Tangle - Dr. Leana Wen on COVID-19, mask-wearing and the J&J vaccine

Episode Date: May 3, 2021

In today's podcast, we sit down with Dr. Leana Wen. Dr. Wen is an emergency physician and public health professor at George Washington University. Previously, she served as Baltimore's Health Commissioner. She’s a contributing columnist for the Washington Post, CNN medical analyst, and the author of the forthcoming book, Lifelines: A Doctor’s Journey in the Fight for Public Health.On the show, I ask Wen about whether we should still be wearing masks outside, her thoughts on our fight against COVID-19, and some of her more heterodox views about how to manage the pandemic.If you're not yet a Tangle subscriber, you can sign up here: https://www.readtangle.com/--- Send in a voice message: https://podcasters.spotify.com/pod/show/tanglenews/message Hosted on Acast. See acast.com/privacy for more information.

From executive producer Isaac Saul, this is Tangle. Good morning, good afternoon, and good evening, and welcome to the Tangle podcast, a place where you get views from across the political spectrum, some reasonable debate and independent thinking without some of the hysterical nonsense you find everywhere else. I am your host, Isaac Saul, and in today's episode, we are sitting down with Dr. Lena Nguyen to discuss coronavirus and the vaccine, some of the stuff going on in the COVID space right now. Dr. Nguyen is an emergency physician and public health professor at George Washington University. Previously, she served as Baltimore's health commissioner.

She's also a contributing columnist for the Washington Post, the CNN medical analyst, and the author of the forthcoming book, Lifelines, A Doctor's Journey in the Fight for Public Health. Dr. Wen, thank you so much for being here. Thank you very much for having me. So first, I want to thank you for your writing. Throughout the pandemic, you have struck me as sort of a heterodox, unique thinker on COVID. I've seen you taking a lot of stances that I think were a little bit outside some of the mainstream, which has been really interesting for me as just a reader. And recently, the reason I asked you to come on this week was because of a column you wrote about President Biden's address to

Congress. And you essentially made two arguments that Biden had an opportunity to show the efficacy of the vaccines by having sort of a non-social distance event, maybe a maskless event, and that he was basically unable to do that because of the CDC guidelines. And I'm wondering if you could maybe walk our listeners through a little bit about your argument and how you were thinking about this. Sure. I think this starts with the overriding concern that I have at this point in the pandemic, which is at the time that we're talking, there is amazing news that we have just crossed the threshold of having 100 million people who are now fully vaccinated. 40% of adults are now fully vaccinated. I mean, that's incredible. And I think we should give the

Biden administration and President Biden so much credit for what they have done. But I'm very worried about the people in the middle, if you will. Yes, there are people who are actually anti-vaccine, who are not going to get the vaccine no matter what we do. But there are a lot of people who need to be convinced and we need to address their concerns. But also what I'm hearing from so many of this group is what's the point of getting vaccinated? What's in it for me? What's in it for me? If nothing really changes and the CDC guidance doesn't differentiate that much between vaccinated versus unvaccinated, then what's the point? If you are telling me that these vaccines are so effective, why can't we be demonstrating that with individuals actually returning to pre-pandemic life in some way? And so my point in the op-ed was saying President

Biden had the ideal opportunity. Yes, he said a lot. That was exactly the right thing about the progress around COVID. But imagine if he had actually demonstrated it. How clear of a message would it have been if he said only vaccinated people with proof of vaccination can attend this joint address to Congress? When they, because they are showing their proof of vaccination we know that their rate of breakthrough infections um is actually 0.008 that's really low we can reduce it even further to get everybody tested prior to coming in but as soon as they come in they can

take off their masks they don't need to distance and we can essentially have a pre-pandemic normal experience and by the way the message is by the way, the message is, by the way, if you all get vaccinated too, this is what's in store for you. I think that's the kind of message that we need to see a lot more of. We really need to send the strong message that vaccines are safe, they work, they help us to return to pre-pandemic normal, or else what ends up happening is this, you know, look, again, I think President Biden has done so much right. And so I don't mean this as a criticism of his leadership. I just really worry that the excessive caution that's projected comes at a price because it looks performative and looks not science-based. And I think at worst, it feeds into a damaging narrative that

nothing much changes if I get vaccinated. So what's the point? You know, I shared this piece, and I got quite a bit of blowback in my own Twitter feed. I think one of the big criticisms was people just saying, you know, look, there are people in Congress who haven't been vaccinated yet, which you're sort of addressing there by saying what he could have done was say you needed to have proof of vaccination to come to the address. What was the response like for you when you shared this piece? I mean, I'm curious what kind of feedback you got, how you felt like it was received, and if there were any interesting points or anything like that that came up for you. You know, I want to go back to something you had

said at the beginning, which is about how my writing and in general, my views are not conforming to any orthodoxy, because I'm not a partisan person. I'm not a Democrat. I'm not a Republican. I'm not here to do partisan work. I'm just here as a public health expert analyzing data and also looking at where people are. I think a lot of public health, it's not just about data, because you can have the same statistic that people interpret in different ways. People could look at, for example, the rate of 0.008% of breakthrough infections, and some people could say, that's really low. I'm going to return to normal. Somebody else could say, but I don't want to be one of those individuals.

And by the way, there are variants. There are long haul COVID issues that we don't know about. I'm going to be really safe. So I think a lot of public health also requires navigating that difficult in between space, understanding that there's a lot of nuance. And I say that because to your direct question here, during the Trump presidency, I got a lot of criticism. Of course, every time I made a point about something negative that President Trump was doing. But I would say in general, with the Washington Post readership, I think it was a pretty anti-Trump group as a whole. What was interesting to me was with President Biden, anytime I give anything that looks like it is a critique of the Biden administration in any way,

I get huge pushback, basically with the implication that I'm somehow disloyal. First of all, no one knows what my political leanings are, and that's on purpose. So I don't know what exactly I'm being disloyal toward. But I also think that there is a big problem in this country that we're now seeing. Yet it's a big problem that people are seeing masks and vaccines as a political symbol. And I think we rightfully will say, look, it's a problem when anti-vaxxers and, you know, members of Congress who are Republicans are branding masks as a Republican versus Democrat issue. But I think it's an equally big issue, actually,

when we see virtue signaling on the other side. And we have to be allowed to have reasonable conversations about policy without somehow being accused of setting back progress when it comes to science and vaccines. If people have real concerns, if the American people have real concerns, they should be able to address them. And we as public health experts have to meet them where they are. In that spirit, as I said, I've been hugely appreciative of your writing. And I've also seen things that I sort of disagree with. And one of the issues that I've written about is sort of the concept of vaccine passports. And in your piece about Biden and this address to Congress, you sort of subtly made a case, I think, for proof of vaccination or vaccine passports by

just saying that it's been really successful in Israel. And, you know, he could have set this up in a way where proof of vaccination allowed people to enter the address. My argument has, I think, been pretty similar to a lot of people who oppose the concept of vaccine passports, that, you know, it might slow the return to normal by sort of boxing some people out who might have trouble getting the passport or getting the vaccine, and that there's just really no precedent, in my opinion, for, you know, getting people's health credentials in order to enter a concert venue or a basketball arena. So I'm interested to hear your case. I mean, what do you think?

Do you think that vaccine passports are a way out of this? Are you supportive of that idea? And how do you see that rolling out? So I wrote a piece for The Post a few weeks back about how we need to stop calling proof of vaccination a vaccine passport, because a passport, to me, implies something that's government-issued that you need in order to access certain types of social services. And that's not what I, maybe some people actually want that, but that's not what I would be advocating for. Here's what I would advocate for. And I think there is a precedent. I would advocate for something, think about like the TSA pre-check or clear at the airport. So everybody can still go through the airport. If you don't have TSA pre-check or clear or whatever else, you can go through

the airport. You just might need to wait for a longer line and you have to take off your belt and take out your laptop and other things. I see the proof of vaccination as a way around those other things, if you will. As in, if everybody needs to have symptom checking and maybe testing in order to enter a venue, but in return for getting those things, for doing symptom checking and testing, you're able to access the service that you really want. You want to fly, you want to attend a concert, etc. You have to do that. But if you are vaccinated, you can skip those other steps. So to me, it's more like an easy pass. It's an extension of the health screen that we already do. And I also think that there can be certain things that we can reserve for

individuals who are fully vaccinated, who it probably might not be safe to do if proof of vaccination does not occur. So for example, I am prior to the pandemic, I used to love going to high intensity gym, indoor classes with a lot of people. I'm not going to do that now. The CDC actually says I can do that if I wear a mask, but the mask is going to get soggy. I'm not going to do that now. The CDC actually says I can do that if I wear a mask, but the mask is going to get soggy. I'm just not comfortable with a whole lot of people crammed together in indoor places of unknown vaccination status, even if I'm wearing a mask. However, if everybody in that room has proof of vaccination, I feel very comfortable. So I guess I don't see this as a pass that somehow removes people from doing certain things, I see it as the easy way to

achieving something additional. One more example of this is around colleges. I think it's great that more than 100 colleges and universities are going to be requiring proof of vaccination, because in return, they're going to get something. They're going to get essentially a return to pre-pandemic life. They can be in college without masks, without social distancing. I think that's incredible. And there's still going to be a way out for those who cannot get the vaccine. They just might have to do three times a week testing instead. So again, I don't see this as being restrictive. I see this as hastening actually a return to pre-pandemic normal. And by the way, I have two young kids who cannot be vaccinated. And just like

with TSA PreCheck, if I'm traveling with my kids, we're going to go through the long route as in, I'm fully prepared that when I'm traveling with the kids or going somewhere with the kids, and there's no way to show proof of vaccination for them because they're not vaccinated, we have to wait in a longer line. I'm totally comfortable with that. So one of the other big issues that has been kind of a flashpoint recently, and I think is sort of gaining momentum in terms of the tide shifting a little bit is the mask mandate outside. I live in New York City, I live in Brooklyn, I go outside and walk around the street, and pretty much everybody is wearing a mask still. And my understanding of a lot of the scientific

evidence around this is that we know outdoor transmission is pretty rare and not very common. We also know that, you know, walking past somebody on the sidewalk is not, probably not going to be a way that you get COVID. And there's been a number of articles in high profile publications now sort of saying like, it's time to end the mask outside mandates in cities like New York and across the country. What do you think of that? Where do you think we are? Are we there yet? You know, I'd be curious to hear your perspective about that. I mean, when it comes to outdoor mask mandates, we never should have had blanket outdoor mask mandates. Never. We always knew about the two out of three concept, which is something that Professor Lindsay Marr has talked about. But I'm just going to say this here that this is, by the way, for unvaccinated people or

even before we had vaccines, we knew that you needed two out of three things, outdoors, masks or distancing. You don't need all three. You just need two out of those three things. So if you're indoors, you need to be masked and distanced. If you are outdoors and you're distanced, you don't need masks. If you're outdoors and you're wearing masks, then you don't need to be distanced. And so you need two out of those three things. It never made sense when I saw governors, as an example, in the beginning, forbid people from going to parks and beaches. It only drove people inside and made things worse. It never made sense when there were blanket outdoor mask mandates, which still are in

place in many jurisdictions, where anytime you walk out your door, even if you live in a rural area with no one around you, you're supposed to be wearing a mask. It defies common sense. And when you have rules and restrictions that defy common sense and that don't pass that common sense sniff test, people don't believe you on other issues too. And it becomes a really dangerous prophecy because if public health isn't trusted, people are not going to follow any public health guidance. If they think this one thing doesn't make sense, it's a really big problem.

I think there's another problem that you're now highlighting on top of that, which is that somehow, again, masks are now seen as virtue signaling by both sides, that there are people who say wearing a mask is a sign of weakness. I'm not going to get vaccinated. I'm not going to wear a mask. Obviously, that's very dangerous. I think it's also not a good thing when people are giving others dirty looks who are not wearing masks outdoors, even though there's literally no reason for them to be wearing a mask. I think that's making our society more divided. It's going against common sense, going against scientific sense, and actually going to make us even harder or going to impede our progress even more when it

comes to encouraging people to get vaccinated. One last question, and I'll let you go. I know you are short on time today, but this has maybe been the biggest or most important story in the last week or two in terms of sort of reaching the end of this pandemic, which has been all the controversy around the Johnson & Johnson vaccine. And, you know, from reading a lot of your columns, I think oftentimes I find you sort of pushing back on maybe what you're viewing as like some overcautious or contradictory behavior. And in the case of the Johnson & Johnson vaccine, I was sort of surprised to see that you had a column that was basically saying, you know, we can resume the vaccine, but there needs to be serious warnings for women who are under the age of 50 who are going to take it. I'm curious

if you could walk us through, you know, what's happened, what's going on, what do we know about where the vaccine is now? I mean, it was obviously paused. And it sounds like there were some issues with blood clots, and now it's being resumed. You know, there was division over whether people thought the pause was going to make people more or less confident. I'd love to hear from you before you go just about sort of where you think we've landed on that. Yeah, so I'll describe where we came from and where we are now. The Johnson & Johnson vaccine is the one-dose vaccine, which offers many distinct advantages over the other vaccines, which are all two-dose vaccines.

The Pfizer-Moderna vaccines are messenger RNA vaccines, so using that mRNA platform. Johnson & Johnson and AstraZeneca, which is not authorized in the U.S., but is given widely around the world, both use another platform called the adenovirus vector platform. So with AstraZeneca, already it was seen that there's a higher incidence of this blood clot issue. And also the benefits significantly outweigh the risks, the older you are, as opposed to the younger you are. So it was against this backdrop that in the US, we saw that the Johnson & Johnson vaccine that had a similar mechanism to AstraZeneca also had this rare effect.

The pause was initially put into place for six cases, all in women under the age of 50. Then when the CDC reviewed the data again, they found that there were 15 cases. 13 of the 15 cases were in women in the 18 to 48 group with clusters, the largest case cluster being in women in the mid to late 30s group. I, by the way, happen to be in that group. I'm in my late 30s. I actually got the Johnson & Johnson vaccine. I was part of the clinical trial. I had the option once I found out that I got the placebo in the trial to get the Johnson & Johnson vaccine or to get something else. And I chose to get Johnson & Johnson. And this is where my thinking is on this. If Johnson & Johnson is the only vaccine, given that this complication

is so rare, even in my higher risk group, it's one in 80,000. That's very low. My chance of getting COVID and suffering a severe outcome from COVID is much, much, much higher than that. So if this were the only vaccine available, I absolutely would say people should get this vaccine. There's no question in my mind that the benefits outweigh the risk. However, we have two other vaccines that are very safe, very effective, that do not have this rare complication in this age group. So I have been arguing that for this particular group of the highest risk individuals, women between the ages of 18 and 49, given that there are alternatives, we should advise them to get the alternatives first. If they say, actually, I want a one-dose vaccine, or for whatever reason, I don't want the Pfizer or Moderna, they should be able to get the Johnson & Johnson vaccine. Actually, we do this in

medicine all the time. We say that people who are in this particular subgroup should get one particular treatment over another. For another subgroup, what's first line or second line is different. I don't see what's different in this case. And I was very worried that those of us who watch the news all the time and are very well informed will make that choice. But that women or people who are in more vulnerable groups, who just haven't had the time, who are not going to see their doctors, but are going to a mass vaccination site, won't realize the implications of having this choice of alternatives. Dr. Lina Nguyen, a valuable voice in this moment and throughout this pandemic. If people want to keep up with your work and keep an eye on your perspectives, where's the best place to do it?

You can visit my Washington Post column page, which will definitely link to all my articles. I actually have an article that just came out like an hour prior to our conversation about how people who are fully vaccinated should assess their risk. And so you can also do that by, I'm trying to be better at social media.

So on various social media platforms, I would also welcome a conversation. Awesome. Dr. Nguyen, thank you so much for the time and hope to check back in with you in a few months. Thank you so much. Great to speak. Today's podcast was produced by Tangle Media in partnership with our friends over at Impostor Radio. If you enjoyed the podcast, be sure to give it a five-star rating, share it with your friends, and go check out retangle.com for more. Thank you.