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The rise of Covid cases in some regions of the U.S., just as testing efforts wane, has raised the specter that the next major wave of the virus may be difficult to detect. In fact, the country could be in the midst of a surge right now and we might not even know it.
Testing and viral sequencing are critical to responding quickly to new outbreaks of Covid. And yet, as the country tries to move on from the pandemic, demand for lab-based testing has declined and federal funding priorities have shifted. The change has forced some testing centers to shutter while others have hiked up prices in response to the end of government-subsidized testing programs. People are increasingly relying on at-home rapid tests if they decide to test at all. But those results are rarely reported, giving public health officials little insight into how widespread the virus truly is.
“There’s always more spread than we can detect,” said Abraar Karan, an infectious disease physician at Stanford University. “That’s true even more so now than earlier in the pandemic.”
Despite groundbreaking scientific advances like vaccines and antivirals, public health experts say the U.S.’s Covid defenses appear to be getting weaker as time goes on, not stronger.
"We're in a worse position," said Julia Raifman, an assistant professor of health law, policy and management at Boston University School of Public Health. "We've learned more about the virus and how to address it, and then we haven't done what we need to do to address it.”
In late February, the Centers for Disease Control and Prevention began relying on hospital admissions and ICU capacity to determine community-level risk. That was a change from relying on Covid case counts and the percentage of positive tests, which are widely considered a better snapshot of how much virus is circulating in a given community. Several states, including Arizona, Hawaii, Nevada and Ohio have now completely stopped reporting daily Covid data to the CDC, making it more difficult to gauge the progression of the pandemic in those states.
According to the CDC, the majority of the country is still considered low risk. Public health experts argue this is misleading though, given hospitalization and death generally occur days to weeks after initial infection. Without widespread testing, that could make it impossible to detect a surge until it’s too late to do anything about it.