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Brian Lehrer: It's the Brian Lehrer Show on WNYC. Good morning, everyone. On today's program, we'll take calls from Asian Americans about being Asian American right now. Anti-Asian hate crimes were already in the news just before the Atlanta spa killings happened, leaving six Asian American women, and two other people dead. We will talk about the response and conditions in our area and take your calls.

Also, UFT President Michael Mulgrew with the teacher's union view on when and how to reopen schools and more. We have a special surprise on today's show our producer Zach Gottehrer-Cohen and WNYC engineer are at this moment headed to the top of the empire state building to place our 2020, '21 time capsule that we've been making with many of you.

We are going to go live to the top of the empire state building where a transmitter is in about an hour but on this show I want to acknowledge, we had Dr. Leana Wen last week, Washington Post Columnist, among other things who had written that the Center for Disease Control was being too timid in advising vaccinated people on what is now safe to do. It's part of the big conversation about topic number one for so many Americans right now, with hope, science, politics, human nature, and personal psychology, all mingling as people and institutions try to get things right. That was last week's guest.

Then yesterday infectious diseases expert Ravina Kullar said on the program that in her opinion, the CDC might be too optimistic in saying vaccinated people can get together unmasked right away because we don't have enough science yet about how some of the new variants might behave. For example, she said, "These recommendations that vaccinated people can get together, not wear masks, not physical distancing. I feel that's too soon."

She said, "We don't have data on whether these vaccines prevent transmission and prevent the acquisition of asymptomatic COVID-19 infection, a reminder is that these trials only looked at symptomatic infection. They did not look at transmission or asymptomatic COVID-19. My concern is with these variants, she said later we have a new one almost every other week. There has to be data that is put out about how effective these vaccines are against these variants. That was on yesterday's show.

Now, the last thing we want to do is soar confusion rather than clarity, but then we also to respect disagreements by experts on the evidence or lack thereof. We also don't know in advance what each expert is going to say. We'll keep having the conversation now, we will keep this conversation going with Dr. Stephen Morse, professor of epidemiology at the Mailman School of Public Health of Columbia University, among many other things.

He published a book back in 1993 called Emerging Viruses and he is credited with originating That term. He has worked in government and academia and more. Gothamist has used him a number of times, as some of you have read in their ask an epidemiologist series. Dr. Morse, thanks for coming on with us. Welcome back to WNYC.

Dr. Stephen Morse: Thank you very much. I'm glad to be back Brian.

Brian: First, I wonder if you can just clarify for our listeners what some of the recent CDC guidance is. For example, they've said, and Dr. Fauci has said that vaccinated people can be with other vaccinated people indoors without masks and social distancing. I'm going to play one 35-second clip of Dr. Fauci here from CNN on February 28th.

Dr. Fauci: If you have individuals, adults who are vaccinated, two people that are doubly vaccinated and are protected, then you can do things that we weren't talking about before. You could have dinner in a home without masks on. You could have friends who you know are doubly vaccinated and are protected together with you. You can start doing things essentially in the home and in a setting where you're not out in the community, where there are 70,000 new infections per day and you can start doing some of the things that you weren't able to do before.

Brian: Dr. Fauci a couple of weeks ago. Dr. Morse, can you take us a little deeper into that fairly simple statement? What's the science behind Dr. Fauci and the CDC feeling comfortable saying something that's straightforward and liberating.

Dr. Morse: The CDC, of course, also said that you could have your grandchildren again if you were fully vaccinated. The fact is that all of these vaccines do a really excellent job of preventing illness. As you said, that was what the clinical trials were designed to test for. We know that at least with the existing variants that we've seen, as well as the predominant viruses so far if people are fully vaccinated, they're not going to get sick. We haven't seen illness. That risk can be reduced keeping you out of the hospital.

We do, of course, have some concern about these new variants and whether some of them may at some point be able to escape the vaccine. What we do know although the data are only beginning to accumulate is that we had hoped originally that these vaccines would prevent transmission or prevent asymptomatic infection, and some results from Israel and other places where there's been a lot of work done on this suggest that a number of these vaccines, certainly the Pfizer and Moderna vaccines do prevent or do seem to prevent asymptomatic transmission, that is people don't seem to get an initial infection and pass it on to others without getting sick.

We can't say that with certainty, but that's something obviously we'd like very much to see happen. I think these vaccines do offer a measure of assurance, but I also think that we still have surprises out there with these new variants and that means that with people we know and are close to, especially if they haven't been traveling much. If they've been in the area or within their own bubbles or pods as we call them, close family connections, trusted friends, we probably can relax many of those precautions. In other situations, we really need to keep those precautions up, to prevent these new variants from emerging and taking over. Some of them, obviously, we haven't studied well enough to know what effect they may have on the vaccine.

Brian: The uncertainty that yesterday's guest expressed was based on not enough experience yet in her opinion, with some of the new variants as well. Let me read to you from the Washington Post article from last week headline, "The CDC said it’s okay for vaccinated grandparents to visit. Some families say: Not so fast." It starts with this story.

Jen Morales, who lives in Vienna, Virginia was taken aback last month by a text from her 80-year-old mother in Rochester, New York. "I feel so relieved." Her mother, Sally Morales wrote in the text after saying she and her husband had received their first vaccine doses and plan to get their second doses in four weeks. "When we're finished, we'll come and visit you."

Morales 52 and her teenage children long to see them, but Morale is communications director for Infectious Diseases Society of America had been working on a news release about the latest variant just before receiving her mother's text. She worried that the vaccine wouldn't protect her parents from the new variants. There's another one.

The communications director for the Infectious Diseases Society of America, no less, quoted not trusting the vaccinations yet for her 80-year-old mother because of the variants. Where are you on the scale and how can you help people land if they're hearing one thing and then they're hearing another thing?

Dr. Morse: Right now, it is obviously a time where there are a lot of different moving parts and we still haven't quite put them all together and the virus continues to evolve rather quickly. We're still learning, but in general, I think I take more of a middle-of-the-road attitude in this. I think that there is optimism and I think there's great cause for optimism, but I also think we need to be cautious. The more difficult question I think comes up when-- What if you're traveling from one area to another? Especially in the area like one coast to another where there are different variants circulating and we don't know about the vaccine with all of them. It does seem to be effective against the ones we know about at least well enough, but we still obviously have uncertainty. If you're within the same area, there are a number of in circulating. Let's say in the New York area, including the Washington Heights variant as Tony Fauci dabbed it.

So far I think probably within fairly limited area within your own family, within close friends or people nearby, the risk is probably at this point still low. Obviously, I think everyone has to decide what risk they consider acceptable. I think at this point the vaccine has made a big difference, but we have to be careful not to get too complacent.

Brian: I know that my neighbors in Washington Heights do not like that term and think that it carries unintentional ethnic connotations to many people, at least the way they will hear it and start thinking of people who live in Washington Heights. They prefer New York variant, which I think has caught on now. Do we need to distinguish between the UK and the New York and the South Africa variants in that analysis? Is the science on each one the same?

Dr. Morse: No. We have varying amounts of information on all of these. All of them, obviously, are of some concern. The South Africa has been particularly concerning and the Brazilian, in part. Sorry to name them too officially. P1 have been of concern because the vaccines do not work in some cases as well against them, but they do seem to work well enough so far. The New York variant, which is officially known as B1526, was actually described by David Howard New York-Presbyterian Columbia University Irving Medical Center, has become very widespread and predominant variant here.

We don't know much about its properties, but so far it hasn't shown the propensity to defeat the vaccine, for example. Although it's been spreading very well as many of these variants have, the vaccine is still working. It doesn't seem to be much different yet from what we know about any of the others that we've tested. So far our luck has held out, but it is a matter that sooner or later we will encounter variants that are more challenging. I think right now we're not in a bad place for those who are vaccinated.

Brian: Listeners, we can take your phone calls for Dr. Stephen Morse on any of this. 646-435-7280, 646-435-7280, your vaccine and variants questions, or anything related. 646-435-7280, for the originator of the term emerging viruses and professor of epidemiology at Columbia 646-435-7280. Let me ask you kind of a medic question along these lines, how much science and how much time is enough.

I could look at it as the specific variance of concern that we've been talking about are only a few weeks to a few months old. So how can we say yet? Or I can look at it as these variants have been around for weeks and months, and millions of people have been vaccinated and are living their lives. We must have a pretty good real-world sample by now. How much science and how much time are enough for people who do what you do?

Dr. Morse: That's a question that I think we're all really trying to answer. I think there is enough science to know that these vaccines are effective, they are safe, and certainly, in comparison for people who might be in a higher risk group for severe disease, older people, for example, like myself or those with underlying medical conditions, the vaccine is certainly a far better bet than taking a chance on getting infected. Definitely, I think the vaccine has shown its safety and its efficacy and in a lot of situations.

The problem, of course, is that the virus itself continues to evolve. We're seeing this evolution unfolding in real-time. In most cases, the variants tend to have the advantage of being more transmissible. The vaccine usually will do a very good job against those, but we don't know what the future might hold. We have a cautious optimism there. We do have a lot of, certainly, information that suggests that these vaccines have been very good against what we already have seen and have had circulating in the general population.

There I have a pretty good confidence, but we do have to be careful. We can't get complacent now, especially since I think we're really close to a point where we can feel a lot safer once everyone is vaccinated, once we continue to keep the virus suppressed.

Brian: How do epidemiologists study the variant vaccine interactions? You're not doing lab experiments or clinical trials anymore, I don't think, so what do you measure to base behavioral guidelines on?

Dr. Morse: There are lab experiments and that's usually where people start with the new variants because they tend to be identified perhaps in a patient or perhaps very often through searches of databases, and then they'll find them in the real world. Almost the first thing they'll do is to take them into the lab and test them against antibodies from people who had the disease and recovered. Of course, more importantly, I think, and more germanely against the people who have antibodies from people who have been vaccinated to see if they still react.

That's not the only task. There are ways of testing them in animals, but usually what you do after you would check it in the lab with serum from people who've been vaccinated is then to look at the epidemiology to see if you can find cases of disease or others who may be sampled as part of a population as they did in the UK, where they were really looking at a lot of the variants.

That's how they found this one because they were doing a lot of characterization of the positive test, people who had the infection, but you would look at people who might be coming into the hospital, see if they have this variant, find out if they've been immunized. It can be a slow process. In the lab, you can find this out fairly quickly, but that doesn't necessarily guarantee that it will be the same in the real world because we have other defenses as well.

Brian: Dr. Wen in her Washington Post column in which she accused the CDC of being too timid and telling vaccinated people what they may do writes that, "Public health must shift its outlook from zero risk to manageable risk that can strike the right balance between controlling infection and restoring the economy." Can you explain what manageable risk means in that context as you understand it or would read it and give us your take on the right balance?

Dr. Morse: Sure. We've always thought in terms of how to keep the risk as low as possible. In reality, such a thing as zero risk is more a theoretical concept than something in the real world because people make mistakes. There are variants of the virus that may turn up that will be harder to control. We want to reduce the risk as much as possible. That means immunization, taking precautions, doing everything that we've been doing up till now, essentially, to keep the risk low.

Avoiding large indoor gatherings, for example. As things improve with vaccination and we learn more about how to control the risk, how to improve ventilation, for example, to make indoor spaces safer and continue to protect ourselves, it becomes possible to keep the risk lower. It's never going to be really zero as long as the virus is around, but we can reduce it to a point that is tolerable for most people and that's often an individual choice. Some people may be highly risk-averse and may want to stay at home and remain essentially isolated. Others may feel that they want to take some chances of hugging their grandchildren if they've been immunized and that's a manageable risk, there's a very small, but really very low risk. I do think that, of course, you want to be careful not to get infected because there's always a danger of passing it on to others and even if you don't get sick yourself that's something that's very undesirable with these new variants. Obviously, as we're controlling these infections, we want to keep those numbers low. Manageable just means essentially what we can achieve in the real world. We can do pretty well to reduce that risk.

Brian: Let me drill down on part of what you just said about personal risk tolerance before we take some calls from listeners. Where does individual risk tolerance start to come into this as an explicit factor or something that we should expect to hear referred to by Dr. Fauci? Or you or anyone else, certainly, people in government who are putting out official behavioral guidelines.

At what point do public health leaders need to acknowledge as one factor in this that different people take different risks in their lives because they're psychologically different as individuals or on the balance between zero risk and manageable risk, the pecking orders of behaviors as part of that psychology? For example, maybe an individual is willing to take a certain amount of risk to be with loved ones, but not to go to the movies, even if they require vaccine passports or negative test results for everyone. Zero risk versus acceptable risk being affected by the degree of motivation from risk to risk. Yes?

Dr. Morse: Yes, I think, and I think that's an excellent question. Obviously, in some states, there's been a real effort to open up the state, open up all activities. I think that really is going too far at this stage. We simply don't know enough and don't have enough under control to feel that this is a reasonable or safe thing to do. I think that perhaps some of these sporting events we're hearing about if people take serious precautions, all the precautions we've been hearing about, and are really serious about adhering to those precautions and those venues are very carefully monitored and very carefully ventilated and protected, that might be a manageable risk.

I personally wouldn't want to take it because part of the problem is it's not just ourselves getting sick, it's the possibility as we see with young people who go on spring break and throw caution to the winds of bringing it back home and perhaps starting new infections in a new spike in infections. That's the point where we have to think in collective terms, not just individual risk, but for the individual, I think there are situations like the immunized grandparents and their grandkids may be under some very controlled indoor situations.

Although, I think we need to do that slowly at first so that we really know what kind of results to expect and what kind of precautions we should take before we do it on a large scale. I think that some people have more appetite for that. Some people will go to the movie theater, but I hope they'll be very careful and I hope the theaters will be very careful. I don't think we have to be hermits now, but I do think we still have to continue taking precautions and the same precautions we've been taking with these variants that are more transmissible, that means they're easier to catch. That means those precautions have to be taken more rigorously than ever.

Brian: We're going to continue at a minute with Dr. Morse. We're going to go to your phone calls and Dr. Morse, get ready because I'm going to ask you what do you think about this new conversation regarding schools and three feet versus six feet of social distancing between students. Stay with us, Brian Lehrer on WNYC.

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Brian Lehrer on WNYC with Dr. Stephen Morse, professor of epidemiology at the Mailman school of public health at Columbia University. Edd in Freeport WNYC with Dr. Morse. Hi, Edd.

Ed: Hi, how are you? Thanks for taking my call and I absolutely love your show.

Brian: Thank you.

Ed: I'm concerned about the lockdown in Italy and how it seems like a disconnect between what's happening there and what's happening here and that's my big concern.

Brian: Thank you very much. Dr. Morse. I know one thing is that they vaccinated fewer people. Is that a good place to start?

Dr. Morse: That's one thing, another thing is that UK variant the B117 has really taken off in much of Europe, including Italy, and it is more transmissible. With fewer vaccinations, it means that people have to be very careful about the other precautions. We can see that it's very easy for this virus to get around. That's the new peak in Italy, in Spain in France, and then a few other countries. Germany is beginning to see that too. It's mostly these new variants.

I think that's why we can't get complacent. It's a reminder because the last time Western Europe got it and then it came here. We should have learned from that experience to be careful. The immunizations, definitely, the fact that we were ahead and they're behind definitely make a difference. There's no question that. If they had been able to immunize or get these vaccines, any of them into much of their population, we wouldn't have seen, they wouldn't have seen nearly as big a spike as they are seeing now, but there would still be additional cases.

Brian: Jackie in Long Island city you're on WNYC. Hi, Jackie.

Jackie: Hi there. Can you hear me?

Brian: Sure can.

Jackie: Oh, thanks so much for taking my call. We've been having such a hard time. I'm getting definitive guidance on this. I really appreciate you taking the time to clarify. We've been listening to the other segments that you mentioned. I'm 38 weeks pregnant, so I'm due in two weeks. I've had both Moderna shots so I know that there's some promising research coming out about the antibodies for the current baby that I'm carrying. We have grandparents driving up from Florida and their risk tolerance is much lower than ours.

We've been very, very conservative and they're very eager to just come over and hang out with us with the new baby. I think my greatest concern is my 28-month-old toddler that I have in the house and trying to give them guidance as to how to keep the toddler safe. All of the grandparents are fully vaccinated, but we're just concerned about whether or not we would be exposing our toddler if they were to show up and spend time with us unmasked. They do indoor and restaurants in Florida. I anticipate that they'll do that when they're here back in New York. What is your recommendation as far as visiting with them so that they can visit us without masks?

Dr. Morse: That's a difficult one and by the way, congratulations.

Jackie: Thank you.

Dr. Morse: I'm very glad to hear about the happy event and also that you got immunized. We, obviously, don't have official recommendations yet on immunizing pregnant women. We do think unofficially and it's being tested right now in clinical trials, that it is safe and effective and it will protect the newborn as well through maternal antibodies. You're doing a good thing for both yourself and your unborn child. The question with the toddlers is a difficult one.

I think the risk is relatively low, but it really depends on how much the grandparents really-- Your parents really are going to be careful whether they could have gotten infected, if they're immunized, there's probably a pretty good chance it's safe probably on both sides. There is also the possibility of getting tested PCR or other tests for the virus before they come just for reassurance. We're seeing fewer people getting tested these days in part because of the vaccinations and other things.

If there's any real concern, I think getting test a couple of days beforehand would be a good idea. Certainly, there's no harm in that. I think the risk is low, but it's impossible to say in any particular situation. I think that is a difficult choice to make. If I were the grandparent, I probably would feel that it's probably safe, but situations vary. I'd recommend they should get tested if you have a concern about the possibility that they might be asymptomatically infected.

Brian: Jackie, I hope that helps you at least to some degree. Thank you very much for your call. Good luck with your labor and delivery. Good luck with the two sets of grandparents. You just mentioned a really interesting topic that we have another caller on explicitly, so I'm going to go to her next. Marybeth in Brooklyn on the role of testing in the people who are vaccinated era. Marybeth, you're on WNYC. Thank you for calling.

Marybeth: Hi, Brian. Love you. Love your show. I work in the film industry, and we're all required to get tested anywhere from one to five times a week. The big question right now is if you're vaccinated, do you still need to get tested?

Brian: Doctor Morse.

Dr. Morse: Well, until we have more certainty about this, I think it's still a good idea. I think that the likelihood is that most of those tests are going to be negative. Hopefully, they already have been anyway, but it does give an additional level of reassurance. Quite frankly, in the research community, one of the things we're interested in knowing is the result of these tests and people who are vaccinated, and what if they're ever positive or if they're sometimes positive, what variants or what virus types might be responsible because that's an important piece of information.

We have a lot of information from Israel, and from other studies suggesting that if you've been immunized, you probably will test negative when you are tested, but it's good information to know. I don't see any harm in knowing that. If it comes up as a surprise, and I think it's important for us to know that.

Brian: I hope that's helpful Marybeth. Here's another wrinkle on the previous caller's question with another family situation. Caller Maryann from Lindenhurst couldn't wait, but she tells her screener, her question. Her brother and family plan to visit this summer. "They are anti-vaxxers," she says, but her family will all be vaccinated. Should she make her anti-vaxxer relatives quarantine when they arrive in New York State before they see them?

Dr. Morse: Well, I think actually they're supposed to.

Brian: I think Cuomo is lifting that.

Dr. Morse: Yes, I hate to say this. I know this has been a real problem because of the questions about vaccine hesitancy for a number of reasons. There is a bit of a disequilibrium there. If she can encourage her anti-vax relatives to get immunized, they probably, obviously, if they're really anti-vaxxers, they're going to be quite adamant about it. It might be wise, if nothing else, at least it will make them appreciate the trade-offs of the consequences of being against getting the vaccine if they do quarantine.

Whether it's medically or epidemiologically necessary or not, is impossible to say. If you're fully vaccinated, you're probably going to be pretty well protected, even against your anti-vax relatives, but I think it would be wise for them to quarantine and it might make them appreciate the various trade-offs that they're making.

Brian: All right, we're almost out of time. I'm going to ask you three questions. If they are answerable in short answer form, do it. If not, tell me, "I can't give you a simple answer to this question." What do you make of some of the local spikes? Our caller asked about Italy and why they're having so much COVID that they need to go into lockdown again compared to us.

What do you make of some of the local spikes or stubborn plateaus in various places in this country? Cases surged 80% in Michigan, just recently I saw compared to a few weeks ago. There are several other states with big spikes, and here in New York City, the number of new cases and deaths has been steady for the last two weeks. That includes about 63 deaths a day in the five boroughs despite all the vaccinations being administered. Other places not so much. How do you explain the US individual differences?

Dr. Morse: Sadly, this has become a political issue. We see a lot of divides about "Do you wear masks?" "Do you take precaution?" "Do you believe that this is a real thing?" Or people just perhaps getting complacent or careless--

Brian: But wait, that was my second question. Which is, do you have a take on the difference between states that have opened more like Florida and Texas? I'm not sure Michigan is one of those states maybe you know, and those that remain more cautious because governors in those fast opening, usually republican states say, "Look, our case and death rates are really not much different from New York or other more cautious places." Have you delved into that?

Dr. Morse: Yes. I think that in a place like Michigan, for example, Florida, Texas are a different story as you know they're really completely reopen now, but places like Michigan, you've got some who do and some who don't. I think you have pockets of resistance to vaccines, resistance to taking various precautions, but in any population that's not fully protected, you're going to see some people who will get infected if they're not rigorously taking the nonpharmaceutical precautions, the mask, the distances, and so on, and/or if they're not yet vaccinated.

We're in an intermediate period where we still have a lot of people who are susceptible and need to be very careful until essentially everybody is vaccinated, and that really means the whole world, but at least here in this country. In other places like Michigan, I think it's partly a matter of pockets, and areas that haven't yet either aren't taking the precautions or haven't yet gotten enough people vaccinated. Some areas, for example, in rural areas and underserved communities, ethnic communities of color, for example, we just don't have enough people getting vaccinated because the system simply is not working as well as it should in those places.

Brian: Last question, we have Michael Mulgrew, the teachers union president coming up as our next guest. Help set us up for something that I'm going to need to raise with him. The studies that have come out on three feet of social distancing between students in classrooms being as effective as six feet of social distancing. Have you looked at those, and do you have a policy recommendation based on them?

Dr. Morse: Oh, yes. The original recommendations from years back used to be one meter, and in Europe, it was one meter for a long time, which is essentially a little over three feet, but in this country, we allowed a little bit of a margin, but those aren't magic numbers. Social distancing is a good thing to the extent that you can do it, but those other precautions are also important. In an indoor environment, ventilation, opening the windows, having good ventilation, really important. I think you saw the article in yesterday's Times about that, but that just reinforces what we've all known.

People really wearing masks and other things when they can, not necessarily when they are learning and speaking, but when they're congregating in other places. I don't think there's any magic number about distancing, I think the more the better, but I don't think there's some point at which it really tips over and suddenly you're safe. I think just do the best you can. If three feet is the best you can, I think that's probably what you can do, and the other things then you have to have other precautions, and other things like ventilation to make sure that the place is safe. Ventilation is probably as important as anything else in a school environment.

Brian: Dr. Stephen Morse, Professor of epidemiology at Columbia University's Mailman School of Public Health. Thank you so much.

Dr. Morse: Thank you. It was a pleasure to join you today.

Brian: Brian Lehrer on WNYC. UFT President, Michael Mulgrew next.

 

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