Just weeks after the Centers for Disease Control and Prevention transitioned to a new system for Covid tracking and reporting by “community levels,” federal health officials are warning that one-third of Americans live in areas with a “high” level of risk. Though mask mandates have been dropped across the country, officials are urging the public to wear masks indoors. CDC director Rochelle Walensky said that data show the seven-day average of hospital admissions rose about 20 percent in the last week. The news was shared at the White House’s first Covid press briefing in six weeks.
KATELYN JETELINA, MPH, PhD, info@yourlocalepidemiologist.com
Jetelina is an assistant professor of epidemiology and the author of the popular Substack newsletter on Covid-19, “Your Local Epidemiologist.”
Last week, Jetelina wrote that the U.S. is “clearly in an infectious surge right now.” Jetelina plotted case estimates against reported case numbers, showing that the current surge reflects case numbers higher than the first two waves in 2020. Jetelina also notes that the current transmission rates (higher than 50 reported cases per 100,000 people) across 66 percent of counties correspond to “substantial” or “high” rates of transmission, despite falling in counties in which the CDC does not mandate masks.
Jetelina told the Institute for Public Accuracy on May 20 that it is currently “incredibly difficult to accurately estimate [true numbers of Covid-19 cases] in the U.S., but the Institute for Health Metrics and Evaluation has been estimating prevalence throughout the pandemic.” Jetelina used those numbers to plot the graph below.
Jetelina says that official reported cases are much lower than true numbers because of a “combination of three factors. First, more and more people are utilizing antigen testing (which is great!), but we don’t have a systematic process in place in the U.S.” to track the results of those tests. “Second, because of increased vaccine and infection-induced immunity, disease is, on average, less severe. The rate of asymptomatic or mild infection increases and people may just not know they are positive, so are not testing. (Or just don’t care to test). Third, we have removed incentives for people to get tested. For example, in March, providers were no longer able to submit claims for tests for uninsured patients and testing disparities followed,” as reported by the Institute for Public Accuracy here.
Jetelina says that there is “no doubt we are in the middle of a case surge in the U.S. Unfortunately, it’s not getting communicated properly.” Officials need to “communicate with communities when transmission is high in an area so they can protect themselves. We also really need to strengthen our surveillance systems. One great way to do that is through random community prevalence testing.” Jetelina also recommends wastewater surveillance.
BA2.12.1 is the third Omicron variant to cause a Covid-19 surge in the U.S., and may cause more reinfection than previous variants, as it has reduced cross-immunity.
The virus’s proven ability to rapidly evolve to escape immune defenses may indicate that officials should take a different tact on vaccination: Rather than focusing on vaccines that prevent serious illness but still allow infected people to transmit the virus (such as the ones currently administered in the U.S.), the approach could pivot to focus on oral or nasal vaccines that stop an infection in its tracks and do not allow it to replicate in the nasal cavity. Without them, experts such as Eric Topol write we may not have any “pandemic exit.”
Figure created by Katelyn Jetelina/YLE using reported case data from CDC here. “True” estimates for under-reporting from here.
