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Brian Lehrer: This is Brian Lehrer Show on WNYC. Good morning again everyone, happy new year again everyone. For 2021, we add a new metric to our ongoing roundup of coronavirus numbers. It's the number of people vaccinated. According to the website Our World in Data, about 12 million people worldwide were vaccinated through Saturday, about 4 million or about a third of them in the United States. The US also, as you've been hearing, passed 350,000 COVID deaths this weekend. We have 4% of the world's population. We've had close to 20% of the deaths.

The deadliest days of the whole pandemic so far are occurring right now. Before December, the deadliest COVID day in the US was April 15th with 2,752 deaths. By late August, deaths were in the hundreds per day, not even reaching a thousand, but last Tuesday through Thursday, the last good days of data before the holiday weekend, the US had more than 3,600; 3,800; and 3,400 deaths according to the New York Times COVID Tracker, that's substantially worse than in April. The deadliest days of the pandemic in this country are happening now, but 4 million Americans so far have been vaccinated. However, there is this disturbing stat from Ohio, from Governor Mike DeWine.

Governor DeWine: I'm asking everyone who's offered the opportunity to take that vaccine, it's obviously your choice to take, but I would ask you to have a sense of urgency about that. The same goes for those who we're entrusting with putting the shots in the arms. Those folks in the medical community who are doing this, the institutions that are doing it, we thank them for what they're doing. We also ask them to have that sense of urgency.

Brian: Governor DeWine revealed that 60% of nursing home workers in Ohio are declining to be vaccinated. Could private employers require vaccinations? That's one of the first COVID policy debates for 2021. Another one is whether to stop giving people their second doses until more people can get their first.

With me now, Dr. Leana Wen, Georgetown professor, emergency physician, former Baltimore Health Commissioner, and a Washington Post columnist whose latest article lays out six things the federal government can do to get vaccinations into people's arms more quickly. Of course the rollout has been shockingly slow so far. Dr. Wen, we always appreciate your time. Welcome back to WNYC, happy new year to you.

Dr. Wen: Thank you, Brian. Happy new year to you as well.

Brian: Let's go through some of your prescriptions for getting more people vaccinated more quickly. The first one is recruit an army of vaccinators. You mean there just aren't enough people giving the shots?

Dr. Wen: I laid out these prescriptions because it seems that the federal government has basically said, "Our responsibility is to give the states the vaccines. And as soon as we do that, we wash our hands and we're done," but that's not right, and there are things that states really need help with. They need guidance and support and resources from the federal government and the workforce is one of these, because it doesn't make sense to have hospital workers and health officials, public health leaders who are already so exhausted from all their other work of caring for patients, of setting up testing, to also now be setting up vaccination.

Now, different states, different locales have different ways that they want to implement the vaccinations, but right now, for example, many states are calling around to see who can they recruit to also do these vaccinations. They're trying to find pharmacy students. They're trying to work out with various nursing associations as well. That's something that could be done on a national level to work through national associations so that each state doesn't have to reinvent the wheel themselves.

The federal government also has a role to remove licensing barriers, cover any liability issues. I think there's a lot that could be done not only for the people but also for space. You've got Germany, Italy, other countries that are setting up these mass vaccination centers on a national level. That's something the federal government can help with.

Also now we're seeing in Florida, in other states, that people are lining up for hours and hours to try to get a vaccine. The shot is not what takes the most amount of time. It's the paperwork and streamlining that process. They'll be having an online registration, having a toll-free number that people can call to ask questions. That way, we can process many more people because at the time they show up, they can just come in and get the shot.

Brian: On mass vaccination centers, you use New York City as a potential example, you write New York City has one of the most well-funded public health systems in the country. Mayor De Blasio has said the city can vaccinate a million people by the end of January. The federal government can select, say, 10 regions with the highest likelihood of success, give them a month to distribute a million doses each. If everybody took you seriously about this, Dr. Wen, what could happen in New York starting tomorrow?

Dr. Wen: What I'm saying in this case is that right now the federal government is distributing vaccine doses on a per capita basis, which seems to be a fair thing to do. The problem is that not everywhere is equipped to distribute these doses right now. We should certainly be trying to level the playing field and work on equity, because you don't want to exacerbate existing disparities, but while we're working to ramp up capacity in many parts of the country, there are other parts of the country that are ready to go.

And I want to take up Mayor De Blasio's offer to say, let's see what it looks like for these parts of the country that are ready to go, let them work it out first, "These are the places that have well-established public health infrastructure." Let them work through the roadblocks and write the playbook for everyone else. See what it looks like to have these mass vaccinations in different cities, and they're going to implement different methods, but there's a lot that we can learn from it. This is not the time for us to be waiting for everyone to catch up.

Yes, we should be helping those others to catch up, but in the meantime, let's not just let as it's happening now, millions of doses of vaccine languish in freezers, when there are plenty of people who want them and there are plenty of places that are able to distribute them to. That level of urgency is missing from the federal government's response, and it actually is up to them. Actually I started all these recommendations by saying the federal government needs to first and foremost set the expectation that this is an all hands on deck, 24/7 operations.

I am actually really appalled to hear a lot of people blaming the holidays for the delay. There are people dying over the holidays too, and I just cannot stand and none of us should be able to stand to have thousands of people be dying every day when there are millions of doses of vaccine that are sitting unused. Basically there should be a policy of use it or lose it. If you cannot use it, give it to somebody else who is able to distribute it in the meantime.

Brian: Listeners, we can take your coronavirus questions for Dr. Leana Wen. It can be on anything having to do with vaccines and vaccinations. It can be on the new variant of the virus that's being identified in more states in the US. It can be on some of these policy questions, like whether vaccination should be required or could voluntarily be required by employers in order to enter workplaces or anything else you want to raise, Dr. Wen is always good enough to come on and answer your coronavirus questions, which I know people have so many that run in so many directions.

Policy questions, also what you should do to keep yourself and your loved ones safe, and all of these things. Our phones are open, 646-435-7280. We did a lot of this in 2020, and I promise we'll do a lot of it in 2021 as we continue to work our way through the COVID pandemic. We'll take a lot of your questions, answering a lot of your phone calls with your coronavirus questions on this show, 646-435-7280. If you have one right now for Dr. Leana Wen, 646-435-7280. Before I go on to some other things, just on this question of rollout,

President Trump and President-elect Biden had a back-and-forth the other day, where President Trump was blaming the states and localities for a slow rollout of the vaccine which has been delivered by the federal government, he said. Biden said, "No, not so much. Trump could be doing a better job." Where does the responsibility really lie? Is this a federal government problem or the states and the cities and the counties failing their residents?

Dr. Wen: This is an everybody problem, and I don't think that the right thing for us to do is to assign blame but to see what is not working so far and what we should be doing going forward. It's clear that right now, the responsibility is lying with no one, and the federal government ultimately needs to be the one that's setting the targets. For example, they could have said when they gave the doses to the states, "You have X amount of time, whatever that time is, two weeks, three weeks, et cetera, to use up all these doses. If you're unable to use them in this time, we're going to redistribute them. And next time, your allocation is going to be smaller because you're clearly not showing that you're able to distribute these doses when other states are able to do this."

Now, the other thing to do then is to say, "What do you need in order to get this done? In order for you to reach this particular target, how can we help you?" Local and state health departments are so overwhelmed. They've been taking on so much. They're doing testing, contact tracing, public education and everything. On top of this, we're asking them to stand up a vaccination program. It's reasonable for state and local health departments to then say, "Okay, we accept this target that you're setting for us, but in order to meet that target, here's what we need from you."

Maybe the National Guard needs to come in and help for a time to do the testing because we can't do both or "maybe we can also be building these community vaccination centers, we need the federal government's help to do this work" or "maybe we can do this on our own, but we need the resources, the funding to do that." That's the job of the federal government, to set these targets and then to then ask state and local health departments, "What do you need?" And then meet those needs rather than simply give unfunded mandates.

Brian: Let's take a phone call. Mike in Queens. You're on WNYC with Dr. Leana Wen. Hi, Mike.

Mike: Hi, good morning. I was just of the view of giving everybody a vaccination to get partial protection. I know it's a two-dose regimen but why not give millions of more people their first dose and wait for the second one for a couple more weeks, maybe?

Brian: Thank you very much. Dr. Wen, I know this is a debate that's breaking out in the public health community, and I think there are good and smart and expert people on both sides. Where are you?

Dr. Wen: It's a very good question, and I understand the appeal of this concept. In theory, the concept is, if more people are able to get partial immunity, why don't we do that? Perfect cannot be the enemy of the good. So, in the middle of a pandemic, let's get this vaccine out, but here are the problems with it. The first is, simply we don't have the data. We don't know what happens if you just give people one dose, because that's not how these vaccines, the Pfizer and the Moderna vaccine were studied.

Now the Johnson & Johnson vaccine, which hopefully we'll get data from that later this month, that's how the Johnson & Johnson vaccine was studied. So, it's reasonable to look at that, but Pfizer and the Moderna, we don't know what happens. We don't know how much that partial protection is after one dose, we don't know how long it lasts, and we also don't know the consequences. If you wait two months, three months before your second shot, we don't know if it'll have any effect or if it could have a somehow an adverse effect. We just really don't know. There is a real danger at this point to going beyond the science.

There is already a lot of vaccine hesitancy and what I've been telling my patients and other clinicians, I've been telling our patients is we need trust the science that no shortcuts were taken in the vaccine development or approval process. If we then go ahead and take the shortcut, how are we going to be convincing our patients that we're following the science? It will contribute to vaccine hesitancy and [unintelligible 00:13:12] distrust.

Not to mention what about the ethics of this? There are people who decided to take the first dose of the vaccine, and now we're telling them they're not getting the second dose as they were promised. There's some, I think, real ethical issues here too. Then finally, right now, the bottleneck is not lack of supply, it's that we're unable to get the supplies of the vaccines that we already have out to people. So, I don't understand what's the problem that we're trying to solve here. It should be to try to figure out vaccine administration, not trying to increase supply using this method that is unproven and could really lead to some adverse long-term consequences on vaccine trust.

Brian: Another vaccination question, Tara in Ocean Township. You're on WNYC. Hi, Tara.

Tara: Hi, thanks for taking my call, Brian. I had a question, and it kind of goes, from what we were just talking about. I think there is still a problem with supply because anyone who wants a vaccine cannot get a vaccine. With the Oxford vaccine being approved in the UK and India, is it something--? I haven't really seen it talked about, but that it should be available to people who want that vaccine in the US. It seems like waiting until April for the US trial to finish up, when by that point, over 150,000 people who are alive today will no longer be alive. It just seems crazy.

Could it be something where they use the data that the UK used for the approval and give people, even if it's, almost like when you have an experimental drug, like this is an experimental thing, but giving people who want to take that vaccine, the option, because it's been proven to be safe, it's been proven to be reasonably effective.

I know they're still working on what is the most effective way with the doses and the dose spacing, but when so many, tens of thousands of people are going to die, shouldn't this be something that people have the option to take? I know, the vaccine hesitancy, that could be a problem, but if it is labeled as experimental and just letting people choose whether or not they're comfortable taking that vaccine while the US trial is still ongoing, I think a lot of people would want to take that.

Brian: Dr. Wen.

Dr. Wen: I understand, Tara, where you're coming from. I think that we need to do everything in our power to expedite vaccine approval, as well as to expedite now vaccine distribution, because, again, I think this is the great tragedy of where we are, that there are 14 million and more doses that have been distributed, but only 4 million or so that are administered. So, we have millions of doses languishing and some may even expire. That certainly is something that should not be happening.

We should not though take shortcuts, again, AstraZeneca has yet to submit their application to the FDA for authorization here in the US. When they do, that application should be looked at immediately. It should be processed as quickly as possible, but again, we cannot take any shortcuts. That's our assurance to the American people.

There are long-term consequences to even having the perception of taking shortcuts, because we know that in order for us to reach herd immunity at some point, yes, it depends on us having enough vaccines [unintelligible 00:16:51], but it also depends on people trusting the vaccine to take it, and we need to be following the science here, for example, if we end up approving a vaccine that ends up not being effective or that ends up having some safety issues, that could erode trust in not just this particular vaccine but every vaccine for COVID as well as for other vaccines as well. I just, would again want us to do everything possible to expedite while not hampering the science.

Brian: Lawrence in Bayside, you're on WNYC with Dr. Leana Wen. Hi, Lawrence.

Lawrence: Hi, folks. Epidemiologists have been expecting a pandemic of this magnitude or worse for many years. There was an Office of Pandemic Coordination in the White House, which was canceled by Trump, but this problem is not going to go away, even with the vaccinations that we're going to eventually roll out. We're going to have other flu viruses and other corona viruses and other mutations of COVID-19 and SARS 3 and 4. I was wondering if it would make sense instead of allowing restaurants, for instance, in New York to have outdoor dining, which is now going to be impossible, to upgrade the ventilation regulations for public spaces.

A friend of mine who is a teacher in a private school in Fresh Meadows, asked me to design a protocol for his classroom that would allow him to continue teaching. I have had some experience in heating ventilation installations and selling those products. So, I designed an intake system and an exhaust system for his classroom that would provide between 10 and 15 air changes an hour, and they have an air purifier in the room. With masks, he can now be fairly certain that aerosol transmission is not going to occur amongst his students.

Brian: Lawrence, let me ask you a technical question, because I think a lot of people are probably very interested in what you're saying. How easy is it to take any particular room, be it a classroom in a school like you're describing or a bigger space, a restaurant or other workplaces, and install these kinds of ventilation systems that you're talking about that turn the air over so many times an hour. Can you do it in a regular room or does it take like big construction projects on buildings?

Lawrence: Technically, it's not particularly difficult. It requires money. The biggest problem that he had with this and that the school has is their heating system. Now that you're changing the air, that many times, you're going against everything that we've done with building regulations for the last 15 to 20-25 years to make buildings tighter and more resistant to air infiltration--

Brian: For energy efficiency.

Lawrence: For energy efficiency. We've been worried about burning oil and burning natural gas and creating pollution and greenhouse gases and saving money. So, we've made buildings more efficient by preventing the number of air changes. The average office has a three to four air change per hour, and that's very, especially when you're using air conditioning in the summertime, it tends to recycle most of the air.

Brian: Will this require more energy, more heating costs, therefore more use of fossil fuels, et cetera, et cetera?

Lawrence: Yes, absolutely. It's a trade-off. We have to make a decision about that. For public health reasons, would it make sense, especially in cities, in restaurants, in stores, in public spaces to have the kind of air exchange that they have in hospital rooms. Hospital operating rooms and ICUs do have a 15 to 20 air changes per hour. They are cognizant of what's happening to the aerosols and they're disposing them by venting them outside the building--

Brian: Lawrence, I'm going to leave it there for time, but so interesting. Please keep calling us. Dr. Wen, what do you think?

Dr. Wen: I think we need to be exploring these innovative ideas exactly as Lawrence mentioned, ventilation, we now know is really critical. This is why being outdoors is so much better than being indoors in terms of reducing the risk because of the fresh air that you get. I think we should be looking at improvements to indoor ventilation as well, that would help us to return many of our businesses and in particular our schools back to normal so as to preserve the economy, our education, and also to do so safely.

Brian: We'll continue in a minute with Dr. Leana Wen and more of your coronavirus questions. I'm going to bring up something that Governor Cuomo is planning for the Buffalo Bills playoff game that has to do with COVID next weekend, that could be a model for all kinds of workplaces around the state. We'll see what Dr. Wen thinks and take more of your calls. Stay tuned.

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Brian: Brian Lehrer on WNYC as we continue with Dr. Leana Wen, former Baltimore Health Commissioner, Georgetown professor, emergency medicine physician, and Washington Post columnist. Her latest article column called Here's What Leadership on Vaccination Would Look Like. Dr. Wen, Governor Cuomo is planning something new for next weekend when the Buffalo Bills play a playoff game in Buffalo. There have been no fans allowed at sporting events in New York State since March, but the governor wants to let a few thousand in but with a recent negative test required for entry. I'm curious if you liked that idea and do you think it can be a model for reopening other things?

Dr. Wen: Yes, it's an interesting idea, and I actually think that testing is very important. Having everyone test in advance will cut down on the level of infection because there are going to be some people who find out that they are asymptomatic who test positive and are then able to take themselves out of circulation, to be then quarantined as a result. So, I think it certainly provides some level of protection. I'm sure there will be other measures that are taken as well, including requiring masks, including distancing, et cetera that will also add levels of protection as well.

I think that there could be even more done. As an example, not allowing food or drink at the event, I realize that that sounds very draconian, but when people take off their masks and are having food and drink, that adds to level of risk. So, perhaps cutting down on food and drink or allowing only water is one way of further reducing that risk. The other thing too is I'm actually less concerned about what happens at the event itself but what people are doing around the event, as in if people are coming but then later on, they may be dining together. They may be going to one another's homes. I'm much more concerned about other events like that rather than in the structured formal setting that then further increase risk.

Brian: Interesting. There is pushback on this going around Instagram that I've seen, that says essentially using the test to go to a party is like using a pregnancy test as contraception. Do you have any reaction to that?

Dr. Wen: If testing is implemented on a regular basis and is actually used as screening, it is something that could be actually a preventive step as well. Imagine, and I know this is not what's the case for the Bills, but imagine if everyone is getting tested twice weekly. If you are getting that level of regular testing prior to going to school, prior to going to work, that in a sense is a type of a preventive measure. In this case, again, testing before going to a game, you are going to find some individuals who test positive and wouldn't have otherwise known.

If this is one way for us to increase testing, I say, why not, just recognizing though that it's not foolproof, that there are going to be some individuals who don't test positive because maybe they're early in their incubation period. There are others who may get a false sense of security as we have seen in the case of the White House, with individuals using tests and then they think that it's now open season, they can do anything that they want to do and that's not ideal either.

Brian: Maria in Sunset Park. You're on WNYC with Dr. Leana Wen. Hi, Maria.

Maria: Hi, good morning. My comments/questions have to do with the delivery of the vaccine. I was born in a Caribbean country, and I know this to be true for other islands and other countries in Latin America and elsewhere where giving an injection was not rocket science. It was often done at home, the doctor would send you home with the vial or maybe it was done at the pharmacy. You didn't spend a day at the doctor for an injection if you needed something that was repetitive.

I remember this clearly. Every time I hear about all of this, what is required in order to be able to work in one of these vaccination sites. I was wondering about that. The other part of that, which is related, is that I personally have the experience when my mom towards the end of her life needed anticoagulants, and I and another relative who were spending a lot of time at her home caring for her firsthand, we're trained in the emergency room when we had to take her in because of certain symptoms.

They had a dummy there and they just wanted to make sure that we, I guess, were somewhat competent. Neither one of us has any medical training whatsoever. We went home and the next day, we had one visiting nurse come the following day to supervise and then we were on our own and everything was fine. The visiting nurse came the following week, checked that the supply was there, that we had not-- The right amount of dosages were still there.

Brian: Maria, let me jump in and get you a response because what you're raising is so interesting. There are all kinds of examples that she is giving. There are other examples, Dr. Wen, as I'm sure you know, people inject themselves andtheir partners in the IVF process, as I understand it. People who are diabetics, inject themselves. Could, if the part of the bottleneck is having enough vaccinators as your Washington Post article says, could people be getting the doses and vaccinating themselves or each other?

Dr. Wen: Yes, it's an interesting question. Actually I've had a number of people send me proposals, even for something like an EpiPen, where maybe you could inject your yourself at home. Here is the problem. It's the entire vaccine administration that is the issue, not just the actual giving the shot. What I mean is, and I think as the caller very well said, it's really easy and fast to give a shot. It's also easy to train someone in order to give a shot or to train yourself even to give a shot.

The problem is that the vast majority of the time that people are waiting in line and then going up to actually get their vaccine is the paperwork, it's the registration, it's all these other things that we can actually figure out how to streamline. You look at Israel, a country that has done I think exceptionally when it comes to their vaccine administration. As I understand, people are able to sign up and register online. They fill out all their details, then they're given an exact time and place to show up.

We can do that here too and streamline our processes. We can design an app, we can do this so that when you come, the same individual, the nurse or pharmacist checking you in doesn't also have to give you a piece of paper and give you the Q&A to read and answer your questions at that time. Your questions of course should be answered, but they shouldn't be at this point where the person who is giving you the shot has to do all this other work as well.

Brian: Can an individual know if these vaccines are, they're saying 94% effective, I think the AstraZeneca is supposed to be 70 something percent effective, but let's say 94. Can an individual know if they're in the 94 or they're in the six so they can know if it's safe for them to go back to normal life?

Dr. Wen: That's a great question and the answer is you don't know until you either get exposed to the virus and you get it or you do not. That is the same with any medical treatment, that we don't know in advance. Imagine if we're talking about blood pressure here, even if we know that a blood pressure medication is effective on most people, there might be still some individuals who may not benefit for whatever reason. And the same thing is the case with vaccines too.

Actually something else to mention about these vaccines is that we don't yet know what these vaccines, whether they reduce your likelihood of transmission. It may be that you get the vaccine, you are protected yourself, so you're 94% to 95% protected from getting coronavirus yourself, but you could still be a carrier [crosstalk]

Brian: That's to protect others from you but on gauging your own level of immunity, I know that with many vaccines, measles, other ones even many, many, many years after you've had the vaccination, you can check your titers as you call it in medicine, meaning check your antibody levels to see if you're still immune. Can you do that with this a little while after getting your second dose?

Dr. Wen: Well, you could get your antibody levels checked. However, just because your antibody level is undetectable, doesn't mean that you cannot mount an immune response because there are other ways for you to mount that immune response as well. Currently, we don't know exactly how to check for this in a way that reliably predicts your protection. That again I think we still need to keep on reminding people that this is still a novel virus that we're talking about that we didn't know much about last year at this time.

However, I would urge everyone to see that in this way that we have not cut corners in this vaccine development and that if they have the opportunity to receive the vaccine, they should because it protects them. And as more people are getting the vaccine too, we're able to protect everyone around us as well.

Brian: And it's not only a novel virus, there's a novel variant of the virus. Justin in Brooklyn has a question about that. Justin, you're on WNYC. Hello.

Justin: Hey, how are you doing? Thanks for taking my call. This morning, I dropped off my two kids, both under six years old, at school for the first time since the holidays. We've been sending them to school for a few months knowing that the evidence generally or I would say knowing as much as we know anything these days, but having done research and seeing that the evidence tends to show that for kids under a certain age, I think it's 10 or 8 or something like that, that they're less likely to transmit the disease to each other. I wonder if this new variant changes that, if there's anything about the new variant that's showing--

Brian: Changes that and I'm going to jump in because we're running out of time in the segment, but the whole thing that's been in the news, as you know, Dr. Wen, about the new variant, is that it's much more contagious. Justin wants to know if that applies to children.

Dr. Wen: It seems to, yes. In fact, in South Africa and in the UK with these two different variants, it does appear that the rate of increase in children may even outpace the rate of increase in adults. Now we don't know exactly which age group of children, maybe in the younger adults, teenage category because of mobility in that category as well. However, anything that's more transmissible certainly makes us more worried because by definition we're going to have more people who end up getting infected, who all then overburden our healthcare system even more and unfortunately lead to more deaths.

Brian: I know you've got to go. I want to throw in one last policy question as we continue to grapple everywhere with how much to shut things down. Florida governor DeSantis who has not shut things down as much as in other states and as opposed to mask mandates, says Florida is doing better than California and with much less lockdown. When we look at what's going on, especially in the LA area, one might scratch their heads and say, "Wait, is there really such a correlation between shutting down and doing better on the virus because LA was more aggressive than Florida?"

Dr. Wen: We don't know our own counterfactual. In the case of LA, which is where I grew up, it is an extremely densely populated area with a lot of families with huge disparities, many low-income families that live in crowded multi-generational housing. I think it's very difficult for us to compare one region of the country versus another in terms of infection rates. The only comparison you can really do is between one part of the country and itself if mandates were not otherwise implemented but we don't know that.

I would just say that this is really the wrong time for any of us to be second-guessing the actions that have already been taken and instead to look ahead and see in this time of rising hospitalizations, hospitals at the brink, what is it that we can be all doing in order to reduce the level of spread?

Brian: Dr. Leana Wen's latest Washington Post column is called Here's What Leadership on Vaccination Would Look Like. We always appreciate your time in answering so many questions.

Dr. Wen: Of course, thank you very much, Brian.

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