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How big is the latest US Covid wave? Nobody really knows.

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In this phase of the coronavirus pandemic, Eileen Wassermann has trouble calculating her daily risk – with infections being drastically undercounted and masks no longer being required.

The immunocompromised 69-year-old settles in her SUV for the half-hour ferry ride across Puget Sound from her home on Bainbridge Island to Seattle, where she’s undergoing a rare treatment inflammatory disease sarcoidosis.

A retired scientist and lawyer who has worked with pharmaceutical companies, Aquarius feels comfortable analyzing coronavirus data. But she said current numbers, which don’t make up most at-home test results, are unreliable.

“My modus operandi, which may sound ridiculous now, is to be as cautious as we were in early 2020,” said Wassermann, who has received two booster doses of the coronavirus vaccine. “I don’t want to run around like a frightened cat all the time, but on the other hand I don’t want to take any chances with my immune deficiency.”

Americans like Wassermann are navigating murky waters in the latest wave of the pandemic, with highly transmissible subvariants of omicron spreading as governments drop virus containment measures and release less data on infections. As health officials shift focus to COVID-related hospitalizations as the US death toll hits 1 million, people are largely left to their own devices to assess the risk amid a potentially stealthy surge.

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Experts say Americans can expect infections in their communities to be five to 10 times higher than official numbers.

“Any kind of look at the metrics on both at the local, state or national level is severe undercounting,” said Jessica Malaty Rivera, an epidemiologist at the Pandemic Prevention Institute, which is housed at the Pandemic Prevention Institute Rockefeller Foundation. “Everyone knows someone who is now getting covid.”

Hospital admissions have risen 57 percent nationwide since hitting a low six weeks ago. But the roughly 23,000 Covid patients in hospitals over the last week still represent almost the lowest hospitalizations of the entire pandemic. The recent The rise is being led by the Northeast, where hospitalization rates are nearly twice those of any other region.

Reported Covid cases have also tripled in the Northeast in just over a month, accounting for much of the national growth, according to the Centers for Disease Control and Prevention. The country has averaged about 100,000 new cases each day for the past week – more than three times higher than at the low point in March.

The recent spike in infections is testing a new CDC alert system, implemented by many local and state governments, that classifies Covid-19 levels in the community as “low” even as the number of new cases rises to levels once thought to be… was high.

Using these criteria, more than two-thirds of Americans live in low-risk areas. But 43 percent of residents in the Northeast live in areas considered high risk compared to 9 percent in the Midwest and less than 1 percent each in the South and West.

White House health officials on Wednesday urged the country to wear masks, get tested and stay up to date on vaccines and booster vaccines to prevent infections and serious illnesses as cases rise steadily in certain parts of the country.

“What’s driving this in the first place are these incredibly contagious subvariants,” said Ashish Jha, the White House Covid-19 response coordinator. “They are more contagious with more immune escape.”

The BA.2 “Stealth” Omicron variant is expected to become the dominant strain soon. Here’s what you need to know about a possible new wave of infections. (Video: Brian Monroe, John Farrell/Washington Post)

Biden’s health officials have said they expect a summer surge in the South as the heat forces people indoors, as has been the case for the past two summers. Some experts have warned this summer’s spike could be worse than last year, as cases are higher than in May 2021.

Federal officials have also warned of a possible fall and winter surge that could lead to 100 million coronavirus infections, caused by Omicron subvariants that have shown a remarkable ability to escape immunity.

“If there’s one word to sum up where we are, it’s ‘unpredictable,'” said Jeffrey S. Duchin, the top public health official for Seattle and King County, where cases have fallen in recent weeks increased significantly after the Omicron Wave.

“Things are clearly better than in the past,” Duchin said. “Vaccines are doing a great job of keeping people out of the hospital, but the virus is becoming more transmissible.”

Experts say the rise in infections is not surprising, especially after governors scrapped indoor mask mandates and a judge invalidated the federal mask requirement on public transportation. Spring is also a season for gatherings from Easter brunch to proms and graduations.

“It’s the next phase of the return to normal: Every time we take the next big step, there’s always a bounce back,” said David Rubin, who tracks national coronavirus trends for PolicyLab at Children’s Hospital of Philadelphia. “If you are at risk, you should exercise caution and definitely consider masking in public places.”

Health officials aren’t as concerned about rising cases as those infected are increasingly vaccinated and boosted, and have access to therapeutics like the antiviral Paxlovid, which help keep people from getting seriously ill.

The bar for the reintroduction of mask requirements is getting higher and higher

But doctors say the new CDC Categories of public reporting obscure the true risk of contracting Covid-19, which is still disruptive to life, can lead to long-term complications and poses increased risk to the elderly and immunocompromised.

“It allows people to move and have a false sense of security,” said Jayne Morgan, executive director of the Covid task force at Piedmont Healthcare in Georgia.

“It is concerning that we have moved away from prevention in a public health crisis,” Morgan added. “The best doctors always do preventive medicine. That’s why you get mammograms. That’s why you get a colonoscopy. They don’t wait for the cancer to develop.”

The District of Columbia is one of the communities where tensions are brewing as residents question the official classification as a low community risk.

Local health officials stopped posting daily cases on their website after the Omicron surge, urging residents to treat the coronavirus more like an endemic disease and less like an emergency. In recent weeks, the city has also stopped reporting results from sewage virus surveillance and providing daily data to the CDC, leaving little information available to people with rising infections.

Residents were once used to checking numbers about community spread ahead of the cementing of social plans are unsure how much weight to give to anecdotal reports of daycare outbreaks, friends and colleagues falling ill, and infections from the recent White House Correspondents Association dinner.

In the country’s hospitals, this Covid wave is different

“I’m just groping in the dark about what the cases are like in my community,” said Isabela Karibjanian, a 24-year-old political researcher who hopes to enjoy her degree Months in DC before moving to Europe for grad school this summer.

She’s been on the safe side for the past few weeks, hanging out with friends outside to avoid infection, before attending a bridal shower and hosting an out-of-town event visitor.

“You can never know the whole picture, but having these numbers gave me confidence that I wasn’t going to be entering a massive wave,” she said.

The DC region’s new Covid normal: infections rise, masks optional

The Institute for Health Metrics and Evaluation estimates that only about 13 percent of cases are detected. But the organization’s director, Christopher Murray, says the United States is still in good shape and not on course to see a surge of omicron subvariants like the UK.

“We have very, very few intensive care admissions. We have really few deaths. And we probably have a very high level of immunity because Omicron has infected so many people, vaccination is moderately high, and a number of people are being boosted,” Murray said. “We’re in good shape and will remain so through the fall and winter, when immunity has plummeted or until a nasty new variant emerges.”

John Brownstein, chief innovation officer at Boston Children’s Hospital, said New England is experiencing a hidden Covid wave, based on survey data suggesting five positive at-home coronavirus tests for every two lab tests. But that hasn’t resulted in a worrying spike in hospital admissions.

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New York State has recorded one of the highest Covid-19 hospitalization rates in the country According to the Washington Post tracker, it was 14 residents out of 100,000 as of Monday. But hospitals say this is being skewed by patients admitted for reasons other than testing positive for the coronavirus.

Mangala Narasimhan, director of critical care services at Northwell Health, New York’s largest healthcare network, said patients with Covid are not coming in with pneumonia and breathing difficulties like they have in the last two years.

“A lot of people I know in the community have Covid,” she said. “None of that is reflected here in the hospitals.”

Delaware and Maine have the highest per capita hospitalization rate in the country at 18 per 100,000 people. But hospital associations in both states say their situation is manageable. In Delaware, the 111 patients hospitalized last Thursday are well below the January peak of 759, which prompted hospitals to declare a crisis that allowed them to ration supplies.

Josh Elliott is watching reports of rising cases in the Northeast and is worried about returning to once-regular pleasures like going to concerts and eating indoors in his suburb of Atlanta.

Elliott is being extra cautious as asthma and lung damage from pneumonia put him at a higher risk of severe Covid-19 disease. He worries about a hidden spike as Georgia now reports cases weekly instead of daily.

With reliable data, Elliott said he would feel more comfortable attending a friend’s upcoming wedding and celebrating his 30th birthday with his girlfriend at a restaurant — rather than eating out.

“I want to have a nice birthday dinner and not… get covid on my birthday,” he said.

Yasmeen Abutaleb and Julie Zauzmer Weil contributed to this report.

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