[music]

Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. Many people are now starting to get their second vaccine doses, some dealing with a few days of feeling sick from those second shots, everyone wondering how much they're protected from the new variants now circulating, and wondering too how much other people are protected from them. Vaccinated against getting really sick themselves, but still capable of unwittingly transmitting the virus, to what degree we don't yet know. The more data that comes out, the more we see how disparate the vaccination rates are by race from lack of access for some people, lack of trust for others.

We'll talk now about life after the second dose, bridging the vaccine gap, and more. We'll take your questions for Dr. Jayne Morgan, M.D., cardiologist, and the Director of the COVID Task Force at Piedmont Healthcare, which is a network of 11 hospitals and more than 500 other locations based in Atlanta. Dr. Morgan, it's great to have you on with us again. Welcome back to WNYC.

Dr. Morgan: Thank you. I'm happy to be here, Brian. Thank you so much

Brian Lehrer: Listeners, we'll invite your calls from right at the start here from anyone who has already gotten your second vaccine dose. You get the first shots on the phones. If you've already gotten your second vaccine dose, how was the experience? Did you have side effects different from the first dose and what are your questions about what you can do differently now? 646-435-7280. We'll open it up for other COVID questions in a little bit, but first, anyone who's already gotten your second dose, you're invited first to describe your experience with that and ask any questions of Dr. Morgan at 646-435-7280. 646-435-7280 or tweet @BrianLehrer.

Dr. Morgan, can I start with some second dose questions? Who's up to that so far at Piedmont Health and around the country generally, if you've been keeping track?

Dr. Morgan: What do you mean who's up to that? [inaudible 00:02:19] [crosstalk]

Brian Lehrer: Well, certain groups who are in the 1A category.

Dr. Morgan: Right. All of our frontline workers have received their second doses by now or are in the process of receiving them within the next couple of weeks. In the 1B category, the first responders as well have started to receive some of those second doses as well.

Brian Lehrer: Now, the practice that I'm seeing from some doctors regarding temporary second dose side effects, and from public health officials who go on the media, is to say out loud what they might be as the better way to fight vaccine hesitancy than by not talking about them. What should people expect and roughly in what percentages if you know?

Dr. Morgan: Is this with regard to the second vaccine, with regard to side effects?

Brian Lehrer: Yes.

Dr. Morgan: After the second vaccine, we have the second vaccine and-- The second dose, actually, not second vaccine, and the second dose, as many have heard, maybe packs a bit of a bigger punch, a bit of a bigger wallop than the first one. We should understand that that is our body's immune response sort of revving up the way you might start a car and push on the accelerator, rev it up, and that's what we're feeling.

Part of that is the first dose gets us to that 50% or 60% efficacy that we keep hearing, meaning how well the vaccine actually works in protecting us, but it's that second dose that takes us from that 50% to 60% up to that 95%. That's where we really, some will really start to feel it, not all, but some. If you don't have any side effects or any symptoms, I've gotten this question many times, I'm concerned that I'm not protected. My immune system must not be working. No, that's not true. Everyone's immune system is different. For the most part, more than half of the people in the trials did not have side effects. Your immune system is perfectly fine and you are protected.

Symptoms that we have, you have the nausea, vomiting, fever, chills, myalgias, headaches, the same as with the first shot, they just may be more intense, including arm pain and stiffness. If I give you my personal example, after my second shot, I had excruciating arm pain, so much worse than a flu shot, and certainly, much worse than after the first shot. In fact, I had to take Motrin for the pain and it impeded my ability to do pilates where I have to support myself on my arm.

I also had some lower back pain, some myalgias at night, and I was restless in my sleep. When I got up to take some Motrin for that, I developed sweating which let me know that I also had a fever. Then two mornings, I also had a headache and I took aspirin for that headache and it resolved. For three or four days, I did have a potpourri of symptoms that responded to basic analgesics.

Brian Lehrer: One question about those basic analgesics before we take our first phone call. I've heard that there's some, there are some differences of opinion among public health professionals over whether you can take something like Motrin or Tylenol or whatever beforehand, to try to mitigate the effects before they come on. Maybe it's a little harder to knock them down once they come on, but whether any of those painkillers actually might reduce the immune response for its long-term impact. Are you aware of that debate and do you have a position on it?

Dr. Morgan: I do. I'm not aware of any immune dampening by analgesics, meaning, I'm not aware of our basic pain killers, aspirin, Tylenol, ibuprofen, interfering with our immune response. As I did, I took ibuprofen. I think if you're having some discomfort, you can certainly take basic analgesics to make yourself more comfortable if you're having side effects. It should not impact your immune response to the vaccine.

Brian Lehrer: Whether or not you take it along with the vaccine or wait until you feel sick?

Dr. Morgan: Either. You're welcome to take it prophylactically, meaning, if you want to take it prior to your shot, or if you want to take it immediately after your shot even though you don't have symptoms, or if you'd like to wait until you have symptoms and see if you have symptoms. Remember, many people don't have symptoms. [crosstalk] We're hearing about all the people with symptoms, but you also are not hearing of people who don't have symptoms.

Brian Lehrer: That's true. We don't hear about the planes that didn't crash in newscasts, and you're saying a majority of people don't have symptoms.

Dr. Morgan: Yes, more than half don't have symptoms. I don't know which category people will be in. I did not have symptoms after the first shot, but I did after the second shot. I would categorize my symptoms as mild to moderate, easily controlled with basic pain medicines that anyone might have inside of their home. I would just categorize that as mild to moderate.

Brian Lehrer: Alex in Jersey City, you're on WNYC with Dr. Jayne Morgan. Hi Alex.

Alex: Hello. Good morning everyone. I have a question and it's more referring to how do you convince people? I had my second shot. I had some mild symptoms for about 36 hours but by day two, I was fine. When I started to tell some friends and family who were all very, very cautious over the duration of the pandemic, when I said I got my second shot, it was really interesting that a lot of people still were not sure that transmissibility would be reduced or that, now that essentially, my immunity is going up to around 95%, I had the Moderna vaccination, I'm having a hard time convincing people who didn't like the Trump disinformation, but it's very curious that they still don't believe in the complete efficacy of the vaccine to not transmit or not be able to carry it-- [crosstalk]

Brian Lehrer: Alex, let me leave it there and ask Dr. Morgan to clear this up. Because the data is only starting to emerge, and Dr. Morgan, those people who are wary might be right. How much are they in your opinion?

Dr. Morgan: All we have is the data. We certainly have the data that was submitted to the FDA on the briefing documents. Moderna, which is the vaccine that you received, reached 94.5% efficacy two weeks following the second dose. Then Pfizer reaches 95% efficacy one week following that second dose. That means how well you are protected, the endpoint of those trials were evidence of COVID-19 cases. How well you're protected from COVID-19 cases.

What we don't know is that other 5%. You're 95% protected, so that's not 100%. Even though these companies knocked it out of the park scientifically with regard to 95% efficacy, we generally are happy with 60% or 70%, you still are not 100% protected. You have to still wear a mask, wash your hands, practice social distancing until we can get enough of the US population immunized, that herd immunity that we're talking about, such that everyone can be protected. You still have that 5% gap. I think that's maybe what people are talking about or what they're focused on, but instead of focusing on the 5% gap, you should focus on the 95% protection that you have.

Additionally, if you were to be one of the unfortunate people who still contract COVID in that 5% gap, we expect that your symptoms would be much milder.

Brian Lehrer: Even beyond the 95% versus the 5%, let's say you're in the 95% and you're as fully immune as people get, that protects you. That doesn't answer the question about transmissibility for which I think the jury is still out, right?

Dr. Morgan: What we don't know is if even though you are not going to be sick and you will not have a protocol defined case of COVID-19, you still could maybe carry the SARS-CoV-2 virus inside of your nose or inside of your throat, and therefore, be a nidus or a subject who can unknowingly spread it to others even though you yourself are not sick. That is what we don't have complete information on as well and that's another reason why we want to continue with all of our public health measures even after immunization.

Brian Lehrer: Here's another related scenario I think from Elle in Brooklyn. Elle, you're on WNYC. Hello.

Elle: Good morning and you pronounced my name beautifully, so thank you.

Brian Lehrer: Thank you.

Elle: I hope everyone is doing well. I would like to know, I got my second dose two weeks ago and I would like to know what the protocol is to hang out with other people who have been vaccinated two weeks after their second dose in size. Is there a limit, can I hang out with one friend or a mother and brother indoors who've been vaccinated? What's the protocol going forward?

Dr. Morgan: We're still advising caution on all indoor gatherings, even with vaccinated individuals if they are not from your household. Here is why, because there are still additional mutations and strains developing, and so we want to still be certain that everyone is protected. Now, one thing that I can say, certainly, if you are only socializing with those who've been immunized and those people with whom you're socializing who've been immunized are also only socializing with people who've been immunized, and you can certainly create your own little pod of herd immunity, and then perhaps be a little bit more casual, but unless you can be certain that where and whom all of the people in your group are also contacting, we want you to continue with public health measures for now.

Brian Lehrer: The future of pods, the herd immunity pod. The immunologically elite hanging out together while other people wait for access or say, "No, I'll pass on the vaccine." Ethel in Manhattan, you're on WNYC. Hi Ethel.

Ethel: Good morning, Brian. Yes, I had the injection, the vaccine, last Wednesday and I have no reaction. The first time my arm was a little swollen but other than that, thank God, I had no reaction, and I'm 92 so I'm pretty lucky.

Brian Lehrer: Yes, you are, Ethel. Thank you very much.

Dr. Morgan: You are lucky. Congratulations. Awesome.

Brian Lehrer: So glad to hear that. I read somewhere, and confirm this or refute it because I don't want to present it as fact, but I read somewhere that older people have fewer reactions because their immune systems are less robust or something like that. Is there any truth to that as far as you know scientifically?

Dr. Morgan: What we know in our two messenger RNA trials and the data that was submitted to the FDA, in the Moderna trial, those patients who were over 55 years of age had fewer side effects. In the Pfizer trial, those who were over 65 years of age had fewer side effects. They did not identify reasons for that but as your previous caller just elucidated, she is happy and free of side effects after the second dose. That's going along with what we saw in the data as well.

Brian Lehrer: Fascinating. That's really good to know and probably reassuring for a lot of people who are relatively first in line to get their vaccine. Ethel, thank you so much for calling and sharing your experience. My guest is Dr. Jayne Morgan who's a cardiologist and head of the COVID Task Force at Piedmont Healthcare which is a network of 11 hospitals and more than 500 other facilities based in Atlanta.

Dr. Morgan, moving on now to getting access to a vaccine. When I go to your Piedmont Healthcare website, the first thing that comes up is a page that says, "Do not contact Piedmont doctors about vaccinations. Our practices do not have any vaccines on-site and cannot accept COVID-19 vaccination appointments. We will reach out to you once you are eligible and appointments are available." I'm curious how that's working, having the system reach out to patients in the system rather than the other way around, and how global a practice outside your Atlanta medical group do you think that is?

Dr. Morgan: I think different hospitals and different states are doing it. As we know, the government left it to the state and supply is different as well. I think when we look out over all the hospitals, everyone is managing it based on what their supply is, what their access is, what their population is. Do they skew more Medicare? Who are they serving, that type of thing? I don't think Piedmont is a single model in all of the hospital systems. This is the way that it's being managed there and I think all hospitals are doing it based on whatever demographics they're having to manage, as well as their supply and demand.

Brian Lehrer: Let's talk about the demographics because I see that one of the things that you're doing at Piedmont Health is developing community outreach to African-Americans in Atlanta. I imagine you have the same starting point there as we do here in New York, that African-Americans and Latinos are not getting vaccinated at their proportion in the population, not even to mention in their proportion of those who are getting COVID, while white and Asian American people are getting vaccinated at their proportion in the population. Do you have an estimate of the mix between lack of access and lack of trust causing the lower rates?

Dr. Morgan: I don't have exact data on that. I think absolutely, you're hitting the nail on the head. I think we see Asians with an acceptance rate of 65%, 66%, 67%, whites just behind that, about 64.5%, and then a steep drop-off when it comes to other populations of color. We have to begin to examine that, understand that these vaccines represent, certainly for the African-American community, an involvement of the healthcare system with which we have a tenuous relationship.

It also involves the ability to accept research with whom we have an even greater divide when we talk about research in historical context within this country, and then you fold in the US government who also holds an uneasy relationship with populations of color. All three of these convalesce to develop these vaccines, and so we can understand what the reticence is and what the hesitancy.

Additionally, these vaccines are fairly, the information is fairly complex. It's hard to figure out. We even have lower acceptance amongst healthcare workers trying to understand messenger RNA vaccines, this new platform. Rollout occurred ahead of messaging, ahead of communication. What does it mean? What words even like efficacy mean, emergency use authorization mean, immunity, how long will that confer? Lots of questions.

I think when we talk about populations of color, we certainly are talking about trust. Then secondly, we're also talking about access. The vaccines would be available in pharmacies, many neighborhoods, populations of color did not have local pharmacies that are accessible. We have to take all of these things into consideration when we look at why there's such a gap in who's receiving these vaccines and who is not.

Brian Lehrer: What kinds of outreach, and this may be the most important question anybody can ask right now, what kinds of outreach are you finding to be the most successful and most necessary on the access side and best practices on the trust side?

Dr. Morgan: I find meeting people where they are, and sometimes that means meeting them physically within the hospital. Sometimes that means social media outposts. Sometimes that means speaking engagements at organizations or groups or affiliations that they have, and starting to peel this away piece by piece by piece, working on that information.

Brian Lehrer: Why should people from groups who have had such dismal histories with respect to how the government has treated them and the healthcare system has treated them, why should they trust?

Dr. Morgan: Yes, interestingly it's, and it's one of the reasons we need to get more Black doctors involved in this as well. When I speak to different groups, we go all the way back to really just discussing clinical trials and what do clinical trials really mean with regard to health access and health equity for communities of color, and clinical trials provide a gateway to tomorrow's medicines today. They provide that health access, that health equity, where there are a team of people overseeing you and taking care of you, and you have direct contact information of nurses, research coordinator, such that people know what's happening with these.

Additionally, you have increased touch points with the healthcare system, and the Black physicians are the ones who have one foot in the culture and one foot in the medical community and serve as those natural bridges. They are really key contact points for recruitment into trials, as principal investigators, as leaders, such that they can be the trusted voice to introduce these trials, introduce these opportunities to their population. 80% of Black Americans are seen by Black American physicians. That's a lot of power, a lot of influence.

We start there to begin to see where these bridges, where are these trusted voices. We certainly look as well to our churches, to our pastors, to our community leaders, and begin to develop that information. People don't necessarily have fear of the vaccine, they have fear of the unknown, they have questions. There's not information, people want information, and it's hard to get that information and it's certainly hard at times to translate the scientific information into just layman's term, just plain English that everybody understands.

Brian Lehrer: What about on the access side, for people who may not have great internet or not great skills at navigating these bureaucratic websites, and they do seem to be bureaucratic and complicated, and sometimes you have to go back 100 times before you can find an available appointment. What about on the access side? What works?

Dr. Morgan: It is and that's a great problem. We have been discussing the possibility of developing these mobile vaccine units, again, where we meet people, where they are. When I say we, we use euphemistic meaning conversations. When I go out into the community and began to talk with other health leaders, these are the discussions that we're having. If we need to begin to develop some type of we bring things to you in these community initiatives, and it's not just populations of color, it's people in very rural areas as well, and whether we need to begin to stand up these vaccine depots in places where people can actually access them.

Brian Lehrer: Nancy in Manhattan, you're on WNYC with Dr. Jayne Morgan. Hi Nancy.

Nancy: Hey, thank you for taking my call. I am 74. I'm taking ongoing meds and I'm concerned about the interactions with the vaccine. I'm going to be taking my second vaccine tomorrow and I just thought of that as a concern. I haven't heard any talk about this.

Dr. Morgan: Thank you for asking that question. Please continue to take your medications. Don't skip any of your medications. Take all of your medications and you can still continue to have the vaccine. We don't have allergies as well to the vaccine, with the exception of if you've had a reaction to a compound called protamine sulfate, which is a liquid, a type of fat, and you would know that because it's found in laxatives or stool softeners like MiraLAX, or GoLYTELY or CoLyte.

If you have other allergies like environmental allergies or allergies to bee stings or venom or hay fever, none of those are contra-indications, and if you've even had allergic reactions to previous vaccine, you still can move forward with this vaccine. You just will need a 30-minute period of observation afterwards, because remember, this is not a live attenuated vaccines, so all these allergies with chickens and eggs and that type of thing, they don't apply here. I would encourage you to whatever medication regimen you're on with your physician, that you continue that regimen and don't interrupt it because of the vaccine.

Brian Lehrer: There's no interruption that's known with common medications, blood pressure, statin, GI things, whatever people might be on. You're saying there's no medication that's contraindicated?

Dr. Morgan: There is none that was submitted in the FDA briefing documents. We don't see any precautions for medication.

Brian Lehrer: Rachel in Queens, you're on WNYC with Dr. Jayne Morgan. Hi, Rachel.

Rachel: Hi, thanks for having me, and thanks for giving us consistently wonderful radio.

Brian Lehrer: Thank you.

Rachel: I got my first shot three weeks ago, and a week later, I got sick with COVID. Thankfully, now we're out of it. I'm having just a little bit- a few more symptoms. I'm just very tired, but I got to work. I'm supposed to get my second dose this Sunday, and I'm really scared that I would get symptoms again and so I pushed it that week. I changed it to a week later and I want to know, do I need to get my second dose? Will it give me any benefit? Is there any risk for me not taking the second shot? What should I expect?

Dr. Morgan: Okay, wow, a lot of questions in there. I'm going to start with the last question. All the clinical trials for even messenger RNA vaccines were based on two doses. When we talk about that 95% efficacy, that's 95% efficacy, meaning how well it works in protecting you with two doses, not one dose. The first dose gets you to about 50% to 60% protection. We definitely want you to reach full protection and so that's why we have the second dose.

Secondly, you stated that you contracted COVID after you received the first vaccine. Sometimes that can happen because either you're exposed to COVID immediately prior to receiving that first dose, or some time immediately after receiving that first dose because it requires eight to 10 days for your immunity to start to build. If you get an exposure in those first eight to 10 days, you can still contract COVID.

Additionally, even as your titers increase, as they're going up, each day, you have greater and greater immunity, but you still have a risk of contracting COVID and so that's why sometimes that can happen.

Brian Lehrer: Rachel, I'm glad you asked that question because I'm sure a lot of people are wondering. We hear these stories and we'll make this the last thought, Dr. Morgan, of people who say, "Hey, I had my first dose, but I got COVID anyway," and then they're not sure whether they should get the second dose delay, the second dose, but then a lot of people are surprised because they thought the first dose confers most of the immunity that you're going to get, so it casts doubt wrongly. I say wrongly in the public's mind, whether the vaccines are effective, all these people who were reporting in the media that they got COVID after their first dose. A closing thought on that?

Dr. Morgan: That's why because immunity doesn't begin for eight to 10 days after that first dose, and even then, it goes up gradually. Even after 10 days, you're not immediately covered. Even at that second dose, you're not immediately covered for one or two weeks afterwards. We have to continue to wear our masks as our titers gradually increase. Each day, we have a little bit more coverage than the day before, but we are climbing, which means that you still are at risk.

The other thing that I will say to our previous call or that the CDC has come out with something called exceptional circumstances. In exceptional circumstances, you can delay your second dose up to 42 days from your first dose, if you have exceptional circumstances. In this case, the woman has developed COVID. She still is feeling some of the symptoms. She's pushed it out a week, that second dose, according to the CDC, that's perfectly fine and perfectly reasonable.

Brian Lehrer: Dr. Jayne Morgan, cardiologist and Director of the COVID Task Force at Piedmont Healthcare in Atlanta. Such great information. Thank you for taking so many calls from our listeners and giving us so much time. Thanks a lot.

Dr. Morgan: No, thank you. I appreciate it. Hopefully, it's helpful and we are looking forward to getting to the other side of this pandemic.

Copyright © 2020 New York Public Radio. All rights reserved. Visit our website terms of use at www.wnyc.org for further information.

New York Public Radio transcripts are created on a rush deadline, often by contractors. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of New York Public Radio’s programming is the audio record.