[music]

Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. I thought I would share some COVID numbers with Omicron now the dominant US variant, and then we'll bring on virologist Dr. Angela Rasmussen. I think I can do a little math on the radio here that you'll be able to follow and might appreciate hearing. These are New York State numbers according to The New York Times COVID Tracker.

We can say New Jersey and Connecticut are following roughly similar patterns. In New York State on Thanksgiving Day, November 25th, the day we first heard of Omicron in the US, and exactly a month before Christmas, November 25th, there were approximately 2800 people hospitalized with COVID in New York State.

On Christmas Day one month later, it was around 5,200-- 2800 up to 5200, hospitalized in New York almost double in this one month of Omicron which appears to be just getting started. That's hospitalizations, let's keep going. On November 25th, Thanksgiving Day, 24 people died with COVID. In New York State, according to the Times, it was up to 83 people on December 23rd, the last day of reporting before Christmas.

The number of deaths per day has approximately tripled in the last month. Again, these numbers from The New York Times COVID Tracker. One more, the number of tests per day in New York State is up 42%. The number of cases is up 165%. In other words, there aren't more cases being known just because more people get tested or got tested for the holidays, the rate of those testing positive increased by four times the rate of those just getting tested at all. 42% jump in tests, 165% jump in cases.

Now, when we last did a live show on Wednesday, we were marveling at the record number of daily cases being reported in New York State around 22,000 per day, that was a record. Then it doubled again over the weekend to around 44,000.

Today, they're saying 54,000 new cases yesterday in New York State and it's so widespread that on Friday, Governor Hochul, as we mentioned earlier in the show, reduced the number of days that healthcare and other essential workers need to quarantine after a positive test from 10 days down to just five days because of fears of all kinds of staff shortages.

They do need a negative test and be fever free for 72 hours as I understand it. The nurses union is objecting to the quick return policy on what they say is safety grounds, but it's also safety to have enough people working in the hospitals. Again, we may just be at the beginning of Omicron so we don't know what the beginning of 2022 will bring for all these numbers.

With us now is Dr. Angela Rasmussen, virologist with the Vaccine and Infectious Disease Organization at the University of Saskatchewan in Canada. Previously with the Mailman School of Public Health at Columbia here in New York, where she also studied. In her career, she's been studying viruses ranging from the common cold to Ebola to COVID, and has been a frequent guest here and elsewhere explaining the science throughout the pandemic.

By the way, I read that she decided to cancel her own Christmas plans last week out of caution because of an unvaccinated young child in her family. Dr. Rasmussen, we always appreciate when you come on with us. Welcome back to WNYC.

Dr. Angela Rasmussen: Thanks so much for having me back, Brian.

Brian Lehrer: I read about you in the Toronto Globe and Mail last week so I guess you're public about it and I hope it was accurate. Would you mind describing your own decision making process in the context of how you're perceiving the uniqueness of the Omicron moment?

Dr. Angela Rasmussen: Absolutely. I have been very public about it just because like everybody else, I think out there, it's been a day to day situation as far as what we were going to do as a family for the holidays. My husband went back to the US about a week before I did so that he could spend a little extra time with his sons and actually go to a Kraken game because we have season tickets and he'd never been to a game yet.

He went there and then over the course of that week, the situation in Canada, in the US, basically everywhere was such that we were seeing case numbers and case trajectories that were basically a straight line going upward.

I just really felt that as much as I wanted to see my family over the holidays, the risk was just too much to assume given that we do have a young niece who is two years old and is not eligible yet for vaccination and would be there, not to mention just the risk that it poses to the community at large. The one thing about Omicron that is really striking to me is that it does seem extremely transmissible including to people who've been vaccinated and boosted.

Now, I've had three doses of vaccine, as has everybody in my family but the risk of passing Omicron on to somebody who hasn't either been vaccinated or who is not as responsive to the vaccine is something that I really did not want to live with.

Brian Lehrer: It really is an indication of how transmissible omicron is, as you say, and as one of our previous guests said this morning, suddenly, we all seem to know lots of people who have COVID, even people who've been careful in the past, and just it's exploding everywhere around us. Before this recent surge within the Omicron, there was still plenty of Delta variant around, and you still would have been with your three-year-old niece and risk the quarantine, so why didn't that already dissuade you? Is Omicron that different?

Dr. Angela Rasmussen: Yes. That's really what did dissuade me. The Delta variant does cause more breakthrough infections and there were and still are Delta surges occurring in many places. Delta is more likely to put you in the hospital, but in general, people who have Delta who are immunized are less likely to go to the hospital. What we're seeing in terms of the severity of Delta and the likelihood of getting infected with Delta is that the vaccines do offer significant protection, especially with a booster.

That's not the case for Omicron. The vaccines are still apparently-- and I'm cautiously optimistic about this, and I have a feeling you're going to ask me about it. The vaccines do seem to be holding up against Omicron in terms of preventing severe illness in people who are vaccinated, and especially in people who are boosted. That was definitely the case with Delta.

I felt with Delta that my booster shot combined with being rigorous about mask wearing, especially while traveling, using rapid tests, all of those above measures would really substantially mitigate the risk of me getting a potential Delta breakthrough infection. I just don't feel that those can adequately mitigate the risk to the same degree of getting Omicron. Now, I want to be really, really clear, though, I'm not worried about getting Omicron and getting COVID and ending up in the ICU.

I do feel that my vaccination provides me with significant protection and that is what the data is starting to show us. Again, I'm cautiously optimistic about that. I was definitely a lot more worried about potentially transmitting it on to somebody who doesn't have that same protection that I do, including my young niece. Now, unfortunately, in many places where there are large Omicron surges, we are starting to see increases in pediatric hospitalizations of largely unvaccinated children, including children under the age of five.

It does suggest that people who haven't had a booster shot, people who haven't been vaccinated are, again, at the highest risk of developing severe COVID-19 from Omicron. Even though that's not a risk I particularly worry about for myself as an individual, it is a risk that I worry about collectively for the community that I'm a part of.

Brian Lehrer: That was a very clear explanation and I know a lot of people must appreciate it. Listeners, we can take a few phone calls or questions via Twitter for Dr. Angela Rasmussen, 212-433-WNYC, 212-433-9692 or tweet @BrianLehrer. Do you know yet how the Omicron variant is more contagious in terms of how it acts in our personal environments? In other words, we've been told with past variants, you need to be exposed with close contact, probably for 10 minutes.

We've been told the aerosols will settle out of your breathing zone in a room where an infected person had been within a few minutes to a few hours after they leave the room depending on ventilation and time spent and other variables.

Are those periods now different? Does 30 seconds of close contact now put you at risk for Omicron when it didn't before? Is it going to linger in an elevator or a bathroom longer? Do we know things like this?

Dr. Angela Rasmussen: We don't actually know things like that to a very granular degree unfortunately, and this is one of I think the big mysteries of Omicron that myself and many of my colleagues are currently working on. We don't really know the mechanism by which Omicron is more contagious and transmissible. In terms of the aerosols lingering in a room, the aerosols are actually little droplets of fluid that you exhale when you breathe or when you speak. That's physics essentially. Those aerosols aren't going to be lingering for a longer period of time.

The question from a virological standpoint is how long are those aerosols going to be containing an infectious virus? I think right now, there's a lot of different possibilities on the table that could explain this. It's possible certainly that the virus might be more stable in the environment, it can hang around for a longer period of time either in the air, or potentially on surfaces, although that's not thought to be a major driver of COVID transmission.

It's certainly possible too that you could be shedding more virus. The virus could be what's called more fit, meaning it replicates better. It could be more infective, which means that it's more likely to get inside a cell and cause an infection. Right now, those things are being looked at. Now, it's clear that it is a little bit different from Delta. In the lab, Omicron doesn't grow as well in cell culture, which doesn't necessarily translate to the real world and how a virus is going to behave when it's actually infecting people.

It doesn't replicate as well. People have had a tough time growing it. Interestingly, it doesn't appear to be as fusogenic as Delta, which fusion is a part of the viral infection process, that's absolutely critical for a virus to spread. Omicron does seem to have some defects as far as that's concerned. That's a bit of a mystery considering that it is clearly in the real world much more transmissible.

There's a lot of questions that we still really need to answer and I assure you that my colleagues and I are hard at work on that.

Brian Lehrer: Carolyn in Westchester, you're on WNYC with Dr. Angela Rasmussen. Hi, Carolyn.

Carolyn: Hi, Brian. This is my second Coronavirus call to you. I'm trying to find out the difference between the molecular tests. There was just a rapid test offered at my urgent care, versus the antigen test that's offered in the at-home testing.

Dr. Angela Rasmussen: That's a fantastic question. I know a lot of people, as tests have become more available to do it yourself, people have had these questions. What's really the difference? The basic difference between these types of tests and there are different kinds of molecular tests as well, so that makes it a little more confusing, but it's really what they're detecting.

The molecular tests detect the genome of the virus, that viral RNA that basically is the set of instructions that SARS Coronavirus uses to do everything it's going to do. It's the equivalent of our DNA genome. It's just the virus' genome which is made of RNA. The molecular tests are detecting that.

For that reason, they're more sensitive because most of the time, molecular tests that look for that viral RNA go through a period of amplification where they can find a little bit of that RNA, then amplify it to a detectable level to make sure that the test can find even a very, very low level infection. The rapid antigen tests look for the antigen, which is the protein actually that the virus is making when you're infected with it.

Those rapid antigen tests are looking not for the spike protein, which a lot of us have heard about because of the vaccines, but for the nucleocapsid protein or the N-protein, which is a protein that the virus makes to complex with its genome, to help stabilize the genome in the virus particle. There's a lot of N-protein that gets made when you're infected with SARS Coronavirus 2, and that's what the rapid antigen tests are detecting.

Brian Lehrer: Bottom line, is one better than the other?

Dr. Angela Rasmussen: They're different. They have really different uses. The molecular test, for sure, is more sensitive. You can detect a very low level infection and sometimes this can lead to some confusion because after people recover from SARS Coronavirus 2, they're no longer capable of transmitting the virus, but they do have viral RNA that's still present. People can test positive for weeks or sometimes even months after recovering from infection.

It doesn't mean that there actually a transmission risk. For that, in that sense, a more sensitive molecular test is actually not necessarily a good thing because it could keep somebody potentially in isolation for a lot longer than they should be when they don't pose a risk to the public. The rapid antigen tests will detect somebody who's shedding a lot of virus, who's actively infected, making a lot of that N-protein that I mentioned, but they are less sensitive.

If you're early on in the course of your infection, you're not producing that much N-antigen yet. It's possible that the rapid antigen test won't be sensitive enough to pick up the infection. Both of them have their advantages and their disadvantages. I think the bottom line, to me, is that whatever type of tests you're able to access, we need to have more testing around the board.

We need to have access to molecular testing to confirm diagnoses and also for reporting purposes, for travel purposes. We also need to have an easily accessible rapid antigen tests so people can really use those to get a snapshot of where they are at on any particular day. If you test positive on a rapid antigen test, the chances are that you are shedding sufficient virus to potentially transmit that onto others. That's real time actionable information that I think is really good for people to have.

Brian Lehrer: Here's another testing question, I think, from Brandon in the Bronx. You're on WNYC. Hi, Brandon.

Brandon: Hi, thanks so much for taking the call. I'm wondering-- and it's possible you answered this while I was calling in. Is Omicron being captured on the rapid tests and at what point in the course of the physical symptoms? I have a three-and-a-half-year-old who's had a bad cold for many days now and he's tested negative several times and we're wondering if we should have to get him PCR tested?

Dr. Angela Rasmussen: Yes, this is a great question, this is something I've been hearing about a lot too. This is the disadvantage of these rapid antigen tests, is that sometimes people tend to make virus almost in fits and spurts. Some people might test positive on a rapid antigen test, weakly positive, and then test negative. Some people may have a confirmed PCR case of COVID and still test negative on the rapid antigen test.

Again, they're not perfect. They can give you a snapshot but you shouldn't rely exclusively on them. Now, I think that so far, anyways, what we've heard and this is something that's developing all the time, we've heard from the FDA that some of the most commonly used rapid tests, specifically the Abbott test, and I believe the QuickVue test do work to detect Omicron.

As I mentioned before, the rapid antigen test for the N-antigen or the nucleocapsid protein, that doesn't have as many mutations as the spike protein in Omicron. It is likely that the rapid antigen tests from any manufacturer will continue to detect Omicron. Again, the rapid antigen tests are limited by their lower sensitivity compared to PCR tests. If your son is symptomatic, and you suspect that he has COVID, I think it's worth seeking out a PCR test if you can get one in a way that's not going to be a giant ordeal.

I know people have been waiting a long, long time for molecular tests in some cases. I think that it is wise to go ahead and try to confirm with PCR if you're still getting negatives on the rapid antigen test and you do suspect that you have COVID-19 or somebody in your family does.

Brian Lehrer: Brandon, I hope that's helpful for you and your three-year-old. How does that answer that you just gave relate to the policy that we mentioned earlier in the show, that just came down from Governor Hochul on Friday? She reduced the quarantine period or isolation period for healthcare workers and other essential workers who test positive for COVID from 10 days down to five days after the first positive test because of fears of healthcare worker staff shortages in hospitals and shortages in other critical industries.

From what I've read, those include food processing and taxi fleets, so all kinds of things, not just healthcare workers in hospitals. I see they would have to test negative and have been symptom-free or at least only what they call mild symptoms with no fever for 72 hours. That would be, I guess, in addition to that negative test. Do you think five days is safe for those they're coming in contact with in hospitals or in taxi cabs or anywhere else?

Dr. Angela Rasmussen: Yes. Brian, this is one of those situations in which I just thank my lucky stars I decided not to go into politics and have to make these very, very difficult policy decisions. I think that probably Governor Hochul herself and all of her advisers acknowledge that this is really not what they would be doing if it weren't an urgent situation. In this, you really do have to balance the need to have continued staffing in your hospitals when you're staring down basically an encroaching huge potential wave of patients.

You can't have nobody working in the hospitals. Those healthcare workers are at the end of their ropes. They're burnt out. They've been through an absolute crucible of two years, and now they're getting sick themselves because they are at higher risk working in these hospitals where all these patients with COVID are coming seeking care. I think it's a really difficult decision to have to make, but the issue with Omicron that everybody's been afraid of, myself included, all of my colleagues, is not so much that Omicron is going to be the worst variant yet in terms of its virulence.

People are worried about the sheer number of patients that might potentially be seeking care all at the same time as a bunch of healthcare workers are all having to leave work because they've tested positive for COVID. Now, in ideal situations, there would be an endless supply of healthcare workers who would be ready to step up and replace those people who have to go into isolation for the full time period but that's not the situation, unfortunately, that we're looking at.

I think that that decision was the best probably that they could do under the circumstances. Now, again, is it ideal? Is it something that I think is safe? There's really no such thing as safe. Is it safer? It's basically intended to prevent the healthcare system from and becoming overwhelmed, which would be associated with potentially much more severe mortality. I think that it's not a decision that I'm like, "Great job, guys. I think that this is an awesome thing and we should do this all the time."

I think that it's really making the best that you can do under very, very difficult circumstances.

Brian Lehrer: The kind decision that we've been hoping that no policymaker had to make since the beginning of the pandemic. Remember at the beginning when we thought there was going to be a shortage of ventilators and they were going to have to literally be deciding who lives, who dies on a case by case basis, and that did not come to pass. This is another one of those really morally and ethically challenging sets of circumstances and unfortunately this time, we're really there.

Hannah, in Brooklyn, you're on WNYC with Dr. Angela Rasmussen. Hi Hannah?

Hannah: Hi, thank you for taking My call. I have a question about how to explain the importance of the boosters to people given that there's more and more evidence of monoclonal antibodies not working. My understanding is that there's more of an oligoclonal or polyclonal response to the vaccines that makes the antibodies you develop less specific to the old variants. That maybe there's some dosage effect, but I've been asked this question a few times and I wondered if you had any insights.

Brian Lehrer: It is so interesting as people who-

Dr. Angela Rasmussen: Yes, Hannah I missed part of your question. I didn't hear it, could you repeat?

Brian Lehrer: It's basically-

Dr. Angela Rasmussen: Are you asking why are vaccines superior in the sense that they elicit polyclonal immunity versus the monoclonal antibody treatments?

Brian Lehrer: Yes, I think she's asking if that's the reason, because we have these two situations where doctors or pharmacists in the case of the shots, or whoever gives us the shots are introducing antibodies into our systems. The ones from the vaccine seem to be pretty effective against Omicron, at least in terms of severe disease. The monoclonal antibodies we've been hearing in the news, this miracle cure for many people, not as effective as they've been against other variants.

Dr. Angela Rasmussen: Yes, absolutely. This is a really important question, and I'm really glad that Hannah brought this up. The monoclonal antibody treatments are based on antibodies that are mounted as part of a normal immune response to COVID 19. They're basically looking at one little part of the spike protein that is known to be good for what's called neutralization or essentially rendering the virus non-infectious.

These monoclonal antibodies have been developed. They've been used as cocktails because they're essentially individual antiviral drugs and in cocktail form, they can be very effective against some of the older variants. However, as Hannah pointed out, Omicron contains mutations where a lot of those monoclonal antibodies are targeting the spike protein. Which means that they're not likely to work anymore.

In fact, there's only one monoclonal antibody currently on the market, the monoclonal antibody product made by GSK and Vir Biotechnologies that is thought to be effective against Omicron. Now, this is where I pitch vaccines because of really the miracle of your immune system.

While these monoclonal antibodies are-- the name implies that they're monoclonal, they target only one part of the spike protein, your immune system mounts this incredibly diverse, incredibly robust response to many different parts of the spike protein when you're vaccinated against SARS Coronavirus 2. The beauty of that, monoclonal antibody treatment is really called passive immunization because you're giving antibodies from outside to the person who's sick.

When you're vaccinated, that's really immunization. That is your immune system making the antibodies itself and the beauty of your immune system is that it can actually move on its feet. It can see new variants that you're exposed to, if you get a breakthrough infection, it will basically alter the antibodies that it's making. These antibody responses are what's called polyclonal meaning there are many different antibodies being made, but it can actually improve those antibodies and make them better.

The immune response can actually evolve along with new variants that you're being exposed to. If given my choice, certainly if I'm in the hospital with COVID, I'll take whatever treatment I can get and hope that it works, but I'm very, very privileged to rely on my own immune system to produce this polyclonal response that even if I get a breakthrough with Omicron, it will effectively be training my immune system to be even better at dealing with SARS Coronavirus 2 really in a trial by fire in a breakthrough infection.

Again, the data with Omicron is very grim in terms of the case numbers, in terms of increases in children who are going to the hospital, things like that, but one place where the numbers are not as grim is that Omicron really does not seem to be sending vaccinated people who get breakthrough infections to the hospital in huge numbers.

I like to think that this is because of this polyclonal immune response that is really adaptable and able to completely clear Omicron and leave your state of immunity even better than it was before. Now, granted, this only applies though to people who have either had prior infection or who are vaccinated.

Because your immune system is wonderful, if you haven't ever seen SARS Coronavirus 2 before, if your immune system is completely inexperienced with it when it first encounters it, it will take some time to develop these really remarkable responses. That's why I encourage everybody whether you've had COVID or not to go out and get vaccinated or boosted, if you haven't already, because the more advanced education we can give our immune systems prior to an exposure, the better off we're going to be in the long run.

Brian Lehrer: Angela Rasmussen, virologist with the Vaccine and Infectious Disease Organization at the University of Saskatchewan in Canada. Thank you so much for so much great information today. We really appreciate it, and we appreciate your time.

Dr. Angela Rasmussen: Thank you so much, Brian, and happy new year. Stay safe and healthy.

Copyright © 2021 New York Public Radio. All rights reserved. Visit our website terms of use at www.wnyc.org for further information.

New York Public Radio transcripts are created on a rush deadline, often by contractors. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of New York Public Radio’s programming is the audio record.