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Brian: Brian Lehrer on WNYC. The new conversation about masks this week is about whether people need to wear them as much outdoors anymore depending on the setting and the individual. Slate and The Atlantic both have articles about this in the last few days. Opinions vary among public health professionals quoted in various media, but the argument goes something like this; people who are vaccinated and not in a crowd, and in a place where enough other people are presumed vaccinated can stop wearing them outdoors.

I read a reference to studies from China and Ireland in one of these articles that found that only one in 1,000 of COVID cases come from outdoor transmission, but that's not zero. There were 70,000 new cases in the US yesterday alone, according to The New York Times COVID tracker, with 44,000 people hospitalized. 10% more people hospitalized than two weeks ago. Locally, New York City recorded around 3,000 new cases yesterday and 26 COVID deaths. That's relatively good news in New York's case. Both of those numbers are 25% less than two weeks ago, but New York and New Jersey are still having more cases on average than most of the country.

Let's talk about outdoor transmission and outdoor mask-wearing and other COVID News with Dr. Wafaa El-Sadr, Professor of Medicine and Epidemiology at the Columbia University Mailman School of Public Health, director of Columbia World Projects an initiative focused on global public health challenges and head of the Public Health Committee for the Columbia University President's Advisory Task Force on COVID-19, involved in the COVID decision making for the university community itself. Dr. El-Sadr, we always appreciate you taking the time for us. Welcome back to WNYC.

Dr. Wafaa El-Sadr: Thank you and my pleasure.

Brian: Does one in 1,000 cases coming from outdoor transmission sound about right to you?

Dr. El-Sadr: Yes, I think that sounds about right. I think in terms of the decision, that critical decision about whether people who are vaccinated should not wear masks outdoors is really dependent on two things. Obviously, it's dependent on the first parameter, which is that they themselves are vaccinated, but it also is dependent on the number of people around them who are vaccinated and the situation with the COVID-19 pandemic in and of itself within the same community. There are three things we look at and most importantly, is the level of vaccination of people overall in a community, and what's happening in terms of the epidemic in that same community.

Brian: Is there evidence to say that certain circumstances of outdoor exposure are where those rare cases of outdoor transmission tend to occur?

Dr. El-Sadr: Well, clearly, I think, again, if a person is outdoors, and they're in a place where there's a clear movement, good movement of air, good ventilation of air, that's really important. The other is, of course, who are the people with that individual who's vaccinated outdoor, that's also very important. It's both where you are, as well as who you're with, that should be always taken into account.

Brian: On TV this morning, one of the shows was briefly discussing, in the context of this story, whether a person outdoors for a run needs to be wearing a mask anymore at all. Now, in my neighborhood, I'm seeing some runners with and some without recently, is there a right answer in terms of either the runner's safety or that of people they pass, and does vaccination status change that?

Dr. El-Sadr: I think all along probably the guidance is really based on-- It depends where you're doing the running and how crowded the setting is. I've seen some runners in some parts of the city where they're bumping into people and maneuvering between people as they're running. I think in those contexts, it is advisable to wear a mask. If on the other hand, somebody is running on a trail by themselves not encountering other people or not encountering people with any frequency, then it's possible for that individual to remove the mask in that context specifically.

Really is dependent on where you're at. That's what makes a difference. Keep in mind that we always have to remind everyone that while we we're very fortunate to have these amazing vaccines that are very highly effective, is that at the same time, they're not 100% protective. In addition of course, there's always the risk that there may be circulating variants that may also not be as susceptible to our vaccines and the antibodies that are produced by our vaccines. I think that's the reason to maintain caution even amongst people who are vaccinated.

Brian: That brings up another story that I wanted to ask you about. I see that both Pfizer and Moderna say they're developing vaccine boosters, and speculating people will need them after six months to a year following their initially fully vaccinated status. Do you know if that's because of new variants or because the immunity even to the current variants might just wear off?

Dr. El-Sadr: I think it's really a little bit premature to know that the answer exactly to your question. I think it probably is both. We don't know as of yet the durability, how long the antibodies that are produced by the current vaccines will last. We're still even trying to find out what's the level of antibodies that is protective. We have a lot of questions in terms of how high of an antibody response do you need to have to protect yourself, and also, how long do these protective antibodies last.

Then, the other is, of course, over time, there's been the evolution of new variants, both in the US as well as around the world, which means that we have to keep thinking about producing vaccines that are effective against these new variants. It's going to be interesting in the fall to get a sense amongst the people who have been vaccinated earliest, maybe the end of last year or the beginning of this year to look at their antibody response and see where they're at now, and then at the same time to offer a look at the vaccines themselves that we had available and whether we need to modify these vaccines, and use new vaccines for a whole new pattern of variants that have evolved since then.

Brian: Yes, do I understand that answer to mean that we can measure the level of antibodies in an individual who's been vaccinated, but we don't know what number however you measure those antibodies, what number is the threshold for actually being protected?

Dr. El-Sadr: Yes, exactly. We also just want to caution your audience that the antibody tests that are widely available may not be the right tests that detect the types of antibodies that are produced in response to the vaccine. I just want to caution people not to run out there and aim to get an antibody test and hope for an answer. I think we have to be cautious that sometimes they measure very different kinds of antibodies, but we still don't know the protective level of antibodies.

The immune system has two branches. There's the antibody response and then there's another response which we call the cell-mediated response. That is not measured by the antibody measurements. It's quite possible that we might have a waning of antibodies in the blood, but at the same time, we may still retain some of the protective effect because of this other branch of the immune system. I think those are the reasons that-- It's difficult at this point to say what level of antibody will be protective.

Brian: One other related question that people ask me a lot, it's that older people seem to react less in general to the vaccines in terms of side effects than younger people. Is that a sign that the vaccines are actually less effective in the elderly because their immune systems are not gearing up as noticeably?

Dr. El-Sadr: I think that actually is not supported by the data. At least the vaccines that we're using now in the United States, the Pfizer, BioNTech, and the Moderna vaccine, when you look at the response amongst younger and older individuals, what's very impressive is that there's a very robust good response by people across the age span, so that's what matters. What matters is what's been seen in these large studies in terms of the protective effect of the vaccine.

Brian: In other words, the infection rate among the elderly is really where it's plummeting. Most of the new cases are among younger people, precisely because they haven't been vaccinated, or that's how it looks.

Dr. El-Sadr: Yes. That tells us that these vaccines really work amongst the elderly, which is very, very encouraging. It is true that younger people tend to have more of these local reactions or immediate reactions after vaccination, and this may be due to a different kind of response, from the protective antibody response that we are looking for.

Brian: Listeners, you're masking outdoors after vaccination and other COVID questions for Dr. Wafaa El-Sadr, from Columbia's Mailman School of Public Health. 646-435-7286, 646-435-7286, or tweet a question @Brian Lehrer. Ryan in Ridgewood, Queens, you're on WNYC. Hi, Ryan.

Ryan: Hi, thanks for taking my call. It seems like there's just a lot of contradictory information out there. People want us to get the vaccine because then we're protected, but yet when we still have the vaccine, and we're hanging out with friends who have the vaccine, we still have to wear masks, different close quarters. I understand doctors have to be cautious about uncertainty. Nothing is 100% certain. At a certain point, will this act like the flu where as long as we're not going to be hospitalized and cases are generally low, we may get sick from it in the future, but we'll just have to keep on getting a vaccine. When can you safely resume some sort of intimacy with friends and work after we've been vaccinated?

Dr. El-Sadr: That's a very good question. There certainly is the possibility that this virus will become something like the influenza virus where we now know that every fall we need to get another vaccination against the flu and that every year, the actual vaccine differs from the prior year. It's dependent on the circulating almost variants from the flu. That's a possibility.

I do think where we're at now is a critical moment, where we're hoping to as much as possible scale up the vaccination because what you need to do is to achieve sufficient uptake by the vaccines in our community, which means that then you will be able to suppress, to decrease the transmission in the community. That's really what will allay the concerns in terms of transmission of this virus.

There's two things that need to happen. One is to expand coverage, expand the uptake of the vaccination. At the same time, we watch and see what's happening to transmission in the community. At that point in time, hopefully, with evidence of decreased transmission and better coverage, then would be the time to say, "Okay, we can start easing on some of the restrictions that have been put in place."

As you know, even the CDC, recently has also eased on some of the restrictions, for example, recommending or allowing that we're suggesting that fully vaccinated people can get together in small groups in social settings in a household, for example. There's already the beginnings of evidence of some easing of the restrictions, but it really is all dependent on how fast and how well we can get as many people as possible from our communities vaccinated.

Brian: Federico in Brooklyn, you're on WNYC with Dr. Wafaa El-Sadr from Columbia University. Hi, Federico.

Federico: Hi, Brian. Hi, everybody. My question concerns something that has been going on since the pandemic. People are dropping the mask from covering the nose to below the nose, just covering the mouth. I'm wondering whether or not the nose, normal breathing, so to speak, could transmit the virus?

Brian: Federico, thank you. I've been noticing that more and more, too. I think masks are going from a COVID safety precaution to a fashion statement in chinstraps, increasingly. Let me throw in another question that comes from a listener on Twitter that piggybacks on that. I think it's another way of asking the same thing in a certain respect. This listener asks, "Doesn't it take minutes of exposure to pass COVID? How can a runner or a biker passing by be enough time?" That's in seconds. So to both of those questions.

Dr. El-Sadr: Yes, of course, it's really important that when one wears a mask to wear it properly. As you know, of course, since the virus is in the nose, and in the throat, of course, it can be transmitted from the nose or from the mouth. That's the reason why we always say that the mask must cover both the nose and the mouth. It has to be molded to the bridge of the nose and below the chin. That's the proper way to wear a mask to actually get the benefits of wearing a mask. I urge people to avoid the fashion statement, as you say, Brian, and when using the masks to really use them properly as recommended. That's the only way to get the benefits from mask-wearing. The other question you had--

Brian: About, doesn't take minutes of exposure to pass COVID? A runner or a biker just going by somebody unmasked?

Dr. El-Sadr: I think as you know, the odds are, again, dependent on the time of exposure and proximity of exposure. Those are the two factors that make transmission more or less likely to happen. Clearly, when you have a few seconds passing by someone, that in and of itself is not certainly as risky as being in close proximity to someone for 10 or more minutes. That's why we use some criteria for how we define close contact when we're doing contact tracing, for example. Again, two things to keep in mind is the duration of the contact and the proximity of the contact.

Brian: This is WNYC-FM HD and AM New York, WNJT-FM 88.1 Trenton, WNJP 88.5 Sussex, WNJY 89.3 Netcong, and WNJO 90.3 Toms River. We are in New York and New Jersey Public Radio. A few minutes left with Dr. El-Sadr from Columbia. Dr. El-Sadr, children are not yet being vaccinated.

I know any number of families where the vaccinated parents are deciding what kinds of vacations they can take with their kids this summer, or summer camps they can confidently send their kids to, especially if it's a sleepaway camp, or vaccinated aunts and uncles and grandparents who don't know if they can safely vacation with their unvaccinated nieces and nephews and grandkids around. I noticed the New York Times even had an article the other day called, How Epidemiologists Are Planning to Vacation With Their Unvaccinated Kids. Where would you start to advise on that?

Dr. El-Sadr: I think we're incrementally-- Hopefully, we're going to get the vaccines. They're agreeing to be available for kids. Now, as you know, for the Pfizer vaccine, it's recommended for individuals 16 and older. There are a new data that were very encouraging, again, with the same vaccine for children between younger ages 12 to 16. Ongoing studies are incrementally being done to determine if these vaccines work for younger and younger children. We're going to hopefully soon have vaccines that work for children.

What's recommended is really that the most important thing is to have the adults in a group be fully vaccinated because that's how we can prevent severe illness and hospitalizations and so on from this virus. We know that children certainly can be infected, and it's very small, rare number of children can get severely ill with COVID-19. What we know is the transmission from children to adults is not as high as between adults and from adults to children. I think the data are reassuring that if you have fully vaccinated adults who are protected from getting COVID-19, and particularly from severe COVID-19, that they can be in proximity with younger children who are not still eligible for the vaccines.

Brian: One out of that to follow up on and I'll ask you to go a little deeper, you said children who might be COVID positive can't transmit the virus as easily to adults as other adults can to adults. This is where a lot of the uncertainty comes in for grandparents and et cetera, trying to make these decisions because you said earlier in the segment, the vaccines while incredibly effective are not 100% effective. If you have children who could be carriers, how does the vaccinated especially older person know what's to be considered safe? Maybe an indoor, they're all staying together in a summer place or something setting, but that one fact that it's harder for children to transmit the virus to adults, how is that measured?

Dr. El-Sadr: That's being done in a variety of different studies that have looked at this. They've looked at transmission in a lot of different studies in different parts of the world, and it seems to hold the fact that it's about this less transmission from children to adults. We have sufficient data to say that. I think the other thing to keep in mind that even though the vaccines may not protect 100% in all adults, we do know that they do work very well in preventing severe illness and that's really very important to keep in mind.

Even if there's a small risk of transmission from a child to a vaccinated grandparent and so on, hopefully, the vaccines that they have received may not protect them from getting a mild illness, but at least it will protect them from getting a severe illness.

Brian: Yes. Last thing before you go, I see that your university, Columbia University has announced that they will require vaccination of students to return to campus this fall with some medical exemptions or religious exemptions. In your role on the University President's COVID-19 Advisory Committee, were you involved in making that decision? Could you explain it to our listeners?

Dr. El-Sadr: Yes, I was involved. Obviously, it was a collective decision of the leadership, but we're involved and strongly supportive of this approach. I think the goal is as much as possible to enable the community of students to come back to campus and to be able to enjoy the campus and enjoy being together on campus. We have had a very safe campus all along with very low positivity less than 0.5%, most of last year but nonetheless, I think we've had, of course, low density of students because of virtual teaching.

The goal is to try to-- We're inviting the students back, we want the campus to be vibrant again and we feel that having the students body fully vaccinated, in addition to some of the other safety measures, will enable us to have a vibrant campus and full engagement by the students and faculty and staff.

Brian: Full capacity classes, in that context?

Dr. El-Sadr: We're working on exactly about the capacity of the classes. This is very much dependant on guidance from the state in terms of the limitations and density in classrooms. At present it is 50%, we're hoping that with uptake of vaccines and improvement in the COVID-19 situation the density will be increased and therefore we'll enable more students to be in the classroom. Hopefully, over the next several weeks and several months as we move towards the fall, we will see an increase in the allowable density to enable getting more and more of the students into the classroom.

Brian: Will faculty and staff be required similar to students?

Dr. El-Sadr: At present, not yet. We're discussing this as well as not just Columbia, but other universities are also discussing whether to mandate vaccination for faculty and staff. We're strongly encouraging vaccination of faculty and staff, unless they have a reason, like a religious or medical reason not to be vaccinated. I have been working very hard to provide the community with information about vaccination, to provide them with information on where to get vaccinated. We're offering vaccination as well on campus now. Our goal is to make vaccination accessible and easy for all members of the community and especially including for the faculty and for the staff.

Brian: What's the rationale though if you are requiring it of students to not have the same standard for faculty and staff?

Dr. El-Sadr: In reality, I think vaccinations have been required as you're aware for students all along. For example, we know that In New York State, there's a requirement for students to be vaccinated for measles, that's one vaccine, as well as for influenza vaccination.

We have already a template, a precedent for mandatory vaccination requirements for students. This does not exist as of yet for faculty and students, but it's an issue that's under intense discussions because the more of the community is vaccinated, I think the better it will be for everybody who's involved. That's the primary reason why we have this distinction between the students and faculty and staff.

Brian: Listeners, we'll talk more about this tomorrow with the president of Rutgers University, which will also require students to be vaccinated except for certain religious and medical exemptions this fall. The president of Rutgers on tomorrow's show. We thank Dr. Wafaa El-Sadr, professor of medicine and epidemiology at Columbia University Mailman School of Public Health, Director of Columbia World projects, an initiative focused on global public health challenges, and Head of the Public Health Committee for the Columbia University President's Advisory Task Force on COVID-19 involved in campus space COVID decision-making. Dr. El-Sadr, we always appreciate all the good information. Thank you so much.

Dr. El-Sadr: Thank you. My pleasure

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