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--:-- Sean Rameswaram: New guidelines released by the CDC on Mondays suggest that the thing we colloquially call normal life may be within reach, at least in the United States. But before we get there, hold the phone. The CDC? We're trusting the CDC again? I hope so. I think it's a great question. We asked Dr. Kavita Patel this morning. She's a primary care physician and also worked in public health under President Barack Obama.
--:-- Sean Rameswaram: The CDC has had a poor track record, especially in COVID, but they're trying to put out guidance, but also put the evidence supporting that guidance into it. And I will be honest, I'm seeing the CDC director speaking much more candidly about not just that set of guidances, but also any questions that are coming up and tackling them very honestly.
--:-- Sean Rameswaram: We've been through a lot this past year, and with more and more people getting vaccinated each day, we are starting to turn a corner. This is a new CDC leader, yeah?
--:-- Kavita Patel: It is, Dr. Rochelle Walensky. She is a bit of a celebrity in the infectious disease and public health community. This is why today CDC is releasing its initial guidance for the public that, for the first time, lays out some of the activities considered safe for those who are fully vaccinated.
--:-- Kavita Patel: Horik was primarily in HIV, but she is an incredible infectious disease public health leader. And I think she's doing a really great job at a pretty pressured time.
--:-- Sean Rameswaram: Sure. Well, what are these new guidelines? Let's talk about them. Yeah, I think the guidelines are probably easiest to break down in kind of three quick hits.
--:-- Sean Rameswaram: Number one, if you're fully vaccinated, you can get together with other fully vaccinated people in a small setting, but no masks, no distance, none of the things that we've unfortunately gotten used to. If you're fully vaccinated, you can also get together with unvaccinated people as long as they're not at risk of getting severely ill from COVID. And that's where there's a big asterisk, like, what does that mean?
--:-- Kavita Patel: The third is that if you are fully vaccinated and you're exposed to somebody who tells you, I have COVID or I might have COVID, instead, you do not need to quarantine for 14 days like we would previously recommend. And that's a big deal as well.
--:-- Sean Rameswaram: And you mentioned there being more candid over there at the CDC now. What's the science behind these updated guidelines?
--:-- Kavita Patel: Yeah, so the science in the footnotes, and those of us that are big science dorks will read the footnotes. The footnotes contain studies that really do point to an interesting kind of risk in that we have more and more evidence that if you are fully vaccinated, your risk of transmitting the virus to someone who is not vaccinated is incredibly low.
--:-- Kavita Patel: We're still waiting for what the major manufacturers are working on, which is kind of that, quote, definitive evidence. But we already have now emerging studies, by my count, seven, and many of those are cited in the CDC guidance, that tell you if you're vaccinated, you're at very low risk of giving this virus to someone else.
--:-- Sean Rameswaram: That does mean we'll have a future soon without masks and without distance. That's a game changer now.
--:-- Kavita Patel: Yeah, it is. I think that's, you know, it's funny, like in healthcare policy, sometimes we always say like, you know, our communications are so poor we bury the lead. I personally think that was my big takeaway.
--:-- Sean Rameswaram: The guidance is a big deal, and I know everybody's talking about it. The CDC is essentially, by putting out this guidance, saying, hey, we know it's pretty low risk that if you get vaccinated, you will not give COVID to someone else. And that should make all of us really anxious and excited to get vaccinated whenever we're eligible and as soon as possible.
--:-- Sean Rameswaram: It feels like we're still trying to convince people in this country to wear a mask, and all of a sudden now the CDC is saying, if you get the vaccine, you don't need the mask?
--:-- Kavita Patel: Yeah, that's a great question. This is actually where the CDC guidance has been pretty conservative, because it basically states very clearly, if you're in a public space, no matter what that public space is, gyms, restaurants, bars, airplanes, travel, you have to wear a mask.
--:-- Sean Rameswaram: And I'll tell you even further some criticism, which I share, but on reflection, I understand. They did not say anything about travel. They're still basically recommending that people do not travel.
--:-- Kavita Patel: I was a little upset about it initially. And after processing it, I can see why they said that.
--:-- Sean Rameswaram: Why were you upset?
--:-- Kavita Patel: So I was upset because, you know, by saying, Sean, that you're fully vaccinated and you're not going to transmit this, why shouldn't people get on a plane and travel? Why would they feel like they can't travel?
--:-- Kavita Patel: And when I thought about it, you always have to remember that the CDC is acting on behalf of the whole population, not the individual. And we still have cases right now. We still have positivity rates in parts of this country that are near or over 10%. We still have incredible kind of concerns about these variants that are spreading.
--:-- Kavita Patel: And so when people travel, we can, even if we don't intend to, we can change the patterns of these variants, of these viruses. And so for that reason, I think today they were silent on it.
--:-- Sean Rameswaram: I got great news for you, Kavita. Travel bookings are surging irrespective of CDC guidelines. Senator Ted Cruz is taking heat for his trip to Mexico this week. But he's not alone. Thousands of Americans are also flocking to Cancun and other resort cities.
--:-- Kavita Patel: Yeah, look at this stock. It's jumping more than 4% right now, edging very close to a one high after announcing a 30% increase in new cruise bookings since the beginning of the year compared with just last November to December.
--:-- Sean Rameswaram: Let's talk about how safe it's going to be for people to travel once they're vaccinated. It seems like you're suggesting it'll be pretty safe.
--:-- Kavita Patel: Yes, people are going to develop immunity sooner rather than later. So I personally do think that if you're a grandparent or you're a grandchild, or me, I haven't seen my parents in over a year and a half, you know, then I would feel comfortable taking precautions and you're going to have to wear a mask. You're going to have to try to kind of consciously stay socially distanced.
--:-- Kavita Patel: So if you're traveling today, that's what it'll look like. If you're booking for 2022, I think it'll be pretty normal and what it felt like in 2019.
--:-- Sean Rameswaram: When traveling right now after you get a shot, let's say if you're in the United States or elsewhere, you should still have some precautions about mask wearing. But does that prevent people from hugging their parents?
--:-- Kavita Patel: I think the CDC actually said something about that, right? No, hugs all around. Yes, yes, yes. If you have, especially the high risk, which I'm just going to make assumptions, parents, grandparents, because of their age, they're high risk by definition. As long as they're vaccinated and you are either vaccinated yourself or not vaccinated but at low risk, yes, you should feel comfortable hugging and touching and being kind of incredibly close.
--:-- Kavita Patel: I think the blind spots for some people are that pregnant women are still high risk if they're not vaccinated. And here's just something interesting to consider. So are smokers. And we have a lot of Americans who are smokers. They are considered at high risk of getting severe COVID.
--:-- Kavita Patel: If you are a smoker and you are not vaccinated, even if you're 25 and totally healthy, we would recommend that you don't actually touch others and you would need to wear a mask and be distanced.
--:-- Sean Rameswaram: What about some of the other stuff that people really miss, like attending a concert or a sporting event? I know sporting events are now sort of ramping up, reintroducing fans into the atmosphere right now. Is that safe? Is that dangerous?
--:-- Kavita Patel: Yeah, so I do think that sporting venues that are kind of doing like 25% capacity, there's still a risk, but I do think that that's way more responsible or it's lower risk.
--:-- Kavita Patel: I would say that we're not going to be kind of seeing major tours of concerts advertised right now, but I would predict by fall that would be safe to do.
--:-- Kavita Patel: And I think, Sean, everybody wants to know when can they attend a concert and not wear a mask? And that's where I do think we're going to have to wait until we get to herd immunity, to be candid.
--:-- Sean Rameswaram: Yeah. By when? So the numbers around herd immunity, you've heard everybody, including myself and people I work with, say somewhere between 70% and 85%.
--:-- Kavita Patel: Remember, herd immunity is not going to be like a light switch. If you're in a part of the country where you're getting people vaccinated more efficiently than other parts, let's say West Virginia, Connecticut, some other states, you're going to probably get to herd immunity sooner.
--:-- Kavita Patel: And so that might be, for example, in the summer when you'll have the ability to safely gather. I think that's where I'm hoping the CDC gets more aggressive about updating their guidance.
--:-- Sean Rameswaram: And how big an issue is the fact that, you know, for a lot of people, herd immunity is the goal. And for a lot of people, they never really stopped doing what they were doing anyway.
--:-- Kavita Patel: And we're seeing states start to like roll back any sort of mask guidance in advance of the CDC. I mean, it feels like there are just two, if not more, different cultures operating in the United States, at least, where some people are trying to be cautious and follow guidelines, and a whole lot of people are just doing whatever they want.
--:-- Sean Rameswaram: It does all of society no good to fight to get to herd immunity if you have 14 states that say, you know, you don't need to wear masks, and let's all accept, quote, personal responsibility.
--:-- Kavita Patel: And if you're not wearing a mask, you are a prime target. So if you're really thinking about personal responsibility, wearing a mask is the most responsible thing you can do, not just for yourself, but think about the people who don't have like a sign on their forehead that says I'm immunocompromised or I have a child that's battling leukemia.
--:-- Kavita Patel: We just don't know what people in society are experiencing. And so if you're trying to exhibit personal responsibility, think about your neighbor and think about people that you don't know their status of vaccination.
--:-- Sean Rameswaram: Sean, we still have, as good as this news is out of the CDC, let me just be blunt, we still have 2,000 people dying a day. And they're not all just older people. There are young people in that category. And that's partly why we're being conservative about things.
--:-- Linda Lowe: My name is Linda Lowe. I am 72 years old. And I live in La Jolla, California. I got my vaccine in late January, my first one. And then my second dose was February 24th or 25th. It was Moderna. Obviously, the thing we plan to do when the world feels safe and we can is we want to travel. I will be flying across the country and I will be visiting my daughter, son-in-law, and our new granddaughter, who I've only seen once since COVID started because she was born in March.
--:-- Victor Polishuk: I'm Victor Polishuk. I'm a retired physician in Rochester, New York. I got vaccinated for the first time with the Pfizer vaccine about four weeks ago and got the second shot two weeks ago. We have been extraordinarily careful. We were not with people. We did not put ourselves at risk. I have two daughters. They're both here in Rochester. Five grandchildren. But we have not been able to gather since the weather turned last fall. We did gather outdoors, separated, distanced, and so on, but we have not gathered indoors since the winter began. And now we have. We've hugged our grandchildren for the first time in months, and we've been able to visit with them and actually eat with them, share a meal together.
--:-- Terry Binder: My name is Terry Binder. I live in Germantown, Maryland. I'm 67. I am very much looking forward to seeing my grandchildren. I have two that live in Philly, and their parents are both doctors, and they feel it's safe. They've had their shots. So we're actually going to get together the end of March. So I'm very excited by that. And the other thing I think I'm probably looking forward to is actually shopping for myself. I found a friend whose son is in his 20s and who is not too concerned about going into the grocery store. So you know sometimes you get low fat when you wanted full fat or you get you know no salt when you wanted salt or that sort of thing. So if you particular about your groceries, then it can get a little frustrating.
--:-- Terry Binder: I think one of the biggest changes for me with the vaccine is that I feel a weight has been lifted. There's no longer the stress in my mind that, oh, we might get COVID, my husband or I. And so that's really a non-tangible thing that I really feel is a big difference with this vaccine.
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--:-- Sean Rameswaram: So, Kavita, it sounds like a lot of people might hear these new CDC guidelines and think, like, wow, once I get the vaccine, I'm pretty much set. Can we clarify what protections you get and do not get from any of the vaccines that are now floating around the United States?
--:-- Kavita Patel: The biggest myth, I think, is that if you get vaccinated, you can't, quote, get COVID. That's not true. These vaccines are good all across the board, across the globe. But what they're good at is preventing you from dying or getting hospitalized, which is actually what the manufacturers set up as the primary endpoints of the clinical trials.
--:-- Kavita Patel: Because candidly, that's the most important thing we're trying to protect against. And you've probably heard, Sean, people say, hey, I got my flu shot, but I still got the flu. That's because the flu shot does the same thing. It doesn't prevent you from getting the flu virus and the viruses that cause the flu. It prevents you from getting sick. Or if you do get sick, you get a milder illness.
--:-- Kavita Patel: So that probably is the biggest myth to kind of bust, that if you get these vaccines, you could still test positive for COVID. It's not as likely, but it's possible, which is why we've had a lot of confusion as people have tested positive after getting the vaccine, but they're not sick. And they're absolutely all across the board not going to die from it, from the evidence we have so far.
--:-- Sean Rameswaram: It sounds like production is really ramping up on this new Johnson & Johnson vaccine, which we actually haven't spoken much about on the show yet. People are calling it a game changer. Why is it a game changer, if it is one at all?
--:-- Kavita Patel: So for me, I practice in a community setting. It's a game changer for two reasons. Number one, it's one shot, and you can get, after two weeks from that one shot, you start to develop immunity. It's incredible to think that shot in the arm, two weeks later, you're, quote, fully vaccinated.
--:-- Kavita Patel: And then number two, for me in a community setting, I work in a pretty primarily Latinx population. We don't have freezers. We don't have that ultra-cold storage that the Pfizer and Moderna and some of the other vaccines require. The Johnson & Johnson vaccine can be stored like other immunizations we're used to in a fridge.
--:-- Kavita Patel: So I would say it's the speed to vaccination immunity and then two, the flexibility to administer this in a broad number of settings. That being said, it doesn't sound like everyone loves it. One of our producers, Amina al-Sadi, was saying that in her family, people are making fun of each other because some of them got the real vaccine and some of them got that Johnson & Johnson one.
--:-- Kavita Patel: Why do people—is it because it's less efficacious? Here's a couple of tangible reasons why. You alluded to it already. There's already been incredible media headlines about the efficacy compared to Pfizer and Moderna, which were 94 to 95 percent, quote, efficacy.
--:-- Kavita Patel: First of all, I don't think anybody in America actually understands what efficacy really means, and I can explain it briefly. But they're comparing 94 to 95 percent for Moderna from their data last year compared to Johnson & Johnson's 72 percent or 66 percent when the variants are taken into consideration. It's apples and oranges between the manufacturers.
--:-- Kavita Patel: The Johnson & Johnson trials were done in countries like South Africa, where they had the highest degree of these variants. And they were done at different times when we had our surge around Christmas. You could argue Johnson & Johnson is closer to what the reality might be if Pfizer and Moderna were actually doing their trials right now with the variants and with kind of the high number of cases.
--:-- Kavita Patel: Either way, what I want to tell people is that no matter what that level of efficacy is, that it mounts an antibody and T cell response in your immune system that is way higher than what we would need and what we would see, Sean, with people who are naturally infected by COVID.
--:-- Kavita Patel: So to me, it's good. Hand in the air, I would say I would take any of them because I was concerned about dying or getting hospitalized. I was also relieved to see that all three vaccines that have been authorized by the FDA exceed the FDA's own 50% efficacy threshold.
--:-- Kavita Patel: So they perform way better than we ever expected them to perform. Even so, the mayor of Detroit rejected the Johnson & Johnson vaccine. Johnson & Johnson is a very good vaccine. Moderna and Pfizer are the best. And I am going to do everything I can to make sure the residents of the city of Detroit get the best.
--:-- Kavita Patel: And I do think that's because, again, going back to the theme of the year, lessons I've learned after a year, we do a pretty poor job of communicating in public health and science. We just don't communicate well.
--:-- Kavita Patel: So those top line numbers, 66, 72, 94, 95, if you're any human, why wouldn't you, Sean, say, well, if I get a 94, that's better than 66, isn't it? But they don't understand what efficacy means. It means it's a reduction of risk. It doesn't mean that it's a probability of you getting COVID. That's totally different.
--:-- Kavita Patel: So when the Detroit mayor did that, and he's quickly kind of walked it back. Well, today his office explained it was a misunderstanding, writing, As vaccine eligibility expands, Detroit will open a second site offering Johnson & Johnson vaccines.
--:-- Kavita Patel: I'm pretty sure what happened is he got a call from the White House that said, wait a minute, do you understand what you're doing? And do you understand you're actually prohibiting a large number of your population from getting immunized sooner and exposing them potentially to risk of hospitalization and death?
--:-- Kavita Patel: And I think that's the right answer. So I do think these people who are rejecting it, whether they're mayors, governors or individual patients, have made a mistake.
--:-- Sean Rameswaram: So it sounds like your advice to patients and to anyone out there is if you can get any of these shots, get it.
--:-- Kavita Patel: Is there someone out there who is at risk, who is pregnant, who is, I don't know, you know, 87 years old with lots of underlying conditions who should be shooting for one vaccine over another?
--:-- Kavita Patel: I want to answer this by looking at the data. So we know that none of these trials really included pregnant women. Now, they are doing trials on pregnant women to answer the question you asked. So we don't have enough data to say, yeah, this vaccine would have performed better or not as good in a pregnant woman.
--:-- Kavita Patel: And so I would still say to pregnant women after talking to your OB, I would accept any of the vaccines because the risk of getting COVID while pregnant is far worse. And unfortunately, far worse for you and the baby.
--:-- Kavita Patel: So I would get any vaccine. But you raise a really good question. When you look at the data, over the age of 60 and people with other chronic conditions, there was a wide degree of variation around the performance of the vaccine. It was still good. It's still performed by FDA standards. But there was a wide degree of variability.
--:-- Kavita Patel: So my only advice to listeners would be that if you are over the age of 60 and you have chronic conditions, have a conversation with your doctor. But because I truly believe that the reason we're all getting vaccinated is to get to that need of herd immunity, I would still recommend, and I have to patients over 60, to get the vaccine that's offered sooner and not to delay.
--:-- Sean Rameswaram: That is a different question. And that's why I do think it's worth having the conversation. But do not wait. I can't tell you how many cases of COVID we're still seeing. And my only regret is that if we could have vaccinated them even a week or two earlier, could they have been protected?
--:-- Sean Rameswaram: You know, you talk about where we'll be in a couple of weeks. It makes me think of where the president says we'll be in a couple of months, which is that every American should have the opportunity to get a vaccine by, I think he's saying, the middle of May.
--:-- Kavita Patel: Yeah, it's crazy. Which feels just wildly optimistic and sort of incredible considering where we were just, you know, three months ago, two months ago.
--:-- Kavita Patel: What are your thoughts? I mean, does that seem likely, especially when there's a lot of vaccine hesitancy in this country, too?
--:-- Kavita Patel: The president said by middle of May, there'll be enough supply. You can have vaccines sitting in freezers and refrigerators, but not in arms. And I think that's what is going to happen.
--:-- Kavita Patel: And it's for two reasons. We as a country decided from the get-go, not this current administration, of course, but the Trump administration, that there would be no national strategy for getting the vaccines out. So we left it to states.
--:-- Kavita Patel: And what did the states do? In many states, they left it to counties and cities. Who is the most under-resourced, underfunded, non-existent public health infrastructure in the world? Counties and cities.
--:-- Kavita Patel: So I think the middle of May, kind of thinking the skies are going to open and everything's going to be better is way too optimistic. But my bet is that by June, end of June, July, we will start to see in parts of the country 70% of people vaccinated. Maybe sooner, but still it's going to take a couple of months after the supply is available to make sure it's in people's arms.
--:-- Sean Rameswaram: And to your point, dealing with people who either don't trust it, have questions about it, or are purely just hesitant. And then remember kids, right? We don't have a vaccine approved yet, or authorized, I should say. None of them are approved for under 16. So we still have to deal with children not being vaccinated, which they likely won't be, many of them, until next year.
--:-- Kavita Patel: And as we look ahead to next year and the year after, I mean, we did an episode a few weeks ago about vaccinations around the world and, you know, vaccine inequity. With the U.S. having ramped up so much so quickly and established a ton of vaccine infrastructure, have you heard plans for making sure the rest of the world gets covered?
--:-- Kavita Patel: Two things. We rejoin the World Health Organization. And then you may have seen, and by the time people listen to this, it might have already happened. But Vice President Kamala Harris is going to address the United Nations. And I think that is going to be an incredible signal. And part of the message is that we're back as part of a global kind of compact to help with vaccines globally. It's not just about us. We can't get to truly kind of widespread herd immunity until the globe has access.
--:-- Kavita Patel: I'm looking to the south, to Mexico, and I'm terrified at what I see. And I do think that this is going to become something that Americans should be aware of. And we should keep as a priority. It's not just about us. But we will not get out of this pandemic if we don't have most of the world vaccinated.
--:-- Sean Rameswaram: Doctor, thank you. I appreciate your time.
--:-- Kavita Patel: Yeah, thank you.
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--:-- Sean Rameswaram: Dr. Kavita Patel. She's a health policy researcher based in Washington, D.C. I'm Sean Rameswaram. This is Today Explained. Thank you.
