It Sure Seems Like Everyone Is Getting COVID. Here’s What You Need to Know.

This was supposed to be the first vaguely normal holiday season in a while. Even though the coronavirus is still with us, it seemed like it was getting better. We have the vaccines and some treatments, with more on the way. 

But the arrival of Omicron, as well as the ongoing Delta surge overwhelming some hospitals in the more highly-vaccinated Northeast, has changed everything. 

More than 1,200 people are still dying every day, and hospitalizations are on the rise in more than two-thirds of states. The testing positivity rate in New York City, the first major center of the pandemic in the United States, has doubled in three days, a rate that’s never been seen before. Offices and restaurants are shutting down again, and outbreaks have forced the postponement of hockey and basketball games and threatened the last few weeks of the NFL season. 

In some ways, this is worse than pandemic fatigue. It’s more like pandemic déjà vu; this all feels very familiar in the worst way possible. And it’s unclear how we should navigate this new-old reality, especially around the holidays.

VICE News spoke with Dr. Lisa Gralinski, an assistant professor of epidemiology at the University of North Carolina’s Gillings School of Global Public Health, to talk about what we do next. 

The conversation below has been lightly edited for clarity.   

For a lot of people, it feels like in some ways we’re back to the uncertainty of March 2020. Why do you think that is, and do you view the current situation in the same way?

So I think, in most ways, we’re in a much better situation than we were in March of last year, with the glaring exception of the fact that we’re incredibly burnt out and tired of all of this. And that definitely includes all of our medical workers and essential workers and our laboratory workers who are doing the tests to confirm cases, and also the people like me who are trying to figure out the research in the background. 

We’re in a better place, but I think it doesn’t feel like it because we want to be over it. It’s coming up on two years, and people are tired of being in the middle of a pandemic. And I definitely include myself in that.

Part of the uncertainty right now is coming from the upcoming holidays. How should people be living their lives right now? Should they not gather with other households, as some health officials have suggested? 

This is a big, open question to me right now. I also have a lot of uncertainty. I know what my holiday plans were, and technically still are. And I’m also thinking about difficult conversations I need to have with family members—we’re supposed to be seeing three households throughout a weeklong trip to the Northeast, and the first household has some pretty vulnerable people in it. I want to make sure everyone’s boosted before we’re even thinking about being in the same household without masks.

I’m personally not considering someone as an adult to be fully vaccinated unless they’ve had a booster at this point. With Delta, we know that waning immunity has been a problem. And then with Omicron, unless you have the increase in antibody levels and the increase in antibody diversity—so both the quantity and the quality of that antibody response—unless you’ve had three doses of your mRNA vaccine, it really looks insufficient to deal with Omicron and the wide array of mutations we see in the spike protein. 

A lot of it’s going to be a wait-and-see type thing. We’re driving, so that gives us more flexibility. And if I need to cancel plans, it’s going to suck, because we’ve been looking forward to seeing people and having a smaller but normalish holiday experience. And I’m also bringing rapid tests.

What are you seeing at hospitals right now and how they’re dealing with this ongoing surge, and preparing for potentially another one driven by Omicron?

I do think we need to be prepared for that possibility [of an Omicron surge] because of what we’re seeing in other countries that are ahead of us in the Omicron wave. And hospitals are in a really tough position right now. We’re not at our peak hospitalization numbers in a lot of the country…but doctors, nurses, all the medical staff that we rely on are burnt out, some of them have left the field. 

So the number of available beds are lower, emergency room waiting times are up. I recently had a family member in the Northeast who needed to go be checked out for something that luckily wasn’t COVID. But a situation of, ‘You can wait in the ER for six hours to be looked at, or you can go home and then come back later and we’ll try and squeeze you in somewhere’—that’s not the situation anyone wants to be in. 

People need to try and avoid COVID, and they also need to try and avoid getting hurt in general. 

A CDC report published last week found that up to a third of people who’d tested positive for Omicron had received a booster. What should people know about their level of protection from a booster, even if they’re seeing a bunch of people in their social circles test positive despite getting boosted a month ago?

The booster offers a lot of protection, but it is not perfect, it is not foolproof—but it is the best that we have right now. 

Omicron is evolved enough and mutated enough, and the speed with which it moves means that our ability to protect ourselves from this respiratory virus is reduced. So, even if someone had their two doses in the spring and then has recently been [boosted], I would encourage them to still be taking precautions. Wearing a mask when they’re out in public indoors is the biggest, most obvious, and personally easiest one to follow. I go to the grocery store and my mask is on, I walk through the public areas of my building at work, my mask is on.

Mixing of households is really tricky. Everyone has different day-to-day risks and different tolerance for risks. And I think, again, we’re in a situation where we need to be having some potentially awkward, difficult conversations with family members that we want to see or friends that we want to see that we haven’t been able to get together with in a long time. And more people are working in-person now, kids are in school, so it’s hard to avoid that type of risk.

But if people talk about what they’re comfortable with and what they’re not comfortable with beforehand, maybe make a plan to reduce optional exposures beforehand in the week leading up to a gathering, getting rapid tests or PCR tests… just be really transparent about what your exposures are and how you’re acting out in the community, and be honest and be willing to use that information. And if it means that now isn’t the right time to get together for somebody’s safety that you care about, admitting that the situation sucks, but that maybe you’ll try again in January or February.

You mentioned vulnerable people. What do you consider to be a vulnerable person at this point, apart from the unvaccinated and young children who can’t get vaccinated?

People who are over 65 are definitely more vulnerable to SARS CoV-2, at risk of more severe disease. After two years of dealing with this, a lot of folks are thinking about protecting themselves as the number one thing, and we’re all kind of tired of thinking about the public nature of public health. But we are a community and a society that all rely on each other.

We’re seeing a pretty rapid explosion in cases. Is this part of the ongoing Delta surge, the arrival of Omicron, or a combination of two? What do we know so far about what’s driving this current surge?

In most of the U.S., it’s still Delta. And we were headed in a bad direction with Delta before Omicron even became a thing that we were generally aware of, and that we were seeing cases of in the United States. 

And now we are starting to see the signal in some of the sequencing reports, from different locations around the country, that Omicron is starting to build. This is expected,  based on what we’ve seen in South Africa and the UK and Denmark and other countries that are ahead of us in this way. We should have a pretty good understanding of what is probably coming our way at this point, where it’s a low-level percolation and then seems like a really rapid exponential rise that is potentially hitting right around Christmas.

So far, how well are the vaccines holding up against Delta and Omicron?

It depends on whether or not you’ve been boosted. The data is all very preliminary, nothing has made it to the publication stage yet, but we have data from so many labs from around the globe that there’s a very consistent story emerging here: With two doses of Pfizer and Moderna, you have almost no neutralizing antibodies that will recognize Omicron.

Now, preliminary data shows your T-cell response is much better preserved [if you’re vaccinated]. So it is likely then that people would still have protection from severe disease. But mild disease really just means you haven’t made it to the hospital. It could still be quite unpleasant.

For people who’ve been boosted and gotten a third dose, or had two doses and a previous infection, the response is much, much stronger. In this case, we’re probably comparing that Omicron infection to what we might have predicted with Delta in two doses.

But omicron has a lot of immunization properties. We’re seeing it go through vaccinated populations without too much difficulty.

To clarify, when you say the two doses produce almost no neutralizing antibodies, does the timing of when you got vaccinated matter, and is this surge driven potentially by waning immunity?

So, this is a great question and something I was really curious about as well. I just saw some preliminary data on this yesterday which indicated that regardless of how recent your two doses were, that they were not enough against Omicron, that you needed that improved diversity and quality of antibody response that you got from your immune system—getting that third dose, getting another opportunity to learn and improve its response.

But with Omicron, at least preliminarily, it’s not a time issue.

What’s new or different about Omicron compared with previous iterations and variants of COVID, in terms of symptoms, incubation period, illness length, etc.?

There are a lot of questions about whether or not it’s more mild, and I think it’s still too early for us to have a clear answer on that. At least in populations that have either previously been infected or have been vaccinated, it looks like we’re seeing a signal of more mild disease, but whether or not that’s intrinsic to Omicron or because they have some protection, my bet would be on the latter. 

It does look like Omicron is potentially faster, that it has a shorter incubation period. It’s an early signal, but it seems pretty consistent and the doubling time of cases is certainly suggestive of a short incubation time. 

Is it possible that having a shorter incubation period could be advantageous in a way in terms of people knowing that they have it sooner, so they’re not spreading it for a longer period of time before they become symptomatic?

It really depends on when symptoms start, and when people become transmissible. If we have people still shedding before they have any awareness that they might have been infected, if contact tracing lags because we used to be dealing with something that maybe had a five day window but now we’re dealing with a three or four day window—I think that can be incredibly problematic, especially with holiday mixing. If contact tracers were constantly a generation of virus infections behind, it would really allow for some worrisome, really problematic growth in cases.

In this sense, I do feel like we’re a little bit back to last year, and maybe the safest way to think about interacting with other people, where before vaccines were around and cases were going up, is to just assume that you might be infected and you don’t know it yet. Because Omicron is moving so quickly and we’re always behind on testing or getting test results or feeling that we’re symptomatic and maybe we need to be tested—personally, I will be moving towards operating in that manner a little bit more.

Is it possible to get both Delta and Omicron at the same time?

It would be possible to have a co-infection with different variants, but I haven’t seen any examples of that yet that have been detected.

Can we still trust rapid tests? And how often should we be getting tested, especially around the holidays?

I have a lot of questions about the rapid test’s functionality and ability to detect Omicron and I haven’t seen any clarification from the CDC or from a manufacturer with data. 

I have my rapid tests ready for holiday travel and I have my fingers crossed that they will be as useful as I think they are. I hadn’t thought about getting PCR tested, but now I’m thinking it would add an extra layer of confidence. It doesn’t give 100% confidence, but I do think that it’s something.

Something I haven’t understood about the boosters is why we only need one although the initial vaccine was two shots. Could you explain the mechanics of how that works, and do you see a fourth shot or one every six months coming in the future?

It is definitely not unprecedented for a vaccine series to require three or potentially more shots. A lot of the vaccines that we get as a kid have two, three, four doses. And it’s really about improving both the quantity and the quality of that antibody response and getting something that is going to be durable. It’s too soon right now to know if we will need either an updated COVID vaccine because the virus has mutated or because our memory response isn’t lasting as well. 

So far, it seems like three is quite good. But we also don’t really have anyone who got their third shot that long ago that we can look and see. So, this is an area where the science for the COVID vaccines is going to be very real time and we just can’t give the public a clear answer yet.

Do you have any final thoughts about what people should know and be thinking about as we head into the holidays?

We all thought we would be in a much better situation this Thanksgiving and Christmas. And we’re not, and that’s rough on everybody’s mental health. Individually, we really do need to to get these boosters and think about what we’re doing to stay safe. But a lack of recognition of the public nature of public health is a big part of what has gotten us into this situation. We need to do everything we can to get vaccines to countries and populations that have not had access, to encourage safe behaviors like masking indoors, and just try to hang in there even though it’s kind of terrible.