Hundreds of thousands of Americans each day are catching the Omicron variant of COVID-19. If they end up in the hospital, no matter the reason, the Centers for Disease Control and Prevention (CDC) will report them as a COVID-19 hospitalization.
From adults with broken arms to kids experiencing mental health crises, a vast swathe of the Americans testing positive for COVID-19 in hospitals aren’t there for COVID-19 at all. And yet, much of the media continues to report on record case numbers and skyrocketing hospitalizations without nuance.
This problem existed before Omicron. Back in September, researchers released a paper that found that in VA hospitals, more than one-third of COVID-19 hospitalizations were asymptomatic. All the way back in May 2021, two papers published estimated that children’s COVID-19 hospitalizations were overestimated by up to 40%.
But the CDC did not change how it collected and presented hospitalization data. Now, more public health officials and journalists are beginning to acknowledge the shortcomings in using hospitalizations as a meaningful metric to measure the state of the pandemic.
Dr. Cody Meissner, an expert in pediatrics and infectious disease at Tufts Children’s Hospital, said it’s problematic that the CDC hasn’t updated its reporting practices: “The CDC hasn’t really done that, because obviously it’s additional work, they have to collect additional information.”
“There are lots of those children who are in the hospital, especially now because Omicron is so contagious, they test positive but they have some completely unrelated illness such as trauma, so they need to be hospitalized but it has nothing to do with COVID-19. But the CDC still counts them as a COVID hospitalization.”
Every hospital in the country is testing every patient for COVID-19 upon admittance. This means that even asymptomatic cases, where the hospitalization has nothing to do with the virus, are reported as COVID-19 hospitalizations.
“What I am hearing from colleagues in the New York City hospital world is that up to half the recorded hospital Covid-19 cases recently (almost all Omicron) are people who checked in for other reasons (adults or children) and then tested positive with asymptomatic Omicron,” said Dr. John Moore, a professor of microbiology and immunology at Cornell University. “Remember that PCR tests can detect very low levels of virus for quite a while after an active infection has been cleared.”
This testing protocol isn’t applied to any other virus or respiratory illness comparable to COVID-19, be it pneumonia or influenza or other forms of SARS, said Dr. Monica Gandhi, a professor of medicine and infectious disease expert at the University of California San Francisco: “Historically, we have never screened patients for a respiratory virus when patients are admitted to the hospital with non-respiratory symptoms except COVID-19. WE did this for SARS-CoV-2 before vaccines because asymptomatic transmission could occur and the virus causes severe disease among some individuals.”
“So, we isolate patients with SARS-CoV-2 in their nose from other patients (and use different PPE as healthcare providers around them), even if they present with non-COVID defining illness.”
It can be difficult to pinpoint what portion of reported COVID-19 hospitalizations this accounts for, but there are some estimates out there, and they’re high.
“This occurred about 40% of the time for pediatric hospitalizations in careful chart review earlier in the pandemic, with adults deaths from COVID able to be downgraded to 25% less when accounting for this screening phenomenon,” Gandhi said. “This accounting becomes even more important in the context of a highly transmissible variant like Omicron … The NYC data shows that 50% of the hospitalizations in NYC are for other reasons than COVID.”
Gandhi and her colleague at UCSF, Dr. Jeanne Noble, believe that more than two-thirds of hospitalizations at their hospital aren’t for COVID-19.
Democratic New York Gov. Kathy Hochul recently announced her state would begin reporting COVID-induced hospitalizations and incidental positive tests. But most other states aren’t following suit, and Omicron is making the problem worse due to the fact that it’s far more contagious, but also less severe, than prior variants.
“Because of the unique characteristics of Omicron there has been a divergence between those hospitalized with COVID-19 and those hospitalized because of COVID-19. This really wasn’t a major proportion of cases with prior variants however it is becoming more commonplace because of Omicron’s spread and the fact that many people are fully vaccinated and having extremely mild or no symptoms,” Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security and expert in infectious disease, told the Daily Caller.
“Omicron is a game-changer in this regard, as it definitely now IS skewing the statistics,” Moore wrote. “In other words, until now the ‘incidental infection cases’ just didn’t matter all that much and didn’t affect policy/perceptions. Now, it seems different.”
Moore added that the data is even more skewed in highly-vaccinated areas because serious infections are rare in vaccinated individuals, while hospitalizations in the unvaccinated are more likely to be for COVID-19 than incidental.
So what is a better metric to use to gauge how bad COVID-19 is hitting certain communities? There isn’t a consensus, but the experts who spoke with the Daily Caller had some ideas.
“A better metric may be to look at those individuals hospitalized who are Covid positive and also receiving dexamethasone,” Adalja said. Dexamethasone is a medication recommended by health authorities for patients who need supplemental oxygen or mechanical ventilation.
“What matters most is severe infections and hence ICU admission numbers and deaths. They are what needs to be tracked,” Moore argued.
Deaths are increasing as Omicron sweeps across the nation, according to the CDC. Although they aren’t surging at nearly the rate of cases or hospitalizations, which may be a sign of things to come with a highly-immunized population and a dominant, milder variant.