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Americans need to make their own medical risk assessments as covid-19 cases accelerate in the United States, President Joe Biden’s chief medical adviser said, reflecting a less virulent virus and public exhaustion with restrictions.
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“This is not going to be eradicated and it’s not going to be eliminated,” Anthony Fauci said on ABC’s “This Week” on Sunday. “And what’s going to happen is that we’re going to see that each individual is going to have to make their calculation of the amount of risk that they want to take.”
Fauci’s comments contrast with more dire warnings he issued during earlier phases of the pandemic. The shift in tone by the Biden administration comes as Americans have tired of restrictions. Almost all have now been lifted, while vaccines, immunity and treatments are helping keep cases less severe.
Meanwhile, in the nation’s capital, more than 50 people who attended the elite Gridiron Club dinner on April 2 have tested positive for the coronavirus, The Washington Post reported — at least 8% of those who attended. The list of the infected includes the U.S. attorney general, Commerce secretary, aides to Vice President Kamala Harris and first lady Jill Biden, and the sister of the president.
Speaker of the House Nancy Pelosi, who didn’t attend the dinner, has also tested positive, raising concern about time she spent in proximity to Biden before her diagnosis.
Fauci said White House protocols “are sufficient to protect” the president. Biden spent an hour with Pelosi in the two days before she tested positive last week, including an embrace and a kiss on the cheek.
“The protocols to protect the president are pretty strong,” Fauci said, adding that Biden has had four covid-19 shots and people who come in contact with him must be tested.
Driven by the BA.2 omicron subvariant, average reported U.S. infections reached almost 100,000 on Friday, the most in a month. Health experts say many cases are being missed, in part due to more widespread home testing.
Infections remain a fraction of the peak of the omicron variant wave in January, when daily cases spiked as high as 1.3 million. Deaths and hospitalizations are still falling.
Some people may want to take extra precautions, Fauci said.
“What is my age?” he said. “Do I have people at home who are vulnerable that, if I bring the virus home, there may be a problem?”
RESULTS UNKNOWN
Testing and viral sequencing are critical to responding quickly to new outbreaks of covid-19. As the country tries to move on from the pandemic, demand for lab-based testing has declined and federal funding priorities have shifted. The change has forced some testing centers to shutter while others have raised prices in response to the end of government-subsidized testing programs. People are increasingly relying on at-home rapid tests if they decide to test at all. But those results are rarely reported, giving public health officials little insight into how widespread the virus truly is.
“There’s always more spread than we can detect,” said Abraar Karan, an infectious disease physician at Stanford University. “That’s true even more so now than earlier in the pandemic.”
“We are probably underestimating the number of infections we are having now because many of the infections are either without symptoms or minimally symptomatic and you will miss people that do it at home,” said Fauci on Wednesday.
Despite groundbreaking scientific advances such as vaccines and antivirals, public health experts say the U.S.’ covid-19 defenses appear to be getting weaker as time goes on, not stronger.
“We’re in a worse position,” said Julia Raifman, an assistant professor of health law, policy and management at Boston University School of Public Health. “We’ve learned more about the virus and how to address it, and then we haven’t done what we need to do to address it.”
In late February, the Centers for Disease Control and Prevention began relying on hospital admissions and ICU capacity to determine community-level risk. That was a change from relying on covid-19 case counts and the percentage of positive tests, which are widely considered a better snapshot of how much virus is circulating in a given community. Several states, including Arizona, Hawaii, Nevada and Ohio, have now completely stopped reporting daily covid-19 data to the CDC, making it more difficult to gauge the progression of the pandemic in those states.
According to the CDC, the majority of the country is still considered low risk. Public health experts argue this is misleading though, given hospitalization and death generally occur days to weeks after initial infection.
“CDC is understating and downplaying cases,” said Gregg Gonsalves, an infectious disease expert at Yale’s School of Public Health. “Their alarm bells won’t go off until we see a rise in hospitalizations and deaths, which are lagging indicators.”
CASES PICK UP
In recent weeks, cases have started to tick up in places such as New York, Massachusetts and Chicago. National leaders have largely declared victory over the virus, but some local governments are starting to again urge caution. New York City delayed lifting a mask mandate for children under 5 years of age because of rising cases and the city’s health commissioner recommended New Yorkers return to masking indoors.
In New Jersey, Stacy Flanagan, the director of health and human services for Jersey City, said that in the past three months she’s had just two people call to report positive at-home tests. Cases are continuing apace in the city with an average of 64 new cases per day, according to health department data. That’s almost double the number of daily cases reported a month ago.
Public health experts are left to piece together data from a variety of sources. For weeks, sewer data has shown cases are increasing in some regions of the U.S. — foreshadowing the uptick in positives that places like New York and Massachusetts are now seeing.
WAITING FOR NEXT WAVE
The White House maintains there’s enough data about covid-19 in circulation to catch the next surge. Tom Inglesby, senior policy adviser for Biden’s covid-19 Response Team, said the CDC gets 850,000 lab-based test results every day, which he believes is sufficient to detect trends in the positivity rate and variant prevalence.
“It is true that there is a larger shift now to switch to over-the-counter testing, that’s definitely happening,” Inglesby said. “There are various efforts underway to try to assess whether people might be willing to voluntarily report some fraction of those tests that are being performed at home.” One biotech company, Ellume, has rolled out an at-home test and app that automatically reports positive tests to the CDC through a secure, HIPAA-compliant connection.
Meanwhile the CDC has pledged to ramp up its wastewater surveillance efforts. Environmental surveillance, like many other tools to track covid-19, may be at risk without additional funding from Congress. On April 5, lawmakers reached an agreement to reallocate $10 billion to pandemic preparedness, which White House press secretary Jen Psaki said would fund “the most immediate needs” such as antivirals and tests. But that bill has yet to clear the Senate.
Information for this article was compiled byIan Fisher, Madison Muller and Elise Young of Bloomberg News (TNS).
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