By Eric Berger
Some U.S. infectious disease experts and public health officials are questioning whether to continue using the number of coronavirus cases as a metric for determining which mitigation efforts are appropriate, as data suggests Omicron is less severe but much more contagious than previous variants.
Those experts argue that the U.S. has reached a stage in the pandemic where reports of dramatic surges in case counts prompt unnecessary worries and that government officials and the public should instead review death and hospitalization data when considering precautions.
Case counts “are causing a lot of panic and fear, but they don’t reflect what they used to, which was that hospitalizations would track with cases”, said Dr Monica Gandhi, an infectious disease specialist and professor of medicine at University of California, San Francisco.
However, other infectious disease experts say that while they are encouraged by data from South Africa showing that its recent Omicron wave was not accompanied by a significant increase in deaths, the virus continues to strain hospitals in the US, therefore the number of Covid cases remains a vital measurement.
The U.S. on Thursday had more than 580,000 new Covid cases, the second time this week that the country has broken its record for daily Covid cases, according to New York Times data. But over the past two weeks, while the number of Covid cases in the United States has increased by 181%, the number of hospitalizations has increased by 19% and the number of deaths has decreased by 5%.
“It seems to be less virulent for two reasons,” said Gandhi. “One, we seem to have so much more immunity in December 2021” than during previous waves, and “there are now five laboratory studies that show that it doesn’t seem to infect lungs very well”.
In reporting data on Covid, health departments should now take the same approach as they do with influenza, Gandhi said. That means releasing hospitalization and death data but not numbers concerning case counts because, like with the flu, it’s not possible to eliminate the virus, therefore we should only focus on its severity, she said.
“Once you have accepted the virus is endemic, just like influenza, then you never track cases because we never screen like this for any other viruses, we track what is causing disease and getting people hospitalized,” Gandhi said.
Other countries are now implementing an approach that is not focused on case counts. For example, in Canada, which has also seen record numbers of Covid cases recently, Dr Robert Strang, Nova Scotia’s chief medical officer of health, said at a news conference Thursday that the government agency would no longer focus on daily case counts.
“We no longer need to identify and have public health manage every single case of the variant because for most people, that will result in relatively mild illness, so we need to focus our efforts and resources on our most vulnerable groups,” said Strang. “Omicron is all around us and we have to recognize that you could be exposed anywhere … It’s about managing and slowing down the spread but not eliminating it.”
The Philippines government also announced this week that it would stop posting case updates on social media, which was similar to an approach employed by Singapore, according to Hawaii Public Radio.
But in the US, there are parts of the country where hospitals remains overwhelmed, largely because of unvaccinated patients with Covid. In Maryland, for example, which saw a more than 500% increase in Covid cases and 50% increase in hospitalizations, at least six hospitals have implemented crisis-mode standards of care, according to the Baltimore Sun.
At Johns Hopkins Bayview medical center, which saw a 360% increase in patients hospitalized with Covid in December, that means rescheduling elective surgical procedures and opening additional space to treat Covid patients.
Justin Lessler, an epidemiology professor at the University of North Carolina, still sees case counts as an “important leading indicator”, he said. “With Omicron are surges are so big, even if it’s on average … much less severe than previous variants, the sheer number of cases is such that hospital systems are going to be overwhelmed and there is risks to individuals because it’s so likely you will be infected.”
Mara Aspinall, a biomedical diagnostics professor at Arizona State University, also said case count data remains important because it prevents the public from overreacting or underreacting to the pandemic.
“The challenge we have had this whole time is finding that balance between keeping our physical health in check, but our mental health and the economy moving forward, and it’s all with the best information” that we are able to do that, Aspinall said.
For Gandhi, that balance lies in health departments tracking case counts internally and only alerting the public on hospitalizations and deaths.
“The reason we tracked cases is because we were hoping we could eliminate the virus, but it’s not in the nature of the virus to eliminate it,” said Gandhi. “The country hasn’t totally transitioned to this idea that we can’t eliminate it.”
Credit; The Guardian