Brian Lehrer: It's the Brian Lehrer Show on WNYC. Good morning, everyone. Here's a thought about the coming of the Omicron variant that goes beyond the usual advice to wear a mask, get vaccinated and boosted, get tested, and choose your interactions wisely. It's that the Omicron variant poses a far greater threat at the collective level than the individual one. That line was written by Atlantic Magazine Science writer, Ed Yong, who's done such a great job generally covering the whole pandemic.

His new article is called America Is Not Ready for Omicron and it goes beyond Omicron. This article does, it goes beyond COVID, to the state, its all left our healthcare system in as it affects the rest of your health too and our healthcare workers too. Ed, always good to have you on welcome back to WNYC.

Ed Yong: Hi, Brian. Good to be on again.

Brian: Before we even get to the societal level, you do write some things about the individual level that many listeners are suddenly having to grapple with. I think they'll hear themselves in this. Just in the last couple of days, you quote virologists Trevor Bedford saying, "People who thought they wouldn't have to worry about infection this winter if they had gotten their booster, do still have to worry about infection with Omicron." Can you explain the science of why that is?

Ed: Sure. I know that everything is quite complicated right now and there's a lot of uncertainty in the air. Here's what I think we can say pretty confidently. I think everyone is a little less protected against infection than they were about two months ago. That's because Omicron has the ability to slip past some of our immune defenses. Now, it doesn't do that totally. The way I try and think about it and this is crude but possibly helpful is that Omicron negates one prior immunizing event. Either past infection or a vaccine dose. If you have three shots, if you're boosted against Omicron, you're about as protected as you were with two shots against Delta.

If you have only two shots in you, you're probably the equivalent of only just one shot before and that's not enough. If you are unvaccinated, you are as vulnerable as you were before. Delta was going to be a problem for you, Omicron is still going to be a problem for you. The picture is a little mix. People who are boosted still have a reasonable amount of protection against infection. They almost certainly have a good amount of protection against severe disease. Of course, that protection is not foolproof.

Booster people can still get infected. We are already hearing a lot of stories of that kind of thing happening. I think it's a setback, not completely back to square one. It's certainly not a great situation, but also not a catastrophic one. Unvaccinated people remain the most vulnerable among us, that hasn't changed. Vaccinated people are a little less protected than they were before, but they've still got a reasonable amount of protection against the worst excesses of the virus.

Brian: Dr. Bedford told you he's been going to movies and restaurants, but now with Omicron, that will change for him. If that's going to change for a boosted virologist at the individual level, what policy choices do you see for government and for private institutions like colleges are starting to change what they do to some degree, at least in the near term?

Ed: Here's the thing. I talked about this distinction between the individual and the societal level and the latter is what we now need to think about to really gauge the threat of Omicron. It's not just about how it affects each of us individually, how it will crash up against our respective immune defenses. It's also the fact that the variant spreads so fast, it spreads so much more quickly than Delta and previous variants have done in part because it can evade some of our immune defenses.

It might also have some inherent transmissibility advantage, we don't know for sure yet, but the bottom line is it's moving very quickly. It already did that in South Africa, it's doing that in the UK and Denmark and definitely in the US too. We can expect a big Omicron wave. That means that even though a large number of people in the US are vaccinated and a small number are boosted, the sheer number of infections we can expect is going to batter a healthcare system that honestly cannot take anymore.

The US healthcare system was already frayed and broken before this winter wave, just because of the traumas of the last two years, because of how many healthcare workers have left, because of how many are thinking of leaving, because of how demoralized the ones who have remained currently are. Now we already had a really bad-looking Delta surge which was going to portend a difficult winter.

On top of that, you now have an extremely fast-spreading variant. That is really bad news. It means that for a vaccinated person, even if your individual risk is only a little lower than it was before, your contribution to a societal risk can still be immense because of your capacity to spread the variant to other populations, including vulnerable ones. If enough people who have the privilege of immunity make that choice, that is going to bite us on the ass too because that's going to hit the healthcare system enough to affect care for everyone and for everything, not just COVID.

Brian: On what you just said about vulnerable populations, you quote-- Let's see which quote is this? Sorry, I'm looking it up. Well, the New York Times had a stat this week, not you about COVID having killed one in every 100 Americans over 65, since the pandemic. That's not one in every 100 who got COVID, that's one in every 100 Americans over 65 in the entire population. It's now the third leading cause of death among the 65 plus.

By contrast, it's killed only one in every 1,400 under 65. I'm curious if you think society needs to have different rules or privileges to protect older people from having to take the same risks than younger people might be choosing to take, but without shutting down their lives more than is absolutely necessary. To set this up, I want to play you a clip of the New York City health commissioner, Dr. Dave Chokshi speaking yesterday.

Dr. Dave Chokshi: Older adults and people who have a health condition that increases their risk of COVID-19, should avoid crowded settings, particularly indoors. This is especially true for gatherings with people who may not be vaccinated or consistently wear masks or where ventilation is poor. In this holiday season, in particular, outdoor gathering should be considered where possible.

Brian: For older Americans and he and you say other vulnerable people too, certainly, people with various underlying conditions, is there a policy response other than those people just have to shut down their lives?

Ed: Well, yes. Listen to that clip. That I think indicative of the problem that we have always faced throughout the pandemic. The advice is if you are a vulnerable person, you should do specific things to protect yourself. It's a virus, it spreads. We all collectively need to do things to protect the most vulnerable people among us. That's elderly people, it's people working in low-wage jobs who experience far more exposures to the virus and have fewer options for protecting themselves. It's people in minority groups, Black, Hispanic and, Indigenous Americans who've been killed disproportionately by this virus so far.

It's immunocompromised people who are less likely to reap the benefits of vaccines and booster shots. We can put in policies that protect those people and we should do that. Instead of really moving on that, the US's posture has basically been to try and beat the pandemic one vaccination at a time like it's down to you, your personal responsibility, your choice pandemic could be unvaccinated, blah, blah, blah, and is insufficient.

We have to put in policies that protect vulnerable people at a population scale. If you talk about over 65s, you can talk about shoring up the levels of protections that are seen in nursing homes. If you want to talk about low-wage workers, you can talk about offering paid sick leave, and policies that allow people to protect their livelihoods and their lives at the same time. All of these things are necessary. These are things that the experts I've spoken to have been calling for since spring of 2020. Yet here we are one administration, one year and 800,000 deaths later, and we're still treating this as a matter of personal responsibility when it is clearly a matter of societal and collective responsibility.

Brian: Listeners, your Omicron variant science and policy questions welcome here for Ed Yong science writer for The Atlantic 212-433-WNYC 212-433-9692, or a tweet @BrianLehrer. Let me stay on the individual track and the societal track with you. You have both things robustly in your new piece about booster shots for individuals. You wrote that the extra dose not only raises a recipient's level of antibodies but their range. What does that mean? How does that work with respect to Omicron?

Ed: Yes. Imagine that the Coronavirus is a ball studded with spikes. Those spikes allow it to recognize and infect our cells. When we take a vaccine, we develop antibodies that recognize the shape of that spike protein disable it by gumming onto it. Like gumming it on a key. The Omicron variant has at least 30 mutations that change the shape of that spike, so the antibodies that once neutralized it can no longer recognize it, but partly that's a numbers game. If we have more antibodies and if we have a wider range of antibodies, chances are that we'll have enough of them that can recognize the spike and still disable the virus.

That is what the booster shot does. It not only boosts the number of antibodies we have, the level that we have but also diversifies them. It means that we have a slightly wider range of antibodies, some of which will still be able to recognize the weird shape of the spike on this new variant.

Brian: Here's a call from somebody who says he's a COVID contact tracer. Jerry in West Milford you're on WNYC. Hi, Jerry.

Jerry: Hi, Brian. Thanks for taking my call. long time, first time. I'll be brief and stick to the facts. As with earlier-- well, the virus, in general, there was fair amount of evidence of asymptomatic or low symptomatic transmission even in people who were unvaccinated. I don't think this is stressed nearly enough in the public dialogue. Has there been any research on this with the new Omicron? I'll take my question off air. Thank you.

Brian: Thank you. You get the question, Ed?

Ed: I am not familiar with anything that specifically looks at that question, but look it's the same virus. It really is. It's a souped-up version of what we've seen before. Many of the same principles apply. The idea that it could spread before symptoms show, we should assume that that is still the case. The fact that it is airborne moves through the air and aerosols between people, we should assume that that is still the case. That means that the things that we know work to protect people against older iterations of this virus should still work here. Better ventilation should still be a good thing.

Wearing masks should still be a good thing. We're not dealing with something that is so completely different that everything needs to be assessed from scratch. We should work off what we know, and all the protective measures that we know have worked so far.

Brian: I think you're touching on an important point that we've mentioned a few times in recent weeks on the show, but now with Omicron rising in a way so suddenly and so quickly it's really relevant to come back to it, which is that vaccines as important and as effective as they are can't be the only strategy. You wrote in the article similar to what you were just saying, the rest of the pandemic playbook remains unchanged and necessary. Paid sick leave and other policies that protect essential workers, better masks, improve ventilation, rapid tests, places where sick people can easily isolate, social distancing, a strong public health system, and ways of retaining the frayed healthcare workforce.

I want to play you a clip about one of those from the head of the New York City Trace & Test Corp, Dr. Ted Long speaking yesterday.

Dr. Ted Long: If you're going to a gathering even if it's with family members [unintelligible 00:15:09] maybe see someone else you haven't seen a while just get tested before you go. My mom was here for Thanksgiving. I got tested the day I was going to see her was negative. We had a lovely and safe Thanksgiving. I kept my mom safe by getting a test.

Brian: Talk about the renewed importance of testing. I know people are starting to get it because-- That is get the importance of testing right now because one of the news stories in the last day is suddenly poof, long lines again at urgent care facilities and other testing sites.

Ed: Right. There's two separate things here. One piece of it is about testing, in general, the way America has been testing, has approached testing as sort of a diagnostic tool. That is really going to suffer in the coming months. Again, Omicron spreads incredibly quickly, and it is doing so all around the world which means that, well, firstly as you said there's going to be a big demand for testing. A lot of people are going to get sick, suffer symptoms, it's the winter even if they don't get COVID they'll probably might well get COVID-esque symptoms from other diseases, so a lot of people want to get tested. Supply, however, is going to be stretched because of the same thing we saw at the start of last year.

If you have a lot of people around the world all wanting to get tested at the same time you stretch the people who'd run the tests, remember there's actually lab workers behind all of this, you run out of reagents. We are going to enter a phase in maybe not too distant future, where our ability to even understand where the virus is is going to start being limited, but then in the clip that you played, that's testing in a slightly different context. That's using rapid tests as a prevention measure to try and figure out whether you are sick so that you don't infect other people. This is a great idea. I would add two caveats to that.

The first is that the Biden Administration has I think really dropped the ball on its policies on rapid testing. We've had a lot of time to build up a rapid testing ethos and infrastructure, and it hasn't. More recently, Biden has mainly decided to make these tests reimbursable. They're $25 for a pair. You have to buy that. It's out of pocket, and then you can claim that. Now, firstly, that's going to be useless for the millions of people without health insurance, who are among the most vulnerable people. It's also going to be useless for people who don't have enough money to pay out of pocket.

A lot of the low-wage workers who we have just said are the most likely to get infected, and the most likely to suffer severe consequences from this, and often the least likely to be vaccinated. It's a ridiculous policy. It's one that stops us from fully utilizing one of the more powerful tools we have. The second thing I would say is that for people who actually do have access to these tests, and I would again predict that there would be a run on them, and the supplies would start dwindling. Note that there are some signs that Omicron's incubation period, that's the period between you getting infected and you displaying symptoms it's much shorter or seems to be shorter than for previous variants.

If you are going to use rapid tests as a way of protecting people around you or establishing that you aren't infected, you probably have to do the tests immediately before, maybe the day before, or the day of whatever event you are planning to go to. There was a famous party in Oslo that turned into a super spreader event, where a huge number of the attendees got infected even though many of them were vaccinated. Even though all of them had tested negative one to three days beforehand. I think rapid tests before potential exposures is a really good idea, but it has to be just before.

Brian: Let's take another phone call Cheryl in Irvington on Hudson. You're on WNYC. Hi, Cheryl.

Cheryl: Hi, Brian. I'm just calling because I agree. We really need a blanket policy for nursing homes and long-term care facilities, congregate group settings, in particular. I have today a holiday party at my mother's nursing home in Great Neck. It's the third day of holiday parties this week. Indoor gatherings in nursing home seems not wise at this time. I've emailed the nursing home several times, they're still going forward with them. They do not require vaccination. They do not require testing. They used to require testing for me to enter the facility, now there's no requirements. We appreciate seeing our loved ones, but I think a non-essential holiday party is not something we need to do at this time, and there's just no enforcement.

Brian: Ed, have you been thinking about this, and here is Cheryl talking about the most vulnerable among vulnerable places, a nursing home that obviously has a sick and elderly population. It seems like suddenly, again, suddenly, in the last few days, the shock of Omicron spreading as quickly as it is in the United States, has made people suddenly reconsider, "Should I be gone to those pre-Christmas holiday parties that were pre-scheduled?"

Ed: Yes, I'm sorry to hear about that situation, Cheryl. It's really hard. I honestly think that it's completely unconscionable that that setup is just right for disaster, and you shouldn't be faced with that kind of nervousness in your life. I can speak to this really personally. Today's my 40th birthday, and I was planning to have a party. I canceled it last week because of everything that I was learning about Omicron from my reporting. To be honest, I probably should have canceled it just because of Delta.

Let me take you through my thinking, my piece up today in The Atlantic about exactly this. I'm boosted, I'm young, I'm pretty confident that if I got infected, I would be-- a bad cold, but I'd be okay. I wouldn't go to hospital. Now, most of my friends can say the same thing, but I know how fast this variant is spreading. I know that today is just a week before Christmas and that if people got infected at a party I threw, at best, it could derail whatever chances they have of seeing family later in the year. At worst, they could carry the virus to vulnerable people that they know, immunocompromised people, elderly people, people who had been vaccinated and boosted, but hadn't mounted a strong immune response.

My choices not only affect my risk, but they affect my guest's risk, and their family's risk, people who don't know me, people who had no say in that decision. Above all else, I know the state of our health care system. I've already talked about this, but I really can't stress it enough. America's health care system is on the brink and cannot take any more. This is what I mean by the difference between the threat of Omicron at an individual and a collective level. The threat to me as a boosted person is pretty small. The threat of my choices to the rest of society, and to the healthcare system that we all depend on is much bigger, and I need to weigh the latter over the former.

This pandemic has always been about choosing we over me. I think those decisions need to factor into our very difficult decisions this Christmas break. I know that it's hard. I know that people don't want to be thinking about this anymore, but this is the situation we're in. The reality of very infectious virus is that a single small bad decision can do exponential harm, but the corollary of that is that a single small wise decision can do exponential good.

Brian: We'll continue with Ed Yong from The Atlantic and more of your calls right after this.

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Brian: Brian Lehrer on WNYC with Ed Yong, Atlantic magazine science writer, whose new article says the Omicron variant poses a far greater threat at the collective level than the individual one. We'll take more of your calls and tweets in just a second. Ed, you wrote to watch countries like Israel, Brazil, and Chile, as early indicators of what Omicron really is. Why those countries?

Ed: Israel has been heavily boosted, it's really gone all-in on vaccines. Chile and Brazil have had a combination of really bad epidemics, a lot of people got infected, and successful vaccination campaigns, so there's a lot of layered immunity there. When I say pay attention to those countries, it's really about seeing like-- We talked about whether-- to what extent boosting, or multiple rounds of immunity give you protection against Omicron.

I think we'll see the clearest signs of that from those kinds of countries. To be very clear, I'm not saying that we should look to those as models for America's fate because no, we are in a different situation, we have only vaccinated, Oh, God, I can't remember the latest number, what is it? 60 plus percent of people in total. It's only 17%, who've been boosted. Apologies to listeners if these numbers slightly off. It's been a very long two years.

Brian: Yes, that's the number that I saw too, 17% boosted.

Ed: Great. Even without the boosting bit of it, I just don't think we've vaccinated enough people. I think there are still plenty of immunologically vulnerable people around in the US for any variant to hit. Delta was going to hit them, it had already started doing so in the winter. I think Omicron is going to do the same.

Brian: Here's a tweet from the listener who asks, "Are the New York City public schools going remote next week into the new year? Anyway, please just shut down the city until at least MLK Day 2022." Now, I'm going to ask Mayor de Blasio a version of that question when he comes on the show in about an hour. He's coming on at 11:30 today, but I think society, in general, is trying to avoid the kind of initial shutdown that we did in 2020, and manage a new spike in the pandemic, with all these other tools that we've been talking about vaccines, masks, testing, everything else that we've learned now through some experience. Do you have an opinion, Ed, about whether shutdowns are necessary in broad swaths of society in the way the caller is asking for?

Ed: This is really tough because obviously, no one wants to do that, and yet, we have a very, very fast-spreading variant at hand. The problem of America's individualistic tendencies is that at the individual level, there's actually not that much we can do, there's boosting, there's masking, and there's the thing no one wants to talk about, which is avoiding social contact with other people. Like, do we need to do more of that at a grander scale?

The thing is, if we do that, we also need to invest in all the other things. Obviously, we're not going to do that forever, and the whole point of shutting down is to buy us time to get other things in place to be better able to control the virus. It's not the case that-- even if the entire country stayed at home for two weeks, this virus is still out there. It's in other countries, it's an animal reservoirs. We need ways of controlling it like at the point when we would conceivably lift or shut down, and that involves all the things we've just said. It involves the physical measures, like masks. It involves ventilation. It involves social policies like paid sick leave. I just feel like a stuck record saying the same list of things again and again.

The only thing, Brian, that I would push back on from your question is that I don't think we fully implemented almost any of these things. I think we've always gone for the short-term solution. I was writing in April of 2020, this is going to be a problem for the next two years, we need to put in the systems and build in policies and things that will help us to protect ourselves, instead of just saying, "Well, the cases are going down, COVID is over." People have made that mistake again and again and again.

Brian: Part of the reason is that people have different opinions and different things that they think should be priority. Some of it is disinformation for political purposes, but some of it is well-intended contrasting fear. I just read you that tweet from one listener who wants basically the city to shut down until at least Martin Luther King Day. Then, we get one in response to that from somebody-- Oh, we're getting so many that this already disappeared. Let's see. Hang on, let me just see if I can find it because I want to read their exact words.

Oh, here it is. "Mr. Yong acknowledged low personal risk from Omicron but the surge, in general, has flagged mental health risks to children from pandemic policies. Now, there are rumblings of school shutdowns. These policies are not costless." You get the one who's saying, "Please, shut down to schools right away," and another one who's saying, "No, the mental health effects on kids and other things outweigh the risks." Is the formula different now than it was in March of 2020?

Ed: I'll say a few things to that. Firstly, school shutdowns are the result of failing to control the virus through other policies, the same with any other kind of shutdown, same with all the economic consequences. From the start, people have tried to create this weird dichotomy between the physical health consequences and all the rest, the economic costs, the mental cost, all of that. It really isn't a choice between those two things because if you let the virus run rampant and if you don't put in the right policies that actually stop it, you're going to suffer both of them at the same time. Yes, I know that there are mental health consequences. I am personally feeling the mental health consequences of the pandemic.

I know that many people are struggling with this, but this is not a result of us trying to fight the virus, it's a result of us failing to adequately fight the virus. That's why we are here in this situation now with another new variant. This was all predictable. Every expert I talked to said that if we didn't really take this seriously we would be back here with more variants, more surges, more talk of possible shutdowns or not. I don't know what to say beyond that. For every listener who is listening to this and is just fed up, who just doesn't want to think about it anymore, who can't believe we're still doing this two years on, I am right there with you.

If we continue to ignore the virus, we continue to try and do this weird, we just have to live with it let it rip thing, we're still going to be here maybe in another year's time, and we're going to do with even less of a healthcare system than we currently have. I really, really need to stress that again. The mental health consequences of all of this, of the pandemic, of restrictions, of having to make these decisions on the regular is really high. The physical health consequences of not being able to get medical care when you need it are going to be really high.

One doctor said to me when I was reporting for this piece on Omicron, the level of care that Americans have come to expect from their healthcare system no longer exists. Present tense, not future tense. That is backed up by the reporting I've done, by the testimonies I've heard from hundreds of healthcare workers who see what is happening around them. If you want to preserve healthcare in this country for anything, for the car accident you might have, for the stroke or the cancer that you might have, we really need to start taking the pandemic so much more seriously than we have been.

Brian: One more call. Maris in Langhorne, Pennsylvania. Maris, you're on WNYC with Ed Yong, science writer for The Atlantic.

Maris: Good morning. Nice to chat with both of you. One of my passions, as I obsess over Twitter and all the epidemiologists and the indoor air quality scientists, is an area that I don't see focused on enough and that is on monitoring carbon dioxide in different environments as a warning of bad indoor air quality, which I think has been done in a number of other countries. Ed, you talked about it in many of your articles, I've seen it with Joseph Allen, out of Harvard, we need to know whether the place we're going into has good indoor air quality.

As laypeople, we have no way to know that. There's this idea of putting little CO2 monitors in an office or in a store so as you walk into a place, you can say, "Ooh, I'm not going into that place, their air quality today is not good quality." I'm curious what you think of that.

Brian: That CO2 monitors, we've talked about this a little bit on the show. CO2 monitors as an indicator, because it's an easy indicator to measure of the quality of ventilation in a particular space, which is an indication of how well it's filtering COVID particles, right?

Ed: I don't know enough about this to really make a recommendation on it. I think the general principle that ventilation is incredibly important-- and indeed is not talked about nearly enough. I know that people want the tools to make decisions for themselves. That's obviously something we all need to do and it would help to have a metric that's better than just indoors versus outdoors although probably, that's still the best thing that we can think about. Again, what frustrates me about this pandemic is that we're expected to do this on our own.

If it's not like, "You need to get boosted, you need to get vaccinated," it's individual people who think carbon dioxide monitors around to check the ventilation of their spaces. Ventilation is a thing that we can address at a broader societal level and need to address at a broader societal level so that someone's fate during a surge of a rapidly spreading variant doesn't boil down to something like whether they have a carbon dioxide monitor or not, so that we create an environment and a society that gives them the best ability to live a healthy life, and we don't have that. The clearest lesson from the pandemic is both that we don't have that and we need it.

Brian: Just on a practical level, short term. We're almost out a time. As this caller raises the question of what spaces are well ventilated and not well ventilated as the previous tweeter was asking about what to shut down, do you have data on where people are tending to get COVID now to then bring it home for household spread? Is it restaurants and movie theaters? Is it NBA games and 19,000 people arenas, but they're really big? Is it airplanes and other mass transit? We keep hearing reassurances from transportation officials. I don't know, is it at work? Is there intel on this?

Ed: I actually don't know the answer to that question now. The last studies I've seen that compared all of these different sources were from last year, and maybe there are more than that, I've not seen them. Honestly, I think the most likely answer is all of the above. It's a virus. We know that it spreads through shared air, we know that the risk of that is far greater indoors than outdoors, we know that it's greater when there's lots of people in the crowded into the same space, when those people are unmasked or those people are talking and shouting and singing or whatnot.

We know the basics. The question of how the virus is spreading, I don't think it's a mystery. It's ticking the all of the above box. I think that means that there's a lot of things for us to fix and think about. It's never just going to be the one thing that defeats COVID, it really has to be a grand reimagining of the world that we live in.

Brian: By the way, some of my colleagues at WNYC are retweeting this that one of them originally tweeted, "Happy 40th birthday, Ed Yong. Thanks for sharing your decision to cancel your party on Brian Lehrer, helps the rest of us weigh our plans. I'm really sorry but I'm so grateful for your reporting these past couple of years, so really genuinely wishing you a happy 40th." That tweet is going around among my colleagues. I'll second that emotion.

Ed: Thanks, Brian. Thanks to all the listeners, all your colleagues. I hope everyone stays safe. I'm sorry, we're still in this mess.

Brian: Ed Yong, science writer for The Atlantic. His new articles about how the Omicron variant poses a far greater threat at the collective level than the individual one. Brian Lehrer on WNYC, much more to come, we turn the page.

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