The rise of Covid cases in some regions of the U.S., just as testing efforts wane, has raised the specter that the next major wave of the virus may be difficult to detect. In fact, the country could be in the midst of a surge right now and we might not even know it.
Testing and viral sequencing are critical to responding quickly to new outbreaks of Covid. And yet, as the country tries to move on from the pandemic, demand for lab-based testing has declined and federal funding priorities have shifted. The change has forced some testing centers to shutter while others have hiked up prices in response to the end of government-subsidized testing programs. People are increasingly relying on at-home rapid tests if they decide to test at all. But those results are rarely reported, giving public health officials little insight into how widespread the virus truly is.
“There’s always more spread than we can detect,” said Abraar Karan, an infectious disease physician at Stanford University. “That’s true even more so now than earlier in the pandemic.”
Despite groundbreaking scientific advances like vaccines and antivirals, public health experts say the U.S.’s Covid defenses appear to be getting weaker as time goes on, not stronger.
"We're in a worse position," said Julia Raifman, an assistant professor of health law, policy and management at Boston University School of Public Health. "We've learned more about the virus and how to address it, and then we haven't done what we need to do to address it.”
In late February, the Centers for Disease Control and Prevention began relying on hospital admissions and ICU capacity to determine community-level risk. That was a change from relying on Covid case counts and the percentage of positive tests, which are widely considered a better snapshot of how much virus is circulating in a given community. 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 progression of the pandemic in those states.
According to the CDC, the majority of the country is still considered low risk. Public health experts argue this is misleading though, given hospitalization and death generally occur days to weeks after initial infection. Without widespread testing, that could make it impossible to detect a surge until it’s too late to do anything about it.
“CDC is understating and downplaying cases,” said Gregg Gonsalves, an infectious disease expert at Yale’s School of Public Health. “Their alarm bells won’t go off until we see a rise in hospitalizations and deaths, which are lagging indicators.”
Transmissible Variant
Though omicron tends to cause milder symptoms for healthy, vaccinated people, its transmissibility led to such a huge spike in cases that it caused hospitalization rates to break previous pandemic records. The variant was also responsible for a record number of children going to the hospital. Black people were hospitalized at twice the rate of White people during the surge in New York. Vaccines are extremely effective at preventing severe disease if not always at preventing cases, one of the reasons metrics shifted toward hospitalizations to judge the state of the virus. But failing to track cases creates a blind spot. Experts say it is critical to continue to track them in order to protect vulnerable communities and respond to new waves of the virus before the health system gets overwhelmed.
In recent weeks, cases have started to tick up in places like New York, Massachusetts and in Chicago, but conflicting public messaging has caused confusion. National leaders have largely declared victory over the virus, but some local governments are starting to again urge caution. New York City delayed lifting a mask mandate for kids under 5 years of age due to rising cases and the city’s health commissioner recommended New Yorkers return to masking indoors.