Image: Bernie Sanders wearing a KN95 respirator at the 2023 State of the Union Address.

The number of reported cases are a fraction of what they should be.

The three stated reasons for ending the national public health emergency status of COVID-19 this May are because, in the time since the Omicron surge at the end of January 2022, daily (reported) cases are down by 92%, (acute) deaths have declined by over 80%, and new hospitalizations are down by nearly 80%.

There are some important things to clarify with these figures. First, daily reported cases. As Shannon Pettypiece reported for NBC News in September, 2022:

The number of reported Covid cases is currently a quarter of what it was at its peak last winter. But Chris Murray, director of the Institute for Health Metrics and Evaluation, estimates that only 4% to 5% of infections are being reported, because so many are uncovered through at-home tests and aren't reported to public health departments, or they aren't being detected at all.

[…] The decline in PRC testing and a shift to at-home tests also leaves public health officials increasingly flying blind with regard to the spread of infections because few at-home test results are reported to public health departments, unlike with laboratory tests. That could make it more difficult for testing manufacturers and laboratories to see a surge coming and ramp up accordingly.

Shannon also noted:

• Congress failed to pass a COVID spending package that included $2 billion for testing

• The White House ended its free COVID testing program

• State and local governments have been running short on funding to provide free PCR tests, and testing centers on street corners or at large gathering sites have vanished

A decision is being based on reported cases, even though we curtailed our ability to ensure that this number reflects the actual amount of cases.

Hospitalizations — and deaths from acute disease — are also down. These are extremely good things, but not the whole story with COVID. Even a "mild" infection carries multiple long-term health risks, including:

• capillary clotting

• heart disease and stroke

• damage to the brain and blood-brain barrier

• tinnitus

• kidney disease

• diabetes

As Katherine J. Wu reported in The Atlantic on February 13:

Recent evidence from two long-term surveys have hinted that the pool of long-haulers might be shrinking, even as new infection rates remain sky-high: Earlier this month, the United Kingdom’s Office for National Statistics released data showing that 2 million people self-reported lingering symptoms at the very start of 2023, down from 2.3 million in August 2022. The U.S. CDC’s Household Pulse Survey, another study based on self-reporting, also recorded a small drop in long-COVID prevalence in the same time frame, from about 7.5 percent of all American adults to roughly 6. Against the massive number of infections that have continued to slam both countries in the pandemic’s third year and beyond, these surveys might seem to imply that long-haulers are leaving the pool faster than newcomers are arriving.

But as Hannah Davis, Lisa McCorkell, Julia Moore Vogel, & Eric Topol cautioned in Nature Reviews Microbiology on January 13:

Long COVID is associated with all ages and acute phase disease severities, with the highest percentage of diagnoses between the ages of 36 and 50 years, and most long COVID cases are in non-hospitalized patients with a mild acute illness, as this population represents the majority of overall COVID-19 cases.

And:

These so-called mild cases that result in long COVID often have an underlying biology different from acute severe cases, but the same types of tests are being used to evaluate patients. […] Other recurring issues include studies failing to include the full range of symptoms, particularly neurological and reproductive system symptoms, and not asking patients about symptom frequency, severity and disability. Cardinal symptoms such as postexertional malaise are not widely known, and therefore are rarely included in study designs.

This tells us that:

1. Long COVID isn’t going away.
2. There are flaws in the way we count what long COVID is or who has it.

That sounds like a public health emergency to me.

Meanwhile, a MaskTogetherAmerica petition is urging the Biden administration to extend the national and public health emergency declarations.

References:

1. U.S. Department of Health & Human Services — Fact Sheet: COVID-19 Public Health Emergency Transition Roadmap
2. NBC News — Covid testing providers scale back despite worries of another winter surge
3. The Biochemical Journal — A central role for amyloid fibrin microclots in long COVID/PASC: origins and therapeutic implications
4. Nature Medicine — Long-term cardiovascular outcomes of COVID-19
5. Journal of Neuroinflammation — COVID-19 and cognitive impairment: neuroinvasive and blood‒brain barrier dysfunction
6. Frontiers in Public Health — Changes in Tinnitus Experiences During the COVID-19 Pandemic
7. Nature Reviews Nephrology — Long COVID and kidney disease
8. The Lancet: Diabetes and Edocrinology — Risks and burdens of incident diabetes in long COVID: a cohort study
9. The Atlantic — The Future of Long COVID
10. Nature Reviews Microbiology — Long COVID: major findings, mechanisms and recommendations
11. MaskTogetherAmerica — Oppose Ending the National and Public Health Emergency Declarations