Pondering A New Normal As The Omicron Surge Continues : Short Wave The U.S. is experiencing a viral blizzard which will likely continue through January, 2022. The omicron variant's surge is pushing hospitalization rates up across the country and most of the seriously ill are not vaccinated. With likely weeks still to go before infections with this variant reach their peak, the message is get vaccinated and get boosted. Emily Kwong talks to Short Wave regular Allison Aubrey about what researchers know about omicron's severity and how the vaccines are changing health outcomes. They also talk about COVID-19 and children. And, they'll talk about some strategies to figure out how to live with the virus circulating, possibly for years to come.

Write us with your omicron questions at shortwave@npr.org.

Pondering A New Normal As The Omicron Surge Continues

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EMILY KWONG, HOST:

You're listening to SHORT WAVE from NPR.

Hey, SHORT WAVE-ers. Emily Kwong here with Allison Aubrey. Hi, Allison.

ALLISON AUBREY, BYLINE: Hey, Emily. It's good to be here.

KWONG: So I was checking my planner to prove to myself that it was true. We last talked about a month ago, December 14, when omicron was detected in a mere 25 states. A month later, where are we now?

AUBREY: Oh, Emily, well, it's been a rather rough month.

KWONG: Yeah.

AUBREY: Omicron has ushered in record-shattering new number of coronavirus cases. We are now averaging more than 700,000 per day officially. This is by far the highest case count since the start of the pandemic. And the number of people being hospitalized across the country, including young children, is hitting new highs, too.

KWONG: Yeah. Doctors say this surge is different. Though a lot of vaccinated folks are testing positive, many are either asymptomatic or only have mild symptoms because the vaccines are doing their job, right?

AUBREY: Yeah, the vaccines do offer protection against serious illness and hospitalization. And the Biden administration keeps pushing for people to get boosters. And yet with so many cases amid this surge, many hospitals are in a rough spot right now.

KWONG: So today on the show, a month into the omicron surge, what we know about its severity and how the vaccines are changing health outcomes.

AUBREY: We'll also talk about COVID rates among kids and how many of them are vaccinated. And we'll talk about strategies to get to a new normal.

KWONG: This is SHORT WAVE, the daily science podcast from NPR.

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KWONG: OK, Allison, we are looking at 700,000 new COVID cases a day. That is a lot, and hospitalizations are rising. Who is most at risk right now?

AUBREY: You know, in some states, hospitalization admissions are nearing or are at their highest levels since the pandemic began. There's about 18,000 people being admitted a day right now. That's creeping towards a 50% increase over last week. And much of the Northeast, Upper Midwest and the South have seen even steeper rises. You know, the people who are most at risk are those who are not vaccinated. The CDC says unvaccinated people are 17 times more likely to be hospitalized

KWONG: And those who are hospitalized - are they winding up in the ER? What's happening?

AUBREY: Many start in the ER. And I think it's becoming clear that a typical case of omicron carries a lower chance of getting seriously ill compared to delta. A preliminary study from scientists at Case Western finds that the overall risk of being admitted to the hospital or the ICU during this omicron surge is about half of the risk observed during the delta surge. But, you know, these researchers point out it is still a nasty disease, even if, statistically, it's a little less intense. And this is especially true for people who are immunocompromised and/or unvaccinated. I spoke to Dr. Lance Becker. He's head of the emergency medicine department at Northwell Health in New York. He says he sees this every day.

LANCE BECKER: It is very upsetting to see a person who's who's made a decision, and now that person pays such a price for it. And we've had people who are dying and had family members say, well, maybe you could vaccinate them right now. And, you know, and they're, like, literally losing their blood pressure and dying in front of your eyes. And you just want to cry. You just want to cry.

AUBREY: So you can hear that in his voice, Emily. It's a really rough time for health care workers, largely because so many of these deaths, they feel, are preventable, and that just makes the work harder.

KWONG: It is such an intense situation right now. How are health care workers doing?

AUBREY: You know, every doctor, every hospital administrator I've spoken to over the last week or so paints the same picture. I mean, infections have multiplied. Lots of health care workers have tested positive. And then they cannot come to work for five days or so. Now, because most health care workers are vaccinated and many are boosted, they're not getting as sick on average. I spoke to Dr. Becker about what he's seen over the last several weeks among his staff.

BECKER: Within the emergency department, luckily, thank goodness no one was hospitalized, but many people were out for several days.

AUBREY: Dr. Becker said he's been able to move staff around Northwell's very large system, so he's been able to compensate. But a bunch of urgent care centers in New York and New Jersey have had to close or alter hours due to a lack of staff amid this surge.

KWONG: And where on the curve are we with the omicron surge in New York but also, like, around the country?

AUBREY: Nationwide, the CDC director said last Friday that we have not reached the peak. Some infectious disease experts say they wouldn't be surprised to see a million cases a day, given that cases are rising nearly everywhere in the country. On Friday, 830,000 people tested positive, according to the CDC. And this doesn't include people who only used rapid at-home tests. I spoke to Michael Osterholm of the University of Minnesota about what he expects.

MICHAEL OSTERHOLM: Four weeks ago, I put out a prediction at that time that we would be literally in a viral blizzard for the next eight weeks or more. And I'm sticking with that. I think another four weeks, and we're going to see case numbers peaking and coming down quite rapidly.

AUBREY: Several models predict the same quick rise and fall. That's what's been seen in South Africa and in parts of the U.K., which has typically been about three weeks ahead of us during this pandemic. There are now some initial indications that the number of new cases may have peaked in those countries.

KWONG: But here in the U.S., we're very much in the midst of this viral blizzard, not at the peak yet. And as cases climb, what are vaccination rates doing? Are those climbing, too?

AUBREY: You know, heading into the holidays, White House advisers said the pace of vaccinations was accelerating. But so far, only about 35% of people in the U.S. have received a booster. We're still at about 66% of eligible people - so that's everyone 5 and up - who are considered fully vaccinated.

KWONG: Two-thirds of those eligible vaccinated in the U.S. - that is not enough to stop the spread.

AUBREY: It certainly does not appear to be enough. So some states are going back to mass vaccination sites, including in Massachusetts. In Oregon, the state Health Authority has opened a bunch of drive-in sites, no appointments needed. And in Illinois, state agencies are setting up one-day mobile booster clinics. And most are offering shots to adults and kids.

KWONG: Allison, let's talk about kids. There's been a pretty significant rise in hospitalizations among them, too. What are we seeing?

AUBREY: Yeah, I mean, hundreds of kids are getting admitted to the hospital each day, about 800 or so. But remember, hundreds of thousands are testing positive each week, about 300,000 in the week leading up to New Year's. Pediatricians tell me that they're seeing a lot of very young children, the under-5 kiddos.

KWONG: Who don't qualify for a vaccine.

AUBREY: That's exactly right. I spoke to Shaquita Bell. She's a pediatrician at Seattle Children's, where they're seeing both COVID and a lot of the other respiratory viruses that are common this time of year in the ER.

SHAQUITA BELL: Our ER here in Seattle, at Seattle Children's is operating at all-time high records of patients seeking care. And we've had record rates of respiratory syncytial virus, or RSV, infections that are even at a higher rate than COVID, which is overwhelming many of our ERs and urgent cares.

KWONG: Pediatricians are dealing with a lot, too. How sick do these kids get typically?

AUBREY: You know, most kids who are treated in the ER end up being released rather than admitted. That's what Dr. Bell told me. And something many parents will know or remember is that when kids are very young and a respiratory infection starts, they can get sick very quickly. If they're congested, it can be hard to breathe and eat. They get dehydrated. They get a croupy cough or asthma exacerbations. So often in the ER, doctors are, you know, doing things like administering fluids. They're giving breathing treatments. They're treating high fevers. Here's Dr. Bell again.

BELL: That might be a really quick visit in normal times, but when our ERs are seeing 200% of the volumes that they would've seen a couple of years ago, that ends up being a really long visit, a really long trip to the emergency room because of all the competing limited resources.

KWONG: And COVID compounding with all the other normal respiratory stuff that would happen on any given winter.

AUBREY: That's right. And sometimes, kids come in for treatment to the ER for something other than COVID. But due to all the testing right now, doctors end up finding that the kid is positive for COVID, as well. CDC Director Rochelle Walensky addressed this on Friday.

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ROCHELLE WALENSKY: We are seeing a rise in hospitalizations both because they they are coming in with COVID but also because they're screening in for COVID. And so I would say we don't yet - have not yet seen a signal that there is any increased severity in this age demographic.

AUBREY: She says they are watching the data closely, and she adds that it was clear that kids are more likely to be hospitalized if they are unvaccinated.

KWONG: And how many kids have been vaccinated so far in the U.S.?

AUBREY: You know, about 25% of 5- to 11-year-olds have received their first dose. Among older kids, 54% of 12- to 17-year-olds are considered vaccinated. And the rates really vary from state to state. You know, as we look ahead, some of President Biden's former COVID advisers say the U.S. is going to need near universal vaccination to get to the point where COVID is manageable and predictable from year to year. Zeke Emanuel of the University of Pennsylvania is among them. He says this may require mandates in school.

ZEKE EMANUEL: One reason we have great response to things like, you know, diphtheria, pertussis, tetanus shots is that we have mandates. You have to be vaccinated to go to school.

AUBREY: And he argues COVID vaccines should be the same. So these fights are going to probably intensify going forward because many states have already moved to prevent this kind of mandate. Right now many experts say as soon as the vaccines go from emergency-use authorization to full approval, that that might be the time when we could start to see mandates.

KWONG: Allison, when the pandemic began and you and I were still working in an office together, I remember all the people on the science desk saying, this could be two years of our life, which was just unthinkable at the time.

AUBREY: Right.

KWONG: And we're almost there.

AUBREY: Yeah.

KWONG: We're almost at two years. And I'm hearing talk shift on our Science Desk about, you know, how are we going to live with this virus into the future? It's not going away anytime soon. What does that picture look like for you?

AUBREY: You know, I think it's just a long road to the new normal because COVID, you know, isn't going away. It's going to move into this endemic phase. And, you know, one of the things that makes flu manageable is that doctors know when they're going to see it. Every January and February, they can expect they're going to see a certain number of people who end up in the ER or the hospital with flu. It's not like everyone's getting it all at once. So when you move away from this pandemic, where hundreds of thousands of people are testing positive each day, to a more predictable pattern, it becomes more manageable. And we're going to need a reset. I mean, just last week, some of President Biden's former advisers outlined some strategies for this reset, including rethinking how we do testing.

KWONG: Right. A year ago, then-President-elect Joe Biden put expanded testing near the top of his strategy list. But nowadays, I mean, if you call around to different pharmacies, it's really difficult to get your hands on a test.

AUBREY: Well, we go back a year, there was a lot of progress. I mean, PCR test sites were expanding. The FDA approved more rapid tests. But then last spring, as cases dropped, the focus on testing pretty much disappeared. One manufacturer of rapid tests, Abbott, which makes the BinaxNOW test, shut down one of its facilities. And President Biden started talking about July 4 as kind of the target date to celebrate our independence from the virus. The idea was that it was going away. Everything seemed good. Then bam - came delta in the summer, now omicron. Here's Zeke Emanuel again. He's an author of the new papers that outline these strategies for a reset.

EMANUEL: I think testing is clearly a case of where we built up an infrastructure that was pretty effective, but that was dismantled. You know, that makes no sense. And as a consequence, we do find ourselves behind the eight ball now. We need to have a clear vision. What is the role of PCR testing going to be? What is the role of at-home testing?

AUBREY: He says it might be too late to fix all of this amid this current surge. But for the future, he says the U.S. could adopt a standard testing program, could use one single test used across health care to identify COVID, flu and other respiratory viruses with a single test.

KWONG: That would be interesting. Does a universal respiratory virus test exist?

AUBREY: Yeah, these kind of combined tests have been developed, but they're just not being used in any systematic way. And more importantly, Zeke Emanuel says testing results are not being linked to quick treatments.

KWONG: Yeah, because if you test positive at home with COVID with a rapid antigen test, it's hard to know what to do. Do you let your doctor know? And what treatments should you be receiving? There are these new antiviral medications that have been approved. We talked to Pien Huang on the show about this a few weeks ago. But she told me, you need to get these medications in your body in the first few days of infection to be helpful.

AUBREY: That's right. And that's why there needs to be a system, he's arguing, to link a test result to a treatment plan.

KWONG: Yeah.

AUBREY: Also, these antivirals are in short supply right now. So the federal government has paid for early supplies of them. And he argues there needs to be a coordinated system to use them efficiently.

KWONG: All right. Well, as omicron surges and we're trying to figure out our omicron strategy. Thank you for reporting out all of the twists and turns as they go along, Allison.

AUBREY: It was great to be here. Thanks, Emily.

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KWONG: This episode was produced by Thomas Lu, edited by Gisele Grayson and fact-checked by Berly McCoy. Berly, welcome back to the team. I'm Emily Kwong, and you're listening to SHORT WAVE, the daily science podcast from NPR.

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