10 Minute Talks with Dr. Martin: Wearing a Mask and the Omicron Variant

GREG J. MARTIN: Hi. I’m Dr. Greg Martin. I’m the Tropical Medicine Infectious Disease Physician at Med here in Washington DC and I’ve been focused over the last couple of years on the COVID-19 pandemic and the effects it’s having on our operations in the State Department both here and overseas, and I thought that it would be a good time to talk to everyone about the really scary news we’re hearing about the new variant, Omicron that is really kind of taking over all across the world right now.

I think that there’s a lot of hysteria in the media about this and I think that we like to try to interpret how we can react to this in a State Department kind of fashion. We are fortunately are really highly immunized group of people with about 98% of our direct hires already immunized which is awesome and we have an ever increasing number of our staff and family members getting booster doses or children who are getting their initial doses, and that’s by far the most important thing that you can do. But I want to talk a little bit about some other things and that’s mainly masking today.

One of the really difficult things about talking about Omicron is that this is really only described about three weeks ago when, as you know investigators in South Africa noticed that they were having a rapid increase in cases and noticed that they had a variant that was quite a bit different than Delta, and that it was moving very, very rapidly in the Southern African countries in general.

So in the short period of time, worldwide science has really been trying to look at what the implications are for the rest of the world. It’s often difficult to compare what happens in Africa with what happens in the Americas and in Europe because the African populations, especially in South Africa have been heavily affected by previous variants, and Beta variant that went through is believed to have infected as many as 80% to 90% of the people in the greater Johannesburg area where this was first described.

So those people already have a background, many of them of a previous infection whereas in our European populations we may not have as many people infected. Although, we do have a significant number of them, we have way more people who have been immunized. So there’s been a lot of concern about just exactly what this means. As this has moved into Europe, we’ve been able to see that this appears to be significantly more transmissible than Delta was, and I liked this little study that just came out this week. It’s an early report that has not been peer reviewed, but I think it is from good investigators and will probably be important.

And if you look at these, looks almost like Christmas ornaments here in this slide. But look at the group in green, and that is Delta there. And if you look on the left they’re talking about the median growth advantage over different strains. Now you have heard of probably the Alpha and the Delta strain, you may have heard a Beta, which died out. All of these other strains have died out almost worldwide with the exception of Delta, and that’s because Delta looks like it has a significant growth advantage over the other strains.

And now it looks like Omicron which came out after this study was really being prepared and published, looks like it is again about two-fold above this which makes this significantly different than what we were dealing with in China when this first came out in December of 2019 and January 2020. So when we were a little concerned about what measures we could take, we were dealing with one virus that was pretty transmissible, but nowhere near as transmissible as what we were seeing with Delta and with Omicron.

So just how important are masks to wear and what type of mask should you use if you’re out there? Well, this has evolved over the last couple of years of the pandemic. Initially, back in February and March of 2020, I was not all that convinced that we needed to wear masks. It looked like it was certainly important if you were actually infected to wear them, but it was marginal whether there was much difference for everybody else to be wearing them.

As we learned more about the virus though, we realized that early on in your infection may actually be your most transmissible period and many people are not even symptomatic during that period of time. And that’s when we modified the recommendations and started saying that everybody who was indoors or outdoors initially should be wearing a mask because of the possibility that they don’t know they’re infected and they’re being able to spread this.

Now that we’ve gotten to progressively more transmissible agents, it gets that much more important. So when you look at the initial ancestral strain, it was about here. And then we got to Alpha, it was more transmissible, then Delta, significantly more than that, and Omicron appears to be significantly higher than Delta is. So the more transmissible this virus is, the more important it is that we have something that blocks our ability to be able to spew virus out and spread it out into the environment and also to diminish what we are breathing in.

So the CDC has modified. They went from what used to just be a face covering that could be a single layer and they’ve gone out now to saying two or more layers. And there’s some belief that they may say, look, everybody should have even better protection than that. I think that the difference between wearing a 3 to 5-layer mask and an N95 is probably not that important. I myself wear a 5-layer mask, but I like because it has a good nose clip on it, it comes down here under my chin, it’s tight around here.

This is not an N95 but it is a 5-layer mask. As you can hear, I can still speak through it, I can breathe reasonably well through it. N95s get to have a lot of difficulty breathing through, especially if you’re wearing them for a long period of time. So I think these are kind of nice. I like the ones over my head because it’s a lot easier to be in my office and just kind of leave this down and go back and forth with this.

So I think masks are more important than they were before. Even those of us who are triple immunized, which most of us are, we’ve had our initial series and a booster dose or a J&J and a booster dose, we may get breakthrough cases that have typically been quite mild, and it appears to be the same thing with Omicron for immunized people, but you are still able to transmit this to others. And you really don’t want to endanger especially the compromised people that might be in your old household or people that you work with by inadvertently spewing virus when you are asymptomatically infected.

So how can you protect yourself from Omicron especially if this really starts to take off in the U.S. and all over in the world of posts over the next few weeks to months. And there’s really not anything new that we’re talking about at this point, I think it is really redoubling what we had recommended before. And by far the most important one is to get COVID-19 vaccination. Now, we’ve been emphasizing this for a year now. If you have not been immunized, you should go out and get immunized now.

If you have family members who you might be seeing over the holidays, encourage them to go out and at least get their first dose of vaccine. Even if they can’t complete the series because they’re going to be traveling, it’s better to have one dose under your belt than it is not to have anything at all. The same thing is true for your kids. If you have, a lot of the 5 to 12-year-olds are just getting vaccinated now, start that series.

If you’re going to be traveling over the holidays and won’t be back for six weeks, that’s OK, get that first dose here. If they can’t get that second dose in three to four weeks, that is all right, it’s better that they get started and that actually that longer period does not hurt their immune response to this at all. If you’ve not had your booster dose yet, get your booster dose. If it’s been more than six months from your primary series or two months from your J&J vaccine, go out there and get that.

Other measures, we just talked about masks, I do think that at least a triple layer mask is what you should be wearing, but I don’t feel strongly that you really need to go out and get N95s at this point. Distancing is again important, especially when you are inside you want to avoid large crowds, more than six feet as we’ve been saying all along when possible. And if you have to get closer, minimize the amount of closer contact that you have. Hand-washing has always been important, this is important for all the respiratory infections. We’re just starting to see influenza start too, and hand-washing is important for all of these.

And the last thing I have in there is, it’s a little cut off, get tested if you have symptoms. Even mild symptoms might be COVID, and most of the people we’ve been seeing now have been quite surprised that they have COVID because their symptoms were really not all that bad or they had it on pretravel testing. So it’s an important part of stopping transmission here. Well, that’s all I have for today. I hope everyone has very safe and healthy holidays and that you go out and get your shots and wear your masks. Thanks very much for your attention.