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The case for COVID optimism, despite sky-high infection rates


Ready for a little hope? Because we are a few days into the third calendar year of the pandemic, and things can seem pretty grim. On average, the U.S. is tallying nearly 500,000 new COVID cases a day. Yesterday, the U.S. hit yet another record high for infections - 1,082,549. So it is something of an act of courage to find glimmers of hope in those numbers, but our next guest says he wants to try.

Dr. Bob Wachter is chair of the Department of Medicine at the University of California, San Francisco. Dr. Wachter, welcome.

BOB WACHTER: Thank you. Thanks for having me.

KELLY: So you laid out the case for hope, your case for hope, in a recent Twitter thread in which you argue that, yes, while things do feel pretty awful at this precise moment, we could - and I'll quote - "we could be in good shape, maybe even great shape, in 6 to 8 weeks." Really?

WACHTER: Yeah, I think that's the likeliest outcome. I should always caveat it by the fact that over the past two years, every time things have started looking good, something bad happened, so...

KELLY: There is that, yeah.

WACHTER: It's possible that will happen again. There'll be another variant that will be a curveball. But if that doesn't happen, I think the likeliest outcome for February and March is that we'll be in pretty good shape. This virus being so transmissible but now, as we understand it, being milder than the prior variants could turn out to be very good news after a very awful January.

KELLY: For people marking their calendars, you wrote this Twitter thread December 29. So if you're right - and I know we're all rooting for you to be - we could be on the path to good to great shape by mid-February, early March. A bunch of stars would have to align for that to happen. Let's walk through some of that.

One of those stars would be the relationship between case rates and hospitalization rates. Explain what we are seeing there, what you hope we might see there.

WACHTER: What's happening now is the cases are exploding as we've never seen before, and that really is a manifestation of how extraordinarily infectious omicron is. What we're not seeing is the same relationship between cases and hospitalizations. So the average case of omicron has about a 60% lower chance of landing you in the hospital than the average case of delta.

Now, you might hear that and say, that doesn't make sense. Why are the hospitals filling up? And the reason is, even if the average case is less likely to land you in the hospital, if there are twice or three or five times as many cases, then you will have more people land in the hospital.

So the short-term risk, and we're seeing it all over the country, is the hospitals will get filled with patients with omicron. A fair number of doctors and nurses will be out sick with omicron. And so we have a pretty miserable month, even though the average patient has a lower chance of ending up in the hospital than he or she would have had if they had a case of delta, particularly if they're vaccinated.

But very importantly, for the people that chose not to be vaccinated - I think a very terrible choice - but who made that choice, there's a pretty good chance they're going to get a case of omicron, which will give them some immunity. And it's those two things combined - the fact that the average case is going to be milder and more and more people are going to be immune to this virus - that gets us out of this pickle, I think, in February.

KELLY: Another star that would need to align - and this is something somewhat new on the horizon - COVID pills. These antiviral drugs being rolled out - small quantities so far, but one from Pfizer, another from Merck. What effect could these have in the coming weeks?

WACHTER: Yeah, it's an important new part of our armamentarium. Up till now, we've really just had monoclonal antibodies to give to people at very high risk who got COVID but were not sick enough yet to be in the hospital. But two new pills have come out. The Pfizer is a much bigger deal than the Merck. The Merck lowers the probability that someone who gets a case of omicron will land in the hospital by 30%, the Pfizer by 90%. So it's in short supply. The supply is growing. Within a month or two, there will be a decent supply. So that is another very important tool that we'll have.

KELLY: When you say they're in short supply, though - I mean, as I mentioned, you're the chair of medicine at a big city hospital there in San Francisco. Can your high-risk patients get these COVID pills?

WACHTER: Just starting to be available - we have them in some of our pharmacies, but we're having to triage them quite severely and be very selective about who gets them. But I think they'll become more and more available over time. It's a pretty tricky chemical compound to produce, so it is taking the company some time to produce them. But they should - the supply should grow steadily over the next couple of months.

KELLY: You mentioned the unvaccinated. In this Twitter thread, you called the unvaccinated sitting ducks. How are things looking for them? Where do you see their risks going in the next weeks and months?

WACHTER: If you are unvaccinated and you're not being super careful, by which I mean wearing an N95 mask all the time if you're going indoors, it's almost hard to believe that you will not get this virus. The problem is people who are unvaccinated are hearing that the average case of omicron is milder. It is milder, but it's particularly milder for people that are vaccinated. For the people that are unvaccinated, the best estimates from the science so far are that maybe it's about 25% less likely to land you in the hospital.

And you might say that's - OK, good. It's milder. But if it's 25% less likely to land you in the hospital and you have a five times greater chance of becoming infected in the next month, that math doesn't land you in a good place. It means there are going to be more and more unvaccinated people who get omicron. A lot of them will end up in hospitals. A lot of them, unfortunately, will end up in ICUs. And a fair number of them will be the ones who die over the next four to six weeks as this hurricane sort of rampages through our country.

KELLY: People are also hearing - and I want to let you just address this head-on - the vaccines and boosters aren't worth it. They don't work because everybody we know is getting sick anyway.

WACHTER: Yeah, I can understand how people would feel that, but that's just not right. The vaccines and boosters are miraculous. And they are miraculous because what they do is markedly lower the probability that you will get very sick, go to the hospital, go to the ICU, end up on a ventilator and die. There's no question that there are more breakthrough cases. This virus is very good at sidestepping some of your immunity.

But the kind of case that you're going to have, if you've had particularly three shots, is so much more likely to be a mild case of a couple of days of cold or flu symptoms than it would be for the unvaccinated person. Those are the ones who are landing in the hospital, landing in the ICU. And ultimately, the deaths that we will have from omicron will be almost entirely in unvaccinated people.

KELLY: Is there anything that could throw this prediction of hope off?

WACHTER: Sure. Two big questions going forward in terms of how rosy the future might be - one is, how good is the immunity that a case of omicron gives you against another case of either omicron or another variant? I'm sure it'll be fine for a while, but does it last for three months or a year? That will make a difference in terms of whether the risk goes up, let's say, next winter.

And the second, of course, is this great unknown, which is, will there be another variant? And anybody who tells you they can predict that is making it up because nobody I know predicted delta. Nobody I know predicted omicron. And all that means is there could be something even nastier than omicron on the horizon, and that will change the projections. But for now, I think things look pretty good.

KELLY: Well, Dr. Wachter, I will look forward to calling you back in six to eight weeks, and we'll take stock of how it's turned out.

WACHTER: I hope I'm right.

KELLY: I do, too. Dr. Bob Wachter, chair of the Department of Medicine at the University of California, San Francisco.

WACHTER: Thanks so much.

(SOUNDBITE OF BELLA BOO'S "ALOM") Transcript provided by NPR, Copyright NPR.

Mary Louise Kelly is a co-host of All Things Considered, NPR's award-winning afternoon newsmagazine.
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