On this last episode, we look back on 23 years of joyous, difficult and always informative conversation.
Guest Host: Sasha-Ann Simons
Earlier this week, the nation’s top infectious disease expert Dr. Anthony Fauci warned of a “surge upon a surge” of coronavirus cases after millions of Americans ignored the advice of public health experts and traveled for the Thanksgiving holiday.
In times of uncertainty, we look to medical professionals for guidance. Johns Hopkins Infectious Disease Specialist Dr. William Moss joins us to share his expertise and answer your essential questions.
Produced by Julie Depenbrock
- Dr. William Moss Professor of Epidemiology and Executive Director of the International Vaccine Access Center, Johns Hopkins University; @JohnsHopkinsSPH
SASHA-ANN SIMONSYou're tuned in to The Kojo Nnamdi Show. I'm Sasha-Ann Simons sitting in for Kojo. Welcome. Later in the hour, we're sitting down with a few of D.C.'s finest crime fiction writers. But first, earlier this week, the nation's top infectious disease expert, Dr. Anthony Fauci, warned us of a surge upon a surge of coronavirus cases after millions of Americans traveled and gathered together for the Thanksgiving holiday. So what should we be doing to protect ourselves during this precarious time? How much are cases rising in our region? And how soon might a vaccine be available to you? Joining us to discuss that is Dr. William Moss. He's a Professor of Epidemiology at Johns Hopkins University and the Executive Director of the International Vaccine Access Center. Hi, Dr. Moss, welcome to the show.
DR. WILLIAM MOSSHi, Sasha. Thank you for having me.
SIMONSDoctor, we are in the thick of the holiday season right now. Can you tell us what consequences we might see from that Thanksgiving travel?
MOSSYeah, so as you said, Sasha, we're seeing -- we're right in the middle of a surge. Yesterday we had in this country over 184,000 cases in a single day, more than 2,600 deaths in a single day. And what we expect is that this could -- this may get worse. With people gathering over the Thanksgiving holiday, people traveling, people coming into contact with one another that creates the condition for the virus to spread from person to person. And so we could be seeing even higher numbers in the coming days to weeks. And then we have another holiday and it's very difficult for people to not travel and see their loved ones. So the cases are rising, deaths are rising and we're heading into another holiday.
SIMONSWow. And here's something else to sort of complicate things. We now know that the CDC has just issued revised guidance to cut the quarantine time in half from 14 days to 7 days. To me, that kind of seems counterintuitive. Can you help us unpack that decision?
MOSSYes. I think what the CDC is doing is trying to make recommendations on quarantine. And just so everyone knows quarantine is the period in which an individual who's been exposed but is still well, is not sick, should minimize and really reduce to zero their contact with other people. And so what they're doing, they're making somewhat of a tradeoff here. What we call the incubation period is the time when people get infected to the time when they start feeling ill when their sickness develops. About half the people develop illness in about five days. But there's a long tail on that when people who are infected may develop symptoms later and later, and that can go out to two weeks.
MOSSBut what the CDC is saying here is that let's say someone stays without symptoms for one week, for seven days, and they test negative. The probability that they are actually have been infected is very low. It's not zero, but it's low. If they don't get tested, the CDC is recommending that period of quarantine for 10 days. And so they're making a tradeoff here. They're not saying the risk is zero after that. But the risk goes down very low that that individual is actually infected.
SIMONSDoctor, with what you've just mentioned to us in mind, tell us what your guidance is when it comes to gatherings this year, because we've got another holiday season upon us.
MOSSYes. Unfortunately, I think, because of the nature of the pandemic right now in the United States, because we're in the middle of this surge, really the safest thing is to stay -- you know, keep your gatherings small. You're gathering for the holidays people who are in your household. What we particularly have to be careful about are exposing people who are at high risk for severe disease and even death. And that can be the grandparents that can be, you know, adults with other underlying medical conditions that place them at high risk.
MOSSSo really -- the safest thing at this really terrible time in the pandemic is to avoid traveling, avoid family gatherings outside of people, who are already in your bubble, in your home. If you need to do that, then -- or if that's not possible people really should be wearing masks, washing hands frequently. You know, keeping that distance that physical distance, because otherwise it's very simple. This virus spreads from person to person. If an infectious person comes into close contact with a susceptible person they're going to transmit. And that's why we're seeing so many cases and so many deaths now.
SIMONSGosh, I feel like we've been hearing this for so long and we went through this with the Thanksgiving holiday and so many people didn't listen to this advice. So, Dr. Moss, in what ways do you think public health messaging needs to be retooled, because I just feel like so many might have just tuned out at this point.
MOSSI think you're right. You know, people talk about pandemic fatigue and it's just very hard to keep this up particularly during the holiday seasons, the Thanksgiving and Christmas season. So I think these revised guidelines from the CDC on quarantine is one attempt to try to find a balance where maybe we -- the risk is still there, but we try to have guidelines that people can actually comply with. You know, a 7 day or 10 quarantine rather than a 14 day quarantine.
MOSSWhat I would say is, you know, we've heard a lot of good news about vaccines and I know we'll talk more about vaccines. I think that gives us kind of a light at the end of the tunnel. It's still months away, but I think what I'd like to do is send a message that if we can buckle down over the coming months, get through this winter, get through this next holiday season. We do see an end in 2021 mid to perhaps third quarter 2021 when the vaccine will be really available to all Americans who need it. And then we can begin kind of a phased measures of backing away from some of these stricter public health measures.
SIMONSOkay. Let's jump to the phone lines right now. Jim Slagel is on the line with us from Bethesda. Hi, Jim.
JIMHi. Thanks for the program.
SIMONSWhat's your question?
JIMAbout a week and a half ago good results were announced for the virus -- for the vaccine. And the committee is not going to meet till December 10th. It seems way too long. Why so slow? Another thing is, you know, the United Kingdom has met and decided and everything already.
SIMONSOkay. Thanks for your question, Jim.
MOSSThanks, Jim. A really important question that people understand why this process takes the time that it does. And the big difference and I think this is really important, is that the Food and Drug Administration takes -- does very careful and rigorous review of the data that are submitted by the vaccine manufacturer, in this case it was Pfizer that submitted their application for the emergency use authorization first followed by Moderna.
MOSSWhat the scientists at the Food and Drug Administration are doing is very carefully going over the data from the phase three trial to really make sure that these vaccines are as efficacious and safe as we can know at this point in time. And so that's what takes the time from the time of the application by Pfizer and Moderna until the decision is made by the Food and Drug Administration.
MOSSIn the UK, what happens is that the regulatory agency that granted that emergency authorization, they take the word of the vaccine manufacturer. They don't do as rigorous a review as the FDA does. And so I think that's really important for building the trust around these vaccines.
SIMONSWell, just so we get a handle of our numbers here in the region, we are seeing this nationwide surge. But tell us how we are doing here in Washington compared to the rest to the rest of the country.
MOSSYeah, so we're seeing increases in cases everywhere throughout the country. So it is relative. But we're seeing an increase in the cases in the Washington region. And we've seen peaks in the number of cases just over the past week, over the Thanksgiving holiday. And again we anticipate that this could even get worse. So we're on the up-rise throughout the country including the Washington region. We're beginning to see our hospitals fill again, you know, as we saw back in the spring. And our healthcare workers are tired. They've been at this for months. And we're beginning to see the strain there.
MOSSSo what we're seeing in the Washington region is an increase. It's not as bad as what we're seeing in some other parts of the middle the United States right now. But we are seeing the increase in the Washington region.
SIMONSA listener tweeted to us in response to our discussion, Doctor, about the CDC's revised quarantine guidance cutting the time in half from 14 to 7 days, and they said, is placating at play here? What do you say?
MOSSYeah. I don't think so. I wouldn't think of it as placating. If we set very, very strict guidelines people -- it's very hard for people to comply. So I think this is making a tradeoff. But if more people comply with the 7 or 10 day quarantine than people complied with the 14 day quarantine, I think we could end up in a situation where these new guidelines are actually helping to reduce transmission.
SIMONSShould we be letting our guard down at all here, because I know COVID-19 is a little less deadly now than it was earlier on this pandemic? But if you're not in a high risk group per say, does this mean you can let your guard down at all?
MOSSI do not think we should be letting our guard down at this time.
SIMONSBecause I feel like some people think that way.
MOSSYeah. Some people do. It is true that if you look at what we call the infection mortality rate, how many people who are infected that actually die, that proportion or the case fatality ratio, you know, how many people actually develop disease who die, that has gone down over time. And there are multiple factors related to that. Some of it is, you know, seeing infections or cases in younger populations who have a lower risk of dying. And there have been improvements in the care of people with severe COVID-19, people who are hospitalized. So we've seen improvements in care. But by no means does that mean we should be letting our guard down.
MOSSEven younger people, people younger than 65, people in their 20s and 30s are getting severe disease. And it's just at a lower rate than perhaps older people or people with other underlying conditions. But they are getting severe disease too.
SIMONSYeah. And we all still have to go grocery shopping. We still have to go to the pharmacy and run all kinds errands. So, of course, it's important to know how to navigate these things. Kirsten tweeted to us and said, experts keep recommending to avoid people outside of your household. What about people who live alone? It's been almost a year now. Those socially distancing alone are really struggling. We'll talk more about that when we return. The conversation continues after a short break. Stay with us.
SIMONSWelcome back. I'm Sasha-Ann Simons in for Kojo Nnamdi. We're talking with infectious disease specialist Dr. William Moss. And he's answering your questions about staying safe during the pandemic's winter surge in coronavirus cases. Doctor, before the break we talked about a tweet we got from a listener who mentioned folks who live alone. What do you say about that because, you know, she says, experts keep talking about avoiding people outside of your house. But, you know, what about those who are lonely right now and socially distancing by themselves? It's a struggle.
MOSSIt is a struggle. And the listener raises a really important point. And there's no doubt that there's a cost to the physical distancing that is required from a public health point of view and we need -- the trick is finding the right balance. And as the listener said there are many people, many individuals who live alone in whom that social isolation can be very devastating. And so we need to be able to find ways to safely kind of be together to safely socialize. Some of that can be done, you know, through computers, through apps, through Zoom. But that is definitely not the same as being face to face with a loved one or a friend. And so when we do come together, we just have to do it safely. Wearing masks, you know, keeping that distance, washing hands.
MOSSThere are ways that we can mitigate the risk and still -- and try to avoid that desperate social isolation.
SIMONSDerek from D.C. called, but he actually couldn't stay on the line with us. His question was, though, What does quarantining mean for someone living in an assisted living setting?
MOSSYes. So there are a lot of challenges, Derek, to actual quarantining in various settings, in multigenerational households, for example, or in as you say, in assisted living situations. And it ideally would mean really avoiding close contact with other individuals. But, again, if that's impossible there are ways to do this safely as we said with the mask wearing, the hand washing and keeping some physical distance.
SIMONSWell, Doctor, something else on people's minds is this vaccine coming out, right? Tell us that latest on it and if you can tell us about how many are seeking or have gained FDA approval and when the vaccines might be ready.
MOSSYeah. So first of all I'll say, you know, it's really astonishing how far we have come in 10 months in the development and having available a vaccine against COVID-19. Where we stand right now is that we have -- there are two different vaccines. One made by Pfizer. One made by Moderna. They're both what we call messenger RNA vaccines, a novel vaccine delivery platform or style. Both of those companies have submitted applications to the Food and Drug Administration for what is called an emergency use authorization.
MOSSThis is not an approval, a formal licensure of the vaccines, but it allows people to receive the vaccine in an emergency. And we are certainly in an emergency situation right now here in the United States with the pandemic.
MOSSWhat we are anticipating is that the FDA will first meet on December 10th to discuss the Pfizer messenger RNA vaccine. And then about a week later December 17th to discuss the Moderna messenger RNA vaccine. As we said earlier, the FDA is conducting a very rigorous review of all of the data from the phase three trials. And I'll state that those trials are not completed yet. But we're at a point where we can make safe determination about both the safety and the efficacy of the vaccines. And then we expect that there will be vaccines distributed very shortly within days after those emergency use authorizations.
SIMONSRene from D.C. also called, but couldn't stay on the line. She asks, if someone gets the vaccine can they still be an asymptomatic carrier?
MOSSThis is an excellent question. And so the phase three trials really have as their primary end point or outcomes whether or not these vaccines prevent disease whether that's mild, moderate or severe disease. What needs to be done going forward is to answer exactly the listeners question. You know, it's possible that a vaccinated individual may develop an immune response that prevents them from getting the disease, but still allows infection. And perhaps even allows that person to transmit the virus.
MOSSI strongly believe that it's going to be at reduced levels than a person who's unvaccinated. But this is a very important question going forward and there will be studies done to address it. So we don't know yet whether these vaccines will actually prevent asymptomatic infection and transmission of the virus, but a very important question.
SIMONSWhat do you say to someone, Doctor, whose feeling concerned about the safety of these vaccines?
MOSSYes. I think it's very important for the public and for people who are considering receiving one of these vaccines to know what we know about the vaccine safety and to know what we don't yet know about vaccine safety. What we know thus far from the phase one, phase two and large phase three trials is the short term side effects associated with these vaccines, and they're what we expect from a vaccine. There's soreness at the site of injection, some fever, fatigue, muscle aches, headache, those kinds of symptoms that reflect inflammation. It's really a marker of our body's immune system recognizing and fighting the vaccine if you will. These are transient. They last maybe from 12 to 36 hours. And these, again, are well recognized kind of side adverse events or side effects from the vaccine.
MOSSAnd we'll have enough follow-up from the trials to know the vast majority of side effects that could result from these vaccines. But we don't know everything. There's still the potential that there might be some rare long-term side effects from these vaccines and that's why it's critically important that we continue to follow the participants in the phase three trials, that we collect information on people, who get the vaccines to see whether there are any rare long-term side effects. But I would say to someone considering a vaccine, I would say certainly these side effects that we know are worth the tradeoff of the high degree of protection that we've seen in the phase three trials given the seriousness of COVID-19.
SIMONSWell, Rebeca tweeted a clarification to us. I want to make sure I get this in. I mentioned earlier that the CDC's new guidelines are cutting the quarantine time in half from 14 to 7 days. And Rebeca reminds us, that's not accurate. They're actually cutting it to 10 days. It's only seven days with a negative test on day seven. Thanks, Rebeca. Let's jump to the phone lines. Louise has been waiting patiently. Hi, Louise.
LOUISEHello, can you hear me?
SIMONSYes, I can hear you. What's your question?
LOUISESo I am to be traveling -- flying at Christmas to be with my mother, who's alone. And I plan on quarantining after landing. So my question is how long do I need to quarantine before I can go get tested?"
SIMONSThank you, Louise. Quick response, Doc.
MOSSYeah, so the quarantine time is generally recommended to be 10 days after a potential exposure assuming you don't have any symptoms then. And generally it's recommended that you get tested at the end of that quarantine period within 48 hours of the end of the quarantine.
SIMONSAnd really quickly before we go, because a lot of people are asking this question. For groups that are considering forming a pod or a bubble to get through the winter, what rules must be in place to keep the pod safe. Just about 10 seconds.
MOSSYes, you know, again, it's the quarantine before to make sure that you don't have any signs or symptoms before and then really keeping that pod closed. Any breaks in that pod could potentially introduce the virus.
SIMONSWell, our thanks to Dr. William Moss. Dr. William Moss is a Professor of Epidemiology at Johns Hopkins University. He's also the Executive Director of the International Vaccine Access Center. We're definitely going to have to have you back, because so many questions were left unanswered, Doc. But thank you so much for your time today.
MOSSThank you, Sasha.
SIMONSWe'll be right back after a short break. This is The Kojo Nnamdi Show. I'm Sasha-Ann Simons.
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