Guest Host: Mikaela Lefrak

Who will be the first to get COVID-19 vaccines?

Who will be the first to get COVID-19 vaccines?

Right now, in the United States, more than 3 million people have active coronavirus cases and are, potentially, contagious.

Put in context, that’s close to 1% of the American population.

So, what do we do to protect ourselves from a virus that’s spreading at an exponential rate? And how might we stay safe for Thanksgiving, and beyond?

Plus, there are now two vaccines found to be 95% effective in preventing COVID-19. So, what could a vaccine rollout look like in the Washington region? We discuss the trial that took place at George Washington University — and the hundreds of local volunteers who helped scientists reach this milestone.

Produced by Julie Depenbrock

Guests

  • Dr. Leana Wen Emergency Physician, Washington Post Columnist, Visiting Professor, George Washington School of Public Health; @DrLeanaWen
  • Dr. David Diemert Professor, The George Washington University School of Medicine & Health Sciences; @djdiemert

Transcript

  • 12:00:03

    MIKAELA LEFRAKYou're tuned in to The Kojo Nnamdi Show. I'm Mikaela Lefrak sitting in for Kojo. Later in the hour we discuss a local Moderna trial and the brave volunteers who helped scientists arrive at a safe and effective coronavirus vaccine. But first in the United States we've reached yet another grim milestone, 250,000 lives lost to COVID-19, and the virus continues to spread. Right now more than three million people have active coronavirus cases and they're potentially contagious.

  • 12:00:33

    MIKAELA LEFRAKSo how do we protect ourselves from this virus that's spreading exponentially? And how do we try our best to stay safe for the holidays? Later in the program we'll look at two vaccines that appear to be nearly 95 percent effective. How might a successful vaccine distribution unfold in our region? Joining us to discuss is Dr. Leana Wen. She's an Emergency Physician, Public Health Professional and a Columnist for The Washington Post. She formerly served as Baltimore's Health Commissioner. Welcome to the program, Dr. Wen.

  • 12:01:04

    DR. LEANA WENThank you, Mikaela. Good to join you.

  • 12:01:06

    LEFRAKAll right. Dr. Wen let's start with our current state of affairs. Right now we have a quarter of a million lives lost. That's a pretty staggering statistic. Dr. Anthony Fauci predicted we'd reach this point. So how did we get here? And what can be done to prevent future loss of life?

  • 12:01:23

    WENWell, there are many reasons as to why we got to where we are including that we never reached a low enough baseline. I think a lot of us were hoping that coming into the winter season when we knew that people would be gathering more indoors, when pandemic fatigue would set in, we were hoping then we would start off this surge that we knew that we would see in the winter at a much lower lever, but unfortunately, we haven't. And I am so worried about the holidays up ahead.

  • 12:01:50

    WENWith every major holiday we have seen a surge in the number of cases. We saw this over Memorial Day, Fourth of July even Halloween. And now Thanksgiving is a time that people tend to get together with their family, with their extended family, with their friends. It also is much colder and so much harder also to socialize outdoors. And I'm so worried about what's coming our way. And that's because we are already at a point, Mikaela, where we have more than one person dying every minute here in the U.S. And we know that the deaths now reflect the infections that occurred three to four weeks ago because deaths are a lagging indicator.

  • 12:02:27

    WENAt that time we had 80,000 to 100,000 new infections per day. We're now at nearly double that number. And so what's going to happen in three to four weeks' time? And so I think the key message that I hope everybody hears is that the future is not preordained. There are things that we can do right now and that, of course, includes mask wearing in public places.

  • 12:02:48

    WENBut I think also, really critically, over the holidays a vaccine is coming. We have to get through this winter. And so we're not asking people to stay away from loved ones for forever. We're just saying this Thanksgiving, this winter holiday, please, do not see loved ones indoors unless they are part of your immediate household. Otherwise see them outdoors for a brief time if you can. And just do not congregate indoors. We have to get through this period and survive until there is hope in the spring.

  • 12:03:18

    LEFRAKSo you're talking about folks staying inside, staying, you know, in their household this Thanksgiving. But in your most recent Washington Post column you said we need to stop taking about a national lockdown, because you say it distracts attention from more practical measures. So can you clarify that a bit? What would you advocate for instead?

  • 12:03:39

    WENAbsolutely. I'm glad that you brought this up, because I think the term lockdown or shutdown is confusing and frightening and it also further perpetuates this myth that it's all or nothing. Either you stay locked in your home and do nothing and see no one or you just let the virus rip through our communities. Now what I'm talking about here is not a sitting at home locking the door, but rather using targeted measures on the policy level. For example, mask wearing requirements, reducing capacity in high risk settings like bars and restaurants, and also people taking matters into our own hands.

  • 12:04:14

    WENAnd so I'm not saying don't see your loved ones at all, but rather if you're going to see loved ones either you quarantine for 14 days and then get tested and then you can see people indoors. You can act as if you normally would in prepandemic days. Or you see one another outdoors only, households spaced at least six feet apart. So these are measures that we can take. And let's talk about them as practical measures and temporary measures.

  • 12:04:41

    WENWe're not asking people to do this for forever. But rather it's recognizing that we do have escalating, exponential spread all across the country. Hospitals are already getting overwhelmed and so let's not add confusion and defensiveness by talking about lockdowns. But rather let's talk about practical things that we can do that really approach this with compassion understanding that people are going through real pandemic fatigue. That's it a really stressful time for so many families. And we want to empower people to make the best decisions for themselves and their loved ones.

  • 12:05:13

    LEFRAKNow I can imagine some people might, you know, be walking out around the streets of their town or city and see, you know, gyms open, retail stores opens, restaurants open and say, you know, hey if those are open, why do I have to stay at home? I think we are seeing restrictions ramping up again across the region. But they aren't as strict or as widespread as they were in the spring. So does that surprise you given the record case levels we're seeing?

  • 12:05:40

    WENYeah, I think is a really good point about the message that we're sending. And that I do think that one of the major reasons why our response has been as haphazard as it is that we've had this mixed messaging at best and misleading messaging and a pandemic of disinformation if you will at worst. You know, I think we need to say that we've learned a lot since the spring. At that time, we didn't know much about coronavirus. And so we asked people to stay at home. When actually that's not ideal, because we know that outdoors is really good for us. That outdoor air defuses the virus. It reduces risk by 18 to 19 times to be outdoors.

  • 12:06:23

    WENAlso, of course, being outdoors is good for our emotional and physical health to get outdoor exercise. And so it is important that people go out and get exercise. And again, socializing outdoors spaced six feet apart is good. It's a way to keep connected to people that we care about and also do so safely.

  • 12:06:40

    WENI think we also have learned about particular high risk settings like indoor bars and restaurants and gyms and salons. Studies have also shown that when you reduce the capacity to 20 percent, even for these high risk settings, you can substantially reduce transmission. And so all of this is to say that we've learned a lot since March or April, we don't need to apply this blunt instrument of shutting everything down or to making everyone stay at home. Rather we can do the things that are a compromise if you will.

  • 12:07:11

    WENAnd I talk about this because you can have a perfect solution, right? On paper, yes, a national shutdown would actually stop the transmission of COVID-19 if everybody follows it, but that's not going to happen. We still have governor's that haven't even implemented a mask mandate. They're not going to be implementing a shutdown. I would much rather have a compromised policy that the vast majority of people can follow rather than an ideal policy that very few will follow.

  • 12:07:36

    LEFRAKNow, I know a lot of us have been looking at graphs, looking at numbers, case numbers for months and months now. So I'm hoping you can kind of put this in context for us. What does it actually mean when we have close to one percent of the population potentially contagious and spreading this disease? Because I think some people out there might hear one percent and say, that sounds really high. And others might feel the opposite.

  • 12:08:01

    WENWell, 1,000 is -- or one in a 100 as a Columbia study just projected is extraordinary. I mean, that's the number of people, who are walking around right now and most likely don't know that they have coronavirus and are able to transmit it to the others. So you can imagine a giant football stadium, University of Michigan football stadium, and in that stadium, if one in a 100 people are infected. That's a 1,000 people in that stadium who are infected.

  • 12:08:27

    WENSo, if you are thinking about having people over to your house and you're inviting 20 people over, chances are really good that somebody there is going to be infected and of course inadvertently, but they are going to be spreading it others. And we know that if people are indoors together in close proximity for long periods of time, the risk of transmission is very high. There was a CDC report about families that were getting together. And they found that 11 out of 15 people in this extended family got infected from one index patient who happened to be a teenage girl -- or a preteen girl in this case.

  • 12:09:01

    WENAnd so, I mean, I mention this because I think one in 100, it should give us serious pause. I mean, that means that there is a very, very high level of community spread all around us. And that's again why I would just strongly urge for people, we have to get through right now. I'm not asking people to stay away from their loved ones for forever. First of all, you can actually see them outdoors or if you're in a pandemic pod with people. Everybody is reducing their risk in that pod. You can see them, but otherwise, I'm asking people to hold off until the spring. Maybe latest until the summer when hopefully we will have a vaccine at that point. Let's plan to celebrate Thanksgiving in July.

  • 12:09:39

    LEFRAKAnd we do have one caller right now. Rosemarie in Washington D.C., you're on the air. Go ahead, please.

  • 12:09:45

    ROSEMARIEThank you for taking my call. I ordered some face masks off the Internet and they came. Some of them were cotton and some of them were rayon. I saw some last night advertised on the Internet, which were polyester. Now I thought we were supposed to be wearing cotton masks. Could Dr. Wen speak to that issue, please?

  • 12:10:09

    LEFRAKDr. Wen, talk to us about masks and the different materials they're made out of.

  • 12:10:14

    WENYeah. So it's a really good question and I'm glad to be able to address it, because I think there's a lot of confusion about masks. So the first thing that I'll say about masks is that you should wear a mask that is suitable for the situation and for you. So let me break this down. There are -- let's say that there are three general types of masks, right? There is the N95 mask, which is definitely the best mask when it comes to reducing your chance of getting coronavirus. This is why healthcare workers, work in a hospital. If we are in very high risk situations with patients who we know has coronavirus, we know that there's going to be a lot of aerosol spray. For example, if we're intubating a patient we wear this N95 mask.

  • 12:10:54

    WENThe tradeoff, though, with an N95 is that it's very, very uncomfortable. And so for the everyday person to be wearing this around relatives or going to the grocery store, running errands, that's pretty uncomfortable and probably not necessary if you're not going to be in very high risk settings. Then you have the surgical mask, the three ply surgical masks. These are available on Amazon and a lot of grocery stores and Costco I think. And these are pretty effective. They're not nearly as effective as the N95. But they're more effective and certainly a lot more comfortable. Those are the ones that I would recommend for people to be wearing if they're doing errands, if they're going on public transportation if there is a level of risk, but not high risk.

  • 12:11:35

    WENThen there are the cloth masks and whether they're made up of different fabrics as Rosemarie was saying, I'm not sure that the fabrics themselves necessarily are the distinguishing factor, but rather I would say the surgical masks are going to be more effective at protecting you the wearer than the fabric mask. All that said is the fabric mask is all that you have and is what you can tolerate wearing for whatever reason, wearing that is certainly much better than not wearing anything. And so ultimately it depends on what you're the mask for, how high risk you are and what you find comfortable.

  • 12:12:08

    LEFRAKSo we have just a couple of seconds left before we have to go to a break. But we got an email from Kate who asked about turkey, stuffing, vegetables and other foods that people are preparing and whether or not they are safe to eat and share. Now I want to address that right after we get to the break. We are speaking with Dr. Leana Wen about Thanksgiving, coronavirus and all of your holiday questions and concerns. Stay with us. We'll be right back.

  • 12:12:59

    LEFRAKWelcome back. I'm Mikaela Lefrak sitting in for Kojo Nnamdi. We're discussing the coronavirus pandemic and the upcoming holiday season with Dr. Leana Wen. Now we got an email from Kate who asks, is it safe to give other food one has prepared like turkey and stuffing to other people? What if the cook wears a mask and gloves while preparing food and if the food is given without contact to others, is that okay? Is that safe? Dr. Leana Wen, what would you say to that?

  • 12:13:28

    WENYes. So it's a wonderful question. And I think it's important for us to clarify what the risks are and what's actually no risk. And in this case this novel coronavirus and coronaviruses in general are not food borne illnesses. And so it is definitely safe to eat food that's prepared by other people. You're not going to get sick from the food. Here's what I'm concerned about. I am concerned about people sharing utensils. And so if you're going to be having people over, of course, make sure that you're outdoors. But let's say that you have people over and you want to share food. Plate their food for them. Pour their drinks for them. Don't have people reaching from the same water jug and pouring themselves water.

  • 12:14:06

    WENWhat I like to do is I plate the food for individuals, I also pour the water and have people come up individually to get that water or drink and that way people are not congregating around one particular area. The most important thing that I just want to convey, again, do not have people indoors for dinner unless they are in your immediate household or everybody has been quarantining for 14 days. That's where the risk is coming from, not the risk from the food itself.

  • 12:14:33

    LEFRAKOkay. Well, I want to get into a bit of the politics of this moment. In an op-ed for The Washington Post earlier this month you wrote, "America has already lost nine months to inaction. We have no more time to waste. The Biden administration has the mandate of the American people and it must begin its critical work now." So what actions can and should President-elect Joe Biden be taking at this moment?

  • 12:14:59

    WENWell, the most important thing that President-elect Biden should be doing now, in addition, of course, to all the work that he and his team are doing preparing and making plans for January 20th etcetera, but it is to exert his moral authority, because what he doesn't have yet in executive power he does have in moral authority. And he has already been speaking. For example, last week, he gave a very powerful speech about masks and how this should not be a partisan issue, how this actually prevents shutdowns and is important for us as a patriotic act to do for one another.

  • 12:15:32

    WENHe can keep on doing these fireside chats. And I think that that makes a big difference. Also there are others who have this type of executive power that he does not yet have and that's mayors and governors and he should be working with them telegraphing what are the policies that he would want to have in place and trying to convince governors and mayors to put them in place now, which I believe that they're already doing.

  • 12:15:57

    WENI think another important component too is we have to recognize that the best policy in the world is not going to do much good if people don't literally follow it. I believe that President-elect Biden's biggest challenge is overcoming a substantial trust in credibility gap. Unfortunately our country is so polarized and so divided and many people, many millions of Americans are not going to listen to President-elect Biden or public health experts. And so I wrote another op-ed about how the most important thing -- another important that Biden can be doing is reaching out to prominent Republicans, reaching out to pastors, religious leaders, business leaders and having them also carry the message for him.

  • 12:16:38

    LEFRAKLet's go to James in Alexandria, Virginia now. James, you are on the air. Go ahead, please.

  • 12:16:44

    JAMESOkay, thanks. I guess one question I had about the masks and it kind of goes to the politicization of it. But, you know, the way the virus spreads if I understand it correctly is through respiratory droplets. And why does it seem to be so hard for people to grasp the concept that a mask can, you know, slow or stop the spread of those respiratory droplets that carry the virus? Thanks.

  • 12:17:11

    LEFRAKThe debate over masks, Dr. Wen, what would you say to this?

  • 12:17:14

    WENI mean, I understand the frustration that so many are feeling, because there are a lot of people in America who are doing the right thing and I think that important to point out that there are many millions of people who have given up so much and are following all of the guidance that is being provided including wearing masks. I mean, the CDC has revised their guidance incidentally about masks to say that not only is it something that protects others from you if you are an asymptomatic carrier, but it also protects you, the wearer, which is something that we in healthcare know. I mean, we wear masks, yes, to protect others from us in case we could be sick. But really we're wearing this to protect ourselves because we're exposed to high levels of this virus. And so I hope that this is a message that people will get behind.

  • 12:17:59

    WENNow, again, my concern is that there has been so much misinformation and disinformation spread about masks. And this is why I come back to this idea of having prominent Republicans, pastors, business leaders, community leaders, there are many millions of Americans for whom public health experts and doctors just cannot reach. I mean, I wish that were not the case, but they're just not going to listen to what we say. And we need other people to be reaching them where they are in order to transcend this very unfortunate ideological gap that exists.

  • 12:18:32

    LEFRAKNow, I know you are a physician, a public health expert and not a family therapist. But we just got email that I am hoping you can address. A listener emails, "My father who lives out of town has informed me that he's hosting a Thanksgiving dinner at his new house for a dozen local friends and relatives coming up from Florida. He's aware of my disapproval of this risky and irresponsible decision. Do you have any suggestions for having to dissuade him from doing this and convince him of the continued danger of COVID-19?" Now, Dr. Wen, I know a lot of us are having these difficult conversations with family right now. So do you have any suggestions or guidance for them?

  • 12:19:12

    WENI do. I think it's important to start with a place of compassion or from a place of compassion and empathy rather than judgment. And so I think it's important for us to understand why it is that they're doing this. So how you approach somebody who, for example, doesn't believe that coronavirus is real is very different from how you would approach someone who thinks this could be their last Thanksgiving. Maybe they're older, they're very worried about their own mortality and they're lonely.

  • 12:19:39

    WENI mean, that's just a very different way of approaching these two people. I think that the people, who don't believe that coronavirus is real that's going to be a much harder battle because -- and I think that if that's the case for family members you should find other people who are trusted messengers. Clearly they're not listening to you. So is there somebody else? Again, a pastor, a religious leader, somebody else that they might listen to could help that individual.

  • 12:20:03

    WENIf it's someone who's feeling lonely and really wants to see people because of that, there are other ways to approach this. Maybe you could say, hey here are some things you could do to reduce your risk. Maybe everybody can be trying to quarantine or get tested understanding that by now quarantining means that they would only quarantine for seven days, which is not great. But that's still better than not at all or if it's a question of loneliness, you could suggest seeing one another outdoors. Rescheduling for the spring or the summer and doing video chats in the meantime.

  • 12:20:34

    WENSo I think that trying to troubleshoot and helping them to work with their value system is what we should be doing rather than judging people, which we know from social science that that's only going to lead to people being even more set in what they were going to do.

  • 12:20:51

    LEFRAKLet's go to Zack in Northwest D.C. Zack, you're on the air. Go ahead.

  • 12:20:56

    ZACKHi. Thank you for taking my call. I was curious what the speaker's -- what her thoughts on the potential of schools being shut down in the area particularly private schools or preschools. That's my question.

  • 12:21:10

    LEFRAKAnd, Zack, can I ask, do you have children in schools right now or kids at home?

  • 12:21:15

    ZACKI have kids at home. I have my daughter in a Montessori program up until mid-March of last year, and have chosen not to enroll her. I'm a single parent. And it's a lot for me working fulltime. And I'm talking to her previous school about enrolling her now. But it is a private school and I'm worried about it shutting down again. And losing some of that tuition money. And trying to figure out what options there are for us.

  • 12:21:46

    LEFRAKDr. Wen, what's your opinion on schools being open or reopening right now?

  • 12:21:52

    WENThis is such a tricky issue. And as a mother of two I completely feel for what so many people are going through right now. I mean, you know, on the one hand we know that schools are essential. That students are falling further and further behind. We are exacerbating the educational divide, the COVID slide is really real. Also kids depends on school for so much more than just the curriculum. It's also their social and emotional development. It's food safety in many cases.

  • 12:22:24

    WENSo I really worry about schools that are not yet being opened or schools that are open, but may close at any moment. At the same, I also think that we need to be talking about the real risk to children, teachers and their families that even though children tend to get less severely ill than adults they can get coronavirus. There could be long-term effects. And I think, ultimately, we need to focus on what we can do to keep schools safe and make sure that they're considered essential.

  • 12:22:57

    LEFRAKGreat. All right. We're going to take a short break right now. When we come back, we'll be joined by the director of one of the two most promising vaccine trials in the U.S. Stay tuned.

  • 12:23:26

    LEFRAKWelcome back. Dr. Wen, before we transition to talking about vaccines, I've noticed that our phone lines have lit up with questions about masks. I'm going to turn now to Christine from Rockville, Maryland. Christine, you're on the air. Go ahead, please.

  • 12:23:42

    CHRISTINEHi, thanks. Yeah, my question is about playgrounds. I let my kids play on playgrounds right now with their masks on if the playground's not too crowded. But I see a lot of other kids without masks, and I'm wondering, you know, is this risky for transmission?

  • 12:23:58

    LEFRAKWe've also gotten questions about people not wearing masks over their nose, do plastic shields work? So, I'm wondering if you could kind of give us the quick-and-dirty of what kind of masks you should be wearing and when and those specifics.

  • 12:24:12

    WENDefinitely. So, the type of mask that you should be wearing in everyday settings, and that includes playgrounds and grocery stores, basically not around ill people, necessarily, but you could be exposed to ill people there. The best type of mask is whatever mask you can wear consistently. And that would include -- I mean, that definitely includes anything that you have to wear over your nose and your mouth. So, a neck or a mask that's just around your neck, obviously not going to be effective. But also, if it doesn't cover your nose and your mouth completely, that's not effective, either.

  • 12:24:41

    WENI absolutely agree that people should be wearing masks in all public spaces. If you're going to be walking outdoors and you're not going to see anyone around you, you don't need to wear a mask. But you should still bring a mask with you in case you, for whatever reason, cannot keep six-foot distance. Kids that are playing together at a playground -- I mean, I have a three-year-old. If my three-year-old were at a playground, he doesn't always know to keep physical distancing. He will almost certainly come within six feet of another child. He should be wearing a mask, so should the other kids.

  • 12:25:09

    WENA face shield is better than nothing, but remember that a face shield does not cover your nose and your mouth. And so, if you're going to be wearing a face shield, you should also be wearing a mask, too.

  • 12:25:20

    LEFRAKAt the same time we're facing down all this grave news about the nationwide surge in COVID-19 cases, we also have gotten some much needed good news. Both the Moderna and the Pfizer vaccines are close to 99 percent effective in preventing COVID-19. I would like to bring in another voice into the conversation right now. Dr. David Diemert is a professor at George Washington University School of Medicine and Health Sciences, and the clinical director of G.W.'s Vaccine Research Unit. Thank you so much or joining us, Dr. Diemert.

  • 12:25:52

    DR. DAVID DIEMERTThank you for having me.

  • 12:25:54

    LEFRAKNow, as someone who's led one of the local vaccine trials for Moderna, how does it feel to come to this result? And what exactly is the result?

  • 12:26:02

    DIEMERTWell, we're ecstatic. I could not have asked for a better result, at least for the initial efficacy results that we have that were reported in the press earlier this week. So, what I can tell you is that, at least early on, after receiving two doses of the vaccine, the vaccine prevents about 95 percent of cases of symptomatic COVID.

  • 12:26:29

    LEFRAKAnd have...

  • 12:26:29

    DIEMERTI should...

  • 12:26:30

    LEFRAKOh, go ahead.

  • 12:26:30

    DIEMERTSorry. I should just say that these are early results, and that what remains to be seen is that if this efficacy lasts for, you know, a longer period of time, which we definitely all hope that it does.

  • 12:26:42

    LEFRAKAnd are these findings similar to other trials sites across the country?

  • 12:26:47

    DIEMERTSo, these are kind of the accumulative results for all of the sites across the country. So, it's the total results from all of the data that's been submitted by all of the sites.

  • 12:26:58

    LEFRAKOkay. And have there been any reported side effects?

  • 12:27:03

    DIEMERTYes, there have been side effects. These are mostly what we term expected adverse reactions to vaccinations. So, both injection site pain and swelling, some redness, just like you might see with the flu shot. People also, usually the day after the second injection, complain of some muscle aches, fatigue, headache. But nothing that's unexpected and nothing that's been serious enough to have any concern, for example, for stopping the study. So, expected reactions. People do feel it, but generally well tolerate it, and they're very short lived. So, usually, a couple of days after the second dose, people are back to normal.

  • 12:27:44

    LEFRAKOkay. Now, of the 30,000 volunteers nationwide, 350 were locals who participated in the study you led at G.W. And you needed volunteers of all ages, all backgrounds. So, remind us who responded to your call for volunteers, and what exactly did the trial entail for them? How did it go?

  • 12:28:05

    DIEMERTSo, I should first preface my response by saying, the trial's not over. In fact, we are still finishing off our second injections. We'll be done next week. So, we still have a long way to go, and we're still following everyone in the study for another two years. But to answer your question, so we did enroll 350 people. Not all ages. This was only adults in the study, so people over the age of 18. But it included a significant proportion over the age of 65. About a third of our participants here at G.W. and nationwide were over the age of 65.

  • 12:28:43

    DIEMERTWe also had a very diverse study population here at G.W. We had over 50 percent of our volunteers came from communities of color, both African-American and Latinx. And I would say that all of them have -- we've had extremely good retention in the study, over 95 percent came back for their second dose. I actually think there's only two who didn't.

  • 12:29:12

    DIEMERTAnd what it entailed was getting the first dose of vaccine, coming back a month later for the second dose. We do have a couple of follow-up, in-clinic visits where we're checking for antibody levels to see what the immune response is. But we do a lot of phone check-ins to see if people are developing any side effects to the vaccine, but also, more importantly, to see if anyone is developing symptoms of COVID. Because we bring those people back in to test them to see if they would potentially meet the endpoint of the study.

  • 12:29:43

    LEFRAKNow, you mentioned that more than half the volunteers were people of color. And I'm curious what methods your unit employed to reach out to black and Latino communities, especially after they've been, you know, so disproportionately affected by the terrible effects of this virus.

  • 12:29:58

    DIEMERTRight. So, we did a lot of outreach, and I would say we -- you know, you can't just drop a phase III clinical trial in on a parachute. I mean, we took advantage of our existing relationships with community groups. A lot through the G.W. School of Public health had existing relationships from prior studies that had been done in communities, particularly with respect to HIV prevention. So, we definitely mobilized our existing relationships to get the word out.

  • 12:30:29

    DIEMERTDid a lot of outreach to local media, informing people about the study. And we utilized a national database that had been put together by the NIH, where people could go and register. And we were able to access that database to contact people to come in who wanted to volunteer for the study.

  • 12:30:46

    DIEMERTI have to say, the other thing that went really well for us is that some of the initial people who we enrolled starting in August at our site have been incredible ambassadors for the study, and have gone back to their friends, family, communities, and really talked about the study and their experience in it. And I think that was extremely useful in getting additional volunteers from those communities. I have to say, we got several volunteers who contacted us after the other spots on Kojo Show that we've done over the past couple of months.

  • 12:31:21

    LEFRAKNow, Dr. Wen, I'm curious to hear more about how these vaccines need to be shipped and distributed once they are ready. One of them needs to remain at ultra-cold temperatures, is that right?

  • 12:31:33

    WENThat's right. So, the Pfizer vaccine, so not the one that Dr. Diemert is talking about, but the other vaccine requires a temperature that is 50 degrees colder than any vaccine that we've ever had, which is essentially an Arctic temperature. And so there need to be special freezers for doing this. And, you know, I've been having conversations with various local and state officials involved in distribution.

  • 12:31:58

    WENAnd one thought is, if we're going to have both of these vaccines, ideally, given authorization and then approval, maybe you think about having this Pfizer vaccine that requires these special freezers to be given to places like urban centers where you can have one freezer for a lot of people, rather than in rural areas. Maybe those places get the Moderna vaccine. I mean, I think there are a lot of questions like that that need to be sorted out.

  • 12:32:25

    WENAnd then we also have to think about the expense. Local and state health departments are already stretched so thin when it comes to their staff who are already putting on many hats. In addition to doing their normal jobs, they're now doing all this COVID work. They've been running a marathon at sprint speed.

  • 12:32:41

    WENNow we're asking them to do vaccine distribution, as well, and they have no resources. How are we going to expect them to buy this freezer? And even for the Moderna vaccine, it still requires refrigeration. It still requires supplies and staffing time. And I think that that's just a level of coordination that I am certain a lot of work is already being done by the Trump administration, by the CDC and by others. But having the Biden team have access to that information now is really critical.

  • 12:33:11

    LEFRAKLet's go to Allison in Northwest D.C. Allison, you're on the air. Go ahead, please.

  • 12:33:16

    ALLISONHello. Good afternoon and thank you. I wanted to know if you're looking for any more volunteers at this time.

  • 12:33:24

    LEFRAKDr. Diemert, are you still accepting volunteers?

  • 12:33:27

    DIEMERTWe are not for the Moderna vaccine trial because that completed enrollment a couple of weeks ago. But there will be additional studies that are on the horizon. We are looking to start another phase 3 vaccine trial of a different vaccine. It's probably starting in December. And Howard University is also going to serve as a site. Very soon, they're going to open to enrollment for the Novavax vaccine. So, there are going to be other options in the near future, different vaccines, but important studies, nonetheless.

  • 12:34:01

    LEFRAKNow, it's my understanding that vaccines normally take years to develop. Dr. Diemert, how was this vaccine developed so quickly?

  • 12:34:13

    DIEMERTThat's an excellent question and one that we get a lot both from our volunteers and from the general public. So, a lot of it has to do with the enormous amount of resources that have been dedicated to this effort. So, usually, you would do a clinical trial -- the different phases of clinical trials. So, we usually do a phase 1 then a phase 2 then a phase 3 in sequence, because often, you want to look at the results, present them to your investors, get more funding to continue the clinical development.

  • 12:34:45

    DIEMERTWell, that barrier, the financial barrier, at least, was completely removed. So, we were able to move extremely fast from initial results from the phase 1 to start the phase 2, and same thing with starting the phase 3. So, instead of sequential clinical trials, we were able to overlap them. Still doing them in the same -- with the same design and taking the same safety precautions, but just in a much more compressed fashion. So, that's the main reason we were able to do it much more quickly.

  • 12:35:14

    DIEMERTAnd also because the MR and A vaccines like the Pfizer vaccine, the Moderna vaccine are using a new technology that was very easy to produce in a very quick fashion. So, that also was one of the reasons.

  • 12:35:27

    LEFRAKLet's go to Ellen, in Reston, Virginia. Ellen, you're on the air. Go ahead, please.

  • 12:35:32

    ELLENHi. Good afternoon. Thanks for taking my call. My question to the screener was that has -- I know Dr. Wen said that maybe get together in the spring or put it off till July. But I'm wondering, have you considered in this, people not getting the vaccine and the impact that would have on us being able to get together in summer, as you've recommended?

  • 12:35:59

    LEFRAKDr. Wen, how would you respond to that question about even if we have a vaccine, are people going to get it?

  • 12:36:07

    WENYou know, this is a really good question. I am worried about uptick. We know that it's not the vaccine that saves lives, it's the vaccination. And we also know that there are a lot of reasons why people may not be able to get vaccines. One is there is a trust gap that we have to overcome. But also, the vaccine distribution process may not be that fast. I mean, certainly, it won't be overnight that suddenly hundreds of millions of people are getting vaccinated. And, by the way, they have to get two doses of the vaccine, which, again, could lead to more people maybe not following the guidance of getting both doses, as they should.

  • 12:36:45

    WENAlso, we still don't know about children. These studies have not yet come out about children and vaccines. And so, I think it's a good point that by spring, summer very likely we're not going to get everyone, or even a large majority who are vaccinated.

  • 12:37:01

    WENYou know, we should think about risk as being additive, and, in the same way, think about protection as being additive, as well. And so just because you have the vaccine doesn't mean that you should go out and just do whatever. But if you have the vaccine and you wear masks and you still maintain some level of social distancing, that will protect you even more than having one of these activities. And so, I think that that's what we should keep in mind.

  • 12:37:25

    WENI'm not saying that by spring or summer, we're all going to go back to pre-pandemic normal, but rather that we have a much better chance of seeing our loved ones at that point, because we have so many more layers of protection, hopefully, by then.

  • 12:37:39

    LEFRAKDr. Diemert, I'm curious to hear your take on this. The vaccine development process has, of course, been highly politicized. So, are you worried that the distribution process could encounter the same hurdles in our very divided country right now?

  • 12:37:55

    DIEMERTRight. I mean, I echo Dr. Wen's concerns. More than distribution, I am worried about uptick and people being willing to get vaccinated from, you know, the numbers that we've been seeing and the polling that we've been seeing. Even over the space of the past six months, there's definitely been a decrease in the proportion of the population that would even take a vaccine, if one were available. So, I think that's my main concern.

  • 12:38:21

    DIEMERTI'm not as concerned about politics interfering with the distribution. I think we have, you know, very professional people who have been spending a lot of effort in planning that out, and I have high confidence. Just like we rolled out these clinical trials in a very professional and safe manner, I have the same confidence in that happening with distribution.

  • 12:38:44

    LEFRAKLet's go to Pauline in Bowie, Maryland. Pauline, you're on the air. Go ahead, please.

  • 12:38:50

    PAULINEHi. My son and I have been following most of the rules, pretty much. And I've been wanting to see two of my children, and we've talked about it. And, of course, they would stay outside. But what happens if one of them needs the bathroom?

  • 12:39:07

    LEFRAKDr. Wen.

  • 12:39:08

    WENYeah, so, great question. So, they can come inside to use the restroom. Here's what I would advise. Designate one restroom, if you have the option. Not everyone does, but if you have the option to designate one bathroom as the guest bathroom. Try to open a window there, open the doors as much as you can to allow as much air circulation in that restroom as possible. Also have hand sanitizer outside of the bathroom.

  • 12:39:32

    WENMake sure that when people go in, they go in one at a time. Ideally, leave at least 20 minutes in between when different people have to go. And then, even once they leave the restroom, they should sanitize their hands, just in case they touch these high-touch surfaces, like faucets and doorknobs. So, you can use the bathroom indoors, but, again, following these, I think, pretty commonsense precautions.

  • 12:39:55

    LEFRAKNow, you've noted that COVID is, in some ways, less deadly now, as doctors have learned to treat it better over the past eight months. Does that mean that we can let our guard down, in some ways if, say, we're not in a high-risk group, Dr. Wen?

  • 12:40:12

    WENNo, not at all. And, in fact, let me just clarify, here, because some people have said -- and I know this is not what you're saying, Mikaela -- but some people have interpreted the lower mortality rate now than back in March or April, as somehow the virus has changed. The virus is the same. It's just as deadly and just as contagious as before. So, that's the first part.

  • 12:40:31

    WENThe reason the mortality rate has decreased is that we have gotten better at treatment. We know better about things like proning, about not intubating patients immediately. We have somewhat better therapeutics than we did before. But note that that only applies if our hospital system is not overwhelmed.

  • 12:40:50

    WENIf our hospital system is overwhelmed to the point that patients have to wait in line for many hours to be seen, then it's not only patients with coronavirus who are going to suffer. It's also patients with heart attacks and strokes who may not be able to get the urgent care that they need. And so, please do not let our guard down. In fact, our hospitals, our ICUs are on the verge of becoming overwhelmed. This is really the time for us to hunker down.

  • 12:41:13

    LEFRAKRight. Do not let your guard down. That's the official word. Let's go to Joyce in Rockville, Maryland. Joyce, you're on the air. Go ahead, please.

  • 12:41:21

    JOYCEHi. Thanks for taking my question. I had a question for Dr. Diemert. I'm wondering, for the volunteers for the vaccine trial, how much they were exposed to COVID. I mean, if these people are already being really careful and wearing masks all the time versus people who were less careful, wouldn't that affect the results? How did you account for that?

  • 12:41:43

    LEFRAKDr. Diemert.

  • 12:41:44

    DIEMERTYeah, that is a fantastic question. And I've had other people say, oh, are you encouraging people to go out and get exposed, because that's how you're going to get the answer to your trial? The answer to that question is no, definitely not. We definitely counseled all of our volunteers to take every precaution that they possibly could. But we had people -- a lot of our volunteers are particularly in professions that would necessitate them being in contact with COVID-positive people, and that includes healthcare workers.

  • 12:42:15

    DIEMERTSo, we had about 30 percent of our study population were healthcare workers who, by the nature of their jobs, were coming into contact and couldn't help it, even though, you know, they would take every precaution that they could. Other people in our study work in the retail industry or in restaurants and construction, you know, or lived in places that are high density and, you know, don't have the option of, you know, living in a single-family dwelling all by themselves or in an apartment all by themselves, even multi-family dwelling.

  • 12:42:49

    DIEMERTSo, even though we counseled people to take all precautions possible, it's unavoidable, in some cases, that people would come into contact with the virus and potentially get infected. And we have had cases like that in our study.

  • 12:43:06

    LEFRAKLet's go to Joe, in Arlington, Virginia. Joe, you are on the air. What's your question?

  • 12:43:12

    JOEYes. I had more of a comment. Where masks are beneficial, but the true benefit of a mask is to prevent a man or woman from passing on the virus if he or she doesn't know it, where if there's an aerosol in the air and that aerosol has the virus, unless you have an airtight N-95 mask, a person will still breathe that in through a cloth mask or through a mask that has some spaces on the side, a person will still breathe that in. So, I wanted to make that comment.

  • 12:43:52

    LEFRAKDr. Wen, how would you respond to that? Another question or comment about masks and their usefulness.

  • 12:44:00

    WENYes. So, of course, the caller's right, that, as I said before, that the N-95 mask is certainly the best in terms of protecting the wearer from infectious particles. But perfect cannot be the enemy of the good. If there are -- again, the N-95 is very uncomfortable to wear. And if we're asking people to wear this for 10 hours at a time, that's just not going to happen. And people are going to put that N-95 aside, in their purse, around their neck and not where it accurately. It only works well in preventing disease when it's worn correctly.

  • 12:44:34

    WENSo, I would rather that somebody wear a three-ply surgical mask consistently, every time, around their nose and their mouth than have an N-95 that's around their neck and not being worn at all. And so that's one, again, N-95 -- if you are a very high-risk individual in a high-risk setting, wear the N-95 for a short period of time, certainly, is the best way of protecting you. For everybody else, a surgical mask is just fine. And if you really cannot get a surgical mask, for some reason, a cloth mask is still better than nothing. Perfect not the enemy of the good, here.

  • 12:45:07

    LEFRAKNow, I know a lot of us are still figuring out what our holiday plans will be. Dr. Wen and Dr. Diemert, as you both know, perhaps better than almost anyone, the U.S. is currently suffering the worst of this pandemic right now, but we have the holidays approaching. So, if you're both comfortable with it, I'm curious to hear what each of you plans to be doing for the holidays. What's your COVID-safe holiday plan? Dr. Diemert, first.

  • 12:45:35

    DIEMERTI am not doing anything. I am worried about where things are going, and I am staying at home with my partner, and we're not seeing anyone else.

  • 12:45:46

    LEFRAKAnd Dr. Wen?

  • 12:45:47

    WENSame here. We have two young kids that our grandparents -- with the grandparents have not yet met my baby. And we've decided that, in their best interest, we are not going to be seeing them this year. But we are making plans for next year, because we want them to be alive for the next holidays to come.

  • 12:46:05

    LEFRAKAnd, Dr. Diemert, let's look to the future. I know we've touched on this but when do you expect this vaccine will be ready for distribution, will be going out across the country?

  • 12:46:18

    DIEMERTRight. I was waiting for this question. So, for both the Pfizer vaccine and the Moderna vaccine, both companies have plans to go to the FDA for what's called an emergency use authorization within days to weeks. And assuming that FDA grants that authorization, then it will be made available for certain groups, at first. So, it will be a staged approach to getting it out to the population.

  • 12:46:48

    DIEMERTSo, people like healthcare workers, especially, you know, intensive care workers, nurses will be prioritized first. People who are older, and especially those living in nursing homes, who are at higher risk of both infection and severe disease, will be prioritized. And then, gradually, it will be opened up to other groups of the population. Probably not until the middle of next year will it be made available to everyone.

  • 12:47:16

    LEFRAKDr. Leana Wen and Dr. David Diemert, thank you so much for joining us. Today's show on coronavirus safety and the local vaccine trial was produced by Julie Depenbrock. Coming up tomorrow, on The Politics Hour, we'll speak with Virginia Governor Ralph Northam on tightened coronavirus restrictions and D.C. Councilmember Brianne Nadeau about the council's plans for more oversight. That's all tomorrow on The Politics Hour. A quick shout out to our engineer Mike Kidd, whose birthday is today. Happy birthday, Mike. And we'll be back tomorrow. Thanks so much for listening.

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