Wastewater data from Biobot suggest that COVID-19 spread is still declining throughout the country, but slowly.
In the past week (February 23 through March 1), the U.S. officially reported about 230,000 new COVID-19 cases, according to the CDC. This amounts to:
An average of 32,000 new cases each day
69 total new cases for every 100,000 Americans
5% fewer new cases than last week (February 16-22)
In the past week, the U.S. also reported about 23,000 new COVID-19 patients admitted to hospitals. This amounts to:
An average of 3,300 new admissions each day
7.1 total admissions for every 100,000 Americans
8% fewer new admissions than last week
Additionally, the U.S. reported:
2,300 new COVID-19 deaths (330 per day)
90% of new cases are caused by Omicron XBB.1.5; 8% by BQ.1 and BQ.1.1; 1% by CH.1.1 (as of March 4)
An average of 50,000 vaccinations per day
At the national level, major COVID-19 metrics continue to indicate slow declines in transmission. As I’ve been writing for the last few weeks, we’re at a “low tide” point in COVID-19 spread: clearly lower than the peaks that occur after holidays or new variants, but much higher than the baselines that we experienced before the Omicron era.
Official cases reported by the CDC dropped by 5% last week compared to the week prior, while new hospital admissions dropped by 8%. Wastewater data from Biobot show declining coronavirus levels nationally, but viral concentrations in wastewater are twice as high as they were at this point in 2021 or 2022.
Biobot’s regional data suggest that the Midwest has overtaken the Northeast in coronavirus concentrations for the first time since late summer 2022. Both regions are seeing declines, but the declining spread in the Northeast has accelerated a bit faster than that in the Midwest.
While most individual states and counties are reporting COVID-19 declines as well, a few have reported increased coronavirus in their wastewater in recent weeks. This includes counties in Idaho, Wyoming, Montana, Florida, Texas, and others in the Midwest and South.
Omicron XBB.1.5 continues to be the dominant variant in the U.S., now accounting for about 90% of new cases in the last week, per CDC estimates. Viral evolution experts will be watching to see if XBB.1.5 mutates further, or if some other variant arrives to compete with it.
As we head into the spring, U.S. COVID-19 data continue to get harder to find and less reliable. Last week, the Department of Health and Human Services announced that it would retire its Community Profile Reports, which I used to rely on as a regular source for this newsletter.
Meanwhile, a study from Denis Nash and his team at the City University of New York that estimated true COVID-19 prevalence during the BA.4/BA.5 surge last summer was recently published in the journal Preventative Medicine. I covered this study when it was released as a preprint last fall, and find it striking that no other estimates like this have emerged since then.
Deaths in U.S. prisons: Throughout the pandemic, the UCLA COVID Behind Bars Data Project has been a leading source for data on COVID-19 cases and deaths in carceral settings. As COVID-specific data on prisons and jails have become more sporadic, the project recently turned its attention to overall mortality data in these settings. Last week, the UCLA team released a new dataset sharing all-cause deaths in prisons through 2020, which combines data from public reports and records requests. The full dataset is available on GitHub, and a summary of this project’s findings on all-cause mortality was published in the New York Times last weekend.
BIOFIRE syndromic trends data: BIOFIRE Diagnostics is a biotech company focused on diagnostic testing, offering tests for a variety of viruses, bacteria, and other pathogens. The company publishes anonymized test results from its labs on its Syndromic Trends dashboard; this dashboard is a helpful way to get an overview of test positivity for COVID-19 compared to other common diseases. (H/t Force of Infection.)
R&D roadmap for COVID-19 vaccines: The University of Minnesota’s Center for Infectious Disease Research and Policy has published a new report outlining the research and development steps needed for the world to produce coronavirus vaccines that are “broadly protective,” not tied to a specific variant. It includes recommendations for research on virology, immunology, and vaccine technologies, along with information on using animal models and guidance on vaccine policy. Related: the CDC’s Advisory Community on Immunization Practices met this week to discuss COVID-19 and other vaccines.
CDC reports on travel surveillance: Two new studies about COVID-19 among international travelers to the U.S. were published in this week’s CDC Morbidity and Mortality Weekly Report. Both studies describe results from the agency’s Travel Surveillance program, which is a collaboration with biotech company Ginkgo Bioworks and testing company XpresCheck. One report compares traveler test results from before and after the U.S. ended its pre-departure testing requirement for international flights, finding that travelers were much more likely to have COVID-19 after the requirement was lifted. The second report provides results from a pilot program testing airplane wastewater at JFK Airport; this report found that the vast majority of plane samples tested were positive for SARS-CoV-2, and researchers identified a variety of Omicron variants. More work is needed to really get airplane wastewater testing going in the U.S., but it’s good to see early results showing this program’s feasibility.
Early data from XBB.1.5 in NYC: Another notable study in CDC MMWR this week provided analysis from New York City’s health department on Omicron XBB.1.5. The subvariant was first identified in the city in October 2022 (though it may have evolved somewhere else), and quickly spread through the region; it accounted for 81% of sequenced COVID-19 test samples by early January. The NYC health department linked sequencing data with patient outcomes data, finding that people infected with XBB.1.5 were not significantly more likely to be hospitalized or to die from COVID-19 compared to those infected with other variants. In other words, XBB.1.5 appears to not cause more severe disease, based on this report.
Predicting COVID-19 cases based on wastewater results: One more newsworthy study to share this week: researchers at Hokkaido University developed a mathematical model to predict COVID-19 cases based on coronavirus concentration levels in Sapporo, Japan. I’m always on the lookout for studies like this, as wastewater data become increasingly important to track true infection numbers. (Here’s a prior example, from the University of Florida.) Of course, it’s worth noting that the Hokkaido researchers had consistent wastewater and case data from spring 2020 through 2022 to use for their model; for wastewater researchers working in the U.S. now, that consistency is often harder to achieve.
The CDC provides norovirus test positivity data from a select number of labs that report test results for this virus. Due to limited reporting, data are only available at the regional level.
This week, I have a new story out in Gothamist and WNYC (New York City’s public radio station) about norovirus, a nasty stomach bug that appears to be spreading a lot in the U.S. right now. The story shares some NYC-specific norovirus information, but it also talks more broadly about why it’s difficult to find precise data on this virus despite its major implications for public health.
Reporting this story led me to reflect on how COVID-19 has revealed cracks in the country’s infrastructure for tracking a lot of common pathogens. I’ve written previously about how the U.S. public health system monitored COVID-19 more comprehensively than any other disease in history; the scale of testing, contact tracing, and innovation into new surveillance technologies went far beyond the previous standards. Now, people who’ve gotten used to detailed data on COVID-19 have been surprised to find out that such data aren’t available for other common pathogens, like the flu or norovirus.
It might feel disappointing to realize how little we actually know about the impacts of endemic diseases. But I choose to see this as an opportunity: as COVID-19 revealed gaps in public health surveillance, it inspired development in potential avenues to close those gaps. Wastewater surveillance is one big example, along with the rise of at-home tests and self-reporting mechanisms, better connectivity between health systems, mobility data, exposure notifications, and more.
Norovirus is a good example of this trend. Here are a few main findings from my story:
People who become infected with norovirus are often hesitant to seek medical care, because the symptoms are disgusting and embarrassing. Think projectile vomit, paired with intense diarrhea.
Even when patients do seek medical care, norovirus tests are not widely available, and there isn’t a ton of incentive for doctors to ask for them. Testing usually requires a stool sample, which patients are often hesitant to do, one expert told me.
The virus is not a “reportable illness” for the CDC, meaning that health agencies and individual doctors aren’t required to report norovirus cases to a national monitoring system. (So even when a patient tests positive for norovirus, that result might not actually go to a health agency.)
The CDC does require health agencies and providers to report norovirus outbreaks (i.e. two or more cases from the same source), but national outbreak estimates are considered to be a vast undercount of true numbers.
Even in NYC, where the city’s health agency does require reporting of norovirus cases, there’s no recent public data from test results or outbreaks. (The latest data is from 2020.)
It seems like the lack of a requirement and the difficulty of tracking kind-of play into each other, where it’s not required because it’s hard to track—but it’s also hard to track because it’s not required.
The lack of detailed data on pathogens like norovirus can be frustrating on an individual level, for health-conscious people who might want to know what’s spreading in their community so that they can take appropriate precautions. (For norovirus, precautions primarily include rigorous handwashing—hand sanitizer doesn’t work against it—along with cleaning surfaces and care around food.)
These data gaps can also be a challenge for public officials, as more detailed information about where exactly a virus is spreading or who’s getting sick could inform specific public health responses. For example, if the NYC health department knew which neighborhoods were seeing the most norovirus, they could direct handwashing PSAs to those areas. In addition, scientists who are developing norovirus vaccines could use better data to estimate the value of those products, and determine who would most benefit.
So, how do we improve surveillance for norovirus and other viruses like it? Here are a few options I found in my reporting:
Wastewater surveillance, of course. The WastewaterSCAN project is already tracking norovirus along with coronavirus and several other common viruses; its data from this winter has aligned with other sources showing a national norovirus surge, one of the project’s principal investigators told me.
Better surveillance based on people’s symptoms. The Kinsa HealthWeather project offers one example; it aggregates anonymous information from smart thermometers and a symptom-tracking app to provide detailed data on respiratory illnesses and stomach bugs.
At-home tests, if they’re paired with a mechanism for people to report their results to a local public health agency. Even without a reporting mechanism, at-home tests could help curb outbreaks by helping people recognize their illness when they might be asymptomatic.
Simply increasing awareness and access to the tests that we already have. If more people go to the doctor for gastrointestinal symptoms and more doctors test for norovirus, our existing data would get more comprehensive.
Are there other options I’ve missed? Is there another pathogen that might be a good example of common surveillance issues? Reach out and let me know.
Biobot provides wastewater testing and analysis for more than 400 sites in the NWSS network, accounting for about one-third of the system’s total 1,200 sites. The CDC/Biobot arrangement basically makes it easy for these wastewater treatment plants to participate in COVID-19 and mpox testing, since sites can send in samples without spending the time and resources needed to build up their own testing programs.
I was glad to see this news, as the continued contract will mean no interruptions in CDC NWSS data for at least another six months. Long-time readers might remember that there were major wastewater data gaps last spring, when the CDC switched contractors from LuminUltra to Biobot.
Of course, six months is far from the long-term investment that the U.S. should be making in wastewater surveillance… but that’s a topic for another week.
This week, I had a new article published in The Atlantic about how COVID-19 wastewater surveillance can be useful beyond entire sewersheds, the setting where this testing usually takes place. Sewershed testing is great for broad trends about large populations (like, an entire city or county), the story explains. But if you’re a public health official seeking truly actionable data to inform policies, it’s helpful to get more specific.
My story focuses on one wastewater testing setting that’s been in the news a lot lately: airplane bathrooms, from which researchers can identify new variants arriving with international travelers. But airplanes are far from the only place where specific wastewater surveillance can be valuable. Here are some of those other places, highlighting some information that I learned in reporting this story (but couldn’t fit in the final article).
K-12 schools
Early in the pandemic, colleges and universities became a hub for wastewater surveillance innovation. At campuses like Columbia University in NYC, researchers tested the sewage at individual dorms in order to determine exactly which students were getting sick—and take quick action, usually by requiring students at the infected dorm to get PCR-tested and quarantining the people who tested positive.
But the same technique can apply to schools with younger students. In late 2020, the University of California San Diego expanded its testing program to elementary schools, in an initiative called the Safer at School Early Alert System. The program started with 10 schools in the 2020-21 school year, then expanded to 26 in the 2021-22 year. Wastewater testing at specific sewershed points next to the schools led researchers to identify asymptomatic COVID-19 cases with high accuracy, program leader Rebecca Fielding-Miller told me.
The San Diego program isn’t alone: other public school systems have tried out building-level wastewater testing, usually in collaboration with nearby research groups. While the research projects tend to successfully show that wastewater surveillance can pick up infections, it’s challenging for school systems to get the funding to do these programs long-term. (Unlike universities, which are in total control of their funding, public schools need to rely on local governments).
As a consequence of these funding challenges, the San Diego program wasn’t renewed for the 2022-23 school year. “We really would have wanted to keep doing it, but funding ran out,” Fielding-Miller said.
Hospitals, other healthcare facilities
Much of the U.S.’s health strategy throughout the pandemic has focused on keeping hospitals from becoming overwhelmed—or at least helping hospitals weather COVID-19 surges. Wastewater surveillance can help accomplish this, by giving hospital administrators warnings about potential increased transmission; wastewater trends usually predict hospitalization trends by a week or more. And when wastewater surveillance is happening at hospitals themselves, these warnings can be really specific.
At NYC Health + Hospitals, the city’s public hospital system, administrators can get these warnings from wastewater testing at the system’s eleven hospitals. The surveillance program includes weekly tests for COVID-19, flu, and mpox (formerly called monkeypox), in collaboration with local researchers. The resulting data “gives us better situational awareness,” said Leopolda Silvera, a global health administrator at Health + Hospitals. If the health system notices a coming surge at one hospital, they can adjust resources accordingly—such as sending more staff to the emergency department.
The Health + Hospitals wastewater program has been running for about a year, Silvera said. At this point, it’s the only program she knows of that does building-level surveillance at hospitals. In the future, the hospital system might start testing for other pathogens and health threats like antimicrobial resistance.
Congregate facilities
Congregate facilities like nursing homes and senior living facilities can include a lot of vulnerable people who are at higher risk for severe COVID-19, all living in close quarters. As a result, this is another category of settings where it could be helpful to have building-level wastewater surveillance: facility administrators could learn quickly about upcoming surges and respond, by doing widespread PCR testing or instituting a temporary mask mandate.
The state of Maryland used to have a program doing exactly this, with a focus on correctional facilities throughout the state—particularly facilities housing the most vulnerable residents. The wastewater surveillance program ran through May 2022, at which point it “quietly ended,” according to local outlet the Maryland Daily Record. An initial $1 million in funding for wastewater testing in Maryland ran out; while the CDC National Wastewater Surveillance System picked up testing at wastewater treatment plants, no new entity was able to continue testing at the congregate living facilities.
According to the Daily Record, the building-level wastewater testing was incredibly helpful for informing COVID-19 measures at correctional facilities and helped keep cases down. I hope the Maryland program isn’t the last example we see of this testing in the U.S.
Large, communal workplaces
Early in the pandemic, some of the U.S.’s worst COVID-19 outbreaks happened at factories, particularly large food processing plants. People in these settings are often working in close quarters, easily able to infect each other—and when an outbreak happens, there are ramifications for both individual employees and the company’s business.
These large facilities could be another target for wastewater surveillance: if company administrators see a warning about rising COVID-19 from their buildings’ sewage, they could institute basic public health measures to curb the spread. Such is the strategy for some mine companies in rural Canada, which work with biotech company LuminUltra to test their wastewater. People often live and work at these sites, making them relatively closed settings for transmission.
At these locations, COVID-19 was previously “kind-of out of control, clinical testing was very reactive,” said Jordan Schmidt, director of product applications at LuminUltra. With wastewater testing, the mining companies can keep outbreaks “to a handful of people.” Fewer people get sick and there’s less interruption to business, he said.
Neighborhood-level testing
As public health agencies face lower budgets and overall lower awareness about COVID-19, some officials want to maximize their limited resources. If you only have the funding and staff for two mobile PCR testing sites this week, you’d want to make sure they go to a neighborhood where the testing would be most helpful, right?
The Boston Public Health Commission had this goal in mind when they launched a new neighborhood-level wastewater testing program, in collaboration with Biobot Analytics. The program includes testing twice a week at 11 sites across Boston, selected to provide good coverage of the city and also enable testing without too much disruption to traffic. While testing just started in January, the program is already helpful for identifying specific COVID-19 patterns, said Kathryn Hall, deputy commissioner for the health agency.
Boston’s program is focused on COVID-19 right now, but could expand to other diseases as needed, Hall said: “Now that we have the infrastructure in place, it allows us to be really be prepared and also to ask novel and interesting questions.”
Airplanes
Airplane surveillance fits into a slightly different category than the other settings I described here. When researchers test airplane wastewater, they aren’t seeking to get advanced warnings of new surges or inform public health policies. Instead, the goal is to track variants—with a focus on any new coronavirus mutations that might come into the U.S. from abroad. (Read the Atlantic story for more details on how this works!)
Other transportation hubs could be useful for tracking variants too, experts told me. This could mean large train stations, bus stations, shipping ports—any location that involves a lot of people moving from one place to another. After all, variants can evolve in the U.S. as easily as they can in other parts of the world.
Overall, the specific wastewater testing settings described here could be valuable pieces of expanding the U.S.’s overall surveillance network, along with the more-traditional sewershed testing. But all these testing sites need sustained funding to actually provide valuable data in the long run, something that could be in jeopardy as the federal public health emergency ends.
Washington’s dashboard includes coronavirus concentration levels over time from a selection of wastewater treatment plants in the state, with data going back to early 2022. It also includes some helpful notes about how to interpret wastewater data and maps showing the service areas for each treatment plant.
I also recently learned that WastewaterSCAN has released a new, upgraded dashboard to share its surveillance data. WastewaterSCAN is a project started by researchers at Stanford and Emory universities (with a focus on sites in California) that has since expanded across the country. The new dashboard makes it easier for users to find SCAN testing sites in their areas and answer specific questions with the data.
As official case numbers become less and less reliable, I’m glad to see public agencies and research efforts step up to make wastewater surveillance more accessible. Both the Washington dashboard and new WastewaterSCAN link are now included on my wastewater data resource page.
Nearly a year after the CDC’s National Wastewater Surveillance System began reporting public data, the system still has very unequal representation across the U.S.
This week, the National Academies of Sciences, Engineering, and Medicine (NASEM) released a major report about the state of wastewater surveillance for infectious diseases in the U.S. The report, written by a committee of top experts (and peer-reviewed before its release), is an extensive description of the promise and the challenges of wastewater testing.
Its authors describe how a grassroots network of researchers, public officials, and wastewater treatment plant staff developed strategies for sewage testing, analysis, and communicating results. Now, as committee chair Guy Hughes Palmer writes in the report’s introduction, broader collaboration and resources are needed to “solidify this emergency response to the COVID-19 pandemic into a national system” that continues to monitor COVID-19 as well as other public health threats. To this end, the report includes specific recommendations for the CDC’s National Wastewater Surveillance System.
Here are some key findings from the report, taken from its summary section and a NASEM webinar presentation last Thursday:
Overall, the report finds that wastewater surveillance data “are useful for informing public health action and that wastewater surveillance is worthy of further development and continued investment.” The authors recommend that public agencies at all levels keep funding and promoting this monitoring tool.
Wastewater surveillance is not a new technology; it’s been used for decades to monitor the spread of polio. But COVID-19 led to widespread adoption of this technology and innovation into how it could be used, driven by some municipalities and universities that were early to embrace wastewater.
As a population-level tool, wastewater surveillance provides data on how diseases spread through a community without relying on access to clinical testing. This surveillance is becoming more important for COVID-19 as people opt for at-home tests over PCR tests, and should be used specifically to track new variants.
Community sewersheds that may be tested range in size from serving hundreds of people to serving millions; they also differ based on geography, demographics, and many other factors. As a result, early researchers in this space developed testing and analysis methods that were specific to their communities.
Now, however, the CDC faces a challenge: “to unify sampling design, analytical methods, and data interpretation to create a truly representative national system while maintaining continued innovation.” In other words, standardize the system while allowing local communities to keep doing what works best for them.
Sites in the CDC’s National Wastewater Surveillance System (NWSS) are currently not representative of the U.S. as a whole, as the system is based on wastewater utilities and public health agencies choosing to participate.
The CDC needs to expand this system to be more equitable across the country, with targeted outreach, offering resources to sites not currently participating, and other similar tactics. This expansion process should be open and transparent, the report’s authors write.
As NWSS expands, the CDC should select and prioritize “sentinel sites” that can help detect new coronavirus variants and other new emerging health threats early on. These sites might include international airports as well as zoos and livestock farms, where potential animal-to-human transmission may be monitored.
Better public communication is needed: the CDC (and other agencies) should improve its public outreach about wastewater data, including addressing any privacy concerns that people may have. The report specifically recommends that the CDC “convene an ethics advisory committee” to assist with privacy concerns and data-sharing concerns.
In assessing potential new targets for wastewater surveillance, the report recommends three criteria: “(1) public health significance of the threat, (2) analytical feasibility for wastewater surveillance, and (3) usefulness of community-level wastewater surveillance data to inform public health action.”
NWSS needs more funding from the federal government to expand its sites, continue its COVID-19 tracking efforts, fund projects at state and local levels, and pivot to new public health threats as needed. This funding needs to be “predictable and sustained,” the report’s authors write.
Illinois is the latest state to get its own dashboard for COVID-19 wastewater surveillance, with a new website that launched earlier this week. It includes data for 75 sites across the state.
The new dashboard—like the state’s wastewater surveillance program itself—is a collaboration between the Illinois Department of Public Health and the Discovery Partners Institute, a research center at the University of Illinois. Illinois’ agency received more than $6.5 million in federal grants to fund wastewater testing, according to local TV station WTTW.
I poked around a bit on the new dashboard, and I’m a fan: it includes a map of sampling locations, charts showing COVID-19 trends over time, easily-downloadable data, and ample information on how to interpret results. Nice work, Illinois!
It’s the fourth year of the pandemic. I’ve written this statement in a few pitches and planning documents recently, and was struck by how it feels simultaneously unbelievable—wasn’t March 2020, like, yesterday?—and not believable enough—haven’t we been doing this pandemic thing for an eternity already?
As someone who’s been reporting on COVID-19 since the beginning, a new year is a good opportunity to parse out that feels-like-eternity. So this week, I reflected on the major trends and topics I hope to cover in 2023—both building on my work from prior years and taking it in new directions.
(Note: I actually planned to do this post last week, but then XBB.1.5 took higher priority. Hence its arrival two weeks into the new year.)
Expansions of wastewater, and other new forms of disease surveillance
As 2022 brought on the decline of large-scale PCR testing, wastewater surveillance has proven itself as a way to more accurately track COVID-19 at the population level—even as some health departments remain wary of its utility. We also saw the technology’s use for tracking monkeypox, polio, and other conditions: the WastewaterSCAN project, for example, now reports on six different diseases.
This year, I expect that wastewater researchers and public agencies will continue expanding their use of this surveillance technology. That will likely mean more diseases as well as more specific testing locations, in addition to entire sewersheds. For example, we’re already seeing wastewater testing on airplanes. I’m also interested in following other, newer methods for tracking diseases, such as air quality monitors and wearable devices.
At the same time, these surveillance technologies will continue to face challenges around standardization and public buy-in. The CDC’s big contract with Biobot expires this month, and I’ve already noticed a decline in sites with recent data on the agency’s dashboard—will CDC officials and local agencies step in to fill gaps, or will wastewater testing become even more sporadic?
New variants, and how we track them
For scientists who track the coronavirus’ continued evolution, 2022 was the year of Omicron. We didn’t see all-new virus lineages sweeping the world; instead, Omicron just kept mutating, and mutating, and mutating. It seems likely that this pattern will continue in 2023, but experts need to continue watching the mutation landscape and preparing for anything truly concerning.
With declining PCR testing, public agencies and companies that track variants have fewer samples to sequence. (This led to challenges for the CDC team tracking XBB.1.5 over the holidays.) As a result, I believe 2023 will see increased creativity in how we keep an eye on these variants—whether that’s sequencing wastewater samples, taking samples directly from healthcare settings, increased focus on travel surveillance, or other methods.
Public health experts—and journalists like myself—also need to rethink how we communicate about variants. It’s no longer true that every new, somewhat-more-contagious variant warrants alarm bells: variants can take off in some countries or regions while having relatively little impact in others, thanks to differences in prior immunity, seasonality, behavior, etc. But new variants still contribute to continued reinfections, severe symptoms, Long COVID, and other impacts of COVID-19. Grid’s Jonathan Lambert recently wrote a helpful article exploring these communication challenges.
Long COVID and related chronic diseases
As regular readers likely know, Long COVID has been an increased topic of interest for me over the last two years. I’ve covered everything from disability benefits to mental health challenges, and am now leading a major project at MuckRock that will focus on government accountability for the Long COVID crisis.
Long COVID is the epidemic following the pandemic. Millions of Americans are disabled by this condition, whether they’ve been pushed out of work or are managing milder lingering symptoms. Some people are approaching their three-year anniversary of first getting sick, yet they’ve received a fraction of the government response that acute COVID-19 got. Major research projects are going in the wrong directions, while major media publications often publish articles with incorrect science.
For me, seeing poor Long COVID coverage elsewhere is great motivation to continue reporting on this topic myself, at MuckRock and other outlets. I’m also planning to spend more time reading about (and hopefully covering) other chronic diseases that are co-diagnosed with Long COVID, like ME/CFS and dysautonomia.
Ending the federal public health emergency.
Last year, we saw many state and local health agencies transition from treating COVID-19 as a health emergency to treating it as an endemic disease, like the many others that they respond to on a routine basis. This transition often accompanied changes in data reporting, such as shifts from daily to weekly COVID-19 updates.
This year, the federal government will likely do the same thing. POLITICO reported this week that the Biden administration is renewing the federal public health emergency in January, but will likely allow it to expire in the spring or summer. The Department of Health and Human Services has committed to telling state leaders about this expiration 60 days before it happens.
I previously wrote about what the end of the federal emergency could mean for COVID-19 data: changes will include less authority for the CDC, less funding for state and local health departments, and vaccines and treatments controlled by private markets rather than the federal government. I anticipate following up on this reporting when the emergency actually ends.
Transforming the U.S. public health system
Finally, I intend to follow how public health agencies learn from—or fail to learn from—the pandemic. COVID-19 exposed so many cracks in America’s public health system, from out-of-date electronic records systems to communication and trust issues. The pandemic should be a wakeup call for agencies to get their act together, before a new crisis hits.
But will that actually happen? Rachel Cohrs has a great piece in STAT this week about the challenges that systemic public health reform faces, including a lack of funding from Congress and disagreements among experts on what changes are necessary. Still, the window for change is open right now, and it may not be at this point in 2024.
In the past week (December 29 through January 4), the U.S. officially reported about 470,000 new COVID-19 cases, according to the CDC. This amounts to:
An average of 67,000 new cases each day
143 total new cases for every 100,000 Americans
16% more new cases than last week (December 22-28)
In the past week, the U.S. also reported about 46,000 new COVID-19 patients admitted to hospitals. This amounts to:
An average of 6,500 new admissions each day
13.9 total admissions for every 100,000 Americans
16% more new admissions than last week
Additionally, the U.S. reported:
2,700 new COVID-19 deaths (390 per day)
28% of new cases are caused by Omicron XBB.1.5; 56% by BQ.1 and BQ.1.1; 5% by XBB (as of January 7)
An average of 150,000 vaccinations per day
Well, here we are: the winter COVID-19 surge. It may have happened later than some experts predicted, but the U.S. is clearly now experiencing an uptick in virus transmission as the latest, most contagious Omicron subvariants collide with holiday travel and gatherings.
You might notice that the CDC’s official case numbers didn’t rise too dramatically this week (though the national count is up 16% compared to last week). That’s unsurprising: case increases after holidays are always delayed, because many testing sites and public health officials take time off from processing new data. Christmas and New Year’s tend to deliver the worst of this trend—and in 2022, limited access to PCR testing made case numbers even less reliable.
Wastewater surveillance, on the other hand, clearly shows a significant rise in coronavirus spread from early December through early January—building on another rise that followed Thanksgiving. Biobot’s dashboard suggests that the U.S. as a whole is seeing about as much COVID-19 transmission now as we saw at the peak of the summer BA.5 wave. In some places, transmission is the highest it’s been since last January (during the original Omicron surge.)
The CDC’s wastewater data similarly show increasing COVID-19: out of 600 sites with available recent data, more than half were reporting upticks in the two-week period ending January 2. 117 of those sites reported an increase between 100% and 999%, and 87 reported an increase over 1,000%.
Regionally, the Northeast has reported the biggest recent COVID-19 spike in wastewater, though the trend may already be turning around. We see this both in Biobot’s regional data and in individual cities and counties, like Boston and New York City. The Northeast is also a hotspot for XBB.1.5, a homegrown Omicron subvariant that’s spreading faster than other lineages. (More on that later in the issue.)
In addition to the wastewater surveillance, hospitalization data have remained uninterrupted by the holidays with clear increases in COVID-19 patients through December and into this week. This week, about 6,600 new COVID-19 patients were admitted to hospitals nationwide, a 16% increase from the prior week and about twice the number of people admitted during the week before Thanksgiving.
Washington D.C., Connecticut, Massachusetts, and West Virginia reported the highest rates of new COVID-19 patients in the week ending January 3, according to the latest Community Profile Report. They were followed by other Northeast states New Jersey, New York, and Delaware. But states reporting the highest increases in hospitalization are in the South: Louisiana, Mississippi, Florida, Texas.
Two pieces of good news for this week: the flu and RSV are both trending down after their surges earlier in the fall. High levels of influenza-like activity remain in the majority of states, though. And we may see a second flu peak driven by a second strain, as Katelyn Jetelina reports in Your Local Epidemiologist.
All the same safety measures we know and love—masks, testing, vaccinations, etc.—continue to help reduce the risk of COVID-19 and other viruses. But uptake of these measures remains low. As of January 5, only 15% of the eligible U.S. population has received an Omicron-specific booster dose, per the CDC.
COVID-19 Data Dispatch 