On this last episode, we look back on 23 years of joyous, difficult and always informative conversation.
Guest Host: Mikaela Lefrak
We’re all looking for reasons to be hopeful.
Here’s one: “Out of more than 30,000 people who received either the Pfizer or Moderna vaccines, only one person became ill enough to be hospitalized.”
So, what might this result mean for the future of COVID-19? Could the virus become more akin to the flu, requiring yearly vaccinations but not overcrowded hospitals or frightening death tolls?
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
MIKAELA LEFRAKYou're tuned in to The Kojo Nnamdi Show. I'm Mikaela Lefrak sitting in for Kojo. Welcome. Later in the hour, Dr. Leana Wen will address children's concerns about coronavirus for our weekly segment Kojo For Kids. She'll talk to us about why she became a doctor and what her job entails. But first she joins us to discuss the latest coronavirus news and to answer your questions. Dr. Leana Wen is an Emergency Physician, Public Health Professor and a Columnist for The Washington Post. She formerly served as Baltimore's Health Commissioner. Welcome back to the program, Dr. Wen.
DR. LEANA WENOf course, great to speak with you.
LEFRAKSo, Dr. Wen, you recently wrote about one crucial result in the vaccine trials that you feel has been overlooked. So let us overlook it no longer. What is it?
WENWell, thank you for the question. You know, so often in the vaccine trial results we've been talking about efficacy. And efficacy at preventing illness is important and it's really wonderful that the Pfizer and Moderna vaccine are 95 percent protecting against symptomatic illness, but actually that's not what most people would care about. Most people don't care if you get the sniffles and a slight fever. They care about becoming so severely ill that they may end up in the hospital or worse. They may succumb from COVID-19.
WENSo the endpoint that we should really care about is endpoint of hospitalization. So if you look at Pfizer and Moderna of the more than 30,000 people who received the vaccine in these trials only one person was ill enough to be hospitalized. In the Johnson & Johnson trial, based on the results that we've seen this far, no one was hospitalized or died, who was in the vaccine group including because this trial was also done in South Africa that includes all the individuals who had the South African variant, this B1351 variant as well.
WENAnd so I think we should really be talking about this because ultimately the goal could be at this point to convert COVID-19 from the deadly disease that it is into something more like the seasonal flu or even a bad cold, because if we don't get that sick, if the worse that happens if you gather with your friends and family is that you get fever, fatigue and body aches, we're not going to close down the economy for that. We're not going to stop seeing people who we love for that. We still want to prevent it from happening, but I actually see this as a best case scenario for where COVID-19 could go from here.
LEFRAKNow you mentioned this a little bit, but I want to dive in a bit deeper. Now you, yourself, are a volunteer participant in the Johnson & Johnson vaccine trial. And this is a wondrous vaccine that has been shown to be about 72 percent effective. And if you compare that to the Moderna and the Pfizer vaccines, they're about 95 percent effective. So should we be concerned about this gap in effectiveness, Dr. Wen?
WENYeah. So we are waiting for the final data from Johnson & Johnson. So far we have their press release, which does give some information about their data, but just to say that we may get more information now that they have submitted for emergency use authorization by the FDA. But you're right that when you just look at the efficacy number Johnson & Johnson says that in the U.S. their efficacy against preventing moderate to severe disease is 72 percent, which of course sounds less than 95 percent for Pfizer and Moderna. Except when you consider that the endpoint for the 95 percent for Pfizer and Moderna is symptomatic illness. It doesn't say that it's moderate severe illness. It's symptomatic illness.
WENAlso in the case of Johnson & Johnson this was done at a different time than Pfizer and Moderna. Pfizer and Moderna studies were done earlier before the arrival of these more contagious variants that some of them may be less susceptible to the vaccine. And so I think it's not doing a direct comparison if you're comparing Johnson & Johnson versus Pfizer and Moderna.
WENAnd I think it's really important to mention the benefit of Johnson & Johnson, which is that it is studied as a one dose vaccine. And having something that's one dose will simplify a lot of matters. It's something that could be stored just like AstraZeneca also could be stored at refrigerated temperatures for months at a time, which would make it much easier for the vaccine potentially to be delivered not just in community pharmacies and mass vaccination sites, but also by doctors' offices and health centers and mobile units that are driving to communities or churches or other sites too.
LEFRAKDr. Wen, let's talk about these new viral variants that we've seen appearing all over the world. You know, I've seen them crop up in the UK, South Africa, Brazil. How might they impact this vaccine roll out?
WENIt's a great question. We don't know is the short answer. There are a couple of scenarios for this. The best case for where we are now is that we are seeing the number of infections, the number of hospitalizations trend down. We're also having vaccinations really ramping up. All of that is fantastic. And so the best case is with the warmer weather coming maybe we'll continue this downward decline of infections and hospitalizations. Vaccinations will catch up. We'll finally get a handle on this pandemic and really come the fall we'll be in a very different place to prevent a resurgence of coronavirus in the winter. That would be best case.
WENHere's what we're worried about though. We know that when there are more contagious variants that those contagious variants could quickly become dominant, because the spread is exponential. It's not linear. So something that's 50 percent let's say more contagious doesn't give you 50 percent more disease. It gives you many, many, many times that disease, which we've seen happen in other countries, in the UK and Denmark and the Netherlands where the B117 this variant that first started in the UK first took over. They have seen explosive surges despite actually having fairly strict lockdowns in some places.
WENAnd so there is growing evidence that the variant from the UK could become the dominant variant here in the U.S. within a couple of months' time. And if that were to happen our race maybe such that we don't get people vaccinated nearly as quickly as we should. And as a result we may end up having unfortunately this out of control virus spread once again. And may need more measures that may be restrictive to try to control the spread and prevent hospitals from getting overwhelmed.
WENWe just don't know. And I think the take away here should be that people should be vaccinated as soon as they're able. Our government should definitely do everything they can to ramp up vaccination efforts. In the meantime, we have to really keep up these public health measures, physical distancing, masking if we can't keep physical distance, avoiding indoor gatherings. That's going to continue to be so important especially given the onset of these variants.
LEFRAKNow speaking of the process of getting a vaccine, let's go to Andrew in Silver Spring. Andrew, you are on the air.
ANDREWThank you very much. And, Mikaela, congratulations on guest hosting today.
ANDREWDr. Wen, thank you for coming on. I guess my question for you is like in the best case scenario what could like Maryland, federal government, what could these bodies do to like ramp up and get more vaccines into arms? I've spent the last like two weeks trying to get my mom in Leisure World a vaccine, which meant like sitting at my laptop reloading frozen webpages over and over and over again. I was able to finally get her a vaccine. She got the first shot of the Moderna vaccine the other day, but it like to way, way, way too long and was not a process that someone over 65 could do on her own. So like best case scenario, what would you have municipalities, government, what would they do?
WENAndrew, it's a great question. And I'm so glad that your mother was able to get her vaccination. But to your point, it is really difficult for a lot of people especially older individuals and people who may not have a lot of resources. I mean there are a lot of people who may not have friends and family like you who are able to help them call over and over again, who may find it difficult to travel to different locations or wait in line for many hours. I think we can all say that there are so many frustrations in every part of the country when it comes to the vaccine roll out. That right now demand far outstrips supply.
WENOur systems are not setup for vaccination campaigns like this. People are signing up on all these different websites and now that the vaccinations are also going to be happening in some pharmacies, you might have to sign up in different places. And you don't know where in line -- if there is even a line that you're at. So I think that the frustrations are really real. I do think that things are going to get better. I think that as the supply increases there's going to be less of a constraint in that sense.
WENI also think that the initial problems, the initial barriers are getting worked out now that people are more used to doing the vaccinations. And I also think that when there are vaccines like Johnson & Johnson, AstraZeneca perhaps that might come online, that don't require the super cold storage I think that that will also help a lot too. I am still hopeful that by let's say April anyone who wants to get a vaccine is now able to sign up and get a vaccine without too much difficulty. That's what I'm hopeful for.
WENOf course, kids are excluded in this because they have not yet -- the studies are still being done in children. But I certainly hope that adults by April across the country should be able to sign up easily to get a vaccine. And I think that a lot of efforts need to continue being done in particular to ensure that we don't cause more problems of inequities in distribution, because we know that this pandemic has not affected people equally. And we really do not want to be worsening the disparities that we've seen when we have only a first come, first serve system and scarce resources. It is those who already faced the greatest burden when it comes to disparities who are going to be left even further behind.
LEFRAKNow for those who have been vaccinated, it's such a relief, I'm sure. But does it mean that once you receive your doses it's safe to interact with your loved ones and particularly those who haven't been vaccinated? What exactly do we know right now about whether vaccination protects against virus transmission?
WENThat's such a great question, Mikaela. And I think it's something that many people are asking especially grandparents as they're getting vaccinated, they want to know, "Can I now see the rest of family?" And hold these grandkids again. So here's what we know about the vaccine and what we don't know. We know that it protects you very well against having symptoms and extremely well against getting severely ill. So that's really important.
WENWhat we do not yet know is whether it reduces your chance of becoming a carrier for coronavirus. So could you still be infected, but just are not showing symptoms? Could you still be infective and you could still infect other people? Could you somehow be carrying the virus in your nasal pharynx and potentially infect others? We don't know the answer to that. Now with the AstraZeneca study -- or the AstraZeneca vaccine there are some preliminary studies that show maybe it reduces your risk of being a carrier if you get the vaccine. That would be great, but we don't know this for the other vaccines yet. And really won't get real time information until contact tracing studies are done.
WENSo it's going to take us some time. What I would recommend is if you're seeing people who are also vaccinated, it is probably fine to see them and even have indoor meals with them if everybody is fully vaccinated, has the two shots and it's been at least two weeks. Otherwise you should still use precautions to make sure you don't infect others around you.
LEFRAKAll right. We will continue our conversation with Dr. Wen after a short break. What questions do you have for Dr. Wen? Have you gotten the vaccine? What was your experience like? Have you had trouble getting an appointment? We'll be back soon. Stay tuned.
LEFRAKWelcome back. I'm Mikaela Lefrak sitting in for Kojo Nnamdi. We're discussing the coronavirus pandemic and the vaccine roll out with Dr. Leana Wen. Now, Dr. Wen, we've been getting a lot of questions about masks. So that's where I want to pivot next. And we have Sarah from Arlington, Virginia on the line. Sarah, go ahead.
SARAHGood afternoon, Dr. Wen. I have to tell you I am such an admirer. Thank you for all that you do. And thank you for sticking with the science. I am a homecare nurse and I see this repeatedly. I have positive patients in varying stages of their illness. And their family members are not isolated. Even in fairly large homes. They're not isolated. They don't wear masks. And, you know, I always do my little lectures respectfully. They just don't seem to understand that this illness is so transmissible, and even though they're in the confines of their homes they need to wear masks.
SARAHAnd I'd like to just bring up one other issue about mask wearing. It appears to me that people have this false sense of security when they go out to eat and they eat and they don't put their mask back on. Not that I've gone out to eat. But I have, you know, stopped at little sandwich shops to get a sandwich. In fact, I did it just the other day at the Alexandria Pastry Shop. And I was astounded of the 15 people -- everyone was grey haired and old and only one person had on a mask. And I just don't know how we can impress upon society that they just have a moral responsibility to take care of each other.
LEFRAKDr. Wen, how do you respond to that? How do we impress upon society the importance of continued mask wearing even as we're also rolling out the vaccines?
WENWell, I think the caller did it very well actually. I really like how you framed it in terms of this being a societal responsibility that it's not just about protecting ourselves. It's about protecting others. There was just a study that was released by the CDC last week that looked at how mask usage will actually reduce hospital usage in that area, which I think is really important for us to keep in mind that something as basic as us wearing a mask when we're around others will reduce the burden on the hospital systems in our area, help patients who really need to be seen to get the medical care that they need for coronavirus and for everything else.
WENSo I think that's that kind of moral societal responsibility is important to emphasize. I want to say to your other points one is that mask wearing is one of the public health precautions that we need to be taking. As you were saying, Mikaela, that helps to protect us on our way to getting vaccinated. Masks are one thing. Physical distancing is another thing. Avoiding indoor gatherings is another. All these things are additive and so we should think about it that way that masks don't replace all these other measures. But it's one more thing that can help to protect us.
WENAnd to the point about eating in restaurants, I think this is a very good point. I do worry about people gathering indoors eating, because by definition you will not have masks on and you're probably not keeping physical distancing. Actually I also really hate the idea of restaurants having to close only for people to still be having dinner parties and game nights and other indoor get-togethers. I actually think that if you're going to a restaurant especially an outdoor restaurant as a family, as a household it's actually probably pretty safe.
WENIt's only when you're also mixing households in restaurants that it becomes unsafe. But again, I would just really hate to see restaurants have to close when people are still engaging in these risky behaviors indoors. And so I think to add to the caller's point about communal sacrifice if you will that we are all having to sacrifice a lot during this pandemic. But it's only by all of us putting in the continued efforts that we're going to get through this.
LEFRAKNow briefly before we go to our next caller, I'm curious, Dr. Wen, are you an advocate for double masking?
WENSo it's a really good question. It depends on the setting. And what I mean by this is if you are just going for a walk in your neighborhood and there's nobody around, well, you don't need to wear a mask. You should carry a mask with you in case you can't keep six foot distance. But you don't need to have a mask if you're literally going to see no one. If there are some people around and you want to be safe, you should put on a mask. But you probably don't need double masking in that situation where you're outdoors and people are pretty far apart from you.
WENThat will be different though if you're going to a grocery store and for whatever reason it's pretty crowded and especially if you have underlying medical issues. I actually would recommend in that case getting an N95 or KN95 if you're able to. If you're not able to, a three ply surgical mask and then wearing -- first and then wearing a cloth mask on top of that could be helpful. And that's because first of all the more plys you have probably it's going to help, but also some surgical masks just leave space around your face. And then if you have a cloth mask on top that can cover up those spaces that could help you.
WENSo I think it really depends on the setting. I will say, I think N95s obviously are the best. The problem is they are uncomfortable. Many people are not used to having that type of restrictive breathing. And I would much rather that somebody uses a mask that's comfortable to them consistently all the time rather than an uncomfortable mask inconsistently.
LEFRAKLet's go to Nancy on the Eastern Shore. Nancy, you're on the air.
NANCYHi, Dr. Wen. Thank you so much for all you do. My husband and I are getting our first vaccine shots today. And we've heard conflicting information about whether a person can use over the counter painkillers like Tylenol and ibuprofen either before or after you get the vaccine. Could you please tell us if those are appropriate or not?
WENAnd, Nancy, it's a really good question, and I would say at this point there isn't conclusive evidence about this. There are some people who think, again, based on some studies although not conclusive studies. But some research suggests that if you have an immune response following your vaccination we know that that's a good thing. That if you start having fever, body aches it may not feel great. But that means that your body is responding appropriately to that vaccine and is amounting its immune response.
WENSome people think that if you then take ibuprofen or Tylenol that then could suppress your immune response. And that may somehow weaken your immune -- the robust immune response that you should be developing, again, inconclusive evidence. So I'm not sure that I would recommend not to take Tylenol and ibuprofen after the vaccine.
WENI will say, you should not pre-medicate. Don't take Tylenol and ibuprofen before your vaccine, because there are some people who may not have any reaction at all or who may have really mild reactions and don't need to take ibuprofen or Tylenol. But that said, if you're feeling so ill afterwards, because of the side effects then you're having a high fever, maybe you're just really feeling very tired and you think that one dose of Tylenol can help you, I wouldn't hesitate to take that if you need it, but I wouldn't take it preemptively.
LEFRAKThank you. Now we are getting a number of questions from folks about managing the side effects of the vaccine. What do we know so far about how people are responding to it? Robin Leds tweeted to us and asked, "Please, give us some updates on managing those side effects especially for the second vaccine."
WENGreat questions. So first is to note that the side effects are -- they are common. They are expected. They are normal. And they indicate that the vaccine is working. And so anyone who gets these -- there are basically two types of side effects. One is side effects -- or a pain or swelling or redness at the injection site. And the other is what we call systemic. So you have fevers, muscle aches, body aches, headache, overall not feeling well, feeling tired, etcetera. If you're having either of these types of side effects it's totally normal. It means that your immune system is revving up and helping to produce these antibodies that will help you next time if you end up getting coronavirus. So it's a good thing.
WENManaging the side effects -- I think knowing what might occur and having those expectations is the first and most important part. Just knowing that that could happen. And that means because people report more side effects for the second dose making sure that when you get your second dose that you're able to take it easy that day and the next day, maybe if you can find a time when you can work from home that day or the next day. If you need to take time off from work letting your employer know about this, your manager know about this in advance that you may need to take some time off if you're tired.
WENAgain, some people don't have these side effects and that's normal too. But if you do, setting those expectations, being able to rest and if you must take Tylenol or ibuprofen, but make sure that you are prepared for this. And again, know that this is normal.
LEFRAKNow we're going to take a short break. And when we come back I want to address an email that we got from Anne in Virginia, who asked about high school students in our area going back to school and safety precautions around that. When we come back, Dr. Leana Wen is sticking around to speak to kids about the coronavirus for our weekly segment Kojo For Kids.
LEFRAKSo adults who are on the line, I'm sorry we didn't get to your questions, but when we come back, all the questions are coming from kids. So, please, stick around and we will be back to speak more about the coronavirus and the vaccine roll out. Stay tuned.
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