Even as much of the rest of the country has had a reprieve, New York City has remained a coronavirus hot spot, with new cases holding level, often at about 25,000 a week.
As variants and vaccinations have taken hold, public health experts have debated what to call the current, confusing phase of the epidemic, when cases remain alarmingly high, but hope is drawing nearer.
“The term I’ve been using is ‘high plateau’,” said Dr. Jay Varma, a senior adviser for public health at City Hall. “We’re basically trying to come down off of our second wave and what we’re trying desperately to do is prevent a third wave.”
At New York University, one disease modeler came up with a more elaborate description.
“The shoulder of the second wave,” said 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. “We’ve been talking about it for weeks, and nobody can come up with a better term.”
But the description does underscore one important point: New York’s second wave never really ended. Cases were rising by November, peaked in early January, and after dropping, leveled off more than a month ago.
Some public health experts worry that cases are beginning to climb again, although the city health commissioner says New York is still on a plateau.
The city may be on a ‘slight upswing’
In New York City, epidemiologists and disease modelers spoke of a stalemate between the pace of vaccinations and the momentum of two new, more contagious variants that were spreading steadily across the city.
Since mid-February, the seven-day average of new cases in the city has largely remained between 3,500 and 4,000.
In the past week, the situation may have worsened slightly.
“We’re on a slight upswing,” Dr. Braithwaite said.
In recent weeks, New York State and New Jersey have been leading the country with the highest rates of new cases per capita for Covid-19. Michigan has recently joined them at the top, as a result of a major surge. But comparisons between states are difficult, experts warn, because of different rates of testing.
While the New York virus situation is not good, city officials say it is not as bad as some recent numbers make it appear. According to the Centers for Disease Control and Prevention, which uses state data, New York City has seen about a 64 percent increase in its cases in the last two weeks. The New York Times’s own tracking website also reflects that. But that spike, city officials say, is largely illusory, a result of a backlog in state reporting of test results and a different way of dating cases.
In reality, they say, there is no major increase. The city site shows cases have mostly stayed level since the end of February.
Cases may begin dropping in May
Several public health experts who use prediction models believe that New York’s current upswing likely will not reach levels that the city saw during the peak after the holiday season, when cases surged to nearly 6,500 per day on average. But the cases are not soon likely to drop much, either.
Dr. Braithwaite predicted that cases would gradually rise — “not so much a wave, but a bulge,” he said — for a month or two until a critical number of people have been vaccinated.
“At our current rate of vaccination, it seems it will be mid- to late May before vaccinations win the tug of war,” he said.
On Monday, state officials announced that all adults in New York will be eligible for vaccination starting next week, which should boost the vaccination effort as supply begins to increase.
But the new normal for New York City, at least until mid-May, may well be an average positive test rate that hovers around 6 percent and a daily case rate of around 4,000.
Wan Yang, a professor of epidemiology at Columbia University’s Mailman School of Public Health, said that changing social behavior might be the tipping point that leads to a sustained upswing in cases. She noted that New York’s restrictions had eased over the last month — including looser limits around indoor dining and the reopening of indoor fitness classes — and that many New Yorkers were socializing and interacting more than before.
State officials have continued the reopenings despite the state data showing an uptick of cases. On Tuesday, Gov. Andrew M. Cuomo announced that college sports venues could host a limited number of fans.
The variants are taking hold
More contagious variants have been steadily spreading in the New York area, and now make up a majority of cases, city officials said.
Out of a sample of 1,481 positive cases from the second week of March, about 32.5 percent were of a variant first identified in New York, B. 1.526. The variant that was first identified in Britain, B.1.1.7, represented just below 10 percent of cases. City officials expect to release the results of a new sample on Wednesday, which will show the variants have gained ground and now make up more than 50 percent of new cases.
Dr. Dave Chokshi, the city health commissioner, said Tuesday that the city did not yet see an uptick in its hospitalizations or deaths attributable to B.1.1.7.
Dr. David D. Ho, whose team is studying variants in about 2,000 patients who were seen at medical centers affiliated with Columbia University, said that it is too early to tell whether the variant first detected in New York is resulting in more severe illness.
More young people are testing positive
The variant first identified in Britain is “rewriting the epidemiology of this disease,” said Dr. Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.
“What we are seeing is a situation where children, who were really not part of the major transmission dynamics of the virus early on, are becoming so now,” he said of new national trends.
Rockland County, just north of New York City, is reporting that its rise in cases is being propelled by teenagers and people aged 20 to 49. Some youth sports have been a driver, along with more socializing among young adults, including in restaurants, said Patricia Schnabel Ruppert, the Rockland County health commissioner.
“They are kind of done with this, they want to go out,” said Dr. Ruppert of the 20-to-49 age group.
In New York City, the American Academy of Pediatrics has documented a slight rise in Covid-19 cases among children under 18, to 10.2 percent of all cases from 9.8 percent in early March. But Dr. Chokshi said the city had not yet documented a rise in youth infections as a result of the variants.
A surge in neighboring states
New Jersey — which has among the highest case rates in the nation — has been grappling with a 20 percent increase in cases over the last two weeks, according to a New York Times database. Judith Persichilli, the state’s health commissioner, called transmission “pretty rampant” in a news briefing on Monday.
But even so, Gov. Philip D. Murphy announced on Monday that he would soon ease the seating capacity limits for sports arenas and indoor catered events. He maintained that even after doubling the indoor arena limits to 20 percent occupancy, places like the Prudential Center in Newark could still maintain six feet of distance between fans.
Mr. Murphy attributed the recent spike in cases to a host of reasons: residents who may be relaxing precautions at small indoor gatherings; faster-spreading virus variants; New Jersey’s status as the densest state in the country; and the state’s proximity to New York City, where virus cases are also high.
The state is sequencing only about 2 percent of its more than 4,000 daily cases for variants, but among those, the variants first identified in Britain and New York appear to be the most common ones detected, officials said.
“It’s the fatigue. It’s our location. It’s how densely populated we are,” Dr. Edward Lifshitz, medical director of the state’s Communicable Disease Service, said of why the state is seeing an increase. “It’s our neighborhood, with New York City right across the river. And, yes, I do think the variants are playing a role as well.”
Connecticut, which lifted most capacity restrictions in restaurants and other venues recently, is also seeing a significant increase in cases. New cases are trending younger, and variants first detected in Britain and New York are estimated to make up about 40 percent of the cases in the state.
Hospitalizations are also creeping up, to the highest levels in a month. But partly because its vaccination campaign moved more quickly than most states, fatalities are low, at about six a day.
“The age group with the highest case rates are 20-29 year olds,” a recent state health alert warned.
Tracey Tully contributed reporting from New Jersey.