coney Island and NYU Langone hospitals before the storm, which he said had been made in consultation with the state health commissioner, Dr. Nirav Shah.


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Estimate of Economic Losses Now Up to $50 Billion





Economic damages inflicted by Hurricane Sandy could reach $50 billion, according to new estimates that are more than double a previous forecast. Some economists warned on Thursday that the storm could shave a half percentage point off the nation’s economic growth in the current quarter.




Losses from the storm could total $30 billion to $50 billion, according to Eqecat, which tracks hurricanes and analyzes the damage they cause. On Monday, before the storm hit the East Coast, the firm estimated $10 billion to $20 billion in total economic damages.


The flooding of New York’s subways and roadway tunnels and the extensive loss of business as a result of utility failures across the region were behind the sharp increase in the estimate, the firm said.


“The geographic scope of the storm was unprecedented, and the impacts on individuals and on commerce are far larger,” said Tom Larsen, Eqecat’s senior vice president and product architect. “Lost power is going to contribute to higher insurance losses.”


Eqecat predicted that New York would bear 34 percent of the total economic losses, with New Jersey suffering 30 percent, Pennsylvania 20 percent and other states 16 percent. That includes all estimated losses, whether covered by insurance or not. The estimates and the share that will be covered by insurers are far from certain at this point, as government officials, property owners and insurance adjusters struggle to assess the destruction.


While the stock market, banks and other financial institutions regained some of their stride on Thursday, other sectors like retailing, transportation and leisure and hospitality face a much longer and more difficult recovery. With fuel in short supply in many areas and utilities warning that power may not be back for a week or more in some areas, businesses found themselves preparing for the equivalent of a long siege.


FedEx, for example, was trying to rent fuel tankers for its trucks in New York and New Jersey as commercial gas stations ran dry.


“We’re reaching out to everyone who has a gasoline tanker that we can move to these areas,” said Shea Leordeanu, a spokeswoman for the company. While FedEx had stocks of oil in advance of the storm for generators, it was not prepared for the gas shortages that caused long lines at stations on Wednesday and Thursday.


“There has not been an impact yet, but this is something we can see as an issue and we’re concerned,” she said.


As logistical problems mounted, and damage estimates surged, economists raised their estimates of the storm’s impact.


“I think the effect will be quite big,” said Julia Lynn Coronado, chief economist for North America at BNP Paribas. “In the fourth quarter, we’re probably looking at an impact of half a percentage point.”


She said some of those losses would be made up in the first quarter of 2013, as insurance reimbursements were distributed and homeowners and businesses rebuilt.


Hurricane Sandy will rank high among disasters in terms of economic impact but will not be at the top of the list, said Mark Zandi of Moody’s Analytics. He estimated that the losses would be less than half of those suffered because of the 9/11 terrorist attacks and from Hurricane Katrina.


Moody’s Analytics also put the impact in the $50 billion range, with about $12 billion in losses falling in the New York City metropolitan area.


About $20 billion of that total is from lost economic activity like meals not served in restaurants, canceled plane flights and bets not placed in casinos, Mr. Zandi estimated. The rest, about $30 billion, will be from property destruction, including damage to homes, cars and businesses, Mr. Zandi said.


Eqecat said it believed that various forms of insurance would cover $10 billion to $20 billion of the total cost. Other losses will be borne by individuals and businesses, or covered by federal government programs like the National Flood Insurance Program. Much of the federal spending will be used to repair damaged public infrastructure, rather than for private property.


Eqecat said that if insured costs remained at the lower end of its predicted range, at $10 billion, then about 60 percent of the losses would be covered by homeowners’ and, to a lesser extent, auto insurers. The remainder would be covered by commercial and industrial insurance.


The firm’s officials said that if total insured losses rose to the higher end of its predicted range, it would be because of costs like business-interruption losses — and in that case, commercial insurers pay more.


They said this possibility would depend to a great extent on how long power failures continued. They said there were no solid data yet on the number of transformers and power lines that had been knocked out. They added that in some cases, power might not be restored until well into December.


Moody’s issued a report on Thursday stating that the large nationwide insurers had “diversified exposures and strong capital bases to withstand” payouts related to the storm. It added, however, that the costs could disrupt the capital bases of smaller regional insurers.


State Farm, the largest writer of home and auto insurance in the region, reported having received nearly 25,000 homeowners’ claims and 4,000 auto claims as of Wednesday. Those numbers are probably a fraction of the eventual totals. Some of the losses will not be recouped. Lost Halloween sales will be especially painful for some retailers, according to a separate analysis by Moody’s.


“As shoppers in the affected regions focus on the storm, other discretionary spending will fall and not be recouped,” Moody’s said.



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Live Coverage: In Storm’s Path, Recovery Efforts Inch Forward




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State-by-State Guide


A look at the devastation caused in the aftermath of Hurricane Sandy from North Carolina to New England.










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