Brian Lehrer: Did you know that back in the 18th-century spring fever referred to an actual sickness that some people would get at the end of winter because they hadn't eaten fruits or vegetables for months, that sickness was scurvy. Now, of course, spring fever relates to a state of warm weather anticipation which is only made worse by the actual fever going around that has made this winter all the darker and all the more unbearable. This week as temperatures climb into the 60s, even above 70 predicted for tomorrow in the New York area, they're saying, and spring fever reaches a fever pitch, what have we learned about outdoor transmission since last spring and summer and have the new COVID variance added any uncertainty into that data? With me now to talk about that and other COVID-19 related issues, and there is some interesting news coming from the CDC just in the last day, Dr. Jayne Morgan, cardiologist and clinical director of the COVID Task Force for the Piedmont Healthcare group in Atlanta. Dr. Morgan, hi. Welcome back to WNYC. Thank you for doing this with us again.

Dr. Jayne Morgan: Hi, Brian. Happy to be back. Thank you.

Brian Lehrer: Remind listeners what we do know, and I think it's mostly good news about how weather changes affect the virus.

Dr. Jayne Morgan: Well, one of the things that's postulated with regard to the weather, and we did not see this bear out in our last season, we are now in a full year, more than that of the vaccine, is that warmer weather can decrease the transmission but what we have discovered however is that our behaviors are more heavily weighted towards what really mitigates and what encourages the transmission of the virus. Even though we're outdoors and the weather is warmer and theoretically the virus should have less survival, if we still are not practicing good population health, public health, social distancing measures, and working towards that herd immunity, we still absolutely run the risk of continuing to deal with this virus.

Brian Lehrer: We know from various studies conducted over the last year that the majority of transmission, the vast majority more than 90% is the stat that I've seen occurs indoors but what are some outdoor activities that account for that last 10%, is that known?

Dr. Jayne Morgan: No, I don't think that we've identified specific outdoor activities with the exception of what is the behavior that takes place in those outdoor activities. Is there crowding, mass concerts or rallies or people close together? Are people shouting? Are people singing? All these types of things that require a projectile and you project out of your mouth. If you are contaminated or if you have COVID, you can forcefully take these viral particles and shoot them across the room. Those kinds of activities, I think we try to discourage. Other than that, even outdoors if you are socially distanced with your mask we like to encourage you to do so because it's certainly much safer outdoors where there's free circulating air than indoors.

Brian Lehrer: Now, listeners, again, today we can take your questions COVID related for today's guest, Dr. Jayne Morgan cardiologist and clinical director of the COVID Task Force for Piedmont Healthcare in Atlanta. We've been doing call-ins with so much new about the CDC guidelines on what vaccinated people can do, and so much new about the variants coming out this week, we've been doing these call-ins for your COVID questions. We know you always have COVID questions. We've been bringing on a different expert every day. This week today, Dr. Jayne Morgan back with us for the third time in the last few months, 646-435-7280 if you want to call in. That, of course, is our on the air number, not our pledge drive number. We'll never ask you for money when you're asking a question on the air I promise.

646-435-7280 for COVID questions this morning. One of the things in the new CDC guidelines about what vaccinated people can do, and we talked earlier in the week about how they're saying it's okay for fully vaccinated people to get together with other fully vaccinated people indoors, no social distancing, no masks, but there's a caveat, which is you have to be-- Sorry, I'm going to add a different one than we spoke of earlier in the week. You also do not need to quarantine if you're exposed to somebody who has the virus, but the caveat is you have to be vaccinated within three months of that exposure to be confident. What does that tell us about how long the CDC is confident about how long vaccine immunity lasts?

Dr. Jayne Morgan: One thing we know about the clinical trials is that we are under an emergency use authorization, not FDA approval, and that really means that all of the data is not in. What data do we have? We have all the safety data, and we have all the efficacy data, meaning we understand how well it works when we start to hear these numbers, 72, 85, 95%, that's efficacy. The data that we don't have fully is that immunity data that you are referring to.

The FDA requires two months of immunity data to qualify for emergency use authorization. If we were not in an emergency, meaning our population is at risk of death or serious health impacts, deleterious health impacts, and we waited for full FDA approval. Then these vaccines would require another one to two years for approval because the FDA would require full immunity data, which means that you would follow these patients out 70,000, between Moderna and Pfizer, another 40,000 for Johnson and Johnson. You would follow all of those patients out probably for at least one year to determine how long immunity lasts.

We don't have that information. We have two months of that data before you go into emergency use authorization, we are now about three or four months into that emergency use authorization. The data that we have now is out about five or six months of immunity, but beyond that, it still remains unclear. The patients in the trial are still being followed for immunity. Every month we have another month of immunity data, the month after that, we have an additional month of immunity data. We're all in this in real-time with regard to immunity. I think what you see are the CDC recommendations reflecting that degree of unknown and erring on the side of caution.

Brian Lehrer: It seems like they're not saying that immunity expires three months after your vaccine. They're saying we only have three months of experience with vaccines and vaccine trials more or less is what I think I hear you saying. That's all they can actually state as a matter of science, and next month they'll be able to say whether it's four months and on from there.

Dr. Jayne Morgan: Exactly, that's right.

Brian Lehrer: Denise in Brooklyn you're on WNYC with Dr. Jayne Morgan. Hi, Denise.

Denise: Hi, good morning.

Dr. Jayne Morgan: Good morning.

Denise: Doctor my question is about your assessment of the risk of swimming. I'm in a family of swimmers and my husband, and I would love to jump in the indoor pool at the Y and swim laps again, we haven't done that in a year. My kids would love to get in a pool with other kids. Both of them seem very risky to me. One of us, one of the adults will be fully vaccinated soon, but I'm so hesitant to do anything without a mask. What's your assessment of that?

Dr. Jayne Morgan: The CDC recommendations that have come out or with regard-- Congratulations by the way on being vaccinated. If you are fully vaccinated, you and your husband are fully vaccinated and your children are not, you all are in one pod, and you're able to socialize with another vaccinated group from another household, but it sounds as if it's unclear whether any of these other people that are in the pool are in another household. Additionally, if you're mixing households, the CDC is advising against that. That sounds as if this public pool is also an area where multiple households will mix.

Additionally, what the CDC is saying is that you are able to visit other unvaccinated households if you're fully vaccinated if you assess that that household is a low-risk single-family household. For instance, grandparents who are fully vaccinated could visit their grandchildren who may be, by and large, have not been in school environments have still been at home during the COVID, when they're going out with their parents, they're masked, their parents have been very careful that way it might be a low-risk household where the vaccinated grandparents can visit an unvaccinated family that is a low-risk family without a mask, but it sounds to me that this is a public pool. Multiple people are coming from multiple households. It's unclear who's vaccinated and who isn't and so I would say certainly proceed with caution with that, absolutely.

Brian Lehrer: Anne in Princeton, you're on WNYC with Dr. Jayne Morgan. Hi, Anne.

Anne: Hi. I was wondering if it's safe to ride in car with friends who have been vaccinated. I have been vaccinated.

Brian Lehrer: You have been also. Probably yes, Dr. Morgan, right?

Dr. Jayne Morgan: If I understand the question, you've been fully vaccinated and you want to be in a car with other people who are fully vaccinated and so yes, you are able to do that. You are able to do that, yes.

Brian Lehrer: It's hard to trust, I think for a lot of people who've been through that, especially people who may consider themselves at high risk for whatever reason of really serious effects if they get COVID. It's liberating to think we can do that and then it's probably hard for some people to trust that that's real.

Dr. Jayne Morgan: Right. Liberating and a little scary as well. Sure, absolutely.

Brian Lehrer: Sarah in Williamsburg you're on WNYC with Dr. Jayne Morgan. Hi Sarah.

Sarah: Hi.

Dr. Jayne Morgan: Hi.

Sarah: My question is about getting tested just precautionary after you've been vaccinated. A little bit of background on me. I received my second vaccine dose on February 26th, and then a week later, I went to get a test just precautionarily because I was going to see somebody who was not vaccinated that weekend and I ended up testing positive. I'm currently, quarantining and not feeling symptoms so the vaccine is working, but I'm just wondering going forward if I should worry about getting tested or not because I clearly would have been spreading the virus unknowingly.

Dr. Jayne Morgan: All right, you tested positive after your first dose, correct? You received the two-dose vaccine.

Sarah: I tested positive after receiving the second dose.

Brian Lehrer: You tested positive. You're right and this is what they say Dr. Morgan can happen. People potentially can still "get the virus", but they don't get sick from it. She said she's fully vaccinated, but asymptomatic and so there's one of those cases, but Sarah you're asking if you should get routinely tested under certain circumstances? We've lost your line. [crosstalk] Go ahead, doctor.

Dr. Jayne Morgan: What I would add to that, which I think is a very important point I wanted to clarify whether it was after the second dose or the first dose, oftentimes if you're getting effect infected after the second dose, this is a great example of additional mutations that are circulating that were not circulating at the time of the clinical trial and that may or may not be covered by the current formulation.

Additionally, it's a great example of the efficacy of these vaccines. I'm talking about Moderna and Pfizer now at 94.5% and 95%. That is not 100%. It's very good, but it's still not 100%. I think Sarah is representing that small sliver where you still could not have protection. That being said since she also became infected anyway, she was one of that very small percent to also get infected, and perhaps with another strain, your infection symptoms will be much milder.

The course of your disease will be much milder and your likelihood to spread the disease to others is less because your viral load is less. If she was in contact with people unknowingly before she realized she was COVID positive, those people have less of a chance of being infected by her because she has been vaccinated and her viral load is less. Any inoculum, any viral particles that she may have spread to them would have been much fewer than if she had not been vaccinated. If in case those people also become COVID positive because they've been infected by her with such a low viral load, they can also expect a very mild case of COVID-19. The vaccines have a lot of positive aspects to them as well.

Brian Lehrer: The last question for today, some might say we're now experiencing a last-mile problem, "in vaccine distribution." Vaccine allocation from the federal government to states has gotten more consistent though there's still not enough supply to go around but going that last mile and actually vaccinating people has brought up problems around access and equity. How do you see the vaccine equity problem being solved? I think your area of Atlanta is maybe trying some different things than my area of New York. What do you see as the most effective?

Dr. Jayne Morgan: Yes, this is such an important question, Brian, and we certainly have seen and been concerned with unequal distribution of the vaccine in addition to vaccine hesitancy, lack of real information, and addressing people's concerns. I think when we look at many of the factors that sometimes impact even access, one of the things that we are starting to explore is whether or not we need to actually go out into communities and not have communities come into us.

That includes pharmacies that are located in those communities. Mobile vans can go to those communities and reach people where transportation maybe is not as easy, where job access is not as easy, and begin to vaccinate people because if we don't all get vaccinated, we end up with what we call pockets of community immunity, where one area of town is fully vaccinated, but another area of town is not. What happens is the area of town that's not vaccinated runs the risk of having mutations continue to replicate and develop.

Then eventually those mutations will mix in with the areas of town that are immune and can overwhelm those vaccines that were not developed when these mutations were developed. We cannot have pockets of people who don't have immunity with these vaccines because it increases the risk of these mutations continuing to develop and we could end up with a mutation that's actually against the vaccine itself or a mutation for which the vaccines are ineffective. It's very important for us to make certain that we have equitable distribution.

Brian Lehrer: Just a good clear description. Dr. Jayne Morgan, cardiologist and clinical director of the COVID task force for Piedmont Healthcare in Atlanta. Thank you so much for joining us again today. We really appreciate it, so informative.

Dr. Jayne Morgan: Oh, you're welcome, Brian. I appreciate being back on. Have a great day

Brian Lehrer: Brian Lehrer on WNYC, stay tuned. More to come

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