Brian: [Music] Brian Lehrer on WNYC and now returned to the pandemic. Yesterday, President-elect Biden laid out his COVID-19 relief proposal and said he will announce this today.

Biden: I will lay out our vaccination plan to correct course and meet our goal of 100 million shots at the end of my first 100 days as president. This will be one of the most challenging operational efforts we have ever undertaken as a nation. We'll have to move heaven and earth to get more people vaccinated, to create more places for them to get vaccinated, to mobilize more medical teams to get shots in people's arms, to increase vaccine supply, and to get it out the door as fast as possible.

Brian: Joe Biden last night, 100 million shots by the end of his first 100 days in office, a concrete goal after nearly a year without many concrete goals. Joining me now to talk about that and other COVID-19 news and to take your calls is, Dr. Dara Kass, emergency medicine physician at Columbia University's Medical Center and a Yahoo News medical contributor. Welcome back to WNYC, Dr. Kass. Hi.

Dr. Kass: Always great to be with you, Brian. What's going on?

Brian: A 100 million doses in 100 days into people's arms. Can you do it?

Dr. Kass: We cannot fail something we haven't tried. Let's do it. I think we can. I think with the right federal investment, with the right state partnerships, and the right communication strategies to the citizens, I am optimistic that we can get this done.

Brian: Even with the two vaccines that are currently available, produced by Pfizer and Moderna, we don't have enough for two doses for everybody at the moment. At the policy level, how might the Biden administration get more doses into the pipeline as quickly as possible? How specific can you get about that?

Dr. Kass: I am not part of Biden administration, obviously but they've been very, very forthcoming about using all of the tools of the federal government, specifically invoking the Defense Production Act to help mobilize resources to not just help with vaccination production, but also the syringes and the other supplies needed to get vaccines into arms. I think that what we need to look at is, are all of the resources in the federal government being mobilized to get vaccines made and then delivered to Americans? Also remembering that we have other vaccines in the research pipeline, and that information should be coming out soon, specifically the AstraZeneca and Johnson & Johnson vaccines.

Brian: Listeners, your vaccine questions, your new variant questions. Any other COVID questions for Dr. Dara Kass? Welcome here at 646-435-7280, 646-435-7280, or tweet a question @brianlehrer. Let me ask you about the case of New York City Congressman, Adriano Espaillat, who says he tested positive Wednesday night no symptoms, but shortly after getting his second vaccine dose. Now I gather it takes up to two weeks for full immunity to kick in. Is his case instructive in any way for you?

Dr. Kass: It is instructive but not in the way most people are thinking about it. Remember that when they did the research on the vaccinations, they actually looked for symptomatic patients. They didn't screen people for asymptomatic carrier status to figure out if they have a PCR positive test but no symptoms. They only waited for people to have symptoms. We also know that the protection is not conferred till 10 to 14 days after the second shot. That 5% of patients may not be protected even when completing the vaccination process. There's a lot of reasons why he could be testing positive and complete the vaccination without any new concerns about the research we have.

One of the things we're going to look at as time goes on as more people are vaccinated is, what happens with people who are screened regularly for COVID, who have been vaccinated? Are they PCR positive potentially and not contagious? Are they PCR positive and potentially able to spread it but not be able to get infected? These are questions we have to ask as we have more information, but it's not any reason to be concerned since he's asymptomatic, vaccinated and we have this information now.

Brian: You mentioned 5% to 10% of people who get vaccinated may not be protected. That's consistent with the data we heard from the trials, 94% protection they said in both the Pfizer and the Moderna. Can an individual know if they are in the 94% or if they are in the 6%?

Dr. Kass: No, they can't in fact. The best way to not be infected even after vaccination is to have a lower number of cases in the community. Every time you're exposed to the virus that puts at risk your own protection. We want to make sure that we're both vaccinating individuals and decreasing the spread in our communities to make sure that there's just not enough virus out there to even test our own immunity after vaccine.

Brian: How can a person who's been vaccinated go back to their normal life? They have to do it with the odds of 94% in their heads before they start doing normal things, going into stores they may have not gone into before, getting on the subway again, whatever normal life in the company of other people indoors may involve for them?

Dr. Kass: The answer is we don't know exactly that yet and we also don't know what the timelines are. I will tell you that every picture I see especially now, as we're moving away from health care workers, to elderly New Yorkers, elderly Americans and teachers really fills my heart with a sense of relief because I know that those are two populations besides healthcare workers that have felt so anxious about their exposure to the virus.

We don't know what it looks like to go back to "normal." I think that once we start to see a critical mass of people in any community be vaccinated, those who are also vaccinated can consider themselves at lower risk and maybe start engaging in ways that we're asking them not to do right now. We're not saying to people post-vaccine, go act like there's no risk to you or your family for the virus. We're asking them to be patient, actually and still wear a mask still stay distance, even though all the data we have, and it's really excellent data, says that they are protected from infection and certainly protected from getting sick or dying from this virus, which is the reason we're so aggressive about the vaccine campaign and vulnerable people.

Brian: Charles in Manhattan, you're on WNYC with Dr. Dara Kass from Columbia University. Hi. Charles, are you there?

Charles: Oh, right here. Thanks very much, Brian. Your show is just amazing. I wanted to ask your guest that- I've been calling in to that call-in line, where they'll try to find within the Five Boroughs a place to get the shots and the hospitals aren't calling them back, giving them the information, and they can't go online and get the information. Then what they do is, they'll try to give you a second party who they say you have to give them your insurance information. I prefer to deal with New York hospitals but I heard last night that you can actually go to the hospital that are doing that and just ask in person. Is this true?

Brian: You mean walk in?

Charles: That's what I heard last time on the news that you can actually go to the hospital.

Brian: Dr. Kass, can you do that at the Columbia University Medical Center?

Dr. Kass: No. I will say and I want to be really clear about this. The vaccination process in New York City is evolving very, very, very quickly, rapidly with sites popping up every single day. The process is getting better each day, having walked my own parents through it, having walked a bunch of my fellow New Yorkers through it. It was clunky even five days ago, compared to today. We're going to start seeing more sites come out.

We're going to start seeing better communication from institutions like the NYP or NYU or Mount Sinai, big institutions that are going to start reaching out to community members, who are patients of theirs or staffing larger vaccine sites like the Armory, which is across the street from Columbia. I think we're going to start to see better communication and access to scheduling. I really am starting to get a little concerned very shortly that we're going to run out of supply in New York with all of these people ready to get vaccinated, which is when we're going to go back to the federal government and say, please, you're holding on to this supply, we're ready to take more.

I want to remind everybody that that is a success for New York City because our first hurdle was operationally meeting the moment having these vaccines and not being able to deliver them to New Yorkers. Now we're seeing so many people have made appointments and we're really ramping up our sites, that we're going to probably run out of vaccine and have to ask people to wait a week or so until we get more from the federal government. I think we should view that as an operational success and really the next step towards protecting our city. Then being a good example for the rest of the country.

Brian: Do you have an opinion then about the sudden expansion of eligibility for the vaccine that we saw this week, as advised by the CDC to anyone over 65, not just people 75 and up or with serious medical conditions? A 66-year old is not at the same risk as a 92-year old and suddenly the 93-year old might have to wait for weeks or months depending on the luck of the draw?

Dr. Kass: The answer is, I actually think it was a really good decision. I'm glad they made it because we're seeing the states that opened in 65 and higher really start to see that that inflection point of vaccine delivery. It may just be availability of sites or the state's investment in the number of sites are opening when that many citizens are eligible. States like New York and New Jersey and Texas and Florida and California are really going to be leading the way in vaccine delivery on a number of citizens vaccinated basis. I think that we want to make sure the most vulnerable people get vaccinated first.

If you are 66, I'd ask you to wait a minute and let the 92-year-olds get vaccinated ahead of you. If you know a 92-year-old who can't get a spot, please help them. This system isn't easy to navigate. It will get easier in time. I have asked people who are maybe in their early or late sixties, early seventies to give their spot up or certainly to help an older citizen or somebody that has heart disease or diabetes, or is overweight, which is a higher risk for contracting and having serious outcome from the virus.

Brian: Marjorie in Manhattan, you're on WNYC with Dr. Dara Kass. Hi, Marjorie.

Marjorie: Yes. I asked my question of, do you want me to repeat it?

Brian: Please?

Marjorie: All right. I am eligible by age and I have an appointment Tuesday morning. My daughter, she has no immune system and she is eligible, but she cannot get an appointment. Is it possible that I give her my appointment, which is at the Javits Center instead of me going, because I think she needs it more than I do.

Dr. Kass: Oh, Marjorie, you're a hero. The answer is we don't have information on a side-by-side basis as far as swapping out appointments. What I would say is keep your appointment, but work hard to get her appointment. There will be more appointments opening soon, but I think you both need to be vaccinated. I'm excited that you're her advocate because I think that's a remarkable thing and she'll get vaccinated soon, I really believe that. Stay safe and stay home until you get vaccinated, but I would like you both to get vaccinated. Don't give up your appointment just yet.

Brian: Could she give up her appointment if she wants to? Is it transferable?

Dr. Kass: I don't know the answer. It's a site-by-site management thing. If they would let you do that, I don't know how successful people have been at it. I know people have tried and it's really about the registration process and the scheduling process. If two people are both eligible and the site is flexible, it may be possible, but given the amount of paperwork it takes to be eligible to get vaccinated and register themselves, they may not be as flexible in the moment because they're trying to register so many people at the same time.

Brian: Donna, in Manhattan, you're on WNYC with Dr. Dara Kass. Hi, Donna.

Donna: Hi, Brian. Doctor, I have a question. I was able to navigate the process for my father who's 87 years old, and I managed to get him an appointment for next week at a Manhattan center. Then it said that I needed to schedule the second appointment, but it said that I had to call, it has to be at the same location and I had to call and then there was never a way to get through they stopped taking phone calls. Then I couldn't get a second appointment scheduled at any of their centers. He has the first appointment, but he doesn't have a second. I'm very concerned about how I'm going to get him a second shot.

Dr. Kass: Again, I would not be concerned about that right now. The system is definitely catching up with the demand. What I would say is definitely take him for that first vaccine and when you're there, try to schedule that second appointment, a lot of people are scheduling it onsite. The reason we ask people to stay at the same site, if possible has to do with the supply and knowing that you need to deliver an even amount of vaccine to any site to make sure there's that second dose available, but don't-- I would give it a couple of days to work itself out from a scheduling perspective, take that first vaccine, take him in, reiterate that you don't have that second appointment and ask them to make it for you on the spot.

Brian: Thank you. I hope that's helpful, Donna. A listener who got their first dose of the Moderna vaccine asked me yesterday if they're required to go back to the same facility for the second dose next month, like if they found someplace closer to their home or for another reason.

Dr. Kass: Again, this is going to come out, I think, in communications as we have more sites and that there's a little bit more transferability on the information, but remember that each site keeps its own records. You want to make sure that people are tracked to have both vaccines. It's really important, at least for now that you go back to the same site, unless for some reason you're told, like, let's say you're doing it in an urgent care chain and that chain has a singular records keeping system and you can go between sites, wherever the vaccine is being delivered. For now I would expect people to plan on having to go back to the same site for the second dose from where they got their first.

Brian: I understand you're saying from a public health standpoint for dose management to have the right number of doses in the right places, but is an individual allowed to make that decision if they want to, to switch up for the second dose?

Dr. Kass: Switch up sites?

Brian: Yes.

Dr. Kass: No, I don't think there's a way to do it is what I'm trying to say. I think that the scheduling aspect of it right now, it needs to be pretty streamlined. Unless it's within the same records keeping system, and I don't know yet how many there are, you have to remember that each site that's delivering vaccines, whether it's a medical center or the Javits Center is using a different medical records process. You have to stay certainly within that if you change sites, but I would expect people for now to have to stay at the same site in less they're being given specific instructions not to.

Brian: If you've got the Moderna you have to stay with the Moderna and vice versa with the Pfizer, right?

Dr. Kass: Yes, that's true. That has been a question people have gotten, especially around timelines, like if they got the Moderna vaccine, but want to get the second vaccine three weeks later, which would be the Pfizer vaccine and that is not recommended. The recommendation is now definitively in America to get the same manufacturer's vaccine both times.

Brian: Maria in Brooklyn, you're on WNYC with Dr. Dara Cass. Hi, Maria.

Maria: Oh, hi, Brian. Hi, doctor.

Dr. Kass: Hi.

Maria: Just two-part quick question. I've heard that the AstraZeneca vaccine is only going to be around mid-sixties percentage-wise effective. Should I be leery if I am offered that vaccine, that it's going to be protective enough? Number two, I know that cancer is considered an immunocompromised condition, I believe, but what does that mean exactly? I had stage zero breast cancer, DCIS, and I had radiation treatments.

If I can't get it now, that's fine. I don't think I can even book it now anyway, I tried, but I don't know if I'm considered immunocompromised, so that's it. Those are my two questions. Also my husband is 61 and diabetic, so type II diabetes. I'm just wondering if he would be able to get it sooner. Thank you. That's it.

Dr. Kass: Okay. I have to remember the first question. Remind me your first question again. [crosstalk]

Brian: AstraZeneca.

Dr. Kass: For AstraZeneca isn't even approved, so it's not a concern. I wouldn't worry as much about what will be available in the future until it's offered. When the AstraZeneca vaccine is hopefully approved, we'll have the data on that and whether or not which dose regimens are effective and how effective they are. The goal is have as many equally effective vaccines available as possible, and also match them to the needs of the patients.

If there are any specific reasons. For now, both the Pfizer and Moderna vaccine don't have any indications different. I would wait on the concern about being offered a sub-optimal or less effective or more concerning vaccine until it's actually happening to see what happens. Okay. That's first of all.

Brian: The question was on radiation for breat cancer treatment. Does that leave her immunocompromised in a way that qualifies?

Dr. Kass: Not that we know of, the qualifications were poorly defined. I think that right now I would go to your own physician and ask them if they consider you qualified and the same thing is true for your husband. Type II diabetes if he's overweight may make him more immune-compromised, but right now I don't think that qualifies either. I would ask your own physician if they think it's qualification, because that would be the first step in getting a letter to support the need for vaccination right now.

Brian: Do you think it's crazy that in New Jersey, anybody who's a smoker, as I understand it can get a vaccine appointment based on that, no matter what their age is and teachers as a category cannot.

Dr. Kass: I do think that's crazy personally. I also think that each state is making their own decisions and we've seen a lot of different decisions at the state level. New Jersey was also slower than New York to go to 65. I would have gone to 65 before almost anything else because of the number of patients that have comorbidities in the age range of 65 to 75 that are covered just by that very objective piece of information. I think we're going to see a lot of different decisions at the state level, not just in the Northeast, but all over the country.

We have to remember that until there's a singular set of standards across the country, different states are going to make different decisions and we have to deal with our local governance. Again, I want to remind everyone, this is a good reason why it matters who our city councilmen are, who is in charge of our health decisions. It matters who our mayor is. It matters who our governor is because these are the decisions that we are going to have to deal with in our city and our states as we get the allotment of vaccine over the next six months to a year.

Brian: Ron, in the Bronx, you're on WNYC with Dr. Dara Kass. Hi, Ron.

Ron: Hi there, Brian. Hello there, doctor.

Dr. Kass: Hi.

Ron: I love your positivity when you said that, who knows if we can do it, we haven't tried it yet. First of all, I just thought that was an impressive outlook to have. The second thing I wanted to help out was I went for my vaccine, but I had gone to school that morning to get my required COVID test. It was a group test where we spit into the vial and doing that with four year olds. You should see that happening in schools, but I went and that was open, not getting run in the system until this weekend and I was denied my vaccination because the test was unresolved. I wish I had known then, [crosstalk] and some other friends had said, "Oh yes, that happened to me except they ended up giving me the vaccine." I was like, "Well, maybe I just got a crotchety person, but I was not expecting that. It got me a little upset."

Dr. Kass: I will just give you some messaging advice. You needed to tell them that you were a screened, positive, not tested for diagnostic purposes. The reason they don't vaccinate people that have pending tests is to not vaccinate somebody that's actively infected with COVID. I think the person who was trying to vaccinate you didn't understand that you were screened as part of your school's process and not because you had symptoms or an exposure, and there probably could have been a two-minute conversation that probably would've clarified it, but just try to make a new appointment and get yourself vaccinated. Hopefully, it'll happen soon. I hope your screening results came back negative.

Brian: Ryan, I hope your screening results came back negative too, and that they let you get the vaccine next time. We just have a few minutes left. I want to ask you a quick question about the new COVID variant known as B117, which appears to be significantly more contagious than previous versions of the virus. NPR reports that study suggests the new variant increases transmissibility by about 50% but what does that mean in practical everyday terms? Do you think the new variant can slip through cloth masks more or stay in the air longer in a room that other people have been in? What does that really mean?

Dr. Kass: What I think it means is we're going to get less lucky about exposures that don't confer to infections. I don't know that it's the masks or the air or the specific environments, but I know that you're going to see twice as many people get infected from the same exposure is how I interpret it. What it really means is we need to decrease our exposure is as much as possible.

These viruses mutate, the more they're exposed to new people. The decrease in the number of cases will actually help us with the mutations and the spreading of these new variants. Our public health measures will work maybe not as effectively, but they will work; if the virus can't find you, it can't infect you. I think that as we see the question about whether or not this infects children easier is very concerning to me as a parent, especially as we look towards knowing that the kids are not going to get vaccinated anytime soon.

I'm watching this very closely, but I think that it means that we need to be more vigilant here in New York and around the country at stopping the spread of this virus. As we increase the vaccinations to our most vulnerable citizens, we also need to make sure that we really do consistently practice the public health measures that we're asking and continue to test people regularly to make sure they're not carriers of this virus or asymptomatic infected or presymptomatic people and really quarantine them appropriately.

I just want to say one more thing about the Biden plan yesterday, which was really exciting to me was it had money for things like sick leave and time off, if you are exposed. We've known that that's been critically important to the stopping the spread of this virus since the beginning and nobody has really invested in it because it's expensive at the front and it's also just counterintuitive to how we practice public health here in America. I'm hopeful that that will also help us decrease the spread of this virus, increasing testing and keeping people home when they're exposed will go a long way, in addition to the masks and the vaccines.

Brian: We have 30 seconds. We have Mayor De Blasio standing by for a weekly Ask The Mayor segment. I'm going to ask him this same question, but I want to ask you if as a public health person you make this recommendation. What about the home-bound second elderly, people who receive meals on wheels, they're not in institutions where the vaccine is being brought to them. They're at home, but there's currently no mechanism in place as I understand it, to bring vaccines to the homes of people like that, to their buildings or anything, or am I missing it?

Dr. Kass: I haven't heard of that, although I know there are conversations about it and it has to happen soon. It is true that the home-bound elderly are at lower risk, except for when somebody comes to deliver them a meal or a home health aid may come. They are at high risk to get sick so we have to vaccinate them as soon as possible. The other issue with this, remember, is any observation period for vaccine side effects needs to be considered in the timeline for that delivery because by cohorting people at vaccine sites, we can watch them at once.

It's a lot harder to do in somebody's home if you have to observe them for 15 minutes, but it must be a priority for the city to vaccinate our most vulnerable people, which includes home-bound people, people in correctional facilities, people in congregate housing but the elderly and the home-bound are very high priority.

Brian: Dr. Dara Kass, emergency medicine physician at Columbia University's Medical Center and a Yahoo News medical contributor. We always appreciate it. Thank you so much.

Dr. Kass: Thank you, Brian.

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