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Brian Lehrer: Brian Lehrer on WNYC. The new vaccination and testing requirements coming from businesses and all levels of government and the indoor masking recommendations from the Centers for Disease Control, even for vaccinated people, again, in many circumstances are coming in response to the spread of the Delta variant, right? Something that most of the public didn't even know existed just a few months ago, but the race between variants and vaccines, and that's what it is.

It's a race between variants in vaccines and we'll get to that doesn't end with Delta. Here's some news stories from just the last 24 hours. The Chicago Tribune reports that Illinois is seeing more cases of the Lambda variant than the Delta variant in the state. Now, the CDC is out with a new report on an outbreak of the Gamma variant, that report says the Gamma variant infected 24 out of the 44 employees of a gold mine in French Guiana, including 15 of the 25 minors who had been fully vaccinated. 

There were no serious hospitalizations though. The Washington Post reports on an as-yet-unnamed variant discovered in Colombia showing up among patients in South Florida. It quotes one local hospital system saying this new variant is now accounting for 10% of the COVID patients that they are seeing in Miami and again, it's so new to the US, it doesn't have a Greek-letter designation yet.

Let's pull back from the Delta variant fight of the moment to talk about the big picture of COVID variance and the best way to deal with COVID is ability to mutate and adapt further, with us for this are Moritz Kraemer, research fellow in Oxford University's department of sociology. He has a new study out on a so-called superseding event in the UK in science magazine, and Krutika Kuppalli MD, infectious disease physician with expertise in emerging infections and biosecurity.

Some of her tweets in the last day, praise the vaccine mandates issued by Facebook, Netflix, and Google for employees to return to work in-person plus Apple's re-imposed mask mandates for all customers and employees at Apple stores. She notes with dismay the highest increase in cases in the US since February happening now, and the most hospitalizations for COVID since April happening now.

She criticizes the idea of widespread third vaccine doses for older people coming from Pfizer when so many people around the world don't have access to any vaccines. Pfizer says its vaccine declines from 95% effective to 84% effective after about six months. Dr. Kuppalli says, hey, 84% is still really good. Professor Kramer and Dr. Kuppalli, thanks for coming on. Welcome back to WNYC.

Dr. Moritz Kraemer: Thanks very much for having us.

Brian Lehrer: Let's start on the topic of variance and we'll get to some of those other news stories and things you've been tweeting about. Dr. Kuppalli, what should people think when they hear all those stories of new variants, more Lambda than Delta in Illinois, the Gamma variant outbreak recorded by the CDC, a rising variant in Miami that doesn't even have a Greek-letter name yet. How much of a deadly game

of whack-a-mole are we playing now?

Dr. Krutika Kuppalli: We're definitely playing a game of whack-a-mole for sure and this is what I think we were all concerned about. We know that this virus mutates, we've been seeing that. I think that the thing that the public needs to remember is that there's different variants that we're concerned about variants of interest, variants of concern and that's all different types of nomenclature.

The ones that we're most concerned about are, the ones that are variants of concern, and those are ones that have been shown to have increased transmissibility. The Delta variant, the Alpha variant the Beta variants, those are the ones that we've known about these other ones are probably variants of interest that we're still learning about. The Lambda variant and the Gamma variant, and then the one that they don't have a name for, we see lots of these different mutations.

As we learn more we'll learn more about how the properties of these new mutations are affecting the virus. I think the bigger picture though, is that we really do need to get the levels of circulating virus down, not just in the United States, but all across the world. We do that then we're going to prevent new variants from emerging and we're not going to continue to play whack-a-mole.

We need to use all the tools we have in our toolbox to keep this virus under control. Vaccines, physical distancing, wearing masks, all the things we've been talking about for the last year-and-a-half.

Brian Lehrer: Professor Kramer, same question, pretty much. What's the big picture as you see it, a variant's beyond Delta for the likely arc of COVID and for how we come at it?

Dr. Moritz Kraemer: Very good question and many thing were already mentioned by a colleague that. I think one of the things that I tell people when thinking about the bigger picture of this science of concern of parents in general, is that we have seen this repeatedly now, right?

We've seen, of course, the emergence of COVID at the time, when it first appeared in the human population that we had this event, it's seeding into the entire world and in causing this global pandemic and then we had the Alpha variant emerging as Southern England and then spreading it across the entire world from there and then that happened again for Delta.

We're always running a little bit behind. We identify them, but then they're like spreading everywhere and then we see these massive outbreaks and that, of course, it's a risk for everywhere in the world and the thing we need to not forget that so whatever happens in one part of the world will affect other parts of the world. For me, this is not the last one. We will have more of those emerging and it will need to identify them faster.

We need to get a better handle on where they're circulating and then we have the tools and we need to use the tools to combat them. At this point in time, this is on the one hand, of course, the vaccine works incredibly effectively against most of the

variants that we have circulating at this moment in time but not just that, we also have learned that physical distancing while spreading and other tools that we have can be incredibly effective in bringing transmission down.

We need to keep transmission down. I think that's one of the big takeaways from what we have seen in the last few months.

Brian Lehrer: Can we talk briefly, Dr. Kuppalli about some of these specific variants? Are you familiar with the Lambda variant, for example, now reportedly outpacing Delta in Illinois, and any differences from Delta or Alpha in transmissibility or severity or anything else?

Dr. Krutika Kuppalli: I am familiar with the Lambda variant, I believe that it's been classified as a variant of interest by the World Health Organization. What that means is that there's some markers that are associated with changes in the receptor binding and it could have some potential impact on transmissibility but it's not been classified as a variant of concern. That's the highest level of being when you look at the levels of variants that we're worried about. It is something that we've been keeping our eye on, I think that we're still learning about it though at this point.

Brian Lehrer: For Professor Kramer, same question for the Gamma variant or the as-yet unnamed one in Miami?

Dr. Moritz Kraemer: I think we know quite a bit now about the Gamma. It was first detected in returning child in Manaus and then there was a huge outbreak, of course, SARS-CoV-2 in Manaus itself which then spread across Latin America and especially in Brazil. We've seen clusters of that variant across the United States and also in parts of Europe and it's been circulating there. We have been worried about it for a long time, and I think we'll continuously avoid the ballads in many ways.

We're still learning I think about exactly whether it would be outpacing other variants that are circulating in other places. The primary concern right now is Delta because Delta has been spreading very, very rapidly from India into the UK, from the UK into many parts of Europe into Uganda, but also then it's now spreading across the United States and causing this immune rise of infections.

Brian Lehrer: Professor Kramer, to follow-up to the extent that there is data yet, how effective are the three vaccines commonly in use in this country against the newest variance? Is there reason to believe vaccines are any less effective against some than others?

Dr. Moritz Kraemer: Yes, and I'll let others to give more detail on the specific US context, but all we know from the UK and public health, England really is doing a fantastic job in collecting this type of information is that the vaccines and primarily AstraZeneca and the Pfizer vaccine, which are in wide distribution across the United Kingdom are incredibly effective against Delta and they were very effective against Alpha as well.

They're a tiny bit less effective against Beta and Gamma but it's still very effective.

How I think about it is, we have incredible tools to bring transmission down and vaccines are really one of the big ones there and as we bring these vaccines into distribution option not just in Western economies, but primarily in low and middle-income countries I think we can really fight the science.

Brian Lehrer: Dr. Kuppalli is this one place where the emergence of new variants as an issue connects with the issue you tweeted about of low vaccine availability in most of the world, while we have the privilege debate about third doses to protect against new variants here?

Dr. Krutika Kuppalli: Yes. I think obviously people are going to have different opinions about this, but I think if you look at again, the bigger picture the way that we reduce the emergence of variants is by reducing the amount of circulating virus. That's not just in the United States or in resource-rich countries, but that really is all over the world. In order to do that we really do have to work on getting vaccine rollout to all of the world.

I think that there are many parts of the world where we have people, healthcare workers, in fact, that have not even received first doses of vaccines and they're putting their lives on the line. I think we should really be focusing on making sure everyone who wants to dose gets at least one dose of the vaccine before we talk about giving people a third dose of the vaccine. When we know that being fully vaccinated at this point still gives you very, very good protection.

Brian Lehrer: Since there's no world government, who can decide to rebalance the global distribution of vaccines?

Dr. Krutika Kuppalli: Well, I don't know that there's a way to decide to redistribute the global vaccination, but I think you know getting countries to continue to contribute to COVAX is a very, very important thing to do. Here in the United States, one of the things that I've advocated for amongst others in my profession is for the United States to donate doses, especially as we were seeing rates of vaccination decline just as that could potentially expire.

We don't want doses sitting on shelves and we want doses getting into arms with people. I think that that's something that needs to happen all over the world, particularly in countries that have excess vaccine at this point in time.

Brian Lehrer: Listeners, we can take some questions about variants or any other COVID news for Dr. Kuppalli and Professor Kraemer at 646-435-7280 646-435-7280 or you can tweet a question @brianlehrer. Professor Kraemer one of the debates about vaccine mandates in this country revolves around the fact that the vaccines in use only have emergency use authorization, but not permanent authorization. The skeptics ask, how can we be mandated to take something that's still officially considered experimental? Are you having that same debate in the UK?

Dr. Moritz Kraemer: Yes, I think not maybe to the same degree than this problem in the United States. In the UK the vaccine road has been incredibly fast. It was one of the oddest ones in the world. It started in December 2020, but also it has been rolled  

out by the NHS and the UK population really, or the English population really loves the NHS. It was done in a way that at this point, I think [crosstalk].

Brian Lehrer: For people who don't know that the NHS is the national health service in Britain, go ahead.

Dr. Moritz Kraemer: It was so effective or so successful that now about 88% of the adult population has received their first dose and about 70% has received a second dose. Compare that to other places in Europe, it's much, much higher and there's a lot less hesitancy to take the vaccine. This debate hasn't yet emerged in terms of where should we be mandating vaccines to the rest of the population and those who may not want to get vaccinated, but there are of course, like nudges in the UK.

For example, you can go to a football game or you can go to a certain restaurant when having received a vaccine that may not be saying that it's serving as a nudge for people to become and get vaccinated.

Brian Lehrer: Go ahead. Did you want to finish your thought?

Dr. Moritz Kraemer: No, no, no, this was it.

Brian Lehrer: We'll continue in a minute. We'll start taking your phone calls for Moritz Kraemer and Krutika Kuppalli.

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Brian Lehrer on WNYC as we continue to talk about variants vaccines and more with Moritz Kraemer, research fellow in Oxford university's department of zoology, but he studies human biology too. Has a new study out on a so-called superseding event in the UK, in science magazine and Krutika Kuppalli MD infectious diseases, physician with expertise in emerging infections and biosecurity. We'll go to your phone calls in just a minute.

I don't know if listeners were able to hear me save this just before the break, Dr. Kuppalli, but I was saying I want to ask you about how Governor Cuomo in New York went a step further yesterday for health care workers employed by the state then for other workers, no choice between vaccines and getting tested once a week, if you work in healthcare and can face to face with patients, get vaccinated or get fired. I'm curious as a doctor, do you support going that far for public-facing healthcare workers?

Dr. Krutika Kuppalli: Yes, so I think that's a great question. I think again, that's one that many of us have discussed quite extensively, and I can tell you that my institution, they instituted a mandatory vaccination mandate as well. I think that if you're going to be taking care of sick people, particularly immune-compromised patients and people who are on chemotherapy and having solid organ transplants and all sorts of things I think it's really important that we're doing everything we can to protect our patients.

We don't want them coming into the hospital and be worried about getting sick. Quite frankly, the data we have at this point shows with the COVID vaccine is extremely, extremely efficacious and also it's extremely, extremely safe. We've had over 150 million people in the United States be vaccinated and people have done extraordinarily well. I don't feel like this is an overreach. I think that if you want to work in healthcare, one of the first tenants of care is to do no harm and we don't want to be harming our patients by transmitting infection to them in the hospital.

Brian Lehrer: I'm going to take what I think is a very basic question, but that might be worth going over from Ed in Manhattan. Ed you're on WNYC, thank you for calling in.

Ed: Yes. Hi. I just wanted to know how the doctor can explain the virus can be transmitted and spread even if you're vaccinated. A vaccine all it can do and possibly do is to make your symptoms less severe, okay or maybe you not die from it, or maybe not get that sick, but where is the science that somebody who was vaccinated cannot spread the disease? It's obviously that hand washing proper ventilation, masking, social distancing, having proper plumbing in different countries. Having sanitation stops the spread of the disease. A vaccine doesn't stop anything from spreading. I'd like to share the science of how being vaccinated stops people from giving the virus to another.

Brian Lehrer: Thank you very much, Dr. Kappalli, will you take that one?

Dr. Krutika Kuppalli: Sure. There's been a couple of studies out there. I can't quote them all off the top of my head, but I can definitely say that in a number of the studies, they looked at people who were vaccinated, and in between doses they looked at their ability to get infected and if they were infected in to pass on the Coronavirus to other people, and they saw in people who were vaccinated versus those who were not, people had a far less chance of transmitting the disease onto other people.

That's where some of the data has come from. I'm not sure if Dr. Kraemer has any other data that he can use to help support what I'm saying.

Dr. Moritz Kraemer: I would just say or ask about that essentially what the vaccine does is protects people to become infected. There's not much replication of the virus in their body, and once there isn't any replication of the virus there it be spread. That's the most of the cases there are of course, cases where people still get a little bit infected and there may be the possibility for, on what infection, but what the vaccine is really good for is preventing virus to be built that and can be passed on from person to person. This is really, really great data that we have seen for that.

Brian Lehrer: Professor Kraemer, take us then one step further into that. I said we would talk briefly about this term that I used that I got from people in the public health field that there's a race between the vaccines and the variants. If we've talked mostly in this conversation about new variants emerging beyond even the Delta variant, the race between the vaccines and the variant, how does widespread vaccination prevent new and potentially more spreadable or more dangerous variants from

breaking out?

Dr. Moritz Kraemer: Yes, it's a very, very good question. Let's take the example of, let's say India for the emergence of the Delta variant This was actually a virus that had. been found already in December, or first I said in December 2020. Then we had continuous relaxation of non-pharmaceutical interventions across India, which led to more mixing of people with each other. At the same time, we didn't really have much uptake of the massive amounts of vaccinations in the same region, which really allowed for the infections to spread between people. Once this occurs, these viruses or these virus variants can really expand.

What we have seen in the data for the Delta variant, for example, is that pick infectiousness of the virus is actually much higher. When I say pick infectiousness, it's essentially how much virus particles are in your body at a given time point, which increases the risk upon web transmission. The more and you can imagine, then you have lots of people unvaccinated in the population, which allows for that virus to really spread through these networks of people, but then allows for that to spread globally.

Now, if you imagine 90 or 95% of population being vaccinated the chances of someone actually finding someone else who is susceptible to infection because they're unvaccinated, for example, that risk is just much lower, I'd say. As we continuously increase vaccination uptake in the population, we're preventing these onward transmission events to really occur, and then for these variants that emerge in many places across the world all the time to spread globally.

Brian Lehrer: Yes, because the premise of the caller's question was really wrong, wasn't it? It's not that the vaccinations only prevent you from getting serious cases. If we see that the trials found the Pfizer and Moderna vaccines, for example, about 95% effective in preventing any transmission. Even if it goes down a little bit from that over time, that's still preventing most people who come in contact with someone from the virus from even getting the virus even in asymptomatic case.

It really is preventing transmission in a large, large, large segment of the population, and therefore, that prevents transmission overall. Eventually, if everybody's vaccinated for exactly that reason, it will die out. That's right. Isn't it? Dr. Kraemer?

Dr. Moritz Kraemer: I think, yes, in principle. That is very good summary, actually.

Brian Lehrer: This is WNYC FM HD and AM New York, WNJT-FM 88.1 Trenton, WNJP 88.5 Sussex, WNJY 89.3 Netcong, and WNJO 90.3 Toms River. We are in New York and New Jersey. Public Radio a few minutes left with Professor Kraemer and Dr. Kuppalli, and Emily in Atlanta. You're on WNYC. Hello, Emily.

Emily: Hi, Brian, longtime listener first time getting through the call. I am calling to ask your guest about surface transmission. I feel like we obviously know that transmission rates are greater with particles in the air hence masks and of course, hand sanitizing, hand washing is of course continued to be encouraged. I'm a mom of a one, and a three-year-old, and it is not always possible to get to hands after

every surface. I wonder if, with the greater chance of transmission and contagiousness of the new variants, does that apply to surfaces as well, and has there been any research or data about that?

Brian Lehrer: Dr. Kuppalli, can you take that one?

Dr. Krutika Kuppalli: Sure. I'm not aware of any data that has shown that there's greater rates of transmission from the surfaces. There really isn't any great data that shows that there's transmission from surfaces. The whole point of recommending good hand washing has been to prevent you from inoculating yourself with the virus and then potentially touching one of your mucous membranes and then autoinoculating yourself. I am not aware of any data that shows that with the Delta variant that's increased when you're touching surfaces to one of your mucous membranes.

Brian Lehrer: Professor Kraemer, your article in Science Magazine about a super spreading or superseding event in the UK isn't about Delta, it's from earlier in the pandemic. Were you able to see anything from how meticulously you looked at the data on how the Alpha variant in that case spread around the UK? Anything that isolates surfaces to say people don't have to worry about surfaces anymore or have to worry about them a little or anything like that?

Dr. Moritz Kraemer: Not in this particular study, but maybe one thing to add to the conversation here is that we still believe that most of the transmission really occurs through aerosols, and when people meet in close contact in crowded spaces. This is really interesting because we see the virus evolving, and we see that when the virus evolves, we see some differences in when transmission occurs.

For example, for the Delta variant, now, it seems like that it replicates incredibly quickly after infections about 72 hours after someone has come into contact with someone who was sick. Then it's very, very high viral load during these early days of the infection, even before symptom onset. This is a time when most of the transmission we believe is occurring. This is, again, a little bit similar to the original Wuhan strain when lots of the transmission was happening from in the asymptomatic or presymptomatic stage.

I think that's why we avoid about this because we're seeing countries reopening. We're seeing more crowded spaces again. Then we are also seeing particularly the Delta variant to be particularly good in infecting others when people don't really know that they are yet very sick. I think that's something that we are continuously monitoring, really, when we see these new variants, in what context really are they most effective in transmitting?

I think we need to learn about this as we go through. I know it's a lot for the public to really follow all of these different things about these variants and how they're different. I think that as we keep this in mind, we'll probably hear about this more as we go through new cycles of new variants.

Brian Lehrer: We have time for one more listener question. Jordan in Northville,

Connecticut, on WNYC. Hello, Jordan.

Jordan: Hello, everyone. I had COVID-19 in March 2020. I tested positive for antibodies twice over the subsequent eight months, and then I was fully vaccinated this spring with Moderna one and two. I work in maskless inside in a restaurant right now. We're busy.

The question is this, when at the beginning of the vaccine rollout in the New York area, anyway, The New York Times reported on a not yet peer review study that indicated that for people, like me, who had COVID-19, and then subsequently got vaccinated, that they were looking into-- That we may develop so-called super antibodies that would protect against all coronaviruses. I'm wondering a, has there been any development in this study? B, because I had COVID-19, and I'm fully vaccinated, am I more protected against these new variants?

Brian Lehrer: Professor Kraemer, do you have anything on that?

Dr. Moritz Kraemer: I have not seen this particular study you're referring to which is interesting. I go back to New York Times to see what there is. What we have seen in studies is that those who have had the infection had two vaccine doses of Pfizer, Moderna or the AstraZeneca vaccine have very, very good antibodies protecting them against infection, especially hospitalization and severe disease against many variants or all of the variants that are circulating today.

Now, whether I would call that someone has super antibodies and is protected against all future coronavirus variants, I would be very skeptical of that. We don't know what these variants can look like in the future. We can't really predict whether someone who's had an infection and two doses of the vaccines is really protected against everything. However, what we do know from other coronaviruses that have been circulating for multiple decades and years, is that future and subsequent infections are more likely to be mild.

Brian Lehrer: Dr. Kuppalli, your last word on that or anything else in our last 20 seconds or so?

Dr. Krutika Kuppalli: No, I think my colleague did a great job. I think the only thing at this point is I would still recommend given what we're seeing with the Delta variant, and we're still learning a lot about the variants and the other emerging variants. I think I would recommend wearing a mask, especially in an indoor crowded place. I think that that's something if you were my family member I would recommend.

Brian Lehrer: That is coming back and maybe Jordan for your restaurant soon enough. Moritz Kraemer from Oxford, Krutika Kuppalli infectious diseases physician, thank you both so much for your expertise today.

Dr. Moritz Kraemer: Thanks for having us.

Dr. Krutika Kuppalli: Thank you.

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