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Brian Lehrer: Brian Lehrer on WNYC. You might say we're in a race now between vaccines and variants, and so some COVID news, as Moderna and Pfizer work on tackling the highly transmissible new COVID-19 variants, another vaccine from AstraZeneca is closer to rolling out, but some countries in Europe aren't recommending it for people over 65.

Also, the World Health Organization has clarified its guidance for pregnant women will sort of clarify, and for people who have received both doses of the vaccine, many are asking with uncertainty, "What now? How does it change my life?" Joining me now with some answers we hope is Apoorva Mandavilli, New York Times reporter focusing on science and global health. Hi, Apoorva. Welcome back to WNYC.

Apoorva Mandavilli: Always a pleasure, Brian.

Brian: Let's start with some of this vaccines versus variants news. You recently wrote Moderna and Pfizer both said their vaccines were effective against new variants of the coronavirus discovered in Britain and South Africa, but they are slightly less protective against the variant in South Africa. Why might the South African variant be stealthier?

Apoorva Mandavilli: The South African variant has some mutations that are very tricky. It has one in particular, that's called E484K, that changes the shape of the spike protein a little bit. That's the protein that the vaccines are using to generate an immune response. The idea is that if the shape of the protein has changed a little bit, that the antibodies find it a little bit harder to latch onto the protein, so the vaccines are a little bit less effective. The good news, though, is that they are effective. These vaccines are so good, so much better than we need them to be that it's not really a big deal to lose a little bit of their effectiveness.

Brian: When you write that the vaccines are slightly less protective, what does that really mean? You just put it in the context of slightly. What's the less protective part?

Apoorva Mandavilli: We don't know the exact numbers, but it looks like it might be about sixfold less effective in the lab. I want to make that distinction, because in the lab, you're really only testing for particular kinds of antibodies, but in real life your body makes antibodies to all kinds of parts of the spike protein. There are T-cells, there are B-cells, the immune response is so much more complicated. If we're seeing something like sixfold less, it doesn't mean that's what it will be in real life, but it's still going to be way more effective than we need, so there's not yet cause for concern.

Brian: Moderna is responding to the variants in two different ways. According to your reporting, one way the company is handling the variant is by developing a new form of its vaccine that you write could be used as a booster shot against the variant first discovered in South Africa. Can you explain a little bit about how that booster might work?

Apoorva Mandavilli: Right. The idea is that if the virus keeps changing, what they may need to do is just tweak the vaccine as we have it now. As you know, the Moderna and the Pfizer vaccines are based on this technology called mRNA, which is essentially a string of code. They can just change that code a little bit to match this new variant better.

That's something that can be done relatively easily. Moderna is planning to create this new version of the vaccine that would work against the South Africa variant and release that as a booster shot so that people who've been vaccinated can just get that booster and be protected against both the variants that are circulating in the US now and the one that's coming up in South Africa.

Brian: That would be a third shot basically of its original vaccine?

Apoorva Mandavilli: Possibly, or it may just be a second shot. All of these details haven't really been worked out. We don't really know whether we need this yet. It's just that they're planning ahead. We don't know what the testing would need to look like, would there need to be another clinical trial that's maybe smaller and shorter. We don't really know all those details, but potentially it could be a third booster, potentially it could be a second one, remains to be seen.

Brian: According to your reporting, Pfizer is saying it could have a newly adjusted vaccine against the variants in about six weeks. The FDA had to approve these vaccines in the first place. How will they handle fast tracking the vaccines for the variants even more quickly than Operation Warp Speed?

Apoorva Mandavilli: Yes. This is a complicated question, because, unfortunately, we don't have a very key piece of information, which is knowing exactly how much of the immune response we need to protect against the virus. If we knew that, testing any new candidate would be relatively fast, but without knowing that, we may need something like another clinical trial. I asked Dr. Fauci this question a couple of weeks ago, and he said maybe they would have to do a trial with a few hundred people instead of a few thousand. I think there are companies are talking to the FDA right now to figure out what that would look like.

Brian: Listeners, we can take your COVID-19 vaccine variant and other questions for Apoorva Mandavilli science writer for the New York Times. 646-435-7280, 646-435-7280, or you can tweet a question for her, @BrianLehrer. You tweeted something interesting yesterday, linking to one of your colleagues at the New York Times articles, you tweeted for people who've had COVID, for people who have had it, "the first dose of vaccine is like the second for the rest of us." Explain that.

Apoorva Mandavilli: The idea behind two doses of the vaccine is that the first dose primes your immune system, it introduces your immune system to the virus, or in this case, the viral proteins spike protein, and then the second dose, your immune system is now ready and boosted to really recognize the protein and fight it. If somebody has had COVID already, they've already had one round with the virus, they already know what the virus looks like. Their immune system is already ready to go.

They may only need one dose, which would function like the second dose for the rest of us, the second in this case, the very first dose of the vaccine that they get would strengthen the immune response they already have from having had COVID.

Brian: You tweeted another interesting thing yesterday, the power of vaccines, we've vaccinated enough people here to see these trends and that links to somebody else's tweet of a chart in people 60 years old and older, who've been the first to vaccinate in the past two weeks and that age group, 41%, fewer cases, 32%, fewer hospitalizations, 27% fewer critically ill people than in the period immediately before. My question is, how much do you think science can attribute that to the vaccinations that have taken place, as opposed to some other things that are going on at the same time, like the end of the Thanksgiving and Christmas spikes?

Apoorva Mandavilli: This is in Israel, the numbers that you're talking about, and Israel has done very well with the vaccine rollout. They've been extremely efficient and they've rolled out the vaccine to millions, more people than we have, and they are seeing some effect on the hospitalizations and deaths.

It's early, and one of the reasons we haven't reported on it yet, but it bears watching because it looks like once you start to have the vaccine out in some number of people who are at risk, you will see the step. That's always been the hope, right? With the vaccine, more and more people will be protected and the virus will find fewer and fewer people to infect, and so we won't see quite the number of hospitalizations and deaths that we have been. You're right that there's also the seasonal element. There's also the holiday element.

Those things have started to wane, and so maybe that's why we're seeing a dip. It's not really clear. In the United States, a lot of states have tightened their restrictions and people may have started to be more careful because they're not hearing about the variants. They're hearing about these huge numbers of hospitalizations and deaths. There could be a lot of factors at play, but I think the idea that, by rolling out the vaccine, we will see a drop in hospitalizations and deaths is not unreasonable.

Brian: Chris, a nurse in Astoria, you're on WNYC with Apoorva Mandavilli, science reporter for the New York Times. Hi, Chris.

Chris: Hi, Brian. Can you hear me okay?

Brian: Yes.

Chris: Okay, great. Hello, good morning to you and the reporter as well. I just had a question. I got the vaccine, I work at a major hospital, and my brother does too, and he also got the vaccine. He recently got an email regarding the antibodies saying that if you go to test for antibodies, they won't show up if you get the vaccine because those antibodies are different than if you got the infection naturally, and that's all infection antibodies.

This is something that I hadn't heard of. I know that a lot of nurses that I know that got the vaccine, I think I'm not going for antibody tests. Few doctors went for the antibody tests and it was negative. I think this information should probably be more widespread. Unfortunately, the email didn't include any links or any articles with the information, but I was wondering if you came across this in your reporting.

Brian: Thank you. What an important question, vaccinated, but then you test negative for antibodies. Does that make sense to you Apoorva, is it something you've seen?

Apoorva Mandavilli: It does make sense. First of all, let me say, it's not anything to worry about, and I'll explain why. The vaccines use a single protein from the virus, which is called the spike protein, to generate the immune response, but the virus has many proteins. Some of the antibody tests that are out on the market, in fact, some of the more common ones, made by Abbott and Roche, test for a different protein in the virus.

They're not going to detect antibodies to those proteins because the vaccines never test against those. That doesn't mean that if you are exposed to the virus, your body won't fight it, it absolutely will. The spike is the most important part of the virus, if you will. It's the part that the virus absolutely needs to latch onto human cells and infect them.

The nucleocapsid is the other protein that the Abbott and the Roche tests are for. Those antibodies are more plentiful, which is why the companies make the tests against them, but it's not the most important protein, nor does the test being negative tell you anything about how well the vaccine worked. Don't worry, and you, I'm sure, still have antibodies to the spike protein, and you will still be protected against the virus.

Brian: Are they developing tests to measure antibodies that the vaccine confers on your body? Because I'm sure people like Chris and many, many, many others would like to know, "Am I as an individual in the 94%, or am I the 6% for whom the vaccine wasn't as effective?"

Apoorva Mandavilli: Absolutely. There are a lot of tests out there, and many of them test for just a spike protein, some of them test for the spike and the other protein that I mentioned. You just have to make sure when you take the test that you are getting the right kind of test, and you're not getting one that was rolled out a long time ago when people were just testing for have they been infected with the virus.

Brian: More of your questions for Apoorva Mandavilli right after this. Brian Lehrer on WNYC as we continue with New York Times Science and Global Health Reporter, Apoorva Mandavilli, on the race between variants and vaccines and other COVID news. Christie in Yonkers, you're on WNYC. Hi, Christie.

Christie: Hi, Brian. My question is really about people that are vaccinated already. There seems to be some confusion from some reports, people I'm speaking with about whether or not vaccinated individuals can still get the virus and pass it on to somebody else. The virus doesn't mean you have a shield or- excuse me, the vaccination doesn't mean you have a shield around you, where you don't get the virus and can potentially still pass it.

I'm just wondering if you can speak to that at all, because there's a sense, like I'm saying that, "I've been vaccinated, so it's okay. I can come around. I'm not going to spread it to anybody, but it--" That's my question. If you can just speak to that.

Brian: Thank you, Christie. Apoorva, it's one of the most important things to talk about right now, I think, that's just getting out there, that people are just starting to understand. I think, correct me if I'm wrong, there isn't enough time yet for science to really know the answer to the question, but that it's possible that we're protected from getting sick from the virus, but we're not protected from technically getting it and spreading it. What's known?

Apoorva Mandavilli: Christie's absolutely right, that this has been one of the most confusing things, I think, people are talking about. The clinical trials for both Pfizer and Moderna and actually all of the clinical trials looked at, does somebody get really sick if they've been vaccinated? The answer has been basically no, but they didn't look at, can people still get infected? That's why we don't know the answer. They are trying to find that answer now after the fact, and it's not the company's fault, this is how it works. You pick one outcome to test and then you figure out other things.

We did find out today, though, from AstraZeneca, they reported preliminary results saying that their vaccine also slows transmission by about two-thirds, about 67%. That's good news. It does mean that the vaccines not just protect against severe illness, but they also will prevent most people from getting infected, but two-thirds is not 100%. It is still important for people who have been vaccinated to wear a mask, because some of them will still be able to get infected and pass the virus to other people.

Brian: Kathy in Kendall Park, you're on WNYC. Hi, Kathy.

Kathy: Hi. Thank you very much. My question is, I have had one shot of Moderna so far. Does anything change in my life? In other words, I've been avoiding the grocery store and things like that entirely since the variance came up. Can I now mask up and go to senior hours at Stop & Shop or Costco? Is there anything else I can do differently or do I have to wait until I've had two weeks after the second shot?

Brian: Apoorva.

Apoorva Mandavilli: Kathy, if you've had one shot, I think you are actually pretty well protected, there's good evidence now that even one shot gives a lot of protection, may not be 100%, may not even be 95%, which is what you would get after the second shot. I think you'd probably be okay if you wore a mask for, say, two months, just to be careful, and went out to the grocery store.

Brian: What about after the second shot? Let's say people are as protected as they're going to be. Everybody's saying, and you reiterated it, "Continue to wear masks and socially distance to the extent that you possibly can because you might spread the virus to others." That means others still have to protect themselves from you, but then, how much back to normal activities? I think a lot of people are scratching their heads about, "Just why do I do now? How confident can I feel to do what after the second shot?"

Apoorva Mandavilli: I think the people who are vaccinated can feel pretty confident that even if they get infected, they will not get sick. These vaccines are so good at preventing illness, so they should feel good. They should feel like they are now shielded from this virus, and they should go around feeling a little bit invincible, but the rest of us haven't all been vaccinated. They do still need to be careful in terms of wearing a mask, just to protect the rest of us, those of us who haven't been lucky enough to get a vaccine yet.

Brian: I want to ask you about one of your articles from the other day, the World Health Organization drops opposition to vaccinations for pregnant women. What's the latest?

Apoorva Mandavilli: This has been an incredibly confusing issue, Brian. The WHO actually does not see itself as having changed its guidance. Essentially, none of the clinical trials tested pregnant women. We just don't really know if the vaccine is safe for them. In the absence of that data, the CDC has determined that it's probably fine for pregnant women to get vaccines because traditionally vaccines have been safe. We've been giving them to pregnant women for decades.

This vaccine has also been shown to be safe. In animal studies it looks fine, and because pregnant women are actually at higher risk of having complications from COVID, the CDC decided pregnant women should be able to talk with their healthcare provider and get it. The WHO looked at the exact same evidence. In the WHO's mind, it is making the same call as the CDC.

I'm saying this based on multiple conversations with their PR people, but what they actually said in their language is that we do not recommend at this time, which sounds like they are actually saying, "Don't do it." Right? It's a lot stronger than how the CDC had framed it, but then they released a newer document on Friday, that did not have that language. It just said something like, "Everything we know about the vaccine so far looks fine. There's no reason to believe that it's unsafe."

It didn't include those words, "Do not recommend." It now is much more aligned with the CDC guidelines, which I think is great for pregnant women because they're not getting contradictory information from the two biggest global health organizations. The bottom line from both now is the same, which is, if you are a pregnant woman, you should talk with your healthcare provider and evaluate your risk. If it seems like you have some risk of exposure, either through your employment or because of healthcare conditions, you should get the vaccine.

Brian: Mark in Bergen County, you're on WNYC. Hi, Mark.

Mark: Hi, Brian, how are you?

Brian: Good. How are you?

Mark: Actually, at the moment, I am symptom-free. I just wanted to share my experience. I have had one shot of the vaccine, this was the Moderna vaccine, approximately four weeks ago. Then I developed some very mild head cold symptoms last week, the early part of last week and decided to get tested. I had the rapid test and came back positive and then repeated a PCR test and also came back positive on that, so I'd been quarantining. My wife has also had the PCR test and she's come back negative. Obviously, there was no spread, even though that we're in close proximity to each other. That's been my experience. The question I have for your guest is, I'm coming up for the second shot very soon, and should I get the second shot?

Apoorva Mandavilli: You absolutely should get the second shot. I think we don't know enough to know yet what we were discussing earlier, that if somebody has had COVID, they should not-- The second dose acts like the third one for them maybe, but I think, in your case, not knowing enough yet, not knowing that whether that's really the case with you, the CDC has not actually given any guidelines on this yet, it sounds to me like you probably should still get that second dose.

Mark: Okay. Thank you very much.

Brian: Thank you very much. Now, he talked about being COVID positive but not spreading it to his wife. I heard a report on the BBC, on the station this weekend from Portugal, which has been very hard hit, in which a doctor described the difference, as she sees it in her practice, between the original variant and the new variants, at least whatever's over there right now, which is that there would be a lot of stories like Mark's, with the original variant.

Some people in the household would get it, and other people living under the same roof with them might get it or might not get it. Now with whatever the new variant is, it's dominant over there, more transmissible, more contagious. They're seeing it, almost every case of somebody in a household has it, the other people in the household gets it. I wonder if that's a pattern that you're familiar with beyond the anecdotal evidence from that one doctor and whether it tells us something important about the new variants.

Apoorva Mandavilli: As we know, the variants are more contagious, they are incredibly more contagious. In the UK, the variant that sprouted there when from being very low proportion to essentially taking over the entire country, so it is much more contagious. We don't know exactly why that is. There are some of these mutations that we know about that may cause the virus to latch onto human cells better, more efficiently.

We don't fully know, but absolutely, it is much more contagious, and once it takes root somewhere, it spreads pretty quickly, whether that's in the household, whether that's outside, any of the precautions that we were taking until now, that that's wearing masks, or washing hands, or ventilating rooms, all of those, we will need to be that much more diligent about, because that variant does in the United States now, and it will spread. If it spreads like it did in the UK, it will get around very fast, so we should be extremely careful now because it is much more transmissible.

Brian: Do you know if there's any research on the new variants and surfaces? I think surfaces were talked about a lot at the beginning of the pandemic, and then the science seemed to be downplaying or discovering that there wasn't much risk of transmission on surfaces, but has it been looked at whether these new variants last on surfaces any longer than the old variance, or it can be transmitted more easily through touching a surface and touching your face?

Apoorva Mandavilli: It's a very interesting question. As you said, we were all about the surfaces and washing our hands and washing groceries and all kinds of things in the early days, and we stopped doing some of that because it didn't seem like the virus transmits very easily from surfaces to people. I don't think that the variants are any different in the routes of transmission.

It's not, for example, going to be more transmissible by surfaces than through inhalation. That hasn't changed. Regardless, your question about, does it last longer on surfaces? I don't know that anybody has looked at that. I think we just have to assume that, no matter what the route of transmission is, this new variant is going to be more efficient. We need to wash our hands and wash them well.

Brian: So much good information from Apoorva Mandavilli. Follow her reporting in the New York Times and on her Twitter feed. Thank you so much for sharing so much with us today.

Apoorva Mandavilli: Thank you for having me.

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