Omicron: Doctors talk COVID-19 testing demand, booster shots, and hospital staffing

Dr. Calvin Sun, an attending physician in emergency medicine in NYC, and Dr. Paul Offit, an attending physician at the Children’s Hospital of Philadelphia, join Yahoo Finance Live to detail how nightclubs are becoming COVID testing centers, whether booster shots can stave off the winter wave of Omicron cases, and the shortage of hospital staff amid the ongoing coronavirus pandemic.

Video transcript

ANCHOR: We've got Dr. Paul Offit, Vaccine Education Center Director and Children's Hospital of Philadelphia attending physician in the Division of Infectious Diseases. We've also got Dr. Calvin Sun with the Monsoon Diaries, Founder and CEO, clinical assistant professor and attending physician in emergency medicine right here in New York City.

Dr. Sun, I want to start with you on that point Anjalee made. We have over here, in New York at least, and I imagine major cities across the country, seen those long lines outside these clinics, some waiting more than three hours. How much of the inconsistencies or I should say the delays that are happening on the testing side is preventing us from getting a full grasp on the spread of this variant right now?

CALVIN SUN: Oh, it's terrible. I mean, the biggest nightclub in New York City now happen to be testing sites, and they're really waiting in line to go to a health care center or a testing center where most of the positive cases are going to be, so the irony is catching it while they're waiting in those waiting rooms, and it's just seeing the writing on the wall.

And on top of that, these tests take about three to five days, if not-- Now we just got an email that some of PCRs are going to take up to five to seven days for a turnaround. I mean, that's clinically useless to me because I have to expect that you are going to somehow quarantine yourself right after that PCR test, walk through that full waiting room, walk outside, go into the subway, go home, and then quarantine for five to seven days so that you finally get a phone call of what your status was five to seven days ago. What about the person you had dinner with two days prior to that phone call for your PCR results? It's not useful if it's taking that long. You cannot wait five to seven days, especially like a city like New York.

Rapid antigen tests are finding out there's a correlation with contagiousness, which gives you your status in that moment, so it's actually a more useful test considering the circumstances to test right before that gathering that you want to do with your family this holiday season. So I would say now given that PCR tests take so much longer, unless you can get your hands on a rapid PCR, which, you know, 45 minutes, one hour turnaround, which is so rare or expensive, rapid antigens will have to do right now.

ANCHOR: And Dr. Sun, to follow up on that point, I know anecdotally plenty of people around me who have gotten COVID despite being vaccinated. They want to test out to see if they are still positive or negative to be able to meet their families over the holidays. And yet they've had to wait more than three hours to get that test done. How much of that is contributing to the infection?

CALVIN SUN: I mean, it depends on if you're waiting outside or you're waiting inside. I mean, outside is a slower spread, but, you know, nightclubs and big parties and big gatherings, it doesn't matter if you're outside or inside. It's more likely you're going to catch it. I mean, three hours waiting in line is so long when it's for a 15-minute test. I wish we had more access to in-home, at-home tests, the ones you can order online, but even that's being scooped up, and it's hard to find. There like liquid gold. And, you know, it's-- And I think the intentions are good, though, that you're testing for your due diligence, you're testing for ethical purposes to be able to know that you can go to your family and holiday gathering knowing that you did your best.

But on top of that, keep in mind you could test negative for 14 days until you're positive after an exposure. Sometimes it takes that long. We've seen that before in the first wave, where patients we hospitalized for COVID because it was positive on the CAT scan or a chest X-ray would test negative until four or five days later in their hospital stay. It's just sometimes this virus is a tricky thing. But, you know, the best thing we've got, considering the circumstances, is the rapid antigen to know your status at that moment if you're going to be contagious.

ANCHOR: Dr. Offit, a question for you. I know that there has been a lot of concern and conversation around the idea that boosters could play a key role in how this winter surge sort of happens. I know that you had some reservations about the handling of the 16 and 17-year-old boosters, but I wonder since the surge of omicron, do you think that we should be thinking about boosters differently?

PAUL OFFIT: The question is what do we want from COVID vaccines? If what we want is protection against serious illness, meaning the kind of illness that causes you to seek a doctor or go to the hospital or go to the ICU, it's very likely that two doses of an mRNA containing vaccine or two doses of Johnson & Johnson's vaccine will provide protection against serious illness. I mean, those are the data out of South Africa where you get at least 70% protection against serious illness.

If, on the other hand, we're trying to prevent more mild illness, it's likely the two dose of an mRNA vaccine won't be great at protecting against mild illness, especially if you're, say, more than six months after having gotten your second dose. There a booster dose will increase your chance of being protected against mild illness, but if that's what we're trying to do, realize that neutralizing antibodies, which mediate protection against mild illness, will fade over time-- six months, nine months-- and then you would need another booster, which kind of is where Israel is coming from, right now offering a fourth booster dose or fourth dose for people who are over 60 years of age.

So we have to define what is we want. Remember, protection against serious illness is mediated by immunological memory cells, which tend to recognize regions on the virus that are conserved and have been conserved now for all four variants, including the omicron variant.

ANCHOR: So what would you say about the timeline, too, of the pills coming out? I mean, do you, especially from your rounds, do you anticipate an impact right now?

PAUL OFFIT: Well, again, get vaccinated. I mean, it's not hard to figure out how to get out of this pandemic. If you look at Israel, which has a vaccination rate in the population of over 90%, they're averaging about one death per day, which would be the equivalent of maybe 35 deaths a day in this country. So that's our way out of this pandemic. Obviously, as Ben Franklin said, an ounce of prevention is worth a pound of cure.

But it's interesting to see what happens with know the antiviral medicines, which if taken early can make a difference. And it may be the people who are unvaccinated would be more willing to take a pill as they've been willing to take hydroxychloroquine or ivermectin or things that don't work. This would work if taken early, so we'll see how that plays out. It could make a difference.

ANCHOR: Dr. Offit, what are you seeing in terms of the impact omicron is having on the youngest kids who can't necessarily get a vaccine right now? Have you seen increasing hospitalizations on that front? And number two, to the point that the President has made over and over again that there are the tools in place, what do those tools look like for the youngest?

PAUL OFFIT: Well, again, we have learned, I think, over the last two years of this pandemic how best to treat children in terms of how to ventilate, whether to give immunosuppressive agents like dexamethasone or baricitinib, so I think we're getting better at taking care of children. I mean, I was on service about a week and a half ago. We saw probably 18 children come into our hospital, including a handful in the intensive care unit. Actually only one was less than five years of age. All the rest were over five, many over 12, all of whom could have been vaccinated. Not a single one was, nor were their parents nor with their siblings.

So again, I feel like with the discussion of boosters and antivirals and monoclonals, we're somewhat taking a detour from what the real issue, which is to try and figure out a way to vaccinate the unvaccinated. I have to believe there is a way to do this at the local level where we go into those communities that are under vaccinated and just listen to them and try and answer their questions. I have to believe this is possible, because that's our only way out of this.

ANCHOR: Dr. Offit, I hope your optimism gets spread around the world. But to Dr. Sun, on that note, I know that there's been a lot of spotlight on the idea and on the efforts of frontline health workers. We know that there are surges happening now in New York, for example. How is the situation when it comes to labor and staffing as it stands right now? Are you running into any issues?

CALVIN SUN: I just got three text messages in the last five minutes during this program asking for coverage. I'm trying not to look at it, but it's popping up on my screen saying two of us are called out sick. One of us is changing their guidelines to come in seven days after the positive test instead of 10 days. We're trying to meet ends, make ends meet. We're increasing premium pay. We're closing down three of our urgent care centers in Manhattan, at least 15 in New York City.

This is the life of a per diem doctor who works everywhere. I'm being-- My phone is blowing up with text messages asking for coverage. On top of that, we are frontline health care workers. We've been working two years straight. And there's no end in sight.

I mean, the conversations with our patients have changed, given the vaccine. Thank goodness for the vaccine, because a year and a half ago before the vaccines, the conversation once you tested positive was about pulse oxes, silent hypoxia, life and death, where the closest ER is, following up your primary care doctor. This time, the conversations are about ruined travel plans and ruined holiday plans for the fully vaccinated that test positive. It's a relief per se but also a different kind of burnout, because we've now become bona fide travel agents on top of trying to see sick patients in our line of work, on top of the fact that we're facing staff shortages.

On top of that, we're cutting corners on trying to get staff members who tested positive to come back earlier than the 10-day window that they mandated for us. So we're trying to juggle a million things at once at real time, active time, and it's exhausting. And when we are going to be able to take a relief on this-- There are also misinformation out there and people pressing us to not talk about the vaccine as much from our patients who don't believe in it. It's unforgiving. But, you know, you can't pour from an empty cup, but we just got to keep fighting.

ANCHOR: Yeah, I think the exhaustion is the right word after having to deal with this pandemic for so long. Dr. Offit, the last question to you, we did hear from Danny Meyer today, the head of Union Square Hospitality Group, saying that he will now require boosters for his employees immediately and then come January for those visiting his restaurants. That raises the question, of course, of those who can't necessarily get the booster, and there seems to be all kinds of reports here about how long somebody has to wait to get the booster after having had COVID. Can you clear that up for us?

PAUL OFFIT: Well, in terms of after having had COVID, you should wait until your symptoms are all completely gone. And then you can get a vaccine. In terms of-- But if you've gotten vaccinated, for example, and then you had COVID, you don't need a booster. If you've gotten COVID and never got vaccinated, then the answer would be to wait until your symptoms are gone.

ANCHOR: I think a lot of people appreciate the clarification there here. Dr. Paul Offit, it's good to talk to you today, Vaccine Education Center Director and Children's Hospital Philadelphia attending physician in the Division of Infectious Diseases. We've also had Dr. Calvin Sun with the Monsoon Diaries. He's the Founder and CEO there. And our Angelee Khemlani joining us on the conversation.