U.S. could see 1 million cases per day, warns departing NIH director Francis Collins
After spending more than 12 years as director of the National Institutes of Health, Dr. Francis Collins is retiring this weekend. But he's no less worried about the public health agency's latest pandemic curveball.
As the omicron variant threatens record-breaking rates of infections in the U.S., Collins departs with a warning. If Americans don't take COVID-19 seriously, the country could see 1 million daily infections, he said.
"We cannot afford to let down our guard," Collins told NPR's Scott Detrow in an interview with Weekend Edition.
"I know people are tired of this," he said, acknowledging Americans' fatigue of having weathered almost two pandemic-stunted years. "I'm tired of it too, believe me. But the virus is not tired of us. It's having a great old time changing its shape every couple of months, coming up with new variants and figuring out ways to be even more contagious."
Early data shows that while omicron has the ability to easily evade immune protection and booster shots, those infected may be less likely to experience severe disease and hospitalization.
But it's too early to know how the highly mutated omicron will act in the U.S. compared to previous variants, said Collins. With omicron's 57 different mutations, he said, it's "almost like we're starting over with a different virus than where we began."
According to scientists' most pessimistic projections, the U.S. could reach over a half-million average daily infections by the end of January — more than double last winter's peak.
The outgoing director fears a worse situation.
"Even if it has a somewhat lower risk of severity, we could be having a million cases a day if we're not really attentive to all of those mitigation strategies," he said.
Even the most optimistic scenarios could mean a strain on hospitals in many regions that are already squeezed by the delta surge.
Collins notes that the Biden administration has at least 60 emergency response teams on standby to support health care systems in the event of a crush of infections.
"I expect those surge teams are going to be busy — already that's been put in place in some instances because of delta — and I'm not going to be surprised if there's even more of a demand in the next month or two," he said.
All in the last week, the rapid clip of omicron infections in the country has once again forced shutdowns of professional sports games, theaters, restaurants and schools. Some people are rethinking their holiday travel plans.
As for Collins' own plans, he says he'll be keeping a close eye. But at the moment, he's hoping to host a Christmas Day gathering with pandemic precautions in place.
"We were planning to invite some of the trainees at NIH who are far from home to come for a brunch on Christmas Day at our house if they're all fully vaccinated and boosted," he said. "Still planning to go forward, very carefully, with a small group, and everybody will be wearing masks except when they're eating."
Ian Stewart and Kitty Eisele produced and edited the audio version of this interview.
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Transcript
SCOTT DETROW, HOST:
That storm, Dr. Wilson expects, will be whipped up by the omicron variant. I asked Dr. Francis Collins, director of the National Institutes of Health, about the variant and whether the Biden administration did enough to prepare for it.
FRANCIS COLLINS: Certainly from South Africa data, it looks as if this is a variant that, while incredibly contagious, seems less likely to land you in the hospital or the ICU. But we're not South Africa. That was a younger population and a population that's been pretty much completely infected previously by delta, so there's a certain degree of immunity from that experience. I think we still don't know what omicron would likely do to somebody who's unvaccinated, never had SARS-CoV-2 infections before and maybe is somebody over 65. So we got to watch that really carefully.
DETROW: All across the country, first of all, we are seeing a lot of people who still aren't vaccinated, people who aren't getting boosted. But beyond that, how worried are you that Americans just aren't listening to you and the other experts at this point?
COLLINS: Well, I'm worried. And I know people are tired of this. I'm tired of it too, believe me. But the virus is not tired of us. If anybody's listening to this who's sort of throwing caution to the winds just because it's been so long and they're just sick of it, there are real consequences there. We do not know what this virus is capable of doing. And even if it has a somewhat lower risk of severity, we could be having a million cases a day if we're not really attentive to all of those mitigation strategies. And, you know, a small fraction of a big number is still a really big number and this is not the moment...
DETROW: I just want to underscore that - a million cases a day. I mean, that is so much higher than even last winter.
COLLINS: Yeah. And I don't know that we'll hit that, but there are certainly projections that say that could happen with a virus that seems to be doubling, most places where it's been, every two to four days.
DETROW: In a lot of places, people can't find rapid tests. In a lot of places, people are having a hard time scheduling boosters, finding a place to get a booster. I mean, these are the main tools the administration has been relying on. Did the Biden administration do enough to prepare for delta and omicron?
COLLINS: Well, nobody expected omicron. This one was really a curve ball - a variant that has 57 different mutations in it that makes it almost like we're starting over with a different virus than where we began. Certainly, the demand now, and appropriately so, for boosters has gone up. I think we're doing OK in meeting that demand. And anybody listening to this who hasn't gotten boosted, go to vaccines.gov, find out what's near you. The testing issue - the demand for that has gone sky high, and understandably so. But many pharmacies will still have home tests that you can get. The testing centers - yeah, they're pretty busy right now because a lot of people are trying to find out, especially before the holidays. But I think we've moved pretty quickly to try to respond to that. Home testing is going to be quadrupled in its availability. And, of course, home tests will now be compensated by insurance if you need to be reimbursed for those; plus 50 million home tests being sent out to community health centers.
DETROW: Can I circle back to something you said right at the top of that answer, though? You said nobody expected omicron, and Vice President Harris said something similar to the Los Angeles Times. She said, we didn't see delta coming, we didn't see Omicron coming. I guess I was confused by that because I've been listening to the briefings from the NIH, from the CDC, from the administration all along, and it's been a constant drumbeat that more variants could be on the way, and that was part of the message for getting vaccinated.
COLLINS: Yeah, let me clarify what I meant by that.
DETROW: OK.
COLLINS: I think all of us thought that we would see something coming on the heels of delta, but we expected it to be delta-plus. Instead, what we got was omicron, which bears no relationship to any of the previous strains, and it does mean we're dealing with a virus that is really quite sufficiently different that does clearly stress the immune system's ability to respond to it and making this a little tougher than we thought it would be.
DETROW: We've done so many stories about how the health care system, how hospitals are stretched to the brink already. What happens next?
COLLINS: Well, I do worry a lot about them. And now I guess we also have to worry on top of that, our health care staff going to get infected with omicron. Even if they end up with mild disease, they can't very well be working if they're sick. It's unfortunate that, in fact, there seems to be some disagreement about whether people involved in patient care need to be mandated to be vaccinated. That just makes total sense. Wouldn't you want to know, if you're going to a health care facility, that you're not likely to be around somebody who's unvaccinated at this point?
DETROW: One last question for you, Dr. Collins. Amid all this news, parents of kids under 5 were just crushed this week - and look, I'm very biased, I was one of them - to learn that it's going to be a while longer wait for vaccines for their kids, spring or summer at the earliest. What do you tell them?
COLLINS: Well, it's not good news, of course, I get that. And it must be very disappointing to be, as you are, in a case where you thought this was something that might happen in the first quarter of 2022. I think all you can say is it's a good thing that this is being done in a fashion where the data's being collected. Not a happy outcome, but at least scientifically, the right decisions are being made.
DETROW: Dr. Francis Collins, the retiring director of the National Institutes of Health, thanks for joining us, and I hope you turn your alarm clock off tomorrow.
COLLINS: (Laughter) We'll see how that goes.
DETROW: At least try.
COLLINS: I'm going back to the lab.
DETROW: All right. Well, thanks for talking to NPR.
COLLINS: Nice to talk to you, Scott.
(SOUNDBITE OF CYMANDE'S "ONE MORE") Transcript provided by NPR, Copyright NPR.
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