Throughout the pandemic, many observers, including this author, have noted that cases are not the correct metric to measure the impact of Covid. We have also questioned hospitalization and death numbers in an environment where every patient who arrives in an emergency room receives a test. Recently, Dr. Anthony Fauci partially vindicated our assertions. The diminutive mastermind behind the entire disastrous pandemic response finally said that the focus should be on hospitalizations, not cases. Of course, that was as the nation cruised past a million new cases a day and record case numbers were posted in the “good” states like New York.
“As you get further on and the infections become less severe, it is much more relevant to focus on the hospitalizations as opposed to the total number of cases,” Fauci told George Stephanopoulos on Sunday. In reality, infections were less severe in vast swaths of the population all along, and hospitalizations were probably always the correct number. When he appeared on MSNBC on Friday, Fauci also admitted that when children get hospitalized, it is with Covid instead of because of Covid. This has been the case throughout the pandemic, thanks to incidental testing. Two retrospective studies in California published in May of 2021 found pediatric hospitalizations were overcounted by at least 40%.
Now that the admissions are coming from the top, other doctors feel comfortable giving a realistic picture. Dr. M. Kit Delgado, an assistant professor of emergency medicine at the Perelman School of Medicine at the University of Pennsylvania, took to Twitter to share his observations. Delgado broke down the patients he is seeing into three categories:
- Hospitalized for Covid: mostly unvaxxed or elderly/chronically ill & unboosted
- Covid exacerbated a chronic illness like COPD
- Incidental Covid that gets caught on blanket screening
In reality, this breakdown always existed in the census of patients hospitalized with Covid. While the relative percentages may differ with Omicron, every patient admitted to the hospital was tested no matter what symptoms brought them to the emergency room beginning in early 2020. Delgado also added that the need for ICU-level care decreased significantly compared to prior waves.
A Manhattan emergency room physician, Dr. Craig Spencer, echoed Delgado’s comments about exacerbating existing illnesses. “Today, it seemed like everyone had COVID. Like, so many. And yes, like before, there were some really short of breath and needing oxygen. But for most, COVID seemed to topple a delicate balance of an underlying illness. It’s making people really sick in a different way,” Spencer wrote on Twitter. No one at this facility required a ventilator. “Thankfully, the Covid patients aren’t as sick.”
An exacerbation of a chronic illness is not a Covid hospitalization. If a person with diabetes goes into diabetic ketoacidosis because of a viral infection, you treat the diabetic complication. Hospitals frequently see these complications in people with chronic conditions with influenza, pneumonia, and other acute illnesses. This phenomenon is not unique to Covid. However, it seems everyone has forgotten.
Delgado also noted the number of people with mild or no symptoms coming to the ER for testing because of the lack of testing in the community. This trend is a result of the panic created by public health leaders like Dr. Fauci over the last two years. Stockholm, Sweden, started testing only patients sick enough to be hospitalized with Covid symptoms in March of 2020. The age striation and risk tranching according to a few serious comorbidities have been evident since at least May of 2020. Public health leaders should be stressing that messaging now to relieve emergency rooms and ensure that those who need care can get it.
In a move that seems particularly smart given all of the stupid ones she has made previously, New York Governor Kathy Hochul ordered a more precise accounting of Covid hospitalizations. During a news conference on Monday, she announced, “Beginning tomorrow, we’re going to be asking all hospitals to break out for us how many people are being hospitalized because of COVID symptoms [and] how many people happen to be testing positive, just while they’re in there for other treatments.” After calls with hospital leaders around the state, she said that anywhere from 20 to 50 percent of Covid patients got identified through incidental testing.
Americans have been dealing with overestimates and poor metrics for nearly two years. It is time to demand accurate statistics for hospitalizations and deaths. Every governor should be requesting this granular level of information from hospitals since the CDC refuses to differentiate. The prepositions “with,” “for,” and “from” matter, and every state leadership team should demand their statistics be categorized that way.