Health experts fear CDC Covid-19 maps and measurements are misunderstood

At first glance, the maps on the Centers for Disease Control and Prevention (CDC) Covid-19 Integrated County View webpage look great. As of April 7, most of the United States was in the green, with green representing “low community levels of Covid-19 in the United States by county.” It almost feels like people don’t have to worry about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) anymore. After all, when you’re told the risk of anything is low, whether it’s contracting a disease, being attacked by lemurs in a restaurant, or falling face-first into a quiche, you tend not to take precautions.

However, some health experts have expressed concerns that these maps and measurements could be misleading. For example, Eric Topol, MD, founder and director of the Scripps Research Translational Institute, tweeted the following:

As you can see, Topol called a CDC tweet and the accompanying “Covid-19 County Level Community Levels” map “misleading.” He added that this will “give BA.2 more of a chance to spread.” This is likely because Americans may take this as a false assurance that Covid-19 is no longer a threat and thus become too lax on Covid-19 precautions. In other words, it could lead to premature relaxation. Premature relaxation of Covid-19 precautions? Well, when has this happened before?

Jonathan S. Reiner, MD, professor of medicine at the George Washington School of Medicine and Health Sciences, and Jason L. Salemi, PhD, associate professor of epidemiology at the University of South Florida College of Public Health, highlighted the differences between the Covid-19 community levels map shown in green and the multicolored CDC Covid-19 community transmission map:

The US community levels map may look like a giant green light, while the community transmission map looks more like the background of a “Where’s Waldo” image. Speaking of “Where’s Waldo,” Reiner pointed out that community transmission maps “are not that easy to find on the CDC website.” Contrast that with the fact that the CDC tweeted out the community levels map without providing the community transmission maps alongside. Additionally, the Community Levels website is what appears first in Google searches.

Focusing on the community tier map would be like using a March weather map to figure out what to wear today. Life coaches often say, “don’t live in the past”, so why should this be done with Covid-19? A county’s level of Covid-19 is said to be “low” when there have been fewer than 200 cases per 100,000 people, the number of new Covid-19 admissions per 100,000 people has been less than 10, and the percentage of staffed inpatient beds used by Covid-19 patients has been below 10% in the last 7 days. But Covid-19 is not like Bieber Fever. You are not diagnosed as soon as you are infected. It may take up to two weeks before you notice symptoms if you even develop symptoms. It may take even longer to be hospitalized. Therefore, the community levels map represents transmission that occurred one to four weeks ago. It will not help you determine when to institute precautions such as wearing a face mask to to prevent an upcoming resumption of Covid-19.

When it comes to Covid-19 precautions, community transmission maps offer much more relevant information than community levels. On these maps, a county is considered “weak” when the number of new cases per 100,000 people has been less than 10 and the percentage of positive nucleic acid amplification tests (NAAT) has been less than 5% in course of the last 7 days. The level rises to “moderate” if the first reading rose in the 10 to 49.99 range or if the second reading rose in the 5% to 7.99% range. “Substantial” means that either the first reading was between 50 and 99.99, or the second was between 8% and 9.99%. When the first measurement has reached 100 or the second has reached 10%, then the transmission levels would be referred to as “high”.

Now, even these CDC transmission measurements don’t give you a fully up-to-date and accurate picture. Many people may never get tested and even if they do, they may take a long time to get tested and may not even report the results. In fact, without Covid-19 testing being free and readily available to everyone, there can be substantial differences between who gets tested and who doesn’t. This may be yet another difference between the haves and have-nots in this country. So, community transmission cards alone can allow you to be a bit more proactive, but still not enough.

Reiner wondered if the public might take the community level cards wrong:

Topol, Reiner and Salemi were certainly not the only ones to raise such concerns. Eric Feigl-Ding, PhD, epidemiologist and head of the COVID risk task force at the New England Complex Systems Institute, tweeted that “countless experts are frustrated with the CDC and their risk level maps that primarily use metrics of hospitalization. It’s always too late,” as you can see here:

Of course, some politicians and corporations may want things to look as “normal” as possible sooner rather than later. The illusion of complete normalcy could tempt people to spend more and re-elect current politicians. Additionally, Covid-19 precautions require upfront expenditure and investment. All of this might make people crave “green” and support it and be reluctant to leave “green,” so to speak. Remember in 2020 when some politicians and business leaders continued to downplay the pandemic, saying the pandemic was “turning the corner” and other overly optimistic scenarios like I covered in 2020 for Forbes? Hmm, what’s happened since?

The rush to get back to normal, whatever “normal” means, and the repeated premature easing of Covid-19 precautions continued to be remarkably myopic. SARS-CoV-2 doesn’t really care what politicians and business leaders say. Failure to adhere to proper Covid-19 precautions, such as the use of a face mask, social distancing and vaccination against Covid-19, could further spread the pandemic and increase the negative impact of SARS- CoV-2. This is especially true with the spread of the more contagious BA.2 Omicron subvariant. The CDC Covid-19 community levels map alone can make you see green as low risk, go, go, go, and maybe even more money. But that could end up being an “off color” conclusion.

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