The super-transmissible omicron variant has changed the COVID-19 pandemic, but the state of Oregon says it has no plans to change the way it collects data on hospitalizations in response. 

Because omicron is so infectious, spreading so easily from person to person, more people are testing positive—just look at the spiraling case counts reported each day by the Oregon Health Authority. Even those eye-popping totals are likely a massive undercount, given how many Oregonians are rapid-testing at home and not entering the results into any official record.  

But, consistent with early evidence on the variant from South Africa and Europe, most of those cases—particularly among the vaccinated and boosted—are considered mild, and many resolve within a week or so. That's shifted focus to another key metric to track the severity of this latest wave: hospital capacity, and whether a system that’s already battered from nearly two years of the pandemic can hold up under yet another surge. 

A key question now is how many people are arriving at the hospital with what’s known as “incidental” COVID—meaning that COVID is not the primary reason for their admittance, or that they learned they were positive only upon a routine test as part of an admitting screen—as opposed to those who need hospital-level care to manage the virus. 

The answer can help the public and policymakers calibrate their response to the rise in cases and hospitalizations, from whether or not to cancel events to reinstituting mask mandates for student athletes during competitions. 

Several other states already break COVID-19 hospital data down this way, tracking whether patients are admitted “with” or “for” the virus, including Iowa, North Dakota and, as of earlier this week, New York state, where between 50 and 60 percent of those admitted to some hospitals have been showing up for other reasons and then testing positive for the virus. In some cases, individual counties or hospital system have begun parsing the data in response to omicron wave, from Jackson Health Systems in Miami, which reported that 50 percent of COVID-19 admits had an incidental case, to Marin County, California’s Office of Public Health. In England, the National Health Service pegs the figure at about 30 percent of cases.  

But in Oregon, the Oregon Health Authority “does not collect data on the cause of hospitalization for patients who test positive for COVID-19,” says Rudy Owens, a spokesperson for the agency. “We are committed to providing data that is accurate and actionable. We constantly balance the benefit of new data collection with the burden of new reporting requirements.” 

Some hospitals in the state have the capacity to track this data, Owens added, but not all. Instead, he said, the state continues to focus on other metrics that demonstrate the severity of the surge, including those with COVID-19 who are in intensive care units or on ventilators. Neither of those numbers has budged appreciably in the past three weeks, even as case counts have skyrocketed. 

Still, even patients with incidental COVID-19 take a toll on hospital systems, says Tracy Brawley, a spokesperson for Oregon Health & Science University, where data analysts are working on breaking out this data, but where it is not yet publicly available.  

"Because the omicron variant is spreading so rapidly throughout the community, it is likely to increase the number of COVID-19-positive patients who are in the hospital primarily, or for other reasons, [like] heart attacks, stroke, cancer care, motor vehicle crashes and other conditions that require care in a hospital," she says. "[And] even among patients admitted primarily for other conditions, a COVID-19 infection can worsen their condition and complicate their care."

Additionally, even patients with mild or asymptomatic COVID need to be isolated in their own rooms, reducing available beds, and their caregivers need to follow all COVID safety protocols, however time-consuming. 

Legacy Health Systems doesn’t track this metric, and its data analysts are focused on “other priorities,” per directives from leadership, says Elizabeth Baker, a spokesperson there; Kaiser Permanente is also not tracking the breakdown of incidental vs. primary COVID admittance. Providence Health Systems told the Oregonian that an estimated one-third of COVID-positive patients are initially there for other reasons.