Current COVID-19 cases are a fraction of what they were at the height of the Omicron wave.
But many people in the country may be noticing an apparent spate of cases in their social circles.
Health experts say this anecdotal evidence may not be a simple fluke as the US may be caught in a “hidden” wave – one much larger than reported data suggests.
“There is a lot of COVID out there. I see it in my social circles, in my children’s schools and in the infection counts of hospital workers,” said Dr. Shira Doron, an infectious disease physician and hospital epidemiologist at Tufts Medical Center in Boston, told ABC News. “We’re definitely in a wave.”
While it is clear that infection rates have been rising steadily in recent weeks to the highest reported levels since mid-February, scientists concede that given the likely “substantially” undercounting of infections.
This is partly due to changes in data collection and reporting, and the proliferation of home testing. Some state officials report that health departments and health facilities have also ended the traditional tracking of COVID-19 patients, which epidemiologists say makes it harder to know how many patients are entering hospitals in need of care.
Last month, former FDA Commissioner Dr. Scott Gottlieb that officials were likely to pick up only “one in seven or one in eight” infections.
And President Joe Biden’s new coronavirus response coordinator, Dr. Ashish Jha acknowledged that there were “many infections” last week, likely the result of highly infectious omicron subvariants spreading across the country.
“We know that the number of infections is actually much higher. It’s hard to know exactly how many, but we do know that many people are diagnosed with home testing,” explained Jha.
Every day, more than 100,000 Americans officially test positive
The country’s reported daily case average, which officials say consists largely of PCR testing, is now more than 100,000 new cases reported daily, according to the Centers for Disease Control and Prevention (CDC).
In recent weeks, almost every state in the country has reported an increase in COVID-19 infections and the number of virus-positive people hospitalized.
The Northeast remains the country’s most notable known COVID-19 hotspot, although surges in some cities like Boston appear to be showing signs of slowing.
According to CDC community levels, more than 45% of Americans nationwide live in an area at moderate or high risk of COVID-19.
The high community level indicates “high potential for health care system burdens” and “high levels of serious illness,” and as such, the CDC recommends that people wear a mask in public indoor spaces, including schools.
The number of hospital admissions has increased in recent weeks, but not as much as infections.
However, as the spring and winter progressed, hospital data has also become less accessible, leading some experts to believe the total number of patients may also be undercounting.
Earlier this year, the Department of Health and Human Services ended the requirement for hospitals to report several key COVID-19 metrics, including a daily total of COVID-19 deaths, the number of overcrowded emergency rooms and patients on ventilators, and information about critical staffing shortages .
Additionally, certain states have stopped directly reporting statistics, including hospital bed usage and availability, COVID-19-specific hospital metrics, and ventilator use.
But Doron said a potential significant spike in infections without an overwhelming number of hospitalized COVID-19 patients could be a promising sign.
“If cases are really much higher than what we’re seeing, that means the ratio of hospitalizations to cases and deaths to cases is even lower than what we’re seeing, and we’re already seeing a ‘decoupling’ between cases and hospitalizations and deaths,” Doron said, which may indicate the virus is nearing a form that Americans can live with.
Still, Doron added, “However, at the population level, COVID poses a higher risk because there are so many cases and hospitals are already so full of COVID and non-COVID patients.”
A departure from traditional testing
In recent months, states from coast to coast have moved to shut down public testing sites, with a plethora of rapid COVID-19 tests now available at pharmacies and through the federal government.
“While home testing has provided broader population access to infection status and hopefully greater access to treatment, it has also created a major blind spot in our public health surveillance efforts,” John Brownstein, Ph.D., an epidemiologist at Boston Children’s Hospital and said an ABC News staffer. “The recent BA.2 surge has been obscured by the change in testing behavior and likely delayed decisions about public health interventions.”
The move away from traditional COVID-19 testing has left some health professionals concerned about ongoing problems in accessing adequate health care and preventative health tools such as testing and antiviral treatments to protect vulnerable communities.
According to ABC News’ analysis last summer of pharmacy locations across the country, there are 150 counties that don’t have a pharmacy, and nearly 4.8 million people live in a county that has only one pharmacy for every 10,000 people or more .
“What worries me even more is what might happen in communities and families with fewer resources. Public testing sites have closed, home testing at drugstores is expensive, and navigating the system to order free tests or have tests reimbursed by insurance requires literacy and technology,” Doron said.
Going forward, broader understanding of infection through home testing and sewage sampling will be critical to fully understanding the magnitude of surges and protecting all Americans, Brownstein said.
Virus does not go away in countries with low transmission
This winter, the CDC released a new map of risk levels in the wake of the Omicron surge, moving away from focusing on the level of transmission within a community and shifting attention more to hospital capacity and admission rates.
The launch of the new map, designed to help people and local officials assess when to take potential mitigation action, has sparked controversy among some Americans, Doron explained. While some people argued that the metrics switch was long overdue and a sign of the times, others said the move was premature.
“Some people were happy because they felt that we had exceeded the period where we had to re-impose restrictions and mandates every time cases increased, given the widespread immunity of the population to vaccination and infection,” he said Doron. “It has made other people angry because moving to medium or high risk status now requires an increase in hospital admissions, which are lagging indicators, in other words there may be many cases before hospitals are full, and some people could choose to take extra precautions sooner.”
Brownstein noted that with the shift away from transmission rates, some Americans may not be fully aware of the virus’ ongoing dangers, since a green county doesn’t necessarily indicate the virus will simply go away.
“Unfortunately, while the CDC map reflects a reduced risk of serious complications from COVID infection, it hides sites of high community transmission,” Brownstein said. “This risk masking can provide a false sense of security, especially for those at high risk of hospitalization and death.”