I perceive several issues related to the controversy and decisions being made as the result of the appearance and measurement of COVID cases associated with the SARS-CoV2 Omicron variant. I can think of three:
- Using antibody levels as a measure protection
- Overusing positive case numbers
- Confusing measurement of hospitalization cases
Using antibody levels as a measure protection
Many times the media has used antibody levels as a measure of the level of protection from infection. The thinking goes, if your antibody levels are low you aren’t as protected as someone with high antibody levels. That maybe true to low virus exposure levels, but antibody levels are not a good measure of protection to higher levels of virus exposure levels. At low levels those antibodies may indeed block the virus from attaching to cells to cause infection, but at high levels of infection, those antibodies are going to be overwhelmed, and the memory B and memory T cells become the primary protection against further infection. However, few measure the effectiveness of those memory B and T cells.
Overusing positive case numbers
The U.S.A. is seeing more than 400,000 positive SARS-CoV2 infection cases per day, but how many of those positive cases are showing COVID symptoms? And how many of them are showing symptoms enough to be of serious concern to public health? Imagine if we determined the number of positive flu cases pre-Pandemic. These measurements would have been probably in the millions per day. What was important was how many of those cases were showing symptoms severe enough to cause them to be in the hospital or to die from flu. We should be focusing on hospital cases and deaths from COVID, not positive infections.
Confusing measurement of hospitalization cases
Since COVID hospitalization numbers are important, we need to know the number of people who have symptoms severe enough to be in the hospital. This is not what the current measure of positive cases in hospitals means today, instead most hospitals categorize anyone in their care who is positive for SARS-CoV2 as a positive case in their hospital, independent of how sick they may be. Many come to the hospital for other health care reasons, say a broken leg or a gun shot wound, and if they test positive for SARS-CoV2 infection, they get counted in the hospitalizations number, whether or not they have significant COVID symptoms which would have hospitalized them.1 This number may be half or more of the number counted in hospitals in the U.S.A.2 One study suggests that at least one-third of COVID hospitalizations are these so-called ‘incidental’ cases.3 The reporting agencies are not providing hospitals with a way to discriminate between those positive for SARS-CoV2 with moderate to severe symptoms and those who have no or mild symptoms, i.e., who wouldn’t even be in the hospital for their COVID symptoms, but are there for other reasons.
- ‘“National data don’t allow us to distinguish between people hospitalized because of Covid-19 and those who happened to test positive while admitted for something else,” said Jason L. Salemi, an epidemiologist at the University of South Florida…’ from How to Think About COVID Data Right Now, L. Gamio, L. Waananen Jones, and A. Schoenfeld Walker. NY Times, January 7, 2022.
- ‘These “incidental patients” may be more prevalent right now because Omicron is so transmissible. Some hospitals are reporting that these patients may make up as much as half of their hospitalizations.’ IBID.
- ‘About one-third of Covid hospitalizations fall into this category, according to a recent analysis at the University of California, San Francisco. In New York State, 43 percent of people hospitalized with Covid were admitted for other reasons.’ from The Morning Newsletter: A Growing Gap, D. Leonhardt and A. Wu. NY Times, January 11, 2022.