The Centers for Disease Control and Prevention’s new guidance this week reversing course and again recommending that vaccinated people wear masks indoors in places where the Delta variant is spreading had a lot of heads spinning, even before the CDC then trickled out some of the ominous new findings that led them to issue that guidance.
So I reached out on Friday to Dr. Irwin Redlener, who’s—take a deep breath—a pediatrician and physician, a professor of pediatrics at the Albert Einstein College of Medicine, the founding director of the National Center for Disaster Preparedness at Columbia University’s Earth Institute and the author of books including Americans at Risk: Why We Are Not Prepared for Megadisasters, not to mention a columnist for The Daily Beast.
In an hour-long phone conversation on Friday that’s been edited for space and clarity, he talked about how Trump poisoned the waters of public confidence, Biden’s messaging mistakes, and why he sees many more surges to come after this one.
Harry Siegel: As a vaccinated person, how concerned should I be given the new CDC guidance about getting COVID? And how concerned should I be about spreading COVID?
Irwin Redlener: The latest data is showing us something very important: that with the new Delta variant, the viral load, the amount of virus carried by an infected person, is the same whether or not that person has been vaccinated. This is a different situation than we understood before, with previous variants and the original virus, because all three of the vaccinations available here—Moderna, Pfizer, and J&J—were able to suppress the amount of virus. Not eliminate it, necessarily, but certainly we were seeing big differences in the virus load being carried by vaccinated versus unvaccinated. That no longer seems to be the case. Even though the vaccines will, by and large, prevent very serious illness or death in a person who gets infected with the Delta variant, it turns out that the vaccines do not suppress the amount of virus in a person’s body.
Which means that we can tell you as a vaccinated person, you’re very, very likely going to be protected from having to go on a ventilator or die. But what we can not say is that you’ll have less virus that you could then spread around. That makes you, as a vaccinated person, a potential threat to people who are still vulnerable. And we have a situation in the United States where we have 100 million people or so who have never had the disease, and who have never been vaccinated and who are vulnerable to getting infected by a vaccinated person who’s contracted the Delta variant.
Why did the CDC put out this new guidance before putting out the data that informed it? And has this new data been fully and adequately vetted at this point?
The White House and the CDC and the federal agencies that deal with the pandemic are still learning how to communicate about this highly dynamic, highly dangerous disease. I think people are surprised by this, but the fact of the matter is that this is not easy because the situation, the data, keeps changing—we keep learning more things. And the communication strategies have not been what they should be.
The first thing we need to know about the communication strategies is that there should never be a policy, a guideline, put out by the CDC that does not have this caveat: Here’s what we know, today, but it’s almost inevitable that we’re going to learn more in the next week, two weeks, a month, that’s going to make us want to change the policies and the recommendations. Be prepared in this very dynamic reality of COVID-19 and especially the new variants that things are not going to stay static for very long. We’re telling you what we think now, not what we will be thinking.
Number two, it was really a big mistake not to precede or accompany the new guidelines with this new data. It didn’t make sense. In May, the message was “If you’ve been vaccinated, you can go indoors or anywhere else you want and you don’t need a mask.” And it turns out that’s not true. So what looked like kind of an arbitrary reversal of policy was actually a change in policy based on new data.
The third thing is that Donald Trump did a terrific job of undermining science, and undermining the credibility of statements from scientists. So that now, there’s inherent skepticism. Every misstep in terms of communications tends to exacerbate this terrible anti-science legacy left by the former president. So we have what Trump has done intentionally to undermine the credibility of science, coupled with the fact that we keep learning new data.
And the fourth thing is that, no matter what, the CDC and the White House really need to get their act together about how to communicate to the public.
This is a complex problem, which is creating confusion in the mind of the public. And the consequence if we don’t get this right is going to be a continuing loss of confidence in the American scientific community, and our really quite extraordinary agencies—and that will end up interfering with our ability to get the public to comply with what needs to be done. So we’re in a very, very bad place right now and it’s understandable when you start looking at the various elements that went into where we are today.
You brought up Trump there. I recall Biden saying on July 4 that “Thanks to our heroic vaccine effort, we’ve gained the upper hand against this virus. We can live our lives, our kids can go back to school, our economy is roaring back.” Was that good and proper messaging by the president, or did he contribute to the deterioration of confidence in science you were talking about?
At this point, it is dangerous for anyone to be too definitive. Scientists, disease modelers—we’re on thin ice. We all need to learn a little humility in making projections or making definitive statements. That’s even more important for people in political leadership positions—they they worry about being overly definitive when it comes to this COVID-19 pandemic and the policies that are coming out. What the president did on July 4 was a lot of really happy talk. It was certainly that in retrospect, but maybe even prospectively: just way too optimistic for what was known. It adds to confusion and to the increasing difficulties that people are having in accepting policy guidelines.
Asking practically, or selfishly, given what we know now should I be returning to my office? Should I cancel my travel plans? Should my kids go to sleepaway camp?
There’s no way that anybody can guarantee that two weeks from now, two months from now, you’ll be able to do what you were planning to do. There’s just no way. We made plans to have a little Redlener family reunion in August. We made these plans in April thinking that certainly we’ll be OK then. But we’re not. So we just cancelled that whole thing. My wife and I are planning to go on a trip in October, and to take a couple of our grandchildren to Europe in February. Every ticket is refundable, and the ones that aren’t we bought travel insurance on for this very reason. We just don’t know. We could be seeing surge after surge of this virus—surge six, seven, ten.
This much, I will predict: If we don’t get control over the spread, if we don’t start seeing ourselves as part of the the world and making sure that countries in Africa and Southeast Asia get the vaccine they need to put this thing to bed, we’re going to end up with festering virus growth in places where there’s less than 1 or 2 percent vaccinations. Those are going to keep churning out new variants with absolutely unpredictable behavior patterns.
We’re in the world whether we like it or not—we have enough problems here in the U.S., but I’m not sure where this is all going to go. I don’t see how this is just going to fade away if we don’t take our global responsibilities more seriously, not to mention figure out how we’re going to deal with the patchwork of vaccinations that we see in our own country.
David Leonhardt noted today that among the COVID mysteries we don’t have solid answers to were the alpha variant spike in the upper Midwest and Canada in March and April that just went away and, more recently, the Delta variant spikes and then abrupt, unexplained drops in both England and India. What should people make of that?
We don’t even know what we don’t know. We don’t know enough to give you a definitive answer about what’s happening in the U.K., for example. And not only that, right now we’re talking about mostly Delta, although we have Lambda waiting in the wings and a long list of Greek letters to follow. We’re just in a wait-and-see mode. It’s very unsettling to say the least.
What’s your level of alarm about future mutations that could cause hospital-worthy breakthrough cases?
I’m very much concerned about this, because, again, we just don’t know. It’s entirely possible, like I was saying, that we’re going to see surge after surge until we are finally somehow able to get some global control of this.
Another thing I want to mention: We’re talking as if the COVID-19 pandemic is a public-health challenge. Well, it certainly is that, but it’s way more than that. It’s way more than that. It’s become a political, ideological challenge that is without precedent. We’ve entered into crazy town.
The people that are not getting vaccines are not only not getting them because they’re not sure, they’re worried about complications. A lot of people are not getting them because they are believing conspiracy theories. They’re believing whatever it is they think Donald Trump wants them to believe. And we’re so far into that world of bullshit, that I don't know how to get extricated. It’s not something that is within the realm of expertise of public health doctors or disaster specialists—there’s other spheres that are going to have to solve this.
Because all we have to say, in my profession, is "Of course you’ve got to get vaccinated. What do you mean? You’ve got to get vaccinated, you’ve got to wear masks, here’s what you’ve got to do."
That’s the public-health strategy. But it’s not really relevant, on many levels, to what we’re actually dealing with today. That’s what really scares the hell out of me. This is not my area of expertise, and I’m not sure whose area of expertise it actually is. How do we break the back of this crazy stuff that’s coming from social media, from politicians? We need to be partnering with the people who are experts in those things, to figure out how we’re going to get out of this.
I think there’s a misconception in the country about what can actually be mandated and enforced by the federal government, which is actually not much. Everybody knows behind closed doors, I promise you, that of course we should be mandating it. But we can’t. We don't have that kind of country. Whatever the federal government’s recommending has got to be actually implemented by states.
And then we have Ron DeSantis and Greg Abbott and a bunch of stupid, politically driven players in high positions in state and local government. So we’re trapped here. People need to understand that President Biden has zero control about mandating people getting vaccinated or even wearing masks indoors. Recommendations from the CDC? Fine. Mandates, enforceable by the federal government? Impossible.
How concerned should people be about transmission inside of their homes? And are there specific behaviors that they might want to reconsider?
It depends. Let's say you take a household that’s got two relatively young parents and a few kids and everybody’s healthy, everybody that can be has been vaccinated. I think there’s not much you need to do inside your home. However, if you live in a multi-generational family, or you have people in the family who have particular risks, you need to be more careful. Keeping a distance, wearing masks around that person. There are commonsense things you’d want to do to avoid possible infection of more at-risk people in the household.
In the CDC messaging memo that leaked right after the new guidance was issued, it says at one point that the Delta variant is more transmissible than Ebola, the common cold, the so-called Spanish flu, and smallpox and as transmissible as chickenpox. Is that a useful comparison?
My wife said to me, “What the hell is somebody supposed to take from this?” A comparison to Ebola? What’s that supposed to mean to the public? It's ridiculous. Even the chickenpox—what? What are you talking about? And why even say that publicly? It’s just not helpful. It adds to the confusion.
You could say that with the original SARS-CoV-2 strain that started the pandemic, an individual who was infected would be able to infect two or three other people. With the new Delta strain, an individual is capable of transmitting to somewhere between five and nine people. So in other words, you’re much more of a walking threat to people around you with the Delta variant than you were with the original virus. To me at least, that is stating it in a way that is more understandable to regular people.
Speaking of regular people in the public, the memo also goes on at some length about the need for NPIs or non-pharmaceutical interventions, like masks. How should people think about how NPIs and vaccines do or don’t relate in their own lives and in the bigger picture of trying to look ahead to some sort of end here?
Well, there’s no question that the NPIs are valuable. They’re an essential part of the strategic planning to get control of this virus. But NPIs by themselves, in the absence of vaccinations, will not be enough. Because of what we’ve now learned about the ability of vaccinated people to carry the Delta variant, the vaccination agenda itself is also not enough. I think we still need, like we did in the beginning, a strong emphasis on getting vaccinated. And until we are all vaccinated, or the vast majority of us, we need to continue to enforce what you might call common-sense, non-pharmaceutical interventions, like masking.
We’ve relaxed things and planes are crowded, airports are crowded, and unfortunately I think that was too soon. We relaxed too soon. And we might have to, because of this new data, tighten up again, which is not going to sit well with the public—I understand that. Which brings us back to the question of how are these things being communicated to the public? And this is why it’s so critical that we get a better handle on things. It’s very, very challenging.
Let’s talk about the schools, especially the elementary school and junior high school levels where we have children who cannot be vaccinated. We need to be enforcing those NPIs in the schools. In addition to that, as far as I’m concerned under no circumstances should any teacher, bus driver, administrator or other adult be allowed anywhere near children if they’ve not been vaccinated. There should absolutely be local mandatory requirements. And the testing of teachers, if they don’t want to get vaccinated, once a week or whatever some of these jurisdictions are proposing—it’s not enough. It’s not enough. I am a strong believer in mandatory vaccinations.
Columbia University, where I'm affiliated, sent out a notice that if you're not vaccinated and able to prove that you've been vaccinated, you're going to be subject to severe penalties, including termination, and not permitted back on campus. If a university can do that, even while the vaccines are still being provided under emergency authorizations, why isn’t every single employer, store, organization and school doing the same mandatory requirements? As I was saying earlier, the federal government can’t. Believe me, Columbia’s lawyers would not have allowed them to be so strong if they didn’t feel that they could get away with it.
What do you say to people who see the new masking call and CDC guidance more generally as a politicized form of social control, and who fear that the government is creating precedents for expanding its reach into people’s private lives as it did after 9/11?
Get over it and get over it fast. We have a deadly crisis on our hands that’s already killed over 610,000 Americans. You've got to get over it. Think about the rest of your life and the things that the government says you can and can’t do. You can’t run naked down the street. You can’t send your children to school if they haven’t been vaccinated. You can’t drive without a driver’s license, or insurance. You can’t drive drunk. There’s thousands of things that you can't do just because you feel like it.
We are dealing with a life-and-death crisis and it’s intolerable that people are fabricating these fears. We already have control over behaviors of individuals that threaten the lives or well being of other individuals. You want to go skydiving? Fine. That’s your risk. You want to do freestyle rock climbing? Go for it. But there are things that you are prohibited from doing in society, because your decision can harm someone else. And to me that’s the cut-off.
You can’t refute the obligation of government to be looking after the good of society. That’s why they’re here. I've thoroughly lost patience with this. I find it so politicized, so crazy, that it’s hard to know what to say other than stand down, let this country take care of this crisis. And don’t bring these spurious arguments about personal freedom and slippery slopes and government overreach. That’s not OK.
What is the end game for this pandemic?
The end game in a pandemic is always to get it under control.
We can’t get our act together to take care of everybody in the United States because of the craziness. We have to somehow convince the crazies, which is why I did that OpEd for the Beast saying Biden should do whatever it takes to get Trump to tell his followers to get vaccinated. We’re going to have to break the back of this outbreak by convincing Americans they need to get vaccinated and that they need to obey the public health guidelines. And we need to be generous with our resources for the rest of the world.
In America, we’re in a much more complicated new phase where we have to figure out how we're going to maximize the number of people who are actually vaccinated. It’s not by telling people to get vaccinated anymore. But it may be through a thousand points of mandates.
In other words, we’re not going to get the federal government to have enforceable mandates, nor are many states going to even think about enforcing mandates. But what we can have is every university, every workplace, every arena insist that nobody’s getting in the door if they have not been vaccinated and if they cannot prove that they have been vaccinated.
If your employer says you’re not coming to work here, or your university says you’re not coming on campus, that may be our last, best opportunity to really make progress.
If that’s the case, is it helpful for the CDC to be stressing masking among people who are already vaccinated?
The CDC saying that is just a matter of commonsense public health practice, given what we now know about the fact that vaccinated people could still transmit it. So putting the politics and even the communication strategies aside, that is the right call. Given what we know now, they have an obligation to say that. What we just learned about the virus says that everybody has to be masked.
