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In this episode, Chelsea speaks with epidemiologist Dr. Syra Madad to answer audience questions on the vaccine, the future of COVID spreading, and where we go from here.

What vaccinated people can do: https://www.belfercenter.org/publication/what-you-can-do-once-vaccinated

Risk reduction strategies: https://www.belfercenter.org/publication/keeping-safe-and-protecting-yourself-and-others-covid19

Effectiveness on masks: https://www.cdc.gov/mmwr/volumes/70/wr/mm7007e1.htm
https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00818
https://www.pnas.org/content/118/4/e2014564118

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Syra Madad on Twitter: https://twitter.com/syramadad
Syra Madad website: https://t.co/z0KGXIvnb2?amp=1

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Hello, everyone.

It is Chelsea from The Financial Confessions, founder and CEO of The Financial Diet, and person who is just generally very interested in talking about money. But unlike essentially every other episode, today we are not talking about money.

We are actually talking about public health and, more specifically, COVID-19 because I think any of us who live a decent part of our lives online, which is probably most of us at this point, feels like there is both an enormous amount of information and very little information that you feel you can completely understand or even, really, totally trust. A lot of us live in different realities when it comes to public health. We might have members of our own family who feel completely differently about this public health situation, who are seemingly operating with a completely different set of facts, and who are generally responding to this entire year and the year that lies ahead in a totally different way.

And with life changing so rapidly, here in New York City, people are getting vaccinated every day in astonishing numbers. I personally know many people who are either already vaccinated or getting vaccinated. As of today-- I'm recording this on March 4-- we feel like we're entering into a world that is, in some ways, much more exciting.

There seems to be more to do. Life will normalize. But we're really not sure of what the new normal is going to be.

We're not sure what the protocol is, what we should or shouldn't do. In some ways, when life was totally locked down here in New York, it was horrible. But at least you really felt like you understood it and there were clear parameters.

Now? Not so much. So we wanted to be part of the conversation around this topic that is fact based, that is based in expert answers and resources, and is easy for us to understand.

We want to be part of making the public health conversation a little bit better, even in our own small and usually financially-oriented way. So bear with us for a slightly different episode, but I think it's worth it. And you guys had quite a lot of questions for my guest.

So I do want to hop right into those and not take up any more of your time with this intro. So to get started, I'd love to introduce you to our guest today. She is an infectious disease epidemiologist.

And she is the Senior Director of the system-wide Special Pathogens Program at New York City Health and Hospitals, here in the city where I live. And she'll tell you a little bit more about what she does. But without further ado, here is Syra Madad.

Thanks for having me on. Thank you so much for being here. So first, before we get into it, can you tell our audience a little bit more about what you do and how you have been involved both with finding solutions to this pandemic and in more action-oriented and medically-oriented ways but also in more communication-oriented ways and improving and providing nuance to the public conversation around COVID-19?

Yeah, sure. So what I do is I deal with all different types of infectious diseases. And my specific specialty is special pathogens.

And when I talk about special pathogens, these are infectious diseases that are highly infectious in terms of they are more transmissible from person to person, associated with more morbidity and mortality, there may or may not be vaccines or therapeutics, can cause a lot of public fear and anxiety. So that's my specialty. But now, as we talk about in the context of COVID-19, the role that I play is multiple.

And the best way for me to explain that is, when you look at an emergency situation and you look at the different phases in an emergency, you are either in the preparedness phase in the response phase. And within the response phase, you have containment and mitigation. And then you have the recovery phase.

You can be in all different phases at once. And in fact, here in New York City, for example, we are in multiple different phases. And what I do as part of all the different phases.

And so when we talk about preparedness-- and what I mean by that is, what are we doing in terms of preparing for that fourth potential surge if we see it across the United States? So we're preparing for that. And there's a lot that's happening there.

We're also still in the middle of response. We're still responding to the contagion, which is sars-cov-2 in this instance. We're still battling thousands of cases.

Here in New York City we have about 3,000 new cases every single day of new infections. You still have hospitalizations ongoing. And so there's a lot to do on the health care and public health end on that.

We're also in the mitigation and containment. And what we're doing is-- I have a role within New York City Test and Trace Corp, which is the contact tracing workforce that we have in New York City. I'm the health and safety lead of the enhanced investigations unit.

And that's a huge part when we talk about public health and trying to box in the virus, so completely different in terms of what we're doing there. And then the road to recovery-- and what I mean by that is the COVID-19 vaccines and the vaccinations and the roll out campaign that is ongoing here, locally, statewide, and nationally. So I have a role in all of that.

It's a privilege. And it is an honor to work with amazing teams and people that are really fighting on the front lines and behind the scenes to contain this pandemic that we're in and to get on the road to recovery and to make sure that we are preventing new infections, we are responding to infections that are currently happening, and really just combating the communication and the misinformation and disinformation out there. So besides what I do at work in the day, if you will, at night, I try to go on shows like yours and others on the media to talk about what we're learning and how to communicate that best with the American people.

Because when you see these numbers on the media, you're just like, well, what does that mean? So I try to help talk about the nuances and what it really means to us on a day to day life and what we can do. And so I think a lot of us are involved in all of these different aspects of COVID-19 response.

As I mentioned in the intro, I think for a lot of people, and for our society in many ways, this pandemic has been kind of a breaking point in terms of, as I was mentioning, not just disagreeing about the world that we live in, but living in different worlds, living in worlds that have completely independent data sets and perspectives and understandings of reality. And I think for a lot of people, that has been the most difficult part of this, feeling that not only are we going through this profoundly difficult thing, but it's also been co-opted and politicized to an extent where you are now not only just talking about the pandemic, you're talking about all of these ideologies that have been projected onto it. And you're talking about these different realities that we're living in, where you can send someone a thoroughly vetted study or piece of research, and someone can refute it with something that may be either dubious or misleading or not true entirely.

So first of all, what has been your experience navigating those challenges on top of just the challenges of public information during a pandemic, but also for people who are going through this in their own lives, who have family members, friends, loved ones who might think COVID is a hoax or might think the vaccine is somehow malevolent? What are ways that you recommend improving that communication and getting closer to a shared reality? Yeah.

I think there's a few things. First, when we're in this particular situation, this COVID-19 pandemic, it's not just biological. It is very much political.

It's very much social. It's very much economical. It has affected every part of our life.

It has affected not only how we interact with people but how we live our day to day lives. And so it has a huge price tag on our mental, and social health, and our well-being, and everything like that, even, obviously, when we talk about from a finance standpoint. And I think when we talk about responding and what we're seeing in terms of communication, for me, in my particular experience, when we deal with infectious diseases like Ebola, like measles, like other vaccine-preventable diseases, we always see that we're combating two contagions-- the contagion itself, whatever the microbe that's causing the outbreak, and then the contagion of misinformation.

And so this is not something new. But in the COVID-19 pandemic, the contagion of misinformation, disinformation has been so widespread that it's been really difficult to try to keep up with the volume. And what bad information does is not only is it, obviously-- people are not only reading this, but it's actually putting them at increased risk of getting infected with COVID-19, hospitalization, and death.

In fact, there's documentation and research and studies that show that, for example, in the early days of this pandemic, in the first three months, you had thousands of people that were hospitalized because they put themselves at higher risk because of bad information that they read. Hundreds of people had died. And I'm sure that number, obviously, has quadrupled now a year out.

And so in our particular roles, whether you're in health care or public health, the way that we look at addressing bad information and making sure people have the right information to make informed decisions is a grassroots level. And it's not one size fits all. And it's not just one thing.

When we talk about addressing COVID-19 and providing good communication, it happens through all different channels. It happens to all different pathways. There is no silver bullet or a single thing that's going to magically turn people into knowing, OK, this is what's true.

This is what's false. And so with that particular approach, A, you need individuals that are competent and are good science communicators that can go in the community and talk to people. And this is not just from a health care approach.

You don't just need to have doctors and nurses. It could be your religious leader. It could be somebody in your household.

A lot of times, it's that around-the-kitchen-table conversation that oftentimes has the most impact. And one of the things that we try to do, one of the programs that I launched, at least here in our health care system, New York City, is be a COVID-19 vaccine champion. And what that is we are harvesting that and empowering people to be ambassadors of the COVID-19 vaccine.

And so we are giving them all the knowledge and information that they need to talk about the vaccines. And then communication strategies-- because it's not just as easy as, OK, let me talk to you about the COVID-19 vaccine. There are certain phrases and words that you should choose.

There are certain ways to approach the conversation. For example, storytelling is much more compelling than saying, hey, I heard about X, Y, and Z. And so we're providing a lot of this information and educating this workforce of ambassadors that could then go out in the community, whether, again, it's around the kitchen table or going to your religious institution or talking with your health care provider to get that information.

The one thing that I'll also mention is that the COVID-19 vaccine, for example, is an evergreen offer. And what I mean by that is that we know that we want you to get the COVID-19 vaccine today. But we also understand that people may not feel comfortable getting it right away, and they want to have more information.

They have more questions. So we need to look at it as an evergreen offer, as we're going to continue to chip away at answering your questions and making sure that we're building confidence in the COVID-19 vaccine so that way, ultimately, you'll get the vaccine when you feel comfortable and you're informed, and we've answered a question. And I think that's the approach that we just need to continue to take, that we'll give them homework, we'll give them more bits of information to make sure that they're comfortable.

But we also know that we're still in a raging pandemic. And what I mean by that is, if you're looking at the cases, our seven day moving average in the United States in terms of new cases is about 66,000 new cases a day. That's still really high.

And in fact, while we were seeing a decreased number of cases generally, over the previous week, we've actually now seen an increase of about 3.5%. So we hit a plateau, and now we're increasing. That could be an artificiality in terms of the storms that we had and the lag in reporting.

But it doesn't seem, unfortunately, to be the case. And so what this means is that we need to continue to, A, stay informed with the best information, and continue to do the COVID-safe behaviors that we've been talking about, but also painting a picture and developing COVID optimism, knowing that we're going to be out of this soon. But this is not the time to let up and say, I'm done with the pandemic.

One of the things that I think makes misinformation, at least in our media ecosystem, thrive more easily and spread more easily is how bad the quote unquote "mainstream" or, in many cases, legitimate news sources are at reporting on medical news, and specifically when it comes to things like developing a vaccine, what it means for COVID to go away, or what we know versus what we don't know. And as a result, even today, I think people who are trying to hew closely toward legitimate, reputable, vetted news sources will often see headlines that are very scary or paint a very black and white picture. And then when you dig into it, you start to understand the nuance of it a little bit.

The day before I saw one that was talking about, I think, the World Health Organization saying that it's very unrealistic or not likely that COVID will be stopped this year. And it was this very clunky language. And of course, when you dig into it, that doesn't at all mean that it's not going to be drastically reduced in countries like ours, et cetera.

But it goes to show that even good media is really bad, sometimes, at reporting on these developments. So how can someone create a more healthy news consumption diet and routine, even using these more legitimate news sources? Yeah.

I think the best way is small snippets. If you're giving individual numbers as you're watching the media and they're seeing 72% efficacious or they're saying 94%, 95%, don't know what those numbers mean. And they don't, maybe, know what-- we talk about efficacious versus effective, variant of concern versus variant under investigation.

These are all new terms. And to distill that down to, what does that mean to me and how does that impact me and what do I need to do? That's the bottom line.

And that is where we need to just make sure that we're providing this information that is based on good health literacy. Not everybody, obviously, understands public health and health care the way that many of us in this field that are scientists understand. And oftentimes, I will be honest, we struggle with communicating effectively in a way that people would understand best because we're just so used to the medical jargon and the terminology that we often forget that when we say B117 and they're looking at you like, what are you talking about?

And when you say the UK variant, they're like, OK, I understand that. But as a scientist, I don't feel comfortable saying UK variant because I don't want to implicate any geographical location in a sense. So I prefer saying B117.

And so it's hard when we talk about the communication of it. But that is where you need individuals that, A, are versed and good communication that can provide this information in snippets and bit-sized information in a way that people understand-- what is the outcome? What does that mean to me?

So when I hear of these variants of concern of B117, of the P1 and the P2, of the B.1427, all these different things. What does that mean? And how does that impact me?

And so the way that I try to approach it is that we say, we have variants of concern. But what this means is that the vaccines we have are still highly effective. And when you look at the vaccines, our ultimate goal is to make sure we're keeping you out of the hospital.

We're keeping you from preventing severe disease and death. And if you look at it from that standpoint, all the vaccines offer really, really great protection. So get whatever vaccine is offered to you first.

And yes, the variants are concerning. But what that means is, A, get vaccinated when it's your turn. And then B, continue to do the COVID-safe behaviors and double down on it.

And when we say double down, when we're saying wearing a mask, that's such an effective way. But also look at how you can improve your mask through fit and filtration. If you're going to be doing something indoors with individuals, try to get a higher quality mask versus, if you're going outside outdoors, you can maybe wear a cloth mask and not have to double mask.

And so talking about it in the terms that what that means to them and what they can do, that is where we want to make sure we're providing more of that information. And certainly, continue to go to trusted sources like the CDC, like the FDA, things like that that are providing much more information that is scientific and some of the research that goes behind it. So we gathered quite a lot of questions from our audience.

We may not have time to get to all of them, but I'd love to run some of these by you. So one is, once you get a Pfizer or Moderna vaccine, can you still get the Johnson & Johnson one in the future if we're going to have to be getting new vaccines every year? Or do you have to stick with the kind of vaccine you got the first time?

So if this is your first serious-- for example, if you're getting the COVID-19 vaccine and you're getting either the Moderna or the Pfizer, you're going to continue to stick with what you have. So if you're getting the two doses of the Moderna, you're going to continue to stick with that particular vaccine. The J&J is just one dose.

And so if the question, if I understand it correctly-- do they need to repeat the series? That's not the case right now. What public health is mentioning in terms of guidance is, once you get your full dose, whether it's the two dose or the one dose, you're good.

And then if we need to have a booster shot, a lot of these companies are developing booster shots. And more information to come on that. But there is no changing of, OK, well, I got the Moderna the first time.

Maybe I want to get the Pfizer for my second dose. That's not the case right now. OK.

In terms of the booster-- so if we're talking about the booster-- so if you got the Moderna and now the Moderna is offering you a booster, that information is going to continue to come out in terms of, if I got the Moderna of the first time and now I'm up for a booster, right now, these booster shots are not available. There's a lot of research being done. And once that's available, you'll have an advisory committee that will talk through what the appropriate administration and distribution looks like, who would qualify, things like that.

So it's a little bit too early to say, if you've got the Moderna, you can only get the Moderna. So I think more information will come out on that through the various advisory committees that have been established and the process that we have for making these recommendations. So someone says, one thing that I keep hearing from people who aren't sure about getting the vaccine is that it was developed so quickly and it hasn't been tested for long.

So what can I say to reassure people that it is safe to take and that there won't be any scary, long-term side effects? Yeah. So A, I think the first is, this is communication.

And this is actually one of the things that we've been teaching on. And so the best way to talk about-- when you hear a question like that or a myth or information that you need address, think of the sandwich approach. And what I mean of the sandwich approach is, you have the top layer, you have the middle layer, and then you have the bottom layer.

And based on studies, people tend to remember what they hear first and what they hear last. And that's their takeaway. So when you're addressing a question like that, start off with something positive.

And so right now we have three highly efficacious and safe COVID-19 vaccines that have been developed in the United States. Millions of people have received the vaccine. Millions of people will continue to receive the COVID-19 vaccine.

Then start with addressing what they had mentioned. And in terms of the speed in which these COVID-19 vaccines have been developed, certainly, if you compare it to the process that other vaccines have gone through-- the shortest time frame has been four years. If you look at how COVID-19 vaccines were developed-- and then you can talk about the way that has been accelerated.

And this includes, A, no safety measures were cut. When we talk about the process of developing the COVID-19 vaccines, you saw the clinical trials that were done concurrently. So all of the trials were done.

The phases where done-- they're doing concurrently. Financial support was given to the pharmaceutical companies to basically take out the risk of it and take out the downtime. And then on top of that, the manufacturing of the COVID-19 vaccines were-- basically, it was happening during the time of the clinical trials.

And so they were building and developing the vaccines. And so by the time that they get authorized, you already have that stockpile available that could then go out to the states. And that's usually not the normal process.

But that is how we were able to accelerate the time frame. On top of that, when we look at, for example, the mRNA vaccines, there was decades and years of research that had been done to develop that prototype. So this is not something where we're completely new.

Certainly this is the first time we are using a mRNA-based vaccine. But if you look at how long the research has been done on it, it's been done for over years. And actually, on that note, can you talk a little bit about how mRNA vaccines are going to be used for other infectious diseases, for people who want to learn more about what it really means to be an mRNA vaccine versus other types and where the future is headed with those?

So the mRNA platform is amazing because it could be a plug-and-play model. And what I mean by that is, you have this template, and now you can use this mRNA-based platform to essentially look at other infectious diseases. And right now, the big news this week for example, is-- we look at malaria.

Malaria is an infectious disease that causes hundreds of thousands of people that get infected every year and thousands of people that still die. And now if you-- you can use this particular platform to now develop a malaria-based vaccine by looking at the gene sequence, inserting it, and then having that as a vehicle. And so we certainly have now reached a point where the field of vaccinology and these platforms have been revolutionized because of these mRNA-based platforms.

So it's really exciting to see that not only have right now the COVID-19 vaccines that we have-- not only is it a huge scientific achievement, but we know that this is going to carry on for all different infectious diseases as we move forward. And so I certainly am really excited about that. I think that also helps people in communicating about it because then it becomes about so much more than just this very politically polarized pandemic.

Yeah, no. Absolutely. Absolutely.

Someone says, what will our summer look like, let's just say here in America? And then, what about life going forward? What is the actual timeline for getting back to "normal?" So when we first talk about a timeline, I think, first, it's really good not to go by a date-based approach like, by July 1, things are going to go back to normal.

It's more about the data. So we want to follow the data. But with that said, if we look at current trajectory, if we look at how many vaccines have been administered-- and right now, in the United States, we're administering about two million doses per day.

About 80 million doses have already been administered so far. And about 60% of the US population has received at least one dose. Or if you look at it in even simpler terms, at least 1 in 10 Americans have received at least one dose of the COVID-19 vaccine.

Really amazing news. And you're going to continue to see millions of more people that will continue to get vaccinated, especially now that we have three vaccines. So that's going to increase our supply.

But when we talk about-- there's two ways to look at it. So when we talk about returning back to normal, there's a difference. What do we mean by normal?

Are we talking about going back to complete pre-COVID-19 days? Or are we talking about lessening of the restrictions that we have, like not wearing a mask and not having to physically distance and things like that? And so the best way to look at it is through a phased approach.

So phase one, phase two, phase three. And the way that I-- the best way for me to explain it is phase one is at the local level, within your city, maybe within your family, within your bubble. How many people have been vaccinated?

And as the number of people within your own bubble, within your own city continues to increase, you'll probably start seeing some loosening of restrictions at the community level or at the policy level within the community, meaning that the mayor or the governor will say, OK, you know what? We can increase restaurant capacity from 50% to 75% or 100%, things like that. And also, knowing that you have more vaccinated people within your bubble, you feel more comfortable to now see individuals indoors without a mask, not having to physically distance among other vaccinated people.

So that's phase one. Phase two now is at the state level and at the national level. So state-wise, how many people have been vaccinated?

And then nationally, again, how many people have been vaccinated? And when can we see some loosening of these restrictions? And that will, again, depend on the data.

How many people have been affected? And how many infections that we've had prior in the community to get to a level of that herd immunity that we're looking for on top of seeing the reduction in the number of total cases? And so if we're seeing less number of cases on a daily basis, we're seeing less impact to hospitals, you'll start seeing some loosening of restrictions.

And then the third and the final phase is at the international level. And as you can imagine, that's going to take a much longer time because, obviously, we have multiple different countries. And only a little over 100 countries have started their COVID-19 vaccine program.

So a large majority have not. It's going to take time for the rest of the world to be able to get to a point where you're not seeing widespread community transmission of COVID-19, you're not seeing severe disease and things like that. So we're going to take it bit by bit.

And certainly, if you overlay the first phase that I've mentioned in terms of when can we reach that first phase, some families have already reached that phase one. So if you're in a family where individuals have fully got vaccinated because they're health care workers or in a family that are high risk-- like for me, for example, my mother-in-law has been vaccinated. I've been vaccinated.

My parents have been vaccinated. I'm actually finally going to go see them this Friday. Tomorrow, actually, I'm going to drive up to Maryland to see my parents indoors after a really, really long time.

And for me, that's obviously going back to some form of normalcy. But it's going to take time. And the two things we're going to look at is, A, how many people are vaccinated?

And then B, looking at the community transmission happening. How many new cases are there? How many deaths are happening?

Things like that. So all those things are some metrics that we're going to continue to look at. Fellow Marylander.

I'm from Annapolis. Oh yeah. Yeah.

OK. Staying on the human level though, using yourself as an example-- because I feel like it's very hard for people to think in terms of these big phases, which have all these nuances and asterisks. So using yourself as an example-- so you're vaccinated.

The people you're going to see are vaccinated. Are you going to be indoors without a mask with them? Yeah.

I am. I'm looking forward to hugging and kissing my dad. We're fully vaccinated.

And we've waited the 14-day period. So we're all fully vaccinated. We waited that 14-day period.

And now I am comfortable enough to go indoors, see them without physical distancing and the public health measures. Now, I think it's important-- again, this is where nuance comes. The risk is never going to be zero.

But it's reduced enough to know that it's not going to cause, potentially, severe disease, hospitalization, and death, which is really the worst outcome in this particular situation that we're in this pandemic. And so that risk is almost eliminated if you're looking at the vaccines. So if you're looking at Pfizer, Moderna, and the J&J, they're 100% effective in preventing severe disease, 100% effective in terms of requiring hospitalization, medical support, and death.

But certainly, there may be a risk involved in terms of transmitting the disease. You can still potentially be infectious. But even then, the data is so compelling now.

If you're looking at the data in terms of individuals that have been vaccinated and their chances of transmitting the disease-- so getting infected and then transmitting it to others-- there's really promising data to show that that's been reduced significantly. And so there's more information that's going to come out on that shortly. So using other examples that people might be thinking about-- so you're fully vaccinated.

Would you eat at a restaurant, indoors or outdoors? So right now, the setting that I'm looking at is more of a privacy setting. So as soon as you start going to a public setting where-- for example, is it OK for individuals to do barhopping or go inside a restaurant with individuals now that are unvaccinated?

That's when you want to continue to abide by all the public health precautions. You want to continue to wear a mask. You want to continue to distance.

You want to continue to be vigilant about risk because now you're among the unvaccinated as well. It's one thing when you're in a private setting among all vaccinated people. It's another thing when you're among a public setting-- or even a private setting-- with unvaccinated people.

So if you're with anybody that's unvaccinated, you want to continue to wear a mask, physically distance, and continue to do the risk reduction approaches that have been discussed. And so for people who are looking to embrace a risk reduction model, especially this summer, what clarity can you give us on the relative safety of outdoor versus indoor activities? For example, people looking to meet up at a restaurant sitting outdoor on a patio versus sitting inside the restaurant-- what is the risk reduction nuance there?

Yeah. So when we talk about risk reduction, the nature of COVID-19-- and we talk about transmission and infection. It's all about risk reduction.

There's no one strategy that is 100% foolproof. And masks are really, really effective. And that's probably the closest you'll get.

But it's not just wearing a mask. It's doing other strategies to-- and you want to layer on these measures because the more you layer on in your pile of prevention, the lower the risk of getting infected with COVID-19. And what I'll do, actually, is I'm going to send you two infographics that I've developed, one that talks about all the different measures in terms of the risk reduction.

And then I actually have a new publication coming out today at Harvard that talks about, what can vaccinating people do, and then what can unvaccinated with vaccinated people do? And it's very simple. And it gets to that communication that we're talking about.

So I'll share that with you. But getting on the point with risk reduction and the measures to take-- A, if you are doing things indoors, we know that is much higher risk versus doing anything outdoors. Outdoors, you have obviously better ventilation, better air flow.

We have more space for viral particles to spread out. And so we often talk about, in the lens of risk reduction, the three Cs, and avoid the three Cs. And this is an approach that Japan took very early on.

And their science communication has been so amazing because it's preventing that cluster-based approach. And we talk about avoiding the three Cs, this is avoiding crowded spaces, close contact settings, and confined, enclosed spaces. And if you layer that on with indoor versus outdoor, if you're going to do things indoors, you want to avoid the three Cs.

You want to have lower number of people, you want to have better ventilation, opening the doors and the windows, and avoiding small spaces, generally. And then obviously, if you do that outdoors, you're having a much better space. It's not in a confined space.

But you want to continue to lower the number of people that you're interacting with. So outdoors, obviously, is much, much better. And in fact, if you're looking at the data, you're seeing that outdoors versus indoors is 20% less riskier in that sense in terms of transmission of COVID-19.

And what would you recommend saying to someone who believes that masks are not effective, or even that they might be harmful? So when you hear and you-- when you hear something like that and you think that that's true, A, you want to follow the science. Everything that we are doing is based on science.

It's based on evidence. It's one thing if you have your own opinion. But it's another thing if it's based on facts.

Everybody's entitled to their own opinion. No one is entitled to their own facts. So A, you want to go with where the facts are, where there's evidence and science that backs it.

And now we have so much amazing information that clearly shows the effectiveness of masks. And not just any mask-- so not all masks are created equal. It actually shows what masks provide you better protection.

And that's where CDC has now come out recently saying, better masks. And how do you achieve better masks? It could be the double masking strategy.

It could be that knot and tuck. It could be the brace or the mask fitter. So these are different ways to achieve better mask and having a higher quality.

And we talk about wearing a better mask in terms of fit and filtration. And so the other thing to layer on when it comes to mask is, what mask are you wearing indoors versus outdoors? So indoors-- if you're in a higher risk setting, wear a better mask like a KN-95 or an N95.

If you're doing it outdoors for example, you can wear a cloth mask because of the risk of transmission. But I think bottom line is, masks work. Follow the science.

Follow the data. Again, you may have your own opinion. But you want to follow what the scientific consensus is looking at.

Do you have specific data points or good articles or bits of research that are helpful to illustrating why masks are effective, how we know that? Oh, absolutely. There's so much.

Just go on the CDC website. They're constantly putting out some really amazing, compelling information. So the most recent one from two weeks ago shows you-- for example, when we talk about better masks, it talks about the efficacy of certain masks.

And then when you layer it on, for example, and you do some of these other strategies, how effective it is. So I'm happy to send you that link if you'd like to use it. Yeah, I think that'd be great.

So another question we have is-- that one you sort of answered. And we did talk about the different variants. We have someone also asking about the Brazil variant and their relationship to the vaccine.

And I believe your response was that we don't have complete information on them, but it seems as though they're largely similarly efficacious. Is that fair to say? So I think all the different COVID-19 vaccines have taken some form of a hit because of these variants.

And some variants have caused more reduction in neutralizing antibodies than others. But again, bottom line is, they're all so highly effective in preventing the worst outcome, which is severe disease leading to hospitalization, medical treatment, for example, and death. And so if you're looking at it, that's the statistic we want to worry about.

And certainly, when you're looking at the effectiveness and efficaciousness and the impact that these variants are having, that's where those pharmaceutical companies that are looking at potentially developing booster shots and when that may be administered. But I think, again, from a basic communication standpoint, all the vaccines that are currently authorized in the United States-- the three that we have are highly effective against the endpoint that we're trying to achieve here. Do you have any personal theories as to why we have now seen the cases plateauing after such a precipitous drop?

Well, right now the case of-- in fact, they were plateauing. But now, as I mentioned, they're increasing. So if you look at the data, there's a 3.5% increase from the previous week.

And so the reason, initially, that we were seeing the decline in cases is based on multiple different things. It's not just one thing. So A, obviously we started a vaccination program.

We have millions of more individuals that are either partially or fully vaccinated. You still obviously have community transmission, meaning that people are developing immunity through natural infection. You're also seeing that more people are abiding by public health measures.

And so you're seeing more mask wearing, being more vigilant. Also, the seasonality effect. You're seeing more people do things, for example, outdoors.

These are all different factors that are going into the decreased number of cases that we're seeing generally. But unfortunately, as I mentioned, we are now starting to see a slight uptick in the number of cases. And this could be because there has been a lag of reporting of new infections because of the winter storms.

Or it could also be-- and this is what we are seeing-- that cases are actually increasing because you're seeing, A-- right now, it's a bit too early-- but you're seeing governors obviously take off the restrictions, basically saying-- not having a mask mandate and things like that, which is very, very premature. And so I think as we have more data and we see more in terms of the averages, we're able to have a better picture of what's causing the overall increases of the variants. And that certainly is very concerning.

And we can have better communication on that means. But I think right now the bottom line is we need to continue to do what we've been doing because right now is no time to take our foot off the pedal-- off the brake. When can we expect to know if the vaccines are effective at preventing transmission of the virus?

We have some really, really amazing studies that actually are now showing that already. And we're having more and more studies that actually show just how effective the vaccines are in essentially reducing transmission of COVID-19. So it's one thing, obviously, to prevent severe disease, hospitalization, and death.

But we're also looking at-- there's growing evidence that many of these vaccines that we have-- you're able to shed less virus, and they're less contagious, for example, after exposure. So right now, for example-- and I'll talk about a couple of preliminary studies. So there's two preliminary studies from Israel that found a decline in the overall viral load after the Pfizer vaccine.

There was a pre-print from the AstraZeneca vaccine that showed there was a reduced positive test results by 67%. You're also seeing data from Moderna also suggesting reduced asymptomatic infection. And so these are all some really, really compelling data and studies that do show that there is a significant reduction in the overall transmission.

But more information is continuing to be gathered. And as that information is gathered, you'll see how that will potentially translate into a change in public policy. For sure.

Can we talk about what the studies do and don't research with regards to pregnancy? Can the FDA ever list the vaccine as safe for pregnant women? Or how does that work?

So I think on the note of individuals that are pregnant or those that are lactating, the clinical trials do not intentionally include those that are pregnant and those that are lactating. That's not to say that they did not get pregnant after enrollment. In fact, that is what has happened.

So if you actually look at the Pfizer, the Moderna, and the J&J, after enrollment, some women did actually get pregnant. And in terms of any adverse effects, no adverse effects were reported on that end. These companies have also done DART studies.

These are developmental and toxicity studies that were done early on in animal models that also showed that there was no impact or adverse effect on the mother and the child. Pfizer recently announced within the last two weeks that they're actually starting trials on pregnant women to look at the immunogenicity of the COVID-19 vaccine. But right now, what we have with these three currently authorized COVID-19 vaccines-- you have various agencies that have come out like ACOG, and FDA, and CDC, and many others that have said that any woman that has offered a COVID-19 vaccines, certainly it should not be withheld from her.

It is her personal choice. I as a mother-- and I'm a lactating mother. I had my third child last-- one year now.

I went to work about a week after I delivered her. And I never looked back. It's been a crazy time.

But I still breastfeed. I got the COVID-19 vaccine because I looked at the risk benefit analysis. I also looked at my occupation putting myself at higher risk and things like that.

And so I decided to get the COVID-19 vaccine. I have colleagues that are pregnant. They also decided to get the COVID-19 vaccine based on their exposure, based on the risk and benefit analysis.

So certainly, more information is coming out. But this is a personal choice. And if there's any questions, certainly speak to your health care provider.

So we have a question about "long COVID" quote unquote. Do we have any more information about why people are experiencing such long lasting symptoms and why it's only happening to some people and not others? What do we know about it?

Yeah. So there's some really great research and studies that have been coming out that shed a little bit light on it. And so I would definitely first, A, encourage you to share that with your viewers to get more of a sense of what these studies are showing.

But I think just generally in a nutshell, we are seeing-- and this is really going to be the next epidemic as it relates to COVID-19-- is the folks that experience "long COVID." And essentially, now there there's an actual terminology for it. It's an actual condition. And you're seeing, unfortunately, a good number of people actually experience long COVID, meaning that they're still having signs and symptoms associated with COVID-19 even after the acute phase.

And this can last for three months, six months, nine months. And as more information is gathered-- obviously, we're only a year into this pandemic. You may even see that extend out.

And this is A, they're not only experiencing potentially cited symptoms like brain fog and fatigue and tiredness and having GI issues or they're just more sleepy, for example. But you're also seeing studies that it's putting them at higher risk for other health conditions. It's impacting the cardiovascular system, renal disease, lung disease, putting them at higher risk on that end.

And so there's a lot more information that is ongoing to show that full impact of long COVID. I think we're certainly in the right direction in terms of now actually recognizing that this is a condition. We can now work towards finding, A, better therapeutics for it.

We can research it more. We can investigate it more. We can follow up on these individuals to get a better sense of what this quality looks like.

And this could be due to a number of different reasons. And you're seeing, for example, this autoimmune component of the COVID-19 vaccine. You're seeing the remnants of the virus and what it can cause in the human body.

And so you're seeing so many different elements of it. But I think, right now, there's a lot more that's currently being investigated. But there's acknowledgment that this is certainly a serious condition and a serious thing that needs to be followed up.

Well, thank you so much for giving us your time. I know you're very, very busy right now, so we so appreciate it. And for all of you guys listening or watching on YouTube, we will be linking you to everything that Syra referenced with us today-- the infographics that she created, those articles, studies, et cetera.

So you guys can arm yourself with the facts and the data and make the right choices in this increasingly changing but pretty exciting landscape. Thank you so much for joining. It was a pleasure to talk to you.

My pleasure. Thanks for having me on. [MUSIC PLAYING]