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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. Some New York and US COVID numbers here on the first weekday of 2022. July 1st hospitalizations in New York State, 750, October 1st, 2700, December 1st, 3,300, January 1st, 7,500. That's according to The New York Times COVID Tracker. Deaths per day, nationwide, 215 in early July, around 2,000 per day in September due to Delta. That had come down to around 1,000 deaths per day. Less, but still very high before Thanksgiving.

Now, with Omicron, it's back up to around 1,500 deaths per day. Actually, not as bad as when Delta was cresting, so far anyway, despite a record number of cases per day. 85,000 confirmed cases in New York state alone, one day this weekend, four times as many as what used to be the all-time record set just two weeks ago. There were 385,000 on New Year's Day nationwide, also a record for one day, but this is not an equal opportunity wave, not at all. The CDC says as of October, people who are unvaccinated had 10 times the risk of getting COVID, and 20 times the risk of dying from COVID as vaccinated and boosted people. 20 times the risk from being unvaccinated.

Back with us now, Dr. Leana Wen, George Washington University Professor of Public Health, Washington Post columnist, CNN medical contributor, author of the book Lifelines: A Doctor's Journey in the Fight for Public Health. In addition to the big picture, she's been commenting on what to do if you test positive, and why it's time for many people to upgrade your mask. We'll get to those things, too. Dr. Wen, thanks for making this one of your first house calls of 2022. Welcome back to WNYC.

Leana Wen: Thank you, Brian. Great to join you, and Happy New Year.

Brian: Despite the eye-popping number of cases, pure cases, would it be useful to start with a little reassurance that this is not March of 2020, if you think it's not, because the hospitalization numbers from New York, for example, are up, but it was more than twice this number when the pandemic was new, and at that time, we didn't have the vaccinated versus unvaccinated self-sorting for serious outcomes? Are these numbers that matter to understand in the moment?

Dr. Wen: Absolutely. I do think that it's very important for us to stay that we are not where we were at the beginning of the pandemic. I know in some ways, it might feel like that, when we're looking at the dramatic escalation in the number of cases, but we are seeing a decoupling between infections and severe illness, and that's thanks to the extraordinary vaccines that we have. We have many many more tools now than we did at the beginning of the pandemic. We also have a lot more knowledge about COVID and how it spread, and what are the things that we can do to keep safe.

I think part of the reason why it's so difficult to understand where we are in the pandemic now is that there's a difference between the risk to us as individuals if we are vaccinated, boosted, and generally healthy, versus the risk to society. The reason is if you are vaccinated, boosted, and generally healthy, chances are really low that you're going to become severely ill due to Omicron, but on the other hand, Omicron is really wreaking havoc on so much of society, and especially, I'm concerned about our healthcare systems being pushed to the brink and beyond. I think that is the difficult disconnect that's happening and reconciling the moment that we're in.

Brian: Right. There may be a smaller percentage of people seriously ill with Omicron because it seems to be a bit of a less virulent variant, but if there are so many more cases, then the total number of seriously ill people is still going to be higher than at some previous points in the pandemic. Do you have any more data comparing outcomes among the vaccinated and unvaccinated? I got that one stat from a few months ago from the CDC.

Dr. Wen: Yes. The data are a bit difficult to come by, and that's because everything is unfolding in real-time. I can tell you that based on what we have seen in South Africa as an example, we have seen that Omicron appears to cause less severe disease compared to previous variants, and there are some thoughts that potentially, it does not go into the lungs as much as previous variants. It's more of an upper airway illness. Also, people who have Omicron are in the hospital for a shorter period of time, they have less need for oxygen, they become less severely ill.

Then there's the other element as well, which is that so many more people, thankfully, are vaccinated compared to earlier variants. As a result, if you have something that's less virulent, and also people are much more well-protected because of vaccination, then the combination of that is this decoupling that we're seeing, but that said, I do want to go back to the point that you made, which is if we are seeing just this huge number of people getting infected, a small percentage of a huge number is still significant.

Part of what we have to recognize too, is that our hospitals were already becoming overwhelmed. They were overwhelmed, because there was not that much surge capacity to begin with, not that much extra buffer, if you will, to begin with. You have all these individuals who put off their medical care earlier in the pandemic, who are now coming in, then you had the Delta wave and what was already going on in the winter, with people being indoors, gathering, spreading COVID to one another, and then you have on top of that, Omicron. There was so little margin for error. Then even if you have a less virulent variant, that's really causing major problems for our healthcare system.

Brian: Right. There are hospitals in New York and elsewhere now restricting elective surgery. I heard of one case a few weeks ago where somebody was on their way to an emergency room, in an ambulance, and the emergency room that they were going to go to said there was no room, and they deflected them to another hospital, not the one they originally headed to. These are the kinds of outcomes that become threatening to people, right?

Dr. Wen: That's exactly right. It's not just affecting patients who are coming in for COVID. You talked about elective surgeries, a lot of these surgeries are not truly elective. If you have cancer, and you want to get the tumor out, I don't think a lot of people would perceive that to be elective, or if you have really terrible back pain, and this is what's going to help you get your life back on track, and you're now postponing your surgery indefinitely. That's a big problem.

Then I think there's the issue that you mentioned, of what's going on with our emergency departments, because hospitals are understaffed, and so many people are now out because of COVID. There aren't enough beds in ICUs, and not enough ability to care for patients in hospital beds. As a result, the emergency departments are totally filled with patients who should be admitted but there's no room in the hospital. That's then causing a major backup, and so many patients are waiting, many hours to be seen. Many of them are leaving without being seen.

Also, this is not just affecting care for patients with COVID but for anything. Maybe you're coming in with abdominal pain. You wonder if you have appendicitis. Well, you could be waiting 15 hours, in some cases, for a CT scan. This is what we would normally consider to be unacceptable quality of care, but that's what's happening around the country because of this overwhelmed medical system.

Brian: Now, you had written a Washington Post column before Christmas, saying vaccinated people should not cancel their holiday plans. Does that still make sense to you in hindsight?

Dr. Wen: I have been a proponent for months, really ever since the vaccines were made widespread, that once people are vaccinated, that we, as a society, should not be putting restrictions on vaccinated individuals. Now, some vaccinated people, of course, people are going to make very different decisions. If you're vaccinated and boosted, but you're living at home with somebody who is severely immunocompromised, or if you have underlying medical conditions, or unvaccinated younger children, you may still wish to be very careful.

I've laid that out in the article that you should still be making the best choice for your medical circumstance, but my point was then, if we as a society, were to put restrictions on the vaccinated, it's not going to go very far. As in, the unvaccinated are still the ones who are, by and large, ending up in hospitals. Maryland hospitals, for example, 75% of those in the hospital for COVID care are unvaccinated.

If you put restrictions on the vaccinated, that's not going to do very much when it comes to reducing our hospital, how overwhelmed our hospitals are. I think it will also be a serious disincentive to people for vaccination. All I'm saying is that we, as a society, should not be making vaccinated people pay the price even more. That vaccinated people have done a lot and have done all the right things. I think there is a sense of weariness among those who have made tremendous sacrifices and are saying, "Look, it's not our fault that we are Here where we are." Really, if you want to restrict the activities of anyone, it should be the unvaccinated

Brian: Listeners, we can take some COVID questions, Omicron questions for Dr. Leana Wen. We're going to get into a few of the very practical things, having to do with her new recommendations about masks, starting to change around the country, regarding what types of masks people should be wearing. Also, because so many people are being diagnosed or testing positive, whether or not they're actually sick. What should you do after you get a positive COVID test, maybe at home? 212-433-WNYC, 212-433-9692, for Dr. Leana Wen or tweet a question @BrianLehrer.

Dr. Wen, a CNN article you were quoted in says, a cloth mask has 75% inward and outward leakage. Does that mean only 25% of potential COVID droplets get blocked by a cloth mask? Is that why we're talking about upgrading people's masks now?

Dr. Wen: Frankly, we should have upgraded masks a year ago or more. We have known for quite some time now that COVID is airborne. A cloth mask might protect you if we're concerned about droplets, as in the droplets that you see when somebody's coughing and sneezing, but we now know of so many cases, and the majority of cases, in fact, are COVID transmission through these microscopic aerosols that you exhale when you are breathing and talking, and the cloth mask just is not very effective in stopping airborne transmission.

Now, I understand at the beginning of the pandemic, when we didn't have surgical masks, when N95s, KN95s were in such limited supply, that we had to save them for healthcare workers, but that has not been the case. You look at, for example, Germany, Austria, other countries, that had made it such that you cannot be wearing a cloth mask out in public. As in, you are not considered to be wearing a mask, you're not meeting the standard for wearing a mask if you're only wearing a cloth mask, because it's not protecting you as it should be, and it's not protecting others from you.

I think it's time for us to acknowledge that here in the US as well. Say that sure, a cloth mask is better than nothing, but we really need to up our mask game. People should be wearing at least a three-ply surgical mask, but if you are in crowded settings and I get so worried. I see patients at the hospital. I see people walking around in crowded train stations who are only wearing a single, simple cloth mask. They think they are protected, but they are not.

The government should be doing a lot more in two things. First, in requiring at least a three-ply surgical mask as what is mandatory when they say masking, and also in making freely available, high-quality masks. Other countries are doing this. There are a lot of states and jurisdictions that are starting to hand out KN95s and N95s that should really be the norm going forward.

Brian: That article about masks also emphasizes masks that are well-fitting. I saw a product online for a fit testing kit, but it was hundreds of dollars, so how do we know at home if our surgical masks, if our N95s, KN95s are fitting well?

Dr. Wen: It's a good question. Fit matters a lot. Filtration and what kind of particles are filtered through also matters, but the fit is really important because let's say that you're wearing a surgical mask, and we've all seen people do this, that's dangling below people's noses and their entire nose is exposed. Obviously, that's not really doing very much. I would use a rule of thumb. In the healthcare setting, we actually have formal fit testing. You mentioned this fit testing kit, but I would just look and see. If you see big gaping holes, obviously not fitting very well.

Also, if the mask has been reused so many times that it's damp and cling to your face, also, probably not going to be very effective, or if you put it inside your purse as I have and it's bent out of shape and no longer conforms to your face, probably, it's time to to use a different mask. Something that you could do with a surgical mask, one thing that I do is I get little rubber bands, and because I have a smaller face, I tie the rubber bands around the ear holes to try to make it a bit tighter.

I've also seen people use hairpins and hairclips to be able to clip it into their hair for a tighter fit. Also, wearing a cloth mask that's really well fitting with elastic over a surgical mask can also be of help, but I would just use common sense to see how well does it fit around your face.

Brian: Here's a masking question from Jane in Chelsea. Jane, you're on WNYC with Dr. Leana Wen. Hi.

Jane: Good day. Yes, I have two questions. The masking question is I can't get myself an N95. I'm having problems with that. I have my cloth mask, but I do have those plastic shields that go around your forehead, and then hang down over your face down below your chin. Would that work as well? That's number one. Number two is a booster shot question. I got my Moderna booster, but I read that the Moderna booster, they did some tests and of course, my booster was 50%, but Moderna came out and said, a 100% booster gives you a good 10% more protection. Should I go back and get another 50% booster?

Dr. Wen: I see, so let me answer your two questions separately. First, with regard to masks. If you have a plastic shield on top of your cloth mask, that does provide an additional level of protection, because it does separate a bit more and disrupts the potentially the airflow of particles that others are maybe spewing towards you. However, the plastic shield is open at the bottom. I still think then you should try to get a surgical mask, but people who do not have access for any, for some reason, there are a lot of places that require masks.

For example, if you walk into a hospital, walk into a train station, or many businesses that require masks, they might be able to just give you a mask, and you can wear that surgical mask. They'll always, in all cases-- almost all cases, there should be a surgical mask and then you can put the surgical mask on, and then the cloth mask on top of that. That would be better than a cloth mask and a shield.

Now, with regard to the booster, the booster dose for Moderna is 50% of the dose of the initial 2 shots, I think that's what you're referring to. The first 2 shots of Moderna, 100 micrograms, the booster dose is 50 micrograms. The booster dose is is effective. This is what is approved by the FDA and CDC, so I would not recommend that you go back for a fourth Moderna dose at this time. What we understand is that people who are vaccinated and boosted are very well-protected against severe illness. They are pretty well-protected against symptomatic infection, although because of the level of virus around us, certainly breakthrough infections can still happen.

Brian: Just to finish the cloth mask discussion. There are cloth masks and there are cloth masks, or maybe we're past that point and all cloth masks we should now think of as the same, but there are cloth masks that have been made with various kind of lab testing at the beginning of the pandemic that have layers, or that you could put a filter in like a polypropylene filter, I think some of them are made of, and that were said at the beginning to be pretty good and start to approach what we think of as medical grade masks. Should we say there are cloth masks and there are cloth masks or not?

Dr. Wen: I think that's a very fair point. I don't mean to imply that all cloth masks are the same. Certainly, if there is somebody, for example, a younger child, who is only able to wear a cloth mask and just will not keep a surgical mask on, or N95 mask on during school, a cloth mask is better than nothing, and a cloth mask that's multiple layers is going to be better than a cloth mask that's single layer, the ones with filters, again depends right on the type of a mask, but could also be more effective than a simple cloth mask, too.

Again, my concern is the number of people I see, whether it's my patients with underlying medical illnesses, or just people that I see walking around in crowded settings who are wearing just a one layer fabric mask in the time of Omicron, that is not enough.

Brian: Carol in Bergen County, you're on WNYC with Dr. Leana Wen. Hi, Carol.

Carol: Hi, good morning. Thank you for taking my call. I just have several questions. One, is why are we no longer talking about herd immunity? Also, regarding the mask, it was initially said that the N95 were the most effective against airborne pathogens, and that's why the government took over the sale of them and restricted them to only medical use.

Then also, all this COVID testing that we're doing, it's not checking for all of these variants that are coming out. All these "COVID cases" that are coming out, how do we know that they are from COVID, or from Delta, or Omicron, because of testing for these viruses has not changed?

Brian: Carol, thank you very much. Three questions there. I think you answered the masking one already. The reason people said at the beginning not to use surgical masks and N95s was because they were in short supply for the healthcare workers who most desperately needed them, but she's got two other interesting questions on the table. The first one, why aren't we at herd immunity yet with so many people vaccinated plus so many people having gotten it?

Dr. Wen: I think we should be having conversations about herd immunity. I agree with the caller about this. In fact, we are seeing the impact of vaccination, depending on where we are in the country and the world, that the parts of the country, including in New York City, with very high rates of vaccinated people, you are seeing that decoupling between cases and hospitalization. Unfortunately, we are still seeing such a high rate of cases that we are seeing an increase in hospitalization, but it's nowhere near what we were seeing back in March with so many more people becoming ill.

I will also add that the herd immunity concept also applies in much smaller settings. As an example, all children under the age of five have not been able to get the vaccine. I have two of those myself, and we really worry about our younger kids. The best way to protect those younger children who are not able to be vaccinated is this concept of herd immunity, meaning that if you surround those children, in all settings, at home, at school, and so forth with other people who are fully vaccinated, that helps to reduce the risk for those children. Herd immunity is something we should talk about on a population level, as well as at a community level, and at family level as well.

Then with regard to her question about variants, when you get ill yourself, typically, you don't find out if what you got was Omicron, or Delta, or some other variant. What the CDC is doing is sequencing, or their labs around the country, but the CDC is collecting information on, as a whole, what are the percentage of cases that are due to Omicron versus Delta, but we as individuals, are not really finding out if we got COVID, was that due to Omicron?

Brian: Is it possible that Omicron will turn out to be our path out of the pandemic because COVID is mutating toward being more infectious but less serious?

Dr. Wen: That is one theory and I hope that it's correct. I hope that whatever variant comes next will be even less virulent, and cause less severe disease. The thing is, though, there's no way for us to predict that that's going to be the case. For us to put all of our strategy into something that's really a wishful thinking isn't a good idea, but I hope that you're right, Brian.

Brian: Would the best strategy to avoid some of those unknowns with new variants be to focus more than we have, we being the whole world, on vaccinating under-vaccinated countries, the people in those countries? Because we see where Omicron emerged from, presuming it was actually South Africa, a place that doesn't have nearly the vaccination rate as the wealthier industrialized countries.

Dr. Wen: That's a good question. Overall, sure, the answer is yes, that we need to focus on vaccinating the world because it's the ethical thing to do, and also because we want to reduce the chance of new variants arising. Although, I do also want to point out that, as you said, we don't know that Omicron came out of South Africa. There are some speculation that maybe they were travelers from Europe who went to Southern Africa, so we don't know that that's the case either, but I think the other point is we have a problem right here in the US.

There are many communities with well less than 50% of the population who are vaccinated, and new variants could very well arise there. I hope that the Biden administration, for example, will do a lot more when it comes to compelling the unvaccinated, because they are the ones in this country where we have ample vaccine, who are prolonging the pandemic, and making the societal situation of overwhelmed healthcare system a problem for all of us.

Brian: Meryl in Port Washington, you're on WNYC with Dr. Leana Wen. Hi, Meryl.

Meryl: Hi. My question is for my son we have to test to go back to school tomorrow, but I asked him to wear, at least for a week, the KN95 mask, and he really doesn't want to, because he says it hurts around his ears. A lot of the boys wear the Under Armour mask. I just bought a bunch of new ones but my anxiety about it is pretty great. I don't know if I should force him, or just let him wear the mask at least that we know he'll wear that?

Brian: Can I ask you one quick factual follow-up question first?

Meryl: Yes.

Brian: You said your 14-year-old doesn't like to wear the KN95s because they're tight around the ears. Were you giving him ones with ear loops or with straps that go-- Yes, so with ear hoops?

Meryl: No, he hates the headband style.

Brian: Oh, even worse.

Meryl: That's even more annoying, even worse. Ear hoops.

Brian: Dr. Wen, the teenage dilemma.

Dr. Wen: Right. I don't know if your child is vaccinated. Obviously, if your child is vaccinated, that adds a very important additional layer of protection. I would say you should have your child wear whatever mask they can consistently wear for the period of time that they need. Ideally, of course, they're wearing the KN95 mask but if he just will not wear it, I'd rather that he wears a mask that he can put on consistently, and have it on the whole time that he's indoors.

Brian: Do you have a guideline for trusting KN95 masks that you find online as well as N95? They're both supposed to be at the 95 standard, which is to say it blocks 95% of the particles, if particles is the right word, that could potentially reach you. The US standard is called N95. The China standard is called KN95, supposed to be the same thing, but I've read that a majority of KN95s that you find for sale are counterfeit, which means you can't trust their quality. Do you have any guidance regarding that?

Dr. Wen: I do. It is very important to make sure that they are NIOSH certified. I'll give you a few resources about this. The New York Times Wirecutter has a very good guide to masks and where you can buy these certified KN95s and N95s. Washington Post has a guide to identifying counterfeit masks and how you can make sure that what you're buying isn't a counterfeit. NBC News did a guide several months ago on where you can find KN95s for younger children. That's actually where I got a KN95 for my four-year-old, which he does not wear, he does not like wearing but he tolerates very well a surgical mask with a cloth mask on top. We do have him wear the KN95 if we're going to be in a particularly crowded indoor setting.

Brian: A listener writes, "I ordered KN95 and surgical masks from the site which was overwhelmingly from lots of choice and little info. I assume the KN95s are good." I guess you just answered that one. A listener writes, "Any guidance for preschools? Should we not do in-person or limit contact beyond school? Thanks.", asks that parent, and I'll throw in one other parenting question. You probably saw the news this morning that the FDA has just authorized the booster for 12 to 15-year-olds.

Talk about preschool. In our area in New York, I know you're in the DC area. In our area in New York, New York City public schools are open. Yonkers, Mount Vernon, Jersey City, Newark schools are closed this week. Do you have a recommendation? I'm giving you three questions at once here, so take the open and closed schools first, with the question about whether that parent should send their preschooler.

Dr. Wen: I strongly believe that schools should be open at this point. We know what it takes to keep our schools open safely. We also have seen the tremendous harm that school closures have done for our children and we should be implementing the safety measures including masking in our schools. We can do this, and especially now that children five and older are eligible for the vaccine, there's really no reason for us to have schools closed at all, unless there are really substantial outbreaks in schools.

Schools can actually be some of the safest places for children when it comes to COVID-19 transmission. Mainly because if kids are not at school, it's not like they're going to be hunkering down at home. They're going to have other caregivers, maybe they'll be hanging out with their friends. There'll be much higher likelihood of transmission in these other settings, so schools should be open.

I am sending my son back to preschool. I'm here in the Baltimore area, where there's also very high case counts as there is in New York City, but I feel very competent about doing that, because our school has such a strong safety protocols in place. With regard to the FDA news that 12 to 15-year-olds are now able to get boosters. The CDC is expected to sign off shortly on this but once that's done, I think that gives a lot of relief for parents of teens who may have gotten vaccinated or may be coming up to that six month mark.

Brian: We have one minute left for these hundreds of thousands of Americans per day right now, who are testing positive, and many of them, surprising even themselves, if they're just taking an at-home test as a precaution before going into a group or something like that and, "Whoa, I'm positive." What's the first thing they should do?

Dr. Wen: If you test positive, the first thing you should do is to isolate from others around you. If you are at work and you're taking that test, please go home and put a mask on, and go home. If you tested positive and you're at home, and you live with others, isolate yourself immediately from other members of your family. They should also be tested too, but right now, your most important thing is to make sure that you are not inadvertently infecting others around you.

Brian: Different for vaxxed or unvaxxed who test positive?

Dr. Wen: The chance of you becoming severely ill is certainly a lot higher if you are unvaccinated versus if you're vaccinated, but we know that vaccinated people can still transmit to others as well, and so there is no difference when it comes to what your immediate action should be, which is again, none of us would want to be infecting others around us.

Brian: Dr. Leana Wen, George Washington University Professor of Public Health, Washington Post columnist, CNN medical contributor, and author of the book Lifelines: A Doctor's Journey in the Fight for Public Health. Dr. Wen, always appreciate it. Happy New Year.

Dr. Wen: Thank you. To you, too, Brian.

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