A year ago, Long Island was facing a surge of coronavirus cases, just as it is today.
Medical experts then were optimistic that COVID-19 vaccines, which had just been authorized, could by the end of this year return the country to near-normalcy. Then-President Donald Trump said they would "soon end the pandemic once and for all."
"We really thought we were going to vaccinate everyone and it would disappear and be in the background," said Dr. Bruce Farber, chief of public health and epidemiology for Northwell Health. "That’s clearly not happening."
What to know
Although 2021 began with optimism of a return to near-normalcy by now, it is ending with another COVID-19 surge, and with coronavirus positivity rates surging to their highest levels since the pandemic began.
Experts say the virus' ability to change and become much more contagious, first with the delta variant and now with omicron, and lower vaccination rates than expected helped lead to the latest crisis.
They say the up-and-down nature of the pandemic will continue unless more people get vaccinated and boosted, and unless people wear masks in indoor public places and take other precautions.
Instead, a larger percentage of Long Islanders are testing positive for COVID-19 than at any time since the beginning of the pandemic in March 2020, with the highly contagious omicron variant accounting for more than 90% of new cases in the region that includes New York. Hospitalization numbers are up. Hundreds of New Yorkers are still dying of COVID-19 every week, most upstate, where vaccination levels remain low.
"We underestimated the virus, and every time we’ve done that, it’s been to our own peril," Farber said. "We underestimated the ability of the virus to change, the evolution of variants and the length of immunity these vaccines are going to give us."
The year ahead is uncertain, but medical experts predict New York eventually will get to the "new normal" of relatively few new cases and of less need for masking and other precautions. When that happens depends on factors such as vaccination levels and adherence to mask-wearing, and on how the virus behaves and changes, they said.
Even amid the optimism of a year ago, experts were careful to say the virus was unpredictable, and that control of the pandemic depended largely on how many people got vaccinated. The vaccines have done what they primarily were designed to do, Farber said: Keep people from getting severely ill and dying. The problem is that more people than expected have resisted getting inoculated.
"We felt that people were going to be hesitant in the beginning, but as more and more became vaccinated and they didn’t see any serious side effects developing in all their friends, neighbors and co-workers, that they would join and feel this is a good thing to do," Farber said. "We were all surprised at the significant percentage of the population that really has no plans to get the vaccine despite the data on safety and efficacy."
Fewer than 62% of Americans, and just over 71% of New Yorkers, are fully vaccinated, according to Centers for Disease Control and Prevention and state Department of Health data.
Scientists knew from the beginning that some vaccinated people would contract the virus, so reports of infections among them are not surprising, said Wafaa El-Sadr, a professor of epidemiology and medicine at the Mailman School of Public Health at Columbia University in Manhattan.
The key numbers to look at are hospitalization and death rates, which remain far lower among vaccinated than unvaccinated people, El-Sadr said.
The highly transmissible delta variant, which spread quickly over the summer and fall and sent case, hospitalization and death rates rising, upset the initial hopes for a more normalized society.
In the late spring and early summer, before the delta surge, positivity rates on Long Island were consistently below 1% for weeks. In June, there were 10 state-sponsored fireworks shows across New York to celebrate, as former Gov. Andrew M. Cuomo put it, "resuming our re-imagined normal." Cuomo lifted almost all remaining state COVID-19 restrictions. President Joe Biden said on July Fourth that "we’re closer than ever to declaring our independence from a deadly virus."
Yet even as the delta variant continued to kill New Yorkers by the dozens daily, the even more contagious omicron variant became dominant.
Studies show a booster shot for those fully vaccinated for more than six months greatly increases protection against omicron. Yet fewer than 32% of fully vaccinated Americans have been boosted, according to the CDC.
Dr. Anthony Fauci, chief medical adviser to Biden, and Gov. Kathy Hochul recently said booster shots eventually may be required for someone to be considered fully vaccinated, depending on when they received their second shot.
Additional booster shots eventually could be needed, but "it’s very hard to tell" when that will be, El-Sadr said.
Although it appears omicron is less likely to cause severe disease, the sheer number of people it has the potential to infect could cause enough serious illness to strain systems, Long Island hospital officials said.
More than 800,000 Americans have died of COVID-19, most during 2021, and, with so many people still unvaccinated, thousands are continuing to die every week.
Hindered by gaps in approach
The ability to control the pandemic has been hampered by "a lack of coordinated strategy" nationwide, as states and localities sometimes take polar-opposite approaches to public health measures, said Carla Williams, an associate professor of medicine and public health at Howard University in Washington, D.C.
The federal government requires most health care workers to be vaccinated, but states including Texas and Florida prohibit any vaccine mandate, and 27 Republican-run states sued to block a federal mandate requiring vaccinations or weekly coronavirus tests at all large workplaces.
The U.S. Supreme Court will hold a hearing on both federal mandates on Jan. 7.
Long Island officials are among those statewide refusing to fully enforce Hochul’s recently announced mandate that businesses require either masks or vaccinations, while New York City recently said it is cracking down on businesses that don’t follow its vaccination requirements.
One of the big shifts between the beginning and end of 2021 was a major uptick in Black and Latino vaccination rates.
In March, Black and Latino Long Islanders were much less likely to be vaccinated than white and Asian residents, state data shows. Now, Latinos are more likely to be inoculated than other residents, and the gap between Black and other Long Islanders has significantly narrowed. CDC data shows similar trends nationwide.
Williams said the key was relying on — and funding — trusted community-based organizations to promote vaccines and combat disinformation and misinformation.
Today, the biggest gap in vaccination levels is a partisan one. A Kaiser Family Foundation poll last month found that 91% of Democrats had received at least one dose of vaccine, compared with 59% of Republicans.
When Trump was still president, and shortly after he left office, many Republicans praised him for the vaccine development under his administration, with even firebrand Georgia Republican Rep. Marjorie Taylor Greene tweeting in March that "President Trump saved lives!" through development of a vaccine that, by August, she claimed was "failing."
Farber said the politicization of the vaccine, and of mask mandates, has been "destructive for control of the pandemic."
In early 2021, the Maryland-based health care nonprofit the de Beaumont Foundation worked to develop strategies to increase vaccine uptake among Republicans.
But at this point, attitudes among most of the unvaccinated, whether Republican or not, "are entrenched," said Brian Castrucci, the foundation’s president and CEO.
With such resistance, Castrucci said, the only way "to get to whatever our new normal is" is to expand employee vaccine mandates and vaccination requirements like the ones New York City and a growing number of other cities have to dine indoors or go to places such as gyms or theaters.
It leaves people the choice to get vaccinated, "But your choice does not come without consequences," he said.
Opponents of mandates said they violate personal freedoms, and that employment mandates force people to choose between a shot they don’t want and their livelihoods and incomes.
But, Castrucci said, alluding to conspiracy theories and disinformation about COVID-19, "If you want to believe the vaccine is unsafe, if you want to believe that COVID doesn’t exist, there’s no more reasoning I can do with you. No one is going to hold you down and put a needle in your arm, and they shouldn’t. But that doesn’t mean we need to facilitate behavior that is deleterious to the broader group."
Mistrust and misinformation
The tensions over vaccine and mask mandates, and other coronavirus-related policies, led to contentious school board meetings on Long Island and elsewhere, and to hostility toward public health officials.
Nationwide, health officials are resigning their posts because of "threats to their jobs, their safety and their family members," according to the Washington, D.C.-based National Association of County and City Health Officials, which asked for federal protection for local health officials.
The increasing antagonism toward health professionals, and distrust of what they recommend about vaccines and other preventive measures, have had effects beyond COVID-19, said Dr. Sharon Nachman, chief of pediatric infectious diseases at Stony Brook Medicine.
"The COVID pandemic has turned people away from seeking medical care or listening to their physicians, which is very disturbing and shocking," she said.
Nachman said colleagues have told her that an increasing number of patients, or the parents of child patients, no longer believe or follow what their doctors recommend.
The logic, she said, is "‘I don’t believe them about the COVID vaccine. They must not be telling me the truth about the other things they’ve talked about.’"
False information about the vaccine is a key reason why vaccination levels remain low for children 5 to 11, who became eligible for the Pfizer-BioNTech vaccine on Nov. 2, she said.
Only about 22% of kids of that age group on Long Island have received at least one dose of vaccine, state data shows.
That will make it more difficult in the year ahead to control the pandemic, and it puts kids in danger, Nachman said.
Parents sometimes are "getting bombarded with 100 different emails saying, ‘Oh my God, vaccines are terrible, don’t give it to your kids,’ " while at the same time incorrectly believe that "if their kids get COVID, they won’t be that sick."
But, she said, "We are seeing many more kids who are sick, we don’t have any idea how long their immunity will last, particularly now to the omicron strain, and we don’t know what will be the long-term consequences to all of these kids getting COVID now."
"Long COVID" is one of the big unknowns about the pandemic, for both children and adults, Nachman said. Many adults and children have had lingering effects of COVID-19 for months and, now, nearly two years after contracting the virus. It's unknown when or if the effects will go away. Many of those with long COVID had relatively mild initial cases of the disease, studies have shown.
Nachman said "the tide will change once [the vaccine is] FDA [Food and Drug Administration]-approved [for children] and perhaps it’s part of the mandated vaccines kids need for school entry," just like other vaccines that have been required for decades.
The Pfizer-BioNTech vaccine has emergency authorization for kids, but full approval — which requires more data over time — is not expected until well into 2022.
Hochul said she supports requiring vaccinations for schoolchildren starting in the 2022-23 school term.
COVID-19 likely to persist
The worldwide spread of omicron, which was first detected in South Africa, where vaccination levels are far below that of the United States and other wealthy countries, is yet another reminder that what happens in other countries will profoundly affect the United States, Williams said.
Variants are more likely to develop in unvaccinated people, and the more variants that evolve, the greater the risk some will become more resistant to current vaccines, she said. A key priority in the coming months should be to increase the supply of vaccines in low-inoculation countries, she said.
"We will not end the pandemic as long as you have big pockets of countries and nations that are not vaccinated, and that has to happen much sooner rather than later," she said.
Meanwhile, despite the plentiful supply of vaccine in the United States, inoculation levels remain low enough that the virus will continue to spread widely, and it’s unlikely it will ever go away, Farber said.
The roller coaster nature of the pandemic, with numbers going up and down and back up again, likely will persist, he said. And the virus will continue to kill.
"Like it or not, we live with 25,000 to 40,000 deaths from influenza [the flu] every year, and it seems we’ll be living with a certain number of them from COVID for the foreseeable future," he said. "What that number is in part depends on the virus and in part depends on our behavior."
Despite the current surge, El-Sadr said she’s optimistic about an eventual return to normalcy.
"I don’t think it’s all doom and gloom," she said.
But the longer that many people resist getting vaccinated, and the more that people refuse to wear masks in indoor public places, the longer it will take to get infection levels down to a low enough level long term that the yo-yo-like trajectory of the pandemic finally stops, El-Sadr said. And the longer it will be until the hopes some had at the beginning of 2021 of COVID-19 receding into the background are finally realized.
Otherwise, she said, "We’re just going to continue this cycle."