Why Are COVID Cases Going Up in New York City?

Not yet there. Photo: Tayfun Coskun/Anadolu Agency via Getty Images

On Monday morning, CDC director Dr. Rochelle Walensky issued an urgent — and at times emotional — plea for the country to stay vigilant against COVID-19, amid a more than 10 percent uptick in new cases nationwide and a smaller but still notable rise in COVID hospitalizations and deaths. Fearing another wave of cases amid the rapidly reopening country’s mass-vaccination drive, Walensky said she felt a sense of “impending doom,” and urged Americans to “just hold on a little longer” and not let down their guard. Amid this mini-surge, New York State is now home to the country’s second-highest rate of new daily infections per 100,000 residents over the past two weeks (548), behind only neighboring New Jersey, which has had a 14-day average of 647 new cases per 100,000 residents. Infections in New York State and City, still extremely high despite having dropped significantly from their mid-winter peak, have been trending up again — and it’s not precisely clear why. Below is what we do know about the uptick in infections and ongoing risk in New York City.

Where things stand now

Compared to previous points in the pandemic, New York City is, of course, doing way better than it was last spring or at the peak of the big winter wave. But new daily cases remain very high, having generally plateaued since the end of February, and ticked up slightly in recent weeks — 4,659 new cases were reported in the city on March 28, making the 14-day average 4,056 new cases per day. That average was below 350 cases per day in late September before the winter wave began, with over 6,100 at that wave’s peak in mid-January, and nearly 4,200 in mid-February. In other words, the pandemic’s winter wave of COVID cases didn’t so much end as get smaller, and the risk of infection in the city has continued to remain extremely high.

Statewide, a USA Today analysis indicates that the week ending Sunday marked a 64 percent jump in cases from the previous week, the largest surge during that period in the country.

According to the COVID Act Now tracker, over the past week, the New York City metropolitan area (comprising 23 counties across New York, New Jersey, and Pennsylvania) has averaged 48.1 new daily COVID cases per 100,000 residents through March 27 — the seventh-highest rate among metro areas in the country. The infection rate remains just over one — meaning each infected person is only infecting one other person on average, a relatively slow and controlled rate of transmission.

Daily new COVID cases per 100,000 New York City metropolitan-area residents through March 27. Illustration: Screencap/COVID Act Now

Within the five boroughs, Staten Island leads with 62.9 new daily cases per 100,000 residents, followed by Queens (51.9), Brooklyn (47), the Bronx (45.4), and Manhattan (36.7). The New York Times also cautions that because the test-positivity rate remains high in the city (a 14-day average of around 6 percent), it’s possible that cases are being undercounted, and there are other ways test positivity can be a misleading metric.

Newly reported cases, as well as new hospitalizations, deaths, and test-positivity in New York City over the past three months, through March 28. (The enormous apparent spike on March 24 was due to a data-reporting factor.) Illustration: Screencap/New York Times

Hospitalizations and deaths from COVID-19 remain down and continue to drop in New York City, which is definitely very good news. It’s possible they will drop further, or at least remain flat: The average age of those infected continues to trend downward; 32 percent of New York City’s adult residents (and 28.1 percent of New York City metro residents) have already received at least one dose of a COVID vaccine — protecting virtually all from death or severe illness from COVID-19 — including more than half of New York City residents between the ages of 65 and 84; the city is nearing the weekly administration of a half-million shots; and vaccine eligibility is broadly expanding again this week to include everyone over 30, and everyone over 16 on April 6.

But, as in the past, hospitalizations and deaths always lag a few weeks behind surges in cases. In the meantime, an average of 55 people have died from COVID-19 every day in the city over the past two weeks. That’s about five times more people than were dying at any point from August to the beginning of December. And as Zeynep Tufekci argued Tuesday at the Atlantic, because of the arrival and spread of more transmissible and deadly COVID variants like B.1.1.7, this next wave could be more lethal for those it hits:

Compared with previous surges, case-for-unvaccinated-case, this surge has the potential to cause more illness and more deaths, infecting fewer but doing more damage among them. We can also expect to see more younger, unvaccinated people falling sick and dying. We’ve observed this in other places, including the U.K. and Israel, which started vaccinating the elderly after B.1.1.7 had already taken hold and then had many younger victims. This variant is also very hard to dislodge; the U.K., for example, was able avoid more catastrophic outcomes by delaying booster doses to cover more people initially, but still battled lengthy surges, as did Israel. Even with the U.K.’s ongoing vaccination campaign, which started in early December, almost 50,000 people in the country died from COVID-19 in just January and February this year, equal to nearly two-thirds of the total for all of 2020.

Why are so many people still getting infected?

There’s no one clear reason. But in the simplest terms, almost all COVID transmission is believed to happen among unmasked people indoors, which means it is entirely preventable, unless people continue to go unmasked around other people indoors while the risk of infection remains high. That’s clearly happening in New York.

The nation’s top infectious-disease expert, Dr. Anthony Fauci, and many other coronavirus experts have pointed to the rapid reopening and lifting of pandemic restrictions in many states, as well as the proliferation of more contagious COVID variants, as likely causes for the ongoing and increased spread of the virus in hot spots around the country.

New York governor Andrew Cuomo has continued to reopen the state more and more, despite the ongoing risk, including broadly loosening restrictions on indoor activity. While he has not lifted the state’s mask mandate, the governor has already controversially allowed the return of indoor dining — now up to 50 percent capacity in New York City — which is perhaps the highest-risk move considering it’s a mostly maskless activity. And as Grub Street’s Allie Conti has reported, some indoor-dining enthusiasts appear to be throwing caution to the wind. Movie theaters, gyms, and indoor fitness classes have also been allowed to open at limited capacity, and gatherings of up to 100 people indoors are now allowed as well.

With contact tracing effectively nonexistent in the city, it is not clear how much transmission of the coronavirus is happening at restaurants or other indoor locations. More restrictions are set to be loosened in the coming weeks, including at indoor arts and entertainment venues, which will be able to reopen at 33 percent capacity (up to 100 people) on April 2.

Meanwhile, coronavirus variants believed to be more contagious appear to be causing the majority of new cases across the city. In the first week of March, they made up roughly 65 percent of new cases, according to city health data. One apparently more contagious strain, the New York City–native B.1.526 variant, accounted for about 45 percent of new cases that week, while the imported more-contagious B.1.1.7 variant (which is now rising exponentially in Florida) accounted for 17.5 percent. Those percentages dropped to 32.5 percent of new New York City cases for B.1.526 and 9.5 percent for B.1.1.7 the following week — the last week for which the city has currently released variant data — but the strains remain of great concern.

The other potential factor, though difficult to measure, is a general relaxation of precautions among the public overall, particularly among young people, and possibly encouraged by the ongoing reopening of the state and country. It’s been a long, awful pandemic, and with the end finally in sight as vaccination rates continue to climb, there’s no doubt that many people are beginning to feel less risk adverse. But while people who are fully vaccinated absolutely should feel that way, everyone else should remember that a high-quality, tightly fitted face mask and common sense continue to be the best ways they can stop the spread while they wait for their shot.

No matter what, the vaccines will shut down the coronavirus

CDC director Dr. Rochelle Walensky’s dire warning wasn’t the only news the federal agency made on Monday. The CDC also released the results of more research reinforcing the remarkable real-world effectiveness of COVID vaccines. In a study of 4,000 essential workers who had received either the Pfizer-BioNTech or Moderna vaccines, both vaccines reduced the risk of infection by 80 percent after one shot, and 90 percent after the second shot. The vaccines didn’t just prevent symptomatic infections at those rates, they prevented infections, period. It’s the latest indication that COVID vaccines prevent transmission of the coronavirus, in addition to the fact that every vaccine almost universally prevents serious illness from the virus and all its known variants. It’s also more proof that mass vaccinations stop COVID-19 dead in its tracks, and that’s why there are calls for the federal government to allocate extra vaccine supply to areas of the country, like New York City, where the risk of infection is highest.

Part of that strategy, as Tufecki recommends at the Atlantic, could involve a tactic known as “ring vaccination”:

We should immediately match variant surges with vaccination surges that target the most vulnerable by going where they are, in the cities and states experiencing active outbreaks—an effort modeled on a public-health tool called “ring vaccination.” Ring vaccination involves vaccinating contacts and potential contacts of cases, essentially smothering the outbreak by surrounding it with immunity. We should do this, but on a surge scale, essentially ring-vaccinating whole cities and even states.

A vaccination surge means setting up vaccination tents in vulnerable, undervaccinated neighborhoods—street by street if necessary—and having mobile vaccination crews knock on doors wherever possible. It means directing supply to places where variants are surging, even if that means fewer vaccine doses for now in places with outbreaks under control.

This post has been updated.

Why Are COVID Cases Going Up in New York City?