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Brian Lehrer: Brian Lehrer on WNYC, good morning again, everyone. The United States now has around 280,000 COVID deaths out of around 1.5 million worldwide. We have 4% of the world's population, 18% of the deaths. Obviously, there are things we're not doing right. With cases, hospitalizations, and deaths spiking nationwide now more and more drastic shutdown measures are coming to more and more places as maybe our only recourse until the vaccines really get out there. Here is Berkeley, California, public health officer Dr. Lisa Hernandez over the weekend.

Dr. Lisa Hernandez: Until we get through this wave, you should not meet in-person with anyone you do not live with, even in a small group and even outdoors with precautions. If you have a social bubble, it has now popped.

Brian: America, are we ready to pop our social bubbles for a while to prevent the worst of the worst? Do restaurants and other small businesses really have to close or can they stay open with social distancing? And are we ready to equitably distribute and to be willing to take the COVID vaccines? Will Joe Biden's nominees for health and human services secretary and CDC director make a difference?

If you haven't heard he's reportedly nominating California attorney general and former Congressman Xavier Becerra for HHS and Rochelle Walensky Chief of the Infectious Disease Department at Massachusetts General Hospital in Boston and a Harvard Med School professor to revive the Centers for Disease Control, which has been so marginalized by President Trump. Then, there's Rudy Giuliani, and apparently three state legislatures he's exposed before being diagnosed with COVID yesterday, lawmakers in Michigan, Georgia, and Arizona, lots of Rudy hugs and loud droplets spreading, rooting, talking hardly ever a Rudy mask.

With me now, Dr. Wafaa El-Sadr epidemiology and global health professor at the Mailman School of Public Health at Columbia University. She is also director of their center known as ICAP leading the design implementation scale-up and evaluation of large-scale HIV and other public health programs in Sub-Saharan, Africa, and Asia. Dr. El-Sadr has also been a MacArthur Genius grant winner for some of that global health work. It's great to have you again, welcome back to WNYC doctor.

Dr. El-Sadr: Thank you very much. My pleasure.

Brian: So many places we could start, but how about that clip from Dr. Hernandez from Berkeley Public Health, the hardest-hit parts of California are going for serious stay at home orders again as of today, is it necessary in your opinion?

Dr. El-Sadr: I do believe it's necessary as has been mentioned before and as we're all aware of, the situation is quite alarming in the United States and almost every part of this country in terms of the large numbers of cases and hospitalizations and deaths. This poses a huge individual health threat, but also, as well as threat to the health system itself and there's some areas where there's the risk of overwhelming hospitals and intensive care units and so on. It's time to act.

I think that is the reason why in Berkeley, they're moving ahead with these kinds of interventions now to say, “We have to do what we know works and that means that we have to limit the exposure to other people as much as we can until we can get over this crisis.” I think the time is now to do whatever can be done to limit contact between people so that we can stop transmission of this virus.

Brian: To limit contact between people. It sounds so draconian when we put it that way. I know we were there in the New York area and California too, in a more preventive way in the spring, New York and reaction to how widely the virus spread there. On the other side of the country from Berkeley, Staten Island, maybe known as a pro-police so-called law and order borough of New York City, being pro-police and law and order was a big reason they just replaced Democrat Max Rose with Republican Nicole Malliotakis for Congress.

The big story out of Staten Island this weekend was the anti-police rhetoric and alleged anti-police violence by a bar owner who was repeatedly breaking COVID safety laws and then allegedly drove his car into a Sheriff's deputy trying to serve him summons, breaking multiple bones on the Sheriff's body, we are told. Now that's one allegedly violent criminal miscreant, but there are many otherwise law-abiding, small business owners who think they can stay open, have social distancing and mask policies and not spread the virus, but still be able to make a living.

My question for you, Dr. El-Sadr is, does the data suggest yes or no? Is there good data on this? Can businesses open with real social distancing policies, limiting capacity in their stores or restaurants with mass policies and not spread the virus? Or do we know that’s how the virus is spreading to some degree?

Dr. El-Sadr: I think it depends. I always think it depends on the type of business. I think it's particularly alarming for bars and restaurants to, for example, have indoor dining or indoor congregation in bars, for example, because those are settings where people are close together and also where people remove their masks. That's particularly dangerous kinds of environments.

I think it's very different from a situation where people are going for necessities, like for example, going to get food shopping and so on, where I believe that with the limitations on density and keeping the numbers of people who can enter into supermarket to the appropriate level, as well as with the physical distancing and the masking.

I think those are situations where that can be done more safely. I think it's the manner. It's not just any business, it's the type of business. How essential is that business and also the fact that there are some situations where just by the nature of the activities that are going on, that people do remove their masks for prolonged periods of time and that's what we know allows for transmission of this virus.

Brian: Dr. El-Sadr, I want to try a few different call-ins while you're on with us. First one, let's try something listeners if you've gotten COVID in the last month, where do you think you got it? 646-435-7280. We know cases are on the rise in the last month. If you've got COVID in the last month, where do you think you got it? 646-435-7280. I  

don't want to hear from you if you got it in March or April or May or if you think you got it last December and it wasn't diagnosed.

I want to hear from you if you think you've got COVID in the last month, where do you think you got it? 646-435-7280. We'll call this an informal unofficial thoroughly unscientific piece of anecdotal epidemiology, but maybe we will at least learn some questions to ask as anecdotal evidence can sometimes provide in public health. If you've gotten COVID in the last month, where do you think you got it? In a bar or a restaurant in a store, in a train or a plane or a bus at a small gathering with your social bubble that the public health officer of Berkeley wants you to pop.

Did you get it at Thanksgiving? It's 11 days now so maybe you did and maybe you did. Did you get it at Thanksgiving? Did you get it at the Michigan State legislatures’ informal hearing when you got your picture snapped with Rudy Giuliani? If you got COVID in the last month, where do you think you got it? 646-435-7280, 646-435-7280 for public health professor, Dr. Wafaa El-Sadr from the Colombian Mailman school, 646-435-7280. Look at that. Boy, the phones are lighting up, which means, unfortunately, Dr. El-Sadr, even here in the New York area, there are a lot of people who got COVID in the last month. We know that from the positivity rates and the hospital occupancy, right?

Dr. El-Sadr: Yes, absolutely. I think now we're up to about 2,000 new cases every day in New York City. You can contrast this with August and September, where we had sometimes only 300 new cases per day. This is almost 10-fold increase in the daily numbers of new cases in the city.

Brian: For you who have worked so much on Africa and Asia with respect to HIV in the past. Why do you think the United States and Western Europe have been hit so much harder than Africa in particular? It's not in the news very much and I feel like our listeners know more about the difference between here and Asia, I think and correct me if you think I'm wrong, but that in Asia, there were more strict lockdown policies at first. At the beginning, they had more experience there with SARS and other past infectious diseases that are similar to COVID.

They did the real isolation and contact tracing there in ways we didn't in the United States, but what about Africa? How do you explain Africa with its relatively low rates compared to Europe and the United States?

El-Sadr: I think this has been an enigma and there are several possibilities or several hypotheses that we believe may play a role in why African countries have not been as hit as hard as the United States or European countries. Firstly is the pandemic came to them later than it did to Europe and the United States. I think in many ways this allowed the leadership and the public health leadership, as well as the political leadership in those countries to be poised to be better prepared than we were.

I think just the timing in and of itself may have helped these African countries. I think another factor is they actually-- Many of these countries moved very quickly to put in  

place quite strong what we call mitigation control measures. They went very quickly to, for example, putting in place the limitations in terms of travel, domestic travel, international travel, they rapidly also closed schools and universities. They also issued the stay at home directives as well. There was a rapid movement to putting in some of these strict measures.

I think for the United States, for some European countries, we did it more incrementally. That's the second factor. Third factor is the population is very different. The population in many African countries, it was much younger than the average population age in several European countries, as well as in the United States. We know that, of course COVID-19 just getting infected at an older age is associated with much more likelihood of getting sick and unfortunately also the likelihood of dying from COVID-19. Keep in mind that we now know that 40% of the deaths from COVID-19 in this country occurred, unfortunately amongst the nursing home residents.

I think because of these actions that these leaders did and did very promptly, I think because of some of the public health measures that were put in place and lastly probably as well because of just the population distribution and a younger population, African countries that may also have helped as well.

I think we should also be cautious because many of the countries in Africa still don't have sufficient supply of testing, for example, so it's possible that we're missing a lot of cases of COVID-19 particularly cases with no symptoms where you actually need a test to detect such an infection. Those are some of the reasons that we hypothesize for the African situation.

Brian: Very interesting. All right. You ready to do some thoroughly unscientific epidemiology with our callers and where they think they got COVID in the last month? We'll start with Juan in Queens. Juan you're on WNYC. Thank you for calling in.

Juan: Hey, how are you? How's it going?

Brian: Good. How about you?

Juan: Sure. So my wife-- It’s my wife actually, she caught it the day-- Well, we found out she caught it the day before Thanksgiving and what was interesting was my son's girlfriend who is 24, she's always in our house and they study together because they're both taking college classes. She wasn't feeling well She had a fever and she wanted to get tested so my wife took her, she was adamant about not getting tested. I said, “Listen, you're going to be with her, if she's positive, you're positive.” It turned out they both were positive. Interestingly though, no one else in the household caught it. I got tested twice since then and I've been negative so it's a little confusing for us.

Brian: That's so interesting, Juan. That by itself, Dr. El-Sadr is an interesting story. A, not everybody who's exposed in the same household gets it. I've heard that before from people. B, here's a story about your bubbles and we don't know what

lifestyle their son and his girlfriend who were in their 20s were living and then the parents are exposed.

El-Sadr: Yes. I think obviously another important thing to keep in mind is if you have any symptoms, I think people should not come together with anyone else. Having any symptom should prompt the person to please stay at home and go get tested. I think that's very important lesson from the scenario that you just described. I think also just to build on the issue of transmission within households or people who live together and this is a, maybe a more scientific survey, but the city itself did a survey where they asked contacts and those who got infected, where they thought they got the infection from and the largest proportion was from the household, from people that they were living together with.

Brian: Somebody had to bring it into the household from doing something outside?

El-Sadr: Right and then it's transmitted within the household thereafter, people that live together.

Brian: Let's go through a few more real quick. I'm going to ask you all to keep this fairly short so we just get some basic facts about what you think is the chain of transmission on the table here. Let's go next to Zainad on Staten Island. Zainad you're on WNYC. Hi there.

Zainad: Hi, a long time listener. I actually developed COVID on the 13th of November. I tend to suspect, and I got tested on the 14th and so it came back positive a couple of days later. I tend to suspect that I got it at work even though I'm an office worker I do have some exposure to some of the individuals that I work with. The thing that surprises me is that I was opposed to go all for adherence to all the restrictions.

I was compulsive about it, I was wearing three masks. I was washing my hands compulsively and on top of that, I was actually restricting, my movements were extremely circumscribed with exceptional work, I wasn't doing anything and yet I ended up getting it, but I just have a question for Dr. El-Sadr. There was a discrepancy in terms of the CDC guidelines post-COVID recovery, and what the doctors are saying.

The CDC says very specifically that when individuals are recovering they should not get tested because there was a possibility that there might be some residual virus that is going to result in a positive test, even though the person does not have the capacity for transmission. When you talk to an individual doctor, they say that you should get tested. I've been in isolation for 24 days now I am petrified.

I haven't come out of my room. I am experiencing a lot of anxiety. My symptoms have abated for the most part, but right now the major impediment to my emergence from my room, which also obviously has psychological implications you can well imagine the solitude, the isolation, and everything. What does one do? Does one get tested? Because if there's residual virus, as the CDC is saying and it's saying, “Don't get tested because you're going to get a positive test, but you're not going to be

transmitting.” I would appreciate any feedback, Dr. El-Sadr.

Brian: Zainad, have you continued to test positive toward your 24 days?

Zainad: I have not been tested since then. I was tested initially when I had developed some weak symptoms.

Brian: I see. Because you're concerned about the result and the CDC guidelines. Can you help her, Dr. El-Sadr briefly?

El-Sadr: Yes, absolutely. I think it's recommended after a positive test, not to get retested again for subsequent three months, 90 days or so. The reason is exactly what you said is the test can be positive because it's picking up remnants of small pieces of the virus or dead virus, for example, and therefore we don't recommend that people who've been diagnosed to be retested again for the three months duration after the diagnosis. I think we need to disseminate this information widely so physicians are able to advise their patients of this information.

Brian: If Zainad's symptoms have abated, as she said, does she need to keep isolating after 24 days? Or can she go back into the world?

El-Sadr: She can go back into the world if symptoms have abated. I think you do not need to get retested and you can go back into the world, but of course, remember you, of course, has to practice all the protective measures that you did previously.

Brian: You hear how she said she was so obsessive about practicing protective measures, but she had to be in close contact with some people in the course of her job, she said, so she assumed she got it from there. I guess that's an indication of even being so careful how much risk is out there.

El-Sadr: Yes, absolutely. I think also, we found that in the workplace while people are careful during working hours and the distancing and the masking and so on, sometimes they let their guard down. I'm not saying that that's what you did, but they let their guard down during breaks or during lunch breaks where they congregate in a break room, and then, of course, that's when they have to pull their masks down and again, in order to eat and drink and so on. We are very much focused on the importance of consistency. If you are going to be with someone in the same space, then please, please do observe the distancing. That's very vital and try to keep the removal of the mask at minimum.

Brian: Teresa in Brooklyn. You're on WNYC. Hi, Teresa.

Teresa: Hi, good morning, Brian. I'm a longtime listener and a monthly sustainer. I have an elderly friend with severe pre-existing conditions. He never left the house. He had three family members taking care of him. He had to go into the hospital for a procedure unrelated to COVID and he got COVID and is now in the hospital. His three family members all tested negative so they did not bring it in the house. They believe he got it from the hospital procedure. Thank you so much. I'll listen to the rest o offline. Thank you.

Brian: Theresa, thank you very much. We have a few callers. I'm not going to go to the, to the other ones because it would be a similar story, but a few who think they got it when they went out for routine medical procedures, do you think that's happening doctor?

El-Sadr: Well, I certainly hope that it's not. I think there's there's as you're well aware, they're screening, of course, of all healthcare workers' daily symptom check to make sure that if anybody has a symptom that are not allowed into the facility. There's also many health facilities that are doing frequent testing of their staff. There's also a very much of an effort to make sure that people again are distancing and wearing masking and also wearing face shields if they're providing additional face-- To the mask if they're providing patient care.

With all these measures, one would hope that there’ll be minimum risk of transmission to an individual patient. Nonetheless, we know that we can minimize the transmission, but it's very hard to say that it can be zero risk. We can decrease the risk as much as we can through trying very hard to adhere to all these measures, but it's very hard to say that the risk can be zero risk.

Brian: I imagine, Dr. El-Sadr, that with the scale-up of large scale HIV public health programs that you've been involved with around the world, you've got some relevant experience for the scale-up of the vaccine distribution that's about to start in the United States and globally. The vaccines are coming and paradoxical as this baby people are jockeying for a position to be first in line and also saying, "I'm not going first."

News stories this weekend said half of all New York City firefighters who would be early in line as first responders, half of them said in a survey that they won't take it. Back in August, only 30% of MTA workers said they commit to being vaccinated. We'll see how these numbers change when presented with a real vaccine in a COVID soak world, rather than a survey. Some people are asking, “Why me?” And other people are asking, “Why not me?”

Listeners, if you are first responders or frontline healthcare workers, this is the second call-in we're doing for Dr. El-Sadr, are you ready to take the virus? Firefighters call us, police officers, call us doctors, nurses, EMTs, anybody who's going to be in that frontline professional A-1 category for eligibility for the virus, are you going to take it? 646-435-7280, 646-435-7280. Dr. El-Sadr, what do you think about these numbers, do they indicate something real and what's going to happen at your medical center?

El-Sadr: Yes, I think they do indicate there's a substantial proportion of people, at least when they're theoretically asked the question if they will get the vaccine, they're quite hesitant about getting the vaccine. This may differ, like you said, as to when people are actually presented with the option of getting the vaccine, but nonetheless, I think it motivates us to think very carefully and we are doing this now in terms of how do we disseminate the correct information about this vaccine. That's very important. Disseminating the information is critical.

I think also very critical is engaging people from these prioritized communities early on so they have the information at their fingertips and then we can also deal with some of the misconceptions that we know exist. I think also very important, this is something that I've learned from my work locally and globally, is the value of engaging communities and identifying champions within those communities. They are the ones who can reach their peers. That's really, really critically important that we do this work now to be able to get those champions who can disseminate the accurate information about the vaccine.

We have answers to a lot of the questions that people have. Some of the questions we don't have answers to, but at least we can engage in a conversation about what we know now as well as what we don't know.

Brian: Maybe we have a few of those champions on the phones right now. Tenaz, a physician in Queens, you're on WNYC. Hello, doctor.

Tenaz: Hi, thank you so much for amazing program. I'm going to take the vaccine 100%. I think science is good and as a physician, not just protecting myself, I have an opportunity to actually prevent the cycle from like me transferring to another person, which is very, very important to vaccination. I'll take it 100%.

Brian: Thank you very much.

El-Sadr: That's really excellent. We know from other experiences that physicians and other healthcare workers are really valuable because for many of us, having a physician or your healthcare workers say, “This is important, this is what you need to do,” can be very motivating for people. We certainly are also reaching out to physicians because they are very important champions as well.

Brian: Here's a nurse in our end. Sade, in Greenpoint, you're on WNYC. Hi, Sade, thank you for calling in.

Sade: Hi, Brian, a long time was there. I'm very excited to get vaccinated. I personally I’m on my second isolation for COVID. I got tested. I have no symptoms, but because my patients were so asymptomatic, I felt it was important to get tested. It was a real reality check even for me, someone who eats lunch outside. I didn't even think it was as viral as it is. I think we should all be really realistic about it. I also understand some communities rather than to take a vaccine, especially with the racist history of vaccinations in the United States and experiments. It's a nuanced thing.

Brian: Did you say you're on your second isolation for COVID, meaning you think you've had it twice?

Sade: Well, I had a presumptive positive in the very beginning when testing was extremely limited back, this is in March. I can't say that for sure it was confirmed, but it was a better safe than, sorry. Then now, right now I'm confirmed.

Brian: Where do you think you got it in the last month?

Sade: Well, it's interesting because my domestic partners and negative. I assume I got it at work, but I was wearing my N95. I follow all the donnings-doffing protocol. It's pretty confusing. I have two confirmed positive patients at work, so that's when I started testing regularly. Again, they were asymptomatic. They weren't being treated for COVID, but they were confirmed positive.

Brian: Then you turned up positive and you are ready for the vaccine?

Sade: Oh, I am. I think it's important to vaccinate, especially as a frontline worker, and set a good example as a nurse

Brian: Sade, thank you so much for your call and I hope you feel well. Here's, Ouju a dentist in South Oren's. Ouju, you're on WNYC. Hello.

Ouju: Hi. How are you?

Brian: Good. How are you?

Ouju: Good, good, good. As far as the vaccine, so I was at the screener, someday, I go back and forth. For me, I believe in science, I definitely I’m not an anti-vaxxer, but I feel like there should be so much transparency where this is concerned. The only way for me, I can trust anything is gone are the days of making decisions behind closed doors. Right now the FDA is looking at the information from Pfizer and Moderna. Once that's done on their end, they have to release every single piece of information.

I understand Pfizer and Moderna definitely want intellectual property, whatever the terminology is, and they don't want anyone to copy them. This is a one time in our lifetime, that if you're going to get people on board, it has to be completely transparent. I'm a endodontist, so my specialty is root canal. I'm not going to sit here and expect me to know all the data, but I have a family friend who's an epidemiologist. I told her, I said, "Once the data is transparent, I need you to look at and if you tell me this is legit, and this is solid, then I will be the first one lining up to do it." The thing is, it cannot be behind closed doors. This is so important and this is too important to know then.

Another thing is, and I know this is all evolving, and we don't know yet, but part of the data needs to be, “If I take this, how long do I have for immunity? Legitimately, what are the side effects?” Because I know when I took the tetanus vaccine, they told me, "Okay, which arm would you prefer it on, your right or your left?" I'm a righty. They said, "Because you're going to have redness, you're going to have flaw in that area. It might hurt for a few days." Lo and behold, two days later, I was like, “Oh, thank God I took it on my left arm because I'm a righty.” I feel like for me personally, if I have all the data and all the information, then we'll be fine.

On the contrary, my mom is a registered nurse, and she's constantly, we always say we're African, all the Africans mom send all this spam via WhatsApp and she's constantly sending all this stuff. I'm like, "Come on, lady, you're a nurse, you're a healthcare worker, you should know better." I'm like, "Stop with disinformation." She's  

like, "Well, you go in and take it and you die."

I'm like, "No, if the information out there is transparent, and it's legit, it will be unwise to not do this." Because at the end of the day, we have to have information. I feel like as human beings who are smart, we can make smart decisions. The smart decision is if it's transparent, and it works, and we legitimately know the side effects and everything is out there, we will be out there taking it. That's just my two cents.

Brian: Ouju, thank you so much. Dr. El-Sadr we're going to run out of time soon. That was more than two cents, but such a beautiful explanation of some of the conflicts, I think, a very clear description of some of the internal conflictness that people have.

Dr. El-Sadr: Yes, and I do agree. I think transparency is very important. I think it's important for people to realize that even the information we have thus far are from independent safety monitoring groups that don't include the pharmaceutical company and that's really critically important. Also, that the FDA advisory group is quite a diverse group of individuals, and includes [unintelligible 00:32:43] and scientists as well as also community members. That the goal is and the plan is for the information that will be shared with the advisory group, that that information will be shared with the public thereafter.

I think that's very critical because we need to be able to let people know exactly what the studies show and also prepare them if there are side effects. People can be prepared, as your caller indicated. If you know what to anticipate, I think it's much better than being surprised. I feel like we have to really work very hard over the next couple of weeks to distill this information that's going to be coming out and to take the information disseminate it as widely as we can and then be available to answer questions about the data.

Brian: All right, this is a start. We've had two really interesting, I think, call-ins a little informal, fairly unscientific, epidemiology and vaccine resistance, or willingness survey data with these two groups of callers who we've had on and some great information from our guest, Dr. Wafaa El-Sadr epidemiology and global health professor at the Mailman School of Public Health at Columbia University and director of the ICAP center which works on public health around the world. Dr. El-Sadr, thank you so much for the information today and for being so thoughtful with our callers. We really appreciate it.

Dr. El-Sadr: Thank you.

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