NY COVID Hospitalizations Up 229% in Month; Severe Breakthrough Rate Rising in NJ

The vast majority of the tri-state area, including all of New York City, New Jersey and Connecticut, is now considered a "high" or "substantial" COVID transmission area, according to the latest CDC data. Under the agency's public health guidance, that means universal indoor masking is recommended for nearly the whole region.

COVID case rates of more than 100 cases per 100,000 residents qualify as a "high transmission" designation, the CDC said as it debuted its new tracking system last month and modified its mask guidance for much of America. A jarring 72% of U.S. counties -- up 13 percentage points in the last week, fall under that category.

That includes all five counties that comprise New York City and nearly half in New Jersey. The same holds true for a quarter of those in Connecticut, the agency's data shows. Of all three tri-states, only a handful of far west and north counties in New York, hundreds of miles from the bustling metro, are moderate transmission areas.

Officials at all levels of government point to the highly contagious delta variant and lagging vaccination rates as the reason -- and warn the pandemic could linger, and more restrictions be reinstated, if immunization rates can't keep up with the virus.

In the city, delta now accounts for 83% of all tested positive COVID samples, according to health officials' latest update. That number is almost identical (83.9%) in New Jersey. Delta is also the dominant COVID strain nationally, accounting for 83.4% of genetically sequenced samples, the latest CDC data shows.

That delta is fueling spikes in new daily cases across the country isn't the primary concern from a public health standpoint, officials say. It has been linked to more severe outcomes among the unvaccinated, which leads to more death by default.

In New York, statewide COVID hospitalizations are back above 1,200, a nearly 230% increase in just the last month. The state reported back-to-back days of double-digit death tolls over the weekend after a lengthy streak in the low single digits. Monday's numbers continued the trend (12 daily deaths).

Breakthrough infections are another point of concern. While their prevalence remains fractionally low, it was a CDC investigation of an outbreak among mostly fully vaccinated people that prompted the updated guidance late last month.

In New Jersey, fully vaccinated people accounted for 18.5% of all new COVID cases in the period July 20 through the 26, Gov. Phil Murphy said Monday. More importantly: Those cases accounted for 3% of all new hospitalizations.

Murphy pointed to the data Monday as evidence that vaccines work, but for many, the fact that even 3% of hospitalized COVID patients were already vaccinated is a worry -- and so is the direction in which the breakthrough cases are trending.

That 3% representation of immunized people hospitalized with the virus in the period July 20 through July 26 is up substantially from the .004% representation in the period up to July 26. The 0.14% representation of new COVID cases within that group leaping to 18.5% also may raise questions about vaccine efficacy vs. delta.

No new universal mask mandate has been imposed in any of the tri-states or nationally. New York and New Jersey both strongly encourage masking in high-risk areas in alignment with CDC guidance, while Connecticut Gov. Ned Lamont signed an executive order empowering cities and towns to reinstate mask mandates if they so choose. So far, Norwalk is one of the biggest cities in the state to do so.

There's still no timeline as to when a vaccine might receive emergency-use authorization for children under 12, which is partly why many states and cities across the country, including New York City and New Jersey, are requiring students and staff to mask up for the start of the year whether they're vaccinated or not.

Nationally, the number of children under age 5 hospitalized for COVID tripled in the first half of July, CDC data shows. At the same time, the country reported 72,000 cases in kids younger than 18 the last week of July, an 84% increase over the prior week. The upticks are stoking fresh concerns about safety in public schools, which won't have remote learning options in New York City when they reopen next month.

Push to Vaccinate Kids Before Next School Year Grows Increasingly Urgent; Masks to Be Required

Monday is the last day children ages 12 and up can get their first dose of Pfizer's COVID-19 vaccine and still be fully inoculated by the time the next public school year starts on Sept. 13, health and education officials are reminding parents.

The Pfizer shot is the only vaccine approved for kids under 18 and requires a minimum three-week wait between doses. It takes another two weeks for full immunity to kick in.

The "Vax to School" campaign is part of the city's latest push to get more people vaccinated amid rising COVID-19 numbers and concerns over the highly contagious delta variant, which has sent new daily case totals soaring locally and nationwide. While the prevalence of breakthrough infections remains fractionally low, those who aren't yet vaccinated are at a higher risk than they've ever been, officials have said.

Not sure how the process works? Check out our handy tri-state vaccine site finder and FAQs here

New York City and New Jersey Vaccine Providers

Click on each provider to find more information on scheduling appointments for the COVID-19 Vaccine.

Data: City of New York, State of New Jersey • Nina Lin / NBC

Mayor Bill de Blasio has said physical classroom learning is critical for children's mental development and that layered protections will be in place to ensure safety.

Part of that includes mandating vaccination or weekly COVID testing for all city workers, including teachers and other education staff. Still, concerns linger. And still, de Blasio insists children will be safe when school comes back in a few weeks.

"We've had this conversation now for months about how you balance all the needs of children, including all the many health care, physical, and mental health care needs of kids. And it keeps coming back to the same answer, get kids back into school. But do it safely," the mayor said last week. "We're going to keep vaccinating young people right up to the beginning of school, even after the beginning of school. Whenever we can get someone to get vaccinated, it's going to help."

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The pace of vaccinations has lagged to the point that New York City officials recently offered up $100 to anyone who gets vaccinated at one of their health sites.

So far, about 44% of kids age 12-17 in New York City have gotten at least one shot, according to officials' latest update. Around 60% of Department of Education employees have at least one dose, though the number doesn't include those who were vaccinated outside the five boroughs.

Randi Weingarten, president of the American Federation of Teachers, told NBC News in an interview on Sunday that vaccinations are "community responsibility."

"We've always dealt, or since 1850, we've dealt with vaccines in schools," Weingarten said. "It's not a new thing to have immunizations in school and I think that on a personal matter, as a matter of personal conscious, I think that we need to be working with employers and not opposing them on vaccine mandates."

Kids of eligible age for vaccination aren't required to get dosed in order to attend school -- again, another reason for the mask requirement in the city. The state Health Department is expected to release formal mask guidance for schools but said last week that such mandates were up to individual school districts.

In New York City, students K-12 and staff must also wear masks indoors regardless of vaccination status, officials have announced. The same applies for New Jersey's public K-12 schools when the new school year starts in a few weeks.

Murphy said Friday the requirement will be lifted again when the state's core viral rates take a significant and sustained turn for the better. Fewer than 50 percent of adolescents over 12 have been vaccinated in New Jersey, and the state as of Monday has 13 pediatric hospitalizations, two of which are in the ICU.

Those numbers represent a big jump in child hospitalizations, going from 0.8 percent of COVID admissions in January to 2.6 percent in the first week of August.

As of Monday evening, the U.S. has had more than 36 million COVID-19 cases since the start of the pandemic, according to an NBC News tally.