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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning everyone. Here we are, as we know, with New York City as the epicenter again, the Omicron variance surging to a record number of confirmed COVID cases per day in New York and some other places, but very different from the early days, neither political party wants government shutdowns. Businesses and individuals have their own decisions to make. The national hockey league has now suspended play entirely for the moment, as just one example, and you know about the Radio City Christmas Show and other things.

Different places have various vaccine mandates and mask mandates. This includes New York City's coming vaccine mandate for employees at all private businesses, which is supposed to take effect next Monday. We'll see if it gets held up in court and if mayor Adams keeps it after his inauguration on January 1st. President Biden addresses the nation on Omicron this afternoon. With me now are two guests, Dr. Jay Varma, Cornell Weill physician and epidemiologist, who was also Mayor de Blasio's Chief COVID Advisor, and he has a New York Times op-ed called There's One City That Can Show Us Our Omicron Future. Yes, folks, that city is New York. We have New York City Council, Health Committee Chair Mark Levine, who is also the incoming Manhattan Borough President. Dr. Varma, Councilman Levine, welcome back both of you to WNYC.

Mark Levine: Thanks so much Brian.

Dr. Jay Varma: Thanks for having us.

Brian Lehrer: Dr. Varma, do you say New York can show the rest of the country its Omicron future because of what New York is doing or because of what you'd like it to be doing?

Dr. Jay Varma: Excellent question because it's a bit of both. The bad news from New York is that this variant is far more transmissible than the Delta variant. The Delta variant, as we know, was far more transmissible than the original strain that came out. What we're dealing with right now is a strain that appears to spread very rapidly from person to person through the air and can cause infections in people who we formally thought were protected. That is people with two and often three doses of vaccines. That's the bad news.

The good news, if we can call it right now, and it's important to emphasize that this is all very tentative, is that all of the efforts that New York City has done to make vaccination the first line of defense, the cornerstone of its program through workplace mandates, through verification programs at the restaurants and bars, has really helped so far keep severe illness and death down. Again, we don't know how that's going to play out over the next couple of weeks, but up until now, we're at about 50% of where we were last year in terms of hospitalizations, despite three, four times the level of cases. What we're trying to say to the rest of the world is to really build those vaccine programs.

Brian Lehrer: I want to talk about some vaccine stats that I saw this morning just so people know what we're talking about, vaccine and outcome stats. On COVID infections at all right now, and I saw these reported on NBC news, the unvaccinated are having 400 cases per 100,000 people, the vaccinated - 100 per 100,000. I'm rounding, but it's about that. The boosted just 48 cases per 100,000 people, less than half even of those who are vaccinated, one-tenth as much as those who were unvaccinated, and that's just cases.

As for deaths, it was so different. The death rate, if you're not vaccinated, in the general population, 6 people per 100,000 people are dying. The death rate if vaccinated is just 0.5 per 100,000 people, and if you're boosted, 0.1. Dr. Varma, let me stay with you on this. Are you concerned that people aren't getting the significance of vaccines for cases or for deaths, because we're seeing so many breakthroughs of people in our lives and in the news?

Dr. Jay Varma: Our single biggest communications fear is that people will see vaccinated people come down with a runny nose and a cough and feeling fatigued and say, "Look, the vaccine didn't protect you." To me, this is similar to if you saw people wearing seat belts, and airbags and they got bumped from behind, and you say, "Look, they were wearing seat belts and car bags and they got into an accident."

Again, we've known from the beginning that it was going to be very difficult to develop a vaccine that stops all infections, but we knew that vaccines can prevent severe illness and death. The data that you're citing right now is what we need to figure out how to communicate effectively as possible. This is to prevent you from getting severely ill and dying, because the numbers tell a very clear story.

Brian Lehrer: Council Member Levine, head of the Health Committee, incoming Manhattan Borough President, in your view, what is the city doing, what should the city be doing?

Mark Levine: It is great news, Brian, that we haven't yet seen a surge in hospitalizations like we have in earlier waves, but I can't emphasize just what a serious impact on the city it is to have 10,000, 12,000, even 15,000 people testing positive every single day. These are unprecedented numbers for the city. It is going to disrupt almost every sector of life here because of the impact on the workforce and so much else.

The good news is the city has a really wonderful menu of supportive services for people who test positive to help them safely isolate at home, to help them relocate to a hotel if needed, to get them connected to a medical provider, but all of the systems are overwhelmed right now. They weren't designed to serve 10,000 or 15,000 people a day. We really do need help. We need federal help, state help, we need help from everywhere to expand the systems for people who, while they might not need hospitalization, need all sorts of support. We may just be at the beginning of this with the worst of the winter surge ahead.

Brian Lehrer: Let me ask you about one benefit or accommodation that the city does have, it came up on the show briefly last week, that a lot of people perhaps could take advantage of, but don't know about it. That is hotel rooms for people who need to be isolated, but live in crowded conditions where they can't get away from vulnerable family members and things like that. Are you aware of that and how much of that there is and how people could find out about them if they want them for themselves or their loved ones?

Mark Levine: This is an incredibly important option for people who live in crowded homes because COVID spreads within households so easily. It's very important that you isolate, especially if you have a vulnerable family member, and that's what these hotels are for. You can stay throughout the duration of your sickness, and they provide you with meals and prescriptions, medical check-ins, free Wi-Fi, transportation to and from the hotels. It really is a great option, also available, by the way, to someone who may be vulnerable but not positive, but have a person in the household who is sick and it's easier for that individual to relocate.

My understanding is, we're not going to run out of hotel rooms because we have flex space options, but the system for administering the program is really overwhelmed right now. The wait time to talk to someone, the wait time to get into a room actually can even be, I've heard in some cases, as much as 48 hours. If you test positive with a lab, you should get a call from a resource navigator that can help you enroll for this, but you can also just proactively reach out to the city's COVID hotline, it's 212-COVID19, if you believe you need a hotel room to safely isolate.

Brian Lehrer: Listeners, your call is welcome about Omicron science and Omicron policy right now in New York City or nationally. We'll get to what Dr. Varma wrote in his New York times op-ed about what he'd like to hear from president Biden this afternoon. 212-433-WNYC, 212-433-9692 or tweet your question @BrianLehrer.

Dr. Varma, why is New York City the epicenter again? People in the city and right around the city may not realize that it is more here again in terms of the numbers of cases that are being diagnosed than most other places around the country. That's not to say it's not intense everywhere or getting intense everywhere, but we know we were the epicenter at the very beginning in March of last year. Now, with Omicron we seem to be the epicenter again, despite the very high vaccination rate compared to the rest of the country. How did this happen?

Dr. Jay Varma: New York has always been the most vulnerable city in the United States for any emerging infectious disease. It's due to some very basic structural factors. The first is that this city receives more international visitors than anywhere else in the United States in terms of both number and frequency. At any given time, any disease emerging around the world is very likely to show up here if not first, soon thereafter. We know about this virus that it takes multiple introductions of it to really seed big outbreaks, and there's nowhere else in the United States that's going to receive as many frequent introductions as New York City, that's number one.

Then number two is, we are the most densely populated place, and you have to think of density in two ways. One is the crowding inside homes, how close people are to each other and their ability to separate, and the next is the proximity from one home to the next. For all of those factors New York City is always going to be the first to be hit. In this situation the power of the vaccines has been the ability to really avert those severe outcomes. Omicron has showed us that vaccines are not the level of protection we want against infection. That's why you're seeing so many infections in this city right now, but again, at this very moment, we'll see how it plays out, far fewer hospitalizations or deaths that are likely to occur in many other parts of the country.

Brian Lehrer: Another New York City policy issue, Council Member Levine, Mayor de Blasio as of now is still requiring city workers who work in office jobs to be at their desks in-person five days a week. Should that change?

Mark Levine: Yes, there needs to be flexibility for hybrid working because of this wave and because the nature of work is changing. Actually, the city has lost a lot of talents, Brian, over the last few months because of people who simply took jobs elsewhere that gave them the flexibility to be at home with kids or to stay safe during this surge. I think that for the foreseeable future we need to have flexibility. We are going to have hybrid work options available in the Borough President's office beginning in January, and I think that should be the policy citywide.

Brian Lehrer: Do you have any indication if Mayor Adams will make it the policy citywide on January 1st?

Mark Levine: Actually I don't know, but I hope he will.

Brian Lehrer: I see that you were quoted saying you think Mayor Adams will keep the vaccine mandate for all private business workers assuming it holds up in court, once it goes into effect next Monday as opposed by Mayor de Blasio. What do you know about Adams and that?

Mark Levine: I don't have insight information on that, but he and his representatives have repeatedly said they're going to follow the science on this policy. As for the courts, again and again and again, they've affirmed these mandates for the workforce, and I expect they will again in this case. I'm certainly hopeful that these will remain in place. We've seen that even to have small pockets of unvaccinated people in New York City leaves us vulnerable to surges. We also have people who commute into New York City to work here, who might be unvaccinated. The mandates that the Mayor has put in place would help address this. I do think it's very important that the next administration continue with this policy.

Brian Lehrer: Marisa on Staten Island, you're on WNYC with City Council Member Mark Levine, Chair of the Health Committee, and Dr. Jay Varma. Hi, Marisa.

Marisa: Hi. I had a question for Dr. Varma. My family and I, all of us who are eligible are vaccinated. My son is vaxed but not boosted yet because he's too young and he was just vaccinated. Myself and my two kids both had COVID at the end of October. I know with Alpha and Delta that people pretty much got a 90-day reprieve before they might be considered reinfected with the virus again, but I haven't been able to find any data about how that holds up for Omicron. I'm wondering, do we have any extra protection because we just had a COVID infection? Obviously, I know our vaccines and our boosters are working, but I was just wondering about the possibility of reinfection with this new variant in less than 90 days.

Dr. Jay Varma: This is one of these really critical science questions that we unfortunately don't have the answer to. I'll tell you what I know and I'll tell you what I don't know. What I do know is that there is a very high level of immunity, probably the highest level that we know of, in people who had what we call hybrid immunity. That means they both had their virus stimulate their immune system because they were infected, and they've also had the vaccine stimulate their immune system. That combination of having been infected at one point and then vaccinated in all of the laboratory studies appears to confer the highest level of protection against both being infected as well as getting severe illness and death.

There have been laboratory studies saying that that should also protect you against Omicron, but we don't know how that's going to play out in real life. What we don't know really is that whether or not if you had the Delta infection, does that confer complete protection against Omicron, or is Omicron so wily that it evades that? This is just one of these questions that's really sitting out there as an unknown.

The other thing I would point out to people is one of the things that concerns me about citing numbers about 60% protection or 80% protection, is when you are swimming in the virus, which is what we have right now, you need to have that protection every single time you run into people. Of course these are all percentages. The more often you're encountering people and being exposed to the virus, effectively your protection over time goes down, because there are more opportunities for it to just evade your immune system. Those are the things we know, we don't know, and what concerns me about the current situation.

Brian Lehrer: On some of the other numbers, Dr. Varma, what do you make of the South African numbers which seems to indicate Omicron might surge like wildfire for the next few weeks, but then begin to subside rather quickly? This doesn't help people figure out how to protect themselves now, but as something, perhaps a ray of hope for the not-too-distant future, is that too optimistic because South Africa's population and immunity status is much different than ours? What do you make of what you're seeing from there?

Dr. Jay Varma: What you're pointing out is the scenario that we anticipate is most likely to happen, that when you have a virus that is this infectious, basically on the order of measles, both because it spreads by the air and it spreads so easily to people, it tends to go through a population so rapidly that you see this super high peak and then you see a super sharp decline. That is the most likely scenario. Again, this virus continues to surprise us. I always assume any prediction I make is likely to be wrong, but that's the most likely scenario.

The concern, of course, is that the original concept to flattening the curve wasn't so much about reducing the number of infections, but was about spreading them out over time. That's really the challenge that we face here. Even if there is a sudden upsurge and downsurge, how we weather that period of the upsurge is going to be very challenging when you have healthcare workers sick, congregate setting workers sick, all the people that we need as essential workers, if they can't work, then your entire system collapses. That's the worry that we have.

Brian Lehrer: In terms of what makes this more transmissible, we've heard about the spike proteins and everything like that, but in terms of human behavior, is it, if you're in a room where somebody who is COVID-positive have been, the aerosols last longer in that room? Is it you only need to be in the presence of somebody who's COVID-positive with Omicron for a couple of minutes instead of what we heard with Delta, 10 to 15 minutes? Can you put it in those behavioral exposure terms?

Dr. Jay Varma: It's an excellent question, and unfortunately, again, one of these areas of uncertainty. My personal feeling, just based on what I'm hearing from colleagues, from friends, from other people, is that we are really dealing with the virus that, as we've known since the beginning, spreads through the air, but it doesn't just spread over a short distance, it appears to spread over a long distance. That means if you're in an indoor space, being a few feet away is probably not anywhere near the protection it was with the original strains. That's number one.

Then number two is, there is certainly enough evidence from scientific experiments on previous strains that this virus can hang around in the air. Everything about the explosive nature of this transmission suggests that it is certainly possible that it could hang around in the air. This is why I would really recommend to people that if you have the ability to do it and you're in indoor space with other people, open your windows, open your doors, do everything you can to ensure adequate airflow, on top of being vaccinated and on top of using masks.

Brian Lehrer: To continue on the basics, what about surfaces? People were concerned about surfaces at the beginning of the COVID pandemic, then we're told surfaces were not the at much of a risk, but you should still wash your hands all the time and still clean high-touch surfaces. Anything to say about that?

Dr. Jay Varma: We don't know anything new than what we've known in the past, which is that it is certainly possible for surfaces to be a source of transmission, but it appears to be very uncommon, not very likely. Again, we as public health people, we love handwashing, and one of the reasons we love handwashing is because we know that you could get influenza or other viruses from surfaces. The challenge of course is that once you develop an illness at this point, you're going to think you have COVID, you're going to stress the healthcare system. Handwashing is good. Also, even if it isn't protection against COVID, it is protection against other infections that could mimic COVID and cause you and your family and other people great distress.

Brian Lehrer: Jennifer in Brooklyn, you're on WNYC. Hi, Jennifer.

Jennifer: Hi. I told your screener something else, but I'm just speaking to what I'm just listening to with this, the variant, how contagious it is, because my daughter and I contracted COVID, and this is after not getting it for almost two years, I guess. My daughter's been attending school in-person. It's a small special needs private school, but still in-person for a year and a half, Just recently we got it, and it seemed to spread like wildfire. The city must be inundated because we still haven't received any information, like your previous guest was speaking to, from the Department of Health of the New York City. Nobody's given us a call or checked. The person from the urgent care where she tested positive called us.

Brian Lehrer: Council Member Levine, you want to talk to Jennifer in Brooklyn?

Mark Levine: Jen, so sorry that you and your daughter are dealing with this. I hope you are not having a serious case. This is happening now. There are so many people who are testing positive, that there aren't enough workers to call people to check in and offer a menu of services. I do just want to explain to folks what's available because it's really important. The city will help you safely isolate at home. They will arrange meal delivery if you need it, prescription delivery. There's a daily symptom check-in that they'll offer you. They can even provide things like pet services, help you connect it to doctor care if you need it.

It's really important that people take advantage of this. Normally, you would get a call right after you test positive if you do it at a lab. There's a backup on that right now. You can proactively dial in and request assistance to isolate at home. Also, this is important, Brian, if you have done a home self-test because you're off the grid, you don't pay a lab, it is very important that people who do test positive at home contact their healthcare provider. If they don't have one, the city can arrange for that. Also you should reach out to ask for support and isolating from home. The number for all these things is the same. It's 212-COVID19. Jen, if you haven't already, you should call that number, and hopefully you'll get through and get the support that you need.

Brian Lehrer: Brian Lehrer on WNYC. We'll continue with Council Member Levine and Dr. Jay Varma. We'll play a clip of something that Governor Hochul said about schools yesterday and take more of your calls. Stay with us.

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Brian Lehrer: Brian Lehrer on WNYC as we continue to discuss the Omicron wave locally and nationally at the science and medicine and also policy level with Dr. Jay Varma, Cornell Weill physician and epidemiologist, who was also Mayor de Blasio's Chief COVID Advisor for a while. He has a New York Times op-ed called There's One City That Can Show Us Our Omicron Future. Yes, that city is New York. We have New York City Council Health Committee Chair Mark Levine, who is also the incoming Manhattan Borough President.

Council Member, you were just talking about the at-home tests and if people take at-home tests and test positive, they can still get support services from the city. The mayor announced the plan to give out free at-home tests last week. I'm curious if you have any insight into why this plan is rolling out now rather than a month ago or three months ago. Was it due to supply or did the mayor want to prioritize vaccination rather than at-home testing, so he didn't want to make it look too easy? Because there was still plenty of Delta around before this Omicron wave.

Mark Levine: I've been calling for the wide availability of at-home testing for, I think, a year or more, and many others have. There are parts of the country and the world that are way ahead of this where they make at-home tests available for free or nearly free, or they'll mail them to your home. We're way, way behind on this. There are some announcements this week that are encouraging. The city is going to be distributing 500,000 at-home tests through a network of community-based organizations. That hasn't started yet, but I think it will before the end of this week.

The city now, in cases where there's long lines at some of the brick-and-mortar testing sites, does have a supply of at-home tests which they're giving out to people on the line if they want to leave those supplies limited, but that is helpful. The governor yesterday announced that 1.6 million tests are coming to New York City. I'm not clear how those will be distributed. Then this morning the federal government announced that there's going to be 500,000 tests available for people to sign up to be mailed to their home nationally, beginning in January. Also, by the way, that there's going to be some federally-run home-testing centers in New York City opening in the next couple of days.

This is a lot, but it's still not going to be enough. It's really outrageous that at this stage of the pandemic you're requiring people to run around from pharmacy to pharmacy hoping they can find a home test kit. It's very difficult to find one in stock, and when you do find one, they're usually $25 for a pack of two. This is really unacceptable at this stage. To make people wait in line for hours at a physical testing site also is deeply problematic. It has an equity impact because people who have intense work lives aren't able to take a day off and stand in line, or people who aren't physically just can't do that. That's led to disproportionate testing.

Finally, we're now seeing longer wait times in getting PCR tests back. I think it's now stretching to three days or more, which is really problematic as a tool to keep you and your family safe. We need a surge in resources in every aspect of the testing system. The city, the state, and the federal government all should be using their buying power to buy millions of tests. Give them out in schools, libraries, community centers, make them available for mail-in. We need more sites available for testing in communities, more mobile vans. We need more lab resources to improve the turnaround. I think when we write the history of this pandemic, the failure on testing is probably going to be one of the recurrent themes from the early days, and it's just maddening that we still haven't figured this out so late in this pandemic.

Brian Lehrer: Dr. Varma, when we had the first COVID wave last year, of course, public schools went remote in New York City and so many other places. I want to play you something that Governor Hochul said yesterday despite the record number of COVID-positive tests that are coming back right now.

Governor Hochul: We are keeping schools open because we're dealing with a very different variant at this time. We believe that it's critically important that our children not end up in that same situation they were for so many months.

Brian Lehrer: Dr. Varma, I see from your New York Times pp-ed that it looks like you agree with that.

Dr. Jay Varma: Yes, absolutely. I think that people need to understand a little bit about the origins of school closure as a public health measure. This was originally designed when people like myself were working on planning for a pandemic influenza scenarios. The idea was that in influenza, young children rapidly spread influenza among them and then spread it to the rest of the surrounding community and cause outbreaks. That short-term school closures might be necessary to prevent widespread community transmission. We have not seen that play out with coronavirus, that's number one. It does not appear that schools play a critical role in the community transmission of this disease.

Number two, we've also seen the devastating consequences to health. Not COVID health, but all of the health of children. Mental health, physical health, and their education from missing school. I think we need to always separate schools and consider them more similar to hospitals or nursing homes. When a lot of healthcare workers get sick, we don't say, "Let's close the hospital." We say, "Let's figure out a way to keep the hospital running in as safe a way as possible." We need to have the same approach when it comes to our school systems as well.

Brian Lehrer: Here's a question, I think, about preschool age children. Elizabeth in Manhattan, you're on WNYC. Hi, Elizabeth.

Elizabeth: Hello, Brian. I am fully vaccinated, my husband is, the parents of my two grandsons are, but I'm concerned about how do you interact with very, very young children? I have one grandson in Washington Heights who is two years old, and one in Sheepshead Bay that's four months old. Should I be getting tested regularly? I'm retired. I'm very very careful. I never had COVID. None of their parents had COVID. My daughter is pregnant. I just feel we're very at risk, and yet I feel, should I be burdening the testing system by anxiety-induced testing when I have no symptoms?

Brain Lehrer: That's a great question. I will say that cousins in Sheepshead Bay and Washington Heights will probably see each other about once a year, considering the distance. You're doing better than that?

Elizabeth: No, they dinner at my house.

Brian Lehrer: Oh, that's good. Dr. Varma, what advice can you give to Elizabeth, who's obviously trying to be a really good citizen and not take more tests than she needs?

Dr. Jay Varma: Elizabeth, your question is both touching as well as maddening at the same time. It's maddening because, as Council Member Levine has said, we should just not be in this situation where you should have to worry about a resource as easy as testing. At this point we had expected the federal government to really expedite the availability, make them abundant and affordable so that you would not be in that situation.

You're obviously not alone in that, because we know that gathering across multi-generation of families, even if you are as far away from each other as Sheepshead Bay and Washington Heights, is important to our health. We can never underestimate that. I think the reality is that, we're in a Darwinian time, everybody's grabbing what they can. I would never give you the individual advice to say that you should be forsaking this for somebody else, because it's unclear who's going to be the other one who's getting those tests. I would say that you should do what is in your best interest for your family. Let me try to answer that, what is in your best interest.

I think the best interest is to always plan around who are the most vulnerable members of your family and keep them as protected as possible. You mentioned one of your family members is pregnant. We know that pregnancy and this infection do not go well together. It is very high-risk for people who are pregnant. That is one person that you should be planning to keep as safe as possible. I worry that with testing, people also need to be aware that in addition to being vaccinated and using a rapid test, you really need to be using it as close to the moment that you're visiting somebody as possible, because virus levels, particularly with this strain, change very rapidly. If you're using testing because you have the kits available, do it almost immediately before you're going to visit that person.

Then on top of that, again, for the most vulnerable people, no matter how painful it is and difficult it is to do, I would really consider the use of both masks and keeping the home as well ventilated as possible, even if that means having to wear many layers of clothing.

Brian Lehrer: We're just about out of time. We have two minutes left. I want to get one quick answer from each of you. I will say also, by the way, in response to Elizabeth's reference to anxiety, that later in the show we're going to be talking about mental health and the COVID surge right now, which is of course so challenging for so many people and in so many different ways. We'll have Dr. Ashwin Vasan from the New York City-based mental health organization Fountain House, who's very focused on this. Dr. Vasan and Omicron era in mental health coming up later in the show. Council Member Levine, very briefly before you go, Mayor de Blasio just announced, our reporter Liz Kim is informing us, that he's offering a limited time $100-booster shot incentive. Now through the last day of the year, December 31st, New Yorkers can get the incentive at all city clinics and SOMOS clinics if they're getting their boosters. Do you think that's a meaningful offer, and anything else you want to say in about 30 seconds?

Mark Levine: Yes, this is great news, Brian. We are still only about 25% of adults in New York City with the booster shot, so we have a lot more boosting to do. As Dr. Varma has explained, this is our best protection. The $100-incentive for the initial course of vaccines proved to be really popular, and I think helped to boost the rates earlier on. This is outstanding news. I hope everyone who has not yet gotten their booster takes advantage of this.

I'll just close by saying that I think this is a time where all of us have to be cautious in a city where Omicron is everywhere. I hope that as you think about your winter plans, your family gatherings, your socializing, and even your work patterns, that you'll bear in mind that Omicron is out there. If you have the ability to play it safe and hunker down, now's a really good time to do that.

Brian Lehrer: Dr. Varma, President Biden will address the nation on Omicron at two o'clock this afternoon. There'll be a lot more coverage anticipating that between now and then. Briefly in 30 seconds, what do you anticipate hearing from him, and what do you want to hear from him?

Dr. Jay Varma: Let's focus, since we have little time, on what I want to hear. What I want to hear is a massive surge in rapid testing. This has to also potentially include not just buying from US-based manufacturers, but really thinking about basically buying up a supply globally and streamlining regulations to make them available. What I've seen in the news reported, 500 million test kits being purchased, is not nearly enough for a population of over 300 million people. That's number one. Number two is, we really need to increase the quality of masks that people have available to them and they use. Releasing the federal stockpile and other things to make N95 or similar types of masks available to the population.

The third is, some effort to impose vaccine verification requirements in areas where the federal government has authority. We know that this is going to be blocked in large slots of the country, but interstate commerce is something the federal government regulates, and it really needs to use its power, whether that's for trains, planes, or other activities that the federal government has the ability to regulate.

Brian Lehrer: I just have to follow up on one thing you said at the beginning of that answer, referring to US should try to obtain global supply or rapid tests, not just from US manufacturers. Isn't hoarding of vaccines by the US and other Western industrial countries a reason that Omicron was able to break out in South Africa and now come back to haunt us in the first place? Should we be doing the same thing with rapid tests?

Dr. Jay Varma: That's an important question. I don't know whether the test supply chain globally is as constrained as it is, for example, with vaccines. The other advantage to testing supplies is, these can be manufactured incredibly rapidly. It's just one of the shames that the US hasn't been able to do that. I've spent many years working in Africa and in Asia in low and middle-income countries. The same technology that you use to make COVID test is used for malaria and many other diseases. I don't think that that is going to create a longer-term crisis, but you are very important and correct to point out that vaccine inequity is one of the major reasons that we are actually in this situation today.

Brian Lehrer: Dr. Varma, Council Member Levine, thank you both so much for your time on this important day.

Mark Levine: Thank you, Brian.

Dr. Jay Varma: Thank you.

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