How to look at the pandemic now

Hospitalization, not cases or positivity rate, is the critical indicator. That's why Florida is a terrible mess and Provincetown is not.

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Yesterday, I decided to buy some bread at a French bakery directly across Manhattan from where I live in Chelsea. I took a 30 minute walk through Chelsea, the Flatiron district and Gramercy Park, to Stuyvesant Town, or Stuytown as it’s known, to a great place called Bread Story. As I’ve discussed here over the past year, I’ve been baking rather than buying baguettes throughout the pandemic. But because of supply chain issues, the flour I get from France won’t ship until August 11th. Quelle tragédie! So, off to Stuytown I went.

These areas I walked through, which are part of three distinct zip codes, have had among the lowest Covid infections, positivity rates, hospitalizations and deaths in all of New York City since the beginning of the pandemic. That was true during the worst time in April of 2020, and as Covid overall plummeted in New York last summer, they plummeted further.

When we saw a surge again this past winter in the city overall, these zip codes saw smaller rises in positivity rate, hospitalizations and deaths. When vaccines rolled out, these zip codes were among the highest in uptake and then saw positivity rates, initially, that were the lowest they’d been since the beginning of the pandemic, well under .5% and even under .1 % in June.

But these three zip codes are now seeing positivity rates soar over 3% and headed toward 4%, among the higher end in the entire city and, for these neighborhoods, a real surge.

As I walked over to the bakery, having looked at the positivity rate numbers online before I left, I thought about how Covid, driven by the supercharged delta variant, was continuing to take its toll and take another turn, and how it now may start hitting these areas hard. These numbers are not much different from those of East Harlem, currently at 3.98% positivity, and a neighborhood that was among the most devastated in the city during the worst of the earlier part of the pandemic.

But then, when I got home, four scrumptious loaves of bread in hand, I looked at hospitalizations in the same neighborhoods — and that’s where you see a completely different story. In each of these zip codes I’d walked through, even with surging positivity rates, there is not one person in the hospital in recent days due to Covid. Zero.

But in East Harlem, where vaccine uptake has been drastically lower than these neighborhoods, there are five hospitalizations. You see the same in other neighborhoods that were both hard hit in the past and are seeing similarly surging positivity rates now, such as Canarsie (11 hospitalizations) and Cypress Hills (seven hospitalizations), both in Brooklyn.

They’ve had far lower vaccine uptake, too. Over 70% of residents are fully vaccinated in Chelsea, for example, while only 36% of residents are fully vaccinated in Canarsie. They’re seeing more hospitalizations than areas with similar positivity rates but where more people are vaccinated. (That was all a snapshot on Sunday, and obviously the numbers will vary by the day.)

This means the vaccines are working. In the neighborhoods I walked through, like everywhere else, businesses had fully opened with no restrictions and many people who are vaccinated had stopped wearing masks indoors in shops and workplaces weeks ago — as the CDC had recommended. Bars and clubs opened — including many that only allowed people in if they had a vaccine passport or proof of a negative Civid test — and restaurants have been packed.

As in the wonderful gay summer destination of Provincetown, Massachusetts —famous for many things, but this past week for a Covid cluster among the vaccinated — vaccinated people are out and about and there are so-called “breakthrough” infections. That adds to the overall case numbers and positivity rate. But the vaccinated who are infected are rarely going to the hospital, as they have mild cases which pass in a few days.

But then look at Florida. It set a record in per day number of cases in the last few days —- a whopping 21,000 cases, greater than any day since January of 2021 — which in previous times would alone have been enormously alarming. But then, a day later, Florida set a record in hospitalizations, over 10,000, which broke the record set in the horrible surge of July 2020 in that state.

That is breathtaking and frightening beyond belief. The huge number of cases in Florida are not among vaccinated people having mild breakthrough infection. These are unvaccinated people, walking around in a state where the governor has banned businesses and employers from using vaccine passports and done everything to stop local mask mandates, and in recent days banned schools from issuing mask mandates.

HuffPost @HuffPost

Florida Gov. Ron DeSantis (R) issued an executive order that forbids schools from mandating classroom masks, even as Florida breaks COVID-19 infection records.

In New York, many people who’d taken off their masks have put them on again indoors, in shops and supermarkets. The subways have always had a mask mandate, as have buses. I’m wearing my mask everywhere now. Sure, I don’t want even a mild infection, the so-called breakthrough, and feel fatigued and congested for a day or as long as a week, as some of my vaccinated friends in Provincetown, in New York and in Los Angeles have told me about their recent infections.

But more importantly, I don’t want to transmit Covid-19 — since as a vaccinated person I might still be able to if I became infected — to other vaccinated people or to unvaccinated people, and see the pandemic continue.

I know I will not die or be in the hospital or severely ill if I do get infected. And that is not only reassuring but the number one reason why everyone needs to get vaccinated. It is the unvaccinated who are keeping this pandemic raging on, putting themselves, their families and millions of children — who cannot be vaccinated — at risk. And it’s Republican officials like DeSantis who are allowing people to die in the name of political expediency.

Some anti-vaxxers now even try to twist things around and claim that since we now know vaccinated people can transmit the virus it is the vaccinated who are somehow driving the pandemic. But that is a ludicrous distortion. If everyone got vaccinated and we all took our masks off, we’d have a number of people getting mild infections, but not being hospitalized or dying, and eventually we’d move beyond the pandemic.

That’s why we have to stop looking at national and state case numbers and look to hospitalizations — and who is being hospitalized — when we talk bout the pandemic.

Even in places with lower hospitalizations it is often younger, unvaccinated people who are being admitted. But Provincetown, which was over 90% vaccinated, showed the success of the vaccines. They saved people even amid an outbreak after all the partying on July 4th weekend, many of the participants young but vaccinated. And Florida is an example of what happens in a a state with just half the people vaccinated and large areas where less than one-third are vaccinated.

And that brings me back to the French — and beyond the great bread I bought! France, like much of Europe, was well behind the U.S. in vaccinations, hobbled by Astrazeneca’s bad rollout. But France like much of Europe has now surged passed the U.S. in vaccinations. And hospitalizations are way down. That is because of vaccine mandates — everywhere from mass transit and airports to shops and gyms — put in place by governments, with vaccine passports.

As French president Emanuel Macron said to the anti-vax protesters in his country:

There’s no such thing as freedom where I owe nothing to anyone. If tomorrow you infect your father, your mother or me, then I’m the victim of your freedom. That’s not freedom. It’s called selfishness.

Absolutely right, and while it’s not legally feasible in the United States to have a federal mandate of either vaccines or weekly testing beyond federal workers and the military — which President Biden has now instituted — states, cities, schools, corporations and businesses can legally mandate vaccines. And even if mask mandates don’t come back, we’d see fewer people get very sick even if the case numbers go up. That’s the way to look at the pandemic now — and the way we need to act on it as well.

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