Move away from daily count of COVID cases has begun

The most familiar indicator of the relentless spread of COVID-19 across the country – the daily number of cases in the state and locally – is about to disappear.

Instead, public health officials are considering moving from increasingly inaccurate case data to numbers they say better reflect the disease’s impact on society and the health care system: COVID-19 hospitalizations and deaths.

The number of Omicron cases is breaking all previous COVID-19 records. But the numbers no longer carry the weight they once had. State and local health departments are preparing to explain this to the public and start reporting more meaningful data about the virus.

“The purpose of public health data is to provide people with information so they can take action to keep themselves safe and healthy,” said Meredith Allen, vice president of health security at the Association of State and Territorial Health Officials. “We’ve come to a point where the daily case count doesn’t give people that information.”

So far, Tennessee is the only state to have reduced the number of COVID-19 case reports since the micron impact. But experts expect other states to follow suit once the omicron surge subsides.

Additionally, last week New York Democratic Gov. Katie Hochul asked hospitals to start providing more meaningful data about COVID-19, indicating whether patients were hospitalized for COVID-19 or were admitted to the hospital for unrelated reasons and accidentally tested positive. to the virus.

For now, daily case counts remain the primary indicator of nationwide omicron spread. But epidemiologists warn that the numbers should only be relied upon as general indicators of the rate and direction of disease transmission.

Due to shortages of tests, unregistered home tests and a high percentage of asymptomatic infections undetected, daily case counts are significantly underestimated, according to Janet Hamilton, executive director of the Council of States and Territorial Epidemiologists. According to her, the true number of infected is several times higher than the number of registered cases.

This week, the average daily number of reported cases was 781,000, more than three times the daily number of 250,000 at the peak of the delta spike a year ago. As of January 3, more than a million cases of omicrons have been reported.

But that doesn’t mean hospitalizations and deaths, which lag new cases by weeks, will rise in equal proportions. Early evidence suggests that omicron infections cause milder symptoms and fewer deaths than previous variants of COVID-19.

“We don’t want to keep telling people that there are X new infections without giving them an idea of ​​how many of those cases will have serious consequences,” Hamilton said.

Despite lower hospitalization and death rates, the skyrocketing omicron infections are causing a spike in hospital visits, almost exclusively among unvaccinated people, putting a strain on healthcare systems across the country. And while it has proven to be less virulent than previous strains of COVID-19, omicron is expected to lead to more deaths due to the sheer number of people infected.

The best barometers

Months after the pandemic began, epidemiologists said that COVID-19 would eventually become endemic, infect almost everyone, and remain in the population indefinitely.

This endemic era may have begun. As a result, many state health officials say they are preparing to reduce the frequency of case updates, possibly once the current surge subsides, Allen said.

“This would allow public health authorities to focus on prevention among high-risk groups such as long-term care facilities and work more closely with vaccination schools and clinics,” she said, “rather than wasting time and energy on producing this daily vaccine.” “. room.”

Tennessee moved from daily reporting of new COVID-19 cases to weekly on Jan. 1, citing the need to focus on other public health priorities, including the expanding opioid overdose crisis.

Florida, Iowa and Nebraska switched to weekly tally last summer as COVID-19 cases declined across the country. Alaska, Kansas, and Michigan publish case data three times a week.

For now, however, state and local COVID-19 policies, including school and business closures, travel restrictions, mask requirements, and quarantine rules, are heavily driven by daily numbers.

Since the start of the pandemic, the rise and fall in cases has proven to be a reliable indicator of whether the virus is gaining ground, leveling off or receding, said Dr. William Schaffner, professor of preventive medicine at Vanderbilt University School of Medicine and advisor to the Centers for Disease Control and Prevention.

“We all know the data is less accurate than it was,” he said. “But we have a good sense of trends over time and geographically, especially in a state as long and thin as Tennessee. This allows us to see what is happening in, for example, Nashville and Chattanooga.”

Official CDC guidance continues to recommend that state and local health departments release daily COVID-19 case counts, he said. But in discussions with health officials, the agency is “giving states leeway to pay more attention to hospital admissions and other data.”

Schaffner and other experts say the number of people hospitalized with COVID-19 may be the best indicator of the severity of the disease and its impact on society and the health system. Others argue that the number of patients in intensive care units would be a more significant indicator.

gray areas

In the case of the omicron fungus, it is becoming increasingly likely that hospital patients will test positive for the virus on admission or become infected in the hospital, according to Ailee Klein, an epidemiologist and assistant professor of emergency medicine at Johns Hopkins School of Medicine.

Even before omicron became dominant, research showed that roughly half of the patients admitted to hospitals with COVID-19 were there for other reasons. However, their COVID-19 infections likely affected their health status and length of hospital stay, Klein said, and that certainly meant the hospital had to spend extra resources on their care.

It is not easy to roll out data on COVID-19 hospitalizations, he said. “There’s a big gray area that’s hard to spot in real time.”

Klein and other experts argue that the use of intensive care is the best indicator of the health burden of the virus.

“For example, in Maryland, hospitalizations are now at an all-time high,” Klein said, “but intensive care use is not.” Last year during the delta blowout, there were far fewer hospital admissions in the state than there are now, but almost every patient was very sick.

“As we move forward, there are some decisions that need to be made about how we adjust our reporting,” Klein said. “Are we looking at weekly reports, separating people hospitalized with COVID and those with COVID? It depends on how we plan to treat people who test positive but not sick.

“Are we putting them in quarantine? Maybe we’ll stop doing it. We don’t isolate people with the flu.”

Shortage Testing

From the start, test shortages, inaccuracies and delays have hindered the country’s response to COVID-19. As a result, many county and city health departments have never been able to release daily case data, said Adriana Casalotti, head of public and government affairs for the National Association of County and City Health Officials.

In this micro-micron surge, long queues at testing centers continue to stress city and county health departments, especially as they receive an avalanche of questions from the public about the CDC’s recent twist on COVID-19 quarantines, she said.

In December, the CDC announced that it was cutting its quarantine advice from 10 days to 5 days. The American Medical Association and other experts called the weaker recommendations risky, suggesting that people get tested before quarantine ends.

With home tests still in short supply and people waiting for hours to get tested in a public place, it’s hard for local health departments to encourage people to get tested before they’re out of quarantine, Casalotti said. On top of that, local health departments usually experience severe public backlash when they try to enforce tougher COVID-19 restrictions than the CDC.

When will the shortage of tests decrease? President Joe Biden announced this week that insurance companies will be required to cover the cost of up to eight tests per person per month starting January 15. But there are still not enough tests in pharmacies.

Mara Aspinall, professor of biomedical diagnostics at Arizona State University, predicts the nationwide supply of COVID-19 home tests will grow from 631 million tests this month to 732 million in February and 907 million in March. Because many consumers buy tests to have on hand in case of need, not all tests are used in the same month they were purchased, she said.

Since the omicron arrived in the United States in December, Aspinall estimates, Americans have used an average of 4 million home tests a day, rising to 5 million a day last week as corporations distributed the tests to employees returning to work. Whether that number stays the same, rises or falls depends on the spread of the virus, she said.

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