In just a matter of days, the new omicron variant went from causing a small slice of COVID-19 cases in the United States to becoming the dominant version of the virus, edging out delta along the way. And while no time is a good time for a highly contagious variant to strike, omicron emerged at an especially bad moment: the start of the holiday season, when many Americans travel and gather with family and friends.
Researchers are racing to learn more about the new strain that’s causing a spike in COVID cases nationwide, including how it could affect the health of adults 50-plus and populations at risk for complications from a coronavirus infection. Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky, M.D., talked with AARP about what to expect during this new omicron era and how best to protect yourself heading into what could be another tough winter.
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This interview has been edited for space and clarity.
The risk of testing positive for COVID-19 is still much lower for people who are fully vaccinated than for the unvaccinated, but breakthrough infections began creeping up in November, according to CDC data. Can we anticipate more breakthrough cases this winter, given what we know about omicron so far?
We've started to see data that our vaccines continue to work against omicron, but not as well, which is why we are really encouraging people to optimize their vaccination and their protection by getting boosted. With more mutations, the omicron variant is going to require a higher level of immune response, a higher level of protection.
We really believe that with the booster shot, we're going to have pretty good protection against severe disease and death. Our current data demonstrate that you're 20 times more likely to die of COVID if you're unvaccinated, compared to if you're boosted, so we really are encouraging people to get boosted.
We anticipate that we are going to see more and more breakthrough infections related to omicron. We continue to encourage people to wear a mask in public indoor settings — even if they’re vaccinated and boosted — because that extra layer of protection with your mask should help prevent infection overall.
Now, if you happen to be one of those people who got boosted and got infected, what I would say is, please reach out to your health care provider, because they can talk to you about your symptoms and your underlying risks. We have things like monoclonal antibodies that your provider may want to offer you if you get sick.
Is there any new guidance or advice on best masking practices going into the winter? Should we be upgrading from cloth masks to N95 or surgical masks?
We don't have any reason to believe that you need to necessarily upgrade your mask in this moment. Our recommendations continue to be that everyone 2 years or older should be wearing a mask in public indoor settings. On our website, we have been consistently saying that a good mask is one that has two or more layers, that's washable, that covers your nose and mouth completely and snugly, and that has a nose wire to prevent air from coming in.
If people have an interest in upgrading their mask to a KN95 or an N95, I think that would be fine; we're not opposed to that. But what I would say is you really want to be able to keep your mask on — you want to make sure it's comfortable enough to keep it on snugly, and those may be harder to tolerate for long periods of time. So I would just measure that trade-off. An N95 that you wear half the time is certainly not as good as a mask that's comfortable that you can wear all of the time.
At-home testing has become more popular in recent months. How do you see this type of testing helping efforts to curb COVID? Any advice for people who want to use an at-home test?
We are encouraging people to use these at-home tests before they gather; they're really great for asymptomatic screening. If people don't have symptoms, the test gives you extra reassurance when you’re gathering that you’re negative for COVID. They're not foolproof — they're not quite as accurate as the PCR [polymerase chain reaction] tests — but they do give you a really good indication of your status.
If you're doing a rapid test and you have no symptoms, and it comes up positive, we’re encouraging people to then go get a PCR. But that's a flag that you really shouldn't be gathering; you should be isolating until you have that PCR test to confirm whether you have COVID. These tests really empower you to make sure that you're protecting others as you gather.
Throughout the pandemic, we’ve been hearing about overwhelmed hospitals and burnout among health care workers. Should we expect delays in elective surgeries and routine care as COVID cases spike with omicron?
We don't yet know that. What I will say is that even in part of the delta wave, we certainly saw hospitals in areas of the country at or above capacity. So this will likely be regionally dependent.
From a COVID standpoint, the best way to stay out of the hospital is to get your vaccine and your booster. Unvaccinated people are 12 times more likely to be in the hospital than vaccinated people.
In terms of urgent or emergent care, I’m really encouraging all populations to go to the hospital if they need care. Hospitals are safe places to be, and we want to make sure that people who need urgent or emergent care absolutely get the care that they need.
As for what's going to happen with elective surgeries, that is going to be regionally dependent. The best way to keep our hospitals from getting overwhelmed is to make sure that people are vaccinated and boosted.
Anthony Fauci, M.D., (director of the National Institute of Allergy and Infectious Diseases) recently said that there isn’t a need for an omicron-specific booster at this time. Has that changed in the last week?
We haven't seen any data to the contrary from what Dr. Fauci said about a week ago; we don't necessarily see any need for an omicron-specific booster. Yet we are still preparing, just in case.
[Both Moderna and Pfizer-BioNTech have announced they are working on an omicron-specific product that could be available as early as spring.]
Do you anticipate another booster dose will be needed in a few months to help keep defenses strong?
There are numerous vaccines that people routinely get that require two shots and a boost six months later, and those vaccines actually give you lifelong or decades-long protection. We have every reason to believe that this could be the case with COVID, but we're not positive. So we are preparing in case we need another booster in some period of time.
What's your advice for individuals who are on the fence about getting the booster, who may be waiting to see how things play out or are worried about side effects?
Please go get your booster. Especially older populations who were vaccinated earlier — they are more likely to have waning immunity, and we know this omicron variant is more likely to need a higher level of immunity to begin with. All of those things coming together mean that our older population really does need those booster shots. We really are working hard to make sure that those who are most vulnerable to hospitalizations and deaths from this variant are well protected.
In terms of side effects, we’ve given over 60 million booster shots and over 400 million doses of the COVID vaccines in the last year, and we have extraordinary data to demonstrate its safety.
Rachel Nania writes about health care and health policy for AARP. Previously she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.