PROVIDENCE, R.I. (WPRI) – Hospitalizations are fast becoming Rhode Island health officials’ best indicators for tracking the severity of the pandemic, as the prevalence of at-home tests and a hodgepodge of surveillance programs outside of the state’s control have scrambled the math on infections.
The results of daily testing had proven a reliable indicator throughout the pandemic, allowing health officials to pinpoint clusters, respond to outbreaks and track community spread. And while state officials said that data will continue to play an important role in understanding public health, they are beginning to lean on hospitalization data as a more accurate measurement in 2022.
“Our test results are a very important metric,” R.I. Health Department spokesperson Joseph Wendelken said this week. “But we look at other metrics closely as well, such as our hospitalization data. Given how delta and omicron are transmitting and affecting communities in different ways, our hospitalization data has even more weight.”
The highly contagious omicron variant has fueled unprecedented daily infections that have shattered single-day records multiple times in recent weeks. The eye-grabbing numbers are also believed to be an undercount, as at-home testing kits are selling out as quickly as they’re stocked, casting a question mark over how many people are testing positive and never counted.
“Thousands of at-home tests are used every day in Rhode Island that do not get reported,” Wendelken said.
Of course, some people testing positive in their homes with an antigen test might follow-up with a PCR test at a government- or pharmacy-run site. But there’s no infrastructure in place to capture those numbers, and people cannot self-report positive results at home, nor can state officials determine whether those results are legitimate.
“The daily data that any state reports now is not perfectly reflective of every test in the state,” Wendelken said, pointing to the at-home tests.
Beyond at-home tests, there are other issues complicating test data. For example, some schools participate in a type of surveillance testing known as “pool testing,” which means a group of swabs are collected from a sample-size of students and PCR tested together.
The results are reported to the Health Department in aggregate form, but excluded from the state’s daily COVID-19 reporting. Wendelken said the reason is because the data doesn’t include underlying demographic and geographic information – also known as “row level data” – that’s collected at state- or pharmacy-run sites.
Currently, the state is running between 8,000 and 10,000 K-12 surveillance tests per month and about 60% are pooled, according to Wendelken.
“It would be very labor intensive for schools to be reporting all of this row level data,” Wendelken explained, adding that the information is now being collected for all school-based antigen testing thanks to a recent federal grant that provided schools with more tools to report data.
On a smaller scale, there is also a group of private employers who run surveillance testing programs for their employees. The data from those programs are likewise reported to the state in aggregate and excluded from the numbers posted on the state’s website each day for the same reasons.
“Schools and many businesses don’t have the kind of data infrastructure needed for reporting tests daily,” Wendelken said. “The goal of these programs is to give organizations a way to easily identify positive cases.”
The Health Department’s decision to start giving more weight to other health metrics, such as hospitalizations, comes at a time when its data shows about 30% of the state’s population has received a booster. Another 48% of residents have been fully vaccinated – but not boosted – meaning roughly three of every four Rhode Islanders have elevated protection against the coronavirus.
Meanwhile, the omicron variant so far has proven more contagious but less severe than prior versions of the coronavirus, such as delta. A Target 12 analysis of COVID-19 hospitalizations as a percentage of cases shows the rate started to fall compared to last year beginning in November – just before the omicron was first identified in the United States on Dec. 1.
Dr. Ashish Jha, dean of Brown University’s school of public health, argued the “decoupling” of cases from hospitalizations means the country should shift its thinking on infections.
“For two years, infections always preceded hospitalizations which preceded deaths, so you could look at infections and know what was coming,” Jha said recently on ABC’s This Week.
“Omicron changes that, and this is the shift we’ve been looking for in many ways,” he added. “We’re moving to a phase where, if you’re vaccinated – and in particular, if you’re boosted – you might get an infection. It might be a couple days of not feeling so great. But you’re going to bounce back.”
Jha – like the state’s health officials – said the best approach now should be to continue to track infections, especially among unvaccinated people who are more likely to end up in the hospital, but to put a greater focus on hospitalizations and deaths trends.
In Rhode Island, hospitalizations have been rising steadily since the beginning of November, and more quickly in the past couple weeks. While they remain below the peak of December 2020, more than 400 people were in the hospital with COVID-19 on Wednesday, representing the largest total since January.
Meanwhile, deaths have also been trending upward since November, but at a slower pace, and the daily average is still less than half the levels seen last year. As of Wednesday, the state’s death toll totaled 3,107 people.