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Omicron variant: Areas with high vaccination rates ‘will just see this as a ripple, not a surge,’ doctor says

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Dr. Ellen Eaton, assistant professor at the University of Alabama at Birmingham's Division of Infectious Diseases, lays out what information is known about the Omicron variant and how prepared populations with high vaccination and booster shot rates may be for potential surges.

Video transcript

AKIKO FUJITA: Let's bring in Dr. Ellen Eaton. She is University of Alabama Birmingham Division of Infectious Diseases associate professor. Doctor, good to talk to you today. It feels like we have been really trying to make sense of this new variant over the last several days, as we continue to wait for additional science and data to come forward. How are you looking at this in the context of what was already concerns about rising case counts here in the US?

ELLEN EATON: Yeah, so I think this is just yet again a reminder that the virus is going to continue to look for opportunities to spread, and unfortunately, evolve and mutate to take advantage of crowded gatherings, as we've heard about, populations that are unvaccinated, and eventually, populations that are not boosted.

So what we're hearing about is really, unfortunately, predictable. We're hearing about people gathering for the holidays. We're starting to see some of the transmissions that happened over the Thanksgiving break. And I think it just remains to be seen how this new variant will affect our holiday infection rates. We're hoping we don't see a big surge. I don't think we'll see what we saw last year. But there's a number of variables, the virulence of this new strain, how it is, if at all, possible that it evade our vaccines, how it responds to some of our treatments, like some of our newer oral options.

But there are a lot of things that we do know. We know that masks are effective. We know that testing can help us identify infections early. We know that we can isolate ourselves and prevent these transmissions that may happen across the Christmas or Hanukkah or other table gatherings. So I think really leaning into the things we know, ventilation, gathering outdoors, masking in gatherings, testing before gatherings, and certainly vaccination and boosters.

We know that all Americans adults are eligible for boosters now if they're six months out of their vaccine. And children like mine who are five and older are also eligible for vaccines. So leaning into those things that have been tried and tested is really going to help us weather this next variant in a much more safe manner.

ZACK GUZMAN: Yeah, and doctor, I mean, when we're weighing out all of these things, obviously, as you said, it's still early, still a lot to be learned about omicron. But when you look at the cases now reported here in the US, specifically the California case, some people in the medical community honing in on the fact that all close contacts there were contacted and tested negative. So if we're talking about transmissibility of this variant, I mean, is it too early to compare to what we saw with delta? Or kind of, I mean, what are the expectations, given what we know now?

ELLEN EATON: Yeah, I think it is too early to say with certainty how transmissible this variant will be. Certainly, in areas where we have high vaccination rates and people are gathering outdoors, wearing their mask, I imagine we will just see this as a ripple and not a surge. And hopefully, if there are breakthrough cases, we'll continue to see them as mild cases, which we've seen. And I feel pretty confident that breakthrough cases will continue to be much milder than those in unvaccinated individuals.

But I think we'll also see what we see in Alabama and we saw in the delta variant, and I imagine we will continue to see throughout the holidays, which is that several areas are largely unvaccinated. Here in the deep South, only 46% of Alabamians are fully vaccinated. And I can speak to the children and teens, less than 10%, more like 5% have had one dose of the vaccination.

So in those areas where we have multiple generations gathering in a household-- some are unvaccinated-- they've been gathering through the holidays-- children have been in schools-- many schools are not masking-- I imagine we'll continue to see transmissions. And unfortunately, just statistically, we're going to see some hospitalizations and deaths over the holiday season in those types of settings.

AKIKO FUJITA: And doctor, to what extent have those numbers already started to go up? And who are you seeing coming through the door? Is it still largely those who are unvaccinated? Or are you continuing to see a lot of breakthrough cases?

ELLEN EATON: Yeah, I do have good news to report on the last few months in Alabama, specifically in the deep South. We know that we did eventually see a downtrend after delta really ravaged our areas and hospitals in the summer and early fall. But the last couple of months have been pretty manageable for our hospitals and health systems. We continue to see the vast majority of hospitalized individuals are unvaccinated or not fully vaccinated. High 80% to 90% of our hospitalized patients are unvaccinated.

Of that small percentage who is fully vaccinated that's hospitalized, unfortunately, this is our vulnerable elderly. These are our patients who have had bone marrow transplants. They have breast cancer. They're receiving chemotherapy. So another reminder that young and healthy people need to be vaccinated. Their children, their entire families need to be vaccinated, so that we can protect these loved ones, whose vaccine may not be as effective due to their underlying chronic medical illness.

And I really encourage people before they gather to also test, test themselves, test their families, especially if you're going to visit a vulnerable or elderly loved one with complex medical conditions, to make sure that you and your family aren't bringing an asymptomatic virus or a new variant that we don't know much about to the dinner table.

ZACK GUZMAN: Lastly, too, I mean, when we talk about all of this, you know, there have been some who have pushed for maybe-- I don't know if I've heard anyone push for lockdown again. No one really wants to go back to where we were in 2020. And obviously, a lot of-- maybe not everybody, but a lot of people have been vaccinated. When you look at maybe what more can be done and what the Biden administration is now imposing here when it comes to travel, I mean, are you maybe seeing the need to go back to maybe universal mask mandates? Or how drastic should maybe be some of the precautions and mandates to be put in place now, when we're dealing with kind of so many unknowns?

ELLEN EATON: Yeah, unfortunately, we have seen a lot of resistance to these mandates, especially in the South, when it comes to masking, even vaccination. I think what we can do is really, as you just alluded to, get out the vaccine push. Have vaccine sites at schools. Have family vaccination sites where people can get their booster and bring their children who are five and older for their vaccine. We should continue to mask in indoor settings. I've continued to do that. My children are doing that, even though it is not required. And in some situations, they are the only child who is in a mask.

But I know that's-- based on the last 18 months, I know that's the best way to keep our family safe. We've stayed healthy and safe. So encouraging those things, but also, I think, making testing more accessible, more affordable. I know a lot of families who are interested in testing before they get on that flight, before they drive to see family members out of state, potentially to a state that has an omicron case by the time they arrive there. I know they're interested in testing, but I've heard from patients and families that testing their entire family right now is very expensive. It's about $20, $30 for a rapid test.

So you can imagine if you're going to test your family before that road trip, before that flight, it can be very costly for a family of five. And certainly if you're encouraging them to test again before they get back on the airplane or at various points throughout their travel, that's very cost prohibitive. So I think encouraging masking, vaccination, but also making some of these interventions like testing much more accessible to Americans is going to help us stop the spread and really prevent, as I mentioned, the surge that we saw last Christmas, which we're really hoping we'll avoid.

AKIKO FUJITA: And on that front, we are expecting the president to make that announcement today, saying that home test kits will be covered by insurance moving forward. We know a lot of other countries have already made those available. How big of a step is that as you see it? I mean, given that a lot of these home kits also have false positives, false negatives, I mean, how significant is that additional layer of testing, given that the case counts are going up?

ELLEN EATON: Yeah, you got it. It's a layer, right? It is not a standalone intervention that's going to prevent transmissions. We know that false positive tests got much less frequent. We have 18 years of science and technology. The tests are much better. And certainly, I think the risk of bringing an infection to a large gathering outweighs the risk of a very unlikely chance you'd have a false positive at this time. So it's a layer. It should be used with vaccination, with masks and public transit and large gatherings. And it should be used to help prevent you from bringing that infection to that gathering. So I think it's a layered technique.

And we haven't mentioned this, but the additional layer that we have now with this surge is we're hearing about more oral options that potentially will treat individuals in the outpatient setting, keep them out of the hospital, which can be a tremendous addition to our toolkit, right, for individuals who may pick up a case of coronavirus while traveling. We'd like to in the future be able to have an oral option to prevent hospitalization, regardless of their vaccination status. And I think we'll hear more about that in the future as well.

AKIKO FUJITA: Dr. Ellen Eaton, appreciate your time today, University of Alabama at Birmingham Division of Infectious Diseases associate professor.

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