Fmr. CDC Director on New COVID-19 Variant

CHRISTIANE AMANPOUR: COVID-19 is back in the news again. A new wave of infections from the Omicron subvariant BA.26 is happening in places like the USA and the U.K. that have actually loosened restrictions but also, in places like Hong Kong with very strict restrictions still. Dr. Tom Frieden is the former director of the CDC and he joins Walter Isaacson now to discuss this incoming surge and why now is the time to pick up the pace on public health matters.

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WALTER ISAACSON, HOST: Thank you, Christiane. And, Tom Frieden, welcome to the show.

DR. TOM FRIEDEN, PRESIDENT AND CEO, RESOLVE TO SAVE LIVES: Great to be here, Walter. Looking forward to speaking with you.

ISAACSON: Besides running the Centers for Disease Control, way back you were the commissioner of health for the City of New York. I just saw this morning that cases in New York have gone up 47 percent on average in the past 14 days. Are we starting to see a resurgence in New York City and maybe other places?

FRIEDEN: I think it’s highly likely that we will see a resurgence. What’s been happening for the past two years is we see it in other parts of the world, and somehow, we think it’s not going to come here. What we’re seeing is that the so-called BA.2 variant of the Omicron strain is extremely infectious, much more infectious than even the BA variant, and that was even more infectious than prior variants.

ISAACSON: And if it’s more infectious, does that mean it is a little bit less deadly as happened with previous Omicron variants or do we know?

FRIEDEN: No. It’s no less deadly. I think there’s a misconception here. How deadly a virus is and how rapidly it spreads are somewhat independent. There are some people who will think, oh, it will get milder with time and kind of be just a common cold coronavirus. That’s possible. But we don’t know that. The only constant here is change. And the best we can do is to adapt rapidly by learning quickly and acting quickly. It’s likely we will see another surge in the U.S. how deadly that surge is, is up to us, because it’s mostly among the elderly, unvaccinated, and medically vulnerable unvaccinated that we’re seeing severe disease.

ISAACSON: Well, you say it’s up to us, but I assume it’s also up to the virus in a way. The variant of the virus, especially for people who are vaccinated and are — don’t have underlying conditions. Do you think this new variant from what we’ve seen so far, especially in Europe and the United Kingdom, is not a big problem to people with no underlying conditions, who have booster shots and vaccines?

FRIEDEN: I think that if you’re healthy and up to date with your vaccination, very important concept, not fully vaccinated or boosted, but up to date, which means you’ve gotten the vaccine when you should have gotten it, then you’re pretty safe. Now, you could get unlucky and get long COVID. You could get unlucky and get severe COVID, and you could infect someone who is vulnerable and might get severely ill or die. The data from Hong Kong is really striking. Hong Kong was essentially what we call a natural experiment. This was a population that had zero natural immunity. Immunity from prior infection. And way too low levels of vaccine-induced immunity, because the elderly had not been highly vaccinated, and we saw a death rate in Hong Kong 100 times higher than the death rate in New Zealand at similar case rates. That shows how stunningly effective the vaccines are, but also how deadly even the Omicron variant is.

ISAACSON: How do we really know how effective the vaccines are over time? I’ve been booster shotted. I was very early on. I actually have the second booster shot because I was in one of the clinical trials, but they tell me it’s really unclear when it starts to fade.

FRIEDEN: There are some things that will only be determined with time. To know how long immunity is going to last, we have to wait to see if it wanes. That’s frustrating. We wish we had a perfect test to tell us, oh, now, is the time to do a booster. It’s highly likely that people will need an additional booster, but who, when, and whether it makes sense to mix and match vaccines, that we don’t know. It’s certainly the case that there was no rushing on safety or efficacy to prove that these vaccines save lives and are safe. But it is true that figuring out the exact vaccine schedule, how often, with what interval, which doses, that takes more time.

ISAACSON: Is there any downside to getting booster shots after four or five months?

FRIEDEN: There is a theoretical risk that if you boost too much, it’s going to blunt your immune system’s response to the vaccine. I think we should wait, see what the data shows. We’re going to learn from around the world, Israel has been giving fourth boosters. And so — or fourth shots with additional boosters. And so, we should be able to get information from other countries and from here in the coming months. But yes, I think for people who are vulnerable, getting a fourth shot, five or six months after your third shot makes a lot of sense.

ISAACSON: How many people in the United States do you estimate have some immunity now from either vaccines or exposure to the virus?

FRIEDEN: I would think that we’re pushing 90 percent of people who have either been vaccinated or had an infection with the virus. On the other hand, only about 60 percent of Americans are up to date with their vaccination. And shockingly, about a third or more than a third of people over the age of 65 are not up to date with their vaccinations. That’s more than 15 million seniors. And you know, unfortunately, this new variant could be coming for them. That’s why it’s so important to scale up vaccination if you’re vulnerable, up your masking to an N-95. And we all need to see if we can get test and treat much more widely done. Because some of the medicines out there are very effective. Decreasing the risk of severe illness by 80 percent or more, but they have to be given quickly and scaling that up in our country’s fragmented and inefficient health care system is not going to be easy.

ISAACSON: You say that there’s an increased risk among the elderly because they haven’t been boosted most recently, or some of them aren’t boosted. When you look at hospitalization rates of people who went into the hospital because they had COVID. How much worse is it for people who did not have booster shots and people who did have booster shots?

FRIEDEN: In Hong Kong where the government has published very informative data, people over the age of 60 who had been vaccinated were 25 times less likely to get hospitalized or have severe illness than those who had been vaccinated at all. And what we’ve seen from a series of studies is boosting reminds your immune system how to fight the virus and keeps you out of the hospital. So —

ISAACSON: Well, and you tell me we’ve seen that from a lot of studies. I’ve not seen those. Tell me what studies we had that show that booster shoots, people who do have them go to the hospital less than those who don’t.

FRIEDEN: Oh, it’s very clear from studies in the United Kingdom, in the U.S., in Israel and elsewhere that getting a booster kind of restores your immunity, and gets it back to an earlier level of protection from hospitalization, which is extremely high. We’re talking 80, 90 percent plus protection from severe illness.

ISAACSON: You talked about long COVID, and you’ve studied that. A new report just came out saying diabetes is something that could happen with long COVID. Tell me how serious and how prevalent long COVID really is. How much should I worry about it? How much should an older person, like myself, worry about having long COVID?

FRIEDEN: There is still a lot we don’t know about long COVID, and part of that is that the studies haven’t been completed. The NIH has a huge amount of money to do these studies. So, I’m looking forward to seeing the results coming out of those studies. Other countries are looking at this as well. When we reviewed it in detail, we found it was strikingly common for people not to feel fully themselves for months afterwards. That might be shortness of breath, a sense of brain fog, loss of sense of smell or taste that can persevere or weakness. We actually, at my organization, Resolved to Save Lives, interviewed people with long COVID and produced a public education series called “Voices of Long COVID” that the U.S. government is now running nationally. And it’s quite striking. You have people jogging five miles before and can’t walk up a flight of stairs. So, Long COVID is a serious phenomenon. We don’t understand well enough what’s causing it. How common it is, or how to treat it.

ISAACSON: You used to run the centers for disease control. I’ve been looking for studies on mask mandates in which you compare counties that have mass mandates, ones that don’t. School districts that have mass mandates, ones that don’t. And the ones I see don’t really show much of a difference. Is there really good evidence that wearing a mask in schools and stuff helps us?

FRIEDEN: Yes, absolutely. We’ve done some studies and there have been good studies. There have been good studies in Bangladesh and elsewhere that show that widespread mask wearing dramatically reduces case counts. It’s our second most powerful tool after vaccination. Now, there’s a lot of unknowns. I think there’s probably more benefit to wearing an N95 mask or above than another mask especially if people around you aren’t masked. Ventilation is also important and feasible in some environments. But masks are much more effective than we thought they would be in blunting the impact of Omicron. It’s not an easy study to do, but we’ve done some studies at my organization, Resolve to Save Lives, that used actual observation of how many people were wearing masks. Not whether or not there was a mandate, but whether or not people were using them. We correlated that both with mask mandates, mandates increased vaccination, they increase masking and it correlates with lower case counts and fewer deaths.

ISAACSON: Does the center for disease control, collect data on when somebody has COVID and they get hospitalized for it, say. Do they collect data on whether or not that person had been wearing masks generally over the past week or not, or not wearing masks?

FRIEDEN: The CDC does some specific studies, but most of the data the CDC has comes from state, city and local government. So when people say CDC doesn’t have good data, what you’re really saying is that we have a public health system that’s been underinvested in for decades. And because of that, we don’t have the kind of information we need to keep us all safer. Now specific studies of people hospitalized for COVID are important to see. For example, when they were vaccinated, correlate that with severity. But masking is something that it’s harder to study because there is what’s called recall bias where people may not remember exactly what they were doing or when.

ISAACSON: Well, wait, you just said, we don’t have all the health data we want because we have this decentralized system. How would you change that? What data do you think we should have on a national basis? And what problems do we have when it’s not one national organization collecting the data, but you gotta rely on state and maybe even parish or county health officials.

FRIEDEN: We need a long term investment in our health protection. We’ve suggested along with a bipartisan group, a health defense operations budget designation. That would allow Congress to invest in our health defense. As we invest in our military defense. We spend 300 or 500 times more on our military defense than we spend on our health defense. And yet COVID killed a million Americans and that’s more than any war in our history. We need to invest in public health. And that means stronger data systems and more consistent data systems. It’s important that the federal government CDC be able to set standards and support states, cities, and the more than 3000 counties around the US to collect and report data in a standardized way in real time. Right now, CDC does not have that authority.

ISAACSON: Well, that’s amazing to me. I mean, why can’t we just order that data get reported in real time?

FRIEDEN: Article 10 of the U.S. constitution reserves the states, anything not specifically delegated to the U.S. government. And there have – has been a longstanding under investment in public health. If we have a nationwide system that’s essentially a franchise and has great core data that states can add to cities and counties can add to that would be a much stronger defense net than what we currently have. What we currently have is 50 states, dozens of cities, 3000 counties. A lot of times the states are not sharing in real time with the CDC and the counties and cities aren’t sharing in real time with the states. So it’s a, it’s a broken system and that was very apparent during COVID.

ISAACSON: Michel Martin on the show just a few days ago had Senator Tim Kaine on talking about a bill that would not only fund public health and work on COVID, but try to create a system. What should be in that bill and why what’s stopping that bill?

FRIEDEN: Well, first off you need money and you need money that doesn’t wax and wane. We have cycle after cycle of panic and neglect, and you can’t build a stable system on one time money. It’s easier to approve supplemental dollars as they’re called, but they dry up. And when they dry up the programs dry up as well, we need long term sustained funding in public health, including in monitoring systems. And we need more authority. So that there’s a national system and what’s called a disease in one city or state at the time it’s diagnosed is the same anywhere you are in the country. And that information is available at the same time to the counties, cities, states and the federal government. That’s not how it works today.

ISAAACSON: Do you think we’ve politicized this so much? How did that happen and how do we get out of this cycle where probably some people for partisan reasons would not even want data collection to be standardized, not want you know, vaccine rollouts to be standardized.

FRIEDEN: It’s certainly the case on the one hand that public health decisions are always political decisions. There are always policy decisions to be made. You don’t make those decisions based on science. You make them informed by the science and we should be upfront when to close how long to close different things. Those are not scientific decisions. Those are policy decisions that should be made by policy makers and which may have different results in different communities, depending on the values of those communities. At the same time I hope, I really hope that one thing that will be clear from this pandemic is that in fundamental ways we are all connected and our fates are bound up with one another. If COVID emerges anywhere in the world in a more severe form, we’re all at greater risk. It’s in all of our interest to improve health defense, ill health anywhere is a threat to health everywhere. And I hope there will be a recognition that yes, although public health programs didn’t do what we hoped they would do in this pandemic, public health programs are essential because there are many things that however ruggedly individualistic any one of us is, we can’t do unless we’re doing it together.

ISAACSON: Dr. Tom Frieden, thank you so much for joining us on this show.

FRIEDEN: Thank you. It’s been a pleasure speaking with you, Walter.