Underneath the Q train, near the intersection of Coney Island and Brighton Beach Avenues, many of the passersby are older and speak in Russian. Last Wednesday, 64-year-old Irina Andreeva was among them, walking alongside her son, Alexander Astafurov, toward one of three COVID-19 testing vans parked side-by-side.

It was the first sunny day in weeks, but Andreeva was feeling under the weather.

“I have a temperature, and I’m shaking,” Andreeva, 64, said in Russian, as her son translated. She said several of her friends had caught the coronavirus in recent weeks as the omicron variant swept over New York City.

Some had more severe cases than others. One unvaccinated friend ended up being hospitalized at Maimonides Medical Center for a couple of weeks, Andreeva said. She felt more secure because she had had two doses of COVID-19 vaccine, but her son, who also lives in the neighborhood, said he now wants them both to get boosters to be on the safe side.

Omicron tore through New York City, with the five boroughs recording 1 million COVID-19 cases since the variant became dominant in mid-December. That’s four times as many cases as the city’s first wave in early 2020. But, as in previous surges, the burden has not been distributed evenly across people from different backgrounds and neighborhoods.

Some at-risk communities are still dealing with much higher rates of hospitalizations and deaths, despite the overall impression of a milder wave. These include people who are older, often fighting against pre-existing diseases. And as local organizations work to make sure these vulnerable groups get their booster shots, they continue to come up against those who don’t want to get vaccinated at all.

One of the city’s omicron hotspots centers on the southern tip of Brooklyn, spread across the neighborhoods of Brighton Beach, Manhattan Beach, Sheepshead Bay and iconic Coney Island.

Over the last month, these zip codes have experienced 75 COVID deaths per 100,000 people, a fatality rate nearly three times the citywide average.

The two zip codes encompassing this region — 11224 and 11235 — have experienced 75 deaths per 100,000 people over the last month, a fatality rate nearly three times the citywide average. The pair of zip codes ranked only behind East New York when it came to the pace of COVID deaths between December 24th and January 20th, while their hospitalization rates were also among the highest in the city.

These two zip codes in southern Brooklyn also have lower vaccination coverage than the city as a whole, a common thread between most of the places hit hardest this winter. The area is averaging 66% full vaccination, compared with 75% citywide. In adjacent Gravesend, fewer than two-thirds of residents are fully vaccinated, and meanwhile, some parts of the city are approaching universal coverage.

Most patients admitted to Coney Island Hospital during the latest surge were unvaccinated, as were the majority of the patients placed in intensive care. City officials described some of these trends in late January when they welcomed a military medical team to the beleaguered medical center.

Hospital leaders said undervaccination is having an outsized effect on these oceanside communities because the area’s demographics make residents prone to severe illness from COVID-19. In Brighton Beach and Coney Island, 26% of residents are over the age of 65, compared with about 14% in the borough as a whole. Many of those elderly residents also have underlying health conditions.

Military medical team arrives at Coney Island Hospital for orientation, January 22nd, 2022.

Military medical team arrives at Coney Island Hospital for orientation, January 22nd, 2022.

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Military medical team arrives at Coney Island Hospital for orientation, January 22nd, 2022.
NYC Health + Hospitals/Coney Island

“One of the things about this neighborhood is the high preponderance of older adults who live in the various retirement buildings that are near here, many of whom have been pushed over the edge by COVID,” Dr. Mitchell Katz, president and CEO of NYC Health + Hospitals, which runs Coney Island Hospital, said at a press conference welcoming the military on January 24th. “And so that's made the care very difficult for this hospital to do.”

About 2,300 New Yorkers are currently hospitalized with COVID-19, a big drop since citywide hospitalizations peaked in early January with 6,100 people. But state data show that the situation at Coney Island Hospital is only gradually starting to get better.

Since the military team arrived a couple of weeks ago, the medical center has gone from only 9% of its beds being available to 15% over the past seven days. But citywide, nearly a quarter of hospital beds were free over the past week. The intensive care unit at Coney Island Hospital also still hovers near capacity, at a time when nearly 20% of ICU beds are open citywide.

Public health experts say that getting people to stay up-to-date on their vaccines will be crucial moving forward to keep omicron and future variants from continuing to prey on high-risk groups.

Keeping Seniors Safe

Older New Yorkers were among the first cohorts eligible to get vaccinated against COVID-19, and several grassroots efforts popped up at the time to help them navigate the Byzantine online appointment-making process. A year later, some local groups continue to wage a tireless campaign to ensure this vulnerable population is vaccinated and boosted – particularly with the arrival of omicron.

One such organization is Brighton Neighborhood Association. Founder and executive director Pat Singer said her small nonprofit has recently doubled down on its vaccination efforts. The group coordinated with the city to station a vaccine van outside its office on Brighton Beach Avenue last week — and recently started working with a local pharmacy to deliver doses to seniors in their homes.

Pat Singer, founder and executive director of the Brighton Neighborhood Association, in her office with a wall full of tchotchkes and photos of the area. Singer has worked to help local seniors get vaccinated against COVID-19.

Pat Singer, founder and executive director of the Brighton Neighborhood Association, in her office with a wall full of tchotchkes and photos of the area.

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Pat Singer, founder and executive director of the Brighton Neighborhood Association, in her office with a wall full of tchotchkes and photos of the area.
Scott Heins for Gothamist
A sign on the wall of the Brighton Neighborhood Association office says “No kvetching,” or “No complaining.” Executive director Pat Singer says she has worked to help the seniors she serves overcome their resistance to getting vaccinated against COVID-19.

A sign on the wall of the Brighton Neighborhood Association office says “No kvetching,” or “No complaining.” Executive director Pat Singer says she has worked to help the seniors she serves overcome their resistance to getting vaccinated against COVID-19.

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A sign on the wall of the Brighton Neighborhood Association office says “No kvetching,” or “No complaining.” Executive director Pat Singer says she has worked to help the seniors she serves overcome their resistance to getting vaccinated against COVID-19.
Scott Heins for Gothamist

Speaking in her office, decorated with photos and memorabilia from her long career in the neighborhood, Singer said some of the elderly clients she serves who were initially hesitant had come around since the vaccines first became available. Others are harder to convince.

“They get an attitude like you’re the enemy,” Singer said. “They think the government is trying to tag them to watch what they’re doing.” She laughed, adding, “You’re not that interesting!”

Citywide, 89% of New Yorkers between ages 65 to 74 are fully vaccinated, but the rate drops to 63% for people older than 85. Municipal data also show coverage varies by region and by other demographics. For instance, just 62% of white seniors in the Bronx are fully vaccinated, and only 65% of Black seniors in Brooklyn.

JASA, a large nonprofit that provides senior housing and social services in neighborhoods across the city, has helped more than 4,000 individuals get COVID-19 shots so far, according to Danielle Palmisano, the organization’s chief program officer.

A wall in the Brighton Neighborhood Association office is covered in newspaper clippings and black-and-white photographs of the area. One at the bottom depicts founder Pat Singer in 1978 with then-Mayor Abraham Beame and current Sen. Chuck Schumer.

A wall in the Brighton Neighborhood Association office is covered in newspaper clippings and black-and-white photographs of the area. One at the bottom depicts founder Pat Singer in 1978 with then-Mayor Abraham Beame and current Sen. Chuck Schumer.

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A wall in the Brighton Neighborhood Association office is covered in newspaper clippings and black-and-white photographs of the area. One at the bottom depicts founder Pat Singer in 1978 with then-Mayor Abraham Beame and current Sen. Chuck Schumer.
Scott Heins for Gothamist

“We have been pretty successful in helping people make sure they get vaccinated, getting them to their booster appointments,” said Palmisano. She said during the latest surge, JASA has been hosting pop-up vaccine clinics in some of its senior residences, such as Scheuer House in Coney Island.

She said despite the statistics showing that older New Yorkers were more likely to be hospitalized from omicron, the view from the ground has been far less bleak compared to when the pandemic first hit New York City.

Back then, doctors barely knew how to treat the disease, and there were no vaccines. This wave, many residents and staff members got sick, Palmisano said, but “we were not seeing the same numbers of hospitalizations and severe illness and deaths.”

Why Vaccines Still Matter

Naum Nakhimovsky, one of the employees at the van where Andreeva got her COVID-19 test, said he was suspicious of the vaccines because he thought they were developed too quickly — a persistent talking point among those who oppose the shots.

“I don't wear a mask, and people who don't wear a mask, they have good immunity,” Nakhimovsky said. The 66-year-old said he was required to get vaccinated for another job. But he claimed many in the Russian community in Brighton Beach share his views.

Such views run contrary to evidence around vaccines versus so-called natural immunity, or what the body develops after an infection. Both routes can offer strong protection, but studies show vaccination is more consistent.

This subtle difference is hard to convey, as well as the idea that omicron still poses a threat. The number of COVID cases citywide has dropped from its peak in early January, but daily infections and deaths still rival last winter’s worst days.

A year ago, the city peaked at around 83 COVID deaths per day over a three-week period, notching 1,800 fatalities during that stretch. These days, the boroughs are averaging more than 100 daily deaths, a pattern that’s been in place for nearly a month and killed about 2,300 people.

I hesitate to think of how bad [omicron] could have been had we not had the opportunity to vaccinate as many people as we did.

Cameron Wolfe, Duke University School of Medicine

Severe cases among high-risk groups continue to contribute to these tallies, even as New Yorkers try to put this surge behind them and resume a sense of normalcy.

Public health experts say, regardless of what happens over the coming months or as the pandemic evolves, vaccination will continue to be an important tool to protect people from the worst outcomes of the virus. But overcoming vaccine hesitancy in all its forms will also continue to be a challenge.

“I don't know many who say we can project whether we're going to have a new variant or not, or whether it’s going to be more virulent,” said Albert Ko, an epidemiologist with the Yale School of Public Health. “But the bottom line is the best way to protect our vulnerable populations is to get them vaccinated, and not only vaccinated, but up-to-date on their vaccinations.”

It remains uncertain what pattern the coronavirus will follow in the future, but many experts predict that it could become seasonal and endemic like the flu. And the flu offers a clue as to the challenges of getting people to take a vaccine on a regular basis, even for something very deadly.

Over the last decade, the number of people hospitalized for the flu in the United States has ranged from 140,000 to 710,000 annually, according to the CDC. During that time, the flu killed between 12,000 and 52,000 people each year. Yet, only half of adults got vaccinated during last year’s flu season, which was an improvement over prior years. Among adults over 65, coverage was much better – 75% — but there were still disparities between racial and ethnic groups.

In New York City, there are some 2,000 deaths each year from seasonal flu and pneumonia, routinely making it the third leading cause of death in the five boroughs, according to the city health department. But last year, just half of city adults got their flu shots – a record number.

Although the number of adults getting flu shots has increased during the pandemic, Ko said he feared that the U.S. had “taken steps backwards” in terms of vaccine hesitancy overall in the last 20 years. But, he said, “COVID has offered a new opportunity to learn.”

Military medical team arrives at Coney Island Hospital for orientation and is greeted by ovation from staff, January 22nd, 2022.

Military medical team arrives at Coney Island Hospital for orientation and is greeted by ovation from staff, January 22nd, 2022.

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Military medical team arrives at Coney Island Hospital for orientation and is greeted by ovation from staff, January 22nd, 2022.
NYC Health + Hospitals/Coney Island

Early data from New York City’s omicron surge show that those who didn’t get any shots were at least eight times more likely to end up in the hospital than those who were fully vaccinated. Shortly after omicron became dominant in Los Angeles, unvaccinated people were 23 times more likely to be hospitalized than those who had received booster shots and five times more likely to be admitted than those who were vaccinated without boosters, according to a new report from the Centers for Disease Control and Prevention.

“I hesitate to think of how bad [omicron] could have been had we not had the opportunity to vaccinate as many people as we did,” said Cameron Wolfe, an infectious disease expert at the Duke University School of Medicine.

Still, the COVID-19 vaccines were not as effective at stopping omicron infections in the first place as they had been for previous variants. Future versions of the shots could restore this defense, but the constantly evolving nature of the virus and the scientific knowledge around it complicates public health messaging, Wolfe said.

​​”I think you've got to keep the message clear as to, ‘What am I trying to do with vaccination?’” Wolfe said. One goal is “to protect those most at risk.”