COVID-19: Booster vaccination rollout was 'unfortunate' based on data, doctor says

Dr. Jeremy Faust, Brigham and Women’s Hospital Emergency Medicine Physician & Editor-in-chief of MedPage Today, joins Yahoo Finance Live to discuss Walmart pulling back its mask mandate for employees, herd immunity myths, boosters and vaccinations, and keeping hospitals safe through vaccine mandates.

Video transcript

ALEXIS CHRISTOPHOROUS: New COVID cases are plunging, and the US appears to be on its way out of this wave of the pandemic. And even the country's chief doctor, Anthony Fauci, says the country is headed out of the, quote, "full-blown pandemic phase" of COVID-19. Joining me now is Dr. Jeremy Faust, Brigham and Women's Hospital emergency medicine physician and editor-in-chief of "Med Page Today."

Dr. Faust, good to see you. Last week, we heard from the World Health Organization warning that another variant, perhaps more deadly and easily transmissible, could emerge. So I ask, are we moving from pandemic to endemic? And are we prematurely lifting some of these COVID-related restrictions?

JEREMY FAUST: Thanks for having me. I think that anytime a new variant comes onto the scene, it's just a lot of question marks. It could be a milder variant. It could be that the immunity that we have from vaccination and previous infections is going to protect us well enough. It's just always a wild card. And the question as to whether or not we are in some sort of endemic phase is really a matter of definitions.

I think that my colleague here in Boston, Bill Hanage, said it quite well when he said that we seem to think that endemic is synonymous with the level of death we are willing to just accept. And in fact, endemic really has a different meaning. It means that the disease is not causing an outsized effect on the population. That's not happening. We are not endemic yet. We are still having far more deaths not just from COVID, but all-cause mortality is higher than ever right now as opposed to pre-pandemic. So I don't think we are in a safe place right now.

We certainly are a lot better than we were a month ago. But when you look at the numbers-- thousands of people dying per day, and it's not just rearranging death certificate deck chairs. It's more deaths than usual. COVID is still driving that.

ALEXIS CHRISTOPHOROUS: Well, having said that, Doctor, and hearing that Walmart, one of the largest employers in the country, now telling its fully vaccinated workers that they do not need to wear a mask-- they can still wear that mask at work if they choose to, but they're not mandating it anymore-- you'd have to think other retailers and other stores in general, companies in general may follow Walmart's lead. What do you think about what Walmart did over the weekend?

JEREMY FAUST: I think that our fatigue is setting in. And sometimes we think with that part of our brains and not necessarily the brains of public health. That's understandable. I'm really focused in my work at looking at whether what we do threatens hospital capacity, because I think that is something that even the most tired of us are willing to think about. I personally, and many of us, are willing to still make changes in our daily behavior if that keeps our local hospitals safe. And I think that's really important.

There are still 100 counties or so in this country out of about 2,400 that we can track that have hospital capacity either threatened or already over capacity in terms of what is considered safe. In places like that, I would not recommend anyone take off their masks. Because not only are you at risk, but you are spreading the virus, more likely, that can put local hospitals at risk for all care. And hospitals are critical infrastructure. And that's part of security in a sense. So in those places, I think it's very premature.

And in other places, there's a sense of what's normal. And I'm not sure we have that figured out yet. And I won't opine. Because my big concern is that even in places where hospital capacity is still threatened, we're still not really doing it correctly.

ALEXIS CHRISTOPHOROUS: I remember earlier on in the pandemic, there was talk of needing to reach herd immunity, and then we would have rounded the corner with the pandemic. With so many people having gotten omicron over the Christmas holiday and the new year holiday, do we have herd immunity? And what does that even mean now for our overall fight against this?

JEREMY FAUST: I think herd immunity is another concept that's been batted around without a lot of specificity of definition. In my view, what I'm looking for is herd protection. I want to know that if you get exposed and infected to a variant of coronavirus, that you will not have any bad outcomes, you won't have any long-term consequences, that it really has been reduced to a flu or a cold, which it certainly isn't unless you have been vaccinated. Plus, some degree of exposure on top of that can be useful. And I would recommend people go in that order. Because again, we may see reinfections over time. And some viruses just are like that. We can't just be completely immune to them. Coronavirus is certainly like that. But we can be protected from the worst consequences.

So I think that we'll see whether the omicron wave did have this one upside, as it's been terrible-- the all-cause mortality has just been astronomical. But we'll see whether or not all these infections lead somewhere better in terms of having that protection against severe disease and long-term consequences. I don't think we know yet. And I think that there's been some pessimism on that because of the antibody responses that it seems to evade. But I don't think we know yet. So I think it's an open question.

ALEXIS CHRISTOPHOROUS: Last week, we got some news about booster immunity. And now they're saying that protection may wane after four months. So how likely is it that we're going to need a fourth shot, and how often do you think we're going to have to get a booster shot? Because talk about mask fatigue. I think people just have vaccination fatigue.

JEREMY FAUST: Absolutely. And I think that the way that the booster rollout happened was a little bit unfortunate in terms of how we looked at the data. by the time we started vaccinating and doing boosting-- by the time we started boosting here in the United States, it was already very clear from the Israeli data, if you look carefully, that the booster was waning with respect to its effect on infections. And I've argued, as many have argued, that we shouldn't really be using boosters that way primarily. Certainly, there's a role for that in some situations, immunocompromised or high-risk populations.

But for the most part, I think we should be thinking about boosters in terms of protection against severe disease and long-term consequences. In that manner, boosters don't wane nearly as much, just as the two-dose series doesn't wane that much unless you are an older person, so 50-plus, 65-plus. The third dose is absolutely necessary to protect against that long-term and severe disease. For younger people, the booster certainly decreases infections, but as you said, very temporarily.

And this is something that we've known since September or October if you just looked. But I think that because people were so set on getting everyone boosted, that was sort of downplayed. But again, I think that boosting people over 50 is really, really essential for outcomes. And for people under 50, it can help in terms of stopping spread and for people with severe risks.

ALEXIS CHRISTOPHOROUS: And Doctor, we saw these truck protesters in Canada protesting the vaccine mandates. Today, several thousand New York City workers will be told whether or not they have a job because some of them-- I think it's about 1%-- have not yet been vaccinated. What would your message be to those people who are saying, look, this is my right to choose to not get the vaccine?

JEREMY FAUST: Well, I think that, as I said before, vaccination is about a lot of things. But one of the things it's about, if you want to think about public policy and health policy, which is something that I do think a lot about, is about protecting the community, our public health infrastructure. The unvaccinated are clearly driving the hospitalization waves that we've seen all over the country. So we know that so-called natural infection or previous infection isn't enough to keep you out of the hospital. It's either vaccination or the combination of prior infection and vaccination which provides the strongest protection.

Look, if we're trying to keep our hospitals safe so that we can treat heart attacks and a kid breaking his leg and going to the operating room and COVID, we need to keep the hospital a safe place. And the unvaccinated are the single greatest threat to that critical national security infrastructure as far as I'm concerned, and as far as the Department of Homeland Security is concerned, quite frankly. And so I think that vaccine mandates are not just about protecting yourself, not just about decreasing spread, but also about keeping our resources safe for everybody.

ALEXIS CHRISTOPHOROUS: All right. We're all in it together. Dr. Jeremy Faust, thanks so much for your insights today. Appreciate it.