Public health doctor on pandemic holiday travel: "It sucks, but cancel your plans" – Salon

The COVID-19 pandemic’s massive toll did not need to be this bed. This is what Dr. Seema Yasmin, who has served as an officer in the Epidemic Intelligence Service at the U.S. Centers for Disease Control and Prevention, expressed to me recently on “Salon Talks.”

Yasmin stated bluntly that President Donald Trump’s lack of a “cohesive, strategic response to the pandemic” caused infections to spike and has resulted in widespread suffering for Americans. And while much of the country may be looking to spend time with extended family and friends for holiday celebrations this week, Yasmin, who also serves as a clinical assistant professor at Stanford University’s School of Medicine, is advising everyone to stay home.

“People are traveling. They are gathering. They’re getting fed up,” she said. “Then we’re hearing these really heartbreaking stories of people on their ICU beds on their death bed saying, ‘Oh, I wish I’d stuck out the restrictions a bit more. Tell people to take this seriously.’ So please don’t do it. It’s not worth it.”

Yasmin and I also discussed how misinformation surrounding the virus, which oftentimes comes directly from Trump, has contributed to the United States having one of the highest mortality rates for COVID-19 of all the developed countries. And if you’re curious about how the various COVID-19 vaccines work differently scientifically and which one could be right for you, watch or read our interview below. While they all show great promise, Yasmin noted that these vaccines are only effective if approximately 70 percent of the country agrees to be vaccinated so that our nation reaches herd immunity.

The following interview has been lightly edited for clarity and length.

We’re seeing COVID cases explode right now, even worse than in the summer. What can you share about why that is happening?

That’s actually pretty straightforward. The reason we’re seeing escalating cases and now record-breaking numbers of infections, deaths, and the number of Americans in hospitals higher than it’s ever been in the pandemic is because we haven’t really had a cohesive strategic government response to this pandemic. States were left in the lurch from the spring and the tests weren’t finalized. We didn’t have a good testing strategy.

Then also, I study epidemics I also study misinfo-demics, which has all the misinformation and disinformation that circulates. And that’s been overwhelming. I’ve talked to really well educated, rational people who’ve told me verbatim conspiracy theories and hoaxes that they fallen for because there’s so much misinformation out there.

People are finding it really difficult to separate the fact from the fiction, especially when you have people at high levels, high office in the country, sharing things that are completely false. It really throws a spanner into the works in terms of getting viral transmission under control. Those are a few of the reasons why we are seeing what we are seeing now, which is the record-breaking numbers of Americans infected contagious, but also dying from this disease every day.

If we had a different president in office when this happened, one that was responsible, one that didn’t mock mask wearing, one that didn’t skew misinformation like Donald Trump objectively did, could this have been different for us as a nation?

I do think so. Cornell University researchers analyzed 38 million English language articles about COVID-19 and through their analysis of those, they determined that the single biggest driver of false information about COVID-19 was President Trump. So that in and of itself, even if you’re in a resource-poor setting, you don’t have the best testing, you don’t have all the best hospitalization equipment and all that capacity, sometimes you can be very effective by just really efficient, clear information, telling people what to do right. Telling them how to stay safe. We didn’t even have that in the U.S.

I’m not saying that every other nation in the world got this right. You will see in that Europe, there are countries that are struggling right now. But you look at our death rate from COVID here in the U.S. And you take it as a rate, per million people. Ours was around 700 deaths per million Americans at one point. Then you look at places like Vietnam, it’s 0.36 per million people. So yeah, it’s a smaller country, much smaller, but even when you account for that massive change in population, there were countries that were just way on top of this. America now has the worst epidemic of COVID-19 in the world. And one of the highest COVID-19 mortality rates of any developed nation, specifically.

It’s horrific to hear that when we’re compared to other countries and you lay it out there for us, that it did not have to be this bad. Americans didn’t have to die. I’ve lost four friends, including one I just learned about today, a comedian. The death toll is upticking, we’re seeing numbers of over 2,000 a day. When will we hit the worst of it in this country? Could it be three months of this?

Yeah, because if you were to look, there’s a lag between the infection rates and then the hospitalization rates, and then deaths. Two to three weeks off in between those. Everything is rising and at the moment, there’s no indication that anything will decrease. What could happen differently, we’ll get to talking about a vaccine in a moment. But realistically, to achieve safe herd immunity through a vaccine, you’d need to vaccinate upwards of 200 million Americans. On the one hand, you’d have to have Emergency Use Authorization of a vaccine.

Then you’d also have to figure out the logistics of manufacturing 400 million doses at least, since everyone’s likely going to need two doses of vaccine. And on top of that, you have to have public buy-in. Vaccines don’t end epidemics, people choosing to get vaccinated, that’s what ends an epidemic. And right now, many of the surveys are showing us that not enough Americans are saying that, yes, they will pull up their sleeve and get a vaccine. And without that a vaccine won’t help us.

We’re in the midst of the holiday season right now. People naturally want be with their family. What do you tell them about doing it safely or is your advice don’t even do it?

As a public health doctor, we correct people when they say the word “safe” because we like “safer.” Everything’s on a spectrum. We know that people won’t always do what we tell them to do, so what are the things that you can do to try and limit the harm in an activity? Still having said that, I’ll start off by saying, I’m sorry. It sucks, but cancel your plans.

Thanksgiving should have just been canceled. We shouldn’t have had Senator Ted Cruz saying on Twitter, “We are not willing to give up Thanksgiving and we won’t be willing to give up Christmas in December.” That kind of sentiment is really deadly. We’re trying to limit gatherings. We had about five to 10 million people go through TSA screenings. And I say that range because depending on which dates you look at. Over Thanksgiving week, it was less. It was fewer people than traveled last year for Thanksgiving, but that’s way too many during a pandemic.

People are traveling, they are gathering, they’re getting fed up. And then we’re hearing these really heartbreaking stories as well of people on their ICU beds on their death bed saying, “Oh, I wish I’d stuck out the restrictions a bit more. Tell people to take this seriously.” So please don’t do it. It’s not worth it. Tulane University has been testing a lot of its students in New Orleans and they said that nine out of 10 students who test positive for the coronavirus have no symptoms, no fever, no cough, not even saying they have any fatigue. And yet they’re testing positive and they’re going to be contagious. So that’s what you’re up against. Yes, you want to fling open the door and welcome your loved ones and give them hugs. We just can’t do that this year. We’re going to have to stick it out, wait until next year. That’s the most important thing.

People are trying to get around this by doing lots of testing. I’m not loving this because I don’t think the U.S. still has adequate capacity of testing. You may have heard some nurses in the news recently, really outraged saying, “Hold on a second. These pro athletes and some Hollywood stars are getting access to really high-frequency testing.” But then nurses they’re not able to get the test that they need. I think that’s starting to overwhelm. I would want to say to everyone, “Yes, get a test once a day.” But that capacity isn’t available.

People fall into a false sense of security when they get a negative test. And I think people let their guard down too much when that happens. Not realizing you can test negative for this coronavirus in the morning and be infectious by the evening. There’s a crossover point at which the virus is in your body, but not high enough levels to be detected by a test. And then at some point that is enough virus to be detected by a test. And negative test result is just telling you your status as a snapshot of one moment in time. Please bear all of these things in mind, as you’re deciding what to do over the holidays. You do not want to need a hospital bed in the next few months. Do everything you can to avoid that scenario, because there may not be space for you.

The COVID-19 vaccine is here. People have a lot of misconceptions. What is the difference between this vaccine and others and what are the differences in COVID-19 vaccines across different companies?

The one that got approved in the UK, the Pfizer-BioNTech vaccine, it works in a similar way to another vaccine. You may have heard about the Moderna vaccine, both of these do something really clever, I think in terms of biotech. Instead of giving you a tiny chunk of the virus, not the whole virus, but not even giving you a tiny chunk. What they’re doing is using messenger RNA that goes into your body. It’s basically a recipe that your cells read. And then they use that recipe to generate just the spike protein of the coronavirus. Your body’s not making anything infectious, but it’s receiving from the vaccine these instructions to make a tiny piece of the virus so that your immune system is like, “Ok, seen it, know what to expect, know what to look out for going to start building antibodies so that if we get exposed, we can fight this.” So that’s how those two vaccines work.

The University of Oxford/AstraZeneca vaccine is different. It uses a chimpanzee virus that’s been modified so that it can’t make humans sick. And into that virus, they’ve actually added a small chunk of the coronavirus, but just the spike protein. So not the whole virus by any means. It can’t give you COVID-19, but it gives your immune system that little primer that, “Hey, this is the thing that you need to look out for.”

What about people’s concerns about side effects? I’m sure each vaccine is different, but what should people look for if they have an option between which of the vaccines to take, to ensure it’s right for them and safe for them?

We’ll be looking at the guidance that comes from not necessarily the drug company or even the regulators, but the independent boards of scientists and vaccine experts who look up all that data on our behalf, on the public’s behalf. They’re not tied in any way to drug companies or to regulators. Most of them don’t get paid for a lot of the work that they do. They’re reanalyzing the raw data from the vaccine trials to say, not just is the vaccine safe or not, but “Hey, this is a vaccine that might do better in those over the age of 55, or this is a vaccine that we might want to use in this particular scenario.” I, for sure, be looking for guidance from them.

Right now it still feels a little bit early to make a call on those things because I think very much, we’re kind of living science by press release. Press releases are really marketing tools. We still need to see some more of the data, but we have seen really promising signs, especially from the Pfizer-BioNTech and the Moderna trials of 95 percent efficacy against COVID-19. I think that’s a lot higher than many of us expected.

You mentioned you would need a booster shots for some of these vaccines. Does that mean when you get the first shot, you’re not immune at all, until you get your second booster shot?

It might vary from person-to-person and also from particular age groups to another, because our immune system does evolve over time as we get older. But if you recall… Anyone watching this who has kids, or maybe you recall from your own childhood, but especially when kids are just babies or a few months and two years old, you’re taking them, I hope to the doctor again and again for more vaccines. Right? That’s because for many vaccines or many diseases, a one-shot approach isn’t enough. It doesn’t give your body enough protection. We have a saying in vaccine science, prime-prime-boost.

Meaning that first shot you get kind of tells your immune system, “Hey, wake up. This is the thing you need to be prepared for.” And your immune system might start making a little bit of antibody. Then you get the second shot, and then that might boost it a bit more. Then you get that third booster shot for some diseases. It varies. You get prime-prime-boost. That final one will really ramp up your immune system’s preparedness level to fight any particular pathogen.

Johnson & Johnson in the case of COVID-19 is currently testing out a one-shot vaccine in about 60,000 people. We don’t have a lot of data from that yet, but all of the ones we’ve talked about, the Pfizer-BioNTech, the Moderna and the University of Oxford/AstraZeneca vaccines. All of those are two doses, mostly because you need your immune system to have that second booster shot to really mount a solid response. We haven’t had enough time yet to say on top of that, you’ll need another booster in five years or 10 years. We don’t know that yet. That might be the case.

Let’s say you get the two booster shots in the vaccines that you need. How long then after are you close to being immune as you can. You’re saying 95 percent of the potential rate there. So in the real world, what does this mean?

We don’t know yet. I want to be really honest about uncertainty. Never trust a doctor that acts like they know everything, that’s when you leave the clinic. Nobody wants a “know-it-all” doctor. It’s just too soon to say, Dean.

I have a lot of questions about the press releases from the early data that’s been published, especially from the University of Oxford/AstraZeneca vaccine. That is the one that actually kind of on paper, I was most excited about early on. It did not use that messenger RNA approach. It used that chimpanzee’s fake virus with a little tiny bit of a spike protein, that approach to vaccinate us. I was excited about the Oxford/AstraZeneca vaccine, because I don’t know whether you saw that the British tabloids were calling it a “vacca-chino,” saying that basically it costs less than a cup of coffee. It was about two to $3. You compare that with Moderna and Pfizer-BioNTech, you’re talking about 20 to 40 bucks a shot. Right? I was excited about Oxford/AstraZeneca one for the cheapness. And also because you can store average temperature, the other ones need to be frozen. The Pfizer-BioNTech needs to be frozen at really, really cold temperatures to the point that many facilities won’t even have freezers that can keep it that cold. So I was excited about that.

But there’s been a number of blunders with the Oxford/AstraZeneca trial. That’s really, really frustrated me. On the one hand as a scientist, because I’m, “Come on, get your together and do the trials properly.” But also as somebody who studies the spread of misinformation and anti-vaccine movements and someone who’s always trying to tell people how vaccines work, how to understand the trials. I think the Oxford/AstraZeneca debacle hasn’t started to erode trust in the vaccine makers, even for those who trusted them to begin with. They’ve made mistakes. They’ve tried to call them useful mistakes and serendipitous. They don’t think that you don’t do in vaccine fires. It’s lumping together data from the British crowds and the Brazilian trials, even though they were kind of designed differently and shouldn’t have been done that way. Right now AstraZeneca and Oxford, aren’t rushing for approval. In fact, in the U.S. They’re seeking guidance from the FDA asking, “Should we submit for approval just yet?” I wonder if their response will be, “No, we still need some more information from you.”

The history of vaccines has taught us that often the first one that comes along for a particular disease isn’t the best one. [It] isn’t the one that sticks around the longest. Or a better one could come along. But if we do imagine it as a race, Pfizer-BioNTech, Moderna and the Oxford/AstraZeneca ones are furthest ahead. And now I feel like the Oxford/AstraZeneca one is lagging behind because of these mistakes and unanswered questions.

Will the vaccine have widespread access in the late spring, early summer for anyone in America who wants to get it? After that, when does it really become that we can go back to not wear a mask, not social distancing and return to our lives?

Yeah, I feel like when people are asking me, “When will the vaccine be available?” Mostly what they’re really asking, but not saying is, “When can life go back to some kind of normal. When can I not wear a mask?” So two things about this. I’m not going to believe any promises, if anyone is making promises about widespread availability by spring. And here’s why we calculate what proportion of people need to get vaccinated in order to reach herd immunity, and you get different numbers for different diseases depending on how contagious they are.

Measles is so contagious that you need like 93 percent of the population to be immunized in order to get a herd immunity. With COVID-19 it looks to be somewhere maybe say 70 or 75 percent. That’s three out of four Americans. And currently in the surveys, around half or less than half, depending on which ones you look at, I say they won’t get it.

If we do somehow get public buy-in, how are we going to make that much that quickly? Even once you’ve produced it with the Pfizer-BioNTech, $20 a shot, needs to be stored at minus 94 degrees Fahrenheit. Who has those freezers? Not any lab I’ve worked in. You can thaw it, and then it only lasts for five days in the fridge and then it goes bad. Then, it’s only just transported in particular numbers of vials in a particular shipment, meaning it may get to some counties that don’t even need that much or has to thaw all of it, because that’s the way it works. You get about five doses per vial, and then there’s going to be an amount that’s wasted. I know I’m getting really into the weeds here, but it’s because those are the things that will matter at the end of the day, in terms of rolling out enough vaccine for everyone who needs a shot to get the shot in order for us to get herd immunity.

In the meantime, like you said earlier, once vaccines do start to become available, which could be by the end of this year for some groups, such as healthcare workers, for some people in nursing homes. I worry that people will say, “Ta-da, we’ve crossed the finish line.” And actually where we’ll be at is getting near the finish line — the point in a race where you’re looking around and you do not slow down. You keep up your momentum.

What I am worried will happen is people will drop their guard and be, “Well, vaccines are coming. Right? So we can do parties. We can celebrate New Year’s as normal. [We] don’t have to wear a mask,” and all of that. But we do until there’s herd immunity, until a significant proportion of people have been vaccinated. Until then, we still have to keep up those safety measures. We’re still trying to understand whether the vaccines will keep you from getting sick, but do they stop you from spreading the virus to others? In which case, if that’s not going to happen, you’ll need to wear a mask, even if you’ve been vaccinated so that you’re not spreading your germs to other people. There’s a lot to think about here.

It’s clear that there is no way to give it a day or even a month. We’re going to see how this plays out.

Before you go, you’re also an author, in addition to being a doctor. Tell us about your new book, “Muslim Women Are Everything.”

It’s a book packed with stories of amazing women who are Muslim — they’re astronauts, they’re ballerinas, they’re Formula One racecar drivers. Women who’ve been told that they can’t do stuff because they wear a hijab. Or women who’ve been told that you’re not Muslim enough because you don’t wear a hijab. It’s that “damned if you do, damned if you don’t.” And they’re just really inspiring women, who’ve kind of jumped over these obstacles that have been put in their way and been determined and that’s try to live their best life.

The thing that I love about it is that as Muslim women, we’re always kind of pigeonholed or told we need to be one way or another. And these are women who are everything from transgender to disabled to military strategists, not necessarily peace-loving. They are kind of shattering this idea of Muslim women are one thing. Actually, no, we are many things. And oftentimes we don’t even agree with one another, that how varied we are, we’re not a monolith. So I hope people pick it up and feel inspired.

I’m working on a book, “Muslim men are mediocre.” It’s going to be a great.

[Laughs] I think that could be a bestseller.

Your next book coming out in early January is called “Medical Myths And Why We Fall For Them.“

This is a book you won’t believe, but it’s been five years in the making. I’ve been writing it for a long time. Because I always get asked these questions. “Do vaccines cause autism? Can you cure this? Can you cure that? Are chemtrails from planes in the air, are they toxic? Should I buy the flat tummy teas that are sold on Instagram?”

This book answers some of the most commonly asked questions, but also does a deep dive into why is it that conspiracy theories persist. I grew up in conspiracy theories. So I talk about why it is that we believe what we believe and why is it that sometimes, something that’s patently false feels much more believable than what’s actually the truth.

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