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People walk past a COVID-19 testing site on May 17, in New York City. New York’s health commissioner, Dr. Ashwin Vasan, has moved from a medium COVID-19 alert level to a high alert level in all the five boroughs following a surge in cases.Spencer Platt/Getty Images

New York City health officials put the city on “high COVID alert” Tuesday after rising case counts and hospitalizations reached a level that could put substantial pressure on the health care system.

The announcement was triggered by a colour-coded alert system that the city introduced in March. But so far, the system has had little impact on the city’s disease control strategy or the public’s perception.

Mayor Eric Adams warned Monday that the city was nearing the threshold but said “we’re not at the point of mandating masks.”

For two months now, there has been a persistent rise in known infections, driven almost entirely by omicron subvariants. In recent days, the city logged on average more than 3,500 new daily cases, although those numbers significantly understate the virus’s prevalence, as many infections are detected by at-home tests but never counted by the health authorities.

COVID-19 hospitalizations have been ticking upward, recently reaching about 130 new admissions a day across New York City, according to state data.

This latest wave of coronavirus cases – New York City’s fifth – began in mid-March and has taken less of a toll so far than when omicron first swept through the city in December and January. In that initial omicron wave, perhaps 30% of the city was infected, according to research by the Centers for Disease Control and Prevention, and hospitals came under strain as sick patients packed emergency rooms.

The city’s colour-coded alert system incorporates data on both case counts and hospitalizations. And it ties specific recommendations to each threshold. On Tuesday, the city entered the orange, or “high” risk level, which comes with the recommendation that city government requires face masks in all public indoor settings.

But Adams has shown little interest in requiring masks. At the “high” level, the mayor may consider reinstating a mask mandate, including in schools, but Monday he said he was not planning to take that step yet.

On Tuesday, his health commissioner, Dr. Ashwin Vasan, put out a statement urging that New Yorkers take their own precautions. But he made no mention of taking government action to impose mask mandates.

“New York City has transitioned to a high COVID alert level, meaning now is the time to double down on protecting ourselves and each other by making choices that can keep our friends, neighbours, relatives and co-workers from getting sick,” he said in a statement.

On Monday, Vasan issued an advisory recommending that people wear medical-grade masks in offices, grocery stores and other public indoor settings.

Still, some New Yorkers were struck by how long it has taken the city to raise the alert level to high, given that the virus has been circulating widely over the past two months, with test positivity rates in some neighbourhoods well over 10%.

“The thresholds are meaningless,” said professor Denis Nash, a public health researcher at the CUNY Graduate School of Public Health & Health Policy, in a phone interview Tuesday morning, as he recovered from COVID-19.

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