With the explosion of Covid cases, some experts believe that the focus should be shifted from new infections to hospital admissions. Data collection remains fundamental “but at this stage communication must be changed”
The daily bulletin has now been circulated for almost two years with the count of new Covid cases, the “currently positive” hospital admissions, deaths, the positive rate. At the start of the pandemic, a press conference was called with Angelo Borrelli which on live TV listed dramatic numbers of hospitalizations and deaths (they have been close to the thousand deaths on December 3, 2020). Months later, he said goodbye to the press conference, switching to a bulletin published online.
With the arrival of the variante Omicron, which has shown an important immune evasion, also infecting those who have already completed the vaccination cycle, the number of daily infections has skyrocketed (yesterday, January 5, 2022, the record figure never reached of 189,109 infections with 231 deaths: and it is likely that the record will not last long). A year ago, the infections were 15,378 and 649 dead. Between December 27 and January 2, 680,000 new cases of coronavirus were recorded in Italy, almost triple compared to the previous week, while the data on hospitalized patients (in the medical and intensive care area) and on deaths, while growing steadily, are still far from the peaks that we touched a year ago, especially if compared to the number of infections – and this, we can never repeat it enough, is thanks to the vaccination campaign.
Now the question that many are asking is whether or not that is the case change the way of “counting” Covid: lowering the importance given to the count of new daily cases (or leaving it completely lost) and it is not more appropriate focus on the number of hospitalizations, the most interesting data to monitor the hospital pressure.
It’s a good idea? What are the reasons for the request, and what effects would it have?
On the one hand, such an enormous number of cases seems less significant than the number of hospitalizations (our color system does not look at the daily number of infections in the choice of colors for the regions, and therefore at the restrictions). On the other hand not counting the cases, we risk seeing the wave of hospitalizations late.
Furthermore, reducing Covid only to the consequences for the health system, without looking at those experienced by society as a whole, such as public services in hiccups due to lack of staff or shops closed because owners and salespeople are positive, could be reductive and do not grasp the true extent of the pandemic, overshadowing a prudential attitude that is more than ever useful in this phase.
The White House pandemic consultant, the immunologist Antony Fauci, interviewed by ABC, said that with many infections they cause few or no symptoms “It is much more important to focus on hospitalizations than the total number of cases”. (The United States is also grappling with record numbers. With Omicron raging, new Covid-19 infections quadrupled in a week and on January 5 reached a record number of one million cases in 24 hours, with 103,000. people admitted to hospitals).
Dr. Wafaa El-Sadr, director of ICAP, a global health center at Columbia University, said that “the case count does not seem to be the most important number to consider at this time, while it would be more appropriate to focus on the prevention of disease, disability and death caused by Covid in a post vaccination context, and then count those “. Without forgetting that the number of infections worldwide is underestimated since only the cases confirmed with antigenic and molecular tests are counted (do-it-yourself tests are excluded) and the many asymptomatic patients who do not undergo swabs are not included in the counts.
However, many other health experts disagree with the idea of eliminating the positive case count, basically because on the basis of the new infections it is possible to hypothesize how the epidemic will evolve.
“If we focus everything on hospitalizations and deaths – points out the virologist of the University of Milan Fabrizio Pregliasco — we risk falling behind the trend of the epidemic because between when a person becomes infected and when he develops symptoms between 3 and 5 days pass; between the onset of symptoms and the result of the swabs, another 2-3 pass. So that contagion is telling us how the epidemic was moving a week earlier. With the admissions data, however, we see how the epidemic was evolving 10-15 days earlier. If we give up knowing the number of infections we also give up understanding what will happen after days, risking to arrive unprepared in the face of a tsunami of shelters ».
At this time the number of hospitalizations is not very high compared to the number of positives because theincrease in infections is affecting mainly young people between 10 and 29 years old, which generally manifest the disease in a milder way. However, for weeks there has been a progressive increase in infections even among the over 60s which, even if vaccinated, often due to the concomitance of previous illnesses, risk hospitalization. Without the analysis of the new infections, divided by age group, there would be the risk of not being able to make estimates on how the hospitalization curve will move.
«It is logical that we can’t stop counting the number of positive people , this is one indispensable epidemiological tool for insiders “adds the epidemiologist P
aolo Bonanni, full professor of Hygiene at the University of Florence. But in fact, these numbers are useful today for those who must study the variants and make predictions on epidemiological trends to move in advance in the organization of hospitals – also underline Pregliasco and the immunologist of the University of Padua Antonella Viola. “The absolute data of infections today is misleading and there is no correspondence between the absolute number of infections and what will happen in terms of hospitalizations and deathsSays Bonanni.
They all agree with the idea that we are in one new phase: «And it is there communication to the public that must change»Adds Antonella Viola. «What matters is the situation in the hospitals, the hospitalized are for the most part unvaccinated or patients awaiting the recall. The absolute data of the infections, if published without an adequate context, risks only frightening and discouraging; people may even be tempted to think that vaccines are useless, while on the contrary they protect well against severe disease. Only the data on hospitalizations and deaths should be communicated, specifying how many are vaccinated and how many are not. We are no longer in an emergency phase in which anxiety and responsibility must fall on citizens. It’s a political choice decide to enter the normal management of the pandemic. It is right to explain the rules, but we have to live with the virus and we have the tools to do it “.
Paolo Bonanni also suggests a sort of “new bulletin” that puts the absolute data on infections in a new, broader framework. “The daily ballet of the new positives has a deleterious effect on people’s psyche
. It seems more useful to me disclose the data on the rate of positivity why is that less subject to daily fluctuations and eventually, even if it is a bit delayed compared to when it is collected, the contagion index Rt can also be disclosed (how many people can be infected by a single person on average and in a certain period of time in relation, however, the effectiveness of restrictive measures, ed). The Rt index tells us how the epidemic is going: above 1 means that we are in a phase of epidemic expansion, the faster the more the value is above one. If, on the other hand, we are below 1 it means that we are in a phase of regression ».
«Also the data of hospitalizations – concludes Pregliasco – should be improved. With Omicron we see more and more patients turning out p
Thesitives to the hospital entry swab, where they arrive perhaps due to a car accident or a heart attack, and for this reason they are hospitalized in Covid wards even if asymptomatic. Despite this, they are included in the count of hospitalized for Covid: but the data should be separated in order not to have an overestimated figure “.
January 6, 2022 (change January 6, 2022 | 13:43)
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