[music]

Brian Lehrer: Brian Lehrer on WNYC. COVID news is all over the place right now. New York City this week went from the low-risk code green to the medium-risk code yellow, but imposed no new public health measures. The Biden administration is not asking the court for an emergency stay to keep the airlines and other public mass transit mask mandate in place, but they are authorizing second booster shots for people over 50.

Cases, deaths, and hospitalizations have all been rising with Omicron BA.2. The current numbers do not approach the winter Omicron surge in hospitalizations and deaths, but for example, in both New York and New Jersey hospitalizations are up about 30% compared to two weeks ago. Deaths are up by more than 40% in New York, according to The New York Times COVID Tracker, but that was 17 deaths statewide yesterday compared to more than 200 a day at the peak of the first Omicron wave in January. Omicron BA.4 and BA.5 are spreading now.

The Wall Street Journal has an article today headlined, "American consumers are shopping, traveling, and working out like it's 2019." One stat from that article, "Ticketmaster says concert ticket sales are 45% higher so far this year than for the same period of 2019, before the pandemic. The number of airline tickets per day has almost completely recovered." A Washington Post headline this week is, "COVID deaths, no longer overwhelmingly among the vaccinated as toll on elderly grows."

Bottom line of that piece, "Vaccination is still elderly people's best bet for mild disease, for keeping it within mild disease." The Atlantic has a new piece on what immunity really looks like for vaccinated or previously infected people. It's not what doctors had hoped it would look like last year. Let's try to make sense of some of this with immunology and virology Professor Brianne Barker from Drew University in New Jersey. She's also a co-host of the podcast This Week in Virology. Dr. Barker, thanks for coming on and welcome to WNYC today.

Dr. Brianne Barker: Thank you so much. I'm happy to be here.

Brian: Let's start in New York City. Do you understand the difference between green and yellow?

Dr. Barker: I do understand the difference between green and yellow. These are differences based on how likely a person might be to be infected based on the community transmission levels that are being seen, and so the change from green to yellow happens because of an increased number of cases in the community.

Brian: The city says no policy response to this except to advise people to consider masking indoors and public places again, but it's not required. You're in New Jersey. Is there a New Jersey code yellow equivalent right now?

Dr. Barker: In some parts of New Jersey, we have gone back into the yellow range, but not in all counties.

Brian: Listeners, any Omicron-related current moment in the pandemic or is it the endemic questions for virologist and immunologist Brianne Barker at 212-433-WNYC, 212-433-9692 or tweet your question @BrianLehrer. How about those words pandemic and endemic, have we moved from a pandemic phase to an endemic phase, and if so, what does it really mean?

Dr. Barker: Well, officially a pandemic is when we are seeing an increased number in cases beyond a background level in multiple areas of the world, and endemic means that we generally are always seeing some level of background cases in our population. We expect that we will be at some kind of background level of infections with SARS-CoV-2. This virus likely will be come endemic because it seems awfully challenging right now for a number of reasons to fully eradicate it. We're probably at a number that is higher than that eventual endemic level right now and so we're in between are in a transition to that endemic state.

Brian: What are the Omicron BA.4 and BA.5 variants compared to the most common one now BA.2?

Dr. Barker: BA.4 and BA.5 are versions of Omicron that are able to evade some immunity. They've been detected in South Africa because of some of the great work that they're doing sequencing-wise there. It's not clear any particular differences in severity or transmission at this point, but they are here in the US and we are still certainly needing to get more information and needing to monitor them.

Brian: BA.2 and I guess along with BA.4 and BA.5 are considered more transmissible than the original Omicron, which was considered more transmissible than the variants that came before that. I wonder if you could explain to a lay audience, what's the functional expression of being more transmissible like if they used to say 15 minutes of close contact with an infected person would be needed to infect you, something like that as a rough rule of thumb, is it now two minutes or is there any formula like that, that people can use as a personal guideline?

Dr. Barker: There isn't a straight linear formula that people can use. It certainly would mean that being in contact with a person for a shorter period of time would give you some risk. There are lots of parts to this change in transmission that we are seeing. It's not just a change in whether or not the virus is more stable or whether the virus is more in your nose, for example. Part of the change that we're seeing in the ability of this virus to transmit has to do with the way that it responds to immune responses and so that throws in another variable in our whole system of what kind of immune response you might have.

Brian: How can people guide their behavior with that science in mind?

Dr. Barker: I think that people should realize that our current numbers are almost where they were going into similar surges with Delta last year. Everything is looking numerically better than Omicron, and if people are vaccinated, they are at a lower risk of severe disease, but precautions are still a useful thing for us to be thinking about with this virus circulating. People should try to have events outdoors, should think about ventilation, should think about masking in crowded locations because the more we can do to really crush this virus and get it to very low numbers in our population, the better off we'll be long term.

Brian: Betsy in Brooklyn, you're on WNYC with Dr. Brianne Barker. Hi, Betsy.

Betsy: Hi, thanks for taking my call. I guess I have two questions. One is, I'm in my 50s and five months out from my first booster and getting the message I should just get a second booster, but also hearing a lot of people say, "You should wait till the fall. Till there's a new different something going on." So just trying to understand whether it's a public health responsibility to just get that second booster now. I live with a almost 90-year-old and an 18-year-old who's out and about, and we're constantly trying to balance how to keep everybody safe and healthy. That's number one.

My second question is, where's the thinking on people having natural immunity? In our family, we've had COVID, my mom's had COVID, and the rest of us have gotten sick. My brother's had COVID while we've all been around him, and the rest of us haven't gotten sick. So we're just trying to understand, why do some people in the family seem to get it and others don't when everybody's in really close proximity? Those are my lingering questions.

Brian: Those are two great questions. Dr. Barker where would you start with the second one?

Dr. Barker: Oh, with the second one.

Brian: Oh, well, whichever one you want to start it's okay.

Dr. Barker: I'll start with the booster question because that's perhaps a little more straightforward. Right now, the CDC is recommending those over 50 potentially get that fourth booster. The data that is out there on that fourth booster really shows that it can decrease infection in individuals based on a study from Israel, though, you are still protected against severe disease, even with three different shots.

When you mentioned some of your details, Betsy, I noted that you indicated that you live with a 90-year-old who would be someone who is at rather high risk, and I think that boosting particularly to make sure that you avoid transmission to that individual might be a really good idea, particularly as we are currently seeing case numbers going up. I think that one thing we've learned is that it's awfully hard to predict this virus. We're seeing this increase in the number of cases, even though it is May. I'm not sure that I'm ready to predict what will happen in the fall. I would think that people should try to work on their protection right now.

In terms of natural immunity, there are a lot of things that could be going on that many scientists are studying based on some genetic differences in people's immune responses, and some of their infection history with other types of viruses that may impact what their response looks like. We do know that the immune response that comes as a result of vaccination and the immune response that comes as a result of infection, do look somewhat different. The way that you are first exposed to parts of this virus to generate an immune response also could make a big difference there.

Brian: Is one better than the other, not that people should go out and get infected on purpose. If you say infected, the protection from infection is better than the vaccines, but is one better than the other?

Dr. Barker: There are a few different pieces of data that are out there showing some potentially problematic parts of immune responses that happen following infection. It seems like the virus is modifying some aspects of our immune response that don't get modified when we just give the one spike protein that we are giving in immunization. The more negative types of immune responses that I've seen have been associated with infection and that is really emerging data that we're seeing right now.

Brian: I was a little confused by that answer. Are you saying you're more likely to get sick a second time if you've had the infection compared to if you haven't had the infection, but you're vaccinated?

Dr. Barker: There have been a couple of different studies that have shown some negative effects on your immune system after infection. We have not seen negative effects on your immune system after vaccination.

Brian: Does the data show that the original vaccines even before the boosters give people T cells or B cells that continue to fight the serious cases of disease long term, even if people can be infected again?

Dr. Barker: Yes, so it looks as though the original doses of the vaccine, although when I say that am really thinking the most about definitely people who have two doses and often, increasingly, people who are getting three doses are getting good long-term protection against severe disease. They may not have the protection against infection, but some of the T cells that are present can protect against a severe disease that does seem to last long term, and it is considerably broadened in order to protect against variants with that third dose of the vaccine.

Brian: The caller was asking whether to wait to get the second booster in the fall when there may be likely to be a bigger surge, I know your answer to her and her case with a 90-year-old, who she's with a lot to get boosted now, but in addition to that, Moderna says it's developing an Omicron specific vaccine that they hope will be ready for the fall. Do you expect that we'll be in a world for a number of years now perhaps, that like with the annual flu shots that do their best to target that year's variant, we'll be doing that once or twice a year for a while with COVID shots?

Dr. Barker: I'm not completely sure that we will be changing the vaccine as frequently. While the Omicron-specific boosters do seem to have a little bit of an improvement in their immune responses to Omicron, it does not seem to be a very large difference. The original vaccine does similarly well against Omicron and so I think that we may not need to switch the vaccine as often. We will need to decide if our goal with the vaccine is to prevent infection or to prevent disease. That will really impact how frequently we need to get additional boosters.

Brian: Do you expect boosters to be a good idea every six months or so for older and immunocompromised Americans for maybe the next few years? That Washington Post article says 42% of COVID deaths this year have been among vaccinated people compared to 23% only last fall during the Delta wave.

Dr. Barker: I think that it is entirely possible that those at high risk may need to get some additional boosters to increase their protection, although I'd want to see some more data and I'd want those individuals to talk to their physicians.

Brian: Sophia, and Leonia, you're on WNYC with immunologist and virologist Dr. Brianne Barker. Hi, Sophia.

Sophia: Hi, can you hear me?

Brian: Yes.

Sophia: Great. Recently, I think I got Omicron, and my family is still in the middle of it. Our case has been pretty mild and I got the Moderna booster and I was wondering whether that impacts the severity of the experience because I had some friends who also got COVID recently, and they had a much harder time despite being similar age, physically fit, but some people really floored by it but for us, it was pretty light. I was wondering whether the booster had anything to do with that.

Brian: Are you saying that they got the Pfizer and you got the Moderna or are you saying something different?

Sophia: Yes, exactly. I was wondering if the choice of booster impacted how severe our experience was.

Brian: A lot of people have this question, Dr. Barker.

Dr. Barker: That's a really interesting question. I have not seen any specific data on that. In the data that I've seen, both boosters should reduce your disease severity and give you a more mild course like what you've described. Given that the two boosters are slightly different doses, perhaps that could be related to what you're seeing, but I have not seen specific data on that.

Brian: Are you among those who recommend mixing and matching? If people are getting an additional shot, get one from the other brand for a broader spectrum of protection. Is that a real thing according to you?

Dr. Barker: I think that if your first vaccine dose was Johnson&Johnson, then absolutely. Mixing and matching is important and I think that there is really no difference in mixing and matching versus not.

Brian: How short is the protection from being infected at all from these fourth doses? I've seen it written that it may be as short as one month. What is the data tell you?

Dr. Barker: The data that I've seen, which comes from a study of older individuals in Israel, said that there was protection from severe disease for about eight weeks.

Brian: Severe disease?

Dr. Barker: Yes.

Brian: From infection at all?

Dr. Barker: I'm sorry, I misspoke. That was actually additional protection against infection for eight weeks. The severe disease protection was actually pretty similar to what they had seen with the third boost. I apologize for misspeaking.

Brian: Which would be more like four months, right?

Dr. Barker: Right.

Brian: Susan in Millburn, you're on WNYC with Brianne Barker. Hello.

Susan: Hi, Hello, thanks for taking my call. A couple of questions and a comment. I'll start with the comment. Earlier, you were talking about COVID being or becoming endemic. As an MPH, I'd like to point out that endemic does not necessarily mean harmless because I think that a lot of the general public have conflated endemic and harmless and---

Dr. Barker: I agree so much. Thank you for making that point.

Brian: We used to say, "Oh, we can't wait till it gets to the endemic phase," and then we learned that endemic means it's permanent, but what's your other question? We're almost out of time.

Susan: My other comment is, could you please comment on the risk of long COVID? For me, that's the worry, not severe disease, not death, but long COVID.

Dr. Barker: I'm so glad you brought that up. I will tell you that personally, that to me is also one of the biggest concerns. There are many patients who seem to have symptoms in many different body systems for long periods of time after getting infection. There are really varied estimates of what that frequency is in terms of how many infected individuals get that type of outcome. Partially because it's hard to say who exactly has been infected, to do that calculation, but it is in some cases up to say 40%.

Some of those people are quite debilitated and have some pretty severe symptoms. I think that preventing infection with whatever measures we have for mitigation are still really important to help us with that.

Brian: That piece of advice is going to be the last word with Brianne Barker, virologist, and immunologist from Drew University and co-host of the podcast This Week in Virology. so informative and helpful. Thank you so much, Dr. Barker.

Dr. Barker: Thank you so much.

Copyright © 2022 New York Public Radio. All rights reserved. Visit our website terms of use at www.wnyc.org for further information.

New York Public Radio transcripts are created on a rush deadline, often by contractors. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of New York Public Radio’s programming is the audio record.