New York state lifted most of its COVID-19 restrictions this week—with fireworks and fanfare—after 70% of adults had received at least one dose of vaccine. The celebration feels warranted given the suffering over the past year. More than 53,000 pandemic deaths have occurred statewide, with two-thirds happening in New York City alone. Jobs lost, an economy stifled and a society traumatized.
But this wide-reaching burden wasn’t felt equally among neighborhoods, counties or sociodemographic groups. Research continues to unpack how income and racial disparities ran rampant as the plague preyed upon essential workers. Even a new study published Thursday shows in intricate detail why disadvantaged neighborhoods in New York City felt the brunt of COVID-19 during its first wave last spring.
This study was done because much of the conversation about pandemic disparities has centered around how health inequities led to higher mortality rates in communities of color—but that doesn’t explain why these groups were getting infected faster in the first place. Going zip code by zip code, researchers at Mount Sinai looked at an array of social variables such as income, access to medical insurance and commuting patterns. They then built a blueprint—or index—of the most influential factors.
“What we found was that the inequity index that we created was strongly related to the amount of infections in the first wave of the pandemic,” said Daniel Carrión, a study co-author and a public health researcher at the Icahn School of Medicine at Mount Sinai. Neighborhoods that ranked highest in COVID inequity—Jamaica and South Richmond Hill, both in Queens—also had more subway ridership well after the lockdown started.
Public health should address the needs of all people, especially the most vulnerable, not population averages.
The COVID-19 vaccines were made to ease the pandemic burden, and broadly speaking, they have. But a WNYC/Gothamist analysis of New York City data shows COVID segregation is widening even as the overall toll of the pandemic relaxes. Hospitalizations and deaths are shifting into areas that have fallen behind on vaccine doses. People of color are making up a greater proportion of cases.
These trends matter because a dangerous coronavirus variant is thriving in the U.S. It could yield resurgences in places that lag in vaccines—and stymie the reopening citywide. And while Mayor Bill de Blasio and Governor Andrew Cuomo cite vaccine hesitancy for these setbacks, federal surveys disagree. Residents of New York City rank among the lowest in the state and the nation when it comes to hesitancy rates.
Despite multiple requests from WNYC/Gothamist, the city and state have not provided data on how many vaccine doses they have delivered to individual providers by zip code, a fundamental way for determining if access has been equitable.
Less Vaccine, More Hospitalizations
This spring, COVID-19 cases and hospitalizations plummeted citywide as vaccines became widely available. The vaccine rollout helped cut down New York City cases from a daily average of 6,200 in early January to 200 this week (or 16,600 to 400 statewide).
But severe cases are now saturating in areas with low inoculation rates. Here is a map of the city’s vaccine coverage:
And below is a map of the last month or so of COVID hospitalizations. Notice how some neighborhoods reported no hospitalizations, while others still experienced a couple dozen.
Overall, the low hospitalization rate is a sign of progress compared to the surges experienced this winter and in spring 2020. But this geographic disparity could foretell where future outbreaks may emerge as variants continue to spread.
“The best prediction is that it’s absolutely possible that we could see outbreaks happening over the summer, especially if we don’t get vaccination rates up,” said Dr. Denis Nash, a professor of epidemiology at the CUNY Graduate School of Public Health. “We could even begin to see increases in deaths and hospitalizations if we don’t target the right people first with vaccination.”
Déjà Vu Disparities
The pandemic’s early days opened up chronic fissures in health disparities—ones that have long harmed senior citizens, impoverished communities and people of color. Nash said those problems could easily resurface unless vaccination rates hit 70 or 80% throughout geographic areas and sociodemographic groups across New York. No county or community can be left behind on the path to herd immunity, he said.
Residents of the five boroughs are already experiencing the outcomes from the seeds of vaccine inequity.
Soon after COVID-19 vaccines received approval in mid-December, the daily share of new coronavirus infections among white New Yorkers began to decline. It dropped by about 10 percentage points from the start of the rollout to the end of February, despite widespread issues with accessing online appointments and the supply interruptions due to inclement weather.
Before this decline, new cases among white residents paralleled their portions of the city’s population, about 40%. The share among Asian/Pacific Islanders stayed low and mirrored their population share of the city, which is about 14%.
For Hispanic/Latino groups, new infections remained flat but high—accounting for 37% of cases. That’s larger than their share of the city’s population, which is about 29%. The Black proportion of daily cases grew during this period, rising by 5 points to 21%. African-Americans make up 24% of the boroughs. By mid-winter, Hispanic and Black residents comprised more than half of daily new cases.
Vaccine demand skyrocketed in March as national supplies improved, leading more New Yorkers to get vaccinated. But Hispanic/Latino New Yorkers continue to bear the brunt of infections, and Black New Yorkers now make up a greater share of new COVID cases than in months past.
“Public health should address the needs of all people, especially the most vulnerable, not population averages,” Dr. Céline Gounder, an infectious disease specialist and epidemiologist at the NYU Grossman School of Medicine and Bellevue Hospital and the host and producer of Epidemic, said via email.
Here’s the full timeline for daily new infections since the vaccine rollout began:
Hesitancy Or Access?
When historians write up the early chapters of the COVID-19 vaccine rollout, it’ll be a success story. Dolling out 8.8 million shots in six months across New York City (and 314 million nationwide) will likely be classified as part of the medical achievement of this generation.
Those tomes will also undoubtedly include the word “hesitancy.” Elected and health leaders are quick to reference the term when discussing vaccine disparities, such as when Mayor de Blasio was asked this week about low rates in Brooklyn.
“Look, we understand that in some communities, there has been particular hesitancy,” de Blasio said Tuesday. “The way to address that is [to] keep answering people’s valid questions. Keep going out there, connecting with family doctors, pediatricians, talking to their patients.”
But ongoing surveys of U.S. households don’t support the hesitancy talking points, at least not for the Empire State. While there is a slight negative connection between hesitancy and vaccination rates among its counties, the trend isn’t statistically significant in New York state. By contrast, hesitancy does correlate with vaccination rates at the national level.
For example in Manhattan (New York County), the estimated hesitancy is 6.5% as of June 7th. In Brooklyn (Kings County), it’s 8%. That’s a small difference. Meanwhile, Manhattan’s vaccine coverage is nearly 20% higher than Brooklyn’s.
Looking deeper, four of the five boroughs—Manhattan, Queens, Staten Island and Brooklyn—sit within the bottom 15 counties in terms of hesitancy rates. The Bronx isn’t far behind and is well within the lower half. Moreover, New York state has among the least hesitancy in the country. Counties in Wyoming lead the way with 25% hesitancy, while the highest area in New York is around 11%.
The five boroughs rank in the bottom 25% of U.S. counties with regards to hesitancy. When asked Thursday about the federal data and why he cites hesitancy as a primary cause for disparities in vaccine uptake, Mayor de Blasio said that those numbers don’t ring true to him.
The five boroughs rank in the bottom 25% of U.S. counties with regards to hesitancy.
“With all due respect to the CDC, that’s not what we’re experiencing,” de Blasio said. “Our data comes from millions of encounters with New Yorkers, almost 9 million individual vaccinations. All the encounters including right within the [NYC] Health and Hospitals, where people are saying they’re not yet ready.”
The New York City health department has not provided evidence to support this claim. But a spokesperson said equity has been at the forefront of the city’s approach, while also saying there have been efforts to improve vaccine resources in neighborhoods with the lowest rates, such as through mobile clinics and community partnerships with trusted messengers.
“Inequities are driven by so many things including barriers to access, sometimes driven by structural factors, such as the ability to get time off of work or other personal demands. That is one reason why convenience is a top priority,” the spokesperson stated via email to WNYC/Gothamist. “Racist policies and practices in medicine and government come at a cost to trust in both institutions. The onus is squarely on us as public health authorities to build trust and confidence.”
A spokesperson for Governor Cuomo’s office responded likewise and said the state is administering “vaccines as quickly and equitably as possible.”
“We have increased efforts to bring shots to local and hard-to-reach communities, ensuring time-off for employees to receive the vaccine, paid sick leave for employees who experience symptoms from the vaccine, walk-in appointments at all state-run sites, the establishment of 11 new pop-up sites to serve zip codes with lower vaccination rates, direct partnerships with houses of worship, and creative vaccine incentive programs, such as the ‘Vax and Scratch’ program and the ‘Get a Shot to Make Your Future’ program,” the spokesperson stated via email. “Because of these collective efforts, over 20.2 million doses of vaccine have been administered – meaning over 70% of adults have received at least one vaccine dose, a federal milestone NYS met early.”
On Thursday, the Cuomo administration pledged another 12 pop-up clinics in areas with low vaccination rates, including two in Brooklyn and one in the Bronx.
The problem is that despite all the recent initiatives, the demand for the COVID-19 vaccines continues to decline. Researchers interviewed for this story say persistent disparities are worrisome because of coronavirus variants. One dose of vaccine doesn’t appear to be enough to fight the delta variant, which is still rare in New York City but swiftly expanding, both in the boroughs and nationwide.
“We know that where vaccination coverage is high, COVID cases, hospitalizations, and deaths are down dramatically. But where few people are vaccinated, cases are on the rise,” said NYU’s Gounder, citing national trends. “This is because people are dropping mitigation measures like masking despite not yet being vaccinated. A false sense of security doesn’t magically protect people against COVID; it leaves them vulnerable to infection.”