The rise in COVID-19 hospitalizations and deaths in New York over the past four months has been far less severe on Long Island and in New York City than upstate, a Newsday analysis of state data found.
Medical experts say that higher vaccination rates, more extensive mask wearing and vaccine mandates downstate are the primary causes along with natural immunity for some previously infected.
“When more people are vaccinated and more people mask and distance themselves, everything will be lower,” says Dr. Aaron Glatt, President of Medicine and Head of Infectious Diseases at Mount Sinai South Nassau Hospital in Oceanside.
What to know
COVID-19 hospitalizations and deaths increased much more sharply upstate than on Long Island and in New York City over the past four months as the highly contagious delta variant spread.
Several people died of COVID-19 upstate since July 1 than on Long Island and in New York City, though nearly 3 million fewer people live upstate.
Experts say higher vaccination rates, more comprehensive mask and vaccine mandates are the main reasons why numbers did not rise as much downstate as upstate. Natural immunity is also a factor.
More people died of COVID-19 upstate between July 1, just before COVID-19 cases began to rise amid the spread of the highly contagious delta variant, and on Tuesday than on Long Island and in New York City – though nearly 3 million fewer people live upstate.
The number of deaths under the delta variant increased 3.7% in New York City and Long Island combined compared to 10% upstate.
The increase in deaths was particularly high in rural areas – more than a dozen saw increases of more than 20% – and less dramatic in counties with larger cities, including Buffalo and Rochester, and in the counties just north of New York City. County deaths are based on daily electronic reporting of deaths in hospitals, nursing homes and nursing facilities.
On Long Island, Nassau County, which has a higher vaccination rate than Suffolk County, saw a smaller increase in deaths than Suffolk: 3.8% versus 6.3%.
Most upstate counties have much lower vaccination rates than those on Long Island and in New York City.
Dr. Nancy Nielsen, senior associate dean of health policy at the University of Buffalo, blamed the politicization of COVID-19, a strong distrust of the government and a resistance to being told what to do about the low frequency of vaccinations and mask use in rural areas of New York.
“We are losing 1,500 people a day to this disease [nationwide], and this can be largely prevented and so sad, “she said.
In Franklin County, which had an 83% increase in deaths between July 1 and Tuesday, the state’s largest increase, fewer than 2 in 3 adults have at least one vaccine dose compared to nearly 96% in Nassau. Ten residents of Franklin County, located in the rural north of northeastern New York, died of COVID-19 within the past four months.
COVID-19 admissions have increased more than 14 times in Nordlandet since 1 July.
Doctor: ‘Peer-driven’ vaccination decisions
The influx of COVID-19 patients to Alice Hyde Medical Center in Franklin County and Champlain Valley Physicians Hospital in Plattsburgh “put a significant strain on the system,” which already had staff shortages and had lost staff to the state health staff vaccine mandate, Drs. . Wouter Rietsema, Vice President of Public Health and Information Services at the two hospitals and a specialist in infectious diseases.
Rietsema said one reason for the dramatic increase in North Country COVID-19 cases and hospitalizations is that entire families or social groups are often unvaccinated, meaning the amount of viruses circulating in the air when people are gathered , can be high, which makes the delta variant especially dangerous.
“The decision to be vaccinated or not is not as individual as you think,” he said. “It’s very peer-driven.”
Rietsema said that unlike previous increases, he saw several unvaccinated married couples admitted at the same time in recent weeks.
“It’s a recurring factual pattern, and we had more [instances] of these scenarios, and there were some deaths in these scenarios, “he said.
Hospital admissions on Long Island and in New York City also increased in the past four months, but much less sharply than in upstate regions, most of which saw increases of more than 1,000% or 2,000%.
On Long Island, hospital admissions rose 323% between July 1 and Tuesday – from 64 to 271 – and in New York City they rose 163%, from 171 to 449.
Although the vaccination gap is the biggest cause of the more severe impact of the upstate pandemic in recent months, mask wearing may also be a factor, said Nielsen, former president of the American Medical Association.
Nielsen said she was in New York City recently and saw a much higher percentage of people wearing masks than in rural areas she has visited, with the prevalence of mask-wearing in Buffalo somewhere in between.
In a crowded place like a subway car, masks can be crucial in preventing the spread of the virus, said Denis Nash, professor of epidemiology at the CUNY School of Public Health in Manhattan. He noted how the subway was likely a major cause of the virus spreading so rapidly in New York City during the first weeks of the pandemic, where riders did not wear masks.
Nielsen said that New York City’s vaccination mandates – for its employees and for anyone who wants to eat in a restaurant, go to a gym or a movie, or attend an indoor concert or sporting event – are why the city’s COVID-19 figures are proportionally lower than elsewhere in the state.
“When we get vaccinated, we are largely protected,” she said. “I was in New York City last weekend, and every place we went we demanded that we show proof of vaccination along with our IDs. No problem. We did, and I think it will keep people safe. “
Dr. Bruce Polsky, an infectious disease specialist who presides over medicine at NYU Langone Hospital-Long Island in Mineola, said that in the most risky places for mass virus transmission, such as major indoor sporting events and concerts, “you remove in the most densely populated environments a possibility of successful virus transmission. “
Vaccinated people can get and transmit the virus, but “the risk is significantly lower in vaccinated people than in unvaccinated people,” he said. “Most importantly, the risk of serious illness and hospitalization is greatly reduced.”
In addition to making indoor venues safer, “mandates push people to get vaccinated,” said Dr. Bruce Farber, Head of Public Health and Epidemiology for Northwell Health.
As of Friday afternoon, New York City began requiring at least one vaccine dose for almost all of its employees. In the past, many had the option of weekly coronavirus testing.
New York City has by far the lowest COVID-19 positivity rate in the state: 0.95%, compared with 2.1% on Long Island and more than 5% in western New York.
Natural immunity plays a role
Natural immunity to COVID-19 infection plays a role in determining cases, hospitalization and death rates, experts said.
Rietsema said that the higher hospital admissions and death rates in Nordlandet are partly due to the fact that the region was not hit as hard as downstate before. This means that there are fewer unvaccinated people with natural immunity, making them particularly vulnerable to serious illness.
The same natural immunity has helped keep the number of cases, hospitalizations and deaths lower in places like New York City, though it is unclear to what extent because it is unknown how long natural immunity protects people, Nash said.
“There are definitely re-infections among people who were previously infected and never vaccinated, and there is a risk of death and hospitalization that the vaccine never even approaches,” Nash said. “The calculation is very clear. Anyone who has never been vaccinated, whether or not they have had COVID, should be vaccinated.”