"We still have a problem with COVID. We're still doing a lot of work on it, but the pandemic is over," President Biden said in an interview that aired on the CBS program 60 Minutes on Sept.14. "If you notice, no one is wearing masks. Everybody seems to be in pretty good shape, and so I think it's changing, and I think this is the perfect example of it."
Like the rest of the country, San Diego County’s COVID-19 numbers have been trending downward over the past several weeks. Despite that, around 400 Americans continue to die from COVID-19 each day. It looks like the virus will remain a part of our lives.
KPBS Midday Edition turned to three local experts on infectious diseases and public health to get their reactions to the president's declaration of the end of the pandemic.
Corinne McDaniels-Davidson, a professor at San Diego State University's School of Public Health, Dr. Eric Topol, director of the Scripps Research Translational Institute in La Jolla, and Rebecca Fielding-Miller, a professor at University of California San Diego’s School of Public Health participated in a conversation Wednesday. The interview below has been lightly edited for clarity.
Is the pandemic over?
Topol: Unfortunately, it isn't. We're going to see more of what we have been seeing. There's some very troublesome variants out there that have more immune evasion than the BA.5 that we had to contend with through the summer. We're already seeing a significant uptick in the European Union. And you mentioned that things are coming down in the U.S. overall and certainly in San Diego, but unfortunately, we're already seeing an upswing in cases in the Northeast, and as you know, we don't track cases that well. So there's a lot of disturbing things out there that tell us, I think, pretty well that while the weeks ahead look okay, we're in for some more trouble in the next couple, few months.
What was your reaction to the president's statement?
McDaniels-Davidson: It was disappointment. It was frustration. You know, I was actually at a conference when he made those remarks, and almost everyone at that conference was wearing masks indoors. And so I looked around and I said, well, we're all scientists here, and we're wearing masks. And so just because where you might be they're not wearing masks doesn't mean the pandemic is over. And people aren't wearing masks because no one is asking them to. When people are asked to wear masks, they do wear masks.
Fielding-Miller: Yes, I really have to second both of those opinions. I think it's very clear that this is not over when it's pretty consistently the second and third leading cause of death across the country when so few children have been vaccinated or likely to be vaccinated in the near future. And I agree, it's a strange metric to say we're not asking anybody to wear masks, so nobody's wearing masks, so the pandemic is over. That's not how we typically measure infectious disease when we're doing a good job.
The president's words came on the eve of an election, and it's hard to ignore how many people seem to be over the pandemic. Has politics been damaging to the public health strategy during this pandemic?
McDaniels-Davidson: I think we can't deny that it has been. I think that when you have politicians who lead public health response or you have political appointees who lead the public health response, they're going to be influenced by politics, they're going to be influenced by polling. And it's strange because polling shows that when people are informed, they're actually willing to do a lot of the public health protections that we ask them to do.
But I think that we stopped talking about COVID and we're trying to minimize it going into the election so that it's not at the front of people's minds. Therefore, it's not at the front of people's minds and they're not wearing masks.
Throughout the course of the pandemic, we have heard comparisons between COVID-19 and the flu. How are they similar and where do they differ at this point?
Fielding-Miller: I think that one thing that's really important to think about in terms of COVID is it's airborne. The flu is too kind of, in different ways.
But it's true, you might have flu like symptoms, you might have a headache, you might have respiratory issues, but the flu doesn't result in up to 20% of people who have the flu having long term disability. The flu does not have these long term cognitive effects that we're seeing in COVID. And so while in the short term it might feel like, oh, this was just kind of a bad flu, the long term effects are clearly a lot worse.
And another really important difference is COVID can have really strong effects on people between the ages of 5 and 65, whereas for flu, we usually see the very young and the very old at high risk. But, I mean, I have friends in their 30s who have experienced stroke and pulmonary embolism who are otherwise very healthy, and you don't get that with the flu.
McDaniels-Davidson: And if I could add to that, the other big difference is that we don't have seasonality with COVID, and I don't expect to see seasonality with COVID while we have transmission out of control and new variants emerging.
With the flu, we have a particular winter season where we expect to see it. We can kind of predict what's coming, and we try to tailor the annual flu vaccine to that, but we don't have that with COVID, and I don't see it anytime in the near future.
Topol: Well, those are some really essential points that have been made. I think the long COVID, which has still not really been unraveled, with no treatment, no biomarker, is completely different than what we see with influenza, of course.
And what is the good part comparing flu and COVID is that we've done so much better against this virus, you lose perspective. There's never been a vaccine against flu that's 95% effective against infections, hospitalizations and deaths as it was all the way through the delta variant. It's only when omicron came where we started to see the problems with infections and transmission not being checked by the vaccines.
We never had a pill like Paxlovid. The best we've had with flu has been Tamiflu. That doesn't work that well. This is a virus that we can triumph over.
But I think that we stopped talking about COVID and we're trying to minimize it going into the election so that it's not at the front of people's minds. Therefore, it's not at the front of people's minds and they're not wearing masks.Corinne McDaniels-Davidson, professor at San Diego State University's School of Public Health
We've already seen some things that show us that we can prevail. The problem that was just touched on is that it's still out of control. We haven't gotten ahead of the virus. It's not contained. We got down to less than 12,000 cases a day in June of 2021, and people said the pandemic is over. And then what happened?
We've seen this movie before, and how many times do you have to see it before you say, "Wait a minute." The only way to know the pandemic is over, that is contained, is to look backwards and say, "Oh, we went all these months and things have been quiescent. Yeah, there's been some small outbreaks, but overall it really has been contained and under control."
We're just not there yet. And different from the 1918-1919 pandemic with the flu, because that just petered out in less time than this has gone on, of course, with no vaccines. So it's a totally different look.
It's been about three weeks since the government rolled out new COVID-19 boosters that target both the original strains of the virus as well as omicron. But numbers released this week said only about 2% of eligible people have gotten it. Does that surprise you?
Topol: Well, not really, because we've had a booster problem all along. In this country, we're less than a half of the use of uptake of boosters in any high income country in the world. So we've had a bunch of our booster campaign. In part, that was our governmental agencies with infighting and reluctance to acknowledge how important boosters were because they thought that was going to interfere with the primary series vaccines and all sorts of issues.
However, with this one added onto the problem that we've had with booster acceptance, it was put out without the data a lot of people would like to see, which is the human response to this BA.5 bivalent vaccine. We're going to see that, I understand, next week. That I think will help a bit.
But also, when you tell the public, which is what they want to hear of course, the pandemic is over. Who's going to sign up for a vaccine? When a lot of people get a lot of reactions in terms of fatigue and fever, chills and all the other things that you get from having a shot. Who wants to get that when you're being told the pandemic is over?
So that doesn't help the cause. Hopefully we can get some momentum. But it is concerning.
I understand that our public health force is tired and burnt out, and I don't blame them. And I think that the lack of political will, the lack of positioning this with any urgency has really removed their ability to push booster campaigns, to do the outreach, to continue the pop-up clinics and all of this. Yeah, I genuinely wish we treated this with the same urgency that we treat cancer. That would be lovely.Rebecca Fielding-Miller, professor at University of California San Diego’s School of Public Health
Given where we're at in the pandemic now, do you think we should start seeing this as a transition from treating COVID-19 as a national emergency into something like heart disease or cancer, deadly health issues that are managed without an emergency in place?
Fielding-Miller: To be honest, I wish we did treat it with the urgency that we treat heart disease and cancer when COVID is creating more long term injury than a lot of pre-existing non-chronic illnesses. And when we see sort of the political will sapping away from addressing this, when there is a moonshot initiative to address cancer, when one of the biggest public health issues in the county, that the county has done really well on, is addressing cardiovascular disease, I wish that we would address it with that urgency.
I understand that our public health force is tired and burnt out, and I don't blame them. And I think that the lack of political will, the lack of positioning this with any urgency has really removed their ability to push booster campaigns, to do the outreach, to continue the pop-up clinics and all of this. Yeah, I genuinely wish we treated this with the same urgency that we treat cancer. That would be lovely.
McDaniels-Davidson: Well, with only 68% of people in the United States fully vaccinated, only 33% boosted, and frankly, not knowing when folks got their boosters, that could have been almost a year ago that they got their boosters, we are not in a good position to come out of the emergency because we're going to be faced again in the coming weeks and months with another surge. It is coming. And I think that taking away a lot of those protections, and taking away funding for testing and vaccines and anti-virals is a mistake leading into the winter.
San Diego's COVID-19 numbers have been trending in the right direction, but we have been on something of a roller coaster over the past few years. What can you tell us about new developments as winter approaches?
Topol: Well, roller coaster is a good term here, so going to get ready for the next ascent in the months ahead. I think because the numbers are turning down here, we have some weeks ahead that will be relatively quiet. But unfortunately, as we go forward, it's pretty clear there's a variant right now that's already past 12% in the country. BA.4.6.
And that one is really troubling because EVUSHELD, which is what immunocompromised people rely upon to prevent infections in sequela, it no longer works against that. And also people who have had a recent BA.5 infection are going to be vulnerable.
So the point that was just made by Corinne about how the lack of boosters and the high infection rates don't necessarily put us in a powerful position to withstand that variant. And then there's the other ones that are creeping up, like this one called BA.2.75.2. Now that one has got lots of trouble. And there's another one called BQ.1.1 and I know these are hard to deal with, these numbers and names, but they are far worse than what we've seen so far in terms of their ability to evade our immune response, which includes vaccines, infections and their combination.
So likely November, December, we have to contend with any one of these or combinations of these new difficult variants.
As I understand it, numbers are slowly starting to rise in Europe again. What does that tell us?
Topol: Well, they're not so slowly rising, they're going up substantially in several countries. And it tells us what happens in Europe doesn't stay in Europe. And every single time it comes here. Not directly, of course, but it's the same story in terms of the variants taking hold and then the winter months and more people inside, the lack of mitigation measures for the reasons that have been discussed, all these things basically help the virus, give it legs. And so what's happening in Europe will unquestionably occur here. The only thing we can hope for without taking more aggressive positions with better vaccines, nasal vaccines and using mitigation is that maybe because of all the immunity wall that has been built that hopefully it won't be as big a wave as what we've seen previously.
What public health strategies are you hoping to see from the CDC to manage COVID-19 in the next few months?
McDaniels-Davidson: I'd love to see a recommendation that everybody has to test to exit isolation. I think that that is one of the most basic things that we can do. We can provide rapid tests to folks so that they can test negative twice before they exit isolation and go back out into the world.
We can work on improving our indoor air quality. We can work on ventilation and until we get ventilation improved, we can work on air filtration. These are simple things. Well, some of them are simple. Ventilation takes a lot more time and engineering efforts, but I think it is possible.
We had the rapid acceleration of diagnostics that we did at the beginning of the pandemic, but still ongoing, where we developed tests, we developed all kinds of things and we can use that to actually improve our indoor air quality and to have a rapid acceleration of indoor air quality. We can also put in place some on ramps based on transmission that we see in wastewater. We have a lot of waste water testing. We should be using that to think about what added protections we need to add to protect those who are less vulnerable to this disease.
This is a question for all of you when it comes to testing and masking. Do you think our approach to those things should change, should be different now that these variants are different?
Topol: Well, I think there's no reason to abandon these things. These are really helpful. As just outlined, rapid testing. We have a CDC that tells us five days is good enough without the need for rapid testing, which is totally wrong. Rapid test should be done, as already mentioned, and they're very helpful. And the average time we just published yesterday for these people to not be infectious is between 10 and 14 days.
So what we've done in this country is actually promoted, spread by having non data driven practices supported by our public health agency. But yes, the masks are really still important, high quality masks when indoors are really important.
Fielding-Miller: I have to second that. I think that it's really interesting, this narrative of sanitizing and hand washing caught on very early. Which you should wash your hands, don't get me wrong, but this narrative caught on very early and it's stuck in people's minds. And I think the narrative of it's airborne, you have to clean the air, you have to wear a mask. Your quality of mask is really important. For some reason that has not had the same hook.
But masking is one of the best things that you can do in the absence of all other structural things to protect yourself in the moment. And it's one of the best ways that you can demonstrate community care and make sure that other people around you are safe.
And I think that we need to be very clear that those fabric masks that we were all using early on, they were a great stop gap, but that is not what we need to be using right now. Everybody needs access to high-quality, well-fitting masks that don't gap. We need masks that fit children well that are accessible. It's actually really hard to find a mask that fits a tiny face.
But masking and really widespread use of antigen testing are some of the most powerful tools that an individual can use to protect themselves or to protect a party or a conference or any other time they want to get together with their friends.
Is there anything else anyone would like to add?
Topol: It's just been great to have a chance to participate in this discussion with Rebecca and Corinne and you, Jade. I think it's not the happy talk that people are hearing, but it's the real stuff. And hopefully, eventually this will pass. Eventually we'll get to a very good point in this whole ordeal, but unfortunately, we're not quite there yet.
