What to make of those soaring COVID counts
By Lazaro Gamio, Lisa Waananen Jones and Amy Schoenfeld Walker
Coronavirus case counts have reached record highs in the United States and continue to climb. Hospitalizations have surpassed last winter’s wave. Deaths are also beginning to rise. The overall pattern is familiar, but a fresh perspective on how to interpret these metrics may be necessary as a faster but less severe variant tears through the country. Here’s how to interpret the data in the coming days and weeks.
Omicron still has room to grow
In just a matter of days, coronavirus case counts have shattered previous records in the United States, as the omicron variant spreads rapidly just about everywhere, including in communities with high vaccination rates. All but eight states have seen record cases in January.
While these case counts are staggering, experts say they are not as alarming as they might have been a few months or a year ago. Instead, they should serve as a warning for the country to adjust behaviors and policies to reduce infections and protect the most vulnerable.
“The circumstances have changed, and we must adapt,” said Dr. Shama Cash-Goldwasser, a senior technical adviser at Resolve to Save Lives, a global health organization. “We have a less severe variant, plus many are vaccinated, but evidence suggests the vaccines are not as good at preventing infection with omicron as they were against delta.”
As high as the case counts are in many places, they are most certainly undercounted right now, as many omicron infections are asymptomatic or mild, and people may not know to test. Testing shortages are also limiting access, and experts say that a majority of results from popular at-home tests are not reported to public health departments.
The sharp rise in cases in many states could be followed by sharp falls, as observed in South Africa, but experts caution that the sheer volume of cases could still lead to significant numbers of extremely sick people, even from a variant that overall gives people less severe disease.
“We are going to have a lot of people sick, and even if a smaller proportion of those individuals have really horrible illnesses and adverse outcomes, it’s still a lot of people,” said Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists.
Hospitals are likely to strain further
Because the omicron variant appears to cause less severe illness, hospitalization figures may tell us less about the disease and more about the strain on the health care system, which has consequences for everyone.
Hospitalizations have not yet seen the same explosive growth as cases, but this metric tends to lag case counts, and it may be too early to gauge omicron’s full effect. What is clear is that the number of people hospitalized with COVID nationwide has already reached a single-day record and is still rising steeply.
Hospitals, emergency rooms, urgent care centers and doctors’ offices are overburdened and understaffed across the country. Hospitals in some areas are already shutting down elective surgeries and must treat even critical care patients in emergency rooms.
And in parts of the country like the Midwest, hospitals may be in a more precarious situation — they were already under strain, having yet to recover from the delta surge before omicron-led illnesses began to rise.
Hospitalization figures are not without flaws. “National data don’t allow us to distinguish between people hospitalized because of COVID-19 and those who happened to test positive while admitted for something else,” said Jason L. Salemi, a public health researcher at the University of South Florida, who tracks COVID data.
These “incidental patients” may be more prevalent right now because omicron is so transmissible. Some hospitals are reporting that these patients may make up as much as half of their hospitalizations.
Salemi noted that a coronavirus infection can still exacerbate the primary illness of incidental patients, pose a risk of infection to staff members and other patients, and contribute to the overall strain on medical centers.
National hospitalization data notably does not include up-to-date measures of severe illness, such as the number of people on ventilators or their length of stay. (Federal data tracks some of this, but it is about two months behind.)
“The absence of these details about hospitalizations in the available data just muddy the water as we try to understand omicron’s impact,” Salemi said.
Public health experts suggest monitoring COVID patients in intensive care as well as intensive care unit capacity to better gauge COVID’s effect on serious illness. About 1 in 4 U.S. hospitals with ICUs recently reported that at least 95% of their critical care beds were full.
Deaths may rise, but not skyrocket
There is hope that vaccination coverage, improved medical treatment and the milder characteristics of the omicron variant will mean that fewer infections end in death. But the unprecedented number of cases may still lead to high levels of mortality.
“Are we going to see deaths increase? Yes, we are,” said Hamilton of the Council of State and Territorial Epidemiologists. “And they are going to go up if cases keep increasing this way.”
Experience throughout the pandemic shows it takes at least three weeks after an increase in cases to see a resulting increase in deaths, which may explain why death counts have risen only slightly.
Trends in deaths lag behind cases and hospitalizations by weeks because of the time it takes for people to become seriously ill and the time needed to complete and file death records. This lag varies by state and often becomes longer in times when there are more deaths, or when a case surge is overwhelming the public health system, as it is now.
Already, there are some troubling early signs of death counts rising in some of the Northeastern states first hit with omicron, including New York, Connecticut, New Jersey and Massachusetts.
Deaths can generally be predicted by looking at hospitalizations and counting backward by three weeks, suggesting that deaths will almost double in the next three weeks, said Dr. David Dowdy, a public health researcher at the Johns Hopkins Bloomberg School of Public Health. But it’s still possible that deaths will not rise as sharply as cases and hospitalizations have, he added.