Western New York has emerged as the state's new coronavirus epicenter

“The second wave is here, and it’s here with a vengeance,” Erie County Executive Mark Poloncarz said on Nov. 19. That was the day that his county reported the highest single-day number of positive COVID-19 tests since the beginning of the pandemic. According to Poloncarz, 651 people tested positive, breaking the previous record set just a week earlier. On Nov. 25, the county would break the record again with 718 positive tests, and it set a higher high of 771 cases on Dec. 2.

The entire region of Western New York has experienced a sharp increase in COVID-19 cases and hospitalizations. On Nov. 13, Lt. Gov. Kathy Hochul called the region the “epicenter” of the state’s current fight against the virus – a designation once bestowed on New York City and its suburbs – and the numbers have only gotten worse since then. Erie County, and in particular Buffalo, has been the main focus of restrictions so far, with nearly the entire county contained in two big yellow and orange zones, imposing different degrees of restrictions on nonessential businesses, indoor dining and schools. But Niagara County to the north has its own yellow zone and a sharp increase of cases, and the region’s other three counties each have high rates of positive tests.

Public health experts have theories about why Western New York has been faring worse during the second wave, but it’s unclear why this region in particular has emerged as the state’s new epicenter.

According to state data, the region began experiencing a sharp increase in the number of new cases at the start of November. On Nov. 6, Cuomo called Western New York “a problem” due to its increasing rate of positive tests. At the time, the region had a 2.9% seven-day average positivity rate – the highest of any region in the state – and 334 new cases, a far higher number than it had at any point during the spring. As of Dec. 2, the region still had the highest seven-day average positivity rate in the state at 7.4%, a position it has largely maintained for weeks. That’s far higher than the state’s seven-day average of 4.4%.

The region has similarly seen a rapid increase in new hospitalizations and deaths. On Dec. 2, the state reported that the region had 446 people in the hospital, far more than its peak of 263 people in late April. Cuomo ordered all Erie County hospitals to stop performing elective surgeries on Dec. 4 to free up space for coronavirus patients. One of the only bright spots is that the number of patients in intensive care unit beds, while going up, remains lower than at the worst of the spring outbreak. Dr. Thomas Russo, professor and chief of infectious disease at the University at Buffalo, also noted that patients are spending less time in the hospital compared to the spring, and greater knowledge on how to treat the disease is leading to better outcomes for patients.

There are multiple theories about why Western New York is getting hit harder this time around. Dr. Rachael Piltch-Loeb, an associate research scientist at NYU School of Global Public Health, suggested that downstate officials were more prepared to respond to the first wave of the crisis. And she said that perhaps people downstate more strictly adhere to the public health guidelines after living through the worst of the initial outbreak. “That experience with the virus that really has shaped people’s risk perception, in the city and the city’s surrounding areas, I think has contributed to people being either more willing or more able to kind of buckle down the second time around as necessary,” Piltch-Loeb said. It’s a theory that Cuomo appears to think holds some weight. “Western New York never lived the full pain of COVID’s wrath,” he said while announcing Erie County’s new orange zone and Niagara County’s yellow zone on Nov. 18. “What caused so many people in New York to change their behavior? It was the fear.”

Cuomo’s opinion did not sit well with many in Western New York. And Piltch-Loeb said she was not trying to suggest that those in other parts of the state did not suffer terrible losses as well. But the impact of the outbreak’s severity on behavior is something she said should not be discounted. “It’s not to say that the western part of the state didn’t have a difficult experience early on, but based on numbers, and the burden on the population, it seems like it was less,” Piltch-Loeb said.

Russo acknowledged that there are likely people in Western New York who are taking lax approaches to public health regulations due to their own political leanings. The region is home to one of the most conservative and pro-Trump congressional districts in the state, a demographic that has generally opposed coronavirus-related restrictions. But he disagreed that the main driver of the new surge in cases comes from the public not taking the pandemic seriously enough.

Russo suggested that the shift in epicenters has more to do with the disparity in the rate of infection compared to the first time around. He suggested that a much higher percentage of downstate was infected in the spring compared to Western New York, leaving them with some degree of immunity and decreasing the pool of people susceptible to illness. “If you’ve got a party of 100 individuals and you invite the coronavirus in Erie County, there might be 85 to 90 individuals that it could pick on,” Russo said. “Whereas downstate it may be somewhere more in the order of they’ve only got maybe 65 to 70.” Piltch-Loeb, however, cautioned against attributing too much to natural immunity, or lack thereof, when trying to explain the shifting epicenter.

Both Russo and Piltch-Loeb agreed that it’s difficult to determine why Western New York specifically has emerged as the newest hardest-hit region of the state. Certainly, other parts of the state, especially the nearby Finger Lakes region, have had troubling numbers of coronavirus cases themselves. But at this point, with community spread occurring, the why and how is less important than attempting to bring down the numbers before area hospitals are overwhelmed. Cuomo can still implement a red zone in Western New York, which would close all nonessential businesses, restrict dining at restaurants to takeout only and prohibit mass gatherings. But in the meantime, state and local officials are saying that people should not attend or host indoor gatherings with people from outside your household, which they say is causing the surge in cases.