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COVID-19 'will not ever go away', public health expert says

By Joanie Dugan

Posted June 3, 2024

This illustration, created at the Centers for Disease Control and Prevention (CDC), reveals ultrastructural morphology exhibited by coronaviruses. The illness caused by this virus has been named coronavirus disease 2019 (COVID-19).

The CDC's wastewater data can be interpreted to find trends in transmission of the virus. (CDC/Alissa Eckert, MS)

The Indiana Department of Health releases new COVID-19 data in a weekly dashboard update every Wednesday. But a public health expert says those numbers don’t show the full picture.

Required reporting of positive COVID cases stopped before the end of the public health emergency last year.

“No data set that you see for infectious diseases is ever going to be truly accurate, because we're always going to be missing cases,” said Graham McKeen, director of public and environmental health at Indiana University’s Office of Environmental Health and Safety.

“That's why one of the greatest data points when we were reporting all the cases was positivity. So if you see a positivity rate of 5 percent or more, generally, that means there's missing cases in the general population. So what we're seeing now is not accurate,” McKeen said. “The only real value I can take in this data is just seeing some trends.”

Wastewater data analysis, on the other hand, is more useful in predicting trends in transmission. It analyzes untreated wastewater for the presence of SARS-CoV-2, the virus that causes COVID-19. Since it doesn’t require access to healthcare or getting tested for COVID-19, it allows for a more accurate picture of whether viral activity is present in a community.

“The wastewater data doesn't lie, and it's really good in terms of telling us trends,” McKeen said. “We're getting better at interpreting that data as well, because there's some normalization that has to happen.”

In Indiana, there is minimal detection of the virus in wastewater, according to the Centers for Disease Control and Prevention.

“These early springs have been kind of relatively low viral activity,” McKeen said. “There are some signs that maybe we're starting to see that activity pickup. If you look at the wastewater trends … we're seeing a pretty big increase in the western U.S. right now.”

McKeen said vigilant testing, masking, and isolating when sick are necessary to manage the spread of COVID. Infection and reinfection increase the risk for developing long COVID – when symptoms persist for anywhere from weeks to years.

“Every infection increases the risk of long term symptoms or long COVID or other complications,” McKeen said. “We still know this virus can cause all kinds of issues across the system, in terms of the body systems, the organs, cognitive function, cardiovascular issues as well. And so there's a lot of utility still in trying to avoid infection,” McKeen said.

Taking precautions to avoid COVID-19 protects not only yourself, but also those around you. McKeen said immunocompromised people are at the highest risk.

“1.2 million of our most vulnerable here in the U.S. are no longer with us because of this virus,” McKeen said.

New variants introduce new challenges. Some variants are more infectious, and have higher mortality rates.

“The virus can change,” McKeen said. “I think there's also kind of this collective misnomer that viruses over time just naturally evolve to be less intrinsically severe. And that's not always the case. So we need to continue to do the surveillance, we need to continue to do sequencing, we need to continue to look at this stuff because these things can come back and bite us.”