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Brian Lehrer: It's the Brian Lehrer Show on WNYC. Good morning, everyone. It is Wednesday, February 1st. Later in the show, we'll start a February Black History Month series, that we're going to do every Wednesday this month on Afro-Latino history. Our first installment for this February 1st on the island of Hispanola, which includes Haiti, with its more Black population, and the Dominican Republic with its more Latino one, how did colonization wind up with Hispaniola, the DR, Haiti, the way we know them today. As February begins, we want to take a few minutes to review some COVID-19 developments from January.

We haven't done a COVID segment yet this year. That's how normalized life with the virus has become, right? Let me give you some numbers, because January the last two years were the two deadliest months from COVID in the whole pandemic in the United States. January, 2021, peaking around 3000 deaths a day, the deadliest single month of the pandemic, January, 2022, peaking around 2,500 deaths a day, the second deadliest month when Omicron was still new.

How'd we do this January? Well, much better, but not nearly where we hoped we would be. The month ended yesterday with around 500 deaths per day nationally, the last few weeks as once again the cold weather months, and the period right after holiday gatherings saw a spike. It's only 25% or about really more like 20% of the spike we saw last year in January. For the year 2022, the CDC reported around 270,000 COVID-related deaths in the US. That's down from around 470,000 in 2021. That's good, but what does 270,000 deaths in a year mean? It means COVID was still the third leading cause of death in the United States last year behind only heart disease and cancer. That means COVID jumped up above accidents, which used to be the third lead in cause of death.

If you are morbidly curious, then came stroke, respiratory diseases, Alzheimer's, and diabetes, according to the CDC. COVID continues to kill more Americans than any of those.

A study out last week ranked COVID as the 8th leading cause of death among children. That's Americans under 18. Their count was around 800 US children have died from COVID during the pandemic. That's a tiny percentage, we should say, out of the 1.1 million total American deaths. It's less than 1% of the deaths, and it's a tiny percentage of the number of total children in the country, but since children don't die from anything very much, 800 kids lost to COVID makes it the 8th leading cause of death among kids and something to at least take note of. By the way, that study estimated that 90% of American kids have now had COVID at least once. Don't forget, according to the New York Times COVID Tracker, unvaccinated Americans die from COVID at five times the rate of vaccinated Americans.

Since almost all the rules have now come off, and we'll talk about President Biden's new announcement that the country will end the official state of emergency soon, but without vaccination requirements almost anywhere anymore, but that five times higher mortality rate among unvaccinated people, be unvaccinated at your own risk. We'll talk about these numbers now, plus COVID news, including Biden's lifting the state of emergency and what it means, a proposal for an annual COVID vaccine like the annual flu vaccine. There are pros and cons and scientists are divided.

The state of the latest Omicron variant, which has gotten the nickname Kraken with Dr. Daniel Griffin, MD, PhD, Chief of Infectious Disease at Optum, formerly ProHEALTH, researcher at Columbia, President of Parasites Without Borders, do parasites have a border crisis too, and co-host of the podcast This Week in Virology. Dr. Griffin, always great to have you, welcome back to WNYC.

Dr. Griffin: Oh, thank you, Brian. It's always great to be back. It always reminds me of Prince when you talk about Optum formerly ProHEALTH, but maybe that's a sign of my generation.

Brian Lehrer: Want to talk about my little data crawl there first, as you compare the three Januarys, 3000 deaths a day, then 2,500 deaths a day, now 500 deaths a day. Of course, those are very rounded-off numbers. What does it tell us about the state of the pandemic?

Dr. Griffin: It's hard to say this, but this is a good thing. We have come a long way. It's crazy that this is as positive news as we're spinning it, but we had reached a peak, well early in the pandemic, people may still remember a lot of us are trying to forget where, just here in New York alone, we were seeing 2,000 deaths a day. Then we were getting to these high peaks and now we're celebrating at only 500 deaths per day, but these are dramatic reductions from where we were in the past. Why are we seeing these dramatic reductions? I think you can sum it up in one word, and that's immunity. 97% of our population we estimate has immunity either from surviving prior infection or vaccination, or in most cases both. Another tough part about the numbers we're seeing is we have lost a million of the most vulnerable of our population, and about 1,000 of the most vulnerable children are not with us anymore. We are in a better place, but boy, this better place is only relative to how bad it was in years past.

Brian Lehrer: What about, if you can predict at all, how will this curve continue? If this January's deaths nationally were only 20% of last January's 500 compared to 2,500, do you expect to see only 20% of that by next January? That would be 100 deaths a day, and then 20% of that in January, 2025, which would only be 20 deaths a day?

Dr. Griffin: I wish I could be as optimistic as that suggestion is. Last week there was a FDA meeting where they were talking, we're in the specialty of trying to predict what's going to happen and what we can do about it. I think when we've gotten to this point that I suggested, 97% of our population is immune, this is what happens to an immune population if we don't throw more tools at this. There will be more children born, there will be people getting a little bit older each year. Unfortunately, the immunity that we're seeing here does not have the durability that certain diseases give us. I don't think any of us are predicting this 80% drop each year.

Unfortunately, unless we start using some of the tools that we have and I'm going to mention antivirals, unless we get better antivirals that more people are willing to use, we're still predicting surges, we're predicting that the highest of these surges will be right around this January period of time, but a challenge that came up at the meeting last week of the FDA is that this hasn't settled into, like the flu, with just a winter rise. We have seen over the last three years that there's also a summer rise as well. That's going to be a challenge, getting to where we want to be.

Brian Lehrer: Is this what we call endemic rather than pandemic? I remember early on when people were saying, "Oh, eventually this is going to mellow out to the endemic phase." Maybe here we are in the endemic phase and it's still 500 deaths every day.

Dr. Griffin: I think a tough thing is to say yes to that. We are now at a point where we have that herd immunity that everyone talked about, this is what it looks like, 500 people dying a day during these winter increases. It's not what we want it to be. We can get those numbers down lower, and we have the tools to do that, but a lot is figuring out how to do that, and a big discussion last week was what do we do when it comes to vaccinations and boosters in the future? I think another thing we'll talk a little bit about is the variants. How does that affect what's been happening?

Brian Lehrer: We're going to talk about the new variant called Kraken. That's its nickname. We're going to talk about this proposal for annual COVID shots, and whether that's sufficient or for some people, maybe even too much. We'll talk about Biden removing the official state of emergency and what that means, including for some of what you were discussing, the underutilization of Paxlovid for people whose lives that drug could save. Before we get off the numbers, when we talk about COVID deaths, just for the sake of accuracy in discussing statistics, do you make a distinction now between deaths from COVID and deaths with COVID, because I've seen that, and of course, it's different if you come into the hospital because of severe COVID symptoms, than if you come in for something else that you might even die from, and, "Oh, by the way, look at that. Huh? We had no idea your screening test came up positive for COVID." Is that distinction real? Are there really fewer deaths from COVID than these total numbers we've been discussing because of that?

Dr. Griffin: It is really a challenge to get an accurate number of who's dying because of COVID, who's dying with COVID. Some people suggest that we're overcounting, other people suggest that we're undercounting. It is interesting. We had a patient recently where they came in, they had COVID. Prior to this, they were fine, but now they get admitted requiring oxygen, they end up in the intensive care unit. They then get a secondary bacterial pneumonia, and on day 23, they die. The initial doctors were saying, "It's not really COVID death, it's that bacterial pneumonia." These are the COVID deaths that we were counting early on.

Sometimes we're seeing undercounting in a situation like that or sometimes we're seeing overcounting, as you mentioned. Someone comes in for something else, maybe they have a complication of that knee surgery. They happen to have a positive COVID test, but they're dying because of something else. These numbers are really hard. That was actually a request at the meeting last week at the FDAs, we need to know these numbers. When we're asking about boosting, when we're asking about strategies going forward, we need to know what's really working. We don't want to just be counting positive PCR tests on someone who comes in for something else and thinking that's a failure of our strategy.

Brian Lehrer: Listeners, we can take your 2023 COVID questions for Dr. Daniel Griffin. 212-433-WNYC, 212-433-9692, or tweet @BrianLehrer. The Kraken variant, a Kraken is a kind of giant octopus. It's also the name of Seattle's hockey team. Go Kraken, except when you play the Rangers, Islanders, or New Jersey Devils. Now Kraken is the nickname for the current dominant variant of COVID, more technically known as Omicron XBB 1.5. Is there something about this variant that resembles a giant octopus?

Dr. Griffin: I think that the suggestion when it was named the Kraken variant was that the sky would fall and this would be the end of all of us. As I think all of us have experienced, we're still here to do WNYC, Brian Lehrer show in the morning.

Brian Lehrer: [crosstalk] [unintelligible 00:12:27] of us are, some of us are. Go ahead.

Dr. Griffin: Not everyone actually is here, right? 500 people a day did not make it to this point. I want to be sensitive to that. Each time we see a rise in the number of cases, a rise in the number of hospitalizations and deaths, we tend to see a new variant. You can go back through. We were predicting in the fall that we would, as we talked earlier in the show, see a rise in cases, and then all the results of that right around the December, January holidays and we saw that. Every time there's a rise, there's a different amount of selection pressure to give us a slightly different change in the virus.

What was the pressure this time? It was trying to get around that 97% immunity in our population. That was what drove and continues to drive the success of the Kraken variant. Are we seeing it present much differently? No. We're seeing how a virus presents in an immunized population, where in most cases, particularly those that are lower risk, it's presenting with milder symptoms. Even those that are high risk, it is often presenting milder. Again, we're trying to jump in because not all those people have a mild course, but no, we're not seeing some groundbreaking change that is foreboding the end of the world.

Brian Lehrer: A New York Times story on the variant last month said, "What's unusual about XBB is that it was the product of two different forms of Omicron that both infected someone. As they were replicating inside that person, their genes were mixed together and then we got a new hybrid. This hybrid is very good at evading defenses from vaccines and infections." Is that your understanding too, that there was a patient zero for Kraken, apparently in New York from what I read, who got two kinds of COVID at once and they mixed together and formed this even more transmissible version?

Dr. Griffin: I'm going to say yes, and actually I was just, sorry that you didn't quote This Week in Virology, where we discussed this in depth. This virus has a couple different ways, two main ways that it can gain fitness advantage. One is, we're pretty familiar with mutations, changes in the genetic code, RNA in this case, that changes the spike protein and some of the other features, but also coronaviruses can recombine. As maybe people have learned, you can get more than one thing at the same time. You can even get more than one type of COVID, of SARS-CoV-2 at the same time. Then those can, as we saw in this case, recombine and you can end up then transmitting a more fit variant, which is, this is our first major recombination variant.

Brian Lehrer: Wendy on Twitter asks, "Please ask Dr. Griffin what he means by immune if people get COVID over and over again."

Dr. Griffin: Okay, excellent. This is a great question. I'm going to spend just a little bit of time, but hopefully succinct. I love to use polio as the analogy. Most of us, I bet almost all the listeners to this show, got their polio shots when they were younger. That gives us a protection that prevents us from getting paralyzed. As we've seen recently, you still can get infected with the polio virus. You just won't get paralyzed. The immunity that we're talking about here that is durable with our vaccines and to some degree with prior infection, is a reduction in your risk of getting severe disease, of ending up hospitalized, of dying.

That protection against infection, that mucosal high antibody levels that are acquired for that, that's transient and that's part of this boosting strategy. We can get that up. It peaks at about four weeks, it wanes by about three to four months, then a person is more susceptible, really back to where they were at getting infected. That's the big distinction here. I think the education, I think we fell down on this, is vaccines prevent disease. They're not great, they're not durable for preventing all infections.

Brian Lehrer: When we say more transmissible or most transmissible yet, as I saw for Kraken or XBB 1.5, I always have a hard time understanding what that means. I get in the context of your last answer that it can more easily evade the immunity we have from past infections or from vaccines. Does it also mean things like you can get it with less exposure to an infected person, I don't know, a 30 seconds of exposure rather than a few minutes? Or what does more transmissible mean in the real world?

Dr. Griffin: That is a challenge. The word transmissible means a lot of things to a lot of different people. I think they think transmissible means it gets right through that mask. It means less time and I end up getting this. What it really just translates into is the ability to go from one person to a number of other people, and in a particular period of time. If it can get from one person and then the next person is transmitting in four days instead of eight, that's going to increase. Because then at day eight, instead of three people, you might have nine people because it's been three and three. It might also mean it takes less exposure.

Currently, what it means is that if you have someone who has antibodies, who has a certain amount of immunity with T-cells as well, we'll throw it all in the mix, right now, that's the big barrier for the virus infecting another individual. What XBB, what this Kraken variant has, it has better ability than some of the former variants to infect someone who has preexisting immunity.

Brian Lehrer: You said better at getting through masks, were you referring to Kraken in particular? Are you seeing that in the clinical settings where you work? Are more people getting it through their N-95s?

Dr. Griffin: No. I think that's the important thing is that that's one of the concerns that people have when they hear it's more transmissible. "Do my masks not work? Cracking those windows and being outdoors, does that cease to protect me?" We're not seeing any of that. The big pressure here is just getting past that immunity. Wearing those masks, the data still supports that. Wearing those N-95s, really the highest level of protection, that still continues to work. We wear these in settings where we're taking care of lots and lots of patients with COVID. Those of us that are wearing them properly, we're not getting COVID.

Brian Lehrer: Rick and Dobbs Ferry, you're on WNYC with Dr. Daniel Griffin. Hi, Rick.

Rick Ferry: Hi, Dr. Griffin. Hi Brian. I just so happened that I was feeling like I had the flu, but I took a at-home COVID test and for the first time, it came up positive. I wanted to ask the doctor, what can I expect? What's the procedure from this point on once you have a positive home test?

Brian Lehrer: We are now all flies in the wall [unintelligible 00:19:38] in the office of Dr. Daniel Griffin. We're listening but we will all respect the HIPAA rules, I promise.

Dr. Griffin: [laughs] Yes, I'm not going to ask you too many details to make it too personal, but I'll lay out. The first question that a physician wants to know, that I want to know is what are the risk factors for progression? If you told me-

Rick Ferry: Oh, I can tell you that.

Dr. Griffin: Don't tell me that on the air. We're going to keep your HIPAA--

Rick Ferry: Oh, I see. It would actually, it's not my problem. It would be your problem. I get it. Okay.

Brian Lehrer: It's up to the patient, I think, but go ahead.

Dr. Griffin: I guess that's true. If you want to share, feel free.

Rick Ferry: I'm 66 years old and I do have a history of heart issues.

Dr. Griffin: One of the first thing we ask is age, right? The cutoff is really 50 when we start looking at just age alone as a risk factor. Interesting enough, because we're going to talk about antivirals here in the second, 65 is really where we start to see that increase go up. Remember, it's not like you step across a line in the sand. Actually the majority of the people in the Paxlovid, we'll talk about that, we're actually under the age of 65, in that 50 to 65-year range. The first thing we try to assess is is this person at risk of progression, is this a non-zero number? If it is, then we start looking at what are our options for treatment and why are we treating people when they're "most likely going to be okay".

The same paradigm when we treat people with cholesterol or we treat the blood pressure, we don't want to wait until it's too late. We don't want to wait till you have that stroke and you've lost control of your dominant arm and then say, "Oh, we should have treated that blood pressure" because you can't go back with COVID. We have a window of about five days jumping in with those antivirals. This whole, "Let's just wait and see how you do if it gets the day aid and you're starting to require oxygen." Our resources are really limited. We start off first with would treatment make sense? Then the next thing we step into is can we access different treatments?

Paxolovid is still number one recommended with we say about a 90% reduction in the unvaccinated, probably a 50 to 70% reduction in progression in the vaccinated or prior infected. Then we start looking through medications. Are there interactions with different medications? Can we stop those for the five to ten days? If not, then we'll move down to remdesivir and outpatient three-day intravenous approach.

Brian Lehrer: Sounds like you should talk to your doctor and consider Paxlovid.

Rick Ferry: Thank you very much, appreciate it.

Brian Lehrer: Thank you very much.

Dr. Griffin: My pleasure. I'm happy to get a chance to talk about this, avoiding the wait and see approach because that's unfortunately what I see in the hospital is the, you are probably going to be okay, which okay, that's true. When you're not, we've lost our window of opportunity and people go to urgent cares, they go to primary care, they got an unnecessary antibiotics. It still surprises me that they wouldn't get necessary antivirals.

Brian Lehrer: Did you just say though, in your answer to Rick, that the progression of COVID toward more and more serious in an individual is more-- Let me ask the question right, that somehow that Paxolovid is less effective in vaccinated people? What did you say?

Dr. Griffin: When we look at the studies and I'm not going to say it's less effective because the ideal is to put all things on the table. Vaccination is going to reduce your risk by about 90% of severe disease. When we looked at those unvaccinated high-risk individuals, our Paxilovid is going to give them about that 90% reduction, but they didn't have that baseline reduction. In our studies, where we looked at previously vaccinated individuals, previously infected, we weren't seeing that 90%, we were seeing numbers in the 50 to 70% reduction range.

Brian Lehrer: We're going to take a break, we'll continue with Dr. Griffin, we'll take more of your calls and tweets for him. After the break, we will get right into President Biden's announcement that he's going to end the official national state of emergency over COVID and why that has implications for the availability of Paxlovid for people among other things. Stay with us. Brian Lehrer on WNYC, as we're talking about various species of COVID news with Dr. Daniel Griffin from Optum Health, from Columbia, from this week in virology. The news this week, Dr. Griffin, that President Biden is ending the official state of emergency in May.

Will this affect you or your patients at Optum in terms of treatment or prevention they can receive? I read that ending the state of emergency, for example, will mean people won't automatically be eligible for free vaccines and free treatment if they're not insured as they have been before. What are the implications of any of that?

Dr. Griffin: I do think this is going to have an impact, but it sounds like it's going to be a gradual over time. One of the first things, you mentioned vaccines, is we are headed towards a point where there will no longer be government-purchased vaccines. This is something that your insurance is going to have to cover or people will potentially be paying out of pocket. The suggestion is there's a whole bunch of vaccines still sitting around, so that day may not come as soon as we expect, but we are expecting should there be a recommendation for a fall booster 2023 fall that those may be coming out of pocket or out of your insurance.

The next, this is a challenge, is we talked about the antivirals, which really makes a lot of sense as a public health strategy. It really cost saving for us as a country, but also huge impact on an individual. Those at some point are going to no longer be under the EUA and provided for free. Those are going to reach a point where you're actually going to have to be checking with your insurance, seeing if it's a covered medication.

Brian Lehrer: I'm sure these numbers run along the same socioeconomic race and class lines as most things. I'm seeing in Dr. Lena Wen's column in the Washington Post today, only about 40% of those 65 and older have received the updated bivalent booster. Only 40% of immunocompromised people have also Paxlovid is even among patients 80 and above, being administered only about 45% of the time. These are race-in-class distinctions I imagine. As President Biden makes these things no longer free, what needs to be done to deliver health and health equity in this new phase we're about to enter?

Dr. Griffin: This is going to be a challenge and is there a silver lining to this cloud? I'm going to go there a little because most of it is doom and gloom. Right now physicians are not using early antiviral treatment as much as they should. That's really specifically Paxlovid at this point that we're talking about. Part of it is because it's under EUA, we're in this health emergency, this is just not a normal licensed medication where they can send out the representatives to the different clinics, educating providers, letting them know what a valuable tool this is. Once we move into the normal arena with the normal promotion, marketing, education, whatever we want to call it, my hope is providers realize what an incredibly effective tool this is and what a great thing this can be to offer to their patients.

That's the silver lining. The challenge is this is a medication that's about $800 for a course. Who's going to pay for that now that it's not coming out of our taxes? Will this be covered by the different insurance plans? How will that work? Testing too. We just had a caller on, they tested at home. We have so many of these free tests out there. That's going away too. The subsidies, all those free tests, so that that person's sitting next to you at work may be saying, "Well, it's probably just the flu, I didn't test because I'm not going to spend $10 on a rapid test." There's going to be some negative repercussions here.

Brian Lehrer: Cassandra in Crown Heights, you're on WNYC. Hi, Cassandra.

Cassandra: Hi, Brian. I had a question for your guest. I have MS and I am vaccinated. I haven't boosted, I have not received the most recent booster mainly because I think this is important for folks to understand about others who are on immunosuppressants. The timing between my treatment and when I'm able to get a vaccine safely is something I have to take into consideration. I missed my window for me to take my most recent booster and I was wondering how much, I guess "more" concerned I should be than if I had received my booster in time.

Dr. Griffin: Okay, great. Thank you, Cassandra. I love the name, Cassandra's one of my favorite names. I'm glad you called in because you represent a pretty significant part of our population. We have millions of people here in the US who do not have the full immune system to get the benefit from the vaccines. Unfortunately, what we've also seen is with the latest variants, the Evusheld, the ability to give people passive protection with antibodies. The medicine, I think Jeff Bridges, Big Lebowski, was spreading the word about is no longer effective for us. We're really back to trying to do what we can with vaccines. A bit of good news, I'm going to say.

As much as we encourage people to get the bivalent boosters, the new boosters, that's what it is. As much as we're trying to time it to get that extra three to four months of added protection, the T-cell, the rest of the immune system, we're actually seeing encouraging data as far as durability. I know a lot of people feel like, ooh, if they didn't get that booster or they couldn't get the benefit of that booster, that suddenly they have to go back to the dark days of 2020. I'm going to say that's not the case.

It is great if you can, but as mentioned here, some of these medicines are really a challenge to get the timing in, "When can I get this booster and actually see a benefit?" Individuals like you, Cassandra, really critical that you have a plan in place ahead of time, so should you end up testing positive? We encourage very strongly for people to get on the antiviral therapy right away, so you want to make sure you have a provider who's on board with that, and also all the logistics are in place so that can happen.

Brian Lehrer: Cassandra, I hope that's helpful. Thank you very much and be well. That also brings us, Dr. Griffin, to this new FDA proposal for an annual COVID vaccine or COVID booster to be given in the autumn along with or combined with the flu vaccine. An article in the journal Nature that I read this morning is called, "Should COVID vaccines be given yearly Proposal divides US scientists", and it describes some who think it's a good idea to simplify the scheduling, which would increase the number of people likely to get it. We heard those numbers on how low the uptake is for the latest booster.

Others say no, COVID comes in different waves than the more predictable flu. New variants pop-up at different intervals. There have been late summer spikes, not just winter like with flu so far. They should continue to be more flexible in terms of timing and some even say young healthy people may not need regularly scheduled jabs at all. Do you have an opinion?

Dr. Griffin: I do. One is it's, I'm still taken back that Nature has titles like this. We're not divided as much as we have not reached a consensus yet as we navigate what is a challenge and you brought up a couple of the points. One is, as we talked a little bit earlier, there's not just one peak with COVID. COVID is not just a December, January we also see a summer rise. The other is the logistics of getting people to get shots as we saw when it was recommended this fall. We did not have everyone rush in and get those shots. This is not the flu. One of the arguments about doing the fall boosters is that we do not want to overwhelm the healthcare system.

We don't want to have as much of a surge with COVID at the same time that we're having RSV influenza which is why people talk about the fall. The other is the reality that that extra boost that we talk about is really about a three to four-month boost. For certain individuals, going into the summer with a rise in the number of cases, there may be some consideration for individualizing that. The other side, which I think is the positive, is that the protection against severe disease, that 90% reduction, that number is durable. Sure, we can boost above that for a certain period of time and then comes the discussion in public health as well as individual, who should get boosted above that. For the immunocompromised, they're counting on all of us to get boosted for those over the age of 50, I'm in that age, those over the age of 65, 70, even more so.

The more we as a community can step up with boosting with these other measures, the more we can help as a community. We're Americans, we still have the myth of the western rugged individual. We want to know, "Well, what about me?" The, "What about me?" is a more challenging question. Clearly people over the age of 50, this is a worthwhile thing. When you start getting into your teenagers, or people in your 20s, then it becomes more of, "What am I doing for society?" as opposed to being a strong push for that individual when you're looking at the data.

Brian Lehrer: One more call and I think it's in relation to one possible implication of president Biden removing the official state of emergency as of May. Marion in Hackettstown, you're on WNYC. Hi, Marion.

Marion: Hi, doctor I was wondering if you were aware of any indications or recommendations that schools start to back off of the requirement to quarantine for five days. Just speaking for my own family here, we've gotten vaccinated and boosters and we've all had COVID and in varying degrees of severity, nothing too bad, thank God. To be locked out at five days at a positive test. [unintelligible 00:34:50] that my kids can log on and do virtual school, but they miss everything extracurricular anything after school. No auditions, no rehearsals, no competitions, nothing. It's just severe since we are getting to that herd immunity as you had suggested at the beginning and I was just hoping to see some relief.

Dr. Griffin: This is a great question. Certainly, an area where emotions run high so I already could tell before I answer, I'm sure there's people on either side of this with really strong emotions but what's the science? What's the reality here? As Brian mentioned early on, we had about 1,000 children, young people under the age of 19. so our zero to 17, 18, die from COVID. In large part, that was the first infection, that was people without prior immunity. Still, that zero to six months, that zero to two years is a high-risk population because they keep coming into the game without that protection.

When you start getting to school-aged children and you start asking about individuals that have prior infection that have been vaccinated, what is the risk in that setting for the children? We're actually starting to get to a very different point, a point where I think it is reasonable to start asking those questions. We still have some immunocompromised, some high-risk individuals, teachers, administrators, other support staff working in those environments. It is a big challenging picture to look at but I think the science says it is something worth asking about and determining, do the policies of 2020 still apply in 2023?

Brian Lehrer: Marion, what were you actually asking when you brought up the five days? Are you asking if kids should be allowed to go back to school while they're still testing COVID positive?

Marion: If they're not symptomatic and they're still wearing a mask, is it considerable, because we've had kids test positive and be completely fine. I still have my kids going to school every day with a mask. They're probably one of 4% [crosstalk] of the entire school population wearing-- I figured--

Brian Lehrer: 20 percentage, yes. Forgive me for jumping in but we're coming to the end of the segment. What about that period when somebody might be symptom-free but COVID-positive on the test, Dr. Griffin, then we're out of time.

Dr. Griffin: I think this is really the question is, do we continue treating COVID separately than other things? If your child has influenza or they have RSV or they have COVID. What do we as a society expect? Should they be staying home for five days? Should they continue to have this interruption in the education or is there a new way to approach this going forward? I think that's complicated.

Brian Lehrer: I'll throw in one little addendum, you're a virologist, not an engineer, but can you answer a ventilation and filtration question? Have you looked at what's effective in terms of an air purifier you can buy for a public space like a classroom or an office or a train car?

Dr. Griffin: Yes, we actually, interesting, we stray into that as infectious disease doctors. I think we probably need more education on that but that is a critical and overlooked way of approaching this. We have all these rules about clean water. what about better rules about clean air, particularly as far as protecting us against all the different respiratory pathogens in our schools or our indoor spaces?

Brian Lehrer: Dr. Daniel Daniel MD, Ph.D., chief of Infectious Diseases at Optum Health, Researcher at Columbia, president of Parasites Without Borders, and co-host of the podcast, This Week in Virology. Thank you for so much information. We always appreciate when you come on.

Dr. Griffin: Thank you so much and everyone, be safe.

 

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