Time to shift focus from COVID-19 case numbers to hospitalizations, infectious disease expert says

With vaccinations underway and a year of pandemic experience behind us, Dr. Martha Fulford thinks it's time to stop being so obsessed with the COVID-19 case numbers.

While the idea may seem shocking to some, Dr. Fulford — an infectious disease specialist at McMaster Children's Hospital and Hamilton Health Sciences — says rates of severe illness and death are much more meaningful than a simple case tally.

"We've been spending so much time talking about cases, but the most important thing is hospitalization," said Dr. Fulford, in a Tuesday interview with CBC Hamilton. "With every resident of long-term care now vaccinated, the chances of them needing hospitalization from COVID is drastically reduced."

Many of the social sacrifices made over the past year were largely aimed at preventing community spread that leads to serious illness in older adults, who are much more likely to become very sick from the virus, she said. As that population is increasingly vaccinated, case numbers become less significant because the cases will, for the most part, be mild, she said.

However, in an interview with the CBC last week, Dr. Elizabeth Richardson, Hamilton medical officer of health, said "We may even need stricter control measures as we go forward. So, any kinds of gathering that goes above the limits that are in place today, I definitely wouldn't see happening at this point or it's highly unlikely. And it may be that things actually even need to be more strict at that point." 

Fulford said, "If people are asymptomatic, who the heck cares? If the vulnerable are protected, maybe we don't need to worry about case numbers at all. Maybe what we should be reporting now is hospitalizations and severe disease."

With current COVID numbers that she sees as low for a city of its size, Dr. Fulford says she is "cautiously optimistic" Hamilton could avoid a crushing third wave of the virus. 

"I think we're going to have wavelets or ripples… It's phenomenal how fast, and how effective (the vaccines have been) at preventing severe disease."

Public health and government officials have continued to encourage people to stay home, even as businesses and schools open. On Monday, Hamilton's chief medical officer of health Dr. Elizabeth Richardson encouraged residents to stay vigilant at this "critical" part of the pandemic, particularly as new COVID variants of concern show up in the city.

Dr. Fulford encourages continued adherence to the pillars of public-health messaging, such as avoiding crowds, conditions with poor ventilation, and close-contact settings. But, she adds, the risk of outdoor transmission is very low, so a new focus on what is safe outdoors would be of better service to residents than to simply say "don't do it." 

It won't hurt to loosen up on excessive surface cleaning as well, she says, noting it may make people feel better but does little to affect transmission.

"With COVID, the risk of transmission from a surface is extremely low. I saw a woman in Fortinos who was wiping (all of her) groceries before putting them in her cart." That's not necessary, she says, nor is worrying about the chance of getting COVID from your food. "It's not food-borne."