Toolkit: Safe or Not Safe (Variants and the Vaccinated)
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Description
What does the science really, really say about wearing masks indoors if you’re vaccinated? Andy gets answers to your most pressing questions on everyone’s favorite game show, Safe or Not Safe, with top-flight epidemiologists Farzad Mostashari and Caitlin Rivers. Plus, Dr. Lisa goes out into the field to take the pulse of people starting to return back to life.
Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt. Dr. Lisa is on Twitter @askdrfitz.
Follow Caitlin Rivers @cmyeaton and Farzad Mostashari @Farzad_MD on Twitter.
Check out In the Bubble’s Twitter account @inthebubblepod.
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Check out these resources from today’s episode:
- Check out this article about Israel and the Delta variant: https://www.washingtonpost.com/world/middle_east/israel-delta-vaccine-shield-holding/2021/06/28/1ba865b2-d7e1-11eb-8c87-ad6f27918c78_story.html
- Learn more about getting an mRNA booster after your J&J vaccine: https://www.reuters.com/business/healthcare-pharmaceuticals/booster-may-be-needed-jj-shot-delta-variant-spreads-some-experts-already-taking-2021-06-25/
- Find a COVID-19 vaccine site near you: https://www.vaccines.gov/
- Order Andy’s book, Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response: https://us.macmillan.com/books/9781250770165
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For additional resources, information, and a transcript of the episode, visit lemonadamedia.com/show/inthebubble.
Transcript
Andy Slavitt 00:18
Welcome IN THE BUBBLE, I’m your host, Andy Slavitt. I want to wish everybody Happy Independence Day. It’s funny to think back a year, Independence day last year which was kind of a blur to me, I wasn’t I don’t think I was sure whether or not it made sense together to see fireworks. Things were bad. But undoubtedly the worst was yet to come. I don’t think we quite knew how much worse it would get. But it got a lot worse. This episode of Safe Or Unsafe, begins the third week of our 10-part series with a focus on where are we now? And here we are a year later. And I can say without question, that the worst is behind us. Without question. So, for those of you who haven’t heard Safe Or Unsafe before, it is our kind of fun game show way of posing your questions to two esteemed epidemiologists, Caitlin Rivers and Farzad Mostashari, they compete fiercely to provide better answers. And of course, I’m the judge.
Andy Slavitt
And Wednesday, we have Scott Gottlieb, the former director of the FDA, and just one of the smartest and most attuned people around, you’re not gonna want to miss that show. So the idea behind both of those shows is what sounds simple, but it’s deceivingly so. It’s about following the science. Following the science, should we just follow the science blindly? Is the science always right? Should we doubt science? It’s a complex set of questions. But there is a state of the science, which tells us based on everything we know, what the best answers are. But it’s not just about finding the science. It’s also about learning to do what we’re comfortable with. Let me discuss what that means and what the difference is.
Andy Slavitt 02:23
Because we make decisions all the time, where we want to understand what the science tells us, we want to understand what the facts tell us. And then we make our decision. So if the science says, when climbing a mountain, with all of the protective gear on, you can safely climb 30 feet up the mountain, you might do that. But, you might feel comfortable only going up 20 feet, maybe you’re scared of heights, maybe you want to be a little more conservative. Whatever the reason, let’s say the law says you could drive 70 miles an hour on a highway, you may choose to drive 70. But you also may choose to drive 65, there’s nothing wrong with that. You’re adjusting for what you feel is right. Maybe your car, maybe your own sense of the conditions, the weather, the lighting, whatever it is.
Andy Slavitt
I think wearing a mask indoors, which is there’s a lot of noise in different states about should they bring back the mask mandate, given the Delta variant is very much the same thing. So let’s be clear what the science says. The science says that if you’re fully vaccinated, double vaccinated with an mRNA vaccine to be even more specific, plus three weeks or four weeks depending on the vaccine. The science says You do not need to wear a mask indoors for your own health. And if you were strictly paying attention to the science, that is the answer that you’d be given. But we also have to pay attention to our own psychology. There are reasons why we may choose to wear a mask indoors. And that’s okay. But be very clear about this. The state of this science on the Delta variant is clear that we don’t need to wear masks indoors.
Andy Slavitt 04:23
Let me tell you what the science isn’t, the science isn’t a few things. The science isn’t telling you what you should do. The science isn’t infallible and unchangeable. Science isn’t reading about someone who got vaccinated and then got COVID. It’s not about even someone who got vaccinated and get COVID and got hospitalized or died. Because the science is that there are very few cases. Small number, a couple of 1000 out of several 100 million, okay? That’s what the science says. So don’t be taken off your game by thinking that the science has it perfectly right. Or that the science doesn’t evolve, or that the science says that the vaccine protects you 100% of the time, that is not the science. Therefore, take hold of the science and adjust to do what you want to do. The news for you, we’re going to need to live with ambiguity.
Andy Slavitt
So part of coming out of this pandemic, healthy, whole sound, responsible comfortably, is learning to live with ambiguity. I know for a lot of us, that’s not easy. It’s just not. We like to have clear cut answers. And people are very angry right now, the CDC, they’re very angry with people who they feel aren’t giving them straight answers, instead of understanding that getting the truth doesn’t mean, you’re getting clear answers all the time, because there aren’t always clear answers. I’ve said this before, we are moving COVID to a stage where it’s a manageable challenge. That means 70% of the time, we will know what to do. And 30% of the time, we will have to use our own judgment, informed by what we know and understand about the science.
Andy Slavitt 06:35
We need to decide what we ourselves, our families, are comfortable doing. People may hate that. But I would put to you would you really want it any differently? Would you really want false sense of security? Would you really want someone else making these decisions for you? So let’s get informed. A little bit ambiguity. So let’s go back of it, in part two of our series, we heard some trusted voices. Dr. Walesnky, Jen Psaki. Why do I say they’re trusted? They’re trusted because they’re honest. They’re not trusted because they’re perfect, or always know what to do. They’re trusted because they’re humble. They’re trusted because they caveat. They’re trusted because they look at the data. So, the mass guidance, that Dr. Walensky and CDC put out some people didn’t like, they didn’t like it, because it felt confusing to them. Well, guess what? Some things are confusing. And we’re going to need to learn to live with that.
Andy Slavitt
But between Dr. Walensky, our two guests today, and Scott Gottlieb on Wednesday, I would be hard pressed to bring you any for more reliable people to present their views. And there is a great deal of consistency with what they say. And it’s not perfect consistency, there is a little bit of difference, which allows for the fact that we have an opportunity to bring our own judgment to things. But all of them are saying what the science says consistently. It’s for you to decide. There are in fact, multiple right answers, as there are too many things. That’s the place you need to live. Ambiguity, your judgment. And if you don’t like that, again, ask yourself whether you’d want to have it any other way I don’t think we would.
Andy Slavitt 08:27
So the first two parts of this series that you’ve heard so far raised a lot of questions about the past, about how we hear information. And the first answer to all of those questions are coming to you this week. We know what the science says. If you’re vaccinated, the news is good. If you’re vaccinated, the news is good. But it’s okay to still be nervous. And it’s also okay, not to be nervous. Let’s finish the sermon there and hear from our contestants, Farzad Mostashari, and Caitlin Rivers, two great epidemiologists.
Andy Slavitt
People are feeling weird, or feeling like in a suspended state of animation. For some people, the pandemic was long over. For some people, the pandemic is still ever-present part of their life and still for others I think maybe they know intellectually, that they’re safer than they’ve ever been because they’ve been vaccinated. But emotionally, it’s hard to get there. And of course, there’s a lot of decisions to make. The edge of things that are really just sort of practical. So we’re using that as a background to play yet another game of safe or unsafe with Team Caitlin Rivers and team Farzad Mostashari. I don’t have to tell you that these are two very accomplished public health leaders. And If I did, I’m not sure that’d be telling you the truth. Because I don’t know. Caitlin is just slightly more accomplished than prior. It’s good to have you guys back.
Dr. Farzad Mostashari 10:13
Hi, Andy, nice to see you. Good to see you again.
Andy Slavitt
I don’t want to create false equivalence between you two.
Dr. Farzad Mostashari
That’s fair. Totally fair. I’m on team Caitlin, frankly.
Andy Slavitt
How are you, Caitlin?
Dr. Caitlin Rivers
I’m shocking all with the support I’m getting right now.
Andy Slavitt
Is it support for you? Or is it abuse for Farzad? Don’t be so sure.
Dr. Farzad Mostashari
He’s just setting you up with high expectations. Caitlin, I wouldn’t want those high expectations if I were you.
Andy Slavitt
Israel is reporting some disturbing statistics with the Delta variant outbreak, and fully vaccinated adults. California recently suggested that maybe the indoor mass mandate ought to be reconsidered and are recommending that people consider wearing masks indoors. Do you think we should continue to wear masks indoors? Or not if we’re fully vaccinated? Caitlyn?
Dr. Caitlin Rivers
Well, the current evidence suggests that the vaccines still work well against Delta. And so I don’t think the at the individual level risk has changed much for people who are fully vaccinated. But at the community level, taking into account people who are not yet fully vaccinated, I do think we’re heading into a period of increased risk. And that’s where I think the motivation around recommending masks is really making sure the community is doing everything we can to keep transmission down. So I’m still wearing masks in public indoor spaces when they go to the grocery store when they go to the library. But I feel well protected with my two vaccines.
Andy Slavitt
So do you do it for your own protection? Or do you do it for some other reason?
Dr. Caitlin Rivers
Well, first of all, because I think it’s […] and second of all, because there are people who are still in vaccinated, I don’t think I’m a risk to them. And they’re not a risk to me. But I it’s kind of a collective action solidarity move.
Andy Slavitt
Okay, that’s a very valid reason. But it’s not because you feel unsafe, if you’re not wearing a mask.
Dr. Caitlin Rivers
Not at all.
Andy Slavitt
Farzad, how do you think about this?
Dr. Farzad Mostashari 12:00
So that there’s parts of the data that disturbing data from Israel. Look, the half the people who were infected were kids who weren’t vaccinated. And it’s important to note because most of the population of Israel is not kids. So the vaccine, even just that data point, if you think like an epidemiologist says to you that the vaccine is protective of people being cases, and then second, those who got it or and we’ll hear people who were, you know, cases who were vaccinated, they’re not getting severe illness, and there weren’t cases of severe illness among those vaccinated with Delta reported from Israel. So by and large, I think it is important to note that if you are fully vaccinated, and I’ll add, particularly with the mRNA vaccines, then you are very well protected against the Delta variant, including and there does also appear to be still protection against not passing it on. So from my personal calculus, I am fully vaccinated, I would feel comfortable being in indoor spaces without a mask. And I gotta tell you, it feels great. It feels awesome. I am so glad to be and it wasn’t that big a deal. But it feels really great now to have a more normal return to normalcy. And I do think that, you know, it should continue to be an incentive for people to go get vaccinated.
Andy Slavitt
Got it. So you dine indoors, or you’re indoors in other settings without a mask, you feel safe?
Dr. Farzad Mostashari
I do.
Andy Slavitt
And if you’re in a community with higher amounts of spread than we have today, would you have to change?
Dr. Farzad Mostashari
I mean, look, I will follow whatever the local ordinances are, I will follow whatever the store, you know, wants me to do. Of course, I’m going to have my mask with me. But I think that even in those communities, the risk to those people, is because they’re not vaccinated, and I think that the number one message should be get vaccinated.
Andy Slavitt 14:19
Okay, that’s very clear. Okay, let’s talk about travel, including air travel within the US for fully vaccinated people. Presuming that the Delta variant becomes a dominant variant, Farzad, Safe Or Unsafe?
Dr. Farzad Mostashari
Fully vaccinated, I think it is still safe. The one caveat I brought last time was if there are variants that seem to cause more severe illness among people, the 464 variants, I think those still I would be looking at the prevalence rate of those. Those are still how low so I’m satisfied. I would wear a mask obviously during travel because you don’t know where people are coming from and what variants they might carry.
Andy Slavitt
And then there’s the rules. But I think one of the things we have going for us is that the more problematic strains got out competed by strains that the variants work for. And that is a that may be serendipity. But we’ll take it. Which is to say that both the alpha, which is the one that came from the UK, and the Delta, which is the one that came from India, those are the ones that become dominant. And they are actually in some ways our friend if we’ve been vaccinated, because they are, they’re beating up on the variants that are more challenging for us. Caitlin, Safe Or Unsafe, same question.
Dr. Caitlin Rivers
I agree with Farzad, I’m comfortable with travel, you have to wear a mask anyways, because that’s the rule. So you might as well wear a good one, but I have traveled.
Andy Slavitt
Let’s talk about the Johnson and Johnson vaccine. We had Rachelle Walensky on the show last week, we asked her about this. Let me ask you guys as well. Terms of returning to normalcy, you’ve just said, if you’ve gotten two doses of the mRNA vaccine, you really have a lot of freedom. There may be reasons for you to wear masks, but you’re not concerned. What about those with a single Johnson and Johnson dose, considering the rise of the Delta variant? Caitlin, start with you.
Dr. Caitlin Rivers 16:21
Well, look, the efficacy of the J&J is lower than the mRNA. We’ve known that and I think that will continue to be true as we see more variants. There’s currently not a lot of data and there’s certainly no official guidance or evidence about what to do. If you have received one dose of J&J. I am postulating that you are probably still very well protected against severe illness, hospitalization, and death, but probably less protected against a mild illness. So for now, if I were vaccinated with J&J, I would hold tight, I would continue to go about my day, but probably wearing that mask. And I would just keep an eye out if any additional guidance comes out.
Andy Slavitt
What would you do, Farzad?
Dr. Farzad Mostashari
I’ll be on the on a different side of this. If I were if I had gotten a single dose J&J, I would get a booster.
Andy Slavitt
Which booster would you get, mRNA? Or would you get Johnson & Johnson.
Dr. Farzad Mostashari
mRNA. I’ll get an mRNA booster. And as Caitlin said, the evidence isn’t there. But I think the logic from other vaccines and other virus of the respiratory viruses would say that that getting a booster just as if you had natural immunity, getting boosted with mRNA vaccine seems to boost the peer, the strength as well as the duration of your immunity, I would suspect that it would do that as well for me, and I would, in the absence of official guidance, I would choose to get a second booster.
Andy Slavitt
So I hate to sound wimpy. And I hate to sound overly kind, which is just not my personality. But both your answers are correct and acceptable. According to folks, it’s very reasonable to wait and see particularly given the low prevalence. But if you are more conservative and want to have more protection, particularly if you tolerate the vaccines well. I think there is an unofficial support for people who say, you know what, I want to get a single mRNA vaccine to make sure I’m more protected.
Andy Slavitt 18:30
If you’re sending kids to camp, this is a question from Robin Graham if you’re sending kids to camp who aren’t yet vaccinated. Would you draw any restrictions? Would you want them to be wearing masks? Are their activities you wouldn’t want them to undertake? Is it okay for them to go swimming? Farzad?
Dr. Farzad Mostashari
Yeah, I mean, I think if anything since the first time we spoke about this question, things have gotten dramatically safer. Outdoor obviously is has been great all along. Swimming is fine, all that stuff. But the prevalence of incidents of cases has just gone down so dramatically in the US because of vaccination and probably also some contribution of seasonality. They really are as low as they’ve been. So I would feel pretty comfortable. And you know the other thing that again, Caitlin and I sparred about a little bit is like for kids, it was always you know, pretty safe. If you send your kids to camp when there was you know, the weather or school when there was flu around then I think you would be fine sending them to camp now.
Andy Slavitt
Caitlin?
Dr. Caitlin Rivers
My oldest is in camp and she wears a mask when indoors and does not wear one outdoors and my younger kids are also in childcare. They’re not good at wearing masks and I don’t sweat it too much. So I largely agree with Farzad but I do enforce the restrictions that I can around masking indoors.
Andy Slavitt 20:02
Okay, now we’re going to talk about immuno suppressive, immunocompromised folks. Two different questions. One from Lynn Lyon, who’s wondering if she wears a mask and has two Moderna vaccines, whether or not that’s enough protection, or should she be isolating at home again, Farzad?
Dr. Farzad Mostashari
I think if you are wearing a mask, one of the things that been really impressive has been how, in a way, how low the prevalence has been for people who wore masks consistently throughout the pandemic. And people who in many cases, you know, were healthcare workers who were exposed all the time, but wore masks and wore good masks. So I think that even I’m sure that there’s legitimate concern for people immunosuppressed even after they’ve been vaccinated. But I think the combination of the vaccines, even if they don’t have full efficacy wearing a good mask well, and the decrease in prevalence in the community, people who are vaccinated are also less likely to pass it on to you. I think those three should combine to make you feel more comfortable.
Andy Slavitt
So you don’t have to stay home all the time to do certain situations you could be […] for.
Dr. Farzad Mostashari
I would say that. Yes.
Andy Slavitt
Good. Okay, Caitlin. agree?
Dr. Caitlin Rivers
I agree, you can get N95 or KN95 really easily now there are about 50 cents apiece. And so I think that would be the first order of business. And I think the second order of business would be to get together with your specialist and see what you can do about boosting your immunity or developing a plan for being able to still participate in the community well, immunocompromised.
Andy Slavitt
I’m going to, I’m going to emphasize something that Caitlin said, which is a place where she probably earns a point, sorry Farzad. Because you’re excellent. your interests have been excellent so far Farzad, and I want you to know that, this has been the top of your game. I think your game isn’t, your game isn’t everybody’s game, but you know, for your game. It’s been good. But the point about the type of mask, we’re at a point now, which is a different place where before where there is an abundance of N95 and KN95 masks. And so if you are concerned if because you’re immunocompromised or whatever reason, then don’t just wear a mask, wear an N95 mask, there are heroic people that were inside, the government inside the Biden administration, at least when I was there, who really fixed the supply chain for N95. As masks came down, we do not have a shortage, we are no longer recommending that healthcare workers reuse N95 masks.
Andy Slavitt
If you have a concern, ditch the cloth. Wear the N95? That’s my addition, prompting it based upon on your on your comment, Caitlin. But there’s another element where I think Farzad actually did make a very interesting point as well. So I’m gonna have to give him a little bit here, which is that the prevalence now is so low is so many other people are getting vaccinated. Becky Garrick asked the question, if you’re going to a very large indoor event, and you’re immunocompromised, but there’s a requirement that everybody else there is vaccinated, and there’s no social distancing. Actually, the event she’s considering is an opera and another 3000 people that could go to an opera. Should she feel comfortable attending even though she’s immunocompromised, knowing that everyone is required to be vaccinated. Farzad, where do you go with that one?
Dr. Farzad Mostashari
I guess I would be a little concerned. Only because like or is the I don’t know about the enforcement of the everyone vaccinated part of it. I mean, I think if you take as the premise of the question that everyone’s vaccinated, then I’d be more comfortable like sure.
Andy Slavitt
If you’re going to an opera, you’re not gonna lie […] Bullfight, maybe you lie but opera, I don’t think opera is generally lie.
Dr. Caitlin Rivers 24:07
It’s probably all adults, too, which weighs in favor.
Andy Slavitt
I’m typecasting here. But I bet you that the number of liars that go to operas, is one of the lowest numbers you can imagine.
Dr. Farzad Mostashari
Depends on the opera.
Andy Slavitt
Okay, Gilbert and Sullivan is an exception. Fine, I’ll give you that. Okay, what should someone do if they’ve had an adverse reaction to the first dose of the mRNA vaccine? Is there another option for them to get fully vaccinated? Should they take a dose of a different COVID vaccine? Should they power through and take another one, the one they had the adverse reaction to? Do you have a point of view on that, Caitlyn?
Dr. Caitlin Rivers
I would see an allergist that’s what they’re for. I would see an allergist they can help you figure out what’s an option for you.
Andy Slavitt
Cop out, but fine.
Dr. Caitlin Rivers
I mean, I don’t know. Yeah, it’s a very specific question.
Andy Slavitt
It’s a legit answer. It’s a legit answer.
Dr. Caitlin Rivers
It depends what the component is you’re allergic to. And so I don’t know if you can just switch to the J&J and expect a different result. I’m not sure
Andy Slavitt
All true, but I’m gonna say this. Unless your reaction was intolerable. And or something that your doctor tells you is dangerous. Really important to get the second mRNA vaccine. Again, unless there are exceptional circumstances, the first vaccine we’re seeing doesn’t hold up as well against the variance. Much like natural immunity alone without a vaccine doesn’t hold up extremely well. So if you want a long lasting, secure situation, and you’re talking about like a day with a fever, or a headache, my advice is grin and bear it, if it’s something more serious than that. Yes, I think you’re right.
Dr. Farzad Mostashari
Yeah. I think by extension, Andy, from what we know, when in clinical practice, you talk to someone and they say, oh, yeah, I, you know, I had an I had a bad reaction to, you know, the flu shot, right? More often than not, they don’t actually have an allergy, right, or I have an allergy to penicillin. What was your allergy? Well, I had stomach ache, right? Like, those are not, those I think we have to you have to be careful not to say like, as you said, if you had a fever or a headache or local pain, that that was an actual allergic reaction to the vaccine that would bar you from having the second dose.
Andy Slavitt 26:30
Heather Harding wants to know, if someone her family has had COVID, they still need a vaccine. And I think the answer is having COVID it’s like having a first dose. You at least need a second dose. Although I would probably get two doses. In any disagreement from either of you there? I’m gonna get myself a point actually.
Dr. Farzad Mostashari
Yeah, that was a good one.
Andy Slavitt
It might be both of you. Home field advantage. Yes. Would you travel to France in August? How risky would that be if you were fully vaccinated in early March? This is from someone who wants to go to France.
Dr. Caitlin Rivers
I would pick up that N95 or KN95 for the trip, but yes, I would go.
Andy Slavitt
Okay. John […] asks, is it safe to resume indoor swimming at a gym? Well, fully vaccinated, Safe or Unsafe?
Dr. Farzad Mostashari
Safe.
Dr. Caitlin Rivers
Safe.
Andy Slavitt
Jennifer Hardy wants to know, are gym safe in general? She’s wanting to return to the gym. But she lives in a conservative county in California with only a 56% vaccination rate. Is it safer to go to the gym? Or should she find another thing to do?
Dr. Caitlin Rivers
They are not safe if you are unvaccinated. They’re high-risk settings. But if you are vaccinated, yes, you can go back to the gym.
Dr. Farzad Mostashari
Yeah, not safe for them safe for you.
Andy Slavitt
As a vaccinated person, is it safe to be in an inside event like a large church gathering? 1000 plus people, it’s a mega church without a mask. Many may not be vaccinated and nobody would be wearing a mask. How about for them? So for the vaccinated person Safe Or Unsafe without a mask?
Dr. Farzad Mostashari 28:03
I think that this is similar to the community prevalence of the variance question. It is just about as high risk as setting is you’re gonna have. 1000s of people, no social distancing ,no masks, singing. Right? That is a lot of particles floating in the air there. So it’s about as high risk is you’re going to get the vaccine offers you great protection. The one thing that I would want to know is what is the genomic surveillance of the variants in the community that we’re seeing in.
Andy Slavitt
Okay, anything you’d add to that, Caitlin?
Dr. Caitlin Rivers
I would wear a mask. if you’re fully vaccinated, your risk of it getting infected is low but like why tempt fate? You know, as Farzad said, it’s a high-risk setting. So I would wear a mask.
Andy Slavitt
Okay, now, just some quick final thoughts on the speed round. If last year, your alert level initially was a 10, a scale of 1 to 10. Right now, as you think about the summer, what’s your alert level or concern level on a scale of 1 to 10 for people who have been vaccinated. Farzad?
Dr. Farzad Mostashari
Point one.
Andy Slavitt
Caitlin?
Dr. Caitlin Rivers
As a person living through the pandemic, very low, one, less than one. As an epidemiologist who feels some responsibility for keeping track of what’s coming. I do worry about the Delta variant for people who are unvaccinated. And so from that perspective, it’s unfortunately a little bit higher.
Andy Slavitt
Yeah, I was gonna ask for people who are unvaccinated as well. I think you were trying to show a little moral superiority there to Farzad, but it backfire.
Dr. Farzad Mostashari
You said you’re if vaccinated.
Andy Slavitt
I did. I said if your vaccine I think it like I said I think it backfired on Caitlin this sort of virtue signaling as an epidemiologist
Dr. Farzad Mostashari
This is just a better person than I am.
Dr. Caitlin Rivers
I had no way to know that you are going to ask a follow up question.
Dr. Farzad Mostashari
I was gonna say that you’re, if you’re in the US, yes, but you know, Gosh, it is, it is hard to feel like we’re behind have this thing behind us seeing what’s happening in the world. That’s the tragedy.
Andy Slavitt 30:07
Right? Okay, you’re a good person too.
Dr. Farzad Mostashari
Thank you.
Andy Slavitt
By the way, I have no problem with virtue signaling because you have to have virtue to signal so I’m good with it. Just minority opinion maybe. Okay, play yourself out to the fall and winter. We’ve got some backseat; a few things are happening. Maybe we got some waning immunity. Maybe we’ve got, you know, did change of weather that’s pushing people indoors. Maybe we’ve got, you know, dominance of Delta or Delta plus or something. Your overall alert level for people who are, again for people who are vaccinated on a scale of 1 to 10. And Caitlin, what would you say?
Dr. Caitlin Rivers
No, no concern. Low concern
Andy Slavitt
Farzad?
Dr. Farzad Mostashari
If you look at the if we take that this is going to become endemic, and I think it is going to be endemic. If you look at all coronaviruses. There’s just such sharp seasonality to them. So I expect that in the late fall, we’re going to see another spike. And all those factors that you said, variants waning immunity are going to play into it. So I think we are going to see another bump. Whether it becomes another wave is going to depend on whether we can get boosters in arms. And I think the kid piece is going to be important.
Andy Slavitt
Solving for boosters. Do you conceive of hospitals being overrun at risk again in the coming season?
Dr. Farzad Mostashari
I don’t think anything, anything like the three waves we had.
Andy Slavitt
So is the worst behind us?
Dr. Farzad Mostashari
The worst is definitely behind us. But for the fall, my concern might go up from a point one now to a one.
Dr. Caitlin Rivers
I will say too, that we’re already seeing hospitalizations rise in Missouri and Arkansas, some of the states that have low levels of vaccine coverage and more virus circulating right now. So I wouldn’t totally write out the possibility that we find ourselves in another tight spot. But for people who are vaccinated, I feel confident that the vaccines will hold up.
Andy Slavitt 32:02
And for people who were unvaccinated all kidding aside, your 10 is not a 1, but it’s about more like a 5, 6 or 7, limit, I think is what I heard you say.
Dr. Caitlin Rivers
You’re at risk, you continue to be at risk, the Delta variant is very infectious, it will find you I fear, and so you should get vaccinated.
Andy Slavitt
Okay, final question. One word answer only. Starting with Caitlin. Lab or bat?
Dr. Caitlin Rivers
Probably bat, but we can’t say for sure either way. How can you do that in one word? That’s unfair.
Andy Slavitt
Farzad, lab or bat?
Dr. Farzad Mostashari
Bat.
Andy Slavitt
Okay, that brings us to the end of our show. And I want to thank you both. But I want to just actually give it maybe I think we should close with an essay question, because I think this is all cute. You guys have been very helpful. I think you guys have been very much on the same theme, which is the world’s ambivalent. It feels weird. But yes, in fact, if you’ve been vaccinated, the same world you’re looking at before that wasn’t as safe is now very, very safe. And they’re very few limitations. And if you haven’t been vaccinated, the opposite is still true, unfortunately. But there’s something deeper than the facts that are causing people to struggle. And that’s some of the psychology perhaps with adjusting back. Maybe it’s because of the trauma we’ve all been through. Maybe because it feels like it’s a really an on and off switch.
Andy Slavitt
Maybe it’s because they’re just continued stories, and you see the words like Delta, and we’ve sort of trained ourselves. So in addition to being a super epidemiologists, and clinicians, you’re all you’re both also parents, you’re great people, you’re wonderful communicators. So I’m wondering if you just have a thought to share about how to help people think about the adjustment, the psychological adjustment, of moving back from a place where we’ve been to a place which makes it easier to accept that, indeed, these changes are occurring, and we can in fact, get back many of the things in our life that we had to put on hold. So it’s a rather serious question, but I think it’s an important one that I think everybody is wracked with. Farzad, are going to start with that.
Dr. Farzad Mostashari 34:11
We all collectively, you know, have to give each other space for a little bit of PTSD coming out of this. And it has been traumatic, it’s been the isolation, the fear of contact, the fear of engaging in so many things that make life meaningful for so many of us, those things are real and coming out of it is it we got to give people some break, give people a break. But I think the antidote to it is the very thing that that we were missing all along is that human connection and I for one, you know, I’m a hugger. So you know, I will make myself available. I’m not gonna make myself available to colleagues and friends for hugs, because I think it is that contact that we’ve been so missing, and it’s going to feel so great.
Andy Slavitt
So true. And Caitlin, any words of wisdom or solace or support that you’d offer?
Dr. Caitlin Rivers
I think what’s been particularly hard is throughout the last year and a half, we’ve been making decisions not just for ourselves, but for everyone around us. And I think that’s harder to let go of than adjusting your own personal risk tolerance is the idea that you are responsible for everyone around you. And so I agree with Farzad that it just takes time to make that transition. And there’s nothing wrong with being prudent and taking it slow. But I do think we’re finally getting to a place where we have the opportunity to do those things that are important to us, like have weddings, attend funerals, all of those milestones that you really hate to miss. And so I you know, I do think we should be taking advantage of those moments.
Andy Slavitt
Well, the winner of this episode is the listener. Because you guys have just been phenomenal. You’ve done a great job. And everybody listening to this. You win. Thanks, guys really loved connecting again.
Dr. Caitlin Rivers 36:08
Thank you.
Dr. Farzad Mostashari
Thanks, Andy. Thank you listener.
Andy Slavitt
Okay, let’s agree to two things. First of all, getting back to normal isn’t just a physical experience. It’s an emotional experience. People are on a journey. It’s harder for some people than others. And we’re gonna listen to Dr. Lisa, talk to folks and see where they are in that journey. The second rule is even more important. Don’t use air quotes around the word normal. Getting back to normal. Like I know, everybody does that. Because they feel like you can’t say the word normal. And because there’s a new normal and an old normal and all that. I agree with all that. But air quotes are so offensive. They’re so offensive. They’re so offensive. You know what I’m saying? So we’re not going to use the air quotes. I encourage you not to use air quotes. If you see people using air quotes, we’re going to have a kind of a petition going to prevent people from using air quotes. Because it’s that important to recovering from this pandemic. Is normal does not need air quotes. It’s just a word. It’s just a thing. Just thing and if you disagree, I’m sure I’ll hear from you. Because Twitter’s really good at that. Okay, so let’s hear how people are getting back to normal.
Dr. Lisa Fitzpatrick 38:02
What was the best thing after you got your vaccination?
Speaker 5
Being able to travel to I mean, truly travel, get on an airplane, get on a train.
Dr. Lisa Fitzpatrick
Does it feel like we’re getting back to normal too?
Speaker 6
Unfortunately, I work in service industry. So I’ve been out here this entire time. But now I have to share my bathrooms with customers again. I’m not here for it at all. I’m not gonna lie to you.
Dr. Lisa Fitzpatrick
Do you feel like we’re getting back to normal?
Speaker 7
Yeah, I don’t bring my mask anywhere.
Dr. Lisa Fitzpatrick
Does that feel weird? Or what do you think feel about that?
Speaker 8
I feel like we’re back to normal, but I feel like when we go places, like I see a lot of people, you know, vaccinated still wearing masks, and sometimes that, you know, kind of surprises me, but then I realized, you know, it’s been a year that people have been, you know, we’ve been living like this. So of course, it’s gonna be a bit of an adjustment. You know?
Dr. Lisa Fitzpatrick
Does it feel like? We’re getting back to normal?
Speaker 9
Yeah, for sure. Like, DC is open like bars, clubs, like social life is open.
Dr. Lisa Fitzpatrick
Have you been out to bars?
Speaker 9
Yeah.
Dr. Lisa Fitzpatrick
And what’s that like?
Speaker 9
It’s packed. Makes me want to keep putting my mask on. So I noticed you’re out here in Navy Yard having dinner. Is this your first-time out since some of the masks have started coming out? People are getting vaccinated?
Dr. Lisa Fitzpatrick
I am vaccinated. I appreciate you asking. So we’re outside at the shopping mall. And you have your mask on? Why are you still wearing your mask?
Speaker 10
I’m still wearing my mask because I’m not fully vaccinated yet. I got our, me and my sister got our first doses, like last week, but, I just want to be cautious. I don’t want to get anyone else around me sick.
Speaker 11
Especially if they didn’t get the vaccine. We want to make sure that everybody safe and but we haven’t got our second vaccine so we’re not fully vaccinated.
Dr. Lisa Fitzpatrick
That’s awesome. How old are you?
Speaker 12 40:00
I’m 14 years old.
Dr. Lisa Fitzpatrick
And you?
Speaker 13 40:01
12.
Dr. Lisa Fitzpatrick
And does it feel weird now having your mask on?
Speaker 13
No, it doesn’t. It doesn’t. I think I’ve been I’ve personally been looking forward to it right. So once I got vaccinated and the CDC said it was okay, it’s like, okay, I am now wearing that acceptive, I have to, so I remember vividly several Muslim. So the first time that I was able to pray like close, because we pray, like standing next to each other was in North Carolina. It was the first time in over like 18 months, I was able to like stand left and my clothes, like, shoulder to shoulder with other people without masks. So it was kind of a monumental pain of oh, yeah.
Dr. Lisa Fitzpatrick
How did you feel the first time you were able to do that during the pendant?
Speaker 2
I feel good. I feel good.
Dr. Lisa Fitzpatrick
And what’s going on here?
Speaker 9
This is the DC different drummers marching band. We are a LGBT plus group that performs in local parades and at local events, just to kind of bring music and celebration to the community.
Dr. Lisa Fitzpatrick
And so how is it to be back outside without masks on?
Speaker 14
It’s a blast, we actually lifted our mass mandate today, we wanted to make sure that everything was super safe, and that everyone in the membership was really comfortable with it. And so we wanted to make sure we were in a good place before we did that. But it’s been a blast to get back out with everybody and be back to doing what we love.
Dr. Lisa Fitzpatrick
Is there anything that’s not that doesn’t feel back to normal?
Speaker 15
You know, I think like, like people don’t hug a lot anymore. I don’t see that yet. Like I people are still kind of fist pumping and elbow touching. So I’d like to see more people like kind of like, start hugging each other when they see each other again.
Dr. Lisa Fitzpatrick
Anything else you want to say about getting back to normal?
Speaker 16
I think people shouldn’t be afraid. You know, the vaccine works and you can take the mask off. That’s me right there too as to say live your life live free, be happy. Be joyous.
Dr. Lisa Fitzpatrick
Okay, thanks, guys. Have a good day.
Andy Slavitt
At least in terms of getting back to normal. With 1 being China, lockdown. 10 being New Hampshire live free or die? Where do you live in? Where are you living your life right now? What number?
Dr. Lisa Fitzpatrick 42:30
I would have to say I’m closer to New Hampshire live free or die. And the thing is, Andy, you know the data early on the data showed you could be outside without a mass because you are least likely to transmit or get Coronavirus if you’re outside. So throughout the pandemic, I tried to be outside as much as possible without my mask. And you should have seen all the side eyes and the evil looks I got. Or even people who know me, Dr. Lisa, where’s your mask? So, yeah, I’ve been eager to get back to normal.
Andy Slavitt
Is that because you’re a risk taker or because you’re following the science?
Dr. Lisa Fitzpatrick
It’s both. But I also know, you know, as someone who has been a researcher, who understand science and tries to explain it to other people, that we really can trust the science even though it sounds confusing, and we’ve been back and forth. Having to explain ourselves over and over again, or explain why we made a mistake, or why the data keep changing. At the core, we have to stand by the data.
Andy Slavitt
So okay, so if you’re closer to New Hampshire now, like, during the pandemic, Were you following the guidelines religiously closely wearing masks indoors, avoiding big crowds? avoiding, you know, particularly like, you know, people have an older generation being very careful. […], were like, were you fastidious then, as you are now, but just a little bit on the other side of things?
Dr. Lisa Fitzpatrick 44:04
Absolutely. Yeah. I didn’t see my mother face to face for almost a year. I always wore my mask when I couldn’t socially distance. Anytime I went to the grocery store. Absolutely, I wore my mask. So absolutely. But now the science shows us that if you’re fully vaccinated, you can get back to normal. It’s time.
Andy Slavitt 44:27
What kind of risks do you think you’re taking? Do you think you’re at risk of getting COVID?
Dr. Lisa Fitzpatrick
No, I don’t. And I don’t think so because I’m fully vaccinated. Even if I get COVID. It’s not going to be a bad case of COVID.
Andy Slavitt 44:40
What if you ran into like, the Delta variant monster?
Dr. Lisa Fitzpatrick
I’m not worried about the variance, Andy, and people have been asking me texting me sending me emails. What about the Delta variant? Should I be afraid? And actually Dr. Gandhi and I had a conversation about this just yesterday. People who are fully vaccinated, should feel confident going out living their lives. I know it sounds scary, but this is what viruses do. When they copy themselves, they make mistakes. And that’s all a mutation or a variant is. So if you’re fully vaccinated, you should also think about living free.
Andy Slavitt
What if you got on an airplane and that was Delta Airlines? And you were sitting next to a sorority sister from tri-Delta? Would you be nervous, then?
Andy Slavitt
No, nothing will shake my confidence and my vaccination, Andy, you can try all you want. But I’m fully vaccinated, and I will live. What if she took a math equation and shooting geometry, and she was solving for Delta? Would you then be nervous?
Dr. Lisa Fitzpatrick
Nice try. No, I wouldn’t, because I’m fully vaccinated. And this is why I keep telling people get, you know, get the vaccination. And you can get peace of mind. You can live your life get back to normal.
Andy Slavitt 46:05
So the people you talk to who are getting back to normal? What were their attitudes? What was the mix of range of their attitude? Are they closer to China or closer to New Hampshire?
Dr. Lisa Fitzpatrick
Actually, Andy, people are all over the place. There are people who told me no, it’s too soon, it’s too soon to take off the mask. And these are people who are fully vaccinated, they don’t have the confidence because they’re concerned they might get it from someone else. I also had people who said, I’m so happy to take off my mask, it’s about time.
Andy Slavitt
So what’s missing between them and you? You know more. You’re smarter, you’re better adjusted, you versus them who are kind of a mess. What’s the difference?
Dr. Lisa Fitzpatrick
Well, I think it’s not exactly a fair comparison, you know, being someone who has a background in medicine and science. But I think the difference for the general public, why do you have some people who say, I’m keeping my mask on despite vaccination versus I can’t wait to take it off, is the communication. We haven’t done a good job communicating the science and building trust. People don’t trust what we say, Andy, it’s really, it’s unfortunate.
Andy Slavitt
Is it also true that there’s no real wrong answer? I mean, if someone’s vaccinated and chooses to wear masks, because it makes them feel more comfortable, or chooses to avoid crowds, putting aside whether they have a child at home or someone who’s immunocompromised? Is it true that we’re in a place where there are multiple right answers?
Dr. Lisa Fitzpatrick
I agree with that. I absolutely agree with that. And everyone has to be comfortable, Andy. So if people feel comfortable without a mask, that’s great, but the next person might not. And that’s okay, too. And I think, because even science is never 100%, we can’t give people guarantees people have to make these decisions at their own pace.
Andy Slavitt 48:18
Let me say what we have coming up. We’re gonna finish third part of our series on Wednesday with Dr. Scott Gottlieb. Dr. Gottlieb is a powerhouse of science, information policy, politics. And it is a phenomenal episode, to give us a real sense of the state of where we are now. And then next week, part four, we’re going into a conversation about the unvaccinated and why people are not getting vaccinated, what the challenge is in talking to them and vaccinating them, and different beliefs out there, we’re going to have. First, the people who have done the best work in my opinion and understanding and studying, people who are not getting vaccinated and why Molly Brody, from the Kaiser Family Foundation, and Frank Luntz, the political poster who has done tremendous amount of work and focus groups and listening to people and hearing why people aren’t getting vaccinated. And then on Wednesday, we’re going to talk about the dimensions of that with a great person, David Axelrod. He’s got a podcast called The X Files. He was a political adviser for President Barack Obama. And he is a great social political commentator. And so we’re going to finish up part four next week with a really best understanding we can of how we meet the challenge of the people in the country that aren’t yet vaccinated. Have a great couple days. We’ll talk to you on Wednesday.
CREDITS
Thanks for listening to IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev. Jessica Cordova Kramer and Stephanie Wittels Wachs still rule our lives and executive produced the show. And our theme was composed by Dan Molad and Oliver Hill, and additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia. And you can find me at @ASlavitt on Twitter or at @AndySlavitt on Instagram. If you like what you heard today, most importantly, please tell your friends to come listen and please stay safe, share some joy and we will get through this together.
