COVID may be on the rise in the US and we may not know it

BILLIONThe surge of Covid cases in some parts of the US, just as testing efforts dwindle, has raised the specter that the next big wave of the virus could be difficult to detect. In fact, the country may be in a boom right now and we may not even know it.

Testing and sequencing of the virus is critical to responding quickly to new outbreaks of the virus Covid. However, as the country tries to weather the pandemic, demand for lab-based testing has decreased and federal funding priority changed. This change has forced some testing centers to close while others have raised prices in response to the end of government subsidized testing programs. People increasingly rely on rapid tests at home if they decide to get tested. But those results are rarely reported, leaving public health officials with little understanding of how widespread the virus really is.

“There is always more transmission than we can detect,” said Abraar Karan, an infectious disease physician at Stanford University. “That’s even more true now than it was earlier in the pandemic.”

Despite groundbreaking scientific advances like vaccines and antiviral drugs, public health experts say the US Covid defense system appears to be getting weaker over time, not stronger. than.

“We’re in a much worse position,” said Julia Raifman, an assistant professor of health law, policy and management at the Boston University School of Public Health. “We learned more about the virus and how to tackle it, but then we didn’t do what we needed to do to tackle it.”

In late February, the Centers for Disease Control and Prevention began relying on hospital admissions and ICU capacity to determine risk at the community level. It’s a change from relying on Covid case numbers and the percentage of positive tests, seen by many as a snapshot of how much virus is circulating in a community. certain. Several states, including Arizona, Hawaii, Nevada and Ohio have now completely stopped reporting daily Covid data to the CDC, making it more difficult to gauge the progress of the pandemic in those states.

According to the CDC, much of the country is still considered low risk. Public health experts say this is false, however, hospitalization and death often occur days to weeks after initial infection. Without extensive testing, that could make it impossible to detect a mutation until it’s too late to do anything about it.

“The CDC is underestimating and downplaying cases,” said Gregg Gonsalves, an infectious disease specialist at the Yale School of Public Health. “Their alarm bells won’t go off until we see an increase in hospitalizations and deaths, which are lagging indicators.”

Transmitable variant

However omicron tends to cause milder symptoms in healthy, vaccinated people, its transmissibility has led to a spike in cases that has caused hospitalization rates to break previous pandemic records there. This variation is also responsible for the record number of children going to the hospital. Black people have hospitalize at twice the rate of whites during the rise in New York. Vaccine extremely effective at preventing severe if not always preventing cases, one of the reasons the indicators turn to hospital admissions to gauge the status of the virus. But not tracking cases creates a blind spot. Experts say it is important to continue monitoring them to protect vulnerable communities and respond to new waves of the virus before health systems are overwhelmed.

In recent weeks, cases have begun to climb in places like New York, Massachusetts and Chicago, but conflicting public messaging has caused confusion. National leaders have largely declared victory over the virus, but some local governments have begun to urge caution. New York City delays lifting a mask quest for children under the age of 5 due to the growing number of cases, and the city’s health commissioner recommends that New Yorkers wear masks indoors.

Even in New York, however, things look very different than they did at the start of previous rallies. Gone are the days of long test lines and sold out antigen tests. And across the country, pop-up test centers, once the headquarters of the pandemic, are starting to disappear. Although state testing facilities continue to operate in some regions, those without health insurance are facing high prices. And as of March 22, the U.S. Health Resources and Services Administration will no longer accept claims from medical providers for Covid testing.

Also, do a quick home check has increased. The problem is that CDC doesn’t not required People report positive home test results so rarely are home test results included in public health data.

“We’re probably underestimating the number of infections we’re seeing because many infections are either asymptomatic or present,” said Anthony Fauci, a top medical adviser to President Joe Biden. mild symptoms and you’ll miss people doing it at home,” Anthony Fauci, President Joe Biden’s top medical adviser, told Bloomberg TV on Wednesday.

In New Jersey, for example, Stacy Flanagan, Jersey City’s director of health and human services, said that in the past three months, she’s had only two people call to report a positive home test. Cases are continuing to occur in the city with an average of 64 new cases per day, according to the health ministry data. This is almost double the number of daily cases reported a month ago.

Dave Henry, health officer for more than a dozen towns in Monmouth County, New Jersey.

Public health professionals were left to compile data from a variety of sources. For Rick Bright, a virologist and CEO of the Rockefeller Foundation’s Institute for Pandemic Prevention, that means using CDC data as well as several other sources to understand the spread of Covid. “Unfortunately, we still have to go to some websites to try to put together what’s really happening around the country.”

Other metrics such as wastewater monitoring and even air sampling could eventually become useful alternatives in understanding how much the virus is circulating in the community. For weeks, sewer data showed cases were on the rise in some parts of the US – heralding the positive surge that places like New York and Massachusetts are now seeing.

In the nation’s capital, more than 50 people who attended the elite Gridiron Club dinner on April 2 have tested positive for coronavirus, the Washington Post reported – at least 8% of those who attended. The list of those infected includes the US Attorney General, Commerce Secretary, aide to Vice President Kamala Harris and first lady Jill Biden, and the president’s sister.

House Speaker Nancy Pelosi, who did not attend the dinner, also had positive results, raising concerns about her time near President Biden before her diagnosis.

Test at home

The White House believes that there is enough data on Covid in circulation to catch the next increase. Tom Inglesby, senior policy adviser on Biden’s Covid-19 Response Team, said the CDC receives 850,000 lab-based test results each day, which he believes is sufficient to detect trends in rates. positivity and prevalence of variants.

“It’s true that there’s a bigger shift now to switching to over-the-counter testing, that’s definitely happening,” Inglesby said in a panel discussion. “There are various efforts underway to try to gauge whether people are willing to voluntarily report some small portion of those tests that are being done at home.” A biotech company, Ellume, has rolled out home testing and an app that automatically reports positive tests to CDC through a secure, HIPAA-compliant connection.

Meanwhile, the CDC has committed to strengthening its wastewater monitoring efforts. Organ do not do There’s still data from sites in every state, so even accessing some samples that are already underway can be helpful. Environmental monitoring, like many other tools for monitoring Covid, could be at risk without additional funding from Congress. On Tuesday, lawmakers reached an agreement to reallocate $10 billion for pandemic preparedness, which press secretary Jen Psaki said would fund “most immediate needs” such as antiviral drugs and testing. But that bill remains unclear in the Senate.

“The information we get from the CDC will be less reliable, less clear, and lose momentum,” Bright said. “There are really big concerns about the lack of sustainable funding to keep the momentum going and get the job done for the surveillance we’re building to contain the pandemic.”

There may be a lesson from the 1918 flu pandemic. After cases began to decline after the first two waves of the flu virus, Public sentiment has changed and many health measures Has been raised. But in 1919, at the end of the pandemic, a fourth wave hit New York City, causing a spike in deaths from previous waves, according to a government-funded research.

“Late pandemics are sometimes the most dangerous because people give up,” says Gonsalves from Yale.

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