COVID rates could be much higher than reported. How bad is the power surge? : Shots

People walk past a Covid testing site in New York City on May 17. New York’s health commissioner, Dr. Ashwin Vasan, has moved from an “medium” COVID-19 warning level to a “high” warning level in all five boroughs following an increase in the number of cases.

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People walk past a Covid testing site in New York City on May 17. New York’s health commissioner, Dr. Ashwin Vasan, has moved from an “medium” COVID-19 warning level to a “high” warning level in all five boroughs following an increase in the number of cases.

Spencer Platt/Getty Images

Cases of COVID-19 are – again – increasing. The US sees an average of more than 100,000 new cases across the country every day. That’s almost double what it was a month ago and four times what it was around this time last year.

And the true number of cases is likely much higher than that, according to health officials. Since many people now rely on home testing, “we are clearly counting fewer infections,” Dr. Ashish Jha, White House Covid-19 Response Coordinator, to reporters at the latest COVID-19 press briefing. Hospital admissions are also increasing, although only gradually in most places.

But in most places, health officials have not called for new COVID restrictions. So how big is the increase really? And is there anything you should do about it?

Measuring the real number of infections

Official undercounting of cases isn’t exactly a new problem. At the start of the pandemic, many cases went undetected because tests were unreliable and supply was limited.

“We saw early on — in March 2020 — that maybe one in 10, maybe one in 12 infections was actually captured,” said Jeffrey Shaman, an infectious disease specialist at Columbia University whose lab has worked to model the actual number of infections.

Very early research efforts to find out how many infections there were in the community involved testing a sample of residents for SARS-CoV-2 antibodies. As the pandemic progressed, that method didn’t work as well, Shaman explains, because antibodies decreased over time after infection and because vaccinations complicated the antibody picture.

Shaman’s research group started using models to estimate the “detection rate” – the proportion of real infections recorded in official case counts. That percentage has fluctuated — by the end of 2020, they estimate that one in four cases had been counted. During the ommicron peak, it was closer to one in six.

Now with the widespread availability of rapid home tests that are not reported to health departments, Shaman thinks the true number of cases is eight times higher than the number of cases. In other words, instead of 100,000 new cases per day, the actual number could be 800,000 cases per day.

Take that estimate with a huge grain of salt, he advises. It is becoming increasingly difficult to get a grip on the current determination rate.

Ellume COVID-19 home tests are seen at a CVS in the Navy Yard neighborhood of Washington, DC, where seniors received free tests covered under Medicare on Monday, April 4.

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Tom Williams/CQ-Roll Call, Inc via Getty Images


Ellume COVID-19 home tests are seen at a CVS in the Navy Yard neighborhood of Washington, DC, where seniors received free tests covered under Medicare on Monday, April 4.

Tom Williams/CQ-Roll Call, Inc via Getty Images

Wastewater monitoring sites across the country reinforce the idea that the virus is on the rise. More than half of the sites have seen a “modest increase” in virus levels, according to the CDC, although the system is not nationwide and has not yet been set up to give people an ongoing estimate of the true number of cases beyond the official counts.

All of this is a predictable consequence of having convenient, ubiquitous tests at home, said Gigi Gronvall, a senior scientist at the Johns Hopkins Center for Health Security.

“For people who have that information at their fingertips to get the results they need so they can act on it immediately — it’s totally worth it,” she says. But it comes at the cost of the data, “and so you have to conclude that there are more cases than are reported.”

The next wave could be worse

As an epidemiologist, this uncertainty isn’t ideal, says Katelyn Jetelina, an adjunct professor at the University of Texas Health Science Center who writes the Your Local Epidemiologist newsletter. And even if the number of cases is much higher than they seem, this summer may not see a healthcare crisis like previous spikes, she says.

As the weather warms and people spend more time outdoors, “transmission is a lot less because of the ventilation outside,” she says. Also, after the massive increase in infections from the omicron variant, she says, “we have such a high infection-induced immunity that we have a very high immunity wall,” something CDC has also estimated. Basically, if someone has had a recent infection, they are less likely to get infected again, so the virus may not be able to spread as quickly or make people sick.

The country’s current population-level immunity is one reason Maciej Boni, a professor of biology at Penn State’s Center for Infectious Disease Dynamics, says it makes sense for policymakers to hold off on rolling out mitigation measures for now. .

“The reason is that we’re going to exhaust people’s patience and potentially exhaust certain health resources.” [and] political capital that we want to have saved for when we really need it,” he says.

He predicts a much more dangerous wave to come in the fall and winter. That’s when he thinks health officials should start ramping up “the new set of measures likely to be needed to lower the number of cases,” he explains.

Jetelina agrees that the country is unlikely to take any major steps at this point. “I don’t see that I don’t see significant policy changes until the virus has another ommicron-like event or a massive mutation,” she says.

Find out what happens to the virus where you are

While public health officials may not sound the alarm about the escalating number of cases, health researchers agree that certain people should take note of the fact of the current, partly invisible wave: the elderly who have not been vaccinated or strengthened recently.

“That’s the low-hanging fruit here,” says Jetelina. “Just get the vaccine. Go get your booster. Don’t think too much about it.” Nearly a third of people over age 65 who qualify for a booster have not received one, according to CDC’s vaccination tracker — despite clear evidence that it reduces the risk of hospitalizations and death.

People at higher risk generally need to be more careful when cases get high. But with official reports of the number of health authorities missing so much data, how do you find out how bad the transmission of COVID is in your community?

Just like when a storm is forecast, you could watch the meteorologist on TV, but also go outside to look at the sky, public health experts say, it’s smart to tune in to both official and anecdotal signals of rising cases. .

Keep an eye on the number of cases (knowing that they only record some of the real cases), and hospitalizations, and listen to public health officials. But also pay attention to text messages from friends and colleagues who tell you they have COVID-19.

“That anecdotal evidence can also be helpful in making decisions,” says Jetelina. If there seems to be a sudden spike, you know there’s more virus circulating where you live.

Another sign to watch out for: if your workplace or your children’s school is conducting surveillance tests—that’s regular testing of everyone, even people who aren’t as symptomatic—it can be very helpful in keeping abreast of what’s going on locally. the virus happens.

“Where I’m in Miami-Dade County, there are still municipal employees who need regular testing, and we can get some sort of underlying signal of when we’re peaking,” said University of Miami epidemiologist Zinzi Bailey.

Bailey also likes to use COVID-19 hospitalization data as a proxy for what’s happening in her community.

“I’m looking at my local hospital admissions, and as they start to rise, I adjust my behavior accordingly — I’m going to pay a little more attention to masking, I’m going to pay a little bit more attention to what interior spaces I choose and how often I do that.” go do it,” she says.

Jetelina uses trendlines when counting cases to make decisions for her own family. “My ears are starting to brighten up [when there’s] just over a 50-75% increase in the past two weeks,” she says. Looking at the trend lines of the case, if the line “just starts to creep up slowly, that’s fine, but if the acceleration keeps getting gets faster, something comes to mind.”

Then there’s grabbing a raincoat when the weather is foreboding — that is, getting your vaccine protection, or getting a boost if you’re not up to date. While it’s easy to make an appointment at a pharmacy, less than half of Americans who got their first vaccines still haven’t gotten the first booster approved in the fall. And now a second booster is available for anyone over 50.

Aside from vaccination, if the virus is currently spreading widely in your community, anyone who is at high risk due to age or underlying conditions — or lives with someone who is — would be smart to take personal COVID-19 precautions: selective being over time in indoor public areas and wearing a well-fitting, high-quality mask when you do.

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