[music]

Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. We'll hear now from Atlantic Magazine science writer Katherine Wu whose sophisticated reporting on COVID continues to contextualize so many complicated twists and turns in this pandemic. One of her recent articles is about how to make sense of the baffling array of changing COVID guidelines. It's called America's COVID Rules are a Dumpster Fire. Another is about how much immunity Omicron gives you with the headline Should I Just Get Omicron Over With? That's about having Omicron parties to get sick on purpose because it's a relatively, relatively mild variant.

With me now is Katherine Wu, science reporter for The Atlantic. She previously was a science writer for the New York Times, some of you might know. She completed her PhD in Microbiology and Immunobiology at Harvard in 2018. A lot harder path to journalism than a J-School degree. Hi, Katherine. Welcome back to WNYC. So great to have you with us again.

Katherine Wu: Good to be here. Thanks so much for having me.

Brian: Let's just go right to that provocative headline, America's COVID Rules are a Dumpster Fire. Why a dumpster fire?

Katherine Wu: Well, I think we are at the point in the pandemic where we have so many divergent fates. We have different vaccination statuses. Some people have three shots, some people have four shots, some people have zero shots. We're dealing with a new variant while Delta is still percolating through parts of the country, people are trying to figure out, how do I isolate safely? How do I manage my own infection? How safe am I if I'm vaccinated if I was exposed at a low level? If I have unvaccinated kids at home? It's a mess. I think this piece was specifically looking at, well, the CDC is now telling us, again, there's a lot of complexity here. We need to keep people safe, but also support the economy. You can choose your own adventure when it comes to ending isolation.

Brian: The detailed 1,800 word version of its new isolation guidelines for people who've been infected by the Coronavirus, as you write in your article, the best way you've got to sum it up in this is this, "Hunker down for five days instead of the typical 10, then do what you want."

Katherine Wu: Yes. I think there was a lot of confusion when these guidelines came out. I had actually written previously, about a month prior, about there being a lot of merit to this idea that we could shorten isolation for people who are vaccinated, especially if there is a test out option, a way to check if you're still carrying tons of virus inside of you before you head back out into society, but the CDC did a catch-all.

Everyone who is feeling better, which is a pretty subjective thing, can exit isolation around day five. They're asked to wear a mask afterward, but that's pretty hard to enforce. It's like entering a soft isolation period where you're still supposed to stay away from other people, protect the vulnerable, but, otherwise, get back to life. This received a lot of criticism. It was really unclear what was motivating this, why there wasn't a test out requirement. Is it about supply? Is it because you don't trust the tests? Why not change the guidelines for vaccinated versus unvaccinated, which the CDC is already doing for quarantine, which is what we do after exposure rather than known infection.

Brian: I should mention that at the end of that little summary of the new guidelines, isolate for 5 days instead of the typical 10 and then do whatever you want, you ended that sentence with one of those shrugging half smoking emoticons. To more of the details, there's a case to be made that shorter isolation periods might make people more willing to follow the CDC's isolation recommendation at all. How did the experts you spoke with in your reporting weigh the validity of that argument as a strategy even though it sounds like it might leave some people who these COVID positive folks expose themselves to vulnerable?

Katherine Wu: Yes. I think that is an essential point here. If everyone who was infected was isolating for 10 days, 20 days, we would be in serious trouble. I think we do have to balance the different priorities here. We've seen the damage that can be done when schools have to close because there aren't enough teachers to lead classrooms, when hospitals are short-staffed. That's not what we want right now, but I think we also do have to make sure that we're not sending infectious people back into society at really high rates without some safeguards in place. Tests can help with that. Really good, clear masking guidance can help with that, but that's not quite what we've been getting so far.

I think this is the really tricky part. The other thing that could really help here is part of the reason that isolation is so difficult for so many people is paid sick leave is not necessarily the norm in a lot of parts of the country. People are not receiving support when they are doing the socially responsible thing and cloistering themselves at home, trying not to infect other people. There's not a ton of incentive to isolate beyond, "Hey, I want to keep others safe."

The more we can do to support people, especially during a surge like this, making sure they're getting food deliveries or have a safe place to isolate if they live in close quarters and multifamily households, that can make an enormous difference. I think the solution is not to send people back out early and take that gamble, but to make sure that people are being taken care of when they are taking care of others.

Brian: We're already getting some written comments and some phone calls. Listeners, if you're a Katherine Wu reader in The Atlantic, or have a comment or a question about some of the things she's reporting on, 212-433-WNYC, 212-433-9692. We've just been discussing some of the content of her recent article, America's COVID Rules are a Dumpster Fire. We're going to get into her article, Should I Just Get Omicron Over With? Maybe we'll get to her article called COVID Isolation Is a Lot Like Muffin Baking, and her newest Calling Omicron Mild is Wishful Thinking. 212-433-WNYC, 212-433-9692, or tweet @BrianLehrer. Okay, I can't resist, COVID Isolation Is a Lot Like Muffin Baking? Katherine, muffin baking?

Katherine Wu: Yes. I decided to come up with a fun Friday analogy for isolation. I think the trick here is to really pay attention to the signals that our bodies are giving us. Say someone is isolating, they know they've been infected, and they're wondering, "Okay, when can I come out of this?" There are two main groups of things to pay attention to; the outward symptoms and the inward things our bodies can tell us. Honestly, I think muffin baking is a pretty good comparison here. Think about what happens when you put raw batter in the oven. You look at the recipe, it says, "Stick it in there for 20 to 25 minutes." That's a rough guide.

Maybe around the 18-minute mark, you start checking are those tops looking golden and toasty? Is the batter still runny and shiny? If so, maybe it needs to stay in there a little longer, but if it's looking done, that's a good sign. That's almost like I'm in isolation and my symptoms are resolving, my body feels like it is approaching the doneness point. The other thing we can do is check with a test. A negative test can be a decent indication that the body's starting to clear the virus in the same way that sticking the toothpick into an almost done muffin can give us a sense of if the batter's still raw in the middle.

Brian: Nice. You mentioned the test, which I think is not required under the CDC five-day guidelines, but can they put out some data to back up the shortening of the guidelines, lest we leave the impression that there's going to be millions of people running around who are contagious and the CDC says that's okay? Data that shows that if you no longer have symptoms five days after your positive test or after your first symptoms, the chances that you're still contagious with Omicron are really very, very low.

Katherine Wu: Yes. I think very, very low is relative. I think there's decent data, though caveated with a lot of this data was collected before Omicron and Omicron could certainly change things. A majority of the contagious period does happen right around the time symptoms start, fairly early in an infection. A lot of people will no longer be that contagious around that five-day mark, but there is still a certain gamble. I think if we can make sure that we are at least minimizing the number of people who are exiting isolation while still contagious, that can make a huge difference. I do totally recognize here that we are limited by supply, by our testing infrastructure.

There are not enough tests out there for everyone who needs one to use it to exit isolation. They're also not necessarily easy to access at this point. That does create a huge issue, but I think that's less a motivation to throw up our hands and say, "Well, we should give up on testing out of isolation," and more motivation to really ensure that people do have access to really cheap, easy to use tests that can give them answers quickly and that they're instructed on how to interpret the results when they get them.

Brian: Here's Gabriel in Brooklyn with a very specific contagion question, I think. Gabriel, you're on WNYC with Atlantic Magazine science writer, Katherine Wu. Hi, Gabriel.

Gabriel: Hello. How are you?

Brian: Good. What's you got?

Gabriel: I was wondering if the Coronavirus is milder if you get infected from a person who has a breakthrough infection versus getting the virus from a person who is unvaccinated?

Brian: That's such an interesting question that I've never heard asked before, Katherine, and it hasn't occurred to me either, but it's a great question. We know that the Omicron variant, any variant, tends to be less severe if you are vaccinated. What about if a vaccinated person with a breakthrough infection does pass it to someone else? Is it likely to be less virulent because that person who passed it on was vaxxed?

Katherine Wu: Yes, it is a really interesting question. Unfortunately, I don't think there is an easy answer here. I think we have to keep in mind that the severity of someone's disease depends on so many factors. How bad your symptoms get depends on you, the host, interacting with the pathogen, the virus, here. If you get a ton of virus that could make your symptoms a little worse. If your defenses are low and you are an unvaccinated person, the disease would be worse. If it's a variant that is more virulent like Delta, it could be worse. We should also keep in mind that Omicron is definitely not inherently mild. It's maybe a little bit less bad than Delta, but Delta is pretty bad.

That's a low bar to set. If it's sourced from a vaccinated person, I could see a universe in which the viral particles that are coming out of a vaccinated person might have more antibodies attached to them, but I would never, I think, want to tell someone feel safer or place a bet or an assumption on your symptom severity based on where you contracted the virus from. Again, it's possible, but a pretty rough gamble to take. The best way to minimize disease severity is to make sure that you, the person who is potentially getting exposed, is ready during that exposure. That's being vaccinated, being up to date on your vaccines, being boosted if it's recommended for you at this time.

Brian: The stats about Omicron COVID being so serious that it lands people in the hospital or the ICU, or kills them if they are vaxxed and boosted, versus if they are not are so dramatic. We talk about that every day on the show. We don't need to go into it again, but the different outcomes between the vaccinated and unvaccinated who get this are just astronomically different and so well documented at this point. Earlier this week, we heard a warning from top health officials that makes it sound like getting COVID might be inevitable given how contagious Omicron is. Here is acting FDA commissioner, Janet Woodcock.

Janet Woodcock: I think it's hard to process what's actually happening right now, which is most people are going to get COVID.

Brian: Most people are going to get COVID. Here's Dr. Anthony Fauci, of course, director of the National Institute of Allergy and Infectious Diseases and chief medical advisor to the president answering a question about that at a Senate hearing.

Dr. Anthony Fauci: Sooner or later, as we begin to live with it, what she was referring to is that virtually everybody is going to wind up getting exposed and likely get infected. If you're vaccinated and if you're boosted, the chances of you getting sick are very, very low.

Brian: Again, the chances of you getting sick, meaning really sick, are very, very low if you're vaccinated and boosted. What do you think about that exchange and the way that the acting commissioner of the FDA Janet Woodcock put it originally? I think it's hard to process what's actually happening right now, which is most people are going to get COVID. It sounds fatalistic.

Katherine Wu: It does. Hopefully, I can inject some nuance here. I obviously cannot speak for Dr. Woodcock or Dr. Fauci, but I hope that the primary message here is that there may be a sense of inevitability. This virus is going to be around for a very, very, very, very, very long time, probably certainly for the rest of our lifetimes. That means that chances are, most of us will be exposed to it, potentially infected with it sometime in our lifetimes. I think that the essential thing to emphasize here is that does not mean we all have to get infected right now. There is value to that.

I think people hear this inevitability exactly as you said, there's this fatalistic sense to it, and think, "Oh gosh, if this is going to happen at some point, why don't I just get it over with?" I think there's a couple of things problematic with that. One is that getting it over with, if I got infected tomorrow, that would certainly not preclude me from getting infected again eight months from now, 10 years from now, both. It's not the kind of thing that you immediately put in your rearview and drive away forever.

The other thing is if we all got infected right now, I cannot even imagine how bad it would be. Our health system is already collapsing under the shared number of infections that are happening right now. The more people who get infected at the same time, the more problems this causes and it's synergistically bad and causes problems for the people who are infected by this virus and need care or who need care for other reasons and can't get it at hospitals that are overwhelmed. I think we do need to keep in mind the idea of flattening the curve, a callback all the way to the beginning of 2020. That's essential to keep in mind. There's maybe some inevitability, but inevitability does not have to be now.

Brian: Right now, all at the same time because of the crisis in the hospitals. I guess this goes to your article called Should I just get Omicron over with? I've heard of people, personally, who are at least asking themselves the question, "Should I go to an Omicron party like sometimes parents take kids to a chickenpox party to get it over with because this is a milder variant?" You're saying no, because of the bad idea of everybody getting it at the same time, but also because we've seen enough people get re-infected. We don't think that this would protect you against future variants, right?

Katherine Wu: Right. I think the thought of trying to maybe get an infection right now for immunity purposes, maybe, or to get it over with, I think there are three huge gambles people are taking there. One is that they're assuming that there will be good, long-lasting protection left behind. There is not a guarantee of that. We would expect there to be some effective immunity, but we don't know the extent or magnitude of it. We don't know how long it'll last. The second gamble is that symptoms won't stay behind. We know how bad this variant can be, especially in someone who is not vaccinated. Maybe that does apply to a very young kid who hasn't had the actual need to get a shot yet.

On average Omicron cases do tend to be milder, but I think a lot of that is due to immunity and the variant per particle might be a little bit less deadly than Delta. Again, that's not much to work with. At its extremes it's still killing people, putting people in the hospital. That's a huge gamble to take. Gamble number three is you are acquiring an infection that is infectious. Your infection could lead to someone else's and who knows what footing they are starting off on, that could endanger other people. Those three gambles are not ones I would ever be willing to take.

Brian: Someone writes-- I had it now I lost it. Hang on. Here it is. "I wonder if she knows how soon you can get COVID again after getting Omicron."

Katherine Wu: I do not know that, but I think this is data that we will start to see in the coming months. The answer will also be really complicated. What is the baseline health and vaccination status of the person who was getting infected with Omicron? Did they have three vaccines, two vaccines, one vaccine, zero vaccines? What brands were they? How long ago did they get them when they got infected? How bad was their infection? There is some sense that super, super, super minor infections, ones that were not terribly symptomatic or very brief might leave behind a little bit less protection that might last a little bit less time.

It's really tough, but rough estimates that I have heard, and, again, this is largely speculation, we might expect immunity left behind by an infection to be on the scale of months especially if we're talking about protection against a subsequent infection, not necessarily one that turns super severe.

Brian: What about the potential severity of future re-infections? For anybody who's had any variant of COVID along the way, I know that some people call up, even people who don't want to get vaccinated because they've had COVID and say, "I know I can get re-infected." Doesn't the science show that each re-infection is going to be milder because now you have some immunity? Does science tell us anything about that one way or another?

Katherine Wu: The general population level trend should be that the more immunity you have built up, whether through vaccination, again, the preferable route, or through an unfortunate infection, the better protected you should be against future encounters with this virus. Those encounters should be less severe progressively. This is a population level trend that does not guarantee that in every single case every subsequent infection will be milder and milder and milder. There are so many other variables here among them. How long has it been since your last exposure or since your last infection, or your last vaccination? What's your underlying health status?

Was your body super well equipped to learn from those vaccines? Maybe, maybe not. The huge wild card, what if another variant comes along and it is more severe than Omicron, maybe even more severe than Delta? We don't have a lot of predictions on what the virus is going to throw our way. I would certainly expect that you would have a better time of that new variant if you are vaccinated than if you were not. That doesn't necessarily mean that a vaccinated person, if a worse variant comes along they will have an easier time of it than last time. There's a difference when we're comparing between variants versus between vaccinated versus unvaccinated if that makes sense.

Brian: Vanessa in Brooklyn, you're on WNYC with Atlantic Magazine science writer, Katherine Wu. Hi, Vanessa.

Venessa: Hi. I just have a question about an infection making its way through a household of vaccinated individuals. My daughter tested positive almost 10 days ago. Now her symptoms have resolved. She's testing negative on an antigen test but her father just tested positive and has active symptoms right now. Can she go back into the world after the 10 days is up without fear of infecting somebody else?

Katherine Wu: Oh, gosh, yes. These household cases are always really, really, really tricky. This is where testing can be so useful. Again, I recognize that it's not always an option but this is the situation where I would want to be careful. A few things. If people are able to isolate and quarantine away from each other as these infections are playing out, that would increase my confidence in that people can do 10-day isolations, maybe fewer where symptoms are resolving and there's vaccination at play. If there's a lot of mixing, that gets a little tough. If you're able to test people around day five, day seven of isolation, and are consistently getting negative results, that would also increase my confidence.

No matter what, if there is uncertainty at whatever time point you are exiting isolation and going back into the world, a well fitting really good filtration mask is essential here. I'm talking something above a cloth mask, either a cloth mask layered with a surgical mask, an N95, something of really high caliber so that if there's any uncertainty or not as much access to a test or some fuzziness around who was able to isolate from whom, that mask can make a huge difference because I know there are definitely pressures to not keep the kids out of school or the adults out of work for too long.

Brian: Vanessa, thank you for your call. I hope that's helpful. The changing mass guidelines also plays into people's distrust. I wonder if you include that in your article that the CDC changing guidelines are a dumpster fire. Didn't even Dr. Fauci say at the beginning, "Don't worry what kind of a mask you have, just be wearing a mask." Actually the CDC director Walensky said that again just yesterday, "The best mask is the kind that you can and will wear for hours at a time when you're in the company of other people." At the same time, they're saying, "The cloth masks don't actually protect you that much by themselves without a surgical mask as a second layer." People say, "Wait, you told us they would be okay." How are you viewing that?

Katherine Wu: This is, again, complicated. This is another place where we have to be careful about potentially binary thinking which is not how this works. Masking, like so many other things in this pandemic, is going to work with degrees of protection. Any mask, I agree, is still going to be better than no mask at all. We do have to balance what's palatable, what's going to be tolerable for people to wear with what's necessarily ideal. If someone is choosing between wearing a cloth mask and no mask at all, cloth mask sounds great.

If somebody has an array of options and is looking for ideal protection, then yes, we definitely should be talking about the hierarchy with N95 as being our best options, but also recognizing that they're not the most comfortable and can be pricey. It is complicated. It depends where people are starting at. We don't necessarily need to think, "Okay, I should only choose the mask that I can wear for 10 hours at a time." Often, that's not the case.

If people need to go to the store, go to the post office, maybe it's only an hour of where, and we should make sure to include that in our guidance. Comfort is relative. What is tolerable for one hour is not going to be the same as what's tolerable for eight hours. People should know what the hierarchy is, and how that fits into their needs and how immediate they are.

Brian: One more call. Kathy in Westchester, you're on WNYC with Katherine Wu, from The Atlantic. Hi, Kathy.

Kathy: Hi, longtime first time. Anyway, I wanted to ask, I have heard that swabbing the throat with the antigen over the counter tests may be more accurate. I know of a woman whose family got infected and her kids tested negative on the antigen test a couple times, then she swabbed their throats and they came up positive. Should we just keep swabbing our noses or should we also swab our throats when using the antigen test?

Katherine Wu: This is a great question that has been coming up a lot recently. Unfortunately, the data is a little conflicting. It is true that the more sites you swab, the higher the chance there is that you are going to catch a virus that is somewhere in your airway. That said, I don't think Omicron, or Delta which is very much still around, is necessarily going to always show up in the throat first or always show up in the nose first. There's going to be some variability. It can't hurt to swab both spots. I've seen advices, maybe go for the throat and then use the same swab and go into your nose.

Sounds a little gross, but that way you're conserving swabs, conserving tests, and maybe you'll pick up on something that you didn't. The thing that I think we have to be really really cautious about is knowing that some of these rapid antigen tests can generate false positives if they're exposed to something that is either too acidic, or just has the wrong chemical composition, that they weren't FDA authorized to be used in the throat.

That is something they do in the UK but those tests come with instructions that say, "Please don't eat or drink or do anything too crazy with your mouth in the half hour or so before you test." Things like soda, juice can actually trigger false positives. That is something to be super aware of. Any test result always has to be interpreted against the backdrop of symptoms. Were you exposed recently? Are you feeling sick? Does it seem highly likely that the test is going to turn positive? Use that as a framework to analyze the results on your own.

Brian: With that, we thank Katherine Wu. Who knew when you got your immunology and microbiology doctorate from Harvard in 2018 that pandemic world was about to begin and you would put those skills to major use and write so many great articles for The Atlantic during the course of this pandemic. Katherine Wu, Atlantic Magazine science writer, we always appreciate when you come on the show.

Katherine Wu: Thanks so much for having me.

[00:29:28] [END OF AUDIO]

Copyright © 2022 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.