Just how big is this COVID surge? It’s gotten harder to say

In Sherman Oaks, Julia Irzyk tries to gauge how widespread the coronavirus is in her community and turns to a constellation of data points to guide her.

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

So Irzyk keeps track of hospitalizations and deaths. She reviews data from wastewater monitoring that predicts spikes in the coronavirus. Recently, troubled by what she was seeing in the numbers, she asked employees at her talent agency to stop coming into the office for work.

But she puts little emphasis on one of the simplest numbers regularly shared by public health officials: how many COVID-19 cases are being reported.

Those official numbers are “relatively worthless at this point,” said Irzyk, who has authored 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 health officials never know of many COVID cases, draining the official numbers.

Federal funding for testing uninsured patients also dried up this spring, limiting the availability of free testing for some Americans. California has tried to continue offering testing for uninsured people through its own programs, and in Los Angeles County, the Department of Health and Human Services indicated the number of its own locations – which ones Offering COVID testing at no cost to LA County residents – has remained stable since earlier this year.

But official testing has nevertheless declined, even as California expects the BA.5 subvariant to spread quickly.

LA County averaged more than 222,000 tests recorded daily in January; by June, that number had dropped to around 77,000 tests a day. These numbers do not include home testing; The health department said it currently has no system for people to report such findings to LA County.

At the University of Washington, researchers who test blood to determine the true extent of infections have estimated that only 14% of cases are reported in the United States. Tests have never captured the full spread of the coronavirus, but the number is much lower than at some earlier points in the pandemic, when more than 40% of cases were once estimated to have been detected.

“Even the cases that are discovered aren’t being reported as frequently as they used to be,” said Ali H. Mokdad, professor of health metrics in the university’s Institute for Health Metrics and Assessment. “In a lot of states, a lot of counties, it’s just once a week.”

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

Public health officials can still 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 those metrics become less reliable…you need to go back to what was before, which is just kind of a general impression of where things are going.”

As the pandemic continues, experts have turned to a range of metrics to assess how the virus is spreading and the toll it is taking. During last winter’s Omicron surge, some health officials argued that the sheer number of cases mattered less than the number of cases that resulted in serious illness, which was reflected in hospitalizations and deaths.

However, infections remain an important metric for anyone trying to avoid them. When government officials are trying to prevent hospitals from becoming overwhelmed, it makes sense to focus on hospitalizations, Dowdy said.

However, the assessment of personal risk can vary greatly. While hospitalizations aren’t particularly high, “the risk for vulnerable, elderly, and people with compromised immune systems is now very high because of high levels of transmission,” Dowdy said.

Barbara Ferrer, LA County Public Health Director.

Barbara Ferrer, LA County Public Health Director. She has said the county could reintroduce an indoor mask mandate by the end of July if the current trend of increasing hospital admissions continues.

(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,” said Dr. Abraar Karan, an associate in the Department of Infectious Diseases and Geographical Medicine at Stanford University.

While trying to calculate the costs and benefits of different activities, “people don’t know what the spread is, they don’t know what the true potential costs are,” Karan said. “People may be doing things now that they don’t know put them at high risk of becoming infected” and infecting others.

Another concern is the risk of a long COVID, where symptoms can last for months or years — even after a relatively mild initial illness. Scientists have differing estimates of how common the condition is, but when a large number of people are infected, even low-end estimates would result in a high number of patients with persistent symptoms.

Despite concerns that many COVID cases go unreported, LA County Public Health Director Barbara Ferrer said, “As we triangulate data from sewage, emergency departments, and reported test results, we are confident that we are beyond the extent of the spread.” the district.”

Ferrer has said the county could reintroduce an indoor mask mandate by the end of July if the current trend of increasing hospitalizations continues.

“We don’t have 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. “It’s important to understand the overall trend of how cases are changing.”

“You have to assume right now that COVID – especially BA.5 – is rampant in our communities everywhere. The bottom line is that there is a massive transmission going on.” Osterholm likened it to estimating the speed of a passing car. “I couldn’t tell you the difference between 80 and 120 mph – I just know it’s really fast.”

The virus is spreading rapidly as US citizens have expressed decreasing concerns about becoming seriously ill or infecting others: By May, the percentage of Americans who said they were concerned about being hospitalized for COVID was down to its lowest level since Pew Research Center began Asking the question early in the pandemic. So too had the proportion of people worried about unknowingly infecting someone else.

“The fact that we don’t have a mask requirement also makes people think, ‘Well, it’s not that serious because otherwise we would have a mask requirement — the danger has to be less,'” said Dr. Sherrill Brown, Medical Director of Infection Prevention at AltaMed Health Services.

LA County public health officials have continued to strongly recommend wearing masks indoors, especially well-fitting respirators like the N95 and KN95. But “when we made it a strong recommendation, virtually nobody did it,” County Supervisor Sheila Kuehl said at a meeting this week.

Irzyk said at the moment: “It’s not like I can be much more careful than I am.” The 44-year-old doesn’t eat in restaurants or meet in groups. Her husband collects her groceries from the curb. She hasn’t been on a plane since before the pandemic – and can’t see herself doing so any time soon.

With few other people wearing masks in her office building, she is afraid to take the elevator to her office, where she still goes twice a week to write paychecks to her employees. Even a neighbor in the office building who was alerted to her health condition has stopped bothering to wear a mask around her, she said.

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

Rothstein, a past editor of public health ethics for the American Journal of Public Health, argued that unless the rate of new infections slows, “we’re always going to be on this treadmill of new variants.” .

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

Osterholm, in turn, argued that the underreporting had little bearing on whether such government measures would be embraced by the public 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 yet.”

Karan said that with an ever-evolving pandemic, it’s difficult even for experts to synthesize the many factors that have changed over time when assessing the range and risk of the coronavirus, including the emergence of new variants and subvariants. “I don’t think the general public will have a clue how to analyze a lot of this,” he said.

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

Instead, Karan argued that health officials must take “community mitigation measures” such as improving ventilation and air filtration in public spaces to stem the spread of the virus. “One-off efforts will only get you so far,” he said, “if you have something that’s spreading so quickly.”

https://www.latimes.com/california/story/2022-07-16/covid-surge-testing-reporting-falloff Just how big is this COVID surge? It’s gotten harder to say

Alley Einstein

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