The Coronavirus Tightrope

New York is walking a perilous tightrope right now, balancing the restart of the economy – and of social contact – with the risk of plunging back onto the pandemic.

Governor Andrew Cuomo and Mayor Bill de Blasio were searching for that balance when they allowed the city to proceed to Phase Three of reopening, but without indoor drinking and dining. The governor said continued discipline was crucial because “dark clouds” were gathering. He cited both the way some New Yorkers seemed to be ignoring mandates for masks and distancing even as the case counts surge in other states.

The governor could also have mentioned that even in New York, cited as a success story for curbing the coronavirus, the transmission rate has been creeping up for two months now and has just crossed into that danger red zone where the overall caseload could begin to grow again instead of shrink, according to city and state data crunched by a not-for-profit health group.

In other words, the room for error is narrowing, just as the pressure to ease up is growing.

“It’s not realistic that we expect everyone to avoid all human contact,” said the chair of the City Council health committee, Mark D. Levine. “We need to help the public understand the spectrum of risk for different social interactions, and help them minimize it. That’s a public health strategy we can sustain for the long haul.”

The long haul is exactly the challenge. The coronavirus has been our unwelcome companion now for six months. We still can not inoculate against the virus or cure the disease it inflicts, COVID-19. But we have learned a lot about reducing the risks of contracting it.

“Spectrum of Risk” Chart

These lessons were baked into the announcements from Cuomo and de Blasio that the city would proceed on July 6 to Phase Three, but without the indoor drinking or dining that many restaurant owners, and surely some diners, had been hoping for.

Fundamentally, virus lofting on stale, indoor air is too risky. “A large group, close together, in an enclosed space, with loud talking,” says Levine. “This checks off all the high risk factors. This high risk can be reduced by moving outside, improving ventilation, and avoiding loud music [to lessen need for loud talking].”

Levine distributed a chart scaling the “spectrum of risk” for different in-person interactions. Walking, jogging or biking outside with a friend is low risk (A bright green signal). Dating a new partner is high risk (bright red signal), and even riskier than that is a crowded indoor house party (two red signals). Taking a date to a crowded bar would likely fall in there someplace, too, judging from the many examples around the country of bars being hothouses for viral spread.

“It’s time to update the all-or-nothing messaging on COVID-19 risk,” Levine said.

None of this is a sudden revelation. Infectious disease experts have long understood that fresh air helps disperse pathogens. Tom Frieden, the former city health commissioner and director of the Centers for Disease Control, recalled that a city pandemic preparedness plan developed years ago suggested opening the windows of subway cars. The current health commissioner, Oxiris Barbot, mentioned opening bus windows. New York City Transit has not mentioned either as part of its extensive plans to keep the system clear of virus.

The R Factor

A look at the health data compiled by Covid Act Now, a not-for-profit, shows why this moment is so tricky. The basic metric for infectious disease control, the rate of transmission, bottomed out in the city two months ago, on May 7 and 8, and has been edging up ever since.

On May 8, the rate of transmission, the so called R or Rt, was .7 in the five boroughs. At a transmission rate of .7 every ten infected New Yorkers, statistically speaking, passed their infection on to 7 new people. They in turn would infect about 5 people who infect 3 or 4, which is why the crisis has been fading.

However, by this weekend the transmission rate in the city had climbed to .91, crossing into a danger zone perilously close to reigniting the epidemic, public health officials say. If the rate climbs as much in the next two months as in the last two, by September it would be well over 1, the line dividing total number of cases shrinking and growing.

A lot happened in the past two months that may be increasing transmission. The state began reopening business, first outside the city and then in a first phase in the city. Some 42,000 private sector employees resumed work in May in the city even before Phase 1 reopening on June 8, according to the state labor department. June numbers aren’t out yet, but they are no doubt up further, based on increases in transit ridership.

In addition, George Floyd’s death triggered a wave of large outdoor protests in late May and June. More generally, as people emerged from home, their willingness to wear masks and distance was, at best, erratic, as the governor noted.

Hospital visits for COVID-19-like symptoms, steady over all, have been climbing among younger adults the past few weeks, according to health department data. “New York City is not isolated from the national trends,” said Levine.

On the other hand, even though many restaurants and bar owners had been preparing to welcome customers inside – some had even spent money on refiguring their spaces to be safer – the overall reaction to the official order was understanding.

“The only thing worse than having to delay the reopening of indoor dining would be to have restaurants reopen and then have to shut down a short time thereafter due to a spike in COVID cases,” said Andrew Rigie, executive director of the New York Hospitality Alliance. “It’s very scary.”

Rigie said his members for now will concentrate on expanding outdoor dining, which the mayor pledged to support, and he will lobby government, property owners and banks for a plan to ease rents.

“The restaurant industry has been financially devastated,” he said. “There is so much uncertainty and we desperately need more support from all levels of government to help us sustain our businesses through the long and difficult recovery.”