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How to navigate the current stage of the COVID pandemic47:04
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Sustained jumps in cases and hospitalizations fueled by the hyper-infectious BA.5 subvariant pushed Los Angeles County into the high COVID-19 community level Thursday, a shift that could trigger a new public indoor mask mandate by the end of this month unless conditions improve.(Irfan Khan / Los Angeles Times via Getty Images)
Sustained jumps in cases and hospitalizations fueled by the hyper-infectious BA.5 subvariant pushed Los Angeles County into the high COVID-19 community level Thursday, a shift that could trigger a new public indoor mask mandate by the end of this month unless conditions improve.(Irfan Khan / Los Angeles Times via Getty Images)

More than two years into the pandemic, cases of COVID-19 are on the rise again across the country.

"The response has to reflect the fact that people have learned to risk-acclimatize to COVID-19 because it's become less severe, because now we have a whole slew of tools that we didn't have," says Dr. Amesh Adalja at Johns Hopkins Center for Health Security, says. "We have more tools for COVID-19 than we do for any other respiratory virus."

And many Americans are looking to move on.

"There are still a lot of risks associated with letting COVID transmission go unchecked," epidemiologist Marlene Wolfe says.

Today, On Point: What we should do to respond to COVID-19 at this stage in the pandemic.

Guests

Dr. Ashish Jha, White House COVID-19 response coordinator. (@ashishkjha)

Marlene Wolfe, environmental microbiologist, engineer and epidemiologist. Assistant Professor in the Gangarosa Department of Environmental Health at Emory University. (@MarleneKWolfe)

Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health. His work is focused on emerging infectious disease, pandemic preparedness and biosecurity. (@AmeshAA)

Transcript: Conversation with Dr. Ashish Jha

KIMBERLY ATKINS STOHR: I'm Kimberly Atkins Stohr in for Meghna Chakrabarti, and this is On Point. COVID-19 is once again spiking across the country. In the past two weeks, there has been a nearly 20 percent increase in COVID-related hospitalizations. But we're not in 2020 or even summer 2021. While cases have risen, so have vaccinations. About 67 percent of all Americans are fully vaccinated. But now we're hearing words like "immunity-defiant" associated with this latest variant.

So with all of that information, how should we be responding to COVID 19 now? What are the goals and how should we be trying to achieve them? With us now is someone tasked with answering those questions at the federal level. Dr. Ashish Jha is White House COVID 19 response team coordinator, and he joins us from Washington. Dr. Jha, welcome back to one point.

DR. JHA: Thanks for having me back.

ATKINS STOHR: So what is your current assessment of the rise in case numbers we've seen, as well as the rise in hospitalization?

DR. JHA: Yeah. So, what we're seeing right now is this subvariant of Omicron, a version of Omicron that we saw over the winter called BA.5. And we've been tracking it since April, and it is now the majority of our cases.

So what do we know about this? Well, first, there is the increased potential for reinfection. So if you were infected three, four or five months ago, your protection against reinfection is very, very low. If you've not been vaccinated recently, if you got vaccinated last year, you can have a high risk of breakthrough.

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But here is the bottom line that people need to know, which is: the things that we know that have been working for us as a country — keeping up to date on vaccinations, using treatments, using the tests that we have — they all work for BA.5. Like, our tools continue to work, and if we use them effectively, we can continue to minimize the impact on serious illness and death.

ATKINS STOHR: So when you're talking about the tools and saying that they work against BA.5, what specifically are you talking about?

DR. JHA: Yeah, so a couple of things. First of all, that the rapid antigen tests that we use at home, they work just fine against BA.5. So there have been some questions of do our tests work? The answer is yes. Second is treatments. I think at this point, anybody who has any elevated risk of a bad outcome — someone who's older or of chronic disease — if they get an infection right now, they should absolutely consider getting treated. And our treatments work great against BA.5.

And then, last but certainly not least and arguably the most important tool, we have vaccines. You know, we are seeing more breakthrough infections. But the bottom line is, even with BA.5, if you've been recently vaccinated and boosted, your risk of ending up in the hospital or dying is dramatically, dramatically lower. So vaccines continue to protect against serious illness, despite the fact that BA.5 is more immune-evasive.

ATKINS STOHR: So I want to talk a little bit more about vaccines and boosters in a moment. But first, I want to talk a little bit more about BA.5 itself, which I think is one reason why there has been some confusion, including on — speaking for myself on my own part — we are seeing that it is very infectious, that it can re-infect people who have previously had the virus. Even people who have had it very recently are getting it again. So help us understand the disparity. We have this very transmissible variant, but you're saying the tools are working.

DR. JHA: Yeah. So, first of all, we should take a step back and think about what's going on here. What's going on is over the last year and a half, we have built up a wall of immunity in our country, largely through vaccinations and boosting, but also through prior infections. And that puts pressure on the virus, evolutionary pressure on the virus to try to figure out how to evade our immune wall. And that's what's happening. So we're seeing every two to three months more and more immune-evasive variant. And this evolutionary process is not going to stop anytime soon. I mean, it's going to continue for a while.

Our job is to try to keep up with the virus, which I think we're doing in many ways. We're going to have new boosters in the fall that are Omicron specific. But also, when I say things are working, what I mean is — look, the number one goal is we've got to keep people out of the hospital. We've got to prevent people from dying. And both being up to date on vaccines, having gotten a booster shot this year, for instance, I think everybody in America who's 50 years of age and above, if they have not gotten a shot in the year 2022, they need to go out and get one now. If people do that, if people get treatments, we can keep people out of the hospital. We can keep people from getting very, very sick. And that is what I mean when I say our tools are working.

ATKINS STOHR: And when it comes to boosters, are they really necessary for everyone? Some experts say, you know, we really need to focus on the most vulnerable getting the boosters. They're perhaps not as effective in healthy people and guarding against what. What do you say to that?

DR. JHA: Yeah. I say, as you know, in medicine, we know that vulnerable people always benefit most. I mean, so obviously somebody who's vulnerable — 85 years old, has multiple chronic diseases — we need to do everything we can to get those people first. But that doesn't take away from the fact that a 45 or a 50 year old also benefits. Benefits always accrue most to the most vulnerable. But, you know, right now we have plenty of vaccines for everybody. And our effort is, of course, we're making extra efforts to try to reach vulnerable people. But for people who are young and healthy, if they have not gotten that third shot, it is absolutely critical. This is a vaccine that requires three shots in my mind, and it is absolutely critical that they get it.

And the other question that comes up a lot, Kimberly, is — people say, "Well, if I get a shot now, will I still be eligible for a, you know, Omicron-specific booster later in the fall or winter?" And the answer is yes. Getting the vaccine shot now protects you for the rest of the summer into the fall and does not preclude you from getting another booster later in the year.

ATKINS STOHR: So I want to talk a bit about the role politics has played in the response. Critics have said that the CDC has been sidelined in the Biden administration. Some even say that it's been held captive by the White House. What is your response to that?

DR. JHA: I don't mean to laugh. I don't — I guess I don't understand what that exactly means. I mean, look, the CDC director, Rochelle Walensky — your audience will know her well. She is from Boston, one of the leading infectious disease experts in the country, arguably the world. She has been leading the CDC response every public and private event we have. CDC is at the forefront. They have been driving policy really across the, you know, since day one of this administration. The president made a commitment, and I think we've seen it, too, with Dr. Walensky out there, that we would be driven by the science, and we'd be driven by evidence.

And so I understand why there were concerns about CDC independence and scientific integrity during the Trump administration. I think under this administration, we have seen CDC at the forefront of these decisions, and that's appropriate. That's what it should be.

ATKINS STOHR: Well, what about the fact that after all of the legal fights over masking requirements, for example, that ultimately fell, most notably with the transportation mandate falling? So now we see lots of unmasked people on planes, for example, that there is not the same push to say, "Hey, people should be masking, particularly when we see these variants." Is that an example of the politics of the pandemic getting in the way with the federal response?

DR. JHA: So, let's talk about this kind of very plainly here on the issue of federal mandates for masking on public transportation. The CDC had that mandate in place, and it was a federal judge that struck it down. And the administration's response was to appeal that decision. We thought that was the wrong decision, both on the legal substance, which I'm not an expert in, but certainly on the public health substance on which we all agree that was a mistake by the federal judge. And that is under appeal.

You know, we're a nation of laws. We're going to follow the laws, and we're going to carry this all the way through. ... So when people say, "Well, why didn't the federal government impose this?" My response is, a federal judge struck it down, and we're going through the courts on that in terms of messaging. You know, I have been very clear and Dr. Walensky's been very clear that in areas of high transmission, wearing a high quality mask indoors, especially when spaces are crowded and ventilation is poor, prevents you from getting infected, reduces transmission. We've been unequivocal on that.

And so, you know, it's interesting, Kimberly, because at this point in the pandemic, I think we know what the science is. We know what the evidence is that there are people who try to create confusion around those things. But we are very clear, and I feel like our job in the White House, at CDC is to communicate very, very clearly. And on masks, I think we've been as clear as we can be.

ATKINS STOHR: So I recently have heard from a lot of people who said — particularly immunocompromised people — have said they really feel like they've been left out on their own with this guidance, particularly when it comes to things like masks. I mean, I speak personally. I was on a plane yesterday. I have asthma. I wore a mask. I was the only person in my eyeshot wearing a mask on the plane. Does that give a sense to the public that the CDC and the folks in charge of the federal response have forgotten about them, that they're not focused on them?

DR. JHA: Well, I would say a couple of things. First is, I also I flew down yesterday from Boston to D.C., and I wore a mask on the plane and actually happened to be on the plane with Dr. Walensky, who was also wearing a mask. So my point isn't the individual mask wearing, but it is I wear one. I think when you have high levels of transmission, it's a good idea. And we've been very clear on the messaging. In terms of policy, I already described that the federal mask mandate was struck down by a judge. And we've appealed it, and it is in the courts.

Let's talk about immunocompromised individuals because we need to always be thinking about our most vulnerable and what we can do to protect them. There, I think there are several things. First is, there is a drug called Evusheld. So one of the reasons why immunocompromised people need extra attention is because often vaccines don't work for them. So the administration has put a lot of work in to make sure we have adequate doses of Evusheld available for free. And every immunocompromised American in the U.S. should be getting Evusheld. It provides a very high degree of protection against infection.

Second is, we've done a lot of work to make sure that high quality masks are widely available and free. Third is the messaging around the importance of keeping infections down, the value of wearing masks. And, you know, look, I think the last point is I'm always up for other ideas. If there are other things we should be doing to protect vulnerable Americans, we're game to hear it. I'm game to hear it.

For me, the most important thing is, we're focused on making sure that the things they need to protect themselves. And then obviously if they get an infection, making sure that high quality treatments are readily available. That's our strategy. And I think it is very focused on making sure we're protecting people who are vulnerable.

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ATKINS STOHR: All right. Dr. Ashish Jha is White House COVID-19 Response Team Coordinator. Dr. Jha, thank you for taking the time to talk with us today.

DR. JHA: Thank you so much for having me on.

Interview Highlights: BA.5 Questions, Answered

ATKINS STOHR: Rene on Facebook [is] asking, is there any data supporting getting a second booster now versus waiting for the more variant-specific vaccine in autumn? Another from Facebook from Terry that says, I am an 82-year-old senior who has had four vaccinations against COVID. Should I be able to get a fifth booster? Now, how should people really negotiate these boosters?

DR. AMESH ADALJA: It's all going to depend upon their risk factors for severe disease. So, for a healthy person, I think it probably doesn't make sense to continue to transiently boost and get some protection against infection for a couple of weeks. But if you're high risk like that 82-year-old, you need to be up to date. And that may mean fourth shots, fifth shots. We have to treat people with precision based on their individual risk factors for severe disease.

So we will likely see booster recommendations eventually evolve to be based on what risk factors a person has. We've already seen that with the use of Evusheld monoclonal antibody for immunocompromised, and we've seen it with second boosters being approved for people above the age of 50. I think that's how you really want to look At it. And it doesn't preclude you if you're somebody that's high risk right now, you should get boosted today. And if something comes along down the line in the fall, like it looks like with Omicron-specific booster, you get that, too.

So we really have to target this towards what risks people have for severe disease. And I think we've done too little boosting in people that are at risk for severe disease and maybe too much boosting in people that are at low risk for severe disease because the message has been muddled.

ATKINS STOHR: Dr. Wolfe, what does the data tell you about long COVID? I know we have a listener from Twitter, Kathy, who has questions about long COVID. Long COVID is a reason to I mask more than the people I see around me. What have we learned about that?

PROFESSOR MARLENE WOLFE: Yeah, me too. Long COVID is definitely top of mind. And I think that, you know, one of the things that we want to look at as we continue to track not just hospitalizations, not just very severe cases of hospitalizations and deaths, but we also want to think about the consequences of long COVID among, you know, many people who are getting infected right now.

So our wastewater data doesn't speak directly to the impact of long COVID, but it's one of those ways that we can have an awareness of what the overall cases are in a community, because that is not captured in the hospitalizations and deaths — some of that risk of long COVID. And I know that that is a very top of mind concern for a lot of people.

You know, we also have like not only people who are at different levels of risk, but, you know, young children. Vaccines only recently became available for young children. So there are a lot of reasons that these vaccines, which are an incredible tool, that we can have these new boosters and that will, you know, help greatly with the impacts of the pandemic. But we also need to consider these other risks that are out there and use tools like masking that are at our disposal to prevent transmission in the first place.

ATKINS STOHR: And Dr. Adalja, to you, am I too worried about long COVID?

DR. ADALJA: No. I don't necessarily think you're too worried about long COVID. I don't really know what the right level of worry should be about long COVID because it's still something where there are more questions than answers. We still don't agree on definitions. There is still a need to separate long COVID and from post ICU syndrome and post hospital syndrome, which are well-described entities that are not related to COVID but related to any person that's been hospitalized. So I think we still are just scratching the surface here, but it is the most pressing research question to understand.

This program aired on July 18, 2022.

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