Your "Dumb" COVID Questions, Answered

Is it too late to say Happy New Year?

I hope you all had a restful and safe holiday.

As I started to think about what to write about this month, I quickly realized that what everyone is talking about right now is, well, COVID.

As you’re well aware, Omicron is raging around the world.

Information is coming at us from all directions, 24/7.

How do we separate fact from fiction?

And how do we manage it all without freaking out?

I decided to check in with a true voice of reason, Dr. Jeremy Faust.

Dr. Faust is a board-certified emergency medicine physician. He’s on the faculty at Harvard Medical School and has studied infectious diseases and immunology.

He also writes a twice weekly, easy-to-digest newsletter for Bulletin called Inside Medicine.

ALINA CHO: We had [more than] one million positive cases in the U.S. [on Monday]. Give me a status report. Where are we right now? How concerned are you?

DR. JEREMY FAUST: We are in a place where my major concern is directed in two ways. The first is with people who have no immunity, unvaccinated, or have never been infected, or both. My second area of concern is for hospitals and hospitals' ability to provide care for everybody, COVID and non-COVID alike.

ALINA CHO: But if Omicron is [a] milder [form of the virus], then why the concern?

DR. JEREMY FAUST: For two reasons. The first reason is that Omicron spreads so quickly that it finds everybody, as the numbers clearly show. But it highlights the people who have any risk factor, be it age or comorbidity. For those people, [Omicron is] not mild enough. In other words, it causes mild disease more often, or it causes severe disease a bit less often, but it's not like the cold or the flu.

ALINA CHO: For the immunocompromised.

DR. JEREMY FAUST: Right. It's like a game of roulette. Maybe there's a couple less bullets in the chamber, but it's still loaded, and it can hit. So, the fact that it's milder is absolutely good news, and I think it's real, but pardon the grammatical misstep, it's not milder enough.

ALINA CHO: Right.

DR. JEREMY FAUST: So, on the individual level, I think for the average person, if they're vaccinated and they get Omicron, they can expect to do very well. But people who are unvaccinated, or people who are under-vaccinated, you're playing a game of chance.

ALINA CHO: Makes sense.

DR. JEREMY FAUST: Any doctor will tell you – they’ve already seen people who have Omicron who, clinically and on X-ray, look indistinguishable from the original strain.

ALINA CHO: Wow.

DR. JEREMY FAUST: We know that this happens. It just happens a bit less.

ALINA CHO: Finish this sentence. "I'm willing to gather in a small group if A, B and C.”

DR. JEREMY FAUST: For me, [it depends] on who I'm going to interact with afterwards.

ALINA CHO: Got it.

DR. JEREMY FAUST: So, for me, I would not particularly fear an Omicron infection. I believe my immunity is sufficient that if I get it, it will be a bother, but not a tragedy.

ALINA CHO: Certainly not life threatening.

DR. JEREMY FAUST: Exactly. But I am worried if I then am going to give it to my child, who's 3 years old who's not vaccinated. Or if I'm going to be spending time indoors with people who are sick or who are immunocompromised.

ALINA CHO: Right.

DR. JEREMY FAUST: My risk has everything you do with thinking about how my actions will affect others around me. The minute that I am thinking about putting others at risk, then I stop and think, "Well, do I need to do this? Can we grab a test before? Can we grab a test after? What mitigation can we take?"

ALINA CHO: I read that the rapid tests aren't so great at detecting Omicron. Where are you on rapid testing?

Because PCR is the gold standard, isn’t it?

DR. JEREMY FAUST: They really test different things. PCR is the gold standard for detecting an infection.

PCR is not the gold standard for detecting contagiousness. So, when I hear these stories of, "We went to a dinner party. Everyone was rapid negative." Then the next day, someone said, "Sorry. I'm now positive," that doesn't necessarily mean the information at the dinner party was wrong. It just means that in the interval, things changed.

ALINA CHO: Got it.

DR. JEREMY FAUST: [With Omicron], there might be, for some rapid antigen tests, a decrease in their usefulness because the window between infection and contagiousness is getting smaller. That means that if you get a negative rapid antigen now, the warranty on that result is just shorter than it used to be.

That could be interpreted by some people as a false negative, when in fact, it was actually correctly negative, but you were an hour or two away from being contagious.

ALINA CHO: That's an important and interesting distinction. What I’m hearing from you, is that with rapid antigen tests, what it does is detect in the moment, are you contagious?

DR. JEREMY FAUST: Exactly. Absolutely that's the way to think about it. Because getting a PCR can take time. Sometimes, it takes days [to get the results].

ALINA CHO: Right.

DR. JEREMY FAUST: So, if you have 100 people who weren't going to get tested, and they were just going to go about their business, and instead, you rapid test them all, and you identify ten people who are contagious, but you miss one, in my view, you don't say, "Oh my gosh, rapid's missing the contagious person." You say, "By doing this, we actually detected nine people we wouldn't have detected."

ALINA CHO: 90% of the people.

DR. JEREMY FAUST: Instead of zero.

ALINA CHO: Correct.

DR. JEREMY FAUST: We can't let perfect be the enemy of the good.

ALINA CHO: I just read something that said, “Don't wear a cloth mask right now. If you can, get a KN94 or an N95. At the very least, wear one of those surgical masks that you can get everywhere." What's your sense on that?

DR. JEREMY FAUST: I agree with that. Let me put it this way: I think that masks work better than the denialists think, and they work not as well as the mask diehards think. But they work. They make a difference.

ALINA CHO: They do.

DR. JEREMY FAUST: It's clear that the more contagious the variant, the better your mask ought to be. This is an area where we can get better. I personally used to be very comfortable walking into a grocery store with one surgical mask, which suddenly looks like a flimsy bathing suit to me.

ALINA CHO: Isn't that crazy? I feel like I need to wear two of those now.

DR. JEREMY FAUST: Yeah. The CDC did some studies looking at that. It makes a difference to wear two. It's like having two goalies in your goal.

ALINA CHO: Makes sense.

DR. JEREMY FAUST: Now, I would never walk into an airport or a grocery store without at least the KN94, N95, or I wear two surgical masks.

But people who aren't comfortable with that, they can wear one surgical. Just not one of those flimsy cloth masks.

ALINA CHO: Good advice.

DR. JEREMY FAUST: And realize that it's only a layer of protection. It's not complete protection. You can limit your risk, but you can't eliminate it. If it's convenient enough to lower it with a good mask, then by all means, let's do it.

Stay tuned for Part 2 of Your "Dumb" COVID Questions, Answered tomorrow. Dr. Jeremy Faust will answer more of my pressing questions, including:

Hope this was helpful, let me know in the comments! And see you tomorrow!