The U.S. may be in a silent covid surge

Top Biden officials warned of the increase in cases yesterday, as the country surpasses an average of 100,000 new infections per day. But that number is a massive undercount and could be anywhere from five to 10 times higher, experts say, since home tests typically aren’t included in official case counts.

One-third of Americans live in areas with rising levels of cases and hospitalizations, prompting officials to urge them to consider taking measures to protect themselves, such as wearing masks, my colleague Yasmeen Abutaleb notes. 

• “If you do just look at those friends, colleagues, neighbors who are infected — confirmed by a home test or a PCR test — it is remarkable how many people are infected right now,” said Michael Osterholm, who leads the University of Minnesota’s Center for Infectious Disease Research and Policy and advised President Biden’s transition team.

Officials have stressed that the country is in a better position than the winter omicron surge, which stretched hospitals nearly to their breaking points. But the pandemic isn’t over, as the contagious omicron subvariants drive a spike in infections. 

Here are the three big challenges facing the administration in the coming weeks:

1. Convincing some communities to put their masks back on. 

This is the first major test of a new Centers for Disease Control and Prevention alert system adopted in February. The agency began incorporating the strain on the health-care system into its guidelines for mask-wearing, in addition to cases per 100,000 people. 

Over 32 percent of Americans live in areas with medium or high levels of the coronavirus. 

• In communities where the virus level is medium, CDC Director Rochelle Walensky said people should consider taking precautions, like masking, based on their own personal risk.
• In communities where the virus level is high, everyone should be wearing a mask in public, indoor settings, she said.

Yet governors and local officials have been reluctant to impose mask mandates again. And a growing number of Americans would likely be hesitant to put their face coverings back on even if they did. 

2. Is a longer course of Paxlovid needed?

Some patients have reported coronavirus symptoms rebounding days after completing a treatment course of Pfizer’s antiviral medication, called Paxlovid. The regimen is currently five days, and the National Institutes of…