In New York City, the number of people taking official COVID-19 tests — those traditional PCR tests given at hospitals and clinics – is the lowest it’s been since May 2020. Back then, the U.S. was still recovering from early setbacks with developing PCR tests, which left the country uncertain about where and how the coronavirus was spreading.
The PCR testing drop affects official recordkeeping. NYC — like most jurisdictions — doesn’t collect results from at-home kits. Public metrics used to capture and communicate the spread of COVID, such as the positivity rate, are set by the number of PCR tests that come back with “Hey, you have COVID-19.’
“It makes it hard to interpret the case numbers — and to get a sense of how much COVID might really be out there,” said Denis Nash, an epidemiology professor at CUNY. “Anytime there's less testing, the positivity rate means less.”
NYC’s current testing lull extends back to Christmas, when the average number of PCR tests taken each day dipped below 20,000 in New York City — where it remained as of Tuesday. This seven-day average hit its lowest point — 16,785 tests — on Dec. 29.
A year earlier in December 2021, this average was more than six times higher at 110,514 tests per day, as the first omicron variant ran amok, drove case rates to new records and filled hospitals.
The drop in PCR testing comes as headlines mount around a highly transmissible spinoff of the omicron variant, XBB.1.5 — also unofficially dubbed "Kraken" by a small group of scientists. But infectious disease specialists and NYC's health commissioner said the city is not in the same situation as a year ago or during past major surges of the disease.
“We do, sadly, still have more deaths related to COVID than I think is acceptable,” Dr. Jessica Justman, an infectious disease physician at Columbia University and senior technical director of the ICAP global health program. “[But] I will say we are in a much better place than we were one year ago and two years ago.”
The testing trend arrives amid a winter wave of respiratory disease — one that’s seen RSV and influenza rise and recede. COVID-19 has held steady, somewhat overlooked as these other outbreaks thrived. A typical flu season lasts about seven months and, in a bad year, kills an estimated 52,000 Americans – or roughly 245 people per day. Over the last seven months, COVID-19 has killed about 88,400 Americans — or about 400 people per day. Most were over the age of 50.
COVID-19 surges and lulls are now largely happening regardless of how many folks take PCR tests. Most people have acquired immunity to the coronavirus through the mix of infection, vaccination and boosters — mercifully dampening how much severe disease is occurring.
Evidence of this is already visible this winter despite the recent arrival of XBB.1.5. The World Health Organization described it on Jan. 4 as the most transmissible version of omicron to date, but so far, the global health agency doesn’t think it is more severe than past variants.
Labs here began detecting low levels of this omicron subvariant in the community around early November. Kraken now makes up about 80% of the state’s analyzed cases, meaning it rose to dominance in approximately the same timeframe as the original omicron.
But even as cases increased this fall and winter, hospitalizations and deaths didn’t follow suit to the same epic degree.
In NYC, 1,455 people are currently hospitalized with COVID-19. The same day a year ago — during the heights of the first omicron wave — nearly 6,200 were hospitalized.
Likewise, the city has recorded 401 COVID-19 fatalities during the past two weeks, according to the Centers for Disease Control and Prevention. Over the same timeframe a year ago, it was 920 deaths, and the rate was rising sharply.
“The correlation between cases and hospitalizations has diverged and stayed divergent,” said NYC Health Commissioner Dr. Ashwin Vasan. “In a way, that makes it actually quite good that we're still doing the volume of clinical testing that we are.”
During this autumn and winter uptick in respiratory disease, access to PCR tests has remained broadly available via city-run clinics. Since August, the city's health department and NYC Health + Hospitals have maintained — and at times, increased — their testing sites and hours, according to an analysis of city data conducted by Gothamist.
“We have also been deploying our mobile test-to-treat [clinics] and mobile vaccine structure out to communities based on where there are higher risks and higher need and demand,” Vasan said.
Justman, Nash and Vasan all said the drop in PCR testing also speaks to the popularity of at-home tests. These kits offer the convenience of checking whether a person is positive without needing to head to a clinic.
“We've been saying for now more than a year, once the rapid at-home tests became available, that testing data was going to become less and less useful,” Justman said.
But in these scenarios, the case rates and positivity rates on dashboards will mostly reflect episodes of moderate or severe disease — ones that people feel strongly enough about to get an official PCR test.
As such, Nash said COVID-19 data now mostly tells people the extent to which people are not being reached by the tools, such as booster vaccines and antiviral drugs like Paxlovid, that can prevent serious outcomes.
The biggest concerns revolve around hardening protection for vulnerable groups and increasing the dialogue about long COVID, so people can better know when to seek treatment, Nash said. The CDC estimates that people with long COVID make up more than 1 in every 20 U.S. adults, or currently about 6%, which mirrors research conducted by Nash’s lab.
Vasan said the city health department made an extra push through “hundreds of community engagement events” this autumn and winter to reach people over 65, anyone with underlying disease and other vulnerable groups.
“We've been doing events and popups at senior centers,” Vasan said. “We've formed partnerships with all of the nursing homes in our city to get elderly New Yorkers… We have programs with our DHS [Department of Homeless Services] shelters.”
All three experts also cited the degree to which misinformation on social media potentially keeps people from these interventions. Only 13% of people citywide have taken the updated bivalent boosters, which are designed to fight omicron. The rate is low even among senior New Yorkers — with just 25% boosted with the bivalent.
“We have to incorporate a battle against misinformation into our public health strategies,” Vasan said. “For a whole host of issues going forward, lest we allow the impact of COVID to really be a contagion on other public health priorities.”