Is not counting COVID cases “flying blind” and “covering failure,” or simply recognizing the reality that tracking hospitalizations instead is “where the rubber meets the road?” Increasingly, experts are disagreeing on the best way to tally omicron cases and the effect they have on keeping the renewed resurgence of the pandemic in perspective.

Until now, the ups and downs of daily case counts have been one of the most closely watched barometers during the omicron outbreak and have been a reliable early warning sign of severe disease and death in previous coronavirus waves.

However, as the variant surges across the world, many jurisdictions, including in Canada, have largely stopped counting cases. And testing (mostly). That’s because some experts believe the focus should instead be on COVID-19 hospital admissions as a more meaningful measure of the severity of the pandemic.

One of those is Dr. Anthony Fauci, the influential chief medical advisor to the US president, who says that with many infections causing few or no symptoms, “it is much more relevant to focus on the hospitalizations as opposed to the total number of cases.”

And the good news is, those aren’t climbing as fast. The bad news is, hospitalizations in many places are still at an all-time high (though severe ventilator cases are down) during the pandemic.

Fauci’s comments were made as the super-contagious omicron variant raging across the US with new daily COVID-19 cases more than tripling and reaching record-shattering averages of close to half a million per day in a matter of weeks, and as short-staffed schools, hospitals, and airlines struggled to cover for infected workers forced into isolation.

In Canada, cases are similarly skyrocketing, including hospitalizations, and Ontario’s COVID-19 Science Advisory Table estimated that roughly only about 20% of cases are currently being confirmed by the province’s testing regime. Prime Minister Justin Trudeau warned there was no “magic bullet” in sight to end it all.

In the US, hospital admissions were averaging close to 15,000 per day, up 63% week over week (in Ontario on Sunday it was 130%), but still short of the peak of 16,500 per day a year ago when the vast majority of the US population was unvaccinated. But deaths were stable at an average of about 1,200 per day, well below the all-time high of 3,400 last January.

Public health experts suggest that those numbers, taken together, reflect the effectiveness of vaccine at preventing serious illness, even against omicron, as well as the possibility that the variant does not make most people as sick as earlier versions.

With this is mind, Dr. Wafaa El-Sadr, director of ICAP, a global health centre at Columbia University in New York, believes case counts are no longer the most important number now in assessing the pandemic.

Instead, she says, at this stage of the pandemic officials should be “shifting our focus, especially in an era of vaccination, to really focus on preventing illness, disability and death, and therefore counting those.”

Dr. Sumon Chakrabarti, infectious disease specialist at Trillium Health Partners in Mississauga, told the CBC the move makes sense.

“The vast majority of the population is now protected with two doses of vaccine. We don’t need to know the case number every day, and we certainly don’t need to be publishing it on the news every morning,” he said, adding, “We don’t need to test every single person that gets mild symptoms. Generally, what we do is we keep a surveillance of what happens at high-risk settings like long-term care and hospitals.”

Moreover, experts assert that case counts are an imperfect measure of gauging the full extent of the state of the pandemic, in part because they consist primarily of laboratory-confirmed cases of COVID-19, not the actual number of infections out there, which is almost certainly many times higher.

Daily case counts are also subject to wild swings. For example, the number of new cases recorded in the US on Jan. 3 topped an unprecedented 1 million, a figure likely inflated by case counts that had been held up by reporting delays over the New Year’s holiday weekend. As such, seven-day rolling averages are considered more reliable.

Current case counts are also believed to reflect, at least in part, an omicron-induced stampede among many people to get tested before holiday gatherings, and new testing requirements at workplaces and other sites.

At the same time, the true number of infections is probably much higher than the case count because the results of at-home tests are not added to the official tally, and because long waits have discouraged some people from lining up to get swabbed. In Ontario, for example, the latest guidelines restrict testing eligibility to high-risk people who are vulnerable or showing symptons.

Also, case numbers seem to yield a less useful picture of the pandemic amid the spread of omicron, which is causing lots of infections but so far does not appear to be as severe in its effects.

However, many health experts and political figures are not prepared to do away with case counts.

Few in France would argue that the country is not being overwhelmed by omicron, when it is reporting a staggering 332,252 daily virus cases on Jan. 5, which smashed a string of previous recent records and set (to that point) Europe’s highest-ever single-day confirmed infection count.

French hospitals reported that more than 72% of ICU beds were occupied by people with COVID-19 and were preparing drastic measures to brace for further patient surges.

Some medical professionals also point out that hospital numbers aren’t a perfect reflection of disease severity either because they include patients admitted for other health problems who happen to test positive for the coronavirus.

At the same time, keeping track of COVID-19 admissions can tell doctors something about the seriousness of the virus and also the capacity of hospitals to deal with the crisis. That, in turn, can help health leaders determine where to shift equipment and other resources.

Ali Mokdad, a professor of health metrics sciences at the University of Washington in Seattle, believes that for each new infection detected, two cases are being missed.

As such, he says tracking the number of positive test results is still important as case numbers can point to future hot spots and indicate whether a wave of infection has peaked.

Also, case counts will continue to be important to people who are vulnerable because of age or health reasons and need a sense of the virus’ spread in their communities so they can make decisions about precautions, he says. Hospitals, schools, and businesses need to plan for absences.

“To give up on knowing if cases are going up or down, it’s flying blind. How can we as a country not know the epidemic curve for infection?” he asks.

If testing has lost its relevance, he says, it is because (many countries) never developed a way to monitor infections consistently and reliably. “And,” he adds, “it’s not acceptable to cover failure by changing the rules.”