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As a fourth COVID-19 vaccine dose is approved by the CDC for immunocompromised Americans and the over 50s, cases are once again rising to early Omicron levels in the city and across Hell’s Kitchen, where locals have mixed feelings over recent precautionary rollbacks and experts recommend cautiously monitoring the possible surge.
“I think we need to continue being very vigilant, but not panic at this time,” said Dr Vino Palli, founder and CEO of Hell’s Kitchen urgent care center MiDoctor. Dr Palli stressed that while transmission of the BA.2 variant increased and he expects a surge to peak later this spring, the newest surge is discernibly different from early-stage COVID-19 waves.
The BA.2 variant now accounts for over 39 percent of cases nationwide and 71 percent of cases across New York City, where there has been an increase in positivity rates over the past few weeks. As of March 27, the citywide positivity rate sat at 2.53 percent (up 72 percent from the end of February), with Manhattan at a higher rate of positivity at 3.88 (a 116 percent increase), and Hell’s Kitchen zip codes 10018, 10019, and 10036 at 3.18, 4.68, and 4.86 positivity (a 126 percent, 93 percent, and 222 percent increase, respectively).
10036’s 222 percent increase, perhaps influenced by its closeness to Times Square and tourist foot traffic, is of particular concern as it far outpaces the citywide increase of 72 percent. Adding to the unease is the possibility of even higher results, as free at-home tests distributed by the government (as well as many others purchased at high cost) are excluded from official data.
In better news, despite the rise in cases, death and hospitalization rates have continued to decline, dropping 38 percent and 50 percent respectively over the past four weeks. The citywide positivity rate is also down 79 percent from the end of January. Additionally, experts have noted that the BA.2 variant, while highly transmissible, is not linked to an increased vaccine resistance or more severe infections. Despite a rise in local cases at MiDoctor clinic, “That doesn’t mean there’s an increase in hospitalizations or deaths — and that’s because of the vaccines,” said Dr Palli.
Cases have risen after the Adams administration significantly rolled back previous COVID-19 restrictions, eliminating mask mandates and vaccination checks in most public spaces including restaurants, bars, fitness centers, and schools. Masks are currently still required on all public transit, in healthcare and correctional facilities, and at the discretion of individual businesses.
The Adams administration has also removed vaccination requirements for athletes and performers across the city, allowing notably unvaccinated athletes like Kyrie Irving and several Yankees players with unconfirmed status to move forward with their seasons without monitoring.
As for live theatre, the Actors Equity Association and The Broadway League still require all cast and crew to be vaccinated and will keep audience mask mandates and vaccine checks in place through at least April 30. While an NYC extension beyond April is not confirmed, a recent survey of regional theatergoers indicated that most were not ready to remove mandates. Asked to respond to criticism of the selective vaccine exemption, Adams responded: “The Kyrie story, the performers’ story — that’s over.”
Earlier this month, W42ST surveyed residents about the change in mandates, with a majority of respondents arguing that it was too soon for safety rollbacks. Said one reader: “I’m concerned that every time restrictions are lifted, the numbers go up. Hopefully, this time will be different, but the definition of insanity is doing the same thing again and again and expecting a different result,” while another posited, “The pandemic phase is over as COVID-19 has become endemic across our population like other common (sometimes deadly) infectious diseases. Our efforts to ‘slow the spread’ to avoid over-running hospitals (which traditionally for cost savings reasons do not keep lots of excess spare ICU capacity) has worked and we now have vaccines and potent therapies to protect and mitigate us against the disease that are available to all.”
W42ST asked Dr Palli whether he believed the rise in cases was due to the citywide rollback of COVID-19 protocols, the highly transmissible nature of the BA.2 variant, or both. “I think it could be a combination of all,” said Dr Palli. “We still have many unvaccinated folks in the US. I think there is a big surge right now of patients that are unvaccinated. They’re remaining unvaccinated because of their beliefs and spreading the virus faster. Also, there is waning immunity in the vaccines themselves after four to six months.”
As for the return of mask and vaccine checks across restaurants and other spaces, Dr Palli notes that it’s more likely that public health experts will continue to monitor case numbers, particularly in regards to hospitalization, before recommending a reinstatement. “It’s all going to depend on what we see in terms of numbers. Right now, even though transmission is creeping up, hospitalizations haven’t gone up, the death rate hasn’t gone up, the case pathology rate is still low and it’s mostly among unvaccinated folks,” said Dr Palli.
Dr Palli agreed with the CDC’s approval of a second booster shot for the immunocompromised and people over 50, adding that he expected a similar expansion of eligibility across age groups shortly. “I think they’re going to perform the rollout the way they did in the beginning of COVID — in a systematic way, in different phases. I strongly believe they’re going to expand it to the rest of the population soon.”
“I don’t think we need to go back to indoor mask mandates right now — but I do think we should wait another couple of weeks to a month and see what happens. I think what the mathematical and epidemiological models are predicting is that there’s going to be a surge at the end of the spring going into summer, and perhaps a real surge in fall and winter. Officials may then consider mask mandates, social distancing and all those other public health measures that we took at the beginning of the pandemic,” he said.
Increased testing and booster shots as needed will be the key to navigating the next wave, added Dr Palli. “I really am concerned with those folks who are still not vaccinated — fortunately in New York City, that number is not very high, but it’s still significant,” he said. Dr Palli and his team at MiDoctor have been working to convince skeptical patients to get the shot, finding that time is the best evidence of limited side effects and vaccine efficacy.
“We’ve had patients in the clinic that completely rejected the vaccines. But I told them, ‘Hey, it’s already been a year since the vaccines came out, and you can see that I’m healthy.’ And they say, ‘Okay doc, go ahead and give me the shot.’ We were able to convert so many patients at our clinic to get the vaccine, and I’m so happy that we have this program. We’ve given over 30,000 vaccines to New Yorkers,” said Dr Palli.
After spending the early stages of the pandemic between MiDoctor and the frontlines of the ER, Dr Palli believes that we have reached an endemic level of the virus, though it is by no means over.
“We went through multiple peaks and troughs over the past two years. I think we are now at a phase where this disease is going to be endemic and pharmaceutical companies can respond accordingly. Future boosters are actually going to be fine-tuned against new variants. The current vaccines are not very specific to the BA.2, but they still help. As long as you have those antibodies in your body it’s going to make the risk smaller,” he said, adding that the development of antiviral treatments and the possibility of a combined flu/COVID-19 vaccine may further smooth response during upticks.
He stressed, however, that while we are nowhere near the earliest phases of the pandemic, it is vital not to dismiss precautionary measures as permanently unnecessary. Witnessing recent global surges across Europe and Asia have shown that “you still need to be very vigilant,” said Dr Palli. “Some people are saying ‘Oh, everything’s fine, back to normal and COVID is gone’, but that’s not true either. COVID is not over.”