COVID’s Sudden New Surge

Suddenly, the virus was everywhere.

“We’ve never seen this before in New York City,” Dr. Jay Varma, the mayor’s former health adviser, said as he watched a record surge in the portion of tests for the SARS_CoV-2 virus that came back positive, doubling in three days to 6.5%.

The data confirmed what everyone around town was feeling. Broadway theaters canceled performances. NYU canceled graduations and other “non-essential” gatherings. The Brooklyn Nets, with seven players benched in COVID-19 protocols, barely scraped together enough players to take the court against the Toronto Raptors (the Nets won anyway).

The new surge was most intense among younger New Yorkers - school-age kids, their thirtysomething parents and young adults in their twenties.

One young woman, living now in Chicago, called her parents on the West Side to say she was terrified to come home for the holidays because all her high school and college friends in New York were getting infected.

“You’re not seeing what I’m seeing on social media,” she told her dad, who was assuring her it was ok to return so long as she tested and wore a mask.

There was a run on testing. Lines wrapped around the corner at urgent care centers and vans parked next to tents along the street. But neighborhoods that were not as well provided with such facilities ran into trouble.

The city acknowledged, for example, that it had temporarily curtailed testing at Sydenham Hospital in Harlem so it could send the staff to public schools to run on-site vaccination of younger kids, just made eligible.

Ted Long, who runs the city’s Test and Trace Corps, promised that the city was working out these staffing kinks. “We’re ready for this wave,” he pledged. “And all we need is for you and New Yorkers to continue to come out and get tested.”

“Moving forward, what you expect from us is more and more testing, especially as we have Omicron here and especially as we’re continuing to go into the fourth wave with Delta,” he added. “Getting tested is one of the most important things New Yorkers can do, which is why we’re doubling the size of our mobile fleet, keeping the lab turnaround times where they are.”

Mayor Bill de Blasio announced Thursday that the city would work to distribute half a million at-home COVID-19 tests.

New Variant

Cases of COVID-19 have been rising in New York City since November 1. But in the last few days that rise became an alarming surge, apparently powered by the arrival in the city of the new variant, Omicron.

There were 4,523 new cases of COVID-19 reported on December 15 in the city, a striking rise from the 200 cases a day being reported just last June. If rates continue to climb like this they will soon rival the previous peaks last winter and in March and April of 2020.

As recently as late October, transmission of SARS-CoV-2 in New York City, while still substantial, had fallen below levels classified as high by the Centers for Disease Control, 100 cases per 100,000 residents.

But in November cases climbed through that 100 per 100,000 measure and have kept climbing. As of December 13, the citywide transmission rate was 311 cases per 100,000 New Yorkers. In Manhattan it was 396 per 100,000 and on Staten Island it was 441 per 100,000.

“Serious Threat”

The recent rise in cases was at first driven by the Delta variant. On November 20, the city’s health department reported it had not identified a single case of Omicron. However, by December 4, Omicron began showing up in a small proportion of the COVID-19 tests that were analyzed to identify the variant. The proportion of Omicron has been rising ever since as total cases have risen, too.

Vaccination or a previous case of COVID-19 was clearly not enough to protect against infection.

“The Omicron variant presents a serious threat to many existing COVID-19 vaccines and therapies,” a group at Columbia University, led by the well-known AIDS researcher Dr. David Ho, reported Thursday, “compelling the development of new interventions that anticipate the evolutionary trajectory of SARS-CoV-2.”

For the moment, however, it was old interventions that were being brought back. Governor Kathy Hochul imposed a mask mandate on indoor activities. That created a certain amount of confusion in New York City because it provided an exception for groups that were vaccinated, which would include restaurants, fitness facilities and entertainment venues already covered by de Blasio’s vaccination mandate.

The two, exhibiting their commitment to unity, said it was all good and they were working together.

The mayor’s bigger problem was the blowback against his broadened vaccine mandate, which as of December 27, four days before the end of his term, will cover every private employer in the city. He also said that kids would now have to show proof of vaccination to eat out at restaurants or go to movies or plays.

Some business people complained about the new burdens and the specter of losing employees through the holidays. But the mayor stuck to his position that vaccination was the single strongest line of defense against the virus.

Both de Blasio and federal health officials, including Dr. Anthony Fauci, have urged everyone to get vaccinated and boosted. The Metropolitan Opera announced that proof of vaccination for performers, staff and audience would now have to include booster doses, the first venue to impose such a rule.

But this emphasis on vaccination and boosters drew criticism from the World Health Organization, which warned there could be a shortage of as much as 3 billion vaccine doses this winter if rich countries continued to use doses to vaccinate and boost lower risk people before many people in lower income countries had received even a first dose.

The Omicron variant was first identified in Southern Africa, where vaccination rates are far lower than in New York.

Boosting those who don’t necessarily need it would “repeat the vaccine hoarding we saw this year and exacerbate inequity,” said the WHO’s director general, Tedros Adhanom Ghebreyesus.

Slower Pace

The only reassuring news was that, so far, hospitalizations have crept up at a far slower pace in the city than new cases. Deaths have not increased at all. This could be because treatments have improved and vaccination, even if it is less effective at stopping infection, still guards against serious illness.

But health officials also note that hospitalizations and death are lagging indicators.

The level of alarm was rising rapidly in nearby places. Upstate some hospitals were close to capacity and in Philadelphia the health commissioner said holiday parties and Christmas gatherings with other families were “too dangerous” with so much virus in the community. “Please do not hold or attend holiday parties indoors,” said the commissioner, Cheryl Bettigole.

Contact tracing shows that most new COVID-19 infections are occurring in household gatherings, she said.

De Blasio refused to go that far. “It’s always about vaccination,” he insisted, despite evidence that the new variants could break through vaccination. “If people are vaccinated, if people getting those boosters, that is the way to make gatherings work best.”

NEW

His health commissioner, Dave Chokshi, offered more nuanced guidance that, by the end, came close to what the Philadelphia health commissioner had said to start with.

“Vaccination is very important,” Chokshi said, echoing the mayor, who was listening at a news conference.

Chokshi continued: “But my practical guidance is to plan around the most vulnerable family member, whether that’s a child younger than five, who’s not yet eligible for vaccination or a senior in your family or someone with a weakened immune system.

“Those situations may mean that you choose to have a virtual gathering or have events outdoors rather than indoors or use masking and distancing to help make, you know, gatherings safer.

“Testing also provides an important layer of safety. We recommend testing both before and after any significant gathering. Which leads me to my final point, which is that smaller gatherings are of course safer. You know, we do recommend not to participate in larger gatherings if they’re at all avoidable, and instead to keep it to a small gathering with family and friends.”