Dr. Scott Gottlieb, former commissioner of the US Food and Drug Administration said the US isn’t doing a good job of measuring how much spread is happening in the country and there is probably a lot more than is being picked up. 

“I don’t think we’re doing a good job of measuring how much spread is actually underway in this country,” Gottlieb said on NPR’s Morning Edition Wednesday. “I think we have far more spread than what we’re picking up.” 

The US is not doing a lot of testing, he said, and much of the testing done is at home and not being reported. Many people who are getting infected now or experiencing mild symptoms are not seeking out tests.

“Generally speaking, the people who are presenting for testing are either people who are getting very sick, or people who are developing telltale symptoms of Covid like loss of taste or smell,” he said. “So, we’re picking up probably a very small fraction of the overall infections.”  

At the height of the epidemic in winter, 1 in 3 or 1 in 4 infections were probably diagnosed; last summer, probably 1 in 10 were being diagnosed, Gottlieb said: “I wouldn’t be surprised if we’re only turning over one in ten infections right now, maybe less than that.” 

“If you start to impute that and you factor in how many people remain unvaccinated and vulnerable to this infection, it’s about maybe 80 million Americans that are unvaccinated and remain vulnerable to infection,” he said. “Probably a lot of them have now been infected with this Delta wave, we probably have a lot more infection in the states with vaccination rates are low than what we’re picking up.” 

The biggest part of the problem, he said, is that there aren’t solid numbers saying this is true. 

“CDC has a retrospective mindset in terms of how they operate, they really don’t have a prospective mindset. They don’t do real-time forecasting, and they don’t collect all the data that’s necessary to make real-time decision making,” Gottlieb said.

“CDC made a unilateral decision to stop tracking outpatient infections among vaccinated individuals I’m told for cost reasons, they didn’t have the resources to do that, so they don’t know, they don’t have data on how many infections, for example, are occurring among unvaccinated individuals. They’re making an estimate that there probably is some infection among vaccinated individuals,” he said. “And so they want to urge them to be prudent as well and be cautious with this new mask mandate but they don’t actually have that data because it’s not being collected.”

In a response to CNN on Wednesday, CDC did not address whether cost was a factor in how it’s tracking breakthrough cases. It noted that in early May, CDC transitioned to focus on breakthrough cases in patients who were hospitalized or die. 

“This shift will help maximize the quality of the data collected on cases of greatest clinical and public health importance,” CDC’s Jasmine Reed said in an email, adding, “State and local health departments continue to report breakthrough cases to CDC to identify and investigate patterns or trends among hospitalized or fatal vaccine breakthrough cases.”

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