COVID-19 has a knack for recovering just as life in New York City opens up a little more.
This fall, many companies started hybrid operations – with a mixture of office hours and working hours from home. International travelers are flocking back to the boroughs – a potential boon for the badly affected hotel industry. And vacation travel has recovered almost to pre-pandemic levels.
But a coronavirus surge has also crept in like a panther in New York City. The daily case rate averages around 1,300 infections and should be twice as high by the end of November as at the beginning. That would bring the infections close to this summer’s peak – when the Delta variant gained the upper hand.
Hospital admissions are still low in the city for the time being, but these severe cases are growing rapidly in the state. These places are also less vaccinated than New York City, but one in four people in the five boroughs still hasn’t vaccinated. However, most vacationers are now in a safer position compared to a year ago when vaccines were not available.
But for everyone involved, COVID-19 security is all about overlaying different types of protection. Vaccines lower the risk the most. Tests can help weed out potential vehicles. If that fails, wearing masks indoors and good ventilation can reduce airborne spread.
To gauge how many precautions to take, the first thing to think about is how many people at your gathering would be in the most trouble if they contracted the coronavirus. Next, a party host will consider how a mix of testing, mask use, and ventilation can limit these risks.
No plan is going to be foolproof, and all gatherings come with some risk of COVID as the case numbers rise. As of Tuesday, every county but one in New York, New Jersey, and Connecticut is reporting high levels of community broadcast. If you follow a few tips, you can minimize the risk.
Returning to normal, of course, involves more risks than just staying at home. From a public health perspective, hopefully people will try to do the right thing to limit the spread of the coronavirus while trying to strike a balance with choices that feel right to them.
Start by finding out how many people are unvaccinated. Real world estimates collected by the Centers for Disease Control and Prevention this fall showed that unvaccinated people were almost six times more likely to be infected with the virus and 14 times more likely to die from it. This trend continued across all age groups eligible for the vaccines at the time, meaning everyone is over 12 years old. All of the country’s approved and approved vaccines – Pfizer, Moderna, and Johnson and Johnson – show this effect.
That year, the unvaccinated in New York City has seen a rate of 266 cases per 100,000 people. Compare that to 40 cases per 100,000 who are fully vaccinated. Look at hospital admissions and it’s 21 in 100,000 unvaccinated versus 2 for the same number of people vaccinated.
People who have recovered naturally from infection but haven’t been vaccinated should also consider themselves at greater risk for a bad outcome. There has been some debate as to whether this so-called “natural immunity” offers the same protection against future infection as vaccination, but when you consider when a recovered person was first infected with the virus, differences emerge. According to several studies, if you got sick during the first or second wave in 2020, you are now less protected against the delta variant, which has grown in prominence this year. And when it comes to hospitalizations, Americans who relied on natural immunity were five times more likely to be hospitalized for COVID than vaccinated people.
The COVID-19 vaccines are also the easiest and most effective way to prevent the transmission of the coronavirus. Before the introduction of the Delta variant, vaccination reduced the chances of contracting the virus by 90%. Even with the variant, the vaccines reduce the likelihood of infection by 67%. Get a booster shot and the odds will return to the 90% range.
Fully vaccinated people are also less likely to spread the coronavirus on the rare occasions when they experience a breakthrough infection. A recent US study showed that the nose of unvaccinated people shed the virus for a total of up to nine days, compared to just four days in fully vaccinated people. And infections are currently increasing fastest among unvaccinated New Yorkers – with about ten times the number of cases among those without vaccination.
If your meeting intends to mix a lot of unvaccinated people with a number of high risk people, maybe you should reconsider.
Next, you should think about how many people are considered high risk patients for severe COVID-19 regardless of their vaccination status.
Even when you factor in the diminishing immunity that occurs slowly over months, the vaccines reduce the likelihood of hospitalization by about 90% or more.
But if you look deeper, you will find that the easing effect is most evident and dangerous for people at risk. COVID hospital admissions are most common among seniors, followed by those in their 50s, then those in their 40s, and so on. Other risk groups are immunocompromised people and those with certain underlying diseases. (The city health department has a nice overview sheet at the end of this website.)
“These are the people who are most likely to have a serious complication from COVID, even if they are vaccinated,” said Dr. Celine Gounder, an infectious disease specialist and epidemiologist at New York University and Bellevue Hospital, told Science Friday last week. “You are at greater risk of a breakthrough infection that can progress to severe COVID.”
It’s obviously too late to get your first vaccine or get a boost in time for Thanksgiving. It will take no more than 21 days to get two vaccinations of Pfizer or Moderna vaccine, then your immune system will have to incubate for two weeks to be fully vaccinated. Children ages 5-11 will still be in that limbo when the turkey arrives, as the Pfizer vaccine eligibility didn’t open for them until November 2nd. Booster shots also need 14 days to develop their full effect.
So if you are concerned about a contagious person showing up for dinner, your guests will want to have a COVID-19 antigen test the day before and the day of your gathering.
“The day a person is contagious, those antigen tests are positive that day,” said Dr. Daniel Griffin, an infectious disease specialist at Columbia University, on the Brian Teacher Show on Friday.
An antigen test detects protein parts of the virus that are pumped out by a well-embedded infection in the nose and throat. Griffin said these antigen tests are very accurate during the length of time one person can pass the virus on to others. So that’s either two days before symptoms like a runny nose and sore throat appear about seven to ten days after, if you still haven’t fully recovered, he said.
“That’s when those antigen tests are 98% or or better to cancel,” added Griffin.
Or if you’re trying to keep people carrying the coronavirus from entering your congregation, you can use the more classic PCR test. Because it detects genetic material, a PCR test can detect fewer traces of the virus and is 30 to 40% more sensitive than an antigen test. This added sensitivity means that PCR tests can better identify people who are not yet contagious – but also the remains of an infection in a fully recovered person.
“You can still pick up the infection from four weeks ago with this PCR because they’re just so sensitive,” Griffin said.
Both antigen and PCR tests can be done in 15 to 45 minutes, depending on the clinic you visit or the home test you are doing. But PCR tests generally take longer to produce results. In September, health reporter Caroline Lewis wrote a helpful guide to find and pay for all of these tests in New York City. Note: watch out for hidden fees at some for-profit clinics.
When it comes to children, health experts including New York Health Commissioner Dr. Dave Chokshi, often that the best mask is the one that you can wear consistently and comfortably.
In truth, this rule applies to all ages as airborne transmission obscures anyone who might be positive. During the holidays, this exposure is riskiest in crowded places with strangers – like airports – where you cannot adequately practice social distancing.
So when choosing a mask, focus on two things: filtering and fit.
According to several studies, loose-fitting cloths and surgical masks only knock out around 50% of the particles suspended in the air. But tighten the ear loops on a surgical mask or place one under a cloth mask and the filtration goes up to 70-90%
As the name suggests, N95 masks and their KN95 equivalents from China block 95% of the smallest particles in the air – but even that only applies if they fit well. People should also watch out for fakes. The CDC says 60% of KN95 masks in the US are counterfeit and offers a guide to finding reputable manufacturers.