The New Yorker Radio Hour - Atul Gawande on the COVID-19 Resurgence

Episode Date: August 6, 2021

For a few brief moments this summer, in places where the vaccination rate was high, we could imagine life after COVID-19: restaurants and theatres were filling up, gatherings of all kinds were taking place, and many businesses were planning to return to their offices after Labor Day. Then the story changed, as the highly contagious Delta variant began sweeping the nation. Atul Gawande, a professor of medicine and an internationally recognized expert on public health, tells David Remnick that the Delta surge has also caused a vaccination surge, which is promising. They discuss the idea of booster shots and the possibility of a future variant that would resist the vaccine and cause more severe breakthrough infections. The Lambda variant, Gawande says, has already reached the U.S., but little is known yet about how it responds to the vaccines in use here. Plus, forget the big white tent and the plate of rubber chicken: the real New York style is a City Hall wedding, complete with metal detectors. Vinson Cunningham tells us what it’s all about. (Gawande has been nominated by President Biden to lead global health development, including COVID-19 efforts, for the United States Agency for International Development. The appointment awaits confirmation in the Senate.) New Yorker Radio Hour listeners, we want to hear from you.  We have a few questions about the show and how you listen to it. The survey takes about twenty minutes, and your feedback will help us make our podcast better.  Take the survey here.

This is The New Yorker Radio Hour, a co-production of WNYC Studios and The New Yorker. Welcome to The New Yorker Radio Hour. I'm David Remnick. For a few brief moments this summer, you could imagine life after COVID. In places where the vaccination rate was especially high and cases were falling, some of us were even getting back to some version of the old life, seeing friends indoors and out, eating in restaurants, and a great deal more. We didn't forget COVID, far from it, but the fear was lifting. It felt amazing. Then in recent weeks, the story changed. At the New Yorker, we're lucky to have on our staff, Atul Gawande.

Atul is not only a staff writer, he's a professor of medicine and an expert on public health. Atul co-founded a company that does COVID testing and vaccination, and he advised President Biden's transition team on how to deal with the pandemic. Atul, I don't want to accuse you of anything, But what the hell? I mean, we thought we were just about out of the woods, at least if you were vaccinated. And now we're hearing about breakthrough cases and we're hearing about the Delta variant really changing the picture in the United States, the way it had in Britain and elsewhere. Yes. You know, it's interesting that people are almost angry about the reality of where we are.

We've been discussing this for a while, right? We talked when the vaccines first came out about we're going to have to wait and see what we know about transmission. We are very concerned about variants. And there's lots of ways in which, you know, you had poo-pooing of the public health folks who would say, we see variants and they are coming and they're of great concern. And now they're here. So here's where we are. We have a new surge.

And it's Delta. And right now, it's almost all of the infections in the country are essentially Delta. It is surging to the point that in the southeast, you have, for example, in Florida, the number of cases and hospitalizations now exceed the peak of their prior outbreaks. Overall in the U.S., these are higher numbers than wave one and wave two, our biggest wave, which peaked in January, we're not exceeding that when it comes to cases. We don't expect deaths to reach the same peaks because some of our highest risk people, the elderly in particular, are pretty well vaccinated. So we're in the thick of it, but it's – but there's – but there are, but there are. are things we can do, and number one is we can get vaccinated. So you mentioned the state of Florida, I assume the culprit there is lack of vaccination and the encouragement or the lack of encouragement

for vaccination from political leaders in Florida. Am I getting that right? The connection to exactly the political leadership components are unclear because you have what I've appreciated in this particular part of the pandemic is unlike masks, vaccination has been encouraged by Republican governors and by Democratic governors. And we haven't been split in the political leadership in the same way. That said, in a lot of GOP states, you have very high rates of people going unvaccinated. And it also coincides with parts of the territory where you have a lot of people of color who are not vaccinated. And so there's a complex story to still unpack about the resistance. That said, as a result of the Delta surge, we have seen a vaccination surge as well.

And demand has jumped up substantially. And we're seeing vaccinations again so that Biden's goal of 70% of the adult population getting vaccinated was actually exceeded finally this week. So there are a lot of people that have a small business or an office. and they've been working remotely for over a year and a half. And people have set return dates to the office for Labor Day. Because Labor Day seems like a good date. After all, that's when the summer's over, and we seem to be coming out of the terrible hole that we're in.

How do you feel about people returning to an office around Labor Day? Is that a good idea? What are the considerations that should be in mind for everyone? involved. First, this is a pandemic of the unvaccinated. And you have to then grapple with bringing people back together requires either that everybody's back in masks again or you are vaccinating. And while this is surging, probably both. I don't think we get around that. We, if we verify that everybody is vaccinated, we still have this surge going on because half the country is not vaccinated. And so we're likely to need to mask, especially if we're not verifying that your workforce is vaccinated.

What about on the most practical banal level? Do you, Atul Gawande, go to a restaurant and eat inside at this point? I am now not. My mother and I, she's 84, get to have the privilege now that we're vaccinated of getting together now on a regular basis. and every week we get together. And now I'll get... There was a period in time when we went to...

when we were going to go to a restaurant. Actually, we never did. We were like, we can finally go to an Indian restaurant and it's going to be great. But, you know, the surge started to come and just realized I can't go back to the restaurants yet.

We don't have... And Massachusetts is doing well. We're under reasonable control. it probably is fine for me to go out for some sushi. But the way that things are surging for most of the country, I really, I'm eating outdoors. I'm going to restaurants and eating outdoors, and I'm taking out, and I'm having my mom over to my place at home.

The most important thing is you see your mom once a week. And I get to see my mom once a week. Sometimes even more. Absolutely, people at CDC and yourself, and all kinds of people warn that, COVID may become endemic, and here it is. And what does that mean and what does that mean for the future? Yeah, so one question is, what's the goal behind everything we're doing?

It's our goal to eliminate the virus entirely from our shores. And unless we get vaccination at exceedingly high levels, not just in the United States, but across the entire world, that's not going to happen. There are too many reservoirs for infection to come back in. Becoming endemic means that we may have circulation of virus in pockets, especially on vaccinated pockets that continues for a while and may continue for the foreseeable future.

Sometimes these viruses really do just sort of gradually disappear at a certain point, and we've never been able to predict when that happens. But what I feel we have seen is that we are going to see continued mutations. There will be ways in which this continues circulating until we get much higher levels of vaccination in our society. We're at 50% of all the people. We're at 70% of all adults. And we're going to have to get substantially north of that. The Delta variant is extremely contagious.

and that means we'd have to get over 90% before you could really drive it down. And that means, you know, what I see as a target is, can we have fewer deaths than the flu, which would be fewer than 100 deaths per day, we're currently 300 deaths per day in going up, and can we have fewer hospitalizations

than we have with the flu and sustain that? That is the ultimate goal, and that is what fully allows us to return to normal. How long is it until we see a variant, evolved that overwhelms the vaccine, where the breakthrough infections are really bad, they're severe, they're fatal, that seems like a nightmare that may be hanging over this entire process, or am I being too alarmist? I don't think you're being too alarmist. We haven't seen that yet, though. There is another variant called Lambda, which has taken over in Peru. We had our

first cases in this past week turn up in Houston. And it again seems to be another contagious variant. And we don't know whether it could be make people sicker or make kids sicker or those kinds of things. We could very well see, given how much of the world is still unvaccinated, how we haven't got the supplies out there yet and haven't got the delivery and distribution, that there are going to be other variants that will appear, and it is very possible that a more resistant variant to vaccines could emerge. Are you suggesting, just to be clear, are you suggesting that the Lambda variant overwhelms the vaccine?

We don't know. It has taken off in Peru where they had the Chinese Sinovac vaccine, which we know not to be as effective. as the MRNA vaccines that are predominant ones we use in the United States and the Johnson and Johnson vaccine. So I don't think that the Lambda variant, we're still trying to understand more about it, is one that is overwhelming, has resistance to the current vaccines.

But again, every new variant that comes, and as it takes off, you begin needing to examine how effective are the current vaccines against those variants. And it is possible that those are things we have to look out for. That's what brings up the questions that people have had about boosters and whether a third dose could end up being required in order to allow broader protection. The people who are infected by COVID compared to getting a vaccination,

the vaccination has offers deeper and broader immune protection against variants. And so we know that if you've had a prior infection, it is hugely beneficial to get a full vaccination set and then still learning to be done about who would need third doses. We've noticed in Israel, for example, that people are getting a third shot, a booster. Do you recommend that now? It's actually tricky to get, even if you wanted it, but do you recommend that? is that in our future?

Well, so what's important to understand, Israel, France, and Germany are all recommending third shots for high-risk groups and then defining what that high-risk group is going to be important. And I think this is going to become something that is clearly needed here. The high-risk groups that we know needed are people like organ transplant patients,

chemotherapy patients and others, who have suppressed immune systems, and we have some good evidence that, you know, two doses didn't work for a substantial number of people, say, with organ transplants, but a third dose boosted their, got them a good immune response. In a sense, there's some learning that has to go on about whether this is a two-dose vaccine or a three-dose vaccine as the regular regimen that people might require. And over certain ages, Israel is vaccinating people over 65. I don't think we have enough good evidence that just being of a certain age puts you at greater risk.

There isn't enough evidence now, I think, for us to follow what Israel's doing. It will be valuable to look and see what their data tells us about who else should be defined as needing a third dose. I guess, you know, I'm the kind of person if I get indigestion. I go to the emergency room. So I would say to myself, okay, a third shot. what's the harm? Is there any harm in getting a third shot and getting a booster? What possible downside is there? Well, we do know that, you know, we have seen side effects from the shots. For example, of Johnson and Johnson, the issue with blood clots. We want to make sure we're not

driving any adverse effects. We've got an exceedingly safe and low rate of major adverse effects, but for sure we see some adverse effects with these vaccinations. There is, some risk that a third dose could fuel more adverse effects, but we don't really know. On the whole, in those who have poor immune response, that isn't a major concern, and therefore getting the third dose has so far been supported. I think it's going to be very likely. We'll define a group who are on high-dose immunosuppression or have immune conditions that will require a third dose and that it can be safely done. Atul Gawande, thank you so much.

Thank you. You can find Atulguanda's reporting on the pandemic and much more at New Yorker.com. A tool has been nominated by President Biden to lead global health efforts for the Agency for International Development, USAID. That's all awaiting confirmation in the Senate. This is the New Yorker Radio Hour. More to come.

This is the New Yorker Radio Hour. I'm David Remnick. Here in New York, one birthday, spot in the city's gradual reopening is this. The Marriage Bureau is open for business, and they started taking appointments last month. A city hall wedding is a distinctly New York style of event. It doesn't usually come with embossed invitations, a white tent, and some cute six-year-old bearing the rings. Instead, you and your loved ones parade down to a big office building downtown, and you weave through crowds of city workers on lunch, you go through metal detectors,

and then you have your moment before a judge. That's what Vincent Cunningham did, along with his fiancé, a few years ago. I grew up imagining a wedding that would happen at a church, certainly by a pastor or a priest or something like that. The scriptures that I had always heard about marriage would be, like, you know, recited. Love is patient, love is kind, things like this. I had not given much thought to what my wedding might be like.

That's Renee, my fiancé. I just knew that I didn't want it to be big. I think in the end, we got married at City Hall because we'd been engaged for a long time. Neither of us had the stamina to plan something on a grander scale, and we thought that we could make this a lot of fun. And so that's, we went with that. Yeah.

So it's a day of our wedding. We're here early, and so it hasn't opened yet, but people are still, like, waiting in line. We made it here. Yeah. We have a good spot. in line. Yeah.

My mom's on her way. Outside, is this like crazy bustle of people. These lawyers headed to the courts. Yes, sir. You're looking for a bouquet? Flower guy selling flowers and a bunch of photographers looking for clients. It's kind of a madhouse.

Oh, you need a wedding book? Okay, sit. Oh, yeah. Yeah, I got it right here. I got a white one. I can make another color. I got Calla Lulibu. Tracking her car right now.

My mom's on her way. She's telling me she's an, car, but I just, I want to make sure she gets there in time so that we can all go through the metal detectors together. Says 11 minutes, this feels like a very modern wedding problem, like, let me look on the map and meanwhile, I'm thinking in the back of my head that I don't want to cry in a couple minutes when this actually happened. I couldn't go to sleep.

When I fell asleep first, I was like, I don't think I really fell asleep until like 3.30. It's like, to get married at City Hall is in some ways to acknowledge the fact that it really is a legal, contractual matter, right? It's totally not unique. Everybody's here to do the same thing that you're doing. Everybody is going to take a number in the same way that you are. So at the same time, it's very beautiful.

It's very generic. Now I'm just like really wondering why people choose to get married here as opposed to other ways. What was the decision like? I think this is the simplest way. You know, we are foreigners. They're trying to adapt ourselves into like a different area, like a different culture. So, yeah, do something new, you know, different than what traditional people do all the time.

I mean, we're doing it sort of for practical reasons. So he's health insurance. Yeah, I mean, this is more of a formality. It wasn't meant to be something that was super. special. It's just supposed to be paperwork, but it still does feel kind of special. You know, now it allows us to figure out being as a family unit, so we really want to think about how to increase that family unit with whether kids or more dogs. It's the first thing I thought of was our dog at home. And I'm like, well, now she'll have, you know,

married parents. Yeah. So we've been friends for 16 years. Yep. When Renee and I met, I found out very quickly because I asked for a quickly that Renee had a boyfriend at the time. But I was always sort of trying. I kissed Renee once. I remember on a subway platform and she was like she was like still dating someone. It was inappropriate.

And her lips did not move. And it was just like we were friends and it was just like, okay, all right, fine. But you know what? I planted a seed that day. Yeah, it's beautiful. What is that? Fancy. Oh, we're moving.

We're finally through the line, and we've got Renee's mother, my mother, Renee's brother, Renee's sister, and my daughter with us. And then at the end of the line, we're just, there's this metal detector. They have, like, the airport magnetometers and stuff. It's very TSA feeling, but you're in a dress and stilettos, or some people are wearing full-on gowns. It's kind of an incongruous thing, and I'll think many people think about getting checked for weapons on their wedding day.

And then once you've given your ID and you've got this number, it's just the nicest DMV you've ever been in. You know, it's like these sort of gold fixtures and big, portentous-looking lights, but it's still like the display of, you know, A-65, pick up your tab, you know. And there's also like a lady telling us, too. I don't even know how to describe her. She commanded the room immediately. Good morning, ladies and gentlemen.

Yeah, she's like half, half Katzgills comedian, half TSA agent. Yes, absolutely. Yeah. Rule number one, no contraband. Rule number two, no contraband. Rule number three, no contraband. And she's also clearly seen a knife. Yeah.

She's like, also no more, like, out of nowhere, she's like, no knives here. I'll be ready? Steady and go. Natsur. A. C. One. So we have to walk over.

Okay, station line. So we walk in and there is, there's a podium. At some point, the efficient just comes into the room. These people second. Renee. Renee and Vincent. Yeah. All right.

Come on up, you two. Are you guys exchanging wedding rings today? We are. All right, bring the rings up. Thank you. Face each other. And she tells us to face each other and hold hands. We were just looking at one.

I were just like, we're staring at one another. We were just like in this death stare. As I suspected, while I'm holding Renee's hands and looking at her, I'm also feeling my eyes start to stay. We are gathered here today for the wedding ceremony of Renee. It was, I don't mean to sound dramatic, but it was sort of otherworldly. Yeah. I kind of blacked out.

I did too. Let them speak now and grab a hold their peace. What is so striking to me is that everything else seems so different than other weddings I've been to. Then all of a sudden you're up there and you're hearing and saying these things that you've heard at every wedding. Suddenly, you're a player in this thing that is very much like a form that you've seen before. Renee, do you solemnly declare that you take Vince? to be your spouse. And we won't

promise to love. Sometimes I guess you get worried about what makes something sacred and important. And it's strange. Like, you realize that so many of the forms that you think take to contribute to that,

all of it, all the sort of veils and lace and all of it, at the bottom of it are these sets of like very simple promises. Do you solemnly declare that you take Renee to be your spouse? I do. Do you promise to love, honor, cherish, and to keep as long as you both shall I do?

Please place the ring on the finger as a symbol of your program. Because you tend to see any kind of ceremony or spectacle, you tend to see from the outside in. You tend to think that the trappings of it are what give it its power. But standing in this room, you realize that there is a power in the thing itself, you know, deciding to partner yourself with someone for life. It really does kind of convince you, like, that is a tremendous thing. By the power vested in me by the laws of the state of New York, I now pronounce you married. You may feel your vows with kids.

Vincent Cunningham is a staff writer at the New Yorker, and we heard from his wife Renee Chung. They were married in 2018. Nice to meet you. That's the New Yorker Radio Hour for today. Thanks for joining us. See you next time. The New Yorker Radio Hour is a co-production of WNYC Studios and The New Yorker. Our theme music was composed and performed by Merrill Garbus of Tune Arts,

with additional music by Alexis Quadrado. This episode was produced by Alex Barron, Emily Boutin, Ave Carrillo, Riannon and Corby, Calalia, David Krasnow, Gauphin and Putubuele, Louis Mitchell, Michelle Moses, and Stephen Valentino. And we had additional help from Harrison Keithline. The New Yorker Radio Hour is supported in part by the Cherina Endowment Fund.