It’s about to get a whole lot harder to anticipate and prevent another Covid-19 surge or outbreak in U.S. With the U.S. declaration of Covid-19 as a public health emergency scheduled to expire on May 11, the U.S. Centers for Disease Control and Prevention (CDC) is planning to cease reporting Covid-19 Community Levels as it has been doing, according to Brenda Goodman reporting for CNN. The CDC won’t abandon all Covid-19 surveillance and will reportedly continue to display what’s happening with Covid-19 hospitalizations and deaths. But hospitalizations and deaths tend to increase only after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already increased in an area. So unless you have a time machine or can somehow enter the quantum realm like the Avengers did, such measures won’t really going to help anyone prevent another Covid-19 uptick. Yep, the U.S.’s reactive rather than proactive approach to the Covid-19 pandemic is about to get even less proactive.
Relying on hospitalizations and deaths to determine what to do can be sort of like saying that you are going to wait until you’re fired or the company is bankrupt before determining whether you need to improve your job performance. Or waiting until the divorce papers arrived before saying, “Hmm, maybe I should start doing the dishes and not do all that that cheating stuff?” Hospitalizations tend to occur about one to two weeks after people have gotten infected. That’s because people don’t typically say, “Oh, someone with Covid-19 coughed in my face. Time to rush to the hospital.” Deaths come even further out after the virus has spread and after hospitalizations happen because that’s how time works. So once hospitalizations and deaths have risen, it’s kind of too late to reinstitute Covid-19 precautions such as face mask requirements. The horse is already out of the barn. The cat is already out of the bag. The Senator has already left for Cancun.
There will still be wastewater testing in communities. But it’s not yet clear what portions of the U.S. will have this available and how this will be reported. Goodman’s article did mention that the CDC will still track Covid-19 sort of like how it tracks the flu. There’s one itty, bitty, long problem with that. Covid-19 is not the flu. Experts have been trying to tell everyone for over three years now that the SARS-CoV-2 is not like the influenza. You don’t see too many people saying that they have long flu. While the Covid-19 hospitalization and death rates have come down, they are still higher than that of the flu. The SARS-CoV-2 can go airborne in ways that influenza virus cannot. Plus, the SARS-CoV-2 hasn’t become seasonal like the flu yet. It may be moving that direction but, and here’s a big but you cannot lie, there are still plenty of Covid-19 in the Spring and Summer unlike the flu.
The big continuing problem is that the U.S. never really got an effective surveillance system in place for Covid-19. That was a huge problem in 2020. Everyone ended up relying on an idea hatched by Ensheng Dong, a graduate student at Johns Hopkins University and his adviser Lauren Gardner, PhD, Director of the Johns Hopkins Center for Systems Science and Engineering. They started the Johns Hopkins Coronavirus Resource Center in early 2020 to compile Covid-19 case reports from different states and municipalities and posting them on a website. The New York Times also set up a website to keep the pubic informed about Covid-19 levels throughout the country. Through all of 2020, these two websites were the go-to places for the public, journalists, the scientific community, and pretty much everyone. In other words, the team of faculty, graduate students, and post-docs at Johns Hopkins University and The New York Times were doing what the big old government with all that taxpayer money should have been doing.
So what the federal government doing in 2020? Well, you had political leaders claiming so often that the pandemic was “turning the corner” that it felt like a freaking polygon. They also kept trying to find others to blame such as trying to call Covid-19 the “kung-flu.”
Things got somewhat better in 2021 with the CDC showing color-coded county maps based on the weekly rates of new reported SARS-CoV-2 infections and the percentage of Covid-19 tests that ended being positive. But then things started getting confusing again. Over the 2021-2022, the CDC would change what the colors represented on the maps and eventually segued into using the current Covid-19 Community Levels maps late February 2022. These Community Levels focused more on Covid-19 hospitalizations and hospital bed availability and less so on how much transmission was actually occurring in the community. This literally turned the maps different colors, going from maps that were largely red to ones that were more yellow and green.
Isn’t that like trying to change how a game is being scored when you are losing in the middle of a championship game? Imagine being down 28-7 in the Super Bowl and saying, “OK, all those previous touchdowns are now worth only 1 point. See, we’re now down only three points.” Soon after the maps changed colors, it appeared as if face masks would no longer be recommended in many parts of the country. When you change a warning system, a grading system, or any type scoring system in midstream, the risk is that people will no longer take it very seriously. The belief may be that, “Oh, it isn’t real. It will change again if we wait long enough.”
At the same time, the surveillance system hasn’t changed to account for changes in testing. Once the Biden Administration began pushing using home Covid-19 testing kits, fewer and fewer people went to formal Covid-19 testing sites. This meant that many Covid-19 positive tests probably went unreported, which made Covid-19 case counts even more unreliable. One way to compensate for that situation would have been to set up sentinel testing sites around the country where everyone is periodically screened. This would get a better sense of what the virus may actually be doing.
In an April 29, Maria Van Kerkhove, PhD, the WHO’s Technical Lead on Covid-19, emphasized the importance of continued surveillance with various XBB subvariants of the SARS-CoV-2 circulating worldwide and “Each week millions of people (re)infected, hundreds of thousands are in hospital & thousands are dying from #COVID19”:
Yeah, the Covid-19 pandemic is not yet over.
It’s not clear when exactly the CDC will stop reporting Covid-19 community levels. It could come very soon, potentially in the coming week. With the end of the public health emergency, the government won’t be able to require labs around the country to keep reporting results of their Covid-19 testing anymore. States and municipalities around the country will likely change how frequently they report Covid-19 cases and outcomes as well. With some states reporting cases as infrequently as monthly, this will make it even harder to anticipate another Covid-19 uptick. So as they say, hello darkness my old friend. The public will be more in the dark of what’s happening with Covid-19 which may be welcome by some politicians so that don’t feel obligated to do something about it.
This isn’t to say that things aren’t getting better with the Covid-19 pandemic. The continuing problem, though, is that with each change in Covid-19 policy there hasn’t seemed to be a very clearly communicated transition plan at the national level. If you are going to stop reporting Covid-19 community levels then how exactly are you going to anticipate any future upticks or waves? How will new variants be tracked when labs aren’t providing the same data? What are the three-month, six-month, one-year, and beyond plans for Covid-19 surveillance?
As the old saying in disease surveillance goes, you can’t prevent what you can’t see. You can’t fight what you can’t see either. Information is power. A problem is not going to simply go away just because you aren’t following it. In fact, quite the opposite, ignoring a problem can be like putting a plate of spaghetti under your bed. You never know what may become of it. It continues to be challenge getting political leaders to see all this.