FNX Now | The COVID-19 Pandemic: Is It Really Over? | Season 2023

(film reel clattering) - Welcome to today's national weekly EMS Zoom news briefing.

[soft background music] I'm Sunita Sohrabji, EMS' health editor and your moderator for today.

Today's briefing focuses on COVID-19.

Where are we now, three years after the pandemic began?

Even as the national public health emergency ends which removes several critical safety nets, a new COVID subvariant known as Arcturus is emerging.

Arcturus was first identified in India where it's causing a surge, and it's now emerged in at least 29 other countries.

In the U.S., Arcturus currently accounts for about 10% of new COVID infections, according to CDC data.

The World Health Organization notes that Arcturus has one more mutation in the spike protein than the prevailing XBB 1.5 variant, which may make it more infectious.

One symptom of the new subvariant is conjunctivitis, which is also known as "pink eye."

We are so pleased to welcome back several familiar faces today, [background music fades] speakers who, throughout this past three years, have helped us make sense of all the information out there, and most critically, helped us weed out misinformation and disinformation.

Our speakers today are Dr. William Schaffner, who is professor and chair of the Department of Preventive Medicine at Vanderbilt University Medical Center; Dr. Wachter, who is professor and chair of the Department of Medicine at the University of California-San Francisco; and Dr. Benjamin Neuman, professor of biology and chief virologist at the Global Health Research Complex at Texas A&M University.

So welcome, reporters.

Welcome, speakers.

Let's start.

So, Dr. Wachter and Dr. Schaffner?

The New York Times had an interesting story headlined, "What's going on with COVID right now?"

And, the article quoted you, Dr. Wachter.

So, may I ask each of you to share your thoughts on this somewhat abstract question of where we are at this moment, and what you foresee in our future?

Dr. Wachter, let's start with you.

Welcome!

- Thank you.

It's good to be with all of you.

I'd say the state of COVID, at least as far as I can tell, feels reasonably mild compared to what we've seen in the past three years, and remarkably stable.

I think the last 18 months, the biggest surprise has been the relative lack of surprises.

- [Sunita] Hm!

- That we're still on the same Greek letter that we were since December 2021, I guess.

So, you know, 18 months or so of the same class or family of variants with, you know, every several months a new one coming out that is a little bit better at its job of infecting people and evading immunity, but not a game changer.

And, by that I mean that the vaccine and the boosters still work reasonably well in about the same way that we have thought for the last 18 months or so; that Paxlovid still works reasonably well, that your home test still works reasonably well.

The biggest change maybe, as I think about it, is probably that monoclonals don't work at all anymore.

But, other than that, the therapies, the testing, the treatments that we've come-- gotten used to all work about as well as they have for the last 18 months.

In some ways, the biggest changes are political and sociological.

Political, it's clear that any rules and restrictions are pretty much gone.

There's a little variation there.

For example, at my own institution, at UCSF, we still are mandated to wear masks when we see patients, but that's, like, the last vestige of a requirement of anybody to do anything.

- [Sunita] Right!

- Or, even the new booster availability from the FDA is permissive rather than mandatory.

It's like, "you can get this and you should discuss it."

But, it's not-- So, it's very much a world where the expectation is people will be left to make their own individual decisions.

And, it's very clear that the value to many people, and I'd say most people, of forgetting about COVID and living life as if it was 2019 is very high.

And so, for folks like me who are still being medium careful, I would say "medium."

I still wear a mask on an airplane, still wear a mask in a crowded indoor space, but I'm quite comfortable eating indoors in a way that I wouldn't have been six or eight months ago.

And, you know, it's very clear that in most places people have ditched the masks and if asked to find them again, probably wouldn't know where they've stored them in their closet.

So, I think that's the biggest change is people really are over it and trying to get back to the rest of their life.

And, we can talk later about whether that's a good decision or not, but that's how I see the current moment.

You know?

The case rates are relatively low, wastewater is relatively low, hospitalizations are relatively low.

Whether the new variant becomes an important thing or just another thing.

I think, you know, the last year or so really feels like new variants that are a little scary, and then they turn out not to be that big a deal.

And so, I think if past is prologue, that's likely to be what happens with this newest variant.

- Thank you.

Dr. Schaffner.

- Well?

Good to be with you, journalists.

And, Dr. Wachter?

Always good to be with you.

And, I'm absolutely on the same page as is Dr. Wachter.

COVID is kind of stable, but just a few brief emendations.

The first is COVID has not disappeared.

We should recognize that in the United States on a daily basis, 200 to 300 people still die of COVID in this country.

But, it's clear that our population immunity is much more secure now than it was even a year ago.

Many of our population have experienced COVID, many people have been vaccinated, and, of course, many people have experienced both.

And so, our level of protection, as Dr. Wachter said, is very high.

And, these Omicron variants seem to be spreading, producing milder disease, less frequently hospitalizations.

The people who are getting hospitalized today are basically in two groups.

One is some people who've never gotten vaccinated, and number two, people who are older, frail, immune compromised.

I call that to everyone's attention because they are eligible, just as Dr. Wachter said, to a second booster, and we could go into those details.

I am concerned that we have not really taken advantage of the now no-longer-new bivalent booster.

Only, not quite 20% of the target population in the United States; something like 45%, 47% of people age 65 and older have taken advantage of this new bivalent booster.

We're looking forward to the fall because there will be, we anticipate, a, yet another, updated booster available, and along with influenza vaccine and maybe also RSV vaccine?

- [Sunita] Hm!

- That will be available, at least for older adults.

And, we will see whether we are going to keep our guards up, whether our population will accept one, two, or perhaps even three inoculations this fall, particularly the older population.

We shall see.

But, I think we have a challenge in front of us.

Everyone-- "Everyone?"

A large majority of people are much more relaxed about their personal infection control, and we keep them (ahem) sufficiently alert so that they will come forward receiving vaccines in order to provide sustained protection over time.

- So, Sandy?

I'm gonna ask you to ask the question.

- Are we sure that the current boosters-- you mentioned a new one, an updated booster would be available in the fall.

But, what about as we move into the summer?

What about now with the new, latest variant?

- I'll take first stab.

I got mine last weekend and I'm 65 and pretty healthy.

And, in my judgment, the benefits of the new-- of getting the additional booster on top of the one I got last September- so, I was six or seven months out- outweighed the risks.

Was it urgent?

No.

Would it have been reasonable to wait another month or two until the case rates were higher?

Reasonable, but I see the risk of vaccination as being essentially zero, and, you know, people talk about the cardiac stuff.

It's mostly in adolescents and young adults, not in people of my vintage.

And, the benefits and the reason I took it were some evidence of, that it'll decrease my chance of getting COVID for the next few months.

Pretty good evidence that it will decrease my chance of getting very sick if I get COVID over the next six months until the new booster comes out.

And, decent evidence that it lowers the probability of long COVID, both because it lowers the chance of getting COVID a little bit for a short period of time, and maybe has a separate effect.

Now, whether the booster does that, 'cause all we know is that people who are vaccinated have a lower chance of long COVID.

Whether I need this booster to do that or not I think is up in the air.

But, I think of-- You know?

I'm a practicing doctor.

All I do for a living is weigh the risks and benefits of giving treatment for your cholesterol, or your heart or your blood pressure.

When I think about the risks and benefits, I think the risks are very low here and the potential benefit is high.

Could I have waited a few months?

Sure.

At 65, would it have been irrational not to do it, and just wait for my fall booster?

I think that would've been an okay decision.

It's not authorized for anybody younger than 65 unless they're immunocompromised.

And, I think that's reasonable 'cause the main benefit is that it lowers the probability of a very severe case.

For your teenage or 30-year-old children or friends, if they're otherwise healthy and not immunocompromised, if they've had any vaccines at all and/or have had COVID, their chance of a very severe case is very low.

So, if they've not gotten a booster, they should and it'd be fine to get it now.

Do they need another one if they got one in September?

Absolutely not.

I dunno.

Bill?

You wanna probably add something?

- Well, let me just add a few details.

As usual, we're exactly on the same page.

(Sunita chuckles) I'm going to emphasize first, immune-compromised people, people who are moderately or severely immune-compromised.

If it's been at least two months since your previous booster, you are eligible for another booster.

And, by the way, down the road, if another two months has gone by, talk with your doctor because you could, then, once again be eligible for yet another booster.

So, for the immune compromised people, it looks like, at the moment, an every two months sort of schedule.

That can change, but that's the current recommendation.

Now, Sandy or people such as yourself who, by age- my wife and I fit into that category- we need to wait four months since our last booster, and if we're eligible, go ahead and get it.

I would urge people to get it for all the reasons that Dr. Wachter mentions.

It turns out my wife and I have plans to do that next week.

- And, I wanted to start right off with a quote that you had in an email to me.

You said, I think the new symptom profiles everyone is talking about are most likely hogwash, but the genetic differences and breakthrough potential are real.

Could you please explain?

- Absolutely.

I'd be happy to, and probably, I could have put things a little more delicately!

(Sunita laughs) So, the first thing that happens when anybody discovers a new variant is they look at the five people or so that they have in front of 'em that have this variant.

They decide that runny noses are common in this group, therefore this variant causes running noses, QED, and that's the end of it.

Then later, larger studies come along and they look at more people and they find that the symptom profiles are usually just about the same.

It's really, really difficult to take into account variability in the virus and in the hosts because both of those matter to the severity of the illness and there are very large components of both of those things that we do not fully understand.

So, I think reporting any new variant as having different symptoms is quite unlikely to be true in the longer term.

But, we do know the sequence of the new XBB-derived variants, and those are different enough to the current vaccine strains that they should be able to break through in many cases.

And, there is some evidence that this is happening.

The new-- I believe it's Arcturus variant is about as different from Omicron as Omicron was different from Delta.

And so, just like we saw the Omicron wave come through, there is at least the potential for that, if we're not masking.

And, if we have to mention masking, I would say, condoms prevent babies, masks prevent infectious disease.

You'll hear a lot of argument about wearing both of them, but that doesn't mean they don't work!

(Sunita laughs) - Excellent!

So, Dr. Neuman, that points out the need for updated boosters.

When you last joined us four months ago, you said the situation is long overdue.

Could you talk about that again?

- Yeah, absolutely.

I think we're up against two things.

So, the funding for some of the COVID vaccines has been restricted at a national level and in terms of specific initiatives.

Because of that, the incentives on the development side for the companies that are making these are a little bit more mixed.

It's very expensive to produce and test, and, yeah, roll out a new vaccine.

I think the other side of it is that the FDA committees that deal with these things have had a backlog of about two years where they basically mostly met to cover COVID stuff.

And, if you look at the schedule, they have meetings set up every two or three days now, which is absolutely unheard of.

I think they're trying to clear the backlog, which means that COVID is kind of on the back burner.

These meetings occur every two months for the Vaccines Advisory Committee, and they're alternating between COVID and influenza at the moment.

So, in May, that's the earliest opportunity where that panel could look at an updated vaccine, and if they look at the data and the data look good, then potentially the CDC could rule on that in the next week or two.

But, that's the sort of timeline, and then they would have to roll it out to everyone before you can get it.

But, we definitely need it.

- Will the new-- given that timeline, will it be oriented against this new variant, particularly since we don't really know how big a deal [Ben chuckles] that new variant will be?

- [Sunita] Good question.

- To answer that, we can go back to the January meeting, and at that meeting, they had looked at resistance of different variants.

And, I think it was only Pfizer that had said that they were starting mouse testing with an XBB, like, one version.

So, it will be closer, but it will not be completely up-to-date.

But, it should cover-?

I think the current variants are about seven mutations different from original Omicron, and the XBB.1 would be six mutations different.

So, it's pretty close, and I think I would like that.

It's a step forward, just not a very quick step forward!

(Sunita laughs) - Dr. Wachter, will you please take a question from Henrietta Burroughs?

It's a local question.

Henrietta?

- [Henrietta] Thanks so much, Sunita.

Dr. Wachter, how worrisome is the COVID outbreak in Santa Rosa, California where even Kaiser Hospital employees are wearing masks?

And, is this variant the same one that's currently ravaging India?

- Actually-- thank you.

I actually don't know what variant that they found there.

I know that they did have an outbreak of, I think a few dozen people and that they re-instituted the mask requirement for, for the hospital.

I don't know whether they've been able to type the case.

I dunno if, Bill, you've heard that at all?

I haven't heard that.

- [William] No, I haven't.

- There will be point outbreaks.

You know, we hear far fewer of them than we did in the beginning.

I mean, my wife's case of COVID was when she went to teach at a science writer's conference a year ago and there were 50 people there, and 23 of them got COVID coming out of the conference.

- [Sunita] Wow.

- She was relatively careful, but they ate together inside.

And so, if you remember the superspreader events that we saw before, you see far fewer of them, and we never figured out why would a given case cause a superspreader event?

Was it something about the person?

Something about the virus?

Something about the environment?

It wasn't clear.

You know, the fact that there is still COVID around and people can get it if you, you know, you probably will see times where one person can spread it to a whole bunch of particularly vulnerable, potentially vulnerable people.

But, I don't know enough about whether that was potentially related to the variant.

I'd be kind of surprised from what we know about the new variant.

It doesn't seem like it's going to be that much more infectious that it, in and of itself, is gonna explain a superspreader event just because it's that new variant.

There may have been something different about the environment, but I don't know the answer to that.

- Henrietta, will you ask your second question?

Because, that's an important one as well.

- [Henrietta] Sure.

Thanks again, Sunita.

There was a study done in Germany that indicated that wearing a mask traps carbon dioxide as one breathes, and this is posing a serious risk that's causing and aggravating serious diseases and birth problems.

So, is this test result taken seriously in the medical world?

- Well, Henrietta?

- [Robert] First of all- - I'll start.

I have not seen that particular study, but there are many, many others that have indicated that even if you're wearing the N95 or KN95 masks, which give a very good seal around your nose and chin, you can wear those for long periods of time.

Now, there are some people who have underlying lung disease who may have real discomfort, and the work of breathing may be more difficult for them, but it is uncomfortable if you wear such a tight mask for a long period of time.

But, other than that, the physiologic studies of which I'm aware, and I invite Dr. Wachter to add his comments, show nothing like what you have suggested concerning birth difficulties and the like.

- Yeah.

I had not seen the study either.

I'd be highly skeptical that it actually shows something that is meaningful from a physiologic standpoint.

You know, plenty of people, as Dr. Schaffner says, tons of studies have not shown that.

Real-life experience of everything from doctors in operating rooms for 10 hours at a time to firefighters has not shown significant physiologic problems with wearing these masks.

It's not something that I-- I would be interested in seeing the study, but my bias going into it is that's not-- I wouldn't worry about that.

- Thank you.

Mark Hedin has the next question, and I think we'll direct it to Dr. Wachter.

Mark, please ask your question.

- [Mark] I just wanted to ask about the, about long-term COVID.

How do we know if that's a concern?

Does it show up positive on tests?

- Yeah.

Both of us can opine about this!

It is a really complicated, knotty problem.

I think the first thing to say is that long-term consequences of viral infections are not new, that there actually is a long flu and a long other-- some viral infections continue to cause lingering problems.

This seems to be more than we are used to for other viral infections.

And, I would say, you know, the things that we've learned in the past year or two is that we've learned what the risk factors are for it, which is, probably the most prominent one is being a woman is about twice the risk of being a man in terms of long COVID.

Age is somewhat related to it.

The severity of your initial infection is somewhat related to it, although not perfectly.

Some people will develop long COVID and their initial infection was quite benign.

- I'd like to end today with another policy question.

The public health emergency which provided several safety nets including free vaccines and testing is ending.

Millions of people now stand to lose their Medicare, and in California, Medi-Cal, as we go through what is known as the "Great Unwinding."

Millions of people will also lack access to Paxlovid and remdesivir, the two therapeutics for COVID.

I'll ask each of you.

Was this the right time to end the public health emergency?

Dr. Wachter, let's start with you.

(William chuckles) - [Robert] It's a hard question!

In a perfect world, you'd keep it going.

But, in the world that we actually find ourselves in, I think the question is, "if not now, then when?"

And, you know, yes, people may have a little harder time getting Paxlovid, but they sometimes have a hard time getting insulin.

And so, the problem is, I do think it's time for us to begin treating it as we treat other parts of the healthcare system and figure out ways of funding and supporting things that people really need.

And, COVID is not, in that way, is no longer a special case.

It's just one of important diseases that we need to be able to fund and take the appropriate action against.

- Thank you.

Dr. Schaffner?

- I would just say that it illustrates the problem that we have with our medical care non-system.

I think it's beyond time that we are the last highly developed country that does not provide medical care, both diagnostic and therapeutic care, as well as preventive health services for its entire population from childhood through senior citizenship.

And, we're going to see more inequities, the difficulties that Dr. Wachter mentions.

I think it's past time.

I'm very frustrated that we haven't dealt with this issue in a much more comprehensive and humane fashion.

- Absolutely.

Dr. Neuman, last word.

[background music] - COVID was still the number three cause of death in the United States in the last year.

And, unlike number one and number two, COVID is completely preventable through public health measures.

For that reason, it seems like the largest, lowest hanging fruit that's there.

And so, from my very simplistic point of view as a virologist, I would like to see less COVID in the world, except in my lab.

And, that's fine!

(Sunita laughs) [William laughs] - [William] Love it!

(laughter) - Thank you all for joining us today!

Thank you, reporters and speakers.

This was a wonderful conversation with lots of great information for good stories, and to our reporters, see you again next Friday.

Take care, everyone!

♪

ncG1vNJzZmivp6x7sa7SZ6arn1%2BrtqWxzmiroZ1dmLy3tcNmaHJloJa7pbHMoppmoaNitrV50Z6YpaSpYry3sdFmsG6klJbAcA%3D%3D