New York City has been locked down and shut off for more than two months.
On sidewalks and in stores, masked New Yorkers stand on pieces of tape six feet apart as they wait to enter, shop, and check out. The person who delivers your mail, your food and your industrial sized box of bleach wipes is wearing gloves. Compulsive hand washing is second nature.
And yet, somehow, tens of thousands of people are still contracting the coronavirus, in the city and across the entire region. Over the last two weeks, more than 47,000 people in New York, New Jersey and Connecticut tested positive — over 13,000 in New York City alone.
In the last week, more than 2,800 patients with virus-like symptoms were admitted to hospitals in New York and New Jersey. The numbers are down substantially from early April, when well over 20,000 patients were being hospitalized every week. But they are still considerable.
Who are these people?
The health authorities know a lot about where people are getting sick, and about their most basic personal data — their age, gender and race or ethnicity.
But they are only beginning to grapple with the questions of how and why people are getting sick — what jobs they do, what housing situations they live in, what avenues of exposure they have to the coronavirus.
Earlier this month, the New York City health commissioner, Dr. Oxiris Barbot, said that the city’s caseload was simply too large to investigate each virus patient’s circumstances.
“The reality is that we’re still seeing transmission across the city,” she said, “Given the large volume of new cases, we can’t track those back to a single point source.”
In the beginning of May, the agency that runs the city’s public hospitals polled the heads of the hospitals’ emergency departments about the types of virus patients coming through their doors.
“It’s a mixture,” said Dr. Eric Wei, a vice president of the agency, NYC Health + Hospitals, of essential workers and “people who have been diagnosed with Covid maybe two, three weeks ago with lingering symptoms and now are getting worse.”
The state health department also looked at the question of who is getting sick enough to go to the hospital. It surveyed over 100 hospitals across the state in early May and learned that four in five incoming patients were retired or unemployed, most had been sheltering at home, and nearly all had other underlying health conditions.
Information on those who are sick but not hospitalized has been harder to come by. The city and state are hiring thousands of the disease detectives known as contact tracers, but they have not yet begun work.
The New York Times talked to doctors and hospital administrators, public-health officials, immigrant groups and patients themselves. Their answers varied, but they painted a collective portrait of those who are still getting sick.
Workers on the front lines and their families are still getting hit hard.
People who spend hours every workday around strangers naturally have more chances to get exposed to the virus, doctors said.
“The majority of people, it’s health care workers, it’s M.T.A. workers, it’s postal workers,” Dr. Sylvie De Souza, chief of the emergency department at the Brooklyn Hospital Center, said in an interview in mid-May. “As opposed to before, it seemed to be people out in the community, and of course a lot of the nursing home patients — but almost all of them have died.”
Javier H. Valdés, a co-director of Make the Road New York, an advocacy group for immigrants, said the virus patients his organization hears about lately are “getting sick because they’re still out there working — construction, delivery men. It’s mostly men.”
Michael Pappas, a family-medicine resident at Mount Sinai Hospital in Manhattan, said that some essential workers are bringing the virus home.
“I suspect you have patients whose family members may be deemed essential workers, but they are younger and healthier,” he wrote in an email. “So they go out, work, maybe are exposed or get the virus, but general asymptomatic (or even if symptomatic still have to work), then those same essential workers come home and expose an at-risk loved one living with them.”
Not everyone can afford to socially distance.
Tens of thousands of New Yorkers live at close quarters in cramped spaces, physically unable to quarantine from any sick household members.
Dr. Ramón Tallaj, the founder of Somos, a health care network that serves nearly 800,000 Latino and Chinese New Yorkers, said that, despite the slowdown in new cases in the official tally, the virus is still spreading inside multigenerational apartments among people who are afraid to get tested because of language barriers or immigration status.
“What we are seeing on telemedicine,” he said, “who is getting sick is people who are stuck at home, immigrants who are living 10 people in one apartment. They don’t want to go to a testing site or to an emergency room.”
Older New Yorkers remain among the most vulnerable.
The New York State Health Department’s survey of 113 hospitals, conducted from May 3 through May 5, found that nearly 60 percent of newly admitted virus patients were over 60 years old. Nearly 40 percent were over 70. More than 20 percent were transferred from nursing homes or assisted living facilities. Nearly 40 percent were retired.
Many doctors echoed these findings. “I personally have noticed many very elderly patients coming in with Covid, often from different assisted living homes/nursing homes in the city,” Dr. Pappas wrote.
Kevin Hu, an emergency medicine physician at Elmhurst Hospital Center in Queens, wrote: “To me, it seems like there are many more elderly patients now. Very few young/healthy are coming in, even for testing.”
The outbreak is taking longer to slow down in the Bronx.
Along with immigrant-heavy neighborhoods in Queens, the Bronx has been hardest-hit borough of New York City for most of the pandemic. Of the 10 ZIP codes with the highest rates of positive tests over the past two weeks, four are in the Bronx.
They include two of the poorest ZIP codes in the city: 10453 in Morris Heights and 10452 in Highbridge, where the median household income is under $29,000.
Latinos are bearing more and more of the burden in New York City.
During the first six weeks of the outbreak, among New York City cases in which race was recorded, Latino residents accounted for 28 percent of virus deaths, 30 percent of hospitalized virus patients and 32 percent of people who tested positive but were not hospitalized, according to city data.
For the period April 27 to May 13, those numbers were considerably higher: 37 percent of deaths, 37 percent of hospitalized patients, and 42 percent of people who tested positive but were not hospitalized.
People who have multiple risk factors are particularly in danger.
A 52-year-old woman from Bushwick, Brooklyn, named Maria said in an interview that she had done all she could to avoid the virus.
Maria, who spoke on the condition that her last name not be published, is an essential worker: She delivers meals for RiseBoro Community Partnership in Bushwick.
But she sprays the interior of the truck with Lysol before she gets in and wipes down the surfaces. She does not enter the building where the food is prepared, she hangs her clients’ meals on the doorknob and leaves before they open the door, and she changes her gloves after each delivery.
She is also the spouse of an essential worker: Her husband works in a supermarket. But he tested negative recently.
She lives in a crowded apartment. But her son has been out of work since March and does not leave home without a mask. Nor does her 17-year-old granddaughter. And her four younger grandchildren rarely go out at all. She never gets in the elevator when there is someone else in it.
Still, Maria started to feel congested around May 4. Then came the sore throat and the body aches. On May 11 she got tested. On May 14, the result came back: positive.
“It’s a mystery,” Maria said. “That’s what I was telling the doctor — how is that possible? She says, ‘You know Maria, this is something that we’re learning about every day.’”
Some people are not following social-distancing rules.
The state has commissioned virus-antibody testing, and a recent round of the tests in low-income, predominantly black and Latino neighborhoods in New York City found a far higher percentage of people testing positive than a previous round of tests covering the city overall.
In some neighborhoods, the rate of positive antibody tests was more than double the citywide rate, Gov. Andrew M. Cuomo said last Wednesday.
Mr. Cuomo said that the state would work to get personal protective equipment, like masks and sanitizer, into the hands of more people in these communities.
“It’s a public health education effort,” he said. “I’ve been all across the state, you drive through some of these communities and you can see that social distancing isn’t happening, P.P.E. is not being used and hence, the virus spreads.”
Some rural counties are seeing higher infection rates than the city or suburbs.
Farm laborers in the New York region often live in dormlike housing with shared bathrooms and dining areas, giving them ample exposure to sick co-workers.
Over the last two weeks, Sullivan County, a patchwork of farms, woods, and small towns an hour northwest of New York City, had both the highest positive test rate and the most new cases per capita in the state.
The county’s public health director, Nancy McGraw, said the county’s Latino residents were among the hardest hit by the virus — “both migrant and permanent residents, as they are a primary work force for local food processing, light manufacturing and agricultural enterprises.”
The second-highest rate of positive tests is in Orleans County, which sits on Lake Ontario and is one of the state’s leading producers of apples and vegetables.
In New Jersey, over the last two weeks, the county with the most new cases per capita was Cumberland, an agricultural stronghold near the southern tip of the state, where the virus spread considerably later than it did in the north.
Reporting was contributed by Annie Correal, Sheri Fink and Brian M. Rosenthal.
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