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  • Writer's pictureThe San Juan Daily Star

Reduced US testing is blurring view of the pandemic

A coronavirus testing site in Durham, N.C., in May. The vast majority of positive results from popular home test kits are not included in official data, and not everyone who gets infected knows or gets tested.

By Adeel Hassan and Sarah Cahalan

At a glance, the pandemic picture in the United States may seem remarkably stable. The average number of new confirmed coronavirus cases per day has hardly budged for weeks, hovering between 95,000 and 115,000 a day each day in June.

A closer look shows that as public testing sites run by state and local governments have winnowed, more states have also stopped giving daily data updates, creating a foggier look at the state of virus across the country.

That comes as new federal estimates Tuesday showed that the rapidly spreading omicron subvariant known as BA.5 has become dominant among new coronavirus cases. As of the week ending Saturday, BA.5 made up about 54% of new cases in the United States, according to the Centers for Disease Control and Prevention. Just a week ago, the agency’s estimates had put BA.5 and BA.4, another omicron subvariant, together as dominant, a trend experts had predicted. The new statistics, released Tuesday morning, are based on modeling and can be revised as more data comes in.

BA.4 and BA.5 are able to evade some of the antibodies produced after coronavirus vaccinations and infections, including infections caused by some other versions of omicron. But researchers in South Africa recently reported that a spring surge driven by BA.4 and BA.5 did not appear to cause significantly more severe disease than the nation’s first omicron wave.

The reduction in U.S. public testing means that lab-based PCR testing capacity in July will be only half of what it was in March, according to a recent estimate by Health Catalysts Group, a research and consulting firm. Even a few testing companies announced layoffs and closures last week.

The vast majority of the positive results from popular home test kits are not included in official data, and not everyone who gets infected knows or gets tested. Many Americans appear to be moving even further away from focusing on daily case counting — which, to be sure, have always been an undercount of total infections — as a measure of the nation’s pandemic health. But other Americans with risk factors have said they feel ignored and abandoned as their governments and neighbors have sought a return to normal.

And some scientists estimate that the current wave of cases is the second largest of the pandemic.

“One of my favorite lines from somebody at the CDC was ‘You don’t need to count the raindrops to know how hard it’s raining,’” Dr. Rochelle Walensky, director of the CDC, said in late June at a conference in Aspen, Colorado. “So we can tell by the half a million to a million PCRs we’re doing every day how we’re doing in areas around the country.”

The CDC’s monitoring of community risk levels shows that in its latest update, 33% of the American population lived in a high-risk county, in most regions outside the Northeast. In May, the map had been flipped, with the Northeast comprising most of the high-risk counties. The CDC recommends wearing a mask indoors in public under such a designation.

In most of the Northeast, cases have decreased continuously throughout June, according to a New York Times database. In the South, many states have seen cases double or triple over the same time. As of Sunday, more than 113,000 new coronavirus cases are being reported each day in the United States.

“That’s not really a reflection of the total amount of virus circulating in the communities,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. He said that his “back of the envelope” estimate was about 1 million cases per day.

As states report less frequently, changes in the trajectory of the virus are slower to reveal themselves. Nearly every state reported the number of new coronavirus cases, hospitalizations and deaths for five days a week or more in 2020 and 2021, but 23 states now release new data only once a week, according to Times tracking.

California, which once updated its cumulative case and death figures every weekday, now does so only twice weekly. In Florida, case and death data are released just once every two weeks. Just last week, many more public testing sites closed in Alaska, Colorado and Rhode Island. Iowa is shutting many sites by the end of next week.

Recent virus figures have hiccupped around holidays such as Memorial Day and Juneteenth, during which many states often pause reporting and then restart tracking afterward, a trend that is sure to continue this week, after the Fourth of July holiday weekend.

“Following the daily test count is less instructive than it was,” Adalja said, citing the close link between cases and hospitalizations in the past.

Today’s numbers should not be treated like checking a sports team’s daily standings or scores, he added.

“I think testing is taking a different role,” he said. “Even when testing was at a different point, it has always been an underestimate.”

To get a localized look at how the virus is faring, Adjala said that he has come to rely on hospitalizations as a percentage of its capacity. He also checks the CDC’s community levels tracker, which includes new hospital admissions and how many beds are used. He urges a shifting focus to severe disease, rather than tracking the “booms and busts of cases.”

Hospitalizations have increased modestly throughout June, though they remain low. Just over 33,000 people are in U.S. hospitals with the coronavirus on an average day, and fewer than 4,000 are in intensive care. Reports of new deaths remain below 400 a day, down from the country’s daily death toll peak of more than 3,300 deaths in January 2021.

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