US Covid cases undercounted: Actual number 30 times than reported amount

As per the official case numbers, the United States is facing its fourth Covid vase and experts believe the correct case count is much higher than reported.

The country records an average of 94,000 fresh cases daily. Since April the daily hospitalization rates have also increased. However, they are lower than the earlier Covid-19 waves.

An early survey from New York shows that cases are undercounted by a factor of 30. Dennis Nash, Professor of epidemiology at the City University of New York School of Public Health is surprised that actual case counts are 30 times the reported number.

Between 23rd April and 8th May, around one in every 5 New York citizens has contracted the virus, cites a preprint study, which is yet to be published or peer-reviewed. This would put the number of active Covid cases at 1.5 million for those weeks, and is much higher than the official count.

Although New York was the focus of the study, the situation might be similar throughout the country. Nash further adds that New Yorkers have tested themselves more than other places in the country, implying worse undercounting at other places.

More than 50% of the Covid patients are unaware of Paxlovid, an extremely effective antiviral that can reduce the impact and hospitalizations relating to Covid among vulnerable people.

“We need to be able to identify who among the most vulnerable is not receiving Paxlovid after suffering from a Covid infection, and we must do all we can to ensure that they are promptly reached and targeted,” Nash added.

Gaps in case numbers may also explain why so many people are unaware that the United States is experiencing a dramatic increase right now, according to experts. Even those who are paying attention to cases may not be aware of how prevalent Covid is at the moment.

"We knew there were undercounts, but we didn't know how much they were undercounted until recently," he said. "Now it seems that the gap is getting wider."

After the first Omicron outbreak, a similar survey was conducted and about 1.8 million people were estimated to have been exposed from January through mid-March.

During the epidemic's peak, according to one epidemiologist quoted in The New York Times, the CDC's official estimate was "about three to four times greater than the actual case count." That figure was roughly three to four times higher than the official tally during that period, according to Nash - significantly lower than the 30-fold difference seen now.

Since home testing is generally not factored into official figures, the significant difference between estimated and actual case counts is likely due to an increase in home testing, which isn't included in official numbers, and pandemic fatigue or a lack of information leading some people to test hardly at all, even if they have symptoms or come in contact with the virus.

There's also a "massive deterrent" for many individuals to get tested for Covid, according to Lara Jirmanus, a Harvard Medical School clinician and family physician who added that people may be afraid of losing their jobs or having to miss school if they test positive.

“It's as though we've established a national ‘don't ask, don't tell' Covid policy - and it's an ideal method to assure that Covid spreads quickly," she added — especially concerning given the fact that up to 60% of Covid transmission comes from individuals who never experience any symptoms.

Without good data on the true extent of Covid, it’s more difficult to protect against it, experts said.

Increasing monitoring of diseases such as Covid - which includes wastewater monitoring or surveys, as done by Nash and his colleagues - would sound the alarm on future increases and assist specialists in determining how many individuals might be susceptible to it.

“We have to first establish what the real Covid burden is and then tell people about it,” Nash added. “Local and national public health officials must provide a more accurate picture of what the true Covid burden may be for individuals to make educated judgments.”

The hospitalization rate and the death toll of this surge are lower than those of previous waves, owing to the immunization protection and recoveries from prior occurrences.

Cases can also cause a slew of other issues, including hospitalization and death. “Even after hospitalizations and deaths go down, the long Covid threat will be with us for some time,” Nash added.

Doctors state that with 10 to 30 percent of patients contracting the condition and each infection – and reinfection – seeming to be a gamble for developing serious problems in later years.

Nash thinks that it's very under-researched, and in his perspective, given its potential importance as a public health issue. But it's at the top of the list of reasons to avoid infection now because it's tragic that this isn't something that is discussed as a way to avoid the consequences of a spike.

According to recent studies, vaccines offer partial protection against the deadly strain of Covid by around 15%, illustrating the necessity for additional precautions to avoid infections.