NYC Covid Cases Are Starting to Drop in Hopeful Sign for Latest Wave

(Bloomberg) -- The recent resurgence of Covid-19 in New York City may be relatively muted compared with the huge spike earlier this year, if recent patterns hold.

The largest U.S. city is seeing a downturn in Covid-19 cases for the first time since early March, local government data show, in what could be a positive sign for the rest of the country. In Manhattan, where case counts have been the highest recently, the seven-day average of cases dropped for four days in a row through April 19. In Philadelphia, local health officials ended a mask mandate this week, citing data showing cases leveling off. 

Despite those positive signals, cases are still rising nationally, driven by omicron and its more transmissible subvariants. On Wednesday, the U.S. reported more than 58,000 new infections — a 46% increase from the daily average a week prior, according to data. That’s still well below the number of infections reported daily during omicron’s peak this past winter.

It’s extremely difficult to know for certain what’s happening with Covid right now because much of the U.S. is  scaling back surveillance. Public schools in New York were on spring break this week, which may also have skewed testing rates. Some states have stopped reporting certain Covid metrics, testing has gotten more expensive as pandemic funding dries up, mobile sites have closed and more people are using at-home tests.

This has all made official Covid data increasingly unreliable just as the U.S. shifts into a new phase of the pandemic. And a new analysis shows that we’re actually missing a significant number of infections from at-home tests, a trend that is likely to continue, experts say.

Last week, more people in the U.S. reported testing positive using at-home tests than they did from molecular tests, according to an analysis from researchers at Boston Children’s Hospital. Those are tests that aren’t part of official counts from the Centers for Disease Control and Prevention and often aren’t reported to local health departments, either.

“At-home testing is great for the individual, it's great for the future of health care,” said John Brownstein, an infectious disease epidemiologist and Boston Children’s chief innovation officer. “But that sort of advance in health care doesn’t come alongside public health and it’s a huge gap in our ability to understand what’s happening in the population right now.”

Brownstein, Benjamin Rader and a team of others at Boston Children’s and Momentive AI have been collecting data about testing behaviors throughout the pandemic. They designed an online survey with questions about testing and results, which has given them key insights into at-home test use and infections.

A few weeks ago, the CDC used their data in a report detailing how more people started using at-home tests when the omicron variant became prevalent. And now, it could help to fill some of the gaps in government surveillance.

Brownstein and Rader estimate more than half of positive cases during the week ending April 16 were diagnosed by at-home tests. That analysis is based on more than 470,000 surveys from people across the U.S. It’s a trend they’ve seen increasing for several weeks, while the amount of tests sent to sequencing labs has fallen sharply since January, CDC data show.

“Infrastructure for public health reporting is starting to crumble a little bit,” Brownstein said.

CDC officials have emphasized that hospital data and ICU admissions are more important than cases for assessing risk during this stage of the pandemic, when we have vaccines that are effective in preventing serious disease and an ample supply of antivirals.

Brownstein said, though, that case surveillance remains important for understanding and identifying new variants, assessing Covid’s impact on different demographics, and as a leading indicator for our hospital system.

The government has not yet indicated publicly how, or if, it plans to shift surveillance to account for at-home tests, but Brownstein and Rader have been working closely with the CDC to share data and analyses. Their survey has yielded thousands of responses, but scaling it further may still prove difficult as it will likely require collaboration with testing companies, Brownstein said.

Abbott Laboratories, which makes the BinaxNOW test, has an app called NAVICA where people can report their at-home test results. Abbott declined to comment on how many people have reported results and it’s unclear if that information reaches health departments.

At-home testing “will continue to become more of an issue, not only for Covid, but as we see testing more broadly available for other infectious diseases like the flu,” Brownstein said. “This is something that we're going to have to get a handle on for public health surveillance.”
 

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