COVID-19 Update: Variants and Vaccines, Expert Q&A

The COVID crisis has gone on far too long, years now. And we're all facing COVID fatigue. But it's important we remain vigilant. Infectious diseases pediatrician Dr. Allison Bartlett and community health expert Dr. Doriane Miller will discuss the COVID-19 Omicron variant and what makes it unique, what you should know about kids and vaccines, how to understand COVID-19 tests, and what it means if you're vaccinated and test positive, plus a whole lot more. And they'll take your questions. That's coming up right now on At the Forefront Live.


And we want to remind our viewers that today's program is not designed to take the place of a visit with your physician. We're going to start off with having each one of you introduce yourselves and tell us a little bit about yourselves. You've both been on this program multiple times. But we do have viewers probably joining us for the first time. Dr. Bartlett, you are at the desk. So we will start with you today.

Thank you. It's great to be here again. I'm Dr. Allison Bartlett. I'm a pediatric infectious diseases physician. And I'm also part of our infection prevention and control team here at the hospital.

Fantastic. Dr. Miller?

Hello, I'm Dr. Doriane Miller. I'm a professor of Medicine at the University of Chicago. I'm also the director of the Center for Community Health and Vitality.

Great. So we do want to remind our viewers that we will take questions. So if you type them in the comment section, we'll get to as many as possible during the course of the program. So start typing away. I'm sure we'll have quite a few as we move through the show today.

So let's just start off and talk a little bit about the Omicron variant of COVID-19. We've heard a lot about it. And I think a lot of folks think it's not as serious, possibly, as Delta. But it is still very serious and it's something we need to be aware of and be vigilant about, correct?

Absolutely. I think there's been two components to this pandemic the entire time. There is the individual health component and the public health component of this. And sometimes, those are a little bit at odds with each other. It looks like for each individual, the Omicron infection may not be as severe as others. But on a public health scale, the fact that it is so incredibly easy to spread from person to person, it's having a very significant impact on the public health. I think, interestingly, in kids, we're also seeing symptoms are a little bit different. And a lot more kids are having upper airway problems or more like a croup that we would see with other viral infections.

And these are things that kind of hang around for a while, don't they?

They can. And they can lead to the foremost of Long COVID Syndrome, but also just a lingering cough or other impacts.

Dr. Miller, talk to us a little bit about, if you will, the community impact. I know part of what you've done, your work is to try to get the word out on how important the vaccine, vaccines are. And I know that's been a bit of a struggle at times. Can you talk to us a little bit about that and where we stand now and what are our continuing efforts to get the positive word out?

We've been working very effectively through the Chicagoland vaccine partnership, which is a coalition of academic health centers, community based organizations, public health entities, as well as philanthropy, in order to provide messaging to get the word out about the importance of getting vaccinated. But one of the things that we see-- and we see these statistics come up week by week-- is that between the ages of 18 and 45, particularly in the African-American community, that vaccination rates are still very, very low.

And what are you hearing from your patients? We were talking a little bit before the show about some of the hesitancy. Can you tell us what people are expressing to you? And what do you tell them? Because I think we all need tips here.

You know, about a year ago, my patients were a little bit more forthcoming about their hesitancy in getting vaccinated in terms of how long the vaccines have been available, questions about research, et cetera. But it seems that these days, and I'm thinking about the past six months or so that my patients are not sharing as much information with me around why they're hesitant to get the vaccine.

I will say that for the patients I see that are 45 to 65, there's been a little bit more of a shift in terms of people now getting the vaccine. My patients over 65 have always been, Dr. Miller, when can I get this vaccine? Literally, when it was available in December of 2020, all of the phone calls and email messages that I received, put me on the list, put me on the list. But for the younger populations, there was some hesitancy because they thought, well, this is only going to be a bad flu, I'll get through it, I'll be fine or questions about the research and the rapid way in which the vaccine was developed.

Early on, I was able to get that 45 to 65-year-old group to think a little bit more about getting it. But I have to say that for the patients that I care for at the University of Chicago, many of whom come to an academic health center because they have lots and lots of illnesses that require fairly intensive management, they've been the people who have suffered. They've suffered with hospitalizations. I've had patients that have unfortunately passed away from complications of COVID. And I'm not talking about 70 or 80-year-olds. I'm talking about people in their 30s and 40s.

You know, I think that's maybe a time in people's lives where you think that you're bulletproof, I guess you could say. I mean, I remember, as I've gotten older and maybe a little wiser, I've realized that there are things that I thought that wouldn't impact me that actually do. And I wonder if that's part of the situation there. Because mentioned that older group, you know, the folks that are 65 and plus and maybe a little bit more mature and realize that they have to be a little more careful. I think that does have an impact.

I think it does have an impact. But I also think that there have been other impacts on how people receive information and also how they judge the credibility of information. And so many of my patients who are in that 18 to 45 category oftentimes will look to social media as a way of doing research on COVID-19 vaccines, et cetera. And so the question of who's telling them the truth, what is the evidence base behind it, and how do you sort through that information I think is something that's been challenging during this time of increased social media uptake.

You know, you hit the nail on the head right there. I think that's probably the most critical aspect to this is social media, where people get their information, and what they believe anymore. And that's, unfortunately, it's just we're in kind of a sad spiral, I think, in that area, which is too bad. We do have some questions coming in from viewers. And I promise to get to as many as possible. So I'll throw this one out there. And Dr. Bartlett, let's go with-- to you with this one. This is from Kat. Will we have to get another vaccine to prevent against future mutations?

I suspect, yes, there are additional COVID vaccines in our future. Now is it going to be a dose that's specifically tailored to a mutation that we have not yet encountered? Or it's going to be sort of an annual booster like the flu or every 10 years like our tetanus boosters? I don't think we know that piece yet. But I think that even for those of us who've gotten our two doses and our booster, we are not, we are not done with COVID vaccines. That said, for the moment, those two doses and booster are incredibly protective.

Well, and the thing we have to remember with this is when people get worried about getting another vaccine, the vaccines that we've seen so far have gone out to millions of people with very little negative impact. So it's not like this hasn't been tested. It has.

I would only correct you and say it's billions with a B and not millions with an M. Yes.

Yeah, so it's probably the safest vaccine in history, I would imagine, I mean, just when you look at sheer numbers.

Both the amount of doses that have been given and the rigor with which we've been following people who've been vaccinated are unprecedented.

Yeah. Another question from a viewer. This is from Allie. What precautions should people who are vaccinated and boosted should still be taking? Is it safe to eat in a restaurant, for example, or to go see a movie? What about vaccinated people with certain high risk conditions such as pregnancy? And, you know, again, I think this kind of goes towards the question about normalcy and lives and we all want to get back to that, some sense of normalcy, I guess. So, I don't know, Dr. Miller, if you want to start us on this one?
You know, I think that being able to assess one's risk of getting a COVID-19 infection, whether it be if you're unvaccinated, certainly, you need to take proper precautions in terms of masking up, washing up, and backing up, which is the phrases that I use in order to remind my patients exactly what to do. But when you think about being in special categories, for instance, we see lots of people who are undergoing treatment for cancer that may not have had a full response to even the first series, two series, for the ones that we have here at University of Chicago, and a booster, that they're still going to be at higher risk for getting a COVID-19 infection.

And so talking to your doctor, your health care provider about what your personal risk is and then deciding how much you want to engage in some of the things that prior to March 2019-- or 2020, rather, we would consider to be normal. Certainly, risks are much lower in terms of people getting infections or having breakthrough infections if they've been fully vaccinated and boosted.

We still see some of these in some people. But one of the things that we know is that these infections tend to be milder in that they are not landing people in the hospital. And they're not dying from the infections. And that's what the vaccines were made for, to prevent death and hospitalization.

Yeah, I think that's a common misconception because we hear all the time that people will say, well, my friend got it and they were vaccinated, doesn't work. And that's not the case. One of the questions that I've been kind of curious about because there has been a lot of debate about this, if you do test positive or if you have symptoms for COVID, when is it appropriate to actually go see your physician? Because I know most of the hospitals are very busy. And so people may tend to shy away from doing that. And I don't know who wants to take that one.

I'm happy to start with that one.


I think there's two reasons to go see your physician. One is clearly if your symptoms are severe and you think that may be a need to be admitted to the hospital because you're going to need oxygen support and are having difficulty breathing. But the other is if you are in one of these high risk groups for having severe disease, we have treatment that we can give very early on in infection that can help keep you out of the hospital. And so that is really when it's important to say, gosh, are the symptoms I'm having right now possibly COVID infection?

And if you have access to a rapid test at home, great. If not, seek testing quickly. And then know that University of Chicago and other places have treatment for individuals in these high risk groups that we can connect you with quickly and hopefully keep your mild to moderate infection mild to moderate and keep you out of the hospital.

You know, we've heard some, in the news about some of the treatments that have been made available and a pill that was coming out. Can you talk to us a little bit about that and describe what that is and what it does?

Sure, there are several different treatments that are out there. One is, indeed, a pill. There's actually two different medications in pill form. One seems to be more effective than the other called Paxlovid. And it is available for adults who have, again these high risk conditions. We don't have as much of it out as we would like.

In the future, I suspect we'll be using a lot more of this to give people with early infections. There is another medication called remdesivir that we've been using in the hospital quite regularly that if you give, of course, very early on in the infection, again, it can prevent progression. And then there also is a monoclonal antibody therapy that can be given as well.

Great. So we do have some more questions coming in from viewers. So let's try to get to those. This is an interesting one from Al. With mask mandates dropping in schools, for example, does that signal that the pandemic is coming to an end? If so, will the motivation to get vaccinated start to wane, which I think could be a bit of a problem? And either one of you can take that one.

The ruling that just came out of Southern Illinois around masking had more to do with the issue of who has domain over making the decisions rather than being related to the public health issue. And that's something that I think people may not understand. And so Al asked a very good question around this. But this did not come from our public health leadership within the state nor the governor. Dr. Bartlett.

I'd take a wild guess our public health leadership would like to see masking continue, I would imagine.

I mean, ultimately, we would all like to be done with this, right? And I think that is it's true for me and my family as well. But just because we want it to be done doesn't mean that it's done. And when I think about the impact of the public health measures and the risk and benefit of masking in schools, the risk is very minimal and the benefit to our students and their vulnerable family members at home and our teachers in the school staff, the upside is just so great. And I really do hope that the vaccination hesitancy does not fall as we lose-- sorry.

Yeah, no, we're getting great questions from viewers, so keep them coming. Here's another one that I think is an important question. This is from Jade. How much confidence should folks have with rapid tests? You know, and should people be swabbing their throat as well as your nose?

And this has been-- there's been a lot of controversy about rapid tests. You know, from what I understand, if it tests positive, you are positive. But if it tests negative, maybe. So your thoughts on rapid tests and how good they are.

I think just that. They are often very useful if you have access to them, which hopefully is starting to increase a little bit since we can now get them from the government. But if you are symptomatic and you test positive, that's easy. You are positive. You have COVID.

If you test negative, you're correct that it could be too early in the disease or not enough virus there to test positive. So it's not as reassuring that you don't have the COVID illness if it's negative.

So this one is from Dale. Dale wants to know if not having a thymus as an adult affects efficacy of the vaccine and boosters. I don't know who wants to take that one.

So, certainly, there are parts of the immune system that don't work quite as well if you don't have a thymus. We talk a lot about how much antibody protection a vaccine gives you. And that is an important part of the immune response. But there are a lot of other parts to an immune response generated by a vaccine. And so we can't measure those as well. So I think that there is still good protection and absolutely would be vaccinated, but I think would also continue to be cautious and do the other measures to keep myself safe.

Sure. Can we talk a little bit about COVID vaccines and children? Because the ages have changed a little bit. We've seen that it's been opened up more and continues to. And I don't know if either one of you wants to tackle this one, but talk to us a little bit about COVID-19 vaccines for the children, what you're seeing coming, and kind of what you hope to see.

As the pediatrician, I will help out with this one.


So, yes, we do have a vaccination approval for children ages five and up. You know, in Chicago, we're doing a little bit better in terms of our rates compared with other parts of the country. But we're still at about one-third of kids in that age range are vaccinated, which, again is significantly less than we would like. There's been a lot of controversy of late and buzz about what to do with this six-month-old to five-year-old group. The initial very low dose that was chosen for the Pfizer vaccine didn't look like it gave a great antibody response.

And there's work to make this into a three-dose series. And then there was a bunch of press about how we're going to go ahead and maybe get authorization for our two-dose series anyway. And I think people are finding that confusing, what happened, what's new, what's different?

And I think a couple of things are at play and we'll know more Friday when it gets presented to the FDA. One thing is this being a three dose series for kids is not surprising. It's frankly a three-dose series for us. We just talked about how important it was to get your two doses and your booster.

Every other vaccine we give little kids, their tetanus shots and their polio vaccines are all multiple doses. So this is not a surprise. And if it really is that third dose that makes a difference, the only way to get to the third dose is by giving doses one and two first.

I think we also are going to benefit from the real world experiment of the Omicron surge. When we were doing vaccine studies back in the fall, there was not much COVID around. And we had to use antibody response as our benchmark to see if this vaccine works. Well, in January, we've had a month of incredibly high rates of infections. And we can actually show the vaccine protected these kids against infection. So I'm really excited for that six month to four-year-old age group to finally get some protection, give their parents some peace of mind. Because it's been such a stressful time for those parents.

Tim, if I could just add one thing--


--about that rate of one-third of children being vaccinated within the Chicago area, to remember that for particularly for the Latinx and the African-American communities, that those rates are significantly lower than one-third. And so the question of having a reservoir of infection that can infect other members of the family is also something that's very important to know.

Dr. Miller, can you talk to us a little bit about what you've seen with patients as far as the long-- we've heard about long haulers and the long haul symptoms that people seem to have. And what can we do to help folks like that?

Well, one of the things that we have at University of Chicago is that we actually have a clinic where people who have Long Haul COVID syndrome are being seen, not just by adult general internist like myself, but also specialty physicians as well. In terms of what I've seen clinically for patients that have Long Haul COVID, I've seen people that have a lot of fatigue, exhaustion after doing just simple activities at home, rapid heart rates associated with it.

And also for some of my older patients, I've noticed changes in their mental status, and that people who are in their 60s and 70s suddenly having difficulty with remembering things and a few signs and symptoms that might indicate that they may be having some problems with what's called mild cognitive impairment, which is the step that can come before someone develops dementia. So, again, these are symptoms that I've observed in some of my clinic patients.

Have we seen much as far as depression?

For some patients, yes, I've seen depression as well.

So, you know, that's the terrible thing-- I, mean lots of terrible things about this disease-- but that's one of them is just these cognitive effects that you just described that I don't think probably most people saw coming, I would imagine.

I think you're right. I think that there are a lot of unknowns. Is Long COVID permanent? You know, it's too soon to tell. Is it going to be more common with the Omicron variant? We don't know. It's too soon to tell. And I think that we were appropriately focused on acute COVID right away, right? And now we are seeing significant impacts outside of just the acute infection.

Another question from a viewer. And this is from Amelia who wonders-- wants to talk about cloth masks. There's a lot of debate on cloth versus paper masks and different mask types. A lot of folks say that the cloth masks don't work as well. So her question is, why do we continue to use them?

So something's better than nothing, one. But there actually have been studies that have been done to look at the possibility of transmission using cloth versus three-layer surgical versus the N95, KN95, and another one that's called the 94 mask, depending upon where the masks are manufactured. I believe for a cloth mask, it's about two hours, is that right, Dr. Bartlett?

Yeah, I don't remember the details, but it is helpful.

But it's helpful. It's helpful. But in terms of having additional protection against transmission, better to have the three-layer surgical mask, but also the KN95s or the N95s that are being sold provide you with much longer and stronger protection.

And I think there is some question too even as to what the purpose is of the mask. Because it's really, it's twofold. It does afford you some protection, but-- and this is the way I've described it to folks before, I hope I'm right. If you go into surgery, the surgeons are wearing masks, not so much to protect them, but to protect you in case, you know, they cough or something like that. So if you're wearing a mask, you're protecting other people. And I think that's lost a lot of times.

I think it is. And I really think that is the major impact of masks. And that component of sort of protecting others around you, that's where a cloth mask that stops the droplets can be very effective. It's less effective at protecting yourself. And so, again, the mask that you wear is the best mask to wear. And a very poorly fitting surgical mask or a surgical mask that you're not wearing over your nose is not as good as a cloth mask that you're willing to wear.

Now the question from a viewer, this is from Sue. We discussed this a little bit earlier. But I think it's important enough that we probably could talk a little bit more about it. Do we need another booster after the third booster? And there is actually a difference between a booster and just another vaccine. So that's another area I think that sometimes people get a little confused. But I'll open that up to both of you.

Perhaps we are looking at the data of people who have been boosted, we're looking at reinfection rates to see if there's a need. And I think one of the countries that has been actually at the forefront of this that we look at their data quite closely is Israel in terms of how they have looked at both doing the third vaccination or the booster and whether or not there's need for a fourth one. And so, again, we're not only looking at data, but we're looking at data from around the world with this.

We touched on this a little bit earlier, Dr. Bartlett, but can you talk to us about a PCR test versus a rapid test and just the differences from a technical standpoint. Because clearly there are differences.

Sure, so a PCR test is actually looking for the genetic material, the RNA of the virus itself, generally in either your nose or your nasopharynx, which is just farther back in your nose. And the good things about that test is it can detect a really, really, really small amount of genetic material, which is helpful when you're trying to make the diagnosis. But we also know that once you have recovered from the virus and you're feeling better, some of that genetic material can stay behind and we can still detect it after weeks.

And it's not actually an infection that you could spread to somebody else. On the flip side, the rapid tests look for some of the virus particle protein itself. And you tend to need more of the virus there for the test to be positive, which is sometimes why it can-- we worry about the false negative tests.

Interesting. Dr. Miller, you talked a little bit about long hauler symptoms earlier. Can you tell us if there's a difference between Omicron versus other variants as far as the long hauler symptoms?

We actually don't know yet whether or not there will be more people who have long hauler symptoms versus not. And also sometimes people who have quote, unquote, "mild" infections with COVID actually go on to have long hauler symptoms. And so the data is still out on that and we're continuing to follow people over time.

And I imagine this is something that for years to come we'll probably see impacts and do studies. So what is different for people who test positive versus people who are vaccinated? Because, again, I think that's an area where people say, well, I got it, I got better, I don't need the vaccine.

So, again, the vaccine is meant to protect you against getting a severe infection or ending up in the hospital or, in the case of children, it protects you against MIS-C or the Multisystem Inflammatory Syndrome that you can get after a COVID infection. And so people with COVID, even though they've been vaccinated, are much less likely to get very ill. They can still transmit it to other people. So they need to be careful and, you know, do their appropriate isolation. But that it really is the individual protection against severe illness that we're looking for.

Dr. Miller, we're about out of time, but I think this is important. So if you can give us some advice to parents and families that have hesitancy when it comes to the vaccine, what would you tell them?

It's safe. It's effective. And it's a way to not only protect yourself, but also to protect the loved ones and your family by getting vaccinated.

And Dr. Bartlett, any closing thoughts for us?

I think that that's so true. It has been discouraging to see the amount of, frankly, selfishness going on. There are individual components to this pandemic. And there are public health and community components to this pandemic. And so I think we need to continue to focus on how we can all benefit the community health as well.

Are we getting closer, do you think, to being done?

I think we'd be even closer if we had more people wearing masks and more people vaccinated.

All right, so there's good advice right there. Wear your mask. Get vaccinated. It's certainly something we should all do. And, again, and I've said this many times, I know that you as physicians, the two of you, know how important this is and believe in it. You've done it yourselves.

You've both been vaccinated. I've been vaccinated. And you've certainly had your family members vaccinated. So if folks think that there is something going on that they shouldn't do it, there's a pretty good proof because I've seen plenty of physicians in our hospital, I witnessed it with my own eyes, get the vaccine. So I think that should be pretty good pretty good news and encourage people to do that.

We are out of time. Thanks both of you for being on. You were fantastic, as always. Big thank you to those of you who participated in the program. Very good questions today. Please remember to check out our Facebook page for a schedule of programs coming up in the future. To make an appointment, you can go to or call 888-824-0200. Thanks again for being with us today and hope everyone has a great week.

UChicago Medicine pediatric infectious diseases expert Dr. Allison Bartlett and community health expert and physician Dr. Doriane C. Miller discuss the latest COVID-19 news, including variants and getting vaccinated. 

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