Interpreting the pandemic: Explaining the omicron variant and what daily COVID numbers reveal: Upstate Medical University's HealthLink on Air for Sunday, Jan. 23, 2022

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," an infectious disease expert discusses the more infectious omicron variant of the coronavirus.

Stephen Thomas, MD: "...It is making plenty of people very sick, putting people in the hospital, and killing people. But, delta, on average, seems to be more severe..."

Host Amber Smith: We'll go over what to do if you wake up feeling sick.

Stephen Thomas, MD: "...Not everything is COVID, but in January 2022 in Onondaga County, if you wake up with the sniffles or a cough, a headache, then you should assume it's COVID until it's proven to not be..."

Host Amber Smith: And a professor of public health talks about the ways the pandemic is measured.

Chris Morley, PhD: "...When we look at how deadly or how risky something is for severe illness, hospitalization is one way to measure the severity of a virus or its morbidity..."

Host Amber Smith: All that, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, we'll talk about how the pandemic is tracked and which public health measures are most effective. But first, what you need to know about the infectious omicron variant.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." We've entered our third year with a pandemic underway and a more contagious variant. So I'm talking again with Dr. Stephen Thomas. He's a virologist and infectious disease specialist who's also the director of Upstate's Institute for Global Health and Translational Science. I appreciate you making time for "HealthLink on Air," Dr. Thomas.

Stephen Thomas, MD: Well, thanks for having me back. I appreciate it.

Host Amber Smith: When we spoke a year ago, you said that life could start looking normal again within 12 months, if we, as a nation, got vaccinated, improved our use of masks and followed social distancing guidelines. So as a society, where did we fall short?

Stephen Thomas, MD: Well, we had, we had successes, I think, in a lot of areas, primarily I think vaccination. You know, you can look at it either way, half full or half empty. I mean, we have 63% of the United States, as of today, is fully vaccinated, and folks over the age of 65, it's almost 90%. Almost 80 million Americans have had a booster, which is good. And the numbers of the doses of vaccine that we've been giving out each day has kind of gradually been rising since July. So it's just over 1 million doses a day. Closer to home, we're in the seventies. So New York's about 73% fully vaccinated, and Onondaga County is about 71%.

So I think that that's a good thing. We certainly did get very lax with safe gathering and social distancing, physical distancing, and, and mask wearing. We did get lax, and I think a combination of reduced vigilance with those non-pharmaceutical interventions, changes in the weather, unsafe gathering, and now this highly transmissible variant has kind of put us back into a bad spot.

Host Amber Smith: The mask recommendations and requirements have changed a lot over time, and they seem to vary depending on where you're living. What is your best advice right now for someone who's determined not to catch COVID-19, but who also can't remain isolated? What sort of masking is recommended?

Stephen Thomas, MD: There is no 100% guaranteed way of preventing yourself from getting exposed or reducing your risk to zero. I mean, there are extreme ways we could all think of, but that's just not, that's not reality. So what we try to do is, we try to take the most effective measures we can and layer them one on top of the other. The most important would be getting fully vaccinated. And I think, now at least with the messenger RNA vaccines, I think that those are three dose vaccines, and I think the Johnson and Johnson vaccine is at least a two dose or, a mix and match of Johnson and Johnson with a messenger RNA vaccine.

As it relates to masks, you know, that messaging has also kind of changed. On the one end you have, people who don't wear masks. And I would say that that's not a good decision right now, to not wear a mask when you're in a public place or to not wear a mask when you are outside of your pod and what you know is a safe environment. The cloth masks and the gators -- depending upon how they're made, because they're not all created equal -- they offer probably the lowest level of protection, but they're better than nothing. The next level would be an ear loop mask. The next level after that would be a surgical mask. So those are the masks that you tie, and the difference between those two is the adequacy of the fit. So lack of open areas on the side, and also their filtration. They differ in filtration with the surgical masks being better. And then you start getting into the higher grade masks, the KF 94s and the KN95s. And then the top, which is what the clinicians who are taking care of patients that are known to have COVID or are being ruled out for COVID, that's when you get into the N95s and the pappers, these positive air pressure respirators. The problem, and it's, it's like Groundhog Day, right? I mean, at the very beginning, there was all sorts of messaging around masks, and part of the messaging and it differed, right. It was health care and high-risk occupations, versus the general public. And part of the reason the general public was being asked to not procure those higher grade masks was because there was not going to be enough for the medical establishment, right? The people who are at known risk every single day.

And that went away for a while. Supply chain was good. And, you know, we were kind of undulating with lower level outbreaks and surges and declines. And now we're kind of back in that same spot again, where the press has grabbed onto this and public health authorities and whatnot have basically said, as I have said, that the cloth masks are not sufficient to protect you, probably, against omicron because it's so highly infectious, and it is so prevalent and it is so everywhere.

So now there's this huge rush on these higher grade, kind of medical grade masks from the general public, and institutions are starting to have issues with supply chain again. So that's sort of the download on masks. To me, just the practical aspect is, if you are going to a public place, I suggest that you wear a mask. If you are going to a restaurant, I would go to a place that requires their staff to wear masks and people to wear masks when they are moving about. But when they sit down, I think if they have properly spaced the tables, I think a vaccinated person in a space to table, with masked staff, I think it's still risky, but it's probably a level of risk that people could consider taking. I probably would not go to highly densely populated events where there was not a vaccine, or a mask mandate, or those mandates were not being enforced.

Host Amber Smith: Looking ahead a little bit. What is your advice for someone who wants to plan a trip for spring break? Is that a bad idea at this point? Or is there some sort of a getaway that might be safe?

Stephen Thomas, MD: I would get refundable tickets, is what I would do. I mean, you know, if you look at the map, like, let's say you're planning a trip in the United States. If you look at the heat map of where the hotspots are in the US right now for omicron, the whole map is lighting up, right? The entire country, except for some very few areas, is basically illuminated. With omicron, it's just absolutely everywhere. And and it is, you know, it is what it is.

So what can you do to reduce your risk or reduce your family's risk? Again, it's methods of transportation where they are monitoring and enforcing vaccination or test negative, mask wearing. Those are the types of transportation that I would utilize. If you can drive yourself, well, that's great, right? Because it's just going to be you and your family or your pod in the vehicle.

And if you're going someplace where the weather is nice and you're going to be outside -- and by nice weather, it could still be snow, it could be a ski vacation, but something that allows you to be outside. I mean, obviously that's a much lower risk, being outside, but just kind of monitoring what's going on. And just be prepared for needing to pivot or needing to change your plans at the last minute.

Host Amber Smith: Upstate's "HealthLink on Air" has to take a short break. Stay tuned for more from Dr. Stephen Thomas.

Thank you for listening to Upstate's "HealthLink on Air." Today we're talking about the omicron variant and its impact on the pandemic. I'm your host, Amber Smith. And my guest is the director of Upstate's Institute for Global Health and Translational Science, Dr. Stephen Thomas. Now that we're hearing so much about the new omicron variant, can you compare what the COVID-19 illness looks like in someone infected with the previous variant, that delta strain versus someone who has the omicron. Are the symptoms the same, or is there something more prominent with the omicron?

Stephen Thomas, MD: There are a lot of symptoms that overlap between the two. You can get fever, you can have cough, you can have a runny nose, you can have a headache with both of them, but it seems to be a little more prominent with omicron than with delta. People with delta seem to have more, I think, gastrointestinal complaints, nausea, vomiting, diarrhea. I think they also have a higher rate of losing taste or smell or having disruptions or abnormalities in their taste or smell. And, delta -- and I'm going to choose my words carefully here because there's a lot of people that are out there saying, "oh, omicron is mild," and that really is not the message -- that is not what people should be thinking because, it is making plenty of people very sick, putting people in the hospital, and killing people. But, delta on average seems to be more severe, and there are animal studies and real world data and science that supports that fact and actually gives us some insight into why we think that may be the case, which I would just summarize by saying the delta variant seems to have a greater predilection for infecting the cells deep in our lungs, versus omicron, which seems to be a little more comfortable in the upper respiratory track.

Host Amber Smith: If somebody had COVID early in the pandemic, are you seeing that they're protected against this variant, the omicron?

Stephen Thomas, MD: That is a great question because it gets to this myth that "natural infection is better than vaccination and I've already had COVID so I don't need to get a vaccinated." Uh, no. You are not protected in general. At least with what we're seeing with SARS CoV-2 is that there are some variants that seem to offer some cross protection between them, but delta, which is what has been predominant in this country from July of 21 until just recently. We do not believe that the immunity a person gets from being infected with delta will protect them from omicron. And there is, again, real world evidence, and there's also laboratory data that supports that. So you're not going to get significant cross protection if you've had delta before. But there is some hope, and there's some lab evidence to support, that if you've been infected with omicron, it could in fact, help protect you against delta. But as interesting as that is, I think it's almost irrelevant because at least in this country, although there are lots of pockets of delta that still exists for the most part, it looks like omicron is going to be the winner of this battle between the two and become the, it already is the predominant variant in the United States.

Host Amber Smith: There's some talk out there of the people that want to go get infected with omicron since there's been talk that it's so prevalent, everyone's going to get it at some point, you know, let's get it over with. Can you address that?

Stephen Thomas, MD: I would not advise that. I know plenty of people who have been infected. They were highly vaccinated. They were boosted. They were young, and they didn't have a lot of other medical problems. And, they tolerated it fine. But I also know, and having worked in the hospital this past weekend, there are also lots of people who do really poorly. So, the unvaccinated, omicron can still kill them, and put them in the hospital. And that's what we're seeing. People with, who are immunosuppressed for whatever reason, either because they have an illness that suppresses their immune system, or they take medications that suppress their immune system, they are also at increased risk for a bad outcome with omicron. And then there's older people, people over 65, for example, and people with other medical problems, lung disease, heart disease, diabetes, kidney disease, they're also at high risk. So even if you may not perceive yourself as somebody who will do poorly, if you get omicron, it is still possible for you to transmit it to somebody else who could do very poorly. So I would never recommend a returning to the days of the chicken pox slumber parties.

Host Amber Smith: Well the groups that you just mentioned -- the immune compromised, the unvaccinated, which includes some children that are not eligible yet. , and the older people -- this population that is at a higher risk, is there anything more that they can do to protect themselves?

Stephen Thomas, MD: Well, they obviously should be fully vaccinated. They should have a third dose, or a second dose depending upon what they received and to boost themselves, for sure. And if they're highly immunosuppressed, we do have some medications out there that are available to people who do not Mount an immune response following vaccination. And so they remain at risk. And that that medication -- I think it's from AstraZeneca, Evusheld -- it's in very low supply. And so we're all trying to figure out who should get it, who needs to be at the front of the line, and how we ration this the scarce resource. There's also the antibodies and the new oral antivirals that can be used and even Remdesivir, for that matter, that can be used if somebody is at high risk and they have an exposure. Or somebody who is known to be infected and might have mild disease now, but may progress to more severe disease. So there's ways we can use these available medications. But again, there's a supply chain issue with lots of these, especially the new oral medications, the Evusheld, which I just mentioned.

Host Amber Smith: Well, I'd like to ask you about treatments for the severe cases of COVID-19, the ones that end up in the hospital. What is working and what is used these days to help these people?

Stephen Thomas, MD: You can think of severe COVID infections in two phases. The first phase is where the person gets infected. The virus goes and replicates in the lungs, and it can replicate in a lot of other organ systems. There's kind of that phase where the virus is causing direct effects on the cells that it's infecting. And then the second phase is what we call like an inflammatory phase, right? So it's the body recognizes it's not supposed to have this virus here and it responds. And typically what we want is we want our body to kind of maintain this balance of inflammation within our body. We want to be able to fight off the virus or the bacteria, the parasite, whatever it is. But we don't want to mount such a huge, huge, overwhelming storm of these inflammatory cells that we damage our lungs or damage our kidneys or damage our liver. And unfortunately, that's what happens in that second phase in certain people. So if you think of those two phases, then the way we treat people is, early on, we try to limit the amount of viral replication. So we do that with things like monoclonal antibodies, of which there's only one preparation that will work against omicron. We do it with drugs, like Remdesivir. We tried to do it in the past with convalescent plasma, but that had limited success. It's still scientifically plausible. It's probably moreso how people were using it and the lack of quality control with it. So that's what we tried to do upfront is limit the viral replication.

And then on the back end,this inflammation -- you know, COVID is not the only disease that can cause that kind of thing -- so, that really then becomes more of an internal medicine, critical care sort of issue where they use anti-inflammatories like dexamethazone or other steroid preparations, or they can use what they call these interleukin inhibitors, trying to block these pathways that lead to inflammation. And so, this is kind of, where we are.

In terms of how effective they are, you'll get different data depending upon what study you read and how they designed the study and what types of patients they got. The overarching summary would be, the earlier that you can treat somebody with the antivirals or with the monoclonal antibodies, the better that they're going to do for sure. If people stay at home sick for 7, 8, 9, 10 days, then the cat's kind of out of the bag, and it's really difficult to catch up.

Host Amber Smith: So for someone who wakes up tomorrow with a headache, a sore throat, a runny nose, what do they need to do?

Stephen Thomas, MD: They need to stay home. They need to not go to work. They need to not go to school. They need to not go drive the bus or do whatever it is that they do for a living. So that's one thing, for sure.

The second thing is they should try to, if they live with other people, they should try to isolate themselves from those other people. If they have a home test available to themselves and they are sick, then they could take a home test. If they do not have a home test available, then I think it depends upon the circumstances of their life and whether or not they can wait a day or they should run right out and get PCR tested. Because unfortunately, people have allergies with the changes of the season and there's influenza and there's other viruses, metapnuemovirus, which is circulating, and RSV, and all these other viruses are circulating again now because people aren't wearing masks and they're not distancing. So, not everything is COVID, but in January 2022 in Onondaga County, if you wake up with the sniffles or a cough aheadache, then you should assume it's COVID until it's proven to not be.

Host Amber Smith: Well, I want to ask you, and I know this is a tricky question, but when is this no longer a pandemic? We can't really put a date on when it's going to end, but what numbers do people like you look at to tell you that the pandemic is over?

Stephen Thomas, MD: Fortunately, I am not somebody who's going to be advising the world on when a pandemic is over. The World Health Organization tries to tackle that question because the pandemic, as we all know, it's a global level epidemic.

You know, I was thinking about this recently, of how do we know when the fourth quarter is over? How do we know when the game is done? Because I don't believe that this is going to go away anytime soon, right? So SARS CoV-2, the virus that causes COVID, it will be circulating on this planet for many, many years. And it's going to make people sick. And it's going to put people in the hospital, et cetera. So I've been sort of thinking that the pandemic will be over when we say it's over. I'm editorializing a little bit. I'm sharing an opinion. I think we are going to, as a society, we are going to say, what is a level of transmission and hospitalization and illness that we are willing to tolerate and say, this is the way it's going to be, and let's move on to other problems, because we have a model with that, right? Influenza. Influenza puts about 750,000 people a year in the hospital, and it kills about 30,000 people a year, and nobody thinks twice about it. So I think we're just going to have to determine what we are going to accept from COVID in that way. And then that's when we'll say, it's over, you know, and we'll all move on. And and I don't want to be dark about the whole thing, but I think that that's kind of how it's gonna play out.

Host Amber Smith: You've given us lots to think about and lots of good information. I want to thank you again for making time for this interview.

Stephen Thomas, MD: Thanks for having me. I appreciate it.

Host Amber Smith: My guest has been Dr. Stephen Thomas, a virologist and infectious disease expert at Upstate who leads the Institute for Global Health and Translational Science. I'm Amber Smith for Upstate's "HealthLink on Air."

How the third year of the pandemic differs from the first two -- next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." This stage of the pandemic is different from the beginning, or even from a year ago. Here to help us understand is Dr. Christopher Morley. He's professor and chair of public health and preventive medicine at Upstate. Welcome back to "HealthLink on Air," Dr. Morley.

Chris Morley, PhD: Thank you so much for having me back, Amber. It's always great to talk to you.

Host Amber Smith: Now, two years ago as the COVID-19 pandemic was just getting started, we learned about the basic reproductive number. It was called "R naught" (written as R0). It was supposed to be a way that scientists tell the average number of susceptible people that each infected person is likely to infect. But we don't really hear about this number anymore. Does it still matter?

Chris Morley, PhD: It does still matter. We don't watch it as, as closely as the sole indicator. One of the reasons we watched r naught so closely early on is because it was the indicator that told us what this brand-new virus was going to do. And the thing that turned out to really matter is the R naught is the value that tells us what a virus does when it's unimpeded. RT, or the reproduction rate at a particular given time, tells us how the virus is responding in real time to the impact of society's interventions, like distancing, masking or the introduction of vaccination, because the reproduction rate will change. So the RT is a measure of how quickly or slowly the viruse is reproducing. And one of the things that's key about measuring RT is that it's how we assess variants against one another.

We don't talk about it as much, in public, because we pretty much understand in broad strokes the dynamics. And in our region in Onondaga county, we settled into an RT of about 1.3 when we were hitting a bad surges. And when we got things under control, we would settle down below 1, because at that point, if a person is infecting less than one other person on average, an RT of around .8 (0.8) is essentially when we were in our lulls.

Unfortunately, the omicron variant now has an RT that we're calculating of almost 1.7. It was about 1.68 the last time the biostatistician, Dr. Dongliang Wang in my department calculated it the other day. So, that's markedly higher than we've seen in the past. That value is a way to express how much worse omicron is.

Host Amber Smith: Is there a number that tells how deadly a virus is or how,if it's going to put you in the hospital, or kill you?

Chris Morley, PhD: We do look at population adjusted rates. So when we look at how deadly or how risky something is for severe illness, hospitalization is one way to measure the severity of a virus or its morbidity. And hospitalizations per hundred thousand allow us to compare hospitalization rates across different viruses, different illnesses, across different variants of the current virus or against regions.

The hospitalization rate is another important metric that we look at, and we understand what those are by adjusting for population. And currently we have a hospitalization rate of about 33 people per hundred thousand in hospitals right now in Onondaga County. Similarly, if you look at the death rate per hundred thousand, that's the way to assess, rather than taking the raw number of deaths, it's a way to express it as a rate within the population. Right now we're about 1.6 deaths per day as a seven day average. So we're losing about a one to two people every day.

Host Amber Smith: So those are numbers that are based on reality. They're not a projection. So you kind of have to wait until time has passed to be able to look back and see what happened. Are there numbers to project, or predict?

Chris Morley, PhD: So there are a lot of models. We've done modeling, other people have done modeling, to try to assess where we're going as a trajectory over the course of the pandemic. And here's the problem. Early on, we didn't know much about the virus, so it was tough to predict. And every time we get one of these new variants, and particularly with omicron, it's been tougher to model. Now that doesn't mean people aren't trying, but by and large, what we are turning our attention to is looking at other regions that, unfortunately, have suffered the introduction of omicron earlier than we have. We basically, the best predictors for what's going to happen here is by looking at comparative states. So a lot of people, for example, looked at what happened in South Africa, but understanding whether that's a good comparison or not means looking at the population dynamics, the age distribution in the population, at how many people have been infected or vaccinated, and what kind of measures the population is taking against the vaccine, as well as the seasonality. So there are things that are different about South Africa. South African is about to enter summer. A lot of their population is younger than ours. And, they also have been more universally exposed. By some accounts, over 80% of people have been, had some exposure to the virus. So the dynamics of how the pandemic will play out there with the new variant will be different. Where we're watching closely are in a European states who are entering winter, just like we are and who have similar vaccination rates and similar age distributions as Western societies. So we're watching particularly the UK, the United Kingdom, very closely for how things play out there. Typically we'll rely on those real world experiments that are playing out before our eyes, before I start modeling, because the modeling is based upon our assumptions. And we don't know what assumptions to make about the new variant.

We're learning more every single day. But at this point we -- luckily for us, unfortunately, for other states and countries -- have real-world examples to look at.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Chris Morley, who leads the department of public health and preventive medicine at Upstate.

I'd like to ask you how cases are tracked in New York state. Does the Health Department, the state Health Department, get the numbers of positives from all of the county- and all of the state-run testing sites on a daily basis?

Chris Morley, PhD: Yeah, that's right. And I do want to sort out that many antigen tests, especially those at home kits, don't go to the state, but basically any certified lab that's doing a PCR test. And any clinical tests that's using using antigens should be referring to the state. With very few exceptions, most of the tests that we see go on are transmitted to the state. The state is the central repository.

Host Amber Smith: So how do researchers know if they can trust the numbers from particular states? Because I'm sure the way New York state does it is different from all the other states. So how are you able to compare?

Chris Morley, PhD: We like to assume that most public authorities are honest brokers of the data, and I want to say that in practice, it looks like most are. I really don't want to get in hot water calling out particular individual municipalities or states, but when you have things that look patently false, like suddenly there are zero cases in an entire state in a day, that is highly suspicious. And I don't feel constrained by saying that if you see a state of millions of people reporting almost no COVID when every other state in the country is still reporting cases, that's suspicious. That's not happening at the moment, but that has happened in recent times. And that's just a signal that maybe something isn't right.

What is important for people to be doing now if they want to avoid becoming infected?

Chris Morley, PhD: I really appreciate that question because the impact of the pandemic has been a multi-headed Hydra. It's impacted so much. Obviously, it's impacted our health, but it's impacted our functioning as a society as well. And I want to recognize that. So when we initially did studies, and I spoke to you about it over a year ago about the impact of distancing and close-down measures, they were effective at shutting down the virus, but they came with a cost.

And so in order to function, we've learned a lot more about the virus. I mean, most of us aren't washing our groceries anymore, and we've learned how to function together without, before omicron, without rapidly transmitting virus to one another. We have crawled back to a semblance of functionality. And there are tools, we do have tools at hand, and the first, obviously, is vaccination.

I do want to talk about that for a moment, if you'll allow me, because a lot of questions arise about vaccination. And I hear them in the form of challenges, like "I got two. Why do I need a third?" Or "I did everything they told me. Why do I need to do this?" or "How many vaccines do they expect me to get?" I understand that the messages potentially have been cloudy and we're learning as a scientific body how to move forward. But the bottom line is that we get flu shots every year. Flu shots every year are intended for exactly what happens with COVID. We have new strains and new variants, and strains compete with one another. Then mutate. And we have a new flu vaccine every year. We haven't gotten to the point where we're reformulating vaccines specifically for variants yet, but we also have the other factor of waning immunity. A vaccine protects you only for so long, so different vaccines last for different amounts of time.

So you should get a tetanus booster every 10 years or so. We should probably update flu, with or without new variants every year. And so there are different periods of time that vaccines last. What we're learning is that the baseline for vaccination against COVID-19 is probably a three-shot regimen. And and we probably need boosters going forward. We probably run out of antibodies after a period of time. And additionally, not everybody forms the same T-cell memory, so we will need boosters to keep our immune systems humming and ready to fight the next wave of COVID.

So my answer to people is, you have experienced this, you have experienced multiple vaccinations. It's not different. This isn't strange. Vaccination is really important, including boosters and including just doing your best to listen to the advice of scientific and medical professionals, and get vaccinations when you're supposed to, and be prepared for more. That's just going to keep happening.

I would also urge people to modify their expectations about what vaccinations do. Although every one of us, at this point, with this surge, probably knows somebody who, despite being vaccinated and boosted, came down with COVID and is experiencing symptoms. But here's what's not apparent, what's not obvious just by watching people around you. What's not apparent is that the hospitalizations we're experiencing are, by and large, still people who are either unvaccinated, and the odds of being hospitalized if you're unvaccinated are five times that if you're vaccinated. So you're still far more likely to be hospitalized if you're unvaccinated, and those people who are vaccinated and end up hospitalized often have a series of risk factors. So it's basically, there are explanations for why vaccinated people are getting hospitalized at all, and it is much less likely. And in terms of people leaving the hospital, which is also a really big issue, you want to leave the hospital if you go in. If you don't leave the hospital, it's because you have had the most unfortunate outcome of all. And that most unfortunate outcome of all -- death -- is 14 times more likely in people who are unvaccinated.

So that's not apparent to the lay watcher who's sitting around watching people who are vaccinated come down with something that looks like a flu. That's not going to be apparent to you, but when we aggregate the numbers and watch them, as public health professionals and as a scientific community, what comes out is a very stark and clear picture that vaccination, when it is done fully and effectively, meaning two shots anda booster, at this point, is really protective against the worst outcomes.

Host Amber Smith: In addition to vaccination, what about masking? Is that still recommended and social distancing? Is that still in play?

Chris Morley, PhD: Absolutely. After vaccination, I would rank the next most important thing we can do is wearing an effective mask. Now that's evolved, and I want to be clear with your listeners that we've had a lot of debate as a scientific community. And unfortunately some of that plays out in front of the public and it's never good watching the sausage get made, but ultimately there is a product, and we know what works and what doesn't work. A cloth mask at this point, in the face of omicron, is probably not very effective. There's multiple reasons for that. One, cloth masks were never ideal, but a good multilayered cloth mask was probably better than nothing for most of the time. To be honest, a good cloth, multilayered, thick mask is probably better than absolutely nothing, but you don't want to be out there with absolutely nothing. It's proving not to be a very effective. It's a little bit too porous and it doesn't stop enough virus for it to stop it from reproducing. Additionally, if you're wearing the same cloth mask, as you have since the beginning of the pandemic, you've probably hopefully washed it several times. It's not a good thing, even if it's brand new. If you've been using it for a while, it's time to retire it.

So what do I mean by a good mask? Well, those cheap, paper ear loop masks that look like you're walking into an OR (operating room.) Well, you look like you're walking into an OR for a reason. They are actually really good at preventing you from infecting another person. And the more people wearing those, the more they're preventing infection across the two individuals. They do multiple things. In addition to filtering our particles, they redirect the flow. So even though people will argue that, oh yeah, I can still smell things. I can still feel air come around the sides. That's true. But if you have a blast of SARS CoV-2 COVID-containing air coming out of your mouth or nose going forward, and it gets redirected to the side, that airflow matters. And so if you haven't blast this one full on in the face, and it's redirected and gets mixed in with the solution of air we're all sitting in and gets into the HEPA filters, hopefully we're using in buildings, or when we're outside, that is actually an effective stop. And it also does help prevent you from getting blasted in the face by somebody else's viral discharge.

We have had problems and concerns, and the CDC has a website that lists out makers of counterfeit or, or otherwise suspect, K-N95 masks. But the bottom line is retailers like Amazon have taken steps to guarantee that K-N95's that they are selling are checked for compliance. K-N95's are typically often considered non-medical devices, but in public they form a better seal than surgical masks.

It is important to make sure that they are sealed. Investing in a K-N95, for example, if you have a thick beard and it doesn't form a seal, you're defeating the purpose. But if you can form a good seal with a K-N95 and adjust the metal clip around the nose so that it's form-fitting, that's really a great level of protection. When I'm walking around in my personal life, I am using a K-N95 now. We do try to use utilize N-95s, which are really the the top tier of personal protective equipment, for medical professionals. And those reasons we're still reserving those. We aren't in the same dire circumstances as we were previously, when we were actually running out. We are still trying to make sure we preserve those masks for people who are treating COVID patients or in clinical settings where they have a high likelihood of exposure.

The other issue, in addition to preservation for our medical professionals, is that for an N-95 to be worth the investment, you have to properly fit test them. For most manufacturers, you have to properly fit test them. So if you're wearing a poor fitting N-95, you're really not doing much better than you would be getting with a K-N95 or even a surgical mask. So at Upstate, we do fit test people. We know the brand and size, and if we change brands, people have to be refit tested and we refit test people every year. So as your face changes you're refit fit tested. And that's the appropriate context to use an N 95. Otherwise, I would save them for people who are using them in those contexts, when they're fit tested, when they're most urgent.

Host Amber Smith: Before we wrap this interview up, I wanted to ask you when we will know when the pandemic is over. Are there parameters or numbers to watch that are going to tell us when this is done?

Chris Morley, PhD: That's a great question, and it's one we all ponder. One thing that I would say is obviously, the numerical value of R equals less than one, or is less than one, is a good sign, but that doesn't tend to last. And so what we really need is a good, solid, several month period or even a year where we are basically not seeing these dramatic surges. If this were a visual presentation, I would show you graphs where we see large spikes. And the reason I'm describing that is because I think most of your listeners, if they have access to a computer, can Google basically any line graph of where the COVID epidemic has played out over time. And you'll see that you see large spikes that come down and then you see another large spike, and that's not how a virus or other pathogen that's endemic behaves. You have a, basically a steady state.

We do actually have other epidemics. I mean, the flu is an epidemic that we actually devote tremendous amounts of resources to managing the flu epidemic we experience most years. Most people don't see it. They don't understand it. But we have a massive vaccination effort. We have a massive tracking effort. We know how to do it. It's just so ingrained that most people don't understand it's happening. But the problem is that SARS CoV-2 is such a worse virus. And I want to keep saying that it is not the flu, and it is such a worse virus and behaves so differently that that's why we are feeling it.

But, when you actually get to the point where something is endemic or is epidemic, but it's a way that you can manage, those fluctuations or those dramatic spikes will be much more blunted or not even appear at all. You'll have a steady state. And unfortunately you just need a period of time where you watch it play out. And you say we haven't had a huge spike in awhile. This is probably turning to an endemic status.

Host Amber Smith: So it started feeling that way toward the end of the summer. But I guess some of us started celebrating a little too soon thinking it was over and it wasn't.

Chris Morley, PhD: Oh, those of us who were watching this didn't feel that way. I don't mean to dispute my on-air host and good friend, but, at the end of the summer, we were watching the last variant, the delta wave, take over in Central New York. We watched that play out at the beginning of August, and by September, we knew we had, well, by mid-qAugust, we knew we were seeing something resurge. And by September we understood, we were in a problem area. And we spent much of September, October, November dealing with quite a large surge. We didn't reach the same peak as we did last year. And we didn't see quite as many hospitalizations because of vaccination, but we did see a surge. It was delta driven.

And in Central New York, we saw that persist beyond where it persisted in Western New York or in the Capital Region, for example, similar regions. But where we had the New York State Fair, for example, we had a large gathering. We actually persisted, and we continued to see a surge through September.

Unfortunately the omicron variant hit us after we were already experiencing a surge. We were already at several hundred cases a day with delta variant. From beginning in August that surged upwards and through November and December, we were experiencing over a hundred, and almost 200 to 300 cases a day before Omicron hit us. So we were not in good shape. So I think we're a fair ways away from being endemic, unfortunately.

Host Amber Smith: Theoretically, would the pandemic be over if we had a vaccination rate of a hundred percent, since we're just talking theoretically? If everybody was vaccinated in the US, would this be over, or would that not be possible because this is global?

Chris Morley, PhD: There's a lot of ways to answer that. If everybody in the U S had been vaccinated, here's how that would've played out. We still would have had variants evolving in other parts of the world. Where the virus can reproduce, it will introduce new variants. New mutations will occur, and new variants will arise where it can reproduce, and it can reproduce where people are still able to serve as hosts. And we still would have had variants.

Would we have had the problem we are having now? Perhaps not. Here's what would have been different. First of all, when we say we are 70, 80, 90% vaccinated, whatever number you want to use, you have to remember that, that immunity wanes. Those people who are vaccinated in December and January and February, first of all, were older, they were more at risk. So you got the double whammy that they're the furthest back. And probably the people who mounted the least robust immune response. So to consider them still vaccinated is probably a fallacy. They needed to be boosted. We didn't have boosters. We didn't have the data to do it, so that's not a criticism.

But the bottom line is, if we had been 100% vaccinated all at once in a rapid short cycle of time. If everybody had basically gone out and we had enough supply and vaccinated, everybody, we could vaccinate rapidly, yeah, you would've had a much more effective wall than we have where we're talking about a number that actually is kind of meaningless because it's trailed out over the course of the year. I hope that explanation makes sense.

Host Amber Smith: It does. And I appreciate you taking time for this interview. My guest has been Dr. Christopher Morley. He's professor and chair of public health and preventative medicine at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from Dr. Jason Wallen from Upstate Medical University. How does smoking cause lung cancer?

Jason Wallen, MD: Cancer in general comes because of cellular damage. So anything that you do that repeatedly damages cells in a given part of your body means that your cells are going to have to repair themselves or grow new cells. And the more cell division or cell repair that is going on, the greater the chance for an error, and those errors are what lead to cancers. And smoking does a lot of damage to the lungs, and the lungs definitely try to repair themselves or heal. And when that's happening multiple times a day, every single day, day in and day out for many years, the chances start to become quite significant that a mistake will be made and that one cell will become cancerous.

And then you develop a full-blown lung cancer.

Host Amber Smith: You've been listening to Dr. Jason Wallen, medical director of the thoracic oncology program at Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week selection.

Deirdre Neilen, PhD: Memories we have of those we have loved give The Muse some heartbreakingly beautiful poems. I'd like to read two of them now. The first is by writer and retired teacher and illustrator Mary Beth o'Connor. It is called "Afterward."

"As October days fall into ripen and char,

"I lean toward what comes next: the darkening,

"the frosts, the nights full of nearer stars.

"I put on your coat, venture out, harken

"to the news of changing seasons -- hushed

"but for crunch of boot steps toward the last

"squash to gather -- then mow dead leaves to mulch,

"sweep the porch, store cushions, watch the forecast....

"Down by the pond the red-winged blackbirds

"have departed, no more chatter and shrill.

"I'll not see them until the spring return

"even though I keep the bird feeders full.

"I'll bring in firewood, clean the smoke-smudged glass,

"light the match -- watch flames devour what's passed."

The next is from semi-retired publisher and poet Jack Hopper, who has published four poetry collections. Here is "Your Presence ."

"Were it not for you

"I'd be sitting here alone.

"You're gone and I accept it

"as the end at last to so much pain

"you had to suffer just to die

"while others whom I've loved live on,

"or pass into the ether

"of distance and neglect.

"Occasionally we still meet

"in that variant version of reality

"we call dreams and you are

"quite real until the sun paws

"kind and quietly at the blind,

"reminding me there is another world

"wherein you will not walk,"

"I will not hear your voice,

"will not lie down beside you

"or reach out for what we both desired,

"as you pass by."

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse. New York. Next week on "HealthLink on Air": Services expand for children with special needs. If you missed any of today's show or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org. Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Stephen Shaw. This is your host, Amber Smith, thanking you for listening.