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LINK Why tracking COVID-19 case rates still matters

COVID-19 cases in the United States have fallen more than 95% from their peak in January, and on Friday, Hawaii became the last state to roll back its indoor mask mandate. Testing has slowed, and states are scaling back on reporting surveillance data, too.

But experts say that tracking new COVID-19 cases is still important — even if it is an imperfect measure.

"Dating back to the beginning of the pandemic, we've always known that case numbers were being undercounted. It was never quite clear how much," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

With at-home tests more widely available and vaccination helping prevent severe disease, people might be skipping laboratory-confirmed PCR tests. Before, limited availability of testing probably created similar gaps in reporting. The U.S. Centers for Disease Control and Prevention estimates that even before omicron, only 1 in 4 cases was officially reported.

"With an infection that can rapidly spread, where we are today in the data isn't necessarily going to be reflective of how bad it's going to be tomorrow or the day after," said Michael LeVasseur, professor of epidemiology and biostatistics at Drexel University's School of Public Health. "There could be many, many more people who are infectious that you can encounter that you're not seeing in the data."

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But even as they fall, daily case counts provide a useful benchmark in a more comprehensive assessment of the situation that calls for a look across multiple trends.

"From a public health perspective, it's always important to look at more than one data source. And when those data sources together are pointing in the same direction, you can have more confidence," said Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists.

Hospitalizations and deaths have consistently been the most reliable COVID-19 metrics, experts say.

"Those two are bookends that don't really change much relative to the availability of testing," Osterholm said.

Early indicators of transmission have more room for improvement. Case rates are best understood in tandem with test positivity rates. Visits to emergency room departments and virus levels in wastewater can help, too.

Covid wastewater testingData from coronavirus wastewater, CDC guidelines can give mixed signals on whether to mask
Despite the dramatic improvement over the past two months, coronavirus transmission is still high.

"Even though things are going down, boy is there a lot of COVID out there," Hamilton said.

Once driven solely by transmission levels, the CDC adjusted its guidelines for indoor masking last month to rely on hospitalization metrics more heavily than cases.

Though the CDC's newer "Community Levels" map is mostly green, the original "Community Transmission" map still has lots of red. As of Thursday, less than 2% of U.S. counties have a "high community level," but more than a third of counties still had "high" or "substantial" transmission over the past week.

Experts admit that balancing all of these metrics is a complicated risk assessment for individuals to make day to day and that public messaging to help has missed the mark.

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"I don't think we have hit our sweet spot for how we're helping communicate that to people," Hamilton said.

"It's hard, because I think it's not only important to look at a metric which says, 'Yes, there's virus out there.' It's also important to apply that to your own individual risk level."

And this individual risk assessment might get harder in the days and weeks to come if signals become mixed. In the U.K., for example, the BA.2 subvariant of omicron led to a rise in cases that has been much sharper than the rise in hospitalizations or deaths.

But an individual approach shouldn't necessarily change, whether there are 500 new cases per day or 50,000 cases per day, LeVasseur said.

"I can take a look at trends and do a back of the envelope guess at how I'm feeling about risk. But it doesn't stop me from wearing a mask. It doesn't stop me from having conversations with the people that I'm going to be with about our approach," he said.

HippieChick58 9 Mar 25
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1

It's essential to surviving this pandemic

bobwjr Level 10 Mar 26, 2022
1

Yes. Today is the first day of voluntary (rather than mandatory) indoor masking for Hawaii. We still have free testing (official and home testing) but we also just begun testing our waste water, and with that we've discovered we do have the new variant on Kauai.

I will still wear a mask indoors for a while, when appropriate. I'm sure the visitors from other states with little respect for the health of our local community, especially the elderly (which I'm in that category) will not be wearing masks while on their vacation, though they will be encouraged to do so at some places.

Also today is the first day will no longer be requiring vaccinations or negative tests to enter our state.

This is a big step, but with vaccination protection waning over the months, it's going to come to simple individual responsibility to protect ourselves and our loved ones.

I did all my shopping and and indoor fun while the mask mandate was in place this week, and now will lay low for a while and not go out to risky places for a while. Those businesses will not suffer, as we have tourists taking my place.

I'm sure the removal of our health safety measures will increase the prosperity of some of the businesses who refused to adapt to the safety guidelines, so simply shut down during the pandemic, but those who did adapt actually have done very well.

Visitor count (to my island anyway) is exceeding the numbers for 2019, so the hotels, restaurants and activities are booked to the max. Prices are sky high, but that is not stopping folks from traveling and enjoying some tropical fun.

Things are moving forward as they must, but it's good that we are continuing to watch for covid cases in the waste water and also offer free and easy testing to those of us who feel we might have been exposed, so that we can do the correct and responsible thing by staying home and wearing a mask around others.

2

How do they track those that test at home? They do NOT.

MizJ Level 8 Mar 25, 2022

Our state Medical Center is doing sampling of the waste removal system to judge the viral load. As I understand it the science is pretty fascinating, I'm just glad I'm not running the tests.

@HippieChick58 The viral load may differ among individuals but at least it gives a ball park number.

The death toll will be more apparent later on when excess deaths are known, those are annual.

If I were to test myself and find that I'm positive, I can still report that, and also have a professionally administered test to be sure. Yes, some people will keep it quiet and may or may not do the right thing while positive -- going to work and attending social gatherings -- with or without a mask. Therefore individual responsibility in protecting ourselves and our loved ones is all we can do.

I plan to continue my social distancing habits for a while and will avoid indoor gatherings with strangers for a while longer too, even though our restrictions went away at midnight last night.

@Julie808 Exactly. My concern is that some have zero regard for others. I will continue to wear N95/KN95 masks and avoid others.

@MizJ Yes, I used to just have a cloth mask in my pocket for those times when a mask was required briefly, but not really for any good reason (like walking to an outdoor dining table only to remove it when seated for a long length of time close to other un-masked diners) but now, if I'm going to choose to wear a mask, it will be one of my K-N95 masks, since the cloth ones were basically just for show, to meet a requirement, but the N95 masks mean actual safety for others and myself.

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