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Norwegian Cruise Line, Oceania Cruises and Regent Seven Seas hosted a virtual chat with Dr. Scott Gottlieb, the former FDA commissioner and chairman of the Sail Safe Global Health & Wellness Council, where he discussed his outlook on COVID-19 and its future impact on society as a whole as well as travel.

Before the discussion started, Frank del Rio, president and CEO of Norwegian Cruise Line Holidngs, said that as of March 1, kids 12 and under will be allowed to sail regardless of vaccination status with Norwegian. In addition, he said, by mid-May all of the crew will be boosted as well. “Society is inching its way back to normal,” said Del Rio.

During the virtual conversation, Dr. Gottlieb expressed his viewpoints on the future of travel and dealing with the COVID-19 pandemic as infection numbers begin to dwindle.

Gottlieb noted that we are starting to see a decline in cases across the country and a rapid change in policy when it comes to government lifting things like masks requirements in places such as schools and public settings.

“I think that’s going to continue. You’re going to see a rapid acceleration in withdrawing a lot of the measures that we had in place to try to deal with the epidemic peaks. Right now we are at about 19 cases per 100,000 people, per day. Typically the metric that you use in terms of assessing prevalence is how many cases per 100,000 people per day, and anything below 10 is historically what’s perceived as very low level prevalence—we’re not quite there yet, but we’re also in a different environment right now where we have a variant that’s far more contagious, Omicron. We have a population that has far more immunity against COVID. And, we’re doing a lot more testing. We’re probably going to pick up more infections, and those infections are going to be less consequential as a whole, than what it was last year, or two years ago,” said Gottlieb. He expects that by the end of this month (March) we’ll be at 10 cases per 100,000 people per day.

“I think that’s going to feel pretty normal around most parts of the country. You’re going to start seeing people going back to restaurants, kids going to schools without masks, which they are starting to do now in most parts of the country. And it’s going to feel pretty normal again, which is good because I don’t think we’ve felt normal for a long time now,” he says.

In terms of the trajectory and whether something is going to come along and wreck this outlook, “I think it’s becoming less and less likely that we’re going to see these successive waves of infections from new variants. That’s because we’ve seen a pretty large degree of the genetic diversity of this virus and the repertoire of this virus and how it can mutate in ways to become more contagious and evade the immunity that we’ve acquired. It doesn’t mean that you can’t get a variant that comes along that creates another wave or infection, but I think that’s the tail risk—the unlikely scenario. The far more likely scenario, I believe, is that Omicron becomes the dominant variant, that Omicron will continue to evolve and we’ll have to update our vaccines over time like we do for the flu and be vigilant when we get into peak respiratory seasons,” he said. “But, this will evolve into a more seasonal virus and its overall impact on society will start to diminish as a result of higher degrees of immunity that we’ve all acquired, more therapeutics, and just more awareness in general. I think we’re going to be more careful around the risk of respiratory diseases, particularly in the wintertime when these things are more likely to spread. I think we’re likely to have a pretty quiet spring and summer. I think it’ll be very low prevalence, people are going to be looking to get back to doing things that they enjoy and feel relatively comfortable doing it.”

Adding that, “Most people are vaccinated; a lot of people have been infected. A lot of people have been infected and vaccinated. So people have a higher degree of immunity at this point and are pretty well protected from bad outcomes.”

Testing might be come less enforced as restrictions are lessened.

When asked about the new variant, BA2, causing a similar situation like Omicron did in the winter, he said that, “We’ve had such a high level of infection with Omicron here in the U.S., so many people have immunity against Omicron, and that immunity is going to be durable and protective against BA2.”

He added that, “We are probably at about 50 percent of the population that has been infected with Omicron—maybe more than that at this point if you look at some of the estimates. It’s just too many people with immunity against Omicron generally for BA2 to really create a surge or infection.

“The risk to the future is the unknown. That there is something out there somewhere that’s going to emerge with time and it’s going to be highly contagious and will be able to pierce the immunity that we’ve acquired and create another wave of infection. That is the tail risk; anything is possible. But the reason I think that is less likely is because we have so much immunity at this point. We’ve been vaccinated, we’ve been infected with Delta, we’ve been infected with Omicron, and so we’ve seen a very broad range of what this virus can do. And eventually this virus is going to slow down its ability to mutate. It’s going to slow down ways to evade our immune system. It becomes less likely that something can come along and race through the population and pierce through that big, tall wall of immunity that we have and create another big wave of infection. Not impossible, but I don’t think it’s the base case anymore. I think we will see low prevalence through the spring and summer. This will start to re-emerge in the fall and winter because it’s a respiratory pathogen, but we are going to be in a much better position to deal with it. We not only have vaccines widely distributed, we have much more immunity against it, and we also have widely accessible therapeutics. The therapeutics are going to be a big part of this story. They haven’t been to date because we’ve always had limited supply, but we’re not going to be in a situation where we have limited supply in the future. These are going to be readily accessible—the oral drugs as well as the antibody drugs.”

Changing Restrictions

The evolution of restrictions is making it easier for people to travel. When asked how they will continue to evolve in the future, Gottlieb said, “I think that these restrictions are going to be lifted as we get into the spring and summertime. I think you’ll see requirements to get tested for traveling into the U.S. from Europe get lifted, I think you’ll see requirements for masking in public transportation get lifted.”

He noted that the CDC is now using a new measure of risk and prevalence when assessing the risk of COVID infection. “They’re now not only looking at number of cases, but impact and specifically hospitalizations. As they look at impact, if you believe my thesis that COVID will have less impact on society overtime because we’ll be better able to deal with it, you’re going to see less hospitalizations. If that’s what the CDC is looking for, to make decisions around implementing public health guidance, and mask requirements, you’re not going to get to the levels of hospitalizations you were before. So you’re less likely to get these kinds of mandates be put back in place. But next winter, when you have peak Omicron season and peak flu season, at some point there’ll be mask ordinances put in place in cities where there’s high prevalence—I think that’s the regime we’re moving to. Where these will be used as temporary tools to deal with the peaks of epidemics and not become things put in place in perpetuity and kept in place too long. We were quick to turn them on, but we were very slow to them them off. “

He also says that he expects there to be an announcement from the administration by March 18 regarding new procedures.

“My expectation would be that they’re going to extend that [the mask mandate], but it’s going to be a time definite. I think they’re going to wait until the whole country is green. Right now about 77 percent of the country is in that low prevalence range, but I think it’ll probably be the end of April before you start to see the whole country get to 10 cases per 100,000 people per day. All the modeling suggests that we’ll be there by the end of March.”

Some travelers might opt to continue to wear masks, even when the mandate is lifted.

Masking Mandates, Therapeutics & Isolation

When it comes to masking, he noted that, “A lot of people want these mandates to be lifted; some people don’t. Some people feel safe in these environments wearing masks, but you can still afford yourself a high degree of safety through masking as an individual if you’re wearing a high-quality mask. I think we’ve gotten to the point in our society where if you’re the sole person wearing a mask on a plane, no one looks at you strangely anymore. Masks have become normalized. I think you’re still going to see a lot of people in environments where masks aren’t required still wearing masks because people feel more comfortable wearing masks now, especially when we get into the colder months.”

He also added that supply for therapeutics is increasing, and that by the time we’re in April, he expects it’ll be readily available. So, if you get diagnosed with COVID, and you want to access to this therapeutic or the monoclonal antibodies, you will have access to it.

Gottlieb noted that supply was short last winter because the therapeutics were new and we were in high peak season of COVID infection at that point. “We’ve never seen an infection infect 50 percent of the population in two months. That’s what happened with Omicron,” he added.

“The Biden administration is trying to maintain a long-term supply of these therapeutics. I don’t think we’ll be caught in a situation where we don’t have tests available; we don’t have drugs available again. Unless we are once again in a situation where the tests or the drugs don’t work, but I think that’s very unlikely,” Gottlieb adds.

Del Rio then asked if there’s a real vaccine in the works that prevents you from getting COVID, rather than a vaccine that just reduces symptoms and severity. Gottlieb referred to the flu vaccine, which works in the same manner by reducing symptoms, but says that the flu vaccine doesn’t even work as well as the COVID vaccine. “The COVID vaccine, particularly for someone who’s had a booster, affords you a pretty high degree of protection. The rule of thumb is that the vaccine affords you protection that is 40-60-80 and maybe a little bit better than 80. What that means is if you’ve had the booster, and you’re within six months of the booster, you have 40 percent protection against infection, 60 percent protection against symptomatic disease, and probably 85-90 protection against severe disease and hospitalization.”

He added that what we’ve come to learn is that the amount of protection it’s affording is a lot less than what it was doing at the outset. “In the beginning when we were dealing with the Alpha variant, the vaccine was like 90 percent protective to infection. So it became a tool not just to prevent people from getting sick, but to actually prevent spread. It’s no longer as effective as a tool for preventing any spread, but it’s still a tool for preventing severe disease,” says Gottlieb.

He noted that there are companies currently working on new vaccines, including Pfizer, which will have data on a specific Omicron-focused vaccine in March. The companies are also working on vaccines that weigh over time, meaning their effects would last for longer periods of time.

Finally, when it comes to quarantining and having to isolate, Gottlieb said that over time those requirements will be reduced and might become like the flu, where there’s an expectation that if you’re diagnosed, you stay home and avoid infecting other people. But it’s not going to be something that’s imposed by a public health ordinance. “I also think there will be less mandatory testing. So less people will be caught in an isolation or quarantine situation,” he added.

“I think this will become more like the flu, and we’ll deal with it that way,” Gottlieb said. “A lot of this is going to be expectations put on people, rather than rules put in place by governance.”

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