Effects of return-to-office, public schools reopening, and vaccination mandates on COVID-19 cases among municipal employee residents of New York City

ObjectiveOn September 13, 2021, teleworking ended for New York City municipal employees, and Department of Education (DOE) employees returned to reopened schools. On October 29, COVID-19 vaccination was mandated. We assessed these mandates short-term effects on disease transmission. MethodsUsing difference-in-difference analyses, we calculated COVID-19 incidence rate ratios (IRR) among residents 18-64 years-old by employment status pre- and post-policy implementation. ResultsIRRs post-(September 23-October 28) vs. pre-(July 5-September 12) return-to-office were similar between office-based City employees and non-City employees. Among DOE employees, the IRR after schools reopened was elevated 28.4% (95% CI: 17.3%-40.3%). Among City employees, the IRR post-(October 29-November 30) vs. pre- (September 23- October 28) vaccination mandate was lowered 20.1% (95% CI: 13.7%-26.0%). ConclusionsWorkforce mandates influenced disease transmission, among other societal effects.

Delays in COVID-19 Diagnosis and Hospitalization and Outcomes -- New York City, New York, USA, October 2020-November 2021

COVID-19 patients diagnosed [≥]3 days after symptom onset had increased odds of hospitalization. The 75th percentile for diagnosis delay was 5 days for residents of low-privilege areas and Black and Hispanic people diagnosed before SARS-CoV-2 Delta predominance, compared with 4 days for other patients, indicating inequities in prompt diagnosis.

Reduced COVID-19 Hospitalizations among New York City Residents Following Age-Based SARS-CoV-2 Vaccine Eligibility: Evidence from a Regression Discontinuity Design

BackgroundIn clinical trials, several SARS-CoV-2 vaccines were shown to reduce risk of severe COVID-19 illness. Local, population-level, real-world evidence of vaccine effectiveness is accumulating. We assessed vaccine effectiveness for community-dwelling New York City (NYC) residents using a quasi-experimental, regression discontinuity design, leveraging a period (January 12-March 9, 2021) when [≥]65-year-olds were vaccine-eligible but younger persons, excluding essential workers, were not. MethodsWe constructed segmented, negative binomial regression models of age-specific COVID-19 hospitalization rates among 45-84-year-old NYC residents during a post-vaccination program implementation period (February 21-April 17, 2021), with a discontinuity at age 65 years. The relationship between age and hospitalization rates in an unvaccinated population was incorporated using a pre-implementation period (December 20, 2020-February 13, 2021). We calculated the rate ratio (RR) and 95% confidence interval (CI) for the interaction between implementation period (pre or post) and age-based eligibility (45-64 or 65-84 years). Analyses were stratified by race/ethnicity and borough of residence. Similar analyses were conducted for COVID-19 deaths. ResultsHospitalization rates among 65-84-year-olds decreased from pre- to post-implementation periods (RR 0.85, 95% CI: 0.74-0.97), controlling for trends among 45-64-year-olds. Accordingly, an estimated 721 (95% CI: 126-1,241) hospitalizations were averted. Residents just above the eligibility threshold (65-66-year-olds) had lower hospitalization rates than those below (63-64-year-olds). Racial/ethnic groups and boroughs with higher vaccine coverage generally experienced greater reductions in RR point estimates. Uncertainty was greater for the decrease in COVID-19 death rates (RR 0.85, 95% CI: 0.66-1.10). ConclusionThe vaccination program in NYC reduced COVID-19 hospitalizations among the initially age-eligible [≥]65-year-old population by approximately 15%. The real-world evidence of vaccine effectiveness makes it more imperative to improve vaccine access and uptake to reduce inequities in COVID-19 outcomes.