In early summer, when COVID-19 positivity rates had fallen to their lowest levels since the beginning of the pandemic, a fully vaccinated Nathan Jacobs took his grandson to a Yankees game, and he and his wife, Ellen, began going to malls again.
"We really weren’t worried at that time," said Jacobs, 70, of East Meadow.
Then COVID-19 cases and hospitalization numbers shot up because of the spread of the highly contagious delta variant. The trips to the malls stopped, the couple avoided any large gatherings, and they tried to shop only outside peak hours.
"All of a sudden with this surge we have to be very careful," Jacobs said.
The story is familiar to other vaccinated Long Islanders. What began as a summer of freedom, when they could finally loosen COVID-19 precautions and return to activities they had avoided for more than a year, ended with increased apprehension and the dialing back of social activities.
What to know
With COVID-19 cases, hospitalizations and deaths up because of the spread of the delta variant, some Long Islanders are becoming increasingly cautious and cutting back on some social activities.
The number of COVID-19 cases on Long Island has risen 1,000% in the past several weeks, and the number of hospitalizations increased by more than 700%, state data shows. The situation is more dire in states with low vaccination rates.
Experts say people should weigh the risk of each activity, and the risk they have of getting severe COVID-19. Unvaccinated people are at very high risk. Vaccinated people are at lower risk, but they should still wear masks in indoor and crowded outdoor spaces, experts say. Older adults and those with certain medical conditions should be especially careful.
Infectious disease experts said it's wise to be more cautious. They advise people — whether vaccinated or not — to carefully weigh the risk of various activities, and the risks to themselves, when deciding where to go and what to do.
The doctor's advice for the vaccinated:
"People have to realize they are still taking a slight risk. For many people that’s a very, very reasonable risk ... each person has to individualize that risk to themselves.” For higher-risk people, "if it’s not an essential activity, maybe don’t go."
-Dr. Aaron Glatt, chairman of medicine, chief of infectious diseases at Mount Sinai South Nassau hospital
Dr. Aaron Glatt, chairman of medicine and chief of infectious diseases at Mount Sinai South Nassau hospital in Oceanside, said even though vaccination greatly increases protection, "you don’t become Superman by being vaccinated. People have to realize they are still taking a slight risk. For many people that’s a very, very reasonable risk to take. I personally think each person has to individualize that risk to themselves."
Fully vaccinated older adults and people with medical conditions that make them more susceptible to severe COVID-19 should be more cautious than a healthy, vaccinated 30-year-old, he said. For higher-risk people, "if it’s not an essential activity, maybe don’t go," Glatt said.
Unvaccinated people have a much starker calculus, said Dr. Bruce Farber, chief of infectious diseases at North Shore University Hospital in Manhasset and Long Island Jewish Medical Center in New Hyde Park.
The doctor's advice for the unvaccinated:
“You have to be extraordinarily careful and really avoid any area where there are unmasked people inside, and outside in crowded areas. The risks are very high, and that’s why we are seeing what we are seeing all over the place.”
-Dr. Bruce Farber, chief of infectious diseases at North Shore University Hospital and Long Island Jewish Medical Center.
"If you are unvaccinated, you have to be extraordinarily careful and really avoid any area where there are unmasked people inside, and outside in crowded areas," he said. "The risks are very high, and that’s why we are seeing what we are seeing all over the place."
Spike in cases, hospitalizations
Farber was referring to the spike in COVID-19 cases, hospitalizations and deaths in New York and nationwide.
On Long Island, the seven-day rate of positive coronavirus test results has increased nearly 1,000% from July 1 to Saturday: from 0.4% to 4.2%.
The large majority of hospitalizations and deaths have been among unvaccinated people, state and federal health officials say. Even after the delta variant became dominant in late June, unvaccinated people were more than 10 times more likely to be hospitalized, and more than 10 times more likely to die, than vaccinated people, and five times more likely to become infected, according to a study released Friday by the Centers for Disease Control and Prevention.
COVID-19 hospitalizations on Long Island have shot up by more than 800% since July 9, from 50 to 458 on Saturday.
Experts say relatively high vaccination rates in states like New York are helping keep hospitalizations from soaring higher. In New York, 61.5% of the total population is fully vaccinated, compared with 53.8% nationwide, according to state and CDC data. Some states with low vaccination rates are seeing record COVID-19 caseloads and overwhelmed intensive care units.
Although the delta variant has led to more "breakthrough cases" of vaccinated people contracting the virus, they still remain far more protected from infection and severe disease than unvaccinated people, said Dr. Bruce Polsky, an infectious disease specialist who is chairman of medicine at NYU Langone Hospital-Long Island in Mineola.
Still, vaccinated people should wear masks in indoor and crowded outdoor spaces, even if there are vaccination requirements, Polsky said.
Some activities riskier than others
New York City on Monday will begin enforcing a requirement that anyone dining indoors, using a gym or going to a bar or an indoor event like a concert show proof of at least one vaccine dose.
On Long Island, a few theaters now require proof of vaccination, and several concert venues will begin doing so soon, with a recent negative COVID-19 test as an alternative.
The doctor's advice on vaccination requirements:
"It’s better if you’re in an environment in which everyone is vaccinated." If you’re in a venue without a requirement, “you have to assume the people to the left and right of you, and in front of and behind you, are unvaccinated. You should protect yourself accordingly” with masks.
-Dr. Bruce Polsky, infectious disease specialist, chairman of medicine at NYU Langone Hospital-Long Island
"It’s not perfect, but it’s better if you’re in an environment in which everyone is vaccinated," said Polsky, adding that he hopes New York City eventually requires full vaccination, not just one dose, which does not offer full protection.
If you are in a venue without a vaccine requirement, "you have to assume the people to the left and right of you, and in front of and behind you, are unvaccinated. You should protect yourself accordingly" with masks, he said.
Some activities are riskier than others.
Outdoor activities are safer than indoor ones. And indoor dining is less risky than a bar, where, Farber said, "people are almost never masked, people are drinking, they’re often very close to one another. They’re generally crowded venues. And people talk loudly. Yelling and singing dramatically increases the number of organisms that are spewed out of your mouth."
Glatt said the number of COVID-19 cases also is a risk factor. "If cases go down, then the risk goes down as well," he said.
What Long Islanders are doing
Rocio Carpio, 27, of Baldwin, who is vaccinated, said in Spanish that the delta variant hasn’t changed her activities — but she was avoiding restaurants and places with large crowds even before the variant began spreading.
Paul Ng, 38, of Franklin Square, said he, his wife and two young children go to places like restaurants and malls during less crowded weekday hours. Ng said he has some "trepidation" over the delta variant. But, he said, "I’m not really too concerned. I’m fully vaccinated."
Shelley Urban, 64, of Franklin Square, who is vaccinated, is worried about reinfection. She got sick with COVID-19 in March 2020. It was a mild case, but she continues to feel the effects of the disease.
"I don't have the energy that I had before COVID," she said.
Studies show that many people, including those who had mild illnesses, continue to have symptoms many months later, with fatigue, shortness of breath and sleeping disorders among the most common.
Urban has been vigilant about wearing a mask, both before and after the delta variant began spreading.
"I'm always thinking I could be infected again," she said. "We have to always watch and be on our guard. We can't let it down."
Several weeks ago, Nichole Murawski, her husband and their three children were going to movie theaters, but the delta variant put an end to that.
"Even though my husband and I are vaccinated, the kids still can’t get vaccinated," Murawski, 42, of Albertson, said as she watched her children, ages 10, 8 and 5, play at an Eisenhower Park playground in East Meadow. "I would hate to contract it and then pass it along to them."
Max Resnik, 54, of Old Westbury, was wearing a mask as he watched his children, ages 2 and 4, both masked, play at Eisenhower.
Resnik said he is mostly wearing a mask to set an example for his kids.
"Obviously they’re not vaccinated, and there’s a lot more interaction between them and other kids," he said.
The doctor's advice for parents:
"Locking up everybody in the house was quite artificial and not sustainable.” Look at a variety of factors in deciding activities for children, (the setting: outside vs. indoors, the size and if others are wearing masks.) Be more cautious if kids have medical conditions, and consider whether kids come in close contact with vulnerable adults.
-Dr. Sharon Nachman, chief of pediatric infectious diseases at Stony Brook Medicine.
Dr. Sharon Nachman, chief of pediatric infectious diseases at Stony Brook Medicine, said she tells parents to look at a variety of factors in deciding which activities to allow for their children, such as whether an activity is outside or indoors, how large an event is, and whether others are wearing masks. Children who are coughing or sneezing should be kept home.
Parents should be more cautious with children who have medical conditions such as diabetes, and they need to consider whether their kids may come in close contact with vulnerable adults, such as grandparents.
But Nachman does not advocate going back to confining kids to their homes.
"Locking up everybody in the house was quite artificial and not sustainable," she said.