More than 1,000 New York City residents are currently hospitalized with COVID-19, the first time the boroughs have surpassed this mark since the second week of February when the massive winter wave started to ebb.
The resurgence has now upgraded every borough to a “high” risk for severe disease, as defined by the Centers for Disease Control and Prevention. If a county records more than 200 cases and 10 hospitalizations per 100,000 residents over the course of a week, it automatically qualifies as high risk. That COVID-19 community level now applies to the Bronx, Brooklyn, Manhattan, Queens and Staten Island. (The city’s version of this alert system recently went offline).
After rising in May and tapering off in June, severe cases are now increasing again — and amid this spike, the Adams administration has given contradictory answers as to why it's closing testing facilities.
As Gothamist reported earlier this week, New York City officials provided twice as much free PCR testing back in mid-February as they did heading into July. The reporting shows that the NYC Health + Hospitals cut in half the number of PCR locations listed as open on its public-facing webpage as the winter wave subsided. And the availability of PCR testing remained lower even as omicron subvariants caused a new wave of infections and hospitalizations.
Since the story was published, the Adams administration has challenged whether free testing has been cut at all. Officials have gone as far as stating the number of addresses listed on their website does not equate to the number of open locations. The closures included brick-and-mortar sites at hospitals and clinics, community hubs visited by mobile vans and places offering saliva-based tests (known as micro-sites).
The city, for example, told Gothamist Tuesday afternoon that community partners were informed before sites were closed. But when asked, multiple borough presidents told Gothamist that they were not notified in advance of any sizable reduction in PCR testing sites or testing hours prior to June. One said they were only alerted two weeks ago about future closures scheduled for mid-July.
In response to Gothamist’s reporting showing that New Yorkers now have fewer PCR testing options, the Adams administration has also emphasized the city’s large-scale rollout of home tests since last December — initiatives that were also highlighted in Gothamist’s previous report.
While home tests offer the convenience of knowing if you’re positive before heading outside, these self-kits aren’t interchangeable with PCR tests, according to independent health experts interviewed by Gothamist and the U.S. Food and Drug Administration. NYC Health + Hospitals spokesperson Adam Shrier also stated earlier this week that home tests and PCR tests are “different modalities,” which, by definition, means they serve separate purposes.
I would very much caution against rolling back PCR testing. It still is important.
“I would very much caution against rolling back PCR testing. It still is important,” said Dr. Jennifer Nuzzo, epidemiologist and director of the Pandemic Center at the Brown University School of Public Health.
Home tests let you know if you're positive before you step outside and expose someone else, which Nuzzo and New York City officials view as a net positive. COVID-positive people have also developed the habit of using the kits day-after-day to gauge when it might be safe to leave isolation.
“Now that we have a strong supply of at-home tests ,which we know people prefer — and treatments, which we know save lives — that is what we are focused in putting in the hands of New Yorkers,” Kate Smart, deputy press secretary for the mayor, said Thursday night via email.
But PCR testing remains the best window for tracking how the coronavirus spreads through the community, Nuzzo said. It is also the window to following the variants, as a laboratory test is the first step in sequencing mutations.
“It's really important for us to stay ahead of what variants are circulating in our communities,” Nuzzo said, citing what society has already learned about different variants to date. “Some are more transmissible. Some have been more severe. We need to stay ahead of the virus, so that we can know when and how and if to change our strategy about how to control it.”
What officials are saying about COVID-19 testing in New York City
When asked by a gaggle of reporters Tuesday afternoon if city-run PCR locations had decreased, Fabien Levy, a press secretary for Mayor Eric Adams, said yes.
“Fine, yes. But that's not what the needs are right now,” Levy said, referring to the free PCR sites and confirming Gothamist’s earlier report. “This is not March of 2020, April 2020. This is June or July of 2022. We are adapting to the new face of COVID.”
Levy’s comments came moments after Mayor Adams told the same crowd of reporters that “first of all, we have not closed testing sites. We have expanded.”
By Tuesday night, city health commissioner Dr. Ashwin Vasan had taken to his official account on Twitter to back up the mayor’s message.
Vasan’s response centered on the city’s efforts to roll out at-home tests this spring. He said the city had doled out 35 million home tests to New Yorkers via “a network of nearly 200 libraries and cultural sites and over 850 trusted community-based organizations” in recent months. He added that this move, plus the city’s mobile testing, expands the number of locations for New Yorkers to get freely tested.
The catch is that New York City has steadily cut its mobile van locations in recent months.
The catch is that New York City has steadily cut its mobile van locations in recent months. Mobile testing dropped from 183 sites in mid-February to 113 by mid-April. By the week of June 27th, the city had added only one mobile site.
Shrier pointed out that Health + Hospitals teams operating mobile sites can serve several different locations over the course of a week. A single mobile van could go to a different location each day, or could remain stationed at the same place for a full week.
As a result, Shrier said, the 87 mobile units in the testing program could serve anywhere between 87 locations and 609 locations each week.
Gothamist’s analysis, however, found that the total hours operated by these mobile sites also decreased over the spring. For example, the total hours that mobile sites were open in the Bronx was cut from about 1,200 during the week of April 18 to 1,000 during the week of June 27. About 600 mobile van hours were cut citywide over this time period.
And even if the testing capacity is technically maintained, location is important. Consider a region like South Brooklyn: Four brick-and-mortar testing sites scheduled to close in mid-July are all located in this area: 4002 Fort Hamilton, Bay Ridge, Bensonhurst and Midwood Pre-K.
It’s unclear whether mobile sites will move to South Brooklyn in response. Shrier said each closing site has “dedicated at-home test distribution sites” within one mile. But residents of Bay Ridge, Bensonhurst and other nearby neighborhoods may need to travel further to get a PCR test — or face high costs at private sites.
Independent health experts also say at-home tests and PCR tests are not like-for-like. Expanding one home test doesn’t cover what’s offered by getting swabbed by a clinic or lab.
“We have to remember that there are two general purposes for testing. One is for the individual to understand or determine whether he or she is potentially infected,” said Dr. Bruce Y. Lee, a public health policy expert at CUNY and executive director of the research group PHICOR. “But the other reason is to get a general population count to know what's actually happening.”
The importance of this is exemplified by the city’s current positivity rate, the portion of PCR tests coming back with infections. New York City’s test positivity rate shot up over 10% last week, its first time reaching this threshold since January of this year. Experts at Johns Hopkins University write that such a high positivity rate — anything over 5% — indicates there may not be enough testing capacity in a given place. In fact, at a time when case counts are less reliable, increasing test positivity can be a better indicator of a new surge.
City officials argue that testing capacity at a microsite — 100 to 150 tests per day — is considerably different than going to hospitals like Bellevue, which can perform 1,400 tests per day.
But PCR testing rates are approaching their lowest levels ever, despite the clear uptick in community transmission of the virus. Long lines like those reported in December and January are rare at the sites that are still open. That could be due to people preferring to opt for home tests — or because they’ve lost access to nearby PCR locations.
And with its COVID-19 alert system offline, the health department no longer formally recommends testing before or after travel and large gatherings.
“The big concern is that we don't really have an accurate eye on the ground of what's actually happening,” said Lee. “If we see testing going down, yet reported cases are continuing to go up, that suggests that the rise is probably higher — potentially significantly higher.”
Will home tests be enough if surges keep happening?
Moving forward, the city said it plans to quickly add testing units if demand increases at any point in the future — even though this shift didn’t happen as cases rose in the weeks before Independence Day. The city also plans to close seven additional brick-and-mortar facilities on July 17th.
The mixed messages come at a tricky period of the pandemic. Vaccines and immunity have lowered the chances of severe disease for many people, and these defenses are holding so far against the ever-evolving variants.
“Having vaccines and now medicines to treat the virus do give us a bit more latitude in terms of how we choose to live our lives,” Nuzzo said. The city has recently launched three mobile vans that can offer tests and treatments at the same time, but it hopes to expand the program to 30 vehicles.
“Due in large part to these at-home tests, we’ve been able to connect more than 10,000 New Yorkers to Paxlovid through our COVID-19 Hotline,” Shrier said in a statement Thursday night, “in addition to maintaining the largest mobile testing fleet in the country that now offers instant connection to treatment through our first-in-the-country mobile Test to Treat program.”
Yet New York City’s COVID hospitalizations are rising again despite the massive rollout of home tests and free antivirals like Paxlovid, which is made by Pfizer. A broad consensus is pinning the ongoing summer wave on omicron subvariants, namely a version called BA.5.
The version of the virus is bypassing immunity and antibodies that people built up just six months ago during the initial wave of the original omicron. Reinfections are creeping up statewide, but the highest rates are happening in Long Island and New York City. There’s also the growing burden of long COVID, which can affect unvaccinated and vaccinated people.
“I am concerned that New York City is not taking the rise of these new variants seriously enough. PCR tests remain important in a limited number of situations,” said Manhattan Borough President Mark Levine. “But I believe that in most cases home self-tests are the best option, and that we should be doing even more to ensure every family has an ample supply of kits at home.”
In his Twitter thread responding to Gothamist’s story, Commissioner Vasan asserted that New York City still has “robust clinical disease surveillance” to spot such changes in community transmission of the virus. His examples include newer data sources such as wastewater.
The city’s data from sewers is difficult for New Yorkers to access, however, and new information from NYC stations has not been available on the CDC’s dashboard since April.
While the city Department of Environmental Protection does share wastewater data on the NYC OpenData portal, it is only updated monthly, meaning the coronavirus cannot be tracked in real-time. The wastewater data also doesn't appear on the city’s main COVID-19 dashboard.
Sewage also doesn’t have the resolution to offer a neighborhood-by-neighborhood breakdown because poop and pee are only collected at a handful of facilities around the city. Along those lines, health experts told FiveThirtyEight in April that wastewater data alone isn’t sufficient to keep track of COVID-19 outbreaks: Communities also need to know who is getting sick.
“I do think it is important for us to continue to understand what's going on in our community,” Nuzzo said. “Because we all have a responsibility to make sure we try not to spread the virus to others.”
Liz Kim and Jaclyn Jeffrey-Wilensky contributed to reporting.