One month and one day ago in New York State, 275 people—out of more than 54,000—tested positive for COVID-19. That marked the lowest single-day total in the state since the first days of the pandemic, when many fewer people were getting tested. And it extended the long downward slope of new cases, which had been declining since early January.
Across the country, the story was largely the same: vaccination rates were climbing, caseloads were falling, and there was widespread optimism that we may have finally turned the corner in the pandemic. (Remember Hot Vax Summer?) On May 13, the Centers for Disease Control and Prevention updated its guidance to announce that vaccinated Americans no longer need to wear masks in most situations. Less than a week later, New York followed suit, dropping its mask mandate for vaccinated people. The long-awaited return to normalcy began.
But it is clear now that the pandemic is not over. With the Delta variant resurgent and some 40 percent of adults in the US still not fully vaccinated, on Tuesday the CDC reversed course and said that people who have been vaccinated should resume wearing masks in public spaces where the coronavirus is surging. That advice is largely informed by data the CDC plans to release Friday showing that vaccinated people who have been infected with the Delta variant carry significant amounts of virus in their airways, meaning they can transmit the virus even if they don’t show symptoms.
We’ll get into the particulars of the CDC’s guidance below. But since that day when cases hit a nadir a little over a month ago, New York’s caseload has steadily increased. Yesterday, 2,567 persons tested positive, 2.5 percent of everyone who got a test. The rolling 7-day average of test positivity has climbed from 0.4 percent at the end of June to 2.2 percent as of July 28.
But the resurgence of COVID-19 is not being felt equally. There are essentially two pandemics now: one for the vaccinated, and one for everyone else. While the rates of “breakthrough cases”—infections among people who got vaccinated—have surprised some scientists, the chances of being sickened to the point of hospitalization are vanishingly small if you have the vaccine. Conversely, transmission of the more-contagious Delta variant has accelerated among the unvaccinated due in part to looser rules concerning mask-wearing.
What’s more, the guidance of the CDC has often been confusing, full of exceptions and nuance that may end up muddying the message. As David Leonhardt of The New York Times notes, the country’s leading public health agency has both a polarization problem and a communication problem. Many people have been rejecting federal health advice on COVID-19 for months; they account in large part for the percentage of Americans who have yet to get vaccinated. Leonhardt writes: “Who, then, is most likely to listen to the C.D.C.’s new request that vaccinated people wear masks indoors? People who live in the places where it will do the least good.”
Where Do the New Guidelines Apply?
The CDC’s new guidance says that everyone, vaccinated or unvaccinated, should wear a mask in all public indoor settings in communities with “substantial” or “high” transmission. (Unvaccinated people should still mask up in all communities, regardless of transmission rates.) Those categories include all counties where there are at least 50 new active cases per 100,000 residents in the past week, or a positivity rate of at least 8 percent.
The trouble with the guidance: Most people don’t know (or constantly track) the transmission levels of their home counties. Cases move fast, and the situation is constantly changing: When the CDC issued the new guidance on Tuesday, Greene County was the only county in The River’s coverage area with “substantial” transmission. By Thursday afternoon, both Orange and Westchester counties had been added to the CDC’s “substantial” group.
The CDC has a live map of transmission rates by county across the US. Cases are rising nationwide, but not at the same rate—and although New York State’s infection levels are rising, they are not going up as steeply as in the states that are seeing the worst of the surge. Areas with lower vaccination rates are generally seeing a steeper rise in cases.
One way to think about the fifth wave, STAT News’s Emory Parker writes, is to look at the rate of acceleration of cases in different places: In other words, not just how fast case numbers are rising, but how much that rise is speeding up. On that measure, Louisiana and Florida are dramatically ahead of the rest of the nation, with New York somewhere around the bottom third.
Will Vaccination Keep Cases from Worsening Locally?
Every county in the Hudson Valley and Catskills still has a significant population that is unvaccinated and vulnerable to contracting COVID-19, including every child under the age of 12. No local county has yet reached the vaccination rate that scientists think is the threshold for achieving “herd immunity,” the level at which enough people are immune to the virus that it can no longer keep spreading through community transmission.
In our region, the counties with the highest rates of transmission and those with the lowest rates of vaccination don’t currently match up exactly, although that may change as the Delta variant moves quickly through vulnerable populations. East-of-Hudson counties are generally better protected than those west of the Hudson.
According to the New York State vaccine tracker, the rural Catskills counties of Greene, Schoharie, Delaware, and Sullivan, as well as Orange and Rockland counties on the western side of the Hudson Valley, all have less than 55 percent of the population with at least one vaccination dose. Ulster County on the western side, along with the eastern Hudson Valley counties of Columbia, Dutchess, Putnam, and Westchester, have first-dose vaccination rates ranging from 59.9 percent to 67.2 percent—near or above the state average, but still below the roughly 80 percent scientists think may be the lower bound for achieving herd immunity in the population.
What Should We Do?
The Delta variant is moving faster than the original form of COVID-19, but it has not fundamentally changed how people should protect themselves and those around them from infection. The best protection against becoming infected with COVID-19 is still vaccination, and the vaccines offer even stronger protection against death and serious illness than they do against contracting the virus. Masks, good ventilation, and gathering outdoors instead of inside all still reduce the risk of becoming infected.
Since the Delta variant has become dominant, the risk to vaccinated people of becoming infected has risen, but the risk to the unvaccinated has risen much faster.
If you have not yet been vaccinated and want to be, check with local pharmacies, health clinics, your county health department, or New York State’s vaccine website or hotline (1-833-697-4829) to find an appointment near you. There is no cost for being vaccinated against COVID-19, and you do not need to be a US citizen to receive a vaccine.
There’s been a spate of news headlines about Pfizer’s vaccine “losing effectiveness,” but they should be kept in context: When scientists talk about “efficacy” in a vaccine, they are only talking about how good it is at stopping infections entirely. Efficacy rates for Pfizer’s vaccine have dropped slightly as time from vaccination has passed and as Delta has become dominant, but they are still high enough for the vaccine to work well—and more importantly, the vaccine’s effectiveness at preventing serious outcomes like hospitalization and death has remained even higher than its efficacy at preventing infection.
The recent Pfizer results might mean that vaccine immunity wanes slowly over time, though. Scientists are studying the issue, and health officials might eventually recommend that people who have been vaccinated should get booster shots.
Who Is Now Required to Be Vaccinated in New York?
As they did in May, New York health officials quickly followed the CDC’s lead. On Wednesday, Governor Andrew Cuomo announced that all patient-facing health workers in state-run hospitals were required to get vaccinated by Labor Day, and all state employees must get vaccinated or face stringent testing protocols.
The mandates are already getting pushback, chiefly from powerful unions in the state. The president of the Public Employees Federation—which represents professional, scientific, and technical state employees—said in a statement that any vaccine mandate must be bargained between labor and management. The president of the New York State Correctional Officers and Police Benevolent Association called the vaccine requirement a “drastic measure.” And the New York State Troopers’ PBA was “caught off guard” by Cuomo’s announcement, according to The Buffalo News, which reports that the union is exploring legal options because it believes the mandate is a change in employment terms and conditions.
The same dynamic is playing out on the national level, with powerful unions already pushing back against a vaccine mandate for federal workers by President Joe Biden. Earlier this week, the Department of Veterans Affairs became the first major federal agency to require healthcare workers to get a COVID-19 vaccine.
Governor Cuomo said Wednesday that the state is reviewing the CDC’s new indoor mask guidance for vaccinated people, though he stopped short of mandating it. It’s not clear when an announcement on new requirements will be made, but the state has aligned with the CDC in the past. And on Thursday, New York City Mayor Bill de Blasio hinted that he will update the city’s mask guidance on Monday. Every county in New York City is currently experiencing “substantial” levels of community transmission, according to the CDC’s map, placing the entire city above the agency’s recommended threshold for masking up indoors.
Further mandates may be forthcoming. The biggest obstacle to widespread vaccination mandates thus far is a legal one: the three main vaccines used in the US only have emergency use authorization from the Food and Drug Administration, and there is uncertainty around whether a vaccine can be mandated without full FDA approval.
That is still months away. But two experts in STAT News argue that, given the uniqueness and urgency of our current situation, the emergency use authorization should be modified to clarify the legality of a mandate. “The nation should not tolerate more deaths, hospitalizations, shutdowns, and economic and personal ruin,” write Arthur Caplan, the head of New York University School of Medicine’s Division of Medical Ethics, and Dorit Reiss, a law professor at UC Hastings. “The key solution to promptly getting mandates requires our health bureaucracy to act, and act now, to rewrite the emergency use authorizations.”
This article appears in July 2021.
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