New York City has always been ahead on this virus, compared with the rest of the United States. It was first to face the tragedy of overwhelmed hospitals and widespread deaths, and then first to recover something that looked like normality. This summer, the restaurants spilled into the streets. The art museums reopened. Sunbathers could again bask in Central Park without risk of seeing their torsos shamed in an evening news segment. But last week, New York, both state and city, teetered back into grim territory. Indicators trumpeted by politicians through the summer as evidence of success—low case numbers, test positivity rates below 1 percent—had begun to flash as bright warning lights.
But the worrisome numbers were not uniformly distributed, state officials argued. They were skewed by certain neighborhoods and groups that were not playing by the rules. So, the state would “attack each area in the cluster with the appropriate restrictions,” as Governor Andrew Cuomo wrote last week on Twitter. The zones, issued last week by state health officials, are splashed across the map: red, orange, and yellow, corresponding to just how far hard-won gains towards normalcy are rolling back. Across large swaths of Queens and Brooklyn, dozens of schools that had reopened last week would be shuttered. Outdoor and indoor dining, depending on the zone, would be pulled back, and mass gatherings restricted. In red zones, nonessential businesses were again required to close. The restrictions would last two weeks, starting October 8, assuming the situation improves by then.
None of this was unforeseeable. The city is confronting outbreaks—and a possible second wave—that are inevitable in places where the virus has been mostly quelled, particularly as the weather cools, schools reopen, and people gather indoors. But once again, New York City is just the first to deal with it. “They have the opportunity to write the playbook,” says Sam Scarpino, an applied mathematician at Northeastern University who studies how outbreaks move.
But can a color-coded, micro-targeted approach meant to place restrictions on places with the most spread actually contain a borderless virus? New Yorkers were quick to point out some problems. There is the fact that New York City is a large and fluid territory. It’s tough to imagine neighborhoods divided block by block, with each area following different instructions to close businesses or schools. It means that in Queens, three shopping malls sitting within a mile of each other straddle three zones. Three malls. Three sets of restrictions. Say you’re a red zoner who wants to dine inside again? By all means! Just take the subway a few stops.
And while the restrictions are geographic, public officials have made clear that they primarily address a particular group of people who live within those zones: the Orthodox Jewish community. The restrictions, Cuomo said last week, are in response to a failure to curb mass gatherings—especially those related to Jewish holidays. Many within the community also believe that “herd immunity” has already been reached—that’s when enough people are immune that a contagion no longer effectively spreads—and that restrictions and mask wearing are no longer necessary. Last week, protesters marched against the plans, arguing they were now living and working in ghettos, their freedoms curtailed while the rest of the city carries on. On Thursday, Catholic and Jewish groups filed a lawsuit to prevent restrictions on religious gatherings.
Still, in some ways, such a hyperlocal focus makes sense, says Lauren Ancel Meyers, an epidemiologist at the University of Texas at Austin. One way to think about this virus is that it toggles between two stages of containment. There’s a phase in which the rate of infection is low and the primary concern is localized flare-ups. They may be centered on specific kinds of incidents, like a big indoor gathering, or individuals who happen, whether by behavior or biology, to be particularly infectious. It’s critical to contain those flare-ups before they spark into a wider outbreak. But after that point, the precise source of any one infection becomes difficult to discern. It’s all a wash. There’s just too much virus, too many potential pathways of transmission. If those cases threaten the capacity of the health system, it may become necessary to lock everything down, as New York did this spring.
New York—unlike Meyers’ home state, she notes, and most of the US—is currently in the stage of containing flare-ups, and there are advantages. It’s possible to hurl resources at a localized problem, testing and tracing aggressively, or targeting education and, if absolutely necessary, enforcement, like fines or citations. (Cuomo has blamed a lack of enforcement for the rise in infections.) In places like Japan and South Korea, officials have had success containing outbreaks by tracing contacts backwards to investigate the super-spreading events that cause a disproportionate number of infections, a technique known as “cluster busting,” Scarpino notes. It only works when the overall rate of infection is low.
New York City is trying something different. In some ways, the block-by-block plan is a micro-scale reflection of the national pandemic strategy, in which virus interventions were largely left up to individual states, counties, and cities. We all know how that went. In research studying how people moved around patchwork lockdowns, Scarpino found that people were willing to travel to get what they wanted—for instance, going shopping or visiting friends and family outside of restricted zones. Top of the list for evasion: religious services. God called. As restrictions spread elsewhere, places of worship that didn’t close down saw surges in attendance. And with that, people likely brought the virus to new places. “You can’t lock down one city block and not another,” he says.
State and city officials have tussled over how exactly those boundaries should be drawn, with the city first proposing rules based on zip code, only to be overruled by state guidelines that are more limited geographically and based on more granular infection patterns. “It may be that the neighborhood-based approach makes sense because the neighborhoods are naturally isolated,” says Meyers. Cities are increasingly relying on data to understand where people move, and thus where the virus will move with them. Because the same restrictions are also in place in Orthodox communities in the boroughs and in the suburbs north of the city, New York’s approach also treats the hot spots as a network. But the question, Meyers adds, is if there’s more mixing than officials might expect. “The virus might have spilled over in a way you haven’t seen yet,” she cautions.
That’s often a problem with localized measures, says Adam Kucharski, an epidemiologist at the London School of Hygiene and Tropical Medicine. When we spoke last month, cases were rising in places like the United Kingdom and Spain—but they were flare-ups, like in New York. Some cities had pioneered a “smart lockdown” approach, curtailing activities in individual towns and, in the case of Madrid, individual neighborhoods. (The latter move sparked protests, just as in New York, with locals arguing that the lockdowns discriminated against people living in impoverished areas.)
But even then, Kucharski said, it was clear that the small outbreaks were not so much anomalies as early indications that broader efforts to control the virus weren’t quite working. They were signs the country had opened up too fast, perhaps, or in ways that allowed the virus to spread quickly. A limited lockdown was more palatable, both politically and for people growing fatigued of virus restrictions. But that means “targeted measures can end up chasing the outbreak wider and wider, to the point where restrictions are equivalent to a broader blanket policy,” he said. Sure enough, both countries have now entered second waves of infections on a much bigger scale. They’ve flipped from model one to model two.
For a place like New York City, avoiding that fate requires “situational awareness,” Kucharski said in a recent follow-up email. That means actively testing and tracing in hot spot zones, and being aware of where exactly the virus is coming from so officials can swiftly clamp down. (He’s also a fan of the cluster-busting method, which hasn’t proven popular in the US.)
It’s not impossible to do that. In New Zealand, after a few cases emerged in Auckland in mid-August, the city shut down. This week, for the second time since the pandemic began, the country was declared virus-free. Australia similarly curtailed a wave of transmission in the southern state of Victoria, thanks to widely available testing, case investigation, and the surrounding areas being most virus-free.
But in the US, that kind of insight has proven elusive. New York City officials say they’re trying, despite trouble reaching the most affected communities. As of mid-September, The New York Times reported last month, the city didn’t have any Yiddish-speaking contact tracers, and officials said Thursday they were reaching only 80 percent of people in the “areas of concern,” compared with 90 percent city-wide. (A spokesman for the city’s health department said the number of Yiddish-speaking tracers was currently “not zero” and that the city was actively seeking to hire 21 contact tracers who speak a variety of languages spoken in the areas hit hardest by the new outbreaks, including Yiddish, Russian, and Hebrew.) The city also plans to step up testing in the schools—from once a month to once a week in yellow zones, starting next week—and has distributed rapid testing devices to health care providers in the color-coded zones.
One concern with targeted lockdowns, Scarpino says, is that they could further drain the goodwill required for effective testing and tracing that could cool these hot spots. The city and state should also be taking a close look at virus restrictions that apply across the region, doing a deeper dive into which activities are truly driving transmission, and what might need to be pulled back in the coming months to protect changes like school reopenings. “We’ve got to figure this out, because I don’t think anybody wants this to be the way we live,” Scarpino says. Data remains scant on which activities are most responsible for increased viral transmission, but a good way to start, he says, would be to evaluate the links between increasing infections and loosening restrictions on dining. That’s one of the few areas where limited data seems to suggest a clear link between individual behavior and the virus’s spread—possibly because dining requires removing masks. And that’s especially important, it seems, indoors. The city began allowing indoor dining, at 25 percent capacity, two weeks ago.
It’s likely New York City officials will know soon if the strategy is working, Meyers says, or if broader measures are required. They’ll just have to look at the numbers in a few weeks. At last Thursday’s press conference, public health officials noted a change in recent days: People were less able to identify where they might have acquired their infection and less likely to have recently traveled—indicating increased community transmission. The outbreak was, in other words, beginning to flip the switch from local to widespread. It was foreboding news, but news we should all be prepared for.
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