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Mayor Adams: Beginning Monday, March 7th, we will be suspending the requirements under Key2NYC, so folks can come in and enjoy the restaurants, enjoy the businesses, and be a part of this great city without having to show proof of vaccination.

Brian Lehrer: Monday, March 7th. Did he say Monday, March 7th? Well, that's today. It's the Brian Lehrer Show on WNYC. Good morning again everyone. That was Mayor Adams speaking on Friday. The Mayor and the Health Commissioner Dr. Chokshi also announced that they're launching an updated alert system on COVID, classifying color-coded risk levels, low, medium, high, and very high or a high level of spread or what they call orange alert would prompt a return to things like face masks in all public indoor settings.

Let's talk about some of this. With me now is Dr. Céline Gounder, senior fellow and editor-at-large for Public Health, that's the Kaiser Health News publication. She's a Clinical Assistant Professor of Medicine and Infectious Diseases at the NYU School of Medicine and Bellevue Hospital. She was also on President Biden's COVID Transition Team. Dr. Gounder, welcome back to WNYC. Thanks for coming on the show again, we've appreciated a lot of your information throughout this pandemic.

Céline Gounder: Great to be here, Brian.

Brian Lehrer: First, can I say what a steep slope up and then steep slope down for the Omicron variant. We know how suddenly it came in and how incredibly widespread it was almost instantly. Now we're all the way, way, way, way back down to 1. something percent positivity rates on people who get tested. How does that even happen so fast?

Céline Gounder: Well, this is what we mean by exponential growth or spread of a virus, and the more infectious the virus, the more you're going to see these dramatic increases. Then the fall is usually going to be a little bit more progressive than the initial spike up, but that is the pattern that we expect. It's great to see numbers coming down, but at the same time when there is another variant or surge, we should anticipate that things can really change very quickly overnight as well.

Brian Lehrer: Can you talk about the changes that I think still have some people confused today? Are they exactly the same in terms of what comes off and what stays on in public settings for masks and for vaccines?

Céline Gounder: The New York City guidance is really modeled after what the CDC has already announced. What the CDC announced about two weeks ago now was a change in its masking guidance that's really guided by how do you preserve the healthcare system so that it doesn't become overwhelmed in another surge. That red, yellow, green coding is looking at not just cases but also hospitalizations and hospital capacity.

That means a place like New York City or Boston or San Francisco, which have a lot of big academic medical centers, lots of hospital beds, they have a bit more elasticity or bandwidth to absorb a surge than say a rural part of the country that might have the nearest hospital a couple hours away. This is really about preserving the healthcare system. It's not to say your risk of getting COVID is zero if you're in a green area but rather that if you get sick, the hospitals will be able to take care of you.

Brian Lehrer: Well, in an op-ed last week, Dr. Jay Varma, the top health advisor under former Mayor Bill de Blasio urged Mayor Adams to keep the vaccine mandate, also known as the Key to New York City, saying that many New Yorkers have become accustomed to the program and that ending the policy would make it difficult to reinstate if we get another surge. How much do you agree or disagree? I know the other way of looking at that is that if we don't keep full tilt requirements on all the time and we ease off, then if there is another surge, people might actually be more amenable to putting them back on. Where are you on that scale?

Céline Gounder: In terms of vaccination requirements, we know that absent requirements with other vaccines, for example, the flu vaccines, we've never hit much more than 50% of adults vaccinated. Secondly, when you vaccinate a population, say, as we have for COVID, your population immunity is going to go down over time, unless you continue to vaccinate. Why is that? It's not just about waning immunity, that's a smaller factor actually in all of this. You also have new people being born into the population, you have young babies that are aging into the age range where they could get vaccinated. Then you have people immigrating, moving into the population.

Over time, your population immunity will go down if you don't continue with vaccination requirements. That certainly leaves us susceptible, more vulnerable the next time, the next surge or variant hits.

Brian Lehrer: It leaves us though in this weird situation where workers, now tell me if this is right, workers, employees in New York City who work in indoor workplaces still have a vaccination requirement but the customers or the patrons, if they're going to the theater, let's say, do not. Correct?

Céline Gounder: That's right. That's right. I think this is really about trying to get vaccination rates up. Of course, some of those very same customers might themselves work in some settings where they are also required to be vaccinated.

Brian Lehrer: I've heard it said that it's still in place for employees to protect the workers. If that's the rationale, you know, I'm thinking of like the no smoking in restaurants rules. I mean, some restaurants could cater to people who don't want to smoke there and some to smokers, but it's for the wait staff and other workers who have no choice, eight hours a day, whoever takes all those restaurant jobs. From a public health policy standpoint, why not require the customers to be vaccinated in order to protect the workers?

Céline Gounder: It's a great question. I think this is one area I really wish our public officials, our public health leaders were actually more transparent about their values, their priorities, their goals, and that they would preface any new change in policy with some sort of explanation of here's what I value, here are the competing issues that we're trying to prioritize, here are the goals.

I think reading into Mayor Adams' policy, I think the goal here is let's get the economy going again, let's reopen, let's get restaurants at full capacity again, and so on, but I think if you're not clear about what it is you're trying to accomplish, it becomes really confusing, because then you find yourself asking, "Well, this doesn't make sense in terms of protecting our workers, so why are we doing this?"

Brian Lehrer: Right, and so we get these weird situations like the Brooklyn Nets basketball star Kyrie Irving, the only member of the team who refuses to get vaccinated, cannot play at Barclays Center because he's unvaccinated, but he could sit in the stands at Barclays Center and watch the game, which he couldn't yesterday.

Céline Gounder: That's right. That's right. I think you have public officials, public health leaders that are trying to maintain vaccination rates, get people vaccinated with what levers they can, but the levers that are available to you are not always going to apply to everyone evenly logically and you're also trying to balance different priorities, the public health, the economic, getting people back to work and back in the classroom, so depending on how you weigh each of those issues, those priorities in different settings, you're going to end up with sometimes confusing guidance.

Brian Lehrer: Last question for now, this Omicron 2, how concerned are you?

Céline Gounder: Omicron 2, it's a sub-type of the Omicron variant, is a little bit more infectious than the original Omicron. Omicron was the most infectious of all the variants to date. We are seeing this Omicron 2 rapidly take over as the dominant Omicron. I think you'll see-- and it's sort of what we've seen across the country and elsewhere, the recovery from the Omicron surge has been a little bit more drawn out, a little bit slower as a result.

Brian Lehrer: Dr. Céline Gounder, thank you so much, and we really do, I said it at the beginning, but I'm going to say it again. You've been coming on with us periodically throughout the whole pandemic, and we've learned a lot from you each time. Thank you very, very much.

Céline Gounder: My pleasure.

Brian Lehrer: Brian Lehrer on WNYC. Margaret Atwood next. Stay with us.

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