“We are changing our measurement strategies, we are testing less, we are eliminating easy access to testing for people who are poor or uninsured.”
Metrics like Covid hospitalizations or Covid deaths have changed in some places, too: Some states have begun reporting Covid hospitalizations only for those on the Covid-specific medications dexamethasone and remdesivir. That means patients who have other issues spurred by Covid—diabetic ketoacidosis, blood clots, early labor, and a number of other closely related ones—aren’t counted in those hospitalization tallies, even though the patients wouldn’t have been hospitalized had they not gotten Covid. Other states only count hospitalizations for patients who actively test positive for Covid, which means that those battling the effects of the virus in intensive care units who have been sick long enough that they’re no longer positive are uncounted. Some states also have changed the way they report Covid deaths. If we were to change definitions like these, it could help standardize data across states and municipalities, if all places were to adopt the same definition, but it might also cause Covid’s true death toll to be overlooked.
The CDC’s controversial change in focus from community transmission rates to hospital capacity was a misstep, experts told me. Having data on cases is important, in part because hospitalization rates are “a lagging indicator,” said Ajay Sethi, associate professor of population health sciences at the University of Wisconsin–Madison. Understanding the prevalence of Covid isn’t just important for determining our risk levels; it also helps hospitals brace for incoming surges. “If we stopped following cases because we didn’t think the data were representative enough, I think hospital administrations across the country would say, ‘Well, what are we supposed to use to determine whether there’s going to be a rise in hospitalizations?’”
Reporting on numbers like these has always been messy, experts say. With mortality, for instance, “we’re very good in the United States at ascertaining the fact of death. We are usually less certain about ascertaining the cause of death,” Cannuscio explained.