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Matt Katz: This is The Takeaway. I'm WNYC reporter Matt Katz, in this week for Melissa Harris-Perry. Good to be with you. Christmas is just days away, and I was hoping and naively expecting a joyful and relaxing holiday season. Of course, it's shaping up to be the complete opposite of that.

Reporter 1: It's here now, and it's spreading, and it's going to increase. For unvaccinated, we are looking at a Winter of severe illness and death for unvaccinated. For themselves, their families, and the hospitals they'll soon overwhelm.

Reporter 2: At least 39 states and over 75 countries have reported confirmed cases of the Omicron variant. Omicron is increasing rapidly, and we expect it to become the dominant strain in the United States.

Reporter 3: It is less important at this point to focus on the absolute number of cases, because Omicron is moving so quickly. Again, based on the international experience with Omicron, it is likely to grow rapidly and more rapidly than we have seen with Delta in the past.

Matt Katz: Over the past two weeks, positive COVID cases have risen around 30% nationwide. COVID hospitalizations and deaths are up around 20%, and infections among vaccinated people are becoming more common due to the Omicron variants. While much of this news is disconcerting, it's important to keep some facts in perspective. The vaccines still appear to be effective at doing what is most critical, preventing severe illness and death. That's why health officials are urging people in the US to get booster shots, to add an additional level of protection.

We still have the tools at our disposal that have been essential throughout the pandemic, masks and physical distancing. Of course, that does not mean this winter is going to be easy and it doesn't mean our government officials are responding all that well. Let's break down what you need to know to make of this current phase in the pandemic. Here to help me do that is Nsikan Akpan, health and science editor for WNYC Gothamist and my colleague in the WNYC newsroom. Great to have you here, Nsikan.

Nsikan Akpan: Hey, how's it going?

Matt Katz: Going okay. A little nervous, obviously like all of us, I think. How about you? How troubled are you by the relative sudden surge in cases, hospitalizations, and deaths over the last several days throughout the country?

Nsikan Akpan: I'm less worried than people might expect. I've closely followed every twist and turn of this pandemic since the virus emerged, and I would say that I'm probably about a 7 out of 10 on the panic scale right now. That's even though New York reported another 22,000 cases on Sunday, which meant that we broke our single-day records for a third day in a row, but these milestones don't necessarily mean that the state and the pandemic at large in the nation has really reached its worst point yet.

What experts are telling us is that COVID seems to be transitioning into its endemic phase, where the coronavirus would continue to still thrive in perpetuity, but vaccinated people would be mostly spared the worst outcomes. We'll be on this roller coaster ride of infection waves every few months or every winter. It could be really brutal for unvaccinated people, but for vaccinated people, you might catch COVID, you might develop a mild to moderate or a really bad cold, but you would largely be spared the worst outcomes.

Matt Katz: You said brutal for unvaccinated people, does that mean that most of the hospitalizations or deaths resulting from COVID right now are happening among unvaccinated people?

Nsikan Akpan: Yes, that's exactly right. By really, really wide margins, 8 to 10 times the number of cases, hospitalizations that we're seeing right now are in unvaccinated people versus vaccinated people. A lot of that has to do with Delta spreading as much as it has to do with the Omicron variant spreading. Both spread really fast. Everyone is mixing so much, especially for the holidays, but we're all indoors right now. Unvaccinated people are really standing to face some very serious consequences over the next few weeks.

Matt Katz: What about the booster shots? Are they likely to help against the Omicron variant, and then how are health officials going to even convince people to get these boosters if that's the case?

Nsikan Akpan: Yes, they are. I do want to talk about the Delta variant too because it is the majority of cases right now. Most infections we're seeing right now are Delta, and we know that the boosters can fully stop those infections. With Omicron, early evidence is very promising that two doses of vaccine will protect against severe disease and hospitalization too, but Omicron can invade our immunity, namely our antibodies, better than Delta, so we are going to see breakthrough infections. Just to give people some numbers, two doses of vaccine used to lower the chances of catching the virus by 80% to 90%. Against Omicron it's looking like 30%.

The same all also appears to apply to people who are relying on previous infections, so-called natural immunity. An Imperial College London analysis of British healthcare workers showed that prior infection used to lower the odds of reinfection by 85%, now that's down to 19%, but on the bright side, we are seeing evidence that boosters can restore this protection against getting the virus, against infection.

Modena just put out some results today, showing that the boosters can restore protection against infection. Pfizer has put out something similar. I think there's still an open question about Johnson & Johnson in that single shot, that that allows you to be fully vaccinated. Those people, I think, will need to get boosters as soon as they can, because it's really looking like, from some independent analyses, that that vaccine cannot protect against infection. Everyone needs to go get boosters, essentially.

Matt Katz: Are vaccinated people just as contagious as the unvaccinated when it comes to spreading either Delta or Omicron? If I'm at a fully vaccinated party, if everybody there has been vaccinated and boosted, is it still possible that I can pick it up there and spread it elsewhere even if I don't necessarily feel sick?

Nsikan Akpan: Everyone can be contagious, but it really depends on for how long. With vaccinated people, that window of infectiousness tends to be shorter. Right now, what we're seeing with Omicron is we're seeing a lot of breakthrough infections. I think what we'll ultimately find is that those vaccinated people, those breakthrough infections are contagious maybe for one to two days, very early on, but given that everything is open and that a lot of our policies right now say, "Hey, if you're vaccinated, you don't need to wear a mask indoors," I think that's why we're seeing a lot of transmission between vaccinated people, because they are contagious for a short window, and they are all mixing in these indoor spaces.

Matt Katz: How concerned should someone be if they're vaccinated, get their booster shot, then test positive?

Nsikan Akpan: I think you should be less concerned. I think that is going to be tough for people to hear because we have for so long set infection as the metric for concern, but truly when COVID transitions into being an endemic, what we're saying is that you can get infected if you're vaccinated. Maybe you'll experience some sniffles, maybe you'll experience a bad cough, but you will be fine. I expect that we're going to hear some recommendations and I think we're already starting to hear some recommendations that if you're fully vaccinated, you're fully boosted, and you catch the coronavirus, maybe you don't need to rush out to go get a PCR test. That's where we're heading in the next couple of weeks.

Matt Katz: It is hard not to be frustrated with government and health officials. I'm wondering if we could have been better prepared for this moment. Did we jump back into indoor socializing and acting normal too quickly?

Nsikan Akpan: Yes, I think we definitely relaxed too much. What we've learned with wearing masks, with social distancing is that they not only reduce the risk of COVID-19, but also of flu and other respiratory diseases that spread during the winter. The flu, for instance, can cause 50,000 deaths per year. I think in some ways it would've just made sense to say, "Hey, we know that another COVID surge is coming. We know that flu season gets really bad in the winter. Maybe we'll start masking again indoors, maybe we'll start social distancing indoors."

Then I think on the testing front, it's tough because the pandemic was improving, levels had dropped off, even though we were expecting resurgence. I think that testing capacity probably would've been enough to catch a resurgence in Delta, but when you layer on Omicron on top of that, just given how quickly it spreads, that's why we're seeing these struggles with turnaround time, with testing, with these super long lines, with not having enough resources. We're hearing that labs just don't even have enough of the reagents for the chemicals that they need to do these tests. That's always going to happen when you have a huge amount of demand for any supply chain.

Matt Katz: There are fewer testing sites in New York City right now than there had been. You walk around New York and you see long lines wrapping around city blocks. It seems in retrospect that more could have been done to ensure testing was widespread and affordable for everyone who needed it.

Nsikan Akpan: Yes, there's always more that the healthcare system can do. I think for one, because we don't have a universal healthcare system and we rely a lot on a private healthcare for these things, private healthcare makes a lot of its decisions around the demand. I do just wonder if scaling up fast enough with the healthcare system that we have would've been possible. I'm not trying to give a pass to public officials. I think, again, we knew that a Delta surge was most likely to happen this Winter. Pulling back on testing resources when that's happening just seems a little silly, for sure.

Matt Katz: If you have any advice for listeners as they navigate this next phase of the pandemic on travel, or Christmas with grandma, New Year's Eve parties, any advice on how we're supposed to be making these decisions?

Nsikan Akpan: Panic and fear, and I think complacency, to some degree can create amnesia. We know how to prevent coronavirus infections whenever there's a surge. Mask, social distance, good ventilation. We now have these vaccines on top of that, which really do lower your chances of severe disease by quite a lot. It's time for the unvaccinated to get vaccinated. It's time for people who are eligible for boosters to go get those boosters, do not wait. Just the similar rules that we had last year for the holidays. Mask indoors when you can, try to spend time outdoors if you can.

I think a big one this year is get tested, if you can, with a rapid test the day of, before you go to see people. I think we're hearing from a lot of our health officials is that people should build their plans around the most vulnerable person who's going to be at that gathering. If you have an 80, 90-year-old grandmother, take extra precautions such as testing, masking, only hanging out with vaccinated people to make sure that that person stays safe during this holiday period.

Matt Katz: Nsikan Akpan is the health and science editor for the WNYC newsroom. Nsikan, thanks so much for explaining all of this to us.

Nsikan Akpan: Yes, of course. Anytime.

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