NYC has peaked

Cases have topped out in NYC.  For about the last week, there's been no change in Omicron cases, with a slight downward trend in positivity in New York City.  The photo below shows cases and positivity for Brooklyn, which follows this trend.  

In Brooklyn, roughly 1 in 20 people have confirmed cases of Covid since Christmas.  We know the truth to be quite a bit higher.  Many people do not get tested or use rapid at home tests, which are not recorded in the official numbers (except in limited circumstances).  Anecdotally, with few exceptions, everyone I know has had at least 1 Covid case in their family in the last few weeks.  

So the good news is partly the result of the enormous outbreak we've just had.  We can now expect a decline, and hopefully one that is almost as steep.  This would mean cases in New York City could drop by 75% from their peak by the end of the month.

So how about hospitalizations?

Hospitalizations lag cases and have been going up daily in NYC, but it seems they are finally plateauing the last few days.  They are at 6,100, with 746 people in the ICU.  How does this compare to Jan 2021?  About the same in the ICU but nearly double the hospitalizations.  This is in line with Omicron being far milder, with only about 10% of hospitalized in the ICU (I discussed this last week here).  New hospitalizations have been running about 1,000 a day, but with people leaving the hospital, increases in number hospitalized have slowed to 100 or 200.  Yesterday, they declined slightly.  So we can hope that the hospital capacity will begin to increase.  

How close are we to the brink?  Well, according to New York State's data, the city has about 10% capacity in beds and 16% capacity in ICU beds (see https://coronavirus.health.ny.gov/hospital-bed-capacity).  In other words, not much.  Assuming we are at the peak this may seem fine, but note that there is variation hospital by hospital, and it's not necessarily safe to transfer patients long distances to find a hospital with capacity.  To get an idea of how this capacity varied, I looked at the site mentioned above to see how many beds are left at the 13 Brooklyn Hospitals.  None have more than 25% ICU capacity, 2 have no ICU beds left and 2 have only 1 ICU bed left.  So we are at the brink, and if cases do not continue to fall, care will decline. 

But to be clear, we seem to have escaped a feared collapse of the NYC health system.  Yes, many people are out sick with Covid, and yes hospitals are nearly full and in some cases full, and without a doubt healthcare workers are exhausted, but we're now going to see a decline.  We never came close to the calamitous situation of April/May 2020, when more than 3,000 people were in ICUs (and more than 12,000 were hospitalized).  

What about the rest of the country?  It's unclear whether they will fare better or worse.  Most places are at least a week behind NYC, so we should expect steep increases in hospitalizations for another week or two outside of NYC.  NYC has a relatively high vaccination rate but had a relatively low summer and fall infection rate (Delta wave).  The higher Delta infections in the South may keep that part of the country on par with NYC.  We know people are getting easily reinfected and vaccines do little to prevent infection from Omicron, but prior infection and vaccination both provide protection against hospitalization.

So, for NYC, things are looking up.  For the rest of the US, we've got another week or two to grit our teeth.