On this last episode, we look back on 23 years of joyous, difficult and always informative conversation.
The unprecedented effort to inoculate the American public in the face of a raging pandemic is now underway. But public health experts are warning about the importance of trust in the vaccine, and transparency about what to expect, to prevent the potential spread of misinformation. It’s an educational campaign that must be done on a hyper-compressed timeline.
“Having side effects isn’t a bad thing; in fact, it signifies that the body is mounting an appropriate immune response,” Dr. Leana Wen writes in the Washington Post. “Though they could be uncomfortable for several hours to a few days, they are not comparable to having the coronavirus, which can cause weeks of illness or even long-lasting consequences and death.”
So, what are doctors doing to build public trust? And what should we expect when we receive the COVID-19 vaccine?
In times of uncertainty, we look to medical professionals for guidance. Emergency physician and public health expert Dr. Leana Wen joins us to share her expertise and answer your essential questions.
Produced by Julie Depenbrock
- Dr. Leana Wen Emergency Physician, Washington Post Columnist, Visiting Professor, George Washington School of Public Health; @DrLeanaWen
KOJO NNAMDIYou're tuned in to The Kojo Nnamdi Show on WAMU 88.5. Welcome. Later in the broadcast Meteorologist Chester Lampkin joins Kojo For Kids. But first in the United States close to 300,000 people have now died from COVID-19, 50,000 of them in the past four weeks. Our pandemic year is ending with overcrowded hospitals and thousands of deaths each day. But there is hope that vaccines approved for emergency use last week will finally bring us some relief.
KOJO NNAMDIWe'd like to hear from you. How are you feeling about getting the coronavirus vaccine? Joining us now is Dr. Leana Wen, an Emergency Physician, Public Health Professor and a Columnist for The Washington Post who formerly served as Baltimore's Health Commissioner. Dr. Wen, thank you for joining us.
DR. LEANA WENIt's great to join you again, Kojo.
NNAMDINearly 1 in every 1,000 Americans has already died of COVID-19. How do you get people to wrap their heads around such staggering statistics?
WENI know. And I really worry about this. I actually think that as the numbers keep on building we lose sight. I mean, I think about my own patients and people that I encounter. When we were talking about dozens of deaths, people were saying, "Wow. This is a new disease. I am taking all these precautions." But now that we're seeing thousands of people more than 3,000 people now dying every single day, I mean this is a mass casualty event every single day in the United States, but I don't know that people's behaviors are reflecting it.
WENI do think that pandemic fatigue is real. And that people are understandably sick of this disease. But I also hope that people will keep in mind now that we have this incredible vaccine news the end is finally in sight. But how tragic would it be if people were to die now, now that actually there is a way for us to save people's lives and thousands of people are still dying every day.
NNAMDISo what guidance are you giving when it comes to holiday gatherings at this point?
WENWell, right now we are already seeing an unprecedented surge. And we have a surge upon a surge with Thanksgiving that's being reflected. The last thing that we would want at this point is for another surge after Christmas and the New Year's. At this point given the high rate of coronavirus across the country, we have a rate that's so high by the way that if you have a gathering of 10 people you have a nearly one in four chance that somebody in that gathering has coronavirus and doesn't know it and will spread it to others.
WENAnd so what that level of coronavirus is best for us to not have indoor gatherings. If you want to see your loved ones, please do so outdoors with households spaced at least six feet apart. If you really want to be indoors with people, there's a safe way to do it, which is that everybody needs to quarantine for at least 10 days or quarantine for seven days and then get a test. One negative test alone is not going to be enough. And it's just not safe for us to gather indoors unless we take all those additional precautions.
NNAMDIDr. Wen, the vaccine rollout began Saturday. Where are the first doses going?
WENWell, so I think this is important for people to remember that we have, again, these incredible news. And it does sound like a lot of doses are going out. We've got more than three million doses that are being delivered this week to hospitals for healthcare workers. But three million plus doses that's one percent of the American population. And it's going to take us quite some time for us to vaccinate enough people that we're going to see a substantial reduction in mortality around the country.
WENAnd so to directly answer your question, the initial doses this week are going to hospitals to vaccinate frontline healthcare workers. And then next week, the week after will also be able to get to nursing homes, which is also really critical, because about 40 percent of people who have died in this pandemic are sadly residents in long-term care facilities. Still in the -- even in the initial allotments that are given about 20 million doses are estimated to be given end of this year early next year. We're still not even going to be able to cover all healthcare workers and nursing home residents who are in that priority 1A group. And so, again, just underscoring how much time it's going to take us in this phased rollout of the vaccine.
NNAMDIThe logistical challenges of distributing this vaccine are truly overwhelming. What are the obstacles here and what are states doing to address them?
WENYeah. You're right that the obstacles are overwhelming. They are present in every way that we look. So first you've got the logistics of distributing the vaccine to different states. And then after that it is much more complicated, because it's also a matter of getting it various facilities. This Pfizer vaccine is one that needs to be stored at ultra-low temperatures basically Arctic temperatures 50 degrees lower than anything we've ever done before for vaccines. Then there's also a very narrow window of time between when the vaccine is thawed and diluted and when it can be given to people. It needs to be given within this very narrow window of time or else this vaccine may not be active and have the efficacy that it needs.
WENAnd so I think to your question about whether states are ready, I'm certain that they are ready for this initial allotment. But this is a massive vaccination program that's going to take massive amounts of resources for the next several months. And what I fear is that all this attention has been put into the development -- the scientific development. And we have been able to achieve this within record speed. It would just be really tragic if that record speed for scientific development is then not translated into rapid speed for distribution. And states urgently need more resources.
NNAMDIHere now is Lena in Rockville, Maryland. Lena, you're on the air. Go ahead, please.
LENAHi. Thank you, Dr. Wen. I was wondering about those who are on immunosuppressants. If they take the vaccine, how will that affect their systems?
WENIt's a really good question and one that we don't fully have the answer to yet. So remember that was given by the FDA was emergency use authorization before all the data are in. And they are given this emergency use because we're in the middle of a pandemic. If we have thousands of people dying every day and we know that the benefits far outweigh the risks, then we really need to be giving this vaccine out even before we have all the data. One of the groups that we don't have the full data for are people who are on immunosuppressants whose immune systems are compromised in some way.
WENIt's actually not so much about safety, because some people will be asking, well, is it safe for me to get this vaccine is I'm on immunosuppressants? It's safe, because this is not a live vaccine. Actually none of the vaccines that are being tested in the U.S. are live vaccines. So you're not going to get coronavirus from the coronavirus vaccine.
WENBut rather it's the opposite that we're worried about. We're worried that it might be that you -- that the vaccine is not so effective for you if you're on immunosuppressants, because immunosuppressants by definition it depresses your immune system. And so will the vaccine trigger as much of immune protection for you as we would want it to if you're on immunosuppressants. We don't know the answer to that just yet.
NNAMDIThank you very much for your call, Lena. A listener asks on Twitter, "Should people get the vaccine if they have had the virus?"
WENAnother great question, that we don't fully have the answer to. So the short answer to this is yes, but with a caveat. So there is no particular reason why you should not get the vaccine if you have already had coronavirus. And in fact over time, we would certainly recommend for everyone who's had coronavirus or think that they've had it to get the vaccine, because very likely the vaccine will -- it may last for longer. It may give you more complete protection, a more consistent protection than if you got the virus because we actually don't know how long that natural immunity is going to last if you had the infection.
WENBut that said, currently the CDC is recommending that if you have coronavirus right now or if you've had coronavirus within 90 days do not get the vaccine. And that's in part, because reinfection is very rare. It's probably not going to happen within 90 days. And when we have a limited supply of the vaccine you probably may not want to get the vaccine right now if you just had coronavirus.
WENBut we're also not recommending that people get the antibody test to see if they've had coronavirus prior to getting the vaccine. And that's in part because of how complicated the logistics are already. If everybody now needs to be tested before they get the vaccine that's adding a whole level of complexity that's not needed.
NNAMDIHere now is Dylan in Rockville, Maryland. Dylan, you're turn.
DYLANHi, good morning. Thank you so much. So my brother has actually had coronavirus in the past 90 days. He caught it through work. He lives out of state and he wants to come home for the holidays to visit my parents, who are high risk. What is the likelihood that he would bring -- catch coronavirus again and bring it home? Is it safe for him to come home?
WENYou know, it's a good question, because on the one hand somebody who has had coronavirus should have immune protection for at least a period of time and probably for at least 90 days. But on the other hand, I just really cannot recommend travel at this time when we have such unprecedented numbers of coronavirus around the country, when we have hospitals that are at the brink, I just cannot recommend for anyone to be doing non-essential travel.
WENIt's also possible that your brother even if he is immune from getting coronavirus himself for this period of time, it's not impossible that he could carry. He could be a carrier still. And with travel and also with potentially higher risk behaviors that he may be engaged in in other parts through work or other settings. Especially with your parents being high risk, I just do not recommend that he comes home at this time.
WENBut, again, I recognize that this is difficult advice to be giving. It's difficult advice to be hearing. But I hope people also hear that we need to get through this very difficult winter. We have to hunker down right now. There's hope on the horizon and people are going to be able to get the vaccine within several months' time. We can celebrate again in person in the spring, in the summer, but not if we're not alive to celebrate at that point.
NNAMDIThank you very much for your call, Dylan. Patsy emails and this is a two part question. I'll do one part at a time. "I do plan to have the vaccine and as a senior hope not to wait too long for my and my family's turn. Dr. Wen, how will we know when it's our turn to get the vaccine and how are people being notified?"
WENYeah, another great question. So this is going to depend on the state and where people live. And I'm afraid we just don't really have the information at this point, because right now what happens to determine priority is that the federal government through the CDC will be determining the priority for after healthcare workers and nursing home residents, who are the next layer of people who will be getting the vaccine. Most likely it will other essential workers. Although, there's a question of who is an essential worker. And it will probably also involve individuals in congregate settings like jails and prisons who are at higher risk and individuals who are elderly with chronic medical illnesses or at higher risk for a severe illness too.
WENBut that's a lot of people and exactly who gets the vaccine at what time will also depend on the states to make the priority at that point. And so it's a lot of that still remains unclear. And I have no doubt that when that kind of prioritization is given a lot of people are going to be angry. And I just -- my hope, though, is that we also see this as, we're in this together. That we're all going to get the vaccine at some point. We just don't know exactly in what order yet.
NNAMDIIn the 30 seconds or so we have left, Patsy has a second part to her question. "How do we know which vaccine is better and more efficacious, the Pfizer or Moderna?"
WENThey are both very safe and their efficacy level is similar.
NNAMDIOkay. That's what I thought. We're going to take a short break. When we come back, we'll continue this conversation with Dr. Leana Wen and take your calls at 800-433-8850. What are you doing to keep yourself and your family safe? I'm Kojo Nnamdi.
NNAMDIWelcome back. Our guest is Dr. Leana Wen. She's an Emergency Physician, a Public Health Professor and a Columnist for The Washington Post. She formerly served as Baltimore's Health Commissioner. Dr. Wen, how do the vaccines work exactly?
WENYeah. It's a very good question. And so, there are two vaccines that are likely to come on market. Well, one is already approved and the Moderna vaccine -- the Pfizer vaccine is already authorized. And the Moderna vaccine will likely be authorized later this week. And they both use the messenger RNA platform. And so what this means is that this is a genetic code that actually teaches ourselves, how to make a protein that triggers an immune response inside our bodies. And so this is a new technology as people have heard. That's very exciting.
WENAnd I think one important thing about this vaccine -- some people hear genetic code and they wonder is this somehow going be modifying the genetic code inside our bodies. No, it does not work like that. But rather what it does is it's a piece of the virus if you will -- a genetic code of the virus that then triggers an immune response inside our bodies. But it does not interfere with our own genetic code.
NNAMDIIn a recent column for The Washington Post, you wrote about two scenarios that could substantially derail vaccine efforts. First can you tell us about possible side effects?
WENYeah, so side effects are normal. They are expected and they actually show that the vaccine is working that it's triggering that immune response that we need in order to fight off the infection in the future if we were to expose to it. But some people have experienced quite uncomfortable side effects. They're in two categories. One is pain, redness swelling at the injection site and then the other is overall not feeling well like body aches, fevers, chills, etcetera. Again, they're uncomfortable. They're temporary. They go away within hours to days. They're certainly things that could be treated easily.
WENBut if people don't understand that these side effects could occur, it may deter them from coming back for the second dose because for both the Pfizer and the Moderna vaccine there is a second dose of the vaccine. And so I wrote in the op-ed about the importance of educating patients at the time that they're getting the vaccine about these possible side effects, because setting that expectation is going to be really important.
NNAMDIOn to the phones, again. Here is Star in Washington D.C. Star, you're turn.
STARThank you for taking my call. I have two questions, which are related to the safety of the vaccines that the press conference in the FDA announced its decision the other day. Dr. Peter Marks said and this is a quote that "most of those on the FDA committee approved release of the vaccines." There was not a word said in the media to my knowledge about those who were on that committee who dissented what their objections were, how many people there were, what the FDA planned to do to answer their objections.
STARSecondly, I personally know two researchers in infectious diseases. They both have PhDs from inverse Washington in Seattle and they concur with a Dr. Caroline North, who's written a book about the potential dangers of the RNA platform based vaccines. According to them there have been tests on related viruses that didn't -- that initially showed very good results and then eight or nine months down the road, they were found to be so dangerous that the trials had to be stopped. And by the time you hit ...
NNAMDIWell, you're going to have to get to your point quickly.
STAROkay. By the eight or nine months millions of people here will have already been vaccinated and it will be too late if there are very bad results. Thank you.
WENYes, so the mRNA vaccine is safe. And let me get to -- because I think this is a really important point that the listener made about the individuals who voted against the specific question during the FDA committee, because what happened was that there is an external committee of scientists, who are not part of the FDA, but who are world renowned experts who met and discussed the FDA's recommendation to give emergency use authorization for this vaccine. They voted strongly in favor of the vaccine.
WENThere were three people who voted against the specific question that I'll come to and one person who abstained. But the reason they voted against it, there was nothing where they questioned the safety of the vaccine for adults. They also were unanimous in how they believed that the benefits will strongly outweigh any kind of theoretical risk that there may be.
WENThe reason why there were people who voted against it was specifically the question that was asked was about consent for 16 and older. And the people who voted against had a question about whether 16 and 17 year olds should be included in that authorization. Not about whether the authorization should be given overall. It's also important to note that at that point there was another committee of separate scientists, who are external advisors to the CDC, the Centers for Disease Control and Prevention, they met over the weekend and they recommended unanimously in favor of this vaccine.
WENAnd so I think, you know, it's important for us to acknowledge that people may have heard certain things from places. But that there are external scientists, independent scientists, the best in the world who have reviewed all the data involved and have determined that this is in fact a safe vaccine.
NNAMDIKurt askes, "My sister has tested positive. One of her sons has tested positive and one has tested negative. Is there anything that they should be doing? Is it possible to prevent the other son from getting infected if there all living in the same house?"
WENIt is. It is certainly possible. People have done it, although it is very challenging to do. The individuals who tested positive -- this depends on the age and whether people need care in different ways. But people who tested positive should generally stay isolated from those who are not yet positive -- are not positive in that same household. And so they should be staying in separate rooms. They should not have shared facilities like restrooms and kitchens as much as possible. They should try to keep their windows open and to allow for ventilation as much as possible.
WENThe CDC has very good guidelines on their website about household contacts recognizing that not everyone is able to follow all of these recommendations. But that it is certainly possible to keep from transmitting the virus within a household.
NNAMDIHere is Ceque in Columbia, Maryland. Ceque, you're on the air. Go ahead, please.
CEQUEThank you for taking my call and good afternoon.
CEQUEI am a Black man in American and here is my Catch 22. So if given the opportunity to take the vaccine, I will take it, no problem. But history tells me to be careful looking at syphilis or the Tuskegee experiment and many other things that Blacks have suffered at the hands of government. How can the government put my fears at ease and why?
WENThis is such an important point. And I think it begins to answer your question with recognizing that we do have a terrible history in this country of unethical and illegal experimentation on Black people and people of color that we need to -- that we need to acknowledge and be honest about. I think we also, though, need to say that this is a virus that has affected people unequally and communities of color have been particularly hard hit by the pandemic.
WENWe need to be building trust at the community level. We need to establish that we are worthy of that trust. I think that also begins with having Black doctors and researchers and pastors and other people who are credible to the communities to do that outreach, because that outreach is really critical. We do not want for the benefits of the vaccine to be unequal especially considering the disproportionate impact on communities of color.
NNAMDIOnly have about a minute left, Dr. Wen, but your second nightmare scenario has to do with deaths that might be wrongly attributed to the vaccine. How do we go about anticipating and mitigating which deaths may be wrongly attributed to the vaccine?
WENWe do need to acknowledge that one of the groups that's prioritized are nursing home residents to receive the vaccine first. These are older individuals some of whom may be medically frail and in this group there may be individuals, who will have illness or who will tragically die totally unrelated to the vaccine, but in a similar time period. And so we need to establish the statistics in advance so we know what is the expected illness rate and death rate within this population as we also very importantly investigate thoroughly and transparently any adverse outcome.
NNAMDIDr. Leana Wen is an Emergency Physician, a Public Health Professor and a Columnist for The Washington Post. Dr. Wen, thank you so much for joining us.
WENGreat to join you, Kojo.
NNAMDIGoing to take a short break. When we come back, it's Kojo For Kids with Meteorologist Chester Lampkin. Remember adults can listen, but only kids can call 800-433-8850. I'm Kojo Nnamdi.
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