As hospitals already strained by the Delta variant threaten to buckle under a crush of patients infected with the even more contagious Omicron, Dr. Anthony S. Fauci said Americans should focus more on the threat the winter wave poses to hospitals and less on the record number of cases.
Over the past week, an average of more than 401,200 cases has been reported each day in the United States, tripling from two weeks ago and the first time the number has topped 400,000, according to a New York Times database (new case numbers are slightly depressed because fewer states are reporting after the New Year holiday). Hospitalizations were by comparison up 33 percent, however, to 92,300, while deaths had dropped 4 percent to an average of 1,249 daily.
It’s unclear how many hospitalizations are patients infected with Omicron rather than the Delta variant, which scientists believe is significantly more virulent. According to the latest data from the Centers for Disease Control and Prevention, for the week ending Dec. 25, Omicron accounted for over 58 percent of new cases versus over 41 percent for Delta.
Dr. Fauci, the government’s top infectious disease expert, noted on Sunday on ABC’s “This Week with George Stephanopoulos” that many new infections, especially in people who are vaccinated and boosted, result in no symptoms or mild symptoms, making the absolute number of cases less important than it was for previous versions of the virus.
“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,” Dr. Fauci said.
That advice is in keeping with what many epidemiologists have said all along. Despite the daily drumbeat of case counts, the number of positive tests has never been a perfect indicator of the course of the epidemic.
The number of cases has exploded because the Omicron variant seems to be much more contagious and able to evade vaccines than other earlier variants, which has spurred more widespread testing. What’s more, the official numbers are almost certainly an undercount, because many people are testing positive on rapid at-home tests or carrying the virus without any symptoms.
Yet, as Dr. Fauci told Mr. Stephanopoulos, the concern is not so much the mild or asymptomatic Omicron cases as it is the number of people with severe or fatal infections.
“The real bottom line that you want to be concerned about,” he said, “is are we getting protected by the vaccines from severe disease leading to hospitalization?”
So far, vaccines and boosters appear to be providing that protection. But the unvaccinated remain at risk.
“I’m still very concerned about the tens of millions of people who are not vaccinated at all because even though many of them are going to get asymptomatic and mildly symptomatic, a fair number of them are going to get severe disease,” Dr. Fauci said.
Also, even if Omicron is milder, as most evidence suggests, a higher caseload means more health care workers who cannot work because they test positive as well as more chances that people could get sick enough to require medical care.
“We have got to be careful about that, because, even if you have a less of a percentage of severity, when you have multi-multi-multi-fold more people getting infected, the net amount is you’re still going to get a lot of people that are going to be needing hospitalization,” Dr. Fauci said.
Hospitals in several states are showing signs of strain and experiencing staffing shortages.
“At the moment, the major concern is the effect of Omicron on hospital staffing in conjunction with fatigue and increasing admissions for Covid-19 as well as other things,” said Julio Figueroa, chief of infectious diseases at the Louisiana State School Health Sciences Center.
Hawaii has requested 700 additional health care workers from the Federal Emergency Management Agency, while some hospitals in the St. Louis area have started to limit visitors again. Leaders in Illinois have urged hospitals to postpone elective surgeries and procedures.
The Maryland Hospital Association said that the number of hospital patients had surpassed the state’s Covid peak from last winter.
“We believe that the next four to six weeks are really going to be a terrible point in this crisis, and it’s potentially going to be the worst part of the whole two-year fight,” Gov. Larry Hogan of Maryland said on the CNN program “State of the Union.”