Brian Lehrer: It's the Brian Lehrer show on WNYC. Good morning again, everyone. Dr. Leana Wen is back with us at a very interesting and maybe hopeful moment in the pandemic, with Omicron cases declining precipitously, certainly in the New York area and other parts of the country likely to follow as we got hit first here. We've seen these moments before with new variants then popping up to pop our bubbles of optimism and normalcy, so where are we now and what should we do about it individually and at a policy level?

Dr. Wen teaches medicine at George Washington University, is a Washington Post columnist and CNN medical contributor, former health commissioner of Baltimore, and author of the book Lifelines: A Doctor's Journey in the Fight for Public Health. We'll talk about her column called Yes, More Variants May Emerge In The Future. That’s Why We Should Lift Restrictions Now. Dr. Wen, always good to have you. Welcome back to WNYC.

Dr. Leana Wen: Thank you, Brian. Great to join you as always.

Brian Lehrer: Can I just first get a response, even though I don't think that you heard the previous segment with the Nassau County Executive, who's against the governor of New York's mask mandate for schools. He asserted that the science indicates that cloth masks and paper masks, as he called them, aren't effective. What is the latest science on that as far as you know, you who've been covering this very closely?

Dr. Leana Wen: Well, this is becoming quite a nuanced issue and I do think it's important for us to not get bogged down in the politics. It seems like there have been this increased division of people who you're either pro-vaccine, pro-mask or you're anti-vaccine, anti-mask. I think that there is a nuanced discussion to be had. Specifically, if everyone is wearing high-quality masks, so N95, K95, et cetera, those masks are extremely protective.

They are protective of the individual. Even if others around you are not wearing masks, wearing one of these high-quality masks still protect you very well. If everyone is wearing high-quality masks, that also makes a much bigger difference than if everybody is wearing not very good masks. It is true that a single-layer cloth mask is simply not sufficient. Is it better than nothing? Absolutely. To say that masks don't have a role isn't true. However, in a time of Omicron, which is extremely contagious, wearing a one layer cloth mask just is not going to do very much.

I've been a proponent to say, "If you're going to wear a mask at all, and to make mask requirements, at least let people know about the masks that are effective for them," because I don't want people walking around thinking that they're well protected with a single-layer cloth mask when it's not.

Brian Lehrer: The other assertion he made, well, he made many, but the other one I'll ask you about is that the mask mandate wasn't necessary in schools, even at the height of Omicron, because kids don't get very sick from Omicron, basically. What's your position on that?

Dr. Leana Wen: Again, nuanced answer, which is that we know that Omicron is milder than previous variants, thankfully, we also know that children tend to get much less ill compared to adults. However, we also know that throughout the pandemic, nearly a thousand children, according to the CDC, have died. More than 6,000 have been diagnosed with this multi-system inflammatory syndrome since the beginning of the pandemic around the country. To say that we shouldn't do easy things in order to protect our kids isn't right.

However, I also think that we need to have an off-ramp for masking, including and especially in our schools because that trade-off of wearing masks, especially for our youngest children is something that we need to have an honest conversation about. I disagree with your previous guest in saying that there was never any use for masks. Certainly pro-vaccine, there was absolutely a use for masks because we didn't have these safe and effective vaccines. Now that everyone five and older is able to be vaccinated, we do also have to have a conversation about what it is that vaccines can replace. Can it replace, for example, required masking?

Brian Lehrer: Your article, and I'll read the title and we'll cut to the chase, the title, again, is Yes, More Variants May Emerge In The Future. That’s Why We Should Lift Restrictions Now, what restrictions do you have in mind?

Dr. Leana Wen: I want to start with a place of saying here are the two things that I don't want to see happen. Sometimes this conversation is framed in the binary of, "Let it rip and let's not care about COVID anymore." I don't think that that's right. We have thousands of people dying every day from COVID, We have an obligation to protect the immunocompromised, those who are medically vulnerable, the elderly, so we can't do that. At the same time, we also cannot live in 2020 or early 2021 mode, pre-vaccine mode, where everything is about infection control.

We're entering year three of this pandemic and we have to acknowledge the many costs of continuing to prioritize infection control above all else, which is, we've had our schools close, we've had such damage to our economy, we've had the opioid epidemic, and childhood obesity, that were already major problems, escalate because all of our attention has been focused, and perhaps rightly so, earlier on COVID.

My point of view is that there is a middle path, if you will, that we have to craft, which is that when we see that there are cases steadily declining, and especially when we see that hospitalizations are down to the point that in a particular region those hospitals are no longer overwhelmed, that we have to end the state of emergency and let people have some level of normalcy.

Some will cite that the potential for new variants is why we have to keep restrictions in place, but I think it's because of the threat of variants in the future that we have to let up while we can. We should remove restrictions as quickly as we place them because that helps us to preserve public health authority for when it's needed again with new threats. I think that now is a good time, especially in places like New York, and DC, and Maryland where I am, where numbers are clearly trending down to have a very clear off-ramp for all restrictions, for vaccinated people, because we know that vaccinated and boosted people are at very low risk for severe outcomes from COVID-19.

Brian Lehrer: Listeners, we invite your calls for Dr. Leana Wen. What have you been doing the last two months to adjust to the Omicron variant and what are you doing or planning to do differently as it wanes? 212- 433-WNYC, 212-433-9692, or tweet @brianlehrer. Also, parents of children under five, are you ready to get your really little ones vaccinated? Six months and up is what Pfizer says their vaccine could be approved for now. We'll get to that with Dr. Wen. Parents of children six months to five years, are you ready, or what questions do you have? 212-433-WNYC, 212-433-9692.

You acknowledge in your column, Dr. Wen, that immunocompromised people cannot let their guard down, but if the rest of society does in the way that you just outlined, where does that leave them?

Dr. Leana Wen: Yes, it's a really important question and I think there is a short-term answer and a medium-term answer. The short a term answer is that for people who are medically vulnerable, including people who are severely immunocompromised, who have other many chronic medical conditions, who are elderly, we do need to advise that they continue to hunker down because there is a lot of virus around us at the moment.

That includes continuing to take additional precautions, including very importantly, wearing that high-quality mask when in indoor crowded spaces. Perhaps when you are visiting with other individuals, for example, other people, relatives, friends are coming over for dinner, having them take a rapid test right before seeing you will help reduce risk as well. Now, that is not sustainable, and I fully recognize that all along in this pandemic, this pandemic has affected people unequally, and we need for the Biden administration to put all their effort behind making antiviral treatments readily available.

There is Evusheld, an antibody treatment that's given to immunocompromised people that can work for at least, it looks like six months in terms of gaining people antibodies even if they cannot produce antibodies on their own. That exists, but we need far more of this supply. We need a lot more tests, we need free masks. All of these things are what we need in order to treat individuals who are medically frail to prevent them from becoming severely ill.

I believe that can be done in the next few months, such that by the end of spring, early summer, those who are immunocompromised will also be able to enjoy the freedoms that everybody else has too. You are mentioning about parents of young kids. I've got two little kids of my own. Right now my husband and I have been living, as many families have, in a state of fear because we have been taking so many precautions to protect our young kids. Essential for us to get our kids vaccinated, but until then, I don't want for everybody else to hold back on what they're able to do in order to protect my family.

I don't want school kids to have to stay home from school, I don't want the want the economy to have to suffer out of deference to my children. It's a matter of time for my kids, it's a matter of time for the immunocompromised, everybody else. Once hospitalizations in that area are trending down, I hope that they will be able to resume some level of normality.

Brian Lehrer: Tori in Cornwall, New York, you're on WNYC with Dr. Leana Wen. Hi, Tori.

Tori: Hi. I'm a Progressive Democrat. My kids are vaccinated. My son will be boosted tomorrow. I am against these masks now. I think enough is enough. My daughter loves singing, and to see her sing on stage with a mask on when the rest of the world are going about their business and going to games and concerts and everything, it's heartbreaking. Our kids are little for only so long. Our family's done everything [unintelligible 00:10:53] mask. Now it's a time to take them off. Enough is enough.

Brian Lehrer: Did you feel that way month ago at the height of Omicron, Tori, or is this coming to you now as it starts to wane?

Tori: I felt it. I think when I saw her singing at her concert and when I saw the pictures of people attending games and basketball games and of a host of other things, and I was like, "Enough is enough." Yes, I felt like this for the last couple of months as my kids are [unintelligible 00:11:34] up and going back into school and getting on with their activities.

Brian Lehrer: You mentioned to our screener that both your kids are boosted. That changed your mindset too once they got those?

Tori: I was like, "We've done everything we've been asked." My daughter's not because she's not quite old enough yet, but my son will be tomorrow. I think after that happened, I was like, "No, our family's done what we were asked. Everybody else can get vaccinated. They can do what they choose or not to do." Honestly, the number of parents who's going to get their kids vaccinated, it's not going to budge that much.

Brian Lehrer: Tori, thank you so much for your call. We really appreciate it. Dr. Wen, she may be the poster person for your argument, liberal Democrat who got her kids vaccinated, and when age-eligible, boosted, arguing for being done with the masks. What do you say to the argument that Omicron has shown itself capable of breaking through the vaccine much more than anyone anticipated?

Dr. Leana Wen: Well, but let's talk about what it is that we care about at the end of the day. What we care about is preventing severe illness and death. We are now dealing with the variant that's dominant, Omicron, by far is still the dominant variant here in the US and around the world. It is milder than previous variants. People who are vaccinated and boosted are extremely well protected from severe illness due to Omicron.

I really hear Tori's frustration. It's frustrating that I hear from so many of my colleagues, and friends, and pediatricians, and infectious disease doctors, and educators who are basically saying, "Why is it that people who are vaccinated and boosted, who have done everything right during this pandemic, who are now having to pay the price for people who choose to remain unvaccinated?" Because those are the individuals who are at highest risk.

Now, in addition, why is it that children are having to pay the price when we see adults are going about their daily lives and going to bars and concerts unmasked, in many cases? Why is it that children are still staying masked when everybody five and older is able to be vaccinated? They are well protected from severe illness. The chance of them getting severely ill, full stop, is low, but also individuals can choose to mask in if they wish. That mask will protect them very well.

There is a movement of physicians and educators called the Urgency of Normal, specifically to address what Tori mentioned, which is maybe it's time, beyond time actually to let our children have a normal existence. I think that it's important to have this conversation because the people who are raising it are not anti-maskers, they're not anti-vaxxers, they're people saying good health and a good life is not just the absence of COVID. We need to look at the trade-offs that our restrictions have had now entering year three of this pandemic. Let's have an honest conversation that's evidence-based about what is good for our children, especially going forward.

Brian Lehrer: Pfizer is seeking approval for the vaccine for kids as young as six months old. Is it ready, in your opinion?

Dr. Leana Wen: I don't know, is the honest answer, because we have not seen any data. Usually, when the pharmaceutical companies have applied for authorization of the FDA, they've released press releases of some kind showing what data they have. We don't have anything. Based on what I understand thus far, we may be in for positive data because, actually, of the sheer number of infections in recent months, that we may be able to see perhaps that there is a substantial reduction in illness for children with two doses of the vaccine.

I would love to see that. I think the concern that many of us have is what was stated by Pfizer earlier was that they're studying the vaccine as a three-dose vaccine, especially for children in this two to four-year-old group. I'm not sure how you can approve a three-dose vaccine until you have three-dose data. I hope that they'll either have those data or they'll have the data for what two doses show, as in if you can see that two doses will reduce, let's say, hospitalization, that might be sufficient, but I really want to see what those data show rather than speculate. I'm really looking forward to this FDA meeting.

What I will say is that I have full faith in the process. I have faith in the FDA, I have faith in the CDC, I am certain that they're going to make sure that the vaccines are safe and they're going to be effective prior to approval. I cannot wait for that moment when I'm able to give my children the excellent protection that older kids and my husband and I and adults have been able to enjoy.

Brian Lehrer: Jeff in Brooklyn, you're on WNYC with Dr. Leana Wen. Hi, Jeff.

Jeff: Hi. I live in New York City. I live in a neighborhood that was hit fairly hard in the first two years of the pandemic compared to the surrounding neighborhoods. I also am vaccinated and am very much for masking pretty much all the time and I'm only using K95s now. I also weekly go up to Westchester to visit my family, in particular my grandmother to take care for, who is completely against vaccination and thinks [unintelligible 00:16:59] masking is very inconvenient, as well as some of my aunts, uncles, and cousins are along those lines.

Whenever I am taking care of her and I have a heavy mask on, it makes [unintelligible 00:17:10] difficulty for communicating since she's an octogenarian. Is there anything that I might look forward to not have to worry that I'm a danger to her in taking care of her as an elder?

Dr. Leana Wen: It's a really good question. I appreciate the way that you frame this as well because there are many people in our lives who, for whatever reason, are choosing to remain unvaccinated. We want them to be vaccinated, but we also want to keep on interacting with them, caring for them, and loving them at the same time. I think there needs to be guidance too on how can we do so in a way that's safe to them and safe to us as well.

A couple of things that you could do. One thought is, especially for people who are generally healthy, if you have other people in your household that you interact with on a regular basis who are generally healthy, you could say, "Well, the chance to me of getting severely ill from interacting with people who are unvaccinated is relatively low. Because it's so important to me to take care of these unvaccinated individuals, I will bear that risk and even go maskless." Now, that is one choice. I understand that's not a choice that many people will make, but it is one choice.

Another choice is to say, especially in your case, because you're concerned about your elderly family, who are unvaccinated and at risk themselves, you could get a rapid test prior to seeing them, especially as case numbers become lower. I believe it would be reasonable to say that the rapid test can replace the need for masking. As in, think about all of this, as we talked about all along, Brian, as these are layers of protection. You need a lot of layers when there's a lot of virus around the us, but when the levels of the virus begin to decrease, then if you're vaccinated and you get a test, I think it would be reasonable to say that that could replace the need for masking. Those are all the options that are on the table.

Again, I appreciate this conversation because I think so much of the conversation or so much of the discussion has been polarizing in terms of what the policies should be. But for those of us who live in the real world with complicated situations, it's helpful to have guidance to navigate those situations.

Brian Lehrer: All right. We will have to leave it there with Dr. Leana Wen who teaches at George Washington University. She's a Washington Post columnist and CNN medical contributor, former health commissioner of Baltimore, and author of the book Lifelines: A Doctor's Journey in the Fight for Public Health. We always appreciate it, Dr. Wen. Thank you so much.

Dr. Leana Wen: Thank you, Brian.

Brian Lehrer: We'll continue to take some of your phone calls right now with your own off-ramps and how you are adjusting to this moment when it's been two years and when the Omicron variant is starting to wane.

Listeners, if you were holding on to ask Dr. Wen a question, please hang up and let other people get through, but if you were calling to tell a story, as some of you were, you can hang on and others can call too on what you've been doing the last two months to adjust to the Omicron variant and what you're doing or planning to do differently as it wanes. 212-433-WNYC, 212-433-9692. If you're a parent of children under five, are you ready to get your really little ones vaccinated? 212-433-9692. Millie on the Upper West Side, you're on WNYC. Hi, Milly.

Milly: Hi, Brian. Thank you for taking my call. Always happy to catch Dr. Wen. My daughter is an experienced preschool teacher in Manhattan on the west side, and we were just having this discussion last night that this is just the beginning of the studies that are going to come about years from now, these young children who have spent two years of their very important years, where their lives and their brains and their attitudes and their whole beings are being formed, three, and four, and five, with masks and whether or not they're germaphobes or afraid to touch anyone.

The whole thing, you've had teachers and healthcare workers on before, and we all know that-- God bless our healthcare workers and our teachers. I think I'm pretty much right behind you because I hear my daughter. She's wonderful with these kids, but oh, man, every single day, the emails and the changes and all this stuff with the kids, eventually, yes, there has to be an offering. I actually dialed the phone, Brian, when I heard "the four words" from Dr. Wen, We need to have a, "A very clear offering".

Absolutely. Last caller said also we're not hearing this from Republicans, we're hearing this from liberal Democrats. Thank you. Thank you so much.

Brian Lehrer: Thank you very much. The fact that liberal Democrats are starting to say a similar thing obviously is Millie's point. Michael in Westchester, you're on WNYC. Hi, Michael.

Michael: Hi, Brian. Thank you so much for all these great conversations you're having. One recurring conversation that [inaudible 00:22:43] and the prior one was the county executive and that I've heard and read in New York Times [unintelligible 00:22:50] is this conversation around children and their well-being when it comes to COVID. We're talking about just New York public schools, [inaudible 00:23:01] of thousands of adults that work in these schools.

Every time this conversation happens, we forget to mention all the adults that are in. As well you did reference it that these children returned home to families with immunocompromised parents or grandparents. I just think whenever we have this conversation, we can't talk about schools without talking about the hundreds of thousands across the country, the millions of people who work in our schools. It comes to off-ramp, but I think the hospitalization is a key factor you'll always be looking at.

Brian Lehrer: Michael, thank you very much. I appreciate it. One of the things we didn't have time to get to with Dr. Wen before she had to go was a part of her Washington Post article that says there are two approaches here. One is gradual and based on case numbers and test positivity. She writes, "Communities can identify two thresholds for transmission. At the higher level, there should be two out of three protective measures; vaccine, testing, or masking. Individuals should be doing at least two of them. Workplaces and schools that require vaccines and that have regular testing can do away with masks."

She wrote, "At the lower level," that is the lower level of spread, "One out of three is enough such that vaccines or testing alone can replace the need for masks," in her model. That's one model. Then she wrote another approach which he wrote that she's beginning to favor. Here's to state that, "Every person five and older can be vaccinated and high-quality masks can protect individuals well. Therefore, masks can be optional, not required, even at high rates of community transmission, the threshold for re-implementing indoor masking would shift from case numbers to hospital capacity in that model.

She writes, "Of course, masking could also return if a deadlier variant arises that evades prior immunity." More of the thoughts from Dr. Wen. Leah in Brooklyn, you're on WNYC. Hi, Leah.

Leah: Hey, Brian. It's Leah and my daughter on the phone here. [crosstalk]

Brian Lehrer: Another child makes their radio debut on the Brian Lehrer show. What's your daughter's name?

Leah: She loves your theme song. Gaetana.

Brian Lehrer: Hi, Gaetana. I'm a disembodied voice. Hi, Gaetana. Go ahead, Leah.

Leah: That's really exciting. Brian, I'm calling as an educator and as a mother. Look, I teach in a number of different schools I go in as a teaching artist. At one school, NYU, I go in, all of my students are vaccinated. There's super high levels of testing and I feel super safe, masking or unmasked, really. The other day I go into a high school and none of my students are vaccine-required, and in this community many of them aren't vaccinated. If they were to shift to no-mask requirements, I would be really frightened going to that school and then coming home to Gaetana, who is too young to be vaccinated.

Again, echoing your last caller, what do the people whose work and livelihoods depend on showing up in these environments do when these mask requirements for, as your last caller said, her daughter who's in the choir doesn't want to wear masks anymore. It's a catch-22, I feel.

Brian Lehrer: Leah, thank you very much. Let's go to Dan in Manhattan, who I think owns a restaurant. Is that right, Dan?

Dan: Yes, I do. Can you hear me?

Brian Lehrer: Yes.

Dan: I'm following the CDC rules to the note. Everybody in my restaurant is fully vaccinated and has a mask. Another thing that's very important, we have children that come in here too, we get calls daily asking if we're fully vaccinated and if we have masks available. We have to keep masks available for any customers coming in. I can't agree with this idea that there's this strong urge out there when Leana, this doctor has come out and said right in her a Washington Post, you can no longer count on the CDC rules to keep you safe. We can't have it both ways.

We give N95 to all our employees. We won't let you in the door if you will not wear a mask and if you're not fully vaccinated. Once again, that's what our customers want. I'm a person who's had a sister die from this two years ago, a neighbor of mine just died recently from COVID, and I'm at ground zero up here in Washington Heights, ground zero. I just don't see this "turn of progressive Democrats" burning their masks or something. I don't believe it and I think it's a great way of keeping people safe.

By the way, I have two children in school. Every week, I get a message from the school saying how somebody just caught the Omicron virus. Let's not fool ourselves, we can have another virus variant come in. You know what I'm saying? I'm all for masks. Children are very resilient. I don't believe they're being greatly damaged, but I don't want to get into that. I could tell you, if anyone did a quick search on Google, you will see hundreds of studies on how good masks are, hundreds of them from very, very, very capable organizations, universities, and yes, the CDC. I have a feeling this is against Fauci, a lot of this stuff, but I don't want to Joe Roganite this whole debate. [crosstalk]

Brian Lehrer: Right. It is interesting that Dr. Wen, and there was a liberal New York Times columnist who wrote a similar thing the other day, on taking an off-ramp, at this moment, at least, when Omicron is really fading, and especially for children. There is more conversation about this, especially with respect to masking in schools across the political spectrum right now, but to one of your points that we shouldn't let get lost, Dr. Wen did make the point very clearly in her column, that one of the reasons to do this is because more deadly variants might be lurking around the corner and we have to be ready to mask up, again, more fully if that does occur, if one does come along. That's a reason to ease up right now to give people a little bit of a break.

Dan: See, I'm not for that. I think we should keep it floored and keep people safe.

Brian Lehrer: Let me ask you one other thing about your restaurant, I guess you say you're seeing your customers do want to mask up. The libertarian position would be, "Well, there are going to be restaurants like yours where that's the culture that develops of the clientele. There are going to be other restaurants where people don't want to wear masks and let people self-sort in that respect. What would you say about that?

Dan: I would say, if I'm going to think like a libertarian [unintelligible 00:30:16] put your business wherever you want, but there is something that we're all missing here. The last administration here said before they left, de Blasio said, "We have not lifted any of our restrictions. They still really are in place." I could have a health inspector come in and say, "Where's your mask? Where is your sanitizers? Where is your list? Where is your reservations?" We keep reservations on everybody. I believe we're doing everything that our customers would want, that our employees would want. Take your business elsewhere. I'm sorry, I can't give you the [inaudible 00:30:51]

Brain Lehrer: Of course, it is always about the workers because the patrons have a choice, where to eat, whether to dine out at all. The workers, if they're going to make a living and keep a job, they have no choice, they have to be in there with them. [crosstalk] Let me ask you one last question, which is how much good, in your experience as a restaurateur, does the masking do in a restaurant where after all people have to have it off to eat?

Dan: How much good does it do? I think it does a tremendous good because you see how people like when they get up to go to the bathroom, they do put their mask on. I think it keeps people on their toes. We used to have a lot of milling around because people know each other in the neighborhood, they don't get up and do that anymore, which is okay, but like I say, I think it's doing good, if that's the question. I think it's doing a tremendous good. People become more vigilant. I should tell you, too, my employees refuse, will not wait on anybody who's not fully vaccinated and has a mask. They just come up to me and say, "I'm not waiting on that person." [crosstalk]

Brain Lehrer: Thank you, Dan. Thank you very much. That's where I guess the Leana Wens of the world will depart from our previous guest, Bruce Blakeman, the Republican Nassau County Executive, and the Bruce Blakeman of the world, which is he's pro-vaccination. He's set up more vaccination, availability pods in Nassau County, he says, but from what I read, he's not enforcing the vaccine mandate in public places. Dr. Wen says the vaccine mandates should remain in place and that's one of the keys to unmasking. The conversation goes on. Obviously, as the pandemic goes on, we will keep having it here. Thanks for all your calls on today's edition. Brian Lehrer on WNYC. The show continues.

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