Toolkit: Safe or Not Safe? (Summer Edition)
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Description
Is it safe to go on vacation this summer? Can I send my kids to camp? Should I invite unvaccinated family members to my summer wedding? Drs. Caitlin Rivers and Farzad Mostashari join Dr. Bob to answer all this and more on this special, summer edition of Safe or Not Safe.
Follow Dr. Bob on Twitter @Bob_Wachter and check out In the Bubble’s new Twitter account @inthebubblepod.
Follow Caitlin Rivers @cmyeaton and Farzad Mostashari @Farzad_MD on Twitter.
Keep up with Andy in D.C. on Twitter @ASlavitt and Instagram @andyslavitt.
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Check out these resources from today’s episode:
- Learn more about the CDC and FDA’s decision to pause the use of the Johnson & Johnson vaccine: https://www.fda.gov/news-events/press-announcements/joint-cdc-and-fda-statement-johnson-johnson-covid-19-vaccine
- Watch Mike Osterholm’s Meet the Press interview Bob mentions in today’s episode: https://www.nbcnews.com/meet-the-press/video/full-osterholm-interview-covid-variant-is-a-brand-new-ballgame-109642309532
- Check out the CDC’s current guidelines for fully vaccinated people: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html
- This article answers frequently asked questions about COVID-19 vaccines and pregnancy: https://www.health.harvard.edu/blog/wondering-about-covid-19-vaccines-if-youre-pregnant-or-breastfeeding-2021010721722
- Learn more about Dr. Bob Wachter and the UCSF Department of Medicine here: https://medicine.ucsf.edu/
To follow along with a transcript and/or take notes for friends and family, go to www.lemonadamedia.com/show/in-the-bubble shortly after the air date.
Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia. For additional resources, information, and a transcript of the episode, visit lemonadamedia.com.
Transcript
SPEAKERS
Iris, Dr. Farzad Mostashari, Dr. Bob Wachter, Dr. Caitlin Rivers
Dr. Bob Wachter 00:08
Welcome to IN THE BUBBLE. I’m Dr. Bob Wachter. Today we have another Toolkit. This one is focused on summer activities. We got a ton of fantastic questions from all of you about planes, trains, and automobiles, and also hotels, Airbnb’s pools, bars, indoor dining, and even making out. We also covered mosh pits. So, it’s a really interesting episode, you’ll get all of your summer questions answered. And to do this, we have two have our great Safe or Not Safe guests here for their fifth appearance on in the bubble. Dr. Caitlin Rivers is a senior scholar at the Johns Hopkins Center for Health Security, and assistant professor in the Department of Environmental Health and engineering at the Johns Hopkins Bloomberg School of Public Health.
Dr. Bob Wachter
Dr. Farzad Mostashari, is co-founder and CEO of Aledade, which is a company that supports primary care doctors. He was also the National Coordinator for Health Information Technology in the Department of Health and Human Services. Prior to that, he worked in the New York City Department of Health where he established the Bureau of Epidemiology services. One quick program note before we start, we taped this episode about a week ago, just before the news about the J&J vaccine came out. The only concern that’s been raised about the J&J is the possibility of this very, very rare side effect of unusual blood clots, probably on the order of one in a million.
Dr. Bob Wachter
The effectiveness of the J&J vaccine is not in question. And so anything you hear that Farzad and Caitlin are talking about, that relates to how safe you are, if you happen to have gotten the J&J vaccine does not change one whit. Now, that is true no matter how the review turns out, because most of our discussion hinged on the assumption that virtually all adults in the United States who wanted to be vaccinated would be by early summer, perhaps the only thing that could change is of a long suspension of the J&J leads the pace of vaccination to slow down markedly. Or, and I hope this doesn’t happen, or if it significantly raises the amount of vaccine hesitancy.
Dr. Bob Wachter 02:18
I think those are both unlikely outcomes. I still am confident that whatever happens with the J&J and my guess is that we’ll come back to market with some warnings perhaps, and maybe limited to certain populations, perhaps older people. But I’m still confident that whatever happens, we’ll still have the vast majority of US adults, and maybe even some 12- to 15-year-olds vaccinated by early to mid-summer. So with that in mind, let’s go ahead and bring on Caitlin and Farzad.
Dr. Bob Wachter
All right, are we ready to go?
Dr. Farzad Mostashari
Yes I am.
Dr. Caitlin Rivers
I hope so, fingers crossed.
Dr. Bob Wachter
Okay, let us go ahead and get started. I understand this is for both of you your 5th appearance on in the bubble, which by far and away makes you the number one guests on the show. So thank you both for that. And I noticed today, folks can’t see the video. But Caitlin is in this incredibly bright, cheery environment, very well lit, beautiful dress and paintings behind or going for an 11 out of 10 on room raider. Farzad has sort of a bleak, dark background behind him. And I’m a little worried that if that mirrors his mood about COVID. So we’ll see how this goes.
Dr. Bob Wachter
So actually, that’s the way I want to start before we get into a ton of great questions about the summer from the audience. But just to calibrate where you are, I’d love to hear a word on sort of, are you optimistic or pessimistic? We’re hearing some messaging about optimism. But then we have a little bit of impending doom from our CDC director, Mike Osterholm was on meet the press yesterday with a pretty glum message. So where are you landing before we get into the questions? Caitlin, how about you?
Dr. Caitlin Rivers 04:07
I think we’re in a bumpy period. But we will get to a better place. It’s true we are stalled much higher than we want to be stalled. But every day, we are rolling out 3 million doses of the vaccine. And so I do think that we will get ahead of this rocky period. It’s just right now we need to stay committed. I know we’re all super sick of hearing it. But I think things will get better here pretty shortly as long as we stay the course with our masking and distancing and whatnot.
Dr. Bob Wachter
Okay. And Farzad, where are you landing right now?
Dr. Farzad Mostashari
I agree. I think that a lot of the we had just a monster week for vaccine not even just looking ahead. Just looking behind the last week was a monster week. This past month has been incredible. And we have yet to see the full impact of that in the outbreak. It just takes time for the vaccine to take effect. And you know the reason why we haven’t seen death And hospitalizations rise the same way in those states where we’re seeing cases rise is somewhat the lag there, but also somewhat that it’s a younger age group that’s being affected at the older age group who’s been immunized. And I think we’re gonna, it’s gonna look better when it comes to deaths. And I don’t think we’re going to have a massive next surge in deaths. That’s the good news.
Dr. Farzad Mostashari
The thing that has me concerned is the variants and we talked at one of our previous in the bubbles around, you know, the vaccine versus the variance The race is on. And I’m watching the South Africa variant in particular. And that’s the one that I’m kind of a little bit nervous about, it’s not spreading as fast as the good news. But it does seem like there’s some evidence of vaccine escape from that. And, you know, we should be prepared, I think all of us for another round of booster vaccines to keep that threat away if we can make it through this period.
Dr. Bob Wachter 06:01
Okay. So guarded optimism with a couple of clouds on the horizon said reasonable way to approach a whole bunch of questions about the summer so let’s just dive into them. Let’s start with Ben’s question. “What is the safest way to travel the summer, driving plane, train, or bus?” Farzad?
Dr. Farzad Mostashari
Yeah, we did this. I think it was our first in the bubble where we tried to relate the risk of driving cross country in terms of car accident fatalities versus flying. And I think it depends on obviously who you are. But if you are vaccinated, and I think that is our framework for today, if you’re vaccinated, it will be safer for you to fly than to drive yourself.
Dr. Bob Wachter
Okay. Caitlin, I guess it depends on whether you have airbags and how good a driver you are, Caitlin?
Dr. Caitlin Rivers
From the COVID perspective, I think it’s safer to avoid other people. So driving yourself would be safer thinking about protection from infection. But by the time you layer in the other risks, which I think as Farzad’s point, maybe it comes out in the wash, I think I would prefer driving maybe I’m not I’m not thinking like Farzad, I think I would prefer driving given an option. But if you are fully vaccinated, then reintroducing buses and trains and airplanes is reasonable.
Dr. Farzad Mostashari
Caitlin and Bob are confident in their driving abilities.
Dr. Bob Wachter
I don’t know about Caitlin, I’m a very good driver. Yes. Except don’t ask my wife. A couple of add on questions on the flying part. If you had a long flight, would you break it into shorter segments? You know, when I think about flying, I think about this, you’re in this tube with a whole bunch of people. And then it kind of turns into a flying restaurant as everybody takes their masks off to eat. Which doesn’t happen if potentially on a shorter segment. So is there any advantage of breaking up in shorter segments rather than flying six hours cross country? Caitlin?
Dr. Caitlin Rivers
I don’t think so because you’re actually introducing more contacts, there are more new people for you to come into contact with and risk getting infection. It’s true that taking off your mask to eat and drink will be some of the riskier points of your journey. But I don’t think that is worth rearranging your itinerary to accommodate.
Dr. Farzad Mostashari 08:16
Yeah, I agree. I would just not eat or drink, you know, use a straw or whatever. Try not to and certainly don’t do it at the same time everyone else is doing it. But I agree, I think the biggest risk is in those metal tubes, probably the couple of people to your right and left and you’re spending a significant amount of time. Close to them you don’t know how well they’re going to be wearing their mask and limiting that to you know, not adding more people into the mix there. I think it’s a good thing.
Dr. Bob Wachter
Okay. And Farzad, how would you behave on the plane? You talked about trying to keep your mask on as much as possible. But let’s say it’s a six-hour flight, you want to take it off? Would you wait an hour until everybody else is done eating? What would you do about the bathroom? And do you have any preference about where you sit?
Dr. Farzad Mostashari
Yeah, you know, I’m freaked about the bathroom. I got to admit. Even more so than usual. So yeah, I try to definitely keep my mask on in the bathroom for sure. I think yeah, I wouldn’t think you have to wait an hour in between when everyone else has their masks off. I think that probably the air would clear. Probably within half an hour in their plane. But again, the key thing is the fit of your mask is really important. And whether you have people kind of sitting cheek and jowl with other people is really important.
Dr. Farzad Mostashari
But the big picture here is if you’re vaccinated, fully vaccinated, it’s been the, whatever 10-12 days after your second dose. Gosh is it great feeling and so many of these like yeah, we’ll do these things like I will do that. I haven’t been on a plane Once I get my […], I’m fully vaccinated, which I’m not, I will feel much better about doing a whole host of things, including flying. The one question I would have is what’s going on in my community in terms of the rate of the variance that I’m likely to encounter.
Dr. Bob Wachter 10:20
Yeah. So Caitlin, that brings up another question, as you think Lexi asked a question about wanting to travel this summer and having so much kind of pent-up demand that she’s thinking about going to five or six places to visit a whole bunch of friends and family. Does that get too risky? And how much you paying attention to how hot and I mean, COVID hot, not heat hot. It is in the cities that you’re thinking about visiting?
Dr. Caitlin Rivers
Yeah, the vaccines are quite good. And so I do think that it’s reasonable to travel whether you want to flip the coin, however improbable five times it’s a matter of risk tolerance. But I don’t see any clear reason why not. Certainly paying attention to the conditions in the place that you’re visiting is useful. If they’re having a worse outbreak, you might choose activities where there are fewer people, you might wear a better-quality mask. But I think the vaccines really changed the equation here and make the whole enterprise much safer.
Dr. Bob Wachter
We’ve been talking as if people are vaccinated, if someone is in by the summer, it will almost certainly be someone’s choice not to for an adult not to have been vaccinated. How much does your advice change for the unvaccinated person in terms of traveling this summer? Caitlin, why won’t you start with that and we’ll go to Farzad.
Dr. Caitlin Rivers
Well, it’s risky, it’s the same risk to you as it would have been at any other point in the outbreak. And so again, it comes back to risk tolerance. And you should be considering risk not only to yourself, but to other people. If you were to become infected and pass it on. I think in that situation, then the prevalence in the community that you’re visiting, and also the origin community is really important. That will be the single biggest factor that determines whether or not you’re exposed to the virus. It’s a little bit harder to figure when you’re considering travel, because people are coming and going from all over. But I think it would still be important to have an understanding of what the prevalence is and the places that you’ll be visiting.
Dr. Bob Wachter 12:14
Farzad?
Dr. Farzad Mostashari
I think the Venn diagram of people who are really concerned about the safety and risk of their travel and listening to in the bubble religiously, the Venn diagram between that population, the population who refuses to get vaccinated is pretty small, Bob.
Dr. Bob Wachter
We’re trying to grow our listenership, Farzad. But yes, I think you’re probably right. Yeah, that’s a good point. I guess, Caitlin said the risk to the unvaccinated is the same as it’s been I have an editorial that I think will be out maybe by the time this airs in the Washington Post, where I’ve argued that it’s actually greater, right, because the variance if for the same exposure, if you’re unvaccinated, your risk is probably higher now than it’s been at any time during the pandemic. I do agree with that. Maybe Caitlin?
Dr. Caitlin Rivers
Well, it depends on prevalence, in the winter, there was just so much virus circulating that was quite risky. And I think it’s true now that B117 is quite prevalent that the baseline risk is increased because that variant is more transmissible, but overall community prevalence has declined and so maybe it comes out somewhere in the wash.
Dr. Farzad Mostashari
Yeah, you may be able to be a freeloader on other people’s good behavior.
Dr. Bob Wachter
Right. That’s a good point. Iris age seven asks:
Iris
Hello world. I’m Iris and today I have a very important question. Is it safe to fly? My brother’s 2, and we want to go back to Houston for favorite summer camp? Can we go? My brother is probably not going to go all the way with the mask. Is it safe? That’s my question. Also. Hello, world. My mom, as you can hear my mom and me are laughing.
Dr. Bob Wachter 14:11
So Farzad, let’s sort of layer the kids into this and also the question about masking for the youngins.
Dr. Caitlin Rivers
I feel like I have to take this even though you gave it to Farzad. I have a seven-year-old and I have two—two-year-olds. And so I feel like it’s perfect.
Dr. Bob Wachter
Maybe this is your question. Maybe this is sort of one of those asking for a friend or something. Go ahead.
Dr. Caitlin Rivers
The thing that is different about children is that they’re at low risk of severe illness but apart from that they are the same as adults in that they are not able to get vaccinated and be worried about not just them getting infected but then passing the virus onto someone else. In general because they are at low risk of severe illness. I think it’s reasonable to consider traveling but this comes down again to risk tolerance. The two-year-olds though they do make me nervous. I’ve got two of them. And they won’t keep their mask on. We’ve been working with them on it. But I think that is a big risk factor for safety and not being able to wear a mask when you’re in transit.
Dr. Bob Wachter
So what would you, how would you answer Iris’ question about traveling with the 7-year-old traveling with the 2-year-old who has not figured out the mask thing yet?
Dr. Caitlin Rivers
Sorry, Iris, I wouldn’t allow it
Dr. Bob Wachter
Would not allow it.
Dr. Farzad Mostashari
Oh, I love it an area of disagreement. Caitlin, I have been agreeing too much.
Dr. Bob Wachter
Farzad, real conflict, go for it.
Dr. Farzad Mostashari
There we go. Finally, we can get some ratings here. I think if you would take your 2-year-old on a plane during flu season two years ago, you should be fine taking them on the plane. Now as far as the risk to them is concerned. Their chances of having a severe problem with COVID this year are significantly less than the chance of them dying from influenza in a previous year. So I think we really like a two-year-old and a seven-year-old have like as good immunity as […] as someone who’s been, you know, fully vaccinated with and an adult who has been fully vaccinated with the mRNA vaccine.
Dr. Farzad Mostashari 16:17
So I would actually put them in that category for their own protection, its concern. If on the other hand, you’re saying, I’m having my 2-year-old and I said, no, we’re gonna fly and then we’re going to go visit for whatever reason, my grandma, who can’t get the vaccine because she’s allergic to something or whatever that I would say, no, no, that’s that doesn’t sound smart, because the kids, I think, can transmit it. But the worry I would have about the kids is not their health. Don’t worry about your 2-year-old, your 7-year-old, your twins, Caitlin, they’re going to be fine, Caitlin.
Dr. Bob Wachter
Caitlin, have you changed your mind?
Dr. Caitlin Rivers
No.
Dr. Bob Wachter
Okay. Good try, though. Well, let me ask you Farzad, you’re very sunny on this. But the point has been made that the now the UK variant is the most prevalent variant in the US it seems to be nastier all the way up and down the age range, including potentially, for kids, does that bother you now?
Dr. Farzad Mostashari
I still don’t think that the data shows that their chance of severe illness and death approaches that of influenza. So my answer stays the same. Maybe what this is, like, gosh, we should have been more concerned about influenza. Right? And we just got used to it right? But I’m using that as my heuristic of like, let’s just keep things risk equal to what we were doing before. I don’t think kids even with B117 are at higher risk.
Dr. Bob Wachter
Okay, we’re gonna leave that as a source of great conflict.
Dr. Bob Wachter
Let’s move on one were, maybe a couple more travel questions. Let’s stay on the ground now. […] and Mary Ellen Sue Sinclair asks kind of versions of the same question. Up to this point, my family’s only considered traveling by car to a private house for vacation now that my husband and I are both vaccinated. I’m wondering how safe places like hotels and resorts are and then Mary Ellen adds, and fully vaccinated how concerned Do I need to be about potentially infectious aerosols left in a hotel room by the previous occupants or an unmasked housekeeper assuming no windows can be open. So now we’re on the ground, we’re going into a house or room that is not ours? How safe is that? So Caitlin, what do you think?
Dr. Caitlin Rivers 18:42
I don’t have any concerns about hotels, the hotels have really stepped up their cleaning protocols. And I think even without that the risk that you would be infected, leftover from the previous occupant is quite low. The thing to watch is the congregate settings, the lobby if there’s a lot of people the elevator if it’s crowded, but in general, I don’t worry about hotels.
Dr. Bob Wachter
So you get into the hotel room and you are not taking out your wipes and doing anything fancy, anything different than you would have done a year and a half ago.
Dr. Caitlin Rivers
No, if I’m traveling in general, I’m gonna be in the hand sanitizer, but I don’t think so.
Dr. Bob Wachter
Okay, Farzad, how about you?
Dr. Farzad Mostashari
Yeah, I am glad that we can dispense with a bunch of the sanitation disinfection theater that we had, you know, schools closing down on Wednesday, so they could wipe down surfaces where it was pretty clear, at least after the first couple of months that it was fomites we’re not that concern, it was, you know, sharing breath, as we talked about in our first in the bubble episode. So yeah, I’m not concerned about that at all. But I want to, like the big picture here is you’re vaccinated. That’s awesome. Like you’re vaccinated, you’re not going to die from this. Right?
Dr. Farzad Mostashari
Like you’re amazingly protected now. You can really afford to relax a little bit compared to the like, oh my god, I’m in this hotel room did the housekeeper maybe who was here before is there lingering, you know, breath from her like, you can really what were the main message here is once you’re fully vaccinated and you’re in the 10 or 12 days past that, like you really, really, really, really can drop your worry index for all of these sort of edge cases that we spent all of our time worrying about.
Dr. Bob Wachter 20:28
Erica Warren asked, My question is how safe should we feel having out of town visitors in our house this summer? If our kids ages two and four, and maybe like Caitlin, they’ve not figured out how to teach the two-year-old how to wear the mask are not vaccinated as of yet. What about an outdoor meal with out-of-town visitors? And I’d add, does it matter how old the visitors are? So I think Farzad you hinted to this before, sort of a vulnerable person who’s older is one of those cases where you kind of still worry a little bit about the kids being a vector, not so much the kids getting sick, but the kids being vectors that the way you handle this one as well.
Dr. Farzad Mostashari
The big thing that you didn’t say was whether the out-of-town guests are vaccinated. That to me is the big question. And again, if they’re vaccinated, unvaccinated, we’re all vaccinated, except for the kids. I’m having an indoor dinner parties.
Dr. Bob Wachter
Indoor dinner parties, no masks for anybody even though you’ve got a bunch of kids there unvaccinated kids there, and let’s say kids, including up above age 12. So you know, I because I mean, the whole story seems to be kids are very, very safe, in terms of spreading of the virus, but that safety seems to not be so safe above age 12.
Dr. Farzad Mostashari
You’re changing the story on me.
Dr. Bob Wachter
Trying to push you here. But yeah, take it both ways. Only little kids, but also, let’s say an array of kids, including 14-year-olds.
Dr. Farzad Mostashari
I think, again, with the caveat around community spread of the E484 mutation variants. With that caveat set aside, if in my community, there’s it’s not that, then I am really looking forward to the day when my friends and I are fully vaccinated. And even if our young children are not we can enjoy each other’s company again. 12- to 15-year-olds, I really hope that we will see this emergency use authorization granted for the adolescence and we can begin, I certainly would strongly advocate for extending the vaccinations to all of our adolescent children as well.
Dr. Bob Wachter 22:29
but until we do it does the fact that you have a 16-year-old as part of the mix, or let’s say 15-year-old below the age that can get vaccinated. Does that change your thinking about the indoor dinner party with the out-of-town guests?
Dr. Farzad Mostashari
I would then be more cautious. I would with for you know, for a 15-year-old.
Dr. Bob Wachter
There you go. That’s why I was pushing you.
Dr. Farzad Mostashari
I know you’re right onto the edge.
Dr. Bob Wachter
Right onto the edge because some people do have 15-year-olds. Okay. Caitlin, what do you think?
Dr. Caitlin Rivers
I agree. My concern is, with regards to children is really in the highest risk situations. With travel, there is crowding, there’s touching with little kids, there’s too much licking and it’s just a mess. But when you’re thinking about lower risk situations, like having a single family visit you so that you can eat outdoors in that example, I would feel comfortable doing that, even with unvaccinated kids.
Dr. Bob Wachter
All right. This may be the hardest question of all, I think from Claire, “How do you handle approach, see or not see family members who refuse to get vaccinated but will also expect to see you this summer? Is it polite? Have we figured out the language to ask friends or family? Have you been vaccinated? And when they say no? What is that conversation like?” Caitlin, go ahead?
Dr. Caitlin Rivers
Well, I think it’s perfectly polite to just ask straight out, have you been vaccinated? Will you be vaccinated by the time we meet? And if they say no, I think it’s reasonable to say then that won’t work for me. If you yourself are vaccinated, you’re well protected against severe illness. And so I also think it’s reasonable to go ahead if that’s what you want. But if you’re not feeling and I think it’s reasonable to say that won’t work for me right now.
Dr. Bob Wachter 24:06
Yeah. And this gets into what may turn out to be the hottest question of the summer, no pun intended, which is why wouldn’t it work for you? Isn’t it just that they are doing something that I disagree with massively, but they’re putting themselves at risk and sort of non-buyer beware, as opposed to why would it not work for you personally.
Dr. Caitlin Rivers
Again, it comes back down to risk tolerance, I think I would feel, I would feel comfortable meeting with someone who is unvaccinated. But if you are someone who’s very cautious and you are not willing to do that, just to kind of support the idea that you can make those decisions for yourself and that, that I think that’s a reasonable option to put on the table. But if you are vaccinated, you are well protected against severe illness.
Dr. Bob Wachter
Yeah, it’s gonna be fascinating because it really is, in some ways, the COVID version of those political debates that we never want to have with families anymore. You know, I could see a lot of different versions of that this summer. Farzad, how do you approach this?
Dr. Farzad Mostashari
I think that it’s different than the political discussions, I think in the political discussions, people are so fixed in their opinions, whereas what I’m reading and hearing is that the hesitancy, which is, certainly can be wrapped up, right, and we have much more hesitancy in certain groups and others, but it is more malleable. And it is more something that can be affected by more information, and by open curious discussions. So I would encourage people to have those discussions with their loved ones, with their friends. And I think we really want to; we really want to continue to encourage everybody and not give up on anybody and continue to influence where we can. But you know, we’ve all said it, the risk is to them, it’s not to assuming that we’re fully vaccinated, not vulnerable, it’s, it’s not to us, the risk is to them.
Dr. Bob Wachter 26:02
So you let them come, that’s okay?
Dr. Farzad Mostashari
I would let them come. And I would say, but you have to listen to me for 15-minutes
Dr. Bob Wachter
That might be enough to dissuade them from coming. Caitlin, what do you think?
Dr. Caitlin Rivers
I think too part of my thinking is that we’ve all spent 15 months doing this high dimensional chess game, I’ve always assessing like, what’s our risk? How do I account for the fact that I’m my grandmother’s caretaker or that I have a kid with an underlying health condition. And so even if the data supports that you can meet with someone who’s unvaccinated. And if you’re protected, you’re at low risk of severe illness. I do want to give a little grace to people who are transitioning into kind of feeling comfortable with these interactions again, and I think that’s why I’m saying if you decide that you’re not up for that, that seems okay. After this horrible year class.
Dr. Bob Wachter
Okay, we have a 9-year-old in Minnesota.
Speaker 5
I’m really looking forward to going to water parks with my friends. Can we do that?
Dr. Bob Wachter
And maybe extend that to pools and other swimming facilities. So, Caitlin?
Dr. Caitlin Rivers
Yeah, I think swimming is great, particularly if it’s outdoors. If you’re a kid or you’re on vaccine, I would be careful in the locker room, but I think it’s a go.
Dr. Bob Wachter
Okay. Farzad?
Dr. Farzad Mostashari
As an epidemiologist who investigated foodborne, waterborne, fecal oral transmission outbreaks, I would say absolutely avoid waterparks not because of the COVID. But just because it’s gross.
Dr. Bob Wachter
That’s too grumpy an answer. We can’t live with that. From the COVID standpoint though, you’re good with this?
Dr. Farzad Mostashari
From COVID is fine.
Dr. Bob Wachter
It’s the rest of the stuff. Okay.
Dr. Bob Wachter
Now, let’s get into camps. Big question. So, Danielle, Susan and Shana Bass, I’ve sort of blended together their questions. So it’s got a bunch of bullet points. So bear with me for a second. I’ve kept my three- and eight-year-olds home with me all school year, and I really want to be able to send them to day camp safely by the summer all adults in our household will be fully vaccinated. So I’m mainly worried about risk to the kids themselves. And so this is a day camp question but also may be extended to sleepway. Are infectious disease experts sending their kids to day camp? Many camps have indoor lunch and snack. Is that okay? Is it okay for the kids to eat together in an air-conditioned room without a filter?
Dr. Bob Wachter 28:32
And one of them says, quote, or parentheses. I might be that mom that offers to buy a heppa filter for the room, that mom, I have not spoken to a camp that has any strategy for testing. Should this be a deal breaker? And should all summer camps require masks? So that’s a lot to absorb. But why don’t you just sort of run with the issue of camps and our camp safe? And what should camps be doing? And what should parents be thinking when they think about sending their kids to camp? Caitlin, where do you start?
Dr. Caitlin Rivers
I think camps are reasonable. I think it looks a lot like school except more outdoors, which is going to be safer. The indoor eating doesn’t bring me joy. I do wish they would move that outside. But beyond that I think camps are really reasonable to consider. My kids are in childcare. And I think that’s, I think that’s something that we can look forward to this summer. Starting to get the kids back to have a little bit of a normal routine.
Dr. Bob Wachter
And no testing is okay for you?
Dr. Caitlin Rivers
I would like to see testing anywhere that children congregate. But that’s not going to be a reality in most places. So I think if it’s a deal breaker, that it’s going to be a universal deal breaker. I’m comfortable going forward without testing but I would like that to be in place for schools in the fall, particularly for younger children who won’t be vaccinated
Dr. Bob Wachter
Farzad, how about you?
Dr. Farzad Mostashari
I’m going to be I’m going to be more on the looser end on this one too. I think during this spring when people have not been fully vaccinated, where there are other adults, were there who haven’t been able to get the vaccine are not fully vaccinated, then we should be doing All the things that we’ve been talking about moving lunches outdoors having kids mask, but once we get to the point where everyone who that kid could come into contact with who was wanted to get the vaccine has been fully vaccinated, the risk to the kids is, you know, not any more then it would have been in a previous year with flu. So I am going to, I’m going to stick with my answer, which is, once we get to the stage that hopefully the summer where we have broad and penetration of full immunization of all the vulnerable adults who we can get, then I think the kids can enjoy themselves in summer camp.
Dr. Bob Wachter 30:43
I spoke to Paul Offit last week, and he said he’s more scared when he thinks about the kids. He’s more scared about the multi system inflammatory syndrome that some of them get than he is about a bad thing happening from COVID. Sort of that may be a bias from working in a children’s hospital and seeing what happens with those kids. Does that change your thinking at all about the risk to kids?
Dr. Farzad Mostashari
It’s pretty rare, I guess I would say and there are postinfectious syndromes with influenza and a bunch of other, you know, diseases that we again, Have been taking for granted. Maybe we shouldn’t have, but it is no worse than what it was before.
Dr. Bob Wachter
Yeah, this whole flu thing is very interesting, because sometimes the social scientists called these reveal preferences that we all say, we’re not going to do anything that causes any risk to us. And then we look at how we live with the flu. And we don’t wear masks and we tolerate 30,000 deaths a year. So that’s sort of where you’re going that when it’s as safe as the flu. Why would we take extra precautions now when we don’t with flu? Jacqueline asks, “Are there any extra precautions pregnant people should take when it comes to summer fun?”
Dr. Caitlin Rivers
I do think pregnancy is considered a risk factor for severe illness. And I think pregnancy in general is a time when people are a little bit more willing to be cautious. And so I would be more likely to stick with the masks and prefer outdoors over indoors, get vaccinated. But in general, I think that it’s a lot of the same decisions that we’ve been living with over the last year in terms of keeping ourselves safe.
Dr. Farzad Mostashari 32:16
While I do not know what the evidence is in terms of vaccine efficacy and pregnant women in the trials, I don’t know if they had enough, or we’ve had enough real-world experience to have any evidence for that. I do want to make it absolutely clear. Pregnant women should get the vaccine. Right? There’s no like no one is saying that it’s a contraindication. And if anything, the sooner you get the vaccine, the more likely you are to be able to pass protective antibodies to your baby when they’re born. So I just want to be really clear on that point, that the absolute most likely thing based on everything we know about immunology and vaccines is that pregnant women are going to be protected as well. And there’s no reason for them, if anything, like they are at high risk of having complications of COVID. And it makes it doubly important for them to get the vaccine.
Dr. Bob Wachter
Yes, that’s really an important point. Christina asks a version of the question we talked about before, which is comfort level asking people about their vaccine status. She says I’m planning a small family only outdoor wedding this summer, congratulations to you. Or maybe it’s a family member. I know at least two of my adult family members will not get vaccinated there will also be unvaccinated kids there. I’ve been asked if we will request that only vaccinated people attend.
Dr. Bob Wachter
Part of me would be more comfortable knowing all the adults are vaccinated and part of me thinks well, this is why I got vaccinated to be around people who aren’t. What do you advise? So a little bit of a version of the question we talked about before, but this is now like on the wedding invites. Do you think about establishing you know, we had Art Caplan on the show talking about immunity or vaccine passports or vaccine authentication? What do you think about people doing that in their own personal lives? And in this example, for a wedding? Caitlin, what do you think?
Dr. Caitlin Rivers 34:11
This is a tough one, because it’s a special occasion. And so you don’t want to exclude people you love and most people are vaccinated. So in general, I think that I would not require vaccination if all but two adults are vaccinated. But I would probably stress about it to be honest, particularly because there are also children there who presumably you won’t be vaccinated and don’t have the same choice that the adults do to protect themselves. So I don’t blame you for being concerned about it, dear writer, but I think I would go ahead and allow them to attend.
Dr. Bob Wachter
Okay. Farzad, what do you think?
Dr. Farzad Mostashari
Same.
Dr. Bob Wachter
Same thing. Okay. One more scenario. John asks, “How does the panel feel about outdoor concerts or music festivals this summer?” I’m guessing you feeling pretty good about those. They seem pretty benign. But how about indoor, add that to it to make it a little bit more complicated. Farzad, what do you think?
Dr. Farzad Mostashari
Assuming you are fully vaccinated, I don’t know if we’re finding different ways of saying this, enjoy yourself.
Dr. Bob Wachter
Okay. And indoor shoulder to shoulder with 2000-5000 people you don’t know. Sweating, yelling, jumping up and down, mosh pit. I didn’t know what a mosh pit is. You’re comfortable with all this stuff?
Dr. Farzad Mostashari
Well, I mean, would I want to have 1000 people share? It’s pretty much the highest risk thing that you just laid out, right? Cramped indoor space. People maybe who possibly have to shout.
Dr. Bob Wachter
These are not random questions, by the way. I do this to push you. Yes.
Dr. Farzad Mostashari
Yeah. People who have to shout, there’s maybe some alcohol involved. There’s like screaming and singing, right? That is like, the most dense cloud formation. Look, I think at that point I would say, well, there are limits, Bob. Even if even if the vaccine protects you against severe illness, you can still get it, and this is like the perfect petri dish for getting it and okay, I won’t be hospitalized on the certainly. But I could get sick with it. So I wouldn’t do that. You found my limit. That is, it’s a personal decision. And if you’re someone who’s like their life is to go in mosh pits. And that matters to them so much, then okay.
Dr. Bob Wachter 36:32
So if you’re really a mosh pit person, then maybe and part of the answer, I’m pushing you a little bit, but I personally have this mindset that maybe it’s overly conservative, that I’m fully vaccinated, but I still don’t really want to get COVID because I still can’t say with 100% certainty, that there’s no chance of some long COVID or something that I will turn out to have regretted. And that colors my thinking a little bit in terms of really risky situations. Is that fair? Or is that over-the-top conservative?
Dr. Farzad Mostashari
No, I think that’s fair. And again, every person draws their line.
Dr. Bob Wachter
Yeah. All right, Caitlin, what do you think about the concert?
Dr. Caitlin Rivers
I agree, outdoor activities, go for it. Indoors, I’m not doing that, that does not sound like something that is safe or enjoyable from my perspective. I agree with Farzad that if you have been waiting this entire pandemic to get back to your mosh pit, once you’re fully vaccinated seems like it’s as good as it’s gonna get, at least until we bring incidents way down. But it’s still that’s a risky situation on the spectrum of activities.
Dr. Bob Wachter
Alright, as we try to calibrate sort of where our limits are, so non mosh pit, but trying to decide going to a crowded bar this summer, that’s going to be front of mind for a lot of people, tons of people in the bar standing around, probably some shouting and hooting, and whatever happens in bars, we none of us have been to one for a long time. I don’t know if anybody has been vaccinated around me, do you? Or Caitlin, are you going into a crowded bar this summer?
Dr. Caitlin Rivers 38:01
You know, it’s easy for me to decide not to do those activities, because they don’t hold much draw for me anyways. And so just I’m going to avoid them, because it doesn’t bother me to not. And I don’t want to take a chance for something I’m not passionate about.
Dr. Bob Wachter
Okay. And Farzad I know you are passionate about being a crowded bar. What do you think?
Dr. Farzad Mostashari
I think it depends on the community incidence; I’m going to take that out. Right? If it’s, you know, we’re having really high rates of community incidents of COVID. In the people we’re likely to be in that bar, then I wouldn’t, because of the small bit of lingering concern that I personally would have. But I think that’s part of the risk calculus.
Dr. Bob Wachter
Yeah, we haven’t spoken that much about community prevalence. But your willingness to go to a bar, or even the mosh pit is probably predicated, at least in part, if you’re in San Francisco with a .7% test positivity rate, it’s very different than if you’re in Detroit. And so you really have to pay a lot of attention to what’s going on in your community as you make these sort of borderline if it’s a clear call to clear call, but on these borderline calls, looking at your community prevalence rate is a really smart thing to do. Last question, this is from Rebecca, and I’m gonna throw this to you first, Caitlin, because apparently you fielded a question that was similar to this in the very first Safe or not Safe episode, you know, many, many months ago.
Dr. Bob Wachter
And I’m glad Rebecca asked this because I’m sure this is front of mind for a lot of people as it should be. “I’m fully vaccinated, and I want to start going out on dates this summer. How safe is an outdoor date and indoor date, kissing someone vaccinated? Kissing someone unvaccinated? And without putting too fine a point on it, maybe go even beyond kissing in terms of other things that romantically involved people sometimes want to do. Caitlin, why don’t you go ahead and take that.
Dr. Caitlin Rivers
I think once you’re fully vaccinated, it’s safe to get back out there. Ideally, the other people or person will be fully vaccinated as well. But at that point, it becomes a matter of their, the risk to their health. And so I think, I think in terms of your own personal perspective, you’re well protected against severe illness and ready to socialize again.
Dr. Farzad Mostashari 40:17
I wonder if profiles are not going to say no smokers and unvaccinated.
Dr. Bob Wachter
I think they’re already beginning to say that. I think they’re getting to ad vaccine status. I bet we joke about it. But would you say the same thing if you knew your partner was unvaccinated kind of intimate activity with an unvaccinated person? After what we just talked about the mosh pits and the bars and being a tiny bit uncomfortable in super close circumstances with somebody with people you don’t know whether they vaccinate, what if you knew your partner was on vaccine? First of all, you might have some questions about […] their judgment that’s an important point. But let’s say you get beyond that, does your answer change if you knew they were unvaccinated?
Dr. Caitlin Rivers
They’re probably they’re not going to get sick from you. It’s very unlikely, right? Because you’re vaccinated. And so from that perspective, it’s quite safe. Would I go on a date to a mosh pit bar? Probably not because they’re vulnerable. But in general, I think that’s pretty safe.
Dr. Bob Wachter
So now we’ve conflated everything, it’s now become a date to a mosh pit bar. It’s quite something, that’s quite a visual,
Dr. Farzad Mostashari
Maybe something more than kissing. The part of it that you would be preoccupied with is constantly worried, like, if you care about someone, you’re constantly worried about their safety. And it’s, I think it’s, it is hard, and I think it is inconsiderate for that person to be like, oh, well, you know, I don’t, you know, like, I don’t care. But that will have implications for you as their partner, if you can’t do things together that you want to do, or you wouldn’t want to do things together that you want to do, because they’re not getting vaccinated. So I think this is again, part of the opportunity for persuasion. And for them to realize like it’s affecting, not just them, but it also is affecting me because I care for you. And so it affects me, it’s a little bit different to me, then, if someone’s an unvaccinated stranger who chooses to come into, like my store or whatever, well, that’s on them. But for someone you care about it is going to affect how you as a couple can behave and the worries that you would have.
Dr. Bob Wachter 42:23
Yeah, and I always sort of move back, even though it largely is on them, there’s still this sort of lingering thing that I’m not completely free of risk of getting COVID even though I’m fully vaccinated, and so to some extent, it’s a statement about how they care about me too. So it is very tricky. Alright, I think we’ve gone through all the questions. The questions were terrific, as they always are. Any final comments that you guys want to make? As you’d now have reflected on some of these things or versions of the same scenario, but there were a couple of, you know, I pushed you hard to apologize. But I push too hard on some of these edge cases to try to figure out what are the limits of feeling good and ready for anything with vaccination. So any final reflections? You want to share? Maybe Caitlin, first?
Dr. Caitlin Rivers
Well, you raised the issue of the first in the bubble, which I think was the end of last summer. And it’s really amazing to think how far we’ve come in a sad way thinking how many people we’ve lost and how many difficult months we’ve endured. But it’s really great to be somewhere on the other side, maybe not on the finish line, but to be able to think about what you can do when you’re fully vaccinated and this community prevalence goes down. And so it’s been a very long year extended version. But I’m glad we’re getting to a better place.
Dr. Bob Wachter
Could you have dreamed when in the first episode that we would have more than half of the adults in the United States vaccinated at this point in 2021?
Dr. Caitlin Rivers
It’s incredible. And so in some cases, we face the worst-case situation with 250,000 cases reported every day at the height of the winter peak. That was much worse than I would have anticipated. But then the vaccine story is even better than I would have anticipated with such great coverage. Mass vaccination sites being stood up all over the country, incredible vaccine characteristics. There’s a lot of good news, but we’ve had hard times as well.
Dr. Bob Wachter 44:10
Yeah, that’s for sure. Farzad any last comments before I declare Caitlyn, the winner of the contest by the way. Go ahead.
Dr. Farzad Mostashari
You know, COVID has made a whole bunch of folks interested in public health, in Epidemiology, in outbreaks. And I think that’s a wonderful thing. And I think it’s also made people really confront how they think about risk. And all of these, these heuristics that we talked about, and, and the irrationality, frankly, that that we all feel, in some cases around the immediacy of the threat that we feel and how we take risks in some areas of our lives that are far out of proportion or the idea of, you know, I take the risk of driving cross country because I’m a good driver. I know that you know, but that feels like I’m in control.
Dr. Farzad Mostashari
And I hope that we can continue this sort of risk communication, public health risk communication around relative risks, and maybe each of us can think a little bit more rigorously around what are the things that we choose the risks that we choose to take the things that matter to us that we’re willing to take risks on. And what are the things that, you know, we don’t, we don’t need to take the risks on and maybe that does include coming back full circle to influenza and saying, gosh, maybe we shouldn’t be wearing masks, maybe 30,000 deaths a year isn’t acceptable. Why are we accepting that? You know, so to me, one of the, you know, I’m a silver lining kind of guy, but one of the silver linings of this has been more attention to, and perhaps a better awareness of how to think about risk. Well, that’s
Dr. Bob Wachter
Well, that’s a great note to end on. Because you guys have done an amazing job educating our listeners about how to think about risks all through this and I remember our last episode, where we talk about your vaccinated, what can you do, and it was really the first public discussion that gave people the license to think about their world differently. Well before the CDC came out, and I think I know from a lot of listeners, it was really important, they began doing some things they might not have done. Because once you’ve hunkered down for a year, it’s really pretty hard to unhunker, it’s not an easy thing to do cognitively and viscerally. So I am grateful to you for educating me and educating us. And it was a terrific segment. And I hope people have an absolutely wonderful summer now with a lot of freedoms that we all didn’t have several months ago. So thanks so much.
Dr. Caitlin Rivers 46:39
Is this it? Are you not inviting us back? It sounds like the end.
Dr. Farzad Mostashari
I hope, I hope we’re done.
Dr. Bob Wachter 46:45
I think we’ve got another segment in you. But it may very well be with that Slavitt guy who should resurfaces from the White House in about six weeks. So this may be my goodbye to you. But I think we’ll have you back again.
Dr. Farzad Mostashari
And before we’re done, Bob, there’s one thing you need to do.
Dr. Bob Wachter
What’s that?
Dr. Caitlin Rivers
Did I win or what?
Dr. Bob Wachter
I said, I said it goes without saying that Caitlin won. Sorry about that. Yeah, so the winner, of course is Caitlyn. Exactly. Great. Thank you so much.
Dr. Caitlin Rivers
Thank you.
Dr. Farzad Mostashari
Thank you.
Dr. Bob Wachter
Well, I hope you enjoyed that discussion as much as I did, and learn from it. There are a lot of situations that seem to have pretty much the same answer, which is we vaccinated, you’re safe and good to go? And if you’re not, you are not? Certainly if you needed any incentive for vaccination. I think you heard it, but I tried to push both of them on these. As Farzad called edge cases, were kind of it is reasonable to ask some questions about is this really safe enough? And is it really worth it? And I don’t know how many people are jumping into mosh pits or going into crowded bars. But you know, for stuff like that it is important for you to think hard about how, how important is the activity to you? Are you willing to accept even a small amount of risk and pay a lot of attention not just to whether or not you’re vaccinated, but to the level of virus in the community.
Dr. Bob Wachter
I think that came through. The other thing that came through is that we are going to face some of these tricky situations about friends and families and dates and loved ones and others who were choosing not to be vaccinated and how to approach those conversations and do it sensitively, but also make the choices that make the most sense for you and your family. I think it will be complex. I have to say that the pace with which we’re hearing about vaccine authentication, which is a you know from you’ll remember from our conversation with Art Caplan a few weeks ago, his preferred term over vaccine passports, the pace with which they are being instituted is surprising to me. I thought that’d be more political debate. Obviously, there is in certain states but and I thought it would take longer before we got to it.
Dr. Bob Wachter
But even today, here in San Francisco, the mayor announced that many, many things were would be opening up including conferences, and large indoor venues, but you would have to show proof of vaccination to go in. So it’s a it is definitely a thing. I wasn’t sure whether it would be and I thought if it was it would be much later so but how you deal with that on a personal level, including with friends and family is really fascinating. That was one of the, the things that struck me most in our conversation. We’ll have other great episodes coming up here on in the bubble, we’ll talk about the global COVID scene, including how vaccination is going with Nikki Laurie a world expert on pandemics both domestic and global. We talked a fair amount about the kids today and what they can do in summer, but we haven’t talked much about how the kids have hoped with the past year to 14 months and some of the lingering effects and how to talk to them about the pandemic as we move into this new phase.
Dr. Bob Wachter
So we will have a Toolkit on that. And finally, one of the things we also haven’t talked much about on in the bubble is the degree to which COVID like all pandemics and all cataclysms really tends to lead to transformation and often technological transformation and this one is no exception. We thought a lot about telemedicine and the growth of telemedicine, but it’s far deeper and broader than that the degree to which COVID has accelerated the digital transformation of medicine, which was underway anyway, but it’s going faster. Our guests will be John Halamka. John is leading the Mayo Clinic’s overall digital transformation efforts. He’s a fascinating guy who, while doing that also raises Alpaca on a farm outside of Boston. So I look forward to catching up with John. Lots of great stuff coming up on in the bubble. Until then, please get vaccinated Stay safe, and I look forward to talking to you soon.
CREDITS
We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced our show. Our mix is by Ivan Kuraev. Jessica Cordova Kramer and Stephanie Wittels Wachs executive produced the show. 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 @InTheBubblePod. Until next time, stay safe and stay sane. Thanks so much for listening.
