On the topographical map of the coronavirus pandemic, it would not be unfair to call America’s recent winter wave an Everest among a series of rolling bunny slopes. At the zenith of the peak, the nation was clocking, scientists estimate, multiple millions of new infections each day; the portion of Americans ever infected by the virus may have doubled in the span of just a few weeks. It was the spike that sent every COVID graph’s y-axis a-reelin’, the trend that rejiggered the nation’s conception of steep.
Now that infection rates are trending up again from their early-spring low, it’s hard to put them in perspective. Sure, we’ve once again blown past the mark of 60,000 new documented cases a day (and that’s just the ones we know about), but that’s less than 10 percent of what the CDC was recording in mid-January, when the original version of Omicron, now called BA.1, was at the top of its game. Sure, hospitalizations are headed in the wrong direction, but deaths, so far, are still going down. If BA.1’s horrific blitzkrieg was a wave, what do we call this? A wavelet? A swell? A bump, a ripple, a Hobbit-size hillock? Euphemisms for the recent rise—sharp, but not the sharpest—have been trickling in for weeks. But maybe it’s time to just call a surge a surge.
To be fair, terms like surge and wave don’t “really mean anything, scientifically,” says Sam Scarpino, the vice president of pathogen surveillance at the Rockefeller Foundation. Still, two years into the pandemic, many people have gotten an intuitive feel for what those words can imply: a sudden and sustained upwelling in infections that activates our crisis radar. It’s terminology that goes beyond semantics. In detecting and describing surges, we can then react to them—take precautions, enact policy changes, in essence hunker down for a bit until the threat abates. Surges are the upswings we take seriously enough to name, to number, to do something about.
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Calling waves and surges was more straightforward in 2020 and most of 2021. Americans’ conceptions of crisis were well-enough aligned to delineate the country’s first five peaks, which all fell within about an order of magnitude of one another—a range small enough to assess on the screen of a smartphone. Back then, logging 50,000 cases a day was bad; 200,000 felt hellish. Now, though, the scale bar is different, and our collective sense for what constitutes a concerning case jump is totally out of whack. “We’ve developed a new normal,” says Maia Majumder, an infectious-disease modeler at Harvard Medical School and Boston Children’s Hospital, that casts what we endured in January as “the very worst possible thing.” After BA.1’s squeeze, our COVID barometer is broken: Anything that’s better than this winter just feels straight-up good.
Perspective isn’t the only problem. Our data, too, are on the fritz. “We are drastically underestimating the number of cases in the community right now,” says Bertha Hidalgo, an epidemiologist at the University of Alabama at Birmingham. Community testing sites have gone dark; many people without medical insurance can no longer access diagnostics for free. Plenty have lost interest in testing at all, and a good number of those still game to swab are performing their nose checks only at home and rarely, if ever, reporting the results. It feels, Hidalgo told me, like the virus has gone “incognito.”
Even with the holes in our data stream, the situation doesn’t look great. Recorded cases are already toe-to-toe with where they were around the middle of last July, when Delta was bursting out of the South and into the North, East, and West; hospitalizations, recently at their lowest since the pandemic’s start, have clambered back up to where they were at the beginning of last summer, when only about half of Americans had gotten their first vaccine doses. In states across the Northeast, including Massachusetts and Rhode Island, where vaccination rates are among the nation’s highest, “we have more cases reported per day than during the peak of Delta,” Majumder told me. And in Puerto Rico, new documented infections are at about a third of their January peak. Researchers tracking the levels of coronavirus particles in wastewater—a metric that’s agnostic to how many people are testing and reporting their results—are painting an even gnarlier portrait, showing in several parts of the country “really, really high rates of viral RNA,” Scarpino told me, “way beyond” what diagnostics show.
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It’s hard to know how much higher the true infection counts actually are. But experts have for weeks been worried about a confluence of factors. New, antibody-dodging subvariants of Omicron have been sprouting left and right; the country is mask-loose and fancy-free; America’s booster campaign remains a big old bust. And even muddy data can’t fully obscure what people are seeing on the ground. “I feel as though we’re swimming in COVID here right now,” says Anne Sosin, a health-policy researcher at Dartmouth College. In Vermont, where she lives, new hospital admissions are dancing around their Omicron peak. And on the (highly vaccinated) university campus where Sosin works, just across the New Hampshire border, “we had a huge BA.1 outbreak. And now we’re having a huge BA.2 outbreak.”
Adding to the murkiness are the messages beamed out from the nation’s leaders. The country’s goals, as determined by the CDC, are now centered less on stanching transmission than on dialing down disease severity; the virus can spread more or less as it pleases, as long as America’s medical infrastructure stays afloat. As things stand, more than 98 percent of American counties are still marked in soothing shades of green and yellow on the CDC’s map of community-level risk, because although cases are rising, hospitals have not yet filled up to precarious levels. How can the nation be in trouble when it still looks like a sun-dappled meadow?
The CDC guidance doesn’t just affect perception; it influences behavior too. In green or yellow spots, masks are billed mostly as a matter of personal preference—no need to cover up, because the health-care system’s still supposedly fine. The shift away from a focus on case rates does make sense in some respects, Scarpino said. The average SARS-CoV-2 infection today does not portend what it did a year ago, or even what it did a few months ago, when fewer people were boosted or recently infected and effective antivirals were even harder to get. The one-two punch of immunity and treatment have lowered the likelihood that infections will turn severe or lethal. In terms of infection, Scarpino told me, “the risks are very high right now, pretty much across the whole U.S.” But “if what you care about is how cases translate into hospitalizations or deaths,” he said, “your tolerance for cases is going to be much higher.”
Maybe hospitalizations and deaths won’t skyrocket this spring. That, however, is not a guarantee. Just 30 percent of people in the U.S. have nabbed a booster dose; kids younger than 5 remain ineligible for any shots at all. Millions of Americans have health conditions that blunt the protective powers of vaccines. And though most people in this country have been infected at some point in the past two years, the protection those encounters leave behind doesn’t seem to stick well on its own. The proportion of SARS-CoV-2 infections that turn serious is indeed reduced, but a big enough crest in case rates will drag along severe disease. Even if hospitalizations fall short of where they were during BA.1—again, low bar—they will still take a staggering toll. The smallest number of hospital admissions the U.S. has hit during a lull was about 1,500 people a day—a rate that, stretched out over a year, rivals some of the worst flu seasons of the past couple of decades. And America couldn’t even sustain that number for more than a few weeks. Nor has serious illness hit Americans uniformly: High-risk, high-exposure communities, including essential workers, residents of rural regions, and people of color, have borne the pandemic’s brunt since early on—disparities that remain largely unaddressed. COVID’s risk is, on average, lower. It just hasn’t been cleaved away from everyone to an equitable degree.
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Hospitalizations and deaths are also just a sliver of the chaos that COVID can cause. Even initially symptomless infections can unfurl into long COVID, which we “can’t say we care about preventing if we say we’re not concerned about cases,” Sosin told me. And any brush with the virus can pull someone out of work, school, or caregiving for more than a week. Many infections fall outside the tight sphere of “severe disease,” and thus largely outside the purview of the U.S.’s new posture on COVID, which purports to minimize impact on the medical workforce. But nonhospitalized cases, too, “have health-system impacts,” Sosin said. Treatments require diagnoses, prescriptions, and drug delivery, taxing the bandwidth of primary-care physicians, pharmacists, and more.
If our crisis compass is off-kilter, maybe it’s time to recalibrate. “We shouldn’t compare to the highest peak we were at,” Theresa Chapple, a Chicago-area epidemiologist, told me last month. Rather, we should set our sights on reaching a sustainable baseline where the most vulnerable among us can feel safe. “Otherwise, people start to feel like they no longer have to contribute to the work of bringing rates down.” This winter, states across the country were pumping the brakes on mitigation well before infection counts had fallen to where they’d been in November, and still about 2,000 Americans were dying each day. The sense of phew took hold, then stubbornly stuck.
The goal now should be to look at what’s ahead. It hardly matters if Americans end up calling this case rise, or future ones, a wave or wavelet, a surge or swell, so long as they take stock of whatever this is and try to keep it from growing even more. If preventing infections is still a priority, “why don’t we just say what we mean?” says Brandon Ogbunu, who studies infectious-disease dynamics at Yale. “We are in a moment where lots of people seem to be testing positive, and I’m concerned about that.”
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