KOJO NNAMDIYou're tuned in to The Kojo Nnamdi Show on WAMU 88.5, welcome. Later in the broadcast WNBA Superstar Elena Delle Donne joins us on Kojo For Kids. But first, the greatest vaccination campaign in history is underway. But what obstacles are we coming up against in the Washington region and what might life look like after inoculation? Joining us to discuss this is Dr. Leana Wen. She is an Emergency Physician and Public Health Professor at George Washington University, previously the Health Commissioner for Baltimore. She is a Contributing Columnist for the Washington Post, a CNN Medical Analyst and author of the forthcoming book "Lifelines: A Doctor's Journey in the Fight for Public Health." Dr. Wen, thank you for joining us.

DR. LEANA WENThank you, Kojo. Happy to join you.

NNAMDILeana Wen, big news today. A federal study found the Pfizer and Moderna vaccines to be 90 percent effective in preventing infections among frontline workers in real life conditions. Why is the CDC report so significant and how is it different from previous reports on the effectiveness of these vaccines?

WENYeah. So I just the results prior to coming on your show, and I have to say these are incredible results, because there is now accumulating evidence for something that we didn't know fully before. We knew that the vaccines that we have are really effective at preventing you from getting sick. So if you got the vaccine it protects you especially from getting severely ill. We didn't know fully about whether getting the vaccine also prevents you from getting asymptomatically infected. So maybe you don't appear sick, maybe you don't have symptoms, but maybe you could still be infected and transmit it to others.

WENThis is a study that is, again, there are accumulating studies like this that indicates that for essential workers in this particular study, they looked at more than 4,000 essential workers who took swabs every week to find out if they are -- if they could have COVID-19, but just not know it. And it found that it reduced their likelihood of being infected by 90 percent, which I think is just, again, really incredible. And points to why these vaccines are so great. Now, we have accumulating evidence that they don't just protect you, but they also protect others from you, and so, again, a reason for us to get vaccinated when it's our turn.

NNAMDIWhat's the story of vaccinations right now? We're ahead of the 100 million in the first 100 days goal that President Joe Biden promised. He now says everyone who wants a vaccine should be able to get one by May 1st. Does it look like that could really happen?

WENI think that the Biden administration has done really good work since coming in in terms of scaling up the rate of vaccination as well as making sure the supply is there. I think what the team has said is that there will be enough supply for every adult American, who wants it by the end of May. By May 1st there will be eligibility that is going to be open up so that no matter what state you're in you don't need to be in any priority category, for example, by age or by preexisting condition in order to sign up to be vaccinated.

WENNow that doesn't mean that everybody is going to be vaccinated by May 1st. But I do think that we are going to get to a point pretty soon in particular in some parts of the country where the supply is going to catch up to demand. And then I think the major challenge at that point is not so much going to be ensuring supply as has been the issue all along this far, but actually in overcoming vaccine hesitancy.

WENAnd I think also in making vaccines convenient, because a lot of people want to get the vaccine, but just are not able to take half a day out in order to go sign up and then go to a mass vaccination site and wait in line. I think we really need to do a better job of bringing vaccines to people including at every doctor's office and every pharmacy and I think also in the workplaces, in churches, in schools going to where people are.

NNAMDIWhy does the distribution vary so much state to state and how does the rollout in the Washington region compare?

WENYeah, I mean, as to why it defers so much state to state, some of it is for good reason as in some states you look at a place like Alaska that's actually done a tremendous job. Their geography is very different, how they'll be able to distribute is very different from a place like New York State let's say. And so I think some of it is natural. I think some of it is also that different states have set very different kinds of eligibility criteria. Some like Connecticut were age based only. Others used a combination of age and whether somebody is an essential worker to initially prioritize.

WENI'd say that we here in the D.C., Maryland, Virginia region we're doing okay. I think that we have scaled up and ramped up a lot. But there are still many challenges that remain in particular in getting vaccines equitably distributed including to the most hard hit areas. And we have to focus a lot more on bringing vaccines to people including through mobile vans, through door to door outreach. And it's that kind of outreach that really we have to double down on now.

NNAMDIThose who have been vaccinated are likely to be grappling with, okay, now what? What is it safe for me to do? So tell me, I'm someone who has had both doses of the vaccine, what can I do now safely?

WENWell, first of all I'm very happy to hear that you are fully vaccinated, Kojo. So congratulations.

NNAMDIThank you.

WENSo the CDC has issued guidelines for what fully vaccinated people can do. I think that they should go further than what they have. But let me just say what the CDC has said. So the CDC says that for you, Kojo, as someone who is fully vaccinated, so I'm assuming you've received two doses of Pfizer or Moderna and it's been at least two weeks after that.

NNAMDIYes.

WENOr you received the one dose of Johnson & Johnson and it's been two weeks after that one dose. But if you are fully vaccinated you are able to see other people who are fully vaccinated. Completely as in you can meet indoors, no masks, have dinner, hug, etcetera. So a couple that's fully vaccinated can see another couple, let's say that's fully vaccinated too. Now the CDC is also saying that fully vaccinated people can see one other household in which there are people in that household that are not yet vaccinated as long as those individuals who are unvaccinated are not at high risk for severe COVID-19 disease themselves.

WENThat particularly applies let's say that you want to visit your grandchildren. And your grandchildren are not vaccinated yet because they can't be due to children not being able to be vaccinated. Maybe one or both parents are vaccinated, but the kids are not vaccinated. What the CDC is saying that you as a vaccinated person can visit one household at a time.

WENYou should not be mixing households. So let's say you have two children and multiple grandchildren in different households, they should not be mixing because the unvaccinated people could pose a threat to one another. But you could see one other household including indoors, no masks, etcetera. I hope the CDC comes out with better guidelines than this even, because I think that especially now that there is accumulating evidence that vaccination really protects you from being a carrier of coronavirus, I think we should be encouraging people who are vaccinated to resume much of pre-pandemic life.

WENNothing at this point is going to be 100 percent safe just like nothing is 100 percent dangerous. And so I don't think we should be talking about whether something has zero risk. But rather about understanding what people's values are. How could we help people retain their semblance of normalcy and also reduce risk as much as possible?

NNAMDIOkay. Here now is Nick in Winchester, Virginia. Nick, you're on the air. Go ahead, please.

NICKThank you, Kojo, and thank you, Dr. Wen. I think you've already answered in principle my concerns. I was explaining that my situation is not that different from a lot of other people my age. I'm in my late 70s. My daughter, who is 40 just had -- gave birth a year ago to twins. But she's up in Massachusetts. And so far we have seen her and her spouse and the grandchildren once in Hartford, Connecticut, because we were afraid Massachusetts wouldn't let us in. Anyway, we're obviously eager to visit them again, and from my point of view to visit relatives in the Deep South. So that's all I need to say.

NNAMDIDr. Wen.

WENYeah. I mean, I really hear you, Nick. And I know that so many people are eager to see their relatives and to see people that they haven't during this really challenging last year. The CDC right now is saying that we should not be engaging in non-essential travel and that's, because anytime you travel we know that whenever there's been a spike in travel there's also been spike in cases. That said -- and this is where, again, I would hope that the CDC comes out with better guidelines that take into account where people are right now, which is that I think it should be fine to say to people, if you are fully vaccinated and you are going to visit one other family, I think it's fine to say, to travel to see that one other family.

WENYou know, definitely take precautions when you're traveling. Once you're fully vaccinated you should still be wearing a mask while in public. But I think if you are wearing a mask -- let's say you're going by car to see one other family, totally safe. The risk on a plane is also very low wearing a mask the whole time. Try to stay physically distanced. Of course, wash your hands regularly. I think it will be fine to visit others as long as you -- I am less concerned about what happens during the transit as I am about what you do once you get to your destination.

WENAnd I just would want people to keep that in mind. So if you go to visit your relatives and you're only seeing one other family, it's fine. Don't go bar hoping when you get to your destination, but I think it will be really fine, and I think it's time for people to reunite with their families.

NNAMDIThank you very much for your call, Nick. Lisa writes to us, "I took Advil 12 hours after getting the second Pfizer vaccine. The healthcare worker who gave me the shot said it was fine. But later reading up, I discovered it may dampen your immune response." Do we know yet whether ibuprofen interferes with the vaccines effectiveness?

WENYeah, it's a really good question. And what I would say right now is that we don't know. There is a hypothesis that it's a good thing if your body is responding by producing the systemic effects. And you don't want to dampen those effects perhaps by taking certain medications. But that said, the evidence is not conclusive. I certainly would not worry about it if you've already taken ibuprofen after your dose of the vaccine.

WENI would say that the guidelines are don't premedicate meaning don't anticipate that you're going to have a reaction and take ibuprofen ahead of your vaccine. But if you happen to have really bad muscle aches or fever, again, all normal effects after getting vaccinated and you really want to take away those symptoms, you can take Tylenol and ibuprofen, but I just would not take it ahead of the vaccine anticipating that you may have a response.

NNAMDIWe only have about a minute left. A listener tweets to us, "How much does stress reduce the efficacy of the vaccine?"

WENWe don't know. I would say that I think a lot of us are going through a lot of stress during this pretty difficult period. I wouldn't worry about this, because I think worrying about whether stress could change the efficacy of the vaccine might even stress you out even more. I would try to get as much sleep as you can heading into your vaccine appointment. Know that the -- whatever reaction you get is normal afterwards. And just get vaccinated as soon as it's our turn.

NNAMDIGot to take a short break. When we come back, we'll continue this conversation with Dr. Leana Wen. I'm Kojo Nnamdi.

NNAMDIWelcome back to our conversation with Dr. Leana Wen, an Emergency Physician and Public Health Professor at George Washington University. Dr. Wen, we're seeing many businesses reopening at full capacity in our region. What did you think when Maryland Governor Larry Hogan announced that the state was quote, unquote "open for business"?

WENLook, I understand why we would want to do that. I mean, I certainly understand the incredible sacrifices that so many people have made in this last year, and the eagerness, the desperation in many cases to get back to normal. I am concerned. I'm concerned, because we're at a really challenging time right now still when it comes to coronavirus. We're seeing a plateauing of cases around the country. And some places like Michigan experiencing a really dramatic uptick in a number of cases. We have more contagious variants that are becoming dominant here in the U.S., which means that the activities that we thought were pretty low risk are now going to be higher risk when you have something that's more contagious here.

WENAnd I worry about letting down our guard at time when we really need to keep it up. We are getting vaccinated in record numbers. And I think that's great that we have 2.5 million vaccinations done every day here in the U.S. But I also worry about letting up too soon. And I just hope that the message continues to be keep on wearing our masks. Keep on avoiding indoor gatherings. You can do things differently once you're fully vaccinated. But before then, please don't let down our guard.

NNAMDIHere is Ward in Bethesda, Maryland. Ward, you're on the air. Go ahead, please.

WARDThanks for taking my call. Dr. Wen, I just received the only dose of the J&J vaccine that I'm getting over the weekend. And I wanted to find out, I know I need to keep wearing a mask in public for the foreseeable future, but is it reasonable once I've reached full immunity after either 14 or 28 days to stop double masking now?

WENYeah, it's a really good question. And first of all I'm glad that you got your vaccine. As you may know, I'm in the Johnson & Johnson clinical trial myself. And I just found out that I'm going to be unblinded this week. So I will find out whether I got the vaccine or not. The question that you asked is a very good one about double masking. We have been recommending double masking in particular when you're in public places where there are more people. As in if you're going for a walk and you're probably not going to run into many people wearing a single cloth mask even is fine, but if you're going to the grocery store or going on a plane or something then wearing either an N95 or double masking with a surgical mask and then cloth mask on top of that that's better fitting may be a good idea.

WENI would say that for people who are fully vaccinated it depends on you and it depends on the setting that you're in. If you're somebody who has other underlying medical issues, whose immunocompromised you still want to take precautions, because the vaccines are really effective at protecting you from getting infected, but they're not 100 percent. And you still want to take precautions and I would say in particular when you're in those crowded places with other people around. And so I don't think there's much harm to continuing to double mask.

NNAMDIIn the Washington region, many students are finally returning to their classrooms. And for elementary schools, the CDC guidance now says only three feet of physical distancing is necessary. Do you believe this is the right decision? What do we know about whether and how kids might spread the virus even if they're less vulnerable themselves?

WENYeah. So there are two different things that I want to say here. One is about the CDC guidelines themselves. I do think that the move to three feet in elementary schools is important and that's not because three feet is suddenly safe. But rather because of how essential in-person instruction is. For many schools they just will not be able to open for full in-person instruction unless that six feet of distancing is removed as a requirement.

WENNow in place of that, I would like to have seen and I think the CDC still is recommending all the other mitigation measures. As in absolutely -- if there's three feet absolutely there should be mask wearing enforced at all times. There should also be improvements to ventilation. I would also like to see the CDC saying, "If we're going to be removing the six foot distancing we also need to put in even more layers of protection." For example, we now also need weekly testing in addition to better protect the kids and the student and the teachers and staff. So I do think it's a good idea, but I would have liked to see more done in order to replace that particular layer.

WENAs to what we know about children and coronavirus, we know that younger children probably transmit coronavirus less than older children. Children tend to get much less severely ill than adults do, although some children have tragically become very ill. And it's rare, but I has happened that children have died from coronavirus. And so I think it bares reminding of how important it is for us to keep up our precautions and for adults to be vaccinated.

WENChildren probably -- young children are probably not going to be able to vaccinated until 2022 at this point. Children 12 and older may be able to be vaccinated later this summer or early fall. And that's even more important for -- that's why it's even more important for adults to be vaccinated, because in order to shed this -- in order to cast this herd immunity, this umbrella immunity over everyone we need for as many adults or people who can be vaccinated to do so in order to protect those who cannot.

NNAMDIHere is Joanie in Eldersburg, Maryland. Joanie, you're on the air. Go ahead, please.

JOANIEOh, hi. Thank you for talking to me. I had bulbar polio in 1952 when I was 10 months old. And that affected my throat and swallow and chest muscles, and some other things, belly muscles. My breathing is hazardous. I sleep with a respiratory device at night. I keep myself very healthy. I have had the first vaccine just by pure luck. And I do not know what to tell people about how dangerous it is for me to allow people into my house when I'm not fully protected.

JOANIEI also can only wear a triple layer cotton mask, excuse me, because my breathing is just not that strong. And I have a healthy agency who wants to insist upon coming into the house for a two to three hour visit analyzing the house, etcetera. And I don't know how to tell them no. What should I say to people?

NNAMDIDr. Wen.

WENI think a lot of people are going to be in this situation soon where we would prefer that those who we're in close contact with are all vaccinated. Right now, of course, it's challenging, because we don't have enough vaccine supply. So it's very difficult to say as an example, Well, I only want someone to come into my house or something else who is vaccinated, although certainly it is your choice. I'm not sure what the case of this particular agency. It is your choice and I think it is up to you -- it is your right to request that somebody is fully vaccinated who is coming to you.

WENI think in the future this will actually be an important incentive that I would hope that we all encourage as well as in maybe if we are going to a cruise, we would feel more comfortable to be on the cruise if everybody is there who is also vaccinated, or if we're going to a restaurant perhaps or some other setting in the future in the months to come when vaccines are easily accessible for us to request this. I think that kind of informal pressure will be important to increase vaccination rates too.

NNAMDIOne caller couldn't stay on the line, but wants to know "Why can't I schedule in-person for scheduling vaccine? I'm having trouble online. It feels like older people who are less tech savvy are second class citizens." Dr. Wen.

WENYeah. I really worry about this, Kojo. I mean, I really am concerned that this digital divide that we have is worsening access to vaccinations. And in fact we've seen in cities where they have made walk-in appointments available that they get a much larger proportion of minority individuals, who may also have -- they may also be a disproportionate problem when it comes to access to vaccines. So I really hope this changes soon.

NNAMDIWe don't have much time left, but before we go, we need to talk about your upcoming book. Tell us about "Lifelines: A Doctor's Journey in the Fight for Public Health". We have about a little more than a minute left.

WENWell, thank you, Kojo, for the opportunity. You know, there's a quote that I like to refer to, which is that "Public health saved your life today. You just don't know it." Well, I think we've seen what happens during COVID-19 when we neglect public health, when we underfund it, when we don't understand what it is. And I primarily talk about in this book "Lifelines" about my experience as the Health Commissioner for the City of Baltimore. And all the work that public health does that's lifesaving, that's life changing that really makes a big difference in improving health and reducing disparities.

WENAnd I wanted to show that in a sense my own story as an immigrant and physician is also a story of public health. And before I go too, Kojo, I just wanted to express my gratitude to you for everything that you have done for health, for justice, for our world. I mean, I have listened to you all the time. And we'll miss you on the air so much.

NNAMDIDr. Wen, thank you so very much. Dr. Leana Wen is an Emergency Physician and Public Health Professor at George Washington University. We're going to take a short break. Then up next, Elena Delle Donne, my favorite basketball player. We'll be talking on Kojo For Kids. Remember only kids can call. Adults can listen. I'm Kojo Nnamdi.