What is a COVID-19 infection? With the definition not consistent, the answer is far from simple.
Few people doubt COVID-19 will stay around, and it is starting to increase again in August 2023. Daily hospital admissions are on the rise, up over 70% from mid-June. Currently, there are 1500 COVID-19 admissions daily in the United States and projected to increase to over 1800 admissions by the end of August. The Walgreens COVID-19 test positivity rate is at 44.7%, the highest it has ever been.
All of this sounds dire, but at the peak of the Omicron surge, there were over 21,000 hospital admissions per day. And although Walgreens’ test positivity rate is surging, only 2,414 tests are performed each week, compared to almost 200,000 during the Delta surge.
Some of the best data is being compiled by EPIC, the electronic medical record company. Compared to mid-June, data shows an almost doubling of infections (up over 80%), a 150% increase in test positivity rate to 11.49%, and a doubling of emergency department visits. Hospitalizations as of July 23, 2023, are up 40%. We must remember that hospitalizations are a delayed indicator; thus, the EPIC data predicts further significant increases.
Finally, what exactly is a COVID-19 infection is still in flux. Unless one is admitted with severe pulmonary involvement, requiring steroid administration, a positive COVID-19 test may just be considered incidental. A better estimation of acute hospitalizations would be comparing the incidence of COVID-19-positive patients in the hospital with that in the community. There is ample evidence that the virus can damage the cardiovascular system, causing cardiac damage, arrhythmias, and thromboembolisms. The answer to the question, “Would you count a patient admitted for a heart attack with a positive COVID-19 test as a COVID-19 admission?” is a resounding yes.
Our current increase in infections has been attributed to the EG.5 variant (Eris), a “new variant of interest,” according to the World Health Organization.
Of additional concern is that the delayed effects of the virus can cause long COVID and even death. A recent article published in the Journal of Neurology summarized 25 studies on magnetic resonance imaging and neurological findings in COVID-19 patients. They found that 22% of studied patients had acute or subacute infarcts, 22% had olfactory bulb abnormalities, and 20% had white matter abnormalities. In addition, there was also a variety of other pathological findings. This article adds to the growing evidence of lasting central nervous system damage in some patients with COVID-19. It lends credence to the common symptoms of brain fog, memory difficulties, and cognition problems in long COVID-19 patients. Maura Boldrini et al reported that neuropsychiatric symptoms can persist in 20% to 70% of COVID-19 patients, lasting months after their respiratory symptoms have resolved.
The CDC has an ongoing Household Pulse Survey of self-reported symptoms of long COVID in the United States adult population. The CDC reported that the prevalence of long COVID in all US adults decreased from 7.5% to 6% from June 2022 to June 2023. However, this decrease stabilized in January 2023, and the prevalence has remained relatively unchanged. A total of 26.4% of long COVID patients reported significant limitations in their activities after developing the acute infection. A study published in Clinical Infectious Disease found that 25.3% of patients with long COVID had their day-to-day activities impacted “a lot,” and 28.9% had acute COVID-19 more than one year previously. Another study from Israel found that 34.6% of COVID-19 patients did not return to their baseline health.
In at least some patients, COVID-19 symptoms can persist. Jennifer Logue et al found that 32.7% of COVID-19 outpatients had persistence of at least one symptom at 3 to 9 months post-acute infection. At 2 years post hospitalization, Xinyue Yang et al reported in JAMA Network that 19.8% of COVID-19 patients still had symptoms. A survey conducted in the United Kingdom found that 1.9 million people were experiencing long COVID. Of these, 69% had the acute infection at least one year previously, and 41% had the infection at least 2 years previously.
At this point in the pandemic, we should have solid numbers on both the short- and long-term risks of COVID-19 and the incidence of long COVID, but there is still just a patchwork of independent studies and a dearth of solid data. We no longer have an accurate accounting of acute infections, and the exact incidence and duration of long COVID is unknown. Presently, EPIC and Walgreens data greatly aid in our tracking of the pandemic.
COVID-19 infections will not go away and will have a lasting impact on our resources. We must be able to accurately calculate and project the societal and workforce impact of COVID-19. We should have the data to calculate the percentage of the population disabled by COVID-19 and project this into the future. But at this point, we appear to still have our heads in the sand, hoping that if we do not measure and report the virus one day, like a miracle, will disappear.