“I am hopeful as I look to the future,” Dr. Leana Wen writes in her new book, “Lifelines: A Doctor’s Journey in the Fight for Public Health.” On the day she spoke to Yahoo News, however, case counts were spiking across the United States, due almost entirely to the increased transmissibility of the Delta variant. Masks were back. So were concerns that schools might reopen in the fall.
A former Baltimore public health commissioner who now teaches emergency medicine at George Washington University, Wen has become a prominent commentator on the coronavirus pandemic. Below, she offers thoughts on how to navigate the next stage of the coronavirus pandemic, as the nation grapples with the Delta variant, students prepare to return to school and President Biden struggles to maintain momentum against the pandemic.
This interview has been lightly edited for clarity and brevity.
Yahoo News: Did we declare victory too soon?
Leana Wen: The single biggest mistake that the Biden administration made during this entire pandemic response — and I would argue in the entire Biden presidency — was back in May when the CDC said that vaccinated people can take off their mask, but did not have proof of vaccination attached to it. And as a result, people understood the pandemic to be over them. The unvaccinated began behaving like they were vaccinated.
And what did we see? We saw exactly what I and many public health experts predicted at the time. The honor code did not work. Surges have happened because of unvaccinated individuals. Now with the Delta variant, restrictions are coming back, except nobody’s listening anymore.
President Biden absolutely declared a victory too soon. That said, I also do want to commend the Biden administration for a lot of their efforts. I mean, they have been exceptional in ensuring vaccine supply and increasing distribution.
YN: Why don’t we know more about how common and serious breakthrough infections are?
LW: We have a serious data problem in the U.S. for unclear reasons. The CDC, back in May, stopped collecting data on mild breakthrough infections. They announced that they were only going to be collecting data on severe breakthroughs, meaning severe enough to cause hospitalizations or deaths. Now I really do not think that this was the right decision at all. We need to understand, what is the likelihood — period — of breakthrough infections?
Are we talking a one-in-a-hundred chance or one-in-two chance? We literally do not know.
I hate to quite put it in this way, but in a way, this is not dissimilar to what happened under the Trump administration, when the mantra seemed to be, ‘If you don't test, it's not there.’ Well, if you don't test, if you don’t track, the infections are still there. We just don’t know about it.
YN: Do we just need to accept breakthrough infections as a fact of pandemic life?
LW: I’ve likened the vaccine to a really good raincoat. It protects you well, if there’s a drizzle, it protects you well, if you're even a medium level of rain multiple times. However, if you're in and out of daily thunderstorms, at some point, you're going to get wet. And that's because if you are around all these unvaccinated, potentially infected people. At some point, there is going to be a breakthrough.
We really need to change our attitude in this country and be honest about the likelihood of breakthrough infections.
YN: So should we all be wearing masks again?
LW: The CDC has announced that they have new research about breakthrough infections and, specifically, that it is possible for individuals who are fully vaccinated and who then contract the Delta variant to still potentially get infected themselves. And they have the potential of infecting others as well.
My takeaway from all of this is if you are someone who is immunocompromised, or if you live at home with someone who is immunocompromised or unvaccinated — for example, if you have unvaccinated younger children — then you should take additional precautions.
Meaning that if you are in public spaces where people around you are potentially unvaccinated and in close quarters indoors, that you should be wearing a mask.
YN: You’ve said that you believe schools should be open this fall. Do you believe they will be open?
LW: I do believe that, come fall, nearly all schools will be open full-time for in-person instruction. We now have overwhelming evidence that schools can actually be some of the safest places for children from a COVID-19 transmission standpoint. Also, of course, schools are really essential for children's emotional development, their cognitive development. I feel very strongly about sending my almost-4-year-old back to preschool.
YN: When will children be able to take off masks?
LW: Depends on the actions that we all take right now. The best thing for us to do to ensure that our children can be back in school safely is for all eligible people to get the vaccine. If the eligible people in this country were all vaccinated right now, we probably would not need to be wearing masks. It is really an issue of the unvaccinated making life harder for everyone else.
YN: Would you eat in a restaurant, indoors, right now?
LW: I, personally, would not. I live in an area with substantial COVID-19 transmission. I have two unvaccinated children at home. I think that crowded indoor restaurants with presumably not great ventilation, a lot of people around of unknown vaccination status — that is a high-risk setting. They’re not going to have their masks on. And also, if it’s a crowded setting, probably people are talking loudly and therefore increasing the amount of aerosols and respiratory droplets that they are exhaling.
I would eat outdoors at a restaurant. Definitely.
YN: Is it time for vaccine mandates?
LW: We know that vaccine mandates work for other childhood immunizations. We have laws in all 50 states that mandate vaccines. That’s the reason why we don’t have polio, why we don’t have smallpox, why we have relegated many of these illnesses that used to kill so many children to the history books. We could do the same with COVID-19.
I see this as being no different to drunk driving, you are welcome to drink at home. You're welcome to drink in private. In various establishments, you can get very intoxicated, but you cannot choose to get intoxicated and then get behind the wheel of a car.
YN: Is the fact that the vaccines are only under emergency approval potentially holding us back?
LW: I do think that full approval by the FDA will make a big difference. There are some employers that might be hesitant. Certainly there might be schools that are hesitant to implement a requirement without the full weight of FDA approval.
But these vaccines are just as good as approved at this point. They have been given to hundreds of millions of people. I’d be hard pressed to think of any other therapeutic that we’ve had in history that we have this much data on.
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