Virus Numbers Are Surging. Why Is New York’s Vaccine Rollout Sluggish?

As the final hours ticked away in a harrowing year, New York City on Thursday once again found itself in a worrying position in the pandemic: Hospitalizations were climbing for the fourth consecutive month, the positive test rate in some areas had doubled and vaccinations that were supposed to bring normalcy had gotten off to a slow start.

Across the city, where the positive test rate over a seven-day average reached 8.87, the virus continued its winter surge.

In Sunset Park, Brooklyn, the positive test rate in the most recent seven-day average in one ZIP code had reached 14.71. A section of Ozone Park in Queens had a city-high 15.61 positive test rate. In the Bronx, the boroughwide rate had reached 9.56 — and yet that was still lower than Staten Island’s 10.34 rate.

In all, 49 ZIP codes in the city had a positive test rate of 10 or higher in the latest seven-day average, and the city has averaged nearly 4,000 cases and about 40 deaths a day.

So far the second wave has climbed more slowly and has not reached anywhere near the magnitude of New York City’s disastrous first wave in the spring — when more than 20,000 people died and 20 percent of city residents may have been infected. But public health experts say that there is urgent need to speed up the rollout of the vaccine to hasten the end of New York’s epidemic before hospitals are overwhelmed or a new and more contagious variant of the virus makes inroads.

The variant, first identified in the United Kingdom and recently detected in Colorado and California, has not yet appeared in New York State, Gov. Andrew M. Cuomo said on Wednesday.

When the first vaccinations were given in New York earlier this month, doctors and nurses said they believed the end of the epidemic was in sight. But the pace of administering vaccinations has gone more slowly than anticipated in New York City.

Dr. Ronald Scott Braithwaite, a professor at N.Y.U. Grossman School of Medicine who has been modeling New York City’s epidemic and is an adviser to the city, said that his team’s analysis suggested that once 10 to 20 percent of the city was vaccinated, the number of new cases would begin to drop — so long as social distancing and mask wearing remained constant and the new variant did not find a foothold in New York.

“If the new variant replaces the existing variant and we don’t vaccinate quickly, the second wave will start cresting again and will crest really high, and that’s something to take really seriously,” Dr. Braithwaite said.

But achieving the goal of vaccinating 10 to 20 percent of the city is still a far way off. In the first 17 days of the vaccination rollout, about 88,140 people had received the first of two doses, the equivalent of about 1 percent of the city’s population. Those vaccinated so far have overwhelmingly been hospital employees, residents and workers at nursing homes and the staff at certain health clinics.

The pace is worrying some experts. “I do feel concern,” said Dr. Wafaa El-Sadr, an epidemiology professor at Columbia University. Despite months to prepare, there still seemed to be a steep learning curve when it comes to “the nitty-gritty of how do you get it from the freezer to the arm as quickly as possible,” she said. “I think there are growing pains as people are picking up how to do this.”

The first phase should have been the simplest, she added. “We’ve started out with the easiest populations, an almost captive audience: nursing homes and hospital workers — you know who they are and where to find them.”

For now, the vaccination effort does not resemble the sort of mass mobilization many imagined. New York City has yet to open any large vaccination sites. Instead, hospitals administered many of the first vaccinations to their employees. Hospitals have been encouraged to use each shipment of vaccines within a week, and the operation does not always have a race-against-the-clock feel.

The number of vaccinations plummets on weekends and all but stopped for Christmas Day, when more planes landed at Kennedy International Airport than vaccine doses were administered in New York City.

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Answers to Your Vaccine Questions

With distribution of a coronavirus vaccine beginning in the U.S., here are answers to some questions you may be wondering about:

    • If I live in the U.S., when can I get the vaccine? While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.
    • When can I return to normal life after being vaccinated? Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.
    • If I’ve been vaccinated, do I still need to wear a mask? Yes, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. But what’s not clear is whether it’s possible for the virus to bloom in the nose — and be sneezed or breathed out to infect others — even as antibodies elsewhere in the body have mobilized to prevent the vaccinated person from getting sick. The vaccine clinical trials were designed to determine whether vaccinated people are protected from illness — not to find out whether they could still spread the coronavirus. Based on studies of flu vaccine and even patients infected with Covid-19, researchers have reason to be hopeful that vaccinated people won’t spread the virus, but more research is needed. In the meantime, everyone — even vaccinated people — will need to think of themselves as possible silent spreaders and keep wearing a mask. Read more here.
    • Will it hurt? What are the side effects? The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection into your arm won’t feel different than any other vaccine, but the rate of short-lived side effects does appear higher than a flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. The side effects, which can resemble the symptoms of Covid-19, last about a day and appear more likely after the second dose. Early reports from vaccine trials suggest some people might need to take a day off from work because they feel lousy after receiving the second dose. In the Pfizer study, about half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headaches, chills and muscle pain. While these experiences aren’t pleasant, they are a good sign that your own immune system is mounting a potent response to the vaccine that will provide long-lasting immunity.
    • Will mRNA vaccines change my genes? No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.

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