The Daily - What to Expect From the Next Phase of the Pandemic

Episode Date: December 17, 2021

The Omicron variant of the coronavirus is incredibly contagious — it is able to infect people with even greater frequency than the Delta variant, and it is skilled at evading the immune system’s defenses. Much is still unknown about the new variant, and scientists are racing to understand its threat. But amid the uncertainty, there’s good news about a prospective new virus treatment: A pill by Pfizer is effective in reducing people’s risk of hospitalization or death from Covid-19.We explore these two developments and what they could mean for the next phase of the pandemic.Guest: Carl Zimmer, a science writer and author of the “Matter” column for The New York Times.Sign up here to get The Daily in your inbox each morning. And for an exclusive look at how the biggest stories on our show come together, subscribe to our newsletter. Background reading: An Omicron surge is likely. Here’s what to expect.Pfizer announced that its Covid pill was found to stave off severe disease in a key clinical trial and that it is likely to work against the highly mutated Omicron variant of the virus.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday. 

From The New York Times, I'm Michael Bavaro. This is The Daily. Today, as infections once again surge, what we're learning about the Omicron variant and a new treatment for COVID, and what both could mean for the next phase of the pandemic. I spoke with my colleague, science reporter Carl Zimmer. It's Friday, December 17th. So Carl, the last time we devoted an episode to the pandemic, the Omicron variant had just emerged. And our colleague, Apoorva Mondavili, told us that when it came to the big questions about this variant,

how contagious is it? How good is it at evading vaccines? How sick might it make us? We had to wait. We had to wait a couple weeks. And we did that. We patiently waited, but now we demand answers. So what do you know? Well, if you're vaccinated and you're boosted, you're probably going to be in good shape when it comes to fending off the variant. If you're not, then the picture's more complicated. What do you mean? the picture's more complicated. What do you mean? Well, we know that Omicron is really contagious.

It's about two to three times as likely to infect people as the Delta variant. We're seeing that in case after case. So for example, in Norway, there was a Christmas party on December 8th, and there were 111 people at the party. They'd all tested negative before going to the party, all vaccinated. 80 people came away from the party infected. Wow. With Omicron? Yes, with Omicron. All the tests that they've done turn up Omicron. So this was Omicron hitting about 70% of people at a single party. Okay. And then in the United Kingdom, scientists would take a look at people who are infected

with Omicron and just test the people who live with them in their house. Again, they would find that people were much more likely to be getting infected in that same house as they had been with Delta about two to three times. So again and again, we can see that, yeah, this thing is really contagious. And eventually, that started to become clear when countries start counting as many of the Omicron cases as they could. And they realized that Omicron was doubling every two to four days. So we don't know if Omicron is going to completely take over in all places, but it certainly is headed that way. But this isn't know if Omicron is going to completely take over in all places, but it

certainly is headed that way. But this isn't just going to be a replacement. You know, in the United States, it's about 120,000 cases a day. It's not like we're going to swap 120,000 Delta cases for 120,000 Omicron cases. Omicron is going to keep expanding. So you're going to have more cases. Because it's more contagious. And it keeps doubling. And that doubling we're now seeing in the United States. The first case of Omicron was identified on December 1st. That was the first time we even had Omicron in this country.

And now where I live in Connecticut, for example, scientists are tracking Omicron and they're seeing it doubling less than every four days. And they're predicting, at least here in Connecticut, it's going to be dominant before Christmas. In Washington State, they're seeing similar patterns there as well. And so likely it's happening across the country. Right now, it might be just a few percent nationwide, but it's actually much higher in some regions. So in New Jersey and New York, the White House said on Wednesday that it was already up to 13%. So think about that, 13% with a doubling every two to four days. So that's already on track to dominance very soon. two to four days. So that's already on track to dominance very soon.

Right. Because if it's 13% on Thursday, by Saturday, it could be 26%. By Monday, it could be 52%. On and on and on it goes. Up to 100. So, Carl, the rapidity of the spread, it seems to be telling us something about this variant's ability to evade vaccines, right? So what have we learned about that in the last two weeks or so? So what scientists have been doing is they have actually been taking blood the Omicron variant and trying to see how well those antibodies stop the virus from infecting cells. And whereas these antibodies would be pretty good at stopping other variants from infection, they're not very good at all going up against Omicron. How not very good at all going up against Omicron. How not very good at all?

In terms of how well these antibodies do at blocking the virus in a dish, you are seeing them reduced by 10, 20, 30 times. You're also seeing in some cases, like with Johnson & Johnson or AstraZeneca, that they don't seem to be stopping these Omicron variants at all. Now, in terms of the vaccines that we're most familiar with in the United States, that would be Pfizer and Moderna. Their antibodies do a mediocre job of stopping Omicron in a dish when you take antibodies from people who've had two shots of those vaccines. And there actually are studies on people who have been vaccinated to see what the actual effectiveness is of these vaccines against Omicron. So in South Africa, for example, they found that if you got the two doses of Pfizer, the effectiveness against

infection with Omicron is about 33%. And that's down from like 80 or 90%. Wow. The problem is that all those vaccines were designed to fight the coronavirus as we knew it in January 2020. And Omicron is a new beast. it in January 2020. And Omicron is a new beast. Right. So this is clearly why Dr. Fauci and everyone else in the federal health bureaucracy is telling us to get boosted. Yeah. The evidence is clear that boosting is a good thing. And you can actually see this again in those experiments where if you go and take the blood of someone who's been boosted and you throw it against the Omicron variant, the Omicron variant does a terrible job of getting into cells.

So the effectiveness of boosters on top of a full vaccination is still pretty strong against Omicron. So how should we think about what it means to be vaccinated right now? The government has not yet said to Americans that it's mandatory to get boosted. But from what you're describing, real protection doesn't really come until you get a booster shot. Yeah, it'll be interesting to see if there's sort of a change in language, a change in rules. But I mean, really, if what you want is like 80, 90% protection against infection from COVID, you need to be fully vaccinated and have a booster shot. Thinking about the unvaccinated and the vaccinated but not boosted, what do we know about how this variant so far infects those groups of people? How sick or not all that sick does it make them? So it's too early to really say much with a lot of precision about exactly

what kind of severe disease people may be facing if they've unvaccinated or vaccinated and so on. Unfortunately, we have to wait for that to come in. But from what we know already about COVID, what we know already about how vaccines work, it's very likely that if you're unvaccinated and never had COVID before, you're at the highest risk of getting severely ill from Omicron. Now, if you have been vaccinated or if you've recovered from an infection, even if your antibodies don't do a great job and you get infected, you may do a better job of fighting off severe disease. And there is actually a little bit of data on that, again, from South Africa. One of their healthcare systems estimates that if you've had two doses of the Pfizer vaccine, it has an effectiveness

at protecting against hospitalization of 70% against Omicron. That's high. That's high. It was 93% against other variants, but that's good. I mean, that's 70%. And that's for two doses. And so then the thinking is that if you then get a booster, you probably are raising your protection against hospitalization way, way up beyond that again. So is it safe to assume that if you have the full vaccination but not the booster, you're unlikely to get very sick from Omicron.

Your risk of going into the hospital is quite reduced compared to if you hadn't been vaccinated. Got it. And do we know for the unvaccinated, I'm guessing we don't yet know, how likely hospitalization is from an Omicron infection? We don't really have those numbers yet. Again, as with previous variants, you know, most people who get sick are going to, you know, not be severely sick. But the problem is, if a whole bunch of people get infected, that still puts a lot of people in the hospital. Just explain that. Well, you know, let's imagine that Omicron is very mild. Let's say that it sends half as many people to the hospital as other variants. As I said before, this thing is taking

off and it could potentially produce far more cases than we're dealing with even now with Delta. So if you have two times, three times as many cases, even though the smaller fraction of them are severe, you're still sending more people into the hospital. And don't forget, our hospitals are already really hurting. There are a number of hospital systems across the United States that are straining under the pressure of Delta cases. So we're still in the middle of a Delta surge. But at this point, we cannot say, correct, that hospitals will be filled because we don't yet know how severe infections are in any population from Omicron.

I want to push back a little on that because what I'm hearing from other people a lot of the time with Omicron, there's this idea that's sort of taken root that Omicron is mild, that it's milder than Delta. And really, like if you talk to epidemiologists, they'll say, well, that's just wishful thinking. It wouldn't be nice if this was just like a mild little cold and it just went away. That would be lovely. But actually, we don't know yet what this is going to look like once millions of people get this thing. I think it's dangerous for us to lull ourselves into complacency with the idea that we're going to get a pass. Just remember, less than 17% of Americans have gotten a booster. So I think that this winter is going to be rough.

We'll be right back. So Carl, you have just laid out what we now know about the contagiousness and evasiveness and severity of the Omicron variant, and it's very sobering. But all of that information is coming just as we're getting what seems like very positive information about a new treatment for COVID. And we haven't talked about that yet on the show and are hoping you can brief us. Yeah, it's kind of a strange whipsaw experience reporting on COVID these days, because there is some really depressing news to deliver. And then, you know, the next day, you might be really amazed at what science is giving us in terms of new tools to fight the disease. And one of those tools is a new pill

made by Pfizer. And we just learned this week that it is extremely effective in reducing people's risk of hospitalization or death from COVID-19. How effective? So for people who take it within five days of developing symptoms, it reduces their risk by 88%. So nobody who took the pill died, and relatively few of them ended up in the hospital. It was a very strong effect. It's really what you hope for when you run a trial on an antiviral pill. How did the trial work?

Who was tested? So Pfizer ran a trial on over 2,000 people. Half of them would get the pill. The other half would get a placebo. And these were people who were picked because they were at especially high risk of developing severe disease from COVID-19. people who were picked because they were at especially high risk of developing severe disease from COVID-19. These are people who are unvaccinated and had some sort of risk factor, things like diabetes, for example. And so these would be people you'd be really worried about

because they'd have a higher chance than others of ending up in the hospital or even dying. chance than others of ending up in the hospital or even dying. And so every day for five days, people take their course of pills. And these pills worked very well, it seems, from the announcement that Pfizer's made. And it seems that they're very safe as well. So those are both great things. And not to sound like one of those endless commercials on the 630 News, but are there any side effects to taking this Pfizer pill? you know, one in 100,000 side effects, well, we can't rule that out. We would have to wait for the pill to go into widespread use before those might come to light. But it's a kind of drug that is already in use for other viral diseases. The same basic idea is behind pills that people take for HIV or for hepatitis. And those pills have a good safety profile. So antiviral experts I've talked to are pretty confident that this will be fine,

especially because you're only taking it for, you know, five days. Everything you're describing makes it sound like this pill could be a real game changer, but how certain are we that it's effective against the various variants of the virus? Delta, which is still very much with us, Omicron, which is about to be very much with us, and whatever else the next variant looks like. As far as scientists can tell, this pill, Paxlovid, works against all variants. Okay, just wrapping up all the inevitable questions about this pill, is there any group of people who can't take it? For example, if you're fully vaccinated and you get a case of COVID, can you use this pill? Or is it really being reserved, we think, for the unvaccinated who are likely to get most sick? Let's say you're boosted and you get COVID. Could you use this pill?

could you use this pill? Well, assuming that the FDA authorizes this pill, and there's no reason to think that they won't, honestly, there's going to be a limited supply at first. You know, Pfizer actually told me that, you know, they're only going to have 180,000 courses ready to go if this gets authorized soon. Huh. That's not very many. That's not very many. And so those are going to be, you know, in really big demand. And so there will have to be priorities set about who is going to get them. Initially, probably, they will have to be saved for the people who are at greatest risk of ending up in the hospital or dying. saved for the people who are at greatest risk of ending up in the hospital or dying. But after a while, that probably will expand to bigger categories.

So if we're looking at this pill to be a lifesaver in this moment, once it's approved, that's only going to be true if you're at extremely high risk of getting very ill or maybe dying. At first, that could be the case. But the important thing is that this pill could save a lot of lives and it could keep a lot of people out of the hospital. And if we are going to be facing surging Omicron cases, putting a strain on the hospital system, surging Omicron cases, putting a strain on the hospital system, any tool we have to keep people out, to let them recover quickly at home, is going to be incredibly valuable. From everything you're saying, it certainly feels like the FDA is likely to approve Paxlovid. So let's say the FDA does, and let's say they do it pretty soon. Is there a version of the next few weeks or month where this pill reaches Americans just as Omicron is slamming the country and it prevents the worst effects of the variant, which is a somewhat severe illness and potentially death, especially among the unvaccinated? Is that a scenario that could play out?

The timing is really tight. death, especially among the unvaccinated? Is that a scenario that could play out? The timing is really tight. Because, you know, that Omicron horse is out of the barn. And so, you know, next week, Omicron is going to be really, really widespread in the United States. Omicron is going to be creating a huge increase in demand for treatments like this. And I don't think Pfizer will be quite ramped up when Omicron really hits us hard. So, Carl, at this point, we've digested a lot of new information about Omicron and this pill from Pfizer. And we've reached that difficult place in any conversation about this pandemic where we want to be sure we're getting the balance right between you should be alarmed and let's not be alarmist. And what I'm hearing from you is this variant is something to be

anxious about and taken very seriously. But this pill is also something of a game changer that might meaningfully begin to mitigate the worst elements of this pandemic. So in getting that balance right, how should we be thinking about all this right now? Omicron does have to change the way you live. Not forever, but certainly at least for the next few weeks. So what do we do to preserve our own health and to preserve the health of our hospital systems? We need to avoid getting sick. We need to wear masks. We need to avoid those poorly ventilated indoor spaces where Omicron is going to be infecting lots and lots of people. Well, Carl, I want to burrow into that a little bit because I think this is the moment in

the conversation, and it feels like deja vu from the earliest days of the pandemic, where people think to themselves, does that mean I'm not supposed to go to a restaurant, even though in a place like New York City, the rules say you very much can, that I'm not supposed to go to a restaurant, even though in a place like New York City, the rules say you very much can, that I'm not supposed to go to a birthday drinks thing tomorrow night that I really want to, and that, again, the rules say you can. And you know this. We have reached a point in the pandemic

where both government rules and personal conduct has started to relax for all kinds of reasons. And it's going to be very hard to convince people, maybe even impossible to convince people, that they need to give up some of those freedoms. And I guess the question is, should they really have to give up those freedoms at this moment? I think we need to just look at the facts that we understand about Omicron and just say to ourselves, like, well, what is it that we need to do? And it's not a question of like, what can we do that's fun?

It's a question of what can we do to keep our hospital systems from breaking? The more we can do to make it harder for Omicron to get from one person to another, the less suffering there will be. Now, we need to make good use of that time. If we can, for example, use that time to get the percentage of people who are boosted way, way up, that will help to sort of bring us something more like a long-term protection against COVID in general. But for now, just saying like, oh, well, protection against COVID in general. But for now, just saying like, oh, well, I still want to go out and meet my friends at a big party. If Omicron's there, it's a pretty good chance you will walk away with Omicron. Now, maybe you have a few days of being miserable, like you have a really bad cold. That's possible. Or maybe you end up in the hospital. Even if you don't end

up in the hospital, who do you give it to? What's your role in this stage of the pandemic? What are you going to be doing? Are you going to be fighting against Omicron? Are you going to be enabling Omicron? This is your, are you with us or are you against us moment, Carl? I think we should be on the side of human beings. You know, we should not be pro-Omicron in any way. I don't want to end this conversation without acknowledging that it's almost the end of the year. And this will mark the end of the second calendar year of the pandemic.

And I'm curious what you think the lessons of this last year were in the pandemic. You know, I think one of the lessons is that we should never be complacent about this virus. We should never assume that we have it in hand. This virus has a lot of surprises left for us. It's got a lot of runway left. Thank you, Carl. We appreciate your time. Thank you.

As of Thursday night, several local governments reported major spikes in infections. On Thursday alone, New York State recorded 18,000 infections, a near record. Overall, the U.S. is recording an average of more than 120,000 new cases a day, a 40 percent increase from two weeks ago, and the hospitalization of 68,000 COVID patients, a 21 percent increase from two weeks ago. For unvaccinated, we are looking at a winter of severe illness and death for unvaccinated. For themselves, their families and the hospitals, they'll soon overwhelm.

On Thursday night, President Biden warned Americans of a long winter ahead. But there's good news. If you're vaccinated, you have your booster shot, you're protected from severe illness and death. Period. We'll be right back. Here's what else you need to know today. On Thursday, U.S. health officials permanently lifted a major restriction on access to abortion pills, allowing Americans to receive the medication by mail instead of requiring them

to obtain the pills in person from health care providers. The decision will make medication abortion more available to women at a moment when the Supreme Court appears poised to roll back or even overturn the 1973 ruling that made abortion legal across the U.S. And President Biden has acknowledged that he will not pass a historic climate and social spending bill by the end of the year, as he and congressional Democrats had pledged, because their negotiations with a centrist holdout, Senator Joe Manchin, have reached an impasse. centrist holdout, Senator Joe Manchin, have reached an impasse. The delay, which could extend well into 2022, highlights the challenge Biden faces in convincing his own party to support the sweeping legislation, which would, among other things, subsidize paid leave, child care,

health care premiums, and the purchase of electric cars. Today's episode was produced by Sydney Harper, Robert Jimson, Michael Simon-Johnson, and Muj Zaydi, with help from Luke Vander Ploeg and Aastha Chaturvedi. It was edited by Patricia Willans and Dave Shaw, and engineered by Chris Wood. Original music by Marion Lozano. Our theme music is by Jim Brunberg and Ben Landferg of Wonderly. That's it for The Daily. I'm Michael Barbaro. See you on Monday.