Right now, Americans are weary of dealing with the COVID-19 pandemic, and many are confused by seemingly inconsistent COVID advice. Albert Ko, MD, Raj and Indra Nooyi Professor at the Yale School of Public Health, has been involved in efforts to contain COVID from the start, including as an expert adviser to Connecticut Governor Ned Lamont. It offers some insight into Omicron, the new widespread COVID variant.
This conversation is edited for brevity and clarity.
How is Omicron different from other variants of COVID, and does it affect different people in different ways compared to other variants?
Albert Ko: There are three ways in which Omicron is very different from what we have experienced during the pandemic. The first way is that it is much more highly transmissible than previous COVID variants. We’ve always thought Delta was supercharged. It can be twice as transmissible as Delta. The second is that the ever-changing evidence shows that it is a less severe or less virulent variant. New data developed by Joseph Lewnard, who holds a doctorate from the Yale School of Public Health now at the University of California, Berkeley, indicates that there is up to 50% less risk of being hospitalized at Omicron that in Delta, and that potentially, and this is very early, the death rates are maybe 10% of what we see with Delta. The third important difference is that the two-dose vaccination is not as effective against Omicron in preventing COVID. However, boosting with a third dose of vaccine provides high levels of protection – over 80% – against the things we care about, namely hospitalizations and deaths. The most important thing in terms of protection is to get vaccinated. If you haven’t been vaccinated, get vaccinated, and if you’ve been vaccinated and are eligible for booster shots, get vaccinated.
Experts have said, “Wear a good mask” throughout the pandemic, but it seems they’re emphasizing that more for Omicron.
Ko: Yes. The quality of the masks is important and also because of the higher transmissibility of Omicron. N95 masks work better than the K95. K95 probably works better than double masking. Double masks will work better than single masking with an ASTM Level 3 surgical mask, and we should ditch the cloth masks at this point.
There are some other things we were told almost two years ago. Many people washed their groceries and kitchen surfaces. These are good things to do, but now that the list of things we should do is getting longer and longer, are there things we can forget about sooner?
Ko: Yes. The most important thing we learned is that exposure to respiratory fluids is the primary mode of transmission. Exposure to contaminated surfaces does not contribute significantly to transmission, so diligent disinfection methods are something that can likely get off this table. Handwashing is always good, but the most important thing, besides vaccination, is the use of face masks and distancing if we want to mitigate risk.
The COVID-19 pandemic has been with us for almost two years and people’s patience is running out, whether from exhaustion or confusion over the messages we have heard. How can people clear their heads and focus again on what needs to be done?
Ko: Yes, people are frustrated and patience with the COVID-19 pandemic is running out. We have people who have been following public health best practices for a long time, wearing face masks and practicing social distancing, and who are now faced with a new high-transmissibility variant and have run out. In addition, knowledge and public opinion are more like an oil tanker than a speedboat and are not able to quickly change direction. All of this is complicated by uncertainty, especially about the emergence of new variants, which I fear.
Yet, in the face of uncertainties, there are focal points that people can focus on to protect themselves and their communities. That is, getting up to date with your vaccinations, getting tested quickly if you have symptoms and receiving oral antiviral treatment once it becomes available and using face masks in settings at risk of transmission, such as indoor public places, while we are still experiencing pandemic waves. We need to do a better job of learning from our past mistakes, such as declaring COVID-free last summer, and preparing for unexpected events, such as new variants or the need for additional COVID vaccine boosters. . Unfortunately, there will be no quick win for the COVID pandemic and public health messaging must be cautious and avoid raising false hopes.
Would we have variants at this point, including Delta and now Omicron, and would we have the disease at this point if there weren’t so many unvaccinated people?
Ko: Although Omicron is less severe, we are witnessing a tragic history of preventable deaths similar to what we experienced during the Delta wave. Right now, we’re seeing a seven-day average of more than 1,600 Americans dying every day. There is a direct link between COVID deaths and vaccination rates. If you look at other countries and within our country, death rates were 10 to 20 times higher during the Delta wave in places with low vaccination rates than in places like Connecticut, where our vaccination rates are high. I see our ability to not be able to vaccinate and really share the benefits of this important public health intervention with everyone as, really, one of the major challenges of the COVID-19 pandemic.
There is talk of Omicron recoiling relatively quickly. What do you think?
Ko: We understand better why we are going up the epidemic curve, but we understand less when and why we are going down the epidemic curve. It seems, at least here in Connecticut, that the tide has come up quickly and will come down quickly, much like what has happened in other countries. A good example is South Africa. Part of the reason is Omicron’s high transmissibility and ability to infect quickly but also deplete quickly within family and contact groups or social networks. My suspicion is that a heavy driver is behavior as well. We have a better understanding of the risks that COVID poses during an epidemic wave, and whether consciously or unconsciously, we have fewer and fewer gatherings, travel less, and overall reduce our social networks and so let’s give Omicron fewer opportunities to spread.
A big concern is whether to keep schools open, even though many closed or moved away altogether during the first wave of the pandemic.
Ko: The costs are too high to prevent our children from going to school. The continued confinement of children and the interruption of their schooling has profound deleterious effects on their development and education, especially for those in our most vulnerable communities. Moreover, the impact is enormous for working parents who depend on the school as a source of childcare. I would argue that children are safer in schools, where face mask mandates are in place and teachers guide students to follow public health best practices, than when unsupervised outside. schools during this wave of community transmission. We must protect the health of our children, whether they are in school or outside. The best way to do this is to promote immunization of eligible children, wear face masks and provide them with safe environments.