With that will come “escalating case numbers and more hospitalizations,” Dr. Eric Topol, a cardiologist and professor of molecular medicine at Scripps Research, told CNNi Monday. “One good thing is that it doesn’t seem to be accompanied by ICU admissions and deaths like previous variants, but this is definitely a concern.” But to look at the official cases, it’s hard to say. The share of officially reported cases is at an “all-time low,” said Dr. Michael Mina, an epidemiologist and chief scientist at the telehealth company eMed. “There’s no doubt about it.” Covid-19 cases have been undercounted to some extent throughout the pandemic for reasons such as a lack of available tests in some places and asymptomatic cases that may have been missed. But as people increasingly rely on rapid at-home tests — and as attitudes toward the pandemic change overall — the U.S. hasn’t landed on a reliable way to track transmission levels. An estimate from the Institute for Health Metrics, a research center at the University of Washington, suggests that actual infection numbers in the first week of July were about seven times higher than reported cases — which averaged about 107,000 each day by the past two weeks, according to data from Johns Hopkins University. Before the CDC lifted the requirement for international travelers to be tested before coming to the country last month, Mina said, it was an “amazing opportunity” to track the state of Covid-19 across the US among a group of mostly asymptomatic people. About 5% of travelers tested positive during May, which he says likely translates to at least 1 million new infections each day in the broader US population — 10 times higher than the official figure. Now that BA.5 is here, “we know there’s going to be a surge in the fall — there’s almost no doubt about that — if not before. So you just have to be really cognizant that it could happen,” said Mina. But with so many variables at play, it doesn’t necessarily make sense to compare the current situation to other parts of the pandemic. “We really don’t have a good sense of what the baseline is,” said Dr. Marcus Plesia, chief medical officer at the Association of State and Territory Health Officers. “To say ‘here we are, right now in 2022, compared to 2021’ — it’s not a fair comparison.” To assess your individual risk for Covid-19 as a new variant takes hold, personal reporting of cases among friends and family may be a better gauge than official data, experts say. “People are asking each other, sharing stories, and that’s probably not a bad source of evidence,” said Baruch Fischhoff, a professor at Carnegie Mellon University and founder of the US Food and Drug Association’s Risk Communication Advisory Committee. Our social networks have probably remained more consistent than national surveillance systems, he said, and “if more people you hear about in your circle now have the disease than in the past, and the size of your circle is about the same , then there’s probably a lot more disease now than there used to be.”
Serious results don’t tell the whole story
In White House Response Team briefings — the most recent of which took place more than two weeks ago — CDC Director Dr. Rochelle Walensky, presented case trends without mentioning these important caveats in the data. Months ago, the CDC moved away from Covid-19 transmission levels that categorized risk based on the number of cases and test positivity rates to focus on community Covid-19 levels based more on hospitalization-related metrics. During this winter’s Omicron outbreak, hospitalizations and deaths did not follow the same sharp trend line as cases — a significant change from previous waves of the pandemic. But the fact that serious effects are still occurring is reason enough to keep paying attention to outbreaks, experts say. “If we ever got to a situation where people were getting infected but it was no longer causing severe disease — maybe it’s a new variant that’s much less severe or it wasn’t causing long-term Covid — if there weren’t really significant adverse health effects, then we wouldn’t we will now care so much about cases,” said Jason Salemi, an epidemiologist and associate professor at the University of South Florida. “But let me be clear, we’re not there yet.” There is no evidence that BA.5 causes more severe disease, but studies have shown that BA.5 can evade antibodies from vaccination or previous infection — even from another subvariant of Omicron. The vaccines are still expected to provide protection against serious disease, and for the fall, vaccine manufacturers are developing updated booster vaccines incorporating Omicron BA.4 and BA.5 strains. There are treatments available, such as the antiviral pill Paxlovid, that dramatically reduce the risk of death or serious illness. And high-quality masks, ventilation, physical distancing and quarantine and isolation can still help reduce the spread of any variant, including BA.5. However, currently more than 5,000 people are hospitalized with Covid-19 each day, according to CDC data, and more than 300 die each day, according to JHU data. Focusing on these “lagging indicators” costs “a significant amount of time to start reducing people’s behavior and prevent a lot of morbidity and mortality,” Salemi said. If 1 in 5 Covid-19 infections results in long-term Covid, and true infections are seven times higher than reported, the number of people with long-term Covid-19 could be increasing by 100,000 every day.
Work around blind spots
For now, the US is in a “sustainable management phase,” with ongoing efforts to keep things under control compared to “what was much more of a reactive, emergent — and emergent — approach of the past.” Plescia said. But the federal government has recently reallocated resources away from testing because Congress did not approve additional funds for Covid, a move that Mina says will leave the US “pretty blindsided as we head into the fall.” Some surveillance programs are underway, such as wastewater monitoring that tracks the amount of virus present in wastewater. But he says they’re “minimal” and “overall, they don’t really give us a good picture of what’s really going on in the United States.” “We just got over that big breakout,” Mina said, referring to the previously dominant Omicron subvariants. “But we shouldn’t let our guard down, I would say, because with BA.5, I expect it’s going to be a very different story.”
