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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning, everyone. Let's keep getting to know our new neighbor, our new roommate, the Omicron variant similar to but different from its relatives like Beta, Delta, and what virologists call the ancestral variant, which dates back to ancient times, meaning early last year. With so many people getting sick and so many people not feeling sick but testing positive anyway, let's reacquaint ourselves with what it means to isolate and to quarantine. The big news from yesterday afternoon, you probably heard it, is that the CDC has shortened the length of time that certain people with COVID have to stay away from others.

Our very special guest for this is Dr. Daniel Griffin, Infectious Disease Clinician and Researcher at Columbia, Chief of Infectious Disease at ProHEALTH, Senior Fellow for Infectious Disease at UHG Research and Development, President of the group Parasites Without Borders, and as some of you know, the weekly presenter of the COVID Clinical Update on the podcast, This Week in Virology.

Dr. Griffin, thanks for coming back on with us at a really astonishing and frightening time in the pandemic, just when we thought we had maybe turned the corner a few months ago. Welcome back to WNYC.

Dr. Daniel Griffin: Thank you, Brian.

Brian Lehrer: Can you explain first what the CDC did yesterday? Because I think a lot of people are confused. What exactly got shortened from 10 days to 5 days?

Dr. Daniel Griffin: I think that you're right. A lot of people are confused, shocked, not sure how they feel about this. Thank you for mentioning This Week in Virology Clinical Updates. I tried to get people a little bit ready for this because the science was moving in this direction, but let's talk about what exactly they did. There's a little bit of terminology here, so there'll be a test, not at the end, but basically every day of our lives going forward, isolation of the infected.

When we talk about isolation, we're talking about what an infected person should do, to keep those around them safe. It had been previously a 10-day period of isolation if you were infected, and what they announced just yesterday, was given what we know, this can be shortened to five days, isolation of the infected, as long as on Day 6 you are asymptomatic. You don't have fevers, you're not feeling sick, you're feeling better. Now, at that time, you no longer have to isolate, but they do recommend that you continue to wear a mask to protect others and this is based on this idea- the science that most of the transmission is occurring in the two days before we get sick, in really the two to three days after symptom onset.

Really, by Day 5, most of the transmission has occurred. After that, there still is transmission, so there's going to be subtleties to this, but they're actually trying to find a balance between public health mandate, public health guidance, and really, the fact that COVID is here to stay.

Brian Lehrer: Listeners, you can call in with a question for Dr. Daniel Griffin about isolation and quarantine about how Omicron behaves differently from other variants, or anything related, and if you are isolating or quarantining, how are you passing the time? If you're not so sick, that you just want to lay around in bed, how are you keeping yourself from going stir crazy? Any tips for your fellow isolates out there? 212-433-WNYC, 212-433-9692, or tweet @BrianLehrer. Dr. Griffin, isolation is for people who have COVID, quarantine is for people who've been exposed to someone with COVID and not yet sure if they have it themselves. Is that correct?

Dr. Daniel Griffin: That is correct and I think that's really important. Isolation for the infected, but quarantine for those who've been exposed, and the CDC also updated quarantine- and there were a few subtleties in there. One of them was- previously it had been if you're vaccinated, there was really no significant quarantine requirement. If you were unvaccinated, it was still that period of time and it was 14 days, but then states could pick different ways of shortening that to 10 or 7 with testing.

What they were actually saying now is they're actually taking individuals who are vaccinated but are six months out from that second shot, so not boosted, two months out from that one J&J shot, not boosted, and they're actually recommending a quarantine period for those individuals as well.

Brian Lehrer: Is the guidance different for vaccinated and unvaccinated people?

Dr. Daniel Griffin: For quarantine, it is. If you are fully vaccinated, and now boosted, and within six months, we'll have to see how long that lasts, you do not need to stay out of society. You can go about your life. You can wear a mask, where they really are still recommending that if you are unvaccinated or have not been boosted, that you quarantine for- they're down to five days, watching, seeing if you have symptoms. Five days after that, you can go back and do whatever you want to do.

They do recommend wearing a mask for those extra five days, a well-fitting mask, that's a little bit of a change. There is an encouragement, what they say best practice, would be to include a test about five days after that exposure. What we want to do is pick up those asymptomatic but infected individuals who we know can spread the virus to others.

Brian Lehrer: About the rules for quarantine and isolation, if you live in an apartment building or any multiple-unit dwelling with a common area, are you allowed to go outside? Even when they're in either of these; isolation or quarantine? Can you take the elevator? Can you take the stairwell? Can you go out and walk your dog?

Dr. Daniel Griffin: That's really tricky, particularly as you described, Brian, in an area where there are these common zones where there isn't really good ventilation. What we've known over time, and part of what drove isolation and quarantine updates is- let's be optimistic, when we say 20% of people ever followed the rules, it's probably lower than that. People are not doing it. People certainly were not quarantining for the 10 or 14 days, so trying to find a balance here.

They do actually add in here, if you cannot- if this is not feasible, then you can wear a well-fitting mask, so if you're going to be going out with the dog, if you're going to be traveling through those areas, don't just wear a cloth mask, don't wear a surgical mask. Actually, get one of those proper N95's which now are in good supply, wear that. That's not only going to protect you if you are not exposed yet, but that's going to actually protect others, really contain that virus and prevent you from spreading it as you transit through those areas. Don't go hang out in that common room and expose others. We're really trying to minimize that.

Brian Lehrer: I'm glad you mentioned the importance of masks for protecting others. Our own health and science editor, Nsikan Akpan, just got COVID. Triple-vaxxed, he wrote it up in a new Gothamist article that's out today called What A 'Mild-To-Moderate' COVID Feels Like. Spoiler alert; before you read the article, not fun. He also wrote this. "How I caught Omicron most likely." He wrote, "I was likely exposed in one or two places based on when my symptoms started; at the office of my wedding suit tailor or on the subway." He writes, "Last Wednesday, I went to my final suit fitting," this is before his own post-wedding reception and additional reception, "And one of the employees at the tailor's office had relaxed views on masking indoors. I had reminded them a few times to cover their nose and even gave subtle hints by occasionally pinching the bridge of my KN95 mask. Then there's the subway which I wrote on Wednesday," he writes. "As reporters and regular New Yorkers have lamented on Twitter, mask usage still feels lax on the transit system. Despite the emergence of Omicron, my experience has echoed these tweets in recent weeks."

Well, first of all, Nsikan, get well soon if you're listening from isolation. That's first, and Dr. Griffin, does Nsikan's hypothesis about where he probably got COVID remind us something important about masking even if we ourselves are wearing an N95 or a KN95 like Nsikan was?

Dr. Daniel Griffin: I think it does. There's a lot in there, so let's hit some of the things. One is masks. There's different types of masks, and for personal protective equipment, if you're out and about and you really can't trust other people to necessarily do everything they can to keep you safe, the N95 is one of the best ways to do that. It's not 100%. It's not the N100, it's the N95. It's a significant decrease, and you want to make sure that that's properly fitted.

A lot of individuals I see, that bridge is actually so tight that they're nasally and I'm not sure they're getting a good seal. Health care workers each year at all the different facilities, we are tested to make sure we have that properly fitted. An individual who hasn't really gone through that, we need to start having I think the fire station, so we get our child seats checked, get those N95s inspected, make sure they're working well. The other is you got to wear that mask--

Brian Lehrer: Can I stop you right there? Because that probably made a lot of people's ears perk up. How do we actually test ourselves to the best of our ability without going to the nearest emergency room or something like that, to see if our N95 or other mask fits as tightly as possible?

Dr. Daniel Griffin: One of the things is that you should not be able to smell things through that mask, and that's actually how we test ourselves. If you're a coffee drinker and you come down and there's that nice smell of coffee in the morning, you put on that N95, and the smell of coffee goes away, that's actually a great test. Move your head around, breathe in and out, try to really sniff. Smell is a great way to sort of self-test, a home quick test of that N95 fit.

Brian Lehrer: You were going to go on to another point after the Nsikan excerpt.

Dr. Daniel Griffin: Yes. I was going to talk about when you wear a mask, as we just talked about, you really got to make sure it fits, it covers the mouth and the nose. The other day someone had a dog and it was attached to a leash, but running freely and they told me, "Oh, don't work, he's on a leash." I tried to explain that if you're not holding the other end, it's not really on a leash. If that mask is under your chin, if your nose is sticking out, you're not wearing a mask and you are breathing out, and particularly indoor spaces, they're going to really fill with the virus. Really upgrading those masks, wearing them properly, this really makes sense to protecting and ourselves and others when we're seeing these skyrocketing rates of infections.

Brian Lehrer: Let's take a phone call. Leo in Brooklyn, you're on WNYC with Dr. Daniel Griffin. Hi Leo.

Leo: Hey, Brian. First time in a long time. I am in my 11th day of isolation because yesterday on my 10th day, I took a positive rapid antigen test. I'm triple vaxxed. We know that people who test positive on a PCR will continue doing so for a while after they're not contagious anymore, but I'm really confused about what the antigen test means in this context and what it means for everybody, but for me, in particular, because I'm feeling okay, but I don't want to infect anybody.

Brian Lehrer: Dr. Griffin.

Dr. Daniel Griffin: This is great, Brian. Thank you for bringing this up because there were two strong comments from I'll say the scientific community about these updates. One is there was no comment about vaccination. It's the same rules for everyone, even though we have evidence that vaccinated people become infectious or cease to be infectious in a shorter period of time. The other was what about a test at the end? I'll say, my friend, Michael Mina, I think we're still friends over the last two years at tumultuous times, but at the end of this period, everybody is a little bit different- [crosstalk]

Brian Lehrer: That's Dr. Michael Mina from Harvard who has promoted the idea of using rapid antigen testing for a long time, right?

Dr. Daniel Griffin: Exactly. One of the questions that a lot of us had is if we're going to shorten it to 5 days, if we're going to shorten it to 10 days, what about a test at the end? What about a test on Day 6? What about a test on Day 10? What if that test is still positive? I think one of the really important parts of this guidance to be reading into is we are not talking about isolation of the infected with a 100% non-infectious at the end of that period of time. If people are really still having symptoms, or let's say, you're going to go visit your 85-year-old mother who has a number of health issues, do you still add a rapid test at the end? Which is not as oversensitive, I'm going to say as a PCR, is that a reasonable thing to do?

I think because the guidance doesn't include testing, I think you need to judge that. I have a friend who reached out to me this morning, an older gentleman, carries a little bit of extra weight, to say that kindly, and has some ongoing health issues. It's Day 6 and he feels better and he wants to go out. Well, I'll get on the phone with him after this and talk to him a little bit about, "You may be able to do that, but you still may be infectious. I think rapid tests can help us feel a little bit more comfortable with the shortened guidance."

Brian Lehrer: Are you telling Leo, our caller who's still on the line, stay home, even though you feel better after 11 days, but you're still testing positive on the rapid?

Dr. Daniel Griffin: Leo, you don't need to stay home, but I think it's reasonable to say you're not 100% clear. There still may be a low risk that you are potentially still contagious and I think it's very low. We're talking less than 1%, but this is part of living with COVID. Once you test negative on an antigen test, I'm going to feel very confident. Time is really important, but also the level of that viral RNA, that viral protein that we're picking up with tests. If you reach Day 6 and that antigen test is negative and you feel great, I feel very confident. If you are at Day 11, that antigen test is positive, but feel better, you no longer need to isolate, but go ahead, wear that mask, be careful for a little bit longer.

Brian Lehrer: Leo, is that helpful? I'm going to give you the privilege of a follow-up if you want one since it's not entirely [unintelligible 00:15:32] [crosstalk]

Leo: No, that clears it up for sure. Thank you.

Brian Lehrer: Thank you very, very much. Let's go to Sean in Westchester. You're on WNYC. Hi, Sean.

Sean: Hi, thanks for taking my call, and appreciate the background from Leo. We've got three kids, our older two are vaccinated, fully vaccinated, but our youngest is a couple a week into her first shot. Our middle one who's fully vaccinated, who's seven, tested positive with an antigen test five days ago. We've all been wearing masks indoors. We just took a follow-up test for two of our kids and our middle one is still positive. The question is if our youngest tests positive, then should we still be wearing masks around one another, or do we just sort of say, "Well, we've all got it now. let's ride it out"? So far everyone is asymptomatic, so really we're just looking for some guidance here.

Brian Lehrer: Dr. Griffin.

Dr. Daniel Griffin: This is another, and I'll say very challenging. Thank you for asking this question because I know a lot of people are either going through this, have gone through this, will go through this. When you end up an infected child, what do mom and dad do? What do the other siblings do? This puts together both the isolation of the infected as well as the quarantine issue. The individual who's infected is going to continue to be infectious for a period of time and this becomes very challenging when the children are young. Physically, how do you- socially and emotionally deal with that isolation period?

The tricky part of this is that the parents, particularly if they're vaccinated, have not necessarily been infected, so they're still continuing to be exposed, still, a potential quarantine period after the infectiousness ends. You've got to really do this on an individual level and try to decide what is the balance between the emotional support and health of your children. Some children are very comfortable wearing a mask all the time. That is not every child, so you've got to figure it out with your child. You are not necessarily infected just because you're living in the house with a child that is infected.

Maybe 30%, 40%, some of our studies come up with numbers like that, but still saying that the majority of vaccinated people can weather it in the home with an infected child and not themselves get infected. If you want to really keep yourself from getting infected, keep those windows and doors open, having the child eat in their own room, wearing a mask, there's a lot of things you can do, but at the end of that isolation period, then the quarantine period will apply or not based upon your vaccination status.

Brian Lehrer: Sean, I'll give you the right of a follow-up too since your situation is complicated. Did I understand you right? Your 5, 7, and 10-year-olds are in the house, only the 7-year-old tested positive?

Sean: Yes, the seven-year-old tested positive five days ago, tested positive today. The 10-year-old and my wife took a test as well, and if you stare at the test for long enough, you start to imagine that you might see a red line, so it's ambiguous is I guess what I'm saying. We're all still masked. We're okay emotionally being masked, we're still having a good time. We've got another week left of winter break. Maybe that's what we do until we test negative with the antigen tests, just to keep everybody safe.

Brian Lehrer: Later in the show we'll be talking about what the school should do and what options they're considering in various places once winter break is over. Sean, did you want to ask a follow-up question, or did that pretty much answer your question from Dr. Griffin?

Sean: Dr. Griffin, it's helpful. Thank you, no follow-up questions.

Brian Lehrer: Thank you much, Dr. Griffin, and happy new year to you. Here's a follow-up question to something you said before from Twitter, a listener writes, "Regarding the smell test. Isn't it true that many odors should be able to pass through the N95? I suppose the coffee particles are larger." What do you say to that listener?

Dr. Daniel Griffin: [chuckles] No, I think that's right. I was hoping that when I went to the hospital, some of the foul odors would not make it through my N95. There is a subtlety there. Coffee's a good one. They actually use saccharin in the testing. Always they have to correct me because they say, "Oh, does this smell sweet?" I'm like, "No, it just smells nasty." There are certain smells that will get through, certain smells that won't.

Brian Lehrer: Smell test is one way to see if your mask is fitting really tight. Are there other ways? If you feel your finger around the edges to see if it feels like there's no opening, of course, a finger is so thick, maybe that's not a good test. If you wear eyeglasses and you breathe out and your glasses fog up, does that mean you don't have a good fit? Any other indicators?

Dr. Daniel Griffin: No, those are good questions. One is, you can look in the mirror and really check and see if you have a nice, tight seal. You certainly shouldn't be able to get a finger in there. Now, breathing out, you still can potentially fog your glasses, even with a proper N95. Some of the N95s actually have a thicker layer of material at the top part specifically to protect the glasses. There even are different qualities for the person who wears glasses. That would be a reasonable suggestion. If you're breathing out and your glasses are fogging up, you do want to really check that seal up and around the nose. That's a particularly tricky place to get a nice seal.

Brian Lehrer: Another question from Twitter. Should organizations like sports teams limit attendance? How can they guarantee a positive-tested person doesn't attend a game? What is the organization's responsibility? I guess this question surfaces again after, some people will remember, a lot of sporting events had vaccine or test requirements at some point earlier in the year. That seemed to evaporate into vaccine only. That was considered a tougher standard, but now with Omicron being able to break through the vaccine barrier in some people and cause infection, even if not cause serious disease for most of the vaccinated, this question seems salient again. A, either just spacing at sporting events and other venues, or reinstitute the testing requirement, not just vaccination. Have you given that any thought?

Dr. Daniel Griffin: Yes. Our listeners probably know that I am involved with actually the infectious disease experts for the Long Island Islanders. I was giving one of the players a hard time the other day that one of the things I don't like about the UBS arena, I would like our team to be winning all the time, which they need to work on. This is a challenge. Originally, there seemed to be an idea in some quarters that vaccination was making people bulletproof, but we clearly know vaccinated people can get infected. Vaccinated people can spread the virus. They are at decreased risk of getting infected. They're at decreased risk of spreading, but not 100% decreased. There's breaks at each level. Testing is another great way of adding a layer of protection. Wearing those, as we discussed, N95s is a way that an individual can take a personal choice and protect themselves.

I went to an Islanders' game actually, a couple of weeks ago, and my daughter, her friend, and I, we had our N95s on the whole time. I felt very comfortable. Spacing is tough. A lot of people want to go and they want to get out and experience these things. There are many different layers that can keep us safe. Vaccination is a huge one. Testing is another really important one. Does it make sense to reinstitute that? I think that it does actually, considering the levels of Omicron at this point. Then we can also protect ourselves with those well-fitting N95 masks.

Brian Lehrer: We'll continue in a minute with Dr. Daniel Griffin and your calls and tweets about Omicron now, the new CDC guidelines on isolating and quarantining. We'll also play a clip of Dr. Fauci when we come back, his take on the isolation and quarantine reduction in length. A distressing reason to my ear why Fauci thinks it's a good idea. We'll play that clip and keep taking your calls and tweets for Dr. Griffin. Stay with us.

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Brian Lehrer: Brian Lehrer on WNYC, as we talk all things Omicron with Dr. Daniel Griffin, Infectious Disease Clinician and Researcher at Columbia University, Chief of Infectious Disease at ProHEALTH, Senior Fellow for Infectious Disease at UHG Research and Development, President of the group, Parasites Without Borders, and the weekly presenter of the COVID Clinical Update on the podcast This Week in Virology. Dr. Griffin, the mask questions just keep coming. I'm going to give you another one of these, and it's going to come from JC in Irvington, New Jersey. You're on WNYC. Hi, JC.

JC: How are you doing? Grand rising, everybody. My question is maybe two parts. As a man, I have a full beard. I know when it comes to masks, let's say, with the fire department, those men don't have beards. They have a skin seal type of situation going on. That's the first question. Should I shave while wearing this mask, or is it okay to have a full beard? The second part is, I do a lot of grocery shopping, and I'm always washing my groceries when I come home. Do I have to keep washing my groceries, or is it not that serious? I'll take my answer from both of you.

Brian Lehrer: Sure. JC, thank you very much. Call us again. Dr. Griffin.

Dr. Daniel Griffin: JC, I feel your pain. I was a gentleman with a beard prior to becoming an infectious disease specialist. When I started taking care of tuberculosis patients and needing to wear an N95, I actually needed to shave off my beard and mustache. Unfortunately, with a lot of facial hair, it's very hard to get that protection that you want with the N95 mask. It's a risk-benefit here. A fine trimmed beard is something to be proud of, but maybe it's something you grow back after the pandemic settles down. If you really want to get that protection-- I hear Brian- because, Brian, you've got a nice mustache and beard going there.

Brian Lehrer: Pretty close-cropped though. Very close-cropped. Do you think that I should shave my mustache and beard off?

Dr. Daniel Griffin: If you could get it close-cropped, you could get a good seal there with the N95, you could get away with that. Your beard doesn't stretch all the way. It's really just on the chin and mustache. That's a problem with radio, Brian. I can't see you.

Brian Lehrer: I know. The photo of me on the website is old and has a longer beard. Based on what you said, I think I'm good, but that's interesting. Another masking question from a listener who writes, "Does Dr. Griffin recommend using surgical tape to seal the edges of masks?"

Dr. Daniel Griffin: Let me really finish off the grocery one. Stop washing your groceries. This is not a contact-transmitted pathogen. This is in the air. It's about masks. If you're thinking about the tape, you're probably not using a mask that really fits well. Some of us will do that. We'll actually put a little bit of tape over the nose, over the bridge, the top part of the mask, just to get a slightly better seal there to protect the glasses. We often don't do that in the medical setting because that plastic cap can get contaminated. Part of the way the masks are designed. It's really designed to be properly adjusted to fit. If you're using this when you're out and about, you're going to the grocery store, you may be coming in and out of different temperatures, I think it's actually something reasonable to consider, particularly for those of us that wear glasses.

Brian Lehrer: I want to play a clip of Dr. Fauci. By the way, just to finish the beard question since you brought up mine, and there might be other people with face hair similar to mine, my own perception of mine because it's a very small goatee, I guess you'd call it, as well as close-cropped, my experience of my mask is that it fits entirely-- It seals outside the parameters of my face hair. For other people who have that kind of thing, if it feels like the parameters of the mask completely cover the face hair, then is it irrelevant?

Dr. Daniel Griffin: I think that your approach and I think now that the Brian Lehrer facial hairstyle is going to become more popular, [chuckles] there is a way to keep it close-cropped to really get a good seal. I think that's reasonable. When I had a beard, it was the full mountaineer beard that I would grow every winter. That's really hard to work with an N95.

Brian Lehrer: It's the old Boston Red Sox look, which very much upsets my fellow Yankee fans here in New York, but that's what it is. All right. Dr. Fauci on CNN yesterday gave his reason for supporting the CDC decision to reduce the isolation period if you're COVID-positive from 10 days to 5 days, as long as you have no more symptoms at the end of your 5 days. The reason that he gives here to my ear is kind of disturbing. Listen.

Dr. Fauci: Obviously, if you have symptoms, you should not be out, but if you are asymptomatic and you are infected, we want to get people back to the jobs, particularly those with essential jobs to keep our society running smoothly. I think that was a very prudent and good choice on the part of the CDC, which we spent a considerable amount of time discussing, namely getting people back in half the time than they would've been out so that they can get back to the workplace, doing things that are important to keep society running smoothly.

Brian Lehrer: He makes it sound like a compromise. We'd rather not do this, but we're going to have hospital staffing shortages and shortages in other essential professions. I don't know if the airlines count, but we know it's been going on with that. We hear that a lot of trains aren't running on the New York City subway system yesterday and today because of staff shortages there. There's essential workers. There's a "keep society running" versus the most protective isolation period policy tension here. How do you hear that?

Dr. Daniel Griffin: Yes, I guess I would present it differently, and hopefully I have presented it differently. I think science really supports this, and it's science over time. [unintelligible 00:31:49] [Hubert?] Mandeville, New York Times writer whose work I really appreciate, was talking about science and actually quoted an article from January of 2021. This science has been out there for a while. It really is that getting that-- I mean the vast majority over 90% of the transmission is occurring two days before symptom onset and the three days afterwards. This is actually a scientifically sound update.

People ask about, "Well, what about the kinetics of Omicron? Is Omicron different than Delta?" We've definitely seen things change over time. The ancestral strain, which I think you mentioned was only two years old, great to be an ancestor after two years, it was an exposure to people having symptoms and testing positive about seven days. Alpha dropped us to five. Delta dropped us to four. Now we're seeing about three days with Omicron. It's really loaded and it really looks like it's scientifically sound to shorten this isolation period, but we're not achieving 100%. It's Day 6. I talked about my friend who I'll talk to afterward, can he go out and visit someone who is at high risk? Is that prudent? No, it's probably not, but if he needs to get work done and he wants to wear a mask and he wants to be careful, his risk to others is small, but not zero.

I think there's a balance, but the balance is supported by the science. We're not sending people out at Day 2 because we need to keep the trains running. We're waiting until that really infectious period has passed. I think maybe it would've been nice to front-load that statement. We're all getting back, but we're doing it in a safe way. We're following the science on this.

Brian Lehrer: By the way, listener tweets, "Sounds like beards are bad for N95, there goes hanging in Brooklyn," writes that listener. Carol in Queens, you're on WNYC. Hi, Carol.

Carol: Hi, good morning. I'm a nurse. I work in a variety of sites because I freelance vaccinations. I do OBGYN clinic. I, of course, come in contact with a lot of unvaccinated or/and vulnerable people. I went for a COVID test on December 22nd mainly because we were gonna be gathering with my family and my mother is 87. I'm triple-vaxxed and I was very surprised- and I always wear a mask, I'm very careful, and I came back positive. I was the only one in my family who tested positive. I know that it was an exposure that was particular probably to my work situation.

I'm still in quarantine because my employer originally told me that the guidelines were about to change, but they still gave me a return to work date of December 30th if I have a negative test. I'm still here because I haven't been able to get an appointment to get a test done until the 30th. That's actually the day I was able to get a test. My family, we had to beg and borrow to get home tests so that they could retest in a day or two to make sure that they hadn't converted to positive. It's a mess, but I'm very bored in my room, catching up on cleaning and things like that and reading and that's where I'm at.

Brian Lehrer: Advice for Carol, doctor?

Dr. Daniel Griffin: Carol, you were kind to just say it's a mess. It's quite a mess, access to testing, access to home testing. I think this is really frustrating for healthcare workers who- they've taken all the right precautions and now they get a positive test. The silver lining I talked about a little bit last week was that, that positive test, that exposure to the virus without symptoms is probably going to give you a really good boost. You're now getting, hopefully, extra protection going forward.

The guidance by the CDC is updated across the board, but then again, we went through several stages. We went through the stage where first the CDC- this was not very long ago, this was last week, shortened the isolation and then a negative test at the end, and as mentioned just yesterday, got even shorter. One of the things that a number of my colleagues who are healthcare workers have brought up is a lot of us are tired, a lot of us are exhausted, and having a positive COVID test with or without symptoms is just another emotional blow. They were actually not that excited that they didn't get a little time off.

There's a balance here. It's frustrating to be bored, but you no longer need to isolate with regard to society. You can get out, you can wear a mask, you task through what we think is the height of infectiousness. You'll get out of your room, wear a mask, go for a walk, get outside, and then the logistics with the employer. It's the holiday season. It's been very difficult I know at our different organizations to get things mobilized, to get everything updated as quickly as these isolation guidance recommendations have changed.

Carol: Yes, that's true. In fact, I just got an email yesterday that we're now strongly encouraged to be using N95s and shields again in patient-facing settings. They're definitely ramping us back up, which I think is a good thing.

Brian Lehrer: Carol. Good luck out there. Thank you very much for checking in. I know that's helpful to other people. Let me check a few last boxes with you before you go, Dr. Griffin. One is, I saw you say on This Week in Virology that there were 38 deaths of children from COVID last week, the worst ever week for that during the pandemic. I assume that's a national number, but why now? Especially if the word on Omicron is it's less severe in general than Delta.

Dr. Daniel Griffin: Brian, we keep hearing that. Omicron, we're not sure that the virus, the viral variant Omicron is less severe. What is making this less severe is that people are vaccinated. There's a really nice piece where they looked through this and said, "Hey, all of the diminution, all of the decrease in the deaths and hospitalizations, a lot of this, almost all of it can be attributed to people being vaccinated, people recently recovering from a Delta infection." It's not clear to me in the unvaccinated, in the children, that this is a less deadly variant and exactly that was proof of it, where it's Omicron everywhere, that was the worst week ever, 38 children dying in a single week.

You listen to my colleagues, you listen to Paul Offit, you listen to people at the children's hospitals and we are seeing lots of children in the hospital. We are seeing lots of children in the ICU. COVID is an issue for children. If children get COVID, it doesn't matter if it's the Omicron variant. If they're not vaccinated, if they don't have protection, they can get incredibly ill. Unfortunately, 38 children dying in a single week, that just puts flu in the rearview mirror.

Brian Lehrer: The last thing, Israel is giving fourth vaccine doses to selected people, second boosters basically, even though Omicron is not that present there yet, but I've also heard some speculation by scientists that the vaccines may begin to get less effective as we have more of them because the body gets used to them in a way that'll stop producing new bursts of antibodies each time. Do you have an opinion on fourth doses or an ability to keep boosting for the next year or next few years effectively if that's what's called for?

Dr. Daniel Griffin: I think it's important to make this distinction as some of us have between the vaccine efficacy against infection, which really seems tied into high level of antibodies, and the vaccine efficacy against severe disease, which actually still looks very durable. To keep those high level of antibodies, to keep the vaccine efficacy against infection, that may require more frequent vaccines. That may require vaccines two, three, or four times a year. For those of us that are in the front lines that are high exposure that really don't want to get infected and spread the virus to our patients and loved ones, four times a year is not a lot to ask. You feel crummy for a day or two. That's really where the science is looking. I think it's tough.

People want to be one and done or maybe two or three and done, the number keeps getting higher, but we're in a pandemic, and lots and lots of infections-- As we just heard from Carol, people who are triple vaccinated still are ending up testing positive.

Brian Lehrer: Let me throw in one more from a listener. One more listener who wants advice on Twitter regarding isolation and quarantine. Our main topic's this morning, "My son has COVID and I have symptoms, but I have tested negative on antigen tests 3 times. Is it just a cold? Do I need a PCR test to be sure?"

Dr. Daniel Griffin: That is an interesting issue. We brought this up a lot of times; the issue between the very sensitive PCR that might pick up few little bits of RNA because sometimes particularly in a vaccinated individual, they really will actually get a true infection. They'll just get a little bit minimal symptoms. They'll never even get to the point that an antigen test is positive. We can remember the famous [unintelligible 00:41:52] where actually half of the people who had positive PCRs never even got to the point where an antigen test would become positive. It may just be a common cold. It may be you're doing great and you're clearing that and you're not really a danger to others. Leave you with that little bit of uncertainty there.

Brian Lehrer: One of my producers asked the question back to that listener, is she putting enough nasal drippings in the vial, and says people sometimes have better luck when they put a lot in. There's at-home rapid test technique, Dr. Griffin, correct?

Dr. Daniel Griffin: There is, and some of the tests come with videos, and like everything else, you can become an expert by watching YouTube. If you just touch your nose and then do the test, it's going to be negative. You really got to follow the directions and you're swirling it around about six times, really getting a good sample from the nose from each side, and then you're doing the test. If you don't do the test properly, then they're going to be negative,

Brian Lehrer: Dr. Daniel Griffin from Columbia University, ProHEALTH, see him and hear him on the podcast This Week in Virology. Thank you for so much good information for so many of our listeners and even for my chin. Thank you very much.

Dr. Daniel Griffin: [laughs]Thank you, everyone. Take care and be safe.

 

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