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Speaker 1: This is The Takeaway with Melissa Harris-Perry from WNYC and PRX in collaboration with WGBH Radio in Boston.

Melissa Harris-Perry: More than two years after the WHO declared a global pandemic, things are starting to look pretty normal here in the US. In many places, mask mandates have been lifted, and physical distancing is essentially gone. This comes after a winter marked by COVID surges across the US, due largely to the highly contagious Omicron variant. The number of cases seems steady here, but that is not the situation elsewhere in the world.

In China, part of the country has been put into lockdown after a four-fold jump in cases in a week. The UK, Germany, Switzerland, and Italy also saw surges in cases over the past week, fueling concerns that another global wave of COVID is on the way. For more on this, we're joined now by Rebecca Weintraub, an assistant professor of Global Health and Social Medicine at Harvard Medical School. Becca, welcome to the show.

Rebecca Weintraub: Thank you for having me.

Melissa Harris-Perry: Okay. Help us to understand what we are seeing in Europe, what is this increase in COVID cases?

Rebecca Weintraub: Thank you, Melissa. You are right. This is a concerning signal and a pattern we've seen before. Unfortunately, we've also seen little appetite for these countries to impose new precautions or restrictions. Many folks have been thinking about what does this mean and why are we seeing a rise in cases related to this new variant BA.2 and number one, it's more transmissible than the original Omicron variant. It's coming at a time when we've seen a reopening of society, we're seeing folks mingling indoors without masks, and we're seeing waning immunity from vaccination or prior infection.

Melissa Harris-Perry: Infections are one thing. I think this is one of the things we really obviously experienced in the context of Omicron. How much illness are we seeing? Clearly, COVID is potentially quite serious, even if one survives that we've been talking a lot about long haul COVID here, but how serious are these infections in terms of the effect that they are having, for example, on the health care systems of these countries where we're seeing a rise?

Rebecca Weintraub: Two parts to that, to the UK Health Security Agency said that BA.2 had an 80% higher growth rate than the original Omicron stream, but as of yet, it does not lead to an increased rate in hospitalization. The other piece of news that they shared is, as we know, as of today, is that the vaccine efficacy is similar to the original stream.

Melissa Harris-Perry: Just to make sure that I'm understanding and following. We've got contagion, we've got a contagion that is-- This is a part of the Omicron strain, is that right? It's got that level of contagiousness of Omicron but doesn't seem to be necessarily more deadly than previous variants that we've seen.

Rebecca Weintraub: Excellent question. The always question, "Is this variant leading to more cases, more hospitalizations, and death?" You're right, what we're seeing is actually this variant. It's a variant of Omicron, it may be renamed and receive its own name. At this point, we're seeing that actually, unfortunately, may have higher rates of transmission, but it's not leading to more cases of severe disease nor hospitalization as of today.

Melissa Harris-Perry: What about China? Because I know that over the course of these two years, we've sometimes seen different variants showing up in different parts of the world. Is the variant that we're seeing driving increased cases in China the same one that we're seeing in Europe.

Rebecca Weintraub: Yes. Just take a step back what we're seeing in China right now. Remember, China had a zero COVID strategy, and they're seeing many of the infections right now in the northeast of China and in rural areas. Two other important points about China, while they have 85% of the population vaccinated, what we know they've been vaccinated with a vaccine that has lower efficacy against Omicron. It's likely that the vaccinated population is not able to slow down transmission as we are in states and countries where the mRNA vaccines have been deployed.

The second piece in China is that, it's an elderly population and unfortunately, 50% of the elderly over the age of 80, while they're vaccinated, that means 50% of the elderly are unvaccinated. We question why is this so low. This is once again, unfortunately, in the rural areas in China, there are actually severe fears of the side effects from the vaccine, sharing all this context because already even with these rates in China, we're seeing that this outbreak has already disrupted global supply chains.

Melissa Harris-Perry: One more piece on this-- Well, actually many more pieces on this, sorry. Help me to understand then, given that we're seeing this rise in cases, again, at this point, just getting to the causes, and then we'll get to what happens next. Were these cases and caseloads rising after rolling back some precautions? I'm wondering, did this increase in cases happen despite the fact that masking, for example, was continuing or the kind of zero COVID strategy was implemented, or did this rise come after some relaxation of those public policies?

Rebecca Weintraub: That's an excellent question. Remember, this is nonlinear. We're seeing in a sense different waves in every country. This is why we call this a pandemic. We're unable and we're uncertain which wave, which surge will happen when. To take a step back, you're absolutely right.

Remember, all the UK restrictions ended on February 21st, on Monday, France ended their COVID restrictions, including mask requirements, and Germany ended similar mandates earlier this week. Yes, we're seeing a concerning form of Omicron and the decrease of restrictions happening, which likely leads us to-- unfortunately, all of us are now more vulnerable both to transmission of Omicron and this new variant BA.2.

Melissa Harris-Perry: What do these global cases mean for the US?

Rebecca Weintraub: We were just discussing the rates and the concerning signals from China. We also know, unfortunately, Hong Kong and South Korea, while 87% of the population is fully vaccinated, we're actually seeing an increase in their hospital admission rate. It's a reminder that we're in this phase, it's a next phase of a pandemic, which is a widespread rapid spread of disease, not an endemic phase of COVID-19.

What we're seeing in the US, the early signs, once again, is from our wastewater data. The wastewater signals for the last two weeks are up in 37% of the sites in the CDC's database, we're seeing a significant uptick, which means once again, we should think about precautions, how do we decrease transmission at this early phase?

Melissa Harris-Perry: Remind us what the wastewater process is.

Rebecca Weintraub: If you think of this almost like a hurricane warning, do you remember we used to watch and forecast during hurricane season, we're concerned it maybe a hurricane five, four, three, two, one wastewater, it really helps to think that a leading indicator, are we seeing an increase in COVID-19 cases because we're shedding this in our fecal matter. It's been shown that the wastewater actually shows us an increase in viral material 10 to 14 days before a new wave of infection was seen by PCR or rapid diagnostic testing.

These are these narrow windows, we need to communicate and to protect our most vulnerable when we're seeing, unfortunately, an increase in viral material in the communities wastewater.

Melissa Harris-Perry: I have been wondering a bit about this, that we saw a really swift decrease in cases right about the same time that it became much easier to test at home and to have the access to testing at home, the free test that went out here in the US. I was wondering if this decrease in cases might also simply be that, when you test positive at home, you may not be calling and reporting it somewhere.

Rebecca Weintraub: You're absolutely right. We did not set up a reporting mechanism for your at-home testing. You're right. We don't know how many cases at home turned positive. You can imagine there's areas of, for example, in the US that people are not distributing free testing, they're not available, they're not as accessible, people may not have asked for those testings. The baseline denominator of who's getting tested and where they are across the United States of America is not representative.

Wastewater on the other hand gets collected. For example, there's no work involved for the general population. We need actually more sites available and more data, but the data even today of the limited availability that we have from the CDC's national wastewater surveillance system is concerning.

Melissa Harris-Perry: Are vaccination rates here in the US and across the globe improving? Are there more people who are vaccinated? I heard you talking about waning vaccination effects, but even in terms of those first shots in arms.

Rebecca Weintraub: There's an important part of this about timing. We need to know not only have people received their first dose, their second dose, their booster, but when they receive that. As you remember, there's waning immunity not only to a natural infection but to the vaccines themselves. I would suggest that we need to reframe and ask the question, "Are you up to date with your vaccines?"

This is the same question I ask you about your tetanus vaccine. When was the last time you received your tetanus vaccine, and as a provider I help give you guidance. Do you need an additional dose of the tetanus vaccine? I'm hoping we will get towards that type of language so folks can understand similar to other vaccines that they have in their routine, vaccines schedule that will in the sense enable them to receive a booster as needed related to when they last received their previous dose.

Mellisa Harris-Perry: I want to talk about a few particular populations here. How are children faring right now during this phase of the pandemic particularly the five and under crowd for whom there isn't even an option for the first vaccine dose.

Rebecca Weintraub: You're absolutely right. With children having no doses of the vaccine and waning immunity of their loved ones, their family units, the teachers that they're around, and the concern for a long haul COVID in young children. There's been some meta-analysis showing some concerning trends of young children who one out of four children who are infected and symptomatic having long standing symptoms even weeks after their infection.

In many ways, I think we're all waiting for the approval to protect young children zero to five and we hope family members and community see their roles and responsibilities to keep those children protected. We ourselves can decrease transmission when wearing masks for example and getting boosted as adults in the population.

Mellisa Harris-Perry: Now, as you talk about waning immunity this is happening at the same time that Pfizer is seeking authorization for a second booster for older Americans, and for those who are most vulnerable like the immunocompromised for example. Is that something we should be focusing on? Is that a good move to address this question?

Rebecca Weintraub: We haven't seen the data itself so remember these are press releases from a pharmaceutical company. We'll be awaiting that data to assess. I'm optimistic that what will happen is we're going to end up having a combined vaccine that's both your flu and your COVID-19 booster. You'll view this in the same way that you line up and queue up to get a flu vaccine. You'll get boosted in a sense with COVID at the same time.

Unfortunately at this point, if you remember that we have about 29% of the United States population boosted. We have a ways to go to remind folks that getting boosted is part of the umbrella of tools that we have to protect them. Those first two doses or one dose of Johnson & Johnson is not sufficient to protect you from both getting infected, severe disease, and transmitting to others.

Mellisa Harris-Perry: The masks are coming off. I live in the South, I live in North Carolina and the masks have been off in a lot of ways for quite some time, but they're truly off in terms of public policy here. They're just simply no longer required but I'm also feeling like, well but the weather's warm. At least we can go outside. We can be outside. We've understood outside and warm weather as being potentially protective here. Can you talk to me about the continued importance or lack of importance of masking and whether or not the warm weather actually makes a difference?

Rebecca Weintraub: First, wearing a mask outside versus inside. The data's quite clear, you're quite protected from being outside with good ventilation and air movement and or in buildings where there's great air ventilation but there's few buildings that have adopted all of the standards that we would suggest. I also would suggest thinking about this once again kind of like a hurricane season where you look at the forecast and sometimes it's a category two hurricane and maybe a category four, and our activities in communities change.

When it's a category one or two you may bring in your lawn furniture, you may stock up on some supplies, but when it's a category four, category five hurricane, we start boarding up our windows. You move in with other family members. You think about, how do I protect myself from the higher risk that I may face where I am locally located.

I would think of masking in the same way. Think of it as a precaution, bring your mask with you if you're going to be indoors somewhere. You'll be protecting not only yourself but decreasing transmission to someone who may not be able to protect themselves. A population who may not be able to get vaccinated. A child from zero to five, our immunocompromised patients that can't host a response, and in many ways, the request for citizens is thinking about, I can protect others by wearing a mask. Hoping folks will keep them in their bags, in their purses, and their backpacks.

Mellisa Harris-Perry: Rebecca Weintraub is assistant professor of Global Health and Social Medicine at Harvard Medical School. Thanks so much for joining us.

Rebecca Weintraub: Thank you for having me, Melissa.

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