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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. In the context of the breaking news, this morning the Mayor de Blasio will require either vaccinations or weekly negative COVID tests for all New York City workers starting after Labor Day, let's talk about breakthrough infections. The pace of breakthrough infections in Israel is leading the Biden Administration to conclude that Americans over 65 and immunocompromised people will need a third shot also referred to as a booster shot soon according to The New York Times.

According to the Israeli Ministry of Health, the Pfizer vaccine which was 95% effective in preventing infection in Israel from January to April has become just 39% effective in late June and early July. More than half the vaccinated population in Israel has had both doses of the Pfizer vaccine, so that's a very vaccinated population that those statistics come from. Here in the US, we've recently seen cases of fully vaccinated people testing positive for COVID at the White House, in Congress, among the New York Yankees, and we're seeing it in Japan at the Olympics. Many people now know people in your own lives who were vaccinated but have gotten COVID.

However, severe cases and deaths are still extremely rare among vaccinated people. The vast majority of COVID patients in hospitals around the country are unvaccinated now, and even the breakthrough cases become a powerful statistical argument for getting the vaccine. Joining me now to explain why so-called breakthrough infections are happening for some people, and what they mean and don't mean, and what to do if you're vaccinated but get COVID anyway, is Dara Kass, emergency medicine physician at the Columbia University Medical Center. Dr. Kass, thanks for coming on. Welcome back to WNYC.

Dr. Kass: Thanks, Brian. It's always great to be here.

Brian Lehrer: Let's get into the numbers first for some context. As of July 19th, the CDC reported about 5,900 cases of fully vaccinated people who were hospitalized or died from COVID-19 in the United States. That's 5,900 out of 161 million fully vaccinated Americans. Well, and there are other numbers we could throw in there but let's focus on those. How should we as the public be interpreting this data?

Dr. Kass: We need to interpret the data that vaccination works and it works extraordinarily well. There will always be cases, and this has been true since the data was published originally, that unfortunately, the vaccine is not enough because nothing is 100%. There'll be people that the vaccine efficacy is lower, maybe because they are on immune compromising medications, maybe because they are very elderly or have other medical conditions, or for some reason, they got a really high viral load, and so the combination of issues in front of them really affected the vaccination efficacy and then they got infected afterwards.

What we know is that getting vaccinated, fully vaccinated, which is the two doses of the mRNA vaccine and the single dose of J&J is absolutely your best defense against any infection of this Coronavirus. The order by which either you get infected or vaccinated is important. If you get infected and then get vaccinated afterwards, it just can't help you. You need to get vaccinated first.

Brian Lehrer: That majority of people experiencing breakthrough COVID, 74% are over the age of 65 is an important stat. What else do we know about the profile of who's getting breakthrough COVID and using perhaps the Israel numbers as a benchmark?

Dr. Kass: I think we need to talk about infections that occur in vaccinated people. The word breakthrough is obviously, it sounds like you have a wall and it's been punched through, right? Basically, vaccinated people will get exposed and some will get COVID. Some will be asymptomatic, some will be symptomatic, some will be hospitalized, and unfortunately, very, very few will pass away. The more risk factors you have, the more likely it is for you to be that far-right category.

What's really important to understand is that the patients who are having hospitalization-- We're not tracking all of the infections after vaccination and casual infections, people that are either hardly symptomatic or symptomatic and maybe they take a rapid test from a pharmacy but they may not necessarily report it. We're likely underreporting these mild cases in healthy young people who've been vaccinated, but we're seeing the numbers of these elderly patients, patients in nursing homes because if they do get hospitalized, all those cases are being tracked.

What we know is that making sure that everybody around those patients, people that are nursing home workers, people that are hospital workers, people that work in cancer centers or on transplant floors, must be vaccinated to continue to protect those people that even if they choose to get vaccinated may continue to be vulnerable.

Brian Lehrer: Listeners, we can take your breakthrough infection questions for Dr. Dara Kass at 646-435-7280, 646-435-7280, or tweet a question @BrianLehrer. The clinical trials on the Pfizer and Moderna vaccine showed 95% effectiveness in blocking infections at all. Are we seeing more than that in the real world, and if so, why?

Dr. Kass: Well, the landscape has changed. We know that when the trials were done, there was no Delta variant. When the trials were done, the entire international community and the infections they were testing against were different. It's the reason why every time there's a new variant of concern, people ask will this variant be as-- will the vaccine be as effective against this variant. What we're seeing is still extraordinary protection by the Pfizer and Moderna vaccines, and even the J&J to hospitalization, severe illness, and death for all patients who've been fully vaccinated.

We are seeing a waning level of protection against this particular variant, the Delta variant because it is 1,000 times more infectious. It spreads faster with a higher viral load and that makes the vaccine protection harder. It makes it harder work for the vaccine and makes it more likely that there will be a crack in that shield that the vaccine provides.

Brian Lehrer: Just a few weeks ago, Dr. Kass, vaccinated people were going back to their old lives, going to things indoors and unmasked indoors with CDC approval. Now many people are more unsure. What should people be doing in your opinion and how much does your advice on that vary by age, like over 65 or health status?

Dr. Kass: It actually varies on risk profile is I say it. It may not even be your age or your health status, but it may be those around you. Do you have a pregnant person in your life or do you have children that are not vaccinated? A parent maybe that's elderly living with you. If that's the case, and even though you are vaccinated and hopefully, they are too if they're qualified, you may decide to mask up in settings that are either high risk, that are like high-density settings, and or places that are filled with people that you don't know their vaccination status.

This is also one of those times where being in an environment where you know everybody is vaccinated may make it possible for us to go mask-free again. For now, because of this confusion around who is or is not vaccinated in settings that are unpredictable, it does seem like it's time for everybody to mask up at the grocery store, in places we're going to be that we can't control our environment, because we don't want to see an increased number of either vaccinated people getting infected or them being exposed, them exposing other people that are vulnerable and maybe even unvaccinated.

It's a very difficult decision to make because as somebody that took my mask off very confidently after I saw the numbers in New York really falling and I was really excited to be able to be mask-free, putting that mask on again is hard. It feels like a level of defeat and it's just frustrating. As somebody that wears an N95 mask at work with patients who are infected with COVID, I will tell you that there's nothing that compares the N95 with a regular mask, and all of that is better than being mask-free in a high-risk environment.

Brian Lehrer: Is there a big philosophical question here about what kinds of risks people should avoid versus just live with so they have a life? The flu vaccines are not 100% effective and flu kills thousands of mostly older people in this country every year, but we never shut down society or our personal lives as much because we might get the flu. For COVID-vaccinated people, now that we have the vaccine, should this be more like that, or is this pandemic just too different, including because of the risk of long COVID?

Dr. Kass: Well, so I think there's a couple of things there. The risk of long COVID is obviously very different than the flu, and these are things that we're going to continue to ask questions and answer and see affect our healthcare system and our citizens for a long time. The other thing about COVID, the reason why we shut down was not because COVID is not the flu or because we didn't have a vaccine, it was because our healthcare systems were getting overwhelmed.

What I can say is the more people that are vaccinated, even if there is COVID out there infecting people that are either unvaccinated or for some reason are vaccinated but getting the infection, as long as our health care systems can handle taking care of the patients that come in the doors, I don't see the risk of this idea of shutdowns happening again.

I think there's this confusion about the idea that every-- We look at what is it, every hammer is it? When you only have a hammer, all you see is a nail. There are a lot of things that we can do to affect the spread of this virus that are not the same thing as going into lockdown but the first step to make that happen, to give us the opportunity to use the tools we have, and keep children in school, businesses open, people out there living their lives, is to get as many people vaccinated as possible and to mask up in environments where there's either increased risk of spread or highly unvaccinated people or people that are at risk so that we don't see the spread overwhelm our hospital system, which is the only time I can really see us shutting down again.

Brian Lehrer: Laurie in Highland Park, you're on WNYC with Dr. Dara Kass. Hi, Laurie.

Laurie: Oh, hi. Hello, thank you for taking my call. My question is, and I have not been able to find an answer to this yet. When a person is vaccinated and they get a breakthrough case, can the virus mutate and possibly subsequently form a variant in the bodies of vaccinated people? If the answer to this is yes, then why are vaccinated people being told to not mask up and not take those precautions if even if they stay out of the hospital the variant can be created in our bodies?

Dr. Kass: That's a great question actually. I think that there are a lot of questions that vaccinated people are having because they did take that step to be vaccinated and they want to be as safe as possible. The idea of variants is really scary, right? It's the idea that all of a sudden, this thing may never end. There will always be new variants and the highest likelihood of new variants forming is high viral loads and increased spread, which will continue to be concentrated in unvaccinated people, not in vaccinated people.

What we really need to remind ourselves is that people who get infected, even after being vaccinated, tend to have lower viral loads and people that are infected and not vaccinated. The risk of these variants evolving really is concentrated amongst unvaccinated people, not vaccinated people who still get COVID. That would be what I would think of when I worry about what to do next as a vaccinated person who is encouraging everyone that I know to get vaccinated is getting as many people vaccinated as possible. It's absolutely the first best step to decreasing the number of variants out there which put us all at greater risk.

Brian Lehrer: I hope that's helpful, Laurie. Can you give us your doctor's take on this order by Mayor de Blasio today that all city workers need to get vaccinated or produce negative COVID tests weekly to go back to work? after Labor Day, of course, it was ordered by the mayor already beginning to take effect next week for all workers in the city public hospital system, what's your doctor's take on these things?

Dr. Kass: My doctors take is that essential workers in all jobs are essential and they are in front of people who are vulnerable, whether it is homeless individuals, whether it's people in prisons and jails, whether it's children, whether it's people in hospitals. It is our collective ethical responsibility to be as safe as possible as we take care of those people, and that is to be vaccinated.

The mayor is actually doing something different than what the 57 institutions that called for health care workers to be vaccinated today asked for. He is saying you can be vaccinated or you can be tested weekly. There is an opportunity for those that are still vaccine-hesitant for any reason to wait, but to be tested weekly because the outcome is to decrease risk to the population, to decrease the spread in New York City, and for New York City residents to understand that when a police officer shows up or their child goes to school or they're going to the hospital, that that city employee is not posing additional risk to them by being themselves unvaccinated and potentially being a carrier of COVID.

We're not going to be able to mitigate all risks but I think this is a really important next step and it reminds us all as frontline workers that we are part of the collective responsibility to keep all New Yorkers safe and I think that it's a good move by the mayor.

Brian Lehrer: At the same time, the mayor is not going to do what the mayor of LA is doing, and that is reimpose an indoor mask mandate for all public spaces. Does one work without the other in your opinion?

Dr. Kass: Well, I think that the three tools we have, and we've been saying this a lot, are vaccination, masking, and testing. I think that the more that the local governments give tools to businesses and individuals to protect themselves, the better off we are. Indoor mask mandates are only important because we have seen detrimental effects on workers who have tried to institute individual mask mandates on the ground. I think that they need as much support as they can.

I think that masking is really important, especially in places like schools, and I am encouraged that the mayor is continuing to include that in the environment for a return to schools, that all children and employees in schools will be totally masked up. I would like to see as we go forward there an opportunity for some version of a mask policy that encourages people to be masked up in small spaces and indoor settings. I think we'll see that but for now, I think that the call for vaccination is still our best defense. I'm going to be thankful that happened today and see what happens next week.

Brian Lehrer: One more thing about the De Blasio policy, the alternative to vaccination is producing a weekly negative COVID test. I'm already getting calls from listeners saying that's not enough. We know how frequently people are exposed to things in their lives and it used to be when there was a requirement to get into various entertainment venues and things like that in New York, that the negative PCR test had to be within 48 hours. A weekly COVID test, is that really enough?

Dr. Kass: No, I actually don't think it is. I'm looking forward to the time when we see daily morning COVID tests at home where somebody can actually test themselves before they go to work if they're unvaccinated or going to a school. I think that that's really what we've been talking about for the last year and a half, something that's a quick check before you leave the house.

I also think that if, and I think this is true from all the mayor's policies, if you are unvaccinated, regardless of your negative COVID test that week, you will need to be masked up indoors because you are correct that if there could be easily a window of opportunity that somebody could be unvaccinated, test negative and then convert to positive before that next test that week. I would say that without hesitation people that are testing weekly and not getting vaccinated have to be mandated to wear masks indoors, certainly when they're at work and with other people.

Brian Lehrer: What about the rapid COVID test? You just talked about daily COVID tests as an alternative. The rapid COVID tests are not as accurate as the PCR test, the nose swab tests, so would those really do it as an alternative?

Dr. Kass: Again, I think that you have to take everything in context. If we're talking about a low-risk setting in which we have other barriers, other protections in place. We already have vaccination policies, we already have mask policies, what we're looking for is those very few infections that may be happening very quickly. The thing about rapid tests is they tell you exactly what's happening in that moment. If somebody is rapid test positive, then they know to stay home, and so it's not about replacing either a PCR or screening or ever vaccination.

What it's saying is in a time where I'm going to go and be with other people, maybe at a wedding, maybe if I'm going to some other dinner party, I would take a rapid test before I go to know that in that very short window, I am currently not contagious with the Coronavirus, and that should give people a sense of comfort even amongst all this anxiety about infections and vaccination.

Brian Lehrer: Dan in Matawan, you're on WNYC with Dr. Dara Kass. Hi, Dan.

Dan: Hi, Brian. How are you doing? It's a pleasure to speak with you and your guest.

Brian Lehrer: Thank you. What's your question?

Dan: Well, I guess the short version is I have a 10-month-old, and the long version is are there any thoughts on when and how the vaccine might be available? In the short term, I send them to daycare and I'm just wondering should we-- Hearing what you're saying about how the shutdown really works and it's about overwhelming the system, I feel like we've seen that in the small scale when a virus cuts through just even a common cold virus cuts through daycare, it basically shuts everything down. Should we be thinking about keeping him home, if not now, maybe in the coming winter months?

Brian Lehrer: I'm curious, Dan, before Dr. Kass replies, is your concern purely for the safety of your child or is it also for the safety of yourself as I'm presuming a vaccinated person, considering that breakthrough infections are now known to be possible?

Dan: That's a great question. I mean, I'm new to this whole dad thing but no, I'm really not concerned about myself. Most of my own concern about getting infected, getting a breakthrough infection outside the home would be that I would bring it home to him.

Brian Lehrer: Dr. Kass, did you hear the question?

Dr. Kass: I need to just summarize, it was a little long. Can you just go, so there's a 10-month old child at daycare?

Brian Lehrer: Yes, and because they don't have vaccinations yet for very young children, his concern about sending him into a group setting.

Dr. Kass: Okay, a couple of things. I think that first and foremost, you want that group setting to have all vaccinated grownups because the highest risk to getting the child exposed would be that the grownups there might bring it in. The second would be, for policies for children over the age of two, you want to still encourage mask-wearing as possible, which is what the American Academy of Pediatrics had said. Obviously, for a 10-month-old, that's not highly likely. I will also say is that young, young children do not seem to be, as long as we keep the virus around them at bay, we don't see them getting infected nearly at the same numbers, even as adolescents, as children over the age of 8, 10, 12, and teenagers.

We've seen a lot of successful childcare programs stay open through the pandemic, even when everything else was shut down. Most of that was related to really good policy at the childcare setting. I think that this goes back to making sure that the workers are at the setting, that the policies are good, that parents keep their children home if they know that there's an exposure in their own family or their child is sick. I do think that it is possible to send your child's daycare, especially now, as long as we continue to do smart policies around the kids.

Brian Lehrer: John?

Dan: That makes sense to me.

Brian Lehrer: Dan, I hope that's helpful, thank you. We're talking about primarily breakthrough infections, infections of COVID-19 in vaccinated people with Dr. Dara Kass from the Columbia University Medical Center. John in Princeton, you're on WNYC with Dr. Kass. Hi, John?

John: Hi, Brian. Thanks for taking the call. I had a question. Do you have any sense of, does the doctor have any sense if they're keeping track of data about breakthrough infections by state? On a probability basis, one would think that in Vermont, you'd have a much lower risk of having a breakthrough infection than you might in Florida or Missouri at this point.

Dr. Kass: Yes, the infections are tracked across the board, whether or not people who have-- We see the numbers whose vaccinated and we see the number of breakthrough cases. We obviously see an inverse correlation between the likelihood of vaccination and the number of cases.

We know that the higher vaccination states have a lower number of cases. The best way to see that is in the number of cases per 100,000 people because that gives you a real sense of the density of cases, not just the total number of people in the state. The states with the highest number of cases per 100,000 people are states like Florida and Arkansas and Missouri, which have very low vaccination rates are certainly on the lower end.

We're not tracking specifically what is qualified as a breakthrough case. Mostly because, again, a lot of people that are getting breakthrough cases are not being tracked because they're not necessarily recording it as having been vaccinated or even going to the doctor to get tested because there are over-the-counter tests. I think that we're just not able to fully understand, but we can generally believe that states like Vermont, which has done an extraordinary job at vaccinating and not infecting its population, really they're seeing just a very low number of cases in vaccinated people in any and anybody in their state.

Brian Lehrer: Well, that's just to say, if there are fewer unvaccinated people around, there's going to be less COVID around, and therefore, fewer cases in vaccinated people, right?

Dr. Kass: Brian, can I say one more thing also? This actually happens out of Israel. When there are fewer number of unvaccinated people, it means that fewer people will be hospitalized, but it also means that the proportion of hospitalized patients might be higher for vaccinated people. What I mean by that is if you have 100,000 people in a group and you know 90% are vaccinated, and then you have, whatever, let's say 10 infections or something, and five are vaccinated. There's a time at which your number of vaccinated and hospitalized individuals seem higher because the total number of possible people to get infected is lower.

In Israel, they started reporting numbers like 30% and 40% of the people in the hospital were vaccinated and it made it seem like the vaccine was less effective than a state like Missouri, which was seeing 99% of its patients in the hospital that were un-vaccinated. What that really was, was that there was such a low number of people hospitalized. Because so many people were vaccinated, it made that percentage number seem very confusing.

I just want to put that out there because, in states like Vermont, where we have high numbers of vaccinated people, you may start hearing that the percentage of patients in the hospital may be higher, and vaccinated people in the hospital may be higher than a state like Florida or Missouri, but it's not because the vaccine is less effective in Vermont, it's because there are fewer people to get infected. Does that make sense?

Brian Lehrer: I think I understand it.

Dr. Kass: Okay, I tried. [chuckles]

Brian Lehrer: Listener asks on Twitter, "I've had the vaccine but I'm pretty sure I've become infected with COVID. Is there any value for me to get a test or should I just assume I'm positive?" What would you say to that listener?

Dr. Kass: Please, please, please go get tested. I have had this in my personal life as well, friends and family who have been vaccinated and symptomatic. There are two reasons to get tested. One is to know if you have COVID and one is to make sure you don't have COVID. You should still, no matter what, if you're symptomatic with a respiratory illness, mask up and stay distanced from other people because we don't want to spread other viruses between people, not just the Coronavirus, but you need to know if you have COVID because if you have been around anybody that is unvaccinated, or if you've been around people that are vaccinated, They need to know for their own exposure and testing themselves.

It's always important regardless of your vaccination status to get tested if you are symptomatic with an upper respiratory infection. The majority of the time it will be negative, but if it is positive, that's really important to know.

Brian Lehrer: Michael in Brooklyn, you're in WNYC. Hi, Michael?

Michael: Hi, Brian. Thanks for taking my call. I was telling your screener I was vaccinated with Pfizer my second dose back in April and I have COVID right now. My question for the doctor was because I've gotten some mixed messages, is it still 10 to 14 days that this will last? Or should I expect it to be done sooner? How should I approach this?

Dr. Kass: Unfortunately, we don't have really good aggregate group data on this. Anecdotally, from people that I know that this has happened to is that people that get infected after they've been vaccinated, fully vaccinated, they really are having, if they're symptomatic, like an 8-10 day course still of symptoms. One of the things I do encourage people to do if they can is actually to buy the rapid test over the counter and test yourself every other day in the morning to know if you're still contagious.

It really does help get a sense of where you're going. Unfortunately, it can feel very defeating if it's still positive, but it reminds you that staying in a room away from other people is still a really important idea. I would say you're looking at it still 8-10 days of isolation before you're going to see the resolution of symptoms if you're symptomatic after being vaccinated.

Brian Lehrer: Michael, thank you for your call. Good luck, I hope you feel better soon. We'll continue in a minute with Dr. Dara Kass on breakthrough infections, stay with us.

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Brian Lehrer on WNYC as we talk about breakthrough infections, that is people who are vaccinated getting COVID-19, and among other things, why it's actually a good argument for getting the vaccine. We could go over some of the basic stats again which show that these things are happening, but they're not happening much. The cases are so much milder than in the cases of people who are getting COVID-19 who aren't vaccinated, and it's still actually so rare. Dara Kass, emergency medicine physician at the Columbia University Medical Center is our guest, 646-435-7280 is our phone number or tweet @BrianLehrer. 4

As an emergency room physician at the Columbia University Medical Center, what are you seeing there?

Dr. Kass: We've been really fortunate in New York still to not have an overwhelming number of cases in our emergency department and in our hospitals. We are seeing an uptick in cases, but it's nowhere near where we were, in the spring and even in the fall. I will say that across New York City, we are still doing very, very well as far as hospitalizations and infections. Even patients that come in for new infections who are unvaccinated, we get to have a conversation about them getting vaccinated and they seem to be very open to the idea after the resolution of their symptoms.

Across the country, that's not the case. We're seeing hospitals, especially in the Southeast and in the South, that are within our doctor communities begging for beds amongst each other or needing to transfer already running out of oxygen and opening new COVID units. Unfortunately, in those places, they're hitting a critical mass and I want to remind everyone that there's also a critical shortage of nurses across the country and that this pandemic going on and on for more months and maybe even another year will continue to cause the exodus of healthcare workers from the system, specifically nurses because we cannot do this for an undisclosed and totally forever.

It is traumatic to take care of patients that are losing their breath in front of you. It's really important that we do our best to keep nurses in the fields because we are seeing that everywhere.

Brian Lehrer: Again, these basic stats, according to the CDC, 6,000 cases of fully vaccinated people who were hospitalized or died from COVID-19, including about 1000 of those, approximately 6,000 who were fully vaccinated who did die from a breakthrough case, but that's out of 161 million fully vaccinated Americans. When you get to the percentage level with that, well, a thousand always sounds scary and 6,000 always sounds scary, it's in the thousands, but out of 161 million, it's so much less than 1% of people.

Dr. Kass: Multiples and multiples and numerous less. It's fractions and fractions of a percent. It's really important to remind everyone that getting vaccinated is absolutely your best defense against getting sick or dying of COVID.

Brian Lehrer: Right. There's also a definitional question about breakthrough cases. Dr. Paul Offit, Director of the Vaccine Education Center at Children's Hospital of Philadelphia was quoted on NPR saying, "I think we are misusing the term breakthrough. If someone who was fully vaccinated is subsequently hospitalized or killed by the virus, that's a breakthrough case." He wouldn't call an asymptomatic or relatively mild case a breakthrough case at all, and neither I think does the CDC. Does this definition matter?

Dr. Kass: Well, I think that the definition is less important than the impact on a community. If you are asymptomatic and not infectious, that's like the tree falling in the forest. Does it matter around you that you have a positive COVID test but you can't transmit it to anyone that's not affecting you? These are the things we need to understand more and more. It is the hospitalizations and the people dying of COVID that we have been trying to stop since this pandemic started. These are the cases we need to concentrate on.

Although we've gotten better at screening, which is why we hear things about baseball players and Olympic athletes and people that are in environments that are getting tested weekly who have been vaccinated having positive COVID tests, even in sleep-away camps. Those are not the same risk to the person or the community necessarily as they are if they are so symptomatic that they need to be hospitalized or eventually pass away. Those are very different infections and very different risks for the community. That's what Dr. Offit was talking about, in my opinion.

Brian Lehrer: Tim in Olive Branch, Mississippi, do I have your location right, Tim? You're on WNYC.

Tim: That is correct. Thank you. My question is I've read that COVID-19 is a neurological disease as well as a respiratory disease. What are the concerns for long-term neurological effects on breakthrough cases of vaccinated people?

Dr. Kass: I would say that COVID-19 is an infectious disease that has effects on multiple systems, not just the respiratory system. We see vascular complications, cardiac complications, and neurological complications. We still don't know the likelihood of long COVID and the neurological complications, things like confusion, brain fog, we've even seen psychiatric complications and psychosis happening to people who have been vaccinated. We need to collect more information to know about that, but again, the likelihood of long COVID, the likelihood of severe infection and complications seems to be much, much, much lower if you've been vaccinated.

We don't know enough about the question that you're asking right now is what are the long term COVID complications, especially neurologic, for people that have been vaccinated, but we know that not getting COVID and trying not to get it again, even if you're vaccinated is the best step to prevent that for now. Hopefully, we'll know more in the near future.

Brian Lehrer: A listener asks on Twitter, "Are you more or less, or just as contagious if you have a breakthrough COVID infection as if you get COVID and you're not vaccinated?"

Dr. Kass: We really can't answer all questions. There's no absolute one answer. What I would say is that the evidence so far shows that people that are vaccinated are less contagious, significantly less contagious, which is probably a reason why they have lower viral loads and they're less infectious, part of the reason why they're less sick. It looks like vaccination does absolutely decrease your infectiousness, your viral load, and your symptoms. That's, again, why vaccination really matters.

Brian Lehrer: We have a few seconds left. Are you for booster shots for everybody over 65 in this country? From what I've been seeing in news reports, we may be hearing that as a recommendation from the Biden administration in a matter of weeks.

Dr. Kass: I think that we are definitely going to continue to evaluate what to consider as full vaccination. Dr. Céline Gounder who I totally respect gave a statement that it may be three shots are full vaccination for some groups, not as much a booster shot as to say that you actually needed a third shot. We've always been asked is one enough, right, for people that maybe had COVID already. What I would say is I am absolutely on board with following the science. Patients that are elderly, potentially transplant patients, chemotherapy patients may need a third shot to consider themselves fully immunized.

Brian Lehrer: Dr. Dara Kass, emergency medicine physician at the Columbia University Medical Center. Thank you so much for coming on today.

Dr. Kass: Thank you for having me.

 

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