Dr. Indu Gupta on the Campbell Conversations
The omicron variant appears to have peaked in central New York, at least that is the hope. Was this area hit harder than others, and why? What can we expect next? And what more can, or should, we do to protect ourselves? This week, Grant Reeher discusses these questions with Onondaga County Health Commissioner Dr. Indu Gupta.
Grant Reeher: Welcome to the Campbell Conversations. I'm Grant Reeher. Dr. Indu Gupta returns to the program to speak with me today. Dr. Gupta is the health commissioner for Onondaga County. She's also a co-chair of the Onondaga County Drug Task Force and a board member of the New York State Association of County Health Officials. Dr. Gupta, welcome back to the program.
Dr. Indu Gupta: Thank you for having me.
GR: So let me just say for our listeners, first of all, that you and I are speaking on Thursday, January 20. Things are in the process of changing. And so people need to know when we're talking. But let's just say at the outset here at the as of January 20, where do you think we are with the omicron variant?
IG: So where are we from the COVID point of view? I think that's and then going into the omicron.
GR: Okay, that's fine. You could take it in that order.
IG: Right. So the COVID, as we have seen fluctuation throughout the world, you know, as of 16 January, over 323 million confirmed cases were noted throughout the world, and 5.5 million deaths. If you look into the US, you were talking 68 million. If you look into the New York state, 4.6 million cases as of now. And in our county, we have a cumulative of more than 95,000 cases, a little bit like 96,000 cases. We have lost almost a thousand people, 987 or 990 people at this point. And our cases overall on an average, if you can think of in January, sorry, in June, 21, we had like three cases, three cases it seems like three cases. And then 27 of June there was one case and January 5, 2022, we have 2355 cases now. So that gives you a little bit of a kind of, you know, perspective that how where we are, it fluctuates. It goes down. It comes up depending on what is happening. So we are dealing with the omicron at this point. Delta was somewhere late in the fall and winter, when winter started omicron has taken over pretty much throughout the United States which is very highly contagious more than delta and pretty much it is causing havoc throughout the United States.
GR: Okay. So that's helpful. Thanks for putting that in context more broadly with the country and the world. So thinking of New York state, though, and given the numbers that you've just given me, now I know that some people have had more than one COVID infection. In fact, I personally know a couple of people who have had COVID twice. So. But still thinking about those numbers, 4.6 million, 95,000 in Onondaga County, if ever, if there were all single infections, we'd be looking at about one out of every four people. Right. Has had COVID. Is that is that correct?
IG: Right. Right. So when you're talking about having a repeat infection, so they can be categorized now in two groups, one is called reinfection. So before the vaccine, people who have recovered could get infection. So that rate was about 3% or so. And with the vaccine, when millions of people have gotten vaccine throughout the United States, we are talking about breakthrough infection. That's called breakthrough because you've got the vaccine and that for the new infection with the omicron especially because it is also causing more infections. Those people who have gotten vaccinated even though milder, that according to New York state, they died about seven, about 7.7% from breakthrough infection. However, the key is important when I bring that, however, is hospitalization and severe infection. So for a breakthrough, infections that has been like less than 1%, .23% to be precise, according to New York state in our state. So that gives so much sort of a comfort in a way that vaccines really prevent severe disease and prevent hospitalization. And that's what we are asking everybody to make sure you get your primary series. It means first and second dose of your Moderna or Pfizer, or if you have gotten Johnson and Johnson and then you get the booster that actually will be very helpful because one of those things would really interesting, I think, for your listeners to know that immunity sort of you know everybody have seen that it wanes a little bit throughout this course. When we got the infection in 2020, there was no vaccine. And people were getting better. But then some of them got a small percentage, got reinfection. But at that time, country was shut down. People were really, really making sure physical distance and mask and not socializing with people, but with the vaccines when it started at end of January and end of December 2020, throughout 2021, when more and more people got vaccinated and the interval between first dose and second dose of vaccine receiving the complete series and the interval increased like five months and six months or seven months. We started to see some more infections at that time. And the question comes is that vaccine effectiveness is decreased. It could be given answer in sort of a two ways. Yes. Vaccine effectiveness was shown a little bit lower. So in May of 2021, fully vaccinated people have like a 92.6% lower chance of having COVID, right? So it means that much effective. And what people were starting to mobilize, they were a lot of people were having their social activities, schools were open mask were coming off. So with that there there's so much vaccines can do. And then the emergence of delta started to happen also. So it decreased to 80% with delta. I think it's important to remember. But again, it's not only the vaccine, it's also our social behavior which adds to that picture. So beginning of December 13 week, with the emergence of omicron, the vaccine effectiveness kind of, as noted, to be declined. These are all New York state numbers and they're publicly available. It's about 77.8%, almost 78%. That means fully vaccinated individuals in our state can have 70% lower chance of becoming a COVID case, which is great. The rest of it, we can use, you know, physical distancing, making sure we limit our social activities. We use the masks and we monitor what we do because those things can combine can keep us in good health. That's why I'm hopeful for, you know, it's like a happy new year. Its just something we have to deal with this reality. We have to live with this new reality. This COVID is here. COVID is going to be considered, maybe what we call it, from pandemic to endemic. It means its there and then how do we live without losing our heart and soul to that and, you know, be respectful to our mental health.
GR: You have encapsulated pretty much everything I want to talk to you about in the time we have remaining. So I'm going to unpack some of the things that you said. You're listening to the Campbell Conversations on WRVO Public Media. I'm Grant Reeher and I'm speaking with the Onondaga County Commissioner of Health, Dr. Indu Gupta. All right. So let me take Onondaga County specifically just for one second and then I have some questions about New York state. I have the sense in looking at the numbers and obviously I don't look at them as closely as you do, but I have the sense that Onondaga County, if we think about the delta variant and now the Omicron variant, it has been struggling a bit relative to the rest of the country and maybe even the rest of the state. And that I thought we went up earlier than other places. And then particularly with delta, I thought once we were up there, we were stickier before we came back down. So first of all, is that general impression correct? And if it is correct, what's going on here in this county to explain that? If you know.
IG: Right. So I. So, first of all, your interpretation is, for the most part, is accurate. There are some other counties and different states also who are far worse than us. However, we pride or we pride ourselves in being the best. And that was in the beginning of pandemic. We were almost flat when everybody was having quite a bit of struggle because our county was so disciplined. People literally did. I mean, when I would go out, I saw the kids on the bicycle riding. These are teenagers we are talking about with the mask on. I just feel like, wow, that is nice. And we saw that impact in the community. But with the time, I think people got fatigued and the travel to different places in the summer with the beautiful county. So people who come throughout come and for the different events we saw quite a bit of surge here and more so than some other places. It is we have really good vaccination rate as compared to some of the other places, could be better. Like our vaccination rate for overall in general you can see about 70% of our adults are 70% of eligible actually are vaccinated as compared to what, 64% as compared to in in the state of sorry in the U.S. And our booster rates are pretty good, too. I was 55% of population got boosted of those were eligible. Not perfect but again that is that tells you a lot. But there is a lot of social activities which happens. People travel. So you have to also think it is not happening because they are coming infection here. People are going out different places. We have colleges, we have educational institutions. So everything can bring those cases from outside to us and they will be counted here because they are county resident at that time, because they're listed here. So some of those things certainly we always struggle to find out why are we continue to see that high cases. And that's why my message has been that get vaccines, but keep the mask on. Make sure you keep your own bubble, keep your own pod so that we are still not out of the woods at this point. Right. The thing is, if you're young, otherwise healthy, most likely you will do okay. But what about that? Your domino effect of infection going to the by the time it goes to fifth or sixth person, they will take it at home and give it to the grandparents or to the child who is not even eligible to get the vaccine and they will end up in a hospital have severe consequences. Right. So these are common sense public health measures, which we still are reminding people to make sure they continue to implement in their daily lives. Yes, it could be frustrating. I get it. I get it. But the other side of that is, is that acceptable to you? Right. These are the things which we need to make decision for our own lives and for our neighbors and for our extended families.
GR: So let me ask a question specifically about the masks. The governor issued recently, an executive order requiring masks to be worn in all public places unless there is proof of vaccination. And then she further asked local health departments to enforce that requirement. Now, in my experience going to several stores recently, I don't think this requirement is being followed, as you pointed out. And I've not witnessed anybody in any store enforcing any of this. And actually, that goes back to the beginning of the pandemic. I've yet to see any employee of a store enforce this on any customer. And I wanted to put a specific element on this and get your thoughts about it. And this gets a little more sensitive, maybe gets into politics a little bit. But I also detect, I think, people not wearing masks and for lack of a better word, a somewhat aggressive way. And I'm not sure the specific message that they're trying to convey, but it does seem like they are aware of the fact that they're not wearing a mask. I find it hard to believe that it's a lack of information at this point that they're explaining why they're not wearing a mask and they almost seem like they want me to see them not wearing a mask. That's bothersome to me what's going on there and what could be done about it?
IG: So I'll go back to the governor's executive order. Mask mandates have been successful in the past, especially in the in 2020. And when 2021, when the masks came off after vaccination, we saw quite a bit of a significant problem in some of the places, you know, even in highly vaccinated populations. The CDC went back and then say a mask away important, especially in indoor setting. Many employers have done throughout among themselves without even governors. We in the county government have that mandate for the indoor when we are, I have the mask right here next to me and whenever I have a meeting here, we try to do a lot of Zoom meetings, but at the same time I have to interact with my team and we always wear masks even though we are all fully vaccinated and boosted. So it's like nobody is enforcing it here. Of course, we are health departments, so we do better than anybody else. That's true. But in general, if you looking for health systems, if you're looking for schools or colleges or some of those, you know, grocery stores, everyone does for their employer. For the customer, it becomes a very slippery slope for them because there has been a lot of negativity, as you have seen some episodes in which the employees were harassed and all those things. So I think employees try to tread it gently. However, what I would like to focus on that those people who are really giving a very strong message that we are going to be respectful of you and we are going to be wearing masks because not only we want to protect ourselves, we want to protect you. So a lot of those things is not focusing on those who are not really doing it at this point rather than focusing on those who are actually following. So hopefully with time and they are, I think they are in minority, I still believe that a lot of people are in minority at this point who are not wearing masks and obviously, obviously showing it to everybody else in general. If you think that they don't believe in it, whatever their reason might be. But majority of people do believe in to a great extent, if the vaccine gives them a what I should say, a comfort that we don't need mask and that is something, especially in the middle of flu, middle of a pandemic. And when with the omicron, which is so highly infectious, I would encourage them to look at the data, look at the statistics at this point where the cases are, as I mentioned to you, in June, we had one case on one day. I was thrilled. And we have more than 2000 cases, right? A few, few, few days ago. So it just gives you pause that something is happening. People are doing home testing. These are one, the reported one. So can mask prevent that when we are talking about effectiveness of the vaccine? If we have a very highly contagious virus and we are giving a big bolus to the people without the mask, you are going to get it. No matter how much you vaccinated you are, even in a short time. So if we have this tool to take us through this difficult time, why won't we do that? If we have a storm, why won't we? Why won't be what you call board the windows if we are living by the ocean and we know there is a going to be a very significant advisory for that, why would you go into a tornado when you know the tornado is going to get you or if you know a pot is hot, why go to touch it? So if we we have the facts. The facts are that we still have increased number of cases. They are going down. Our positivity rate is about 17,18 to 19, 20% and we are vaccination rate are good but they could be better. We still need many people to get boosters who are eligible. So when we don't have all those perfect models, we have those additional tools by keeping our social structure intact, by limiting our movements and keeping the mask on. So we create barriers for the virus and that is a proven strategy. We proved it even before the vaccine. So we need to take that lessons and remind us because our goal in 2022 will be to go back and take our lives back the way we know of so that we can try to put this virus behind in whatever shape and form it will be, whether it becomes like a parallel with us. And would the mask come off? I don't know the answer to that question right now, but right now we are not there.
GR: You're listening to the Campbell Conversations on WRVO Public Media. I'm Grant Reeher and I'm talking with Dr. Indu Gupta. She's the health commissioner for Onondaga County. And we've been discussing the COVID-19 pandemic and in particular the recent omicron variant. So let me ask you this question about the Biden administration and the national handling of this. I have read some criticisms of his administration's handling of the pandemic, even from those who are otherwise supportive of what he has done regarding it. But it's that of late, there hasn't been enough attention paid to treating the virus and making breakthroughs and the treatment of the virus, as opposed to trying to prevent the spread of the virus. Could you reflect on that a little bit?
IG: So the COVID mitigation measures are many that we could talk about, prevention measures, which we have talked about before. But mitigation can be done by public health measures as we talk about mask and social distancing and all handwashing and staying home if you're when you're sick. And the vaccine is another one for prevention, but then mitigation will be treatment, monoclonal antibodies and antivirals, which takes some time for them to get developed and also manufacture. Right. The vaccine became so readily available within such a short time because government took quite a significant chance to manufacture at the same time when they were actually testing it. And it was a big gamble if the effectiveness wasn't there, that the whole thing would have gone down the drain. But it was a smart move because in pandemic, all bets are off. And the same thing is for medications. Some of the medications were used for something else, and then they came and started to play a role here. And manufacturing of any medication takes time, and especially when it has to be distributed after it has been approved. You don't want to jump the guns right away because there could be side effects, there could be problems, you know, FDA approval, all these things are every step has to be done very meticulously because do no harm is the very important part of any public health measure. And it would be true for any administration, because CDC oversees that, FDA oversees that, and they work through the states and local health departments and distribute those. At this point, there are not many antivirals of are available, but as we are going into the next phase so hopefully more and more will be available. However, the tools which we have available at this point with the testing and continued vaccination and boosting that should complement some of that should continue to complement some of those ways people are feeling. Dependance on medication is not the right way to do that because if we have the vaccine which can prevent that, most of the people won't get that sick and won't be able to that won't be in the need of the medication. Right. So a lot of times what we are seeing are hospitalizations, major. A large number of hospitalizations are among those who are unvaccinated, who are end up requiring critical care and unfortunately passing away. So those are the people which we are trying to focus, get vaccine that actually saves lives. And we know that it's proven so. At the same time, when the medications are coming, they certainly are going to be additional tool on our hands.
GR: Okay. We've got about 5 minutes left. I want to squeeze at least two and maybe three questions in here if I can. Looking ahead, how likely do you think it is that there will be another variant? I don't know. Let's just call it Upsilon or whatever, another variant that the vaccine is not going to fully protect against. Is it a certainty that there's going to be another one? And I guess the hope is each time it's less severe int the illness that causes. But how certain what do you think the likelihood is that there's going to be another one of these big variants to come along?
IG: Great question. There is no playbook for this pandemic. All right. That's that's there. So we are learning along as we are going along the way. When alpha came, then the delta came, people kind of were taken aback with the severity and it literally created havoc. Then omicron and suddenly appeared from nowhere and fortunately did not cause that much of a severe disease. But still some of the people we are still learning about that. Can there be another one in horizon? And very important thing, I think people have to remember until we have equity throughout the world, until we have majority of the people who get vaccinated like any other infectious disease, whether it's a smallpox whether it's a polio. And this is true for the for for this one. Also for the for the COVID, the opportunity for virus to thrive in human body will be there. As long as we provide that opportunity to this virus, it will find the smart way to mutate and what can we do? And at least as a most developed country, we have so much vaccine, we have so many tools and information from technology, from testing and tracing and keeping ourselves safe. We should use all those tools and we should be a leader. We have been a leader for the world, but we can be by modeling our behavior throughout the world, that's the way I think we will avoid any future chance of having severe mutation in this virus, because they won't be enough opportunity. There won't be any human body for this virus to mutate. So that is in our hand. And I ask everybody to do their part to put this virus and this pandemic behind.
GR: So this will be probably the last question we have time for. We've got about a minute and a half or so. But you are not the COVID commissioner for Onondaga County. You are the health commissioner. And I'm guessing that your laser focus on COVID has meant other things haven't had the attention that your office would like to put on them. And so my last question for you is what are the other important public health issues that you are most concerned about that are not getting the attention while we put all of our attention on COVID? What's what worries you the most? There?
IG: Right. Great question. So the health department has existed before pandemic and will continue to do so. We are there to protect the health of the community every single day and address the disasters as the pandemic came. So there are many things in 2020 we could not pay attention to. In 2021, we became much smarter. And we I actually look over many departments from our from other communicable diseases, TB and STD, syphilis to the opioid epidemic, which continues to impact our community. Suicides impacting mental health at so many places, maternal and child health as well as other community health like overweight obesity. How much attention we are paying to those prevention messages, food protection, right? All of these things are there to serve the community and we certainly are in full force our all programs are working throughout, everywhere. And we are back in our core public health work at the same time, we started to address the COVID-19, a need for our community and will continue to do so. So the COVID certainly is going to be part of our community, but at the same time, we really need to go back and making sure the health of our community is good and will continue to work every day.
GR: Well, we'll have to leave it there. And what will leave, as our final note is a reminder that it does look like the omicron surge at least is on the way down. So that's a track at least as of January 20. So we'll leave on a happy, hopeful New Year note that was Dr. Indu Gupta. Dr. Gupta, thanks so much for taking the time to talk with me. I appreciate it very much. And one day, not too long in the future. I hope things calm down for you a little bit.
IG: And thank you for having me. And I'm hopeful that we leave this behind. Thank you. Bye bye.
GR: You've been listening to the Campbell Conversations on WRVO Public Media, conversations in the public interest.