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Brian Lehrer: Brian Lehrer on WNYC. This week marks the two-year anniversary of COVID-19 in this country in the biggest possible way. Two years since the World Health Organization declared a global pandemic and two years ago this week, Mayor de Blasio announced this.

Mayor de Blasio: We are dealing with a challenge and a crisis that we have never seen in our lifetimes, and is only just begun. I regret to have to announce that as of tomorrow, our public schools will be closed.

Brian Lehrer: In fact, it was two years ago today March 16th, which was a Monday in 2020 that was the first day that the New York City public schools were closed because of the pandemic. We debated on the Brian Lehrer show team how to mark the two-year anniversary whether to do call-ins about the things we've lost or the things we've learned, but nothing felt exactly right. It's an odd time right now. Mostly, we're sick of talking about pandemic things, and looking back is not really how we want to spend our precious time when so much of it was already taken away.

We wanted to do something today and so we decided to do something practical and forward-looking we hope. Manhattan Borough President Mark Levine and Dr. Jay Varma epidemiologist, former adviser on the pandemic to Mayor de Blasio. He's the director of the Cornell Center for Pandemic Prevention and Response and a Population Health Sciences professor at the Weill Cornell School of Medicine. He and the Borough President of Manhattan have put out a short plan on what they think New York City needs to do right now, in this stage of the pandemic, to prevent a slide backwards. Borough President Levine and Dr. Varma. Welcome back to WNYC.

Mark Levine: Thank you, Brian. It's great to be here.

Brian: Dr. Varma, do we have you?

Dr. Jay Varma: Oh, yes, thank you very much for having me.

Brian Lehrer: Sorry just making sure. Just to mark the moment of where we are, Borough President, the city, in accordance with the CDC, as you know has put out a new color-coded COVID alert system to inform New Yorkers on COVID risk and as some people are figuring out, what's my next step out into my old life or whatever, where is New York today?

Mark Levine: We are in the green according to the CDCs rubric, and the city alone has adopted a slightly more detailed plan for COVID alerts based on the color code. Boy, it is great to be in the green, Brian, we've come so far in the last two months since the horrible highs of the Omicron peak. We're not imminently moving into orange, which would be the next level of alert, but as we'll talk about, there are some clouds on the horizon we need to pay attention to.

For now, I think we're all enjoying this reemergence from a difficult two years, with our economy starting to bounce back and spring coming. Dr. Varma and I are really focusing on a plan to keep it going to stay open. We call our plan Staying Healthy to Stay Open. We don't want a setback as we suffered with all the previous ways in New York City.

Brian Lehrer: Right and we'll get next to the specific points in your plan and we'll go tick tick tick one two three four, but Dr. Varma, I do want to acknowledge that the Borough President mentioned some of the potential clouds on the horizon, so I want to ask you as an epidemiologist, how you see the threat from the so-called BA.2 variant, which is said to be more contagious than the Omicron variant which was known for its contagiousness. It was doubling statewide as of last week, and accounted for 1 out of every 10 cases, though it's a low total number of cases for the moment. How concerned are you about us getting back to an Omicron situation, and therefore having to backslide into restrictions?

Dr. Jay Varma: This is one of the hardest times I think that we have had in our pandemic because we all want to be hopeful for the future, but we also have to learn from our recent history. What we've seen over and over again is that what happens in Europe happens in New York City next, it doesn't just stay there. There are three reasons that we're seeing increases in Europe right now. We're seeing it because this sister variant or sub-variant Omicron is even more infectious than Omicron, which to me as a infectious disease specialist is frightening because omicron was probably the most infectious disease I've ever seen.

This sub-variant is more transmissible from one person to the next. Number two, Europe is doing what we are here doing in the US which is moving away from community protection measures, community basking, and restrictions on various activities. Number three, we know that large swathes of the population in Europe and here in the United States have not gotten that third vaccine dose, which we know that is particularly helpful against preventing severe disease for people with these new variants.

Brian Lehrer: That, in fact, is the first point of your plan. Borough President, I'll go back to you for this in order to protect ourselves for the future while things are relatively okay right now, and people may find this counterintuitive. Why right now is omicron is receding for the moment as COVID is receding for the moment, your first priority is to increase the percentage of adults who get a third dose.

Mark Levine: Yes, well, Brian to echo Dr. Varma's point, in each of the four ways that New York City has been through, there were signs of trouble, specifically in the UK and in London, before we were hit in New York. In every case, we were slow to see it and hoped even irrationally that it wouldn't come to New York City. We don't want to make that mistake again, we want to be prepared now. We are behind on the booster shots. We're at 36% city-wide, compare that to Britain, which is at 67%. That number in total is too low but the picture is even more stark when you dig down and look by neighborhood or broken out by racial and ethnic groups.

You see that there's enormous inequality in booster rates throughout the city, mirroring some of the same patterns that we've been suffering with throughout this pandemic. It's really an indictment of our system that we are continuing to see such inequality. There are neighborhoods that have well over 50% of the population already with their boosters and somewhere, it's under 25% a couple that are even under 20, and that leads--

Brian Lehrer: At the policy level, Borough President, what can the city do to increase the number of their doses? I feel like people have seen the Dr. Dave Chokshi commercial or public service announcements on TV over and over again, and his other colleagues from the health department, what can people do? What can the city do to increase that third dose uptake substantially?

Mark Levine: I'm going to miss Dr. Chokshi's commercials, but well, we're not talking about anti-vaxxers here, Brian. We're talking about over 3 million adults in New York City who got their first vaccine series and have just not gotten their booster shot. Actually, more than half of the people who got their first series have not yet gotten their booster shot. In talking to many of them myself, I can say, usually what I hear is that they just haven't gotten around to it, that they haven't found the time, or that they just don't see the compelling need anymore since "The pandemic is over."

We have a plan to really encourage people to take this step by actually making appointments for everybody who got their first shot, but not yet their booster, and sending them out a postcard saying you have an appointment on the following day at a location near you. We have their information because of their first shot, and there's real evidence just to show that some people when you do that for them, they'll respond by actually going to the appointment. For those that don't, we're calling on a more resource-intensive action of going door to door.

We have the staff for that because we have our Public Health Corps and we have a 2,000 Strong contact tracer workforce, which is now transitioning off contact tracing, and could be redeployed to go door to door to those people who got their first shots, but not yet their boosters. We know who they are. In many cases, we have phone numbers and emails so we can reach them. We want to go now before we're in the midst of what could be another wave.

Brian Lehrer: Dr. Varma, can I get your reaction to the fourth shot news in the last day? Pfizer is asking for authorization from the federal government to give fourth doses or second boosters to anybody over 65. I guess the science is saying the boosters wane after maybe four months in terms of protecting you from getting COVID at all. I guess there's still some protection against serious disease. I wonder if you have a scientific take, an epidemiologist's take on how much longer-term protection against serious disease which is the most important thing about the vaccines and whether you think people over 65 should all be getting fourth doses.

Dr. Jay Varma: This is incredibly complicated because the science is evolving at the same time we're trying to make a complicated public policy decision. There's a lot of logistics and research implications, so the way I look at it right now is that it's pretty clear from what we've gathered over the past two years that two doses is not sufficient for most people. There are some people that had prior infections or have some difference in their immune system that can get away with fewer doses, that's true with every vaccine that we have.

Even though we have a multi-dose polio series or hepatitis series, some people benefit from fewer doses, but for now, it's pretty clear that the vast majority of people, particularly older people benefit from three doses. The challenge becomes, do you start to now think about additional dosage? My basic thinking right now is that from what we have seen is that three doses provides fairly broad and durable, that means long-lasting protection against severe illness and death. Additional doses of vaccine probably help for the short term to protect you against getting infected at all.

By giving you that additional protection against any infection, you get an additional benefit over not getting severe illness. If you can protect yourself from even having the virus enter and infect your nose, that's obviously super beneficial. There may be situations in which particularly vulnerable people, particularly people living in congregate settings especially those with severe immune dysfunction may benefit from a additional dose not to give them long-term protection, but to probably give them short-term protection during periods when there's a lot of community transmission.

The way I'm looking at it is an additional safety net over the short term when you're about to face a future wave. Right now I would really focus on trying to get those over 50% of that adult New Yorkers that haven't gotten a third shot getting that to them and not worrying so much about even an additional dose.

Brian Lehrer: Can you do radio sound bite length science on why the vaccine wanes for protecting you against getting COVID at all but why despite that it persists for protecting you against serious disease?

Dr. Jay Varma: I think the briefest way to understand this is that your immune system has many layers of defense, but it takes a little time for you to bring that defense onto the field, think about it like a football game or something like that and you got to bring your defensive specialists in off the field. In that time while you're getting those players onto the field, the virus has an opportunity to cause some damage to you.

Basically, the virus lands in your nose or mouth, it starts to cause some damage, and then as your body's saying, ''Wait a second, we're under attack. We're bringing these new defense players onto the field,'' that's when you're protected against the severe illness. We know that vaccines can work really well to block any infection when there's a long lag time. It takes a while for once that virus lands in your nose to make you sick, but with this virus, it's a very short period, so your body just doesn't have enough time to mobilize the defense against that.

Brian Lehrer: All right, Borough President, I'm going to go back to you and because our time is short I'm going to tick off a number of these other points on the plan for protecting us against future COVID waves that you and Dr. Varma have put out. One is to make high-quality masks, standard and ubiquitous in every building. I think you mean in every building where there's a workplace. Another one is improved data collection--

Mark Levine: Not only that Brian, it should be also in public schools and public libraries, in community centers. Now when you can get a mask, it's pretty spotty, it tends to be lower quality cloth masks or surgical masks. We want to up the quality and really make sure they're everywhere. There should be standard in a building as Dr. Varma says, no less standard than soap in the bathroom.

Brian Lehrer: Another one is improved data collection and remain vigilant for early warning signs. One of your suggestions is to establish and fund a program for the city to monitor disease in a sample of households and long-term care facilities and shelters across the City. Then here's one that is related that a lot of people probably don't think about; you recommend utilizing and publicly sharing wastewater data to identify the new waves and variants before high community spread begins. Do you want to talk about why wastewater, Borough President?

Mark Levine: Sure, briefly and I might pass it to Dr. Varma but this is not a perfect tool, and I think it still needs to be studied more but it does offer a very early warning even before the virus could start to show up in test samples. There are a number of monitoring locations in New York City right now looking at wastewater. They, by the way, have shown some early signs of increase, that's also true nationally. I don't think we want to use this as our sole source of information but as part of a collection of data, they are valuable and we'd like to see greater transparency so the public can monitor this as well.

Brian Lehrer: Anything to add on any of those points, Dr. Varma, from your plan?

Dr. Jay Varma: Yes. Just to emphasize the importance of getting better data. One of the reasons we in the United States have relied so much on data from the UK, for example, is because they have household surveys, for example, that are being done continuously to track disease. We know as more people either don't get tested because their symptoms are mild and they don't worry about them or they tested at home and don't get a formal laboratory diagnosis. We need better data to be able to track what's going on.

The public appreciates that. I know that from my time working inside government, as well as my time working outside government. The more we can do to fund better quality real-time monitoring systems like they use in other countries, I think the better prepared the public will be to take actions that they themselves may want to take even if the government doesn't feel the need to impose a widespread mandate or to restrict certain activities.

Brian Lehrer: Dr. Varma, can I get your take on a new controversy that's broken out about vaccine mandates and the Yankees and the Mets, this apparently just emerged yesterday. I guess a lot of people assume that because they play baseball outdoors. It's not going to be the same as for the Nets who of course have their star Kyrie Irving who can't play in Brooklyn but can play on the road.

I was hearing reports yesterday that four of the Yankees' main starters including Aaron Judge are apparently not vaccinated and the City clarified to some sports media that, in fact, the in-person workplace vaccine mandate does apply to major league baseball. I think it's the only major city in the United States where that does apply. Do you think that should be lifted or do you think pressure should come to bear now only on the players to get their shots?

Dr. Jay Varma: Yes. We absolutely need to keep this mandate in place and I'll explain very quickly why that's so important. The most important thing we can do is to protect our health system from collapsing, which it was a great risk of doing obviously during previous waves. The number one way to do that is to achieve and maintain high levels of vaccination among anybody that's an adult in New York City because adults are highest risk. The employer mandate is one way that you can reach a vast majority of adults to make sure that they are fully vaccinated. It is not fundamentally about reducing the risk that vaccinated and unvaccinated people mix together.

We know they'll do that just like Kyrie Irving did over the weekend at a basketball game, but what it is about doing is making sure that people who might use New York City health facilities are protected as well as they can. It's not about indoors and outdoors and we just need to remember all of these athletes, Aaron Judge went to Cal State Fresno. He had to get five or six vaccines to play baseball there. Getting a safe and effective vaccine for this is not something new and it's not overly burdensome because he had to do that many times during his life before.

Brian Lehrer: That is the last word for today from Dr. Jay Varma who was a top COVID advisor to Mayor de Blasio, now he's with Cornell Weill and Manhattan Borough President Mark Levine. They've got their pandemic prevention from it coming back in a big way plan that they're laying out on this two-year anniversary of the day the New York City public schools and so many other things shut down. Thank you for joining us.

Mark Levine: Thank you so much, Brian.

Dr. Jay Varma: Great, thank you.

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