Is Omicron Less Dangerous Than Delta? Dr. Fauci Weighs In

BIANNA GOLODRYGA: The Omicron variant is now the dominant strain of COVID in the United States. Less than a month since the first case was reported, the CDC is now saying that it made up more than 70 percent of all new infections last week. That staggering speed is provoking some incredible statements from public health leaders. Just take a listen to what the head of the World Health Organization had to say about holiday gatherings.

(BEGIN VIDEO CLIP)

TEDROS ADHANOM GHEBREYESUS, WHO DIRECTOR GENERAL: An event canceled is better than a life canceled. It’s better to cancel now and celebrate later than to celebrate now and grieve later.

(END VIDEO CLIP)

GOLODRYGA: And it’s not just words. We’re seeing some pretty dramatic action too, the European Union announcing that E.U. vaccine passports will expire for people who don’t get a booster. Well, as this all gathers pace, Dr. Anthony Fauci, chief medical adviser to President Biden, has been speaking about the latest details with Walter Isaacson.

(BEGIN VIDEOTAPE)

WALTER ISAACSON: Thank you, Bianna. And, Dr. Anthony Fauci, welcome back to the show.

DR. ANTHONY FAUCI, CHIEF MEDICAL ADVISER TO PRESIDENT BIDEN: Thank you very much. Good to be with you.

ISAACSON: Can you give me the latest on Omicron? We know that it spreads much more fastly. It’s driving up cases. But, as of this week, what data do we have to show whether or not it might be less dangerous, it might be less likely to cause death?

FAUCI: Well, there are suggestions of that from the South African data, where they show with the rather profound vertical spike in Omicron in their cases, that, if you look at the ratio of hospitalizations to cases, it’s lower than with Delta, the duration of the hospital stay is a day or two less, and there appears to be a less need for oxygen. The only issue with that, it’s unclear whether that is due to the underlying level of immunity in South Africa, because so many people have already been infected with other variants like Delta. So you may be getting a protective effect against severe disease, as opposed to it inherently being a less virulent virus. What that means is that, in countries like our own, where you have a substantial proportion, 50 million people, who are unvaccinated, who may not have been previously infected with Delta or other variants, they may get hit just as hard from a severity standpoint as Delta. So we have to reserve judgment that this is such a good thing that it might be less severe. When you have so many cases, Walter, it essentially obviates any diminution in severity because of the quantitative number of cases that you will get with such a highly transmissible virus like Omicron.

ISAACSON: How many people being hospitalized now with Omicron in the past couple of weeks in the United States have been vaccinated?

FAUCI: Well, there’s — I can’t give exact numbers, but whenever you look at the hospitalization proportion, it always weighs very heavily towards the unvaccinated, even though, as you might expect, as you get breakthrough infections which will occur among vaccinated people, that some of them — and they are usually the elderly and those who have underlying conditions. It would be very unusual for an otherwise healthy person who was vaccinated and, particularly, boosted who had a breakthrough infection to get a severe outcome. That would be extremely unusual.

ISAACSON: You said something interesting just a moment ago, which is that, in South Africa, one reason it may be less dangerous when people get it is because they’re protected because they have already had the disease. I see that in my home state of Louisiana. We had a huge spike for the fourth wave. Hospitalizations, even though Omicron is in Louisiana, are going down. They’re drifting down in Louisiana. Do you think that there is some validity to maybe there’s a herd immunity that comes from people who were healthy having been exposed to this disease?

FAUCI: Oh, no doubt that is a strong possibility that an individual or a cohort in a community, be that Louisiana, New Orleans or what have you, if you have enough people who are either vaccinated or who have experienced COVID-19 illness, that, when they get exposed to and infected with another variant, be it Omicron or whatever other variant, that the chances of their getting a severe disease are much less. Underlying prior immunity always mitigates against severe disease.

ISAACSON: Does that mean, though, that maybe we should not worry about very healthy people with no underlying conditions who can avoid exposing elderly or other people, we should not worry about them getting exposed to the disease, it might actually be helpful?

FAUCI: No, that’s a dangerous assumption, Walter, because even though, quantitatively and relatively speaking, they have less of a likelihood of getting severe disease, we have plenty of young people in the hospital who apparently had no underlying condition who have gotten seriously ill. Also, there’s the issue of long COVID, where you get infected, you recover and you have the lingering, sometimes weeks to months, of sometimes incapacitating, unexplainable symptomatology, like severe fatigue upon exertion, sleep disorders, inability to focus or concentrate. The other thing that we need to be careful of is that, even though many young people will get infected and not have a severe outcome, they likely will infect someone else who might actually be vulnerable to severity of disease. So you can’t just discount young healthy people and not be concerned about their getting infected, which is the reason why, in addition to vaccination and booster, we still feel that there are other non-pharmacological mitigation methods, such as frequent testing, mask- wearing in indoor congregate settings, all of those things are important.

ISAACSON: And you say the other level of protection we can do is get frequent testing. It’s something you have been advocating for, for a while. You have been saying flood the zone with easy-to-use tests. Well, I just came up here to New York, and we can’t find any tests anywhere. People are waiting in long lines. Why haven’t we just flooded the zone with testing, and — instead of having all this reimbursement from insurance, and all that sort of stuff?

FAUCI: You know, Walter, I wish that I had a good and acceptable answer to you. If you look at the difference between available tests a year ago and now, it’s just orders of magnitude better now, but, still, you’re absolutely correct. In some places, you go and you want to get an easy test that you can do point of care, and they’re not available. This is despite the fact that the government has invested billions of dollars to make anywhere from 200 million to 500 million tests per month available. So, the bottom line is, we have to do better than what we are doing, because, as improved as it is, it still does not allow very easy and free access to as many tests as you need, particularly now, as we’re in the middle of the holiday season, where people who are going to be gathering socially with friends and others would like to know if they’re positive or if a person who is coming into their home is positive.

ISAACSON: So what are we doing to fix that?

FAUCI: Well, we’re putting a lot more effort and money. There’s been a new — for example, there have been 10,000 centers that are now going to have free testing available throughout the country. Hopefully, that’s going to alleviate the issue that we’re talking about. But I believe that the billions of dollars that have been invested to get that half-a-billion tests per month available are going to go a long way to make this better.

ISAACSON: I just saw that Boeing, General Electric, I think even Amtrak have gotten rid of the vaccine mandate for their employees. Boeing is a huge contractor of the U.S. government. I can’t quite figure out, why is it we’re not able to say, at least we’re big contractors of the U.S. government, you have to get vaccinated? What’s gone wrong here? Why can’t we get a national standard?

FAUCI: Well, there has been some success with vaccine requirements. United Airline instituted, Walter. They got like 99 percent of their employees vaccinated. Tyson’s Food did it. I don’t understand why some companies do not do that. It is just this issue of the political situation in our country of pushing back on anything that looks like government’s encroachment on your right to decide what you want to do with yourself. But what I think that does not take into consideration is that, in addition to our individual rights to make a decision between — about what we do or don’t do, all of us have a societal responsibility. And we are living through historically the worst outbreak of an infectious disease in over 100 years. And that’s the reason why I think people need to put aside this issue of, you can’t tell me what I need to do, and say perhaps, for the good of society in general, not to mention your own safety and health and that of your family, it just makes such good sense to get vaccinated.

ISAACSON: Well, let’s talk about this week. It’s Christmas. Those of us who have been vaccinated and booster shotted and our families have been vaccinated and booster shotted, are we OK just to celebrate Christmas together without masks on and to just be careful?

FAUCI: Absolutely. And that’s the thing we want to make sure people don’t get confused. When we talk about the threat of Omicron, the ongoing surge, when you have vaccination, plus booster, plus being prudent about not congregating in indoor settings where you don’t know the vaccination status of people, and even, Walter, adding the extra step of these handy point-of-care testing, I mean now a number of people before they have people come into the home for a dinner or a reception are asking them to get tested within 24 hours, even if they have been vaccinated. That’s going the extra mile. If you do all of that, you should be able to enjoy, in a peaceful, non-anxious way the typical kind of family gatherings that we all cherish so much, particularly over the holidays.

ISAACSON: Should schools reopen after Christmas?

FAUCI: I believe so. We can keep the schools safe. We now are vaccinating children 5 to 11 years old. We have got to get parents to vaccinate more of these children. And I believe, if we surround the children with vaccinated people, they can be safely brought to school. And there’s this test-to-stay program, which, instead of having a situation, when you get a child infected, that you have to quarantine all of the contacts, that no longer is really working. What we feel we can be successfully doing is testing the children and, if they are negative, keep them in school. You don’t have to be quarantining groups of children.

ISAACSON: What mutations in this new variant make it so that it spreads more easily? And can you scientifically — you’re a great infectious disease specialist scientifically. Can you look at those mutations and say, here’s why it may not be as dangerous? Maybe it doesn’t affect the lungs or something.

FAUCI: Yes, good question, Walter. You can predict that it would be more transmissible because of the mutations around the receptor binding domain. You can predict that it would evade immunity by where those amino acid substitutes are. But it is much more difficult to predict virulence on the basis of mutations. What you can do is, you can look at a virus that might be more virulent and then backtrack and look at the mutations and say, it appears that greater virulence are associated with these particularly mutations. But when you look, for example, at Omicron now, it has 50 mutations, 30 of them in the spike protein, 12 or more in the receptor binding domain. None of them specifically say that it could or could not be more virulent.

ISAACSON: So what does that tell us about the possible future variations, that they will mainly come at the spike protein level, which affects how much it can be infectious? Is that what we have to look out for?

FAUCI: Yes, but there may be mutations in other areas of the virus that might have some impact that we have not yet experienced. But most of the ones that have given the Alpha, the Beta, the Delta, and now the Omicron are concentrated in that very important protein, which is responsible for the binding of the virus to the cell, and which is the target of monoclonal antibodies, as well as neutralizing antibodies that are induced by vaccines. That’s a very critical part of the virus.

ISAACSON: But some of these monoclonal antibodies don’t seem to work as well against Omicron. Is that correct?

FAUCI: Oh, that is absolutely correct. And that’s been really quite concerning. We had a whole bunch, a whole host of monoclonal antibodies from multiple companies. And several of those now have been essentially rendered useless, if not close to useless. There have been one or two that seem to have survived those mutations and still have a degree of potency of neutralization, but several of them have fallen by the wayside.

ISAACSON: Yet all that you have said so far makes it seem that it’s harder to get to herd immunity. We can’t just let the healthy communities get infected. We don’t have some of the things that can stop each new variant. So, if we’re never going to get to herd immunity, how do we get to and when do we get to the fact that this may just become like the flu, in other words, we can just live with it, we can get the flu, and, hopefully, it won’t be as deadly?

FAUCI: So, if we do not have variants that are really substantially different than the prior variant — Omicron is an example of one that’s substantially different. If you have only minor modifications, by the time you get almost all the people in the country either vaccinated and/or having gotten infected, you very likely will have a degree of baseline protection, maybe not against infection, but for the most part against severe disease. At that point, it becomes more like the common cold, which means, for the overwhelming majority of people, it will either be asymptomatic or very minimally symptomatic, similar to the common cold coronavirus.

ISAACSON: So, can we start treating it that way in the next few months, or are you talking about…

FAUCI: Well, I hope — I hope it’s within the next several months, I hope as we get into 2022. First of all, we’re in the middle of a Delta surge, and we’re looking over our shoulder at an Omicron surge. So I want us to just get through the winter relatively unscathed, which I don’t think it’s going to be unscathed, we don’t overwhelm the hospitals, and we get more people vaccinated and boosted. And as we get into the spring, if in fact we do get such a large proportion of people who’ve either been vaccinated boosted or — and/or gotten infected, that we’re going to have virus, it’s not going to be — well, certainly, we’re not going to eradicate it the way we eradicated smallpox. Certainly, I don’t think we’re going to eliminate it the way we have eliminated polio and measles by vaccination campaigns. But I hope the level of control will be so low that, in fact, it will be like a common cold, with few exceptions of people getting seriously ill.

ISAACSON: As a scientist, you have been looking at these messenger RNA vaccines. They seem easy to program. When will we be able to program them so that they will knock out any coronavirus and not have to be updated every time there’s a mutation in a spike protein?

FAUCI: Great question, Walter. And that is what we are putting a considerable amount of effort on. We refer to it as a pan-coronavirus vaccine. And, in fact, a week-and-a-half ago, I wrote a paper in “The New England Journal of Medicine” describing the urgent need for that. In fact, that was the title of the paper we wrote, a pan-coronavirus vaccine, an urgent need, because it would be foolish for us to think that we are not in the future going to be challenged with yet again another pandemic-potential coronavirus. We have had three in the last 19 years. We have had SARS-CoV-1, we have had MERS, and now we have had multiple iterations of COVID-19. So it really behooves us to go full blast about trying to get a pan-coronavirus vaccine.

ISAACSON: Dr. Anthony Fauci, thank you so much for joining us.

FAUCI: Thank you very much, Walter. It’s a great pleasure to have been with you. Thank you for having me.