COVID could be rising in the US and we may not know it

JThe rise in Covid cases in parts of the United States, even as testing efforts wane, has raised the specter that the next major wave of the virus could be difficult to detect. In fact, the country could be in the midst of a surge right now and we might not even know it.

Testing and viral sequencing are essential to respond quickly to new Covid outbreaks. And yet, as the country tries to emerge from the pandemic, demand for lab testing has declined and federal funding priorities have shifted. The change forced some test centers to close while others raised prices in response to the end of government-subsidized testing programs. People are increasingly relying on rapid home tests if they decide to get tested. But those findings are rarely reported, giving public health officials little information about the true extent of the virus.

“There is always more spread than we can detect,” said Abraar Karan, an infectious disease physician at Stanford University. “That’s even more true now than when the pandemic started.”

Despite groundbreaking scientific advances like vaccines and antivirals, public health experts say America’s defenses against Covid appear to be weakening over time, not strengthening.

“We’re in a worse position,” said Julia Raifman, assistant professor of health law, policy and management at the Boston University School of Public Health. “We learned more about the virus and how to fight it, and then we didn’t do what we had to do to deal with it.”

In late February, the Centers for Disease Control and Prevention began relying on hospital admissions and intensive care capacity to determine community-level risk. It was a change from the number of Covid cases and percentage testing positive, which are widely seen as a better snapshot of how much virus is circulating in a given community. Several states, including Arizona, Hawaii, Nevada, and Ohio, have now completely stopped reporting daily Covid data to the CDC, making it more difficult to assess the progress of the pandemic in those states.

According to the CDC, the majority of the country is still considered low risk. Public health experts argue this is misleading, given that hospitalization and death typically occur days to weeks after the initial infection. Without widespread testing, this could make it impossible to detect a power surge until it’s too late to do anything about it.

“The CDC is downplaying and downplaying cases,” said Gregg Gonsalves, an infectious disease expert at Yale’s School of Public Health. “Their alarm bells won’t go off until we see an increase in hospitalizations and deaths, which are lagging indicators.”

Inheritable variant

Although omicron tends to cause milder symptoms in healthy, vaccinated people, its transmissibility has led to such an increase in the number of cases that it has resulted in hospitalization rates that have broken previous records for pandemic. The variant was also responsible for a record number of hospitalized children. Blacks were hospitalized twice as many as whites during the outbreak in New York. Vaccines are extremely effective at preventing serious illnesses, if not always at preventing cases, one of the reasons why measures have shifted to hospitalizations to judge the state of the virus. But not tracking cases creates a blind spot. Experts say it’s essential to keep tracking them in order to protect vulnerable communities and respond to new waves of the virus before the healthcare system is overwhelmed.

In recent weeks, cases have started to surge in places like New York, Massachusetts and Chicago, but mixed public messages have sown confusion. National leaders have largely declared victory over the virus, but some local governments are starting to urge caution again. New York City has delayed lifting a mask mandate for children under 5 due to rising cases and the city’s health commissioner has recommended New Yorkers return to masking inside.

Yet even in New York, things look very different than they did when previous surges began. Gone are the days of long test lines and exhausted antigen tests. And across the country, pop-up testing centers, once mainstays of the pandemic, are starting to disappear. Although state-run testing facilities have continued to operate in some areas, people without health insurance face high prices. And as of March 22, the US Health Resources and Services Administration is also no longer accepting reimbursement claims from healthcare providers for Covid testing.

At the same time, rapid home tests have increased. The problem is that the CDC does not require people to report positive home test results, so home test results are rarely considered in public health data.

“We are probably underestimating the number of infections we have right now, because many infections are either symptomless or minimally symptomatic and you will miss the people who have it at home,” said Anthony Fauci, the chief medical adviser. of President Joe Biden. Bloomberg TV Wednesday.

In New Jersey, for example, Stacy Flanagan, Jersey City’s director of health and human services, said that in the past three months only two people have called to report positive home tests. Cases continue at a steady pace in the city with an average of 64 new cases per day, according to health department data. This is almost double the number of daily cases reported a month ago.

“We’ve only heard from a handful of conscientious people calling us and saying, ‘I did a home test and it’s positive,'” said Dave Henry, the health manager for more than a dozen towns in Monmouth County, New Jersey.

Public health experts need to gather data from a variety of sources. For Rick Bright, virologist and CEO of the Rockefeller Foundation’s Pandemic Prevention Institute, that means using CDC data along with a number of other sources to understand the spread of Covid. “Unfortunately, we still have to go to a handful of sites to try to piece together what is really going on across the country.”

Other measures such as sewage monitoring and even air sampling may eventually become useful alternatives for understanding the amount of virus circulating in a community. For weeks, sewer data has shown cases rising in parts of the US – foreshadowing the spike in positives places like New York and Massachusetts are now seeing.

In the nation’s capital, more than 50 people who attended the elite Gridiron Club dinner on April 2 tested positive for the coronavirus, The Washington Post reported — at least 8% of those who attended. The list of those infected includes the US Attorney General, Secretary of Commerce, aides to Vice President Kamala Harris and First Lady Jill Biden, as well as the President’s sister.

Speaker of the House Nancy Pelosi, who did not attend the dinner, also tested positive, raising concerns about the time she spent near President Biden before his diagnosis.

Home test

The White House maintains there is enough Covid data circulating to catch the next surge. Tom Inglesby, senior policy adviser for Biden’s Covid-19 response team, said the CDC gets 850,000 lab test results every day, which he says is enough to detect trends in the rate. positivity and prevalence of variants.

“It is true that there is now a bigger shift to move to over-the-counter testing, that is definitely happening,” Inglesby told a panel discussion. “Various efforts are underway to try to assess whether people might be willing to voluntarily report some of these tests that are done at home.” A biotech company, Ellume, has rolled out an at-home test and app that automatically reports positive tests to the CDC over a secure, HIPAA-compliant connection.

Meanwhile, the CDC has pledged to step up its wastewater monitoring efforts. The agency doesn’t yet have data from sites in every state, so even having access to some of the sampling already underway could be helpful. Environmental monitoring, like many other tools for tracking Covid, may be at risk without additional congressional funding. On Tuesday, lawmakers reached an agreement to reallocate $10 billion to pandemic preparedness, which press secretary Jen Psaki said would fund “the most immediate needs” such as antivirals and testing. But this bill has not yet been approved by the Senate.

“The information we get from the CDC will be less reliable, more patchy, and will lose momentum,” Bright said. “There are really big concerns about the lack of sustainable funding to maintain momentum and complete the surveillance work we are building for pandemic prevention.”

There could be a lesson to be learned from the 1918 flu pandemic. After cases started to decline after the first two waves of the flu virus, public opinion changed and many health measures were lifted. But in 1919, at the end of the pandemic, a fourth wave hit New York City, causing a higher increase in deaths than in previous waves, according to a government-funded study.

“These late waves of pandemics are sometimes the deadliest because people have given up,” Yale’s Gonsalves said.

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