Episode Transcript

Welcome to Health Matters – your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Faith Salie.

This week I had the opportunity to speak with Dr. Yoko Furuya, the chief epidemiologist for NewYork-Presbyterian Hospital and infectious diseases expert at NewYork-Presbyterian and Columbia. She’s been fighting COVID-19 from the front lines since the first wave hit New York City in March 2020. 

Now three years later, Dr. Furuya talks about what we know about COVID today — how the virus has evolved, whether the COVID-19 pandemic is officially over, and if we will experience another pandemic in our lifetime.

Faith: Hi, Dr. Furuya.

Dr. Furuya: Hello. Thank you for having me.

Faith: To start, I want to ask the question on everyone’s mind: Are we still living in a pandemic?

Dr. Furuya: I would say that we are emerging out of a pandemic into what we consider the virus going endemic.

Faith: Will you explain what endemic means?

Dr. Furuya: An endemic virus is a virus that’s constantly present in a population and it can go up and down, but it never completely goes away.

What happened with COVID initially was that it was a totally new virus to the human species. So at that time, no one had immunity to it. And, as it turned out, it was just a bunch of factors that made it really dangerous to the human population. So it was really infectious and transmissible through the air, through respiratory droplets and aerosols. It can spread quickly from one person to the next, even before someone develops symptoms.

And then it’s also, unfortunately, it’s a virus that was very capable of making people really sick and even dying. At this point, because so many people have now been exposed to the virus, a lot of people have developed at least partial immunity to it and now that’s why we’re sort of seeing it come down to a more manageable level, but it’s not going go away, which is why we now consider it endemic.

Faith: What does partial immunity mean?

Dr. Furuya: What I’m referring to is our immune systems have seen the virus before. Whether it’s because we got infected or we got the vaccine.

So for most of us our immune systems have a little bit of familiarity with the virus so that if we were to get infected again, there’s already some antibodies and immune cells that can arise quickly and help fight the virus.

And there are still people who have never been infected. For people like that, the virus can still be quite dangerous.

Faith: Speaking from an epidemiological point of view, how has it evolved as a virus?

Dr. Furuya: So there was an original strain, what we sometimes call the ancestral strain of the COVID-19 virus.

And then now there have been many, many offshoots of that virus. Some of those mutations have led it to potentially become more transmissible and some of the ways in which vaccines were created to fight against the virus, the virus has learned some ways around that so that the vaccines have become a little bit less effective.

But I think overall we’re seeing a little bit less virulence and so there have been pros and cons where the virus in some ways has learned to be smarter and evade some of the things that we’ve come up against it, but in other ways I think it’s become a little bit less dangerous.

Faith: And do all of your answers apply globally? You’re not just speaking about COVID-19 in America. Is that right?

Dr. Furuya: Yeah, that’s right. I’m talking mostly about the way the virus is around the world.

We continue to see strains mutate and different offshoots continue to arise. Most of them now are offshoots of the Omicron variant, which has many different sub variants now. But it’s gone through many different phases.

Faith: So clearly we’ve come such a long way since 2020. I was walking through Penn Station and I was really struck with the fact that virtually no one was wearing a mask.

But what are your current recommendations for the public and how to approach COVID in our day to day?

Dr. Furuya: Now with most people, again, having a certain level of immunity to the virus, I think it’s really become much more of a personal decision of how you approach COVID on a day-to-day basis.

I think it’s unlikely that we’ll see a lot of mandates again around masking or vaccinations. So now it’s mostly about how much risk are you willing to take, or are you willing to take on behalf of your loved ones? And when I say risk, I mean everything from risk to your health or the health of those close to you.

Since we know that even with vaccination and prior infection, older people and people with underlying conditions are still at higher risk for getting severely ill if they get infected. So if you’re one of those people or someone close to you is one of those people, you might be more cautious.

Faith: What does that look like right now to be more cautious?

Dr. Furuya: I think to be more cautious is around paying attention to the COVID transmission numbers of what’s going on in your community right now. It means continuing to wear a mask when you’re around other people.

Faith: Indoors and outdoors? Or is outdoors very 2020?

Dr. Furuya: I would say indoors is most important. Outdoors, we know now that transmission is much, much less likely. It can still happen under certain circumstances if you’re in really close proximity.

We know that masks work best if everyone’s wearing them, but that doesn’t mean that they don’t work if you’re the only one wearing them. So, it’s still going to help protect you. It’s going to help protect other people around you, if you happen to be sick and you don’t know it yet.

So for me personally, for instance, I love to travel. I’m still always extra cautious on planes and I wear either a mask or a KN95.

If the numbers are higher in the community then I might — if I’m having a social get together — I might recommend that everyone who’s coming, test themselves with an antigen test at home and obviously not attend if they have symptoms.

Faith: How have the antigen tests evolved? Have they improved in accuracy?

Dr. Furuya: There’s still a lot of variability out there. But they’re not going to be as good as PCR-type tests. So the recommendation is you can do a home antigen test but if you have a high suspicion, for example, because you were exposed to somebody that you knew had COVID, or if you have symptoms, then you’re not supposed to just test once.

And I think this is something that a lot of people forget about. But the antigen test, because they can be less sensitive, you’re supposed to retest a couple of days later. And the more tests you have over time, the more accurate and sensitive it’s going to be.

Faith: Right. So, the Biden Administration recently announced the end of the COVID national emergency. What are the implications of that?

Dr. Furuya: So there are a lot of implications.

My biggest concern is this: A really important part of the COVID response I think has been to make testing and treatment essentially free and widely available to everyone in the U.S., regardless of their economic status, regardless of whether they have insurance or not.

So I’m concerned that by that going away, it might disincentivize people from getting tested and treated, and of course could certainly widen the health disparities.

I do have concerns that it would be easy to forget all of the lessons learned. I think that we need to have a better plan the next time around regarding the threat of pandemics.

Faith: Let’s talk about a better plan. What are the lessons learned? What do we need to do if there’s a next time?

Dr. Furuya: We need to have monitoring in place at a national and global level. We need to be ready to mobilize in terms of rapidly standing up diagnostic testing on a large scale. That was one of the things that was very slow to make testing widely available. It had spread so much before we even knew it. We have to be ready to create, study, and rollout vaccines and treatments, and have stockpiles of PPE and other items. So we need an infrastructure in place to be able to respond rapidly the next time. And I’m concerned that that may not happen if people are just tired of thinking about and talking about COVID.

Faith: And all those things you just named, they’re necessary to prepare us for any future infectious disease, right?

Dr. Furuya: That’s right. I think what we’ve been seeing over the last decade and a half is that the pace at which emerging infections have been arising and spreading has been accelerating over time. So we are seeing a lot of new things emerge and whether it’s because of more global travel and the way that things can spread more easily around the world.

Faith: Climate change is also part of it.

Dr. Furuya: Climate change. Right. Mosquito-borne illnesses like Zika virus; humans and non-human animals living together in close proximity; pathogens from animals that can mutate and then enter into human populations — I think all of those things are combining to make it that much more likely that we could see another pandemic like this in our lifetimes.

Faith: The FDA just authorized a second Omicron booster shot for those who are 65 and older and for the immunocompromised. What does this mean for COVID vaccines in our future?

Dr. Furuya: Yeah, so I think there’s still a lot of unanswered questions. At the moment, a lot of scientists, as well as the FDA, are thinking along the lines of a yearly shot, similar to the flu shot. And the advantage of that approach is that allows the vaccine to be tailored to the latest circulating strains for a better match. Similar to what’s done with a flu shot every year, and also addresses some of that waning immunity that we’ve been seeing.

What has been kind of frustrating for us to see is that none of these vaccines last forever. So you can’t just get your vaccine and then feel like you’re forever protected. So all of the vaccines work really well in the beginning. And then the immunity we see start to wane.

So I think that we’re probably going to have to rely on some kind of regularly recurring type of schedule for the COVID vaccines, but we’re still only a few years into this, so we’re still learning and that could always change.

Faith: What do we know about the long-term health impacts of COVID, both mental and physical?

Dr. Furuya: Long COVID, or what’s now being called post COVID conditions is a real issue. And another thing that we’re still learning more about. Generally, we are talking about something that you’re still experiencing more than, let’s say four weeks out from the start of your infection. And we’re learning that they can last anywhere from weeks to months to years.

We’re talking about things like fatigue or low energy or brain fog. And then there’s a whole host of other things that we’re still learning about. So people with chronic headaches or joint pains, neurologic symptoms like dizziness, numbness and tingling.

For some people loss of, or change to the sense of smell and taste can last for weeks to months and sometimes even years. So, other things like cardio-pulmonary type symptoms, chest pain, chronic cough, chronic shortness of breath, neuropsychiatric symptoms like depression or anxiety.

Faith: I mean, is this unusual for a virus to create all those negative effects?

Dr. Furuya: It is unusual, but it’s also unusual for so many people to be affected by a novel virus, again, that nobody had ever experienced before. We also know that the family of viruses that the COVID-19 virus belongs to — the coronaviruses — can sometimes cause a lot of very broad and puzzling types of symptoms. But not to the degree that we’re seeing with COVID-19.

So, yes, it’s unusual, but I don’t know that it’s that surprising given the way this virus has emerged.

Faith: I imagine that you’ve run the gamut of emotions over the past three years from terrified to sad. Has this also been an incredibly purposeful time for you?

Dr. Furuya: It has. And I’m glad that you raised that because I think you’re right that while it has been an exhausting experience, I have definitely felt like the work that I’m doing is very important and maybe even more important than it’s ever been.

I’ve also really appreciated my team and the other healthcare workers that I work with. There’s something to having a unity of purpose. The problems become very clear when everyone is faced with one enormous challenge.

And I’ve also learned a lot on a personal basis. I’ve learned a lot about pandemics, pandemic preparedness, and I’ve also learned about my own resiliency as a person, I think.

Faith: I am a New Yorker. I had nowhere to go when this all started. I and my kids and their pajamas would go out on the building’s terrace with pots and pans for the 7:00 PM clap, and thank all those folks like you and all your colleagues and I still thank you. We all still thank you.

Dr. Furuya: Thank you very much. Everyone on the front lines appreciated hugely to know that we weren’t alone in it. And I think that was very much what we felt in New York City. We were not alone. We were in it together.

Faith Salie: Dr. Furuya, thank you so much for joining us.

Dr. Furuya: Thank you, Faith. It was a pleasure.

Our thanks to Dr. Yoko Furuya

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