Despite A Rising Wave of Infections, New Covid Cases Do Not Appear Severe

The greater number of people who have been vaccinated in addition to those who have had Covid have combined to reduce the severity of recent infections, keeping hospitalization rates low. JL

David Leonhardt reports in the New York Times:

The official number of cases has already increased 43% in the past two weeks. Nationally, though, hospitalizations have not yet risenIn several places where the number of cases has risen in recent weeks, hospitalizations have stayed flat. (In past Covid waves, by contrast, hospitalizations began rising about a week after cases did.) How could this be? Vaccines and booster shots are effective and universally available to Americans who are at least 12. Tens of millions of Americans have already been infected with the virus, providing them with at least some immunity.

A couple of weeks ago, the news was full of stories about high-profile people contracting Covid-19. The list included Attorney General Merrick Garland, Commerce Secretary Gina Raimondo, Speaker Nancy Pelosi, other members of Congress (like Joaquin Castro, Susan Collins, Adam Schiff and Raphael Warnock), New York Mayor Eric Adams and several Broadway stars (like Sarah Jessica Parker, Matthew Broderick and Daniel Craig).

Some of these infected celebrities were not exactly young. Collins and Garland are both 69. Pelosi is 82.

So far, however, none of their cases appears to be severe. These anecdotes are part of a trend. In several places where the number of cases has risen in recent weeks, hospitalizations have stayed flat. (In past Covid waves, by contrast, hospitalizations began rising about a week after cases did.)

Similar patterns are evident in Chicago and Seattle, as well.

How could this be? As is often the case with Covid, the answer is not completely clear. But at least some of it reflects the changing nature of the pandemic, many experts believe. The share of cases that turn into severe illnesses seems to be declining, for three main reasons:

• Vaccines and booster shots are effective and universally available to Americans who are at least 12. (Covid continues to be overwhelmingly mild among children).

• Treatments — like Evusheld for the immunocompromised and Paxlovid for vulnerable people who get infected — are increasingly available.

• Tens of millions of Americans have already been infected with the virus, providing them with at least some immunity.

To be clear, these trends will not eliminate severe Covid. The number of nationwide hospitalizations will probably rise in coming weeks, especially if cases continue to rise. The official number of cases has already increased 43 percent in the past two weeks, and hospitalizations have risen in a small number of states, like Vermont. Nationally, though, hospitalizations have not yet risen, probably for the same three reasons I listed above.

 

Even if hospitalizations do rise in coming weeks, a declining share of coronavirus cases that result in serious illness would be very good news, Dr. Craig Spencer, director of global health in emergency medicine at Columbia University, has pointed out.

“I haven’t seen a Covid patient in the E.R. in weeks and go to work now expecting not to,” Spencer told me, “despite a swirl of Covid in the community.”

Among other things, a decoupling of cases and severe illness would mean that hospitals were less likely to become overwhelmed during future Covid surges. When hospitals avoid getting swamped, they can provide care to every patient who needs it — which becomes another factor that reduces bad health outcomes.

‘Misleading’

Going forward, this newsletter will begin to pay less attention to statistics on coronavirus cases and more attention to statistics on hospitalizations. “Looking at the data in the same way we’ve been accustomed over the past two years can be misleading,” Spencer said.

We won’t completely ignore the case numbers, because they still have some relevance. But the cases data has become both less reliable and less meaningful than earlier in the pandemic.

It is less reliable because of the recent closure of many testing clinics and the shift toward at-home testing. The data on Covid hospitalizations and deaths doesn’t suffer from these problems and appears to be as accurate as it was earlier in the pandemic.

The cases data is less meaningful than it used to be because vaccines are universally available to U.S. adults — and vaccines tend to turn Covid into an illness of similar severity to a flu, including for the elderly and the immunocompromised. More recent treatments like Paxlovid play a role, too.

One telling comparison: In the county that includes Seattle (which keeps detailed data), the daily Covid death rate for boosted elderly people has recently hovered around two per million. That’s higher than the national flu death rate during a mild influenza season and somewhat lower than the rate during a heavy influenza season.

For boosted people (and children), the odds of severe Covid really do resemble the odds of severe influenza. And you don’t tend to see news stories every time a member of Congress or a Broadway star contracts the flu.

I understand why the country is still treating Covid as a much bigger deal. For one thing, the large number of unvaccinated people means that Covid is still killing about 500 Americans a day. For another, Covid has dominated life for more than two years, and we can’t simply flip a switch and return to our 2019 habits.

But nor would it be rational to treat the 2022 version of Covid as if it were identical to the 2020 version. It isn’t. Vaccines, treatments and even natural immunity have transformed the impact of the virus, especially for Americans who have chosen to protect themselves