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Melissa Harris-Perry: This is The Takeaway, I'm Melissa Harris-Perry.

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Melissa Harris-Perry: Well, technically, I'm Dr. Harris Perry. See I earned a Ph.D. in Political Science 22 years ago, but I do avoid describing myself as doctor.

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Melissa Harris-Perry: Because when it comes to medicine, human biology, and most related subjects, I readily admit to having no expertise.

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Melissa Harris-Perry: Like many of you, the unexpected experience of living amid a global pandemic has awakened my inner epidemiologist. Watching your kids play at the park, I'm happy to tell fellow parents about the FDA's approval on Monday, a vaccine booster shots for children ages 12 to 15.

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Melissa Harris-Perry: Inline at the grocery store, you'll catch me discussing with other fully masked shoppers whether COVID has reached an endemic stage.

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Melissa Harris-Perry: On a call trying to decide if my community group should hold a plan celebration in person or over Zoom. Oh, yes, I'll quote the latest infection and hospitalization rates in our county.

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Melissa Harris-Perry: In short.

Speaker 2: I'm not a doctor, but I play one on TV.

Melissa Harris-Perry: This multi-year pandemic life, it's baffling, and even with good intentions, most of us are googling, groping, guessing, and hoping that our choices will keep us, our families, and our communities safe.

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Speaker 2: Doctor. Well, we missed anyone?

Melissa Harris-Perry: Now, Dr. Céline Gounder is the kind of doctor that can help us make sense of this moment. Dr. Gounder is an infectious disease specialist and epidemiologist at Bellevue Hospital in New York City and host of the EPIDEMIC podcast. Thanks for being here Dr. Gounder.

Dr. Céline Gounder: It's great to be here.

Melissa Harris-Perry: I really wanted to chat with you today because I am confused. Woke up to this reporting about more than a million cases. Help me to understand and all of us to understand what this means. What does it mean to have so many more positive cases?

Dr. Céline Gounder: What we're seeing with Omicron is that this is a far more infectious variant by far the most infectious variants of SARS-COV2 that we have seen to date. That means that it spreads more easily from person to person, a lot more people are getting infected, but the good news is that many of us have some level of immunity, hopefully through vaccination, which is durable and more robust than the immunity you get from a natural infection. That's protecting us from this wave of Omicron.

Then there's also data to suggest that Omicron is itself a less virulent form of the virus, which means that it causes less severe symptoms and disease in individuals who are infected. We're seeing a lot more cases, but we're also seeing that hospitalizations are not spiking up the way they would have with prior variants.

Melissa Harris-Perry: Okay, so let's dig into that just a bit more. When you say that it is somewhat, I guess, less likely to make you very ill, is that only for those who are vaccinated, vaccinated and boosted, or is Omicron operating that way even for the unvaccinated?

Dr. Céline Gounder: Yes, this is really a good question, because, initially, we were concerned that Omicron was only less virulent in people who had some level of prior immunity, whether from vaccination or infection. There is more recent data using mice and hamsters to look at how Omicron differs from other forms of COVID. We are seeing that Omicron really infects largely the upper airway, so your nose, your throat, but doesn't infect as efficiently down deep in the lungs the way Delta and other variants did. What that means is that you're less likely to develop really severe disease in your lungs, in your internal organs with Omicron as you were or compared to your risk of that severe disease with prior variants.

Melissa Harris-Perry: Okay, now, are the prior variants gone or is it just that Omicron is sort of most rapidly spreading? Where is Delta right now?

Dr. Céline Gounder: It really depends a bit on what part of the country. In New York City, where we are, Omicron really is the dominant variant. There is still some amount of Delta but Omicron really has become the dominant variant. In other parts of the country, they're sort of headed neck and neck, but I think we anticipate that in the coming weeks Omicron will be responsible for most of the new cases we're seeing across the country.

Melissa Harris-Perry: Okay, Omicron is relatively new. Do we know that the fact that it seems to affect those upper respiratory rather than deep down in the lungs? Is that likely to be true overall for Omicron, or is there some possibility that in three months, six months, a year, that this variant will behave differently?

Dr. Céline Gounder: Well, if there's anything we've learned from the pandemic over the last two years is that the virus will mutate, when you allow the virus to spread, it will replicate, and every time it replicates, it mutates. Some of those mutant viruses will go on to become new variants of concern. Omicron is not our last variant. I think many of us declared mission accomplished last summer in June, July, very early thinking that we were turning the corner, or the pandemic was over, only to be hit with the emergence of the Delta variant. I think similarly, Omicron will not be our last variant, and we really do need to remain on guard for what may come after this.

Melissa Harris-Perry: When you say mutant variant, I have to say that sounds absolutely terrifying. That is the sort of thing that makes me feel like, okay, cancel it at all, close up the schools, we're going inside, but help me to understand how viruses work or mutant variants, something that are relatively common.

Dr. Céline Gounder: That is the definition of a variant, in fact, is it's a mutant. It is evolving over time. It is evolving before our very eyes. Every time a virus replicates, it's a bit sloppy in its genetic machinery, and so it makes mistakes, and those mistakes are mutations. Some of those mutations have no impact. They don't really matter. Other mutations will make the virus less fit, and so that variant will die out. Other mutations will make the virus more fit. Through natural selection through competitive advantage, those are the variants that will get selected for that the virus will evolve into overtime. Some of those variants might be more infectious, more virulent, so more disease and death-causing, and some might be more immune-evading. That's just the nature of how viruses evolve over time.

Melissa Harris-Perry: Okay, lots of languages these days about endemic versus pandemic. First of all, help us to understand what endemic is versus pandemic, and, also, is it preferable? Do we want to be living in an endemic COVID age?

Dr. Céline Gounder: I think an easy way to think about the difference is the curve that you see in the cases. As long as you're seeing these big surges, these tidal waves, in cases so to speak, you are in an epidemic or pandemic phase. Once you see those curves settle out into what looks like ripples in a pond, you have now transitioned into an endemic phase. We're nowhere near that. We are still seeing these big spikes up and down in cases. We are still very much in an epidemic or pandemic phase of this.

Melissa Harris-Perry: Okay, so what does that mean then for decision-making? I mean, there's a little bit less in terms of individual decision-making. Clearly, that hasn't changed for quite some time where your mass get vaccinated and boosted if you're eligible, all of that kind of thing, social distance, wash your hands. From a collective decision-making, if I'm an organization leader, and I have to decide are we having this event in-person, if I'm a business owner, and I need to decide if my employees are coming back into the office, if we're not yet in endemic phase, should we be again pausing, pumping the brakes on everything?

Dr. Céline Gounder: I think especially right now in the middle of an Omicron surge, we should be careful. This is not the time to be having big in-person gatherings without masks. I think there will come a time when we can do that safely again, but we're not quite there yet.

Melissa Harris-Perry: What are the kind of stats we want to be seeing when we can say we are there? Are the right numbers to be looking at, in other words, infections, hospitalizations, mortalities? What are the relevant numbers I should be watching to understand where we are in this process?

Dr. Céline Gounder: We're starting to see a decoupling between cases and hospitalizations and deaths. That's because many people who are getting COVID now are having very mild cases because, say, they've been vaccinated, and so they're relatively well protected. They're essentially having the symptoms of the common cold. I think at this stage, we really need to be focusing on hospitalizations and deaths. I am speaking to you from Bellevue Hospital. Right now we are furiously trying to get everybody out of the hospital that we can get out because we are trying to prepare for a big surge in cases.

A number of our nurses and doctors are also out, so we're really short-staffed. Hospitalizations are a really important metric care in terms of what is the stress on the healthcare system, and that stress doesn't just impact on people who have COVID. It also impacts on everyone else. If you come to the hospital, say, with a heart attack or a stroke but we're full of patients with COVID, you're going to have to wait that much longer to have your needs met. I think at this stage in the pandemic, hospitalizations and deaths are really what we should be focused on.

Honestly, every community is going to have a different sense of what is too high, what is acceptable. I do think you're going to start to see some geographic differences emerge as some parts of the country decide they're willing to tolerate a much higher level of hospitalization and death than others.

Melissa Harris-Perry: I want to talk about two other metrics there. One is this unvaxxed, and we've been hearing that COVID is moving into now a pandemic of the unvaccinated. When you mentioned Bellevue it's obviously a public hospital dealing with patients who may have real barriers to vaccination as opposed to simply choosing not to be vaccinated. How do we continue to lower barriers for those who may want to be vaccinated, and how do we think about again those metrics of the unvaccinated between personal preference versus barriers?

Dr. Céline Gounder: I think we need to be very careful here. I think this is a really important question that you're asking. If I had to gestalt estimate what proportion of our patients are not vaccinated when they come into us, I'd say about three quarters, and that's a lot. Many of our patients at places like Bellevue Hospital, these big public hospitals, many of our patients are homeless, they're struggling with alcohol or substance use disorders, there are undocumented immigrants who are living these lives under the radar, and all kinds of different obstacles.

I can tell you every morning I go through the list of patients and I say, okay, who needs to be vaccinated? We offer vaccinations, and it's very rare anybody says no. These are not anti-vaxxers. These are people who have barriers to accessing healthcare who have some reasons for disorganization in their lives where this is perhaps not the first priority. We really do need to figure out how do you reach out to those populations and recognize not every unvaccinated person is against vaccination.

Melissa Harris-Perry: I'm wondering if the positive test rate that we're seeing, is there any reason to think that that is just an artifact of more testing, or is that a real new increase in cases?

Dr. Céline Gounder: If you have a test positivity rate of 25% and at the same time you are testing so much more because of work or school requirements, that's actually indicative that there is rampant spread of the virus in the community. You're testing more and your positivity rate is still really high. Usually, when your testing rate goes up, your positivity rate will go down because people who may be very low risk are getting tested. That really does represent rampant spread of the virus in your community.

Melissa Harris-Perry: Dr. Céline Gounder is an infectious disease specialist, an epidemiologist at Bellevue Hospital in New York City, and host of the EPIDEMIC podcast. Thank you so much for your work and for your time today, Dr. Gounder.

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