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Brian Lehrer: Brian Lehrer on WNYC and beginning today, more New Yorkers can sign up for COVID vaccines. Teachers, police officers, firefighters, and anyone over 75 is the category delineation set that I'm seeing beginning at four o'clock today. The COVID vaccination hotline will open for scheduling vaccination appointments for those new groups of eligible New Yorkers.

If you want the number it's 1-833-NYS-4-VAX. I'll give it to you again later when you get a chance to get something to write with, but it's 1833, the letters NYS for New York state then the number four, then VAX. 1-833-NYS-4-VAX. That's for New York. In New Jersey police and firefighters can sign up now, but as I understand it, not yet teachers or others based on their jobs and the 75-year old plus age group hasn't kicked in yet, either. Again on that New York state vaccination hotline that goes live at four o'clock this afternoon, we are told.

Vaccine availability can't come fast enough as the pandemic in this country is now at its deadliest. The most deaths in a single day in the first wave was 2700 back on April 14th. The daily deaths passed 4,000 in one day last Thursday for the first time. The stats I've seen are that there were about 14,000 deaths worldwide on Thursday. That would mean the US has 4% of the world's population, but right now we're having more than 25% of the deaths. Through that same day, last Thursday, 6 million people in the US had been vaccinated a much smaller number than was first promised and projected, and all of this as the new variant or possible variants of the virus spread more easily through society.

Again, to compare the first week in April to today, the worst day for diagnosed cases in April had 59,000 positive US COVID tests. On Saturday, there were 130,000 and hospitals in some parts of the country are beginning to ration care, actually ration care, something that we came close to, but didn't quite happen in New York in the spring.

With us now, Dr. Wafaa El-Sadr, infectious diseases epidemiologist, director of the global health initiative known as ICAP at the Columbia University Mailman School of Public Health and from the global to the local since the start of the COVID-19 pandemic. Dr. El-Sadr has also shared her expertise as a member of mayor de Blasio scientific advisory council, the New York City test and trace group and the Columbia University COVID-19 task force. Dr. El-Sadr, thanks for coming on again. Welcome back to WNYC.

Dr. Wafaa El-Sadr: Thank you. Pleasure.

Brian: First, can you shed any light, other than that call-in number that I gave that people can start calling it four o'clock this afternoon in New York state to sign up for vaccinations, how eligibility will work. I'm hearing that it's so bleak and confusing. Do you have anything on that?

Dr. El-Sadr: Yes, I think we can-- Obviously, this is an unprecedented effort in recent history, but I do think that there's another way also to be able to at least try to schedule an appointment for vaccination. The New York city as well is utilizing a website called vaccinefinder.nyc.gov/locations and if you go to that website, then you can actually enter your zip code where you reside and you'll get a listing of the vaccination sites that are closest to where you live and there are several quite a large numbers and a large number of these locations that are already indicated on that website situated in all the five boroughs. That's another way of trying to get an appointment if you are eligible for vaccination. To get an appointment to be vaccinated at any of those city sites as well.

Brian: Good information and again, listeners, I said I would give it in another minute or two after you were able to get something to write with, if you want the number that goes live at four o'clock this afternoon for people in the newly eligible categories for vaccination as of today, police officers, firefighters, teachers, anyone over 75 it's 833-NYS-4-VAX. 833-NYS-4-VAX. Or in all numerical terms, that's 833-697-4829, 833-697-4829.

Dr. El-Sadr, do you have any opinions on a policy level, how this should be best rolled out in terms of priority groups or anything else?

Dr. El-Sadr: Yes, I think from the beginning there really two principles that have guided the rollout of the vaccines. Obviously, a lot of people are very interested in being at the front of the line, but the two principles are, number one, is we need to obviously protect the people who are most likely to have a major complications if they develop COVID-19 and that's why the focus on for example residents of long-term facilities and also now individuals who are 75 years or older. That's one group.

Then the second group is, of course, the issue of equity and trying to reach the group of individuals who are at the highest risk, because they do have frequent contact with the public. They need to take transportation to go to work. They don't have the luxury of being able to work virtually and so on. It's both equity as well as burden of disease that really have driven the priorities both from the CDC perspective, but also from the state and from the city's perspective.

Brian: Mayor de Blasio has said a few weeks ago that he would prioritize the zip codes in which COVID has the most afflicted people and that tends to line up with where brown and Black people in New York tend to live disproportionately but I don't see anything about rollout by zip code in what the governor is taking live today. Do you?

Dr. El-Sadr: No, not really. I think that's been an issue of intense conversations at every level, in terms of, again, the populations that have been at most risk of getting, just getting the infection itself, which are, as we know, have been largely in certain areas in our city, live in certain areas in our city. There's been a lot of conversation about who comes first.

The goal is maybe that if we do focus and expand what's called essential worker groups and make them become eligible incrementally, that in all likelihood we will be reaching a disproportionately high group amongst the individuals who are from Black and brown communities in our city.

I think that the hope is that as more vaccine becomes available, and that's a big issue, the supply of vaccines themselves, is that there will be an expansion hopefully of the essential worker population to reach those who are the individuals who have been coming to work, who have been serving all of us and to get them access to the vaccine as the next priority group

Brian: Listeners, we can take your COVID questions for Dr. Wafaa El-Sadr infectious diseases epidemiologists from Columbia university's Mailman School of Public Health on vaccine science, on new variant science or anything else in her expertise, 646-435-7280. I don't think she's an expert on the New York state and New York city government, or New Jersey logistics of rolling out the vaccine. As you're hearing, she's got some background on that, but callers, I'm just going to say, I don't think Dr. El-Sadr is the person to call to ask, "Where do I go from my vaccine?" in too much detail. Correct me if I'm wrong, Dr. El-Sadr, because some people are calling with exactly that kind of a question but-- Go ahead.

Dr. El-Sadr: Again, I would guide them to that website that I mentioned, the New York city website, which is very helpful and like I said, I encourage people to, if they want the answer to that question and they're able to go to that website and enter the zip code, that's probably the fastest way to identify the closest location where they can get vaccinated.

Brian: Screeners take note on that. All the questions aren't ones that Dr. El-Sadr can answer, but we continue to bring on COVID experts to answer your questions and we're grateful Dr. El-Sadr could join us today. 646-435-7280. What's the latest science you have on what makes the UK variants so contagious?

Dr. El-Sadr: Well, I think the evidence that's evolving is that this variant, which means there've been some mutations in the virus that have resulted in this new variant. I have to say that just keep in mind that there are new variants that arise all the time. I think the concern with this variant that arose in the UK is that it appears that it's kind of taken over in terms of crowding out all the other variants that are being transmitted in the community. That provides a hint or suggestion that it is more infectious or more transmissible than other variants.

That's the concern is that this variant has characteristics that make it more transmissible from one person to another. We don't know for sure that that's the case. We don't know for sure the mechanisms. Some people are saying that this variant may be able to attach itself more firmly or more effectively to cells that line or respiratory system, but that remains to be proven.

Nonetheless, I think whether it be the usual variance or this new variance, this in essence we have to stick to the fundamentals to stop transmission and the same fundamentals apply to this variant as they've applied to any other variants of SARS-CoV-2, which is of course the need for the distancing and the wearing of face coverings and masking and so on. The same principles, the same practices apply but I think now with this spread of this new variant, it should really motivate all of us to redouble our efforts to be particularly cautious and particularly adherent to these recommendations.

Brian: Some specifics on that, because would this mean it would spread more easily in public spaces like in stores or restaurants or mass transit that the original virus might not be contagious enough in? If someone felt comfortable going into a given store that seemed to be taking distancing or ventilation or airflow precautions previously, should they be more wary now and even outdoors. LA shut down even outdoor dining, not based on the UK variant per se, but on how prevalent the virus is there right now. If having a socially distanced walk with friends or play date for your kids was kind of safe before, should we be more wary of those things now?

Dr. El-Sadr: So long as are applying what you just said, the distancing and the face covering and so on consistently, I think that should be similarly effective for prevention of transmission of this new variant, as well as the other variants that exist. We have no evidence that these kinds of protective measures are not effective for prevention of transmission. I think what might be the case is that in situations where people are not following these recommendations then based on this early data, they might be more likely to get infected with this variant than other variants. I think the same principles continue to apply that we've talked about all along.

Brian: Jane, in Brooklyn, you're on WNYC with Dr. Wafaa El-Sadr from Columbia. Hi.

Jane: Hello. I think the websites to give vaccines are good, except for nobody has a vaccine or they don't have an appointment. I'm a physical therapist. I have direct contact and I'm struggling to get a vaccine. I'm in practice, so not affiliated with a hospital. I just wanted to give people that information and I'm happy that the website's working, but the actual vaccines right now aren't very readily available. Thank you.

Brian: Jane, thank you.

Dr. El-Sadr: Thank you very much, Jane, for your call. I think that's what I was getting at is that certainly we can, now there's more people who are eligible more demand, but of course at the same time we need to increase the supply. That's the critical issue is to keep up with the supplies so that all the people who would like to be vaccinated or are eligible to be vaccinated, that they can find a vaccine. It's kind of you have to work on both sides.

You have to work on eligibility and demand while at the same time also enhancing the supply so that supply can meet the demand. I think we're in a very fragile situation now where there's been an increasing eligibility and more and more people who are eligible now while we haven't seen a similar or congruent kind of increase in the supply of the vaccines. We need to work on both sides in order to reach the people who need to be vaccinated.

Brian: I think Jane in Chelsea is going to have a somewhat similar story to Jane in Brooklyn, who we just heard from. Hi, Jane in Chelsea, you're on WNYC.

Jane: Hi, thank you for taking my call. I'm an 84 year old woman. I went on that site over the weekend and and on Friday and also Monday, and I have talked to three places and old people are fairly down the line. They are rightly so taking care of the people who take care of us. I was told call back in a week or two, and I even spoke to my internist and he said they hope to have him by February.

Brian: Well, just to be clear, Jane, what we announced at the beginning of the segment is that anybody 75 and up based on age alone will be eligible to sign up in New York state beginning this afternoon at four o'clock. If you were getting some information from individuals that was different than that, Governor Cuomo changed it over the weekend. You should know that.

Jane: Sir, no, what they're saying is they do not have it for us. What they have in their freezers is to take care of the people who take care of us, that they will not take my name. I have to call them back. I may not make an appointment.

Dr. El-Sadr: I'd like to clarify one thing. I think you are right in that the first priority was to take care of healthcare workers, right? The first supply of vaccines did go to hospitals and clinics and large clinics and physician practices and so on. That was the 1a, the very first priority. I think we're expanding now and with the opening of community locations for vaccination, and some of those are on that website that I mentioned, the New York city website.

There also are other large locations that are also being opened that will allow for a much larger access to individuals beyond healthcare worker groups to the vaccines. Stay tuned. This has just been announced as you know on Friday and Saturday and today the website is active. I would say probably in the next few days, hopefully you will see more of these sites having vaccine availability and having slots for scheduling of visits.

I do think though in order to provide access to the larger community and some people find it hard to access websites or keep calling numbers and so on. There may be the need to in addition to having the by appointment kind of a plan is to hopefully also allow for some ordered walk-ins particularly once large sites like the Javits Center are open for vaccination.

Brian: Will peoplel be able to choose among sites now that they're eligible in new categories or will they be told where they have to go.

Dr. El-Sadr: The plan is that people choose their sites based on what's most convenient for them. If you put in your your zip code, you will get the closest locations to where you are living, but you're not required to go to that side. You can pick and call any of the sites that are on the list, but the hope is that people would like to go to whatever's most convenient to them, but they're not required. They're not assigned to a specific site.

Brian: This is WNYC-FM, HD and AM New York. WNJT-FM 80.1, Trenton, WNJP 88.5, Sussex, WNJY 89.3, Netcong and and WNJO 90.3, Toms River. We are a New York and New Jersey public radio, as we take another phone call for Dr. El-Sadr and it's Renee in the Bronx. Renee, you're on WNYC. Thank you for calling in.

Renee: Thank you. Can you hear me?

Brian: I can hear you just fine, yes.

Renee: Okay. Thank you so much, Brian. I appreciate you and I've been listening for years and thank you for all the services you're doing for all of us.

Brian: Thank you.

Renee: I'd like to say that I'm 81 years old and that I have many pre-existing conditions. I have many allergies, I have an EpiPen, I've had an anaphylactic reaction. I'd like to know if there will be any sites that I can go to where they will have medical people available should I have a major reaction to the vaccine?

Dr. El-Sadr: I think that is absolutely required so that you can be properly monitored. If you will actually look at the sites that are available now, many of them are clinical sites, meaning they're clinics and so on and any of these clinics will have availability of clinical staff, as well as the medications that you might need if you develop an anaphylactic reaction. I think for anyone with a history of anaphylactic reaction, I strongly recommend that you get vaccinated at a clinical site.

Brian: There are different kinds of sites that cater either more or less to people who might need to be monitored like I've heard that it's best for everybody to wait around in the area of the place they got vaccinated for about 15 minutes to see if they have any immediate reaction but how do you do that when you go to a mass vaccination site or even how do you do that in safety in the winter, if you're going to have to be indoors with a lot of other people who just got their shots, do you know any of that?

Dr. El-Sadr: Yes, certainly. I think for some of the locations that I mentioned, I have seen some of the layout that has been put in place, and that includes the necessity of having places where people can sit appropriately distance from each other for a minimum of 15 minutes after receipt of the vaccine.

For anyone who has a history of anaphylaxis or severe allergic reaction, they must inform the person who's vaccinating them, the nurse, or whoever's vaccinating that they have a history of such a reaction. They will be monitored for a minimum of again, half an hour so it's twice as long as for everybody else and that's critically important to share that information before you get vaccinated so that you can get special attention during that period of time, the period of observation.

Brian: Well, let me ask you this, I've read that the South African variant that starting to be in the news might be either vaccine resistant, unlike the UK or the original variants, or somehow worse in some way or another. Do you know anything about that?

Dr. El-Sadr: No, we have no evidence to support what you just said. I think from what we know thus far, and there have been sharing of data regarding the Pfizer vaccine, BioNTech vaccine specifically and it looks like it should work fine for these variants. We don't have any evidence as of yet that either the UK or the South Africa variants essentially are not appropriately protect individuals who have received those vaccines from these variants. We don't have such information as of yet.

I think that's the reason why I always say we have a race, a race between the vaccines and the race with the virus itself and the more we can expedite and scale up vaccination as rapidly as possible, on the one hand, in terms of the vaccine side, that would be extremely helpful because we get larger and larger segment of our population that's protected from the disease, from COVID-19.

At the same time, we have to continue to practice all the protective measures that we know we must practice in order to stop this virus and its track, to stop further transmission, because we know that we are in this race and the only way we're going to be able to control this pandemic is that if we are able to work on both sides of the equation, expand access to the vaccine as quickly as possible at the same time, do everything we can to prevent further transmission of the virus itself.

Brian: We have two vaccines in use here so far, the Pfizer and Moderna, which both require two shots a few weeks apart and are said to be about 94% effective. The next one likely to be approved is from AstraZeneca and I'm seeing numbers like 70% effective, which is significantly lower but that one might be more useful, I've read globally. I actually want to detour from all these local questions about what to do next, how to sign up in New York? As a global health expert, is that your understanding that the AstraZeneca is actually going to help more people around the world more quickly?

Dr. El-Sadr: That's quite a possibility because in essence, ultimately, we're going to have to balance between how effective the efficacy of a vaccine versus scalability. Can it be scaled up? That's really critically important. We know that both the Moderna and the Pfizer buying vaccines require freezing which is not widely available.

On the other hand, the AstraZeneca vaccine, which appears to have less efficacy about 70% or so based on the available studies at the same time, it requires only refrigeration. It's still two doses so that's still the complexity, but requiring refrigeration rather than freezing is a major advantage and therefore in many settings in the world having a vaccine that only requires refrigeration can go a long way.

Ultimately, what we want is a vaccine that requires one dose. That will make a huge difference for scaling up globally and hopefully such a vaccine may be coming down the line. We don't know as of yet if such vaccines will have efficacy or not yet. In every setting you have to balance the resources that are available, freezers, refrigerators versus the efficacy of the vaccine that fits within the specific setting and the requirements for that setting.

Brian: Last question, since you mentioned the complexity of these various vaccines we have requiring two shots weeks apart. Do you have a position on this conversation, which seems to have broken out in scientific circles about potentially trying to get one shot of the two for as many people as possible before anybody is allowed to go back for a second? Now that we've been hearing all these calls from people who were told, even if they're in the category that's eligible, it might be awhile before there's enough vaccines doses to get them into their arms. What do you think about this one shot for everyone before anyone gets their second?

Dr. El-Sadr: I think many of us are concerned about this strategy because we really don't have the convincing evidence that one shot is protective. Most people in the studies that have been done received two shots, so the data are really based on receiving these two shots, either 21 days apart for Pfizer or 28 days apart for, for Moderna. That's the evidence we have. It's very limited evidence on one shot and how effective one shot would be because almost everybody in the studies got two shots.

I think it's rather premature to think that one dose would be sufficient to achieve the protection that's acceptable. I do think that what we need to be doing is to be thinking about the supply chain. How can we enhance availability of vaccines, expand the production of vaccines as quickly as possible so we can meet the demand rather than to start skimping on the vaccine doses and jeopardizing the vaccine efficacy. I don't think that's to anyone's advantage.

Brian: Dr. Wafaa El-Sadr, infectious diseases epidemiologist, director of the global health initiative known as ICAP at the Columbia University Mailman School of Public Health and from the global to the local since the start of the COVID pandemic, Dr. El-Sadr has also shared her expertise as a member of mayor de Blasio scientific advisory council, the New York city test and trace group and the Columbia university COVID-19 task force. Thank you for sharing so much of your expertise with us this morning. We really appreciate it.

Dr. El-Sadr: Thank you.

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