The most familiar indicator of the relentless spread of COVID-19 across the country — daily state and local case counts — may be on the verge of disappearing.

Instead, public health officials are considering turning increasingly inaccurate case data into numbers they believe are more representative of the disease’s impact on communities and the health care system: COVID-19 hospitalizations and deaths.

Omicron case counts are breaking all previous COVID-19 records. But the numbers don’t carry the same weight as they used to be. State and local health departments are preparing to explain this to the public and begin reporting more meaningful data on the virus.

“The goal of public health data is to provide information to people so they can take action to keep themselves safe and healthy,” said Meredith Allen, vice president of health security for the Association of State and Territorial Health Officials. “We’ve gotten to the point where the daily case count doesn’t give people that information.”

So far, Tennessee is the only state that has scaled back its reporting of COVID-19 cases since omicron emerged. But experts expect other states to follow suit once the omicron surge subsides.

In addition, New York Democratic Gov. Kathy Hochul last week asked hospitals to start providing more meaningful data on COVID-19, specifying whether a patient was admitted for COVID-19 or for an unrelated reason and accidentally tested positive for the virus.

Currently, the daily number of cases remains the primary measure of the spread of omicron across the country. But epidemiologists warn that the numbers can only be used as broad indicators of how fast and where the disease is spreading.

Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists, said the number of daily cases was grossly underestimated due to testing shortages, unreported home testing and a high rate of asymptomatic infections. She said the true number of infections was several times the number of reported cases.

This week, the average daily number of reported cases was 781,000, more than triple the 250,000 daily cases at the peak of the delta surge a year ago. On January 3, more than 1 million ohmic cases were recorded.

But that doesn’t mean hospitalizations and deaths that are weeks behind new cases will rise in equal proportions. Early data suggests that omicron infection produces less severe symptoms and fewer deaths than previous COVID-19 variants.

“We don’t want to keep telling people there are X new infections out there without them knowing how many of them have serious consequences,” Hamilton said.

Despite lower hospitalization and death rates, omicron’s soaring infection rate has led to a surge in hospital visits, almost exclusively among the unvaccinated population, putting pressure on the nation’s health care system. Although it has proven to be less virulent than previous COVID-19 strains, omicron is expected to cause more deaths due to the high number of infections.

better barometer

Months into the pandemic, epidemiologists say COVID-19 will eventually become endemic, infecting nearly everyone and remaining in the population indefinitely.

That pop era may have already begun. As a result, many state health officials say they are preparing to scale back the frequency of case count updates, likely as soon as the current surge subsides, Allen said.

“This will allow public health agencies to focus on prevention efforts in high-risk groups, such as long-term care facilities, and work more closely with schools and vaccination clinics,” she said, “rather than devoting time and energy to day-to-day production. Medium numbers.”

Tennessee switched from daily reporting of new COVID-19 cases to weekly reporting on Jan. 1, citing the need to focus on other public health priorities, including the expanding opioid overdose crisis.

Florida, Iowa and Nebraska moved to weekly counts last summer as COVID-19 cases dwindled across the country. Alaska, Kansas, and Michigan release case data 3 times a week.

For now, though, state and local COVID-19 policies, including school and business closures, travel restrictions, mask requirements and quarantine rules, depend heavily on daily numbers.

The rise and fall in the number of cases since the beginning of the pandemic has proven to be a reliable indicator of whether the virus is spreading, leveling off or receding, said Dr. William Schaffner, a professor and consultant in preventive medicine at Vanderbilt University School of Medicine. . Centers for Disease Control and Prevention.

“We all know the data is not as precise as it used to be,” he said. “But we do have a good understanding of trends over time and geography, especially in long, skinny states like Tennessee. It allows us to look at what’s going on in Nashville and Chattanooga, for example. “

Official CDC guidance continues to recommend that state and local health departments publish daily COVID-19 case counts, he said. But in discussions with health officials, the agency “gives states leeway to put more emphasis on hospitalizations and other data.”

Schaffner and other experts say the number of people hospitalized with COVID-19 may be a better indicator of the severity of the disease and its impact on communities and health care systems. Others argue that the number of patients in intensive care units will be a more meaningful measure.

grey area

Eili Klein, an epidemiologist and associate professor of emergency medicine at the Johns Hopkins School of Medicine, said that, as in the case of omicron mushrooms, hospitalized patients are more likely to test positive for the virus on admission or be infected in the hospital.

Even before omicron’s dominance, research showed that about half of patients admitted to hospital with COVID-19 were hospitalized for other reasons. Still, their COVID-19 infection could affect their health outcomes and length of stay in hospital, Klein said, which of course means hospitals have to spend additional resources treating them.

Extracting data on COVID-19 hospitalizations is not easy, he said. “There’s a big grey area that’s hard to pin down in real time.”

Klein and other experts argue that the use of intensive care is a better way to measure the health burden of the virus.

“In Maryland, for example, hospitalizations are currently at an all-time high,” Klein said, “but not with intensive care use.” During last year’s surge in Delta, hospitalizations in the state were much lower than they are now, but nearly every All patients were very ill.

“As we move forward, we need to make some decisions about how to adjust our reporting,” Klein said. “Are we going to look at weekly reports to separate people who are admitted with COVID from people who are admitted with COVID? That depends on how we plan to treat people who test positive but are not sick.

“Are we going to quarantine them? Maybe we’ll stop doing that. We’re not going to quarantine people who have the flu.”

test shortage

Testing shortages, inaccuracies and delays have plagued the U.S. response to COVID-19 from the beginning. As a result, many county and city health departments have been unable to release daily case counts, said Adriane Casalotti, director of public and government affairs for the National Association of County Health Officials.

During this omicron surge, long lines at testing centers continued to stress city and county health departments, she said, especially when they were flooding the public with questions about the CDC’s recent shift in COVID-19 quarantines.

In December, the CDC announced it was reducing the quarantine recommendation from 10 days to five days. The American Medical Association and other experts have called weaker recommendations risky, advising people to get tested before ending their isolation.

With home testing still in short supply and people waiting hours in public places to get tested, it’s difficult for local health authorities to advise people to get tested before they end their isolation, Casalotti said. On top of that, when local health departments try to impose stricter COVID-19 restrictions than the CDC, they often encounter backlash from the public.

When will the testing shortage ease? President Joe Biden announced this week that starting Jan. 15, insurers will be required to pay for up to eight tests per person per month. But pharmacies still lack testing.

Mara Aspinall, a professor of biomedical diagnostics at Arizona State University, expects the national supply of COVID-19 home tests to increase from 631 million this month to 732 million in February and 907 million in March. She explained that because many consumers buy tests to take with them when needed, not all tests are used within the same month of purchase.

Since the omicron landed in the U.S. in December, Aspinall estimates the average American has used 4 million home tests a day, a figure that rose to 5 million a day last week as the company distributed tests to employees returning to the field. Whether that number stays the same, rises or falls, she said, depends on the spread of the virus.