Fauci, Gottlieb urge self-interpretation amid COVID-19 case undercounts, relaxed mask rules

Public health experts and officials took to the Sunday shows April 10 to talk about COVID-19 case increases in numerous states, the BA.2 omicron subvariant and mitigation strategies. 

Commentary from Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, and Scott Gottlieb, MD, former FDA commissioner and current Pfizer board member, comes as the U.S. sees an uptick in COVID-19 cases nationwide after two months of sustained declines. 

Cases have increased 3 percent during the last 14 days nationwide as of April 11, with 26 states and Washington, D.C., reporting increases. Hospitalizations have fallen 18 percent in the last 14 days nationwide, with nine states reporting increases as of April 11.

Drs. Fauci's and Gottlieb's remarks suggest the U.S. has reached a pandemic stage where self-determination among the public is more emphasized than ever — first to interpret the risk of COVID-19 transmission in their communities, then to decide what mitigation measures to take.

Reported case counts may be directionally helpful at this point of the pandemic, given the use of rapid, at-home COVID-19 tests that result in under-counting. Dr. Gottlieb said recorded cases could be only one-eighth of the picture. 

"I think that we're dramatically undercounting cases," Dr. Gottlieb told CBS News. "We're probably only picking up one in seven or one in eight infections. So when we say there are 30,000 infections a day, there's probably closer to a quarter of a million infections a day."

"It's tough right now," said Dr. Gottlieb. "I think you have to look at the state data and you have to look at week over week increases and just assume that we're only capturing a very small percentage of infections. So if you see cases going up in your local community, that's a pretty good indication that there's more infection than what we're measuring."

In his interview with ABC News, Dr. Fauci stressed the need for self-determination of risk right now based on the level of COVID-19 in their county, which the CDC color codes in a map. The levels are calculated by new hospitalizations for COVID-19, current hospital beds occupied by COVID-19 patients or hospital capacity and new COVID-19 cases. Green indicates a low level, meaning the virus is having a limited effect on the healthcare system with low levels of severe disease.

"This is not going to be eradicated and it's not going to be eliminated," Dr. Fauci said of COVID-19. "And what's going to happen is that we're going to see that each individual is going to have to make their calculation of the amount of risk that they want to take in going to indoor dinners and in going to functions, even within the realm of a green zone map of the country where you see everything looks green but it's starting to tick up. So you're going to make a question and an answer for yourself, for me as an individual, for you as an individual. What is my age? What is my status? Do I have people at home who are vulnerable that if I bring the virus home there may be a problem?"

The CDC eased indoor mask guidance Feb. 25 to rely on how COVID-19 is affecting a community's healthcare system — rather than transmission rates alone —  as a guide for mask recommendations. 

"Remember, when the metrics were put forth, the new metrics looking at the guidance of masking, it was said that if we do start seeing an uptick, particularly of hospitalizations, we may need to revert back to being more careful and having more utilizations of masks indoors," Dr. Fauci told ABC News. "But right now we're watching it very, very carefully. And there is concern that it's going up. But hopefully we're not going to see increased severity." 

Dr. Gottlieb said he expects BA.2-driven COVID-19 case increases to be regionalized and doesn’t expect hospitalizations to swell "because a lot of the people who are getting infected right now with BA.2 are people who escaped the B.1 Omicron wave, and they escaped it in large measure because they were vaccinated," he told CBS News. "They were prudent. They took precautions, they tested. And so the simple fact is that a lot of the people who are getting infected right now are people who are vigilant. And they are more likely to take decisive action once they diagnose an infection, get treatments – things like that." 

 

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