Why Hospitalizations May Be the Best Gauge of the COVID-19 Pandemic, Especially with the Omicron Variant

Some experts say that hospitalizations are a better benchmark of the COVID-19 pandemic than new cases, especially with the Omicron variant producing milder illnesses. Francine Orr/Los Angeles Times via GettyImages
  • Health officials have been reporting that the average daily number of new COVID-19 cases is rising in the United States.
  • However, some experts say that the focus should shift to COVID-19 hospitalizations as the primary indicators of the pandemic’s status, especially in light on the new Omicron variant.
  • They say that this is because almost all new cases among vaccinated people don’t develop into serious illnesses, so counting cases has become less important.

As the world enters its third year with the COVID-19 pandemic and the more than 5 million deaths that it’s caused, a growing number of experts say that the disease is here to stay, and it’s time we start looking at the novel coronavirus in a new light.

Specifically, they say that it’s time to measure the pandemic’s impact by shifting how we look at the statistics, especially with the Omicron variant rapidly advancing all over the world.

Even before the Omicron variant emerged last month, experts said that vaccinated people could still get COVID-19, but their risk of being hospitalized or dying is much lower than that of an unvaccinated person.

So, instead of looking at the case numbers, experts say that it’s time to focus on the severity of the pandemic through the number of hospitalizations. This is especially true as early research shows that Omicron, while probably more transmissible than other variants, is likely less severe when it comes to symptoms.

“It’s always been the way we should have been looking at it,” Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University in Tennessee, told Healthline. “Hospitalizations and deaths are much better documenters than new cases.

“Both measures, case rate and hospitalizations, continue to be important,” Schaffner continued. “Omicron clearly is more transmissible than Delta. In order to measure its rapid spread, case rates will be up front.

“We’re not entirely sure how virulent Omicron is. Most cases have been mild, occurring in vaccinated people. What will it do among an unvaccinated population, such as my state’s rural areas?

“It will take a bit of time for Omicron to get into such places. Once there, the hospitalization rate will once again become an important factor,” he explained.

“If Omicron is both highly contagious and generally mild, then we in the U.S. will be able to move from acute pandemic into more chronic, endemic COVID,” Schaffner predicted.

“However, the pandemic still will be active over much of the world. All the variants of concern have originated in other countries, so new virulent variants could arise and be imported here, once again. This comprehensive global view is necessary.

“Never underestimate the abilty of COVID to throw a wicked curveball,” he noted.

Schaffner added that testing capacity has been limited throughout the pandemic, which can cause an undercounting of COVID-19 cases. So can false negatives, especially for at-home rapid tests.

The argument against case counting

Dr. Monica Gandhi is an infectious disease expert and a professor of medicine at the University of California, San Francisco.

She wrote an op-ed for the San Francisco Chronicle last month saying, among other things, that herd immunity is no longer achievable and that we need to rethink the notion of tracking COVID-19 by new cases.

“It made sense to do it before,” Gandhi told Healthline. “We thought somehow we could break the chain of transmission. But it was so transmissible, you couldn’t break that chain.”

With more vaccines becoming available as well as new antiviral drugs effective at limiting COVID-19’s severity, Gandhi said that case rates are no longer an effective barometer in measuring our pandemic response, especially with Omicron’s ability to spread faster but with milder illness.

“The Omicron variant makes this concept even more important,” Gandhi said. “We are likely to get many cases with Omicron worldwide, but — since the severity of disease is reduced — the impact of this variant, and policy restrictions, should be based on tracking hospitalizations.

“The pandemic is widespread enough that most people will be exposed to the coronavirus at some point, so the sooner we get used to the idea, the sooner we get back to normal. Especially with the more transmissible Omicron,” she added.

“The idea was, in general, if cases went up, numbers of people in the hospital went up,” Gandhi said. “Now, it’s not only de-linked, but it’s completely muddled. Cases and hospitalizations are no longer linked.”

Gandhi said that we can expect COVID-19 to continue evolving into something causing fewer deaths and hospitalizations, “either because it is less severe, or because our immunity in the population worldwide has increased.

“Much of the population will be exposed to Omicron, since it is so transmissible, which will provide even more immunity – hybrid in the case of those who have been vaccinated — to COVID-19, so I hope we won’t get any more severe curveballs ahead.”

Although COVID-19 remains a bigger threat than influenza, both are respiratory infections, Gandhi pointed out.

“We need to get everyone on board,” she said. “We’re never stomping out the flu or any other respiratory virus. We only did that with smallpox, and we wore that on our skin [meaning it was easier to diagnose visually].”

Looking to the future

Gandhi said that the notion we could completely eradicate COVID-19 was a political idea instead of a practical one.

“It’s all political,” she said. “It’s more serious than the flu. But once you’re vaccinated, it’s not. Nobody knows how many cases of the flu are in a particular city. I mean, I do, but I’m a doctor. But we don’t follow that. People have reduced trust of public health officials.”

The way to regain some of that trust is realistically dealing with the novel coronavirus by opening things up and continuing to push vaccinations, especially as we’re seeing the typical uptick in cases coming as winter approaches, Gandhi said.

“Americans are all going to be exposed [at some point], I’m sorry to say,” Gandhi told Healthline. “That’s how a respiratory disease works and how they’ve always worked.”

Schaffner agrees we need to learn to live with COVID-19.

“For the rest of our lives, we will likely need regular boosters,” he said. “There are vaccine researchers working on combining the COVID-19 and flu vaccines [into one shot] right now.”

You May Also Like