STEVE INSKEEP, HOST:
The omicron wave has struck different parts of this country at different times. On this Monday morning, this holiday, we can say that in some parts of America, the wave seems to have peaked; case numbers are dropping. The country as a whole is not quite there. So let's work through the situation, as we often do, with NPR's Allison Aubrey. Allison, good morning.
ALLISON AUBREY, BYLINE: Good morning, Steve.
INSKEEP: Where are case numbers maybe past their peak?
AUBREY: Well, cases have been declining for several days in New York and Massachusetts, several other Northeastern states. This is also the case in Maryland and the District of Columbia, all places that were among the first to see the surge. I'll also point to Ohio, a state that has seen a 150% increase in hospitalizations compared to last winter's surge. Now that has begun to flatten in parts of the state. Cleveland Clinic is seeing fewer admissions. So the direction is encouraging, and overall, cases are less severe. But I spoke to a critical care doctor, Abhijit Duggal, at Cleveland Clinic. He is treating some of the sickest of the sick, including unvaccinated people and immunocompromised people.
ABHIJIT DUGGAL: You feel for them and their families. You want to ensure you do everything to help them. But sometimes the things that we do in the ICU are just temporizing measures, and sometimes it is too late.
AUBREY: Now, deaths are not nearly as high as they were last January, but amid this surge, deaths have risen to about 1,800 per day.
INSKEEP: Wow. That's still a September 11 every day or two, a reminder...
AUBREY: That's right.
INSKEEP: ...That this is still a deadly virus, or it can be for some people.
AUBREY: That's right. I mean, though cases amid omicron have not been as severe on balance, there are just so many more of them, and there are still lots of people who are not vaccinated and people who have compromised immune systems. I spoke to Dr. Emily Landon. She's an infectious disease doctor at the University of Chicago. She says it would be helpful if they had more access to new therapies, such as monoclonal antibodies right now.
EMILY LANDON: We're - have our hands tied a little bit in medical care. We can't rescue people as well as we could when we had delta because we don't have as many monoclonal antibodies. We are out of the sotrovimab, the one monoclonal antibody that works for omicron. We're completely out of it and have been for a couple of days, and we don't know when we're getting another shipment to our hospital. And the same is true at many other hospitals.
AUBREY: In addition, the new antivirals are also in very short supply. These are the pills that are taken in the first few days of an infection to help keep people out of the hospital.
INSKEEP: What do doctors and nurses do when they don't have access to the very latest treatments?
AUBREY: You know, they're relying on some of the older therapies. At one large health care system in Southern California, Kaiser Permanente, they're using remdesivir, an older antiviral that has to be administered by infusion. Now, clearly, that's more complicated than just prescribing a pill, but Dr. Edward Blews of Kaiser told me they're offering more of these transfusions just after a person is diagnosed, especially for people at high risk of progressing to severe disease.
EDWARD BLEWS: We have some workflows where we're able to infuse it in the home setting but also have some infusion centers which are designed to get folks treated with remdesivir while we're waiting for some of the other supply chain shortages to iron themselves out.
AUBREY: He says remdesivir has been shown to reduce the risk of death in people at higher risk, so this is a strategy to keep people out of the hospital at a time when many hospitals are stretched thin and cases have continued to rise.
INSKEEP: Yeah, we keep reporting on the shortage of medical personnel.
AUBREY: That's right.
INSKEEP: So we mentioned also that cases are crashing in some places, like Washington, D.C., for example. But when might the country see a decline?
AUBREY: You know, some models predict the peak will actually come later this week. Here's Ali Mokdad of the Institute for Health Metrics and Evaluation at the University of Washington.
ALI MOKDAD: Our projections for the peak are around the 19, so January 19, at 1.2 million reported cases a day. Hospitalization will peak a little bit later, around January 25. And our projections - for the long-term projection, cases would keep coming down; deaths will come down.
AUBREY: Now, some modelers think it could take a bit longer to hit the peak. And the virus is not going to just disappear, of course. Eventually, the majority of the country will likely be infected. But the idea, Steve, is that cases will become more manageable, less disruptive, as more people have immunity.
INSKEEP: Some people have gone into this surge thinking, well, it's inevitable; I'm going to get infected. They might even have the idea that they should get it over with.
AUBREY: Yeah. You know, even if it seems inevitable, infectious disease doctors say it does not make any sense to try to get infected. I mean, even if you were to become only mildly sick, there's still a lot of vulnerable people out there that you could spread it on to. Here's Dr. Emily Landon again.
LANDON: Unless you're going to take extreme care to make sure that you quarantine, you're going to put other people at risk by trying to get COVID, and that is socially irresponsible. I mean, you do not want to be - you do not want it hanging over your head in terms of karma.
AUBREY: Or just being a decent person. In addition, she says, look; there's no guarantee you won't get infected again in the future, so better to get immunity from the vaccine, doctors say.
INSKEEP: I like that we're now talking about the karma effect here in the pandemic.
AUBREY: (Laughter) That's right.
INSKEEP: It all comes together - things come back to bite you. Let's talk about another thing here. People have been quite upset in recent weeks because it's been so difficult to get enough tests, especially as kids are going back to school and everything else. The Biden administration has said they're on this. It hasn't helped much yet but that they're on it, that starting this week, people will be able to order free rapid tests that the federal government buys for them. How's this supposed to work? And what's the advantage and disadvantage?
AUBREY: Yeah, so the idea is that people will be able to order these tests for free. There has been some confusion about just how sensitive they are. You know, people are asking, do these tests work? Do they detect omicron? Well, a new study out from researchers at UCSF tested the BinaxNOW rapid test earlier this month amid this surge. They found that tests do detect omicron with very high sensitivity when people have high levels of the virus. But similar to prior strains, when a person has low levels of the virus early in an infection, the tests only detected about 65% of the time. So infectious disease doctor Diane Havlir of UC San Francisco says the bottom line is this - the tests are performing about the same amid the omicron surge.
DIANE HAVLIR: Our results are consistent with what we had seen previously, and that was reassuring. However, if a person has a negative Binax, they should get a repeat test because they may be on the upswing. Their virus might still be going up, and the first test did not diagnose it.
AUBREY: This is why Abbott, the maker of BinaxNOW tests, recommends that symptomatic people do two tests over three days with at least 24 hours between tests. Researchers are also looking at whether swabbing the throat might yield more accurate results.
INSKEEP: Oh, good, I can gag rather than feeling like somebody is poking my brain. Great.
AUBREY: (Laughter) You know, it is possible that that might help improve sensitivity. There's been chatter on Twitter by some doctors asserting that swabbing your throat in addition to your nose could be better. The directions on those tests specify, you know, swirling that swab around your nostrils, but there is increasing evidence that omicron may replicate in the throat before the nose. So if you swab there, the idea is it may detect the virus sooner. But until there's some data on this, Steve, the FDA is suggesting that you stick with the manufacturer's directions.
INSKEEP: OK, we'll try to choke all that down. Allison, thanks so much.
AUBREY: Thank you, Steve.
INSKEEP: NPR's Allison Aubrey. Transcript provided by NPR, Copyright NPR.
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