Today, Explained - Will omicron speed up the pandemic’s end?

Episode Date: January 4, 2022

The omicron variant is very transmissible, but it might make Covid-19 less miserable. Today’s show was produced by Miles Bryan with help from Hady Mawajdeh, edited by Matt Collette, engineered by Efim Shapiro, fact-checked by Laura Bullard and hosted by Haleema Shah. Transcript at vox.com/todayexplained Support Today, Explained by making a financial contribution to Vox! bit.ly/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices

Get groceries delivered across the GTA from Real Canadian Superstore with PC Express. Shop online for super prices and super savings. Try it today and get up to $75 in PC Optimum Points. Visit superstore.ca to get started. It's Today Explained. I'm Halima Shah filling in for Sean Ramos-Furham. The year is 2022, but it doesn't feel like it. I'm having all kinds of deja vu. Schools are debating whether to close again.

I'm still working from my living room. And an R&B singer who peaked in the 2000s is getting a lot of play. What's up, everybody? It's Omar Rian, the 2000s, is getting a lot of play. It's all thanks to Omicron and a spike in COVID-19 cases. Omer Erfan, science reporter at Vox, I know this hits close to home for you because we were both at the same holiday party last month and had a COVID scare. And it turns out that one of the guests tested positive. So I isolated myself at home until I could find a test, which sucked. What did you do?

Well, I had gotten back from the UK a couple of weeks earlier. And as a souvenir, I picked up a pack of rapid tests. So I already had some at home. And so I took a test as soon as I found out about that exposure and then followed it up with a PCR test at a testing site near my house. Oh, way to share your stash in there. I offered you, didn't I? I don't think so, but that's okay. Go back to the Slack message. I specifically said that I have a pack of them at the office. Oh, damn. Okay, fine. I take it back. I take it all back. But how many people weren't as fortunate as we were? How many cases of covid are there in the

rest of the country? Well, we're seeing a pretty big spike. I mean, with this new wave of covid infections, we're having cases around the country. New infections have gone up so much that the chart showing our daily case counts, they just look like mistakes. In New York City, the virus shredding the ranks of frontline workers. 30% of emergency services employees are out. 21% of the police department. 18% of the fire department. I just felt like, here we go again.

Here we go again. That's all. But it was inevitable. We knew it was coming. A lot of places throughout the U.S. are reporting record levels of new COVID cases, including where we are in Washington, D.C. It's the worst it's been throughout the pandemic. So it's pretty substantial. You know, this is much larger than we saw even in January of 2021. And do we know which variant is causing this at this point? Can we assume that it's Omicron? I think that's fair. The Centers for Disease Control and Prevention recently reported or

estimated that about 95% of new COVID-19 cases are being caused by Omicron. Now, the Delta variant is still present and contributing to some of these cases, but Omicron has seen such a stunning rise and takeover in just a few weeks, and now it is the dominant source of new infections. Okay, so we know the caseload is high and that it's almost entirely because of Omicron. Are hospitalizations and deaths spiking too? There is an increase in hospitalizations, but not at the level that we saw with previous waves. And so there has been sort of a decoupling between the number of cases and a number of hospitalizations. Now, hospitals are still facing a lot of stress because two years into the pandemic, there's a lot of staff right

now that are burned out. Winter is also a major season for other respiratory illnesses. So hospitals are usually stressed in these winter months anyway. And on top of that, they are seeing many new cases. Now, while some of these cases are going to be fairly mild, as they're testing patients, as they're coming in, they're finding a lot of COVID cases among them, people being admitted for other reasons. And so then those patients have to be put into isolation protocols. So all of these factors converging to put a lot of stress on the healthcare system, though fortunately we are not seeing the same massive rise in deaths that we would have seen in a previous wave. And even with all of the stress on the healthcare system, it doesn't seem

like things are really shutting down. I mean, I just went to a restaurant last week and I'm told the airports are still very busy. Are we hearing anything from the Biden administration? Are there any new measures to fight the latest wave? Well, just before the winter holiday, the Biden administration announced a number of different measures that they were putting into place. Three weeks ago, I laid out a COVID-19 action plan for this winter that prepared us for this moment. Today, we're making the plan even stronger. First. One was expanding the eligibility for booster doses of the COVID-19 vaccines. These doses, you know, these extra doses do help bolster immune protection against Omicron and other variants, according to some of the research that we've seen so far. I got my booster shot as soon as they were available. And just the other day, former President Trump announced he had gotten his booster shot.

It may be one of the few things he and I agree on. The Biden administration are putting together basically teams of researchers and health workers and other personnel who will go to these hotspots whenever they see an area with hospitals facing stress and go there to help assist with testing and also providing medical care, administration and other things. And they also put out a large purchase order for these rapid tests that they're going to distribute throughout the country. The federal government will purchase one half billion, that's not million, billion with a B, additional at-home rapid tests with delivery starting in January. And these rapid tests that they're distributing, is that the same rapid tests that the Biden administration scoffed at handing out for free just weeks ago?

Yep. Should we just send one to every American? Maybe. Then what happens if every American has one test? How much does that cost? And then what happens after that? We did an episode last month about how there's this big test shortage, and that's for a lot of reasons. But one of them is because the federal government has made it very hard for test manufacturers

to get their tests authorized. Is there any sign that that is going to change in 2022? Well, we are seeing a number of new rapid tests being authorized. You know, the Food and Drug Administration has granted emergency use authorizations to more manufacturers and more test designs, so that should increase the availability of different tests on the market. But for the most part, the U.S. hasn't really invested in testing as part of its COVID-19 strategy.

The U.S. went pretty all in on vaccines and so didn't really deploy the infrastructure, not just having the tests, but like manufacturing them and actually developing an infrastructure for reporting tests. And so without all those other things in place, even having these rapid tests out there, many of them are either going to be too costly or not going to be deployed in the right fashion in order to actually make them useful for containing the virus. And to make things more confusing, we got new guidance from the CDC over the holidays. They said if you test positive but are asymptomatic or improving, you only have to isolate for five days instead of 10. What's behind that change? Right. The Centers for Disease Control said that

people are most likely most contagious right after their positive test, and that contagiousness wanes fairly quickly, particularly if you're vaccinated. And so if this is a breakthrough infection and you're asymptomatic, you only have to wait five days from your first positive test before you're free to go. Now, this didn't actually follow up with a test out requirement, though some researchers are saying that that should be part of the guidelines. And other researchers are also pushing back on this saying that even after five days, people with no symptoms can still have enough virus in their airways that they can transmit it to other people. And they're saying that the evidence to support a five-day

isolation period compared to the previous guidance of 10 days is not as robust. And especially when we're dealing with a massive increase in spread right now, the way we are right now, they say that it's more prudent to actually increase the isolation guidelines. So there's a bit of a tension between what the CDC is doing and what some public health researchers are saying is most optimal. I believe that the CDC soon will be coming out with more clarification of that since it obviously has generated a number of questions about at that five-day period, should you or should you not be testing people? Yeah, interestingly, the producer of this very show, Miles Bryan, is actually recovering from

COVID. And he says that when he first started feeling sick, he kept testing negative for days. And it wasn't until his sixth COVID test that he found out he was positive. Huge bummer. That seems to suggest that on top of the issue of availability, these tests aren't very accurate. Well, there's a few factors at play. One is that, yes, these rapid tests are not as accurate as the PCR tests that involve a nasal swab and then sending that swab to a laboratory for further analysis. These rapid tests, they look for proteins on the surface of the virus. And so what that means is you really need to have the virus in a very accessible part of the body in order to actually test that. So basically, the virus has to be in your upper

airways, in your nose, at detectable levels in order to show up. And so what that indicates is that, you know, in the early stages of the infection, you may start feeling symptoms, but you may not have enough virus in your airways to actually be detected. Whereas once the symptoms pass, you might actually still have virus in your airways

that you can transmit to other people. So those are other factors that you have to consider. And then on top of that, yes, these tests, since they are less accurate, you know, you can't use this as just, you know, an absolute guarantee that you are infected or you're not infected. Rather, what you have to do is also keep track of your symptoms and oftentimes using multiple tests to help validate these results. So you can't just look at one test in isolation. If you're trying to, you know, test out of isolation, you have to look at, you know, one or two or three tests in a row to verify that you are or not infected.

Well, it seems clear that COVID is going to be with us in the new year, but the way that we're going to handle it will probably be different. At this point, what should we be bracing for? I mean, I think we can still expect that the virus will continue circulating, that we'll still have some degree of precautions in place. We may need to get another dose of vaccines. But on balance, I think what we'll likely see, based on just from the people I've talked to as well, is that overall, a lower and lower health burden over time. Essentially, we'll have fewer and fewer people going to the hospital and fewer people dying from this illness, but we may still have people being

infected by this for a few more months, maybe throughout the rest of the year. But again, hard to predict. And that's part of why it's so hard to come up with a set of guidelines that people will actually adhere to. I mean, there's also a lot of fatigue. We're two years into this, and I think a lot of people really want to get back to school, get back to work, go back on vacation. It'll be difficult. It's a balancing act between what people are willing to do, what is necessary, and also what level of misery we're stuck with COVID-19. But we might not be stuck with a COVID-19 pandemic. More on that after the break. Thank you. by Wirecutter. AuraFrames make it easy to share unlimited photos and videos directly from your phone to the frame. When you give an AuraFrame as a gift, you can personalize it, you can preload it

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Sigal Samuel, you're a senior reporter for Vox's Future Perfect, and you recently wrote a piece about how COVID-19 will not be eradicated, but it'll at least stop being a pandemic. If it's not eradicated and it doesn't stay a pandemic, what will it be? It'll go from the pandemic phase to the endemic phase, which basically puts it in the category of something like the flu or the measles. So for me, endemicity means a lot more people get vaccinated, a lot more people get boosted. And although you don't eliminate or eradicate, that infection is not dominating your life. That's what endemicity means to me. You know, it still circulates in parts of the population for years and years,

but its impact will come down, its prevalence will come down. It'll become something relatively manageable as opposed to this insane world-stopping disease. What requirements does COVID-19 have to meet in order to become endemic, to become something that's seasonal but doesn't shut down the whole world? Okay, so the basic bare minimum requirement is that the rate of infections has to pretty much stabilize more or less across the years instead of showing these giant, unexpected spikes like we're seeing right now. And so basically the way an epidemiologist would put this is that the disease's reproductive number has to be stably at one, which means that one infected person on average is infecting one other

person. Right now we're nowhere near that because we have this extremely contagious Omicron variant, and each infected person is infecting definitely more than one other person. And is it possible that we'll keep seeing COVID variants. That's largely because we're not vaccinating the globe fast enough to starve the virus of opportunities to keep mutating into something new and serious. And so a lot of the experts I talk to say that the key determinant of when the pandemic phase will end is when we will successfully vaccinate the globe, you know, enough of the globe to stop giving the virus just tons and tons of opportunities to mutate. So if we were to guess when we reach this endemic point, when would that be? So it's funny, and by funny, I mean somewhat heartbreaking. When I spoke to experts just a few months ago, they were saying,

2022, we're pretty confident. 2022, we feel like Delta is the last big act of this pandemic, and then it'll become endemic. And do we get there next year in the United States? I think it's conceivable that we will. I mean, I hope we do. And it might even be likely. That could still be the case. It's just the trajectory is a little more uncertain now with Omicron. On the one hand, it could be the case that Omicron slows down or sort of delays our path to endemicity, to COVID becoming endemic, because it's going to put a big strain on the healthcare system with so many people getting infected that inevitably some do end up hospitalized, etc. On the other hand, it could end up infecting so many people so quickly that it actually speeds up our path to intimacy by just giving us a pretty big layer of natural immunity in the population. Experts aren't quite sure yet which way that'll go.

It has the potential to either delay or speed up intimacy. But I will tell you that in the past few days, I've been feeling a bit more optimism on this front because there have been a couple of small preliminary studies, one out of Hong Kong, one out of South Africa, that are seeming to suggest that people who recover from an Omicron infection may now have antibodies that can help them fight off Delta and other variants going forward. Well, I would hope that that's the case. There's no guarantee that that would happen.

But if you have a very transmissible virus that replaces another virus, and that virus has less of the degree of severity, that would be a positive outcome. But you can never guarantee... So that could be a meaningful source of, you know, cross-protective immunity. I should just say those are not yet peer-reviewed studies. They're small and preliminary, but they're giving me a little bit of hope. And in 2022, we have treatments available that weren't around in spring of 2020.

Could those play a role in speeding up the process of endemicity? Yes, absolutely. So I think it's really important that we all kind of internalize the fact that even though it's very frustrating to be in this situation right now, we're not back to March 2020. We do have a lot more knowledge about COVID. Our scientists have designed a rapid COVID-19 test so remarkably simple, it puts the power of a lab in your hands. We have great masks, we have rapid tests, etc. We have antivirals now like Pfizer's Paxlovid pill, which early studies suggest can reduce the rate of infection stabilizes, whether the reproductive number just gets down to this objective one. It's also about, you know, what's happening societally.

Are we seeing hospitals become totally overwhelmed and in really perilous situations? Are we seeing huge numbers of hospitalizations and deaths? So in that context, the new antivirals that are coming online can be really, really helpful in us reaching endemicity because that means that even if lots of people are getting sick, not that many are being hospitalized, not that many are dying. And does that explain why people who are vaccinated and have a booster shot are getting breakthrough cases of COVID-19 that end up being pretty mild? We are basically seeing, thanks to vaccinations, thanks to boosters, and maybe thanks to Omicron being inherently less virulent, we are seeing this sort of muted effect, which best case scenario could mean that as a population, we're kind of building up this wall of immunity that will help us going forward defend against not only Omicron, but also

other variants. It's still possible that a new variant could emerge down the road that will evade or that we'll be able to get around that wall of immunity that we've built up. But these early studies I mentioned earlier are seeming to suggest that we at least have some hope that there will be cross-protective immunity for people infected with Omicron against future variants. If endemicity is the best we can do, can we at least hope that we won't see more lockdowns or thousands of people won't lose their jobs again, or that kids will finally be able to stay in school? I think so. I mean, I think that in March 2020, when this all first started, lockdowns, shutdowns, you know, they were proposed for a reason. It really,

it made sense at the time to slow this virus when we didn't know anything about it. We had to learn how this virus works. We didn't have any vaccines. We didn't have, we didn't, we didn't even know that masking was effective and advisable, right? Like it's, it's, we really knew almost nothing. We're not in that state anymore. And I think we've also learned that those shutdowns really do come at a serious cost, you know, in terms of our mental health, our economic health. And so, by and large, experts and politicians aren't saying we should go back into total lockdown now. What they are saying is that for the next few weeks, it does make sense to once again be a bit more cautious. Right. And I think it's worth it.

That's what my personal plan is to be doing, at least. Sigal Samuel is a senior reporter at Vox. Omer Erfan, who you heard from earlier, is Vox's science reporter. And for the record, he does like to share and is not hoarding COVID tests. Today's episode was produced by Miles Bryan with help from Hadi Mawagdi. I'm Halima Shah. It's Today Explained. you