Analysis & Comment

Opinion | Why Hospitalizations Are Now a Better Indicator of Covid’s Impact

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By Monica Gandhi and Leslie Bienen

Dr. Gandhi is an infectious disease doctor and director of the Center for AIDS Research at the University of California, San Francisco. Dr. Bienen is a faculty member at the O.H.S.U.-Portland State University School of Public Health. She has researched zoonotic — from nonhuman animals to humans — disease transmission.

The world has a new Covid variant, Omicron, that’s expected to drive up cases if it becomes the dominant strain in the coming months. Much remains unknown, including how quickly Omicron will spread in more highly vaccinated areas, or whether it causes more mild disease than Delta, the variant the United States is continuing to battle.

Thankfully the variant is arriving in a different pandemic landscape in the United States: one in which vaccines, tests and, soon, oral treatments are available. The country will need a new framework for thinking about what comes next, and in highly vaccinated areas, focusing on a different set of numbers, hospitalizations, rather than case counts, can better tell us how we’re doing.

America is in the slow process of accepting that Covid-19 will become endemic — meaning it will always be present in the population at varying levels. But the United States has effective tools to deal with that reality, when it happens in the future.

Learning to live with the virus long-term will require changes in both mind-set and policy. Relying on Covid-19 hospitalizations as the most important metric to track closely will provide the most reliable picture of how an area is faring with the virus. And by focusing attention on the number of hospitalizations, health professionals can better focus on reducing them.

This becomes especially important as case counts become more complicated. A positive case of Covid-19 doesn’t mean what it used to if you are vaccinated. Most breakthrough infections, which will grow as the number of vaccinated people increases, so far remain mild. Although antibodies wane over time and may be affected by variants, T cells and B cells generated from vaccines should continue to offer protection against severe illness. Right now, in areas of high vaccination, an increase in cases does not necessarily signal a comparable increase in hospitalizations or deaths.

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