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Brigid: You're listening to The Brian Lehrer Show on WNYC. I'm Brigid Bergin, Brian is off today. Now we turn to the latest in COVID-19 news in New York City as the city sees a 32% increase in new cases. According to the latest data from the health department, the likely cause in the spike comes from a combination of the highly contagious Delta variant, a new data, which shows that 6 out of the 10 New York City zip codes with the highest positivity rates this past week had less than 50% vaccination rates.

Joining me now to talk about the latest news and what can be done to increase New York City's vaccination rates are S. Mitra Kalita, co-founder of URL Media and the CEO in publisher of Epicenter-NYC, and Harlem Gunness, the director of public health at St John's University. Professor Gunness, welcome to WNYC.

Professor Gunness: Thank you very much. It's a pleasure to be here and an honor.

Brigid: Mitra, welcome back.

Mitra: Hi, Brigid. It's so great to be back. Thanks for having me.

Brigid: I'm so excited to dig into this news with both of you. Unfortunately, it shows that 6 out of the 10 New York City zip codes with the highest positivity rates this past week had less than 50% vaccination rates. Mitra, what neighborhoods are we looking at here?

Mitra: Sure. In Brooklyn, Cypress Hills and East New York have the most new COVID cases in New York City. That's from data ending on July 7th, I believe. Then, really significantly though is that, of the top six, four of the top COVID rates are in Staten Island. That's mostly on the South Shore of Staten Island which-- I've been on the show for a few months now talking about vaccines, and this is an area we've been concerned about for a few reasons, but the South Shore of Staten Island is among the most disconnected parts of New York City.

Even early in the vaccine rollout, we were getting calls at Epicenter from folks in these communities that might not be near a mega-site, might not be near a subway, might not be near bus lines, and so, unfortunately, the least vaccinated parts of New York are indeed where we're seeing these surges.

Brigid: Professor Gunness, do you want to weigh in a bit on why certain zip codes are still below the city-wide vaccination rate? Are we talking about access to a vaccine, or is it really vaccine skepticism, or is it a combination of both?

Professor Gunness: I think it's a combination of both. When you look at the neighborhoods with the low vaccination rate, you're seeing that it's almost mere as the neighborhoods, when we look at it a year ago, with high infection rate or high mortality rate. For instance, in Far Rockaway, about a year ago, it had one of the highest mortality rates in the city due to COVID. When you look at the vaccination rate now, it's less than 40% for those who are fully vaccinated. It's significantly way behind that compared to other communities in New York City.

I think that there is a lot of things that are going on here in these communities. It's not an issue of having a mega-site. I think there's a lot of hesitancy, there's a lot of history behind these communities in terms of historical events that led to mistrust in the community, lack of information, health literacy, access to information, education, access to subject matter experts that understand the community and convey the message to the community in a manner in which the community would understand it.

There's a lot of things in terms of, when you look at the operational aspect of vaccination programs. Are they really sending the message that the community needs to hear? Do they have tailored health education campaigns? Do they have the sites that are open during the hours when the community is available? These are some examples.

Brigid: Lots of issues at play. Focusing a little bit more on Staten Island, we saw that the city's seven-day positivity average rose from point 63% last Monday, July 5th to point 91% on Sunday. Staten Island's seven-day rate is 1.42%, making it the highest in the city. Mitra or professor Gunness, it's been a few weeks of lower positivity rates around the city. What happened this past week? What explains this increase?

Mitra: I think it's important when your listeners hear percentages, I think it's important to note that in some of these cases, we're talking about dozens.

Brigid: Sure.

Mitra: The highest, for example, in East New York is 33 cases. I share that because, in a community like this area of Staten Island, you might have blended families, you might have the son living in the basement, or two-family house, or something like that, and so one family can have a significant increase on the rate, especially if you have unvaccinated households as the statistics are bearing out can be very significant.

On the other hand, even if you take other side, New York City is a city unleashed right now. I feel like the minute that the mass guidance changed, you really just started seeing people not just out and about, but in full force. I think we're seeing some of that coming to bear in these unfortunate statistics. It was the 4th of July weekend might have contributed. The data is still early on that and we'll see what next week brings, but it was a pretty rainy 4th of July weekend, and so I think that drove people indoors. The last thing I'll say, and I'd love Dr. Gunness's perspective on this too, but this moment feels like one of the most confusing times to navigate COVID. Some places have mask policies, others do not.

There are still a significant portion of the population that are not vaccinated, and that's not a choice. I'm including my own household in that. I have a daughter who's nine years old. There is this-- I don't know. I think it's almost the perfect storm where mask guidance is confusing. You still have a significant portion of the population that's unvaccinated, not all by choice, and you have the growth of the variants, specifically the Delta variant that you mentioned. That's all converging to create these rates.

My question now is, what are we going to do about it? Are going to continue to be a city going about to "normal times," or are we going to solve for the reality of many of our communities that are either still not vaccinated, can't be vaccinated, live in dense households, might have jobs where they're interfacing with many folks and don't have the privilege of only being in a bubble.

Brigid: Professor Gunness, what is your take on it? It was striking to me, even just over this past weekend, listening to our likely Democratic mayoral nominee Eric Adams as he was in the national television circuit, get asked about, would he support mass guidance for people who are indoors similar to what I believe Los Angeles is continuing to do, and he said he would.

That, of course, runs in conflict to the actual guidance given by our current mayor and others in charge of managing the pandemic right now. What is your take on what Mitra was just describing in terms of how this may in fact be one of the most confusing moments in the pandemic?

Professor Gunness: Yes, absolutely. Just to add to Mitra's point, I think that when you look at what's the behavior of this virus or the behavior of the pandemic, there are so many variables and there are so many moving parts and changes that are occurring. I think that if we haven't already gotten used to these changes that are happening briefly on a weekly basis or a daily basis as new science comes out or new information is available to us, I think that right now--

We heard that CDC, I think, this weekend, they talked about a booster vaccine, they talked about wearing mask in public or the need to not wear mask, but it becomes very confusing, I think, for New Yorkers because, although we have 70% of us who are vaccinated, some of us may not be vaccinated. As New Yorkers, we have lots of tourists that visit, a lot of people that come in back and forth from different states, so we don't know and can't confirm who is actually vaccinated from who's not vaccinated. We don't have policing in that sense, nor do we need it necessarily, but I think that there's so many factors that play into the Delta variant as well. We know that it is spreading much faster, almost two times as fast as the Alpha variant. We also know that, with a new variant, like the Delta, it will accelerate the spread of disease. It becomes a much more infectious. There could be many factors that may have been going on in Staten Island.

I know that, last year, around this time, during the pandemic, when I was in Staten Island, and this is, anecdotally, I was having lunch, I think, in Breezy Point, and people were going on with their daily lives and their daily business with no mask. This was at the peak of the virus where government officials and public health authorities were advising that we wear mask and socially distance. That was not occurring for my two hours that I spent there.

Again, that's anecdotally. I don't know, what are the behaviors and the perception of those, in Staten Island, that may play a role in terms of their behavior, that may put them at risk. I'm reading also that politics may play a role as well. I don't know if that has an association with those who live in Staten Island versus those who live in other places in the city.

Brigid: Sure. Of course, Breezy Point on the Rockaway peninsula, just across the water from our friends in Staten Island. Listeners, I'm wondering if any of you out there recently decided to get vaccinated against COVID, and why did you come around now, or maybe have you recently convinced a friend or a family member to get the vaccine? Tell us what worked, tweet @BrianLehrer, or give us a call now at 646-435-7280, that's 646-435-7280. We're going to go to a caller who has been on this show before, Mark. I believe it's Dr. Horowitz, a family physician in Manhattan. Mark, welcome back to WNYC.

Mark: Brigid, thank you for having me. It's so great to hear you pinch-hitting for Brian. My esteemed colleagues, who are on the air with you, have raised some very important points and my highly esteemed and good friend Mitra has in particular made some really great points.

Mitra: Hi, Dr. Horowitz.

Mark: Hi, Mitra. Let me relate to you my own experience as a primary care physician in Manhattan, who was allocated pretty much an unlimited amount of vaccine by the department of health in early March. I still have an adequate supply of both the Johnson & Johnson and Moderna vaccine. The people, who we have termed vaccine "hesitant" have for the most part, come down off the fence and received the vaccine. They've had their concerns address, their doubts addressed. They've come around to understand that the vaccine is safe, it's effective, and it's done so much to highly impact the prevalence of the virus in our community.

What we are seeing now, and when I say now, I mean over the last, say, four to six weeks, are the vaccine refusers. We are seeing people who come in-- We ask every patient that comes into the office whether they've received the vaccine, and if they say no, we ask if they want to receive the vaccine. When they decline the vaccine, we enter into a real open-minded, nonjudgmental, non-shaming discussion with them and ask them what their reasons are.

Unfortunately, what I'm finding are four categories of what I would call bizarre, misinformed, or, frankly, delusional reasons that people have for not receiving the vaccine. Everything from "it's not FDA approved and it was rough rushed to the market," to concerns about the vaccine on their fertility or other long-term effects. We also get people saying that-- I just had one a half an hour ago, a young man whose father has coronary artery disease. He's a patient of mine as well, but he declined to get the vaccine because he feels "my immune system is strong enough, I don't need the vaccine."

Finally, we get people, and a fairly significant number of people who believe because they've had COVID, they remain immune to the virus in all of its forms, variations, and manifestations. These are all really misinformed rationale. In some cases, people offer fairly delusional or bizarre theories, which I suspect they read on some dark corner of the internet.

Brigid: Sure.

Mark: They pretty said that in refusal. They say, "Doc, thanks for your discussion, but I'm simply not going to get it." Obviously, to me, who believes very, very strongly that the vaccine is saving lives and helping us return to normal, it's a bit frustrating.

Brigid: I just wondered, Dr. Horowitz, since you have both identified these different types of individuals who are refusing to get the vaccine, I'm wondering if you feel that you yourself have not been able to persuade them. Do you get a sense of what is persuasive to them? Is there an individual- are they expecting to read something or learn something, or do you get any sense of what might start to help change their mind? Now, obviously if you could change their mind, you would. I'm just wondering if you get a sense of what the thing is that could help start pushing them in another direction.

Mark: I have two answers to that question, both of which I've thought out at great length. The first is, and I'm a great believer in individual freedom, but this is not about individual freedom. The average person with COVID is highly infectious before he or she starts manifesting symptoms of the disease. That person is spreading the virus to other people before they become sick.

I think what's going to have to happen in the future, and a lot of my patients work in lower Manhattan, haven't come back to the workplace yet, but are coming back to the workplace in early September, I think there will need to be workplace mandates. I really do. As hard as that is, for those of us who are in favor of civil liberties, that's going to be a necessary factor.

People are going to be at risk of losing their jobs if they're not vaccinated, but frankly, I don't want to be sitting at a desk next to an unvaccinated individual. I think that the Houston Methodist case really lends tremendous, legal support to the notion of workplace mandates. Of course, we have to give people religious and medical exemptions, but if you're working in a workplace where there are other people close to you, you need to get the vaccine.

I also think that social gatherings, concerts, sporting events, restaurants, I think we're going to start needing to examine whether people need to be vaccinated in order to be present at those locations. It's hard to imagine requiring it. There are some venues, Bruce Springsteen comes to mind. There are some venues where vaccination is required. I think, as more and more venues require vaccination, I think that the FOMO, the fear of missing out, may convince some people to vaccinate.

Now, here in New York City and among my patient population, I don't think there are a lot of political reasons for refusing the vaccine, but frankly, I've often thought if the man who shall remain nameless, but used to sit in the oval office, got on TV and said, "I want all of my supporters to get vaccinated," I think a good number of people will line up and get back. It may be not in New York City, but in other places in the United States.

Brigid: Dr. Horowitz, thank you. Thank you so much for your call and perspective, a lot for our guests to chew on. Mitra, I know Dr. Horowitz. Any initial reactions to some of the issues he raised?

Mitra: Sure. We've been keeping in touch with both Dr. Horowitz and Dr. Gunness who is on with me, just so that our, both journalism, as well as our efforts to help the community are grounded in current reality. It's great to hear that distilling of the four characteristics, which I had not heard from him before. I think that's great guidance. I think one trend we're seeing, because we're obviously working to still get folks vaccinated, I agree that the hesitant are switching, but I think we need to almost take the refusers, get them on a path to the hesitance, and then get them vaccinated. There's a way to flip the script, which now it takes weeks.

I think that's where government doing things the way they've been doing it just does not work anymore. Organizations like ours, for example, we'll get calls saying, "My daughter refuses to get vaccinated. Can you help me?" Then we begin the process of saying, "Why are they refusing?" Let's say, as Dr. Horowitz pointed out, a medical issue, we say, "Do you want to talk to a doctor?" Dr. Horowitz might be the doctor I call, that they can talk to. What I think, we're definitely sensing from the last few weeks of helping maybe about a dozen people or so in this situation is that it has to be somebody they know, who's doing the approach, married to expertise. The expertise might be a medical professional, but it also might be a member of the clergy. I just had a woman who's from the Sikh community, the Indian religion, and she asked, "Is there somebody from a Gurdwara," that's their place of worship, "who might speak to the guardian of a family." We're coordinating that process right now. She doesn't really care about talking to a medical expert. She's concerned about her faith and what it says about vaccines.

You really do need to do this pretty intricate matchmaking to get the vaccine refusers into the camp of hesitant, but willing to listen, and then ultimately, we hope, vaccinated. That is a weeks', maybe months-long process.

Brigid: I want to bring in a caller who, I think, is going to share a story of going through a similar process. Sharon from Guttenberg, New Jersey. Welcome to WNYC. Can you tell us your story?

Sharon: Thank you. I really was very, very hesitant to take the vaccine. Recently, I have a coworker who contracted COVID-19 and it scared me. He had the vaccine and I was very nervous that, why even bother, he got the vaccine. Then within three days, another coworker also got COVID. Unfortunately, he was not vaccinated and he's been hospitalized now for over two weeks. The difference in the two coworkers really convinced me that, even if you do still contract COVID, the recovery was so short and so speedy he had no side effects. He really just was home on bed rest. It really hit home to me that the vaccine works.

Brigid: Wow. You decided to get your vaccine.

Sharon: I decided that myself and my 16-year-old daughter should get a vaccine, and we did like 5 days ago.

Brigid: Sharon, thank you so much for sharing your story. We have another caller with a different type of story. Jeremy in Gramercy, welcome to WNYC.

Jeremy: Thanks for having me.

Brigid: What's your story with vaccinations?

Jeremy: Basically, I was expecting it very early, but then I grew up in the Midwest. My family still lives there. I was back visiting about a month or so ago, and my mother was very skeptical of the getting the vaccine, had a lot of misinformation about it. Basically what I did was just reframe it for her in the fact that she's eligible to get the vaccine and her granddaughter is not. You're putting her at risk, and framed it like that, like, "What if you got COVID and somehow give it to her, how would that make you feel?" Then after that really made her start thinking, like, "Maybe I should think about it."

Then we just went over all the science. She had a lot of information from social media, so we just went through that, debunked it, found reputable sources to get the information that proves those things wrong.

Brigid: Jeremy, thank you so much for sharing your story. Professor Gunness, since the number of deaths have gone down in the city and more people are getting vaccinated, the sense of urgency around testing seems to have gone down, can testing in the infrastructure we've built around it, since the pandemic began, still be used to help combat the Delta variant?

Professor Gunness: Yes, absolutely. I think we would need more targeted and strategic approach similar to what needs to occur with vaccination. What I mean when I say that is that we know that, with a Delta variant, it's highly infectious, much more infectious than the Alpha, as well as it's accelerating the spread of a disease. We also know that there are gaps in the city and there are areas with low vaccination rates. We may find that there may be pockets within the cities where we have seen the infection occurring at a rapid pace, as well as the severity of the disease and/or deaths due to those who are not vaccinated.

Just listen to what Mitra said and Dr. Horowitz said, I hope I pronounce his name right, I think that we really need to hone in on the issues that are happening in the communities that are not vaccinated. I'll stick with Far Rockaway as an example because I studied Far Rockaway, and I've also published about the issues in Far Rockaway. I think that what really needs to occur is, we really need to have a sort of education and outreach or, for lack of a better word, a dog and pony show where we have all the bells and whistles.

It's not just about pop-up sites. It's about really getting connected with the leaders in the community, having all the announcements and the language and the literacy so that the community understand this. I think someone referenced about, really, when you communicate about the the purpose of the benefit of vaccination, how does that benefit you and your loved ones?

It's not about you necessarily, but your granddaughter, if you get it vaccinated, then you can protect your granddaughter who lives with you. It's really about really trying to deliver these messages so that the communities understand, a lot of communities may have single moms or grandmothers taking care of kids. There may be religious beliefs, connecting with the religious leaders. We see that this is working, it has worked in south Jamaica, and I do believe it can work in other places as well. We have the resources to pull it together. We're learning that as much as vacs, we have mega sites for vaccination.

We may not have the resources to go into these pockets of the communities where there's a low vaccination rate, connect with the community leaders, bring in the resources, bring in the education, bring in the information, and to share with them. There are pop-up sites. We've seen that pop-up sites may not be as effective as brick-and-mortar sites that have an existing relationship in the community. These are a lot of factors to consider when we think of variant. I think that the great thing is that we have a system already in place. Let's build on it and let's do more targeted and more focused strategic planning.

Brigid: Professor Gunness, we have another caller on the line we're not going to be able to get to because we're running out of time. To summarize her question, she says it's premature to say there are no long-term consequences to taking the vaccine. What can you say to put people like this color at ease in terms of long-term effects of the COVID vaccines?

Professor Gunness: That's an excellent question. I think, with all vaccines, we know that it serves a perfect purpose in protecting our immunity and protecting our health. To answer the question, the mRNA vaccine has been studied for decades. It's a familiar, well-known vaccine among scientists. The studies have shown over and over again, the data, the research that it's proven to be effective and it causes severe side effects for a very, very small number of people.

We hear a lot about a side effect of the vaccine, the J&J or any other vaccines, that it may cause-- Always remember, it's a very small number of individuals. As we get more data in the years progressed, we're going to see the impact, the benefit of the vaccine. What we don't know, what concerns us, I think, as researchers and scientists is whether or not the vaccine, how long it will last in our system and with how much immunity it's going to provide as different variants may emerge from the COVID-19.

I think that that's a concern to me, and I think to a lot of the public health community, but I think we'd have to stick with what we have now, but what we have now is a vaccine that is really working. We're seeing the difference that it's making. We're also seeing the difference what's happening for those who are not vaccinated, where you have like a 99% who die or those who are not vaccinated, which is really telling that the vaccination is really effective and it's working. I really don't think that-- I think that that's going back to Dr Horowitz's comment. I think that, added to his comment, one of the concerns that I hear because I developed a fact sheet to debunk the myths, and one of the things that I'm hearing when we did a qualitative assessment off the information on the fact sheet is, people really want to hear what's the difference between the expedited emergency vaccine developments versus the FDA sort of traditional two-to-five-year development process.

They really want that information and they want it to be broken very simply so they know that it has gone through all the checks and all the testing and what is required for the vaccine to be safe. That was one of the biggest concerns in all the different languages that we tested.

Brigid: So much more to talk about here, we could keep going on, I know, and so grateful to have both of you join us today. My guests have been S. Mitra Kalita, co-founder of URL Media and CEO and publisher of Epicenter-NYC, and Harlem Gunness, the director of public health at St. John's University. Mitra and Dr. Gunness, thank you both so much. Clearly, a lot more to keep talking about in the days and weeks ahead.

Mitra: You're welcome, Brigid.

Professor Gunness: Thank you, it's a pleasure.

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