How big is this COVID surge? It got harder to say

In Sherman Oaks, Julia Irzyk tries to assess how endemic the coronavirus is in her community, turning to a constellation of data points to guide her.

“I have very little confidence that I would survive COVID,” said Irzyk, who is more vulnerable to the coronavirus as she has lupus and other health conditions.

Irzyk therefore tracks hospitalizations and deaths. She checks sewage monitoring data that predicts coronavirus spikes. Recently, confused by what she was seeing in the numbers, she told her talent agency employees to stop coming to work in the office.

But she pays little attention to one of the simplest numbers routinely shared by health officials: how many COVID-19 cases are being reported.

Those official numbers are “relatively worthless at this point,” said Irzyk, author of a book on disability and the law. “Positive tests are discovered through home testing – and they are not reported to anyone.”

The boom in home testing for the coronavirus has meant that health officials have never heard of many COVID cases, deflating official numbers.

Federal funding to test uninsured patients also dried up this spring, reducing the availability of free tests for some Americans. California has sought to continue providing testing for uninsured people through its own programs, and in Los Angeles County, the Department of Health Services said the number of its own sites – which offering cost-free, reimbursable COVID testing to LA County residents — has held steady since the start of this year.

But official testing nonetheless plummeted even as California reckoned with the rapid spread of the BA.5 subvariant.

In LA County, an average of more than 222,000 tests were being logged daily in January; by June, that figure had fallen to around 77,000 tests per day. These figures do not include tests carried out at home; the public health department said it currently has no system in place for people to report such findings to LA County.

At the University of Washington, researchers who test blood to assess the true level of infections have estimated that only 14% of cases are reported in the United States. Testing has never captured the full spread of the coronavirus, but the figure is far lower than at some earlier points in the pandemic, when more than 40% of cases were once estimated to be detected.

“Even detected cases are not being reported as frequently as they used to be,” said Ali H. Mokdad, professor of health sciences at the university’s Institute for Health Metrics and Evaluation. “In many states, many counties, it’s only once a week.”

Between increases in home testing that go unreported, budget cuts to testing services, and mild or asymptomatic infections that go unnoticed, “we don’t really know how many cases we have,” said Dr David Dowdy. , an infectious disease epidemiologist at the Johns Hopkins Bloomberg School of Public Health.

Public health officials can always piece together what’s happening with other data, but the challenge is that “you want your public health systems to develop responses based on these kinds of metrics,” Dowdy said. “As these metrics become less reliable…you’re left with going back to how it was before, which is just kind of a general sense of where things are going.”

As the pandemic lingers, experts have turned to a range of measures to assess the spread of the virus and its consequences. During last winter’s Omicron wave, some health officials argued that the number of cases was fewer than the number of them resulting in serious illness, as evidenced by hospitalizations and deaths.

But infections remain an important measure for anyone trying to avoid them. If government officials are trying to keep hospitals from being overwhelmed, it makes sense to focus on hospitalizations, Dowdy said.

Personal risk assessment, however, can be very different. Even though the hospitalizations aren’t particularly high, “for those at risk, those who are older, those with weakened immune systems, the risk is now very high because of the high level of transmission that exists,” he said. Dowdy.

Barbara Ferrer, LA County Public Health Director. She said if current trends of increasing hospitalizations continue, the county could reinstate a mask mandate for indoor spaces by the end of July.

(Al Seib/Los Angeles Times)

When COVID cases aren’t counted, “people think it’s safer to do activities that aren’t as safe, for people who are still trying to avoid infection,” Dr Abraar said. Karan, a member of the Division of Infectious Diseases and Geographic Medicine at Stanford University.

As they try to calculate the costs and benefits of different activities, “when people don’t realize the magnitude of the spread, they don’t know what the true potential cost is,” Karan said. “People can now do things that they don’t realize are going to put them at high risk of getting infected” and infecting others.

Another concern is the risk of long COVID, in which symptoms can persist for months or years – even after a relatively mild initial illness. Scientists have different estimates of how common the disease is, but if huge numbers of people are infected, even lower estimates would result in high numbers of patients with persistent symptoms.

Despite concerns about many unreported COVID cases, LA County Public Health Director Barbara Ferrer said that “because we triangulate data from sewage, emergency services and test results reported, we are confident that we have a good understanding of the level of spread across the county.”

Ferrer said if current trends of increasing hospitalizations continue, the county could reinstate a mask mandate for indoor spaces by the end of July.

“We don’t need to count every case to understand what’s happening in our communities,” said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “What is important is to understand the general trend of the evolution of cases.”

“You have to assume right now that COVID – especially BA.5 – is prevalent in our communities everywhere. Ultimately, an extended transmission is underway right now. Osterholm likened it to assessing the speed of a car as it passes. “I couldn’t tell you the difference between 80 and 120 miles per hour – I just know it’s going really fast.”

The virus is spreading rapidly as US residents expressed diminishing concern about becoming seriously ill or infecting others: In May, the percentage of Americans who said they were worried about being hospitalized with COVID had fallen to its lowest level since the Pew Research Center began asking the question at the start of the pandemic. The same was true for the part of people who feared infecting someone else without knowing it.

“The fact that we don’t have mask mandates also makes people think, ‘Well, that’s not that bad, because otherwise we’d have mask mandates – the danger must be less,'” said the Dr. Sherrill Brown, Medical Director of Infection. prevention at AltaMed Health Services.

LA County public health officials continued to strongly recommend wearing masks, especially properly fitted respirators such as N95s and KN95s, in indoor settings. But “when we made it a strong recommendation, hardly anyone did,” County Supervisor Sheila Kuehl said during a meeting this week.

Irzyk said that right now, “it’s not like I can be much more careful than I am.” The 44-year-old does not eat in restaurants or gather in groups. Her husband does his shopping by curbside pickup. She hasn’t flown since before the pandemic – and can’t imagine doing so anytime soon.

Because few other people wear masks in her office building, she worries about taking the elevator to her office, where she still goes twice a week to issue paychecks to her employees. Even a neighbor at the office building who was told about her condition stopped bothering to wear a mask around her, she said.

“Brilliant people, experts in their fields, email me asking what my dad says they should do about COVID because they don’t trust anyone else,” Irzyk said, whose father, Mark Rothstein, is an expert in public health and bioethics. “We just do a terrible job of messaging.”

Rothstein, who in the past served as editor of public health ethics for the American Journal of Public Health, argued that unless the rate of new infections is slowed, “we will always be on this treadmill of new variants”.

And as more and more cases have gone unreported, it is more difficult for public health officials to make decisions about masking and other protective measures that may be warranted with such data,” where you can say, ‘Look, we’ve gone from point A to point B – and we’ve crossed a very important line,’ Rothstein said.

Osterholm, in turn, argued that the number of unreported cases has little bearing on whether or not the public takes such government actions, because “the public has come to the conclusion that they are done with the pandemic, even if the virus is not I’m not done with them.

Karan said with an ever-changing pandemic, it is difficult even for experts to synthesize the many factors that have changed in assessing the scope and risk of coronavirus over time, including the emergence of new variants and sub-variants. “I don’t think people in the general public will know how to analyze a lot of this,” he said.

“Telling people to do these risk assessments won’t work” for many reasons, Karan said, including “there’s too much data coming out all the time.”

Instead, Karan argued that health officials should pursue “community mitigation measures” such as improving ventilation and air filtration in public spaces to reduce the spread of the virus. virus. “Individual efforts won’t get you far,” he said, “when you have something spreading that quickly.”

Los Angeles Times

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