Via Teleconference
12:59 P.M. EST
MR. ZIENTS: (In progress.) And thanks for joining us. Today, Dr. Walensky will provide an update on the state of the pandemic, and Dr. Fauci will discuss the latest science.
Over to you, Dr. Walensky.
DR. WALENSKY: Thank you, Jeff. Good afternoon. I'd like to start by walking you through today's data.
The current seven-day daily average of cases is about 744,600 cases per day, a decrease of about 5 percent over the previous week. The seven-day average of hospital admissions is about 21,000 per day, an increase of about 1 percent over the previous week. And the seven-day average daily deaths are more than 1,700 per day.
As these numbers indicate, in some parts of the country, we are seeing the number of daily cases caused by the Omicron variant beginning to decline. But, as we have seen during other phases of this pandemic, the surge in cases started at different times in different regions, and may continue to see high case counts in some areas of the country in the days and weeks ahead.
Today, I would like to discuss three new reports being released by CDC that provide a look at vaccine protection against Omicron, including the added protection provided by booster doses.
These reports add more evidence to the importance of being up to date with COVID vaccinations — that means getting your primary series and getting boosted when eligible — to protect against severe COVID-19.
The first report published today in CDC's Morbidity and Mortality Weekly Report, or MMWR, examines the effectiveness of mRNA vaccines and how they've been preventing emergency room visits, urgent care clinic visits, and hospitalizations.
The blue line on this slide represents the period when Delta variant was dominant.
Vaccine effectiveness against emergency room and urgent care visits for those who received their primary series was 76 percent at six months after receiving the second shot.
As you can see, following a third shot, vaccine effectiveness increased up to 94 percent — even higher than it was in the first six months after vaccination.
Now, still looking at emergency room and urgent care clinic visits, vaccine effectiveness against Omicron is displayed by the red line.
In general, we see lower overall vaccine protection against Omicron, as we saw against the Delta variant, shown by the blue line, especially with just two doses of an mRNA vaccine.
For those who received the first two doses, vaccine effectiveness was 38 percent against emergency room visits and urgent care visits after six months. However, vaccine effectiveness increased up to 82 percent for those who received their booster dose. The effectiveness of the booster dose is close to the level of protection that was experienced for those with boosters during the Delta wave.
The next slide shows vaccine effectiveness against hospitalizations, both with the Delta variant — again, the blue line — and against hospitalizations with the Omicron variant — again, the red line.
Similar as to seen with emergency department visits on the prior slide: For both the Delta and Omicron variant, there was a decline in vaccine effectiveness against hospitalization over time.
But following a third dose, vaccine effectiveness against hospitalization with Omicron increased to 90 percent, nearly matching the effectiveness against the Delta variant and even higher than vaccine effectiveness after the first two doses of the mRNA vaccine.
Overall, for — those who received a booster dose had the most protection against emergency room visits, urgent care clinic visits, and hospitalizations.
An additional study also published today by CDC scientists in JAMA further adds to this evidence. This JAMA report similarly shows that a booster or third dose of the Pfizer or Moderna COVID-19 vaccine provides greater protection against symptomatic COVID-19 disease for both the Omicron variant and the Delta variant compared to the primary series alone.
To further demonstrate the protection of boosters, we're publishing data in MMWR and on CDC's COVID Data Tracker as well that look at cases and deaths by vaccination status. In these data, you can see significantly lower case and death rates among those who are boosted compared to those who are unvaccinated.
The graph on this slide displays data from 28 jurisdictions, representing over two thirds of the U.S. population. The blue shaded area represents the time that the Delta variant was dominant and the pink shaded area when Omicron variant is dominant.
As you can see, case rates are highest among those who are unvaccinated, represented by the black line on the top graph. Case rates are lower for those who have received their primary series, represented by the light blue dotted line, and lower still for those who have received their booster dose, represented by the solid blue line at the bottom of the graph.
During December, when Omicron was first emerging, unvaccinated adults had a five times higher risk of infection when compared to adults who had received a booster dose.
The data here show the protection provided by vaccines and the importance of being up to date on your COVID-19 vaccination — which, for tens of millions of Americans, means getting your booster dose.
Taken together, these data highlight two important points. First, those who remain unvaccinated are at significantly higher risk for infection and severe COVID-19 disease. Second, protection against infection and hospitalization with the Omicron variant is highest for those who are up to date with their vaccination, meaning those who are boosted when they are eligible.
There are still millions of people who are eligible for a booster dose and have not yet received one. As we continue to face the Omicron variant, representing over 99 percent of infections in the United States today, I urge all who are eligible to get their booster shot to get it as soon as possible.
Thank you. I'll now turn things over to Dr. Fauci.
DR. FAUCI: Thank you very much, Dr. Walensky.
What I'd like to do over the next several minutes is to answer a question that's shown on this first slide. And that is: When new variants arise, why do immune protection against infection diminish much more so than does protection against severe disease? And what are the immunological mechanisms that account for that and account for what Dr. Walensky just described clinically to you a moment ago?
These are somewhat technical concepts, but I'd like to give you the bottom line message from each of these.
Next slide.
When one thinks about either infection or vaccination, although there are a lot of things on this slide, the fundamental basic message is that there are two limbs of the response:
The B-cell limb, which provides the antibodies that we measure when we show you neutralizing titers. Those B-cell responses can give antibodies but also memory; namely, when they see an antigen again, which I'll explain in a moment, they respond quickly.
The other limb of the immune response is the T-cell limb, which in some respects helps the B cells to make antibody, but have function of their own, both direct function and memory function.
So now I want to describe some of the terminology that you probably are hearing about when new scientific papers come out. So here's some simplified explanation of these very complex responses:
An antibody that's made by B cells primarily prevents initial infection. They are more specific than T cells, and their half-life — or their durability in the plasma are shorter lived. But they are backed up by memory cells that are more durable.
T cells, however, generally prevent the progression of a disease — namely, prevent progression an infection you already have by eliminating the virus-infected cells. They have a greater breadth; namely, they are more cross-reactive, in many respects, than antibodies.
Next slide.
Now, when you talk about the — can I have the next slide, please?
When you talk about the antigens and epitopes, an antigen is a molecule capable of stimulating an immune response. So, viruses themselves are big antigens, and parts of viruses are also antigens.
But the antigens themselves have many components. We refer to them as "epitope."
Why does that mean anything to us? It does because B cells specifically respond and react to B-cell epitopes. Namely, antibodies recognize certain parts of an antigen. And T cells recognize certain parts of an antigen, and they're called "T-cell epitopes."
When you give an antigen in a vaccine, we refer to it as an "immunogen." So, let's take a look at what that means and why it's important to understanding the clinical issues.
Next slide.
So, this is a picture, schematically, of the now spike of the coronavirus of SARS-CoV-2. The arrows on the left are pointing to what we call "B-cell epitopes." They're mostly on the surface.
And when a virus mutates the way these variants do, it causes changes that interfere very, very easily with the binding of antibodies. We see this specifically impressive with monoclonal antibodies. So, a single mutation, for example, might nullify the effect of a monoclonal antibody.
You go to the righthand part of the slide, and then those parts that are reacted to by T cells — which we refer to as "T-cell epitopes" — they are on the surface, but they're also buried.
The changes that affect an antibody do not nearly impact as much T cell recognition. And that is absolutely critical because that's one of the reasons why when you have variants that change, in fact, you still have protection against hospitalization because T cells, as I mentioned a moment ago, protect more against progression of disease.
Next slide.
This slide actually tells you that. Because if you look at either the left or the right, when you go from one variant to another, there's a great deal of conservation of these T-cell epitopes, so that, even though the variant changes, either a vaccine or a prior infection can give you protection against the various variants.
And then in the next slide — this slide just merely shows papers that many of you have read about, that vaccination can induce memory able to cross-react all the variants — from Alpha, to Beta, to Delta, to Omicron.
Next slide.
Same thing with laboratory studies: that T cells induced from vaccination or prior infection seem to hold up well.
Next slide.
Now, getting back to what Dr. Walensky said. These are data from the UK. She showed us data from the United States. They're very similar.
If you look at just symptomatic infection on the left, two doses of an mRNA — and this is Omicron — two to four weeks later, have a 65 to 70 percent protection. But as Dr. Walensky showed, if you look about 10 weeks later, you have only a 30 percent.
When you give a boost, you bring that up 65 to 70, and 45 to 50.
But the important part of the slide is on the right with the red. When you look at two doses plus a boost, you get very good, durable protection against hospitalization. That is the important key issue.
Next slide.
So, what's the bottom line of what I've said? Protection against SARS-CoV-2 infection is mediated mostly by antibodies that are generally short lived. Variants with extensive mutations easily escape protection from infection, which is the reason why you saw the data that Dr. Walensky showed you.
But protection against severe disease is mediated predominantly by memory B cells and CD4/CD8 T cells. These are longer lived and more broadly reactive.
And so, the current vaccines, particularly with regard to boosting the current regimens, continue to induce immune responses that provide strong protection against severe disease, hospital, and death.
Therefore — final slide — the same message that Dr. Walensky gave you: Get your vaccinations up to date. It is essential for your protection.
Back to you, Jeff.
MR. ZIENTS: Well, thank you, Doctors.
Before we turn to questions, I want to provide some perspective on where we stand. As you've heard the doctors say, Omicron is an extremely transmissible variant that has driven an unprecedented number of cases in recent weeks.
But as a nation, we're in a far different place than we were this time last year. Two hundred and ten million Americans are fully vaccinated and therefore are protected from serious illness — especially, as the doctors have said, if they've received a booster shot.
Ninety-six percent of K-through-12 schools are open for in-person learning, up from just 46 percent this time last year.
And we're coming off the greatest year of job growth in American history — an amazing economic turnaround.
The reason this January is so dramatically different from last January is because we have the tools we need to protect people; and because President Biden and his administration have acted aggressively to follow the science and deploy these tools; and because so many Americans have done the right thing and taken the steps to protect themselves, their families, and their communities.
As we recognized from the start, vaccines are the single most important tool we have in the fight against this virus. We established a nationwide vaccination program that's gotten more than 500 million shots in arms.
Today, nearly 75 percent of adults are fully vaccinated. That's up from just 1 percent at this time last year. And importantly, we keep driving additional progress, with about 9 million more shots going into arms each week.
On testing, we've increased manufacturing capacity by making multibillion-dollar investments and deploying the Defense Production Act. And we've created new streamlined pathways to get tests authorized more quickly.
As a result, we've gone from zero at-home tests when the President took office, to having 375 million tests available in January alone. And now private health insurance covers the cost of at-home tests. And you can order at-home tests to be delivered to your home for free.
On treatments, we've stocked the nation's medicine cabinets so that we have more effective treatments available now than at any other point in the pandemic — importantly, including Pfizer's antiviral pill, a game-changer that helps keep people out of the hospital.
We've secured 20 million treatment courses of the Pfizer antiviral pill for the American people. And working closely with Pfizer, we accelerated the delivery of these pills.
We continue to take additional steps to ensure that Americans have what they need to protect themselves, including by making hundreds of millions of N95 masks available for free to all Americans.
This is the largest deployment of personal protective equipment in U.S. history. We've already shipped millions of these masks out. And across the coming days, masks will begin to be available at local pharmacies and community health centers across the country.
So, we've come a long way in our fight against the virus. Across the last year, we've provided multiple layers of protection for people: vaccines, boosters, tests, masks, and treatments.
And even as we face the extremely transmissible Omicron, we see that these tools are working. In fact, fully vaccinated individuals are 16 times less likely to be hospitalized from COVID compared to those who are unvaccinated. And schools and businesses are open.
As the President says, we know the job is "not yet finished." But because of how many people we've gotten vaccinated, the country is in a much stronger position to face Omicron and to deal with COVID going forward.
And because of the administration's actions, we're moving toward a time when COVID won't disrupt our daily lives, where COVID won't be a constant crisis but something we protect against and treat.
We're not there yet, but the President's COVID plan is clearly working. And we're confident we'll continue to make progress and get to where we all want to be.
With that, let's open it up for some questions. Over to you, Kevin.
MODERATOR: Thanks, Jeff. Happy Friday, everybody. We'll get through as many questions as we can.
First question, let's go to Tamara Keith at NPR.
Q Thanks so much for taking my question. I know that COVID tests have begun to ship out to people's homes. I'm wondering how many have gone out. And, as well — at this point, what is the government's supply like? Have the supplies come from the warehouse companies? Have they come from Abbott and iHealth? Are you satisfied with the pace of deliveries to the government?
MR. ZIENTS: So, thank you for the question. You know, tests started shipping yesterday. We're hearing stories of some already arriving today. The day after the website launched was yesterday — sorry, it was midweek. So we started shipping right away.
We've made clear to the testing manufacturers that had been contracted with that as quickly as they deliver tests, we will get them out to the American people. The Postal Service is moving incredibly fast here. They are packing and shipping tests immediately as they arrive. Tens of millions of tests have arrived so far. It's an all-hands-on-deck effort.
And as we get a clearer picture of the demand of orders through the website and shipments after this initial wave, we'll have a better sense. And we'll report those numbers next week.
I want to continue to emphasize: If people need a test immediately, we continue to encourage them to utilize one of the many testing options that are out there in addition to the website — 20,000 community-based testing sites nationwide. Federal surge sites, dozens of which have opened in the last few weeks, are online and are being set up across the country. Many state and local governments have local distribution of free tests. And tests from online retailers and pharmacies, as we talked about earlier, are now covered by private insurance for free.
Next question.
MODERATOR: Let's going to Josh Wingrove at Bloomberg.
Q Thank you very much. Jeff, just to clarify the — do you have a number on how many people have requested tests? And have you heard any complaints around that issue that people are having where if they don't enter their apartment number correctly, it shows up as tests already having been claimed?
And more broadly, Dr. Walensky, can you expand a little bit more on what you had said — how we're seeing peaks in some cities, other cities earlier in their curves? Does that mean that you think we're going to see national caseloads, more or less, as they are now? Or is it just going to sort of trail off but not go down as steeply as it came up? What is the expectation (inaudible) the sort of overall national curve on Omicron? Thank you.
MR. ZIENTS: So, Josh, on the apartment issue, I want to clarify that almost every resident in an apartment is able to order a test. U.S. Postal Service is seeing a very limited number of cases where addresses that are not registered as multi-unit buildings within its database, and they're working to fix that issue or are helping people through that process.
But I want to emphasize: It's a very, very small percent of people who live in apartment buildings, and we will make sure that those people get tests for free.
And as we work through the issue, people can fill out a service request on the website or you can call the hotline on the USPS — United States Postal Service — website to get the issue fixed.
Over to you, Dr. Walensky.
DR. WALENSKY: Yeah, thank you, Josh. So, we are starting to see steep declines in areas that were first peaking. So, areas of the Northeast — New York, Rhode Island, Connecticut — are really starting to come down.
That also means that some areas are higher than they had been before, but overall, nationally, the case numbers are coming down, which I consider an optimistic trend.
MR. ZIENTS: Next question.
MODERATOR: Let's go to Theo Meyer at the Washington Post.
Q Thanks for taking my question. Can you hear me here?
MR. ZIENTS: Try again.
Q Hi. Thanks for taking my question. Can you hear me
here?
MR. ZIENTS: Yes.
Q Thanks. Céline Gounder, Zeke Emanuel, and Rick Bright published a piece yesterday arguing that the U.S. should move toward tracking COVID, influenza, RSV, and other viral respiratory infections as a whole and make decisions about the pandemic based on hospitalizations and deaths from all such infections rather than just on COVID numbers alone. Is the CDC considering, you know, taking such an approach? And what are the barriers, if any, in terms of data, to doing so?
MR. ZIENTS: Dr. Walensky?
DR. WALENSKY: So, the CDC already collects data on influenza, RSV, and other respiratory illnesses; we have for years now. And what — and we are obviously collecting data on COVID.
So, you know, as we are moving forward, we are closely watching the severity of disease, how our hospitals are doing.
One important thing to note is that our absolute number of case counts is a really good indicator as to how our hospitals will be doing in the weeks ahead. So that is why we've been tracking that number as well.
MR. ZIENTS: Next question.
MODERATOR: Let's go to Meg Tirrell at CNBC.
Q Well, thanks. A question for Dr. Fauci about vaccines for kids under five. We've been hearing a lot about the Pfizer vaccine and the setback that they had adding the third dose, and so now we're expecting data — at least we heard at a recent ACIP meeting — maybe end of March, early April.
Moderna recently said they expect data in two- to five-year-olds in March. I'm wondering your expectations for that vaccine, given it's a higher dose, and also just generally how we should think about what the data will look like and take into account regarding Omicron being the predominant variant now. Will they need to show neutralizing antibody data against Omicron too?
DR. FAUCI: Well, the broad answer to your question, Meg, is that the FDA will gather the data that will be presented to them by the company, and we'll make a decision regarding the safety and the efficacy of this particular product.
I don't foresee any differences in the differentiation of the effectiveness or not against the different variants between the adults and the hu- — and younger children at various age.
And Dr. Walensky just gave you a very nice delineation of what the effectiveness is against Omicron — and I did in my own presentation. I don't see any fundamental differences there.
But I think the bottom line — because people keep asking this question: This will occur, and this will or will not get an EUA from the FDA, based on what they do very well — to very meticulously go over the data for safety and efficacy, and make an appropriate decision.
So, when they do that, it will come out and we will know the answer.
MR. ZIENTS: Next question.
MODERATOR: Let's go to Kaitlan Collins, CNN.
Q Thanks so much. Two questions. Jeff, I just want to follow on Josh's question, because I didn't hear an answer, which is: How many households have requested the tests? And if you don't have that number, can you explain why you guys aren't disclosing that?
Secondly, for Dr. Walensky, you talked about the millions of Americans who have yet to get a booster. Less than half of those who are eligible to get booster shots have done so. And so, given what these numbers show — this new data about how important a booster shot is — can you explain just — I know you've talked about this before, but can you explain why the CDC is not changing the definition of "fully vaccinated," given that could potentially encourage more people to get a third shot?
MR. ZIENTS: So, Kaitlan, demand has been high in the first few days. Households around the country are clearly ordering tests and completing the process quickly. As we said, the website is working well. And I know from personal experience that that's not an easy feat to pull off in a short period of time. But fortunately, the website is working smoothly. We already have millions of completed orders through the website. And those numbers keep increasing each and every day.
As we get through this initial wave of ordering and it winds down next week, we'll pull the numbers together, and we'll give you a fuller picture of the number of tests ordered, and we'll report that number publicly.
Over to you, Dr. Walensky.
DR. WALENSKY: Yeah, thank you for that question, Kaitlan.
So, you know, in public health, for all vaccines, we've talked about being up to date for your vaccines. Every year, you need a flu shot; you're not up to date with your flu shot until you've gotten your flu shot for that year.
And what we really are working to do is pivot the language to make sure that everybody is as up to date with their COVID-19 vaccines as they personally could be, should be, based on when they got their last vaccine.
So, importantly, right now, we're pivoting our language. We really want to make sure people are up to date. That means if you recently got your second dose, you're not eligible for a booster, you're up to date. If you are eligible for a booster and you haven't gotten it, you're not up to date and you need to get your booster in order to be up to date.
MR. ZIENTS: Next question.
MODERATOR: All right, a couple more questions. Let's go to Sheryl Stolberg, The New York Times.
Q Thank you for taking my questions. I have two questions that I think are on a lot of Americans' minds.
First, many people who are vaccinated and have nonetheless gotten infected with Omicron want to know if they are protected against Omicron. And if so, for how long?
And second, Jeff, you talked about COVID — we're heading to a place where COVID won't be a constant crisis but something we protect against and treat. And I'm wondering — I guess this is for both Dr. Fauci and Dr. Walensky — what is your best guess about what the next six months will look like with respect to COVID-19? And if you don't know, could you please lay out several possible different scenarios? I think many Americans want to know what to expect.
MR. ZIENTS: Why don't we start with you, Dr. Fauci?
DR. FAUCI: Well, in answer to your last question, Sheryl: We don't know. But what one does when you have a situation where you don't know — because we have also had the experience, as you know, of the unpredictability of things like what happened with Delta and what happened with Omicron — so you put together a best-case scenario and a worst-case scenario.
What's the best-case scenario? The best-case scenario is that the description that Dr. Walensky just gave us about the diminution in cases in many regions of the country will continue to go down to a baseline level that is a level of what we call "adequate control."
Namely, it's not disruptive of what we do. And the combination of vaccinated and boosted people and the protection afforded by prior infection will have a level of protection in the community so that you won't get the situation where there's enough activity which leads to hospitalizations, deaths, and stressing the healthcare system — which, in fact, answers a bit of your first question, Sheryl, about: What about Omicron? If you get infected, can you get infected again?
Sure, there are reinfections. But it is unlikely that if you mount a good immune response — at least over a period of several months — it is extremely unlikely that you will be re-infected with the same variant.
We've seen reinfections, but those are mostly in people who've been infected with Alpha, who then wind up getting re-infected with Beta or re-infected with Omicron. That's the best-case scenario.
The worst-case scenario is something we have to be prepared for, and that is: We do get down to a level that we would say would be "adequate control," but we're faced with another surprise with a variant that's so different that it eludes the accumulation of the immune protection that we've gotten from vaccinations and from prior infections.
I hope that doesn't happen. I can't give you a statistic of what the chance of that happen, but we have to be prepared for it. So, we hope for the best and prepare for the worst.
MR. ZIENTS: Yeah, the thing I would add here is that we have the tools, we have the vaccines, we have the therapeutics, we have the ability, as Dr. Fauci has talked about before, to change the vaccines if we ever need to to fight a new variant.
So, we have the tools to make sure that we are able to continue to operate businesses, to keep our schools open, just as we've done through this surge in cases. This is so different than a year ago.
And going forward, we have that toolkit, and we'll continue to expand that toolkit to make sure that we can deal with any scenario.
Next question.
DR. FAUCI: One other thing, Sheryl —
MR. ZIENTS: Sure —
DR. FAUCI: If I could add one other thing, Sheryl, and that is: One of the reasons I gave the presentation about the conservation of epitopes — on the slide that had all those red circles in them — it really answers, in part, your question.
Because if we get another variant, the background immunity, together with the fact that we likely will boost against a different variant, should provide the protection that Jeff is talking about, where even a new variant, given the tools we have, does not disrupt us as much as we would have been disrupted if we didn't have the vaccines in the first place, not to mention the therapies that will be available.
MR. ZIENTS: Okay, Kevin.
MODERATOR: Last question. Let's go to Zeke at the AP.
Q Thanks for doing this. Dr. Walensky, as cases in some of those areas, as you mentioned, begin to come down, what is the current CDC guidance for municipalities and states, in terms of relaxing some of the restrictions that have been put in place to control the Omicron spread? Is it the same as it was for the same — other variants going into, you know, moderate community spread and lower to remove masks? Or is the CDC eyeing a different threshold, given all that we know about Omicron being — and seemingly being less severe for those who are vaccinated compared to earlier strains?
DR. WALENSKY: Yeah, thank you, Zeke. So, let me just say: Cases are coming down. They have just started to crest in some of these places and started to come down.
We still are at extraordinarily high levels of disease in almost all of the places in — and even in areas where cases are starting to come down — places that — we are still recommending public indoor masking.
Again, cases are still well higher than the threshold to start thinking about taking off some of those measures.
MR. ZIENTS: Thanks, everybody. I hope everybody has a good weekend. And we'll look forward to seeing you next week. Thank you.
DR. WALENSKY: Thanks.
1:33 P.M. EST
