N.Y.C. Virus Cases Appear to Plateau. Could an Uptick Lie Ahead?

The Delta variant’s rapid spread in New York City this summer has slowed in recent weeks, convincing some epidemiologists that the city’s third coronavirus wave has begun to ebb. But others are bracing for an uptick of cases as school starts.

Dr. Dave Chokshi, the city’s health commissioner, described the current moment in an interview as a plateau, and warned that the level of virus transmission — at some 1,500 cases per day — “remains at too high a level for us to be complacent about where we are.”

With the school year starting, and municipal agencies and some large companies mandating a return to the office, the old weekday rhythms — families rushing out the door, morning commutes, lunch meetings — are about to return for hundreds of thousands of New Yorkers, even as levels of the virus remain relatively high.

Here’s where things stand:

A possible plateau

For the moment, the rate of new cases and hospitalizations are down from their summer peak.

In mid-August, nearly 2,000 people a day on average were testing positive in New York City, a tenfold increase from earlier in the summer. The rate of new cases was highest among young adults, 18 to 34. More than 100 people were being hospitalized each day.

But over the past three weeks, new cases and other indicators have begun dropping gradually, raising hopes that infection rates are subsiding. Staten Island has had by far the highest level of transmission, with one in every 417 people testing positive in a recent seven-day period. That was more than twice the rate in Queens, which had the lowest virus levels.

“I really do hope that the trends that show the Delta surge going in the downward direction stay that way, but I’m not sure, and if we look at what happened in the U.K., there was a second surge,” said Dr. Denis Nash, an epidemiologist at the City University of New York. “We are in a very precarious place right now and the next few weeks are going to be critical.”

Dr. Wafaa El-Sadr, an epidemiology professor at Columbia University, was more optimistic. “We’ve peaked, I think, and now we’re coming down the slope,” she said. She noted that by nearly every metric there seemed to be less coronavirus circulating in the city.

“When you look across the board, everything seems like it is going in the right direction,” Dr. El-Sadr said.

While Delta drove case levels up, the surge in New York City and much of the Northeast has been mild compared to the South, largely because of diverging vaccination rates, epidemiologists say. On Thursday, the city reached a new milestone: five million New York City residents, about 60 percent of the population, are now fully vaccinated against the coronavirus, which is seven percentage points ahead of the nation at large.

But there are still large pockets of New York City that remain unvaccinated. In particular, Black New Yorkers, who have far lower vaccination rates than other groups, have been hit hardest by the third wave.

So far, the third wave has been minor compared with the previous two. In early September, the number of people hospitalized with Covid-19 in New York City in a single day reached 900, before falling below 800 this weekend. In April 2020, when ambulance sirens filled the air and morgue trucks were parked outside hospitals, there were more than 12,100 Covid-19 patients in hospitals in New York City at the peak. During the long second wave, which extended from fall 2020 to this spring, there were more than 3,800 patients in hospitals on a single day.

Household infections remain prominent

Last week, 60 percent of people who told contact tracers that they knew how they had gotten the coronavirus said they believed they had gotten sick from a household member, according to the city’s Test and Trace Corps. Another 8 percent reported they believed they were infected at a social gathering.

And 20 percent of all people who tested positive said they had traveled within 14 days of getting sick.

The city said that these three main sources of infection are very similar to those at earlier stages of the pandemic.

Because household transmission is still the main driver of infections, the city is offering at-home testing for all contacts of confirmed virus cases, as well as all New Yorkers who are immunocompromised or age 65 or older. The city can also arrange at-home vaccinations for any New Yorker who asks.

School reopening will be a test

Children are faring relatively well so far through the city’s third wave.

The hospitalization rate for children, Dr. Chokshi said, is significantly lower than that for the general population. Doctors at several large New York City hospitals said they were not seeing many pediatric hospitalizations for Covid-19 at the moment.

But New York City’s school year starts on Monday, and classrooms will be full for the first time in 18 months, as students who learned remotely last school year must now return to class.

City schools are continuing with their layered approach to virus prevention: Masks are required for all. There will be air purifiers in every classroom and schools will try to maintain social distancing of at least three feet. All staff must have at least one dose of a vaccine by Sept. 27, including at pre-K and after-school programs contracted with the city.

City public schools had a very low in-school transmission rate last year, and that continued during summer school. Of the roughly 50,000 tests conducted in public school programs during the summer, even as Delta surged, only 110 students and 49 staff members tested positive, for a positivity rate of 0.32 percent, according to city data.

Still, that does not mean that city schools were virus free. Nearly 20,000 classrooms closed for at least a week over the past year because of a virus case, according to the city. And a total of almost 28,000 school staff members and children tested positive for the virus between Sept. 14, 2020, and Sept. 8. 2021.

While vaccines are a huge plus for safety, the new school year also brings extra concerns, particularly for elementary schools where children remain unvaccinated because those under 12 are not yet eligible. The lunchroom in particular is a weak link in school safety plans, as children will not have masks on, and the airborne virus can travel more than six feet, said Dr. Nash.

Class sizes will be larger, as some 60 percent of city school children did not attend in person last year, and those who did typically had a mix of remote and in-person classes for most of the year.

And even though the Delta variant is more transmissible, the city’s Covid testing program in public schools is less rigorous than last year’s. This year, only 10 percent of unvaccinated students will be tested every other week.

The mandates may be working

New York City was the first major American city to announce widespread indoor vaccination mandates for businesses. Since Aug. 17, all customers over age 12 and staff members have had to be vaccinated to participate in a variety of indoor activities, including dining, gyms, museums and movie theaters. City enforcement, however, will not begin until Monday, and some businesses are waiting until then to implement the rule.

Restaurants already asking for proof of vaccination report a variety of responses from guests.

“Some restaurants are saying it hasn’t been an issue, and they even have new customers who are now more comfortable because of the vaccine requirement,” said Andrew Rigie, the executive director of the NYC Hospitality Alliance, a restaurant industry group. “Others say their business is down and they’re turning people away, or that customers aren’t showing up like they used to.”

Gyms had already been asking for vaccination status, because vaccinated customers are allowed to work out without having to wear masks. Keith Worts, the chief executive officer of Crunch Signature, which has 28 gyms in the city, said that his gyms have been busy uploading the vaccination information of members into the computer system for the past three weeks, and will begin excluding unvaccinated members on Monday.

He said that the vast majority of members and staffers were vaccinated and that there had even been a small bump in memberships among those who said the policy makes them feel safer.

Some experts cautioned that the city’s decision to forgo an indoor mask mandate, including for high-risk settings like gyms, may blunt the effectiveness of its vaccination mandate, which only requires one dose of a two-dose vaccine. Delta can spread among vaccinated people, according to the Centers for Disease Control and Prevention, though the risk is lower, and they are far less likely to get severely ill from the disease.

“Even if you have a fully vaccinated gym population, it doesn’t mean that you can go to the gym and not worry about getting infected, because it is absolutely going to happen,” Dr. Nash said.

“People view the vaccines as something that will prevent transmission of the virus, because that’s how they were pitched to us,” he said. “But I think what we have seen is that they prevent against severe disease and death. They don’t necessarily block against transmission of the virus.”