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Nancy Solomon: It's The Brian Lehrer Show on WNYC. I'm Nancy Solomon from the WNYC and Gothamist Newsroom, filling in for Brian today. The Biden administration is starting to work toward booster shots for fully vaccinated folks, even while too many people still need their first dose. The FDA just gave the Pfizer vaccine its full approval, which could lead to more mandates and more acceptance of the vaccine safety. Maybe it's just in time with the Delta variant cases swamping some hospital systems. It's a good moment to look at what we know and what we don't know about the vaccines, immunity, and variants. We bring you the segment we like to call Ask a Virologist.

Joining us now is Brianne Barker, an immunologist, oh, man, they're killing me here, and virologist who is an associate professor of biology at Drew University in Madison, New Jersey, and a co-host of the podcast, This Week in Virology. Welcome back to the program, Professor Barker.

Professor Brianne Barker: Thank you. It's great to be here.

Nancy: I think you're going to have to help me with that word. I cannot say it. Virology.

Professor Barker: Virology.

Nancy: Geez, it's the R. See, I'm from Massachusetts, I don't do Rs. Listeners, you can tweet @BrianLehrer or call 646-435-7280 with your questions about the COVID vaccines, the current risk, how to be safe. 646-435-7280. Professor Barker, I think the news out of Israel has been daunting, that they got more people vaccinated sooner than anyone else and they have a healthcare system that allows data to be tracked. They're seeing a lot of post-vaccination or what's called breakthrough cases of COVID. Are you following that?

Professor Barker: I am and I think that it's very important that we look closely at what the data from Israel say. Right now, the data from Israel say that there are increasing numbers of people who are getting infected with the virus, SARS-CoV-2. However, the vaccine is still preventing more than 90% of severe disease cases. There's a bit of a difference between whether or not people are getting infected and whether they are having severe disease. That's what we saw in the trials and that's what we would expect from a vaccine like this. Yes, we are seeing more infections, but those infections are not sending people to the hospital.

Nancy: What are the current plans behind getting booster shots here?

Professor Barker: Part of the reason why we thought a little bit about booster shots is that if individuals are infected, even if they don't get severely ill, they may be able to transmit the virus to others. Given that we have a large proportion of individuals who are not yet vaccinated, we need to block that transmission. There is this idea that boosters may be needed to improve immune responses so that we can stop infection and stop transmission altogether.

Nancy: Is it possible to say what might have been if more people had immediately gone and gotten vaccinated?

Professor Barker: One can come up with some models for what might have happened. If perhaps over 90% of individuals had been vaccinated, we may have been able to really block transmission altogether, but at this point, that's not where we are. We have to be looking at the data that we have, not the data that we'd like.

Nancy: Yes, but some of us want to complain, myself included.

Professor Barker: Believe me, I understand.

Nancy: One thing that I've seen that's a caveat to the Israeli data is that the first people to be immunized were those whose immune systems might not have worked as well because that was the priority here and there as well. Is it possible that this eight-month figure is not a general rule, that what we're seeing are the most vulnerable of our population are the ones who's got the vaccine first and so it's waning for them?

Professor Barker: Absolutely. A lot of the immunology data on this vaccine indicates that the immune responses elicited by the vaccine are fantastic and should last for a long time. There's data showing that they are quite persistent out to six months following vaccination. We really worry about this the most in those immunocompromised individuals who have been shown to have a reduced response to this vaccine and in older individuals where the data is a little less clear, but it suggests that we may have less of an immune response.

Nancy: You're listening to The Brian Lehrer Show on WNYC. I'm Nancy Solomon, and we're taking your calls on COVID with Brianne Barker of Drew University. You can tweet @BrianLehrer or call us at 646-435-7280. Brianne, is virus fatigue something that you look at in your lab?

Professor Barker: My lab looks at the immune response to the virus and in some ways, we can think about the fatigue of the immune response. However, I think that if we think about how we, as a population, are responding to this pandemic, we can all see a lot of fatigue. It's been hard to make all of these changes in our lives for such a long time.

Nancy: Okay, let's go to the calls. We have Malcolm in Tenafly. You have a question, Malcolm?

Malcolm: Hi. I'm an 81-year-old man, immunocompromised. My first two shots were Moderna, and then when I went to have the booster shot, they gave me a Pfizer booster. I wonder if it's a problem in mixing and matching in that way.

Nancy: Good question.

Professor Barker: That's a great question. The Moderna and the Pfizer vaccines are very, very similar in terms of the composition and the way that they work. I would not imagine that there would be any particular problem. I have not seen specific data on that, but my intuition based on how those vaccines work is that there would not be a problem with that mixing and matching.

Nancy: Okay, let's go to Charles in Brooklyn. Charles, you're on the air.

Charles: Hi, thank you. I had my first shot, I guess, five and a half months ago now, had severe headaches that lasted almost three and a half or four months. Needless to say, I did not go back for the second shot. Do I have to start over now that it's been five and a half months or can I just go and get the second shot?

Professor Barker: Hi, Charles. I'm really sorry to hear that you had those effects. You don't have to start over. You would be able to go and get a second shot to become fully vaccinated.

Nancy: I'm actually surprised to hear you say that, Brianne, because there was so much stress put on coming back within a certain amount of time to get your second shot after the first one. Why is that?

Professor Barker: Sure. We know that the second shot dramatically improves the immune response compared to having just one shot and we wanted people to be at that high level of immunity as quickly as possible. There was a lot of focus on making sure people got their two shots as early as they could so that they were fully vaccinated at that point.

Nancy: Less effectiveness is better than none?

Professor Barker: Exactly.

Nancy Solomon: Okay, let's stick with the callers. Steven in Kingsbridge Heights in the Bronx.

Steven: How are you? Hi, I'm a listener, Brianne, of the TWiV. What I've been wanting to ask you though, is it true that the early viral replication involves goblet cells in the nose, the same cells that produce mucus? If that's the case, is it an issue that the IgA antibodies, the mucosal antibodies are not exactly your first responders?

Professor Barker: That's a great question.

Nancy: Totally over my head.

Professor Barker: I'm excited to think about that, given that I'm right now thinking about my immunology class as well. We have a few different types of antibodies. All of our antibodies aren't the same. The listener here has mentioned a type of antibody called IgA, which is one of those subtypes of antibodies. IgA is really good at protecting you in mucosal sites like the nose, but as he correctly points out, IgA is not usually the first antibody type that is made in a response. That actually may be part of why a second shot and then further on, a third shot and a booster is important so that we can help switch our immune response to a response that involves more IgA production.

I think that you're exactly on the right track here. It's a little bit harder to make a mucosal immune response including IgA than more of a systemic response, which is what protects you from disease. This may be related to why we have infection in some cases because we don't have that IgA, but we are protected from disease because of the other types of antibodies.

Steven: Can I try to do one more?

Nancy: Oh, sure. Go ahead.

Steven: Oh, okay. Tregs, the sorts of T cells that do the regulation, given that severe disease seems to be driven by a dysregulated immune response even after the virus has been largely cleared from the body, who's doing research on the role of the regulatory T cells, the cells that are supposed to be modulating the immune response?

Professor Barker: That's a great question. Tregs are really important for helping to control other cells of the immune system. In some of the large-scale studies of the immune response, I have not seen data that indicates Tregs playing a role as you mentioned. However, I think that we really need to study that more. It's a great hypothesis and I would love to see the data on that.

Nancy: We have a question that came in via Twitter from Carol who asks, "I am soon due for COVID booster. I also need a seasonal flu shot. What is the timing you would recommend? Flu shot first then booster? Vice versa? What's the recommended lag time between the two?"

Professor Barker: The CDC will have some guidance on this with their recommendation. In the first round of getting vaccinations, they often recommended about a two-week interval between two different vaccines. Given that the FDA recommendation for boosters is still ongoing, I don't know that they have any official recommendation on that yet, but I would assume it would probably be a two-week window, which may be a little bit flexible.

Nancy: Getting to questions of safety for a moment and how to protect oneself against the Delta variant and getting a breakthrough infection if you're vaccinated, where do we stand right now, particularly, for our listeners here in the New York-New Jersey-Connecticut region? Is it safe to eat indoors at a restaurant if you're vaccinated? Is it safe to go to a party indoors with your friends? What's the current situation on unmasking and being inside with other people even if they're vaccinated?

Professor Barker: I think that this really depends on your community's current infection numbers. Right now, there is this recommendation from the CDC that if transmission in your area is high or substantial, then you should be wearing masks indoors. If you are in a community where there are over, I believe it's 50 per 100,000 cases, you should be wearing a mask indoors. Right now, every-

Nancy: I'm sorry. Community speaks to your town, your neighborhood? How would you do that?

Professor Barker: -that is really where things become difficult. Right now, the CDC is making those calls based on county, but we know that vaccine levels and virus spread levels vary in smaller locations than that. You would want to know more about the specific area that you are in. You're right. It's a really difficult thing to parse.

Nancy: Okay, let's go back to the phones. We have Robert in Manhattan. Robert, your question? I might have thrown this at the producer to-

Robert: Wonderful. Thank you so much for letting me speak here. I'm calling because I'm really concerned about side effects as a result of the vaccine. About 1/4 of my friends are having some really difficult problems now. I have one friend, he got COVID after he took the vaccines. Then he was in the hospital for over three weeks and he didn't think he was going to make it out. Fortunately, he got out. Now, he has to go back and forth to the doctor. He's got ongoing problems. Another friend of mine, she took the vaccine. She can almost not walk anymore now and she says now, it's traveling to other parts of her body.

Then another friend of mine, she said, "Robert, I don't know what happened. I took the vaccine. My left leg feels like a truck drove over," and she thought maybe she had blood clots. They tested her and they said, "No, there's no blood clots," and they said, "We're sorry, I don't know what we could do for you." They said, "There's nothing we can do for you."

Nancy: -Robert, are you vaccinated?

Robert: What are the issues in the vaccines?

Nancy: Brianne?

Professor Barker: Sure. I'm sorry to hear about all of your friends having those issues. There have been a huge number of people vaccinated. The last I remember was that there were about 161 million vaccine doses that have been given. There are rare reports like this. I, unfortunately, am not a physician and non-MD so I can't speak to your friends' specific cases. In the large-scale trials, there have been side effects reported only extremely rarely, and those have mostly been arm pain or fever or things like that. I would certainly say that individuals would want to talk to their personal physicians to determine what's going on with any of those others. I have not seen reports of side effects like you've mentioned.

Nancy: Brianne, is there any data at all about the most severe end of the side effects spectrum? What kind of number are we talking about if it's known in terms of a percentage?

Professor Barker: I think that in the data that are reported, it's a relatively low percentage of very severe side effects. If we start to think about things like arm pain, then we can get to maybe a quarter of individuals, but that is not always reported so it's hard to say.

Nancy: We're going to go to a call. We have Margo in Manhattan. You're on the line.

Margo: Thank you for taking my call. I would like to know about what would be a safe protocol in a situation where w`e have a choir. We're all fully vaccinated. We would like to sing unmasked, socially distanced, and we're all planning to have PCR tests. We'll be singing together on and off over a period of 17 days, and it will be-- Well, actually, six or seven different times. How often should we be taking PCR tests? How soon before we will be singing? We do have some people who are teaching adults in person.

Given the Delta variant, how much of a-- This is somewhat of a separate question. Well, it's a related question, but I am still unclear as to how much of a viral load someone who's fully vaccinated can carry when they're asymptomatic or might carry. Do we know that?

Professor Barker: I think that your question about what kind of viral load someone might carry is a great question and it's something that scientists are still working out. There have been some recent reports that indicate that while people will have virus in their respiratory tract that can be detected by PCR, that virus is not able to be cultured in cells, which, of course, is something that would be needed for that virus to spread.

I think that it's a little bit difficult to answer your question about how frequently you should be testing because I don't know things like how frequently you all will be in contact with others outside of your group, your community transmission levels, or some of the other levels of risk, do you have young children at home, things like that. Those would all be things that you might want to consider. I would say that perhaps, we usually think about transmission happening within maybe three days following having a detectable viral load. You could use that to start thinking about the timing of your testing.

However, give without knowing all of those other parameters, it would be a little bit of a challenge to answer that question.

Nancy: Thanks for your call, Margo. We're going to stick with more questions from callers. We have Robert in Atlantic Highlands in New Jersey. You're on the line.

Robert: Hello. Thanks for taking my call. Here's my situation. February, I get COVID, but the test shows negative. Three days later, I get the Moderna vaccine. I'm sick as a dog and I go when I get the test. I'd recover after about six weeks. Six months ago, this was last week, I get tested for antibodies and they're present. My doctor says, "Well, don't worry about it." My question is that I am excluded from certain venues because am I "fully vaccinated two shots?" No. However, I'm probably as good as anybody who has had two shots. My question is where do I stand, first of all, and second of all, is the booster shot just the name booster and it's actually just the third shot of the same old thing? Thank you.

Professor Barker: Sure. To answer your second question first, yes, the booster shot is just the third shot. That is the same as the first two. It's really a third shot of the same thing. You've been shown to have antibodies based on this test that you've done with your doctor, but it's probably not clear how those antibodies are going to last long-term given that they've come from infection and then vaccination. There is some fantastic data showing that people who have been infected and then vaccinated, and by which I mean fully vaccinated, receiving two shots, have a tremendous immune response, really a super high immune response.

You certainly don't have the highest immune response that you could have, and that data could be important for allowing you to get into those types of venues. I would say that becoming fully vaccinated would really allow you to have a spectacular immune response.

Nancy: Okay. Thanks for your call, Robert. I'm not sure if this is outside your area of expertise, but what does it mean that the FDA has fully licensed the Pfizer vaccine? Have they been reviewing data all this time and what can we glean from that announcement today?

Professor Barker: Sure. Really, what it means is that they have received data that Pfizer has been collecting over time. Pfizer collected a large amount of data. They have been able to follow up with individuals who were vaccinated for a longer period of time, and they've been able to look at more people and they presented those data to the FDA who's able to make this full approval based on that larger amount of data.

You can look at some aspects of those data and compare to the original approval. For example, with the shorter period of time and the smaller number of people, there was that 95% effectiveness at preventing disease. Now that they have been able to wait longer and look for disease in those people as well as to look in more people, they've come up with 91% effectiveness. It's really about the timing of follow-up as well as the number of people.

Nancy: Now, if listeners want to hear more, you're scheduled to participate in a virtual town hall that the American Society for Virology-

Professor Barker: Hey, I finally did it, actually.

Nancy: -is conducting. You'll be there on Thursday to answer people's vaccine questions. How can people register?

Professor Barker: Sure. If people go to asv.org/education, they can register for the town hall. This town hall, like all of the ASV town halls, are times where virologists are volunteering some of our time to answer questions over Zoom for anyone who'd like to ask questions and that's a free opportunity. I'd love to hear your questions there.

Nancy: Oh, very cool indeed. Thank you to everyone who called in for your questions about vaccines and, of course, to our guest, Brianne Barker, an immunologist and virologist who is an associate professor of biology at Drew University in Madison, New Jersey and co-host of the podcast aforementioned by one of our questioners as TWiV, This Week in Virology.

Professor Barker: Thank you so much. Thank you. It was wonderful to be here.

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