COVID Q&A: Winter storm could lead to local spike in infections.
“Now is not the time to relax”: That’s the bottom line for Texas A&M epidemiologist Rebecca Fischer.
Fischer, an assistant professor of public health, works with A&M’s COVID Investigation Operations Center. She lives in Houston, but spoke to us from her office in College Station.
This interview has been lightly edited for length and clarity.
Q: Could you give us an epidemiologist’s overview of Texas and the pandemic right now?
A: We are in the backside of the curve. There’s been a sharp decrease in cases, which makes us all feel like we have things under control, and we’re coming to a place where our vaccines are working. We’ve learned a lot about what we’re doing. We know how to prevent transmission.
But what is important to remember is that we’ve been here before. We still have a lot of infections happening every day — we’re not in the clear — and we may very well see another increase in cases as we move forward.
Q: You’ve done research about infections rebounding after the last COVID downturn. What did you find?
A: With SARS-CoV-2, we have person-to-person transmission. It’s passed largely between individuals that are in close proximity to each other — in households, in social gatherings, in close quarters. This is largely not the sort of thing that you get from passing a stranger in the grocery store or through casual brief encounters.
What we learned is that when we see a decrease in cases, we start to gain a sense of confidence that we’re coming to a better place, and it becomes very easy for us to let our guards down in those exact situations that are most risky. That happened with the holidays: People who had been so careful for so long wanted to get together with family for Christmas and feel normal again. It was, “Let’s sit around the tree in the family room. We’re going to take off our masks. We might have the kids sitting on our laps.”
Then a few days later comes the call: “It turns out I was positive, and I didn’t know it.”
That’s the story that we saw from a lot of people. We want to be social. We need to connect with people. But we need to do so safely — to continue to protect them as well as ourselves.
The other really important lesson that we’ve learned is that individuals do not necessarily know they’re infected when they are spreading the virus. Anywhere from 20 percent to 80 percent that laboratory tests show are infected show no signs of symptoms. They don’t feel sick. They don’t realize that they’re ill.
That could be me. It could be you. It could be Mom. Any one of us could pose a risk to somebody else completely without knowing that we do. That’s really important with the transmission of SARS-CoV-2.
Q: Do vaccines change the game?
A: Vaccines are a huge game changer. They are fantastic. The vaccines that have come out already have great efficacy.
But it’ll take a while to see that. It’s a slow change in the game, right? The rollout has been fairly slow. It’s an enormous undertaking. It’s huge not just in terms of production, but in logistics and delivery. And the Pfizer and Moderna vaccines require two injections to reach full efficacy.
But these vaccines are fantastic if we can get them into enough people, and get enough people to take them. The vaccines are keeping people out of the hospitals. They’re keeping people from dying. This is great news.
What we don’t know about the vaccines are how well they keep somebody who might acquire the virus from passing it on to somebody else. The recent literature shows that that we do have transmission in vaccinated individuals. So somebody who has been vaccinated — or also, somebody who has recovered from disease — can pick up the virus and pass it on to somebody else.
This is really important. It means that a vaccine is not a license to to act carelessly. We still need to be very careful about how we’re behaving, particularly around others, because we could unknowingly pass a virus on to somebody else who is not vaccinated, and they could end up in the hospital or worse.
Q: As an epidemiologist, what are you thinking about the variants?
A: The most recent evidence suggests that vaccines may not be as effective against some variants, but what we know is still evolving. That means that people who’ve been vaccinated, or who had a natural infection already, may not have antibodies that efficiently attack these new variants. We don’t yet know what that means in terms of getting sick, disease severity, ending up in the hospital or fatality.
The South African variant in particular has been concerning There seems to be greater ease of transmission. It may be more easily dispersed, and then it would cause more infections.
If it’s more easily transmissible, we could potentially have more super-spreading events.
Q: So this is not the time to accept a wedding invitation or go to a party?
A: We are not there yet. We want to be there so desperately, and as more of us can access the vaccine, it will keep us safer. As families and households can access the vaccine and get that second dose — the full dose — we will see guidance that people can relax around each other. But we’re not quite there yet.
We’re also not there as a society. After this sharp decrease in
cases, we are again the precarious situation where we were before this summer, and also before the holidays. Epidemiologists and my other public health colleagues are not expecting cases to decline to zero. At the very least we will have a lot of infections continuing to occur daily.
Then we’re watching what’s going to happen over the next few days. We’ve just had Super Bowl Sunday, Valentine’s Day, and then Snowpocalypse 2021 in Texas.
That last could result in what’s been called “SNOVID.” We’ve already seen cluster come from folks that sort of had to huddle together to stay warm. We’re not placing blame there, right? Because we were just surviving. But we need to be vigilant — checking to see if we have symptoms and checking in with the people we were around.
Q: What else is on your mind these days?
A: I’m thinking about where we’re going from here. What will things look like in six months or a year? We don’t really know, and it’s hard to to predict.
I work with a public health modeling team, and we try to project what it might look like next week. It’s like the spaghettinoodle models of the weather forecasting: The further out we get, the more wildly different the possibilities are.
And it’s really to tough to think about the variants. We’re not dealing with just one bug that we’ve learned to predict and are really going to quash. We’re still learning about these new ones. Some really interesting research at Texas universities shows that the variants are moving through different phases of the pandemic with us.
Q: Wait, wait, wait. What does that mean?
A: As viruses reproduce, there are lots of different small changes to their genomes. We see that with SARS-CoV-2, but it happens with other viruses as well. As those micro-changes happen, slightly different versions of the virus dominate during specific times.
It’s not something that everyday people, or doctors or COVID patients, would notice at the time. But when molecular scientists go back, they’re like, “Oh, we think that second wave might have really been dominated by something slightly different.”
Q: Like a different strain? The way that we see different strains of flu?
A: Right. Or even less different than one flu strain is from another.
For epidemiologists and scientists, it’s almost refreshing to know about those changes. It means that we’re not just fighting this one bug that keeps knocking us down. The things that we’re doing are working. But this bug is throwing curveballs left and right. It’s sidestepping us.
So really: Now is not the time to relax. More than ever, in fact, we need to buckle down and do those things that we are so tired of: wearing masks, staying a safe distance apart, really being careful who we’re around, thinking about not just our risk level but the risk level of those people that we’re associating with. These things are so important right now.
This is our normal today, but it will not be our normal forever.