As Omicron gallops across the globe, some countries begin to ask the once unthinkable: Should we just stop counting cases?
Since COVID cases hit an all-time high in January in the U.K., case numbers have been steadily falling. That is, until this past week.
The daily number of positive tests being reported in the U.K. averaged above 90,000 last week, with experts and epidemiologists blaming loosening restrictions, back to school measures, and waning immunity for the stalling case decline.
But as high daily caseload figures have led some experts to push for the continuation of robust measures, others are suggesting quite a different course of action: that we stop using case numbers as the key metric, because in the age of Omicron they don’t adequately represent the risks of the disease.
That, in a sense, we stop counting.
Panic and fear
Case counts “are causing a lot of panic and fear, but they don’t reflect what they used to, which was that hospitalizations would track with cases,” Monica Gandhi, an infectious disease specialist and professor of medicine at University of California, San Francisco, said in the Guardian.
In an online interview, Gandhi notes that Omicron has caused a dramatic uncoupling between case numbers and hospitalization rates; she argues the disease is endemic and the latter metric is a far better way of tracking how we are doing with the virus.
“Once you have accepted the virus is endemic, just like influenza, then you never track cases because we never screen like this for any other viruses; we track what is causing disease and getting people hospitalized,” Gandhi said.
Tim Spector, the epidemiologist behind the ZOE COVID Symptom Study app, similarly notes that watching daily case numbers constantly rise and fall has a binary effect on people. “People are unfortunately moving into these two camps of either still very frightened and not moving, and the others pretending there’s nothing wrong at all,” he said, noting it’s not about the numbers but about “presenting data in a way that puts it in context.”
“For the public it’s quite a useful metric, but at the same time they should be saying, ‘But even if you do get it, you are less likely to go to the hospital with Omicron than with Delta,’” Spector told Fortune.
“It’s becoming impossible”
One of the first countries to plan a move past daily case counts is Spain, which has already called on the European Union to treat COVID-19 as an endemic illness akin to the flu. The country is preparing to move to a system in which it counts how many people test positive in a statistically significant sample and then estimates COVID cases, rather than counting each diagnosed infection—similarly to how the country counts other respiratory illnesses.
“It’s becoming impossible,” said Amparo Larrauri, head of the influenza and other respiratory diseases at the National Center of Epidemiology of the Carlos III Health Institute. “Given how tremendously transmissible COVID is right now, it is an enormous challenge to strictly meet universal surveillance protocols,” Larrauri told the Spanish daily El País.
One of the early stalwarts of draconian COVID-zero policies—Singapore—is also coming around to viewing case numbers as less important.
For much of 2020 and 2021, Singapore kept some of the most meticulous COVID-19 records of any government amid the pandemic, painstakingly tracking down every possible case of COVID-19 and reporting it publicly to the government.
Such case tracking was critical to Singapore’s largely successful COVID-zero strategy, which managed to keep COVID-19 at bay in the city-state while the virus ravaged the U.S. and Europe.
While still pursuing COVID zero, Singapore’s intensive contact-tracing measures differentiated between infections based on their threat to the community. Cases could be “linked,” meaning they had contact with a known COVID case, or “unlinked,” meaning that authorities could not determine how the person was infected.
But in transitioning from COVID zero to “living with COVID,” Singapore did away with the linked and unlinked distinction last September, saying the data was “no longer relevant” given Singapore’s strategy of living with COVID.
“When we stop linking cases, perhaps we accept that the virus is everywhere and we can loosen up some restrictions,” professor Paul Tambyah, president of the Asia-Pacific Society of Clinical Microbiology and Infection, told Singapore’s Straits Times in September.
More recently, amid a surge in Omicron infections, Singapore said it would stop differentiating between variants in reporting daily case numbers and that it was questioning the importance of reporting them at all.
“The fact is that with vaccinations working well and the Omicron variant being less severe, the top-line infection number is becoming less and less meaningful in our response to COVID-19,” Singapore Health Minister Ong Ye Kung said in a press conference on Friday.
Even as places like Hong Kong, mainland China, and Taiwan remain committed to COVID-zero strategies and fastidiously tracking case counts, much of the rest of Asia appears to be similarly changing its tune regarding new cases. In Australia, Prime Minister Scott Morrison has urged the country to “push through” its current record wave of infections instead of going into lockdown. He has also said that taking COVID tests is important only for connecting patients with doctors and no longer important as a measure of how widespread COVID is in the community as the virus becomes endemic.
“The reason we want people to report is not to count numbers,” Morrison said recently. “It’s about connecting people to care.”
Not likely to disappear
Tracking COVID case numbers is a way to measure the virus’s prevalence and incidence rate, which allows people to modify their behavior based on risk. While some countries and epidemiologists are forging ahead with the idea that COVID-19 is endemic, the U.S.’s top infectious disease specialist Anthony Fauci noted last week that the virus is not yet endemic because it still heavily disrupts our lives.
“I still think I would like to know how many people in my area currently are infectious with COVID, so I could know how careful to be,” the epidemiologist Spector said.
Malcolm Bennett, a professor of infectious disease in veterinary medicine at the University of Nottingham, told Fortune counting cases should stick around but “how those counts are interpreted and used” should be reconsidered.
“As a general comment I’d suggest that it’s not the counting that’s the issue, but rather knowing what you’re counting,” Bennett says.
Spector and Bennett both note that hospital figures can also be difficult to interpret as infections, disease, hospitalization, deaths with or caused by infections can skew numbers.
“I don’t think it’s black-and-white. I don’t think it’s a question of let’s totally ignore it and let it rip, we’re just worrying people. It is still much worse than a cold,” Spector said.
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