State Epidemiologists On The Latest COVID-19 News, Including Approval For Vaccines In Children | New Hampshire Public Radio

State Epidemiologists On The Latest COVID-19 News, Including Approval For Vaccines In Children

May 12, 2021

Dr. Ben Chan at a press conference.
Credit Dan Tuohy; NHPR

New Hampshire’s top epidemiologists update us on the pandemic in our state, including the recent federal approval of the Pfizer vaccine for children ages twelve to fifteen, and whether the chance for herd immunity has slipped away.  

Producer's note: This conversation happened before the CDC changed it's guidelines to say fully vaccinated individuals do not need to wear masks or social distance. Click here to read Dr. Chan's statement about this news during the Governor's press conference on Thursday afternoon. 

Click here for all of NHPR's COVID-19 coverage. 

Air date: Thursday, May 13, 2021. 


GUESTS:

  • Dr. Benjamin Chan - State epidemiologist for New Hampshire.
  • Dr. Elizabeth Talbot - Deputy state epidemiologist and infectious disease specialist at Dartmouth-Hitchcock Medical Center.

This show was produced by Christina Phillips. 

 

 

Transcript:

This is a computer generated transcript, and may contain errors. It has been lightly edited for clarity. 

Laura Knoy:
So, Dr. Chan, younger teens are now eligible to get vaccinated. How major a development is this?

Dr. Chan:
This is really exciting news. As I'm sure many are aware, the FDA extended their emergency use authorization for the Pfizer vaccine to include people down to 12 years of age. The CDC, their advisory committee, met yesterday and voted to recommend use of this vaccine in people down to 12 years of age. And statewide vaccination is open for adolescents now. So we encourage everybody to go online vaccines.nh.gov And there's wide access to vaccine availability right now throughout the state. And we encourage everybody to sign up, including adolescents. People down to 12 years of age can now get the vaccine.

Laura Knoy:
And Dr. Chan, you know, if people do have problems registering. 2-1-1 right, that's where people can call if they do have, you know, just difficulty making those registrations happen. Dr. Talbott, how much of a dent could this make in the pandemic?

Dr. Talbot:
I think this is another important step toward getting back to some kind of normal or maybe we'll call it a new normal. So I think that this is going to help us to keep our schools functioning people. And we need our students in person. We need our teachers to be confident and certainly not risk getting disease. So for me, too, it's a very exciting announcement where we're getting closer and closer as our citizens take up vaccine and start to appreciate the benefits of being protected against this virus.

Laura Knoy:
So, Dr. Talbot, how was this approved for children so quickly?

Dr. Talbot:
The Pfizer biotech company has had this in their sights all along. So there has been some study, if you will, a small study smaller than the Phase three trial we've talked about in the past that was done in the older age cohorts that really looked to safety. So they were able to bring in about 2300 people in the right age group and watch them for efficacy. That is how well the vaccine works and also to see if there was any safety signal. So it was underway from very early days of our vaccine experience. And Moderna is going to follow suit there. They're also actively studying and Johnson and Johnson will come forward with announcements about safety in these younger age groups.

Laura Knoy:
So 2300, Dr. Talbot, doesn't sound like a lot. So is it that, you know, you can extrapolate for kids from those very large studies that were done for adults or how does that how does that work?

Dr. Talbot:
Yeah, that's right. Given the mechanism of this vaccine there, there is no intuitive reason to suspect there's anything unusual that that would happen in this age group. And all experts convened to suggest that this was an appropriate size for improving safety and similar efficacy as for older age cohorts. And there will also continue to be unprecedented scrutiny for any safety signal as this is rolled out, as there has been for the other approved vaccine.

Laura Knoy:
So speaking of vaccine safety for kids, here's an email, Dr. Chan, from Michael who says, Ask your guests what the percentage of children experiencing severe systemic adverse effects from the Pfizer vaccine in comparison to hospitalizations from covid in this age cohort. And Michael, thank you for writing in. And Dr. Chan, can you address this, please?

Dr. Chan:
Yeah. So the phase three clinical trials in this age group of the 12 to 15 year old showed a very, very low rate of serious adverse events. Less than half a percent of participants in this age group had any type of serious adverse event. And, you know, keep in mind, this was comparing also to placebo recipients in the clinical trials that that also had reported some, you know, serious adverse events. So there was no concerning patterns noted in the clinical trials.

Dr. Chan:
There were no specific types of adverse, serious adverse events that were noted to be more common in people who got the vaccine versus people who got the placebo. So we believe the risk is very, very low and the benefits for the individual or the community are are very high.

Dr. Chan:
So we continue to encourage and strongly recommend that, you know, even adolescents get the vaccine to protect themselves, to protect their families, to protect their communities.

Dr. Chan:
Relative to the second part of that question, the risk certainly of hospitalization and death in the younger age group is also, you know, very low. But it can occur. There have been reports nationwide, you know several hundreds to thousands of reports of multisystem inflammatory syndrome in children. So we know that this is a type of serious clinical syndrome that can occur in children.

Dr. Chan:
We know that even children can get infected and spread it to others. We know that children could be hospitalized. Thankfully, the numbers of those complications have been low. But this is important to protect the individual, the family, the community, and to to bring this pandemic to an end. It's important for everybody to get vaccinated, including younger age children. And I think Dr. Talbot wanted to follow that up with a comment as well.

Laura Knoy:
Yeah, go ahead. Dr. Talbot, I have heard of this multisystem inflammatory syndrome among teens and kids, and it's it's kind of terrifying. You spike these massive fevers and, you know, your organs are at risk.

Dr. Talbot:
That's true, that's relatively rare. Thank goodness.

Dr. Talbot:
I wanted to build a little bit on what Dr. Chan said too, in discussions I've had with parents of persons in this age group. I think that an underappreciated risk of getting covid itself is post acute covid syndrome, long covid. So even if you perceive your teen is is not at risk for hospitalization or death as much as older age cohort from covid, even if you have mild or even asymptomatic disease. Your child could could suffer from long covid or PACs, as it's now being called, and that is really concerning for, you know, as a parent myself, thinking about the predominant features of brain fog and fatigue and, you know, on a kind of sense of shortness of breath and other very real side effects. That's something I certainly want to avoid for my kids.

Laura Knoy:
Let's take a call. Michael, thank you for writing in. And Rob is calling from Nashua. Hi, Rob. You're on the exchange. Go ahead.

Caller:
Hello. So we've been talking about covid improvements on these shows for the last few weeks, and everyone keeps focusing on the decline of nuclease numbers since the 90s with the spread of the events of the holidays. But it occurs to me that we had a decrease in Lukasz numbers last year as well as the virus seems to be seasonally affected. But year to year, date for date, there are twice as many new cases today than there were last year at this time, and that was three a month ago, both nationally and in New Hampshire. So I'm curious about where the cause for optimism is, even though our news today is twice what it was last year with half the country vaccinated. Why are people talking about getting school students back in school when the threat is increasing at twice the rate? Why are people talking about getting workers back at work despite federal expenditures to the contrary, even though the number of cases is expanding at twice the rate and the threat is increasing their weapons at three or four times the rate that we can develop vaccines presentation of this year is three times as much. Next year it'll be, well, 27 times as much

Laura Knoy:
Such good questions. And thank you so much for calling in. And I'd like to deal with both of what he seems to be getting at. One is, you know, the actual numbers. Why are we still seeing cases with so many people now vaccinated? And then secondly, you know, are we opening things up prematurely? So, Dr. Chan, the numbers first of all, I have wondered that myself, why we're still seeing, you know, a relatively unknown to a large number of cases, but we're still seeing cases even with lots of folks vaccinated. So go ahead, Dr. Chan.

Dr. Chan:
Absolutely. And this is an important point and something that we have been talking frequently about with our on our partner calls over the last couple of weeks. So I think there's a couple important points to make.

Dr. Chan:
One is that we're in a transitionary phase right now and the numbers are still high because we're coming down out of a very high surge that we saw over the winter months. So the trend is a good trend. The numbers are coming down. But to Rob's point, the numbers of covid in our community still remain high. And that's I think both of those are important messages to get out there because the down trend in the pandemic and the uptrend in vaccination is a cause for celebration and optimism. But we are not out of the woods yet to use that, you know, to use that term because levels remain high in our communities.

Dr. Chan:
In fact, if you look at our data, if you look at CDC data, all of our counties in New Hampshire are still classified as having a substantial level of covid-19. And that is why, even with increasing vaccination, we continue to stress the importance of attention to the non pharmaceutical meaning non vaccine interventions that community mitigation measures like mask use, social distancing. You know, even though our numbers are coming down there, there's data, there's modeling studies that are out there showing that with high vaccination, combined with continued use of things like social distancing facemask use, avoiding crowds and gathering, the numbers will come down more quickly and we will limit the number of cases and hospitalizations and deaths that occur.

Dr. Chan:
So I think it's an important point that we are in this transitionary phase. The trajectory is one of decline, but we still have levels that are too high in our communities which, you know, highlights the importance of continued attention to the mitigation measures.

Laura Knoy:
So, Dr. Chan, I got to ask you this then. Given those high numbers that you mentioned, why did the state lift the mask mandate? Gosh, at least three weeks ago, I think it was late April and as of Saturday, lifted all restrictions and made them, you know, recommendations, but not requirements. It almost sounds like you're saying these pullbacks were premature given the levels of covered that we have in the state.

Dr. Chan:
No, you know, I think that what we're all struggling with is how to transition. And I think de-escalation of of. Some of these restrictions or requirements is always, always difficult, and so even though some of the requirements have gone away, I think what we continue to stress is that the public health recommendation around the importance of faith must use the importance of social distancing continues to be important. And I think what we've seen and what we hope to see is that even as some of the state level mandates and requirements have gone away, that that people are still hearing the message of the importance to not let our guard down and to continue to, you know, implement facemask use and social distancing in public in crowded locations.

Laura Knoy:
Dr. Talbot, I'd like to ask you to, again, given the levels of cover that are still concerning, did the state, you know, pull back a little too early there? Would you rather have seen them wait, you know, until June 1st when young adults and teenagers could be fully vaccinated? Because, for example, the mask mandate went away long before young adults had a chance to be fully vaccinated, even if they were just waiting for an appointment.

Dr. Talbot:
Changing the recommendations from requirements to recommendations. Just means that I think that we believe everyone knows what they need to do, they know their own community as best, they know their own underlying medical conditions. They know their vaccination status. We've all had to be steep on a learning curve for controlling this disease. And now we're in a state of transition in this pandemic where each individual is entrusted with this knowledge of how to prevent transmission.

Dr. Talbot:
We hope everyone accesses vaccine and adheres to the hard fought community mitigation measures as described so many times, even on this show, when it's appropriate to do so. You know, Rob is has clearly dug into the data and had some really interesting observations to make.

Dr. Talbot:
One thing I'd like to say with regards to vaccines is if there's no suggestion that these vaccines don't work to help control disease. First of all, we have the example of other countries that are out ahead of us observing decreases in populations that have taken this vaccine up to a place of the so-called herd immunity. And we're seeing that in our own state where the cases that persist that, Rob, you're observing are in those generally who are unvaccinated. So the shift from the early days of the terrible morbidity and mortality in our long term care facilities and our elders, that that's the past now as they have taken that vaccine up in the numbers that we hoped and facilitated.

Laura Knoy:
And Dr. Talbot, as we talk about, again, this big development, you know, kids age 12 to 15 now being eligible for vaccine, what else do you think is important for parents to know about the covid-19 vaccine for this age group?

Dr. Talbot:
That this vaccine and all of our vaccines, all three of our vaccines have been extensively studied through all the usual phases that bring these are vaccines to to our use. So what's unique here is how fast the approval processes have come, but all aspects of safety scrutiny have been in place. We know so much about these vaccines and we will continue to learn more. We're staying tuned into all the different safety monitoring processes that are put in place. Some were historic. Some have been in place all along in the background that many people didn't even know about.

Dr. Talbot:
But there are new ways that we're watching for any safety signals. And when I talk to folks and they present their concerns, I think that there's a lot of information out there. So if you have questions, I certainly hope that you have a health care provider who can help you have your questions answered for safety on behalf of choosing this vaccine for your online.

Laura Knoy:
And Dr. Chan, what's the state's role going to be in getting this going with, again, kids age 12 to 15? You know, will we see those big mass vaccination sites or is it going to be done differently?

Dr. Chan:
Yes. So the the mass vaccination sites or the community vaccination sites, as we refer to them, that are operating around the state but remain open and remain available for appointment to vaccinate this age group. It's not just the state run six vaccination sites that are offering this vaccine to adolescents. Pharmacies around the state are offering this vaccine currently. You know, hospitals that are operating vaccine clinics for their communities are offering these vaccines are regional public health networks are very active, setting up clinics like school based clinics targeting this age population.

Dr. Chan:
So there's multiple efforts under way to to reach this population through various mechanisms. And people can go online right now and sign their kid up for any number of these options for how to how to vaccinate their their adolescents.

Laura Knoy:
Dr. Talbot, in the bigger picture now with the Pfizer vaccine, the company is seeking full FDA approval instead of emergency use approval, which is how they are being, you know, the framework they're being used under now. What's the difference, Dr. Talbot, between full FDA approval and emergency use approval?

Dr. Talbot:
It's somewhat more complicated for the pharmaceutical company to present the biologics licensure application to the FDA, which includes lots of basic science kind of studies, animal studies, the experience we have through phase one, two and three of human studies, and also the experience to date in use of the vaccine in countries globally. So so there's there's a complication factor, but this application moves us closer to normalizing the use of this vaccine. And I know Dr. Chan is following that closely as well.

Laura Knoy:
Sure. Go ahead, Dr. Chan.

Dr. Chan:
Yeah. So just to add to what Dr. Talbert's said is, you know, our understanding of this process is that there are not new studies that need to be conducted by all the basic scientific studies that are needed have already been conducted. And that's what the emergency use authorization is based on. This is an issue of, you know, to put it more simply, paperwork. You know, the license or application is a long involved process. There needs to be, you know, combines the mission of the multiple studies that have already been conducted. And so, you know, I think what I've heard is that we're looking at a timeline of at least six months, maybe between when this. Submission happens, and when the vaccine might get for licensure or full approval from from the FDA, but I just want to be clear that there's not new studies that need to be conducted. This is a paperwork regulatory process that the company has to jump through.

Laura Knoy:
And Dr. Chan, does full approval change vaccine policy? I have read, for example, that since these were approved under emergency use, you know, companies and so forth can't require employees to get vaccinated and so forth. But once a vaccine is fully approved by the FDA, it can become a public requirement. Is that correct?

Dr. Chan:
I think partly, yes. This is really a little bit of a gray area in terms of whether businesses and organizations can require a vaccine that is only under emergency use authorization. And the statements that we've gotten from legal experts and legal groups are that it's possible, but it's maybe a little more difficult to do. Certainly once that receive the vaccine receives full licensure or full approval, it becomes much easier for a company or a business to be able to take that step. But I think what you're already seeing is that some places, some, you know, private colleges and universities around the country are already saying that they're going to require the vaccine for entry next year, even if it's only under emergency use authorization. So I think it's certainly possible, but it's a little bit more of a gray area.

Laura Knoy:
Well, here's a question from Susan. Very practical question about the timing of vaccines. Susan says, My son tested positive for covid-19 five days after returning to college after a visit home on Easter weekend. He was in isolation at a university property for 10 days after his positive test and thankfully has remained symptom free. How long should he wait before having his vaccine? After his positive test? Dr. Talbot.

Dr. Talbot:
Complete isolation and feel well, that's what we really want, folks who have had Cauvin to access vaccine as soon as they're able to. So we certainly don't want people who are ill coming to the clinics to get their vote. But please do once isolation is over and your symptoms have largely resolved access to vaccine and also long standing, durable, high level protection.

Laura Knoy:
So isolation, 10 days, is that the recommended period now? Because that's also been kind of a moving target.

Dr. Talbot:
Yeah, well, what's Susan described is quite right. If this is an asymptomatic positive test, then it's 10 days from the test date that we generally apply isolation duration for for those who are asymptomatic, it's 10 days from the onset of symptoms, no matter when the testing was done.

Laura Knoy:
She's also wondering, Dr. Talbot, should he get an antibody test? I don't know if that's required, you know, given that he had covid.

Dr. Talbot:
The antibody test simply shows that your body has evidence of having this virus, so it would have no relevance in the scenario that Susan described. Given that there's a positive test isolation complete, we know everything that would be needed to suggest that the person access vaccine, there are very, really very few clinical indications to have antibody testing for this infection.

Laura Knoy:
We got two emails from listeners who are both dealing with vaccine hesitancy. Amy and Harrisville says, I would like to resume in-person Scrabble games with a friend. She will not be getting the vaccine. I've had both of mine or both in our 60s. What is the protocol I should follow for outdoor games and indoor games? Second part of the question, Amy says, is the reason my friend will not be getting the vaccine is many years ago her mother got a vaccine and afterwards developed Lou Gehrig's disease and she believes the disease was a result of vaccination. Is this even possible? Amy asks. And what, if anything, can I say to my friend about it?

Laura Knoy:
Along these lines, we also heard from Peggy in Hollis. Any suggestions for my 17 year old grandson who has refused the vaccine? His parents are both somewhat reluctantly vaccinated, vaccinated, but he says he's uncomfortable getting the vaccine. Peggy says, I believe this is influenced by social media that has given bad and some sometimes conspiratorial information. Are your guests planning any marketing campaigns to counter this hesitancy? Amy and Peggy, thank you for writing, both of you.

Laura Knoy:
So, Dr. Chan, Marketing campaigns to counter hesitancy?

Dr. Chan:
You know, this is a this is a tough this is a tough topic to tackle because we know that there are people out there who eithe are solid in their, you know, their stance that they will not get the vaccine. And then there are other people that are hesitant and are not rushing out to get to get vaccinated. And I think, unfortunately, what we have seen throughout this pandemic is that there are there are some people that simply don't or won't trust, you know, governmental regulations or governmental advice.

Dr. Chan:
And so I think this is where having a conversation between a person and a trusted provider, for example, a health care provider, a pediatrician, is very, very important to talk through the concerns, the issues, what people are hearing in social media, because you're right, there's a lot of misinformation out there. And unfortunately, we will continue to do our best at a state level to try and overcome some of these messaging challenges. And the vaccine has a hesitancy that's out there.

Dr. Chan:
But at the end of the day, there are people that will not necessarily trust or believe what the government is saying. And that's where the individual pediatrician, the primary care provider, would would need to step in and try and address some of those concerns on an individual level. I'll say it from a personal level. I have no concerns about the safety of these vaccines.

Dr. Chan:
My own son, who's, you know, in this 12 to 15 year old age range, is getting vaccinated today. I was super excited. He was super excited about this. I thought, you know, I think I think there needs to be more more focus on the importance of this group being vaccinated and the safety, because it's really important to get as many people vaccinated as possible.

Laura Knoy:
Well, and Dr. Talbot, you've worked globally on other, you know, infectious disease outbreaks. Given that experience and given what we've been living with for more than a year here, what types of messaging or campaigns do you think work?

Dr. Talbot:
The principals, Dr. Chan began, are early appropriate. I think people are on a continuum when they are so-called vaccine hesitant. Our job is to figure out where on that continuum and what their concerns are and recognizing them as valid. So there are lots of studies that show us, not surprisingly, that our words matter. So when we speak with somebody who is vaccine hesitant, I think understanding again, validating that first and then understanding why many of the issues that my own patients, my community bring forward are those that I can sometimes speak to with science in a in a credible way.

Dr. Talbot:
So there's no shortcut here. This is all of us understanding these vaccines, being transparent about potential side effects, what we know and we don't know, and recognizing that people's concerns around these new vaccines are often valid. And yes, in the background, there's a very active anti vaccine campaign out there putting false information about which younger persons might be somewhat more susceptible to through social media. So we're all looking to understand and communicate clearly as we bring people toward vaccination. So so we could achieve this so-called herd immunity

Laura Knoy:
Or something reasonably like it, but maybe not complete herd immunity. We'll talk about that in a second. But we have Nancy on the line from Pembroke. Hi, Nancy. Thanks for calling the exchange today. Go ahead.

Caller:
My question is regarding research on MRNA and a vaccine in development. Now do we know what effect it might have on them [women of childbearing age] when they're in their 20s or or something. This is one of the reasons why my friends are afraid to get the vaccine. And similarly. Women who don't want to get it because they want to know what the evidence is on women of childbearing years, what's this going to do that would affect their eggs?

Laura Knoy:
Nancy, yeah, your line dropped out there, but you seem to be asking about, you know, young women being concerned about fertility, is that correct? I mean, your line dropped out a little bit there, Nancy, you seem to be asking about young women who were concerned that the vaccine would affect their fertility. Just wanna make sure I got you right there, all right?

Caller:
Yeah. Yeah. You eggs and their children, to be sure.

Laura Knoy:
I appreciate you calling. And Dr. Talbot, this is a concern that I have heard expressed as well.

Dr. Talbot:
Sure, these vaccines have been studied for now several decades, so we talk about the MRSA vaccine is new, but but they've certainly been under medical research for for quite a long time. And so we know a lot about their intended mechanism, how they work, how long they last in one's body, whether they get into a nucleus now. And there are extremely reassuring studies coming fast and furious to us that these are safe not only in the trials, but but also in real life use the issue of any potential impact on fertility is not grounded in any science or evidence.

Dr. Talbot:
In fact, there were multiple pregnancies that occurred during the trials in those tens of thousands of people who participated, and there was no signal for any adverse event in those pregnancies. So this is exactly where I think it's worth taking a look at what we know and not allowing vague fears or hypotheses that are ungrounded in the evidence to get in the way of our achieving protection in our communities.

Laura Knoy:
So say that again, Dr. Talbot, because that's an important point. These so-called the suspicion that these vaccines might harm future female fertility are, quote, not grounded in any fact.

Dr. Talbot:
That's right. I look for it. And that that that makes me more credible in this. You know, like I dug in. I've understood where the the Facebook campaign came from, from a from a, you know, really organized anti box method that was identified by Facebook. And have fact been taken down. I've listened to medical experts, obstetrician obstetrical experts and the like, and there's no plausible mechanism by which these MRNA vaccines compromised fertility. I have no concerns on this issue.

Laura Knoy:
Robert writes, To reinforce continued mask wearing indoors, would you remind us that some covid variants are more resistant to the vaccines and that some people here in New Hampshire and elsewhere have gotten covid after being fully vaccinated? Dr. Chan, can you address that? There's two points actually there that Robert makes that are important. One, some covid variants might be resistant to vaccines or might be able to to pierce the vaccines. Is that is that what we're concerned about here?

Dr. Chan:
So I think there's a couple of points to make here. The first is I think that with unfortunately, masks have become a controversial issue throughout this pandemic. But masks have emerged as one of the more important control non pharmaceutical control measures because you get double benefit from masking right masks, protect the wearer and masks protect the people surrounding that person, what we call source control. You know, the reason for continued recommendations around mask used when people are in public locations and crowds, particularly if they're indoors, if for a couple of reasons. One is that levels continue to be high in our in our communities. There's still covid out there. There's still risk. And we're working at ramping up vaccination, getting more and more people vaccinated. So we're still, you know, below 50 percent of our population that's fully vaccinated. And so while we're in this transitionary phase of trying to ramp up vaccination and get the numbers to continue and to continue to go down in this transitionary phase, we really need a multipronged or a multilayered approach. And masks are one of those important layers of protection.

Dr. Chan:
Regarding the question of the variance, you know, no vaccine is 100 percent effective there. They're actually quite good, quite a very, very effective at preventing covid-19. But the possibility for breakthrough infections remains. And then there's the issue of the variant. The the vaccines we have available still remain highly effective against the one one seven variant, oftentimes called the UK source variant based on when it was first identified. But there are there are other variants that are out there, certainly in much lower numbers where the vaccine still work. But there are probably less effective in some of these are like the South African variant or the Brazil source variant. So that's certainly a piece of the puzzle. And part of the reason why when we still have covid at higher levels in our community, why we why we continue to stress the importance of masks when people are in public locations. Around other people that might be unvaccinated and certainly an indoor environment,

Laura Knoy:
Ok, and that relates to an email we got from Arnie, who says the Union Leader reports 12 fully vaccinated residents and three staff have tested positive for covid. What's up with that?. That seems like Dr. Chan. What you're saying is the vaccines are great, but they're not perfect. And sometimes you can still get covid, but maybe you don't Dinant up in the hospital. Just clarify that again, please. There.

Dr. Chan:
Yeah. I don't have the exact numbers of vaccine breakthrough cases. But so there is a possibility, although the risk is low. I mean, keep in mind that we've put approximately one point three million doses of vaccine into people's arms. And, you know, having double triple digit numbers is a very, very low rate of vaccine breakthrough. So I think that that highlights the high effectiveness of these vaccines.

Dr. Chan:
But as we've said all along, no vaccine is going to be 100 percent and so welcome. It still remains at higher levels in our community as we as we work to vaccinate more and more people at this point in the transition, we're still recommending people look to wear masks in public locations and social distance.

Laura Knoy:
Well, here's a question from Steve. Steve says, I'd like to understand how having the vaccine provides different protection than having antibodies from actually having covid. Steve asks, Is there a difference in the way our bodies react to the vaccine versus how they react to the actual disease? Dr. Talbot?

Dr. Talbot:
Vaccines will provide better protection longer than having had natural disease. So I want to start with that statement, and that's why we continue to recommend that people who have even had confirmed covid access vaccine, the focus often is on these antibodies. That's one component of our immune response to either natural disease or vaccination. But there are lots of other things that happen in our efforts to become protected against this viral pathogen.

Dr. Talbot:
So there's the arm calledcell mediated immunity, where we have aptly named memory t cells that persist in our bodies even if we can't measure them routinely. They are there for us if we're exposed months or even years later to an infection. So, indeed, Steve, you're exactly right that there's a complexity here, an immune response, and there is a difference between having natural infection and having immunity from immunization, from vaccination. Of course, there's far more risk in having covered itself, given some of those potential sequela or immediate adverse events, not to mention transmission within our community. So we are highly favorable for the immunity rendered by vaccines.

Laura Knoy:
Let's talk more about herd immunity. We've been hearing since vaccines were approved that the goal was to reach herd immunity, where the coronavirus lacks enough hosts to be spread effectively. But more recently, health officials have been kind of dialing this back. Dr. Talbot, first just remind us, what does herd immunity actually mean?

Dr. Talbot:
Herd immunity. A layman's term, right, it's not an epidemiologic term.

Laura Knoy:
Sorry about that.

Dr. Talbot:
But it's intuitively understood by most to describe the proportion of a population protected from infection. Higher is better. And the confusion arises when herd immunity is achieved, either by having had the disease itself, natural immunity, or from being vaccinated or immunized.

Dr. Talbot:
So they're in the early stages of this had been modeling, had been predictions, had been crystal balls brought out, suggesting that we would need to get to a proportion of our population protected from this virus in the order of 80 or 90 percent. This is a very heavy lift given we've not achieved that kind of proportion of vaccination in our populations previously.

Dr. Talbot:
That doesn't mean we can't do it. And it also, even if we were to do it, doesn't mean that this virus would go away completely. There will almost certainly be pockets of our population that don't achieve that kind of high level of immunity through vaccination either because they are not able to access vaccine through usual mechanisms through disenfranchized or racially ethnic or ethnic minorities who don't have the same kind of access to care. And so we believe that this virus will likely be one that we need to learn to live with. There will potentially be seasonal flares. There will be outbreaks at institutions where people don't achieve high levels of vaccination and et cetera. So that's really where our thinking has turned in this pandemic.

Laura Knoy:
So, Dr. Chan, I got to ask you about this, too. So has the opportunity for this sort of desired herd immunity where we can all, you know, chuck the masks and go back to concerts and parties and so forth? I mean, has this opportunity slipped away?

Dr. Chan:
No, I don't think it has. And as I think you're seeing, we're still in the process of trying to get as many people vaccinated as possible. And and just to move back to this term, herd immunity, that's a term that we have always shied away from using in in New Hampshire because, you know, it's been talked about at the national level. But I think the writing has been on the wall for a while now that there's not a magic number, that we're going to totally break transmission and make this virus go away.

Dr. Chan:
I think what people are seeing is that we're in this transition phase and we keep coming back to that term transition between trying to move from a pandemic response to dealing with this virus that we expect to become endemic and that that's an epic term, meaning it's going to likely continue to circulate around the globe, around the United States and around. Vaccination then becomes an issue of keeping the numbers low and controlling the spread of the virus, preventing outbreaks. And that's the whole purpose of getting as many people vaccinated as possible.

Dr. Chan:
The higher the number, the higher the proportion of people we can get vaccinated, the lower the numbers will be, the better control will have, the more likely will be able to prevent outbreaks and prevent, you know, surges in the future, future like a potential winter surge, for example.

Dr. Chan:
And so looping back to some of the some of our prior conversation, for people that have been hesitant that they get vaccination, there's a lot of benefits to vaccination, including, you know, adolescence, 17 year old 18 year olds that might be going off to college. There is the real possibility that as this virus continues to circulate, that there will need to be restrictions where organizations may choose to implement restrictions in the future, especially if we start to see numbers going back up. And so vaccination will help prevent that from happening and prevent the potential future surge that is is a possibility.

Laura Knoy:
So for each person who chooses Dr. Chan to not get vaccinated, does that increase the possibility of these flare ups and possible shutdowns? I mean, is it kind of a numbers game there?

Dr. Chan:
Simply put, yes. I think the goal is to avoid any type of shutdown, but certainly outbreak, institutional organizational outbreaks are possible. And when that happens, there are additional public health measures that need to be implemented. And we deal with this on a yearly basis with influenza, for example, or norovirus or any number of other outbreaks, mumps, you know that that have occurred on college campuses. When there are outbreaks of these diseases, then there are additional restrictions that are needed to bring those outbreaks under control. And every person that is vaccinated is one step towards preventing that.

Laura Knoy:
Laura in Concord says, We welcomed a baby in October and we are unsure how to navigate. Visiting with immediate family and friends all fully vaccinated, it seems like Laura says we can still carry covid even if vaccinated. Is our baby at risk when interacting with unmasked adults? What can we do to protect him?

Dr. Talbot:
It's tough when you have the joy of this new family member and then you have to navigate all these really complicated issues, you know, the. It's been a very difficult message to communicate. I marvel at the CDC graphics that are out right now and are here to help us do this. They're pretty complicated.

Dr. Talbot:
You know, when people make broad sweeping statements regarding "we don't need masks anymore", it's really betraying the fact that there are a lot of footnotes to this. There are suggestions around how to interact with people safely, like you've asked about Laura, and the best is when everyone is vaccinated and in small groups and also outside is better.

Dr. Talbot:
So, you know, you've heard these themes and hygiene is great, social distancing, keeping distance. But we are recognizing increasingly that there are benefits of being vaccinated. So learning those and hearing about activities is not as dichotomous, not as safe or not safe, but somewhere on a continuum. It depends a lot on, you know, what setting you're in, your own risk tolerance, your ability to wear a mask, your number of people in the circle who are vaccinated. So take take a look at some of that data and just know the principles here are that it's a transition. Being vaccinated is affording us a great new number of freedoms. And we're all finding our way in this next stage.

Laura Knoy:
So and I understand you don't want to give specific advice, Dr. Talbot, but it's my understanding that when someone is fully vaccinated, the risk of them infecting someone else is quite low, you know, because who wants to, you know, be six feet apart from a baby? I mean, you meet a new baby, you want to hold it. So that's social distancing with the baby isn't very satisfying.

Dr. Chan:
No, it's a good one. Thank you for circling me back to that really important aspect of Laura's question, which is, if you're vaccinated, is it possible that you can still transmit even if you don't have symptoms? And that's one of those places where we're learning more and more and more. And it's frankly all good news that a person who has Breakthru disease, even though vaccinated, is a lot less likely to transmit. And and we just think that that initial fear of widespread asymptomatic transmission from fully vaccinated persons is as diminished. We just it's, as you say, Laura, that the vaccinated persons probably need to put aside that concern that they may be asymptomatic vectors or transmitters of disease. Dr. Chan, what do you think?

Dr. Chan:
Yeah, I was just going to add that, you know, that this is the whole purpose of vaccination is to allow people to begin to feel comfortable with some of these, you know, social interactions. With that said, I think, you know, some some people are having a more difficult time pulling back on some of the restrictions than others. And so there are steps that people can take if they're uncomfortable, like, you know, asking family members, even fully vaccinated family members, to wear masks while they're holding an unvaccinated newborn or, you know, limiting the number of people that you're allowing into your household or, you know, coming in to see the baby. So we want these social interactions to take place. And that's the whole benefit and purpose of vaccination is to but again, to allow these types of social interactions. But for people that are feeling uncomfortable still and we know those individuals are out there, there are additional steps, reasonable steps that that could be taken to help people feel more comfortable beginning to socially reintegrate, if I can frame it that way, you know, including asking people to wear masks that people are uncomfortable.

Laura Knoy:
So here's an email from Judy in Dublin. Judy's group operates a small beach on Dublin Lake for town residents. They didn't open the beach last year due to covid this year. They're looking at how to safely reopen it. She's outlined her plan here. I can't read the whole thing, but basically, you know, no swimming lessons, yes to port a potties, access to the rafts and docks, no requiring masks of individuals who've been fully vaccinated. So kind of a mix there.

My broader question, I hope this is helpful to you, Judy, and others. Dr. Chan, is the current advice now on transmission outdoors? The latest that I have seen is that it is quite low, even possibly lower than what the CDC says, which is, you know, roughly 10 percent. I've seen some analysis from, you know, epidemiologists interviewed by The New York Times who say it's probably even lower than that. So what about outdoor transmission, Dr. Chan, especially as we get towards summer activities?

Dr. Chan:
Yeah, it's a great question. And we absolutely believe that the risk is substantially lower from indoor transmission, but the risk isn't necessarily zero. And so even in outdoor locations where there are public gatherings, meaning people coming in from, you know, who don't know each other, you know that that there still be precautions taken. CDC and their guidance around not needing to, for example, wear face masks is for. Primarily fully vaccinated people in smaller private family friend gatherings. And so if you're talking about something like a beach or another public location, what I would say that the duty is to take a look at the universal best practices document. There are multiple different layers of protection or layers of mitigation that we continue to recommend be implemented at this point in the pandemic. Certainly by summertime, we hope and expect numbers to be lower. Maybe some of those precautions could be pulled back on. But because it is going to be with us and this is going to be a I think, a transition process where, you know, we need people to get vaccinated. And until we have a higher level of vaccination, there's still going to be recommendations put out by public health to implement some of these protective measures.

Laura Knoy:
Well, I really want to share this email with both of you just to close out our show today. This is from Catherine, who says after hearing this morning on NPR that 12 to 15 year olds can sign up for the vaccine, we immediately made an appointment for a 13 year old who will be going in for his first shot in a few minutes. Katherine says, As a mother, I'm thrilled, and in particular because it will protect me. Katherine says I'm immunocompromised, having undergone a stem cell transplant and taking immunosuppressants and other medications that have made it impossible for me to take the vaccine. Yet when I do get the vaccine in late June, it's unknown whether my immune system will be able to generate antibodies, Katherine says. To have the best chance of remaining alive. For my kids, the best I can do is to take care of myself, get my whole family vaccinated and hope like heck, but as many people out there as possible get vaccinated. So thank you for the shots, Katherine says. Katherine, good luck to you both with your child and your own health issues. And boy, Dr. Chan, Dr. Talbot, we have to close it out there. But Dr. Talbot, it's always good to talk to you. Thank you for being with us today.