ABSTRACT
We describe how the COVID-19 pandemic affected reproductive choices in New York City, the most acutely impacted area of the United States. We contrast changes in New York City with reproductive outcomes in the rest of the US. We find that births to New York City residents fell 8.4% more between March, 2020 and February 2021 than that would have been expected given trends leading up to the pandemic. Births to US-born residents of New York City fell 5.5% over the same year, triple the observed decline in the rest of the US. Births to foreign-born New York City residents fell 11.4%, twice the decline observed in the rest of the US. Reported induced abortions to New York City residents fell precipitously whereas induced abortions nation-wide rose slightly. The acute downturn and robust recovery in births in New York City maps closely with the spike in mortality and its equally rapid decline three months later. We conclude that the fear and uncertainty in the early months of the pandemic is the best explanation for the sudden, but brief drop in births in New York City.
ABSTRACT
This article used supplementary information sources and relied on direct data importation and matching of patient identifiers for data on hospitalisation status, the occurrence of death, race/ethnicity, and presence of underlying medical conditions. The highest rates of cases, hospitalisations, and deaths were concentrated in communities of color, high poverty areas, and among persons aged 75 years or with underlying conditions. The crude fatality rate was 9.2% overall and 32.1% among hospitalised patients. Using these data to prevent additional infections among NYC residents during subsequent waves of the pandemic, particularly among those at highest risk for hospitalisation and death, is critical. Mitigating COVID-19 transmission among vulnerable groups at high risk for hospitalisation and death is an urgent priority. Similar to NYC, other jurisdictions might find the use of supplementary information sources valuable in their efforts to prevent COVID-19 infections. This report describes cases of laboratory-confirmed COVID-19 among NYC residents diagnosed during 29 February 29 to 1 June, 2020, that were reported to DOHMH. DOHMH began COVID-19 surveillance in January 2020 when testing capacity for SARS-CoV-2 (the virus that causes COVID-19) using real time reverse transcription polymerase chain reaction (RT-PCR) was limited by strict testing criteria because of limited test availability only through CDC. The NYC and New York State public health laboratories began testing hospitalised patients at the end of February and early March. DOHMH encouraged patients with mild symptoms to remain at home rather than seek health care because of shortages of personal protective equipment and laboratory tests at hospitals and clinics. Commercial laboratories began testing for SARS-CoV-2 in mid to late March. During 29 February 29 to 15 March, patients with laboratory confirmed COVID-19 were interviewed by DOHMH, and close contacts were identified for monitoring. The rapid rise in laboratory-confirmed cases (cases) quickly made interviewing all patients, as well as contact tracing, unsustainable. Subsequent case investigations first included medical chart review for patients who were hospitalised or who had died, but then progressed to chart review only for patients who had died, and then finally only for deaths in patients aged <65 years. Mitigating COVID-19 transmission among vulnerable groups at high risk for hospitalisation and death is an urgent priority.