How big is the recent US coronavirus wave? Nobody really knows.


Leah Nash

A mix of masked and unmasked people shop at the Portland Farmers Market at Shemanski Park in Portland, Ore, in May. Leah Nash / The Washington Post

In this phase of the coronavirus pandemic, Eileen Wassermann has trouble calculating her daily risks – with infections being drastically undercounted and masks no longer being required.

The immunocompromised 69-year-old settles in her SUV for the half-hour ferry ride across Puget Sound from her home on Bainbridge Island to Seattle, where she is being treated for a rare inflammatory disease called sarcoidosis.

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A retired scientist and lawyer who has worked with pharmaceutical companies, Wassermann enjoys analyzing coronavirus data. But she said the current numbers, which don’t account for most at-home test results, are unreliable.

“My modus operandi, which may sound ridiculous now, is to be as cautious as we were at the start of 2020,” said Wassermann, who has received two booster doses of the coronavirus vaccine. “I don’t want to run around like a frightened cat all the time, but on the other hand I don’t want to take any chances with my immune deficiency.”

Americans like Wassermann are navigating murky waters in the latest wave of the pandemic, with highly transmissible subvariants of omicron spreading as governments drop virus containment measures and release less data on infections. As health officials shift their focus to Covid-related hospitalizations as the US death toll hits 1 million, people are largely left to their own devices to assess the risk amid a potentially stealthy surge.

Experts say Americans can expect infections in their communities to be five to 10 times higher than official numbers.

“Any look at the metrics at the local, state, or national level is a gross undercount,” said Jessica Malaty Rivera, an epidemiologist at the Rockefeller Foundation’s Pandemic Prevention Institute. “Everyone knows someone who is now getting covid.”

Since the bottom six weeks ago, hospitalizations nationwide are up 50%. But the roughly 23,000 patients with Covid in hospitals over the last week still represent nearly the lowest hospitalizations of the entire pandemic. The recent spike has come from the Northeast, where hospitalization rates are almost twice those of any other region.

Reported Covid cases have also tripled in the Northeast in just over a month, accounting for much of the national growth, according to the Centers for Disease Control and Prevention. The country has averaged nearly 90,000 new cases each day for the past week – triple the March low.

The latest spike in infections is testing a new CDC alert system, implemented by many local and state governments, that classifies community levels of Covid-19 as “low” even as new cases are rising to levels once thought to be high.

Using these criteria, more than two-thirds of Americans live in low-risk areas. But 43% of residents in the Northeast live in areas considered high-risk, compared to 9% in the Midwest and less than 1% each in the South and West.

“If there’s one word to sum up where we are, it’s ‘unpredictable,'” said Jeffrey S. Duchin, the top public health official for Seattle and King County, where cases have fallen in recent weeks increased significantly after the Omicron Wave.

“Things are clearly better than in the past,” Duchin said. “Vaccines are doing a great job of keeping people out of the hospital, but the virus is becoming more transmissible.”

Experts say the rise in infections is not surprising, especially after governors scrapped indoor mask mandates and a judge invalidated the federal mask requirement on public transportation. Spring is also a season for gatherings from Easter brunch to proms and graduations.

“It’s the next phase of the return to normal: Every time we take the next big step, there’s always a bounce back,” said David Rubin, who tracks national coronavirus trends for PolicyLab at Children’s Hospital of Philadelphia. “If you are at risk, you should exercise caution and definitely consider masking in public places.”

Health officials aren’t as concerned about rising cases as those infected are increasingly vaccinated and boosted, and have access to therapeutics like the antiviral Paxlovid, which help keep people from getting seriously ill.

But doctors say the new CDC categories for public reporting mask the true risk of contracting Covid-19, which is still disruptive to life, can lead to long-term complications and poses an increased risk to the elderly and immunocompromised.

A health worker administers a dose of the COVID-19 vaccine at a vaccination clinic in Reading, Pennsylvania. – The Associated Press

“It allows people to move and have a false sense of security,” said Jayne Morgan, executive director of the Covid task force at Piedmont Healthcare in Georgia.

“It is concerning that we have moved away from prevention in a public health crisis,” Morgan added. “The best doctors always do preventive medicine. That’s why you get mammograms. That’s why you get a colonoscopy. They don’t wait for the cancer to develop.”

The District of Columbia is one of the communities where tensions are brewing as residents question the official classification as a low community risk.

Local health officials stopped posting daily cases on their website after the Omicron surge, urging residents to treat the coronavirus more like an endemic disease and less like an emergency. In recent weeks, the city has also stopped reporting results from sewage virus surveillance and providing daily data to the CDC, leaving little information available to people with rising infections.

The Institute for Health Metrics and Evaluation estimates that only about 13% of cases are detected. But the organization’s director, Christopher Murray, says the United States is still in good shape and not on track to see a surge of omicron subvariants being seen in the United Kingdom.

“We have very, very few intensive care admissions. We have really few deaths. And we probably have a very high level of immunity because Omicron has infected so many people, vaccination is moderately high, and a number of people are being boosted,” Murray said. “We’re in good shape and will remain so through the fall and winter, when immunity has plummeted or until a nasty new variant emerges.”

John Brownstein, chief innovation officer at Boston Children’s Hospital, said New England is experiencing a hidden Covid wave, based on survey data suggesting five positive at-home coronavirus tests for every two lab tests. But that hasn’t resulted in a worrying spike in hospital admissions.

New York state recorded one of the highest Covid-19 hospitalizations in the country, with 14 residents out of 100,000 as of Monday, according to the Washington Post tracker. But hospitals say this is being skewed by patients admitted for other reasons who then tested positive for the coronavirus.

Mangala Narasimhan, director of critical care services at Northwell Health, New York’s largest healthcare network, said patients with Covid are not coming in with pneumonia and breathing difficulties like they have for the past two years.

“A lot of people I know in the community have Covid,” she said. “None of that is reflected here in the hospitals.”

Delaware and Maine have the highest per capita hospitalization rate in the country at 18 per 100,000 people. But hospital associations in both states say their situation is manageable. In Delaware, the 111 patients hospitalized last Thursday are well below the January peak of 759, which prompted hospitals to declare a crisis that allowed them to ration supplies.

Josh Elliott is watching reports of rising cases in the Northeast and is worried about returning to once-regular pleasures like going to concerts and eating indoors in his suburb of Atlanta.

Elliott is being extra cautious as asthma and lung damage from pneumonia put him at a higher risk of developing serious Covid-19 disease. He worries about a hidden spike as Georgia now reports cases weekly instead of daily.

With reliable data, Elliott said he’d feel more comfortable attending a friend’s upcoming wedding and celebrating his upcoming 30th birthday with his girlfriend at a restaurant — rather than eating out.

“I want to have a nice birthday dinner and not bring it home and get covid on my birthday,” he said. How big is the recent US coronavirus wave? Nobody really knows.

Rick Schindler

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