A full month in, this is how San Francisco’s omicron surge is unfolding

San Francisco continues to set new COVID-19 case records, and the number of people in the hospital with COVID-19 has now surpassed the summer’s delta-variant-driven wave. However, it’s increasingly clear those hospitalization figures are a poor metric for understanding how many patients are seriously ill with the disease.

These cases of “incidental COVID” — patients who are in the hospital for other reasons and happen to test positive for COVID-19 — have always existed, and many public health departments still count these cases as “COVID hospitalizations.” But as the omicron variant has spread through the Bay Area like wildfire, often causing asymptomatic or mild illness, some experts are arguing that there’s far too big a gap between official hospitalization numbers and the true burden of the virus.

dr Jeanne Noble, the head of UCSF’s emergency room COVID-19 response, told SFGATE that 70% of COVID-19-positive patients at UCSF were there for reasons other than COVID-19. Despite that, the hospital has been including those patients when it sends reports to the state about COVID-19 hospitalizations. The state then sends that data to the counties, supposedly to inform them about how at-risk their communities are from the disease.

“The crisis from the Omicron peak is not generated by serious COVID illness in regions with highly vaxxed populations,” Noble wrote in an email to SFGATE. “The crisis we are suffering in the Bay Area is largely driven by disruptive COVID policies that encourage asymptomatic testing and subsequent quarantines. … The vast majority of COVID-plus patients I take care of need no medical care and are quickly discharged home with reassurance. “

Hospitalizations across the city are increasing, as you can see in the first chart below. But the second chart — which shows hospitalizations and intensive care unit hospitalizations — supports the claim that hospitalizations are being over-counted.

Deaths from COVID-19 tend to lag 21 days behind hospitalizations. As you can see in the graphs above, there’s just a one to three day lag time between hospitalizations and ICU hospitalizations, meaning those trends can be seen much earlier.

Marin County Health Officer Dr. Matt Wills recently told SFGATE that he believes the ICU count is a reliable metric of how many people are currently sick with COVID-19. When he looked for incidental positives in the official case counts last week, he found that patients in a psychiatric ward, pregnant women in obstetric units and an individual undergoing orthopedic surgery had all been included in official case counts, despite not needing significant medical care related to the virus. At the time, just one of the 19 patients listed under COVID-19 hospitalizations required intensive care. “That ratio has never been so small,” Wills said.

In fact, San Francisco is recording fewer COVID-19 ICU admissions than during either of the previous two waves, despite record numbers of people testing positive for the virus every day, both inside the hospitals and out. In the last week, about 145 people in hospitals have tested positive for COVID-19 daily and 25 total people were admitted to the ICU with COVID-19. During the summer delta wave, the city saw 125 COVID-19 hospitalizations at the peak — but nearly 40 people with the virus were landing in intensive care. When hospitalizations last winter were similar to today’s average, COVID-19 ICU admissions hit 39 a day.

UCSF experts have repeatedly told SFGATE that given the astronomically high cases in the city, hospitalization numbers would be significantly higher if this surge were like past waves. Fortunately, it seems that San Francisco’s high vaccination rate (81% of residents are fully vaccinated) and the fact that the omicron variant causes more mild illness than previous strains are blunting the impact on hospitals.

“It’s just less severe,” epidemiologist Dr. George Rutherford said of omicron. “Unless we’re ridiculously wrong, things are different now.”