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Brian Lehrer: Brian Lehrer on WNYC. We will continue to update you this morning if we get new information about the shooting at the 36th Street Station where the N, and the D, and the R train stop in Sunset Park. Right now, the fact that Mayor Eric Adams got COVID raises a number of questions both for public policy and for your personal decision-making in this time of Omicron BA.2. One question, should big events like the Gridiron Club Dinner or your wedding or anything else continue to take place? More than 70 people who attended the Gridiron Club Dinner on April 2 have since been diagnosed with COVID. All of them had to show proof of vaccination to get in.

Those who then got COVID, include the mayor of New York, the Speaker of the House, Nancy Pelosi, Attorney General Merrick Garland, and all the 69 or so others. If you are going to work in indoor offices or to attend concerts or movies or indoor restaurants or weddings or whatever, is being vaccinated enough to protect yourself and others, or should a negative test also be required in certain settings once again, or indoor mask requirements be restored even in places that require vaccination? Philadelphia did just restore its indoor public space mask mandate yesterday, in response to the new Omicron variant.

On Friday's show after the mayor was on, we got a phone call from Fanny in Brooklyn arguing to remove masks from two to four-year-olds in preschool and daycare. Part of her argument was this.

Fanny: I've seen many, many pictures of the mayor posted by Carnegie Hall on Instagram or other celebrities where he's like just there unmasked with tons of adults. The idea that somehow the toddlers are the only ones that have to remain masked doesn't add up.

Brian Lehrer: Adams has been seen a lot in public gatherings with no mask. Is that okay? Besides the Gridiron Club Dinner being an apparent super spreader event, maybe you heard about a weekend event at South Brunswick High School two weeks ago, after which 150 high school students got COVID. That school reinstated for last week the mask mandate that Governor Phil Murphy had previously lifted for all New Jersey schools. Those are public policy questions. Then there are the individual choices that once again we have to recalculate depending upon our individual risk profiles and risk tolerance.

If most public gatherings are not becoming super spreader events, but some are, how do we decide what to go to or not or what precautions to take? Dr. Leana Wen has thoughts on this and her latest Washington Post column. One that's getting more pushback than most of what she's written during the pandemic from other public health people. It's called the Gridiron Club outbreak shows what living with COVID-19 looks like. Dr. Leana Wen, besides being a Washington Post columnist, is the George Washington University professor of health policy, former Health Commissioner of Baltimore, an emergency room physician, and author of the book Lifelines: A Doctor's Journey in the Fight for Public Health.

Dr. Wen, we always appreciate it. Welcome back to WNYC.

Dr. Wen: Thank you, Brian. Great to join you.

Brian Lehrer: I have to alert you and all our listeners that it looks like the NYPD is going to have a news conference pretty soon about the shooting in the subway station in Sunset Park. We will take that when it occurs. We can't tell right now if that's 2 minutes away, or 20 minutes away, but just a heads up that we may have to interrupt on short notice. Before we get to your column in response to it, some facts, we don't know if all those 72 people all got COVID at the Gridiron dinner. Mayor Adams, for example, does many things in person and in groups every day, but would you label it a super spreader event from what you know?

Dr. Wen: I think at this point, we have to reset what we really care about at this point in the pandemic. Specifically, what I mean is we need to accept that infections are going to occur. That because we're not going to eradicate COVID in the foreseeable future, it is with us just like colds and the flu are going to be with us. If you're going to be interacting in any way indoors unmasked with other people, you will have a chance of contracting the Coronavirus.

We keep on talking about the Gridiron dinner, but I think there's another story here which is that first of all, the individuals thus far, have not gotten severely ill, no one that we're aware of in the 70 something people who may or may not have contracted COVID, connected to the Gridiron dinner. No one is hospitalized. No one is severely ill. That really shows the success of the vaccines and boosters. The other part is, there are events like this happening all over the country. This is the event that we know of. Unless we're prepared to end all events in perpetuity, we need to accept that these infections are going to happen, and therefore these events should still occur.

Event organizers who want to can implement additional safety precautions, for example, requiring proof of vaccination, requiring same-day negative testing, that will reduce the risk of at these events. I think that individuals beyond that can take additional precautions should they wish. For example, you can still choose to wear a high-quality mask at such events, although eating and drinking becomes problematic, you could decide that you're not going to eat and drink at these events. You could also decide not to attend, or if you attend, before you go see a vulnerable relative who lives in a nursing home, or who is immunocompromised, you could take a negative test.

I think at this point in the pandemic, most people including Mayor Adams are recognizing that we have to be up and about, we have to do this for work, we have to do this for our own mental health, and socialization. As a result, we need to accept the likelihood that all of us are going to be infected with COVID in the near future if we have not already had it.

Brian Lehrer: You're getting some serious pushback, Dr. Wen, on this column. As you know of course from some of your colleagues in public health and public health media, who I think it's fair to say you were previously more aligned with during most of the pandemic, and based on the argument that you just gave. For example, Jeremy Faust from Inside Medicine wrote, "We can't leave it to individual choices because people don't know enough about their individual risk." He compares the Gridiron dinner vaccination required, but no testing required to the State of the Union address, which also required a negative PCR test.

In addition to vaccination, four members of Congress tested positive during the screening that afternoon or that morning, so they stayed home, and nobody got COVID at the State of the Union address of the 600 or so people who were there, in contrast to the Gridiron Club event. The argument is that event organizers or the law should require testing in addition to proof of vaccines at at least events of a certain size. Do you disagree?

Dr. Wen: There's no question that the more precautions we put in, the lower likelihood of virus transmission. I absolutely agree that if you have an event that has great ventilation, great spacing, requiring vaccinations, requiring same-day negative testing, that's going to be a lot safer than an event that does not have these precautions. At the same time, we also have to look around us and see that people are going back to indoor dining and indoor gyms and bars and nightclubs are packed once again, people are resuming life. I actually think that the question to ask isn't so much, how do you calculate the risk of a single event that you're going to becoming super spreader or you're contracting COVID at that event?

I think that is going to be very difficult to assess that risk. How do you factor in the number of people attending from other parts of the country who also may have high rates of COVID in those areas? There are lots of factors here. I think the better question to ask is, how much do you want to continue avoiding COVID-19? I don't mean to suggest that COVID is harmless. Certainly, COVID has many potential impacts, including long COVID, which we still don't fully understand. There's the chance of severe illness, although the person who has vaccinated and boosted, chances of severe illness are extremely low.

I think the question to ask though is, what is the price you're willing to pay to avoid getting COVID. Understanding that about 50% of Americans are estimated to have contracted Omicron during this last surge. We're dealing with an even more contagious variant BA.2 now, it's going to be very, very difficult to avoid. Do you want to keep your kids out of school and out of extracurriculars? Do you want to wear a mask in perpetuity? Maybe the answer is yes, in some of these cases, but I think that right now what we're seeing is quite a steep divide within the public health community.

Whereas in 2020, before we had vaccines, I think all of us were saying, "We need to take a lot of precautions because we really want to avoid getting COVID-19." I think there are a lot of us now in public health and medicine who are saying, "Not that we want to get COVID, but rather that we need to see COVID more like we do the flu. It's not something we want to get, but we're also not going to take such extraordinary precautions that we're not going to be living our lives."

Brian Lehrer: Even today when deaths have been declining in the country since the peak of Omicron in the winter, when there were 2,000 or so deaths a day, it's still about 500 people nationally dying per day from COVID right now. Extrapolate that out over the course of a year, and with some surges that will take place, that's going to be a few 100,000 deaths every year from COVID as long as it continues at this pace. Is that acceptable?

Dr. Wen: I think this is a question that is not so much a scientific question, but rather a question for us as a society, because everything has a cost. If we want to get that number below 600 deaths, let's pick a number, let's say it's 100 deaths or 50 deaths, there's going to be a heavy toll on society. How much do we want to impose additional restrictions, including continuing lockdowns in order to get to that point? It's a very difficult question and not one that I have the answer to, but I think we do need to think very seriously about the trade-offs for every intervention.

I'm not in favor of mask mandates returning at this point. I think that mask mandate should return if two things happen, one is if it looks like our hospitals are getting strained, again, which they're not at the moment, and two, if we have a new variant that evades existing vaccines. Other than that, mask mandates are a blunt instrument. I think every time these mandates are implemented by the government, we have the potential to undermine trust in public health because everything is a trade-off in public health between government responsibility and individual choice and individual rights.

Every time the government comes in and says, "You have to do this," in a way we're using political capital, and at this point when, sure, cases are increasing, but hopefully we have enough prior immunity from vaccination and prior infection that we have decoupled hospitalization from infection. We really need to leave it to individual choice, I believe, for the time being. People should be encouraged to mask if they wish and especially if they're vulnerable, but let's also remember that we have many more tools that we did in 2020 and 2021, and we cannot keep on living in this state, in this perpetual state of emergency, because that will really undermine trust in public health.

Brian Lehrer: Listeners, we can take some phone calls, assuming that the NYPD press conference doesn't start, for Dr. Leana Wen, 212-433-WNYC, on what to do about Omicron now at the level of public policy or your personal choices. 212-433-9692. I presume from what you just said, that you oppose Philadelphia reimposing as of yesterday an indoor public space mask mandate.

Dr. Wen: Look, I think that local jurisdictions should be able to do what's best for them, and I also have worked in the past with the Philadelphia health commissioner and I'm certain that they have the best intentions in mind. I just really worry about what this is going to do for trust in public health. Right now if you look at the CDC's website, they rate Philadelphia county as having a low risk of community COVID-19 levels. They are saying that masks are not required. I think people could rightfully be confused and say, "Well, why is it that the CDC says this is low risk, no mask required, but the city is now requiring masks."

At some point, there may be a need, a real need for masks, and let's say that a new variant arises that completely evades prior immunity to infection and vaccination and we really want people to put on masks. Well, I don't want to be in a situation of the boy crying wolf and people saying, "Well, last time you said masks were acquired and it wasn't. Why should we trust you now?" I fear that that could happen if we implement masks all the time without clear justification.

Brian Lehrer: Before we take some calls, assuming we have time. As you say, there's a divide in the public health community, and in a way, it's the first time that there's such a stark divide, I think, and an emotional divide in the public health community over what to do next. It used to be all of you who would come on the show who are in public health positions or in academia or whatever versus vax mandate, vaccine disinformation spreaders, and people like that, but now we have this intense divide. Another criticism of you for the things you've been laying out here today that's surprisingly emotional.

Gregg Gonsalves from the Yale School of Public Health tweeted, "This is just repulsive stuff from Leana Wen. She's now pro-super-spreader events, anathema to all public health represents, and yet these events can go on, masks would have made them safer." Besides reacting to him, which of course you can, how would you describe the intensity and the extent of the split among public health professionals right now?

Dr. Wen: I think that Twitter does not represent reality. I think most public health people who work on the ground in the field probably are closer to where I am because they live in the world of the pragmatic. We're seeing that the majority of Americans have returned to everyday life. It doesn't really make sense to tell them that it's fine. They're going about their daily lives and going to restaurants and bars and gyms, you can't really tell them, "Well, then when you go to indoor events, like a wedding, you should be keeping on your mask indoors at this wedding reception." That doesn't make sense and people are not going to literally do that.

When public health is so divorced from reality, people stop believing you. I think that that's the other part that's really important. Those of us who are practicing physicians and see our patients, we also understand that our patients live in the real world and we have to give them advice that matches where they are. If we keep on telling them things that just don't jive with their every day, they're not going to listen to us. I think there's a role for people who are actively advocating for additional resources, which I completely agree with. We need to do a lot more to protect the immunocompromised.

We need to make sure that we have Evusheld, the preventive antibody, that we have the treatments available like Paxlovid so that the immunocompromised and those who are vulnerable are able to live their lives too. I think at some point we also have to accept that good health is not just the absence of COVID-19. There are studies coming out, for example, that show even in 2020, the number of people dying from alcohol-related diseases, for people under the age of 65, that actually exceeded the number of people dying from COVID. The number of overdose deaths has been climbing, cancer screenings, routine cancer screenings, especially colonoscopies have fallen off the charts.

Routine childhood immunizations have fallen off the charts. We need to also pay attention to issues that are not just COVID because I don't think that avoiding COVID infection is the be-all and end-all of good health. I think that there has been an intense backlash to maybe what people are perceiving to be the individuals at the beginning of the pandemic who didn't believe in Coronavirus and now people are equating masks and vaccines in the opposite way. I think one group sees them as being about control. The other group sees them as about respect, and I think that kind of backlash is also not necessarily helpful for individuals who are just trying to live their lives.

Brian Lehrer: Brandon in Ridgewood Queens, you're on WNYC with Dr. Leana Wen. Hi, Brandon.

Brandon: Oh, hello, Brian. Thank you very much for having me. I just think the sad thing about all of this is that we aren't even asking about the super spreader event. What are the infection rates of the working people that actually serve these elites at this Gridiron dinner? How are they doing? What's going to happen to them if they're out of their job for two weeks, three weeks, and they have no job to go back to because they've been fired? Or they don't get sick leave, they don't get comps? That's completely missing from this equation is everything is-- all this is responsibility being just thrusted onto people that are living paycheck to paycheck, I still don't see their concerns being addressed.

Brian Lehrer: What policy would you land on out of that concern for the workers?

Brandon: First of all, we need to get single-payer healthcare in this country. We absolutely need to make testing free and affordable, or just completely government-mandated. We need to actually allow people to stay home and rest, and we need to talk about a UGI or some sort of benefit to people so that they can actually afford food.

Brian Lehrer: Universal guaranteed income.

Brandon: Yes.

Brian Lehrer: Brandon, thank you very much. I'm going to leave it there for now. Well, when we talk about the workers, this is a particular New York City controversy right now, Dr. Wen. I don't know how much you're paying attention to this as a local issue, but I think New York is the only place in the country anymore that has a vaccination requirement for all in-person private-sector workers. This is broken out as a news story because of the exemption that Mayor Adams recently gave to performers and athletes. It's also the only one in the country of its kind, the vaccine mandate for all in-person workers.

The reason that he says they maintain that in the private sector as well as the public sector is to protect the workers. We've talked on this show about how the no smoking in restaurants policy, which is 20 years old now in New York City, that wasn't to protect the patrons who could choose to go there or not. That was to protect the workers in the restaurants who had no choice if they wanted to stay employed in that field. I wonder how you feel if you have an opinion about this particular requirement in New York City.

Dr. Wen: In general I support the concept of doing whatever it takes to increase vaccination. I think vaccines and boosters are our way out of the pandemic in a way that imposes the least amount of restriction on everyday life. I would say to Brandon's point that it is really important that we protect workers. I've been long a proponent of paid sick leave, of universal healthcare, of not pricing people out of the ability to get health insurance and to get healthcare. I totally agree with all of that. I think there's one missing piece of the equation though, which is that individuals are able to mask if they so choose. One-way masking with an N95 or equivalent, so a K95 or KF94 mask, is extremely effective.

I hope we don't lose sight of that, that workers who wish to can continue to wear a high-quality mask. If you're working around the Gridiron dinner or something else, where there are a lot of people who are unmasked around you, you should still be wearing a mask if protecting from infection is important to you. That's different from smoking. People are smoking around you. You can't really wear a mask to block out the smoke, but it actually is different in the case of COVID-19. I don't want to take away this idea of autonomy, of people deciding for themselves how much protection they want.

I think we've actually seen this pretty dramatic shift back to your earlier point, Brian, about where we are. The Biden administration is clearly aligned with where I and I think the vast majority of the country is, in terms of saying what we really care about is not so much infection but severe illness. We need people to move on with their lives. Now that we have tools available, the government's job is to provide the tools, empower people to use the tools ideally free of charge, but the government can no longer band-aid that these tools be used.

Brian Lehrer: You made a great point early in the conversation, which I was also going to raise as something that no matter how we feel about the mandate issues that you and other public health people are on different sides of, another point that has been underreported, and I'm glad you brought it up, is that there are no reports of deaths or even hospitalizations among these 70 plus people who got COVID at the Gridiron Club dinner. Probably because there was a vaccine requirement to get into that and there were a lot of older people there. Nancy Pelosi is, what, 80 years old? She got COVID, she got over COVID and she's back at work as of yesterday in person. That's a really important advertisement for vaccination, right?

Dr. Wen: Yes, and I fear that those individuals who are still living in 2020 reality are actually undermining trust in vaccines, because we are not in 2020. Some people have compared for example the Gridiron Club dinner to the Rose Garden ceremony, where that was a super spreader event during the Trump administration. While that event took place in September of 2020 before we even had any data that vaccines were coming and they were going to be effective, you cannot compare what's happening now in March or April of 2022 to September of 2020. If you do that, then you're not taking to account that vaccines are safe, effective, life-saving, and have totally transformed how we think about COVID.

Look, I have two little children up until I would say December of 2021, I was exceptionally careful to avoid COVID on their behalf, but several things happened in December of 2021. One is that Omicron occurred. It was so contagious that I knew that it was very hard for us to continue to avoid getting COVID. The other thing was there was no vaccine on the horizon for my little kids, and I didn't want them to keep on postponing their lives in order to wait for this vaccine that, as you know, still has not come for the under five-year-olds. For us, we are now thinking about COVID as we do the flu.

Understanding they're not the same of course, but that we don't want to get the flu, but we're also not taking such extraordinary measures to avoid the flu or COVID that we are preventing my four-year-old from going to camp or not allowing him to do extracurriculars indoors or other things. I think a lot of people have moved onto that stage in their thinking and I think that's okay. As long as we continue to promote vaccinations and boosters and are working on additional protections and funding for people who are still very vulnerable like the immunocompromised.

Brian Lehrer: Myra in Manhattan you're on WNYC with Dr. Leana Wen. Hi, Myra.

Myra: Hi, that's what I wanted to ask about the immunocompromised. Dr. Wen is very cheery about all this, we just have to live our lives, but there are people for whom getting COVID is a big risk. I understand there are, I don't know if this figure is accurate, about 7 million immunocompromised people. There are also many, many elderly people. While some people are lucky, like Nancy Pelosi and many others, and get sick and don't get hospitalized, don't die, obviously some people are dying. The possibility of long COVID is something that still very little is known about and nobody knows who may get that.

I'm 80 and I don't think I have much time left. I don't want to use up that time being sick with long COVID. I question whether we should be so cavalier about the real risks that still exist. We don't want to ruffle feathers.

Brian Lehrer: Myra, thank you very much. We are getting a fair amount of pushback on Twitter too to things you've been saying, Dr. Wen, and one that's related to Myra's call says, "Dr. Wen is whatabouting COVID and not even speaking about long COVID." Deal with long COVID and the immunocompromised and how policy needs to take them into account.

Dr. Wen: Let's take them separately because I do think that these are separate issues. One with the immunocompromised and people who are still vulnerable, they're my patients, they're my friends. I mean, they're people I care a lot about. What I would say for them is there are a lot more tools for them as well. Evusheld, the preventive antibody I mentioned earlier reduces their risk of being severely ill by 90%. Paxlovid, if taken after contracting COVID, reduces their risk of hospitalization death by another 90%. We need to make these types of tools readily available.

Also, I would highly recommend if you are severely immunocompromised if you're a cancer patient on chemotherapy, for example, or a transplant patient, you should ask people who are coming to visit you to test before getting together. That allows you to still have indoor gatherings and to remain engaged in social life. Testing is an important tool that helps people to gather safely. That's one aspect. The second aspect of long COVID, I think about this differently. I fully acknowledge that long COVID is very real and that a lot more research needs to be done about it. We don't really have a working definition even of long COVID to know how prevalent it is.

There are many unanswered questions for viral illnesses that result in long-term consequences. EBV, Epstein-Barr virus, for example, we also have Lyme disease. We have many other diseases that cause long-term consequences that we don't fully understand. My way of thinking about this is not so much what's the risk of long COVID because we need to answer that as a research question, but rather what's the endpoint here. Yes, we know that long COVID is real, but how much are you willing to put your life on hold for the foreseeable future, given that we're not going to have answers about long COVID for a really long time?

I've been asking this question to people who are still very cautious around COVID, basically asking them, "What are you waiting for?" Some of them have said, "We need ventilation to be improved in different buildings. We need for global vaccination rates to be higher. We need for long COVID to be solved for there to be treatments and cures." I agree with all of these as goals, but they could take years for us to see through if ever. Are we going to put our lives on hold until then? I think many people might say yes, but many people might say no. I think this is where we need to have tolerance for people's individual decision-making because people are going to have very different priorities going forward.

Brian Lehrer: There are people agreeing with you on Twitter. There are people disagreeing with you on Twitter. Listener writes, "I've been very supportive--" Now I lost it. They're going by so quickly. All right, I'll have to go back to that one. Let me raise another issue then. The mayor, Mayor Adams who got diagnosed on his 100th day in office on Sunday released a statement that raises an issue and a tool that you mentioned briefly, but that we haven't really dived into, and that is, who should get the antiviral drugs upon testing positive? Here's Mayor Adams yesterday.

Mayor Adams: We have an unbelievable service where all New Yorkers are able, who qualify, able to get necessary medication that assists them during this period of time, the antivirals. I was eligible because of my preexisting conditions, prediabetic as well as a history of having high blood pressure and other medical issues that allowed me to be eligible for them. I want to thank the doctors, pharmacies, and everyone that's involved.

Brian Lehrer: Mayor Adams there yesterday on the antiviral medication that he was prescribed. Dr. Wen, Eric Adams is 61 years old. He says he was previously prediabetic. I've heard him say diabetic in the past without the pre, but that veganism cured him. He said he has a history of having high blood pressure. Is he in the group you would prescribe day one antivirals to?

Dr. Wen: Yes. He is in that category even by age alone. I want to also state that there are three different types of treatments for early COVID if the treatment is started within a few days or up to five days of symptom onset. You've got the antiviral pills, Paxlovid from Pfizer, Molnupiravir from Merck. Then you also have Remdesivir, the IV treatment as well as monoclonal antibodies. All three are treatments that can be used and are most appropriate for individuals who are at high risk for progression to severe COVID. Depending on the availability of these treatments, individuals who are not necessarily in these high-risk categories may also be eligible for them just depending on how much supply there is.

To me, that's the main issue. We need to be able to have enough supply that anybody who needs them or wants these treatments are able to access them. Again, this is all part of turning COVID from something that is a devastating illness that could kill you, which is what it has been for the first couple of years of the pandemic, into something that we can live with. Again, I think many people, if they know that there's a backstop, that even if they get COVID, it's going to be fine because they're able to take these medications that further reduce their chance of progression to severe illness.

I think that will allow many more people, including those who are immunocompromised and elderly with chronic medical conditions, to be able to move on with their lives.

Brian Lehrer: Are the antivirals being underused in your opinion. I've read that many doctors don't really even know about them or how to get them to patients.

Dr. Wen: I think that it depends on the part of the country. I do think that the Biden administration in setting up a one-stop shop website-- that was extremely helpful including for physicians and providers because now we can figure out-- we can look at this website ourselves that's accessible to anyone. We can help to advise our patients as to which pharmacy near them carries these antivirals. I think that that's the kind of access barrier that we need to help break down. Of course, there are other barriers. There are patients who may not know about them. There are patients who may have transportation barriers. There are patients who are uninsured.

There are many types of barriers, but the more we can help to streamline that care, the better it's going to be and the more equitable that distribution is going to be too.

Brian Lehrer: We're going to leave it there for now with Dr. Leana Wen, former health commissioner of Baltimore, Washington Post columnist, CNN medical contributor, author of the book Lifelines: A Doctor's Journey in Public Health. What am I leaving out? George Washington University health policy professor. Last thing. How do you feel about being so controversial in a different way right now? I mentioned our Twitter is exploding and it's exploding both with people who are supporting you and people who are like, "What? Dr. Wen has jumped the shark," and those kinds of things. You've taken your own way. You're thinking your own thoughts.

How does it feel to have gone from being the [unintelligible 00:34:19] of Fox News to getting a lot of criticism from the public health community?

Dr. Wen: I think that it is very difficult for those who are pragmatic and who take moderate stances, which is actually where the majority of the country is. It's much easier to be somebody who chooses to take a polarizing position. I don't mean that people on Twitter necessarily do, but rather that those voices on any given issue tend to be the loudest. For me, I just want to do my job of advising my patients and my patients don't live in the Twitter world. They live in the real world and that's what I focus on every day.

Brian Lehrer: Dr. Wen, we always appreciate it. Thank you very much.

Dr. Wen: Thank you, Brian.

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