New York City (NYC) is dealing with some next level stuff. On Monday, an upswing in Covid-19 cases prompted the city to raise it’s Covid-19 Alert Level from “Level 1: Low” to “Level 2: Medium.” However, cases ain’t the only thing that’s been going up. Over the past 14 days, the daily averages of new reported Covid-19 cases (8,259 per day over the past week), hospitalizations (2,421 per day over the past week), and deaths (17 per day over the past week) have jumped up by 28%, 38%, and 24%, respectively, according to the New York Times.

Obviously, this isn’t good news. Here’s a tweet from the the NYC Department of Health and Mental Hygiene (DOHMH) on the “leveling up,” so to speak:

What’s been fueling this upswing in the 212 area code as well as other NYC area codes? Well, the highly contagious B.2.12.1 Omicron subvariant has been spreading. Based on the Centers for Disease Control and Prevention (CDC) Covid Data Tracker, this subvariant is now present in an estimated 36.5% of all active Covid-19 cases. While the BA.2 is still the “alpha dog” of all variants in the U.S., accounting for an estimated 61.9% of all cases, that may change soon.

Before you lay all the blame on this new variant, keep in mind that the number of new reported Covid-19 cases per 100,000 people over the past seven days has been trending upwards since early March. NYC’s “Covid-19: Latest Data” web page shows that this number for all of NYC has now exceeded 200 at 242.2. Of the five NYC boroughs, Manhattan tops the list at 328.48, followed by Queens (257.25), Staten Island (251.19), Brooklyn (228.88), and the Bronx (140.18).

So, what happened in early March? Well, that was around the time Covid-19 precautions such as face mask and vaccination requirements were being dropped, as Candace McCowan reported for ABC 7 News on March 7. The concern back then was that such “droppings” would turn out to be premature relaxation, as I covered for Forbes. And as you know (or maybe have heard), things that are premature can leave rather messy situations. After all, back in early March, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) hadn’t yet been brought under control, Covid-19 booster rates hadn’t even reached the 40% mark, and, of course, new more contagious Omicron subvariants were continuing to emerge. Amidst all of this, lifting face mask and vaccination requirements may have sent the wrong message to the public. Heck, people were even claiming that the pandemic was somehow over, which was indeed next level stuff.

Speaking of levels, medium is the second of NYC’s four Covid-19 Alert levels. In this case, levels are like golf scores, bad Tinder dates, or the number of times a marmot puts a bowling ball in your pants. The higher the number, the worse things are. The highest level marked by red is “Very High,” which means that “There is very high community spread of Covid-19. Health care services are overwhelmed.” Clearly, being “very high” is not good, at least in this case.

The next highest level is Level 3, the “High” level, marked by orange, as in orange you implementing more Covid-19 precautions? At this level, “There is high community spread. Substantial pressure on the health care system.” This wouldn’t be the same as a doctor saying, “you’re about to feel a little bit of pressure.” It means that the hospitals are being filled and overtaxed, which could threaten those who don’t have Covid-19 but need urgent medical attention.

As mentioned earlier, Level 2 is the “Medium” level, implying that “There is medium community spread of Covid-19.” And the “Low” level is Level 1, which is in place when “There is lower community spread.” Remember that the number of new reported Covid-19 cases is a very flawed measure. It depends heavily on who is actually getting tested and whether the results are being reported. For example, people with less access to testing may be walking around infected with the SARS-CoV-2 without even knowing it. Plus, reported Covid-19 cases typically lag actual transmission by anywhere from a week to several weeks since people don’t tend to get tested as soon as they get infected because the SARS-CoV-2 typically doesn’t say, “I’m here” as soon as it gets inside your body. Therefore, when the alert level is at “Medium,” there’s no guarantee that things may not actually be already at a higher level.

What then does “Medium” mean? Well, NYC Health Commissioner Ashwin Vasan, MD, PhD, tweeted out the following recommendations:

As you can see by the tweet above and the level change announcement, the NYC DOHMH is recommending that everyone “wear a face mask in public indoor settings.” Recommending ain’t the same as requiring though. Imagine what would happen if paying taxes was recommended rather than required. You’d actually have people getting away without paying any taxes. OK, maybe that wasn’t a great example.

Regardless, with so many people ditching face masks as if they were made out of thumbtacks and leeches, it’s unclear what percentage of people will end up heeding such recommendations. The NYC DOHMH also suggests upgrading to higher-quality masks, such as a KN95, KF94, or N95 respirator or a surgical mask with a cloth mask on top of it. The announcement did say that should the Alert Level go up to “High” the City would “consider requiring face masks in all public indoor settings.”

A second recommendation from the NYC DOHMH is staying “up to date” on Covid-19 vaccination. That means not only getting vaccinated but also getting boosted as well. With waning immunity and decreased effectiveness of the Covid-19 vaccines against the Omicron variants, simply being fully vaccinated without being boosted can be a bit like wearing a thong without pants or a skirt. It can leave you a bit too exposed, something that others around you don’t want to see. As of May 6, only 37.6% of the NYC population had gotten at least one Covid-19 booster shot, according to the NYC Covid-19 Data web page.

Another recommendation from the NYC DOHMH is getting tested whenever you have Covid-19 symptoms or may have been exposed to SARS-CoV-2. They recommend staying home if you are sick or may have been recently exposed to SARS-CoV-2 as opposed to yelling, “freedom,” and potentially spreading the virus to many others.

Oh, and the NYC DOHMH reminds you to wash your hands frequently with soap and water for at least 20 seconds, which is about how long it takes to get past the first chorus of the Divinyls song “I Touch Myself.” Soap and water are preferable but should they not be available you can use hand sanitizer. Of course, the hand-washing reminder shouldn’t just apply for pandemic times. Don’t be one of those people who says, “can’t wait until the pandemic is over so that I can stop this hand washing stuff.”

Will this upswing in Covid-19 cases, hospitalizations, and deaths progress into yet another Covid-19 surge? The answer is unclear right now and depends on what precautions are being taken. Even if a surge does end up occurring, it probably won’t be as large as the one seen this past Winter. Nevertheless, it would be a good idea to maintain Covid-19 precautions such as face mask wearing and social distancing for now. After all, Covid-19 precautions are more effective at preventing a surge from happening before it actually occurs. Once the cat has gotten out of the bag, the horse has left the barn, the ferret has entered the nightclub, and the virus has left the nose and mouth, there’s a lot less that you can do.