Counting coronavirus cases just isn’t what it used to be.
It’s long been known that many coronavirus infections go unreported. Then the omicron variant blasted off the charts earlier this year — just as rapid, at-home tests became more commonly used (with their positives often going uncounted).
Now state health officials are changing course. When evaluating new public health actions, the state is pushing a renewed focus on tracking severe illness, hospital capacity, deaths and new variants.
That’s despite a recent uptick in confirmed infections. Because the increase hasn’t yet translated to an increase in severe illness or deaths — and omicron’s infectious subvariant, BA.2, appears to be fairly mild — keeping track of individual cases is becoming less important, state Secretary of Health Dr. Umair A. Shah said in a news briefing.
“Our focus is on hospitalizations, which remains flat and markedly less than what we were seeing in the peak of omicron,” Shah said.
The state Department of Health, whose COVID-19 data lags slightly compared to data from local health departments, recently started recording an increase in infections, from about 440 daily cases in mid-March to about 850 in early April.
COVID hospitalizations have remained stable for the past month, with a seven-day average of about 24 daily hospitalizations, down from a peak of about 308 in mid-January, according to DOH.
Deaths have continued to decline for the past few months, and as of mid-March, according to the most recent complete state data, fewer than five people were dying from COVID every day, down from nearly 60 a day in January.
While Shah said the state has “good capacity in our health care system,” hospital beds are still about 90% full, with about 4% in use by COVID patients, according to DOH data.
The increase in cases isn’t surprising, Shah said, given the recent end to statewide mask mandates and other restrictions.
“This is the transition we expected,” state epidemiologist Dr. Scott Lindquist said during the briefing. “… The need to count every case is not realistic nor is it going to be as useful as it was in the past.”
Lindquist compared future COVID surveillance to how the state tracks influenza, noting that DOH doesn’t count every case of the flu but still knows when flu season is starting or ending based on tracking general trends, like flu deaths or significant outbreaks.
“This is going to be our path forward with living with COVID,” Lindquist said.
While epidemiologists will continue to watch case counts, more of their attention will be directed toward monitoring variants, outbreaks, and severe illness and deaths, as well as genotyping and utilizing wastewater data as an early COVID warning system, Shah said.
Trevor Bedford, a leading infectious disease scientist in Seattle who has tracked the virus’s genome since the pandemic began, made similar comparisons between tracking COVID and influenza cases this week. Bedford noted the recent evolution of omicron’s subvariants in other parts of the world has provided a glimpse into how the virus might continue to change.
Still, health leaders pointed to vaccination and boosters as the best ways to avoid getting seriously ill. And though a federal court ruling struck down the nationwide mask mandate on airlines and transit this week, Washington’s health officials still recommended masking up while taking public transportation, especially during busy times.
“We respect the national guidance,” Lindquist said. “We respect the rules of the room as [they] apply, but we still feel the need for masks.”