(NEW YORK) — Current COVID-19 cases are just a fraction of what they were at the peak of the omicron wave.

But many people in the country may be noticing what seems to be a flood of cases in their social circles.

Health experts say this anecdotal evidence may not be simply coincidence, as the U.S. may be in a “hidden” wave — one much larger than reported data would suggest.

“There’s a lot of COVID out there. I see it in my social circles, in my kids’ schools and in the hospital employee infection numbers,” Dr. Shira Doron, an infectious disease physician and hospital epidemiologist at Tufts Medical Center in Boston, told ABC News. “We are clearly in a wave.”

Although it is clear that infection rates have been steadily rising in recent weeks to their highest reported level since mid-February, scientists acknowledge that it is difficult to know how high COVID-19 case and even hospitalization numbers truly are, given the likely “substantially” undercounting of infections.

This is due in part to changes in data collection and reporting and the proliferation of at-home tests. Some state officials report that health departments and healthcare facilities have also ended traditional tracking of COVID-19 patients, which epidemiologists say make it more difficult to know how many patients are coming into hospitals in need of care.

Last month, former Food and Drug Administration Commissioner Dr. Scott Gottlieb estimated that officials were likely only picking up “one in seven or one in eight” infections.

And President Joe Biden’s new coronavirus response coordinator, Dr. Ashish Jha, acknowledged that there are “a lot of infections” last week, likely the result of highly infectious omicron subvariants spreading across the country.

“We know that the number of infections is actually substantially higher than that. It’s hard to know exactly how many but we know that a lot of people are getting diagnosed using home tests,” Jha explained.

More than 100,000 Americans officially testing positive every day

The nation’s reported daily case average, which officials say consists largely of PCR tests, now stands at more than 100,000 new cases reported a day, according to data from the Centers for Disease Control and Prevention (CDC).

In recent weeks, nearly every state in the country has reported an increase in COVID-19 infections and the number of virus-positive people who are admitted to the hospital.

The Northeast remains the nation’s most notable known COVID-19 hotspot, though surges in some cities, like Boston, appear to be showing initial signs of slowing.

Nationally, according to the CDC’s community levels, more than 45% of Americans live in an area with a medium or high COVID-19 risk.

The high community level suggests there is a “high potential for healthcare system strain” and a “high level of severe disease,” and thus, the CDC recommends that people wear a mask in public indoor settings, including schools.

Hospitalization numbers have been increasing in recent weeks, but not at a rate as significant as infections.

However, over the course of the spring and winter, hospitalization data, too, has become less accessible, leading some experts to suggest patient totals could also be undercounted.

Earlier this year, the Department of Health and Human Services ended the requirement for hospitals to report several key COVID-19 metrics, including a daily total of the number of COVID-19 deaths, the number of emergency department overflow and ventilated patients and information on critical staffing shortages.

Further, certain states have stopped outright reporting of statistics including hospital bed usage and availability, COVID-19 specific hospital metrics and ventilator use.

However, Doron said a possible significant surge in infections, without an overwhelming number of hospitalized COVID-19 patients, could be a promising sign.

“If cases are really a lot higher than what we are seeing, it means the ratio of hospitalizations to cases and deaths to cases is even lower than what we are seeing, and we are already seeing a ‘decoupling’ between cases and hospitalizations and deaths,” Doron said, which could indicate the virus is moving closer to a form that Americans can live with.

Even so, Doron added, “at a population level, however, COVID poses more risk because there are so many cases, and hospitals are already so full with both COVID and non-COVID patients.”

A shift away from traditional testing

In recent months, states from coast to coast, have moved to shutter public testing sites, with an abundance of rapid COVID-19 tests now available in pharmacies and through the federal government.

“While home testing has created broader population access to infection status and hopefully better access to treatment, it has also created a major blind spot in our public health surveillance efforts,” John Brownstein, Ph.D., an epidemiologist at Boston Children’s Hospital and an ABC News contributor, said. “The latest BA.2 surge was masked by the shift in testing behavior and likely delayed decisions on public health interventions.”

The shift away from traditional COVID-19 testing has left some health experts worried about continued issues of access to adequate healthcare and preventative health tools, such as testing and antiviral treatments, to protect vulnerable communities.

According to ABC News’ analysis last summer of pharmacy locations across the country, there are 150 counties where there is no pharmacy, and nearly 4.8 million people live in a county where there’s only one pharmacy for every 10,000 residents or more.

“What concerns me even more is what might be happening in communities and among families with fewer resources. Public testing sites have closed, home tests are expensive at the drugstore, and navigating the system to order free tests or get tests reimbursed by insurance requires literacy and technology,” Doron said.

Broader insights on infection through home testing and wastewater sampling will be critical in the future to fully understand the scope of surges and protect all Americans, Brownstein said.

Virus not disappearing in low-transmission counties

This winter, following the omicron surge, the CDC released a new risk level map, which shifted away from focusing on the level of transmission within a community, and rather shifted the attention to hospital capacity and admission levels.

The rollout of the new map, which aims to help people and local officials assess when to implement potential mitigation measures, caused controversy among some Americans, explained Doron. While some people argued the shift in metrics was long overdue and a sign of the times, others said the move was premature.

“Some people were happy because they felt that we were beyond the time period in which we needed to reimpose restrictions and mandates every time cases increased, given widespread population immunity from vaccination and infection,” Doron said. “It made other people angry because a transition to a medium or high-risk status now requires increases in hospitalizations, which are lagging indicators, in other words there can be a lot of cases before hospitals get full, and some people might choose to take extra precautions sooner.”

Brownstein noted that given the shift away from transmission rates, some Americans may not be fully aware of the continued dangers of the virus, as a green county is not necessarily indicative of the virus simply disappearing.

“While the CDC map reflects decreased risk of severe complications from COVID infection, it unfortunately hides places with high community transmission,” Brownstein said. “This masking of risk may provide a false sense of security especially to those at high risk of hospitalization and death.”

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(NEW YORK) — At least 19 children and two adults are dead after a shooting at Robb Elementary School in Uvalde, Texas, according to the Texas Department of Public Safety.

The 18-year-old suspect, who is also dead, was a student at Uvalde High School, according to Texas Gov. Greg Abbott.

The governor said the suspect also allegedly shot his grandmother before entering school premises, but did not give any details about her condition.

In the wake of the deadly mass shooting, many parents are left grappling with how to explain the horrific act of gun violence — at a setting where most kids spend a majority of their days — to their children and teens.

“For the majority of students, school is a safe and supporting environment,” Dr. Robin Gurwitch, a licensed clinical psychologist and professor at Duke University Medical Center, told ABC News in 2018, after 17 people, including students, were killed at Marjory Stoneman Douglas High School in Parkland, Florida.

“So when a shooting happens at a school, it undermines our sort of worldview about where I can be that is a safe place,” she added.

Gurwitch, a member of the National Child Traumatic Stress Network, broke down how parents can discuss the news with their children, and how to help them to feel safe in the aftermath of the harrowing headlines.

Parents should initiate a conversation

Gurwitch stressed that in situations like a mass tragedy, it is “extremely important” for parents and caregivers — especially those with children in high school — to “be willing to bring this topic up.”

“We really want to want to wrap our arms around them and make them feel safe,” she added. “But part of being a parent is willingness to discuss difficult topics.”

“To believe that our children don’t know that these events occur is wishful thinking,” Gurwitch said. “We live in an age where we can go online and see live feed of people leaving the school, of responders, it’s updated every few moments.”

Gurwitch suggests that if you are watching the news with your children, turn it off and talk about the events calmly in order to get an idea of what they know, where they are coming from, and what misconceptions they may have already heard.

It is also critical to reassure children that parents and adults at their school “are going to do everything we can to make you safe,” Gurwitch added.

“Let them know that their school has plans in place to do everything to the best of their ability to make them safe,” she said.

Adapt the conversation based on your child’s age

Gurwitch emphasized that the conversation about the news should vary based on the age of your child.

“I use the analogy ‘it is the same as having a conversation about where do babies come from’ — it is a very different conversation if I’m talking to a preschool or elementary school student than if I’m talking to a high school student,” Gurwitch said.

When it comes to children preschool age and below, she added that parents should limit their media exposure.

“Preschoolers may not understand instant replays,” she said. “So that loop of children running out of the school, if they don’t know that that’s a replay, they think that school has thousands and thousands of students.”

For high school and older middle school age students, Gurwitch recommends addressing the incident directly, saying that you want to talk to them about the school shooting that happened and asking them what they know about it.

For children younger than that, Gurwitch recommended initiating the conversation by saying, “There was a very sad thing that happened at a school … today. It is very sad because people were hurt and people were killed, and I just want you to know about it if you hear kids talking about it at your school, and if you have any questions, you can talk to me.”

Regardless of your child’s age, Gurwitch stressed that parents should “most importantly show a willingness to answer questions,” and listen to their children’s concerns.

“Younger children may ask the same question over and over again,” she added. “That is how they process information.”

How to respond if your child says they don’t feel safe going back to school

If your child or teen says they do not feel safe going back to school, Gurwitch emphasized that it is important not to invalidate their feelings, but to talk about them.

“Say, ‘Tell me what it is that you’re worried about? What it is that you don’t feel safe about?'” she said. “Validate why your child may not feel safe. If we just discount it with a throwaway, ‘You are going to be fine,’ we shut down the conversation.”

Gurwitch added that you can reassure your child that “nowadays schools do have safety plans, and schools do practice shooting drills.”

“Some people are concerned about practicing these drills, but it’s like fire drills, it doesn’t make kids more scared that fires are going to break out, it makes students feel more secure that they have a plan in place,” she said.

“Be patient and supportive as children are trying to make sense of how something so horrific can happen at a setting where I go to be with friends, to learn,” she added.

Check back in

“I think that is really important to check back in tomorrow, to check back in the next day, to find out what are your friends talking about related to this school shooting,” Gurwitch said. “It is very important to get an understanding of how children are coping.”

“When there is a tragedy … a one-and-done conversation is not sufficient,” she added. “Let your child or teenager know that ‘I really do care about you and I am open to having this discussion.'”

If you notice your child or teen is distressed for a longer period of time, and Gurwitch added this may show up in “problems with sleep, problems with attention and focus, and increased irritability,” she recommends that parents reach out to their school guidance counselor, a local psychological association or even their pediatrician for further help.

The National Child Traumatic Stress Network offers comprehensive resource guides for parents, caregivers and educators to support students. Click HERE for resources related to school shootings.

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