The number of COVID infections is being underestimated in the world, experts warn

10 days ago, the number of people infected by COVID daily in the world averaged 1.5 million and experts from the World Health Organization (WHO) were already warning that fewer tests were being done to track the coronavirus and that this was a problem to monitor the mutations that the pathogen makes over time.

Yesterday, Johns Hopkins University in the United States, which counts the number of daily positives thanks to reports sent by countries to WHO, recorded only 320,000 new infections in just 24 hours.

There is no doubt that the Ómicron variant is in retreat. But experts warn that new subvariants such as BA.2, BA.4 and BA.5 from Ómicron are advancing and that there are difficulties in tracing them because of the few tests that nations and individuals today carry out privately on a daily basis.

“Several countries are drastically reducing diagnostic tests” on COVID-19. This inhibits our ability to see where the virus is, how it is spreading and evolving,” World Health Organization Director-General Tedros Adhanom Ghebreyesus warned last week.

He added: “Testing continues to be a vital tool in our fight against the pandemic, as part of a comprehensive strategy,” said the official who observes that there is a real risk that scientists around the world will “lose sight” of new variants of the coronavirus. as tests plummet and the key surveillance infrastructure for this pathogen that has not yet left is dismantled.

The US Institute for Health Metrics and Evaluation estimates that only 7% of positive COVID-19 cases are detected in that country, which means that case rates are actually 14.5 times higher than those officially reported. The last time the infection detection rate was so low was at the beginning of the pandemic, in March 2020. The significant decline in data reporting and nationwide in public testing has left health experts worried that officials may be missing viral surges and not knowing about true positivity rates in the country, given the lack of information.

“I think we are dramatically underestimating cases. We're probably only detecting one in seven or one in eight infections. So when we say there are 30,000 infections per day, it's probably closer to a quarter of a million infections per day,” said former FDA Commissioner Dr. Scott Gottlieb, during an appearance on CBS's “Face the Nation” on Sunday.

The prestigious Argentine neurologist Conrado Estol, who has become a specialist in information and data during the pandemic, told Infobae that the epidemiological moment is essential to determine the tests.

“In Argentina, with a low infection rate as is the case these days, it is not so critical to count the number of positives. So, the hard numbers of hospitalization and death are what effectively confirm that there is a low number of infected people. However, it is important to test in the midst of an outbreak, as is happening in Asia or Europe. It is likely to increase also in the United States, where in the last week hospitalizations increased by 29% in New York, in people over 60 years of age due to BA.2. In fact, in New York State, they have already registered the subvariant BA.12 and BA.12.1, which are much more contagious than Ómicron's BA.2,” Estol said.

“But two important things have happened. In the case of Europeans, who are advanced in booster vaccination, unlike what happens in the US or in Argentina, who are lagging behind in the application of third doses, the disease was very minor. That meant that many people with minor symptoms were not tested. The other variable is that people who test positive through a home test, do not appear in most cases on the official lists of countries. It is also known that it is widely used, since when taking the test, the person can know if they have a cold, flu or COVID-19, and thus isolate themselves,” added the expert.

He added: “But the availability of these antigen tests and the fact that people know that most people have colds or symptoms have decreased the number of infected people, which on the other hand was always the case. There were always many more real cases than those reported. It would be important that, in the face of an outbreak, the State provide PCR tests as should have been done in Argentina en masse during the pandemic.”

Dr. Liliana Vázquez, an infectiologist (MN 67434), a specialist in perinatal and pediatric infectology at Funcei, told Infobae that tests were always low in Argentina. “Today there are different ways to evaluate the disease. Both the number of cases is not a parameter to do so. The figure to follow today is the number of boarding schools in relation to the dead.”

“In this second stage of the disease in the country, which finds us with a large number of vaccinated people, does not necessarily imply knowing the total number of cases, when the behavior of the disease today is different. Today we no longer have the morbidity and mortality that we had before. That is why it is important in our country to remain attentive to the number of people who are interned due to COVID, the number of available UTI beds and mortality,” said the expert.

“An effective public health response depends on high-quality, real-time data,” said Dr. John Brownstein, an epidemiologist at Boston Children's Hospital. “Underreporting, driven by changes in testing behavior, lack of public interest, and underfunded local public health departments, create a perfect storm of misleading case counts and hospitalizations.” Since last summer, dozens of states in the US, along with federal agencies, have chosen to reduce regular reporting of COVID-19 data. A shrinking number of states are still offering daily reports of COVID-19 data, with most now switching to an alternate-day schedule or even a weekly schedule.

“With changing case definitions for hospitalizations, declining testing, and increased use of rapid home testing, data on COVID-19 in the US has become increasingly difficult to interpret,” said Sam Scarpino, vice president of pathogen surveillance at the Foundation Rockefeller. As a result, test levels are now at their lowest point since June 2020, with official test numbers falling by more than 80% since the beginning of the year, with only half a million tests reported daily, compared to 2.5 million tests reported nationally during viral peak in January .

Dozens of states have also moved to close public testing sites, as at-home COVID-19 testing has become more accessible. “These are waters unknown to us with this virus. We're probably underestimating the number of infections we're having right now, because many of the infections are asymptomatic or minimally symptomatic, and you'll lose it if people do it at home and don't report to a central bank,” Dr. Anthony Fauci said in an interview last week, reiterating that it's impossible to predict how COVID-19 will develop in the coming months.

Hospitalization data

The Centers for Disease Control and Prevention recently updated its guidelines on how it determines the level of risk of COVID-19 in communities. Rather than relying primarily on the percentage of positive tests, the method now emphasizes hospital admissions and occupied beds along with the count of COVID-19 cases. For many officials, monitoring COVID-19 hospitalizations related to the virus has been key to assessing the state of the pandemic. However, in recent months, hospitalization data have also become less accessible.

Earlier this year, the Department of Health and Human Services eliminated the requirement that hospitals report several key COVID-19 metrics, including a daily total of the number of deaths from COVID-19, the number of patients ventilated and overflowed in the emergency department, and information on critical shortages of staff.

“Hospitalization data is now considered a key metric that defines the severity of the pandemic by CDC. At the same time, with massive gaps in hospital and state data, it is difficult to set this data as a gold standard by which policy decisions can be made,” Brownstein explained. Meanwhile, demand for COVID-19 PCR tests is falling as more people use rapid tests at home, the results of which are often not reported to public health agencies.

In the US, all of this has led some jurisdictions to reduce COVID-19 testing capacity and contact tracing efforts. “We are in a place where we can focus a little more on serious illnesses because we have such high immunity in our population, both through vaccination and through recent infections, particularly with Omicron,” said Dr. Crystal Watson, principal researcher at the Johns Hopkins Center for Health Safety.

However, this could lead to gaps in our understanding of the extent of COVID-19 circulation. “Hospitalizations are a lagging indicator, so it's really important to stay vigilant where we can to get an early warning that an increase is coming and to watch for new variants that may have consequences,” Watson concluded.

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