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Brian Lehrer: Brian Lehrer on WNYC, and listeners did you go to one of the newly reopened music or theater venues this weekend, or to one of the Yankee games on their opening weekend, how safe did any of it seem? How do you think the vaccine or negative test proof or passport system worked? Tell us your stories of going out this weekend, if you had to use a negative test or vaccine passport, and went to one of the venues that's newly reopened. 646-435-7280. 646-435-7280.

We can also take your questions in this segment for our guests who we'll bring on in a minute about the newly updated CDC guidelines for travel, for vaccinated people. That's also welcome in this segment at 646-435-7280. On vaccines and variants, last week, WNYC science editor, Nsikan Akpan got to ask a COVID question at the daily White House briefing with press secretary, Jen Psaki, here it is.

Speaker: We go to Nsikan Akpan at New Yolk Public Radio.

Nsikan Akpan: Hi, thank you for taking my question. New York health officials continue to voice concerns about the B.1.526 variant. Early studies suggest this variant was first detected last November and it now represents a large proportion of cases in New York City and New Jersey, namely in counties undergoing surges. Yet the CDC still classifies B.1.526 as a variant of interest rather than a variant of concern. I'm wondering, what additional evidence is needed before B.1.526 is classified as a variant of concern? Does the CDC plan to release state-by-state case numbers on the New York variant rather than just a rough proportion? What's the national tally of B.1.526 cases so far?

Dr. Rochelle Walensky: Thank you for that question. I'm going to have to get back to you on the details on the national tally. What I will say is that there is an inter-agency group that looks at these variants and classifies them. There is that inter-agency group the CDC is a part of, that is actually looking at exactly this question right now.

Brian Lehrer: Actually, a little correction, I said it was White House, press secretary, Jen Psaki. I believe that was the CDC Director Dr. Rochelle Walensky who then later came back, and updated Nsikan and everybody else after she was able to look up more details about this New York City variant. Why are they just calling it a variant of interest and not a variant of concern if it's spreading so fast?

Dr. Rochelle Walensky: I want to briefly follow-up on a question I received on Wednesday from Nsikan Akpan at New York Public Radio, about the B.1.526 variant and its classification as a variant of interest rather than a variant of concern. I want to be clear that listing a variant as one of interest rather than a variant of concern does not mean we are not prioritizing the variant, or that the variant is not important for us to carefully follow. Rather, it means that we are still working to understand the variant, gather data on it, and determine its impact on medical therapies, disease severity, and transmissibility. As we are better able to characterize the variants, its classification may change based on those findings.

In the case of B.1.526, the one most recently found frequently in New York, we continue to assess its prevalence regionally and nationally, its transmissibility. To conduct studies to understand how its mutations for example, its E484K substitution impact therapeutic and antibody responses. Until those assessments are complete, it will remain a carefully followed variant of interest.

Brian Lehrer: There is that. The CDC issued some new travel guidelines under Dr. Walensky for vaccinated people just on Friday. We'll talk about those two and more now and with your questions which are welcome here or your stories of going out with vaccine or test passports required to newly open music or theater venues this weekend. 646-435-7280. 646-435-7280. As we welcome Syra Madad, infectious disease epidemiologist and Senior Director of the System-wide Special Pathogens Program for the New York City Health + Hospital System. Dr. Madad, thanks so much for coming on with us. Welcome to WNYC.

Syra Madad: Thank you for having me.

Brian Lehrer: Since you have that position here in New York City, would you follow up on Dr. Walensky's answer there and talk about how fast the New York City variant is spreading as far as you can tell. Whether it should be of concern to people who have already been vaccinated even?

Syra Madad: The variants certainly are circulating, they're spreading, the proportion of cases are increasing and that certainly is very worrisome. I think at the same time looking at our vaccination rates, looking at what these vaccines are providing to not just the individual level, but at the community at large is very, very significant. What I mean by that is that the COVID-19 vaccines that we currently have that are authorized do protect against the variants. That's why you're hearing constantly in the news, it's a race against variants and vaccinations.

I think that certainly we should take this news and be cautious about it, be concerned, continuously follow-up on it. At the same time, we have new tools in our pandemic toolbox with the advent of vaccines that can help us get out of this pandemic. With that, I'm certainly very optimistic.

Brian Lehrer: Now, on the basis of the various findings of vaccine effectiveness, those new CDC guidelines say vaccinated travelers do not have to quarantine or get tested when they arrive at their destinations, but they still recommend only the essential travel. I'm not sure how that all fits together, and it's still recommended that they wear masks, that the travelers do and social distance along the way. I wonder how you put all of those details together. What should vaccinated listeners understand? Since this is in the context of air travel or other mass transit travel, what's the risk of let's say somebody's grandparent, when they arrive by plane, even as a vaccinated person in that vaccinated household?

Syra Madad: That's an excellent question. I think we're all trying to navigate the social calculus of how to interact safely with other members, family, friends in the community once you're vaccinated. I think it's important just to take a step back and first look at it from first a scientific standpoint. What we know about these vaccines, they are extraordinary. The bar has been so high, and if you compare it to, let's just say measles which we in the infectious disease community hold to the golden standard of, this is how a vaccine should be in terms of preventing infections and transmitting it.

COVID-19 vaccines that we have are right up there. What I mean by that is not only are they protecting you against severe disease and symptoms, but also we have more and more real-world evidence to show that it's preventing asymptomatic transmission. Not only are you being safe, it's protecting you from disease, but it's also helping prevent transmission of infection to others. With that said, they're not 100%. Virtually nothing in that sense is 100% safe.

When you look at it from that standpoint, we need to make sure that while we're protected as a vaccinated individual, and the activities that we can engage in certainly have opened up. When you look at it from the lens of those around you, and when we talk about it from that standpoint, only about 18.5% of the American population is fully vaccinated. That's not a whole lot. Even though our vaccinations are going full steam ahead, there's a large portion of the American population that is still vulnerable to disease.

When you're going and you're mingling with a large number of individuals that could be vaccinated and un-vaccinated, that's why we want to make sure that you're continuing to do the COVID-19 safe behaviors of masking and other social distancing measures.

Brian Lehrer: The theoretical 25-year-old who's flying from California to visit their grandparents back here in New York. Let's assume both ends of that equation are vaccinated, but the 25-year-old has been through an airplane trip and whatever else on the way back. Can that person hang out with the grandparents without masks in all cases like we hear from the CDC, vaccinated households can hang out without masks with each other?

Syra Madad: If you're vaccinated and you're engaging in travel and then going to a household that has elderly individuals, you want to see first in these elderly individuals, are they at a higher risk for severe infection and hospitalization if they have not been vaccinated? If you have somebody that's immunocompromised, then certainly you want to continue to do the COVID-19 safe behaviors. If they're individuals that are over 65 but they're not at high risk because they're not immunocompromised for example, then you can certainly do things indoors without masks. It gets tricky when you add in un-vaccinated individuals that are at higher risk and then you start adding in more families in that regard. I think the precautionary principle just should be invoked at that time.

Brian Lehrer: Interesting, because the new thing here, one of the new things is that the traveler in that equation is no longer being told by the CDC to quarantine first or get a negative COVID test first.

Syra Madad: That's correct, but if you're visiting somebody and that's for the travelers, if you're visiting. I think if you look at the guidance that's shows that if you're visiting an individual in a household setting for example that are at higher risk for COVID-19, you want to continue with the COVID-19 safe behaviors in that private setting.

Brian Lehrer: Let's pick a phone call from Larry in Metuchen who says he's a pediatrician and professor at Rutgers. Larry, you're on WNYC, hello. Oh, let me try that if I click the clicker actually on Larry's box then I put them on here [chuckles]. Hi Larry, now we have you I apologize.

Larry: No problem. Good morning Brian. I wanted to follow up on the last point that you're discussing about the contacts of people who've been vaccinated, because I think the CDC has not been sufficiently protective of children and adolescence in their recommendation. I think if you have any children in your bubble, it's not okay then to go socialize with others in the household without masks because while the risks are small they are there.

This pandemic began with the myth that children are spared and we're learning more and more that that's not the case. While it's infrequent, some children get very serious infection or serious reaction this disease called MIS-C. Then there also is the potential for long-haul COVID even in children.

Brian Lehrer: I'm glad you brought this up, I'm going to get an answer for time purposes. Dr. Madad, here's a pediatrician and he's commenting specifically on the CDC guideline that says vaccinated adults can get together in households with other vaccinated adults without masks or social distancing even if the children have not been vaccinated. He doesn't think that's protective enough. Do you?

Syra Madad: I think that his point is definitely right on. I think if you're looking at the data over three million children have tested positive for COVID-19 since the pandemic began and there's been thousands of hospitalizations related to children and hundreds of deaths. Certainly, while we're saying that children are not as at risk for severe cases they're certainly still vulnerable.

In the context of interacting with vaccinated individuals in a closed setting, in a low-risk environment, you can certainly continue to do those activities. I think it's just important to understand nothing is going to be 100% protective. We're trying to minimize a risk as much as possible and then you can add on risk reduction techniques. If you want to do activities outdoors, that's going to definitely be a great benefit.

Brian Lehrer: Let's take a call from one of our listeners who went to one of those newly reopened music venues this weekend in New York City. Adam in Brooklyn you're on WNYC, hi Adam, where did you go?

Adam: Hi, morning, thanks for having me. Last night we went to a City Winery, the Hudson River Park location. Saw Willie Nile and it was really very comfortable, very spread out, beautiful new venue. All the tables were amply spaced even more than six feet. Just to get in you had to register with Clear App which is just an app I guess that the venue using where you take a picture of your face, you scan your ID, then you get a temperature check when you get there. You do the typical survey of have you had COVID recently or whatever, but no mention of a vaccine or anything like that. Everything was smooth and--

Brian Lehrer: You didn't have to show a vaccine or a negative test?

Adam: No, nothing like that.

Brian Lehrer: Thank you very much. You know what, we're going to take a break that we need to take right here. When we come back, Dr. Madad I want to get your comment on that. On whether that is as good in your opinion and good enough compared to the vaccine or negative test passport system. Then Jess in Yorkville I see you, we're going to take your call about going to the Yankee game, where they do have a vaccine on negative test passport requirement.

Hang on, you're going to be the next caller as we continue with Syra Madad from Health + Hospitals right after this.

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Brian Lehrer: Brian Lehrer on WNYC and we just heard from Adam in Brooklyn who went out to City Winery on their first weekend of having live music back in New York City. Jess in Yorkville went to a Yankee game. Jess, you're on WNYC, how did it go?

Jess: Hi Brian, thanks so much for taking my call. Yes it was great, it was wonderful, beautiful day out. Before you got into the stadium everyone had to show either a negative PCR or antigen test or their vaccine card. There was no from what I saw no vaccine passport involvement yet, and then you also had to get your temperature taken,, so I felt pretty safe.

Brian Lehrer: Since it was like 10,000 people there which was still a lot of people even though it was only 20% capacity. How did they handle the group part of that? When you are entering the stadium there would be a lot of people all together there typically and also in the restrooms?

Jess: I would say that was sort of the part that was probably the least regulated, so definitely when we were walking in there wasn't a lot of space between folks. People weren't keeping six feet of distance. Similarly at concession lines and as you said in the rest rooms there was nobody checking capacity or anything like that. Although in the rest rooms they actually had every other stall closed off, so that was nice at least.

Then in the seats themselves you couldn't buy a single ticket, you had to buy at least two or more so that groups could stay together and there was a row separating and a full empty row separating each group. Then I would say there were not more than really one or two groups of people per row, but I was up high noticeably. I'm not sure further down if that was the case.

Brian Lehrer: Then Yankees scored some runs this weekend, it might have been a better experience, but Jess thank you.

Jess: They won on Saturday when I went, so that was good.

Brian Lehrer: Then won the day you were there, that's good. Thank you very much. Our guest is Syra Madad, infectious disease epidemiologist, and Senior Director of the System-wide Special Pathogens Program for the New York City Health + Hospital system. Dr. Madad, what do you think about this particular kinds of reopenings and the kinds of proof or assertion about your level of protection?

Syra Madad: Well I think there was two parts, first I think the reopening certainly will depend on what is happening at your specific locality. If you have very high rates of community transmission and still low rates of vaccinations then I think we need to rethink what we're opening up. Make sure that we're looking at it through the lens of what activities pose the lowest risk versus the highest risk and the risk and benefit analysis.

We are so close to the end, but we want to make sure that we're continuing to do what's right. To prevent obviously new infections and cases while we're trying to roll out vaccines full steam ahead. I think the other part is when you have venues like this open, I think it's great that they're applying the risk reduction techniques, because that's what we're trying to do. We're trying to reduce the risk as much as possible. We know we can't eliminate it 100%. Having these venues that can have low occupancy, during it outdoors, ensuring that people are wearing masks, keeping a distance, things like that.

These are all different strategies that really help with ultimately reducing the overall risk of contracting and spreading COVID-19.

Brian Lehrer: There were two different systems that we heard from our callers. The Yankees are using what might be called a vaccine or negative test passport system. Where you can use that passport as they're calling it or the Excelsior Pass that New York State has set up that's digital. You could just show your vaccination card or other proof of a recent negative test that you're carrying. They require that, it sounds like it was loser than that. The music venue that the first caller went to, what's enough?

Syra Madad: Yes that's a great question. We are certainly in a time where these are things we've never grappled with before and so we're literally building the bridge as a walk across it. This concept of a vaccine passport which is a record of an individual's COVID-19 status whether they've been vaccinated or they've tested negative for the virus recently. This is something that I think you're going to see much more common. There's an entire force both at the Federal state and local level that's looking at how can you actually implement this. Where can you actually use it, whether it's just travel related outside the US, inside the US, to venues.

There's a couple of issues that they are grappling with right now and some challenges which include state of privacy and healthcare equity. These are conversations that are happening right now. I'm glad we're having these conversations because we have to look at it from those lenses. I think that it's just an added measure just to ensure from that risk productions standpoint that people are negative. That they have been vaccinated if they're engaging in some of these higher risk activities.

Brian Lehrer: We've got about two minutes left, under two minutes. Let me raise one more thing with you, did you see the survey of epidemiologist from 28 countries which found two-thirds believe that mutations will make the current vaccines obsolete in nine months to a year. Do you agree with that?

Syra Madad: I think we're in a situation where anything is possible, but right now looking at the vaccines that we have, and the variants of concern, and those that are under investigation. Our vaccine certainly do hold up, but there is a plan B, and that's exactly what we want. We want to anticipate the worst-case scenario, which as you stated. The plan B is having these booster shots that are multivariant in that sense that we can provide to the population.

I think from that standpoint, we have a good game plan, but I wouldn't be surprised down the line if we have a new variant that's able to-- We have these breakthrough cases. That's down the line, and certainly right now at this moment, that's not the case.

Brian Lehrer: If the majority of epidemiologists are right in this prediction, does that mean we go back to square one on national vulnerability by next winter, and start this vaccination with tears of who gets vaccinated first process all over again?

Syra Madad: Not necessarily. I think that we're in a much different situation now, because A we have leadership that understands that once you start seeing an uptake, then you're able to come in and do additional strategies. I think we're also getting to a place where everybody understands what are these COVID-19 safe behavior? As we are vaccinating more individuals, protecting more people, we're going to look and see at what point do we need these booster shots. When we start seeing some data showing vaccine breakthroughs from these variants. I think we have a good pulse on this situation. I think it's going to be very, very different moving forward.

Brian Lehrer: Syra Madad, infectious disease epidemiologist and Senior Director of the System-wide Special Pathogens Program for the New York City Health + Hospital System. Thank you very, very much. It sure was great to hear the joy in the caller's voices who went out to music or a ballgame this weekend, wasn't it?

Syra Madad: Oh, yes. It's great to see as we're trying to get back to our new normal.

Brian Lehrer: Hopefully all these systems work and keep people safe in addition to their behaviors. Thanks again for joining us.

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