New York City Health + Hospitals initially experienced some challenges with staffing and supply shortages and capacity limitations. As the pandemic unfolded, the agency assumed a significant role in planning for and responding to New York City’s public health emergency, launched the largest test and trace program in the country and implemented a vaccine program. The agency managed financially early in the pandemic due to the receipt of federal COVID-19 relief funding but, with the rise of new variants and subsequent increase in hospitalizations, costs continue to grow.