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Making sense of the omicron spread


Public health experts say it is undeniable that a surge in new COVID cases fueled by the omicron variant is going to hit the U.S. hard over the next few weeks. President Biden acknowledged as much last week.


PRESIDENT JOE BIDEN: For unvaccinated, we are looking at a winter of severe illness and death for unvaccinated.

PFEIFFER: A winter of severe illness and death for the unvaccinated - those were strong words. Yesterday, New York state set a record for the number of new confirmed cases. And that surge has raised concern that the rest of the country could be next, just as it was at the beginning of the pandemic. But we're also at a point nearly two years in where many people are exhausted and confused. There are countless questions about this virus, but there seem to be few clear answers. So we've called Dr. Eric Topol. He's a professor of molecular medicine and director of the Scripps Research Translational Institute. Dr. Topol, welcome to the program.

ERIC TOPOL: Thanks very much, Sacha.

PFEIFFER: You wrote an op-ed for the LA Times this week headlined "Pandemic Fatigue Has People Glossing Over Omicron. But We Can't Give Up (ph)." You wrote, and I quote, "the greatest danger is the false sense of security and complacency among the public after living with the pandemic for nearly two years." Would you tell us why you think that fatigue is so dangerous right now?

TOPOL: Well, the problem is, of course, we have delta that's still raging throughout the country. We've never gotten containment. And superimposed on that is the omicron onslaught, unfortunately. And many people are thinking, you know, omicron is just going to be mild, and that's really a misperception.

PFEIFFER: You know, you say raging. But I think people hear words like that, and they think mass death. And that's not what they're seeing. They've seen what they believe seems to be more mild illness. So tell us why you feel like there's still a reason for concern.

TOPOL: Well, certainly for delta, we didn't see any reduction in mildness. In fact, it was somewhat more severe and - as compared to the prior versions of the virus. With omicron, the perception that it's more mild is mainly related to - that we have an immunity wall - not as good as we should, but the fact that we have 60-some-percent of the people in the U.S. fully vaccinated and increasing number that are getting booster shots.

But that's not enough because we know that the risk of a breakthrough infection with omicron is at least five-fold, even after a booster, compared with delta. So we have a problem where omicron has worked its way around our immune recognition, even after vaccination. And that puts us in a tough position for a lot of spread of omicron throughout the country.

PFEIFFER: And is the concern that if we have more cases, even if they end up being more mild, inevitably, more people will end up in the hospital, and we could once again have an overwhelmed health care system that has ripple effects for other people with other medical issues?

TOPOL: That's exactly right, Sacha. The idea of having such a large numerator of cases that is at least a million, potentially, in the U.S. in a day of confirmed cases, that we have, in that large number, a portion that would wind up in the hospital. We've already seen in the U.K - as of yesterday, there were 85 people with omicron in the hospital and seven deaths. So it's not a benign virus, even in a country that's much better immunized than the United States.

PFEIFFER: There is a lot of mixed messaging - talk of shutting down schools and other public places, yet some public experts advising keeping schools open, yet avoiding crowded spaces while doing lots of testing and masking. How do you advise people to make sense of all that?

TOPOL: Well, we don't have to get - resort to these lockdowns and closing down schools at this point because we have so many tools that we're not using. We've relaxed so much on mitigation. We have the knowledge of better masks, tighter-fit masks, medical-grade quality, the distancing. We're not getting the boosters nearly where they should be, nearly as well as many other countries. And our vaccination - still just over 60% - is woefully inadequate. So if we just use the tools we have and also if we rev up the pill, the anti-COVID pill that is imminently going to be approved that works very well against omicron, we'll be in very good shape.

PFEIFFER: I want to go back a moment to the confusion out there, because we had another doctor on this program yesterday. And at one point, he said he didn't want to overreact to COVID, to omicron. But then I got two very different tweets about this. One person said it's not possible to overreact because it's a, quote, "deadly, airborne, rapidly mutating virus that maims and kills prolifically." And then another person tweeted and said, all you do is fearmonger - complete opposite reactions. I'm wondering at this point, with the country so divided about everything, including COVID, how do we reconcile those two attitudes?

TOPOL: Well, those are the two different polls. And the truth is somewhere in the middle, of course. There is no reason to go into some fear. We have the ways to combat omicron and, certainly, we've had against delta. Our vaccines were remarkably effective against delta. But they just weren't taken up by the - people as they should. As we've seen in other countries, well over 80, 85, even 90% of people, of the population, vaccinated. So it's really on us that we take further toll.

The real concern I have is that, even with mild infections, we can see long COVID. And we're not going to know the story about omicron for months about long COVID. But with that very marked increase in number of infections and spread throughout our country, we could see a lot more of the chronic sequela with this new version of the virus. That's deeply concerning. The mild infections on their own are not the concern. It's the lingering aspects, which can be disabling in people - young, healthy people who have suffered a mild infection.

PFEIFFER: I think we could wrap up this conversation with something you wrote in your LA Times piece, which is plan for the worst; hope for the best.

TOPOL: I think that's a good adage here, Sacha. I still am hoping and remain optimistic. And, you know, I think that we will ultimately prevail over omicron. And I'm at - I am excited about having a whole dimension, a new dimension of treatment which we haven't had before.

PFEIFFER: Dr. Eric Topol is a professor of molecular medicine and director of the Scripps Research Translational Institute. Dr. Topol, thank you for coming on today.

TOPOL: Thank you, Sacha. Transcript provided by NPR, Copyright NPR.