Experts say COVID-19 cases don’t tell whole story

For nearly two years, Americans have looked carefully at coronavirus case numbers in the country and in their local states and towns to judge the risk of the disease.

Surging case numbers signaled growing dangers, while falling case numbers were a relief and a signal to let one’s guard down in terms of gathering with friends and families and taking part in all kinds of events.

But with much of the nation’s population vaccinated and boosted and the country dealing with a new COVID-19 surge from omicron — a highly contagious variant that some studies suggest may not be as severe as previous variants — public health officials are debating whether the nation needs to shift its thinking.

Many people are going to get omicron — but those that are vaccinated and boosted are unlikely to suffer dire symptoms.

As a result, hospitalizations and deaths are the markers that government officials need to monitor carefully to ensure the safety of communities as the nation learns to live with COVID-19.

“This is the new normal,” said Leana Wen, a public health professor at George Washington University and former Baltimore health commissioner. “This is what we will have to accept as we transition from the emergency of COVID-19 to living with it as part of the new normal.”

David Dowdy, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, said that Americans all need to shift to focus on hospitalizations over cases as we enter into another year of the pandemic.

“I think that we need to start training ourselves to look, first of all, at hospitalizations. I think hospitalizations are a real-time indicator of how serious things are,” he said.

Rising case numbers still say something about the disease, and the spikes from omicron are leading to real concerns.

Anthony Fauci, the government’s top infectious disease expert, noted on Sunday that even if omicron leads to less severe cases of COVID-19, if it infects tens of millions it will have the potential of straining resources in hospitals.

“If you have many, many, many more people with a less level of severity, that might kind of neutralize the positive effect of having less severity when you have so many more people,” he said during an appearance on ABC’s “This Week.”

At the same time, the nation must get used to dealing with the coronavirus as it would deal with an annual flu season. It’s a challenge for most parts of American life, from schools and businesses that have to consider worker and student safety, to professional sports leagues that must decide how long someone sits out after a positive test — even if the person is vaccinated and not symptomatic.

“Omicron in a way is the first test of what it means to live with COVID-19,” said Wen. “And by that I mean we are going to see many people getting infected but as long as our hospital systems are not overwhelmed and as long as vaccinated people are generally protected against severe outcomes, that is how we end the pandemic phase and switch into the endemic phase.”

The omicron strain is so infectious that once the current surge has faded in the United States, it’s likely a large majority of the population will either have been vaccinated against COVID-19 or have been infected, experts say. At that point, the focus should shift away from preventing infection to preventing serious illness, multiple experts said, a message already being echoed in some corners of the White House.

Many states have been seeing staggering numbers of positive tests and lines for COVID-19 testing that stretch for several blocks. Washington, D.C., and New York state have set records in recent days for the number of new cases reported as omicron barrels through the population.

But even with case totals surpassing last year’s numbers, President Biden and White House officials have been quick to point out that hospitalizations haven’t been as high as the numbers seen in the winter of 2020.

“Because we have so many vaccinated and boosted, we’re not seeing hospitalizations drive as sharply as we did in March of 2020 or even this past fall. America has made progress; things are better,” Biden said on Monday on a White House COVID-19 response team call with the National Governors Association to discuss the administration’s response to the omicron variant.

“But we do know that with rising cases, we still have tens of millions of unvaccinated people and we’re seeing hospitalizations rise,” he added, saying that some hospitals are going to get overrun both in terms of equipment and staff.

The White House pointed to Biden’s remarks last week when asked about whether the president wants Americans and health experts to take the emphasis off of case numbers and put it on hospitalizations.

“Because omicron spreads so easily, we’ll see some fully vaccinated people get COVID, potentially in large numbers. There will be positive cases in every office, even here in the White House, among the vaccinated … from omicron. But these cases are highly unlikely to lead to serious illness,” Biden said on Dec. 21.

Chief of staff Ron Klain on Monday retweeted a CNN report about how hospitalizations are about 70 percent less than what they were around the last peak in September, but that COVID-19 cases in unvaccinated Americans could end up overwhelming health systems.

Health experts have suggested the White House’s shift in messaging away from a focus on the number of cases is a sign of what’s to come as the pandemic eventually becomes endemic.

“For two years, infections always preceded hospitalizations which preceded deaths, so you could look at infections and know what was coming,” Ashish Jha, dean of the Brown University School of Public Health, said Sunday on ABC. “Omicron changes that. This is the shift we’ve been waiting for in many ways.”

Dowdy said positive tests are also up because people are getting tested before visiting relatives.

“If a lot of people are testing positive because they are asymptomatic and wanting to make sure that they can travel etc., having a lot of those kinds of cases is not a big problem,” he said.

“In fact, that’s a good thing. It means that we’re doing the right thing as a country to define those cases,” Dowdy added.

Lawrence Gostin, a professor of global health at Georgetown University, said the shift away from tracking case numbers as a way to measure the pandemic means devoting more resources toward treatment options like the Pfizer antiviral pill.

Gostin also said testing should increasingly be used to self-diagnose so individuals can get proper treatment, rather than testing for the purpose of stopping the spread of the virus.

“The White House has got a very difficult balancing act. Certainly for now it’s going to have to emphasize the idea of masking and distancing for the purpose of protecting the health system,” Gostin said.

“We can’t live our lives in a bubble to prevent us from getting a pathogen that’s so contagious that you can’t avoid it if you’re going to be circulating and living a life in this world,” he continued. “What it means to transition to a normal life or more normal life is you have to focus not so much on preventing cases, but on preventing hospitalizations and deaths.”

Nathaniel Weixel contributed to this story.