In general, we rely on organizations like the CDC to conduct surveillance and monitoring of diseases in the United States. Unfortunately, case reporting, which we are relying on now to understand COVID-19 in the United States is the weakest type of surveillance for an ongoing pandemic. Case counts meant something very early on in the epidemic when each case reliably was associated with a certain risk of severe disease, hospitalization or death. Once there was a substantial number of people with immunity to severe outcomes due to recovery or vaccination those case counts became disconnected from expected outcomes. Test positivity also used to be a reliable measure of the community burden of infection with increased positivity correlating with increased spread of infection and hospitalization. But because now many only seek medical testing to confirm a home-based positive test for employment sick-leave or other purposes, the frequency of those testing positive through medical testing is artificially high. Remember the days of "flatten the curve," the idea that we had to preserve hospital capacity through efforts to reduce the spread of infection? That curve was the number of hospital admissions due to COVID-19 and reasonably reflected the number of people admitted to hospitals severely ill with COVID-19. Now, however, due to the continued universal screening of all hospital admissions, a majority of reported COVID-19 hospitalizations are not hospitalized "for" COVID-19 but "with" COVID-19.