The highly contagious omicron variant has once again changed the risks that many people are willing to take. Meanwhile public health officials are struggling to keep a pandemic-weary public up to date about the latest science. Dr. Jennifer Vines, lead health officer for the Tri-County region, joins us to talk about what it’s like to work in public health right now.
The following transcript was created by a computer and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. The omicron variant is here in a big way. Every day now Oregon is setting new record numbers of COVID cases. More than 10,000 new cases were reported today. To put that in perspective, the highest one-day total during the delta surge was less than 6000. Workplaces, from restaurants to schools to hospitals, are facing staffing shortages as a result, and as predicted, COVID hospitalizations are starting to rise. Meanwhile, access to testing is limited. As for the public, it is hard these days not to be some combination of confused, tired, scared and resigned. So what better time to go back to the very first public health official we talked to about what was then called a novel coronavirus – nothing novel about it, at least in our psyches, right now. Jennifer Vines is the lead health officer for the Tri-County Portland metro region. Welcome back.
Jennifer Vines: Thank you. Thanks for having me back.
Miller: What’s your big picture for where we are right now?
Vines: I think we have just entered a very difficult moment during what is otherwise a very difficult era, if you will. The omicron variant is here, it’s spreading quickly, hospitalizations are ticking up. And we see the kind of devastation it can cause by what happened with the airlines over the holidays, by just the sheer speed and scale of illness it can cause. So I think we’re headed for a lot of disruptions in services and healthcare. At the same time, we have to realize that there are things we can do. It will not be perfect. Omicron will spread. But we can be vaccinated; we can be boosted. We can wear the best type of mask we can find, limit our interactions and try to slow the spread of this virus, understanding that it is going to spread quickly to a lot of people over the next several weeks.
Miller: What do you see as the specific challenges that omicron presents in terms of public health messaging?
Vines: We have two sort of contradictory messages that we have to get out there. On the one hand, I believe the forecasts that are showing well over 1000 people hospitalized over a very short period of time. That is a staggering number given just where our hospitals and health systems are now and the strain that they’re under to begin with. That is something that I don’t take lightly, so that is where we need people’s attention – especially if they’re high risk. They need to be vaccinated; if they’re due for a booster, they need to get it as soon as possible. And they need to take the other precautions that we’re all familiar with as far as wearing a quality mask and using testing if you’re sick or you’ve been exposed, to stay away from other people so that you don’t take part in those chains of transmission. On the other hand, we also need people to understand that omicron is here. It’s spreading, and it will spread. This is what viruses do. It has figured out how to get around some of the immunity that our vaccines provide. There are questions about the level of mask protection you need to ward it off, but these are not things to abandon. These things still offer us some important ways to protect ourselves and others and to act individually in a way that will hopefully lower the chance of spreading to others that we care about and others in our communities.
Miller: Given that omicron is so much more infectious than previous variants and the fact that, as you noted, it’s infecting people who are vaccinated and boosted, I’m seeing and honestly I’m feeling more of a sense of inevitability now than I can remember since maybe the early months of the pandemic. Honestly, the feeling that I have is that, no matter what I do, there’s a much better chance now that I’m going to get this virus even though I’m vaccinated and boosted. I’m curious, first of all, if you personally share that sense?
Vines: I share some of that. As a human being, I hear exactly what you’re saying. I think that [given] the news about the speed of omicron and how easily it gets around vaccines – less easily around people who are recently boosted, I understand that sense of resignation. I think this is our chance to figure out how to start living with COVID. By that I mean being vaccinated and as well-protected as we can be, using tests when we’re ill to connect with rescue treatments that are going to be available soon, we hope, and to use those to know, “When am I okay to be around other people?” Because I have to believe that nobody wants to knowingly pass on this virus. And yet unfortunately it is going to spread.
Miller: That question of when is it alright to be around other people, that gets to some guidance from the CDC that got a lot of pushback recently – basically shortening the isolation period for people who have tested positive from 10 days to five days – despite the fact, as I noted at the beginning, that there is not widespread availability of tests right now. How do you think about that as a Tri-County health officer?
Vines: I’ve grappled a lot with the recent Centers for Disease Control guidance around isolation and quarantine. Isolation – this is when someone is sick or tests positive and it’s the amount of time that they need to stay away from others until they’re much less likely to be infectious. That’s the rally cry of “stay home if you’re sick” and that is always good public health advice. So, no disagreement there. I think Centers for Disease Control, for that advice, is really trying to strike a balance for when they think people are most likely to be infectious with releasing them back to their activities, some of which may be critical activities that the rest of us depend on. And they were up front about that rationale, about wanting to get workers back into the workplace for the second half of their 10-day isolation period as long as they were super diligent about wearing a well-fitting mask. I think contact tracing and quarantine, which is when we look for contacts and people who are exposed and give them similar advice, having them sequester away from others while they wait for symptoms or wait for a test result. That becomes more difficult because contact tracing works when we have time. It works when we have a slow moving disease that has really clear symptoms. Unfortunately omicron is the opposite. It’s a very fast moving disease. Some people will have no symptoms at all; some people may have mild symptoms and maybe not even really take account of their symptoms. So that makes contact tracing much more difficult. That’s why you’re hearing local public health, state public health, really start to dial back that individual level notification and contact tracing and focus on places where people live and work in close quarters, where that kind of testing and rapid separation of sick from well can make a difference.
Miller: I want to go back to this question of inevitability or resignation. What does it mean, from a public health perspective, if a lot of people feel like it’s just a matter of time before they get infected? I guess the question is, how worried are you that people who have kept their guards up for nearly two years now, are just getting ready to let their guards down?
Vines: Yeah, I completely understand the sense of fatigue. The news about omicron is not good. I think this is where we are. We have been in a perpetual state of emergency now for two years, asking people day in and day out to mask, to distance, to limit their gatherings. I understand that people are tired. I think we’re not talking about forever; we’re talking about a difficult four to six weeks until the peak, at least according to the forecast. So, for what that’s worth, we are asking people to double down one more time on what we think is going to help in this situation and that is being vaccinated with all the doses that you’re eligible for including boosters, wearing the best fitting mask you can, pulling back from socializing – especially if you’re high risk – and understanding, despite all of those things, omicron will spread and it will be a very difficult couple of months.
Miller: Well let me push you on two of those phrases that really stood out to me there. We’re not talking about forever; we’re talking about a time period and we have to just get through this variant. But it strikes me that one of the scariest and most demoralizing aspects of omicron is that it’s just a matter of luck and literally the dumb luck of genetic mutations that, while this variant is a lot more transmissible, it’s also less virulent. We dodged a gigantic genetic bullet there. In other words, it could have been both more transmissible and more deadly. The next variant of concern could be that though. I mean, where is there a light at the end of the tunnel?
Vines: I think the light for me, Dave, is that the vaccines work. The vaccines have held up remarkably well in protecting us from severe disease and that appears to be holding true for omicron. That is a revelation in terms of the [fact that the] Pfizer and Moderna vaccines have an amazing track record for safety, for doing their job which is to keep us from getting severely ill. I think they set a very high bar initially with preventing infection at all, which was almost too good to be true. We’re now seeing variants getting around that. But I think that the fact that we have these vaccines now, they may be reformulated so that we get into a rhythm with COVID more like influenza with a periodic update of our vaccine. But that is where I see the real difference. We also have antiviral rescue treatments about to come online that we expect to work for omicron. So again, I feel the palpable sense of resignation. I also feel a lot of hope in what we have now that we did not have two years ago.
Miller: One of the big issues now that people are experiencing all over the state is that there are simply not enough COVID tests to go around, for all kinds of reasons: people who are already feeling various cold symptoms or want to travel or want to be able to go back to school say or go back to work in a way that it is as safe as possible. What do you see as the broadest repercussions of a lack of testing?
Vines: I think the lack of testing is incredibly frustrating, especially as people build their guidance according to what CDC has published which is fairly reliant on testing as far as a marker for whether or not someone is infectious and therefore whether they’re, quote-unquote, safe to return to certain activities. I think that’s going to change as we get more rapid tests into the hands of individuals themselves which is great. It means people are going to be able to test at home at their convenience and have an answer on the spot. We’re not there yet though. I think, as people start to adapt to the reality of omicron and become much more attuned to their test status if they have symptoms, I’m hoping it will become easier for people to do the right thing and also for others to feel confident in their workplace, knowing that tests are in the hands of their coworkers, available and that people are doing the right thing, coming back when they are least likely to transmit.
Miller: What’s the timeline that you envision for that?
Vines: I know Multnomah County has gotten several tests out through community based organizations; these were tests that we ordered on our own. We have tests that are coming to us from the state – that we’re getting ready to distribute – and supposedly more on the way from the federal level. I understand people want them now; they wanted them yesterday. It’s going to take days and weeks to get these out. But I do think that is an area that I expect to improve.
Miller: How much faith do you have in the rapid test themselves, in the results, say, of a negative result from a rapid test?
Vines: No medical test is perfect. I think the rapid tests are good enough to be useful. I think there is concern that they may not always pick up virus or that they will have flaws or that maybe someone won’t follow the instructions exactly. But I think they’re pretty simple and they’re pretty useful and I think they’re good enough. So this is just part of the risk that is going to exist in our world that we cannot eliminate. Unfortunately this is the lesson of omicron.
Miller: For a whole bunch of reasons, local and statewide public health officials and the governor have been wary of returning to the really major shutdowns of public life that we experienced at the start of the pandemic and other earlier, more deadly waves. I’m thinking about shutdowns of restaurants and bars. What would it take for you to be among the voices calling for a return to those kinds of restrictions?
Vines: Those restrictions inflict a lot of pain on a lot of people as we now know. They’re a pretty blunt.. they’re the most blunt public health tool in terms of disrupting disease transmission, as far as prevention is concerned. To answer your question head on, I think it would take a variant that completely escapes a vaccine, is more transmissible and is more deadly. So we are fortunate that we are not in that situation at this point. So, rather than restrictions,we are using the tools at hand to help people make the best individual choices for themselves, hoping that, if we all do that in the right way with just the right balance, we get through these next several weeks together.
Miller: Then there’s the potentially even thornier question of K-12 schools. Just in the last day, two Portland high schools announced they were going back to distance learning because of the number of positive cases among both students and staff. What does a school environment look like to you during this omicron wave?
Vines: The school closures were for administrative reasons; it was for reasons of staffing. Again, like the airlines, this is a reminder that these are the types of disruptions that are going to come up in the next several weeks. The closures are not to disrupt virus transmission or because of unacceptable virus risk, per se, but it is the reality that this virus is going to spread and people are going to have to stay home sick. It’s a reminder that people need to have plans in place. You need to make sure you have food and pet supplies and medications and a child care plan in case, at the drop of a hat, some service or something that you rely on is suddenly not there. I think the school environment is one where we want people to feel confident in the precautions that are in place. That means teachers need to stay home if they’re sick; they need to stay home if they’re positive. So, you see the closures happening for administrative reasons.
Miller: As you’ve noted, the omicron variant eludes enough people’s boosted or vaccinated defenses that people can get sick, but it’s very unlikely that they’re going to get sick enough to need hospitalization or are going to die. But the fact is that in Multnomah County – even though it has one of the highest vaccination rates in the state – about one in seven residents, almost 100,000 people, have not received a single vaccine dose yet. Do you have a radically new idea for how to convince them to get vaccinated? Because, at this point, clearly nothing else has worked.
Vines: Well, I would say the news of the omicron variant and people’s attention now to this wave, has actually created a lot of new interest and energy around vaccine – certainly for boosters, but we are also seeing people coming in for their first doses. In public health, we always want to take the voluntary pathway towards the right thing which in this case is vaccine. So I think our efforts are really focused there, on where there is voluntary uptake. And I think your question is a longer term one for all jurisdictions – local, state and federal – to figure out how can we get our community to a level of protection that COVID is not as disruptive as it has been these last two years.
Miller: Jennifer Vines, thanks very much.
Vines: My pleasure.
Miller: Maybe one day we’ll talk about something that’s not COVID.
Vines: That would be great. Thank you.
Miller: That’s Jennifer Vines, lead health officer for the Tri-County region.
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