Ho-Ho-Omicron: Dr. Blackstock Takes Your Last-Minute Holiday COVID Questions

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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. One of the things that President Biden announced yesterday as a response to Omicron is the federal government will send 500 million rapid test kits to Americans for free. This is one important measure, considering the shortage. This is actually a turnaround as well from something the White House Press Secretary Jen Psaki said back on December 6th when the variant wasn't here very much yet, but we knew it was coming. Psaki mocked NPR's Mara Liasson, when Mara asked about the idea of free rapid tests for everyone. Here's that exchange from December 6th. We'll pick it up with Psaki describing their efforts, then Mara will come in with her question.

Jen Psaki: Look at what we've done over the course of time. We've quadrupled the size of our testing plan, we've cut the cost significantly over the past few months. This effort to ensure ensures, or you're able to get your tests refunded, means 150 million Americans will be able to get free tests.

Mara Liasson: Why not just make them free and give them out and have them available everywhere?

Jen Psaki: Should we just send one to every American?

Mara Liasson: Maybe.

Jen Psaki: Then what happens if every American has one test? How much does that cost, and then what happens after that?

Mara Liasson: All I know is that other countries seem to be making them available in greater quantities for less money.

Jen Psaki: I think we share the same objective, which is to make them less expensive and more accessible. Every country is going to do that differently. I'm just noting that again, our tests go through the FDA approval process.

Brian Lehrer: White House Press Secretary Jen Psaki and NPR's Mara Liasson on December 6th. Now Biden is doing a version of just that. We'll talk about it in some detail, as with me now to talk more about the state of the pandemic, locally and nationally and the local and national responses to it, is Dr. Uché Blackstock, emergency physician and founder and CEO of Advancing Health Equity. She's also an MSNBC medical contributor. Dr. Blackstock, always great to have you on. Welcome back to WNYC.

Dr. Uché Blackstock: Hey, Brian, always honored to be in conversation with you.

Brian Lehrer: You tweeted yesterday about that Jen Psaki-Mara Liasson exchange. Let's start with that. Why did that draw your attention?

Dr. Uché Blackstock: Oh, wow. Just listening to that exchange, I would say, horrified me. Only reason being that we know that testing is such a crucial layer when we're looking at public health measures. For Jen Psaki to respond like that because of this idea of free rapid tests for Americans, showed me that maybe there was a disconnect, that for some reason, the Biden administration wasn't discussing this as an option in terms of reducing the spread. They seemed incredibly out of touch. We have in the US been very behind on testing, since the beginning of this pandemic. It all started with the CDC, they had developed their own test that ended up being a botched test. Then private companies like Abbott started making rapid tests. Because the demand went down for testing, they ended up throwing away all of these rapid tests that we actually need now.

One of the other issues is that we've been using rapid tests and thinking of them as a medical test, when they really are a public health tool. They've had to go through the very rigid and regimented FDA approval process. That has also delayed rapid tests being available. I think we are way behind on the eight ball right now, as we can see from the long lines. I've sat on those lines over the last weekend about four hours for my children to get tested.

Brian Lehrer: Yes, so many people have, oh my goodness.

Dr. Uché Blackstock: Yes, tested for their after-school program. We're very behind, and these 500 million tests that President Biden mentioned in his strategy plan, definitely, it's a start. We know it's not adequate because there are 330 million Americans, and those rapid tests are used often. They have to be used more than once in a short period of time, that helps to improve the accuracy of them.

Brian Lehrer: So many people are calling in already to talk to you. Let me give out the phone number so I make sure everybody has it and an equal shot to get in. Your questions about Omicron science, Omicron medicine, Advancing Health Equity in the time of Omicron, and other Omicron policy responses, your questions about any of those things welcome here for Dr. Uché Blackstock at 212-433-WNYC, 212-433-9692, or tweet your question @BrianLehrer. Do you know how that rapid test distribution will work? I see it's by request. Can you help people know how to ask for them?

Dr. Uché Blackstock: Brian, that is the issue. There really wasn't that much detail in President Biden's message yesterday or the plan. We don't know if this is, you go to a website, you sign up for it, whether there will be a limit based on household. We also don't know whether or not the test will target high-risk people. Initially, will it be sent to people who are immunocompromised or elderly? Those are the details that we need to find out about.

The other thing that we don't know is, will all 500 million be available in January, or is it just starting in January, and they'll be available over a few months? I'm thinking more likely that they will be available over a few months because, in order to produce 500 million tests, that would have had to start months ago. These are the questions that I think the public needs to know. We really need to know in terms of planning over the next few months, but I would say that even January is too late because right now, we're seeing cases explode.

Brian Lehrer: You raised the question just now of whether 500 million tests is actually a lot or a little, and Jen Psaki in her exchange with Mara Liasson suggested a question of whether it's an expensive bottomless pit of need. Listeners, think about the math, 500 million tests is less than 2 per American. The emerging practice is that people should take them regularly before going to work, depending on your job, or other places where you'll come in contact with people. How do you see the number 500 million, Dr. Blackstock, and what's feasible or sustainable after that economically?

Dr. Uché Blackstock: The other thing is, Brian, one thing that US has not done that other countries have done is they have actually helped subsidize the manufacturing of these tests. Just like they did with the vaccines, they will pay, give funding to test manufacturers to manufacture these tests, and that offsets the pricing. Yes, it probably would be a tremendous investment, but we spent billions of dollars on defense.

I think that the pandemic is well worth that funding that is spent if we're talking about saving lives. Not just saving lives, but managing this pandemic adequately and competently. I think if we do anything less than that, we are going to lose many people. These are all preventable deaths. Again, if European countries can do this, I think we should be able to do this as well. Honestly, I don't think that the funding part should be as much of an issue. That's me as a physician speaking, obviously.

Brian Lehrer: Let's take a rapid test question from Laura and Warren, New Jersey. Laura, you're on WNYC with Dr. Blackstock. Hi.

Laura: Hi. Can you hear me okay?

Brian Lehrer: Just fine, Laura. Hi.

Laura: Great. I love your show. I'm a physician. I'm a general internist hospitalist, I've taken care of a lot of patients with COVID. I think we can vaccinate and mask our way out of this, I don't think we can test our way out of this. I also teach evidence-based medicine to medical students. I think the data on the rapid testing is that it picks up about 70% to 80% of infections, that means that it misses about 20% to 30% of infections. For the asymptomatic infections, which are the really important ones to pick up, it probably misses almost 50% of them.

If 50 people take a rapid test, and they say it's negative, and then they decide to congregate, there's a very high chance that at least one or two of those tests that are negative are falsely negative. If they decide to congregate because all of them had a negative test, you're setting up super-spreader events, if there's a high prevalence in the population. I'm really not a fan of these rapid tests because when you've got a lot of people out there with the disease, there's a lot of false-negative tests.

Brian Lehrer: Doctor to doctor. Dr. Blackstock, what do you say?

Dr. Uché Blackstock: Brian, I think you've had Michael Mina on here. He was formerly at Harvard, and he's really been--

Brian Lehrer: Yes, he's the evangelist of rapid tests.

Dr. Uché Blackstock: Yes. I appreciate the point that the caller is trying to make. It's also two things. One, when we think of the Swiss cheese analogy for managing pandemics, each layer has holes in it, each layer is important. That's why testing is important, that's why masking is important. Vaccination, ventilation, air filtration, when you put them together, you create an effective strategy.

Obviously, you're not saying one just to rely slowly on testing, but two, for rapid tests. As I mentioned a little bit earlier, no one is saying to go based on one result. The whole point of the rapid testing is you take multiple tests. You do at least two of them within a 24 to 48-hour timeframe because it can change very quickly. That's actually one point.

The other point is that rapid tests are important for specific situations. It's to tell not just if a person is infected, but if they are also infectious, if they're contagious to other people. In that way, rapid tests actually work quite well. I think it's just important for the public to understand, and I think the messaging could be better on this, how to use rapid tests, what the advantages and disadvantages of rapid tests are versus PCR.

Brian Lehrer: Do you want to have one more go, Dr. Laura?

Laura: Yes. I see people like my brother and other people deciding to have a big party where people will be eating, and talking, and dancing, and therefore close to each other, and unmasked. 50 people come in and have a negative rapid test that day. That doesn't strike me as a safe use, and a lot of people are using them that way. I'm very concerned that people are doing things because they have this false reassurance of the rapid tests.

Brian Lehrer: That context is really interesting, and Laura, I'm going to leave it there. Thank you. Please call us again. The picture she painted of that event, Dr. Blackstock, that goes to other things that people need to deal with at the same time as they're taking rapid tests.

Dr. Uché Blackstock: Yes, exactly. I'm hoping those people are also vaccinated as well as boosted and they're also keeping the windows open. Do you know what I mean? That it's not just the rapid test that is determining whether or not they're going to spend time together in close proximity.

Brian Lehrer: Masking, if they're in groups.

Dr. Uché Blackstock: Yes, exactly, and masking as well.

Brian Lehrer: We'll continue in a minute with Dr. Blackstock and more of your calls and more information on the science and policy responses taking place right now. Stay with us.

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Brian Lehrer: Brian Lehrer on WNYC, as we continue with Dr. Uché Blackstock, emergency physician and founder and CEO of Advancing Health Equity. She's also an MSNBC medical contributor. To the name and the goal of your organization, Dr. Blackstock, how much do the various things the president announced yesterday advance health equity, in your opinion? We've been talking so far about the rapid test distribution, but there's also military personnel for hospitals that are short-staffed. There's establishing a big federal testing site in New York City with more to come elsewhere. How did you assess his entire presentation yesterday?

Dr. Uché Blackstock: I would say it was a first step, but it definitely was not an adequate plan, especially as it addresses health equity. I would've loved to have seen a strategy to get free high-quality masks out to every household. KN95s or KF94 free mask for every American that wants it. I would have also liked to see some data-driven mask policies. There was no mention of masking at all, and we know that is another important layer.

I also am concerned about the therapeutics. We know that early on in the pandemic, even with monoclonal antibodies, there was concern about racial inequities and who was getting the monoclonal antibody treatment, which hospitals were giving it to their patients. I'm seeing with the new antivirals that are coming out by Merck as well as Pfizer, I'm concerned about equity issues as it relates to that. That was also not mentioned in the president's plan.

Brian Lehrer: How Mayor de Blasio-- Before I even ask you that, let me ask you something about your colleagues in emergency medicine, because that's what you did practice. I think you're not actively doing that right now in an emergency room. You're working on your organization, Advancing Health Equity, but I have seen that while the cases are surging to a record number, let's just talk about New York City for the moment, more than 20,000 a day now really for the first time in the pandemic being confirmed by testing, the hospitalization rate has not surged. Put that in context for us based on what we know and, frankly, what we don't know.

Dr. Uché Blackstock: It's a great question. The characteristic of Omicron that we're still trying to characterize is whether it causes more severe disease than Delta does. So far, based on the data that we have from across many different countries, we don't have data that shows that it causes any more severe disease. I think what we're seeing in terms of the increase in cases here in New York City and in other parts of the country, it's Delta, but I'm sure if we were actually able to look at the data for breakthrough infections, I think we're seeing infections in fully vaccinated and boosted people.

I think we're also seeing some decoupling of the cases and hospitalizations. Meaning that people are getting infected, but if they are fully vaccinated or boosted, they are having relatively mild disease that is not leading to hospitalizations. Again, it is still quite early in the surge, we would need to actually look at that clinical data several weeks out more to see if that is indeed true.

Brian Lehrer: Craig in Westchester, you're on WNYC. Hi, Craig.

Craig: Hi, Brian, thank you so much. This is in response to the pandemic. Obviously, testing and masking is very important, but I feel something that's lacking, and I'm hoping to get your opinion on this, is a public relations campaign intended to really educate the public, for example, people who aren't getting vaccinated. Is it true that they are contributing to variations that are being generated by this virus? If so, can't we have a campaign that says something like this, "The vaccination is one of the greatest inventions of mankind. We don't get polio because we have vaccinations for polio, and mumps and measles and things like that"?

Brian Lehrer: I feel like we've heard that kind of public health campaign repeatedly over the past year now that we've had the vaccines. Dr. Blackstock, take Craig's suggestion and Craig's concern and tell us how you see it. There is still a certain percentage of the population that's refusing to get vaccinated. I think demand is up again because of Omicron. We'll keep moving toward a more and more meaningful number. How do you see vaccine- I don't even know what the word is anymore. I don't know if it's hesitancy anymore, or refusal, or pigheadedness. [chuckles] What are you looking at?

Dr. Uché Blackstock: Brian, I do think that there could have been and could still be a better job with public health messaging around the pandemic. I do think that we should be seeing informational ads on TV and in social media. In some places we do, but there really seems a disconnect between what is happening within certain spheres of public health, of science, and what the general public knows. There are people that are still very, very confused about vaccines and what vaccines can and can't do.

For example, my former barber, he is in his 50s. He has multiple medical problems, and he still had not been vaccinated up until several weeks ago. He stopped me in the street and said, "I really want to talk to you, I trust you." He literally had about 10 incredibly thoughtful questions about coronavirus and about vaccines, that he said that he could not get answered because one, he doesn't have a primary care physician. Two, he said sometimes he finds what Dr. Fauci is saying very confusing.

I do think that not everyone out there is an anti-vaxxer per se, but I do think that access to information, and to accurate information, culturally responsive information as well, is still lacking. That is an area that I'm hoping still to see some effort from the Biden Administration and the CEDC on, especially dealing with this 40% of people who remain unvaccinated. I think that vaccine mandates will help. We see that sometimes they get tied up in the courts due to legal challenges, but I do think that we should still be focusing on outreach and education, even if it seems like people are not listening.

Brian Lehrer: John in Brooklyn with another rapid test question, I think. John, you're on WNYC with Dr. Blackstock.

John: Hi, Brian. Thanks for taking my call. Can you hear me?

Brian Lehrer: Can hear you just fine. Hi.

John: Great. I just wanted to comment that while 500 million tests doesn't seem like a lot, I was under the impression, the way they describe it, that these tests are to be used for maybe when you feel sick and you can't get out of bed to get to a testing site. It would be helpful to know your status so you could quarantine yourself, and maybe that's why it seems like maybe two per person. Depending on if it's a positive test, you quarantine, and then you could take a second one to show a negative test.

That's the impression I was getting with this. Not that they would be used for traveling or to get into places. If you're fine to get out of bed and make it to a testing site, then you should probably do that. I'm not even sure the results would get to the CDC.

Brian Lehrer: Good questions, all. Dr. Blackstock on taking an at-home rapid test versus going out to a testing site, for example.

Uché Blackstock: I think that the intention of these tests are for people to take these tests at home, like the caller said, if they're not feeling well. At the very minimum, they should take two tests, 24 to 48 hours apart, to increase accuracy. I still say that 500 million is not an adequate number.

Brian Lehrer: The reason that people are buying up rapid tests, the reason you can barely find them in the stores anymore, if you can find them at all, and the reason that, by the way, there are reports now of price gouging on the rapid tests that you can still find in stores, Gothamist has an article about that today. I don't know if there's anything before the fact, rather than trying to process execute somebody after the fact that the city government or anyone else can do about that. The reason there's such a run on them right now, I think, is largely because people are using them at home before routine Christmas gatherings with their families and things like that.

Uché Blackstock: Yes, absolutely, Brian. I even had a personal experience yesterday where our babysitter texted me and said, "My family member was exposed and I was with that family member all weekend." I told her, "Why don't you meet me at the playground and I'll test you?" She tested positive. I said, "You need to go home and isolate, and I want you to get a PCR test just to confirm," because she really wasn't having any symptoms." That was a really great opportunity for me to use a rapid test to find someone who was indeed infected to make sure they isolated and they told people that they were around over the last two to three days.

Brian Lehrer: To the caller's other question, and I have a tweet like this too, I'll read the tweet. It says, "Is your guest at all concerned about the lack of insight we're going to be facing and the inability to trace with the rise of at-home testing?"

Uché Blackstock: Yes, that's a concern. Some of the rapid tests do offer a third-party verification. There's a way, using an app on your phone, that you can actually upload your results, and a third-party will verify them, and you can actually get official results. That information could potentially be transmitted to the CDC, but I do think that the benefits really outweigh any negatives, that people will take these tests and take them as they should take them, two tests at least 24 to 48 hours apart, and to use them wisely to help dictate their behavior.

Brian Lehrer: Someone writes, "I just received a negative PCR test and a positive rapid test with symptoms. Which one do I trust?"

Uché Blackstock: I think if you are having symptoms and one of those tests is positive, I would say you were likely positive. I would say that is probably a false-negative for the PCR. The PCR actually is the most sensitive test. It is usually positive earlier in the course, and it stays positive for a longer period. The rapid test usually only stays positive for the duration that you are infectious, a much shorter period of time.

Brian Lehrer: Can you give people a little refresher on masking? I can't believe we're talking about this a year and a half later after we did our original, "These are better quality masks. Here's how you make sure a mask fits well. Here's how you use a mask," but it seems to be back, that people are talking again about different quality masks, especially because Omicron is so transmissible. You mentioned some models before. Are the cloth masks that we've all acquired still useful?

Uché Blackstock: What I would say is that cloth masks, they are effective, and this is based on the wild type, about 30% to 40% effective. We don't have any data on how effective cloth masks are with Omicron, but from what we know of Omicron being so contagious, a cloth mask alone is not adequate. If you have a cloth mask and you still want to wear it, I would say to likely wear a surgical mask underneath. Surgical masks have effectiveness about 75%. You could still wear your cloth mask, but wear it with a surgical mask underneath.

Really the mask that everyone should be wearing right now given that Omicron is out there are either KN95 or KF94 mask. Those can be purchased online. I still do think that they should be made available for free to every New Yorker and every American. I think that is the responsibility of our public health departments and our government. I don't think people should be still be confused about masking the way that they are, because we really should be responding dynamically in real time to the needs of our population.

Brian Lehrer: Last question, and coming back to the central mission of your organization, Advancing Health Equity, do you know if the rates of who's getting Omicron are as disparate by race and class as the original wave? Looking at the whole course of the pandemic so far, are people doing things that you advocated from the beginning to advance health equity for the duration of these COVID times?

Uché Blackstock: That's such a great question, Brian. In terms of the racial and ethic demographics on who the new cases are, we don't have that data yet. I do know with respect to boosters that there seems to be some both racial and socioeconomic inequities in terms of who's been boosted. Only one in six Americans have been fully boosted, and we're seeing in that small number some racial as well as socioeconomic inequities.

In terms of some of the areas that we had hoped to be addressed very early on in the pandemic, we still are not seeing complete racial and ethnic demographic data being collected at the state level and by the CDC. We are still pushing the CDC to make sure that they're holding states accountable for collecting that data. That is an area that obviously still needs a lot of work.

Brian Lehrer: Dr. Uché Blackstock, emergency physician and founder and CEO of Advancing Health Equity. She's also an MSNBC medical contributor. We always learn a lot when you're on, Dr. Blackstock. Thank you very much. Hang in there.

Uché Blackstock: Thank you, Brian.

 

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