COVID-19 cases are spiking once again in and around Philadelphia as a subvariant of omicron continues to spread.

The reported case counts are surely undercounts, due to people who are using at-home tests, or dismissing mild symptoms.

“I think they are very much just the tip of the iceberg,” said Jennifer Horney, founding director of the University of Delaware’s epidemiology program. “There are a lot of people who are like, ‘I have allergies’ or ‘I have something else,’ but they probably have COVID.”

New Jersey is facing a steep spike in COVID-19 cases thanks to the highly transmissible BA. 2.12.1 subvariant of omicron, which has yet to become dominant in Pennsylvania. That state is averaging nearly 5,000 new COVID-19 cases a day, the highest rate of new infections since the beginning of February. Per capita, New Jersey has about double the rate of new infections than Philadelphia.

The case rate in the collar counties is higher than Philadelphia’s — but lower than New Jersey’s — and rising.

“With workers returning to their places of work and with the arrival of nicer weather we are seeing more socializing, and the typical social activities such as Mother’s Day, end-of-school activities, summer leagues, etc. are all having a collective impact,” said Chester County Health Director Jeanne Franklin. “The vast majority of these social activities are happening with no prevention strategies in place.”

But the collar counties and even Philadelphia — which throughout the pandemic has had the region’s strictest COVID rules — are stopping short of implementing new restrictions, instead opting to strongly encourage masking indoors but leaving the decision up to individuals.

The increase in new infections comes as leading health officials in President Joe Biden’s administration are warning of a substantial jump in new cases and a rise in hospitalizations, with cases up more than 50% nationwide over the last two weeks. The new surge is mostly being driven by omicron subvariants that are more transmissible than previous versions of the virus, matched with waning protection over time, according to Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases.

» READ MORE: COVID-19 cases rise in South Jersey as new omicron subvariant takes over

“Vaccines continue to provide strong protection against severe disease, and that’s the reason why as cases go up ... the discrepancy or ratio between hospitalizations and cases clearly is much less than it was, for example, in the delta wave,” Fauci said during Wednesday’s briefing. “However, immunity does wane, and that is why it is so important to stay up to date with vaccines and particularly boosters.”

Hospitalizations are up, both locally and nationwide, but health experts have commented that those numbers could be misleading. Because COVID is so prevalent, some people admitted to the hospital for other reasons are also testing positive for the virus, though their symptoms are not serious.

“Fortunately, even with cases ticking up right now, hospitals in Bucks County are not currently reporting high numbers of COVID-related admissions,” said David Damsker, Bucks County’s health commissioner.

Elsewhere in Pennsylvania, hospitals are also reporting an increasing yet manageable number of COVID patients, with few suffering severe enough symptoms to require intensive care.

At Penn State Health’s four hospitals in Dauphin, Berks, and Cumberland Counties, 31 patients were being treated for the virus Thursday, two of whom were in intensive care, said spokesperson Barbara Schindo. Meanwhile, UPMC was treating 187 COVID patients at its dozens of hospitals statewide, compared with more than 1,100 in January, said senior medical director Donald Yealy.

At Guthrie hospitals in the northeast corner of the state, 6% to 8% of beds have been taken up by virus patients in recent days, said Michael Scalzone, executive vice president and chief medical officer; during the omicron surge, that number was 30%.

He said he isn’t greatly concerned about this spike overwhelming hospitals, citing less severe cases in hospitalized patients, warmer weather, and falling cases in central New York, where the regional spike began.

COVID-19 hospitalizations are up 42% in New Jersey over the last two weeks but are still well below peaks reached during the initial omicron wave in the winter.

Death rates, meanwhile, have remained low and even declined in some areas over the last two weeks, including in Philadelphia and statewide in Pennsylvania. New Jersey is averaging 10 deaths daily, a 44% increase over a two-week period.

The regional picture

In Philadelphia, the case rate has risen 91% in the last two weeks, well above the national average, according to an analysis of New York Times data by The Inquirer. Philadelphia is averaging about 434 new cases a day over the last week.

Hospitalizations are also on the rise. As of Wednesday, there were 142 patients in Philadelphia hospitalized with COVID-19, an increase of 82% over the last two weeks. Among those hospitalized for COVID-related illness, most are not fully vaccinated, said Tony S. Reed, chief medical officer at Temple Health.

For now, the Philadelphia Department of Public Health doesn’t intend to revive any of its mandates designed to mitigate the spread of the virus. The city’s last intervention was a mask mandate imposed in April that lasted just four days before it was withdrawn. City health officials said the mandate was no longer warranted because vaccinations and natural immunity from prior infections meant COVID cases were less frequently resulting in serious illness.

“While we are not looking to reinstate a mask mandate at this time, now is the time for Philadelphians to remember that the pandemic is still here and take precautions,” said Cheryl Bettigole, the city’s health commissioner, in a news release. “We strongly recommend that every Philadelphian and visitors wear a mask whenever they’re indoors in public.”

» READ MORE: Philly’s COVID-19 cases are up since the mask mandate ended. Did the city make the right call?

The health department release included quotes from the administrators of several Philadelphia hospitals, all urging people resume wearing masks.

Bettigole also recommended people get tested for COVID before visiting seniors or people with health conditions. Just under 33% of Philadelphians 12 and older have received booster shots, and Bettigole urged people to get those shots if they haven’t already.

“At this point, indoor masking for adult residents is an individual choice, based on one’s own level of acceptable risk,” said Montgomery County medical director Richard Lorraine. “We are encouraging reasonable mitigation strategies, and are not considering any mandates currently.”

Chester County’s Franklin said residents “must be prepared and willing to step up personal efforts and choose to mask” if transmission rates continue to increase.

With nearly all restrictions lifted, it comes down to individual and community decisions to determine how quickly the virus continues to spread, Horney said.

”Wearing a mask is a really low burden for the vast majority of people and seems to be highly effective at stopping spread in indoor spaces,” she said, “but I don’t think the general public has the appetite for that.”

All Southeastern Pennsylvania and South Jersey counties bordering Philadelphia now have “high” levels of COVID-19 in the community, according to the Centers for Disease Control and Prevention, which recommends wearing a mask indoors in counties with high transmission. The CDC looks at metrics that include cases, hospitalizations, and hospital capacity to determine community levels.

Delaware is averaging 514 new cases a day, COVID-19 test positivity rates have skyrocketed past 18%, and two of the state’s three counties — Kent and Sussex — have a “high” level of spread. Hospitalizations are also up 20% over the last two weeks, though the number of patients admitted to ICUs remains low.

“While severity is reduced [for most people], it’s still a really scary virus to a lot of people,” Horney said. “I think it’s a really challenging time when most people have moved on to some extent.”

What to do if you test positive or are a close contact to someone with COVID-19

  • If you test positive for COVID-19, the CDC says you should remain at home for at least five days and isolate, regardless of your vaccination status. If you must be around others, wear a well-fitting mask. You can end your isolation after five days if you no longer have symptoms or are fever-free for 24 hours and your symptoms are improving.
  • The CDC recommends taking continued precautions for the next five days after isolation, including wearing a well-fitting mask while around others and not traveling. If you were hit hard by COVID-19 and got very sick, or have a weakened immune system, the CDC recommends isolating for at least 10 days. You should also consider consulting your doctor before ending your isolation.
  • If you were exposed to someone who tested positive for COVID-19 and you’re fully vaccinated, you don’t need to quarantine unless you develop symptoms, which include fever, coughing, difficulty breathing, fatigue, muscle aches or headache, loss of taste or smell, congestion or runny nose, nausea, and diarrhea.
  • If you’re not up to date on your vaccinations and were a close contact to someone with COVID-19, the CDC recommends quarantining for five days and wearing a mask while around others for 10 days, regardless of your symptoms.
  • More information is available on the CDC’s website.
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