The US is running a fever. Which way will it go?

This moment in time, like so many during the last two-plus years of the pandemic, is a confusing one for our country. Mixed signals make it hard to accurately gauge risk and act accordingly.
On the one hand, with the almost complete lifting of restrictions and mandates around the country, and with case numbers, hospitalizations and deaths at relatively low levels, it’s easy to feel that life is on track to getting back to normal, if not already there.
That’s especially true when someone as cautious as President Joe Biden’s chief medical officer, Dr. Anthony Fauci, says that we are out of the pandemic phase, as he did a couple of weeks ago on PBS NewsHour.

“Namely, we don’t have 900,000 new infections a day and tens and tens and tens of thousands of hospitalizations and thousands of deaths. We are at a low level right now. So, if you’re saying, Are we out of the pandemic phase in this country? We are,” he said.

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But hundreds are still dying every day. The United States is marking the tragic milestone of 1 million confirmed Covid-19 deaths. In a statement on Thursday, Biden urged the United States to “remain vigilant against this pandemic and do everything we can to save as many lives as possible.”
Covid-19 cases have been trending up in almost every state; the country is now averaging more than 70,000 new cases per day, according to Johns Hopkins University. Pediatric cases are on the rise too — up 69% from two weeks ago, according to the American Academy of Pediatrics.
Even hospitalizations, a lagging indicator, have been increasing slowly: They’re up in more than half of states (including most of the Northeast and Midwest) compared with last week and as of Thursday morning stand at more than 20,000 — levels last seen at the end of March.

The White House is warning that if Congress doesn’t provide additional resources for testing, treatments and vaccines, the country will be ill-prepared for a surge this fall or winter, when it says the country could see 100 million new Covid-19 infections. That’s just one possibility for the seasons ahead, and the White House hasn’t released specific modeling to support that number. But if it happens, that’s almost a third of the entire US population. For context, seasonal flu causes illness in 9 to 41 million Americans — that’s 3% to 11% of the population — every year, according to the US Centers for Disease Control and Prevention.
Growing share of Covid-19 deaths are among vaccinated people, but booster shots substantially lower the risk
Growing share of Covid-19 deaths are among vaccinated people, but booster shots substantially lower the risk
And even Fauci felt the need to clarify his earlier remarks. “We’re not over the pandemic. Don’t let anybody get the misinterpretation that the pandemic is over, but what we are in is a different phase of the pandemic,” he said in a telephone interview with CNN a few days after his original comments.
“A phase that’s a transition phase, hopefully headed toward more of a control where you can actually get back to some form of normality without total disruption of society, economically, socially, school-wise, et cetera,” he said.
So which is it: Are we headed back to life as usual or are we headed toward another wave of infections?
Absolute numbers vs. trendlines
I want to return to the analogy of the country as my patient, as I have done several times during the pandemic.
If I had to describe the current situation, I’d say it’s like my patient has checked out of the hospital — a bit weak, still being monitored carefully and receiving outpatient care.
And now, as the rising case numbers indicate, they’ve spiked a fever, developed a sore throat and are starting to feel all-around miserable.
Why Covid-19 vaccine boosters may be more important than ever
Why Covid-19 vaccine boosters may be more important than ever
The big question is, will they get better with time, or is this a harbinger of more bad things to come?
While it’s true that the numbers are nowhere near as dire as they were with the Delta or original Omicron surges — which saw an average of more than 166,000 and more than 807,000 daily new cases at their respective peaks — these insidious increases in cases and hospitalizations reveal a trendline. In medicine, trendlines are often more telling than the absolute numbers themselves: They’re important to spot because they show us where the patient is headed. And right now, the trendline is moving in a risky direction.
So it seems that we’re now in a watchful waiting phase with my patient to see what happens next.

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