with Alexandra Ellerbeck

Virtually everyone was vaccinated at the joint session of Congress this week. Yet it still looked like a pandemic scene as President Biden addressed masked and distanced lawmakers in the House chamber.

The approach frustrated a number of public health experts, who are starting to question the Biden administration’s conservative approach to public health guidance despite highly effective — and now widely distributed — coronavirus vaccines.

“Everyone could have been in that room,” said Monica Gandhi, professor of medicine at the University of California at San Francisco. “If we’re all fully vaccinated, we could all be unmasked and distanced in that room.”

For the vaccinated, the risk of serious illness from the coronavirus — and spreading the virus to others — is vanishingly low.

There have been some cases of breakthrough infections even among those who have received the shot. But based on data posted on the Centers for Disease Control and Prevention website, the risk is tiny — well below 1 percent. Consider the numbers:

  • Out of 87 million people vaccinated, 7,157 experienced breakthrough infections.
  • Of those, 498 were hospitalized and 88 died.
  • So, vaccinated people have a 0.0005 percent chance of hospitalization and a 0.0001 percent chance of dying from the coronavirus.

Those percentages are far lower than the risk of being hospitalized with or dying of the seasonal flu, some experts note. They also represent much less risk than people are willing to take on every day when they drive in their car or engage in a sport.

“There is nothing that’s 100 percent safe,” said Leana Wen, a professor of health policy at George Washington University. “I think we need to be living with the concept of living with risk and reducing risk.”

Yet the CDC has only mildly softened guidelines for what vaccinated people can do.

Earlier this week, the CDC rolled out revised masking guidance. The agency did relax rules around outdoor activities — although some felt the guidance was late, given evidence that the virus doesn’t easily transmit outside has been around for nearly a year.

Yet the agency is still recommending some strict distancing and masking measures for the fully vaccinated. This population should continue wearing masks at indoor public places and should still avoid crowded, indoor venues, officials say.

“Is the CDC guidance a little too conservative? I think so,” said Carlos del Rio, a professor of medicine at Emory University.

In explaining its guidance, federal officials have noted the potential for breakthrough infections, without clearly explaining just how rare this is. They’ve also pointed to the possibility that fully vaccinated people could still spread the virus to others, even though there’s mounting evidence to the contrary, both from the coronavirus vaccine trials and how other vaccines typically work.

We do believe that vaccinated people are much safer when they’re wearing those masks indoors,” CDC Director Rochelle Walensky said. “It's not just to protect themselves, but largely to protect others, and really to protect the unvaccinated.”

But some outside experts fear that approach is undermining vaccine trust.

Not only do multiple studies point to negligible risk that the vaccinated might spread the disease, but the spread of the coronavirus in the United States also has fallen dramatically. The number of new cases being detected per day — about 52,000 — is below that of a mild flu season, said Marty Makary, a surgeon and professor at the Johns Hopkins School of Public Health.

Add it together, and the risk of getting or transmitting the coronavirus is tiny for the fully vaccinated.

Makary echoed a concern expressed by Wen and Gandhi: that by insisting that vaccinated Americans continue to distance, the agency is feeding into a distorted perception of risk among the public and causing some people to question why they should get the shots at all.

“We’ve got the CDC moving toward a culture of absolute risk intolerance,” Makary said.

“As a physician, I can tell you, if you’re out of step with where people are and don’t have good answers to their very logical questions — such as don’t these restrictions contradict the messaging on vaccine safety — you lose credibility,” he said.

Biden could have used his joint address to illustrate how well the vaccines work.

The president wore his mask to the podium, only taking it off to speak. Behind him sat Vice President Harris and House Speaker Nancy Pelosi (D-Calif.), also wearing masks. All three have been fully vaccinated for months.

Del Rio envisioned an alternate scenario, in which Biden might have turned around and told Harris and Pelosi they should take off their masks because of being vaccinated.

“He could have done a theatrical point that would have been effective,” del Rio said.

Wen said the approach could have been to require all attendees to show proof of vaccination — and then allow people to enter the House chamber without masks and without restrictions on where they could sit. She’s been hammering this point for weeks — that people need a clear answer on when life can go back to normal.

“We should tell people the end of the tunnel is when you are fully vaccinated,” Wen said. “Not some mythical number we can never actually get to.”

Ahh, oof and ouch

AHH: Democrats plan to push Medicare expansion in a new relief plan, after the White House left it out.

Congressional Democrats aim to lower the eligibility age for Medicare to 55 or 60 and expand the range of benefits it covers.  Roughly 100 House and Senate Democrats encouraged Biden in recent days to include an expansion as part of his latest investment package, known as the “American Families Plan.” But Biden left out Medicare expansion, along with other top Democratic health-care priorities, when he released the plan on Wednesday.

Lawmakers say they may forge ahead anyway, The Post’s Tony Romm and Seung Min Kim report.

Sen. Bernie Sanders (I-Vt.), chairman of the powerful Senate Budget Committee, has said he intends to push for Medicare expansion as lawmakers translate Biden’s $1.8 economic overhaul into reality. Sen. Richard J. Durbin (Ill.) called Medicare reform a “game-changer.” And Sen. Ron Wyden (D-Ore.), chairman of the tax-focused Senate Finance Committee, has said he intends to look at every possible avenue to lower drug costs.

“The early pledges from some party lawmakers, led by prominent members of its liberal wing, threaten to create even more political tension around a package that is already facing no shortage of it. The expansion push comes as Biden on Wednesday stressed in his first address to Congress that he is still committed to making health care more affordable,” our colleagues write.

OOF: The FDA said it will move to ban menthol cigarettes.

The Food and Drug Administration faced a deadline Thursday to respond to a 2013 citizen petition seeking a ban on menthol cigarettes. Public health and civil rights advocates say that a ban on the cigarettes, which have been aggressively marketed to Black communities, will reduce health disparities.

“It could be years before any ban takes effect. The move would also ban flavorings in cigars, which are popular with young people. But at a briefing Thursday, top FDA officials promised to begin the process by proposing regulations in the next 12 months,” The Post’s Lenny Bernstein reports.

OUCH: Three doctors are suing the USDA over its dairy guidelines.

The doctors allege in a federal lawsuit that the Agriculture Department’s dietary guidelines are driven by concerns for the meat and dairy industry, not nutrition, The Post’s Laura Reiley reports.

“The USDA’s conflict of interest is perhaps best illustrated in its statement that ‘most individuals would benefit by increasing intake of dairy,’ even though there is no convincing evidence that this is true,” said Donald Forrester, a family practice physician in Sacramento involved in the lawsuit.

The guidelines, which recommend three servings of dairy a day, are the road map for food assistance programs and school lunches. The USDA, for instance, prohibits schools from offering a plant-based milk unless a student presents a doctor’s note about a disability. This can pose challenges for the quarter of Americans are unable to fully digest lactose, the primary carbohydrate in dairy. 

Coronavirus latest

People are still trying to get the Johnson & Johnson vaccine.

“There is no government data yet on whether health authorities’ 10-day halt in administration of the Johnson & Johnson vaccine soured people on the product, and the company declined to discuss the matter. But in spot checks across the country, people seeking vaccines and officials dispensing them appear eager to resume using the vaccine, which is also easier to store and transport,” The Post’s Mary Claire Molloy, Lenny Bernstein, Frances Stead Sellers and Nick Anderson report.

Leana S. Wen, a visiting professor of health policy and management at George Washington University, addresses the rare side effects associated with the vaccine. (The Washington Post)

On Tuesday, more than 1,355 people opted for Johnson & Johnson at a vaccine clinic run by Indiana University Health, while 407 took the Pfizer vaccine.  Reporters encountered a similar sentiment at a homeless program in San Francisco, drugstores in Maine and universities across the country.

A recent Washington Post-ABC News poll found that fewer than 1 in 4 people wanted to get the Johnson & Johnson vaccine, but the survey was taken during the pause when health regulators were still reviewing safety data related to reports of rare blood clots.

On the Hill

Lawmakers grilled Biden’s top science nominee.

Eric Lander, Biden’s pick for director of the Office of Science and Technology Policy, faced questions over his record on race and gender issues and his past meetings with Jeffrey Epstein, Politico's Cristiano Lima reports.

Lawmakers pressed Lander, a world-famous geneticist, over two events he attended with Epstein in 2012. Lander said that he was unaware at the time that Epstein was a convicted sex offender and that he did not accept money from the philanthropist.

Lander also sought to reassure policymakers that he would prioritize inclusion and diversity in the OSTP if confirmed. Lander has faced criticism for downplaying the role of two female scientists, Jennifer Doudna and Emmanuelle Charpentier, in developing the gene editing technology CRISPR.

AbbieVie’s CEO will appear before the House oversight committee next month.

Rep. Carolyn Maloney (D-N.Y.), chairwoman of the House Oversight Committee, announced that pharmaceutical executive Richard Gonzalez will appear before the committee on May 18 to answer questions about the high prices of some AbbieVie medicines.

“AbbVie sells Humira, the highest-grossing drug in the United States and the world.  The committee has obtained internal documents showing the tactics AbbVie uses to suppress competition for Humira and other drugs and maintain monopoly pricing in the U.S.," Maloney said during a House Judiciary Committee hearing on health-care consolidation and monopolies. 

It won’t be the first time lawmakers grill a top pharmaceutical executive about high drug prices. Gonzalez also testified during a Senate Finance Committee hearing in February 2019, along with six other drug company leaders.

Sugar rush