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Brian Lehrer: Brian Lehrer on WNYC, and back with us now, Dr. Leana Wen, Washington Post columnist, former Baltimore health commissioner, and George Washington University professor who's given us so much medical and public health insight during the pandemic, and so many things to think about from her opinion writing. Today, we'll talk about the Delta variant, a question about booster shots from people who were vaccinated in January, and Dr. Wen's column arguing that COVID vaccine should be an urgent priority for young children. Dr. Wen, we always appreciate it. Welcome back to WNYC.

Dr. Leana Wen: Thank you, Brian. It's always a pleasure to join you.

Brian Lehrer: Can we start on the Delta variant? It's more transmissible than any previous one and it's causing new outbreaks in the US as around the world. What are some of the things you're seeing, first, in this country?

Dr. Leana Wen: Let's talk about the transmissibility of the Delta variant, which is key to why we're so worried about it. The Alpha variant, the B117, the one that originated in the UK, already displaced all the other variants here in the US because it was about 60% more transmissible than the other variants. The Delta variant, the one originating from India, actually is 60% more transmissible than that Alpha variant.

It is now 99% of all the variants in the UK itself, is now well over 20% of all the variants here in the US. There are also some studies that show that the Delta variant causes more severe illness, increases the likelihood of hospitalization. I certainly am very concerned about this. We are seeing surges and localized outbreaks in parts of the country that have low rates of vaccination.

I think at this point, people have two choices. You get vaccinated, or you are very likely, and at high risk for contracting the coronavirus, in particular, with the Delta variant becoming the predominant variant here in the US very quickly,

Brian Lehrer: I read that in Israel with high vaccination rates of the Pfizer vaccine, half the new Delta variant cases in the recent outbreak are among vaccinated people the very few among those vaccinated with cases are serious cases, but they've re-imposed indoor masking rules in a country that's been one of the biggest vaccination success stories. What would you say the lessons are from Israel regarding the Delta variant?

Dr. Leana Wen: I think it's important for us to take away the right lessons and not the wrong lessons, because I think there might be the temptation to look at what's happening in Israel and other countries with high vaccination rates that still have surges and say, "Well, then what's the point of vaccination? The vaccine clearly doesn't work."

Well, actually, even against the Delta variant, the vaccines that we have here in the US-- In particular, we have data for the Pfizer and Moderna vaccine, maybe the Johnson Johnson too, but at least for Pfizer and Moderna it appears that those vaccines are very effective against the Delta variant as well, especially against preventing severe disease, which is the outcome that we most care about. We care about whether we are prevented from getting such severe illness that we end up hospitalized or dying from COVID-19.

We also know that getting the vaccine substantially reduces our likelihood of passing on the virus to others. Now, the Delta variant appears that it probably is in people in larger quantities, and that's why it's transmissible easily, but getting vaccinated still substantially reduces that viral load. I hope the right lesson is that vaccination is still our best and only way out of the pandemic, and also then we need to have these other public health tools at our ready, including the tool of reimposing indoor mask mandates, which I really hope that people in this country-- I think there is a tendency in the US to think that the pandemic is behind us.

It's really not, especially for those who are unvaccinated, but I hope that people remember that even if you are vaccinated, there's still a small chance that you could contract COVID-19 and pass it on to others. Also that the more COVID is in your community, the more likely you are to be at risk. That's why making sure that we still have those tools of reimposing indoor mask mandates is important.

Brian Lehrer: Listeners, we welcome your questions about the Delta variant, anything about vaccines and children or vaccines and young adults and vaccines and senior citizens, or anything else relevant for Dr. Leana Wen at 646 435 7280, 646 435 7280, or tweet a question @BrianLehrer.

Dr. Wen, I got a question the other day from a listener in his 90s, vaccinated in January, and asking if he'll need a booster shot soon since July is six months, and some people say it could be that soon that immunity weakens. I told them you were coming on and I would ask you, so what would you say to that six-month-vaccinated senior citizen?

Dr. Leana Wen: What I would say is that right now, all the data point to immunity lasting for quite some time. We don't know exactly how long it lasts, but it should last well beyond six months and probably into years. There are some exceptions. People who are severely immunocompromised, for example, may already need a booster shot. In fact, there was just a paper that was published in the New England Journal of Medicine, pointing to the effectiveness of a third booster shot for people who are recipients of organ transplants on immunosuppression, that a third booster shot could really help to increase their immune response.

However, for everybody else, there are more and more studies that indicate that our immune system remains very robust, because it's not just about the antibodies, it's also about these memory B cells that could produce antibodies very quickly if we are exposed to COVID-19. Now, those studies are still ongoing about when people are going to need booster shots.

You'll need boosters under two circumstances. One is if immunity does appear to wane. Again, right now for generally healthy people, it does not seem that that's the issue with the vaccines we have. Two, is if there are variants that arise that may make the vaccines less effective, and maybe we need a specific booster to target those variants. Right now, the vaccines that we have seem to be effective against all the variants of concern that we know of.

That said, the CDC, the FDA, they're actively evaluating the circumstances, and I would imagine that the people who are most likely to need a booster, other than people who are immunocompromised, are going to be older individuals, however, that recommendation has not yet come. For the time being, I would say six months later, even a year later, very likely your immune system still is very robust against the variants of concern.

Brian Lehrer: Is there any way for an older person to tell how robust their immune response or their immune system is to know if they are individuals who would benefit from a booster shot?

Dr. Leana Wen: This is a really good question that I get a lot from patients as well. People want to know, "Well, is there a blood test that I can get?" Usually, they're thinking about the antibody test. Here's the problem though. The general antibody test is not actually measuring the neutralizing antibody that we're looking for, and so you can have a negative antibody test, but actually, you could have plenty of robust response because even if you don't have the antibody at the ready, you have these memory B cells that are capable of producing the antibodies very quickly. I would say if you're generally a pretty healthy person, you should not be getting a test in order to look for your immune response.

Brian Lehrer: You mentioned the J&J vaccine a minute ago, and we have a question about that coming in from Ethan in Brooklyn. Ethan, you're on WNYC with Dr. Leana Wen, hello.

Ethan: How are you, guys?

Brian Lehrer: There you go. Now we got you. Go ahead, Ethan.

Ethan: Oh, hey, Dr. Wen. Hey, Dr. Lehrer. It's good to talk to you. Thank you for taking my call. I was curious about the efficacy of getting Pfizer or Moderna vaccine after-- I got the J&J three months ago, and just the concern about Delta variant and how J&J works against that got me thinking maybe I should just also get one dose of the Pfizer or the Moderna. Is that a good idea? I'm seeing online some people doing that.

Brian Lehrer: Dr. Wen, and, by the way, I'll say that I think Ethan was just being cute, but I am not a doctor. I only interview them on the radio, but Dr. Wen, go ahead.

Dr. Leana Wen: [chuckles] I was going to say I haven't been calling you Dr. Lehrer this whole time. To Ethan's question, actually, this is something that I think about a lot, of course, as a physician advising my patients, but also as an individual myself, because I received the Johnson & Johnson one dose, the vaccine, and here's what we know about the J&J vaccine.

We know that if you're only going to get one dose of a vaccine, you should get the one dose Johnson & Johnson as in the Pfizer and Moderna vaccines are meant to be two-dose vaccines. One dose, for example, of the Pfizer vaccine is only about 33% effective against the Delta variant, so you should be getting both of those vaccines, but if you got the Johnson Johnson vaccine, it does appear to be less effective against mild to moderate disease than the mRNA vaccines. Probably, it's very effective against severe illness, and even though we don't have the exact data about Johnson & Johnson, the effectiveness against the Delta variant, the Delta variant has a lot in common with the Belta and Gamma variants, which the Johnson & Johnson vaccine is very effective against.

Should you be getting a booster shot at this time of an mRNA vaccine if you got the Johnson & Johnson one dose? Right now, CDC and FDA, and other health authorities are not recommending this. However, there was a study that came out this week looking at mixed vaccines, so individuals who got the AstraZeneca vaccine, which is similar to Johnson & Johnson, it's also an adenovirus vector vaccine. They found that if you mix one dose AstraZeneca with one dose of Pfizer, that you do get a robust response.

Could there be a recommendation coming out about people who got the Johnson & Johnson vaccine is certainly possible and I would say even likely. That is not the recommendation now at the time. Now I will just add one more thing here, which is, I hope that the CDC is tracking these so-called breakthrough infections better. Breakthrough infections are what happens if you are fully vaccinated and then get COVID-19.

The CDC a couple of months ago decided to stop tracking mild cases of breakthrough infections. They're only tracking severe cases that are severe enough to cause hospitalization or death. I think tracking mild cases is actually important because if you find that people who got the Johnson & Johnson vaccine have a much higher likelihood of having breakthrough infections, that would indicate that it's time perhaps to think about a booster shot.

I'm not sure what type of tracking the CDC is doing in this regard, but I think they should do a lot more so that we get the answers to the questions that Ethan and I, frankly, as a patient have as well.

Brian Lehrer: I wonder if they're doing it in other countries. Our health and science editor Nsikan Akpan has an article on Gothamist today showing how fast the Delta variant is spreading in various places and among the vaccinated or unvaccinated or partially vaccinated people, including all of this about J&J and matching it for some people with a Moderna or a Pfizer shot. He cites the stat from an Imperial College of London study that finds while COVID deaths among vaccinated people are extremely rare, they occur mostly in people over 50 and when they do occur because their immune systems are likely to have been weaker before vaccination.

I wonder if that London finding suggests to you either that people's natural immunity tends to decline around age 50, rather than much older than that, and whether it suggests anything about how to proceed on these additional immunizations? On measuring, I should say, sorry, circling back to what you were saying just a second ago whether maybe in London, maybe in England, they're measuring the breakthrough cases in a more precise way than they are in the United States?

Dr. Leana Wen: I think that measurement is really important because we also need to know the denominator. Understanding the severe illness, of course, that is what we need to track most of all, but we also need to know, I think it would be really good to know how many cases are now mild versus severe because that also is a great outcome of being vaccinated.

One great outcome of getting vaccinated is you have less viral loads, you're less likely to be sick, you're less likely to transmit to others. Another benefit of vaccination is maybe you only get mild illness. Maybe you only get the sniffles and loss of taste and smell for a little bit, but you don't become severely ill and end up being hospitalized. I think that's also important too.

I do think it's important to also note what we now understand about the vaccine. We know that if you recovered from Coronavirus, you do have some level of immunity. If you get vaccinated on top of that, you seem to have a very robust and long-lasting immune response. Even those who have recovered from COVID should still be getting the vaccine.

I think that then leads to the Johnston & Johnson question. If you've got just one dose of the Johnson & Johnson, but let's say in time, a booster dose is recommended, probably you will have an even more robust response in the same way that those who got the AstraZeneca vaccine and then got the mRNA Pfizer or Moderna will have a strong response. I think it's something that we really need to understand better, but I hope that recommendation is forthcoming from the CDC soon because many people have this question.

Brian Lehrer: We'll continue in a minute with Dr. Leana Wen and we'll get to her columns on COVID vaccines for young children and young adults, stay with us.

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Brian Lehrer: Brian Lehrer on WNYC with Dr. Leana Wen, Washington Post columnist, George Washington University professor, former Baltimore Health Commissioner and author, by the way, of a forthcoming book called Lifelines, A Doctor's Journey in the Fight for Public Health, and Dr. Wen, I know we already have a schedule for around the release date in August to come back on the show and talk about the book. We're looking forward to that as well. Your Washington Post column, saying development of a COVID vaccine for young children should be an urgent priority. How young and how urgent?

Dr. Leana Wen: My point in writing this article is I keep hearing this untrue misconception that somehow children, well, don't worry about kids. Kids don't get sick from COVID. They don't spread COVID, and so let's not focus on vaccinating children. That's just not true. The premise is not true and therefore the conclusion is not true.

To be clear, right now we only have vaccines approved for children 12 and older. I'm talking about getting the research done so that we are able to, at some point, have safe and effective vaccines for children under the age of 12. That currently is not authorized yet.

Let's look at the data because it's just not true that children do not get sick from COVID-19. Since the beginning of the pandemic, more than 4 million children have been infected with COVID-19, more than 400 have died, tens of thousands have been hospitalized, more than 4,000 have had this multi-system inflammatory syndrome that is very frightening, could occur in previously healthy children, could even occur weeks or months after the infection, including with mild illness.

I make the point of this column then, it's a mistake for us to compare the severity of illness in children versus adults, because let's imagine that COVID-19 was a disease that only affected children. Of course, that's not the case, but hypothetically, imagine those same numbers that I gave you just a minute ago applied, but it only affected children.

Parents would be terrified. We would all be saying, "We want to do everything we can to protect our children." It's just a fallacy I think to say, "Well, if children tend to not get as ill as adults, that it doesn't really matter in children."

I believe that we really need to get our children vaccinated to protect them, including against unknown, potentially long-term consequences of contracting COVID-19. In addition, this is a lasting problem as in COVID is not exactly going away in the next month or even years, and so we need to get our kids vaccinated to protect for the longer term.

In addition, I can tell you as a parent of two young kids, almost-four-year-old and a one-year-old, my husband and I are not returning to our pre-pandemic lives until our children are also vaccinated. Having the vaccines approved for children when they are found to be safe and effective is going to be really important.

Brian Lehrer: That was one of the most interesting parts of your column to me. I want to ask you to elaborate on it that you and your husband will be reluctant to return to your pre-pandemic lives until your kids are vaccinated too. In what ways, for yourself, have you returned to your pre-pandemic lives, and in what ways are you not?

Dr. Leana Wen: It's a really good question. I'll tell you how I and my husband are thinking about this, understanding that other families are making very different types of decisions and that's all okay. The people who are fully vaccinated, I think there is a wide spectrum of what we are deciding to do when it comes to our own risks. For me and my husband, we are generally healthy, we are vaccinated. If it were just us, I don't think we would have a lot of limitations on what we would do, but right now we are concerned because we live at home with two unvaccinated children.

We then are taking additional precautions as in there is still the potential that we could become infected. We'll probably be mildly symptomatic if symptomatic at all, but we could still, in theory, be able to transmit it to our unvaccinated children. We will, for example, do anything outdoors. We're happy to socialize even in large groups outdoors. We'll also be happy to be indoors, including unlimited numbers, maskless individuals with no social distancing if we know that everybody there is fully vaccinated.

However, if I'm going to a crowded grocery store, to crowded church service, to something else indoors where other people around me are probably unvaccinated and unmasked, I am still going to be wearing a mask. I am not going to go to high-intensity exercise classes indoors in a packed gym where other people around me are breathing heavily and unmasked.

I mean, these are the choices that we're choosing to make at this time. We're also choosing right now to not travel by plane with our children because our one-year-old is unable to be masked. Now I understand that's very conservative and some people will say that's too conservative. That's fine. People are making the choices that are best for them and their families, but I give this example because I think many parents are choosing to be careful at this time, and here's the reason why, this is I think the ultimate reason why a vaccine for young children, again, when it's researched and authorized is going to be really important because even if the risk of an adverse outcome to our children is low, there's still that possibility.

I think for many parents if we can reduce the chance of a horrible thing, from low risk to essentially zero risk, I think all of us, or at least many of us would do that.

Brian Lehrer: This is WNYC FM HD and AM New York, WNJT-FM 88.1 Trenton, WNJP 88.5 Sussex, WNJY 89.3 Netcong, and WNJO 90.3 Toms River. We are a New York and New Jersey public radio. Alex in Greenwich Village, you're on WNYC with Dr. Leana Wen. Hi, Alex.

Alex: Hi, I'm wondering if your guest knows whether vaccinated people who have had mild COVID cases are susceptible to the same long COVID symptoms that unvaccinated people who have had mild or asymptomatic cases seem to be having? Thank you.

Brian Lehrer: I get this question all the time, Dr. Wen?

Dr. Leana Wen: I agree, I get this question a lot too. I don't think that we have the data to be able to say definitively one way or another. One would imagine that just based on common sense that if the vaccine substantially reduces your likelihood of illness full stop, and then reduces your likelihood of severe illness, that probably, just logically speaking, it would also reduce the likelihood of your having mild illness that then leads to long term long COVID symptoms.

However, I don't believe that we have those information. I will say anecdotally, I have not heard about the large numbers of individuals who have long COVID symptoms after having mild infection, but again, this is another reason why having that kind of documentation from the CDC would be important because now we know for certain it's not just severe illness from COVID-19 that we care about, it's also mild illness.

There was a study of nearly 2 million individuals who were diagnosed with COVID-19 and they found that a quarter of all those individuals, regardless of whether they had severe or mild COVID-- By the way, this was pre-vaccination, so these are individuals who got COVID, were not vaccinated, but a quarter of them within one month of their COVID diagnosis went to visit their doctor for something other than COVID, for new symptoms, that was probably because of their COVID but was not just because of their COVID. For example, they had new muscle pain or loss of concentration or fatigue. All this is to say COVID is a disease that we really do not want to get, including, in children.

Brian Lehrer: On the young children, Mayor de Blasio, here in New York, announced the stat on the show last week that the positivity rate in New York City public schools is now 0.03%, three one-hundredths of 1%. Is that an argument against urgency for kids or maybe an argument for managing institutions with children like schools in certain ways that maybe they're doing well in New York City?

Dr. Leana Wen: Look, I actually don't think that the incidence of COVID is what should determine whether we offer vaccines for children. We haven't had a case of polio in the US since the 1970s but my children, and I'm sure almost all the listener's children, your children probably all got the polio vaccine. The entire point of having childhood immunizations is to prevent diseases from occurring. Frankly, also, we're not going to be able to reach herd immunity as a society unless our children are vaccinated too, and children can also be reservoirs of the disease who can transmit to others.

I do think it's great news that New York City and many places around the country, there are enough adults vaccinated that you have been very successful in reducing the rate of COVID-19 in the community. That's great, that makes life safer for everyone. That does not mean, though, that children should not be getting the vaccine.

Brian Lehrer: You have a separate column than your one about young children about the importance of young adults getting vaccinated, and they are proving to be a relatively resistant population. Now the news of cases of the heart inflammation known as myocarditis is spreading. Even you cite a study that found two out of every 100 college athletes recovering from COVID showed signs of myocarditis, that heart inflammation. What's your argument to young adults?

Dr. Leana Wen: Well, my argument for teens, young adults, people over the age of 12, who are able to be vaccinated is that you really need to be vaccinated, the benefits far outweigh any potential risks. Yes, it is true that myocarditis and inflammation of the heart muscle appears to be associated with the mRNA vaccines, it's extremely rare. To date, the CDC has found about 323 cases in people under the age of 30 tends to be associated more with the second dose more than the first dose, tends to occur within three to four days after that second dose, and is more concentrated in younger males in particular.

Let's talk about these cases. These cases generally were very mild, resolved with minimal treatment within days, vast majority have had full recovery, no one has died because of myocarditis from the vaccine. You have to weigh that very small, mild risk against the risk of COVID-19. Teens and young adults at ages 12 to 29 now account for 33% of all new COVID infections. There have been more than 300 deaths in this age group of 12 to 29 just since April.

As you mentioned, Brian, there was a study of more than 1,500 collegiate athletes that found that 2.3% of those people who have recovered from COVID-19 actually got myocarditis. Your chance of getting myocarditis from COVID is much higher than the small likelihood of mild myocarditis from getting the vaccine, so my message is it's truly important to get the vaccine.

Brian Lehrer: I'm glad you said that clearly because I think I said it unclearly in my question in a way that might have confused myocarditis cases among people recovering from actual COVID with people who got the vaccine so that relatively large number and I consider two out of every 100 people in any category actually a relatively large number when you're talking about a population as big as the world. That's going to be a lot of people. That two out of every 100 college athletes who got myocarditis were those recovering from COVID, not those who got the COVID vaccine.

Dr. Leana Wen: That's exactly right. For the COVID vaccine, there have only been 323 cases in people under the age of 30 total in the US out of the many tens of millions of doses given in that age group. As opposed to the study you were citing is of more than 1,500 athletes who were diagnosed with COVID-19, 2.3% of them or about two in every 100 who got COVID-19 had evidence of myocarditis. Again, illustrating that your chance of getting myocarditis is much higher if you get COVID-19 than if you get the vaccine.

Brian Lehrer: Last question. Do you have an opinion about whether things are reopening too quickly in this country? Like here in New York, we're having a ticker-tape parade to celebrate the essential workers marking the end of the pandemic at least as we've known it, a concert in Central Park to do same for 60,000 people, outdoor stadiums reopening at full capacity with no proof of vaccine. Broadway is reopening indoors so far with proof of vaccines. What do you make of the mix of reopenings and requirements?

Dr. Leana Wen: I really understand that people want to get back to life as normal, but the pandemic is not over. I actually would be okay with anything taking place outdoors, and anything taking place or anything taking place outdoors full stop, and anything taking place indoors where there is proof of vaccination or recent testing, but when you have large numbers of people gathered indoors in poorly ventilated areas of mixed vaccination status with this very contagious Delta variant floating around, that's a recipe for disaster and I am very concerned that we are going to see upticks in many places of preventable infection.

I just hope that there is a way for us to put the genie back in the bottle, as in, I really hope that public health officials and officials, in general, they understand that if we see upticks that there is going to be the necessity at some point and it may not be this summer, but it may come this fall, where we will have to reimpose indoor mask mandates. I'm not sure that everybody is ready to hear that message.

Brian Lehrer: Dr. Leana Wen. You can see the columns of hers that we've been talking about in the Washington Post and her forthcoming book is called Lifelines, A Doctor's Journey in the Fight for Public Health. We will talk to you in August when that book comes out or maybe even before. Dr. Wen, thank you so much.

Dr. Leana Wen: Thank you, Brian.

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