When it comes to COVID, I never seem to run out of questions.
Which is why I’m back for Part Deux of my interview with Dr. Jeremy Faust.
Yesterday, we covered some of the most pressing issues – immunity from Omicron, the latest data on boosters, dining indoors, non-essential travel.
Today, we're tackling big picture questions.
Is Omicron the last big wave? When will COVID become an endemic versus a pandemic? And what does it all mean for our daily lives?
ALINA CHO: So, give me a status report. Infection rates are definitely down in places like New York City that saw early rises in cases, hospitalizations seem to be nearing a plateau. Where are we right now?
DR. JEREMY FAUST: I think we're still in the middle of this.
ALINA CHO: Wow.
DR. JEREMY FAUST: Clearly, several weeks ago, there were periods where more than half the country had hospitals where their capacity was being stretched. Certainly, there are fewer now, but there are some places that are just getting the worst of it.
ALINA CHO: Got it.
DR. JEREMY FAUST: So, if you want to think about the United States as a single entity, I will say that things are a little better than they were a couple of weeks ago. But when you realize that we are 50 states and 3000 counties, I would say that there are still many, many places that are really in the middle of this. And, it really depends on our behavior. We control a lot of this with what we do.
ALINA CHO: So, just as a reminder, it's mask up, limit your interactions?
DR. JEREMY FAUST: Exactly. Choose the things you want to do right now, because if you get sick and you're at risk, or you get someone else sick and they're at risk, you want to know that there's a place for them to go. That they have a hospital bed.
ALINA CHO: Well, right. And as you pointed out in our last interview, even though everyone likes to say Omicron is a milder variant, you said – pardon the grammatical error – it's not milder enough.
DR. JEREMY FAUST: Exactly. And what I've seen since then is basically what I expected, which is people who are unvaccinated who look like they've got COVID-19, I don't care what the variant is called, it looks like they're fighting for their lives.
ALINA CHO: Wow.
DR. JEREMY FAUST: And on the other hand, you have a large swath of individuals, people who are vaccinated, older folks in particular, who come in and get hospitalized because of an existing condition that their coronavirus infection exacerbated or aggravated. And those folks are actually getting hospitalized, and in some cases even dying. So, it's different than 2020, where everyone came in with this life-threatening pneumonia. And, yet, it's not that different because we still see it.
ALINA CHO: There is this popular myth that, "Oh, Omicron, generally speaking, is a weaker variant." And that COVID, as time wears on, and as there are more and more variants, will be milder. As you've pointed out, that is not evolutionary principle for viruses, right?
DR. JEREMY FAUST: Correct. It's evolutionarily advantaged to be more contagious, so that if a virus has an easier time infecting you and an easier time spreading from person to person, that is a variant that will take the world over. And we just happened to observe it, and that's evolution.
ALINA CHO: Omicron.
DR. JEREMY FAUST: Right. Whereas the changes to the virus that happen when it's replicating, these are called mutations, there's no guarantee that those changes will make the virus any more or less deadly. So, we should anticipate more contagious variants, and whether or not those variants cause less or more serious disease is an open question. In my view, it's basically a wild card.
ALINA CHO: But this whole idea that with the sheer number of infections we've had combined with those who already have immunity from vaccination, some have suggested maybe this could be the last big battle with the virus. Even Dr. [Anthony] Fauci said, "Things are looking good." So, how you square that with this evolutionary principle that we just don't know?
DR. JEREMY FAUST: Let me answer it this way. I think that one thing that is absolutely true and fortunate, is that every day that goes on, the herd has more protection, because more people get vaccinated, more people get boosted, and the people who recover from infection have some degree of protection. So that whatever comes down the pipeline, whatever the next variant is, there's more of us walking around with some degree of protection. So, that means that we are making progress, whether it's safely through vaccinations, or unsafely through infection. So, that's to the good. I mean, let's not…
ALINA CHO: Discount that.
DR. JEREMY FAUST: Exactly. On the other hand, there's no data that suggests that we've reached a point where this virus has affected enough people that nobody needs to worry about it anymore. We're not there.
ALINA CHO: Let's talk about the possibility, or the hope that this turns into an endemic, meaning that it becomes something like the seasonal flu, it becomes a permanent part of our lives that we just have to learn to manage. Do you see that in our near future?
DR. JEREMY FAUST: Well, I see an endemic phase. I see reaching an endemic phase as a realistic goal. And I say safely reaching the endemic phase, I mean, getting there through vaccination and through medical intervention, not through just letting it rip and seeing how many people die, and how many people are left over.
ALINA CHO: Exactly.
DR. JEREMY FAUST: And so, now where are we, right? And to me, the final frontier remains under-vaccinated adults who think they're immune to this but aren't, under-vaccinated kids who rarely have bad outcomes, but when they do it's tragic, and the under-five set, who are completely unprotected, don't have vaccinations, [yet], and for whom it's a tragedy when we lose those lives.
Just yesterday, Pfizer announced it asked the FDA to authorize its vaccine for children under 5 years old as a two-dose regimen.
We don't need to completely shut down our lives to protect a smaller number of people, but it makes sense to do some mitigation to protect all those lives.
ALINA CHO: Makes sense.
DR. JEREMY FAUST: So, when people hear endemic, I think they're thinking about two different things. One, the biological, where are we with respect to how the virus interacts with us as a herd? But then they sort of conflate that with the idea of how do we live our lives with that? I think a lot of people think that when we say it's endemic, that just means we don't have to do anything anymore. And that's just not quite right.
ALINA CHO: Interesting.
DR. JEREMY FAUST: Is this virus reaching a point where it's not causing historical numbers of hospitalizations and deaths, even though it's infecting people? That would be a sign that we've reached the endemic phase. By the way, we haven't reached that. We have 3000 people dying a day of and with [COVID]. We have a population under five who cannot be vaccinated, [yet]. There are going to be hundreds of kids who are going to die. And far beyond the usual influenza numbers. So, that's not a situation that we would shrug off if we weren't so freaking tired.
ALINA CHO: Exactly.
DR. JEREMY FAUST: But I think that because we're tired, people are failing this marshmallow test where I say like, "Just do a few things and things will get better, we'll get more out of it," but they're just tired of it. So, I think the buzzword of, “It’s endemic," is sort-of becoming a fault line for not just where we are, but what we should do about it. And I think that on all counts, most people have it wrong.
ALINA CHO: Good point.
DR. JEREMY FAUST: There's kind-of this dichotomy, the two extremes of do everything, do nothing. And my vision is that we have so much more data now and we have so much more information that we can do something sometimes, and that can make a big difference. But the approach that says close your eyes and stop your ears, that bites you back every time.