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Brian Lehrer: Brian Lehrer on WNYC. The New York City Health and Mental Hygiene Commissioner, Dr. Ashwin Vasan, is going to join us now. One reason is that since last month, New York State and, in fact, a big part of the Northeast have seen an uptick in COVID-19 cases. This seems now to be an annual summer surge in addition to the annual fall and winter surges where rising cases might be expected as people tend to socialize more indoors. Why in the summer? Joining us to discuss this and more is Dr. Vasan, commissioner of the New York City Department of Health and Mental Hygiene. Commissioner Vasan, always good to have you. Welcome back to WNYC.

Dr. Ashwin Vasan: Good to be back, Brian.

Brian Lehrer: How big is this uptick in the city?

Dr. Ashwin Vasan: Well, we've been seeing an increase in COVID-19 cases since early July as we might expect. Hospitalizations have lagged and we're starting to see an increase in those relative to recent weeks. Overall levels still remain very low. We had similar levels of cases in hospitalizations back in March. As we've seen over the past year plus, when it comes to hospitalizations, the majority of them still are people who are hospitalized for something else, and then incidentally test positive for COVID rather than being hospitalized directly due to or a complication of COVID.

Other positive signs despite this uptick are that we're not seeing any significant increase in severity measured as ICU admissions or certainly deaths. We're not seeing any issues with bed capacity or staffing issues. While these are real numbers and they are increasing, we have to see it in the context of the time we're in. The other good news is, of course, we've got a lot of options for New Yorkers to manage this little uptick.

Testing is still widely available through pharmacies, through public settings like libraries and other public institutions, and, of course, through providers. Treatment is still available through your provider or 212-COVID-19. Of course, we've talked a lot about vaccines and boosters over the previous years. The CDC and the FDA are about to issue a new updated booster in September. It's a perfect time to get reboosted, especially if you're more than six months out from your last dose as we enter the fall and winter viral season.

Brian Lehrer: I want to come back to that new vaccine in a couple of minutes, but just staying on the current surge, the number that I saw for the Northeast in general is a 20% week-over-week, that is last week over the week before, increase in people in hospitals with COVID-19. If it increased that much that quickly, I imagine it couldn't just be people who were in hospital for other things testing positive, huh?

Dr. Ashwin Vasan: Well, no. Overall hospitalization rates, meaning hospital capacity and hospitalizations, total are stable, which means that more people are getting hospitalized. The same number of people total are getting hospitalized, but more people are testing positive for COVID-19. We're seeing anywhere from 50% to 60% of people who are hospitalized with COVID-19, hospitalized for something else, and then testing positive upon routine testing.

That's been a trend that we've seen since spring of 2022 after the Omicron wave. It is pretty consistent. It doesn't mean it's not concerning, but it also means we need to see it in context. We're not seeing any real increase in either the significant transmissibility of these variants, that variant soup that we're currently experiencing nor are we seeing any real difference in lethality. Again, we're starting to see COVID-19 evolve into similar patterns of behavior as other seasonal coronaviruses. This is the process of really it being endemic to our society.

Brian Lehrer: What is the current variant or subvariant? It's some subvariant of Omicron still, right?

Dr. Ashwin Vasan: Yes, they're all subvariants of XBB.1.5, which is a recombinant variant of Omicron and other variants. That's the dominant strain from which these subvariants have emerged, including the most recent one, colloquially known as Eris. I think it's EG.5 as it's otherwise classified. We're not seeing a significant dominance of any one of these strains. For instance, XBB.1.9 makes up about 40% of the circulating strains. That's just a very small iteration on XBB.1.5.

This new one, EG.5.1, is only about 10% here in New York City. It's about 17% nationally. I'd like to describe this a little bit like a variant soup. We have a number of circulating variants and subvariants. That's why the CDC and the FDA are about to approve a new booster, which is really tailored for XBB.1.5, because we're seeing the subvariants emerge from that master variant, XBB.1.5. That should hit much as we update the flu vaccine every year to catch the dominant strains. This season, it appears that XBB.1.5 is that dominant strain, so we think it should be--

Brian Lehrer: Do you happen to know the exact availability date of that new vaccine?

Dr. Ashwin Vasan: I know that the CDC and the FDA are still in discussion. What we heard from the CDC director recently was she's thinking late September to the first week into early October, first week of October.

Brian Lehrer: Do you know why this surge would be happening even if it's a mini-surge in the summer at all? Is this a way in which COVID is different from flu? I mentioned in the intro, the annual fall and winter surges where rising cases might be expected as people tend to socialize more indoors, why would there be a summer surge, which seems to be an annual thing now?

Dr. Ashwin Vasan: I think this is really down to one principal thing, which is waning immunity. We have seen, and now we're three-plus years into this pandemic, we know that COVID immunity, whether it's through infection or through vaccine-derived immunity, really lasts about six months, eight months, maybe 10 months at the most. It's not long-term, multi-year, durable immunity in the same way that other vaccines are or other infections are.

That's why we're recommending updating your immunity. Most New Yorkers are probably more than six months, if not more than a year from their last dose of the vaccine, whether it be a booster or whether they completed their primary series. We're seeing waning immunity in the population combined with increased congregation, indoors, outdoors, all of the above.

This has been a pretty consistent pattern that we've seen over the last several summers. It's not entirely surprising. It's also why we want to see our vaccination rates really increase. If we even reached the same levels of our flu vaccination as we do with COVID boosters, we'd be in a much better shape in terms of our overall level of immunity heading into the winter, and then, of course, heading into next year and next summer.

Brian Lehrer: Why don't they release this new vaccine before the school year starts so teachers and even parents and grandparents, who might be susceptible to getting it from kids who are newly congregating again in September, might be a little more protected? Not that you have any control of that, I guess that's a federal government decision, but it's one I'm wondering.

Dr. Ashwin Vasan: You basically said, I don't have a ton of control over that. It's obviously when the manufacturer submits their proposal to the FDA, when the CDC is able to review the data on its efficacy. There's a lot of moving parts. Most of which, I'm not directly privy to. I don't have much more common than that on the timeline.

Brian Lehrer: We're with the New York City Health and Mental Hygiene Commissioner, Dr. Ashwin Vasan. We're talking about the summer COVID surge. Not that big a surge, but I know a bunch of people who've gotten COVID in the last few weeks. Other people are telling me the same thing. We're kicking that around and talking about details of that. We're going to get into a couple of other things as well.

You can ask Dr. Vasan a question about anything related to his work as Health and Mental Hygiene Commissioner of New York City, 212-433-WNYC, 212-433-9692. Call or text to that number or tweet @BrianLehrer. Staying on COVID for a couple of minutes more. It's funny. When we first talked in our office about inviting you on again, it was just before the summer surge became apparent. What originally had us talking about COVID again was a positive milestone that we had seen that the number of deaths in New York had stopped being any more than would have been expected without COVID.

That might be a little dense way to state that statistic. To put it another way, if in 2019, before the virus arrived, one would've expected X New Yorkers to die per day. Then, of course, it went way up once we had COVID. It stayed. Various degrees have elevated. As of a couple of months ago, there were no more excess deaths than would've been expected had there never been COVID-19. Is that a stat you can confirm and talk about the meaning of?

Dr. Ashwin Vasan: Yes, you mentioned it in that last phrase. Excess deaths is a thing we track very closely. You and I have talked, or at least I've talked on WNYC before about life expectancy falling in New York City and across this nation in an unprecedented way due to COVID, but also due to a host of parallel pandemics like overdose and rising rates of diet-related and chronic diseases and violence and suicide on the rise.

We're in this era of shorter and less healthy lives. Certainly, COVID has contributed to that. As we exit this phase where COVID is this dominant cause of excess deaths, we're also seeing rises in things like overdoses year on year, quarter on quarter, rising data that says fatal overdoses are becoming more and more of a burden of disease. Here in New York City, we're seeing rising rates of heart disease deaths.

We're seeing widening birth inequities, especially for Black women in our city. As we think about what public health really needs to focus on in the post-COVID emergency era, of course, we're pleased that COVID is becoming less and less of a leading cause of death, a leading cause of excess death, and a leading cause of premature death. All of which, it had been death below 65. All of which, it had been over the last three years.

We're starting to see these other parallel pandemics emerge and worsen, exacerbated due to COVID. As we think about the next era of public health, we've really got to drill down on those causes and get those years of life expectancy back in our city. There's more to come there in this space that the city will be focusing on and launching in the fall and into the new year.

Brian Lehrer: Why would heart disease deaths be going up? I thought they've been going down for decades.

Dr. Ashwin Vasan: I think what we saw is they've actually flatlined for some time. Then we saw spikes in heart disease deaths during COVID. Now, there's a host of issues that explained that phenomenon. Delays in care, denied care, or lack of access to care during the COVID era, delay in regular screening, difficulty in accessing preventive measures as well as worsening diets, increased rates of alcohol use, and this really intersecting set of risk factors that can certainly worsen heart disease deaths. Overall, they're lower because, clearly, tobacco use has gone down. Diets have gotten better overall even though nutrition access and nutrition inequity still remains a huge issue.

Look, as we start to look towards the future, childhood obesity is on the rise in New York City. We have to focus on this because those will end up being young adults and adults who then end up growing up to have higher risks of heart disease in the future. This is something we got to get ahead of now by putting into place the systems to both prevent heart disease deaths, to intervene on people with known heart disease and also really prevent people from getting it in the first place by reducing risk factors in the population. More to come in this space.

Brian Lehrer: The COVID-19 question from a listener who wrote in asking if the current subvariants are transmitted by aerosols like the earlier variants. That is for hours after people leave a room if they're infected, would it still be possible to contract COVID-19 if you then enter that room?

Dr. Ashwin Vasan: I think we know that COVID and respiratory coronaviruses are spread through respiratory droplets. Respiratory droplets actually do not linger in the air all that long. They are airborne-transmitted viruses that can spread longer distances and certainly be spread through routine talking and breathing.

Unlike something like tuberculosis, which is a droplet-transmitted disease where heavier respiratory droplets can actually suspend themselves in the air for a longer period of time where you can enter a space where a TB-infected person was there and acquire the disease, it's a different mode of transmission. There's nothing new about the way that these variants are transmitted to previous variants of COVID. COVID, coronavirus, SARS-CoV-2, and all of its variants and subvariants remain an airborne respiratory virus transmitted through airborne spread of respiratory droplets.

Brian Lehrer: Meaning you generally have to be pretty close to an infected individual?

Dr. Ashwin Vasan: Same rules as we've had for three years, right? We put in those 6-feet rules as much as there is wiggle room around that because we acknowledge that transmission levels decline when you're more than 6 feet away from another person. This is why we focus on crowded indoor settings and close talking, close communication, close breathing with other human beings. Yes, nothing has changed in that regard. Like I said, there's nothing in these subvariants of XBB that says they're in any way significantly more transmissible or certainly not more lethal or severe than previous variants. It's the same virus. It's just a new flavor.

Brian Lehrer: We've got a whole handful of text messages coming in with a version of this question. I'll read one that's particular to one listener, but there are other pretty similar questions coming in. Listener writes, "If one is over nine months since their last bivalent booster and leaving on an overseas trip on October 1st, should they get another booster now or just wait until they come back for the new booster?"

Dr. Ashwin Vasan: That's a good question. I think there are certainly other ways to reduce your risk of acquiring COVID. When you go on long flights wearing a high-grade mask, it remains a sensible way to reduce transmission. We recommend masks for people in particular who have underlying health conditions or who live with people with underlying health conditions or who are elderly.

I think that's a very tricky question. If you're nine months out, do you get the vaccine now? Well, we know that it takes two to four weeks for the vaccine to reach peak immunity or to trigger peak immunity. If you're going away now and you'll be back in a month, waiting to get the next updated booster is sensible. Also, we have to not just think about this current uptick.

We have to think about what might be ahead for the fall and the winter, the typical viral season. Getting the most updated version of the COVID booster, which will be available at the end of September hopefully, is probably a good idea to get you through the next two seasons and the viral season. I might recommend as a clinician, just wait until the new booster comes out. Take extra precautions on your trip like wearing a mask when you're on your plane or in indoor trains or crowded settings.

Brian Lehrer: Totally changing topics. The FDA recently changed blood donation rules for men who have sex with other men. The regulations have been evolving in the past couple of years. It used to be a lifetime ban because of early HIV transmission rates and methods. In 2015, the FDA dropped it and replaced it with a one-year abstinence requirement before you could donate blood if you were a gay or bi male. In 2020, after donations plummeted during the pandemic, the agency shortened the abstinence period to three months. What's the latest? Who gets to donate now?

Dr. Ashwin Vasan: Number one, let me start by saying that this was a great decision by the FDA to really undo and unwind an unjust policy that targeted a particular group of Americans, a particular group of people based on their identity rather than based on real behavior. What they have done by taking away the subcategory of men who have sex with men and focusing in mainly on who has multiple high-risk sex-partners regardless of one's sexual orientation means that they are undoing a really unjust and stigmatizing rule that has prevented men who have sex with men from donating blood.

At a time when we need more preparedness for emergencies, we need our blood banks full at a regional and local level so that we can respond to emergencies as well as routine operations and hospitals, this is a core part of our public health and preparedness infrastructure. To deny a whole group of people the ability to participate in supporting their community and their nation was really unjust.

What they're basically saying is they're eliminating all of the time-based deferrals for men who have sex with men, and instead asking all prospective donors about new or multiple sexual partners in the past three months regardless of sexual orientation or gender identity of the partner that they specify. I think this is a very good change in ruling. I think we'll not only expand the blood supply, but we'll continue to keep it the safest blood supply that we can.

Brian Lehrer: On another topic, before you go, I wonder how closely you've been following the air quality index in New York City this summer as the health commissioner. I think it's something that many people never paid attention to before until we had those really extreme air quality days from the Canada fires in early June.

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Brian Lehrer: Something is leaking into our audio source, but I think it's gone now. Now, people who never looked before are looking and they see, "Oh, a lot of days, the air quality isn't rated good. It's rated moderate at best, according to the AQI, that 50 to 100 range." The question is, was this always happening in the summer, not just from ozone but also from these PM2.5s as they're called, which we think of as the fire-related particles that we thought were new this summer? What's the baseline here that we should be comparing to and gauging our activities by?

Dr. Ashwin Vasan: Your first question was, was I paying attention? Am I paying attention? Very much so. Because, once again, it re-emphasizes to us that climate change is a public health issue and that events and extreme weather in particular doesn't have to actually be present in New York City to affect the environment in New York City. In fact, I don't know if the listeners will know this, but 30% of the PM2.5 pollutants in our air actually on a regular basis comes from industrial pollution in the Midwest.

We are all very much connected on a daily basis by climate change. Air quality is one of those unspoken parts of climate change that we've taken for granted that we breathe relatively clean air on the eastern seaboard here in the United States. Poor air quality and pollution leads to nearly seven million premature deaths across the world each year. That's death below the age of 65, including causing things like stroke and chronic pulmonary disease, lung disease, lung cancer, heart disease.

We've known that there is a link between air pollution and poor health, mostly chronic poor health, for a long time. What we're seeing and what we've seen this summer, of course, is extreme degradation or deterioration in air quality due to extreme weather events, which are a function of climate change. The speed with which the conditions have changed has, I think, surprised everybody. I don't think anyone expected wildfires in Canada, which are occurring at a scale and at a time that is really unprecedented, to land on our doorstep.

It's causing us to take extra care and extra precautions and extra preparedness as we look into the future about air quality and how to guide New Yorkers throughout the crisis that we face, particularly the one in June where air quality got really poor. What we try to do is focus on the most vulnerable people, young children, older adults, and, of course, people with really very poor underlying heart or lung conditions, and to get them, in particular, paying attention to the air quality index and how to make adjustments in their behaviors and their daily activities.

When it got to a certain point where it was hazardous to everybody, we obviously had to make broader recommendations like closing outdoor events, recommending that we close outdoor events. The city closed down its outdoor events for a couple of days and/or postponed them. I think this is just another reinforcement that climate change can land in our doorstep.

It's important that New Yorkers get comfortable looking at the air quality and making choices about their behavior. This is pretty typical for people in California, people in Oregon, and it's just new for us here in New York. We've learned a lot also from our colleagues in those jurisdictions to say, "How do Californians incorporate this in their daily lives as they go about making choices about what they do outdoors?"

Brian Lehrer: As one follow-up and then we're out of time, we've gotten various versions of a question that I'll frame this way. You're 70 years old. You're in generally good health. You go out for a daily run. Suddenly, you become aware that, "Oh, on a lot of days this summer, the AQI is like 75 or 80." Can you keep doing that run or you're putting yourself at more long-term risk even if you don't have immediate effect?

Dr. Ashwin Vasan: It's pretty typical in the summer for us to have some days of poor air quality. When I say "poor air quality," I mean certainly below the levels we saw in June, which was hazardous to everyone, regardless of your underlying health, but obviously worse for some than others. For the scenario you've described, though, I think it's largely about people paying attention to their bodies and paying attention to their symptoms and taking some extra precautions if the air quality index reaches a certain level that says it's hazardous in particular to vulnerable groups.

You're describing a 70-year-old healthy person who's physically active. It's not clear that they fall directly into a vulnerable group despite their age or certainly compared to their peers who might have underlying conditions or medical problems. I think a lot of what we're getting into is the health department and the city can provide information, education, guidance based on science and based on practice from other jurisdictions and experience.

Individual New Yorkers really have to take smart decisions based on what they're seeing and pay attention to their bodies and how they're feeling. Nothing stops you if you go out for that run. You're starting to feel a little short of breath more than usual or dizzy or lightheaded to just go back indoors and stop the run or to reduce its length. This is a lot about incorporating this into our daily lives and, of course, then being prepared if we're ever in a position again to see this extreme degradation in air quality.

The last thing I'll say is the air quality worsened so badly and so quickly in June that it was very obvious for everyone to see. It was very much in your face. The sky was orange. It was a very logical decision for people to not go outdoors. I think what you're describing is the more daily routine monitoring of not just the AQI, but how it impacts your own body. A number is a number, but really paying attention to your body is the most important thing we can do to take care of ourselves.

Brian Lehrer: Yes, and that's still a short-term response, which leaves questions about long-term impacts of repeated exposures, but I hear you on paying attention to your--

Dr. Ashwin Vasan: Brian, if I can answer that, a lot of the data around the impact of poor air quality and pollution on death and disease comes from cities and places where they're chronically living with very poor air quality. You're talking about these fluctuations, not at the extreme levels that we're talking about that Delhi and Nairobi and places like that live with on a regular basis. I think this is an area of real study for public health because we don't know as much about how these small fluctuations and day-to-day fluctuations in air quality really impact long-term health because, frankly, we haven't seen major impacts of those things on long-term health just yet, but it is an understudied area for sure.

Brian Lehrer: The New York City Health and Mental Hygiene Commissioner, Dr. Ashwin Vasan. We always learn a lot when you come on. Thank you so much.

Dr. Ashwin Vasan: Thanks, Brian. Always glad to be here.

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