April 19, 2022

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By David Leonhardt

Good morning. Coronavirus cases have risen in major cities. Hospitalizations have not.

A coronavirus testing site in Brooklyn.Spencer Platt/Getty Images

'Big screaming headlines'

A couple of weeks ago, the news was full of stories about high-profile people contracting Covid-19. The list included Attorney General Merrick Garland, Commerce Secretary Gina Raimondo, Speaker Nancy Pelosi, other members of Congress (like Joaquin Castro, Susan Collins, Adam Schiff and Raphael Warnock), New York Mayor Eric Adams and several Broadway stars (like Sarah Jessica Parker, Matthew Broderick and Daniel Craig).

Some of these infected celebrities were not exactly young. Collins and Garland are both 69. Pelosi is 82.

So far, however, none of their cases appears to be severe. As David Weigel, a Washington Post reporter, noted yesterday:

These anecdotes are part of a trend. In several places where the number of cases has risen in recent weeks, hospitalizations have stayed flat. (In past Covid waves, by contrast, hospitalizations began rising about a week after cases did.)

Consider New York:

Charts show 7-day averages. | Source: New York Times database

Or Washington:

Charts show 7-day daily averages. | Source: New York Times database

Similar patterns are evident in Chicago and Seattle, as well.

How could this be? As is often the case with Covid, the answer is not completely clear. But at least some of it reflects the changing nature of the pandemic, many experts believe. The share of cases that turn into severe illnesses seems to be declining, for three main reasons:

Vaccines and booster shots are effective and universally available to Americans who are at least 12. (Covid continues to be overwhelmingly mild among children).
Treatments — like Evusheld for the immunocompromised and Paxlovid for vulnerable people who get infected — are increasingly available.
Tens of millions of Americans have already been infected with the virus, providing them with at least some immunity.

To be clear, these trends will not eliminate severe Covid. The number of nationwide hospitalizations will probably rise in coming weeks, especially if cases continue to rise. The official number of cases has already increased 43 percent in the past two weeks, and hospitalizations have risen in a small number of states, like Vermont. Nationally, though, hospitalizations have not yet risen, probably for the same three reasons I listed above.

Charts show 7-day averages. | Source: New York Times database

Even if hospitalizations do rise in coming weeks, a declining share of coronavirus cases that result in serious illness would be very good news, Dr. Craig Spencer, director of global health in emergency medicine at Columbia University, has pointed out.

"I haven't seen a Covid patient in the E.R. in weeks and go to work now expecting not to," Spencer told me, "despite a swirl of Covid in the community."

Among other things, a decoupling of cases and severe illness would mean that hospitals were less likely to become overwhelmed during future Covid surges. When hospitals avoid getting swamped, they can provide care to every patient who needs it — which becomes another factor that reduces bad health outcomes.

'Misleading'

Going forward, this newsletter will begin to pay less attention to statistics on coronavirus cases and more attention to statistics on hospitalizations. "Looking at the data in the same way we've been accustomed over the past two years can be misleading," Spencer said.

We won't completely ignore the case numbers, because they still have some relevance. But the cases data has become both less reliable and less meaningful than earlier in the pandemic.

It is less reliable because of the recent closure of many testing clinics and the shift toward at-home testing. The data on Covid hospitalizations and deaths doesn't suffer from these problems and appears to be as accurate as it was earlier in the pandemic.

The cases data is less meaningful than it used to be because vaccines are universally available to U.S. adults — and vaccines tend to turn Covid into an illness of similar severity to a flu, including for the elderly and the immunocompromised. More recent treatments like Paxlovid play a role, too.

One telling comparison: In the county that includes Seattle (which keeps detailed data), the daily Covid death rate for boosted elderly people has recently hovered around two per million. That's higher than the national flu death rate during a mild influenza season and somewhat lower than the rate during a heavy influenza season.

For boosted people (and children), the odds of severe Covid really do resemble the odds of severe influenza. And you don't tend to see news stories every time a member of Congress or a Broadway star contracts the flu.

I understand why the country is still treating Covid as a much bigger deal. For one thing, the large number of unvaccinated people means that Covid is still killing about 500 Americans a day. For another, Covid has dominated life for more than two years, and we can't simply flip a switch and return to our 2019 habits.

But nor would it be rational to treat the 2022 version of Covid as if it were identical to the 2020 version. It isn't. Vaccines, treatments and even natural immunity have transformed the impact of the virus, especially for Americans who have chosen to protect themselves.

More on the virus

A federal judge struck down the mask mandate on public transit, although the ruling may not be final. Amtrak dropped its mandate, as did the largest airlines on domestic flights.
The Supreme Court said the Pentagon could punish an Air Force Reserve lieutenant colonel who refused to get vaccinated.
President Biden and the first lady hosted the first White House Easter Egg Roll since the pandemic began.

Continue reading the main story


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THE LATEST NEWS

State of the War

A missile hit a tire-fitting plant in Lviv yesterday.Finbarr O'Reilly for The New York Times

Russia started its large-scale offensive in Ukraine's east, said Volodymyr Zelensky, Ukraine's president. The region is bracing for its full force.
Russia claimed its missiles hit hundreds of targets, including fuel and weapons depots, to weaken Ukraine's supplies.
The U.S. will soon train Ukrainian troops to operate the howitzers that Washington is sending.

MORNING READS

Families greeting Mickey Mouse at Disneyland yesterday.Alex Welsh for The New York Times

Disneyland: It's been two years, but they're back. "Hugs for everyone!"

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A Times classic: The island where people forget to die.

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ARTS AND IDEAS

Yuka, 3, goes shopping by herself on the show.Netflix/Nippon TV

Little kids in the big world

Netflix's latest hit seems designed to turn American parents into nervous wrecks. "Old Enough!," a Japanese series, follows young children, between 2 and 5, as they leave home for their first solo journey to run an errand.

The show is a delight, with each episode running around 10 minutes. Kids pick up groceries, visit grandma's house or fetch a cabbage from a farm. They often forget their instructions or get distracted by the big world around them. Camera crews and safety teams covertly follow along, and a narrator provides excited commentary.

While "Old Enough!" is new to U.S. audiences, it has been airing in Japan since the 1990s. Its popularity there reflects Japan's parenting culture, which views independence as a central part of a child's life, Hisako Ueno and Mike Ives write in The Times. "It's a rite of passage," one filmmaker explained. "These errands have been a very symbolic mission for decades." — Tom Wright-Piersanti, a Morning editor

For more: In the On Parenting newsletter, Jessica Grose writes that the show made her consider how overprotective American parenting has gotten.

PLAY, WATCH, EAT

What to Cook

Stephen Scott Gross for The New York Times

Spring is here, and asparagus has appeared.

What to Watch

In the show "A Very British Scandal," Claire Foy plays a duchess whose sex life became the subject of salacious tabloid stories in the 1960s.

What to Read

Grant Ginder's fifth novel, "Let's Not Do That Again," is about a woman whose adult children alternately help and threaten her political aspirations.

Late Night

The hosts condemned Florida's ban on some math books.

Now Time to Play

The pangrams from yesterday's Spelling Bee were complicit and impolitic. Here is today's puzzle — or you can play online.

Here's today's Wordle. Here's today's Mini Crossword, and a clue: Do a great job (five letters).

If you're in the mood to play more, find all our games here.

Thanks for spending part of your morning with The Times. See you tomorrow. — David

P.S. A data scientist, a bar trivia host and more. Meet The Times's first Diverse Crossword Constructor fellows.

Here's today's front page.

"The Daily" is about dissidence in Russia.

Claire Moses, Ian Prasad Philbrick, Tom Wright-Piersanti, Ashley Wu and Sanam Yar contributed to The Morning. You can reach the team at themorning@nytimes.com.