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Mayor Adams: We want to see the faces of our children. We want to see their smiles. We want to see how happy they are. We want to see when they feeling sad so that we can be there to comfort them, and a mask prevented us from doing so for almost two years. It's happy to see those smiles again.

Brian Lehrer: Brian Lehrer on WNYC, and that was Mayor Adams, of course. That was from last Friday. It's officially been one week, therefore, since the mayor lifted New York City's public school mask mandate and ended vaccine requirements for restaurants and entertainment venues. Governor Phil Murphy has also lifted statewide school mask mandates in New Jersey. That took effect on Monday. Mayor Adam says he will reinstate mask requirements if the city gets into high alert, which is how public officials are now classifying COVID risk, a color coded alert system from low to very high, which uses CDC guidance to combine case numbers, hospital admissions and occupied hospital beds.

For example, the positivity rate over the last seven days in the city was just 1.29%. That's how many other percentage of PCR tests that were coming back positive, with 486 confirmed new cases per day on average over the last week, 21 new hospitalizations and 9 deaths per day, that is so much lower than it was just weeks ago, and the CDC classifies that as low risk. Masks are still required in a number of places don't forget, including on the subway and at Broadway theaters. The TSA will keep mask mandates in place for flying on airplanes until at least April 18th. They just extended that this week.

Listeners, we want to open up the phones right away. How did it go this week? How do you feel about the city's new guidance 212-433-WNYC? If you're let's say a public school parent or a teacher, did you opt for a mask which you still can do for yourself or for your child? 212-433-9692. What was the ratio of masks to non-masks in your school? If you're a restaurant owner or worker, is your establishment choosing to keep vaccine requirements going despite the requirement from the government being lifted? 212-433-WNYC. If you work in restaurants, how do you feel about the mandate applying to you, to work there, but now not to your customers? Does that make you feel safe enough? 212-433-9692.

Call in with your thoughts on this transitional week and your experiences. Are you keeping mask mandates or vaccine requirements or giving them up in places for which it's now voluntary? 212-433-9692. With me now are Dr. Denis Nash, professor of epidemiology at the CUNY Graduate School of Public Health and Health Policy and executive director of CUNY his Institute for Implementation Science and Population Health, as they call it, and Dr. Wafaa El-Sadr, Columbia University professor of epidemiology and medicine, and Director of Columbia world projects and the group called ICAP Global Health Center at the School of Public Health. Basically, we have an epidemiologist from CUNY and an epidemiologist from Colombia to compare notes here. Welcome back, both of you, Dr. Nash, Dr. El-Sadr, welcome back to WNYC.

Dr. Denis Nash: Thank you, Brian.

Dr. Wafaa El-Sadr: Thank you. Pleasure to be with you.

Brian Lehrer: Do you both want to start by talking about how you felt going into this week as epidemiologists, how big a milestone is lifting these requirements in the pandemic, and is it happening too quickly? How much are you holding your breath? Dr. El-Sadr, you want to go first?

Dr. Wafaa El-Sadr: Sure. I think as you said, Brian, this is a transition moment. I think there's an appreciation that we are in a favorable situation when it comes to COVID-19 in the city based on all the metrics that you mentioned, that put us in a low risk situation at this point in time. It's a moment where I think that people have been clamoring for in terms of needing and really yearning for a respite from some of the restrictions that have been put in place.

It's good a moment as any to be able to ease some of the restrictions. At the same time, of course, we and are concerned because we have not eliminated or eradicated this virus. It is still circulating, the pandemic is not behind us as of yet. We have to take this moment and ease maybe some of the restrictions, but always be keeping in mind that we have to maintain vigilance, we have to be careful, we have to monitor the situation and be ready if things change, to be willing and ready to put back some of these same public health protective measures.

Brian Lehrer: Dr. Nash, same question.

Dr. Denis Nash: I feel similarly, it's wonderful to be in a good a better place, a much better place than we've been in a long time, but yet, this is also one of those many times where I am holding my breath about what comes next. Certainly, we need, as others have said, a plan, we need to know what the plan is in the event and the perhaps likely event that there could be a future surge and so these removal of restrictions with provisos that they could be needed again, should also come with a plan about how we're going to avoid what was a pretty chaotic and disruptive and devastating impact of the last surge.

Brian Lehrer: Let's take a phone call. I think we have a dad with a question for you, Matt, in Jersey City. You're on WNYC. Hi, Matt.

Matt: Hey, Brian. First off, thanks so much. I work at a-- or help out at a co-op preschool in Jersey City and I feel like you're our own private epidemiologist. Thanks for all the guidance and it's partly too, though, [crosstalk]

Brian Lehrer: I'm no epidemiologist and I don't even play one on the radio, but we're happy to have conversations with epidemiologists all the time. Go ahead.

Matt: That's right. I also feel like I've had to call in once or twice for advice already because there's so little for under-five and we're kind of left in the lurch. There's been a lot of discussion in the community about what to do with mask since our group still can't be vaccinated, but then I think there's been a sea change with the maps from the CDC and everything looks green now. Also even maybe the 5 to 11-year-old vaccine isn't even that effective. I'd love a little perspective on what people in under-five settings everywhere probably should be doing, but I guess particularly what makes sense for a preschool in terms of masking and other safety measure.

Brian Lehrer: Matt, thank you very much. Dr. Nash, you want to take this one? Here's a dad with choice now about his, I guess, five year old. What do you recommend?

Dr. Denis Nash: Yes, I really feel for the parents and the kids who are very young that have been enduring these restrictions for so long, and even holding out hope for availability of a vaccine that many of us expected to be coming late 2021 or early 2022. It's still not here. I think that age group is among the highest risk of kids in terms of the potential for a bad outcome of COVID. That's really important to keep in mind, and the other thing about kids is, while we know that the risk of severe disease for the most part is on the lower side, that COVID doesn't stop with the people that it infects, it can continue to spread onward, and so we need to remember that there's an important role for precautionary measures even for the youngest kids.

Brian Lehrer: Right, so that's the tension. Should I take that as a, yes, keep your kid masked piece of advice to the caller?

Dr. Denis Nash: I think if we're talking about schools, especially where there's either no vaccination rates because of age or very low vaccination rates, I think it's very important for kids to continue to mask.

Brian Lehrer: Dr. El-Sadr, do you want to jump in on that?

Dr. Wafaa El-Sadr: Yes, I know, I agree with Denis and I do think we-- One thing that I always highlight is it is, especially for young children under five, that it's really important to make sure that they're surrounded by vaccinated and boosted adults, because in some way that will end up protecting them as well. That means parents, family members, friends, and hopefully also the workers in the places where they go for childcare, I think that is extremely helpful. I think we should not lose track of the importance and the value on the effectiveness and the safety of vaccination for the other age groups above the age of five and now the importance as well as getting a booster dose.

Brian Lehrer: Lexi in Brooklyn, you're on WNYC. Hi, Lexi.

Lexi: Hi. Oh, I'm on the air. Again, speaking to this issue of two to four-year-olds masking, I'm not sure if the epidemiologists you're speaking to spend a lot of time with two to four-year-olds. Have you seen how two to four-year-olds actually wear a mask? Usually, my three-year-old mask is wet and soggy, pretty unsanitary at the end of the day, no matter how many masks I send him with throughout the day. She doesn't tolerate the mask while he chews through it. I know I'm not the only parent that had this issue with their children. I'm just not sure the messaging about masking two to four-year-olds with the masks probably do very, very little, and yet, there's the harm developmentally.

I know you guys are in public health, you're epidemiologists, you look more at the numbers, but from an overall public health perspective, I think there's needs to be more discussion on the possible developmental harm this is doing two to four-year-old. I have a two-year-old and a four-year-old, they're learning to speak. They're learning to read. They're learning social-emotional. They're learning empathy. It's obvious to a parent, I think it's also obvious to a lot of pre-school teachers and people who take care of two to four-year-old, they don't wear a mask correctly, the KN95 are not approved for that age group. There's possible harms that we are not going to see maybe for years to come. There's an article in the New York Times that said that reading was below I think--

Brian Lehrer: Go ahead.

Dr. Wafaa El-Sadr: Most recent article in New York Times was that reading was way behind in children.

Brian Lehrer: Lexi, hang on. Let me get a response from you. We're getting a number of people with basically the same question, Dr. El-Sadr, because the mask requirement is still in place for that age group under five years old, if they're in group settings, and you hear how this parent feels about it, including wondering if the masks are even really doing that much good.

Dr. Wafaa El-Sadr: Yes. I think I genuinely appreciate the complexity and the difficulty in terms of masking of young children. Just to reassure you that public health people look at more than the numbers, we're very interested in the uptake of these measures by people and how they're acceptable, and how feasible it is to use masks in every age group. There are its risk then, it's essentially a balance and you're thinking of what are the risk versus what are the benefits of the masks.

There are, as you said, some complexities. We know the deficits that we've experienced from virtual learning and we know how difficult it is for young children to wear masks, and there's variability. I was just talking to a colleague yesterday who has a young child and I asked her about masking his three years old, and she said he has no problem. There's great variability as well amongst children. I think we need to be as parents and public health practitioners to be aware that it's not going to be perfect and that we always need to be careful about making sure that we're balancing the risks and benefits based on their specific trials and their circumstances.

Brian Lehrer: Dr. Nash, let me ask you more about the data locally. The CDC labeled all five boroughs as medium risk last Thursday in a recent batch of data, but that risk level dropped down too low on Friday. That raises a few questions. One, should people change their behavior individually if risk levels are fluctuating from day to day based on, "Oh, today it's red, today it's orange?"

Then looking at the data the city puts out, they say the whole city is at low risk according to these CDC color codes, but still, they provide neighborhood-by-neighborhood positivity rates, in some cases in shades of red, which are of much higher concern. Breezy Point, for example, out there is currently deep red with a 3.2% positivity rate, while Woodlawn in the Bronx is 0%. Who is this data for, and what are people supposed to do with it?

Dr. Denis Nash: I think it's hard. We have very imperfect data to really guide us on a daily basis as we would like to have. I look to places like the UK which I think has the gold standard of surveillance for COVID right now, and they're doing routine population surveys of prevalence levels of COVID that reflect the general population, not just those that are going out to test, and I think that helps to remove a major blind spot that we have in our metrics. I do think that the hospitalization and depth data that we get from the city are representative of the population, but the problem is, is that they come weeks later after a surge happens.

We're working with a lot of imperfect data. I think the 500 or so cases that we hear about every day in New York City certainly is not the totality of the cases that are prevalent and occurring out there on any given day. We are I think not in a place where we should follow metrics from one day to the next and change behaviors from one day to the next, but I think the overall picture is saying that we are in a much better place now than we have been in quite some time, and the trends seem to indicate that, it's continuing to go that way.

Brian Lehrer: Susanna in Brooklyn, you're on WNYC. Hi, Susanna.

Susanna: Hi, Brian, thank you so much for taking my call. I'm calling mostly concerning the drop of the vaccination mandates in restaurants. I'm a server in a restaurant. I'm just a little confused because I understand as the vaccination rate in New York City is so high and we're moving towards being maskless as a means to get back to normalcy, it feels to me like a rush into this. I'm wondering what the overall, also it's safety, as well as the idea that if a worker in a restaurant gets COVID, they can't work from home. They have to quarantine for 10 days even if it's mild symptoms, or 5 days as the CDC recommends right now. I'm curious, if someone could speak to that. Thank you so much.

Brian Lehrer: Thank you. Dr. El-Sadr, would you do that?

Dr. Wafaa El-Sadr: Yes. I do think restaurants are very unique setting like you just mentioned. I think that's a situation where I think the idea of optional masking is important to keep in mind that it is an option for workers in restaurants, for example, since they will not be able to have the status of all the people who are dining know that they're vaccinated. The option of continued masking is a good option for them. I think over time, and that's what I mentioned the importance of being vigilant and watching the data. Over time, we will have to keep an eye and see the impact of some of these, the easing of restrictions like the vaccination requirements in restaurants.

As you said, the vaccination uptake is admirable in the city, with the exception, of course, that certain subsets of our population, but nonetheless, I anticipate that over the next several months, we're going to have an influx of visitors and tourists, and others coming from regions of the country in the world where vaccination rates are much lower. That makes me worried that although we are in a good place when it gets to vaccination coverage in our city, over time, we might note that there will be a much more of a mixing of unvaccinated and vaccinated people that are frequenting movie theaters and restaurants and so on, and that may require us to make some adjustments in the future.

Brian Lehrer: By the way on that city neighborhood-by-neighborhood map, what I'm seeing is the highest positivity rate now in the city is in the financial district at over 5%. Dr. Nash, does that sound right to you? One would guess I think that a higher income neighborhood like that, because in housing there is higher income now. It's not just the people who work on Wall Street would have a low positivity rate.

Dr. Denis Nash: Again, working with imperfect data here, but the testing data can reflect a number of different things, in addition to just who's testing but also where they're testing. I think we just have to take that with a grain of salt, but I would say we would expect, as people return to the office, for example, and if there are situations with optional masks, when people are indoors without masks, there is going to be additional COVID spread happening in those environments.

I wanted to just say as public health people, of course, we think about masks and things like that, but really the mask is like the last layer of protection and we really like to try to reduce risk through other means that are at a higher level. Vaccination is also one of those things, but ventilation of workplaces and schools and other things like that are really important, especially as we hear young kids have difficulty wearing their masks. We need multiple layers of protection to help reduce the spread that will happen as we relax these restrictions.

Brian Lehrer: Can I get each of your takes on this? Oh, go ahead, Dr. El-Sadr, you want to add something?

Dr. Wafaa El-Sadr: I think the issues regarding the positivity rates and the complexities of interpreting those numbers is the reason why both the city as well as the CDC are moving away from that metric, and rather moving to more of measuring severity of illness as reflected by hospitalizations and so on. We have to keep an eye on certainly on numbers of cases, but I think we're shifting towards a better metrics like customizations.

Brian Lehrer: Also, I guess, people who can afford them have the at-home tests now. That would probably hide a lot of positives from the positivity rate. Well, it would-

Dr. Wafaa El-Sadr: These are not reported as you well know, of course.

Brian Lehrer: -make the positivity rate look lower than it actually is. Before we run out of time, I'd like to get each of your take on this new variant of the Omicron variant that one report I saw I said is doubling in New York. Now, it might be doubling from extremely low to very, very low, but what do you make of the new Omicron and your estimate of its threat level for the city in the coming weeks? Dr. El-Sadr?

Dr. Wafaa El-Sadr: Yes. I think that part of the concern is that and that's why we have to be thinking ahead in terms of what's coming down the line, and certainly, new variants are something to keep an eye on, I think that the data seem to be, at least the early data, seem to be reassuring regarding this new sub-variant of Omicron. It appears that it is not causing more severe illness, and it appears also, at least in the laboratory, that our vaccines and boosters appear to be effective against this new sub-variant. This is exactly highlighting the fact that even though we are easing some restrictions for individuals, that the public health system and all of us collectively should not ease on our preparedness and our work in order to detect the new variants in the future and so on.

Brian Lehrer: I should mention on the rapid tests that President Biden mentioned in the State of the Union, that anybody can get a second batch if you've sent away for your first batch of four rapid tests from the government. Now, it's COVIDtests.gov if you want to go to the website and order that, COVIDtests.gov. Dr. Nash, we have 30 seconds left in the segment, your take on Omicron too. They say it's twice as contagious as Omicron 1, but the essential characteristic of Omicron 1 was that it was so contagious.

Dr. Denis Nash: Yes. I think it is worrisome and something we need to keep an eye on. There are some pretty substantial surges in cases happening in Europe right now. The UK is having a big surge including increases in hospitalizations and we know that what happens there can happen here a few weeks later, so we really need to keep an eye on it. It's really important for people to get boosted and for our elected officials to have a plan for a possible surge that is multi-sector.

Brian Lehrer: Dr. Denis Nash from CUNY, Dr. Wafaa El-Sadr from Columbia. Thank you so much for joining us today. We always appreciate when both of you come on and continue to enlighten us about the pandemic.

Dr. Wafaa El-Sadr: Thank you.

Dr. Denis Nash: Thanks, Brian.

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