As Omicron Rages, How Important Are Case Counts Anymore?

By Dennis Thompson, HealthDay reporter>

WEDNESDAY, January 12, 2022 — The records surrounding the omicron surge have been staggering, as many Americans have fallen prey to the highly contagious COVID-19 variant.

The United States reported more than 1.3 million cases of COVID-19 on Monday, the highest daily total recorded for any country in the world. The seven-day average case tripled in two weeks, reaching more than 700,000 new infections each day.

But this statistic may be less important than another record: that more than 142,000 Americans are currently hospitalized with COVID, a number that has doubled in three weeks and itself represents another all-time high.

Some public health experts assert that when it comes to assessing the threat from an epidemic, it is COVID hospitalization Now a sign is more valuable than the total number of case.

That’s because vaccines have reduced the risk of severe COVID-19, making it difficult to explain the risk of COVID spread by the number of cases alone. This is especially true in the face of the Omicron variant, which is as contagious as measles but tends to cause less serious disease than the Delta variant.

“I’ve always said hospitalization is the most important metric when it comes to COVID. This is even more so with an immune escape variant such as Omicron,” said Dr. Amesh Adalja, a senior researcher at Johns Hopkins Health. Security in Baltimore. “The goal was never to eliminate COVID – that’s not biologically possible – but to tame it and separate cases from hospitalizations.”

Hospitalization represents “the diseases that we are basically trying to prevent,” said Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases.

“This is where all the tragedy is. This is where the suffering of the patient and the patient’s family is. This is where the stress on the health care system is fundamental. And frankly, there are a lot of costs. Hospitalization is very, very expensive,” added Schaffner.

Home test results are hidden

For muddy case statistics, the emergence of home test kits means many positive cases will never be reported to officials who keep COVID statistics, Schaffner noted.

“Previously, almost all testing was done at controlled sites, so the information on the number of tests and the percentage of positive results all went to the state health department’s databases,” Schaffner said. This data was very accurate.

But now, people can buy over-the-counter COVID test kits to test themselves, and those results aren’t reported to anyone. The true number of infections is likely to be much higher than the number of reported cases because positives from at-home tests are not included in the official count.

“My family has done any amount of testing at home, and it hasn’t been reported — either the number of tests or the results,” Schaffner said. “This data, in terms of numbers, is not as accurate as it used to be.”

That doesn’t mean the number of cases is worthless, Schaffner was quick to add.

Schaffner said the proportion of positive tests — the number of total tests reported that are actual infections — is useful “in the public health approach.”

“Think of it as standing back and looking at the mountain from afar, and you can see where things rise and where things fall,” Schaffner explained. “You get a general idea of ​​what’s going on.”

Sort hospital numbers

And if the rate is still high in your area, Schaffner continued, “you know, according to George, that the virus is there and infecting a lot of people.” “If it starts to drop in a sustainable way, well, you can take some comfort in that. If it eventually drops below 5%, which is the goal, we can all take a deep breath.”

COVID hospitalization data has its issues, too.

The numbers include people who have tested positive for the coronavirus after being admitted for other cases, so some patients may have been admitted for reasons other than COVID-19. There is no national database showing the actual number of patients who have been hospitalized specifically for COVID.

At this point, Schaffner said, hospitalization numbers are collected in a more serious way than test data, and are safe enough to make sense.

Schaffner said hospitalizations involving COVID have always been “very strict data.” “We have been testing people who are hospitalized in a very sustainable way. This data will remain very safe, along with the mortality.”

Overall, the data at this point indicates that the Omicron variant is “less likely to cause hospitalization, and when you are in the hospital you are less ill,” Schaffner said. “You’re less willing to go into the ICU and you’re less willing to need help with ventilation. People say we can get these people out of the hospital faster than we used to.

“This is consistent with in vitro data that omicron is highly effective in infecting cells in the upper airway, in the throat and behind the nose, but not very effective in infecting lung tissue,” Schaffner noted. “Obviously the ability to infect the upper airways is linked to infection, because we get rid of more viruses, so we spread them more easily and are more willing to infect people around us.”


  • Amish Adalja, MD, senior investigator, Johns Hopkins Center for Health Security, Baltimore
  • William Schaffner, MD, medical director of the National Foundation for Infectious Diseases

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