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Brian Lehrer: It's the Brian Lehrer Show on WNYC. Good morning and happy Friday, everybody. I heard an interesting analysis the other day of why Americans are so ready to go back to "Normal" and live with hundreds of thousands of COVID deaths again this year. Even with the one million deaths the country has now suffered in total, and let's say each of those people leaves behind 10 loved ones, that's 10 million people, 11 million people out of our nation of 330 million, so the vast, vast majority has not been touched by COVID death, so the politics of protection don't add up in this theory.

Many more have been touched by COVID rules that they don't like, and that's one explanation for statements like this that we're about to play from Mayor Adams this week. Now, after he raised the official COVID status of New York City to high alert because of how fast it's spreading right now, he was asked by a reporter why he is not reinstituting mask or vaccine requirements for indoor public places other than the subways and the buses. Remember, as you hear this clip, that nobody is asking about shutdowns, only mask and vaccine standards for protecting vulnerable people, while remaining open.

Mayor Adams: If every variant that comes, we move into shutdown thoughts, we move into panicking, we're not going to function as a city, and so I feel extremely pleased based on my analysis in the morning with my health experts that we are being extremely strategic and we are fighting COVID with not only the tools that we didn't have before, but we're also fighting COVID using the intelligence we need to win in a COVID environment.

Brian Lehrer: Mayor Adams at a news conference on Wednesday. We'll start there today and also talk about rebounding from Paxlovid, that's a new thing people are experiencing. We'll touch on monkeypox and more with Katelyn Jetelina, creator of the Substack newsletter called Ask an Epidemiologist. She's also an Adjunct Professor of Epidemiology at the University of-- Sorry, the newsletter is called Your Local Epidemiologist. Sorry about that. Your Local Epidemiologist. Let me get that exactly right. She teaches at the University of Texas. Professor Jetelina, thanks for coming on with us. Welcome to WNYC.

Katelyn Jetelina: Hi, thanks for having me. Excited to be here.

Brian Lehrer: Listeners, here's why I got confused. It's because I'm about to give you this invitation to ask an epidemiologist, 212-433-WNYC, 212-433-9692. Again, that epidemiologist is Katelyn Jetelina, author of the Substack blog newsletter called Your Local Epidemiologist. Let me start here, Professor Jetelina. With the current Omicron infection surge, you wrote a post titled Are We in a Public Health Emergency? Why did you frame the question that way?

Katelyn Jetelina: Yes, I think that there's this interesting, very challenging phase right now of the pandemic, which has really sparked this intense tug of war between pushing towards normalcy and the push back towards urgency from others. Where one stands on this spectrum, from urgency to normalcy, is really centered around that one question, that person's answer to whether we're in a public health emergency, is what we're experiencing today considered a manageable situation or is it still an emergency, as a definition of epidemic?

I think that this can't just be answered epidemiologically, but it's also answered psychologically, culturally, politically, and even morally, and so it's very difficult, particularly in the United States to truly know where the public is right now.

Brian Lehrer: So, how do you answer the question? Are we in a health emergency?

Katelyn Jetelina: [laughs] Well, as an epidemiologist, I would say yes. An epidemic or an emergency is defined as cases of disease above which we normally expect. If we just look at deaths alone, yes, they are plummeting, which is great news, due to immunity and due to our treatments, but what is considered acceptable. We're still experiencing about 300 deaths a day. If we add this all up, COVID-19 will still be the third leading cause of disease in the United States this year.

Brian Lehrer: The third leading cause of death in the United States?

Katelyn Jetelina: I'm sorry, yes, third leading cause of death in the United States this year, and it has been the past two years. To me, that's just not an acceptable level for SARS-CoV-2.

Brian Lehrer: We talk about deaths being down compared to the first Omicron wave and I guess to the original wave two years ago, but it's still hundreds of people every day in this country, as you just said, but how does that compare, say, to the worst flu season in recent times? Because people say, "Well, we just have to treat it like the flu and go about our business the way we always went about our business knowing that people die from the flu every year in substantial numbers." I see you retweeted some of those numbers just the other day.

Katelyn Jetelina: I did. I looked back till 2014 to see what were the number of deaths. The worst flu season was from 2017 to 2018, and we lost 61,000 people due to the flu, which is terrible in and of itself. If we compare this to the first five months of 2022, we already surpassed this number by more than two-fold. We have experienced about 162,000 deaths from SARS-CoV-2. We are already very much higher than the flu, and we think this will be sustained throughout the year as well.

Brian Lehrer: I just did the math, on 300 deaths a day, which is where the country is roughly right now, that's considered low, and multiply it by 365, that's over 100,000 deaths. That's around 110,000 deaths for COVID for this year if it continues at that pace.

Katelyn Jetelina: That's right, and that's assuming that this continues at this pace. We know that SARS-CoV-2 is mutating extremely quickly because it's jumping from person to person very quickly. That is "Best case scenario." Now, if we have another Omicron-like event, in which this virus significantly mutates to escape even more immunity, the high estimate of deaths this year would be closer to about 480,000. It's a wide range, and we don't have a crystal ball, we don't know where we'll land, but to me, even that low number is unacceptable.

Brian Lehrer: Nobody wants or is asking for shutdowns anymore. I played that Eric Adams clip where he invoked shutdowns and panic in response to a question from a reporter about mask and vaccine requirements for indoor public spaces. It's really a very specific and limited question that he was asked. Do you see an epidemiological mismatch between the state of the pandemic and the state of pandemic politics?

Katelyn Jetelina: I do. We know that this virus has very high transmission levels right now across the United States, and we know what works. Science tells us, we know masks work, we know vaccines work to reduce transmission. If we all leverage these tools on a systematic level, there's no doubt we would get this a lot more under control than it currently is.

Brian Lehrer: What's the epidemiology of vaccines reducing transmission? You just said we know that vaccines reduce transmission, but so many vaccinated people spread COVID to other vaccinated people these days that the public gets confused.

Katelyn Jetelina: That's right. Omicron really changed the game with this, I will say. There is really two ways someone can spread the virus, or the vaccine helps reduce transmission, is first that vaccines and particularly boosters with Omicron, and that's the really big important difference, is that if you're boosted, the viral particles that try to find the hosts are quickly destroyed, so you don't even get infected in the first place. This is called sterilizing immunity, which of course then reduces transmission. Even if you are a breakthrough case, say you do get infected even if you're boosted, the vaccine still kicks in, it makes the breakthrough cases less contagious than unvaccinated cases.

It does that by, one, clearing the virus faster. The vaccinated are contagious for far fewer days than the unvaccinated, as well as it reduces the number of infectious particles For example, even if the viral load is the same between vaccinated and unvaccinated, that doesn't necessarily mean the number of infectious viral particles are the same, and we see that it is significantly reduced among the vaccinated. Yes, vaccines are not perfect. We see quite a few breakthrough cases, and we'll see more with Omicron changing, but we do know that boosters reduce transmission well and will no doubt help with community transmission.

Brian Lehrer: Just before we go to some phone calls, and listeners, if you're just joining us, my guest is Katelyn Jetelina, creator of the Substack newsletter called Your Local Epidemiologist and a Professor of Epidemiology at the University of Texas. She's not really our local epidemiologist here in the New York area, but Your Local Epidemiologist is the name of her really excellent newsletter. She is an epidemiologist, PhD epidemiologist.

You can ask an epidemiologist your COVID epidemiology question at 212-433-WNYC, 212-433-9692 or post it online on Twitter. Tweet it @BrianLehrer. Before we go to calls, I wish I could remember who said that thing on TV that I quoted at the top about the politics of COVID reopenings right now. Even with the numbers we've been discussing, the small percentage of people actually touched by a COVID death close to them a million deaths, let's say 10 million mourners compared to 330 million people in the United States, almost all of which have been touched and aggravated by a COVID requirement. You think there's anything to that in terms of a political analysis?

Katelyn Jetelina: I think that it can get political very easily. Politics should not be correlated with deaths, but unfortunately, we are seeing that in the United States, and it's incredibly tragic. I think it's a national tragedy the number of avenues of mis- and disinformation and how that has equated to about 300,000 to 350,000 preventable deaths in the United States. Yes, I think that, one, we need to learn our lessons from the past, but going forward, it's not just about getting vaccines very quickly, it's not just about finding effective treatments, but it's also figuring out a way to communicate clearly as well as fight misinformation along the way so this doesn't happen again.

Brian Lehrer: Here's, I'll call it a baseball game epidemiology question from a listener via Twitter. It says at Citi Field yesterday, that's where the Mets play. They're one of our local baseball teams, it's doing really, really well. It says, "At Citi Field yesterday in the stands and even in the crowded fairly enclosed concourse, among the thousands of people, I saw not a single person, not one was wearing a mask, except me," writes this listener. "Trouble ahead," he concludes. How much risk do you think there is at an outdoor baseball stadium? Pretty much all of them in the baseball popular cities being packed right now like pre-pandemic.

Katelyn Jetelina: We know that outdoor transmission is much more rare than indoor transmission, and that's because of ventilation. Think of it as like you're smoking a cigarette, that plume of smoke in the outdoors dissipates very quickly compared to indoors, and so outdoors, it is a lot less risky. I think the worry that I start getting at is when you are shoulder to shoulder in a massive crowd and maybe there isn't air ventilation. It gets very stagnant here at our Texas baseball fields. There's going to be risks there. I think that everyone right now needs to weigh their risk tolerance. Unfortunately, make decisions on an individual level basis on what they are and are not willing to accept.

Brian Lehrer: Laurie in Manhattan. You're on WNYC. Hi, Laurie.

Laurie: Hey, good morning. I'm a mom of a public school child, and I wanted to ask your expert opinion on why there's no redo of the mask requirement. It had been required in public schools, that's been done away with. There's a huge increase, everyone I know is getting sick. My kid was able to get through it, but he just came down with COVID. You don't have options to show up at school, and if you want to wear a mask, that's fine, but others don't have to. In your expert opinion, why is there even an updated Red Alert if there's nothing being translated to an action, particularly in New York City public schools? That's my question. Thank you so much.

Brian Lehrer: Thank you very much, and that is another new story today, the uptick in cases being reported at public schools in New York City. Professor, what would you say to this mom?

Katelyn Jetelina: I'm a mom of two little kids as well, and I don't know why. I think that it is very practical to reinstate mask mandates, especially given the really high levels of transmission and given that even with the new CDC guidance, a lot of New York is now in the highest threat level, according to the CDC. I do know though that we are living in a very individualized culture in the United States, and so a lot of pressure is being put on the individuals to make their own decisions.

As an epidemiologist, I always think of populations, so I don't necessarily agree with that perspective, but I do know that masks protect the wearer, not just those around us, especially if the mask is well fit and well filtered. Even if your kid is the only one wearing a mask at the school, it's a very good bubble around them. Then, two, the vaccines are just incredible, they are really holding up very well against severe disease and death. I think that we can put a lot of trust in those as well. I don't agree with it, but I do know that we have lots of layers of mitigation we can take on the individual level to continue to protect ourselves.

Brian Lehrer: What is the epidemiology now of one-way masking as being protective? I think some people remember the very beginning of the pandemic when at first we were told not to mask ourselves because masks were needed for the healthcare workers who were really in an emergency situation and there wouldn't have been enough masks to go around at the beginning. One of the things that the experts seem to be saying at that time was, "Well, masks are really to prevent COVID from leaving you, they don't really do much coming in," but I think either the science or the rhetoric has changed since then. What does the science tell us? What does the epidemiology tell us two years into COVID?

Katelyn Jetelina: Yes, that's right. Our understanding of the virus continues to change because we're learning about it as we go. Now, one, we recognize that SARS-CoV-2 is airborne as well as transmitted through droplets, it makes masks even that more important. We know that on average, if you take in cloth masks and surgical masks, on average, masks reduce transmission by about 58%.

That increases substantially if we all upgrade our masks to N95s, which is truly necessary right now with Omicron. If you can't get your hands on an N95, or they're uncomfortable, KN94s and KF95s are just as good. They protect about-- and that's where the number comes, 95% of particles coming in. Again, they're not perfect, but if we start layering masks with vaccines and with air filtration and with using antigen tests, we are really putting a nice bubble around us.

Brian Lehrer: What's the epidemiology now of more transmissible, which we heard about Omicron originally compared to previous variants, and now we hear Omicron BA.2 even more transmissible than the original Omicron. What's the functional epidemiology of that? Like if I'm in an elevator for 45 seconds, that somebody else who was infected was just in before me, am I at risk?

Katelyn Jetelina: That's a great question. I don't know if the actual time frame has been measured yet. I do know that when someone exhales, for example, in a bus, it takes about 45 seconds for everyone to be inhaling. It's pretty quick, but again it's [crosstalk]--

Brian Lehrer: What does that mean, if somebody exhales in a bus, it takes about 45 seconds for what?

Katelyn Jetelina: For everyone else to be inhaling it, those particles.

Brian Lehrer: For everyone else, in other words, for the particles to spread throughout a whole bus?

Katelyn Jetelina: That's right. If it's not ventilated well, it's that quick.

Brian Lehrer: And if [unintelligible 00:20:41]?

Katelyn Jetelina: If you're masked, it helps a lot. It helps filter about 95% of those. What also helps, and we already mentioned this in the beginning of this show, is vaccines with sterilizing immunity, and especially the boosters. They can act really fast and attack the virus before it reaches your cells, so you don't even get infected in the first place. It's a bit complicated question to answer, but it is possible if you're close to a very contagious person.

Brian Lehrer: In that bus example, when does it dissipate? Let's say that there's only one infected person on the bus and then the person exits the bus, but they were breathing in there. You're saying 45 seconds after the last breath, everyone else in the bus would have been exposed, if I'm hearing you correctly. When does that dissipate?

Katelyn Jetelina: We've seen some scientific studies in the lab. This is not the real world, but in the lab, they show-- they can stay up in the air for about 16 hours, and that's the maximum. Now, of course, ventilation and filtration and getting those bus windows open and the doors opening and people moving will change that, but in a sterile situation, it can stay up in the air for a long time.

Brian Lehrer: 16 hours? If somebody was in a restaurant restroom, let's say, and was infected while they were breathing in there. There are going to be particles, there are going to be droplets or aerosols, I guess, in that bathroom that can infect the next vulnerable person for 16 hours?

Katelyn Jetelina: Yes. Think of it as a plume of smoke, but yes, that certainly can happen. Georgina in Manhattan, you're on WNYC with Katelyn Jetelina who writes the Your Local Epidemiologist Substack newsletter. Hi, Georgina. No Georgina? All right, we'll take a break and then we'll continue. I do want to ask you about monkeypox. I do want to ask you about your post the other day about Paxlovid rebounding and what people, who do go on Paxlovid, should know about that. Stay with us, folks. We'll finish up with Katelyn Jetelina, a few more of your calls as well. Stay tuned.

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Brian Lehrer: Brian Lehrer on WNYC with Katelyn Jetelina, creator of the Substack newsletter called Your Local Epidemiologist. She also teaches epidemiology at the University of Texas, and now, I think we have Georgina in Manhattan on the line. Georgina, are you there?

Georgina: Yes, I am. Can you hear me?

Brian Lehrer: Hey there. You're on WNYC. We can hear you.

Georgina: Okay. Thank you. Good morning. I have a question for the doctor, please. I have a very rare type of asthma for which I receive a biologic injection every 28 days, and I have other autoimmune issues. I have been nothing less than religious about not only guarding other people but myself of course, because I know COVID will kill me with no doubt in my mind.

I'm getting my fifth shot, which will be my third booster on June 10th, but this is what I go through with the people who, for whatever reason, it makes them feel powerful or authoritative or I don't know, but it's insulting to have somebody tell you that they were vaccinated twice, they got the two shots.

I said, "Oh, which company? Which company's brand did you get?" "Oh, Johnson & Johnson." I can't tell you how many times I've met people who've lied about being vaccinated and they lie about-- And then the other trick is, they already had COVID, so that's their vaccine. [crosstalk]

Brian Lehrer: That's their excuse. "Oh, I had it, so I'm immune like a vaccinated person."

Georgina: Yes, but what they're so willfully ignorant of is that the virus attacks the entire immune system if you're not vaccinated. Now, the mere fact that I have not contracted, though I've been very careful because that's not how I want to die. I know all about emergency rooms and not being able to breathe [unintelligible 00:25:35] years old, and I don't want to die with a ventilator down my throat.

I will tell you this, and I live in Manhattan. I remain appalled on a daily basis, and people who don't care if they do any harm or not, and actually say to me, "Well, we invited you to dinner at Christmas time and at Thanksgiving time, and you wouldn't come." I said, "Well, it's not that I wouldn't come. I couldn't come because I couldn't put myself at risk. None of you in your family of eight has had a vaccine." They said, "Well, we're waiting to get the virus, so we'll have our natural immunity." [crosstalk]

Brian Lehrer: Georgina, let me ask you a question. As somebody who is as vulnerable as you apparently are, as immunocompromised as you are, because of what you were describing before about your condition and your treatments, what do you think the rules of society should be to protect people in your position?

Georgina: Well, I think they could at least wear masks. In order to go to public school, we were all vaccinated. I vividly remember the day, my lovely mother, I was only three or four years old, she put a sugar cube under my tongue at the high school football field. I'm one of nine children. She said to me at that time, "This goes under your tongue, this will give you a life. This will protect you." I didn't know anybody [crosstalk]--

Brian Lehrer: One of the vaccines.

Georgina: Yes, the Salk vaccine. We had to have vaccines to go to school, but now, for some reason, the virus that has killed one million people in two years in America, which doesn't come-- I mean, it just far exceeds the 25,000 to 50,000 flu deaths.

Brian Lehrer: Right, and the vaccine is controversial and the mandates that were normal when we all entered school. The modern equivalent for COVID is this politicized controversial individual freedom thing. It's really just selfish in my own opinion, I will say my own opinion, it's just selfish of people unless they have certain medical reasons not to get vaccinated against COVID. Georgina, thank you for your story. Stay well, stay safe, and for you as an epidemiologist, Dr. Jetelina, and for people who are policymakers even more, it's a tough set of decisions to make, right?

What do we do as a society that's fair to the most vulnerable people like Georgina and that also doesn't restrict the behavior of the vast majority of people who are not as vulnerable any more than we have to?

Katelyn Jetelina: Yes, I absolutely agree. It's incredibly tough and you have to also balance that with pandemic fatigue. People are very tired of this. They're losing a lot of hope. Also, there's just no safety net or trust in the United States, and so all of this is making, like we said in the beginning of the show, a really tough landscape to navigate not only for individuals but how do we accept a new SARS-CoV-2 virus into our repertoire of threats. I guess I'm just glad I'm not the one making policy decisions right now.

Brian Lehrer: The luxury of being an epidemiologist instead of a mayor or a governor or a president. All right, let me touch a couple of other things that you've written about before you go. You wrote a post called Rebounding after Paxlovid. Paxlovid, the antiviral drug, that's being used much more for COVID in vulnerable people, and apparently with a good deal of success, but what's this rebound effect?

Katelyn Jetelina: Yes. What rebounding means is that after the end of treatment, someone quickly turns positive again. Their antigen test turns positive, and we actually saw this during the clinical trial, about 2% of participants in the clinical trial rebounded, but interestingly, also 1.5 participants in the placebo group also rebounded, and so we didn't--

Brian Lehrer: 1.5%, yes.

Katelyn Jetelina: Yes, so we didn't think it was-- there was really no statistical difference between 2% and 1.5%, and so we didn't really think it was a big deal, but now that Paxlovid has been in the real world for a while, a lot of anecdotal evidence of rebounding is accumulating. We are trying to figure out real quickly if it's just 2%, and 2% of a lot of people is a lot of people, or if something is happening, maybe because of Omicron, that clinical trial was during Delta. We know Omicron is very different, or is it because people are getting the treatment too early, so they're not mounting a full response. We have a lot of unanswered questions.

Brian Lehrer: Or maybe need longer than a five-day course, which is the standard to really knock it down. By rebounding we just mean the symptoms return after they had gone away?

Katelyn Jetelina: That's right. The symptoms return and you test positive again on your antigen test.

Brian Lehrer: One of the stories in New York today is one case of confirmed monkeypox. Do you know what monkeypox even is?

Katelyn Jetelina: [laughs] I do. It is a cousin of smallpox, and it's been around since the '70s. It's endemic in west and central Africa, and it's not unusual to have a case randomly pop up, but what's really unusual right now is how many cases are popping up across the globe, how many of those cases don't have a travel history, and how they're hundreds of miles away from each other? This means that there's undetected community transmission and a high likelihood of more cases.

Brian Lehrer: Why now?

Katelyn Jetelina: That's a fantastic question. Either the virus has mutated or what's more likely is our behaviors are changing. We actually expected an outbreak because since the eradication of smallpox and that's the end of smallpox vaccinations and waning immunity, we were going to start seeing increased number of monkeypox cases. We combined this with more and more people exposed to monkeypox, it's a predictable stage for large outbreaks.

Brian Lehrer: Does it have anything to do with monkeys?

Katelyn Jetelina: [laughs] Well, it did in the beginning. The first animal case was a monkey, so hence the name, it was in the 1950s. Since then, we actually don't know the natural reservoir of monkeypox. We don't know where this virus calls home. We do know though that rodents and small mammals usually infect humans through scratches, bites, or hunting and eating wild animals.

Brian Lehrer: Does it have epidemic potential? I heard that you have to have very close contact to get it from somebody.

Katelyn Jetelina: You do. It's either transferred through droplets or bodily fluids, or even indirect contact with, like clothing or bedding. In the past, it's been not typically transmissible because you need a lot of the virus to become infected. That's what's so puzzling right now, is because it seems like it's a little more transmissible than before, and so we really need to understand these cases a lot better through genomic sequencing as well as epidemiological real-world data to figure out what's truly going on right now.

This is not going to turn into the SARS-CoV-2 pandemic. It's a little too early to tell how worried we should be, but it's the reality we're living in that the next epidemic is really just around the corner.

Brian Lehrer: One more question from a listener, says, "Hi, please ask your guest if you are a vaxxed and boosted and are exposed in your household to COVID but do not get it, does that function as another boost to your immunity?" That's related to another question, if that's a confusing way to put it. Another post asks, "Is exposure to a little bit of COVID immunizing?"

Katelyn Jetelina: Not necessarily. You need to be infected for your immune system to be activated. If that person-- It's not unusual for household members to not get infected. Household transmission of Omicron is about 30% to 50%, so that's not unusual. Now, if you are sure you weren't infected, so you weren't asymptomatic, the likelihood of you having hybrid immunity, which is the vaccine plus infection-induced immunity, is low. You do need to have an infection to mount the hybrid response.

Brian Lehrer: Only about 30% to 50% of people who live with infected people get COVID themselves, is that what you just said?

Katelyn Jetelina: That's right, and boosters reduce that number. Usually, if you're boosted, it reduces the likelihood of transmission in the household.

Brian Lehrer: There we leave it with Katelyn Jetelina, who writes the Substack newsletter Your Local Epidemiologist. Thank you for so much information. We really, really appreciate it. Let's do it again.

Katelyn Jetelina: Yes, absolutely. Thanks for having me.

 

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