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Dr. Rochelle Walensky: Today, CDC is updating our guidance for fully vaccinated people. Anyone who is fully vaccinated can participate in indoor and outdoor activities, large, or small without wearing a mask or physical distancing. If you were fully vaccinated, you can start doing the things that you had stopped doing because of the pandemic.

Brian Lehrer: Wait, what? Why is that different today than it was a week ago? That is Centers for Disease Control director Dr. Rochelle Walensky announcing their new guidelines for wearing masks yesterday. While they had faced some criticism for being too cautious about when fully vaccinated people could safely go without masks, they used to say mainly outdoors, and still while distanced. Now they're going beyond what some public health experts are comfortable with and saying fully vaccinated people can go maskless except in a few specific circumstances, like on public transportation, or in health care settings.

They did say that people still need to follow their state and local guidelines and New York and New Jersey have said their respective health departments are reviewing the new CDC recommendations, but the old ones still apply. Some labor groups and businesses are also not ready to expose their workers to unvaccinated unmasked folks too and have said their guidelines won't change.

They won't know everybody who's coming into the store, for example, whether they're vaccinated or not, so they'll require for everybody. Let's try to understand the new guidelines and what they mean for you and for everybody with Dr. Stephanie Silvera, Epidemiologist and Public Health Professor at Montclair State University. Dr. Silvera hi, welcome back to WNYC.

Dr. Stephanie Silvera: Hi, thank you for having me back.

Brian: Listeners, your questions are welcome here about the new CDC guidelines for vaccinated people 646-435-7280. 646- 435-7280. What about your own choices so far? We see that in some neighborhoods, you probably see this too, as you walk around or drive around, in some neighborhoods people are still fully masked on almost empty streets and in parks. Some places that are crowded have a lot of people without.

Have the new guidelines made you more willing to go maskless outdoors or how are you navigating this for yourself? Definitely an opportunity to call with your questions for Dr. Silvera. 646-435-7280. 646-435-7280. Dr. Silvera, is this science, or is this politics? Why did this suddenly flip on the basis of I think the same science that we've known for weeks or months?

Dr. Silvera: I think a big part of what's playing into this and unfortunately, as we've seen with this pandemic, we've been unable to extricate politics from the science all the way along. I do think that the science is more and more heading in the direction that people who are vaccinated are very well protected. These are highly effective vaccines, in terms of not only COVID symptomst but transmission. I think that really is a big part of what we're seeing come into play now. I think the other part that's likely playing into this is that more and more people are getting vaccinated.

The goal of herd immunity is to reduce the possibility that somebody who is susceptible will come in contact with somebody who has the virus. As more people get vaccinated, that probability decreases and we can start to reopen the world and take our masks off.

Brian: That's a really important point. It's not just about the individual, it's about the community. Mayor de Blasio was just on announcing that New York City is well below at 2% positivity rate. If there are relatively that few people out there who might even be carrying the virus, and you're vaccinated, then it's safer to go maskless than it would have been a month ago with a 6%, whenever it was, a 6% positivity rate or something like that for the same vaccinated individual, is that part of it?

Dr. Silvera: Yes, so what we're seeing right now of the total for New York State population, I think it's 41% of the state, has been fully vaccinated. In New Jersey, I think it's for people who are at least 12 and above, people who are eligible, 50% are fully vaccinated. If you have fewer people who are sick and fewer people who are susceptible, that means that the virus cannot spread as quickly.

Again, a really important caveat though is for people who are susceptible because they're either not vaccinated or they're immunocompromised, or they're just not eligible yet due to age, they can still contract this virus. Any host is a potential for the virus to continue to mutate. We're not completely out of the woods yet. We are certainly much closer to the end or the other side of this pandemic than we have ever been.

Brian: There had previously also been a messaging critique lobbed at the CDC by people like Dr. Leana Wen, the former Baltimore Health Commissioner in Washington Post medical columnist now, who also came on this show to say requiring vaccinated people to keep wearing masks lessen the incentive to get vaccinated. If you had to act as cautiously as the unvaccinated and it wasn't really medically necessary, then you were disincentivizing hesitant people from getting vaccinated. Did you share that critique and do you think that's part of what the CDC was trying to correct yesterday?

Dr. Silvera: I do think that that's part of what they were trying to correct. I think we also have to recognize that science is iterative. We learn as we conduct more studies, and as time goes. In terms of illnesses and viruses, this is still a relatively new one and I think that erring on the side of caution was a good idea. I think now that we know more, we can adjust our guidance and our information in a way that still follows the science.

I will also put in a plug that we need people who are trained to do public health education, being part of this conversation because it's their job to understand the science and translate these really complex guidelines in a way that is, I think, more easily understood by the general population.

Brian: I do want to bring up this weird juxtaposition of a story that's been breaking around the New York Yankees this week at the same time that the CDC released these unmasking guidelines and curious if you have any take on the Yankees having eight people fully vaccinated with the J&J, who got COVID in the past week or so, only one of the eight was symptomatic, and only for a few days, but still a cluster of vaccinated people like that is unusual as far as we know, have you seen that?

Dr. Silvera: I have and I think it's very easy to look at that as an example of why we shouldn't be taking our masks off or potentially people saying vaccines don't work. The reality is, however, that the J&J vaccine has been shown to be about 66% effective at preventing these lab-confirmed COVID-19 cases. All of these individuals on the Yankees had the J&J vaccine. When you look at the population that was at risk here that was exposed, they had about 50 to 60 people that they were traveling with between coaches, staff, and the team players.

Eight cases is still 87% effective in preventing lab-confirmed COVID-19 in this population, meaning that the vaccine is actually doing exactly what we needed to do in terms of preventing symptomatic illness and not allowing this to spread wildly through the team. If this were an unvaccinated group of 50 to 60 people, those numbers of cases would be much, much higher, and there would be the likelihood that people would be hospitalized and potentially die.

Brian: That's a great point on looking at this in the context because the headlines have been Gleyber Torres, the shortstop plus eight members of the non-player staff, seven other members, I should say, eight total, the one player and seven others all got COVID and they were all vaccinated. The other way to look at it that you bring up that I have not heard in most of the media coverage is that if they were like 60 people in that traveling entourage, it would be about the percentage you might expect from a J&J vaccinated group.

It could be seen as really a big success story because only one of them got any symptoms at all and so mild that they were gone in a few days. Statistically, it seems like a case of the vaccines working really effectively.

Dr. Silvera: It is. In epidemiology, we say denominators matter. It's out of how many. Eight cases might seem like a lot if you're thinking about the team, but this is the team, the coaches, the staff. I think it's also really important to know that the coaches and staff had been in because of the rain delay, and a smaller indoor space than where the players were. We know indoors are just more dangerous in terms of transmission. It sets up a higher-risk environment. It's also not surprising that we're seeing more of coach and support staff and fewer of the players who are testing positive.

Brian: I also see relevant to this that the CDC, among the things that it has changed recently is its definition of a breakthrough case. A breakthrough case used to be described as anybody who tests COVID positive after being fully vaccinated. Now I think they're calling a breakthrough case, only people who are hospitalized, which is hardly happening at all.

Dr. Silvera: Right. The initial goal for the vaccine and what they've been tested to do in the clinical trials was prevent hospitalization and death. These vaccines have been not just highly effective, but more effective than most of the other vaccines that have been on the market for decades. This is actually a really incredible case study on vaccines that work and how you navigate through a pandemic using vaccination.

Brian: By the way, Dr. Leana Wen, who I mentioned before tweeted that, "Masklessness should be tied to vaccination rates in the community to keep the incentives high." That's what we were talking about before. Masklessness at the local level should be tied to vaccination rates in the community. It's not just about the individual?

Dr. Silvera: Yes, absolutely. When you look at the CDC right now, the percent of the population that is vaccinated, there's a pretty big range. In Mississippi, for example, 32% of the vaccine has received one dose, 25% are fully vaccinated compared to places like Vermont where 63% of the population has gotten at least one dose. I think it's really important to note that the CDC is issuing guidelines and recommendations, but that's not policy, and that the policy really needs to take place, not just at the state level, but at the local and hyper-local level because that is where the risk is really arising. You need to have different policies based on different risk profiles.

Brian: Nick, a school psychologist in the Bronx, you're on WNYC. Hi, Nick.

Nick: Hi, good morning, almost afternoon. Thanks for taking my call. I live in the Bronx. I'm actually a school psychologist in Rockland County and I know that it's-- I think everyone is feeling pretty anxious about the return to normal, but also I think people are wondering, especially with the new guidelines coming out what that's going to mean for people under 16, or what it means for school professionals and other professionals across the board moving forward as we hope for a better and healthier tomorrow.

Brian: Dr. Silvera.

Dr. Silvera: I think that for schools, we are actually getting very close to the end of the school calendar for kids now 12 and older who are now eligible, even if they start the vaccine yesterday, as my 15-year-old did, he's not going to be considered fully vaccinated until I think his last week of school. I don't see the policy at the school level really changing terribly significantly this academic year. I think as we head towards the fall for potentially middle and high school age students who are more likely to be vaccinated and potentially be fully vaccinated, I think that we will need to really consider whether or not they need to wear masks in school during those times.

That said, I am a proponent of we've seen that mask reduced not just COVID transmission, but cold and flu. We have some of the lowest flu case rates and death rates in history. I don't want to see masks fully go away. I think there's a role for them.

Brian: What about for kids under 12 who are not eligible for any of the shots yet? What does the no mask requirements even indoors for vaccinated people mean for them in your opinion?

Dr. Silvera: I think there has been this idea that kids don't get COVID or they don't get sick and that's not entirely true, they're less likely. I think that as a family, you need to make the decision on whether or not your children are at risk and what you feel comfortable doing. I wouldn't feel comfortable having my children-- My daughter is not yet vaccinated be at a concert yet, without a mask because she could become sick. We don't have good predictive model for which kids are going to get very sick and which ones are not.

I think, again, as we move forward, we're going to be outside more for the summer, we know that those case numbers they went down last year, I suspect they will, again, the transmission rates are down, so risk is going to be generally lower. I think as we get back to September, we're going to see whether or not under 12 is eligible to be vaccinated. For Pfizer that may come into play, that's moving along pretty quickly, and then are people willing to have their children be vaccinated? I think that's really for a lot of this, for adults, and children alike, that's the crux of this. Are we going to get those few people who are still not willing to get vaccinated to participate in the vaccine program?

Brian: I see that the CDC said that separate guidelines for summer camps and for schools will soon follow yesterday's update for vaccinated 12 plus. Nicole in Metuchen has a related question, I think. Nicole, you're on WNYC. Hello.

Nicole: Hi, Brian. I'm a huge fan. Yes, my question was related to kids. I have a three and a seven-year-old who obviously can't be vaccinated. My husband and I are. I felt like it was a little premature for the CDC to announce anyone that's vaccinated can be unmasked indoors. Outdoors I'm more okay with, but how does that protect our children? How does that protect the little ones especially if we don't know how long we as vaccinated people have antibodies for? I don't know if that's known. That was really my question.

Dr. Silvera: Right now the studies about how long the immunity lasts with a vaccine are ongoing. I think that we're going to overtime find out whether or not a booster is required or necessary. I understand the concern about children and what I think is a way to look at this is if people choose to continue wearing a mask, whether that's outdoors or indoors, we should not yell at them. I know there have been people in other parts of the media who have said you should confront those people. We don't know what individual's health risks or comfort levels are. If you have children, and you think that they should continue wearing masks indoors, I think that we should all allow that.

I don't think that-- This is not the time to start getting into people's faces and yelling at them about their children continuing to wear a mask. They're unvaccinated and I think that that is really the safest route for them.

Brian: Part of the Yankees' response to their outbreak was to go back to mask-wearing around other people which they had stopped doing just in their circle because 85% of their team and staff were vaccinated, which I think is herd immunity by almost anybody's definition. How does that fit in with Nicole's question and with the new CDC guidelines that vaccinated people don't any longer need masks?

Dr. Silvera: I think a few things that we know pretty well is, if somebody who has COVID wears a mask, they're much less likely to transmit it to susceptible individuals. If you think you've been exposed, if you are showing symptoms, then really the good thing that you can do for your community is to put the mask on. I think the Yankees are showing that and demonstrating that. I will go back to my argument about the flu and cold.

If we think about how we used to live, people used to go to work sick because we have to work. There's no time off. I think we really need to start changing how we think about how we interact with one another. We tend to be a very individual-focused society. I think this pandemic should have if it hasn't teach us that we are part of a broader community and our actions have an impact on others. From the very beginning, mask-wearing has been something that you can do to protect the people around you.

Brian: Let's see if we can get one more caller in here real quick in our last minute. Priscilla in New Rochelle, you're on WNYC. Hi, Priscilla. 15, 20 seconds for your question. Hi?

Priscilla: Hi Brian. My question is about conflicting information about how long the vaccine lasts. My second shot six months will be over August 8th. Does that mean, it doesn't work? Does that mean I need a booster, but there's no info on the boosters.

Brian: That's a great question. I think we're going to be asking this one a lot more because Pfizer and Moderna, both say that boosters are going to be likely necessary after six months to a year. What can you say in 30 seconds, doctor?

Dr. Silvera: As I said, science is iterative. We're continuing to learn, we're continuing to collect the data on the people who are originally enrolled in those trials. I think that if that changes, they will put that information out there.

Brian: We just don't know yet

Dr. Silvera: We don't know yet, but we hopefully will soon.

Brian: Of course, Pfizer and Moderna will be able to sell more vaccines if we go in that direction.

Dr. Silvera: Absolutely.

Brian: We have to take that into consideration too. Dr. Stephanie Silvera, Epidemiologists and Public Health Professor at Montclair State University. Thank you so much.

Dr. Silvera: Thank you for having me.

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