It’s getting even harder to tell how many Americans have the coronavirus

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Hello good morning, happy hump day. You may (not) be surprised to hear that Americans are divided over masking on mass transit.

Today’s edition: The Justice Department kicks the decision of whether to appeal the travel mask mandate ruling to the CDC. Moderna releases data supporting its fall booster shot strategy. But first…

Covid case numbers are increasingly unreliable

Coronavirus case counts have never been a perfect tally, but the numbers are becoming even less reliable.

The culprits? The proliferation of at-home tests (which often aren’t reported to the government); the maintenance of surveillance testing, including at some colleges; and the unwinding of some community testing sites in several states and cities are all playing a role.

The undercount of infections comes as health officials across the country are grappling with understanding the impact of the BA.2 subvariant — and preparing to track even more transmissible forms of omicron. While infection rates can be useful indicators, some federal officials and public health experts say they’re increasingly focused on other metrics, such as hospitalizations and tracking the virus in sewer water.

  • “The systems that we’ve used to detect cases — whether they be testing, surveillance, how we report out information — I think is very different today than it was even 12 weeks ago,” said Michael Osterholm, who leads the University of Minnesota’s Center for Infectious Disease Research and Policy and advised President Biden’s transition team.

Scott Gottlieb, former Food and Drug Administration commissioner:

The overall infection rate isn’t an accurate snapshot of the pandemic. Cases went underreported even before the prevalence of at-home tests.

For example: More than 140 million Americans had the coronavirus as of late January, according to estimates from blood tests that reveal antibodies from infection. That was about double the rate indicated by national case count trackers, our colleague Dan Keating reported in late February.

But some epidemiologists say they still look to case counts to track the relative differences in infections, particularly since hospitalizations and deaths are lagging indicators.

Case counts are beginning to tick upward after reaching lows virtually not seen since before last summer’s delta wave, but at the moment, hospitalizations haven’t followed suit. Some experts say they’re not anticipating the same explosion of cases as last winter, but acknowledge it’s still difficult to predict the virus’ path over the next few weeks. The virus has changed since 2020, and federal officials say the country has more tools — like vaccination and treatments — to fight it.

  • “We’re going to this moment where reporting’s lower than it was before. … I do wonder if things will look a little different, that we just won’t really get that signal,” said Natalie Dean, an assistant professor of biostatistics at Emory University.

Top federal officials say they’re aware of the undercount. Ashish Jha, the new White House coronavirus response coordinator, pointed to hospitalizations, wastewater data and community-based surveys as metrics he uses to gauge how much infection is in the community.

  • “I do feel like we have a pretty good grip of the overall picture, but no doubt about it, obviously, we’re not capturing every infection, especially with people doing more home tests,” Jha said last week on NBC News’s “Today” show.

the Centers for Disease Control and Prevention recently started incorporating the strain on the health-care system into its guidelines for mask-wearing recommendations, in addition to cases per 100,000 people. That was a major shift, prompting the easing of face coverings in the majority of the country seemingly overnight.

In the meantime, efforts are underway to better predict the pandemic’s future.

A new forecasting center: A team of federal health scientists officially launched yesterday with a mission to better predict what’s likely to happen next in this public health emergency and in future outbreaks.

Beefing up wastewater surveillance: This tool has been used to track other disease outbreaks in the past, but it’s gaining increasing importance in this stage of the pandemic, our colleague Lena H. Sun wrote last week.

  • But still, there are major gaps in wastewater monitoring. In fall 2020, the CDC set up a reporting network that tracks sewage from sites covering about 100 million people. Yet, the system isn’t fully in place, with fewer than half of states regularly reporting data to the CDC — and in some areas, only one or two sites are included.

Better reporting of home tests: That’s still a question mark. Some experts — such as Mara Aspinall, adviser to the Rockefeller Foundation and a professor of practice at Arizona State University — say it’s time to hash out a system of reporting at-home tests for the future.

Justice Department may appeal blocked transportation mask mandate ruling

The Justice Department is putting the ball in the CDC’s court. The DOJ said it would appeal a judge’s ruling to void the federal transportation mask mandate if the public health agency determines the requirement is still needed, The Post reports.

The CDC said late Tuesday that it would assess the need for such a requirement based on factors such as the risk of virus variants and trends in caseloads.

The announcement came after a day of mixed signals. Here are officials’ comments throughout the day:

  • President Biden: The decision is “up to them,” he said when asked whether Americans should continue to mask.
  • White House Press secretary Jen Psaki: “I’m not going to prejudge the Department of Justice and how they make considerations or assessments about whether or not they’re going to appeal.”
  • HHS Secretary Xavier Becerra: “We are right now in the process of deciding, and we likely will appeal that ruling. Stay tuned,” he said, according to CNN.

The administration had originally extended the mandate through May 3. But Monday’s ruling lifting the requirement prompted a slew of airlines, Amtrak and ride-sharing companies Uber and Lyft to shift toward a mask-optional policy. But airport officials in a few cities, like New York and Philadelphia, kept a mask mandate in place.

Moderna releases dual variant booster data

New data from Moderna suggests a booster shot that combines different versions of the coronavirus could offer better, longer-lasting protection against multiple variants than a regular dose, our colleague Carolyn Y Johnson reports.

The redesigned shot — called a bivalent booster — was tailored to fight the original version of the virus and the beta variant detected in late 2020.

Early evidence, which has yet to be peer reviewed, found that the bivalent shot appeared to broaden immunity and increase the level of virus-blocking antibodies, “even when additional variants of concern were not included in the booster,” Stephane BancelModerna’s chief executive, said in a statement.

The study is early proof of concept that the approach might work. But outside experts said the research provides limited insight into the future strategy because the formula is unlikely to be used. The beta variant fizzled out in late 2020, and omicron’s evolving subvariants have taken over as the dominant strain globally.

Bob Wachter, chair of the University of California, San Francisco Department of Medicine:

CDC: Unvaccinated children were more likely to be hospitalized during omicron wave

Unvaccinated children aged 5 to 11 were about twice as likely to be hospitalized during the record-breaking omicron surge than their inoculated peers, according to a CDC report released yesterday.

The study analyzed data from nearly 400 children in 14 states who were hospitalized with the coronavirus between mid-December and late February. It comes amid lagging vaccinations for kids in that age group, with less than 30 percent having received the shot, according to the post’s tracker.

  • Of the hospitalized children, 87 percent were unvaccinated and 30 percentt had no underlying medical conditions.
  • About 19 percent of children hospitalized during last winter’s surge were admitted to an intensive care unit.
  • Non-Hispanic Black children made up the largest share of unvaccinated children and represented roughly one third of the age group’s hospitalization overall.

CDC’s Morbidity and Mortality Weekly Report:

FDA warns of risks associated with prenatal screenings

Patients and healthcare providers should not solely rely on information gleaned from genetic non-invasive prenatal screenings (NIPS) tests when making decisions about a pregnancy because they can produce false results, the Food and Drug Administration cautioned. The move comes after a New York Times investigation found the tests’ grave predictions are often wrong.

Key context: The blood tests are used to inform pregnant women about a fetus’ risk for genetic abnormalities that could lead to a child being born with a serious health condition. But NIPS are screening tests, not diagnostic tests, and additional testing is needed to confirm the results, the FDA said.

The agency hasn’t cleared any of these tests widely used by providers, but said their results can be improperly interpreted and sometimes report genetic abnormalities when the fetus doesn’t have one.

In its warning, the FDA acknowledged reports of patients using the screening results alone to end pregnancies without confirming them with a diagnostic test.

  • On the move: Jennifer S. Lee will become the Alliance of Community Health Plans‘ chief medical officer. She was previously the director of Virginia’s Medicaid program and a deputy undersecretary at the Department of Veterans Affairs.
  • HHS wants distribute almost $105 million in grant funding already authorized by the American Rescue Plan Across 54 states and US territories to improve their mental health crisis call centers in preparation for the National Suicide Prevention Lifeline’s July transition to a 988 dial code.
  • The Biden administration could propose scrapping a Trump-era policy that allows medical workers to refuse to provide services that conflict with their religious or moral beliefs by the end of this month, political reports.

Why Cheap, Older Drugs That Might Treat Covid Never Get Out of the Lab (By Arthur Allen | Kaiser Health News)

Do I still need to wear a mask? A guide to help you decide. (Fenit Nirappil, Katie Shepherd, Salvador Rizzo and Dan Diamond l The Washington Post)

Boost now? Boost later? Tricky calculation for a 4th coronavirus shot. (Joel Achenbach and Carolyn Y. Johnson l The Washington Post)

Thanks for reading! See y’all tomorrow.

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