The Daily - A New Chapter of the Coronavirus

Episode Date: August 2, 2021

Recent data from the C.D.C. has found that not only can vaccinated people get infected with the Delta variant of the coronavirus, though instances are rare, but they also can potentially spread the virus just as much as an unvaccinated person.What are the practical implications of this new information?Guest: Apoorva Mandavilli, a science and global health reporter for The New York Times.Sign up here to get The Daily in your inbox each morning. And for an exclusive look at how the biggest stories on our show come together, subscribe to our newsletter. Background reading: A recent report from the C.D.C. strongly suggested that fully immunized people with so-called breakthrough infections of the Delta variant can spread the virus to others just as readily as unvaccinated people.According to an internal C.D.C. presentation, the Delta variant is much more contagious, more likely to break through protections afforded by the vaccines and may cause more severe disease than other known versions of the virus.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday. 

From The New York Times, I'm Michael Barbaro. This is The Daily. Today, the United States takes a step backward in the pandemic, warning that even vaccinated Americans may spread the virus and asking millions of them to resume wearing masks. I spoke with my colleague, Apoorva Mondavili, about this new chapter of the virus. It's Monday, August 2nd. Hey, Apoorva. Hi. My sense is that you do not come bearing good news.

I do not. Well, I have only come to expect that from you. Could be worse, though. Could be worse. Could it? So, as I think we're hinting at, a lot has changed since we spoke to you exactly one week ago. And that conversation was about breakthrough infections of COVID-19, vaccinated people getting the virus because of the Delta variant. And right after we spoke, we got a bunch of new information about those kind of infections that really began to change how the government and a lot of other people are approaching the entire pandemic. So talk us through all of that.

Last time when we talked, we were talking mainly about anecdotal cases of vaccinated people getting infected, these breakthrough infections. I was describing these incidents of breakthrough infections in weddings and family gatherings. And there was this one outbreak in Provincetown, Massachusetts. weddings and family gatherings. And there was this one outbreak in Provincetown, Massachusetts. What changed this week is that the CDC looked into that Provincetown outbreak more closely. That outbreak has spread to now 900 people across the country. About 450 of them are in Massachusetts. And what the CDC and the Massachusetts Department of Health found is that not only can vaccinated people get infected, but they have about the same amount of virus in their nose and throat as unvaccinated people do. And that's completely unexpected.

And why is that so important to our understanding of the virus? If you have virus in your nose and throat, you can spread it. And we did not expect that once somebody was vaccinated, that they would be very likely to get infected or to spread the virus to anybody else. What we learned this week is that if somebody who's vaccinated does get a breakthrough infection, they end up having a lot of virus in their nose and throat. And now they can spread that virus to people around them. virus in their nose and throat. And now they can spread that virus to people around them. So this new understanding is that a vaccinated person could potentially spread the virus just as much as an unvaccinated person who becomes infected.

Right. We don't know how often a vaccinated person is likely to get infected. It's looking like it's actually very rare. But when that happens, when a vaccinated person does get infected, they end up with just as much virus in their nose and throat as an unvaccinated person. And they may be just as likely to spread it to other people as an unvaccinated person. So just to be super clear, in order to have a breakthrough infection that could then lead to transmission in a vaccinated person, that person has to be infected by COVID. They can't just breathe it in the air from somebody and pass it on to somebody else without being infected. That's right. And not only do you have to be infected, but you have to be infected and have enough virus in your nose, have had enough opportunity for the virus to grow into these large amounts that you

can then infect somebody else. That's why it's as rare as it is. Okay, so now I want to understand the mechanics of this transmission. What is happening inside a vaccinated person's nose that's allowing this transmission to happen? Because we had been told in the past that the vaccine was going to prevent the transmission of the virus, but what you're describing is the opposite. So this is a little bit complicated. You know that the vaccines that we have are injected into the muscle. And from there, the vaccines do a really good job of stimulating our body to produce a lot of antibodies, but in the blood. And not a lot of those antibodies

are going to make their way into the nose, which when you think about it, is really the place where the virus comes into the body. Right. This was always the case. This was the case even for the original virus. But with the original virus, just a small amount of antibodies

was probably enough to stop the virus from multiplying in the nose. With Delta, there's just way too much virus for the small amount of antibodies in the nose to probably completely contain. So what you're describing, these breakthrough infections that are leaving vaccinated people with large viral loads that may make them spreaders, that doesn't have a lot to do with the strength or weakness of our vaccines or them potentially wearing off. It has a lot to do with the strength of the Delta variant

and how it operates in the body in particular, in the nose. That's exactly right. But the chances that you'll get infected with Delta if you're vaccinated are still very, very low. It's just once you do get infected, you do end up having a lot of virus. You keep referring to these breakthrough infections as rare. The chances is low. Just how rare and just how low are the chances?

Because in our last conversation, you described some pretty meaningfully large clusters. And I get the sense that these breakthroughs may be somewhat widespread. The short answer to your question is we don't really know yet how exactly where they are. There are some state-level data, and the Kaiser Family Foundation just looked at all of those data and said it looks like less than 1% of vaccinated people may end up with a breakthrough infection. They may have symptoms that are cold-like, that they may have a sore throat, they may cough, they may feel tired and have to take a couple of days off work at the most. But they're not going to end up in the hospital, most likely. And it's very, very unlikely that they would die.

But when you are vaccinated, it's supposed to be really difficult to get infected, and then really difficult if you are infected to have that much virus in your nose. So all of those things are happening now. And that is why the CDC changed its decision last week on whether vaccinated people should wear masks indoors in certain places. Walk us through that new mask guidance and explain how it's connected to this new information about the breakthrough infections and the viral load. The CDC is saying that because vaccinated people can spread the virus to others,

they should be wearing masks indoors, in public indoor spaces, especially in communities with high transmission. So when we look at the maps of the U.S., for example, the Times has them, and we see those large concentrations of red in Wyoming, Florida, parts of Missouri, those are high transmission areas. Right. And you could have a very low transmission state because the state overall has, let's say, a fairly high vaccination rate and they're not seeing very many cases. But there could be a few counties within that state that are red, where the virus is really finding a foothold. And people in those areas should be wearing masks.

But everything you just told us is that theoretically, although it's rare, any vaccinated person could be at risk of a breakthrough infection. So why isn't this new mask guidance in place everywhere, given what we know about how transmissible Delta is and how quickly someone who has it can get on a plane and go from a high transmission area to a low transmission area? Isn't every part of the country potentially on the verge as a result of becoming a high transmission area? This is a really excellent question, and I think one that a lot of experts are asking as well, because why not make it universal masking at this point? If there are counties that aren't quite at high transmission,

they probably will be soon. And there are many that are just on the cusp. I think the CDC is trying to tread carefully, but I was able to look at a document last week that was shared internally within the CDC, and that one is not nearly as conservative. In that document, CDC scientists were quite openly saying that the country should have universal masking.

Hmm. So why isn't there going to be universal masking? It's a good question and one I've asked the CDC. I'll let you know when I have an answer. Hmm. So it seems like the CDC does not want to scare people, wants to take a narrow, judicious, modest approach to what it has just learned. I think that's understandable for a public health agency. I mean, the CDC's job is to

lead people and give them guidance, but to do so in a way that doesn't cause people to panic. Mm-hmm. lead people and give them guidance, but to do so in a way that doesn't cause people to panic. But there was this document, the internal CDC document, and that described the Delta variant as more contagious than SARS and MERS, you know, the previous coronaviruses, more contagious than the common cold, more contagious than the flu, than the 1918 flu, than Ebola. Wow. One of the things it said that really made me sit up and take notice is it said the next step for the CDC is to acknowledge that the war has changed. Meaning the war on COVID. Exactly.

And I think that's because the enemy has changed. Delta is not anything like the original enemy that we were fighting. We'll be right back. So Apoorva, let's talk through the practical implications of this new information we're getting and how people are starting to act on it or should act on it what are we seeing it's only been a few days and i think things are going to change a lot in the coming days but already we're seeing some reactions disney and walmart the latest company is announcing vaccine mandates for employees it follows uber jeffries, Facebook, Google, Netflix and the federal government.

We've had companies put in vaccine mandates for all their employees and some companies have decided not to bring their employees back to the office. Companies like Lyft are delaying six months to February. Apple and Google also pushing back their dates. And Twitter closed its offices in New York and San Francisco due to the surge in cases. Some places put in masking mandates. The CDC's new mask guidance has triggered mask mandates in New Orleans, Washington, D.C., even Broadway theaters. And it's now under consideration in San Francisco and New York. So there's a lot of change, and I think we'll see a lot more of it, and it'll be very patchy,

like everything else in this pandemic. I think some will react by putting in a lot of precautions into place, and some will do nothing. I want to zero in on one of the things that you mentioned, which is companies delaying their return to office. As it happens, that's something that's impacting us very intimately because our employer, The Times, just announced that we won't be returning to office in September because of this new information. They're going to delay that indefinitely.

But why do you think companies are delaying the return of workers to the office? Wouldn't a vaccine mandate solve that problem? Because then the risk of transmission would still be relatively low despite breakthrough infections happening. A lot of companies haven't really put vaccine mandates into place because it's very complicated.

But even if companies do put one in place, I think what this data is telling us is it's very rare for somebody who's vaccinated to get a breakthrough infection, but it does happen, right? And if you are somebody who's vaccinated and has someone at home who's immunocompromised or who has kids who haven't been vaccinated yet, even if it's a small risk, you may not want to take that risk and go into an office and be around people who may bring the virus to you, and then you bring that home. So the thinking is it's just not worth taking the risk. I think that's right.

And maybe all of these companies will be able to revisit that decision sometime this fall if Delta comes back down like it did in the UK and like it did in India, but it's just too soon to tell. You mentioned kids, Apoorva. This new information and this new guidance from the CDC would seem to have pretty meaningful implications for education. It does, because the CDC said that there should be universal masking in schools across the country, not just in places with high transmission, but everywhere. And that means that every kid over two should probably be wearing a mask,

all teachers, all staff should be wearing a mask. And that's going to go down okay in some places and not at all in others. But I think the CDC made that decision because we know now how important it is to have kids back in school. And it's worth doing whatever we can to make sure that they still have a place to go and learn every day. Right. Return to the office, in some people's minds, might not be worth it. But in the minds of people at the CDC, returning to school is very much worth it. That's exactly right. So beyond the workplace and beyond schools, let's turn to what this means for our day-to-day interactions.

And we've done this with you in the past, Apoorva. I'm going to give you some scenarios and have you help us think through the best way for us to approach them. Let's take the example of two vaccinated friends. Very grateful that over the past couple of months, they've been encouraged to spend time together indoors, have drinks, no masks, have dinner. Now, we're being told that one of them could theoretically have a breakthrough infection of COVID and a high viral load and pass it on to the other person who could then pass it on to their family,

should we now think of our vaccinated friends as potential risks? A lot of this depends on what your personal tolerance for risk is. If you live in an area with low transmission of virus and you don't live with anybody who's immunocompromised and you don't have kids under 12 who are unvaccinated, you don't think you'll be interacting with anybody who's immunocompromised. You don't have kids under 12 who are unvaccinated. You don't think you'll be interacting with anybody who is at risk.

And you don't mind yourself getting mild symptoms. Then, yes, of course, you can have dinner with a friend indoors. But if you do live with anybody who is vulnerable or may come into contact with someone who is, then I think we're going back a few months to where we were socializing mostly outdoors and wearing masks whenever we saw people indoors. And if you live in a high transmission area, you should be wearing a mask in all public indoor spaces. That's what the CDC guidance is telling us.

Mm-hmm. So according to that thinking, even vaccinated parents with kids under 12 should probably be masked when socializing indoors because they could spread the virus, a breakthrough case of the virus, to their unvaccinated children. Right. And as we know, kids are at very low risk of getting infected. And even when they do, they have very mild symptoms and they don't really transmit to others very efficiently. But the risk is not zero, so a lot depends on your kids' health and how many risks you want to take with it. mostly psychological, but meaningful, which is the idea that the vaccine meant that most people were not going to spread the virus,

that we, those of us who got the vaccine, were going to be part of the solution, which is not just keeping ourselves safe, but contributing to the end of this global scourge because we could not become vectors ourselves. And now we don't have that same assurance anymore. And that feels like a pretty big loss. I think it's a loss if you look at it in a glass half empty way. I think the glass half full view is you may get a little bit

infected, you may pass it to somebody else, But you are still doing a great service by not getting sick, by not burdening the health care system. And I really don't want to forget here that we've said the breakthrough infections are rare. It's not like all of us are going to go out and spread the virus. So I think there is a way to look at this that is not bleak. Mm-hmm. So are we maybe missing the bigger picture here if we focus on vaccinated people and breakthrough infections and viral load,

which is that this really is still a pandemic of the unvaccinated, despite this new information? I'm so glad you asked me that. We can't take our eye off the ball, which is we need to vaccinate as many people in this country as quickly as possible. As long as we have this massive number of people who are unvaccinated,

who can keep getting infected and spreading the virus, we're going to see these waves and surges, and we'll need to take precautions. I know that we've spent all this time talking about breakthrough infections and vaccinated people and that they can spread the virus, but the vaccines are doing their job. They were designed to stop people from getting really sick, ending up in the hospital and dying. And they are doing that very well. Really, the only way that we can get out of this pandemic

is to vaccinate as many people as possible. Well, Apoorva, thank you very much. We appreciate it. Thank you, Michael. And I hope not to have to talk to you really soon. But just in case, we'll put you down for next Monday. Yeah. In an interview on Sunday, the head of the National Institutes of Health, Francis Collins,

praised government agencies and private companies who are now requiring that their workers be vaccinated and encouraged employers across the country to do the same. I'm delighted to see employers like Disney and Walmart coming out and asking their staff now to be vaccinated. I'm glad to see the president has said all federal employees. I oversee NIH with 45,000 people need to also get vaccinated or if they're not to get regular testing, which is inconvenient. All of those steps, I think, are in the right direction. But I think maybe that's what it will take for some of those who've still been a little reluctant to say, OK, it's time.

We'll be right back. Here's what else you need to know today. In the latest example of a cluster of breakthrough infections, at least 233 workers at two major hospitals in San Francisco, most of them vaccinated, have tested positive for COVID-19. The majority of the workers were infected with the Delta variant. And a nationwide moratorium on residential evictions put in place by the CDC last fall has expired over the weekend, after efforts by the Biden administration to win an extension had failed. The expiration puts hundreds of thousands of tenants at risk of losing their shelter,

just as COVID-19 infections surge across the country. Today's episode was produced by Rob Zipko, Jessica Chung, Diana Nguyen, and Alexandra Lee Young. It was edited by Paige Cowan and Lisa Chow, and engineered by Chris Wood. That's it for The Daily. I'm Michael Barbaro. See you tomorrow.