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UCSF Medicine chair answers our omicron questions


The U.S. is dealing with another spike of COVID-19 cases. Public health officials say it's an alarming rise, and they fear the worst is yet to come. Offices, schools, sports events and theaters across the country are again beginning to shut down. It's starting to feel a lot like March 2020 due to the rapid spread of the newest coronavirus variant, omicron. It was first reported in southern Africa, where it spread at twice the rate of the already highly transmissible delta variant. And omicron has become the dominant variant in countries like South Africa, but some experts say it could be milder and cause less severe illness than its predecessor.

That leaves many questions, especially with the holidays just ahead. How worried should we be? What precautions should we be taking? Should we cancel our holiday plans? For answers, we've reached out to Dr. Robert Wachter, chair of the Department of Medicine at the University of California, San Francisco. Dr. Wachter, welcome to the program.

ROBERT WACHTER: Thank you, Sacha.

PFEIFFER: I think for many people, the public health message has become confusing. It feels like mixed messages. People say it's serious, but it's not going to cause that much illness - which, by the way, doesn't mean it's not serious. How concerned are you about this new wave of infections caused by omicron?

WACHTER: Very but not massively - and it is confusing. I completely understand the way people are feeling. First of all, we're all tired of it and tired of being jerked around, so that underlies a lot of our feelings. But then this particular variant, there are just some unknowns that really are going to influence how bad it is. What we don't know for sure is severity, and that is a big note of uncertainty, and that will make a big difference. You know, if a ton of people get this virus and the average person has a very mild case, then it will be bad. A lot of people will be out sick. Hospitals will get busier. But it won't be overwhelming. If it turns out it's a little bit less severe than delta, but the cases are two or three or five times what we've seen before, that is a crisis that will overwhelm hospitals. And so it can be anything from bad to terrible, and we're just not sure yet.

PFEIFFER: We mentioned how highly transmissible omicron is. I read an article in which a public health expert said he's resigned to eventually getting omicron. And he said, I quote, "this is not even an elevator-ride issue anymore." And by that, he meant people can't protect themselves simply by avoiding proximity to other people in close spaces. I'm trying to figure out what that means in terms of can any of us - do we all really need to be resigned that we'll get it and hope it's mild for us?

WACHTER: No. I don't think so. I think that the risk of getting it is certainly at least two times that of Delta. But if you are vaccinated and, if appropriate, you are boosted and you are careful, I don't think it's inevitable that you're going to get it. I can understand that point of view because it absolutely is more transmissible. But if you are taking the kind of precautions that I am now taking - you know, N95s when I'm inside with other people who I'm not 100% sure are fully vaccinated, that kind of thing - I don't think you have to hide under the kitchen table the way you might have in March 2020. But I think if you take reasonable precautions and you've gotten your vaccines and boosters, think there's a pretty good chance that you will avoid getting it. And the good news is if you get it and you have been vaccinated and boosted, the chances that you will be one of those severe cases is relatively low.

PFEIFFER: Although there are many reports of people who are vaxxed and boosted still getting omicron. And that's leading vaccine skeptics to be even more skeptical about whether vaccines have value. What's your medical response to that?

WACHTER: Yeah. It's tricky because I can understand the messages. You know, we say, you really need to get vaccinated and boosted, and then we say, and the vaccines don't work as well as they did before. And people might hear that and just say, well, why bother? And the answer is that the vaccines with omicron are a little less protective than they were against delta but still are tremendously more protective than nothing. And the more immune you are, the better off you'll be, the more protected you are from an infection - although there are - certainly will be breakthrough infections - and, probably more importantly, the more protected you are against a severe infection, the kind of infection that will kill you.

PFEIFFER: One big difference between this year and last is we have more treatment options, which is good news. But if people test positive over the holidays, what should they do?

WACHTER: Yeah. The challenge is going to be that not only are hospitals going to fill up but the other resources that we've come to depend on are also going to be hard to come by, so even getting a test now is difficult. If you haven't gotten one from a pharmacy to have a rapid test around, I would do that. I think it's a very helpful resource. If you wake up in the morning and you have a sore throat or a new other symptom, it's worth getting a rapid test to figure out whether you have it. And they're reasonably accurate. So if you test positive, basically, you need to isolate from other people. You need to treat yourself as you would any other infection. It's worth getting a home oximeter to be sure that your oxygen level's OK if you feel OK. COVID can get serious relatively quickly. But those are the basics of what you need to do.

But the challenge is going to be if hospitals really get packed and doctors' offices get packed, testing sites and monoclonals are all hard to come by. It is a time where, even though we want to celebrate, it's worth being careful. I, for example, would not go to a big, indoor, unmasked holiday party right now. And I just heard from a friend in New York City today who did that last week. This is someone with three shots and has had prior COVID, so he's about as immune as you can get. And he felt badly yesterday, tested himself this morning. It was positive. And so you know, that's an anecdote, but it just says, this thing is very infectious, and you have to be more careful than you might have been last week.

PFEIFFER: Dr. Robert Wachter chairs the Department of Medicine at the University of California, San Francisco. Thanks for talking with us, and I hope for you and us - all of us - this ends soon.

WACHTER: Thank you. Thank you so much. Transcript provided by NPR, Copyright NPR.