People with compromised immune systems and the unvaccinated make up a high percentage of patients who end up in the hospital.
Since early July, the average number of coronavirus cases in New York City has quadrupled, from about 250 to more than 1,000 per day, as the more contagious variant Delta has spread.
Hospitalizations are also rising, though not as quickly, thanks to vaccinations and improved treatments.
Still, hospitalizations are up 90 percent since July 4, and more than 300 people are now hospitalized in New York City with Covid-19. They are, for the most part, unvaccinated, or vaccinated but immunocompromised, doctors say.
“A week and a half ago, we had 50 patients in our hospital systems,” said Dr. Mangala Narasimhan, the senior vice president of critical care for Northwell Health, the state’s largest health system. “Now we have double that.”
To shine a light on who is getting hospitalized, city officials provided The New York Times with an age breakdown of people being admitted with Covid-19 between June 15 and July 12. Two of the main hospital systems operating in the New York City area, Mount Sinai and Northwell, also provided demographic and vaccination data for their patient population. Here’s what the information shows.
Patients are younger
Citywide, young adults, 25 to 34 years old, were the age group with the most people hospitalized with Covid-19 between June 15 and July 12, according to the city’s Department of Health. This is in keeping with nationwide trends showing that the average age of Covid patients is skewing younger, largely because more older people are vaccinated.
Of the 627 people hospitalized during that stretch, 18 percent were 25 to 34 years old. The second most common age group for hospitalizations was people over 75. The city did not provide any information about vaccination status.
In the city, the full vaccination rate of people between 25 to 34 is 57 percent, and for people 75 to 84, it is 70 percent.
Hospitalizations among children for Covid-19 in the city remain rare, but they do happen. Over that month, nine children under 4 years old, and 10 children between ages 5 and 12, were hospitalized with Covid-19.
The two private hospital systems said that the average age of people they are admitting is declining, reflecting the citywide trend, though the average age in their systems remains above 50.
The average age among the 109 patients hospitalized as of July 27 in the Northwell system was 63, dropping to 57 among those who were unvaccinated. At Mount Sinai, the average age of hospitalized Covid patients this month was 55, down from 62 earlier in the pandemic.
Some hospitalized patients are vaccinated
The coronavirus vaccines are highly effective in protecting against serious disease, but they are not a guarantee. This is especially the case for a subset of elderly and immunosuppressed people whose immune system did not mount a strong response to the shots.
In the regular patient wards of Mount Sinai Hospital and Mount Sinai Queens, there were 14 unvaccinated patients and three partially vaccinated patients as of Wednesday, said David Reich, president of the hospital system. And, perhaps surprisingly, four of the five Covid patients in the intensive care unit were vaccinated.
Of those, two are “quite elderly,” he said, and the other two were organ transplant recipients who had been taking medications to keep their immune system suppressed. The fifth is a person who is younger, morbidly obese and was not vaccinated.
“It is a scary time for us, because even though we have highly effective vaccines, nothing is 100 percent,” Dr. Reich said. “And so it says to us that if you are a vulnerable person, even if you are vaccinated, you should probably take some precautions.”
In the Northwell system, 10 to 15 percent of patients hospitalized with Covid-19 in recent weeks have been vaccinated. As at Mount Sinai, those who are vaccinated and severely ill are on chemotherapy, high-dose steroids, elderly or otherwise immunosuppressed.
“We really haven’t seen healthy people who are vaccinated in the hospital with no other problems,” said Dr. Narasimhan.
Even among the elderly, vaccines are still offering a great deal of protection. Nationwide, outbreaks and case rates in nursing homes remain at a fraction of their peaks. There have been several outbreaks in nursing homes locally recently, Dr. Narasimhan said. But for the most part, she said, those sick “seemed to be able to deal with the infection in a different way than before being vaccinated” and managed to be treated as outpatients.
“We are not seeing a lot of severe breakthrough disease in vaccinated elderly yet,” she said.
Racial breakdown remains the same
The people most likely to get severely sick now are the same as in previous waves, the hospital executives said. Obesity, diabetes and hypertension, among other factors, predispose people to severe illness.
The racial breakdown of admitted patients also seems similar to earlier waves, with a few exceptions. Northwell noticed a small uptick in the percentage of patients who were unvaccinated and white. Mount Sinai also noticed a small uptick in white patients, and fewer Asian American patients, but cautioned the sample size was too low to draw conclusions yet.
Hospital executives are also noticing how Delta is much more infectious than previous variants of the virus. Dr. Narasimhan said Long Island Jewish Hospital has had two recent situations where adult families — grandparents, parents and grown children — all developed severe Covid-19 after a relatively brief exposure to an infected relative, such as a 10-minute drive together, or a single meal.
The hospital has also “definitely” seen cases where vaccinated people have transmitted Covid-19 to unvaccinated people, she said. The Centers for Disease Control and Prevention says that vaccination reduces the risk of getting symptomatic Delta by sevenfold, and severe Covid-19 by twentyfold. Still, vaccinated people can carry substantial amounts of the virus, which is a key reason the C.D.C. now recommends that even vaccinated people in high and substantial transmission areas like New York City and Long Island wear masks indoors.
There is good news
Amid all the scary developments, there is also hopeful news.
Northwell and other hospital systems are using monoclonal antibodies successfully to keep people with Covid out of the hospital. Under an emergency use authorization, the treatments can only be given to patients who are over 65 or at high risk of progressing to severe Covid.
Like other antivirals, monoclonal antibodies have to be given quickly, within a week of symptom onset. One problem is that some people are not getting tested or seeking treatment until they are short of breath with the onset of pneumonia, which tends to happen around Day 8. At that point it’s too late, said Dr. Reich.
The message, he said, particularly for those with risk factors, is “Get tested, even if you are vaccinated.”
Another positive sign is that hospitals are way below their peaks in terms of admitted patients with Covid. (At their height, in April 2020, New York City had almost 19,000 people admitted to hospitals with Covid.) As a result, hospitals are not overwhelmed and can deliver good care.
Despite the increased transmissibility of Delta, both Mount Sinai and Northwell reported that the percentage of patients progressing to intensive care is about the same as in previous waves, another promising development. Dr. Rahul Sharma, chief of emergency medicine at NewYork-Presbyterian/Weill Cornell, said that his doctors are noticing people are coming in earlier and less sick than in earlier waves, giving them a better chance of positive outcomes.
All of these are reasons the death rate in the city and state has remained low so far. About three people per day are dying of Covid-19 in New York City, a rate that has stayed stable for the past month even as cases rise.
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