--:-- Sean Rameswaram: Support for Today Explained comes from BetterHelp. Let me tell you a true story. Last weekend, I got an email from a listener who wanted to discuss their problems with me. And I said, look, I don't think that this is about me personally. At least I hope it's not. Why don't you try BetterHelp.com slash Explained? Absolute truth.
--:-- [Sound of typing on a keyboard]
--:-- Sean Rameswaram: As the largest online therapy provider in the world, BetterHelp can provide access to mental health professionals with a diverse variety of expertise. Find the one with BetterHelp. The one is not me, guys. Our listeners get 10% off their first month at BetterHelp.com slash explain. That's BetterHelp.com slash explained.
--:-- [Sound of a coffee machine]
--:-- Sean Rameswaram: We all have moments where we could have done better, like cutting your own hair. Yikes. Or forgetting sunscreen, so now you look like a tomato. Ouch. Could have done better. Same goes for where you invest. Level up and invest smarter with Schwab. Get market insights, education, and human help when you need it. Learn more at schwab.com.
--:-- Sean Rameswaram: Today Explained, Ramisverm, vaccinated. For today's episode, we're doing something we haven't done in like 16 months, y'all. You sound way too loud, but it'll probably be good for the thing. What did you eat when you went to Annapolis?
--:-- [Sound of a smoothie being blended]
--:-- Sean Rameswaram: I just had a coffee smoothie because it was very hot, and I don't like eating big meals when it's hot outside. Okay, great. You sound great. We're interviewing a guest in our studio at the office in person, but don't worry about breakthrough COVID or anything like that. Umair Irfan, Science Vox, also vaccinated, is in the studio, and I am in our control room. We're separated by a few panes of glass, a wall, some soundproofing.
--:-- Sean Rameswaram: But Umair, we asked you here because we had a very important question. Are we blowing it on COVID in the United States?
--:-- Umair Irfan: It's a little too soon to say, but we definitely could be doing a lot better than we are right now. Tonight, the Delta variant fueling an alarming rise in cases across this country. Authorities say those ending up in the hospital and the rise in deaths largely among the unvaccinated. Now the seven-day average of new infections is above 40,000 cases per day.
--:-- Umair Irfan: COVID cases nationwide will likely continue to rise over the next few months, peaking in mid-October. The United States is once again seeing more cases and more hospitalizations. Fortunately, deaths are not rising at the same level, but it's still very alarming because it shows that, one, vaccines have not reached everywhere that they need to go, but also shows that, you know, that once we have a very high level of vaccination, there are going to be some number of breakthrough infections and illnesses that still start showing up in the data, particularly with a far more transmissible variant of the virus.
--:-- Sean Rameswaram: What are the numbers, Umair? We're certainly not back at our COVID peaks from 2020.
--:-- Umair Irfan: That's right. You know, we're still, you know, below even the peaks from earlier this year. In November, December, January, you know, where we saw the huge spikes here in the U.S., that was roughly around 250,000 new cases per day. That's the high that we were seeing in the U.S.
--:-- Sean Rameswaram: Since then, it started falling off quite drastically by around February because we started rolling out vaccines and also some of these people were not spending as much time indoors. But then we saw another bump in March and then eventually sort of a valley back in the end of June where we're seeing roughly around 10,000 new cases per day. But now we've seen an inflection and cases are going back up. And recently, you know, we're seeing more than 50,000 new cases per day and rising.
--:-- Sean Rameswaram: And fast. And fast, yes. That's a pretty aggressive spike that we're seeing right now. This Delta variant, the CDC says it's now 83% of new cases.
--:-- Umair Irfan: The Delta variant is more aggressive and much more transmissible than previously circulating strains. It is one of the most infectious respiratory viruses we know of and that I have seen in my 20-year career.
--:-- Sean Rameswaram: And it's also pointing out that, like, these new outbreaks are happening in a few concentrated areas. Forty percent of new cases are reported in just three states. That's Florida, Missouri, and Texas. But we're also seeing spikes in a number of different states that are across much of the South, like Arkansas, Mississippi, Tennessee, and Alabama.
--:-- Sean Rameswaram: The first week of May here at St. Dominic's, they had two COVID patients. The first week of June, they had five. First week of July, they had 10. They've got 59 this morning, and they're looking at extra wings of the hospital to try and find space to house these people.
--:-- Sean Rameswaram: But even if you look at states that have been historically doing pretty well, if you zoom into the communities at the county level, you're finding that there are still some counties that are still well below the national average in terms of vaccination. You know, still below 50 percent, some below 30 percent vaccination rates.
--:-- Sean Rameswaram: And that's really where the highest risk of transmission remains. The CDC recently called this a pandemic of the unvaccinated. Pandemic among the non-vaccinated. Those who are not vaccinated. If you are vaccinated, you are safe. Is that what we're seeing in all these states you just mentioned?
--:-- Umair Irfan: I don't particularly like that framing, but the CDC is correct that, you know, the vast majority of people who are getting ill with COVID-19, you know, the people who are actually getting severe symptoms showing up in hospitals, almost all of them, more than 95 percent of them, are people who have not been vaccinated.
--:-- Sean Rameswaram: That said, people who are vaccinated are still affected by this. You know, even if they are seeing very little in the way of infection or even mild cases of the disease, our communities are still affected by this.
--:-- Sean Rameswaram: As mask mandates go back into effect, everybody's being affected by this. And so even though the people who are vaccinated are not the ones being affected in terms of their health most directly, the economic and social consequences are still there and we can't really avoid them.
--:-- Sean Rameswaram: And that's really why we can't, you know, wash our hands of the people who are unvaccinated because what happens to them will impact the rest of us.
--:-- Sean Rameswaram: We miss President Biden's goal of getting 70% of adults at least one shot by the 4th of July. Come on. Weeks later, how are we doing on vaccinations in the United States?
--:-- Umair Irfan: When it comes to adults, you know, people over the age of 18 were at roughly 60% of all adults, but we've also expanded vaccine eligibility to people over the age of 12. So the overall percentage of that is a little bit lower. Come on. Come on, folks.
--:-- Sean Rameswaram: And that amounts to about 162 million people that are fully vaccinated at this point. And do we know how the vaccine is standing up against these variants, the Delta variant in particular?
--:-- Umair Irfan: For the most part, we see that the vaccines are holding up quite well against the Delta variant. You know, we have seen both laboratory studies and some real-world analyses that seem to show a lower level of efficacy, meaning that some of these vaccines may allow a few more infections and some illnesses to go through. But overall, on balance, the vaccines remain the most potent and powerful tool we have to contain this disease, even against something like the Delta variant.
--:-- Sean Rameswaram: And what's the story with booster shots, Umair? What's the latest there? I hear maybe elderly folks will need them. Anthony Fauci was on the TV this weekend saying that might likely happen.
--:-- Umair Irfan: If there's going to be a third boost, which might likely happen, we'll be among first the vulnerable. The concern now is particularly among people who've had downgraded immune systems from the get-go, you know, people who are immunocompromised or who may be taking immunosuppressant drugs or elderly people who have, you know, diminished immune function.
--:-- Sean Rameswaram: The worry is that the immune response from the vaccines isn't going to be as good or as long-lasting. And because they're more vulnerable to the disease to begin with, they may need boosters to bolster that protection, particularly as we are seeing a new rise in cases.
--:-- Sean Rameswaram: And so for the rest of us, those who are fully vaccinated at this time, no booster shot on the on the agenda? Well, it's not even clear yet for the people that are more vulnerable. We're still investigating them right now.
--:-- Sean Rameswaram: A lot of the companies that develop vaccines are researching booster shots and also the formulations for the booster shots, you know, whether they should be targeted generally or to some of the specific variants. But this is something that's still being researched.
--:-- Sean Rameswaram: And it is a possibility now that we have to contend with because, again, the U.S. is seeing a spike in cases and there are people that remain vulnerable even after being vaccinated. Come on.
--:-- Sean Rameswaram: And that's also why we're seeing cities roll back some decisions they've made on masks, right? I believe St. Louis brought back its indoor mask mandate today. I think Los Angeles brought theirs back last week.
--:-- Sean Rameswaram: Well, the Centers for Disease Control still hasn't budged from its guidelines. You know, they've said that people who are vaccinated can go around unmasked. They can lift a lot of the restrictions that are around them.
--:-- Sean Rameswaram: But we have seen areas where we have seen spikes in cases, some of these hotspots that local authorities have decided to reimpose some of these mandates. I've talked to some researchers and doctors as well who've made the personal decision to return to masking in certain circumstances because of their own personal risk factors.
--:-- Sean Rameswaram: And, you know, I've talked to doctors and researchers who are parents of young children and children under age of 12 are not vaccinated. And even though they're at lower risk of being infected and becoming ill, they don't have the protection from the vaccines.
--:-- Sean Rameswaram: And so the adults are saying, well, I want to mitigate my risks as much as possible. And so when they go to grocery stores or doctors who interact with sick patients, they're still making the point of masking and taking precautions in these high-risk environments.
--:-- Sean Rameswaram: And that's sort of a personal decision. And that's kind of the challenge in this stage of the pandemic, that because we have to balance both a collective risk and an individual risk.
--:-- Sean Rameswaram: In aggregate, the guidance still seems to be that, you know, we are largely protected if you're vaccinated. But some people have particular circumstances where they individually or the people around them may be at higher risk and they want to take additional precautions.
--:-- Sean Rameswaram: But where does that leave us, Umair? I feel like every few months I come back to you with the same question, which is, what is herd immunity? Are we going to get there? Is this ever going to end?
--:-- Umair Irfan: You keep coming back to me with the same question because those guidelines still haven't changed. The roadmap is still in place. The idea behind herd immunity is to get enough of the population vaccinated such that the virus can't jump easily between people.
--:-- Sean Rameswaram: And that's even harder now that we have a far more transmissible variant. Now, when it comes to our vaccine rollout, we did get a very aggressive rise early on because we got the people that were most enthusiastic about getting the vaccine, the people who are willing to refresh webpages to register and wait in line for hours to get the vaccine.
--:-- Sean Rameswaram: And now at this point, we're reaching sort of a plateau in terms of the overall vaccination rate. And that's where we're running into some of the holdouts, some of the people that are far more aggressively opposed to the vaccine or still have concerns that they think have not been addressed at this point.
--:-- Sean Rameswaram: And that group is going to be much harder to reach. And that's where some of the most significant transmission risk remains.
--:-- Sean Rameswaram: Mayor, Irfan, nice to see you. Stay safe this summer. Maybe hit the beach. The beach seems safe. Make more waves. Splash around a bit. Sounds nice. Vamanos.
--:-- Sean Rameswaram: How to reach the unvaccinated in a minute on Today Explained. Support for today's show comes from Adio. What is Adio?
--:-- [Sound of typing on a keyboard]
--:-- Sean Rameswaram: Adio is an AI-native customer relationship management system built specifically for the next era of companies. They say it's extremely powerful, adapts to your unique data structures and scales with any business model.
--:-- Sean Rameswaram: According to Adio, Adio takes less than a minute to set up, and within seconds you will have your email and calendars synced. You'll see all your relationships in a fully-fledged platform, they say, all enriched with that actionable data.
--:-- Sean Rameswaram: And they say you can build AI-powered automations and use its research agent to tackle some of your most complex processes to seize so that you can focus on what matters, building your company.
--:-- Sean Rameswaram: You can join industry leaders such as Flatfile, Replicate, Modal, and so much more. You can go to addio.com slash todayexplained to get 15% off your first year. That's A-T-T-I-O dot com slash todayexplained. Explained.
--:-- [Sound of a coffee machine]
--:-- Sean Rameswaram: Explained. Support for this show comes from macy's. It's almost fall and that means it's time to cycle your wardrobe to the cold setting because while everyone loves a breezy summer outfit, let's be real layering is even more fun.
--:-- Sean Rameswaram: That's why macy's fall fashion guide has everything you need to piece together the perfect look for you. It's your one-stop shop for fall's latest trends and must-curated by their experts.
--:-- Sean Rameswaram: Add a statement shoe to your collection, like the calf hair loafers from Steve Madden, or tap into your romantic side with flowy dresses from Cece and sheer pieces from INC.
--:-- Sean Rameswaram: You can even throw in some textural layers for contrast, like a faux fur bomber jacket from Karl Lagerfeld Paris. Whether your old favorite sweater or coat is on its last threads, or you're just craving a new vibe to switch things up, Macy's has got you covered this season.
--:-- Sean Rameswaram: Find the perfect layering pieces for you by exploring the Macy's Fall Fashion Style Guide. Shop in-store or online at Macy's.com.
--:-- Sean Rameswaram: Okay, we're back. We've established that this COVID surge is largely happening among people who aren't vaccinated, and that's made a lot of vaccinated people mad.
--:-- Sean Rameswaram: Even public officials who are responsible for encouraging people to get vaccinated have started to point fingers. Here's Kay Ivey, the governor of Alabama, where just 34 percent of the population is fully vaccinated.
--:-- [Sound of a news clip]
--:-- Sean Rameswaram: But it's time to start blaming the unvaccinated folks, not the regular folks. It's the unvaccinated folks that are letting us know. But Dr. Rhea Boyd disagrees with that strategy.
--:-- Sean Rameswaram: Too often, especially if you're spending a lot of time online right now or on social media platforms, we see this description of the unvaccinated as this vilified monolith.
--:-- Sean Rameswaram: As if everyone in that group is unvaccinated for exactly the same reason, and that reason is their own selfishness. Dr. Boyd is a pediatrician and health advocate from the San Francisco Bay Area.
--:-- Sean Rameswaram: In reality, the unvaccinated actually includes every single child who's under 12 in this country. The folks who are also in this unvaccinated group include populations for whom our healthcare system has chronically underserved their needs.
--:-- Sean Rameswaram: I'm talking about folks who are uninsured and underinsured, people who live in rural America, and racial and ethnic groups like Black and Latinx folks who are the least vaccinated right now.
--:-- Sean Rameswaram: She helped start an organization called The Conversation to reach out to underserved communities and answer their vaccine questions without blame.
--:-- Sean Rameswaram: In general, blaming is a really ineffective way to move anybody towards a medical procedure. And technically, it's not even a part of the process that we typically engage in when we do what we call informed consent, which was when we give people the information you need to make the right medical decision in your interest.
--:-- Sean Rameswaram: We don't blame you into that decision. We make sure you have access to credible information. And what we know right now is that we are facing one of the most enormous disinformation campaigns we have seen around vaccines and healthcare in general, really in our recent history.
--:-- Sean Rameswaram: And so given the rampant amount of disinformation that people have to contend with, people don't know the things they need to know to make this decision well, which is why we've worked really hard to make sure we can spread credible facts about the vaccines.
--:-- Sean Rameswaram: Right. As I understand it, you've been giving talks to groups around the country, answering questions about the vaccine and encouraging people to go get it. Can you tell us a bit about the talks that you've been giving?
--:-- Dr. Rhea Boyd: Essentially, our project is centered around the needs of Black and Latinx, or Spanish-speaking populations. And so we're primarily trying to hit folks who our healthcare system has chronically underserved.
--:-- Dr. Rhea Boyd: And when we're thinking about the needs in these communities, we knew early on that we'd have to combat disinformation. So the first thing our campaign did was we created a library of frequently asked question videos that feature Black and Latinx healthcare workers, folks like doctors, nurses, and some of the folks and scientists who participated in the clinical trials so that our community can hear directly from providers who look just like them who are going to tell them the truth.
--:-- Dr. Rhea Boyd: What the vaccine is doing is just helping your body do what it naturally does. It's not doing anything different. It's not changing who you are. This is something that's going to hopefully help your immune system to get ready, to be able to fight.
--:-- Dr. Rhea Boyd: After we created that digital campaign, we also acknowledge that our communities don't have equal access to the Internet. And so right now, especially in rural areas in the South, we are going through a process to actually go door to door with written information so that people have a few facts at their disposal as they make this choice, and to host what we call teletown halls, call-in kind of webinars, where people can live, almost like you're on the radio, just ask your question in front of thousands of your neighbors and co-residents of your state so that we could start having an honest conversation about the safety and efficacy of the vaccines.
--:-- Dr. Rhea Boyd: What do you say to the people who say, you know, I trusted the Johnson & Johnson vaccine, for example, And now there's reports of this greater risk of blood clots or there's this report of this rare nerve syndrome now. Like you, the scientific community, told me that these shots were OK. But now I'm reading these headlines that are freaking me out.
--:-- Dr. Rhea Boyd: And these aren't even, you know, the anti-vaxxer conspiracy theories. These are the stories being published in The New York Times. I got that question last night in Louisiana. A woman called in in her mid-30s, a Black woman, who said, I got the Johnson & Johnson vaccine. I'm worried about the cases of blood clots that are in our community.
--:-- Dr. Rhea Boyd: I have higher risks of blood clots. Why didn't you guys just tell me? I really appreciate people's vulnerability to first share that they're scared about the vaccine they already got. I also appreciate people putting us on the spot so that we can actually just straight up answer that question.
--:-- Dr. Rhea Boyd: And for her it was to be able to reassure her and say most people who have that side effect from Johnson Johnson although it incredibly scary tend to have it the week after you get vaccinated. And so if it's been months and months and months since your vaccination, you don't have to worry. You got a safe vaccine and you can count on the protection that it's giving you.
--:-- Dr. Rhea Boyd: But until people can actually say that to a healthcare provider, they carry that fear with them. And they transmit that fear to other people, right? When they're having informal conversations, they'll say, I'm still worried about the one that I got. I'm not sure I would have got it if I knew then what I know now.
--:-- Dr. Rhea Boyd: And so we're also in these conversations trying to make sure that every person we talk to becomes an influencer for their families, for their networks, for the communities around them. And we end by saying, if one thing we said today resonated with you, if you heard one fact that helps you answer a critical question about the vaccine you already got or about the vaccine you're considering getting, tell one other person.
--:-- Dr. Rhea Boyd: Post it on your Facebook. Say it to somebody at the grocery store or at your child care pickup. Because we have to start shifting the public conversations more informally to actually be repeating science, to be repeating the facts we know about the vaccines instead of anecdotes that are rooted in disinformation.
--:-- Dr. Rhea Boyd: What are the stranger questions you've been asked? I mean, the most poignant question I think we've gotten on our teletown halls was an older gentleman who called in who said, you told me to get this vaccine. And I think he meant, you know, you and the scientific community told us to get this vaccine because it would protect us.
--:-- Dr. Rhea Boyd: And my wife got COVID two weeks ago and she died from COVID. What happened to my wife? And it had a chilling effect on the call. We spent a lot of time just, you know, sharing condolences and saying how devastating it is what he's been through because you could hear it in his voice.
--:-- Dr. Rhea Boyd: And then we had a really honest conversation about what vaccines do in terms of protection. That that gentleman was absolutely right, that vaccines will protect folks and give you the most protection we have against COVID infection, spread, complications and death.
--:-- Dr. Rhea Boyd: But they're not 100%. And so what we actually need is everybody that we encounter to also be vaccinated. And so when he asked that question, it gave us an opportunity to say to everybody on the call, if what you heard was devastating to hear, get vaccinated so things like that don't happen, so other people don't die of COVID too.
--:-- Dr. Rhea Boyd: I think we can, in these conversations, have kind of a more collective understanding of people's needs in a way that's harder to reach when you're just blasting out messages online to mass groups of people.
--:-- Dr. Rhea Boyd: It sounds like a lot of the questions you're getting and the concerns that you're hearing about are pretty distinct from the typical anti-vax rhetoric. But do you ever run into the anti-vaxxers that are just hard opposers to anything involving these vaccines?
--:-- Dr. Rhea Boyd: Not in our communities. And so I'll say because our campaign focused specifically on Black and Latinx and Spanish-speaking populations, I think it's part of why we don't hear those messages.
--:-- Dr. Rhea Boyd: And here I think it's important for us all to remember historically how those communities have been treated and undertreated by our healthcare system. It's never that Black and Latinx folks don't want equal access to primary care services.
--:-- Dr. Rhea Boyd: People aren't foregoing necessary medical care because they just don't want to be well. Even when they have complications of their disease. People don't pick up medications or go to follow-up appointments, even when they need it, because of the structural barriers, many of which are rooted in forms of historical racism that keep people from having equal access.
--:-- Dr. Rhea Boyd: And the same thing's happening with our vaccines right now. Black folks don't hate vaccines. We aren't anti-vaccines. We don't not want medical care. We want equal access to medical care. And that begins with equal access to information about our health and about interventions that can help us protect our health.
--:-- Dr. Rhea Boyd: I mean, do you being on the front lines think we'll actually get there? Do you think we can turn the corner in the United States?
--:-- Dr. Rhea Boyd: Absolutely. Having these conversations with people and seeing people be willing to ask questions and be moved to be vaccinated after we answer their questions lets me know that this is doable. We can do this.
--:-- Dr. Rhea Boyd: I think the timescale over which we can do this may be longer than what we expected. Because instead of just putting out messages and hoping it reaches everybody, we now have to employ strategies that actually bring us to every single person.
--:-- Dr. Rhea Boyd: What that means is it's going to take longer. And so in the interim, we need those other mitigation strategies to curve spreads, which work, right? Masks for indoor spaces works. Distancing works.
--:-- Dr. Rhea Boyd: So I think we should employ multiple mitigation strategies at once while we continue to do the hard work of helping people be prepared and access vaccination.
--:-- Sean Rameswaram: Dr. Rhea Boyd, she's a pediatrician and public health advocate and the co-developer of the conversation between us, about us, you can check out their campaign at greaterthancovid.org. It's Today Explained. Thank you.
