Ask Delta Questions, Get Delta Answers with Dr. Joshua Sharfstein | Crooked Media
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July 23, 2021
What A Day
Ask Delta Questions, Get Delta Answers with Dr. Joshua Sharfstein

In This Episode

  • The U.S. is at another pivotal point in the pandemic, with loosening restrictions and the rapidly spreading Delta variant leading to a concerning rise in cases, and less than half of the population fully vaccinated. We talked to Dr. Joshua Sharfstein, Johns Hopkins University’s Vice Dean for Public Health Practice and Community Engagement, about the current state of the pandemic in the country.
  • And in headlines: Biden plans to sanction Cuban officials for human rights abuses, Mississippi attempts to overturn Roe v. Wade, and NASA researchers map the inside of Mars.





Akilah Hughes: It’s Friday, July 23. I’m Akilah Hughes.


Gideon Resnick: And I’m Gideon Resnick, and this is What A Day, where we are calling on the FCC to clamp down on misinformation by temporarily shutting off the Internet.


Akilah Hughes: Yeah. You know, keep hospitals and stuff on, but the rest of us could use a break.


Gideon Resnick: I will we use the Internet damage as a chance to learn Spanish


Akilah Hughes: I plan on taking a nap. Don’t bother me.


Gideon Resnick: Yeah, realistically, that’s probably what I’m going to do also. On today’s show, the White House issued sanctions on Cuba after the country’s recent crackdown on protesters. Plus, NASA researchers have given us our first ever look into the hot center of Mars.


Akilah Hughes: But first, the fast-spreading Delta variant has health officials sounding more urgent than just a few weeks ago.


[clip of CDC Dir. Dr. Rochelle Walensky] We are yet at another pivotal moment in this pandemic, with cases rising again and some hospitals reaching their capacity in some areas.


Akilah Hughes: That was CDC director Dr. Rochelle Walensky during a briefing yesterday.


Gideon Resnick: Yeah, and this reflects how things have changed in the US just since July 4th. That was the day the White House was hoping to symbolically mark our collective independence from COVID, based on the progress of vaccinations. But less than half of the country has been fully vaccinated, and slightly less than 70% of adults have received one dose, which was a goal the president hoped to reach on July 4th.


Akilah Hughes: Right. Cases have jumped rapidly in the U.S. also, with a two-week average spiking over 170%, and there are projections that it’s going to get a lot worse. Hospitalizations and deaths are also increasing, but to a lesser degree in places where more of the population is vaccinated. And Dr. Walensky said that the Delta variant makes up more than 83% of identified cases in the country. And here’s more of what she said yesterday:


[clip of CDC Dir. Dr. Rochelle Walensky] The Delta variant is more aggressive and much more transmissible than previously-circulating strains. It is one of the most infectious respiratory viruses we know of and that I have seen in my 20-year career.


Gideon Resnick: Yeah, wow. And here’s another startling fact, Akilah, that I found that we can link to in our show notes: there is data suggesting people infected with Delta can carry up to 1,000 times more virus in their nasal passages than with the original strain.


Akilah Hughes: That is a huge number. And we’re also seeing this week that local officials all over the country are grappling with instituting or reinstituting masking requirements for everyone, although for now the CDC has not updated their overall guidance. Though some—say me, obviously—that they should come out with stronger guidelines in the face of these rising cases.


Gideon Resnick: So we wanted to get you some expert advice and information since, as Walensky said, America is at another pivotal moment in this pandemic. We have with us again Dr. Joshua Sharfstein. He’s the Vice Dean for Public Health Practice and Community Engagement at Johns Hopkins University. Dr. Sharfstein, thank you for being on WAD?


Dr. Sharfstein: Thanks for having me.


Gideon Resnick: What are some of the biggest factors that have led to what kind of feels like a dramatic change in terms of how health officials are talking about the pandemic in just a few weeks?


Dr. Sharfstein: We have the Delta variant now in the United States, not just the occasional case of Delta variant, but four in five cases now are Delta variant. There are more than 250 deaths a day. That appears to be rising again. There’s a 30% increase week over week in hospitalizations. So this is not the direction we want to see things heading. It’s leading people to take a look at the situation we’re in and what could happen and how it could get worse.


Akilah Hughes: When it actually comes to masks, the CDC just this past May advised that fully-vaccinated Americans could go without them in most settings, and that’s because transmission was significantly lower and daily vaccination rates were a lot higher, as we both know. But with where we’re at now at this point, was that decision by the CDC too soon? I have my opinion about it. And also, is reinstituting mask mandates the way to go now? Is that even a possibility?


Dr. Sharfstein: Well, I think there was some misunderstanding at the time about that CDC statement. I think the CDC statement that people who are vaccinated have an extraordinarily low risk of getting sick, even if they’re unmasked, was, is true. But people interpreted that to mean it’s OK to get rid of mask mandates in all settings and a lot of states immediately dropped them. I do think that people got rid of mask requirements a little early, and you know, may need to put them back irrespective of how good the vaccine may be in preventing cases of the virus.


Akilah Hughes: I feel vindicated in that, you know, you’re a professional and you know what you’re talking about. And I’ve been saying it’s just for the people listening: I was right.


Dr. Sharfstein: Well, I think the analogy that I used at the time was that it may well be the case if there’s some self-driving car that can make it through the intersection without causing an accident, even if the light is red, but if a lot of the cars still the driver is driving, it doesn’t make sense to take down all the street lights.


Gideon Resnick: Right. And I guess the alternative to that in terms of public spaces, specifically public indoor spaces, would have been this determination as to who is vaccinated and unvaccinated in those settings, because I think that’s what we’re left with not knowing at this moment. Is that the way to go everywhere? Is that an alternative, perhaps better, way than trying to enforce masks again?


Dr. Sharfstein: I don’t think that’s a blanket answer, because, for example, there are some places that you really want everyone to have access to. You wouldn’t do something like that at the Department of Motor Vehicles, everyone needs to be able to get their car regardless of what they decided about the vaccine. On the other hand, there are certain settings where it may well make sense because it’s so potentially risky for unvaccinated people to be together, having a way to prove your vaccination status and if a private business wants to keep people safe, to be able to use that information, I think can be reasonable in the right settings. So I think it depends a little bit on the setting.


Akilah Hughes: Earlier this week at a town hall, President Biden said that he expects the FDA will give full approval to the vaccines as opposed to where we are now with the emergency use authorization. Let’s take a listen:


[clip of President Biden] They’re not promising me any specific date, but my expectation, talking to the group of scientists we put together—over 20 of them plus others in the field—is that sometime, maybe in the beginning of the school year, at the end of August, beginning of September, October, you’ll get a final approval, saying the FDA said, no, this is it. It’s good.


Akilah Hughes: So what would that change mean for mandates, and potentially case rates?


Dr. Sharfstein: When it gets licensed I think more, there are some people who just want to wait. And they just said, look, I understand there’s a track record of 100 million Americans, but I want to see that final stamp of approval. And I think some people will then get vaccinated. I think it probably will have a bigger impact on businesses that are going to feel more comfortable strongly recommending, or in some cases requiring, people to be vaccinated. And I’m particularly thinking about businesses where the people come in contact with some people who may be at risk from, for severe COVID, not just health care workers, but maybe nursing home workers or people who are working with older adults. I would expect that more of those companies will say we have an obligation with a fully-licensed vaccine for our employees to keep them safe


Gideon Resnick: In the midst of increasing vaccinations we’ve also seen a number of so-called ‘breakthrough infections.’ This is where fully vaccinated people have tested positive for COVID—that includes several Olympic athletes, some of the Texas Democrats who flew to D.C. recently. But can you walk us through the science for people who may just casually see these headlines and then perhaps start to get nervous?


Dr. Sharfstein: When these vaccines are approved, and like I said, there were tens of thousands of patients, they did not skimp on the size of the studies at all.


Gideon Resnick: Right.


Akilah Hughes: Yeah.


Dr. Sharfstein: There really wasn’t skimping at all. What the data showed was a dramatic reduction of the chance that you’d get sick at all, and a reduction was even greater for hospitalization and death. Now, the more virus that’s out there, the more people will be in that vaccinated-but-getting-sick group. So it’s not surprising with cases rising and the Delta variant more transmissible, that we’re seeing those cases. But the vaccine isn’t perfect and it never was. It wasn’t from the original studies. It’s just extraordinarily good, and extraordinarily good protection is what people should be wanting now.


Akilah Hughes: Sort of keeping with that track, because I, you know, we’re all hearing anecdotal evidence about people getting these breakthrough infections, so I’m just curious if a breakthrough infection happens and a person is asymptomatic, you know, is there a sense of whether or not there can be sort of long-term implications or long-haul symptoms, or are they just totally in the clear? I personally am very afraid of getting COVID at all.


Dr. Sharfstein: It’s a fair, totally fair question to ask. I don’t think we know the full answer to that. But I think based on what we know about how viruses work, it’s quite likely that you will not get those long-term effects. So obviously it’s scary to know that you’re infected. You thought you were protected. That’s a scary thing to see. But I am not familiar with evidence showing that this is a serious risk for long term.


Akilah Hughes: And just to make it about me a little bit more, so I had a sore throat this week and had to miss an episode of the show. I think it was just allergies. But a lot of people are coming down with colds and flu and things because we haven’t been around each other, our immune systems are readjusting. But what is your advice to people who might be worried about where that sniffle is coming from? Like, should they go get a COVID test immediately? What should be the sort of protocol if you’re not feeling well, but you’re not sure if it’s COVID?


Dr. Sharfstein: It’s totally fine to take a test if it’s on your mind. You know, I mean, you could have done that this week if you wanted. I don’t know if you did, but—


Akilah Hughes: Would it have been too soon? I heard it has to be five days.


Dr. Sharfstein: No, that’s not true. I would say if you have symptoms, it should pick it up. So you do not have to wait.


Akilah Hughes: You girl’s good, y’all. [laughs] No COVID over here then.


Dr. Sharfstein: You know, it’s the kind of thing that if it crosses your mind, you might as well get a test. They’re very widely available. And obviously, in general, I think if people are feeling sick, they should stay home. That’s something from our pre-pandemic lives that we should change. We should stay home. We should keep other people safe in the workplace, and I think we’ll see a lot less transmission of other infectious diseases going forward.


Gideon Resnick: We don’t really know how or where all of this goes, but if this is the kind of case threshold that we’re at in the summer, what are some of the scenarios that could happen when schools and colleges start opening up again with colder months ahead? Obviously, we’ve baked in nearly 50% of the population protected via vaccination, but what is your sense there?


Dr. Sharfstein: What it looks like is that if people aren’t wearing masks and the vaccination rate isn’t really above 70% of people who are eligible, it’s most of the models are predicting a spike in the Fall. None of them like last winter bad, but still, you know, thousands-of-deaths-a-week bad, which is a lot. And so there is reason for taking this seriously. So that doesn’t mean that we’re doomed to have that. We don’t know exactly what the effects, the virus is going to do. And, of course, we control our own fate because we don’t have to be in the 70% or below group. We can be higher than that. But this is a serious situation still for the United States. Of course, you know, it’s even more serious in other parts of the world at the moment.


Gideon Resnick: We probably have a lot of folks that listen who are vaccinated at this stage. They might be talking to people in their family or friends or otherwise who are not. What would be your message for them in those conversations to help convince people and talk to people about getting vaccinated?


Dr. Sharfstein: The instinct sometimes is to get angry or to say, how come you don’t see the evidence like I see the evidence? But it first helps to listen and to understand that people are sometimes nervous about things, and you can express that you were nervous about it, too, if that’s true. One thing that I have started doing is not talking about the ‘what’ in the evidence, but ‘who.’ Who would you get vaccinated for? I’ve had people who stop midsentence telling me some piece of misinformation from the Internet and they just change and they go, well, if I do it, I would get vaccinated for my mom. And I say, well, tell me about your mom. They’d say, well, I live with my mom, she’s got diabetes, I don’t know whether the vaccine worked for her. And so I think if we think about the reasons people get vaccinated, it’s both an intellectual and it’s emotional. Some people will see it right away and want to do it. Other people come to think about the people in their lives that it really would matter for them.


Akilah Hughes: Well, Dr. Joshua M. Sharfstein, Public Health Professor at Johns Hopkins University, he’s also the co-host of the podcast “Public Health on Call.” Thank you so much for taking the time. We really appreciate it.


Dr. Sharfstein: It’s a pleasure.


Akilah Hughes: And that’s the latest for now. We’ll be back after some ads.


[ad break]


Akilah Hughes: Let’s wrap up with some headlines.


[sung] Headlines.


Gideon Resnick: President Biden announced plans to impose sanctions on Cuban officials for their involvement in human rights abuses during the government’s response to recent protests on the island. Among those censured were the country’s defense minister and a Cuban special forces unit called the quote unquote “black berets.” The sanctions came a day after Biden’s Wednesday night phone call with Democratic Cuban-American activists in Miami who have been demanding action since the July 11th uprisings, which resulted in hundreds of people being beaten or arrested. The Biden administration’s response also includes measures to bring increased Internet access to the island, and calls for more international pressure on Cuba’s government.


Akilah Hughes: Yes, and hopefully there will be some pressure on America’s government to treat our protesters better. But Mississippi’s attorney general asked the Supreme Court to overturn Roe v. Wade yesterday in order to uphold the state’s restrictions on abortion cases. Attorney General Lynn Fitch said the case to overrule Roe was, quote, “overwhelming” and she urged the justices to sign off on a controversial Mississippi law that bars most abortions after 15 weeks. AG Fitch also asked the court to overrule the 1992 abortion rights case, Planned Parenthood vs. Casey, which followed Roe. The court’s six to three conservative majority, will hear the case this fall. Overturning Roe would likely lead to the prohibition of abortion in twenty 24 states and three territories.


Gideon Resnick: Awful, awful. The House voted 407 to 16 yesterday to expand the number of available special immigrant visas for Afghans who helped American troops and diplomats during the 20-year war in Afghanistan. By removing some application requirements, the House moved to increase the visas from 11,000 to 19,000, and allow each visa applicant to include up to four family members. Only Republicans voted against the bill, meaning they’ve picked an extremely convenient moment to forget how much they typically love war. The move to shorten the wait time for Afghan allies to enter the US is essential as they are all potential targets of retribution from the Taliban forces in the wake of the US’s withdrawal from the region.


Akilah Hughes: The government managed to do something in space while all the billionaires were distracted. So NASA researchers announced on Thursday they had used seismic recordings from their InSight lander to map the inside of Mars—sadly, it is not filled with candy and prizes, so I lost that bet—but it does contain a core that is larger and less dense than scientists previously thought, with elements like sulfur, oxygen and hydrogen comprising a significant portion of its contents. Scientists were able to confirm for the first time that the core of Mars was molten. They said the findings were significant and that they represented the first measurements of Mars’s dimensions that could be drawn from empirical recordings instead of theoretical calculations. The translation here: we now have Mars is real height instead of the height he claims to be on Bumble.


Gideon Resnick: Yeah, I got to see the actual profile picture too. I don’t believe the one that’s on there.


Akilah Hughes: Yeah, just be 511, you know, there’s no shame in that. And those are the headlines. Two more things before we go. On this week’s episode of With Friends Like These, host Ana Marie Cox is joined by sportswriter Alyssa Roenigk to discuss Simone Biles and the politics behind gymnastics at the Olympics. Listen to this and other powerful conversations by subscribing to With Friends Like These wherever you get your podcasts.


Gideon Resnick: And then, second thing, have a great weekend and do not freak out when you don’t hear us on Monday. We will be back in your ears next Tuesday. That is all for today. If you like the show, make sure you subscribe, leave a review, match with Mars on Bumble, and tell your friends to listen.


Akilah Hughes: And if you’re into reading, and not just the children’s menu at restaurants like me, [laughs] What A Day is also a daily newsletter. Check it out and subscribe at I’m Akilah Hughes.


Gideon Resnick: I’m Gideon Resnick.


[together] And please turn off the Internet!


Akilah Hughes: I’m over it. It’s so much. There’s so much Internet.


Gideon Resnick: Yeah, we had a good run but it’s, it’s done. It’s over.


Akilah Hughes: Yeah. We’re all set.


Gideon Resnick: I’ve had enough.


Akilah Hughes: What A Day is a production of Crooked Media.


Gideon Resnick: It’s recorded and mixed by Charlotte Landes.


Akilah Hughes: Sonia Htoon and Jazzi Marine are our associate producers.


Gideon Resnick: Our head writer is Jon Millstein, and our executive producers are Leo Duran, Akilah Hughes and me.


Akilah Hughes: Our theme music is by Colin Gilliard and Kashaka.