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Kerry: This is All Of It. I'm Kerry Nolan, in for Alison Stewart. I'm happy to say that one of our producers saw Alison yesterday and reports she's recovering well after donating a kidney earlier this month. She'll be back in the host chair after Labor Day. On today's show, we'll talk about the sounds of New York City and how to deal with noise in a city that never sleeps. We have a live in-studio performance from singer/songwriter Margaret Glaspy and jazz drummer Jonathan Blake will join us for a listening party for his new album. That's the plan. Let's get this started with an update on where things stand with COVID.

While May 11th marked the end of the federal COVID-19 public health emergency declaration, we're still not out of the woods just yet. New York City Health Department saw an uptick in cases this summer as the EG.5 variant, including a new sub-strain called Eris, becomes the dominant strain in the United States. About 594 people contracted COVID-19 within the last seven days, mostly in Brooklyn and Queens. Our next guest will help us understand why we're seeing these trends and how to protect ourselves from getting sick as we get ready to head into fall.

Denis Nash is a distinguished professor of epidemiology and the executive director of CUNY's Institute for Implementation Science in Population Health. Denis, welcome to All Of It.

Denis: Thanks for having me.

Kerry: Listeners, we want you to join in on this conversation. What precautions have you continued to take to stop the spread of COVID? Are you still wearing a mask in public? Are you social distancing? Are you vaccinated against COVID? What about the boosters? How often do you get tested for COVID-19 and have you been tested recently? Did you have to pay for it or did insurance cover it? What free testing sites do you go to? Lots to talk about here. Give us a call or send us a text at 212-433-9692. That's 212-433-WNYC, or you can hit us up on social media, our handle @allofitwnyc.

Denis, recent CDC data shows a 12.5% increase in hospitalizations due to COVID-19 across the country, and infections within the city have also gone up. Why are we seeing a surge in COVID-19 now?

Denis: I think the main reason we're seeing a surge over the last several weeks around the US and in New York City relates to the changes in extreme weather that we've been experiencing and the heat that's getting people indoors to be cool. It's like people being placed between a rock and a hard place. They're wanting to stay safe from extreme weather and also wanting to avoid COVID, but in this situation, this summer, there's been several heat waves. That gathering of people indoors to stay cool has certainly fueled a bit of spread of COVID.

We're seeing a summer wave that is not too big, and luckily, in terms of hospitalizations, which are going up, they're going up from a low place. When you hear things like a 40% increase in hospitalizations, it is significant, but it's going from a small number to another small number, and hopefully stays that way for a while. It is a concern that it is an increase to be concerned with. It reflects that people are also having a waning immunity with time.

It's been quite a while since we've had a major surge that boosts people's immunity in the population and we haven't seen vaccination rates going up a lot. Over time, the populations become a bit more susceptible to these kinds of surges.

Kerry: It's so interesting that it seems to be correlated with the extreme weather we've been having. Normally, you would think, "Oh, we get a few hot spells. Everybody stays in the air conditioning. Everything should be fine." You shouldn't see that spike and yet there it is.

Denis: Yes. I do think that's what it is. Of course, there are, as you mentioned, other variants circulating, but I think the surge or the increase that we've been seeing over the last several weeks more relates to people's behavior than it does to the virus itself.

Kerry: Are public health professionals concerned that this surge will put another strain on hospitals and health centers?

Denis: I don't think that we're seeing a situation right now that would suggest that. In the recent past, we've been able to absorb pretty significant surges in transmission of the virus without surges within the healthcare system. This relates to the high levels of immunity that people have in New York and elsewhere, both because of vaccination and prior infection or both.

Kerry: We're talking with Denis Nash, who's an epidemiology professor at CUNY's Institute for Implementation Science and Population Health's executive director. That is a mouthful. We're talking about the recent uptick in COVID-19 cases here in the city. If you have any questions, if you want to share your story, we would love to hear from you. Our number is 212-433-9692, that's 212-433-WNYC. Denis, the federal public health emergency for COVID-19 ended in May. What does that mean for the city and the state's strategy for dealing with COVID-19 moving forward?

Denis: In New York City, we were extremely lucky. We had our challenges with testing availability, of course, as many places around the country did, but when it was going well, it was going well. Almost everyone could have access to a free COVID test, whether that be with an urgent care provider or getting at-home tests for free from the library or from the federal government through the mail. That has changed. We are in a situation where testing access is more limited than it has been ever and except for the period when there were no tests available in the beginning of the pandemic.

What that means is that people will tend to access COVID tests only in situations where they feel it's highly necessary or for clinical reasons. If you're presenting to care with severe illness, you'll get a COVID test. That makes it hard to be able to track what's going on with the pandemic. We've relied heavily on what's going on with the number of people diagnosed with COVID, the number of cases, the prevalence among testers, and things like that. With less availability of testing and more barriers to accessing testing, we don't have those indicators to help get a sense of what's really going on with the spread of the virus.

Kerry: Let's take a phone call. Adina in upper Manhattan, welcome to All Of It.

Adina: Thank you for having me. I am still taking precautions against catching COVID because I had Long COVID, and when I've been reinfected in the past, I've been bed-bound for about two months with each reinfection. I'm still wearing a mask indoors in public and I'm still getting a test if I feel sick to avoid passing out to anyone else. I would encourage other people to do so as well because, for some people, COVID might not be a big deal, but for other people, it really is quite debilitating.

Kerry: Thank you for your call, Adina. We also got a text from a listener named Sabrina. She says, "Hi, Dr. Nash. What can you say about the sensitivity of testing? A lot of people seem to be having negative tests despite symptoms and exposure." She says, "I took care of my son who had a positive antigen test, and now, I'm very sick, but the antigen and PCR tests are negative."

Denis: If I could just first speak to the caller with you.

Kerry: Yes, of course.

Denis: I'm very sorry to hear that. I do agree that this is an important reason that we should be concerned about, the ongoing spread of COVID. Long COVID, I think is, beyond the horrible numbers of deaths that we've had, is the biggest legacy of this pandemic, and it will be long-lasting. Many people who survived COVID continue to have debilitating symptoms. I think Long COVID is another reason why we should do things like try to prevent spread, try to prevent getting COVID, and increase the levels of vaccinations. It also seems to be increasingly clear that if you do get COVID, taking antivirals might help prevent the risk of developing Long COVID after that. I just want to highlight that this is a very important phenomenon. It's a major public health issue and something that's not talked about as much as it should be in terms of the reasons why we want to continue to prevent spread of COVID-19. To the second question about negative tests, yes, this is something that's tricky. We don't have any evidence to suggest that the tests are less effective with the new variants that are circulating right now or less sensitive.

However, it's always important to keep in mind that the way these at-home rapid tests are intended to be used, it's not once just the first time you experience symptoms. If it's negative, you still should test again in a day or two after that because sometimes, the symptoms we first experience are our immune systems responding to the virus. The rapid tests don't detect viruses as well as PCR does in the early stage of infection, so what you have is a situation where people feel symptomatic. They test negative on a rapid test and say, "Oh, well, it's not COVID. It must be something else."

In fact, many of those folks who test a day or two later while they're still experiencing symptoms, they do end up having a positive rapid test. I think a lot of COVID cases are missed and a lot of opportunities to prevent onward spread because of that. We don't think the tests are less sensitive for new variants than they have been in the past, no.

Kerry: Let's take another call. Miriam in Brooklyn, welcome to the show.

Miriam: Hi, thanks for taking my call. I have a couple of questions because my husband and I each had COVID in the early part of July, and we are going to be flying to Europe next week. We're wondering whether or not we should do masking during the flight, particularly because my husband has asthma. In the past, when he's had COVID, has developed some pretty intense symptoms. The question is how long we should wait before we get a booster. Thank you.

Denis: My advice for anyone who is at risk for severe COVID is to mask in situations like that, where you're in crowded situations, so in the airport waiting on the plane, especially before they start up the ventilation system, which I do think improves air circulation and reduces the risk. There are times before that happens where I do think spread can happen on airplanes in an airport. I think it's important for people who are susceptible to severe disease to take these kinds of precautions always. There's a surge happening now in the US and around the world.

I would also advise to try to take some antivirals with you, should the situation arise where there was an infection so that you would have them on hand if you needed them.

Kerry: I think Miriam was also asking about immunity after having had COVID. Is there immunity? Does it last? Tell us a little about that.

Denis: Yes. Clearly, the data do show that if you've been vaccinated and are up-to-date with your vaccines or if you've been infected recently, that your risk of severe COVID can be lower, and your risk of infection can be lower even given an exposure. However, we also know that some people are very vulnerable and susceptible to severe outcomes, even if they have been vaccinated and boosted. These include older people and also people with certain comorbidities, so I think it's important to take precautions in those situations.

Even if you have been infected recently, the level of immunity conferred from an infection can be variable depending on how severe it was, depending on your own immune response, and many things. It's hard to really say how long it will have a protective effect after that.

Kerry: We're talking with Denis Nash, who's an epidemiology professor and the executive director of CUNY's Institute for Implementation Science in Population Health, about the recent surge in COVID-19 cases, not only in New York City, but around the country and around the world. We're taking your calls at 212-433-9692, 212-433-WNYC. Fred in New Milford, New Jersey has an interesting question. Hi, Fred, welcome to the show.

Fred: Hi, thank you for taking my call. Yes, I'm 84 years old. I have never had COVID. My last booster was in June of 2022. Should I get another booster, a different booster, or where do I stand as of now?

Denis: Yes, that's a great question. The advice I've been hearing on this is for, I guess the average person who may have been vaccinated or had infection in the past would be to wait until the new booster that is more well-matched to the circulating strains of virus comes available, which is expected to happen in September or maybe more likely October, a little late, in my view, for the potential increases in spread that we might see this fall. I would consult with your doctor.

Not having received the vaccine in a while and having never been infected and being age 84, I think that puts you in a category of high risk for a severe outcome. It may be that the best choice right now is to get a booster of what's available right now.

Kerry: Thanks for your call, Fred. The EG.5 variant, which has been named Eris has become the dominant strain now. EG.5 has been found in more than 50 countries as of last week according to the World Health Organization. It's estimated to be responsible for about 17% of COVID cases in the United States, and that's according to the CDC. Are there different symptoms? Are there more recognizable symptoms of this latest variant?

Denis: No, not that we've been hearing. The symptoms are similar to other variants of sore throat, cough, runny nose, fever, and fatigue are among the most common. There's not any evidence yet that it's more severe than other variants either.

Kerry: I think I remember hearing that the incubation period for this particular strain is much quicker than previous strains, in a matter of a day or two before the infection sets in. Do we know anything about that?

Denis: I don't have good handle on that. When epidemiologists talk about incubation period, that means, to us, the time between when you're infected and when you begin to develop symptoms. I still think at the time when symptoms develop, my earlier comment applies about testing, even if that first rapid test may be negative and don't trust it, if you still have symptoms, you need to test again if you're not positive.

Kerry: Let's take another call. Carol in Manhattan, welcome to All Of It.

Carol: Yes, hello. Thank you. Could you expand on what are antivirals exactly, when one is feeling so ill? I am over 70. I'd like to know how to protect myself and whether or not to take this new vaccine and whether it should be Moderna or Pfizer. Thank you.

Kerry: I think she was asking about antivirals. I think her sound went out a little bit there.

Denis: Yes. Antivirals are something that you can take if you become infected with COVID. Regardless of whether you're vaccinated or not, you probably do want to, if you're at risk for severe outcomes. I would say the age category of the caller puts them in this category of being at high risk. You'll want to take antivirals very soon after you're recognized as having COVID. This is something that can reduce the risk of severe disease, hospitalization, and death by quite a lot. It's a five-day course of medications that you take. In New York City, there are hotlines to help get access to these kinds of antivirals very, very quickly.

Kerry: Okay, Giovanni in Bed-Stuy has a question for you. Giovanni, thanks for calling.

Giovanni: Good morning. I'm 83 and actually, a follow on that call. At this point, I got a booster a week ago because of this incoming variant. My big question is, at 83, I'm more concerned about RSV, and I understand there is a vaccine. What and how is that available? When I go outside, I do all the things, I have COVID before. I wear N95 at space I do. I still think that, is this a threat that I could do something more about?

Denis: I think the caller raises an important point which is we're moving into respiratory virus season, and while we see COVID circulating and not always in a seasonal way, we can see its surge in the spring and in the summer, we can expect surges of other respiratory viruses to happen alongside COVID this fall. That includes RSV and it includes the flu. My recommendation there is to talk with your provider about getting access to the RSV vaccine if you're a candidate for it, it sounds like you may be.

As always, with the flu vaccine, it's important to get up to date on your vaccines as early as possible going into the fall season.

Kerry: Thanks so much for your call, Giovanni. Students are returning to school soon. How do we keep them from getting sick and spreading COVID-19 to an entire family?

Denis: I think that's very hard to do in today's environment where there are not really any measures in place to prevent spread in schools. I'm very disappointed that most schools around the country have not moved to improve ventilation, which we know is a very important way to reduce the spread of not just COVID, but other respiratory viruses. This would have the added value of protecting households and communities that are connected to those kids in the classrooms. I don't have a good answer to that question.

I think that this is a situation where we're going to see a lot of spread amplified in schools the way we have in many past years with COVID.

Kerry: We just got a text that says, "If your doctor advises you to get another booster now, instead of waiting for the updated one in the fall, how long should you wait between getting that one and whatever is going to be made available in the colder months?"

Denis: I know this is a tough call and you can hear different experts say different things about it. My sense is if you're in the category of being vulnerable you and your doctor is saying that you should get the vaccine you can get now because you need it in order to be protected, you should do that, where I think it's less clear is for people who are not necessarily at high risk for severe disease, they're up-to-date on their vaccines. They're about to be eligible for another booster and they could get what's there now or they could wait until September to get the new XBB monovalent booster or monovalent vaccine.

In that situation, I think it's reasonable to wait but if your doctor's advising you to do it now, I think you have to go with that.

Kerry: How worried should you be if you come in close contact with someone who is sick with COVID-19? Should you consider quarantining, and if so, how long do you do that?

Denis: Well, I think it depends on the nature of contact. If it was prolonged, if it happened, if the person was wearing a mask or not. I think the best way forward is to test and be sure that especially if you're going to be around other people, that on a given day that you're testing negative before you go out and do things. It certainly is reasonable to mask if you're around people who are vulnerable.

Kerry: We have a call from William in Long Island. William, welcome to the show.

William: Yes, hi. Hello. Thank you. Yes. I wonder, I have certain few tests that I bought in the pharmacy, and they have a date that some are expiring, some other already expire, and some will expire soon. Somebody told me, "No, that date is not that important. They are still good after the expiration they show." What is the opinion there?

Denis: Well, I think that that's both right and wrong. The expiration dates are very important to pay attention to. However, it's also true that for some test kits, expiration dates have been extended because they've realized that the test kits continue to work and there are websites available that you can go to and type in the lot number for those tests to see if those expiration dates have been extended or not.

Kerry: Thanks so much for your call. As an epidemiologist, what kinds of things are you tracking now with this latest surge?

Denis: Our team at CUNY is very much focused on Long COVID right now. We're trying to understand the extent to which things like vaccination and being boosted and getting the new monovalent boosters may be protective against the development of long COVID. Same around antivirals. We're also tracking the use of antivirals in the population among people who do get COVID. Our sense is that the level of uptake is not high enough or it's not high enough in the right populations because we do see COVID deaths happening and we know that they're all almost 100% preventable with vaccines and antivirals.

There's more work to do there. Another thing that I think we are interested in is how the confluence of other respiratory viruses are going to interact during a surge this fall and the extent to which there may be, people may rely on some of the strategies that we've come to know as really important as an effective to reduce the impact of the spread of respiratory viruses. I think we've learned a lot of lessons. I think we have a lot of great tools. This fall is a great time to have them at ready.

Kerry: With a minute or so we have left, I was really curious about, was it people going to the hospital that gave you the information that there was an uptick? I'm also wondering about this wastewater testing. Can you tell me a little bit about that?

Denis: Yes. As I mentioned, wastewater-- or it's hard to really monitor what's going on with the pandemic in real-time by looking at cases, especially now that testing is much less common. Wastewater, which is testing the wastewater from over 8 million New Yorkers that goes to water recovery facilities around the city, which is then tested for the presence of COVID and as well as other viruses to get a sense of what the amount of virus circulating in the community is. Is it going up, is it going down? Is it staying steady?

It's a good way that obviates the usual problems that we have of relying on testing and reporting of cases to be able to get a sense of what's going on in the community. We have been seeing slight upticks in the wastewater data, which I think supports this notion that there is a community-wide surges happening around the US, around New York. Also though, we still don't really know the extent to which-- how to interpret a certain level of virus in the wastewater and what it means in terms of how many people might be infected in the population at a given time, and whether or not that's changing with population immunity.

This is a very open question right now that many of us are interested in trying to understand more about. I believe that wastewater surveillance for COVID and other viruses of epidemic potential is the way of the future, is an important way for us to be prepared for what's happening and to get earlier warnings for these kinds of surges.

Kerry: Denis Nash, epidemiology professor and executive director of CUNY's Institute for Implementation Science in Population Health, thank you so much for sharing all your knowledge with us this afternoon. We really, really appreciate it.

Denis: Thanks for having me.

 

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