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Brian Lehrer: Brian Lehrer on WNYC. The Omicron news today includes the New York state now has more than 10,000 people hospitalized with COVID for the first time since May of 2020. According to state officials widely quoted in the press, that includes 1,700 new admissions on Monday alone, but the New York Times reports ICUs in COVID hotspots like New York and Florida and Texas are not filling up as fast, and that the majority of those COVID positive hospital admissions in New York might be people admitted for other things and then test positive for COVID when the hospitals screen them.

There was also Chicago public schools closing, at least for today in the face of the teacher's union there planning a walkout over what they see as unsafe working conditions right now. Here in New York, many individual students and teachers have been out. The last two days, attendance was 67%. Meaning, a third of the students stayed home on Monday. The teacher's union here wants a pause in classroom learning, but Mayor Adams insists schools will stay open and are the safest place for kids to be. Safest from COVID and other hazards.

There is also debate around the CDC guidelines for getting out of isolation. Once you have a COVID positive test, they're saying five days, if your symptoms have abated, but without the need for a negative test to confirm it, that's the controversial part. Governor Hochul does give her state of the state address today. There is reporting that she may let the COVID era eviction moratorium expire. That would be on January 15th because despite Omicron, people are going back to work, but New York City's unemployment rate remains around 9% around double the national average because we have so many arts and tourism jobs here.

Meanwhile, there is still too little supply of tests and too little demand for vaccinations. With us now is the New York City health commissioner, Dr. Dave Chokshi who has been serving under Mayor de Blasio and who Mayor Adams is keeping on until March because of the situation as his own next health commissioner Dr. Ashwin Vasan transitions in. Dr. Chokshi also remains a primary care physician at Bellevue hospital. Dr. Chokshi, we really appreciate your time with so much for you to manage right now. Welcome to WNYC.

Dr. Dave Chokshi: Thank you so much, Brian. Good morning and thanks for having me on.

Brian Lehrer: Not to bury the lead here, what's the relationship between the pressure on the hospitals in New York City right now and the number of people who remain unvaccinated?

Dr. Dave Chokshi: There's a direct relationship between the two. We know from our New York City data that people who are unvaccinated are at severalfold higher risk for hospitalization. Particularly from the most severe outcomes, such as requiring an ICU bed or a ventilator compared to people who are fully vaccinated and particularly compared to people who are fully vaccinated and have received their booster dose.

That's why we've had such a focus on vaccination in New York City. We have about 73% of the entire population fully vaccinated, but we want to push that number as high as we possibly can.

Brian Lehrer: What should we make of that 10,000 hospitalizations number from the state? It's a statewide number, but half or more are in the city. Is it as bad as meets the eye or more complicated than that?

Dr. Dave Chokshi: Well, in New York City, we have about 5,500 patients currently hospitalized with COVID-19. That's about 80% of our total beds across all of New York City hospitals occupied. It has significantly increased in recent days and recent weeks. It's a very real surge that's being experienced. It's happening at the same time that unfortunately, our healthcare workforce, which has borne so much over the past two years of the pandemic are also falling ill in higher numbers due to how infectious Omicron is. Those two things are converging. It is concerning, but thus far, our hospitals are holding the line.

Brian Lehrer: Listeners, your questions welcome here for New York City health commissioner Dr. Dave Chokshi at at WNYC 212-433-9692, or tweet your question for Dr. Chokshi at Brian Lehrer. That Times article that I mentioned in the intro says, in Omicron hotspots from New York to Florida, to Texas, a smaller proportion of those hospitalized patients are landing in intensive care units or requiring mechanical ventilation doctor said. At least that's a little bit of good news. It says, many, roughly 50 to 65% of admissions in some New York hospitals show up at the hospital for other ailments and then test positive for the virus. If you agree with the facts in that story, what does it mean for our understanding of the Omicron wave?

Dr. Dave Chokshi: Yes, we are seeing similar patterns here in New York City as well. The first part of it is almost certainly related to vaccination rates as well because we know that vaccination does help to protect from the most severe outcomes like requiring a breathing tube or death due to COVID-19. That is a hopeful note and again, why we have emphasized vaccination so strongly. We are seeing just due to the pervasive nature of Omicron that many people who are being hospitalized for other reasons are also infected with COVID-19.

Clinically, I'll tell you, it's a little bit more of a complicated picture than just saying that it's someone incidentally with COVID-19 or due to COVID-19. Sometimes there is a gray area. For example, I helped take care of a patient the other day who has emphysema, and they were found to be infected with COVID-19 and required hospitalization. In that case, perhaps, the emphysema would have required hospitalization even without the infection, but COVID-19 could also have tipped them over to where they need a higher level of care.

We're sorting through all of the different data here in New York City and trying to guide people to do the things that make the most difference, particularly for those who are most vulnerable and that remains vaccination, including booster doses, wearing a mask, particularly a high-quality mask, and using testing, including rapid testing.

Brian Lehrer: Let's take a phone call. Michael in Brooklyn, a teacher I believe in the city public schools. Michael, you're on WNYC with not the school's chancellor, but the health commissioner Dr. Dave Chokshi. Hi.

Michael: Good morning, Brian, and good morning, Dr. Chokshi. My question has to do with the recent authorization by the FDA for the approval of booster shots, Pfizer boosters for 12 to 15-year-olds. There's a discrepancy though because on the CDC website as I was checking, and the reason I'm interested is because my daughter falls into that group and I would like her to obtain the booster. The CDC recommendation is still listed at 16 to 17-year-old for the Pfizer booster. Can you shed some light on that discrepancy and does the FDA authorization hold precedent? Will my daughter be able to obtain a booster or does she have to wait until the CDC and the FDA are in alignment?

Brian Lehrer: Thank you, Michael. Doctor.

Dr. Dave Chokshi: Thank you, Michael, for your question. First, let me just acknowledge what you and so many other teachers and educators are doing for children all across the city. With respect to the question about your own daughter. Basically, the CDC is taking up that authorization from the FDA today. There's the meeting of the advisory committee this afternoon. I do expect after the CDC reviews all of the data that they will also give the green light for booster doses for 12 to 15-year-olds. If all goes according to plan, then people like your daughter will be able to get their booster dose as soon as Friday here in New York City.

Brian Lehrer: Here's a call from member of the NYPD, he says, Michael on Staten Island. Michael, you're on WNYC with health commissioner Dr. Chokshi. Hi.

Michael: Hi, Brian. You actually have it on your show when Mayor de Blasio was there. I was talking about a [unintelligible 00:09:02] that I was putting on. Anyway, doctor, I was hoping to get your attention regarding the opioid epidemic and hoping that you could understand that if we switched to a harm reduction approach in the New York City public school systems in the same way that in the '90s when everyone was catching AIDS and HIV, they had an abstinence-only, and then they switched to a safer sex with condoms. I was hoping that we could start teaching our students about Narcan in public education. [unintelligible 00:09:29] something that would be appropriate for this new administration?

Brian Lehrer: Changing topics from COVID. Dr. Chokshi, is that a question you thought about?

Dr. Dave Chokshi: Yes, we certainly have. Thanks, Michael, for a really thoughtful question. We are strong proponents of a harm reduction approach to drug use because quite frankly, we're in an overdose epidemic. In the year 2020, over 2,000 of our fellow New Yorkers died of a drug overdose. These are not faceless numbers, they are brothers and sisters, are aunts and uncles, are neighbors and that means that a New Yorker died every four hours because of drug overdose. We know to the point of your question that a science-based approach embraces harm reduction as

one of the reasons that we move forward with overdose prevention centers.

Being the first city in the country to do that in November and they are saving lives every single day. We do want to build on that in terms of other harm reduction approaches and your thought specifically about extending that into public schools is certainly worthy of consideration, and we'll follow up on that.

Brian Lehrer: Mercedes in Forest Hills, you're on WNYC with Dr. Chokshi. Hi, Mercedes?

Mercedes: Oh, good morning, Brian. Good morning, Commissioner? I wanted to ask you--

Brian Lehrer: Go ahead.

Mercedes: Sorry, I wanted to ask about COVID testing. I was just in Elmhurst Hospital two days ago and I ran in fear. There were 300 people kittled behind barriers on the sidewalk trying to get in. It was a super spreader event. If you didn't have COVID going in, you probably pick it up standing there for hours waiting to get tested. What are you do about that?

Dr. Dave Chokshi: Yes, thank you Mercedes, for this important question. You and I are neighbors because I live very close to Elmhurst Hospital as well and I've seen that testing site. In fact, I was just there last week and I do know there have been long lines at Elmhurst as well as other testing sites over last couple of weeks. What we're doing is we are expanding testing capacity every day. We have over 160 city testing sites that are now operating including 60 new ones just in the last week to 10 days to expand testing capacity.

We're also bringing to bear rapid home test kits. We've procured over 2 million for New York City alone and one of the ways that we're using them in addition to distributing them in our public schools to allow them to reopen. Another way is specifically for those types of lines, essentially going down the line and offering those test kits when we do have enough supply so that people are able to get tested one way or another, by self-testing or by coming to one of our sites.

We've seen unprecedented demand for testing and that has been a very real phenomenon over the past couple of weeks. I'm proud to say that we're doing more testing per capita than just about any other jurisdiction in the United States, but we're going to keep expanding that in the days to come to meet the demand.

Brian Lehrer: We had Dr. Michael Minna on the show yesterday. Sort of the apostle of at-home rapid testing since the early days of the pandemic, and he was very critical of the federal government for not having stockpile enough rapid tests to be ready nationwide in the event of something as transmissible as the Omicron variant breaking out. Are you similarly critical?

Dr. Dave Chokshi: I do wish that the federal government had additional supply and that it had been ready for the Omicron wave. I know for a fact it would've made a significant difference for New York City, given that we're experiencing Omicron ahead

of many other cities across the country. They have been responsive to our requests, but unfortunately, the supply has just been constrained.

We need them to do more both for the supply of rapid tests, as well as for the supply of treatment options that will work for Omicron. We are advocating and pushing for them to do as much as possible to help us bring to bear all of those tools to fight back against Omicron.

Brian Lehrer: Another testing question. Do you have an opinion about the CDC not requiring a negative test before ending COVID isolation after five days? If your symptoms have abated, does the science say your perception of your symptoms is proof enough after just five days that you're not contagious?

Dr. Dave Chokshi: In New York City in collaboration with New York state, our guidance around this was initially limited to critical workers. Like healthcare workers who are fully vaccinated saying that after a five day isolation period, if you are fully vaccinated and if you are asymptomatic or had mild symptoms that are completely resolving and you can wear a high-quality mask for five more days, then it would be okay given some of the staffing shortages that we were seeing for critical workers to come back to work.

That was based on our read of the science in terms of balancing what is very real with respect to staffing with the fact that we don't want to a further the spread of COVID-19. The CDC guidance does go beyond that. We're reviewing that right now again in collaboration with our New York state partners. We'll always be guided by what the science tells us in striking that balance.

Brian Lehrer: Is vaccination status a relevant marker in the face of Omicron as to whether you're going to be dangerously contagious enough or not going back after five days since we know that Omicron is defeating the vaccines pretty frequently at least for infection, even if not for serious disease?

Dr. Dave Chokshi: Yes. I do believe that it is an important marker. Particularly if you're fully vaccinated or fully vaccinated and have received a booster dose. We have scientific evidence from before Omicron that incubation period for someone who has a breakthrough infection is shorter if you're fully vaccinated. We're still awaiting the definitive evidence in the Omicron era, but that's what we have to go on thus far. The most important point is what you ended with.

I would not say at all that Omicron is defeating the vaccines. In fact, the vaccines are holding up quite well for their primary purpose, which is trying to protect people from the most severe outcomes, needing oxygen, needing a hospital bed or needing a ventilator. That's why we have to keep emphasizing how important and actually more important vaccination is in the Omicron era.

Brian Lehrer: Another testing question from Elliot in Manhattan. Elliot, you're on WNYC with New York City Health Commissioner Dr. Dave Chokshi. Hi.

Elliot: Good morning, Brian, and good morning, Dr. Chokshi. Always is good to

speak with you, Brian. Dr. Chokshi, I'm vaccinated and boosted, I'm 69-years-old. I live on the upper west side of Manhattan. I've not yet had a COVID-19 test. I started the new year of the last four days with a cold. I've been living largely isolated, a lot of friends and neighbors who had somewhere to go left town in the beginning of the pandemic. My question is about all these curbside testing sites that have popped up and certainly in my neighborhood.

I don't know who these companies are, I don't know what they're charging. There's no signage that says they're affiliated with the city or state health department or any of the major hospital systems. Beyond the fact that it's now cold outside, I'm really concerned about whether I should go to somewhere like that for a COVID test or whether I should be looking another resources. I'm very nervous about the whole situation.

Brian Lehrer: Elliot, thank you very much. What about those curbside testing popups that suddenly, I know I heard some reports on the news with all these lines at other places to get a test. Some of these sites, you walking down the street and there's a popup curbside testing site and there's no line. Is that a great thing or should we not trust them?

Dr. Dave Chokshi: Thanks, Elliott, for the thoughtful question. My recommendation would be, if you have any question in your mind, it's better to go to one of our city testing sites. I'm really grateful to the test and trace core which has expanded capacity in the way that I describe and where we know they're using validated tests. They generally have a shorter turnaround with respect to test results as well.

As I mentioned, we are supplying those sites with rapid test kits when lines do get longer, so that people are able to get tested as quickly as possible. To access that, you can call 212-COVID-19 or just text COVID test to 85548 and you'll be able to to find a testing site that's close to you.

Brian Lehrer: Are there reasons to suspect the popup site as being somehow scams or anything like that?

Dr. Dave Chokshi: Some of them are quite valid, in terms of using the FDA authorized tests and having a good setup operationally as well. We do know on occasion that particularly when demand is as high as it is that some of them may not be using the most rigorous methods. If there's any question in one's mind, I would go to nyc.gov/covidtest and find one of the city sites which we can say with certainty will take care of you well.

Brian Lehrer: We'll continue in a minute with Dr. Chokshi and Dr. Chokshi I'll give you a heads up that we're going to take a call after the break asking why the science doesn't support closing the public schools for a short period of time right now. That's coming up. Stay with us. Brian Lehrer on WNYC.

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Brian Lehrer on WNYC with New York City health commissioner Dr. Dave Chokshi. He was Mayor de Blasio's health commissioner and he is being good enough to stay

on until March while under the Omicron circumstances. Mayor Adams health commissioner Dr. Ashland Vasan gets up to speed. Dr. Chokshi is also good enough to be on with us this morning taking your questions and we'll go next to Kai in Brooklyn. You're on WNYC. Hi, Kai.

Kai: Hi. I'm a teacher at an elementary school in the city and I'm calling in because I'm homesick today. I want to make it really clear what I feel like teachers are screaming from the rooftops right now and no one's listening which is that schools are not safe. There are severe staffing shortages. Gotham has said yesterday that a lot of the families that are staying home are our most vulnerable families and they are not getting remote education the way they should be. Classes are being combined because of the staff shortages in my building, the heat is inconsistent and so we have the windows open because that's our only ventilation.

These combined classes are shivering in freezing classrooms because of all the testing issues that have already been discussed and also the testing in schools being wildly insufficient and ineffective. We really don't have any way of quarantining. Plus, the quarantine rules have been relaxed right now when we need them most. Students who live with people who are immune-compromised, students who are immune-compromised themselves and staff in the same situations are being really thrown to the walls.

It's unacceptable working conditions, it's unacceptable learning conditions. I just want to know why we're not going temporarily remote. We know that going remote for even two weeks would help stop the spread. Why is that off the table?

Brian Lehrer: Dr. Chokshi?

Dr. Dave Chokshi: Thank you, Kai, and first, I hope you do feel better and I do understand the stress and the duress that you and other educators have been under for almost two years now. I and so many other New Yorkers are grateful to our educators, our healthcare workers who have put up with a huge amount over this period. To your question, what I would say is that schools are among the safest settings in our communities. We have evidence from New York City which has been corroborated in many other jurisdictions around the world which indicates that the risk of transmission in schools is significantly lower than in community settings and in household settings.

This makes sense because of the layered mitigation measures that we have put in place in schools, that is vaccination every single adult in the school building has to be fully vaccinated. We have a universal mask mandate and we have distributed higher quality masks like KN95s and KF94s over the last several weeks as well. Testing which we have strengthened with the return to school. This year, we're doubling surveillance testing overall and there're over a million rapid test kits that are also being distributed to schools as well as ventilation and distancing where possible.

All of these things taken together do help to keep our schools as safe as possible. I

would return to our fundamental mission which has been consistent from the beginning. I think the American Academy of Pediatrics really summarizes that the best when they say policy considerations for school COVID-19 plans should start with the goal of keeping students safe and physically present. That's because we know that in-person learning which right now is happening for hundreds of thousands of kids across New York City is vital, not just for their educational development, not just for their social development but for their physical and mental health as well.

Brian Lehrer: For the caller's point or to the caller's point, presumably just a week or two as other schools in our region are doing some other school systems in our region are doing as well as Chicago beginning today, that that might be more protective of the kids' health while Omicron is raging and then it's expected to settle down. Why not?

Dr. Dave Chokshi: It hinges on the notion that we have to put kids in the safest environments for them. Again the data indicates that schools are safer environments. We saw this last year as well before Omicron where because we did have so much remote learning that was happening, we were able to look at the spread of COVID-19 in schools compared to what was happening in communities. We were able to demonstrate that in-school transmission was significantly lower. I understand the rationale and the argument for doing remote for two weeks. The science indicates that that would not necessarily be a safer option, and it comes at a great cost with respect to all of the benefits that in-person learning and the school community provides.

Brian Lehrer: This is WNYC FM HD and AM New York, WNJTFM 88.1 Trenton, WNJP 88.5 Sussex, WNJY 89.3 net con, and WNJO 90.3 Toms River. We are New York and New Jersey public radio. Dr. Chokshi, we've just about run the table with you. We've gotten calls from Brooklyn Manhattan, Staten Island, and Queens. We're going to finish the set with David in the Bronx. David, you're on WNYC with a health commissioner. Hello.

David: Hi, are you hearing me okay?

Brian Lehrer: Hearing you fine.

David: Good. There's contradiction between what the CDC site says about do not combine the KN95 mask with any other mask. What governor Hochul demonstrated and recommended at her recent December 31st briefing of covering her K95 mask with a cloth mask. First of all, why did the CDC sites say that do not combine it and what's the best way to improve the quality of the KN95 mask?

Brian Lehrer: It's closest to an N95. If it's a legitimate KN95 not counterfeit, it's the same as an N95. Dr. Chokshi, tell me if you disagree but the masking advice seems to be changing from where a good multi-layered cloth mask to cloth masks. Everybody should be wearing at least a medical-surgical mask.

Dr. Dave Chokshi: Yes, that's exactly right and let me try to make it as clear as possible with respect to the up-to-date recommendation which is I do recommend

higher quality masks particularly for people who are more vulnerable but for the entire population to consider. That means a KN95 or a KF94 or an N95. I do not recommend layering any of those with another mask. It's sufficient to wear one of those higher grade masks. If you are wearing a cloth mask, I do encourage upgrading that either to a surgical mask or one of those higher-quality masks that I described.

The circumstance where layering may be helpful is if you want to put a cloth mask over a surgical mask which does give you some additional layers of protection. Again, to make it as simple as possible, a surgical mask better than a cloth mask and the highest grade masks KN95s, KF94, and N95s are encouraged at this time.

Brian Lehrer: Dr. Chokshi, I know you got to go in a couple of minutes. I want to ask you about one more thing, not about COVID. Mayor Adams yesterday announced an effort to cut back on unnecessary fines for small businesses. He said within three months, agencies, including yours, will be required to identify the 25 violations that result in the most summonses or fines. Do you have a rough estimate of the top of your head of the top few reasons for fines from the health department today?

Dr. Dave Chokshi: I don't have a specific list of those top reasons but what I can tell you is that my department enforces, for example, food safety requirements in restaurants and other eateries. Our goal there is always to promote high standards to protect the public not to generate fine revenue. We've seen the toll that the pandemic has taken on our city's restaurants. To Mayor Adams's point, we have to balance the need to create an easier environment for them to operate in, and the need to protect public health. I'll just point out that one of the shining examples of this, in my view is our letter grading program for restaurants, which is a great way to promote high food safety standards while not relying on fines as the incentive for good practice.

Brian Lehrer: Well, what would you say are the most important fines to keep enforcing to protect the public health, at business venues?

Dr. Dave Chokshi: Look, when there are, egregious examples that our inspectors come upon whether it's related to food safety, or our pest control, inspections, or thinking about air and water quality standards, those are all things that we take extremely seriously. When there are those egregious examples that need to be rectified, we will issue fines, always with the fundamental purpose of protecting the public's health.

Brian Lehrer: Dr. Dave Chokshi, New York City Health Commissioner, thank you so much for your time today, and all the information you've given us. Thank you. Thank you. Thank you.

Dr. Dave Chokshi: Thank you, Brian.

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