The surge in COVID-19 hospitalizations and deaths in New York over the past four months has been far less severe on Long Island and in New York City than upstate, a Newsday analysis of state data found.
Medical experts say higher vaccination rates, more extensive mask-wearing and vaccine mandates downstate are the primary reasons, along with natural immunity for some previously infected.
"When more people are vaccinated, and more people are masking and distancing, everything is going to be lower," said Dr. Aaron Glatt, chairman of medicine and chief of infectious diseases at Mount Sinai South Nassau hospital in Oceanside.
What to know
COVID-19 hospitalizations and deaths increased much more sharply upstate than on Long Island and in New York City over the past four months, as the highly contagious delta variant spread.
More people died of COVID-19 upstate since July 1 than on Long Island and in New York City, even though there are nearly 3 million fewer people living upstate.
Experts say higher vaccination rates, more extensive mask-wearing and vaccine mandates are the main reasons numbers did not increase as much downstate as upstate. Natural immunity also is a factor.
More people died of COVID-19 upstate between July 1, just before COVID-19 cases began to spike amid the spread of the highly contagious delta variant, and this past Tuesday than on Long Island and in New York City — even though nearly 3 million fewer people live upstate.
The number of deaths during the delta variant wave rose 3.7% in New York City and Long Island combined, compared with 10% upstate.
The increase in deaths was especially high in rural counties — more than a dozen saw increases of more than 20% — and less dramatic in counties with major cities including Buffalo and Rochester, and in the counties just north of New York City. County death totals are based on daily electronic reporting of deaths in hospitals, nursing homes and assisted-care facilities.
On Long Island, Nassau County, which has a higher vaccination rate than Suffolk County, saw a smaller increase in deaths than Suffolk: 3.8% versus 6.3%.
Most upstate counties have much lower vaccination rates than those on Long Island and in New York City.
Dr. Nancy Nielsen, senior associate dean for health policy at the University at Buffalo, blamed politicization of COVID-19, a strong distrust in government and a resistance to being told what to do for the low rate of vaccinations and mask-wearing in rural areas of New York.
"We’re losing 1,500 people a day to this disease [nationwide], and this is largely preventable and so sad," she said.
In Franklin County, which had an 83% rise in deaths between July 1 and Tuesday, the state’s biggest increase, fewer than 2 in 3 adults have at least one vaccine dose, compared with nearly 96% in Nassau. Ten residents of Franklin County, which is in the rural North Country of northeast New York, died of COVID-19 within the past four months.
COVID-19 hospitalizations have risen more than 14-fold in the North Country since July 1.
Doctor: Vaccination decisions 'peer driven'
The influx of COVID-19 patients into Alice Hyde Medical Center in Franklin County and Champlain Valley Physicians Hospital in Plattsburgh "put a significant stress on the system," which already had a staffing shortage and had lost employees to the state health care worker vaccine mandate, said Dr. Wouter Rietsema, vice president for population health and information services at the two hospitals, and an infectious disease specialist.
Rietsema said one reason for the dramatic increase in North Country COVID-19 cases and hospitalizations is that oftentimes entire families or social groups are unvaccinated, meaning the amount of virus circulating in the air when people are gathered can be high, making the delta variant especially dangerous.
"The decision to get vaccinated or not is not as individual as you think," he said. "It’s very peer driven."
Rietsema said that, unlike in earlier surges, he saw several unvaccinated married couples hospitalized at the same time in recent weeks.
"That is a recurring fact pattern, and we had multiple [instances] of those scenarios, and there were some deaths in those scenarios," he said.
Hospitalizations on Long Island and in New York City also rose in the past four months, but much less sharply than in upstate regions, most of which saw increases of more than 1,000% or 2,000%.
On Long Island, hospitalizations rose 323% between July 1 and Tuesday — from 64 to 271 — and in New York City, they increased 163%, from 171 to 449.
Although the vaccination gap is the biggest reason for the more severe impact of the pandemic upstate in recent months, mask-wearing also may be a factor, said Nielsen, former president of the American Medical Association.
Nielsen said she was in New York City recently and saw a much higher percentage of people wearing masks than in rural areas she has visited, with the incidence of mask-wearing in Buffalo somewhere in between.
In a crowded place like a subway car, masks can be critical to preventing the spread of the virus, said Denis Nash, a professor of epidemiology at the CUNY School of Public Health in Manhattan. He noted how the subway probably was a significant reason the virus spread so quickly in New York City in the first weeks of the pandemic, when riders did not wear masks.
Nielsen said New York City’s vaccination mandates — for its employees, and for anyone wanting to eat inside a restaurant, go to a gym or movie, or attend an indoor concert or sporting event — are why the city’s COVID-19 numbers are proportionately lower than anywhere else in the state.
"When we’re vaccinated, we’re protected by and large," she said. "I was in New York City last weekend, and every place we went required us to show proof of vaccination along with our IDs. No big deal. We did it, and I think that’s going to keep people safe."
Dr. Bruce Polsky, an infectious disease specialist who is chairman of medicine at NYU Langone Hospital-Long Island in Mineola, said that in the riskiest places for mass virus transmission, such as big indoor sports events and concerts, "You’re removing in the most dense environments an opportunity for successful virus transmission."
Vaccinated people can contract and transmit the virus, but "the risk is significantly lower in vaccinated people than in unvaccinated people," he said. "Most importantly, the risk of serious illness and hospitalization is very much reduced."
In addition to making indoor venues safer, "Mandates push people to get vaccinated," said Dr. Bruce Farber, chief of public health and epidemiology for Northwell Health.
Starting Friday afternoon, New York City began requiring at least one vaccine dose for almost all its employees. Previously, many had an option of weekly coronavirus testing.
New York City has by far the lowest COVID-19 positivity rate in the state: 0.97% on Saturday, compared with 2.11% on Long Island and more than 5% in the North Country and western New York.
Natural immunity plays a part
Natural immunity from COVID-19 infection plays a part in determining case, hospitalization and death rates, experts said.
Rietsema said the higher hospitalization and death numbers in the North Country in part are because the region was not hit as hard as downstate earlier. That means there are fewer unvaccinated people with natural immunity, making them especially vulnerable to severe disease.
That same natural immunity has helped keep case, hospitalization and death numbers lower in places such as New York City, although it’s unclear to what extent, because it’s unknown how long natural immunity protects people, Nash said.
"There are definitely re-infections among people who were infected in the past and never vaccinated, and there comes with that a risk of death and hospitalization that the vaccine never even approaches," Nash said. "The calculus is very clear. Anyone who has never been vaccinated, regardless of whether they’ve had COVID, should be vaccinated."