Do the Omicron Numbers Mean What We Think They Mean?

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      Should we be focussed on case counts at all? Some experts, including Anthony Fauci, argue that hospitalizations are now the more relevant marker of viral damage. More than a hundred and fifty thousand Americans are currently hospitalized with the coronavirus—a higher number than at any other point in the pandemic. But that figure, too, is not quite what it seems. Many hospitalized COVID patients have no respiratory symptoms; they were admitted for other reasons—a heart attack, a broken hip, cancer surgery—and happened to test positive for the virus. There are no nationwide estimates of the proportion of hospitalized patients with “incidental COVID,” but in New York State some forty per cent of hospitalized patients with COVID are thought to have been admitted for other reasons. The Los Angeles County Department of Health Services reported that incidental infections accounted for roughly two-thirds of COVID admissions at its hospitals. (Pediatric COVID hospitalizations have also reached record levels, probably because Omicron’s transmissibility means that many more kids are contracting the virus; there’s little evidence that the variant is causing more severe illness in them, though.)

      Clarifying the distinction between a virus that drives illness and one that’s simply along for the ride is more than an academic exercise. If we tally asymptomatic or minimally symptomatic infections as COVID hospitalizations, we risk exaggerating the toll of the virus, with all the attendant social and economic ramifications. If we overstate the degree of incidental COVID, we risk promoting a misguided sense of security. Currently, the U.S. has no data-collection practices or unified framework for separating one type of hospitalization from another. Complicating all this is the fact that it’s sometimes hard to distinguish a person hospitalized “with COVID” from one hospitalized “for COVID.” For some patients, a coronavirus infection can aggravate a seemingly unrelated condition—a COVID fever tips an elderly woman with a urinary-tract infection into delirium; a bout of diarrhea dehydrates a man admitted with sickle-cell disease. In such cases, COVID isn’t an innocent bystander, nor does it start the fire—it adds just enough tinder to push a manageable problem into a crisis.

      It is a positive development that we’re able to engage in this discussion at all. With Alpha and Delta, almost all COVID hospitalizations were related to the infection. The situation is different with Omicron—a function both of its diminished ability to replicate in the lungs and of its superior capacity to infect people who’ve been vaccinated or previously contracted the virus. Still, parsing the numbers in a moment of crisis can seem a subordinate aim. Omicron is imposing an undeniable strain on the health-care system. Last week, a quarter of U.S. hospitals reported critical staffing shortages. Many have postponed non-urgent surgeries, and some have asked their employees to continue working even after they’ve been infected. Some states have called in the National Guard; others have enacted “crisis standards of care,” whereby overwhelmed hospitals can restrict or deny treatment to some patients—I.C.U. beds, ventilators, and other lifesaving resources—in order to prioritize those who are more likely to benefit.

      But this wave, too, shall pass—possibly soon. At the end of it, the vast majority of Americans could have some degree of immunity, resulting from vaccination, infection, or both. In all probability, we’d then approach the endemic phase of the virus, and be left with a complex set of questions about how to live with it. What level of disease are we willing to accept? What is the purpose of further restrictions? What do we owe one another? A clear-eyed view of the numbers will inform the answers. But it’s up to us to paint the targets.

      Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

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