Hospitalizations ‘decoupling’ from COVID counts as severity is not surging with cases

Always Investigating

HONOLULU (KHON2) — As Hawaii COVID case counts rise, hospitalizations are not going up at the same pace — a trend seen elsewhere in the world where the omicron wave hit before Hawaii. Always Investigating digs into the data and what it means for this phase of the pandemic.

COVID still needs to be taken seriously as even a fraction of people needing hospital care can become a big number when overall case counts balloon. But experts said the lessened severity of cases shows we are flattening the elusive curve.

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With several thousand cases a day, Hawaii is bracing for a worst-case scenario if hospitals become overrun. Hospitalizations tend to lag positive counts as much as two weeks.

Yet, with more than 21,000 cases in just two weeks, the hospital count on Dec. 31 was 141 — 18 in ICU and 10 on ventilators.

“It does follow what we see on other places that have been exposed to omicron prior to us, like South Africa or in Europe,” explained University of Hawaii Manoa Professor Monique Chyba with HiPAM. “Hospitalizations are lesser than they were with Delta.”

The Hawaii Pandemic Applied Modeling Work Group (HiPAM) is a team of Hawaii scientists, mathematicians and epidemiologists modeling COVID trends. They show a sky-high projection for case counts that have been largely right-on, but hospitalizations are lower than even their most optimistic forecasts, and even they are wondering why.

“We were at the beginning working with data and numbers that were coming from other geographic locations, and while you can sort of transpose them, it’s a different population, different demographics,” Chyba explained. “So it’s very difficult. And we’re seeing that (lower actual hospitalizations than expected) — yes, it’s great. The dots are under and that’s where you want to be.”

“When we say that omicron is ‘milder,’ what we mean is it spreads very, very infectiously. So, we will see a very large surge as we’re seeing in cases. But the extent to which the hospitalizations will also surge, it won’t grow as fast as we saw in the past.”

Dr. Victoria Fan, a HIPAM expert

This trend is called “decoupling” where case trends move at a way different rate than hospitalizations — it is most pronounced with omicron. But it has been happening all along as our collective ability to manage, treat and vaccinate against the virus has improved.

When COVID first struck in 2020, our first shockwave was that summer, with a peak of 354 cases on a single day, followed weeks later by a peak of 315 hospitalized at the same time — an 88% correlation of that wave’s worst day of cases to its worst day of hospitalizations.

By Wave two in January 2021, a case peak of near 300 daily was followed by a hospital peak of 129 — just 44% correlation, thus representing a peak-case-to-hospitalization decoupling by half the last wave.

Wave three in fall 2021 saw hospitals were overrun with 473 peak hospitalizations that followed a 1,600 daily case peak — as bad as that was, the peak-case-to-hospitalization correlation had decoupled to 29%.

Wave four, the peak, so far, is 3,500 and 141 hospitalized. That is a peak-case-to-hospitalization correlation of just 4%. We are likely still on the upswing of this wave, and it is not clear how high it will go.

“We’re looking at a (case) peak by, I would say, the second half of January,” Chyba said. “And then with a little bit of lag, like by end of January, for the hospitalization (peak) likely.”

That is a reminder of why omicron should not be taken lightly because even a percent or two heading to the hospital out of tens of thousands of cases could crush the healthcare system.

“Because there are so many cases, the chances that you may go to the hospital will be less,” Fan said, “but there will still be many, many cases going to the hospital. I will also add that the neighbor islands have much lower hospital capacity to begin with.”

Experts said severity measures, such as hospitalizations, should take the front seat for data highlights and policy interventions.

“Cases is not the right goalpost or benchmark for us to be a measure of panic or dismissal,” Fan continued. “We should try to not go either way, saying ‘oh, it’s fine’ with 3,000 cases or the same measure of being ‘oh, my God, the sky is falling’ with 3,000 cases.”

Find more COVID-19 news: cases, vaccinations on our Coronavirus News page

If there is any good news, what goes up must come down.

“The silver lining, I would say, from my perspective, is in the fact that as we’ve seen with the delta during the summer, you go up rapidly, but you come down rapidly as well,” Chyba said. “We are surging more rapidly than we did with the delta. However, once we start breaking that transmission, we’re going to go down very rapidly.”

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