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Brian Lehrer: It's the Brian Lehrer Show on WNYC. Good morning, everyone. I think the real headline today is what we just heard, our morning man, Michael Hill, who starts his morning edition shift at like five o'clock in the morning is not a coffee drinker. Maybe during the news later in this show, we'll ask how do you do it?

We'll begin today with two segments that we might characterize as remote learning. Later this hour, it's Economics Professor and New York Times columnist Paul Krugman on what he calls Krugman Wonks Out, the Return of the Economic Cockroaches. Remote learning with Paul Krugman in about a half-hour.

First, a lesson in why vaccines are home-run despite eight vaccinated people testing positive for COVID on the New York Yankees, from UNC professor and Atlantic Magazine and Times contributor, Zeynep Tufekci, who is also a faculty associate at the Berkman Klein Center for Internet and Society at Harvard and author of the book, Twitter and Tear Gas: The Power and Fragility of Networked Protest. Zeynep, we always learn things when you come on the show, welcome back to WNYC.

Zeynep Tufekci: Thank you for inviting me.

Brian Lehrer: First, by way of background for our listeners, one player and seven members of the coaching and support staff, all fully vaccinated with the Johnson & Johnson shot, tested positive for COVID last week. You call it a cluster, but only one had any symptoms at all and they were very mild. Professor Tufekci, what just happened?

Zeynep Tufekci: What just happened is you have an environment in which there's a lot of testing and couple of people tested positive, but as far as we can tell, a single one of them had symptoms and they were very mild and fleeting like he just had a few mild things, probably just maybe a fever. It doesn't even say what it is. It was that mild. It was transient.

If we weren't testing this much, we wouldn't even know this had happened. With vaccines, what we have gotten wrong is to think in binaries and think they work or they don't work. As if it's like a zero or a hundred on the other hand, whereas what they do is they stop the virus from being able to replicate by helping our immune system figure out how to respond really quickly.

In some cases, it might take our immune system just a little bit more than other times, so that there's just enough virus to pick up by these really sensitive tests they're doing, the PCR tests, and they're doing them all the time. As far as I can tell, at some point they were testing them three times a day. You're literally looking for fingerprints three times a day and if these people were exposed to probably like a highly infectious source, so the virus jumped at them and just struggled just a little bit to replicate, but couldn't manage, none of them had symptoms except one and even that was very mild and then it's gone. That's like, that vaccine's working.

Now, if these people had progressed to severe disease, meaning their immune system wasn't able to quickly respond and even if they all got sick, really, I would have said, "Okay, this is a concern. Let's look at it," but just having people exposed is not something we can avoid when the virus is still circulating. Having the virus replicate just so little that somebody being tested three times a day with essentially a fingerprint detector sensitivity is occasionally picked up, that's not something we can avoid.

I don't really even think when we say breakthrough infection for vaccines, I'm not even sure that's the word we should be using when we're literally finding the mildest fingerprint that has no consequence. Maybe we should even think, you know what? One of them had a mild breakthrough and that was transient. To me, this is great news.

This is the vaccine's working. This is exactly what we hoped they would do and that's what they're doing.

It's just like, as the members of the public, we have this binary view, "Oh, it picked up something, it must have failed," which is misleading us. I almost feel like we shouldn't even constantly talk about all of this except to say, "Look how it worked," rather than use the word breakthrough.

Brian Lehrer: In fact, my understanding is the CDC has now changed their definition of a breakthrough case from a positive test to somebody who's hospitalized or dies, which almost never happens. They've in fact changed the definition of breakthrough case.

Let me follow up on one thing that you said there that I think could be really interesting for a lot of people, even if they're not on professional sports teams who travel all the time and therefore get tested three times a day. When you wrote about this cluster, you pointed out and you just said it in your first answer, that the COVID tests these days, so-called PCR tests with the nasal swabs are so sensitive now that they can detect tiny amounts of virus. Are you saying, in a way, that the tests are so good that they're less accurate in a certain sense for telling us how sick we are, or how contagious?

Zeynep Tufekci: You have to distinguish what the tests are. There are many different kinds of tests you can do, and this is one of them. When you are trying to pick up cases in an unvaccinated population where any infection has this potential, there could be a place for them, especially, for example, if you're trying to, let's say, admit to a hospital, which is a high-risk environment because there's lots of other people. There's a place for these things. It's not a question of accurate or not accurate, it's a question of what's the use for them?

Whereas for most purposes, what we're interested in is, is somebody really getting sick or somebody infectious. For those things, a PCR test could tell you certain things and there's a lot of technical details to it because you can also figure out like is it just picking up a tiny amount, or is it picking up a lot? There are other values that tell you this. Used correctly and interpreted correctly, they have a place.

There are alternative tests that only pick up if you have a lot of virus, which is when you're more likely to be infectious, these rapid tests, which you have been discussing, we never implemented them in the US. Those have a place as population screening devices too, but in this particular thing, I understand the sports teams are very sensitive to this, but if you keep testing people with the most sensitive test three times a day, and not even looking at like, "Did we find a lot? Did we find very little?"

Those are known values, but they haven't been released. We'll keep doing this. I'm a professor. I work at a university and I was just groaning that for a lot of fall last year, we did mandatory testing all the time, every week, because we wanted to catch the young people who were infected and help them isolate before they infected lots of other people in a dorm.

That made sense, but when fall comes and when these students are all vaccinated, as many colleges are now requiring, if we do the same mass testing, we're going to have unnecessary freakouts because it's going to happen. It's going to be exactly like this. A few people will test positive exactly because they have just a little bit and if we don't pay attention to those technical details, it will be like, "Oh no, a cluster," but a cluster among-- [crosstalk] Yes, cluster among the unvaccinated is a very, very different thing than vaccinated people barely testing positive, no symptoms, nobody getting sick.

We need to really just think-- This is where terminology's failing us. I wish we had different words for cluster breakthrough cases in an unvaccinated population versus a vaccinated population because it's not even-- Like if I tested positive post-vaccination, honestly, I'd be like, "Huh, interesting," and I would just get on with my life, whereas if it was before the vaccine, even if I didn't have symptoms yet, I'd be like, "Ooh, I'm worried. Let me see, because I could be pre-symptomatic."

There are real odds even for someone without high-risk factors like me, I would be extra careful and cautious and worried to be honest, just psychologically if I test positive before the vaccine, even without symptoms, but after the vaccine, I would just raise an eyebrow and say, "Huh, interesting," and basically go on with my life for my 99% of what I do.

Brian Lehrer: I like the academic term you use there, unnecessary freak-outs. I think that's in the literature.

Zeynep Tufekci: I have citations three pages for exact definition.

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Brian Lehrer: I want to go on to a second topic, which is remote vaccine learning with professor Tufekci section two. Why she writes that maybe we need masks indoors anyway, just a bit longer. As you were assigned listening for this section class, here's Dr. Anthony Fauci in a new AXIOS interview, saying the new CDC mass guidelines for vaccinated people are being misunderstood.

Dr. Fauci: They misinterpret guidelines, that happens all the time. It's not their fault. That's just people either read them quickly or listen and hear half of it. They are feeling that we're saying, "You don't need a mask anymore." That's not what the CDC said. They said, "If you are vaccinated, you can feel safe that you will not get infected, either outdoors or indoors." It did explicitly not say that unvaccinated people should abandon their masks.

Brian Lehrer: Anthony Fauci there. Zeynep Tufekci here. Zeynep, do you agree with Dr. Fauci?

Zeynep Tufekci: Let me just step back a little because I did write a piece for the New York Times on this when the guidelines came out. There are two different elements to this that are being conflated at the same time. I think that's partly because the CDC didn't really put in a proper full package. Question number one is, what is the risk to the vaccinated from this pathogen? What is the risk that they may transmit from this pathogen?

I think what we have here is an acknowledgment from the CDC that the vaccinated people are fine, they are at such low risk for getting it themselves in any way that matters, and they're also, he confirmed-- Chris Hayes posed myopic question to him, and he confirmed that the CDC thinks that the vaccinated people transmitting is also a vanishingly low risk, so they do not think this is important for the vaccinated people. That's fine with me. That's completely fine in the sense that that is also my interpretation of the many studies that have come out and a vaccinated person, I think, can feel comfortable in that pronouncement.

As far as I'm concerned, I think this is a trustworthy and proper pronouncement. The problem is, you don't just have the question of what should the vaccinated do? You have the question of what should we [sound cut] society in terms of enforcement of mask guidelines?

In that case, you have a twist in which we don't have vaccine passports and we're not going to have vaccine passports. What happens is when you are at say, a grocery store, or an indoor environment-- [sound cut]

Brian Lehrer: Zeynep's line is obviously breaking up a little bit.

Zeynep Tufekci: Tell the vaccinated what you should do. Did you lose me?

Brian Lehrer: Yes, we lost you for a second, but I think--

Zeynep Tufekci: Am I back?

Brian Lehrer: Yes, you're back. I think your point is clear. Let me ask you one follow-up question, we're going to run out of time soon. Here's a tweet we got from someone who asked about standards for clean air as restaurants reopen at higher capacity and other workplaces. It says, "COVID has revealed how unhealthy the air is in enclosed spaces, or can be in enclosed spaces," it actually says, "Tons of rules relate to surface and foodborne pathogens in restaurants, virtually none on airborne."

Zeynep Tufekci: Asolutely.

Brian Lehrer: Zeynep, I saw that you do write about possible unhealthy pressures on restaurant workers with the new reopenings and relaxed rules. What would you say to that tweeter?

Zeynep Tufekci: This is a very good question. I have a lengthy piece in last week's New York Times on exactly this question, because this pandemic has forced us to realize that we don't really take airborne pathogens as seriously as we should have and this is one of them and this is what we have learned. It means that we have to pay attention to this.

Two things, in indoor spaces, people who are immunocompromised or haven't really gotten around to being vaccinated yet have higher risk, so we do have a duty to protect them as best we can. Restaurants are a particular challenge because you can't eat with masks on and plus working in a cramped environment.

We should have had OSHA guidelines on all of this, some of it being rules, we do not so it's coming down to individual places. Ventilation standards do exist. From talking past year to a lot of aerosol scientists, whenever possible, opening windows even just a little bit is a really powerful force, even a few inches because air can move very fast.

The other thing that's more challenging and there are trade-offs is changing the air that's circulating from completely indoor air circulating to bringing in some fresh air from the outside. That's, again, complicated because there's energy and other trade-offs there. I can't just expect people to just flip a switch.

Another thing that's effective is a proper HEPA filter, which is strong enough for the room. Again, I hear from the scientists, there's a lot of gimmicky things like this and that and none of those are really necessary. In fact, it may be harmful, so just a plain HEPA filter that has the correct power level to be able to keep cleaning that room is a very good way to filter out a lot of pathogens, including these.

Plus, if you have higher risk yourself, you can do what other health professionals who work with sick people all the time do, which is wear a higher grade mask, which includes respirators like those N95s, which attention to fit, but also, we're finding that even cloth masks or surgical mask, as long as they're the right material, and there's good fit, can be really helpful beyond what people think.

People sometimes think, "Oh, aerosols, they just escape from the sides," and what we're finding is that with a little bit of attention to fit, we can really improve how good they are. Of course, there are respirators, the N95s, that medical people wear and they go into really--

Brian Lehrer: Yes surgery and stuff.

Zeynep Tufekci: Places. Yes, and hospitals have a lot of good ventilation, but we do know these things work. As a person yourself, if all the other things that are beyond your control is not being done, the highest grade mask you can find that you make sure fits properly and there are lots of guidelines on the internet. You just want to make sure there aren't really gaps and all of that, that's really your best individual bet, especially if you're immunocompromised and haven't really had a chance for a vaccination yet.

Brian Lehrer: Really good information for all kinds of indoor employers, especially ones with some enclosed spaces like restaurant kitchens and things like that. Thank you so much. We have learned again from Zeynep Tufekci, UNC Professor and Atlantic Magazine and New York Times contributor who's also a faculty associate at the Berkman Klein Center for Internet and Society at Harvard, author of the book, Twitter and Tear Gas: The Power and Fragility of Network Protests, and also the author of a recently launched newsletter that's really good called The Insight. Thank you so much.

Zeynep Tufekci: Thank you. My pleasure.

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