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Brian Lehrer: It's the Brian Lehrer Show on WNYC. Good morning, everyone. As we begin year two of the COVID-19 pandemic, we are at a hopeful but complicated place. In the United States, nearly two-thirds of people over 65 have gotten at least one vaccine dose according to the New York Times COVID tracker. We're vaccinating people at three times the rate of Germany, Italy, and France, which are all in new lockdowns.

Israel is vaccinating people at three times the rate of the US. Research there reported in the Jerusalem Post finds the Pfizer vaccine, the one they use in Israel, is effective against the UK variant, but that the variant is still 45% more contagious than the original Wuhan one and continues to spread fast among the unvaccinated and researchers are unsure how the vaccines will do against future mutations. They pointed that out in that Israeli research.

Back here in the United States, for all the reporting on vaccine hesitancy among Black Americans, an NPR/PBS Marist Poll finds a larger percentage of white Americans say they do not plan to get vaccinated than Black Americans, 28% versus 25%. The single biggest group broken down by politics and gender is Republican men. 49% of Republican men said they do not plan to get vaccinated and around the same number, 47% of the men who voted for Donald Trump said they will not.

Now, Trump did just last night, make his most direct and public appeal to his supporters to get the shot. This is obviously a reaction to these recent polls, but there's the data on who's the most vaccine-hesitant from the NPR/PBS Marist Poll and a CBS News poll found similar trends. More than 1,200 Americans died from COVID-19 yesterday according to the New York Times COVID tracker. That's down by a third from two weeks ago, but would still be another 400,000 or so deaths over the next year at the current pace.

There are hotspots including New York City which has had fairly aggressive behavior rules, and Miami, which has none. The number of new cases per day and new deaths per day in New York City, about 63 deaths a day, is the same as it was two weeks ago despite the aggressive vaccine rollout expected to have reached three million shots administered by sometime today. That's just New York City, three million shots.

There is hope, but uncertainty here on the second St. Patrick's Day of the COVID-19 era. At least there was a small St. Patrick's Day parade up Fifth Avenue this morning, unlike last year when it was just canceled. Let's try to make sense of where we are at with my first guest today. Sorry. I had her name right here. She is Ravina Kullar, epidemiologist and infectious disease expert. She's a PharmD or a doctor of pharmacy, and an MPH, master of public health. Dr. Kullar, thanks so much for joining us. Welcome to WNYC.

Ravina Kullar: Thank you, Brian, for having me on. It's great to be on.

Brian: We could start lots of places. Let's start in Western Europe. Why are they experiencing a new wave of serious lockdown? We always say that the Europeans have been more serious about controlling the virus than Americans have.

Ravina: What we're seeing in Europe is that the vaccine rollout has been quite slow. It's very slow in comparison to the, US where here in the US, we are seeing a decline in cases, but in Europe, there's been a very slow rollout of the vaccines and secondly, these variants, which are circulating around, the B117 variant which, as you stated, is up to 70% more contagious and up to 65% more deadly. With a variant that is more contagious, that just inherently will cause more cases.

Brian: Some public health experts say US watch out. We have always been right behind Europe in the timeline of new waves and it's likely to happen again, the UK variant, the one you just cited, plus what they're calling the New York variant are going to cause a big surge here, and the US is opening up too quickly and still vaccinating too slowly to stop it. Do you have an opinion about that?

Ravina: I've said the same exact thing. I think Europe has been an example for what the US could expect. My fear is with businesses reopening and people loosening their guard and they're being currently 17, 18 states that have let go of their mask mandates that we are going to see another wave. There are other variants that are circulating here in the US the New York has a B.1.526 variant, which has an ability to outwit our immune system and prevent antibodies from neutralizing the virus. They aren't as effective against the Pfizer and Moderna vaccines. I have a huge concern that we could see another wave.

Brian: Say that again about the Pfizer and Moderna vaccines. Are you saying the New York variant isn't effective against the vaccines or the vaccines aren't effective against the New York variant?

Ravina: These vaccines actually have a decreased effectiveness against this variant. What it's been shown through publications is that this B.1.526 variant has the ability to actually outwit her immune system and prevent antibodies from actually neutralizing the virus. It's been shown that the vaccine just has a decreased effectiveness against this variant. It behaves very similarly to the South African variant and also the Brazilian variant as well.

Brian: Given what you just said, are you confident in the recommendation from the Centers for Disease Control that vaccinated people can hang out without masks or social distancing with other vaccinated people, or are they jumping the gun since we don't have that much data yet on the variants' interaction with the vaccines that you were just describing?

Ravina: I think the CDC has a very difficult role in terms of trying to advocate and get more people to get vaccinated as there are still a large group of the American people which are vaccine-hesitant, but then they also have to come out with data, with recommendations, which are backed up by science. These recommendations that vaccinated people can get together, not wear masks, not be so concerned about physically distancing, I feel that's too soon.

We don't have enough data on whether these vaccines prevent transmission and prevent the acquisition of asymptomatic COVID-19 infection. A reminder is that these clinical trials only looked at the prevention of symptomatic COVID-19 infection. They did not look at transmission and they did not look at the acquisition of asymptomatic COVID-19 infection.

Brian: At the same time, the CDC is saying fully vaccinated Americans can get together with other fully vaccinated Americans without mask or social distancing, but should still avoid large groups and clustered situations like air travel. Do you understand where that line is and why the CDC is telling?

Ravina: I think that the air travel situation, I feel like anytime you're traveling, you're going to have touchpoints where you can run into-- With community cases still high, there's still the probability for someone acquiring COVID-19 infection. I still think that the congregation, even though you're fully vaccinated, you still have to be mindful. It's too early to say that you can remove those masks and get together even if you're fully vaccinated.

Brian: Is that to protect even the fully vaccinated because of the variants or is that to protect the unvaccinated from the asymptomatic cases that the vaccinated people might have?

Ravina: Brian, it's both. With variants that are there, we still don't know how effective these vaccines are. Even though you're in a group where you're all fully vaccinated, once everyone disperses from that gathering, you could still be harboring the virus and then you could pass it on to someone else which has not been vaccinated. There's still a concern of having these even small gatherings and removing those masks.

Brian: There is research from Israel where they only used the Pfizer vaccine. That's the only one tested, but it's come out similar to Moderna and many other kinds of tests. From Israel where a lot of people have been vaccinated shows high effectiveness against the UK variant according to a Jerusalem Post article I read on the study, and that would be huge news if confirmable and would allay the kinds of fears you were just expressing and the kinds of uncertainties, have you looked into that or other findings that might give us clues now about the effectiveness of the vaccines against the UK variant, which is mostly what they have in Israel?

Ravina: Yes, I know I have. I think that's definitely some promising information, there's a light here from this darkness and this real-world study actually confirmed the high effectiveness of the Pfizer vaccine and it was shown to be effective against the B.1.1.7 variants. That's great, but there are other variants as well, such as the one which was in New York, there's one here in California.

It's very promising to know that this Pfizer vaccine is effective against the B.1.1.7 variant which has the highest prevalence thus far here, which is the most common variant, which is circulating here in the US. Israel has the highest, I would say, rate of vaccinating people even higher than us and we can see here that vaccines do work and that's also promising as well.

Brian: Listeners, your questions about vaccines and variants and comparative COVID rates in the US and Europe and Israel, New York versus Miami, white versus Black, vaccine hesitancy, or anything else? 646-435-7280 for Dr. Ravina Kullar. Dr. Ravina Kullar at 646-435-7280 or you can tweet a question @BrianLehrer. Can you help us explain New York City? The New York Times COVID tracker labels the COVID risk in New York City extremely high and some suburban counties like Nassau, Rockland, Monmouth, and Maurice counties even higher than the five boroughs and even as the city hits three million vaccine shots administered, can you help us understand that

Ravina: Yes, I think it has to do with this new variant, which is circulating around and this new variant has been shown to be more contagious, more deadly. Again, it has the ability to not be as effective-- The vaccines have the ability to not be so effective against this variant of concern.

Another item about New York is that New York, I would say, it's not like California, which is a little bit more, I would say, open in terms of its people not living on top of one another. That's a concern too in New York where people are closer in a smaller tight areas and you give the ability for this virus to also spread rather quickly. That's a concern. I see restaurants are opening indoors. I still think that's too early. I think we have to be very careful.

Brian: Miami also still high risk despite faster reopening in Florida. What about the New York versus Miami comparison and what it tells us if anything about the effectiveness of masks and business limitation rules? Because I think all our listeners know, Texas is opening fully. Some other states are opening fully, New York is being much more conservative, but we're doing as bad as anywhere.

Ravina: It tells you that masks they work. We know that for one thing, face masks, double masking, practicing physical distancing, washing your hands frequently, that works. This is what we need to continue doing in order for us to really get past this pandemic and get into a new sense of normal. Indoor restaurants, I still think it's too early. We have to do as much activities that we can outdoors, physically distance, keep that COVID-19 bubble that we're in and there will be a light here soon, but it's still too early to open up these businesses.

Brian: How do you account for the much of the country, let's say, including states that are opening much faster than some other states, not apparently doing worse than those states. Certainly, in the political sector, Republicans make the case that the lockdowns and the mask mandates are less effective than public health experts say when you look at the relative persistence of COVID from place to place with different rules.

Ravina: I think that's a good point. I don't have an answer for that quite honestly. I think every state is different. Every county is different. There does seem to be almost the rate of cases being similar in some of those areas where they have loosened their restriction sooner. I don't have an answer for that. I wish I did, but I think that we know that mask work and there just has to be a slow progress to opening up businesses.

Brian: Question from a listener via Twitter, "Are we tracking how many vaccinated people are now getting COVID?"

Ravina: I know that the CDC is currently evaluating that. Yes, that is being tracked by the CDC and they will be I'm sure reporting that information in the future.

Brian: What about as a follow-up question, vaccinated people getting serious COVID winding up in the hospital or dying. The numbers were said to be zero and the Pfizer, Moderna, and Johnson & Johnson trials. What about now that they're being rolled out in the real world? I haven't heard of a death or even a hospitalization. I would imagine if there was one, it would really make the headlines and everybody would be chattering about it. Have there been any?

Ravina: Not to my knowledge, but there may be. That's the thing with any vaccines. With any vaccine and as we can see with these vaccines as well is that these vaccines not only prevent symptomatic COVID-19 infection, also, if someone does get the infection and they're vaccinated, they're going to have a less of a severe form of that virus. That's very positive and promising to know that there have not been really any reported cases thus far where people that have been vaccinated have been severely sick which have led to death. I'm sure there are a few cases, but nothing that's made the headlines.

Brian: Listeners we're going to take a short break then we're going to continue with Dr. Kullar. Oh, actually we're not going to take a short break. We're just going to continue right now with Dr. Kullar. That was my error. Let's go to a phone call and it's Kai in Newark. You're on WNYC. Hi, Kai.

Kai: Hi, good morning, Brian. How are you?

Brian: Good. How are you?

Kai: I'm great. I'm a long-time listener and thank you for everything that you do. My main question for the doctor. I own three restaurants here in Newark we have declined to open for indoor dining at all three. Our city is greatly affected, of course, we have a huge population that is very hesitant to get the vaccine.

One of the things that I have a question about is the fact that you can still, one, contract the virus once you're vaccinated as well as still spreading the virus once you're vaccinated. Correct. When you say, "Hey, the vaccine is very effective." I'm just trying to be clear on what that actually means because for us, obviously, our entire community that is greatly affected as well as my livelihood, owning three restaurants here, it's just a serious cause of concern and that's my question.

Ravina: By effectiveness, I mean the clinical trials they looked at the prevention of symptomatic COVID-19 infection. Most of these individuals, which were included in the clinical trials, they were healthy individuals. For the Pfizer and the Moderna vaccine, there were shown to be 95% effective at preventing symptomatic COVID-19 infection.

We still don't know how these vaccines work in preventing transmission and then preventing the acquisition of asymptomatic COVID-19 infection and transmitting the virus in not only healthy individuals but other individuals too with comorbidities. Those individuals which are immunosuppressed and elderly, as we know for other vaccines, that those individuals, which are immunosuppressed that are elderly, that have comorbid conditions, they may not respond so well to vaccines and they may need additional booster doses.

I know that the CDC is collecting further information on these other populations and we need to see that data. Until we really get more data from these vaccines, that's what I mean by we don't know really how effective it is against transmission and prevention of really transmitting the virus and someone being a carrier and passing that virus onto other people.

Brian: There is, again, a positive indication along those lines from the studies in Israel looking at a USA Today headline for example, from a few days ago, right here, it says Pfizer Vaccine Appears Effective Against Asymptomatic COVID-19 cases, Data from Israel Suggests.

Ravina: Yes. That's very positive to know that there is a potential for not having the transmission for preventing asymptomatic COVID-19 infection. I think we need more data from other countries. That's just one country, one small subset, and theoretically with other vaccines that's what we have seen, but I think we need more data on that.

Brian: I see that you retweeted and Kai, thank you for your call. I hope that was helpful. Please call us again. I see you retreated that two new papers found large COVID clusters in fitness centers. Can you describe what you know about that? I'm curious if those two studies distinguish between fitness studios and gyms, which currently have different rules in New York, gyms are allowed to open fitness studios are not.

Ravina: In fitness studios, if you think about it, everyone is confined in a smaller indoor space and even if they're a mask mandates in those fitness studios, there is a high probability that that mask is going to fall off and slip off your nose. Being in a closed confined area that has a high potential to cause an outbreak situation. This is what the study showed. Is that there was an outbreak that was found in these fitness studios where unlike a gym, which may be a little bit more spread out and the potential for there to be those face masks potentially even more mandated. There is a higher likelihood for people to potentially acquire the virus in those studio settings, which are a little bit with more people there all in one space and that's what the study showed.

Brian: Anita in Brooklyn. You're on WNYC. Hi, Anita. Oh, I don't have her. Let me click again. Anita in Brooklyn now you're on WNYC. Hi.

Anita: Now I'm on. I appreciate you taking my call. I appreciate everything you do. I'm 73. I've had my Moderna vaccine, four weeks ago, three or four weeks ago. We were going to get together a bunch of six of us Friday night in a home everybody vaccined a while ago for dinner. Can we do that? The other wrinkle for me is that I'm in remission from lymphoma since January.

Ravina: The understanding is that all of you have been vaccinated, is that right?

Anita: Correct. Yes.

Ravina: These are all your family members, is that correct?

Anita: No, these are friends and we're all what I would call older. I just saw my seven grandchildren for the first time outside this weekend. I really don't want to chance it.

Brian: Dr. Kullar, the CDC says yes. Right?

Ravina: Yes. The CDC says yes. My concern is that you are under remission. That means that your immune system has been impacted. Again, we don't know how these vaccines work and or how effective, they are still effective, but exactly how effective they are in those individuals that their immune system is somewhat compromised. I don't want to prevent you from seeing your friends which have been vaccinated, but as I've always said, being outdoors is always safer.

If you can be outdoors, you can be somewhat socially distanced, maybe you can remove those masks, but if the probability for all of you acquiring COVID-19 infection is going to be lower than those that have not been vaccinated, but I would still be careful because you are under remission and your immune system has been compromised and just something to be mindful about.

Brian: This is one of the takeaways from this segment because we've been over this ground twice before and we didn't know when we booked you as an expert to come on the show who we haven't had yet and we see your background and track record. Terrific that you're on the show today. One of the headlines emerging from this conversation for me so far, and just let me make sure that I'm understanding it correctly, is the CDC says fully vaccinated people can get together. No social distancing, no masks. Dr. Khullar says, "I'm not so sure."

Ravina: That's correct. The CDC states that. I think they put out great recommendations, but I still think that I would be mindful about fully vaccinated people really all gathering together. My concern is that this will give a reason for people to all gather together and then we may see a surge in cases. My concern is with these variants. That's why I'm saying still be careful. We have variants here which are almost-- A new variant that comes out almost every other week. There has to be information that's put out as to how effective these vaccines are against these variants.

That's why I would be a little bit cautious about having mass gatherings, having some gatherings where you have variants which are here in the US, which is an unknown factor.

Brian: Bob in Manhattan. You're on WNYC. Hi, Bob.

Bob: Oh, hello. Can you hear me okay?

Brian: Yes.

Bob: My question is I was unblinded and I'm on the AstraZeneca double-blind study. I'm a veteran 66, very healthy. I didn't get the flu shot until a few years ago because I never got sick. I'm about to travel to Thailand to teach for a year and I was going to do this last year, but it COVID got in the way. I had malaria pills years ago that made me definitely sick. I was expecting to be sick from this AstraZeneca, but I had no arm soreness, no nothing.

I actually went into the VA to get the Pfizer vaccination because I thought I got the placebo, but they told me I actually got the AstraZeneca. I stayed with that and I got the second shot. Again, no side effects, but I'm wondering if this vaccination is as strong as the other drugs, should I have any concerns? Because I'm about to leave for Thailand at the end of the month. I'm at the Thai embassy as we speak to try to get everything put together for my travel. I'm not a worrier, but should I be concerned with this AstraZeneca issue?

Ravina: The AstraZeneca vaccine has been shown to on average be about 60% effective. If you think about it, the Pfizer and Moderna vaccines with both doses have been shown to be about 95% effective. 60% effective is still good at preventing COVID-19 infection, but with an efficacy of about 95%, that's going to be a little bit higher. The fact is that you got vaccinated. You got the vaccine and still be mindful obviously about those infection prevention measures. You got a vaccine, you are protected, you have a lower probability of acquiring the infection than those that have not been vaccinated. I would feel, just be cautious, but you haven't been vaccinated.

Brian: Bob, thank you for your call. I hope that clears that up. The AstraZeneca is another very interesting story this week. We haven't been dwelling on it just because it's not so relevant in the United States for the most part right now. They've stopped using it for the moment in parts of Europe where they were using it because a few cases of reported blood clots following vaccination with the AstraZeneca vaccine. I think the closer look that they're taking is revealing that there is not a relationship between the blood clots and the vaccinations. What can you say?

Ravina: That's correct. AstraZeneca has stated that they are aware of 15 events of deep vein thrombosis, DVT, and 22 events of pulmonary embolism, but that's in 17 million people who have had at least one shot. They've stated that this number is much lower than would be expected to naturally occur in a general population this size. This is also similar to what's been seen with other COVID-19 vaccines.

Just yesterday or the day before the head of the European medicines agency has stated that they're firmly convinced that the benefits of this vaccine outweigh those risks, especially in Europe where the vaccine rollout has been so slow, halting a vaccine such as this AstraZeneca vaccine would definitely impact the community.

Brian: We have a few minutes left with Ravina Kullar epidemiologist and global infectious diseases expert. Are you surprised by the surveys showing the most vaccine hesitancy in the United States is among Republican men, almost 50% of Republican men or about twice the rate of Black Americans in the NPR Marist poll who say they won't get the shot?

Ravina: I'm not surprised at all. I think that, unfortunately, politics has gotten into the way of science here. I think that those individuals which are vaccine-hesitant they have let politics take over and their beliefs about vaccines and being suspicious about some of the science that's come out for these vaccines. I think that we have got to separate politics from science in order for there to be some headway that's put into this pandemic. People have got to feel comfortable that they're scientists that worked extremely hard to get these vaccines approved, to get these clinical trials done in a very timely fashion, and not be afraid of getting vaccinated when it's your turn

Brian: Latino hesitancy is in between white and Black. Again, white being the highest and Latinx communities have been hit so hard by the virus. Do you think the public health outreach to the different communities and, of course, there are so many different white communities, so many different Latinx communities, so many different Black communities, but that the outreach to the different communities needs to be done differently?

Ravina: Yes, I think there has to be more of an outreach, more of a education that's put to these minority communities that these vaccines are safe and even for it being available to that population. I know that various counties they're putting their own measures in place to really focus on those populations. I think there has to be more done because we know that these minorities they're the ones which have worse outcomes with COVID-19 infection and they have got to be educated on the benefits of getting vaccinated and where they can get a vaccine.

Brian: What about the outreach to white people who are so vaccine-hesitant based on their politics. Trump himself came out last night, just last night with his most direct and most public statement that his supporters should get vaccinated. Do you think that in and itself is going to make a big difference?

Ravina: I think that will. It's very encouraging to see that President Trump has been encouraging people to get vaccinated. I think all efforts are needed. Those individuals that supported President Trump and some of his beliefs, if he can advocate for vaccines, I think those individuals that support him, they will listen and they will take direction from what he says if they do not believe what president Biden has to state.

Brian: Last thing, the New York Times has an article about Serbia today with a better vaccination rate than most of Western Europe, three times that of Western Europe, but they're using the Russian and the Chinese vaccines as well as the various Western ones. From what I understand, there's more uncertainty about whether the Russian and Chinese ones have actually been tested enough to know if they actually work. Do you have any opinion about that?

Ravina: Yes, I do. Those vaccines they have got to undergo more of a rigorous clinical trials. We don't know yet about the effectiveness of those vaccines. Even those, Serbia has been having a high percentage of the population has been vaccinated, I still don't think that we know how effective those vaccines are. It would be very encouraging to see if the Pfizer and Moderna vaccines were available there, but currently with the Sputnik vaccine and we don't know how effective those really are yet.

Brian: Ravina Kullar global infectious diseases expert PharmD or Dr. Pharmacy and MPH Master of Public Health. Thank you so much for joining us.

Ravina: Thank you.

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