As U.S. Sees COVID Uptick, NYC Cases Remain Mostly Flat But Stubbornly High

As the nation sees another uptick in COVID-19 cases, New York City’s coronavirus cases have remained stubbornly high since mid-February—despite hospitalizations and deaths dropping and vaccinations rising.

Cases over a seven-day average in New York City have hovered between 3,600 and 4,200 since mid-February, while hospitalizations and deaths have fallen, according to city data. Overall, the spread remains at a steady rate of transmission of around one in the New York City metro area, meaning the virus is spreading slowly. Last summer, when cases remained low for months, around 430 to 560 new daily cases over a seven-day average were reported from the months of July to September.

But the high number of cases in NYC and New York State at large is creating an “inflection point,” according to Dr. Denis Nash, an epidemiologist at the City University of New York.

“It does appear that things have plateaued or we’re in a steady state here, but the number of cases each day is still quite high, concerningly high,” said Nash, the executive director of CUNY’s Institute for Implementation Science in Population Health. “We always need to remember that for every diagnosed case there’s probably two to three times as many undiagnosed cases. There’s a lot of transmission happening out there.”

Indoor activities without masks are the underlying reasons for COVID-19 cases generally. Nash suggested a mix of those conditions and more contagious variants are driving the consistency in New York City. The city’s positivity rate over a seven-day average was at 5.83% on Friday, a slight dip from a sustained 6% to 8% since mid-February, though data from most recent days are incomplete.

“At this time, when we’re trying to roll out vaccine and get as many people covered as possible, we would like to have it be much lower than this,” Nash said. “The fact that we are not really pressing to keep community transmission to a minimum right now…is a problem in my view.”

On a national level, federal officials fear the latest U.S. uptick could lead to another surge in infections. New York State is among the states driving cases higher, at 35 daily new cases per 100,000 people, the fourth highest in the country. The city’s metro area, which includes counties from New York, New Jersey, and Pennsylvania, is seeing 48 daily new cases per 100,000 people. New Jersey, Michigan, and Rhode Island are the top three—at 47, 46, and 37 daily new daily cases per 100,000 people, respectively. Michigan has seen rapid spread of coronavirus in recent days, with more young people being admitted to hospitals than in previous waves, the Detroit Free Press reported.

The country’s top infectious disease official Dr. Anthony Fauci said Sunday on CBS News’ Face the Nation that the nation’s uptick is concerning, given new lockdowns in parts of Europe spurred by variants. He blamed the lifting of some coronavirus restrictions in addition to new variants, like the United Kingdom variant (B.1.1.7) for the U.S.’s new rise.

“The variants are playing a part, but it is not completely the variants,” Fauci said Sunday. “What we’re likely seeing is because of things like spring break and pulling back on the mitigation methods that you’ve seen. Now, several states have done that.”

Nash suggested it does not seem like New York is at risk of what’s happening in the United Kingdom–where the variant B.1.1.7 exploded across the nation resulting in strict lockdowns. He added the U.S. has higher vaccination rates than parts of Europe. But Nash worries that relaxing COVID-19 restrictions on certain businesses, which Governor Andrew Cuomo has announced, will send a message that such activities are more safe than they may actually be.

“People’s behavior could be changing,” Nash said.

Councilmember Mark Levine—who called on Cuomo to pause April’s reopening plans—wants the federal government to direct more supplies to coronavirus variant hotspots.

Nash called that option a “tough call,” but worth considering. With the current allocations, New York’s leaders can focus on optimizing delivery of vaccines to people at the highest risk.

Tracking COVID-19 trends is getting more complex as vaccinations roll out, he added. Positivity rates are imperfect since they’re dependent on how many people are getting tested and who is getting tested. Hospitalizations and deaths help show what’s going on with community transmission—but those most at risk are now getting the shot, impacting what those data tell us, Nash added.

“Those trends are now representing the effects of vaccination roll out as well as community transmission weeks earlier,” Nash said. “The deaths and hospitalizations can now tell us where we need to be targeting vaccine the most.”

He said a key event to watch for is whether anyone fully vaccinated or already infected with coronavirus becomes severely ill again. A case like that would show a shift in New York’s epidemic. Brazil has seen a surge in COVID-19 cases and deaths due to a variant (P.1) that has infected people who’ve already recovered from the disease. One case of P.1 has been found in a city resident.

For now, Nash said, “It’s all about staying the course, ramping up vaccination as soon as possible in as targeted and smart way as possible, and doing everything we can with masks and behaviors to keep community transmission to a minimum.”