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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. With us now, to answer your latest COVID questions and some of mine, is Jessica Malaty Rivera, infectious diseases epidemiologist and the lead science communicator for The COVID Tracking Project which collects and explains many kinds of data about the pandemic. Jessica, great to have you on the show. I know from your Instagram feed that people really appreciate how you explain things. Welcome to WNYC.

Jessica Rivera: Thanks for having me, Brian.

Brian: Listeners, your COVID questions on the vaccines, the new variants, demographics of the latest waves, policy options or anything else, welcome here at 646-435-7280, 646-435-7280. Jessica, as a self-described data nerd, how much of an impact do you think any of the new variants seem to be having on infection rates so far?

Jessica: It's a little bit hard to tell, at least in the US because we're just not doing enough genomic sequencing and that's been a disadvantage from the beginning. The US is ranked I think 43rd in the world when it comes to the volume of samples that we're actually doing sequencing for, and I've seen that there have been within the university settings and even from the CDC a deep desire to ramp that up because we need to know exactly how pervasive these variants are in the US.

Brian: When they say the UK variant is 50% or 70% more contagious than the original, I don't understand what that measures. What's the metric that is being translated as 50% more contagious?

Jessica: It's a bit hard to explain too because we don't have the full scope of what it's been like in the US or even from the UK, we have some data to show that the way that the virus has mutated is that the spike protein is better at attaching at receptors in the human cell, so it makes it easier to be infected by it. Now, I think what that translates to, I think in lay terms, is often that masks are somehow impervious to the virus so you can't protect yourself anymore from the regular mitigation, but that's not what that means. It just means that should you be exposed, it seems more likely that the virus will attach with more ease to cells in your body.

Brian: Should you be exposed? In other words, people should be more meticulous about following the same measures, 6 feet, masks, things like that.

Jessica: Exactly. The same public health mitigation efforts work and we want people to continue to be diligent about mask-wearing, practicing physical distancing, avoiding indoor gatherings which are very high-risk because those are ways that you can get exposed to the virus. There's nothing unusually different about how this virus works. It still attaches to the same cell receptors, it just may do it with a little bit more ease. Again, it's not become this unrecognizable version of the virus.

Brian: It's like if you have a hundred people in a room who have the exact same exposure to the virus, with the original virus, maybe 40 of them would have gotten it and with the new variant, maybe 60 would have gotten it. It's that kind of thing.

Jessica: Yes. Maybe, yes.

Brian: Do any of the new variants cause more serious illness than the original one? I heard no. Now, I heard with one that's still fairly obscure, I think maybe yes.

Jessica: Again, there's so many unknowns. It feels a little bit discouraging to constantly say we don't know yet because we still need more data. So far, what I've read is that it hasn't shown any severe disease or difference in disease manifestation when it's causing new cases but again, they're still doing a lot of research and I'm especially curious about the variants that have been identified in Northern California to see what that means for infection there.

Brian: Let's take a phone call. Joe in Westchester, you're on WNYC with Jessica Malaty Rivera. Hi, Joe.

Joe: Good morning. Excuse me. A team from the Mayo Clinic published a paper in October showing that the COVID spike protein can invade the cells that carry electrical signals that control the heart rhythm. It might fuse those cells together and then create arrhythmias. If the vaccines are delivering the spike protein or telling the body to manufacture it, is it a great idea to be delivering the spike protein if it might be implicated in heart arrhythmias?

Jessica: It's a good question. The spike protein that's in the virus isn't going to cause any infection. It's just essentially the blueprint of the spike protein so that the body-

Brian: You mean that's in the vaccine, right?

Jessica: -that's in the vaccine, sorry. What did I say? The virus?

Brian: In the virus, yes.

Jessica: In the vaccine. It's essentially training the body to identify if you should be exposed to it and then to fight it with antibodies. You're not getting any live version of the virus or part of the virus that could cause the infection that would be risky. You're right in the sense that COVID-19 is very much a respiratory disease and a vascular disease and I think that's especially why we want people to be protected in case they have issues of myocarditis or other cardiovascular issues.

Brian: That's such an important distinction to make for you as a science communicator because I think that's just the kind of question that reflects the limited understanding of the science of vaccines that leads to resistance or hesitancy to get the vaccine. That distinction that you just made between the actual spike protein of the virus being in the vaccine and something that is not that, but that just gets our immune system to react as if it was, right?

Jessica: Right. The mRNA vaccine mechanism is quite genius. It's like you're giving the body the blueprint to manufacture the spike protein. It's giving it the instructions without causing infection. It's just saying, "Hey, look out for this guy. If he comes, you know what to do."

Brian: Let's take another call. Vic in Manhattan, you're on WNYC. Hi, Vic.

Vic: Hi. Last week, I received my first Moderna shot and now, I find out that Biden doesn't want to leave any second doses "on the shelf." He's planning to give as many people as possible the first dose and stretch the time until the second dose. That's not following the science as he promised. There are no doubt on the efficacy of a delayed second dose. It is reasoning that confuses treatment with doses. The only proven treatment is two doses given within the prescribed time. Even the FDA and Fauci have warned against delaying the second dose.

Jessica: Yes. I think-

Brian: Go ahead, Jessica.

Jessica: -I think that's a legitimate concern and I think that you're right that the data says that we have what's been told by the data in the clinical trials is that the time is very specific for when we have maximum efficacy, but I don't think that that's actually what's happening with the Biden-Harris vaccine administration plan. I think what they're trying to do is to increase the total for both. I think what they're trying to do is essentially tap into the Defense Production Act to do that. There have been no clear decisions to deviate from the data if, in fact, I think that they're trying to follow the data as closely as possible.

What it means is manufacturing more. I also think that with the potential inclusion of maybe the Johnson & Johnson vaccine in the near future, I think that's going to alleviate some of the concerns of stockpile shortages for dose one and two for Moderna and Pfizer.

Brian: Lori in Manhattan, you're on WNYC. Hi, Lori.

Lori: Oh, hi. I'm a registered nurse and I have a full-time job, but I would love to volunteer or get paid, of course, just a few hours a week administering vaccines. Is there any place that I could work just maybe four to eight hours a week?

Brian: I don't know if is in your portfolio, Jessica, but if it is, that's great.

Jessica: I don't know for New York or for where this nurse was calling from, but I just tweeted yesterday that the Los Angeles Public Health Department has just put out a call for volunteers just exactly like what she was asking for. They're asking for MDs, NPs, DOs, nurses, skilled EMTs, dentists, and pharmacists. I think that each jurisdiction's public health department is doing their own volunteer collection because we do need more bodies to help with the large coming infrastructure shift that's going to happen with the Biden-Harris administration. I think they want to set up 100 new vaccine sites.

That's going to require a lot of people and we don't want to be adding more burden to healthcare facilities and hospitals. I think that to check in with your local public health department to see if they have similar calls for volunteers would be the best bet.

Brian: We had that one call with concern that the second dose might not be available in a timely way. We have another related call and I think a lot of people have this on their minds as they're getting their first doses now. Jane and Chelsea, you're on WNYC. Hi, Jane.

Jane: Hi. Thank you for taking my call. I'm getting my first shot tomorrow. I don't know whether it's going to be Moderna or Pfizer. My specific question is if I cannot get the second shot between the second and third week, whichever is appropriate, do I have to start all over again? My second question is, let's say, it's the Moderna but if there's a Pfizer that's available in two or three weeks, can I take the Pfizer instead of the Moderna?

Jessica: Good question. These vaccines are not interchangeable. If you start on the Pfizer regimen, then you'll have to get your second dose with Pfizer. The same goes for Materna. I know that there are a number of places that have either tentative appointments for the second dose because of the influx of new appointments, but I would say to follow up with the location that you've chosen to get your first dose to see what their protocol is for either second appointments, cancellation lines, and walk-ins because I've heard that, that is an issue in a number of jurisdictions.

The vaccines, that's one of the reasons why we have those COVID-19 vaccine cards, is to make sure that the providers know which manufacturer was the one that you've got for the first dose.

Brian: People are starting to get their second vaccine doses, is that having any measurable impact on anything yet?

Jessica: It's still a little early to say. It takes a couple of weeks for the body to develop a robust immune response after the vaccine. I'm hoping that we'll start to see the implications for people being protected in a couple weeks, maybe we're reflected in fewer infections and cases that we see nationwide.

Brian: Do you know if people will be able to check their titers, that is their antibody levels a few weeks after vaccination to see if they, as individuals, can safely go back to old exposures?

Jessica: Well, I want to caution against that as a behavior modification. Even if you have antibodies, what we know from the data from the COVID-19 vaccine trials is that it prevents severe illness and death. What we don't know yet is if it prevents transmission or even primary infection. If you remember from the data from the trials, there were cases of COVID-19. Among those cases, they had very mild symptoms, which means they still were able to get the disease, but they didn't get very sick. Because of that, we still need to be doing mask-wearing, physical-distancing, and avoiding indoor gatherings, et cetera.

You won't go back to say your previous life completely normal post-vaccination, even post-two-doses but yes, you can check your titers. If your doctor or provider is able to run that blood work for you, I think it'll be very interesting long-term to be seeing how antibody levels wane or remain. Right now, from what I've heard, the Moderna CEOs said that they expect the vaccine's durability to be about two years at least, so time will tell.

Brian: Caroline in Manhattan, you're on WNYC. Hi, Caroline.

Caroline: Thank you for taking my call. I was just wondering, if you'ce had the original coronavirus and you've recovered, can you get the variant?

Jessica: The simple answer is yes. Reinfections, in general, they happen. They're quite rare, but because we are dealing with the variants circulating, it is another concern for reinfection, yes.

Brian: One of our local Congress people, Adriano Espaillat got COVID shortly after getting his second vaccine dose, but before the two weeks that it's supposed to take to become fully effective, does his infection surprise you?

Jessica: No, it doesn't. I think a lot of people jumped to some conclusions about which events happened because of the other. COVID-19 infection happening in between doses or even after the second dose is totally plausible because we have transmission levels that are still very, very high in many places in the US, which is why we're still not done with all those tried and true mitigation efforts that we've been working on.

Brian: He has very mild symptoms, which would be in line with what we expect after being vaccinated, but before it takes full effect two weeks after the second dose. Was there something like this in Norway that I saw you had commented on?

Jessica: In Norway, there were reports of-- I think it ended up being-- It was 29 to maybe 33 now, residents in long-term care facilities that died "shortly" after being vaccinated. Just recently, the Norway regional authorities said that there wasn't actually a correlation between the two events, no causal link after they had performed some of the autopsies on the people who died.

You have to think of the totality of evidence in the context of things when these deaths were happening. On average, about 400 deaths occur in long-term care facilities in Norway. It wasn't outside of the norm when it comes to the number of people who died, but they were described as people who were in frail health with severe terminal illness. Of course, the headlines jumped to some pretty dramatic conclusions about which events were related to the other.

Brian: I guess there are two conclusions that people could jump to. One, that the vaccine caused them to get sicker and die and the other, that the vaccine was just ineffective. Either would be alarming. You're saying both are wrong.

Jessica: Yes.

Brian: Roya in Manhattan, you're on WNYC with Jessica Malaty Rivera from the COVID Tracking Project. Hi, Roya.

Roya: Hi. Oh my God, Brian, it's such an honor to be talking to you. I had a question. I guess it's two questions. I got really lucky and was able to make an appointment for my mother for two weeks from now. Unfortunately, and I'm just getting emotional thinking about it, my mom contracted COVID. Her appointment is about 15 days out, it's after that two-week period, but I was wondering if this affects the first dose of her vaccine, if she should postpone it in any way? I'm not really sure how that would even work. Then my second question is what if one contracts COVID between the two doses of the vaccine? If contracting the virus affects the efficacy or anything like that. Thank you. Thank you so much.

Jessica: Great question. There have been some jurisdictions that have said to wait the 90 days after a confirmed COVID infection before you get the vaccine, but the CDC actually doesn't say that that's necessary. I think what is more necessary is that the person is fully recovered and symptom-free before they get vaccinated because you don't want to kind of put that much more stress on the body if they are still fighting off the infection. Of course, talk to your doctor about that because I don't know if the experience of COVID will be short or long.

You just want to make sure that the person is asymptomatic or symptom-free and no longer feeling sick. Like I said before, COVID infection can happen in between doses. What they'll probably do is make sure that that person again is no longer sick before the second dose because again, this is putting some work on your immune system. It's asking your immune system, especially after dose two, to get into high gear and fight off this virus. You want to make sure that you are in your optimal health.

Brian: They say you shouldn't get the flu vaccine if you're sick on that day, the regular flu vaccine. They might turn you away for a few days. Is there anything like that with the COVID vaccine?

Jessica: Yes. For the COVID vaccine, they want people to come in when fever-free and not sick or symptomatic with anything else. They also want to make sure that you haven't had any previous vaccines within the two-week period before too, just to make sure that you're not overworking your immune system.

Brian: Deb in White Plains, you're on WNYC. Hi, Deb.

Deb: Hey. Good morning, Brian and Jessica, longtime intermittent listener. Brian, thank you so much. Jessica, could you comment on the drug ivermectin to emergency care physicians? Dr. Paul Merrick and Dr. Pierre Curie presented findings on it before a Senate hearing around COVID and also to the NIH last week, NIH COVID team. As a result, NIH bumped up. They changed the recommendation against ivermectin to neither for or against, and they have a wonderful protocol on their website called Frontline COVID-19 Critical Care Alliance.

They've come up with an effective protocol treatment for both prevention they call prophylaxis and also when you're hospitalized. It's now in the same category as the antibody treatment and that kind of thing. Can you comment on that? Let me just say that they say that this ivermectin which is an anti-parasitic has been shown to be a miracle drug against COVID-19. Other doctors can now use it because of the upgraded status by the NIH.

Jessica: A couple things on this. When ivermectin first started circulating in the headlines, what was concerning was a lot of people were using it off-label and they were using it from access to veterinary use of this drug. It is a anti-parasitic that is given to dogs and other animals and can be quite toxic to humans at the dosage prescribed. In animals, it has been used effectively for other diseases that it's been indicated for. In Africa, it has been used for anti-parasitic things there but again, what was missing when this first started circulating was randomized control trials, which is the gold standard for clinical data.

I have been waiting to see that before I've made any kind of comments about it. I understand that there can be exceptions right now for use in a clinical setting as prescribed by a doctor, but I also think that to date, it does not qualify as a miracle drug. I think that we should all be cautious when we hear things like that because we need randomized control trial data to be able to make any claims about perfect or miraculous efficacy of anything. I think that's a red flag when you start to see those superlative claims on any treatment right now.

Brian: One more before we run out of time. Jennifer in Manhattan, you're on WNYC. Hello?

Jennifer: Hi, thanks for taking my call. I had two questions. My first question is why the United States postal workers aren't in the 1B phase stage because per CDC, they're supposed to be in 1B, but the form when you try to apply for the vaccine, they're not considered it. Then my second question is I had read that Asian people, the Moderna vaccine is better. Is there a vaccine that's better for certain races like Asian people or African American people?

Jessica: Good question. To answer the first question, the frustrating part of having the vaccine rollout fall primarily on states for logistics is exactly that, that there isn't a streamlined prioritization of demographics and people who are at various levels of risk being in what position of line they can be in to get the vaccine. I think that's really frustrating. I'm hoping that that'll shift a bit as we move to the new administration, that those things will become more clear because I think in some jurisdictions, it's really clear and in some, it's not. Then to answer your question on the indications for the vaccine on race, both Pfizer and Moderna had very similar results when it comes to efficacy in different demographics.

I think that there's some misinformation circulating about one being better or not for certain ethnicities, and I think that's actually not true. They're both safe and effective and have found to be safe and effective in the populations that were represented in the trials.

Brian: Let me end on a policy question that may or may not be within your portfolio as a science communicator, but you'll tell me because here we are in the day when we are likely to officially hit 400,000 deaths and it took four months to get to the first 100,000 deaths, it took only five weeks to record the latest 100,000 deaths. This is still accelerating at an alarming rate.

Yet, we're seeing a reluctance to get vaccinated to the point where Governor Cuomo here in New York said it's around only 30% of the frontline healthcare workers eligible in at least some New York City hospitals have been taking the vaccine. A coming debate is whether employers can or should require vaccination till that people back to work in person, except for people with certain health exemptions. Do you have an opinion about whether that's a good idea or scientifically recommended?

Jessica: Well, I think right now in emergency use authorization, that would not be likely or recommended. I think if we're dealing with a vaccine that is actually fully approved by the FDA, that's another conversation, but I still don't actually think that that's in our future. I don't think that the vaccine will become mandated on any level. I think it's a very tricky policy question, but I don't expect that that would happen.

It is concerning though to think about populations like healthcare providers in healthcare facilities refusing the vaccine, but that's why vaccine science communication is so important and the work is not done. There's still so much good that can still happen with us explaining the safety and efficacy profiles, the data, and debunking all the myths.

Brian: Well, you've done a great job with some really clear explanations on some complicated things today. We really appreciate it. Jessica Malaty Rivera, infectious disease epidemiologist and the lead science communicator for the COVID Tracking Project. Do you want to tell people the best place to find you online?

Jessica: Yes, they can find the COVID Tracking Project on Twitter @COVID19tracking, or they can follow me, JessicaMalaty on Twitter or on Instagram, Jessica Malaty Rivera.

Brian: Malaty is M-A-L-A-T-Y, not D-Y which would indicate an unhealthful condition, which would be the opposite of what you're communicating. Jessica Malaty Rivera, thank you so much.

Jessica: Thanks, Brian.

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