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Brian Lehrer: It’s The Brian Lehrer Show on WNYC. Good morning, everyone. The COVID pandemic continues to have many moving parts and not moving a straight line. Here are eight things to know today, and there could be many more. The Centers for Disease Control is ready to relax masking recommendations for when you’re outdoors, but not always when you’re outdoors.

COVID hospitalizations are down in New York City, but so is the number of people getting first doses of the vaccine. The national trend is more hospitalizations among young adults. The Johnson & Johnson vaccine is back in use but what to do about that tiny but real risk of blood clots.

India is currently experiencing the highest number of new cases of any country at any time during the pandemic, and it’s really suffering the oxygen shortages that the US was afraid it might experience last April. India today is a massive COVID tragedy, is the US doing enough to help? Deaths are down in the US from the surge in the winter, but it’s still 700 people a day in the last week, that would be 20,000 more COVID deaths every month in this country at the current pace.

The Wall Street Journal reports that flying now is relatively safe, but not always. A New Delhi to Hong Kong flight has been linked to more than 50 new cases, the journal reports. What are the lessons for other flights? More than 40% of Americans have gotten at least one vaccine dose, but hesitancy among a variety of groups could prevent true herd immunity. Experts say some vaccinated people in the United States are resuming normal life too quickly, and some not quickly enough. How do we find that Goldilocks sweet spot of getting back into the world for ourselves?

I could go on with more COVID news stories but those are some trends and stories in the news. We’ll talk about some of them now with Dr. Celine Gounder, Professor of Medicine and Infectious Diseases at the NYU School of Medicine, Bellevue Hospital doctor, medical analyst for CNN, and the host and producer of the podcasts American Diagnosis and Epidemic. Dr. Gounder was also a member of President Biden’s COVID Task Force during the transition after the election. Dr. Gounder, thanks for coming on again. Welcome back to WNYC.

Dr. Celine Gounder: It’s great to be here, Brian.

Brian Lehrer: Let’s begin on the breaking news. Multiple news organizations reporting new guidelines are likely to come today on wearing masks outdoors, and generally what vaccinated people can safely do. As patched in as you are and a member of the Biden COVID Task Force during the transition, do you have a good idea what’s coming?

Dr. Celine Gounder: My sense is you’re going to hear about this two out of three rule where you can think about it as, are you indoors or outdoors is one, are you wearing a mask or not is two, and your distance from other people that six feet rule is number three. If you’re outdoors, you need to hit two out of three. Outdoors is already one and so either you should be wearing a mask if you’re close to people, or if you can maintain that six feet apart, you don’t need to wear a mask.

Brian Lehrer: One thing that I’ve heard reported is that mask wearing and I guess one of the criteria you just listed his version of this, mask wearing will still be recommended for crowded outdoor settings. Can you describe the mechanism of how the virus blowing in the same breeze, if you’re with two people or 200 people is more likely to get you in a crowd?

Dr. Celine Gounder: Yes, sure. When you’re outdoors, whatever virus you are exhaling when you breathe, or when you cough, gets diluted in the open air, and so if you’re closer to one another, there’s a lot less air for that virus to be diluted in. Once you get a few feet apart, that virus particle really does get deleted out, so your risk is much, much lower.

Brian Lehrer: Why is this just coming now? Didn’t we know a year ago, or at very least after the big racial justice rallies last summer did not produce spikes that outdoor transmission is very unlikely?

Dr. Celine Gounder: Yes, there’s a lot of discussion about this last summer, because you had political rallies and you had the Black Lives Matter protests. A major difference between the two was the rallies people were packed in together, standing together, close together without mask, even though they were outdoors we did see transmission occur. With people walking spread apart in the streets and not standing in place, many of them also wearing masks, we did not see transmissions.

We already had anecdotal evidence that you could be outdoors in some situations with a mask and reduce your risk and that other situations were riskier. Remember this was also under a different administration and the CDC was really under attack from numerous sides at that point in time and it was very difficult for them to step back and credibly review the science and change the recommendations.

Brian Lehrer: Related of a vaccinated people, I’ve seen several articles now, maybe you’ve seen them about the range of comfort or discomfort vaccinated people are feeling about interacting again. David Leonhardt in The New York Times had one such article headlined Irrational COVID Fears that even quoted the Brown University dean of Public Health and renowned COVID experts after Ashish Jha saying, it was psychologically hard for him to feel safe when he finally met a friend for a drink two months after being vaccinated.

I’m curious where you might see the line between irrational COVID fears and personally reopening too quickly and carelessly for people who are vaccinated.

Dr. Celine Gounder: To be quite frank, Brian, David Leonhardt is somewhat problematic. He’s one of the many armchair epidemiologists whose expertise is in politics and economics, and this is one of many problematic articles he’s had. That said, I understand what Ashish Jha saying, I think once you’ve been in the bunker for so long, it does feel strange to see people socially again, and I think that is something that we need to psychologically adapt to.

In terms of the risks, there’s a massive misunderstanding of the protection you get from vaccination. Vaccination works best at a population level, not at the individual level, and it’s a percent risk reduction. It is not perfect, and if there is a ton of virus out in the community, a lot of community transmission, even a 95% reduction in risk for yourself, there’s still a very real risk. The only way that you really stamp down that risk is if everybody has that 95% reduction, and we’re nowhere near that because not everybody has been vaccinated yet.

Brian Lehrer: Let’s turn to some of these vaccination and new hospitalization numbers. Gothamist reported on New York City data, for example, showing new hospitalizations have plummeted during April, but so has the number of people getting first doses of the vaccine from about 48,000 people a day earlier this month getting first doses to around 22,000 people a day now, if I’m reading their graph correctly. Since you New York-based, I wonder what you see is the meaning of the trends in the city right now, and what lessons they might hold for the rest of the country?

Dr. Celine Gounder: Yes. We’ve seen surveys being conducted serially over time, whether it’s the group Surgo Ventures up in Boston or the Kaiser Family Foundation or others who have looked at what are people’s intentions to get vaccinated over time. We have seen that you have a group of people who are very excited, anxious, enthusiastic to get vaccinated.

You have a group of people who are like, “We’ll, wait and see, maybe I’ll get vaccinated in three months or in a year.” Then you have people who say, “I absolutely will not get vaccinated.” What’s happened is we’ve almost completely gotten to all of the people who really, really want to get vaccinated.

Slowly, you’re seeing some of those people who are sitting on the fence who’ve been like, “I’ll wait and see.” They’ve seen others get vaccinated, they’re becoming a bit more comfortable, but you definitely have a group of people about 20% of Americans who remain very intransigent in their views, and very reluctant to get vaccinated.

We have anticipated we were going to hit this point sometime in late April or May when we were going to see a big leveling off in demand. New York City is really no different from the rest of the country in that respect.

Brian Lehrer: What are the implications?

Dr. Celine Gounder: I think we’re really going to have to work very hard on two fronts, one is access, one is trust, really. Access, a lot of work has been done on that front, we now have mass vaccination sites that are open on a walk-in basis, which really makes it much easier for people who maybe have hourly wage jobs where it’s not so easy to predict when they can get away and they don’t want to lose those hourly wages to take time off work to get vaccinated.

I think you’re going to see a lot more hyper-local approaches. Folks going out, for example, to housing complexes, especially places where you have a lot of homebound or older people, to community centers, really to meet people where they’re at.

The other piece of this is, in addition to access, making it as easy as possible for people to get vaccinated is trust. The people who are most reluctant to get vaccinated are people who either don’t trust the health system, and frankly have very good reason not to trust, and people who don’t trust government. Those are slightly different groups, but that’s really going to require work. You can’t say this to somebody, “Trust me.” You have to show that you’re trustworthy and that’s a very long-term process.

Brian Lehrer: How do they do that in the relatively short-term period that we really want people to get vaccinated in to have the vaccines win the race against the variants, as they say, so the new variants don’t get a foothold and start the surges going again?

Dr. Celine Gounder: I speak now also partly from some of my experience working in other epidemics and pandemics, whether that was Ebola or HIV in other countries as well. You really have to turn over control of funding and power to the affected communities. You can’t just be top-down and tell people, “Go get vaccinated.” You really have to provide that local control, let them decide how they want to organize the programs, have the funding go through local organizations. Because frankly, there’s nothing like creating jobs in a community to convince people that is something that they should be supporting.

Brian Lehrer: This minute, we can take your COVID questions for Dr. Celine Gounder on any of the things we’ve been talking about so far, the CDC reportedly relaxing masking recommendations for when you’re outdoors today, but not always. When you’re outdoors, these competing trends of COVID hospitalizations down in New York City and a lot of other places for the moment, but so is the number of people getting first doses of the vaccine.

The horrible India situation. We’re going to do a separate segment on that later in the week, but we can talk about that today. Dr. Gounder is looking at that and I will touch on some aspects of that with her at least to some degree in this segment and anything else you want ask, 646-435-7280, 646-435-7280 or tweet a question @brianlehrer.

Dr. Gounder, the reported increase in hospitalizations among younger adults nationwide. We hear about Michigan as a hotspot for that, for example. Is that young adult increase in hospitalizations, as you understand it, simply compared to older adults who are more likely to be vaccinated now or is COVID itself, the severity of the virus taking a more serious turn in younger people who get it now compared to earlier in the pandemic?

Dr. Celine Gounder: We are definitely seeing more severe disease among younger people. We are seeing more severe COVID where younger people are needing to be hospitalized, and as hard of an outcome as it gets younger people dying at higher rates from COVID right now in places like Michigan. We think it is, in fact, related to the B.1.1.7 UK variant that has become widespread in the United States. Michigan was one of the first to be really hit by that.

We’ve seen a surge really across the upper Midwest, Minnesota, Illinois have seen some of this as well. Even here in New York City where I practice at Bellevue, we certainly have seen younger people, people in their 30s, 40s, 50s, who are being hospitalized with COVID more frequently than we might’ve in the past.

Brian Lehrer: More than 40% of the US population has gotten at least one dose, but we need more than that to really beat the pandemic before new variants can develop and grow strong. For all we’ve spoken in the last few months about the difficulty in making vaccine appointments, are we now flipping that script to where supply is actually beginning to exceed demand?

Dr. Celine Gounder: Yes. We definitely have hit that point where supply is exceeding demand. We knew that this time was going to come, but that said, you do have some variability geographically, some urban areas not so much New York, but other urban areas may have pockets where they have a mismatch where they do have more demand than supply. I think part of the challenge now is how do you better allocate the vaccine to places where people really want it and need it?

Brian Lehrer: On the variation from place to place before we start taking some phone calls, I’m looking at the numbers of deaths in various states compared to two weeks ago on The New York Times COVID tracker today, New York deaths are down 22%. Texas deaths where they fully reopened down 30%, but Florida also reopening faster than the Northeast has an increase in deaths over the last two weeks. These numbers don’t seem to correlate well on first blush with the pace of reopening either way. How much can you relate outcomes to reopenings based on what you know?

Dr. Celine Gounder: There’s a lot we still don’t really understand about the seasonality of the virus and the temperatures, the humidity. We saw a surge in the southern states last summer and is that because maybe they were more protected in the spring when people were outdoors, but then in the brutal heat of the summer, they were indoors in air-conditioned spaces, and so you saw an increase in the transmission. We don’t know the answer to that.

Trying to predict or trying to explain these correlations across states between reopening and vaccination rates is really quite difficult. Because there are really so many different factors that play, some of which we just don’t understand.

Brian Lehrer: Let’s take a phone call. Here’s one on the new CDC about to be released today, outdoor masking guidelines. Tom in Brooklyn, you’re on WNYC with Dr. Celine, hi.

Tom: Hey, how are you, doctor? Thank you for taking my call, Brian, big fan. With the new CDC guidelines being relaxed for outdoor mask usage, what is your comment on wearing a mask walking down the sidewalk because I think there’s a lot of implications with that on a societal level?

People looking at you weird if you’re just walking your dog outside, somebody walks out with a mask, they shake their head at you, then that’s how you have to start your day getting scoffed at. We need some clarity on this because it doesn’t make sense to walk down the sidewalk with a mask on and then go and do indoor dining without one on.

Dr. Celine Gounder: [laughs] It’s a great question. Again, it’s really about the distance and the crowding. If you are on a crowded sidewalk, walking your dog, or you’re at the dog park, and there’s a lot of people there and you’re not able to maintain that six feet apart, you absolutely should continue to wear a mask. If you’re able to maintain that distance, then you do not need to wear a mask.

I think what you’re addressing is less about the public health guidance and more about the social stigma or judgment. I think that’s a situation where having a mask in hand or around your neck where it’s clear that you’re prepared to put it on if somebody comes closer to you, I think that’s the way to bridge that.

Brian Lehrer: I think he’s asking about the interaction between the public health guidance and the social stigma. I take it from the tone of his question that he thinks the public health guidance has now determined that if you’re outside walking your dog and one or two people pass you on the sidewalk, you really don’t need to be wearing a mask in public health terms, but not everybody is comfortable with that yet. Where are you on that?

Dr. Celine Gounder: I think it takes time for people to get comfortable with any kind of social change. It took people time to get comfortable with wearing a mask in the first place. I do think there’s going to be an adjustment period. I think an important piece of this is the CDC coming out with the updated guidelines explaining the science why and communicating that broadly so that people feel comfortable with the shift.

Brian Lehrer: Maybe you just did. He wants you to say, “No, it’s okay, Tom, in Brooklyn for you to be walking your dog without a mask if there isn’t a crowd of people who you’re going to be exposing yourself to.”

Dr. Celine Gounder: I think that’s what I’ve said a couple of times is again, it’s that two out of three rule, if you’re outdoors, you only need one of the other two, which is either wear a mask or the six feet. If you’re six feet apart and you’re outdoors, it is okay not to be wearing a mask.

Brian Lehrer: Suzanne on Staten Island, you’re on WNYC with Dr. Celine Gounder. Hi, Suzanne.

Suzanne: Oh, hello. Thank you very much for taking my call. I’m a big fan of yours. I’m calling because I have a friend who will not get the vaccine and she says she will not get it because before the pandemic, she lost her mother to lymphoma and she feels vaccines put you at very high risk for getting lymphoma, especially if it runs in the family. What can I say to her about this?

Dr. Celine Gounder: That’s a tough one. I think very often, decisions about whether to get vaccinated are as much about science and the facts as they are about emotion. I think what I would do is really spend time just talking to her about her mom and what she went through with her mom and how that affects her. I think eventually that can open the door, potentially to have conversations about vaccination, but when people have had a traumatic experience like that, you really need to address the emotional side first and build a relationship there first.

Brian Lehrer: Suzanne, I hope that’s helpful. We’ll continue with Dr. Celine Gounder, and more of your calls right after this.

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Brian Lehrer: Brian Lehrer on WNYC. As we’re talking about various news stories and trends and public health recommendations that keep changing with the evidence with respect to COVID with Dr. Celine Gounder, Professor of Medicine and Infectious Diseases at the NYU School of Medicine, a Bellevue Hospital doctor, medical analyst for CNN and the host and producer of the podcast American Diagnosis and Epidemic. Dr. Gounder was a member of President Biden’s COVID Task Force during the transition after the election.

Barbara in Carmel, New York, you’re on WNYC with Dr. Gounder. Hi, Barbara. Barbara are you there? Do I have your name right? Barbara in Carmel. Barbara ones, Barbara twice.

Barbara: Hi. Are you there?

Brian Lehrer: Yes, we’re there.

Barbara: Hello.

Brian Lehrer: Hi there. Go ahead.

Barbara: I’m sorry, I’m calling from the car, honestly. [laughs] I just had a question. I just had my second shot. I wasn’t prepared for how sick I got. I was really, very, very high fevers, body aches, it’s just something I wasn’t prepared for. I was definitely gung ho in getting the shot and suffer from emphysema, so I waited a long time. Unfortunately, I thought I would be able to get a shot much earlier, but it didn’t work out that way because I can’t find the site.

Is there any way that you can tell people that maybe they can prepare their bodies? Is there something I should have done differently besides drinking a lot of water? Did I somehow miss something of the possibility of protecting my body from any kind of bad reaction? Because it was worth it. In the long run, I know in my heart that I did the right thing, and it was worth the small price to pay for being sick with those two days.

Brian Lehrer: Yes, and reactions are all over the map, Dr. Gounder, right? So many people have mild reactions, some people have reactions like Barbara’s.

Dr. Celine Gounder: Yes. I think that’s a great question, Barbara. Some, maybe 15%, 20% of people have the experience that you have, especially after the second dose where they have those fevers, chills, body aches, fatigue, maybe a headache.

The advice that we have been giving is really to prepare yourself in the sense that you give yourself a day off ideally after your second shot, in particular, that you give yourself the space to recover, to let your immune system do its work of seeing the vaccine, responding to the vaccine, that’s really what’s happening. There’s really nothing we can recommend before you get the shot to manage those symptoms.

After you get the shot if the aches and pains and fevers are really more than you feel comfortable with, what we are advising is Tylenol is a good option. We would not recommend something like Advil or ibuprofen, but Tylenol is okay in that situation, but I wouldn’t take that until after your second shot and only if you’re having some of those symptoms.

To give you some perspective, when we, in the hospital started vaccinating folks, we staggered people’s vaccinations in a work unit so that all the nurses on the same unit wouldn’t be vaccinated on the same day, wouldn’t be calling out sick the next day, because we knew that this was a realistic possibility. I think the best thing to prepare is really more about schedule and giving yourself that space to weather those side effects.

Brian Lehrer: The Johnson & Johnson vaccine is back in use in this country as you know, but we know about the very rare instances of those dangerous blood clots. It’s only one person for every half-million who get the shot according to CDC, but that’s enough to have a big psychological impact. It seems to be solely or almost solely among women under 60, so the risk percentage for those women would be higher than one in half a million. For you as a doctor, how would you counsel your patients about whether to get a Johnson & Johnson shot now?

Dr. Celine Gounder: I would really base that decision on the schedule. If you are somebody who thinks you can come back for that second dose, or if you’re somebody who would rather be one and done. The risk we’re talking about here, even if you’re a woman under 50, which is where the vast majority of these blood clots occurred is in that group, your risk is seven per million or 0.0007%. Your risk of being struck by lightning is much higher than getting one of these blood clots, even if you’re a woman under the age of 50.

That said, if you compare that with the risk of getting COVID, and the risk of getting a blood clot from COVID, you have a one in five or 20% chance of getting a blood clot if you end up in the hospital with COVID. There’s no question, hands down, you should get vaccinated. I think it’s really a question of timing, scheduling, as to how to decide amongst them, but I would not let this deter you from getting a vaccine.

Brian Lehrer: Regina in Jersey City, you’re on WNYC with Dr. Gounder. Hi, Regina.

Regina: Good morning. Thank you. Dr. Gounder, my question was whether or not you have any advice for people whose immune systems are already at war. I’m talking about a serious autoimmune diagnosis like with MS, or lupus, or sarcoidosis. I’m asking because when I take over-the-counter aids that target or strengthen the immune system, they render me disabled. I’m really afraid to provoke my immune system when it’s at war now unprovoked.

Dr. Celine Gounder: People who have either autoimmune diseases or immunosuppressive diseases, we actually still very much do recommend vaccination, that’s a group that is at higher risk of complications from COVID. The main concern we have is that the vaccines may not work as well, that the strength of your immune response, the longevity of the immune response to the vaccines may not be as good. That’s really what we worry about, not the side effects, so to speak of the vaccine itself.

Brian Lehrer: Regina, I hope that’s helpful. Dr. Gounder, adjacent to the horrible situation in India, which we’ll do a dedicated segment on separately on the show. You tweeted, “Vaccine manufacturers have insisted on sweeping liability protections that make it difficult for poorer countries unable to guarantee those production protections access, these companies want to protect their profits over human lives.” You tweeted, can you explain that situation more fully?

Dr. Celine Gounder: To give you an example, Pfizer has asked governments to put up their national assets, including their bank reserves, their embassy buildings, military bases as collateral against potential lawsuits against Pfizer for any issues with the vaccine. They’re really holding these governments in very poor countries hostage in a way that’s unconscionable in this moment. The way that that has been addressed to some degree is, for example, when the US, quote, loaned a vaccine to Canada and Mexico is us taking on some of that liability.

Really when you consider that the United States taxpayers paid for much of the research that is actually in the vaccines, so technology that is in the Pfizer, Moderna, Johnson & Johnson vaccines, this was technology developed at the NIH that allows for stabilization of the spike protein. We have a patent on that. I think that is something that the US government can be leveraging to get companies like Pfizer and Moderna to be a bit more humane in what they’re requesting of these very poor countries.

Brian Lehrer: Are these vaccine companies making a lot of money? I should say pharmaceutical companies making a lot of money on the vaccines. We tend to be so skeptical of the pharmaceutical companies and their motivations in normal times, and now we’re like, “Oh, wow, the Pfizer. I got the Moderna.” Are they price gouging in general? Are they making profits at all? I saw one story that said, one of the companies maybe it was AstraZeneca is pledging to be profit neutral on this. What can you tell us?

Dr. Celine Gounder: Yes, it varies from company to company. If you look at Pfizer and Moderna, for example, they are certainly making money. Much of the risk has been mitigated by the US government. This is a lot of what Operation Warp Speed did was to reduce the risk for companies like Moderna to develop the vaccine, and now they are making a profit.

Part of the reason certain markets are being less well addressed by the pharmaceutical companies is because they realize there’s less of a market to be made or profit to be made there. Could they be scaling up production to meet the needs, for example, of the African continent? Sure, but is there a profit motive to gear up manufacturing to meet that need? No.

Brian Lehrer: Where should that money come from?

Dr. Celine Gounder: This is a classic market failure. This is really the role of government where you have a market failure, there is public interest in addressing it to still making that manufacturing in this case happen. Many of us are calling for the Biden administration, the EU, and others to essentially license some of the technology to have that be used by contract manufacturing organizations, which could be public or private sector to be manufacturing at scale for the world. Unfortunately, there’s just not the profit incentive to share that technology, the manufacturing know-how with others who could be helping to scale up production.

Brian Lehrer: Pfizer and Moderna seem to both be predicting third doses will be needed somewhere between six months to a year after the first two. Should we be skeptical of that because they’ll make more money vaccinating everybody again, or do you agree with that as a scientific likelihood?

Dr. Celine Gounder: Yes, I think it’s a little bit hard to tease apart right, what is being said for shareholders and what is true from a public health perspective. I think there is concern that with the rise of some of these variants, in particular, the South Africa variant, the India variant, for example, that our immune responses to the vaccine will not be protective, be strong enough to overcome some of these newer variants. I do think we will need to have a booster or a second-generation vaccine.

I also think it’s really important to understand though that Coronavirus or SARS-CoV-2 does not mutate like the flu, it mutates much more slowly. What you’ll probably see is the highest rate of mutation in the first couple years after SARS-CoV-2 became a human infection, and that that will plateau. It’s very unlikely that this will become something we need to vaccinate for on a yearly basis, but we may need a couple boosters in the short-term.

Brian Lehrer: The opposite of the caller, Barbara before who got so sick after her second shot. George in Kaneland, you’re on WNYC. Hi, George. George, are you there? Is it George? George, once? George, twice? I’m going to ask George’s question as he told it to the screener, which is that he had no reaction to the second shot. He has the opposite concern of the call of Barbara from Carmel. Georgia asks, “Does that mean it’s not working as well?”

Dr. Celine Gounder: Yes, another great question, and one that I get all the time. This has been looked at where people who did not have side effects, did they have an immune response? Yes, the good news is that they did. I wouldn’t let that worry you, but I think it is important to understand that when you are having those side effects, it’s not because you have been given COVID, it’s because your immune system is recognizing the virus, and it is mounting an immune response.

We’re all a little bit different in terms of how our immune systems react, and whether we notice it, just like when people get COVID, some people have really severe disease. Some people have milder symptoms. That’s really what we’re seeing here.

Brian Lehrer: You said before, did I hear you right? Don’t take Advil or any other ibuprofen to ease the symptoms if you’re having a bad reaction to the vaccine. Tylenol is okay, but even with that, take it after the shot. Is that what you said?

Dr. Celine Gounder: Yes, that’s right. With ibuprofen, what we call NSAIDs, non-steroidal anti-inflammatories those can weaken your immune response, and so we really don’t recommend Advil, Aleve, ibuprofen, anything in that class. Tylenol, acetaminophen is the generic name, does seem to be okay, but I wouldn’t use it preventatively, I would only take it if you have side effects after your dose.

Brian Lehrer: Fran in Redbank, you’re on WNYC with Dr. Gounder. Hi, Fran.

Fran: Hi, long-time listener, first-time caller. Dr. Gounder, I had a question. A friend of mine had COVID in January. He’s feeling very confident in his antibodies, and I’ve been vaccinated. I was just wondering what the difference is. Is there a different level of immunity that you get from having had the disease versus having had the vaccine?

Dr. Celine Gounder: Yes, there is. Your level of immunity after infection is highly variable from person to person. Some people do have a strong long-lasting immune response, but many people don’t. We have no way of predicting really reliably, who after infection is going to be immune and who isn’t. The other wrench in all of this is that they would have been exposed probably to an earlier strain of the virus, not one of the variants.

Particularly in the face of emerging variants, the B.1.1.7. UK variant is now the dominant variant in the United States, you really want to get the vaccines, which provide much higher levels of neutralizing antibody, which is one of the parts of the immune system that protects against infection. It’s much more reliable in providing that level of immunity and it’s much more reliable in having long-lasting immunity. We really are recommending that even if you’ve had COVID, that you still get vaccinated.

Brian Lehrer: I hope that’s helpful, Fran. We’ve got just two minutes left. I’m just curious to get your take on the safety of public transportation at this point. I mentioned in the introduction, the case of the airline flight from New Delhi to Hong Kong, it’s now been linked to more than 50 cases, but that seems to be an outlier.

From the way I read that Wall Street Journal article, they may not have screened very well before boarding compared to many other flights. What do you think about the safety of flying right now? Pertinent to New York City, what do you think about the safety of getting on the subways when we keep hearing even as things loosen up a little bit, it can be risky to be in crowded spaces? We know as people return to the subways, those cars are crowded, you’re close to people, you can’t stay six feet apart, even with a mask.

Dr. Celine Gounder: Yes. To tick those one at a time, so planes, in the case of that particular outbreak, people were tested 72 hours, up to 72 hours prior to flying, and we know that that’s a pretty long window. Ideally, you would want to have had a test result within 24 to 48 hours. Probably you have people who were infected, who just didn’t know it, who flew on that flight.

The challenge of being on a plane, especially a long flight is you may want to take off your mask to drink or to eat. It’s very difficult to protect against transmission when you’re doing that. Some people may not wear a mask at all on the plains, depending on how well those guidelines are being enforced.

I think some of this depends on whether you have been vaccinated, the particular guidelines on the airline that you’re flying. Are they still leaving middle seats open? Because if you do fill middle seats, you’re going to have more people on the flight. With every additional person, the risk of one of them having COVID is going to go up. It’s not entirely safe still, but certainly safer if you’ve been vaccinated.

With respect to public transportation, they are closed subway cars, but remember, they’re also opening their doors every couple of minutes, and so you are getting reasonable ventilation in the subway cars. At least my experience of riding the subway and I have been is that people are really good about wearing their mask and trying to stay apart as much as they can.

I think the subways really are pretty safe. We’re not on them long enough that we need to eat or drink a meal, and so by wearing a mask and trying to stay apart from other people, I think you really are minimizing your risk.

Brian Lehrer: Let me follow up on one thing if I may, because we’re getting a bunch of tweets from people asking after what you said about ibuprofen. Listener writes, “I took ibuprofen after a second shot. Am I not vaxed?” Someone else, “If you took Advil or Motrin, not knowing it was not recommended right after you got your vaccine shot, does that mean it will not be effective?” What do you say to those people?

Dr. Celine Gounder: It’s hard to predict. There is a risk that your immune response may not be as strong as it may have been. I think the good news is if you got both shots, you’re still in pretty good stead.

Brian Lehrer: Can a person find out their individual level of immunity because of that or any other reason?

Dr. Celine Gounder: We don’t routinely do that kind of testing. There are tests available to see if you have antibodies after vaccination, but it’s not something that we would routinely recommend.

Brian Lehrer: What another guest said is that they don’t know what level of antibodies are actually protective. Even if you can come out with a number, it doesn’t answer the question. Do you agree with that?

Dr. Celine Gounder: Yes, there’s some truth to that and the medical jargon for that is the correlates of immunity. We’re still trying to figure out what that number is. It’s a bit of a shifting target also because of the emerging variants where the neutralizing antibody level that may have been high enough for an older strain may not be adequate for a newer strain like the South African variants.

It is a bit of a moving target, but I think the most important message here is get vaccinated, get both of your shots because you really do get much more robust, long lived immunity from that second shot of Pfizer and Moderna, if that’s what you’re getting. If getting two shots is more than you have time for, or just don’t want to deal with needles twice then I would definitely opt for the Johnson & Johnson vaccine. It is safe and highly effective.

Brian Lehrer: Dr. Celine Gounder, professor of Medicine and Infectious Diseases at the NYU School of Medicine, a Bellevue hospital doctor, medical analyst for CNN and host and producer of the podcast, American Diagnosis and Epidemic. Dr. Gounder, you covered so many topics with us. Thank you very, very much.

Dr. Celine Gounder: Oh, my pleasure. 

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