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Brian Lehrer: Brian Lehrer on WNYC and here to discuss what we do know about the Omicron variant and how we can translate that into smart public health policy is Dr. Leana Wen, emergency physician and public health professor at George Washington University. She's a CNN medical analyst and has a weekly column in the Washington Post where she also anchors the newsletter, The Checkup with Dr. Wen, plus she's the author of the book released this year Lifelines: A Doctor's Journey in the Fight For Public Health. Thanks for coming back on the show, Dr. Wen. We always appreciate it. Welcome back to WNYC.

Dr. Leana Wen: Thank you, Brian. Great to join you again.

Brian: Listeners, what are your questions about the Omicron variant or Omicron policy responses so far for Dr. Leana Wen. 212-433 WNYC 212-433-9692 or twitt a question @BrianLehrer. Dr. Wen, let me start here. Is restricting travel good public health policy? It's been controversial since President Biden announced the first restrictions the other day and some of the other countries too. Does limiting travel help infectious disease stop spreading?

Dr. Wen: It's a really good question and one that doesn't have a simple answer. Travel restrictions are what we call blunt instrument. They have a lot of unintended consequences including economic consequences for the affected countries. The jury is out on how effective they are. What we believe is that travel restrictions when implemented the right way, can slow down transmission. It's not going to stop the transmission of a really contagious virus as Omicron or COVID-19 in general is, but it can slow down the seeding of Omicron in places when it's done the right way.

My concern with what President Biden has done, I don't think that he and his medical advisors were wrong to implement travel restrictions. One way to look at it is if he did not implement these travel restrictions and then we ended up having a terrible surge, there would be a lot of Monday quarterbacking to say, ''Hey why didn't he do this sooner?'' Right now as they stand, the restrictions are so porous. For example, American citizens and permanent residents are able to come back from Southern Africa which they should be able to return.

The problem though is there's not even quarantining or retesting of these individuals and we know that the virus is not only going to be attacking individuals who don't have an American passport. My point here is that if the Biden administration is going to go so far as to employ this blunt instrument that has a lot of negative consequences, they should do it the right way. At the very least be quarantining, retesting, and having additional measures for everyone returning from Southern Africa.

Brian: Let me see if I understand you correctly. For the American citizens and other residents here who are allowed to come back into the country from the restricted nations in Southern Africa, they don't have to get tested?

Dr. Wen: Right now the requirement is that they need to get vaccinated. If you are vaccinated and if you're unvaccinated, you do need to have a test prior to arrival but vaccinated individuals could get tested up to 72 hours prior to arrival. 72 hours is a long time especially given how contagious Omicron is. Let's look at what happened with the two flights coming from Johannesburg to Amsterdam. Out of about 600 passengers, there were about 60 passengers who tested positive for COVID, at least 13 for Omicron.

My concern is that if we are now letting people come back with a negative test 72 hours ago, they could have picked up Omicron on the way. In fact, we also know that there are individuals who are in quarantine facilities in Hong Kong who returned from Southern Africa that they tested positive into their quarantine period. My point is we have a lot of loopholes. If we want to do travel restrictions, let's at least do them the right way.

Brian: You practiced in Southern Africa for a while, didn't you?

Dr. Wen: I did. I did clinical work as well as research in South Africa. My husband is South African as his entire family lives in Johannesburg.

Brian: We're hearing from some critics that travel restrictions are wrong because once you impose them the virus is already here for one thing so they're ineffective by that criticism. Also, it therefore becomes just another form of discrimination or at least disadvantage toward Black people in this case Black people who live in Southern Africa or travel back and forth between there and here. What's your feeling about that?

Dr. Wen: I understand this and I understand this in a very personal way as well as my mother-in-law. It's been more than two years since we've seen her. She had plans to come to visit the US but those plans have to be scrapped. I understand this in a very visceral way and I also have many colleagues who are scientists and doctors in South Africa who feel like they're punished. They did the right thing. They produced excellent science. They were transparent with their results which is something that we cannot say about China, for example, at the beginning of the pandemic and now they feel like they're being punished for their transparency.

At the same time, countries first and foremost have an obligation to their own people. I understand the desire by Israel, many other countries, and the US to protect our own residents to buy us time. I guess that's what we have to see the travel restrictions as. They're not going to stop the spread of COVID and Omicron, but they could buy us time to find out more about Omicron. They can also buy the US, in this case, time to encourage everyone to get booster doses which is a message that until yesterday really was not made clear by the CDC

Brian: For you who work in that intersection between public health and policy, the practice of medicine, you're a doctor, and you've also been a health commissioner of a major city, Baltimore, so you're at that intersection of science and policy. Do you think that maybe Israel and Morocco and Japan are getting it right, and the US should look to go that far which is to say basically block almost all incoming travel from any country now that we know it may have been first discovered in Southern Africa?

We had a guest yesterday who said there's no reason to think that there's more of a cluster there than anywhere else. Maybe they just had better sequencing, more testing of which variant it was down there which apparently South Africa is known to be very good at. Even if not that, we know that it's already in the Netherlands. We know that it's already in other European countries. If we're going to have a travel ban, why not from everywhere for the time being?

Dr. Wen: That is one approach. The thing is though if you're going to implement that approach, you also have to be taking measures in your own country as well. Right now, many of us think that Omicron is probably already in the US. We don't know how widespread it is. It probably is not very widespread but it probably is here in some way. One thing that we could do in addition to looking at preventing more Omicron from entering is to stop Omicron's spread here too.

Actually, I think this is the right time to be bringing back additional restrictions in the US not lockdowns but masking requirements. President Biden was asked about this yesterday and he said he would encourage individuals to mask while in indoor crowded places. He did not go as far as to say that he would urge governors and mayors to bring back indoor mask mandates, which actually I think if we really wanted to contain Omicron, we also have to be looking within our own shores and doing what it takes to buy ourselves time by taking the necessary measures here too.

Brian: Carol in Lynbrook, you're on WNYC with Dr. Leana Wen.

Carol: Good morning. I'm so happy to have the opportunity to ask this question. I'm 65, I have two doses of Pfizer. I've been waiting to get my booster shot. Now I'm wondering if I should wait a little longer to see if they're going to adjust the booster shots for this new variant.

Brian: Dr. Wen, should she wait to get her booster to see if they tweak it?

Dr. Wen: Carol, this is a great question that I've been getting asked a lot as well and I have a straightforward answer for you which is no. Do not wait and this is the reason why. First, the main risk that people have right now in the United States is Delta. Delta is by far the most dominant variant and it is a very bad variant to have. It causes severe disease, it also is very contagious. We know that immunity wanes including to Delta and you need to get a booster dose to protect against Delta. Second is that scientists believe and I've talked to many vaccines scientists who believe that getting a booster will increase antibody protection and very likely will give additional protection against Omicron right now as well.

The third thing is by the time that a vaccine specific to Omicron is developed, if it even ends up getting rolled out, it might be months down the line and you're going to be unprotected for that period. If it does turn out that we need a booster dose specifically targeted to Omicron, you can get it at that time. It will be many months from now if we even get to that point, but do not wait to protect yourself now.

Brian: Many have brought up vaccine equity as perhaps a primary cause for the continued rise in variants like Omicron and suggest sending more vaccine doses to regions like Southern Africa. I think the nation of South Africa was about 30% vaccinated and that was the high for the region. We've had a parade of guests on this show in recent months who say, "Look, vaccine equity is not just a matter of fairness. If you leave certain parts of the world under-vaccinated compared to others, those are the places that are most at risk for new variants to have the environment in which to develop, and then they're going to come and get us anyway." What do you think about any of that?

Dr. Wen: Well, in general, I agree with the importance of vaccine equity from a humanitarian standpoint and ethical standpoint, our obligation as wealthy countries to help others, and also a self-interest perspective as you mentioned. That as long as there's virus circulating around the world, none of us are going to be safe, but I also think that the reality is a lot more nuanced than this knee-jerk reaction of, ''Let's just give more vaccines to Southern African countries.'' You mentioned in South Africa that the vaccination rate is low. It's well under 40% of people who are fully vaccinated.

The issue though there is not vaccine supply. Just last week, Bloomberg reported that the South African government asked Johnson & Johnson and Pfizer to stop sending supply because they have too many doses that they're unable to get out. There are major issues in South Africa around vaccine hesitancy. Similar issues to here, there's rampant disinformation and misinformation, also in other countries in Southern Africa, including at least four of the eight other countries affected by the Biden travel ban. They're also sending back their vaccines, in part, because of distribution challenges.

They don't have enough freezers. There are issues with distributing to more rural areas, and so we need to adapt the assistance that we give for the country's circumstances. I am not saying that the globe has enough vaccine, obviously, this is a big issue around vaccine equity. I'm just saying that we need to be a lot more nuanced in our perspective and tailor the assistance that we provide each country depending on what it is that they need. In the case of South Africa, I don't think that vaccines are what they need, but they really need economic assistance, especially as they are so affected by the travel ban.

Brian: Let's take another phone call. Here is a Dr. Elena. She's called us before from Florida. Hello, Dr. Elena.

Dr. Elena: Hello?

Brian: Hi there you're on the air.

Dr. Elena: Good to speak with you again. I love your show, Brian. I've never had the time to tell you that. It's just a lifeline.

Brian Lehrer: Thank you so much.

Dr. Elena: The question is, and it was from one of your guests last week, I believe, who was talking about how paltry our sequencing is. We're sequencing less than 3% of our testing apparently, and so we have no idea how widespread this new variant is here already. I think that's really important even on your news, just now I was hearing about out how we have not demonstrated any Omicron here yet. Well, we're not looking.

Brian: Dr. Elena, thank you for the nice words and always thank you for your calls. Dr. Wen, how much are we not sequencing here? Again, for people who don't know the term, sequencing basically means testing your positive COVID sample for what variant it is. Are we doing it or are we not doing it at all? Are we doing it less than South Africa on a per person basis? What's the story?

Dr. Wen: We are definitely far behind a lot of other countries, especially, Israel, the UK, many countries in Europe when it comes to sequencing. At the same time, we've gotten a lot better. I do want to credit the CDC and the Biden administration for substantially ramping up the ability to sequence. Based on what we understand, by far the dominant variant in the US remains the Delta variant. By the way, it appears that even without doing sequencing, now that we're looking for Omicron, it appears that there is an early signal even based on the PCR tests that can alert us to the presence of Omicron, which again is thanks to the excellent work of South African researchers.

South Africa by the way sequences less than the US, substantially less. I think they sequence about 1% of all their samples. However, what happened in South Africa, again, speaking to my colleagues there is that doctors began noticing a pattern of cases, especially clusters in younger people in college students and they were able to identify that there was something different going on. That's how they found out about Omicron. I do think along with the rest of the conversation, we also have to bring in that South Africa really did the world so much good because they were able to recognize that something was happening. They were able to alert not only their own medical and scientific community, but the world as well.

Brian: Jerry in Port Washington, you are on WNYC with Dr. Leana Wen. Hello, Jerry.

Jerry: Hi, Brian. How are you? Interesting when we heard it was called Omicron. My daughter said that's a Greek letter and I had never heard of it despite having done math my entire life. I realized that it looks like an O so they don't use it in formulas because it looks like a zero, but if you parse the word Omicron, Omicron versus Omega, Omega, one is a small micro O and the other is omega O. I thought that was interesting. A long over it's a short O.

Brian: Yes. Linguistically, one represents a long O pronunciation. Maybe Dr. Wen you know which one it is. I think it's as Jerry was indicating, I think, Omicron is the shorter O, and Omega is the longer O, though the English translation is that they both represent the letter O, but in science terms and this has no meaning at all, but when I saw the word and I know it's a Greek letter, but you could read it as zero microns, which is the length that we want a particle of COVID to be because that means it doesn't exist if it's zero microns.

Dr. Wen: [laughs] That's an interesting point. I actually do not know about the Greek alphabet. Am glad that we are not naming new variants by the country that discovered them. I'm glad that we have removed that stigmatizing language, but I did not know about the etiology of Omicron.

Brian: Mark in West Orange, you're on WNYC. Hi, Mark.

Mark: Hi, how are you? Given the fact that this is Omicron, which is I think the 15th letter of the Greek alphabet and that means there has been 15 variants. Some of them have not been as horrible as the Delta and the Omicron. It seems that this COVID-19 is something that mutates and survives and it implies that like herpes and other flus and other situations in human illnesses will be, I don't want to say forever, the common cold. Will we see that every six months or every year we will need some kind of booster or slightly different vaccine to help us?

Brian: Not only that, Mark, thank you for your call. I think Mark implies an emotional challenge and a behavioral challenge because everybody's exhausted, Dr. Wen, right? We thought it was going away maybe last spring, last summer, and then Delta came upon us, and we've been experiencing what we've been experiencing in the last few months. That was beginning to wane, although still, a thousand people are dying of COVID every day in the United States.

Imagine if it hadn't been the pace all along and we weren't so inured to what a thousand deaths from one pandemic means to one country, 365,000 deaths over the course of the next year if it continues like that, and with Omicron, it might only get worse, not better. The emotional exhaustion, the extra difficulty that is added in making the right choices or even figuring out what the right choices are because people want to see their loved ones. People want to have lives. Mark's question is, is this a forever thing?

Dr. Wen: It's a really good question. I hear you and I hear Mark in the times that we're in, I think there are so many people who've been trying to do the right thing all along. Wore masks when asked to, got vaccinated when asked to, got boosters when asked to, who are now thinking, ''Well, when is this going to end?'' I guess the problem is we just don't know. We really just don't know. Look, I think there is a lot unknown right now about Omicron. My hope and I think many scientists best guess is that the vaccines that we have do provide at least partial, if not very substantial protection against this variant.

I do think that as you and I have talked about before, Brian, we need to figure out a way to live with the virus understanding that it is continuing to mutate. We are going to continue to get variants along the way that we'll have to keep on assessing and at some point we have to understand the threat from COVID 19, the same way that we understand other threats in our lives. Whenever we drive a car or really anything else, there is some level of risk. I think we need to get to the point that we need to weigh the risks of COVID when it comes to our own individual circumstances.

I think what's been so hard in all of this is that there is no end goal and then it's not like, ''Okay, as long as you can live through the next month or the next six months, it'll be fine.'' We don't know but I do want to commend though, so many Americans who have done the right thing and who have made a lot of sacrifices that I very much understand the frustration and the mental health toll of all of this too.

Brian: Dr. Leana Wen, George Washington University, CNN, Washington Post and author of the book, Lifelines: A Doctor's Journey in the Fight for Public Health. We always so appreciate it. Thanks for coming on again today.

Dr. Wen: Thank you, Brian. Be safe.

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