3 Metrics Will Tell Us When COVID-19 Is Over, CDC Director Says

John Whyte, MD; Rochelle P. Walensky, MD, MPH


June 08, 2021

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

JOHN WHYTE: Hi, everyone. I'm Dr. John Whyte, Chief Medical Officer at WebMD, and you're watching Coronavirus in Context. Today I have a very special guest, Dr. Rochelle Walensky, the Director of the Centers for Disease Control and Prevention. Dr. Walensky, thank you for joining us today.

ROCHELLE WALENSKY: Thank you, John. I'm delighted to be with you.

JOHN WHYTE: Well, let's start off with, remind us who does and doesn't need to wear a mask and when.

ROCHELLE WALENSKY: So the first thing to know is anybody who feels more safe wearing a mask should wear a mask if they want to wear a mask, right? People should look to the local guidance that has been given and be deferential, certainly, to the guidance. If you are in a public place that is asking you to wear a mask, please wear a mask.

In general, however, if you are vaccinated and you are not immunosuppressed or don't have an immunosuppressant -- are not on an immunosuppressive agent, it is really safe for you to be able to take off your mask. If you are not vaccinated, you should continue to be masked.

JOHN WHYTE: The CDC recently raised awareness of hospitalizations increasing in kids 12 through 15. What do you think is causing this?

ROCHELLE WALENSKY: So this was data that was from March through October that essentially said that hospitalizations among adolescents was two to three times higher associated with COVID than it had been to prior influenza. That's really important because that was true even in the context of schools being closed.

And so the reason that I think that that's such important data to emphasize is people have been wondering, are my adolescents at a high enough risk if they get COVID to merit vaccination. And I think these data were really important to say, not only were they getting hospitalized, but they were ending up in the ICU and oftentimes on mechanical ventilation. And so -- I should say sometimes on mechanical ventilation. And so we really wanted to demonstrate that this should yet be a reason why parents understand it's really important for their adolescents to get vaccinated.

JOHN WHYTE: And we know that vaccination rates are going down, particularly in adults in certain areas of the country. We're addressing these issues of hesitancy, particularly in communities of color. I wanted to ask you, what's the role of physicians in helping to get out the message about really evaluating risk and helping patients make that decision?

ROCHELLE WALENSKY: So first thing to say is, we expected vaccination rates to not continue at the sky high levels that we had them at. We knew that there was going to be this period of time, this inflection point, where all the people who were rushing to get vaccinated would soon get vaccinated, and then we had to do the hard work of reaching people who were not rushing to get vaccinated, and that really is the role of the physician, of WebMD, of Medscape, to get the message out to physicians.

To be honest, physicians are the place that patients go for their medical knowledge. They are the trusted person that people come to. And so I would say physicians have a really important, really active, and I hope proactive role in understanding who their patients are, what might be their reason for not wanting to be vaccinated, and for being very proactive in reaching out and saying, these are all the reasons why we think it's important for you specifically to get vaccinated.

JOHN WHYTE: What about doctors who say, you know what? I don't have time to do that. I have a busy clinical practice. It's not my job. You feel it is our job to help educate patients and help them evaluate the risk and benefit of COVID and put it into context for them. People are concerned about the risk of a blood clots, potentially from vaccine, yet the risk of blood clots from getting the disease is much greater. We don't always explain that well as clinicians, do we?

ROCHELLE WALENSKY: Right. And I think one of the things that's really important is to understand why people might have not stepped up to get vaccinated yet. And we as physicians, I personally am a data person, I like to see the data, but data don't drive everybody.

What might drive somebody's decision is seeing their neighbor who had headaches the day after their vaccinations, so they may not be likely wanting to get it. And so I think we really do understand what people -- what are the reasons that people might not have stepped up yet.

We as physicians, our job is to educate, so I think that this is really part -- and our job is prevention. And so really, I think this is squarely in what we should be doing. I recognize that there are a lot of competing needs in any given visit for what you need to accomplish in taking care of a patient, but I think the prevention of COVID-19 disease, of severe COVID-19 disease, really, right now fits squarely within the mission of what we need to do for our patients.

And I would say it may not be -- it may not take a ton of time. It may take -- it may be some others in the practice that can help deliver some of these messages. It may be that you can deliver them via video. It may be -- there are a lot of different creative ways that you are able to answer questions for your patients. So I would say be creative in how you do this and, in fact, be persistent, because it may not be the first or the second call or visit that gets them to be vaccinated, but really the third or fourth.

JOHN WHYTE: You know, I have a few patients that say they want to wait because they're hearing about boosters, they're hearing about variants, so they don't want to end up getting three shots. So I want to ask you, what's our current thinking on the need for boosters, and if so, when might we need them?

ROCHELLE WALENSKY: So this I think is a really important message that we as physicians need to be sending. First is, after you get your one dose of J&J or your two doses of Pfizer or Moderna, you're protected. You're protected two weeks after and you're protected immediately two weeks after. And you probably have some increasing protection even over time before then.

The question about boosters is, does that protection wane over some period of time. So far, we have data out to six months. We don't have that much data much further than that because the vaccines haven't been around that long. But what we are doing now is collecting the science and the data to understand when we might need them if we might need them.

And so I really want to make sure that everybody understands and knows, the question is not, am I protected today, do I need a booster later to protect myself today. The question is, in a year from now, might I need a booster to remain protected. And I think that those are really important conversations. Of course, we want to be prepared. We want to be in a situation where we're not catching up in a year from now, so we're collecting that science right now.

JOHN WHYTE: Do you think it'll be at least a year, based on past experience of SARS and some other viruses?

ROCHELLE WALENSKY: You know, I think we have seen so far that these are durable at six months. I think a lot has to -- I don't know the answer to that question and a lot depends on what variants are circulating at the time, in the United States at the time, what variants might come in. So far, we've been in a fortunate situation that all of the variants that we've seen here in the United States our vaccines are protecting against.

JOHN WHYTE: I want to ask you about some predictions if I may. I want to ask you about the fall and elementary schools. So kids primarily less than 12 years of age, is it your expectation that elementary school kids will need to wear masks in the fall and what are the metrics that the CDC is going to use to give guidance to the school systems?

ROCHELLE WALENSKY: In the fall, I want everybody to understand that we believe that schools should be open five days a week and our children should lean in and be back at school. Now, what I think are going to be some of the metrics that we're going to be looking at the local level and where we will be at the local level is, what are your vaccination rates at your local level, what are the disease rates at your local level, to really start formulating discussions about what should be the policies at the local level for our kids under 12.

Also to note is we are really hoping that, by the end of the year, we will have vaccines that will be available to younger aged children. So I'm hopeful that, over time, not only will we have better data on higher vaccination rates and continued low disease rates, but also a way to keep our younger children protected as well.

JOHN WHYTE: But does that mean elementary school kids will have to wear masks until there is a vaccine? Are those being tied together in your mind?

ROCHELLE WALENSKY: We're looking at those data right now, and so I think it's too early for us to say whether we will recommend that kids wear masks or not wear masks. I can say that there are proponents of both sides of that. I've heard from many people on both sides of that request.

JOHN WHYTE: But when we look at the science and we know that the disease behaves somewhat differently in elementary school kids than it does in older teenagers and adults, is that right? And we have to really assess that risk versus the other risks of distance learning as well, correct?

ROCHELLE WALENSKY: Absolutely, and that's why I am saying I don't really -- distance learning, in my mind, you know, we need to get all of our kids back in school. And if the way to have everybody in five days a week and to have everybody feel comfortable includes masks, then maybe we should be doing that.

On the other hand, I think you're exactly right that we've seen more disease in school systems when the kids are among the teachers and among the older kids. That said, we have to see, with those populations now vaccinated, will it move to the younger kids. And so all of those are going to be part of the equation in weighing this.

JOHN WHYTE: You know, Dr. Walensky, the other day I was asked, what are the metrics we're going to use to say that the pandemic is over. And I said, you know what? I'm going to talk to the CDC director next week. Let me ask her because I'm not sure. So at some point in time, you're going to have to make an assessment. How do you decide at least that the epidemic in the United States is ended?

ROCHELLE WALENSKY: I think we're going to be living with this disease for some period of time. I am really cautiously optimistic that, as of this morning, our seven day average of cases in this country is less than 15,000 a day, which is really extraordinary from where we were. So we are going to be looking at case rates. We are going to be looking at vaccine rates.

We have this push this month to get 70% of people with a single dose and I would emphasize not just 70% of people with a single dose, but ultimately over 70% of people with their double dose if they merit a double dose, getting the Pfizer and Moderna. So I really do want to focus and make sure everybody understands not just one dose, but two.

And so -- and then we're really going to have to look at the trends with regard to what's happening with variants across the country and in other countries. But yes, we're evaluating that right now and making those determinations and decisions. But again, vaccination rates, disease rates, and testing rates, and really trying to make sure that we're, in places that we're not seeing disease, we're doing adequate testing to make sure that that's happening as well.

JOHN WHYTE: There's been a lot of discussion lately about the origins of the virus and that, perhaps, it originated in the Wuhan lab. What's the latest thinking about the origins? And some people would say, does it really matter?

ROCHELLE WALENSKY: So we know that most coronaviruses, when they come into human disease, like the first SARS as well as MERS, have jumped from animal hosts. So that has standardly been how we have been introduced to coronavirus disease in other kinds of coronavirus disease. So it's not -- it's understandable to say, well, that may very well be how this coronavirus came as well.

The first WHO report did not give us enough transparent data for us to understand, could this, did this come from a lab or did this come from the animal source. And that's really where I think we're all leaning in and saying, we really need another report. The president has said we need another report that is more transparent in the data, that gives the line item data for the scientists to really understand, could this have come from a lab, did this come from animals.

And I think it is important. I think it's important for us to understand because, in fact, this is how we learn. This is how we prevent the next time. And so I think that the etiology really is critical for us to understand so that we can be prepared for the next time, better prepared for the next time.

JOHN WHYTE: Will we be better prepared the next time?

ROCHELLE WALENSKY: I think we've learned a lot of lessons in the last year and a half, and one of the things that we learned here in this country is that we had a frail public health infrastructure in order to be able to deal with a pandemic of this magnitude. Public health works for you when you don't know that it's working, and that means that when there's a small measles outbreak, or a legionnaires outbreak, or a salmonella outbreak, that it can be quickly shut down.

We didn't have the capacity to do this with something of this magnitude. We are working towards and have received some resources to improve that, and I think everybody now knows and understands what the CDC does for public health in this country, what your state and local jurisdictions do, what your health care practices do to try and keep America safe. And then I think we -- I'm hopeful we'll have the resources and the workforce to build up to make sure we're in a better place for the next time.

JOHN WHYTE: And I want to give you an opportunity to respond to what some folks have commented on our social properties, as you know, that the CDC seems to be giving out conflicting information or they change their mind. A lot of our clinical colleagues are really looking to the CDC for guidance, recognizing that sometimes the data are not clear-cut. They're gray. It's not black and white.

So what do you say to our clinical colleagues who sometimes, let's be honest, are getting a little frustrated? And they don't always have time to dig deep into the data, as you pointed out, to figure out what's the best guidance. It's a tough job trying to sort through all this. So what's kind of your advice to clinicians who are also burned out? We're asking them to do more things, right? And they're already overwhelmed in many ways.

ROCHELLE WALENSKY: So maybe I'll -- three things. First, just, like, huge gratitude to everybody in the health care workforce for what they have endured over the last 15 months in trying to keep their patients safe and in trying to understand and keep up with an evolving, rapidly evolving literature.

And not just in reading the published literature, but now so much is sort of in the media on the prepublished literature, and that means that we as physicians have to do the peer review ourselves to understand whether this is a good paper or not a good paper, and that's hard too. So huge thanks and gratitude to the workforce and to all of you physicians out there who have been doing that hard work.

Second, I think that we get two major areas of challenges. One is, people say it's too complicated. And yes, the truth is this has been complicated. And so much of what we have to say is, well, it depends. It depends on how the ventilation system is. It depends on how crowded the classroom is. It depends on whether you're wearing masks or not.

And so while everybody sort of wants to say, in this situation, can I go visit Grandma, it really does depend. Is grandma immunosuppressed? So there have been -- we have tried very hard and worked very hard to make sure our messages can be simple enough so that people can generally follow them, but there is some complexity here.

And even in the complexity of messaging, really, as we were scaling up vaccines, we had some high case rates. We had a lot of people who were vaccinated. It does depend. So it has been complex to try and extend that. And then the other thing is, the science is changing. The science is evolving. And so decisions that might have been made even three months ago, between the science evolving and the epidemiology involving, our guidance has had to change.

And so we really do try to do the hard work for you all to distill the science, to update our scientific briefs, to convey to you the synthesis of all the science that's out there that leads to our decisions. And so yes, I will acknowledge it is complex and it is changing, and it is because that is where we are in the status of this disease.

We have resources for health care providers. If people have questions about how they should handle questions, please come to our CDC website and call us for resources so that we can give you those resources to empower you to make your job easier.

JOHN WHYTE: And finally, what does spring 2022 look like? I'm not giving you the fall, but I'm saying the spring, March or April of next year. What does it look like?

ROCHELLE WALENSKY: Oh, gosh. I -- thank you. I am really cautiously optimistic. And I know I use that term -- it would be naive, in this pandemic that has thrown us so many curveballs and so many disappointments, to not keep our eye on this ball and to not make sure that we are doing all the due diligence we need to make sure that spring of 2022 is a really, really bright spring.

We know the variants are out there and so we have to watch that carefully. We know that the potential for waning immunity is out there. We have to watch that carefully. But now we're prepared. We know we need to watch. We've scaled up genomic sequencing extraordinarily here in this country, and so I am really cautiously optimistic that we will have a bright, bright spring of 2022.

JOHN WHYTE: Well, Dr. Walensky, I want to thank you for all that you are doing, for all that your colleagues are doing in Atlanta and throughout the world at many of the offices in keeping us safe, and keeping the world safe, and really advancing the mission of public health.

ROCHELLE WALENSKY: Thank you so much.

This interview originally appeared on WebMD on June 08, 2021

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