With a new variant of the virus emerging elsewhere in the country, it’s crucial to vaccinate New Yorkers quickly. But so far, only about 88,000 have received the shots.
As the final hours ticked away in a harrowing year, New York City on Thursday once again found itself in a worrying position in the pandemic: Hospitalizations were climbing for the fourth consecutive month, the positive test rate in some areas had doubled and vaccinations that were supposed to bring normalcy had gotten off to a slow start.
Across the city, where the positive test rate over a seven-day average reached 8.87, the virus continued its winter surge.
In Sunset Park, Brooklyn, the positive test rate in the most recent seven-day average in one ZIP code had reached 14.71. A section of Ozone Park in Queens had a city-high 15.61 positive test rate. In the Bronx, the boroughwide rate had reached 9.56 — and yet that was still lower than Staten Island’s 10.34 rate.
In all, 49 ZIP codes in the city had a positive test rate of 10 or higher in the latest seven-day average, and the city has averaged nearly 4,000 cases and about 40 deaths a day.
So far the second wave has climbed more slowly and has not reached anywhere near the magnitude of New York City’s disastrous first wave in the spring — when more than 20,000 people died and 20 percent of city residents may have been infected. But public health experts say that there is urgent need to speed up the rollout of the vaccine to hasten the end of New York’s epidemic before hospitals are overwhelmed or a new and more contagious variant of the virus makes inroads.
The variant, first identified in the United Kingdom and recently detected in Colorado and California, has not yet appeared in New York State, Gov. Andrew M. Cuomo said on Wednesday.
When the first vaccinations were given in New York earlier this month, doctors and nurses said they believed the end of the epidemic was in sight. But the pace of administering vaccinations has gone more slowly than anticipated in New York City.
Dr. Ronald Scott Braithwaite, a professor at N.Y.U. Grossman School of Medicine who has been modeling New York City’s epidemic and is an adviser to the city, said that his team’s analysis suggested that once 10 to 20 percent of the city was vaccinated, the number of new cases would begin to drop — so long as social distancing and mask wearing remained constant and the new variant did not find a foothold in New York.
“If the new variant replaces the existing variant and we don’t vaccinate quickly, the second wave will start cresting again and will crest really high, and that’s something to take really seriously,” Dr. Braithwaite said.
But achieving the goal of vaccinating 10 to 20 percent of the city is still a far way off. In the first 17 days of the vaccination rollout, about 88,140 people had received the first of two doses, the equivalent of about 1 percent of the city’s population. Those vaccinated so far have overwhelmingly been hospital employees, residents and workers at nursing homes and the staff at certain health clinics.
The pace is worrying some experts. “I do feel concern,” said Dr. Wafaa El-Sadr, an epidemiology professor at Columbia University. Despite months to prepare, there still seemed to be a steep learning curve when it comes to “the nitty-gritty of how do you get it from the freezer to the arm as quickly as possible,” she said. “I think there are growing pains as people are picking up how to do this.”
The first phase should have been the simplest, she added. “We’ve started out with the easiest populations, an almost captive audience: nursing homes and hospital workers — you know who they are and where to find them.”
For now, the vaccination effort does not resemble the sort of mass mobilization many imagined. New York City has yet to open any large vaccination sites. Instead, hospitals administered many of the first vaccinations to their employees. Hospitals have been encouraged to use each shipment of vaccines within a week, and the operation does not always have a race-against-the-clock feel.
The number of vaccinations plummets on weekends and all but stopped for Christmas Day, when more planes landed at Kennedy International Airport than vaccine doses were administered in New York City.
The vaccination program is now in its third week and has yet to accelerate dramatically, even as supply has begun to increase. More than 340,000 doses have been delivered to New York City so far.
On Thursday, Mayor Bill de Blasio said the city planned to have administered doses to one million people by the end of January. He has suggested that the state is acting as a bottleneck by not authorizing the city to open up vaccinations to larger categories of people yet.
“If we’re given the authorization, we can move very quickly,” Mr. de Blasio said this week. “We need the state guidance in terms of the categories of people, and the more that expands, the faster we can go.”
State officials have expressed satisfaction with how the rollout is progressing, saying it makes sense to proceed with a few carefully delineated categories for now. “I’m not here to do 5 percent of the hospital and 5 percent of physicians and 5 percent of home care workers,” said Larry Schwartz, a member of Mr. Cuomo’s coronavirus task force who is overseeing the rollout. “We’re going down the line, and we’re only three weeks in.”
He added that the problem was the limited supply of the vaccine. “If we had a greater allocation, we probably would have gone to other group categories,” he said.
But already, there are growing complaints about fairness, with some doctors saying that hospital affiliation rather than risk has become decisive in determining who gets the vaccines.
Pediatricians who come into contact with Covid-19 patients daily have yet to be vaccinated for the most part if they do not work for a hospital. Yet some hospital employees who see fewer Covid-19 patients — such as radiologists — have been vaccinated.
“We feel forgotten,” said Dr. Kerry Fierstein, a pediatrician and chief executive of a company that runs pediatrician offices, mainly on Long Island and in New York City. “If you’re owned by a hospital, you’ve probably been vaccinated, but if you’re completely unaffiliated, you don’t know when you’ll get vaccinated.”
In recent weeks, the stakes have grown. The numbers across the state continue to rise, with concerning positive test rates in a seven-day average in the Mohawk Valley (9.5 percent), the Capital region (9.1) and the Finger Lakes (9.2) — and the new variant raises the risk that the epidemic could dramatically worsen in the weeks and months ahead.
The variant, known as B.1.1.7., is believed to be more than 50 percent more contagious. But surveillance of it is limited here. Less than half of a percent of confirmed virus cases in the United States are examined for variants, a far smaller fraction of cases than in a number of other countries, according to the Washington Post.
Mr. Cuomo said on Wednesday that more than 350 virus samples were recently tested for the new variant, and none were found to have it.
“That doesn’t mean it’s not here,” Mr. Schwartz said in an interview. “It doesn’t mean it is here.”
Despite the surge in cases and delays in the vaccine rollout, there is a bright spot for New York City: For the moment, hospitals are not in crisis.
With hospitalizations rising gradually — rather than suddenly, as happened in the spring — hospital systems have been better able to transfer patients to prevent any one facility from being overwhelmed.
The city’s public hospital system has moved around about 100 patients, mainly out of harder-hit hospitals in the Bronx and South Brooklyn and more recently Harlem, Dr. Mitchell Katz, head of the city’s hospital system, said.
“As long as the numbers keep drifting upwards, but not jumping, I’ll be fine,” Dr. Katz said. Intensive-care units in the city’s public hospitals were at 70 percent occupancy levels, he said.
Earlier in the month, Dr. Braithwaite thought it might take a shutdown of two or four weeks to prevent rising cases from overwhelming the health care system. But over the last few weeks, the case counts have climbed relatively slowly, with each case seeding about 1.2 new cases, he said. That is far below the more dire predictions he was considering at the start of winter.
“It’s simmering along,” he said of New York City’s epidemic.
Things could change if the new variant begins to speed up infections.
“That’s a reason to vaccinate really, really quickly,” Dr. Braithwaite said.
Yet if the spread continues at its current pace, some public health experts say that vaccinations might begin to bring New York’s epidemic under control before hospitals are overwhelmed — even without any additional government restrictions or stay-at-home orders. And neither Mr. Cuomo or Mr. de Blasio has shown much appetite for a full shutdown.
Dr. Jessica Justman, an infectious disease expert and epidemiology professor at Columbia University’s Mailman School of Public Health, said that the gradual increase of cases in recent months reflects the high level of social distancing and mask wearing in New York City.
“You could argue that the second wave represents a flattening of the curve,” she said, “that all the social distancing and mask wearing are doing what it’s intended to do: flattening the curve so the health care system isn’t overwhelmed.”
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Virus Numbers Are Surging. Why Is New York’s Vaccine Rollout Sluggish? - The New York Times
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