ARI SHAPIRO, HOST:
President Biden recently had an experience that many of us have gone through lately. A family member tested positive for COVID - First Lady Jill Biden. And like many of us, Biden faced the question, should I cancel my own plans and isolate? Unlike the rest of us, he had a press secretary on hand to answer. Here was a reporter's exchange with Karine Jean-Pierre after the first lady's diagnosis.
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UNIDENTIFIED REPORTER: Yeah. If President Biden does test positive for COVID in the coming days, we can assume he's not going to travel to India.
KARINE JEAN-PIERRE: I'm just not going to get time for those. I'm really not. There's no updates to his schedule. That's where we are right now. He tested negative last night. He tested negative today. That's what matters.
SHAPIRO: It seems like people all around us are testing positive for COVID even as few of them become seriously ill. Now the Food and Drug Administration has approved an updated booster, and just today the CDC recommended it for everyone 6 months and older. So how should we be navigating the pandemic right now? Dr. Robert Wachter is chair of the Department of Medicine at the University of California San Francisco. Welcome back to ALL THINGS CONSIDERED.
ROBERT WACHTER: Thank you. It's great to be here.
SHAPIRO: To start with just, like, a headline, in a sentence or two, how would you describe where we are in this moment?
WACHTER: Worse than we were a month or two and substantially better than we've been at most times in the last three or four years. So this is - it's definitely an uptick, but it still is nowhere near the kinds of surges that slammed us in the past few years.
SHAPIRO: Just anecdotally, for me, it seems like everyone from family members to coworkers is getting a diagnosis and not being debilitated by it. Is that what the science bears out, too?
WACHTER: Yeah. I got my first case of COVID two months ago. That's a pretty common story. The science says that the fact that we essentially have a 100% population immunity - you cannot find anyone now who has neither been vaccinated nor been infected. And in most people, they've gotten both. So the virus doesn't find any humans anymore that have zero immunity. That's obviously very different than 2020. And what that means is that when it strikes humans - and it still is giving a lot of people COVID - the cases tend to be substantially milder than they were before. There are still people dying of COVID, but the chances of getting super-sick, going to the hospital and dying are much, much lower than they were a couple years ago.
SHAPIRO: And so now there's this updated booster. Doctors have been saying for years that getting a COVID vaccine might become an annual routine like a flu shot. Is that where we've landed at this point?
WACHTER: I think so. It's complicated because it's a little bit of four-dimensional chess that you've got to play. The boosters do four different things, and the relevance of those things differ depending on who you are and how old you are and whether you have other medical illnesses. The first thing they do quite reliably is lower the chances you're going to get very sick, go to the hospital and die. And that is most relevant to people who are at risk of those things. And so a 75-year-old is. A 50-year-old who's got a couple of medical comorbidities is. A 25-year-old healthy person has a very low risk of getting very sick if they get COVID. So the benefit of vaccine there is small for a young, healthy person and much larger the older and sicker you are.
But there are other benefits that, to me, tilt the scales to favoring the vaccine and the booster in pretty much everybody. It lowers the chances of getting long COVID. It lowers the chances of getting COVID but only for a couple of months. But that's meaningful. And if you do get COVID, it reduces the amount of time that you're sick - not by a ton but by a little bit. So I think about this as a doctor and the benefits versus the risks of everything we do, like treat high blood pressure, cholesterol. It's an easy decision for an older person or someone with medical comorbidities to get the booster because they are at significant risk of a severe case. And to me, when I talk to my 30-ish-year-old healthy kids, I recommend they get the booster. I don't think it's a slam dunk for them. But I consider it really quite safe. I think the benefits outweigh the risks in pretty much everybody.
SHAPIRO: Do you apply the same kind of risk protection calculus to some of the practices that were so common a couple years ago, from mask wearing to social distancing to outdoor dining? Or is this kind of like cold and flu season, where you go out in public, you take your chances, and you live your life?
WACHTER: I think it is that whole risk assessment - and the risk assessment is tricky. It's not just the risk to you, but are you living with other vulnerable people? And that has to get factored in, too. And then how much COVID is there in the environment? So that's why it's very tricky to sort this out. But, yeah, I think, Ari, that's a fair way of thinking about it. The same kind of thinking that goes into the importance of getting boosted also goes into your thinking about how careful to be. So if you're an older person who's vulnerable and there's a spike in COVID cases, as there is now, it is a time where you should be thinking about masking, thinking about forgoing indoor dining, thinking about taking Paxlovid if you get COVID. Those are things - you might say, if I'm healthy and 25 years old, even though there's some more COVID around than there was a couple of months ago, I'm not going to be quite as careful. So this kind of drives people a little bit crazy because it really is such a multidimensional and challenging decision.
SHAPIRO: Dr. Robert Wachter, professor and chair of the Department of Medicine at UCSF. Thanks a lot.
WACHTER: My pleasure. Thank you. Transcript provided by NPR, Copyright NPR.
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