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Brian Lehrer: Brian Lehrer on WNYC. With kids age 5 to 11 now eligible for pediatric Pfizer vaccines and with booster shots for oldsters with a new federal mandate for vaccines or testing for large companies as we still deal with the fallout of current vaccine mandates both in the 9,000 New York city workers on unpaid leave and maybe in some of the election results this week, let's spend some time looking at some of the words we use to explain what vaccines do and put them in the context of these developments. I'm joined by science writer, Katherine Wu, a staff writer at The Atlantic where she's been covering the pandemic as she puts it acting as a "jargon liaison between scientists and the rest of us". Maybe you saw her recent piece all about this titled Nine Pandemic Words That Almost No One Gets Right. Welcome back to WNYC, Katherine Wu, hi.

Katherine Wu: Thank you for having me back. Always a pleasure.

Brian Lehrer: Let's jump right in with one of these nine, fully vaccinated. What does that mean now that some people are eligible for booster shots?

Katherine Wu: Oh gosh, this is a tough one to start with, but I love it. Honestly, I think it depends a little bit who you ask. If you're asking the CDC, which most people still are, they have not changed their definition. This is still what it was back in the spring, which is two weeks after the final dose in what's called your primary series. For Moderna and Pfizer, that's still those two shots. For J&J, it's the one and done.

Brian Lehrer: How about breakthrough infection, that's changed even at the CDC, right?

Katherine Wu: Yes. Well, I guess the definition has not really changed, but certainly, the way they're tracking it is, and this is a really tricky one. I think a lot of people have taken breakthrough infection or breakthrough case or just the word breakthrough straight up to become synonymous with vaccine failure. "Oh, someone has a breakthrough case of COVID. Someone has a breakthrough infection. That sounds horrible. That means the vaccine might have failed them," but there's interesting subtlety here. If we think about how the CDC is defining a breakthrough, they're counting pretty much anyone who gotten a positive test for this virus after they have been fully vaccinated. That could mean so many things.

It could mean a totally asymptomatic infection. You just picked up a hunk of virus that your immune system actually was on the way to totally clearing out and keeping you from getting sick, or it could be something full-blown. These very, very rare cases where people are ending up in the hospital. Certainly, we are more concerned about some of those than others. There's a huge range here, but keeping in mind that these vaccines were originally meant to stop symptomatic disease and especially the worst cases of disease, it seems like a weird yardstick to use. If I have an asymptomatic breakthrough, am I that worried about it?

Brian Lehrer: Maybe not, but some of the confusion stems from the fact that the mRNA vaccines, the Pfizer and the Moderna, did seem to prevent the infection at least at first. Then it turned out that not as well as they thought at first or they tend to wane over time, and then the conversation changed to the way you just put it. Well, what we really expected out of the vaccines is that they're going to keep us out the hospital and out of the morgue, which they do.

Katherine Wu: Yes. That's absolutely right. I think it's a really important point to make. I don't want to guess like people and say like, "Oh, you know, we were never setting expectations about infection." No, I think public health officials were definitely talking about prevention of infection, prevention of transition in the spring. Things really were looking good then, and the data did seem to be pointing generally in that direction. It's part of the reason vaccinated people were told, "Hey, you can really start taking off your mask in most settings including indoors," but the situation changed, time went on.

I think we have to keep in mind that a vaccine's effectiveness and certain parts of immune protection, not necessarily all, but some parts of immune protection are going to erode a little bit over time. That's partly due to the virus mutating to be a little bit less recognizable, and also just time itself erodes things away. Things experience some wear and tear, but what's essential to keep in mind here is it seems like vaccine effectiveness against severe disease and death really seems to be holding steady at an extraordinary rate, and I'm hoping that that continues to be the case for some time yet.

Brian Lehrer: Right. That's still the main message vaccine effectiveness against severe disease and death holds its effectiveness over time and certainly with the boosters. What about to prevent transmission, that the vaccines don't entirely prevent transmission if you have an infection is one of the arguments against the vaccine mandates?

Katherine Wu: I think this is a tricky thing to be talking about right now. The bottom line is still going to be that vaccinated people are still less likely to be yet infected and less likely to transmit this virus. That is still absolutely true. I think we have to get away from binary thinking. When we hear that some vaccinated people are getting infected or that some vaccinated people are even on occasion transmitting the virus, I don't want people to think, "Oh, that means they can transmit as easily or they can get infected as easily." There's absolutely a middle ground here.

Keeping in mind that this data is pretty tough to track, not everyone is getting tested every single day. Sometimes infections are tough to catch. It does seem to still be the case that vaccinated people are a lot less likely to even contract this virus in the first place. Their immune protections are still really holding their ground to a pretty strong degree. Current estimates are anything from two times less likely, five times less likely, maybe even more, depending on how people are looking, but that makes it really important.

To balance the two sides of this point here, one is that we can have some degree of confidence that as more and more people get vaccinated that lower likelihood of getting infected and transmitting really does mean that more vaccination means that this virus is going to spread less and that's going to push us toward ending this pandemic and making all of this more manageable. It also means that vaccines by themselves are not going to be our silver bullet here. Adding masks in are going to help, adding tests when people need them is really going to help, ventilation, all of these other measures that we know also really cut down on the risk of spread.

Brian Lehrer: Listeners, we can take a few phone calls for Katherine Wu from The Atlantic about immunity and terms you're hearing or using that you aren't sure about with respect to the pandemic. We've gone over a few of them from the nine on her list in her latest Atlantic article. We've talked about fully vaccinated and breakthrough infection. You have a question about a term you don't quite get or know how to use correctly, 212-433-WNYC, 212-433-9692. Okay, fun fact, or head exploding, there are no COVID tests because COVID is not actually what they measure.

Katherine Wu: [laughs] I will use any excuse to be annoyingly pedantic here. COVID is the disease. It's this thing that we use to describe this collection of symptoms, the things people experience once they're infected by the virus, which is called SARS-CoV-2. Not every infection is going to turn into a disease, and tests can pick up asymptomatic infections. When you take a Coronavirus test, you're looking for the virus, not the disease. Some people can test positive on one of these tests and not have symptoms. Definitely can't just be picking up COVID.

A lot of people definitely still use that term, and generally, people know what we mean, but I think it really can't help to be more precise because when you say, "Oh, I tested positive for COVID," a lot of people are going to assume, "Oh God, you have symptoms. Are you okay?" Sometimes that's not totally the case.

Brian Lehrer: About the tests, the anti-mandate argument includes that testing is actually a more foolproof way or at least just as good for preventing the spread of the disease because vaccines don't prevent infection or transmission as much as first thought as we discussed earlier. You take a test. If you do it within the window that the test actually measures, you know if you're positive or negative. Do they have a point?

Katherine Wu: I think this is a little tricky. Let's keep in mind that the current mandate, which is really a vaccine or testing mandate, not quite just a vaccine mandate because it does have this testing option. The minimum required to meet the mandate is weekly testing, which is not all that frequent. Considering the tests we have available, some of them take three or four days to come back, some of them if you only test once, you might totally miss the window where you're infectious. How much is that really going to do?

Tests absolutely can be powerful. I think we have to keep in mind that tests are inherently reactive. Tests aren't going to do anything for you until after someone is infected and they catch that infection, and then someone has to use that result and behave and say, "Okay, I'm going to stay at home, isolate myself, and make sure I'm not infecting anyone else while I'm contagious." That depends on a lot. Vaccination is something that everyone can do proactively before they're even exposed to the virus and reduce the chance that they get infected and spread it. I am not here to knock tests. They're super useful, but honestly, the ideal is having both in place at once.

Brian Lehrer: Jay in Queens, you’re on WNYC. Hi, Jay.

Jay: Hi. I'd like to ask the difference between natural immunity that the body generates if you've had COVID compared with the immunity you get from the vaccine? Do they both get weaker over time? Is one better than the other?

Katherine Wu: Jay, this is a really great question. A lot of people have been asking this recently. I think the first thing to keep in mind is that it's actually a really difficult question to answer. We know that there is an enormous range of immune outcomes that can happen after someone is infected by this virus. There are exceptions to this trend, but generally, you're left with stronger and more durable protection the sicker you are, to an extent. You can also get so sick that it wipes your immune responses to a certain extent, but that means there's this enormous range.

Some people will be pretty well-protected after they've been infected. Some may not be at all. I think that is one point hugely in the vaccine's favor. Pretty much every vaccine dose within a brand is going to be the same. People are getting the same regimen around the same time. Even if people are different, this is one constant thing. We're seeing that across the board in people who are healthy and don't have compromised immune systems. People are mounting really strong, durable responses to these vaccines.

I think one thing that I've been thinking about lately is maybe moving away from this term natural immunity, because what happens after infection? What happens after a vaccine? Both are natural. Both are playing on our body's ability to really protect us from pathogens. That's what vaccines do. They safely mimic pathogens so that we can get protection without getting sick. What question I might ping back to you is, why are we asking about the difference? There are at least two reasons to do this. One is scientific curiosity. If we see really strong production after a certain type of infection, can we mimic that better with a vaccine, but do it safer so that we're not putting people at risk?

There's another reason maybe, and some people might be arguing, "Oh, is it better to get infected?" I think that is never going to be the case, because getting infected risks disease, death, long COVID, severe disability, missing time from work and spending time with your family. That's a huge downside that a vaccine is just not going to be saddled with. It really does seem like people who are vaccinated, even after getting infected, they lower their risk of reinfection by many folds. There've been several studies that have come out of the CDC and recently showing that people are less likely to get infected with the virus after they've been vaccinated rather than infected. I think part of that is because of the enormous range of outcomes that happens after you're infected.

Brian Lehrer: That's another term that you tackle in the piece, right?

Katherine Wu: Absolutely.

Brian Lehrer: Hybrid immunity. Getting a vaccine dose after having been infected. Hybrid immunity, which as you say, does seem to be much stronger than either individually. How much better is it?

Katherine Wu: It's a little hard to quantify. I'll point to a recent publication out of the CDC, it's called Reduced Risk of Reinfection with SARS-CoV-2 After COVID-19 Vaccination. These people were infected, then they got vaccinated. They've lowered their risk of reinfection by 2.34 times. That's just one study, but that's pretty compelling to me.

Brian Lehrer: The CDC also just weighed in on what the data shows about post-infection immunity for so-called natural immunity, but we can say post-infection immunity. There's some level of protection for at least six months following recovery, they say. In your opinion, should vaccine requirements take that into account? This is one of the things, that we've been hearing a lot from the unions, delay the requirement for a period of time after a documented case for those individuals.

Katherine Wu: Yes, this is interesting, and I know there are other countries that have been counting infections as interchangeable with one or two doses of vaccine. I really do think the safer course of action is to get vaccinated as soon as possible, not wait. Get that protection as soon as you can. If you're still feeling sick, certainly wait, but there is no reason to not build on that protection, ensure that you are really safe against this virus.

It's an enormous gamble to bank that you are protected for six months or however many months after you're infected again, because you're gambling on two fronts. One, that the virus isn't going to make you really sick, possibly even kill you, and that there is going to be protection left behind, which is no guarantee at all.

Brian Lehrer: A few more minutes with Katherine Wu, from The Atlantic who has a piece on nine pandemic words that everybody gets wrong or at least that a lot of people are confused about. Here's Hiam in Manhattan. Hi, Hiam you’re on WNYC. Thanks for calling in.

Hiam: Hi, I'm 68 years old, fully vaccinated, and I got a breakthrough infection. I recovered. Should I get a booster or no?

Katherine Wu: Oh, this is another great question. It sounds like you would qualify for a booster based on your age. I suppose I would still encourage you to get one, especially depending on what other risks might be in your life. Do you have unvaccinated family members like really young kids? Do you have health conditions that might put you at higher risk? Do you have a job or frequent exposures to the virus that might increase your risk?

It does seem like there is emerging data, and this is super preliminary so far, that breakthrough infections can, and again, the operative word here is can, act like accrued booster. It seems like that is still tickling the immune system to say, "Hey, this is a threat. Remember this. You saw a version of this a few months ago. Let's really keep this in mind and keep our defenses strong." Again, I think that would be a gamble in some cases, depending on how severe that infection was. We don't really have a good sense of how to check how effective that infection was. I would probably not count that as a booster at this point until we really know for certain what that means.

Brian Lehrer: Is booster another of the words that you scrutinized in the article in terms of people not really understanding what it means?

Katherine Wu: Oh, well, actually not in this article, but I spent a whole another article dissecting that term. It's an interesting one. I'm curious what you, Brian, think first when you hear the word booster. Here, think back to before the pandemic. What was your primary association with that word?

Brian Lehrer: Oh, there are so many. I don't know where you want me to go with this, but you could talk about it in terms of politics, "I'm a Joe Biden booster or a Donald Trump booster." I certainly would have thought about it in terms of vaccines. You get a tetanus booster every 10 years, things like that.

Katherine Wu: Yes. I think this points to the fact that the word booster plays so many roles in our language. You're absolutely right. Tetanus booster is a pretty common term. Most people know what that is, but we also use booster, exactly, in politics. We use it to describe morale. We use it to describe booster seats, booster rockets. In this arena, the non-vaccine arena, it's like, "Hey, let's push something higher. Let's promote something. Let's support something. Let's send something to above and beyond, where we could never go before."

I think in the world of vaccinology, that does work. The booster is increasing your protection, but what's interesting about what boosters are supposed to do as vaccines, the goal is to restore protection that has been lost. The whole point of a booster is maybe some type of immunity has waned. Let's put it back with a booster. Let's refill your water loss. Let's refill your gas tank. The word booster doesn't quite capture that for a lot of people. Maybe a better word is a reminder shot, a refill shot. I think it's cool that in other languages, like in French and Italian, they use words like richiamo or rappel, which actually mean reminder shot or recollection shot.

Brian Lehrer: Back to our discussion of fully vaccinated and immunity, what is your best understanding as a science writer of what the booster shot really boosts, or the reminder dose really reminds our immune systems of? Is it that the original shots are lasting way beyond six months to keep people out of the hospital or out of the morgue? This really protects people further against getting infected at all for more months, we don't know how many months down the road, or is it something other than that?

Katherine Wu: I think frustratingly, the answer is, once again, we are not quite sure. Remember, we talked a few minutes ago about how protection against severe disease and death is still looking quite strong. It's not clear that a boost for those types of protection is really needed quite yet. The exceptions here may, of course, be people who are much, much older and have weaker immune systems to begin with. For people who are immunocompromised, these third shots are not even being called boosters because they may not have really been protected in the first place by their first two doses. I wouldn't count that as a booster, for example.

Then, for the rest of us, especially for those of us who are younger and healthier, what are we boosting? It's a really great question. Certainly, if there is declining protection against infection or milder disease, that's interesting. We certainly don't want people to get any kind of sick. We want to keep people from transmitting the virus if we can, but it's not always possible to keep protection against those outcomes high indefinitely. I can't name a single vaccine that we know of that completely blocks all infection in perpetuity.

That's enormously hard to do. Imagine how hard your body would have to work all the time and imagine how hard your body would have to work all the time considering all the viruses and bacteria and parasites we encounter every single day. I think all of us would've exploded a long time ago if our bodies tried to do that every single day in perpetuity. It's unclear, maybe a booster will make some of these responses better and last longer. That's another thing a booster could do, or some of this could be temporary. We can't answer that until we get a few more months out and see what waning happens, if at all, after these boosts.

Brian Lehrer: Katherine Wu, staff writer for The Atlantic, where she's been covering the pandemic. As she puts it, acting as a "jargon liaison between scientists and the rest of us". Maybe you saw her recent piece all about this, which we've been talking about called Nine Pandemic Words That Almost No One Gets Right. Thanks for setting us straight, Katherine.

Katherine Wu: Thank you so much for having me.

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