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Brian Lehrer: Brian Lehrer on WNYC. The good news and the bad news about COVID just keep on coming and we'll keep trying to help you make sense of it, and how it affects your life choices, and more. Some of the good news this week is very, very good. This morning's COVID headline. Have you heard this yet? Is that, Pfizer vaccine trials on 12 to 15-year-olds are turning out 100% safe and effective. Teenagers rarely at 100% on anything, and of course, so do clinical trials, 100% safety and effectiveness for 12 to 15-year-olds.

For adults, now that the Pfizer and Moderna vaccines have been out in the real world for a few months and not just in clinical trials, studies published this week show them being 90% effective at preventing getting the disease at all. The trials just focused on hospitalizations and deaths, which they prevented totally. The finding of 90% effectiveness also against even becoming an asymptomatic carrier is really good news. At the same time, cases and hospitalizations are once again on the rise as more state and local governments open more things. Yesterday we played that widely shared clip of CDC Director Dr. Rochelle Walensky saying she has a feeling of impending doom. Here's 20 seconds more of her emotional appearance on Monday.

Rochelle Walensky: I'm speaking today not necessarily as your CDC director, not only as your CDC director but as a wife, as a mother, as a daughter, to ask you to just please hold on a little while longer. I so badly want to be done. I know you all so badly want to be done. We are just almost there, but not quite yet.

Brian: Dr. Walensky on Monday. A survey of epidemiologists in 28 countries, finds two-thirds believe the current vaccines will become ineffective within a year, almost a third predicted ineffective in nine months or less. These are just the last two days worth of headlines as scientists continue to keep real-time track of the changes in the things they can measure or see with their eyes a pace of scientific observation and response like maybe never before in medical history.

With me now, Dr. Celine Gounder, an infectious disease specialist and epidemiologist at NYU and their Langone Medical Center. She was a member of the Biden administration's COVID-19 transition team. She is the host and producer of in Sickness and in Health, a podcast on health and social justice, and a CNN medical analyst and is written for general leadership publications ranging from the New Yorker to Sports Illustrated. Dr. Gounder, great to have you join us this morning. Welcome to WNYC.

Dr. Celine Gounder: It's great to be here.

Brian: Can we start with the newest good news, breaking this morning, 100% safety and effectiveness in the Pfizer vaccine trials on 12 to 15-year-olds? Do you know what they're measuring there exactly?

Dr. Gounder: They looked at infection. Were these adolescents carriers, not just did they have disease, did they end up in the hospital? This is really important because as we know, young people, children, and teenagers are less likely to have symptoms. What was most important here was not just did it prevent disease, but also does it prevent that carrier state where they could be spreading to adults?

Brian: What are the implications of that for a society more broadly?

Dr. Gounder: Well, we've been talking about this holy grail of herd immunity. Based on the data that we've seen so far, and with COVID, it is a moving target, we're learning something new every day, but our best estimates are that probably around 80% of the population needs to be vaccinated have robust immunity from vaccination to reach that herd immunity where the virus basically has no place to go because it keeps encountering people who are immune.

To reach that level of herd immunity, you really do need to vaccinate kids, kids are about a quarter of the population here in the United States. If you are not able to vaccinate them, if you're not able to induce a strong immune response in that population, it's very unlikely you would be able to get to herd immunity. Essentially, this is news that, yes, it is possible to get to herd immunity eventually.

Brian: Now, listeners, we're continuing to try to serve you with direct access to leading COVID experts, and once again today. Our phones are open for your COVID science questions. We're talking about vaccines. We'll talk about reopenings and COVID passports, and more as we go today with NYU infectious disease specialist and epidemiologist Dr. Celine Gounder who was also on the Biden COVID transition team. Your COVID questions welcome here at 646-435-7280. You can also tweet a question @BrianLehrer, or call 646-435-7280.

Dr. Gounder, now could you describe this other piece of good science news from this week. The Pfizer and Moderna vaccines are proving 90% effective against blocking Coronavirus infections in their real-world uses not just clinical trials according to studies of first responders in six states who had been vaccinated. We already knew the vaccines were blocking virtually any hospitalizations or deaths. What's the significance of this new piece?

Dr. Gounder: What we're seeing is that the Pfizer and Moderna vaccines are 80% effective against infection 14 days after the first dose, and 90% effective against infection 14 days after the second dose. That means the vast majority of people who are vaccinated with the Pfizer and Moderna vaccines are protected not just against severe disease, hospitalization, and death, but also from infection that carrier state. As we've seen over the course of this pandemic, a lot of the transmission is occurring by people who have no symptoms or minimal symptoms but are carriers. So this is really very important data that we're seeing here.

Brian: Would that have implications for what vaccinated people should feel comfortable doing once they've had their shots plus two weeks?

Dr. Gounder: I think it should, and this is why you're going to see as this data comes in, the guidance evolve. I think about the vaccines a bit like a raincoat and an umbrella, which are really highly effective, they'll keep you safe and dry in a thunderstorm, but in a hurricane, you really do need additional protections. We are currently in a hurricane, we have very high levels of coronavirus transmission in the community. We are at the beginnings of another surge right now. I do think even if you've been vaccinated, and I've been vaccinated myself, you do need to continue wearing a mask when you're out in public. I'm doing so, and you do need to avoid crowds.

I think that said, if you're fully vaccinated, can you socialize with other people who are not? Yes, as long as you are with people of one household at a time who have not yet been vaccinated, you can do so safely without a mask.

Brian: Because people are confused about this, why should people who are fully vaccinated still avoid crowds if they themselves are protected, and these studies are showing that they're highly unlikely to be asymptomatic carriers and a risk to others?

Dr. Gounder: Remember, we're talking about percentages. 80% of what? 90% of what? This is what I'm talking about with the hurricane. When you have that much transmission in the community, yes, you're seeing significant reduction in risk, but when you have even still very high baseline risk, you're still facing some level of risk, these vaccines are not 100% effective. Until we can bring down that community transmission until more people are vaccinated. The risk is not zero, and so we do need to keep being somewhat careful.

Brian: How much would you say that applies to outdoor events, where people are wearing masks? I know there's debate about the reopening of Yankee Stadium, opening day tomorrow, Citi Field next week, approximately 10,000 people are going to be allowed in as fans, there are going to be mask mandates except for when they're eating, and outdoors just makes such a big difference compared to being indoors, baseball is only one example. If there were to be an Easter Parade or a million other things.

Dr. Gounder: There is no question that being outdoors is much, much safer, that is as good of ventilation as you're going to get. The problem with some of those venues is that you're not spending the entire time in the bleachers, you're going to the bathroom, you're going to the concession stands, you're waiting in line to get in or to leave where some of those spaces are indoors. That's where the risk comes in.

Brian: Let's take a phone call. Paul, in the West Village, you're on WNYC. Hi, Paul.

Paul: Hi, Brian. Thank you for this useful and helpful section of your show. I wanted to ask a question of your experts about the experiment that's going on in Britain, where they are mixing and matching vaccines, where if you take, for example, the AstraZeneca vaccine in your first dose, and then your second dose, which they're spacing out further in England in the UK, they're saying, "You can take whatever is available. If it happens to be an AstraZeneca. Good. If you use a Pfizer one or a Moderna one that's okay."

They're allowing this pick and mix between the vaccines in the hope that A, they believe that it doesn't matter and B that it may actually help things. It might improve it because instead of having what's called a homogenous second prime-boost, it's called, you have the heterogeneous, which is the opposite of homogenous, your $10 moment of the day, sorry. Heterologous prime-boost allows you to get a broader spectrum of reaction against the virus, against the spike protein or different interpretations of the spike protein. Obviously, that isn't happening here, but it may be something with the variants coming that may be something helpful to consider.

Brian: Paul, thank you for that. Great question. Dr. Gounder, a lot of people have that question now. Of course, it's a policy question too, even more than it's a personal question. Is it not only okay to delay the second shot so more people could get protected by the first shot? Is it may be even better?

Dr. Gounder: I think there's two separate questions there. In terms of delaying the second doses, there is real potential risk in that. I think people think too much in terms of binary, immune, or not immune. We really should be thinking about immunity on a continuum of different levels of neutralizing antibodies, for example. We know that after your first dose, you do have some level of immunity, but your neutralizing antibody levels are much lower after that first dose. They do start to decrease in the numbers by the time you hit four or five, six weeks after that first dose.

If you're extending that delay between first and second dose, there is a risk that your neutralizing antibody levels will be lower. That creates a window where you could be exposed to some of these variant strains and be more at risk for infection with one of those. A lot of this is still very much up for debate, how that would play out. This is something that needs to be formally studied because you can't model, predict the answer to all of these things.

With respect to the heterologous prime-boost approach, where you mix and match different vaccines for number one, number two, I think this is something we were discussing on the advisory board for months and something that certainly needs to be studied. In Britain, it sounds like they may be moving forward with that even in the absence of formal studies.

In the US, we do actually have two different platforms, two different technologies that have been granted emergency use authorization. You have the mRNA vaccine, so Pfizer and Moderna, which were approved back in December. Then more recently you had the authorization of the Johnson & Johnson, which is an adenovirus vector vaccine, which is similar to some degree to the AstraZeneca vaccine.

I do think you're going to see this studied here in the US, mixing and matching Pfizer-Moderna and Johnson & Johnson. I would say, here we are very science-driven in the recommendations we're making. Until there is a formal study, I don't think you're going to see that outside of a clinical trial in the United States.

Brian: We'll continue in a minute with Dr. Gounder and your calls among other things I'll ask her about this study that she tweeted out of epidemiologists in 28 countries that found two-thirds predict that the current vaccines will become ineffective within a year. That and much more coming up. Stay with us. Brian Lehrer on WNYC.

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Brian Lehrer on WNYC. As we continue with Dr. Celine Gounder from NYU and formerly a member of the Biden COVID Transition Team. We'll get to more of your calls in just a second. Dr. Gounder, I do want to ask you to comment on this more troubling international survey, now that we've been talking about a lot of good news of epidemiologists in 28 countries, I see you tweeted it out, that finds two-thirds of these experts on the spread of disease. That's what an epidemiologist is, an expert on the spread of disease, predict the current vaccines will become ineffective in a year. In addition, a third of them predicted they will become ineffective within nine months.

Were you surveyed for this and in any case, would you count yourself with the majority there?

Dr. Gounder: I was not surveyed for that, but I would count myself among those even the third who say that within nine months, we may need second-generation vaccines.

Brian: With that prediction in mind, what do you think the implications are for personal behavior or for public policy?

Dr. Gounder: With the virus, you have to understand that every time the virus spreads from one person to another, it has the opportunity to mutate to evolve. Even if we achieve very high vaccination rates in the next few months here in the United States, as long as the virus is spreading anywhere in the world that puts us all at risk for the emergence of mutant variant viruses.

Some of the places where these mutant viruses have emerged are the UK where you have this more transmissible, more virulent virus that has prompted the UK and then now Europe to re-institute very strict lockdown measures. France is seeing its ICU currently overrun. They are about to re-institute a strict lockdown. That same variant is now spreading in the United States. It is driving in part our surge that is just beginning now. Then, you have other variants that have emerged in countries like South Africa and Brazil, where, again, the virus has been allowed to spread like wildfire.

Those also threatened our vaccination response because the vaccines appear to be still effective, but less effective against those variants. We could find ourselves in a place where almost everybody in the US has been vaccinated and then you have a mutant variant that emerges in another part of the world that the vaccines are not effective against. Then, that comes back here to haunt us.

Brian: That's such a nightmare scenario. How will we know the early warning signs? Do we need to wait for a few dreaded cases of vaccinated people dying or getting sick enough to be hospitalized in half a year or more from now, or can we hit it off at the past in some way?

Dr. Gounder: Well, I think this speaks to a couple of different things. One, we need to be doing much more in terms of what's called genomic surveillance, where you're looking at the genetics of the virus and how it's mutating and changing over time. We have increased that over the last two months or so significantly, but we've gone from close to zero to a bit more. That's still nowhere near enough in where we need to be. We're not doing testing on the order of countries like the UK or even South Africa.

That really needs to be ramped up. Part of what we need to do on that front is really get the university academic labs involved more. We need to be building up more of this testing capacity in local and state health departments and that will take some time. I think the other thing is we need to look at the root cause, the drivers of mutation, and that's when the virus spreads. We really do need to be thinking about how to help other countries scale up their vaccination so that you're not having the emergence of these mutant variants. It's really not just for them, but it's also for our own protection.

Brian: The science writer, Zeynep Tufekci, has a new piece in the Atlantic where she argues the federal government should do some kind of vaccination surge in the places that are facing case surges now like Michigan and New Jersey. She tweeted yesterday, "I understand why we did and each state does their own thing policy now, but the administration should immediately implemented a national strategy of geographic prioritizing. We already have federal sites in many States, and we have the vaccine supply." For you as a former member of Biden's COVID task force during the transition, would you recommend that to him, and do you think it's doable?

Dr. Gounder: I would agree with that. I think the one challenge though, is that once you see the increase in cases, hospitalizations, you're really behind the eight ball. I think the places that we are concerned about seeing cases rise next, and we've already seen it in Michigan, we're already seeing it in Massachusetts, in New Jersey, New York, I think the South is what we're going to see next.

Where do you prioritize? Do you prioritize the place that you're already seeing the surge or do you try to get ahead of it? I don't think we have a good answer to that. I do think big picture in addition to vaccination, we really do need to be doubling down on these other mitigation measures the masking, trying to be in well-ventilated spaces outdoors ideally if you're around other people, at least until we can achieve a much higher coverage with vaccination.

Brian: This is WNYC-FM HD and AM New York, WNJT-FM 88.1 Trenton, WNJP 88.5 Sussex, WNJY 89.3 Netcong, and WNJO 90.3 Toms River. We are in New York and New Jersey Public Radio. Few more minutes with Dr. Celine Gounder, infectious disease expert, and epidemiologist from NYU. As I just mentioned, a former member of President Biden's COVID Task Force on the transition team. Kim, in Queens, you're on WNYC. Hi, Kim.

Kim: Hi. Thanks for taking my call. Thanks for doing this program.

Brian: Sure.

Kim: I'm asking how we should think about risk in terms of when to return to the gym, not necessarily classes in rooms, but sort of machines spread out after you're vaccinated. It seems from what you're saying that this is definitely not the time until we have a much higher percent of vaccination, but what are the conditions under which it would be reasonable to do that for somebody who's been vaccinated?

Dr. Gounder: Yes, great question. I think, unfortunately, many states, including our own have reopened indoor dining, indoor bars, indoor gyms, other indoor businesses far too soon. I understand the trade-off between economics and public health concerns. This is also why the President has included a lot of different supports for small businesses, and the like in his various different plans, because there is an understanding, you don't want to be forcing people to choose between their economic well-being, being able to pay the rent, and public health.

That said, it's going to be a while yet before it would be safe to go back to gyms, even for just individual workouts. We are at the beginning of another surge here in New York City right now. When we see an increase in cases, usually, previously in the epidemic, in the pandemic, that means that you're about to see a spike in cases. I'm hoping that's curbed a little bit by the fact that some people are vaccinated now, that it won't be as sharp of a rise, but this really is not the time, I think we really have to wait until we're on the other side of this impending surge.

Brian: Kim, thank you for your call. So, when you see something like Mayor de Blasio encourage tourists to come back to New York this summer, does that make you cringe?

Dr. Gounder: [chuckles] I think it's too early to give that advice. I really think we need to be, as I said on the other side of this, reassess where things are. I think so much of what's been challenging about how to talk about the pandemic is people want, "Okay, here are the facts. Here's what's predictable, that I can count on and I can plan my life around." The problem is, this really has been a crash course in the science of coronavirus. We are learning something new every day, and that means that our advice, our understanding is going to shift with time.

Brian: All right. What about bringing people back to their desks in offices with social distancing? There's only 10% of the office workers in Midtown and Downtown Manhattan, according to what I've read, than there were before the pandemic, and Mayor de Blasio is trying to lead people back by ordering city office workers to start coming back to their desks in phases in May. Is that too soon?

Dr. Gounder: My understanding of that from having spoken to some people in city government is that really is going to be phased in. It's not going to be all at once. I do think that's important to understand. Big picture in terms of returning to the office, I really think it depends on how good is the ventilation? Do you have windows you can open? A lot of these skyscraper office buildings, that's not really an option.

If you don't have that ventilation, are you going to be putting in HEPA filtration units around? Are you going to still be requiring people to wear masks? It's less about really the distance between people and more the density of people as we've learned, and so that needs to be ensured at least until enough people can be vaccinated again.

Brian: Can you explain that difference for people who don't understand it? The difference between distance between people meaning, if you can keep six feet between you and your fellow co-workers, and the density of total people in the office? Is that what you're getting at?

Dr. Gounder: Yes, that's a great question. This relates to CDC guidance on can students be three feet apart or six feet apart? The six feet apart was really based on the idea that COVID is droplet transmitted. Droplets really do fall to the ground within a six-foot radius, airborne transmission can occur at much longer distances. If you're focused on droplet transmission, yes six feet. If you're not focused on droplet transmission, that becomes less important.

Now, with the question of density, it's really a probability question where the more people you have in a room, the more likelihood that one of those people will be infected and will infect others. It's sort of like if you flip a coin once, what are your chances of getting tails? But if you flip a coin 10 times you're almost 100% sure to get tails at least once. Similarly, if you have higher density, your chances of somebody being infectious in that room is very high.

Brian: Before you go, we had a segment yesterday on the vaccine and negative COVID test passports now being introduced by the state of new york and others intended to allow safe reopenings of denser entertainment events, and restaurants, and other things. Do you have any take yet on those passports in terms of effectiveness or equity or anything else?

Dr. Gounder: I think equity and privacy are the two main concerns here. I know that the white house is working with a number of different companies. I think some 20 different companies are working on these different passport technologies where you have both a smartphone app and a paper version and trying to make sure that all of those systems do maintain privacy of information. The other concern is around equity and is it fair to be limiting access to certain places if not everybody who wants to get vaccinated can get vaccinated? I do think we have to be very careful about instituting vaccine passports until everybody has equitable access to vaccines, and for that matter to testing as well.

Brian: One question I had that yesterday's guests wanted the right kinds of experts to ask, the use of rapid tests right at the door as a screen to get into the theater or concerts or sporting events or whatever. I read the rapid tests are significantly less accurate than the nasal swab PCR tests, which don't give instant results, so you can't use them that way. So, I don't know how confident people should be going into a venue where rapid tests are supposedly protecting them from the virus. Do you ever take on rapid tests as entertainment passports?

Dr. Gounder: Yes. I do think you're going to see more of the use of rapid tests in the coming months. What we see with those rapid tests is that you're really picking up the most infectious people, so you are going to miss some people who might have low levels of virus with those rapid tests, but the most infectious people you will pick up, so it's still a useful screening tool in that respect. I would still advise, at least until more people are vaccinated also combining those kinds of measures with masking and decent ventilation indoors.

Brian: Last one from a listener on Twitter. "Can therapist and their patients meet safely in person if both are vaccinated but also have children?"

Dr. Gounder: I think if both people are vaccinated, yes. I think that would be perfectly reasonable for a therapist and patient to meet in person.

Brian: Even if they have children unvaccinated which I guess was the particular question there?

Dr. Gounder: Yes. I think even if they have children. Now, let's say there were somebody high-risk in the household, some elderly person with chronic medical conditions, that might be a slightly different calculation, but if it's a therapist who has children or the patient has children, they have both been vaccinated, the adults, I think it's reasonable for them to meet in person.

Brian: As we go out, let me give you a chance to plug your podcasts and any other media work. I'll say first Dr. Celine Gounder is an infectious disease specialist and epidemiologist at NYU, and their Langone Medical Center. She was a member of the Biden administration's COVID-19 transition team task force, and you've got a couple of podcasts going, right?

Dr. Gounder: I do. The epidemic podcast I launched in February last year, originally with Ron Klain who's Biden's chief of staff now. That's a weekly podcast, season one is on the covid pandemic. The other podcast which has been going for several years now is called American Diagnosis, and you can find Epidemic and American Diagnosis really wherever you listen to podcasts, Apple, Spotify, all the usual suspects.

Brian: Thank you for being so clear and detailed in your answers to my and our listener's questions, and for your generosity with your time today. Thanks a lot.

Dr. Gounder: Oh, my pleasure.

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