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Brian Lehrer: It's The Brian Lehrer Show on WNYC, good morning again, everyone. Over the last week in the United States, an average of 878 Americans a day have died of coronavirus. That's up from 838 deaths a day the week before. By comparison, the five Western European countries we're most closely associated with averaged 118 deaths a day over the last week. That's the UK, France, Spain, Italy, and Germany, with about the same total population as the US.

About 100 deaths a day there, about 800 here, up 40 deaths a day from the week before in this country. The US will hit 200,000 coronavirus deaths sometime in the next few days. Despite that, President Trump yesterday publicly disagreed with the director of the Centers for Disease Control about the centrality of wearing masks to get the virus under control. Here's Dr. Robert Redfield, head of the CDC.

Dr. Robert Redfield: We have clear scientific evidence they work and they are our best defense. I might even go so far as to say that this face mask is more guaranteed to protect me against COVID than when I take a COVID vaccine because the immunogenicity may be 70%. If I don't get an immune response, the vaccine's not going to protect me, this facemask will.

Brian Lehrer: Here's the President.

Donald Trump: When I called up Robert today, I said to him, "What's with the mask?" He said, "I think I answered that question incorrectly. I think maybe he misunderstood it."

Brian Lehrer: One reason that Dr. Redfield is stressing masks is that realistically he says and he indicated it in that clip, vaccines won't be available or make a dent on a widespread basis until well into next year and they may only be 50-60% effective, a statement for which the President says the head of the CDC was confused.

Donald Trump: When we go, we go. We're not looking to say, "Gee, in six months, we're going to start giving it to the general public." No, we want to go immediately. No, it was an incorrect statement. I saw the statement, I called him, I said, "What did you mean by that?" I think he just made a mistake, he just made a mistake. I think he misunderstood the question probably.

Brian Lehrer: Don't believe the science in front of your eyes, believe me instead. That was consistent with an earlier appearance this week, in which the President said in a blanket way, that science doesn't know science as well as he does. This was about global warming.

Donald Trump: It'll start getting cooler. You just watch.

Wade Crowfoot: I wish science agreed with you.

Donald Trump: I don't think science knows, actually.

Brian Lehrer: Fact check, the Earth has been getting warmer year by year. The President says it's going to start getting cooler with a very cold amount of evidence, absolute zero. In that context and in the context of all this disinformation competing with actual information, local governments and private institutions all over the country continue to try to muddle through difficult decisions about how much to resume indoor schools. We just heard New York City's delay once again, indoor dining, sporting events, and more.

Maybe you heard the Big Ten college sports conference reversed its early decision and will now play college football this fall. Many of the schools with in-person attendance allowed for fans. Major League Baseball announced that the World Series to be played in Dallas next month will also allow fans in the seats to some degree, how safe is that? How safe is the protest you may have gone to? How safe is that Trump rally you may have gone to?

Let's talk about all of this with Dr. Leana Wen, former Baltimore City Health Commissioner, now teaching at George Washington University and Washington Post columnist. Her latest column argues, "Trump rallies have higher COVID risks than most protests." Always good to have you on Dr. Wen, welcome back to WNYC.

Dr. Leana Wen: Nice to join you again, Brian.

Brian Lehrer: I'll bite on your column to start off, people will accuse you of being motivated by political bias if you say Trump rallies are riskier than protests, so make your case.

Dr. Leana Wen: This is not about politics, but about the science and the data. This is why I wanted to write this column because every time I and other public health experts talk about the dangers of Trump political rallies, we're accused of hypocrisy. People will say, "Why aren't you talking about protests?" Here is the science and the truth, that the virus itself does not discriminate. It doesn't care why it is that people are gathering.

In this case, the reason why Trump rallies are more dangerous when it comes to COVID-19 risk, it's not about the politics of the gathering or the politics of the participants, but it's rather about the behavior of those attending. Consider that many of these rallies are indoors, rather than the protest being outdoors. We know that outdoors versus indoors reduces risk of transmission by 18 to 19 times.

We also know that many of these protests people are wearing masks, not everyone, but many people are wearing masks as opposed to these political rallies where masks are seen as some cultural symbol and are mocked openly and so people are not wearing masks. We also know that universal mask-wearing will reduce the rate of transmission by 80%.

In addition, you can imagine that for people who are mocking masks and physical distancing, they're also unlikely to be abiding by other harm-reduction practices. For example, people attending protests are being told that they should try to keep physical distancing as much as possible.

You and I have talked on this show about also the importance of when you go back, if you are attending a protest to also self-quarantine and then to get tested. Those are unlikely to be the behavior of people attending Trump political rallies. I think the key difference here is that many people are going to protest in spite of the risk, as opposed to going to political rallies, often in defiance of that same risk.

Brian Lehrer: Though, I wonder how many people who attended protests actually then quarantined themselves for five days. That got me wondering, your column cites a stat about there being no coronavirus spikes from the protests of this summer, so that's pretty strong proof on that front, but have there have been any documented spikes or clusters from Trump rallies either? For example, when he held his convention speech with an in-person audience close together and many not wearing masks, people expressed concern, but it's been a few weeks now and I haven't heard of it being a spreader event.

Dr. Leana Wen: I think part of the issue is that data has been lacking throughout this pandemic response. It is also hard to trace back to a particular event, in particular, because people are coming from all over the country. I think it also needs to be said, it's not just what happens during the event itself, it's also people are coming from all over, they may also be going to indoor bars and restaurants and other gatherings around too, and then disperse into different parts of the country.

I do think it's important for us to get the data, but in the meantime, I wrote this column to dispel this common talking point, if you will, that many people have of saying, "Hey, public health, what's wrong with you all? Why are you only calling out Trump political rallies?"

Actually, I think from a purely epidemiological perspective, we shouldn't be having mass gatherings of any kind during a pandemic, but if you are going to a gathering for whatever your reason is, you need to take the right precautions when it comes to protecting yourselves and others and that is the key difference between what's going on at these political rallies, where people are defying the precautions as opposed to people going to protests and trying their best to protect themselves, their loved ones and their community members.

Brian Lehrer: You said, from an epidemiological standpoint, we shouldn't be having mass gatherings of any kind, but is the evidence from at least the protests and maybe outdoor Trump events too, I'm not sure, that being outdoors is incredibly protective, under almost any circumstances, or would that be drawing too much of a conclusion?

Dr. Leana Wen: I don't think it would be fair to say that outdoors are fully protective, it certainly is much preferred over indoors, and especially now that we know about aerosol transmission, that diffusion of the virus particles by outdoor air is really helpful. This paper by the National Bureau of Economic Research looked at patterns of spread in over 300 major cities and they found that there wasn't a surge that followed the onset of Black Lives Matter protests.

Again, we don't know yet about other gatherings, the Sturgis Motorcycle Rally did have clusters that resulted from it, but again, I don't think it's so much what happened necessarily outdoors, it's all the other things that occurred at the same time. These individuals that are coming from all over are probably also going to bars and other gatherings, and those events might be where even more of the risk is accrued.

Brian Lehrer: Listeners, we can take coronavirus questions of any kind, really, on what we've just been talking about specifically or other coronavirus in the news type things. For Dr. Leana Wen, 646-435-7280 or you can tweet a question @BrianLehrer, 646-435-7280 the phone number again. What about sporting events then? Dr. Leana Wen, do you have an opinion about the COVID safety of college football?

Dr. Leana Wen: I think that some sporting events may be okay. The bubbles, for example, that are being created by the NBA, where individuals are tested very frequently and are kept really in this isolated bubble, we're going to see if that is something that will work. I do have concerns about college sports. It is just by definition of being college sports versus professional sports, the type of choice that people are making is very different.

If the testing is not readily available, and in particular, if people are playing in places with active virals spread, I do have a lot of concerns about what that may do for the individuals involved as well as for the community members too.

I think there is still growing evidence and there's still a lot that we don't know about coronavirus. We don't know what the long-term effects will be. There is now accumulating evidence of how COVID-19 isn't just something that affects the respiratory system but it also affects, for example, the heart.

There have been studies looking at college athletes getting myocarditis, inflammation of their heart muscle, and we don't know how much that may contribute to long-term damage in these college athletes too. A lot that we don't know and we should be using an abundance of caution, in particular for people who don't have the full range of choice as professional athletes might.

Brian Lehrer: What about for spectators at outdoor sporting events? The ones that are doing it are limiting it to 20% of capacity, but that means, for example, around 13,000 people were permitted in a 65,000 seat stadium last week for a University of Miami home game. It's just 20% but then again, it's still 13,000 people in one Stadium. Is it safe?

Dr. Leana Wen: That's a lot of people and it is an area where virus is actively circulating. Again, I am concerned about the people coming from other places too. The individuals are not only coming from the city, they might be coming from rural parts, places where there is much less health care and public health infrastructure. They may be engaging in other events while they're there that are not as safe as sitting outdoors, and they may come back to their home communities and seed it further.

I think this is just one example though, Brian, about the larger picture that we're seeing, which is that we are removing restrictions far sooner than we should, frankly. We are at a very high baseline level of infection. We're coming into fall and winter, where there could be the twindemics of the convergence of flu and COVID-19. We're coming into a season where being outdoors is going to be much harder.

There are also many other respiratory pathogens that circulate in this period. I really worry that people are letting down their guard and our policies are not taking into account that we're starting off the season with a very high level of infection. I think people need to also understand the concept of cumulative risk, that risk is additive. I think often and I hear many people in my community saying this that, "Hey, kids are going back to school so it's fine for us to also have birthday parties and to also resume playdates."

Actually, it's quite the opposite. If we want for our students to be in school for in-person instruction, we need to cut out as many of these other activities as we can and prioritize the things that we have to do. Think about this, if you will, as a coronavirus budget, but you only have a limited budget as individuals, a limited budget as a society, so we need to be prioritizing those activities that we really need and not do these other things. I just don't think that we've been conceptualizing risk in this way.

Brian Lehrer: Let's take a phone call. Myart in Manhattan, you're on WNYC. Hi, Myart.

Myart: Good morning. Great show. Dr. Wen, Dr. William Haseltine, very renowned doctors explain two points. He explained that you cannot always get a vaccine against certain viruses. I think he mentioned MERS and SARS not so much extensively. The second point he made was that 20% of your population cannot benefit or get a vaccine and he particularly mentioned the elderly.

For some reason as we get older, and he used the example of when giving flu shots, they have to get double or triple. They have to get a pumped-up dose which is problematic. The director of the CDC, when he emphasized the mass and put that over vaccines, I think in his own way, he was making similar points. If you have my questions, Dr. Wen, I'll listen over the air. Thank you.

Brian Lehrer: Myart, thank you. Great questions. For people who don't know this, when somebody over 65 gets a regular flu shot, they get some enhanced dose because it's considered that they need more of a dose to be as protected as people with a lower dose who are younger. Dr. Wen, would something like that likely apply to a coronavirus vaccine?

Dr. Leana Wen: We just don't know at this point and I actually want to back up for a moment. I think it is important for us to talk about vaccines because it's in the news so much and obviously we're all thinking about vaccines as this important endpoint. Vaccine development, as I think Myart very well highlighted that Dr. Haseltine and others have said, vaccine development is incredibly complex.

There are viruses to which we don't have vaccines. I think about HIV, we don't have a vaccine against HIV. There is no guarantee that we're going to get a vaccine against COVID-19, against the virus that causes COVID-19. I hope that we will. We have many different shots on goal. We have many dozens of vaccine candidates. There are nine candidates that are already in phase three trials being given to tens of thousands of individuals, but we have a long way to go before approval, and that approval is also not the endpoint.

It needs to be said. The FDA has given the cutoff of at least 50% effective for a vaccine to be approved, but 50% is a pretty low bar. Dr. Fauci has said he'll be happy if we have a vaccine that's 70-75% effective, but that does not mean that by the time we get a vaccine, that somehow this pandemic is over.

First of all, it's a question of if we get to that point of a vaccine that say 70-75% effective. Then in order to protect everyone in the community, and get to herd immunity through vaccination, you may need to have nearly everyone in the community get the vaccine.

There's a long process when it comes to distribution and manufacturer of the vaccine, something that I'm concerned about because we have seen the federal government fail when it comes to testing and getting PPE. There's no guarantee that we're going to be able to ramp up the production of this vaccine and distribution. Also, there is a serious problem of trust. There has already been an anti-science vaccine skeptics movement that's underway and is very strong in our country.

Now you add on top of that, the suspicion of political interference. Now a whole different group is also suspicious of a vaccine when it's tied to something like an election date. It's not the traditional group that's skeptical of vaccines or anti-science, these are people who are very much pro-science but are concerned about political interference in politics, and the election driving vaccine approval.

I take Myart's point, and I think what Dr. Redfield was saying yesterday was really important too, that you have here a mask, the universal masking. Masks can reduce transmission, according to a Lancet study by 80%. That is more effective than a vaccine that's 50% effective or even 70% effective. We already have, in essence, a vaccine that works if all of us will do it. Why can't we implement something as basic as mask-wearing and see that as a public health imperative, rather than some political or cultural symbol?

Brian Lehrer: Then tell me this because I bet a lot of people are wondering when they hear the stat that's getting thrown around a lot now that a vaccine when it comes might only be 50%, 60%, 70% effective. What does that mean for an individual? Let's say a vaccine is 70% effective, would I be able to tell if it was effective on me after I got it or would I just have to play roulette and go out there and know, "I have a 30% chance of getting coronavirus if I'm exposed"?

Dr. Leana Wen: That's a really good question. More than likely, there will not be a way for us to find out until you get ill or not get ill. Think about the flu vaccine. Every year the flu vaccine is about 40% to 60% effective. We recommend for everyone to get the flu vaccine and this year by the way more important than ever to get the flu vaccine because there isn't a COVID vaccine but there is a flu vaccine so you can at least protect against the flu, but 40- 60% effective means that you could still get the flu, even if you get the vaccine against it, and may well be the case with coronavirus too.

Let's say that it's 70% effective. We should definitely still get it once it's proven to be safe and effective, but that means that for the individual there is a, let's say, a 30% chance that you may not develop the immune response in order to protect against getting coronavirus, or you may still get coronavirus anyway. This is why it's so important for us to dispel the myth that I think is going around that somehow the vaccine is the endpoint. That once we get the vaccine, we can go back to life as normal.

I think it's much more realistic, and I know this is hard to hear. This is not ideal. None of us want this to be the case, but it's much more likely that, let's say, best-case scenario, a vaccine is as approved by beginning of 2021, it will take months for the vaccine to be made available and to be distributed to the public. We're looking at mid to late 2021 for distribution.

Even after that, even after people actually get the vaccine, we're still going to be living in a- we still cannot go back to pre-pandemic normal. We still will be implementing some level of mass squaring, social distancing, because we still need these other measures in order to keep it safe.

Brian Lehrer: Here's Susanna in Brooklyn on the current coronavirus risk obsessions in New York City. Susanna, you're on WNYC with Dr. Leana Wen. Hi.

Susanna: Hi, Brian. Thank you so much for taking my call. I love your show.

Brian Lehrer: Thank you.

Susanna: I'm calling particularly because I work in the restaurant industry and I was curious because de Blasio now pushed most schools' opening to September 29th and the quarter capacity is supposed to start on September 30th. There is a particular mandate that says you have to wear a mask until you're sitting down and then you can take your mask off. Which-- [crosstalk]

Brian Lehrer: In a restaurant.

Susanna: In a restaurant, correct. Which is the same mandate that they have outside. I'm wondering, are we fooling ourselves that it will be safe to open? Will it continue to be pushed forward with the evidence across country of what happened in Chicago, where there were opening inside and then the restaurant shut down again? I'm wondering if we're doing it for economic reasons or if there is an actual safe way to do this. Thank you so much.

Brian Lehrer: Thank you so much. Dr. Wen, now everybody's on the edge to their seats waiting for this answer, indoor dining at 25% capacity.

Dr. Leana Wen: It really depends on the part of the country and the level of our research. I have friends who are restaurant owners, who work in restaurant, who work in the restaurant business, and I very much understand the huge economic impact that it's had on the restaurant business. I would continue to urge listeners though that outdoor is going to continue to be much safer than indoors, so continue to do outdoor dining or outdoor activities as much as possible.

Indoors in some places where the level of virus in the community is low, where the test positivity remains low. I think it is a reasonable thing to try. I would urge those individuals who are particularly vulnerable, of course, not to do indoor dining. I would also urge listeners to think about their own cumulative risk. As in, if you are now back at work, if you're taking public transportation, if your kids are back at school, maybe you should consider not also doing indoor dining, not also going to sports games, and not also getting on planes and think about the idea of cumulative risk for yourself.

I think when it comes to society in which restrictions are going to be removed, in a way, it is going to be a delicate dance. I think in the case of New York City, it would make sense given where the numbers are to remove some of these restrictions further, but also to keep a very careful eye on the numbers. Not on the numbers of hospitalizations and deaths alone, because these are such lagging late indicators, but keep on looking at the numbers of test positivity of the number of new infections. If those go up, these restrictions may need to be reapplied.

Let's not think about reopening as an on and off switch, but as a dial that can be dialed up and down depending on what the numbers show.

Brian Lehrer: Dr. Leana Wen, former Baltimore City Health Commissioner. Now teaching at George Washington University and a Washington Post columnist. Her latest column argues, "Trump rallies have higher COVID risks than most protests and that has nothing to do with politics." Thank you so much. We always appreciate it.

Dr. Leana Wen: Thank you, Brian.

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