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Transcript: Coronavirus: New Variants with Rochelle Walensky

MR. DIAMOND: Hello, and welcome to Washington Post Live. I’m Dan Diamond, a national health reporter here at The Post. It’s been barely 24 hours since the White House announced that President Biden tested positive for covid-19. It’s a spotlight on the continued health threat posed by the pandemic. I’m joined today by the head of the CDC, Dr. Rochelle Walensky, to help us make sense of the latest virus surge and what is to come. Dr. Walensky welcome to Washington Post Live.

DR. WALENSKY: Thanks so much, Dan. Delighted to be with you.

MR. DIAMOND: Doctor, let’s start with the president’s health. According to the CDC, more than 500,000 Americans have tested positive for covid this week. Joe Biden is one of them. If we can’t protect the president from infection, what does it say about our ability to protect the most vulnerable Americans from infection too?

DR. WALENSKY: Yeah, it’s a really important question. First, good wishes to the president for a speedy recovery. We know that he is on Paxlovid and that that should assist with his speedy recovery, in addition to the act that he’s received his vaccine series and two booster shots, which really does protect him from severe disease. We know now that there’s a lot of covid out there--as you said, 500,000 documented cases this week. We’ve seen hospitalizations that have been on the rise since early. April, about a two-fold increase in hospitalizations. And what we’re doing is, is what--sending the messages that we’ve been sending all along. If you’re in an area of high covid-19 community levels--and now this week that’s about 60 percent of our population living in those counties--we really are asking people to take the necessary precautions, to wear masks, to test if they’re going to events, and to take the precautions necessary to protect them and their family.

MR. DIAMOND: Let’s stay on the White House for a second. The White House has pledged to go beyond CDC guidance in caring for President Biden, for example, to make sure that he stays in isolation until he tests negative. If the White House thinks that’s the right approach for the president, shouldn’t that be the right approach for all Americans?

DR. WALENSKY: Yeah, I think we can all agree that the president’s protocols likely go above and beyond and have the resources to go above and beyond what every American is able and has the capacity to do. As we put forward our CDC guidance, we have to do so so that they are relevant, feasible, followable by Americans, and that is Americans that live in urban jurisdictions and rural jurisdictions, that have resources and less resources, that have, you know, work constraints and many other things. So, when we put forward our guidance, we do so so that they reflect such that every American is able to follow them. We have said in our isolation guidance--that is guidance after you have been infected--that you really should stay home for those first five days. You shouldn’t consider going out after those five days unless your symptoms have really fully resolved. And if they have, you should wear a mask if you decide to go out for those second five days.

We also put in the option to go ahead and get a test--not everybody has access to them, but to go ahead and get a test. And if your test remains positive, you would consider staying home until that test is negative, which is exactly what the president is doing.

MR. DIAMOND: Doctor, just to ask this a different way because it’s important, if you tested positive for covid, would you want to be around family or coworkers if you were still testing positive? Would you follow the CDC guidance here?

DR. WALENSKY: Our guidance actually says that if you decide to go ahead and do a test, if it’s positive, that you go ahead and stay home. What I’m saying is that not every American has the capacity to do those tests, and that a very good surrogate for a test, if you don’t have the capacity to do the test, is to wait for five days to see if your symptoms have resolved. And if so, then you are pretty low risk of continuing transmission. But because you are still at some risk, we have recommendations to go ahead and wear a mask. And I believe that’s a safe way forward.

MR. DIAMOND: Thinking more about the wave of infections and what we’re facing, the contagious BA.5 variant has been blamed for the recent surge. Is this our new reality, just waves of variants leading to more infections and reinfections for the foreseeable future?

DR. WALENSKY: Certainly, we’ve now seen numerous waves of sub variants of omicron. So of course, we saw BA.1, BA.2. We saw the BA.2.12.1, and now most recently BA.4 and BA.5, and that really has all been since really Thanksgiving time, Christmas time. So, we have always an anticipation that there could be another omicron sub variant coming. And further, we have the potential that there could be another variant altogether coming, and that is exactly what we are working to prevent. We can’t always--many of these come from international settings. So, we’re working closely with international partners and why it is so critically important to remain up to date on your vaccination, such that you’re maximally protected for whatever might come next.

MR. DIAMOND: The more people who are infected, the greater risk that people will be developing complications. What is your plan for Americans who are dealing with long covid?

DR. WALENSKY: Yeah, this is certainly going to be a challenge. It is a challenge, where we are right now. So let me just unpack a little bit of long covid. Long covid is not a single thing. Long covid is a manifestation after you’ve had covid. It could be more predisposition for clotting. It could be earlier onset of diabetes. It could be brain fog. It could be neuropathies and pins and needles and tingling. It could be chest pain or shortness of breath. So, it is not a single entity. And we have a lot to learn about all of the pathophysiology related to all of these manifestations of long-term impact or post-covid conditions. Importantly, there are emerging data that actually suggest that even if you were to get covid, you’re at lower risk of long covid if in fact you’ve had vaccination, or you’ve had more doses of vaccination. There was just a study that demonstrated the more vaccine you had, the less likely you were to actually get long covid should you get an infection. So, we have a lot of ongoing surveillance studies that we’re doing to understand long covid. I know NIH is also working to understand long covid. And we’ve put out guidance to primary care physicians as to how you first address patients with long covid.

MR. DIAMOND: I know there are patient advocates for long covid who feel passionately about this, but we just got a very different question in from Instagram, and I’m going to read it now. User Whitney N. Lee [phonetic] asks, “Many of us are too tired to continue caring about covid. Where does that leave us?” Doctor?

DR. WALENSKY: Yeah, I mean, this is a challenging situation, because while we are tired, the virus is not yet tired of us. And so we have to take the precautions that are necessary, such that we can protect ourselves and our loved ones from severe disease, hospitalization, and death. So, while I would say--what I would say is the best protection you can get right now is to make sure that you’re up to date on your vaccination. That is not a huge effort. There’s vaccines all over the country, and easily accessible vaccines. So, you can really protect yourself from severe disease by just getting up to date on your vaccines. If you are living in an area that has high community transmission of disease, we really do suggest that you wear a mask. But if you decide not to wear that mask, you are pretty well protected against severe disease if you’re up to date on your vaccination. And what I would say is, even if you’re wanting to be more relaxed about these measures, one thing you may want to do is if you’re going to visit somebody who is at high risk of severe disease--a loved one who’s immunocompromised, an elderly person--you may really want to test before you go ahead and make that visit.

MR. DIAMOND: Doctor, you've mentioned a few times the risk in certain areas and whether someone should mask based on that community risk. CDC earlier this year overhauled its metric. You moved to the community level of risk to focus less on how much virus was spreading and more on factors like how many people were hospitalized for covid. Now, you said in February--and I'm going to read it now--quote, "We want to give people a break from things like mask wearing when our levels are low, and then have the ability to reach for them again"--reach for masks again—"should things get worse in the future." Under your new rubric of community levels, there are tens of millions of Americans living in cities that would qualify for indoor masking. Doctor, why haven't you made more of a push to insist on bringing back masks in those places?

DR. WALENSKY: Well, certainly that is--I remember saying that, and I still think that that's very important. CDC, of course, provides guidance and recommendations and thresholds. But in fact, we have always said that masking policies happen at the local and the jurisdictional level. We don't make those masking policies. They happen locally. And so we defer those policies to the local level, and provide as much guidance as we can as to how to move forward. We have every single week put out our covid-19 community levels. Every week, we tweet it. It is available on covid.gov. It is available on cdc.gov on I believe our landing page. So, these levels for your jurisdiction are available so that even if those policies are not happening at the local level, that individuals are empowered to know where they are, know what the infection rates and community levels are around them so that they can make their own individual decisions.

MR. DIAMOND: I looked at those community levels earlier today. There are cities like New York, St. Louis, Phoenix, by the CDC’s metric, there should be indoor masking, widespread. But there isn't. Anecdotally, observationally, no mask mandate. How concerned are you by that?

DR. WALENSKY: You know, I think that as I said, those are going to be decisions that happen at the local level, and they have many things to balance as they make those decisions. When I visit those cities, I am wearing a mask in those cities. And so I think certainly individuals that are at higher risk of severe disease should absolutely be wearing a mask in those areas, doing what they can to remain as up to date as possible on their vaccines. That includes a fourth shot for those over the age of 50. We have, you know, about 25 percent of people over the age of 50 who have gotten that fourth booster dose or that fourth shot, their second booster dose. And so really what we're working to do is give jurisdictions the information that they need so that they can work to make policies according to our recommendations, and then also individuals the information that they need so that they can protect themselves.

MR. DIAMOND: I have been covering this pandemic from the beginning. You've been part of responding to this pandemic from the beginning in a couple of different roles. Throughout the pandemic, the view of public health agencies has weakened if you're looking at polling. Public trust has fallen at agencies like CDC and others. What is your message to Americans who feel frustrated with how the public health apparatus or public health system has responded to the pandemic?

DR. WALENSKY: This has been challenging times. There is no question about it. As you said, I've worked in this in different roles. For the first year of the pandemic, I was running a clinical division at the hospital level in the very beginning when we had our first cases in Boston at the patient bedside. It has been challenging for the entire two and a half years. When I came into the administration, I said that we were going to be making decisions based on science. That remains true.

What I didn't say, which was implied, but I think we should articulate, is that that science moves, that science changes. And sometimes we have to make decisions in the absence of all the data and all the science that we would like to have before all of that information is available. That is very hard in a pandemic. People want to understand a decision and have it not move. But my responsibility to the American people and to populations and to individual patients is to deliver the best information that I have at the time, and sometimes that has changed.

I will tell you that since the beginning, since that first case that we had in early March 2020 in Boston that that we saw, you know, we have had a Wuhan--a Wuhan variant, we have had alpha, we have had delta, and now we've had four or five different omicron variants. Not all of them behave exactly the same, and it is my responsibility and the responsibility of this agency to move as that virus moves.

MR. DIAMOND: I'd like to take another audience question, and this one is going to come from Agnes from Virginia. She asks, "As an immunocompromised and immunosuppressed person, I am terrified of going out with all the unmasked people and new variants. Is there any positive news for me?" Doctor.

DR. WALENSKY: So we do have data that demonstrates that Evusheld, the monoclonal antibody for protection, is still working against these variants. That is good news. We have data that demonstrate that if you are responding to the vaccines, that you are up to date on your covid-19 vaccines, we have really good protection from our higher-level masks, our KN95s and our N95s. And all of those layers, I think, are good news, because it does mean that if you merit Evusheld and you get it, if you get your three or four doses of vaccine, if you have people who are coming to visit you or who gather with who are all taking a test at the same time so that before they gather they--their latest test demonstrates that they're negative, I think all of those things, in addition to wearing an N95 or a KN95 means that you can gather safely.

MR. DIAMOND: I just wanted to ask a question or two on vaccines. What is the CDC’s plan to reach the tens of millions of adults who still haven't gotten a single dose of vaccine, let alone the additional Americans who haven't gotten booster shots? What is your plan?

DR. WALENSKY: We continue to do that work one day at a time and one vaccine at a time. We are still seeing about a million people getting a vaccine dose every single day. Every single one of those is a win. I've talked to many people in communities, many people in public health who continue to do that outreach. We knew early on that people were going to flock who were interested in getting that vaccine early, and that we knew that we were going to have a lot of hard work on the tail end. That's the hard work we’re doing now. I've been to vaccine sites where people have said to me, I came--I visited a store and talk to a worker in that store every single day, asked him if today is the day to get the vaccine. It may very well be that there are numerous conversations that need to be had. One of the things I always encourage physicians and clinicians to do is to listen. It's very easy for us to say you should get vaccinated. But what we really need to do is take the time to listen and say why haven't you been already and to give information, to provide information that addresses their specific concerns. Not everybody's concern is the same. And we as clinicians can't guess what the--what somebody's concern is. So, we need to do a lot of time--spend a lot of time listening as well.

MR. DIAMOND: A quick follow-up. My colleagues and I have reported that you and other Biden administration officials are discussing a plan to make second booster shots available for younger adults. Can you provide an update on that?

DR. WALENSKY: Yeah, we've started to look at some data--well, we have been looking at the data all throughout. What I can tell you right now is that since April of 2022, so really just in these last several months, we have seen that about 94 percent of the deaths are happening in people over the age of 50. Now, there's a small portion that are happening under 50, and we need to get those people up to date and understand where those fatalities are happening as well. But we do know that we can make a huge stride in those over the age of 50 if we can get those folks vaccinated and double boosted. We have had discussions with the FDA. They are continuing to look at those data, as are we. But the first action there would have to be an action from the FDA to authorize a fourth dose in the meantime, one of--for people under 50.

In the meantime, another thing that we are doing is planning for the fall and understanding what the implications are and where we are going for the fall, which is just about six weeks away.

MR. DIAMOND: I do have questions beyond covid. Maybe we can start turning to those. The consequences of vaccine resistance appear to be on the rise. Just yesterday a case of polio was reported in New York, an unvaccinated man. Doctor, how do you shore up trust in vaccines at this moment?

DR. WALENSKY: Yeah, we've had a very divisive country where it comes to vaccines, and that has only grown over the covid pandemic. And I think one of the things that you're seeing is a challenge related to that. Another challenge that we have, data put out from the CDC just a few months ago demonstrated that incoming kindergarteners were less vaccinated than they had been in the year prior. So, if you look at 2019 to 2020, we have less vaccination 95 percent compared to 94 percent. It's just a 1 percent drop. But it represents about 35,000 incoming kindergarteners who are under vaccinated. So, it does speak to the fact that we need growing trust in vaccines. And this case of polio, detrimental to the patient himself, but importantly demonstrating that we really do need--we are at a real public health crossroads if we can't protect communities against preventable diseases. One thing we certainly learned the hard way with polio and that this case reiterates, this tragic case reiterates and demonstrates is that we--sometimes we can't do anything about the infection after it's happened. And really the most important tools that we have are in prevention and how important it is to get young people and our older populations vaccinated.

MR. DIAMOND: There is another virus that is concerning public health experts. It is monkeypox. It was not historically found in the United States. CDC has reported more than 2,500 cases in the past two months. Former FDA commissioner Scott Gottlieb criticized the federal response earlier this week. You said his comments were, quote, "misinformed and off base." To outside experts and some administration officials I’ve spoken with, it does look like the CDC is repeating some of the same mistakes from earlier in the covid pandemic. Can you say categorically that the CDC has a better handle on this virus than it did on covid in the earlier days of that pandemic?

DR. WALENSKY: Let me say a few things about those comments and your question. First, we're in a very different situation with monkeypox. It's a very different disease, a very different virus than SARS-CoV-2. With monkeypox, we are standing on the shoulders of decades of research that has happened here at the CDC. We had a test for it that was already approved, and we launched that test. We were able to do immediately 6,000 tests throughout the country per week, scale that up to 10,000 tests per--in the country per week. And now we're up to about 70,000 tests that we're able to do in the country per week. And just to give you a sense of where we are, we get right now about 3,000 samples a week to test. So one of the things that we've really had to do, in addition to our ability to scale up, is to do some teaching around the country to tell patients how monkey pox will present so that they can go present for care and to teach providers and clinicians what to look for and how to do the test for monkey pox.

But I do want to articulate that we have never seen the demand for testing that has taken over our possibility of testing, our supply of testing. In fact, we have more and more testing that we should be doing, and we are doing a lot of clinical outreach in order to do so. But there's one key important similarity with covid and with monkey pox, and that is CDC’s inability to see the data in real time. And I think that this is really important. I have been struck as we at CDC are now conquering another public health challenge--monkey pox--as to how little authority we at CDC have to receive the data. So, I can tell you that while we have been working with our ASPR colleagues to get vaccine out to jurisdictions, we at CDC currently have no data on who's been vaccinated. So, when people are asking has this distribution, allocation, administration, where has it gone to people and how will that vaccine be working, we at CDC have no authority to receive those data, and we haven't received any of it. Data like case, data. Case data are coming in, and as you noted, about 2,500 cases around the country. We have about 50 percent rate on our data on race and ethnicity of those cases. About 80 percent rate in our data on age of those cases. So, we very much want to get as much information as informed decisions out to the American public as possible. And yet again, like we were for covid, we are again really challenged by the fact that we at the agency have no authority to receive those data. We're working on that right now.

MR. DIAMOND: But what's stopping CDC from just putting a couple of people in a room and calling local state health departments and compiling data that way? Are they saying no to CDC when CDC calls?

DR. WALENSKY: Well, of course--of course, we do that. We have been speaking to our state and local partners probably at least three times a week, all of them. And I myself made phone calls to at least five jurisdictions in the last 48 hours. That is not how you synthesize data. We need--we need standardization of those data, and we need to have those data come to us in a standardized fashion so that they can be connected, we can compile them and rapidly report them out. We cannot at CDC collect the data and make informed decisions by calling 64 jurisdictions and honestly 3,000 counties.

MR. DIAMOND: You've warned that monkey pox cases could rise into August. Do you have projections on what those total cases would be, and how many would be in children?

DR. WALENSKY: You know, I don't have projections as of yet. I have seen projections that are depending on estimates that are--go from very high to very low. So, I don't think that we have a stable estimate now to see what those projections will be. What I can tell you is, with the scale up of testing, with the scale up of information that we are getting out to providers, we anticipate that there will be more cases before they are less cases. We do--have seen now two cases that have occurred in children. Both of those children are traced back to individuals who come from the men who have sex with men community, the gay men community. And so when we have seen those cases in children, they have generally been what I call adjacent to the community most at risk. I should also mention, importantly, those children are doing well.

MR. DIAMOND: Thank you for that update. One more monkey pox question. When do we know that monkey pox has become permanently entrenched in the United States? Is there a threshold of cases? Is there something else that you're looking at?

DR. WALENSKY: You know, your question implies that that's going to be our steady state, and I would like to push back on that being our steady state. What I'd like--what I would envision is--

MR. DIAMOND: I’m not suggesting it's going to be the steady state. It's just a possibility that some experts have said could happen, especially if monkey pox gets into the animal reservoirs, or if it circulates that way. So as the head of the CDC, is there something you're looking at as the red flag, the warning light?

DR. WALENSKY: Certainly--well, certainly, one of the things that we have said is it would be--we really want to try and work to prevent a reverse zoonosis or it getting back--getting into the animal community. What I will--or the animal population. What I will say is we're working really hard now on containment, on testing, on isolation of cases, on vaccination of those who might either be at highest risk or potentially exposed. And I do think over time, when we have ample vaccines available, as people are understanding the things that they can do to protect themselves, how and when they should present to care, how clinicians can identify this disease and provide information and treat it, that we will get to a place where we are able to contain this in this community, but importantly, our outside--we will be able to contain this from this community.

Importantly, though, I think we also have to recognize that this outbreak is now not just in the United States, and not just in areas endemic in Africa. It's in 70 countries. And so unless we have trust in our vaccines, scale up of our vaccine so that people at risk choose to get vaccinated, and we do so around the world, we will continue to be at risk of somebody traveling to a place where monkey pox may have not been contained, and bringing it back here to this country. So, the hard work ahead of us is working within some constraints of vaccine availability right now. And the U.S. government is actually working to procure more vaccine. But working within those constraints right now, ultimately, we need to get to a place where we have more and more vaccine available. We are offering that vaccine and people are taking us up on that vaccine, especially those in the highest risk communities.

MR. DIAMOND: You know, something I've been curious about, as CDC director, you're being probed by Republicans in Congress. You get second guessed by experts like Dr. Gottlieb. Your comments can be distorted, taken out of context. You have to deal with questions from reporters like me. Is this job fun for you?

DR. WALENSKY: I have this incredible agency that is working 24/7 to work towards public health around this country and around the world. And that is truly a gift and truly an honor. I will say maybe in the context of your question, I came from the bedside. When you go see a patient at the bedside, especially when you go in the wee hours early in the morning or later in the evening, the patients generally know that you're there. And the only reason that you're there is because you care. And when you--when you take care of that patient, they don't really challenge you. They don't challenge your intentions or think that you're there for some malintent. That has been challenging for me, to go from that position to one where my intentions are frequently challenged. But in general, I will say I have the great gift of leading an agency of people, individuals who work 24/7, whose names public will never know, you will never know, but who work to benefit public health. They are working not just on covid and not just on monkey pox, but they are working to, you know, deliver antiretroviral therapy to 12 million people around the world with HIV. They are working to avert 63 foodborne outbreaks that we had last year that most people never heard about. This is the work of CDC. And it's truly a gift and an honor for me to be in this position.

MR. DIAMOND: Quick last question. We understand that CDC has been conducting an internal review and those findings may be public soon. When do you expect your review to be public? What can you tell us about that?

DR. WALENSKY: Yeah, this has been an important thing for us to be able to do. And even as we did this with covid, you know, we had some time to do some introspection, to understand where we were both internally and actually to speak with our key stakeholders, not just with covid, but with our systems and processes throughout CDC and to learn some of the lessons that we learned in covid and actually apply them now--I didn't think we'd be applying them so quickly--but apply them now to a new outbreak, the timeliness of our science, how quickly we need to deliver, how well we need to communicate, how well we work with our public health partners. And so we've been learning those lessons and applying them in real time. And I'm really anticipating that the work that we've done as part of this review will be available soon.

MR. DIAMOND: Well, Dr. Walensky, unfortunately, we're out of time, so we will leave it there. Dr. Rochelle Walensky, head of the CDC, thank you for joining Washington Post Live.

DR. WALENSKY: Glad to be here. Thank you.

MR. DIAMOND: And thanks to all of you for watching. To check out interviews that we have coming up, please head to WashingtonPostLive.com to register and find more information about our upcoming programs. Again, I’m Dan Diamond, a health reporter at The Washington Post. Thanks for joining us.

[End recorded session]MR. DIAMOND: Hello, and welcome to Washington Post Live. I'm Dan Diamond, a national health reporter here at The Post. It's been barely 24 hours since the

White House announced that President Biden tested positive for covid-19. It's a spotlight on the continued health threat posed by the pandemic. I'm joined today by the head of the CDC, Dr. Rochelle Walensky, to help us make sense of

the latest virus surge and what is to come. Dr. Walensky

welcome to Washington Post Live.

DR. WALENSKY: Thanks so much, Dan. Delighted to be with you.

MR. DIAMOND: Doctor, let's start with the president's health. According to the CDC, more than 500,000 Americans have tested positive for covid this week. Joe Biden is one of them. If we can't protect the president from infection, what does it say about our ability to protect the most vulnerable Americans from infection too?

DR. WALENSKY: Yeah, it's a really important question. First, good wishes to the president for a speedy recovery. We know that he is on Paxlovid and that that

should assist with his speedy recovery, in addition to the fact that he's received his vaccine series and two booster shots, which really does protect him from severe disease. We know now that there's a lot of covid out there--as you said, 500,000 documented cases this week. We've seen hospitalizations that have been on the rise since early April, about a two-fold increase in hospitalizations. And what we're doing is, is what--sending the messages that we've been sending all along. If you're in an area of high covid-19 community levels--and now this week that's about 60 percent of our population living in those counties—we really are asking people to take the necessary precautions, to wear masks, to test if they're going to events, and to take the precautions necessary to protect them and their family.

MR. DIAMOND: Let’s stay on the White House for a second. The White House has pledged to go beyond CDC guidance in caring for President Biden, for example, to

make sure that he stays in isolation until he tests negative. If the White House thinks that's the right approach for the president, shouldn't that be the right

approach for all Americans?

DR. WALENSKY: Yeah, I think we can all agree that the president’s protocols likely go above and beyond and have the resources to go above and beyond what every American is able and has the capacity to do. As we put forward our CDC guidance, we have to do so so that they are relevant, feasible, followable by Americans, and that is Americans that live in urban jurisdictions and rural jurisdictions, that have resources and less resources, that have, you know, work constraints and many other things. So, when we put forward our guidance, we do so so that they reflect such that every American is able to follow them. We have said in our isolation guidance—that is guidance after you have been infected--that you really should stay home for those first five days. You shouldn't consider going out after those five days unless your symptoms have really fully resolved. And if they have, you should wear a mask if you decide to go out for those second five days.

We also put in the option to go ahead and get a test--not everybody has access to them, but to go ahead and get a test. And if your test remains positive, you would consider staying home until that test is negative, which is exactly what the president is doing.

MR. DIAMOND: Doctor, just to ask this a different way because it's important, if you tested positive for covid, would you want to be around family or coworkers if you were still testing positive? Would you follow the CDC guidance here?

DR. WALENSKY: Our guidance actually says that if you decide to go ahead and do a test, if it's positive, that you go ahead and stay home. What I'm saying is that not every American has the capacity to do those tests, and that a very good surrogate for a test, if you don't have the capacity to do the test, is to wait for five days to see if your symptoms have resolved. And if so, then you are pretty low risk of continuing transmission. But because you are still at some risk, we have recommendations

to go ahead and wear a mask. And I believe that's a safe way forward.

MR. DIAMOND: Thinking more about the wave of infections and what we're facing, the contagious BA.5 variant has been blamed for the recent surge. Is this our new reality, just waves of variants leading to more infections and reinfections for the foreseeable future?

DR. WALENSKY: Certainly, we've now seen numerous waves of sub variants of omicron. So of course, we saw BA.1, BA.2. We saw the BA.2.12.1, and now most recently BA.4 and BA.5, and that really has all been since really Thanksgiving time, Christmas time. So, we have always an anticipation that there could be another omicron sub variant coming. And further, we have the potential that there could be another variant altogether coming, and that is exactly what we are working to prevent. We can't always--many of these come from international settings. So, we're working closely with international partners and why it is so critically important to remain up to date on your vaccination, such that you're maximally protected for whatever might come next.

MR. DIAMOND: The more people who are infected, the greater risk that people will be developing complications. What is your plan for Americans who are dealing with long covid?

DR. WALENSKY: Yeah, this is certainly going to be a challenge. It is a challenge, where we are right now. So let me just unpack a little bit of long covid. Long covid is not a single thing. Long covid is a manifestation after you've had covid. It could be more predisposition for clotting. It could be earlier onset of diabetes. It could be brain fog. It could be neuropathies and pins and needles and tingling. It could be chest pain or shortness of breath. So, it is not a single entity. And we have a lot to learn about all of the pathophysiology related to all of these manifestations of long-term impact or post-

covid conditions.

Importantly, there are emerging data that actually suggest that even if you were to get covid, you're at lower risk of long covid if in fact you've had vaccination, or you've had more doses of vaccination. There was just a study that demonstrated the more vaccine you had, the less likely you were to actually get long covid should you get an infection. So, we have a lot of ongoing surveillance studies that we're doing to understand long covid. I know NIH is also working to understand long covid. And we've put out guidance to primary care physicians as to how you first address patients with long covid.

MR. DIAMOND: I know there are patient advocates for long covid who feel passionately about this, but we just got a very different question in from Instagram, and

I'm going to read it now. User Whitney N. Lee [phonetic] asks, "Many of us are too tired to continue caring about covid. Where does that leave us?" Doctor?

DR. WALENSKY: Yeah, I mean, this is a challenging situation, because while we are tired, the virus is not yet tired of us. And so we have to take the precautions that are necessary, such that we can protect ourselves and our loved ones from severe disease, hospitalization, and death. So, while I would say--what I would say is the best protection you can get right now is to make sure that you're up to date on your vaccination.

That is not a huge effort. There's vaccines all over the country, and easily accessible vaccines. So, you can really protect yourself from severe disease by just getting

up to date on your vaccines. If you are living in an area that has high community transmission of disease, we really do suggest that you wear a mask. But if you decide not to wear that mask, you are pretty well protected against severe disease if you're up to date on your vaccination. And what I would say is, even if you're wanting to be more relaxed about these measures, one thing you may want to do is if you're going to visit somebody who is at high risk of severe disease--a loved one who's immunocompromised, an elderly person--you may really want to test before you go ahead and make that visit.

MR. DIAMOND: Doctor, you've mentioned a few times the risk in certain areas and whether someone should mask based on that community risk. CDC earlier this year overhauled its metric. You moved to the community level of risk to focus less on how much virus was spreading and more on factors like how many people were hospitalized for covid. Now, you said in February--and I'm going to read it now--quote, "We want to give people a break from things like mask wearing when our levels are low, and then have the ability to reach for them again"--reach for masks again—"should things get worse in the future." Under your new rubric of community levels, there are tens of millions of Americans living in cities that would qualify for indoor masking. Doctor, why haven't you made more of a push to insist on bringing back masks in those places?

DR. WALENSKY: Well, certainly that is--I remember saying that, and I still think that that's very important. CDC, of course, provides guidance and recommendations and thresholds. But in fact, we have always said that masking policies happen at the local and the jurisdictional level. We don't make those masking policies. They happen locally. And so we defer those policies to the local level, and provide as much guidance as we can as to how to move forward. We have every single week put out our covid-19 community levels. Every week, we tweet it. It is available on covid.gov. It is available on cdc.gov on I believe our landing page. So, these levels for your jurisdiction are available so that even if those policies are not happening at the local level, that individuals are empowered to know where they are, know what the infection rates and community levels are around them so that they can make their own individual decisions.

MR. DIAMOND: I looked at those community levels earlier today. There are cities like New York, St. Louis, Phoenix, by the CDC’s metric, there should be indoor masking, widespread. But there isn't. Anecdotally, observationally, no mask mandate. How concerned are you by that?

DR. WALENSKY: You know, I think that as I said, those are going to be decisions that happen at the local level, and they have many things to balance as they make those decisions. When I visit those cities, I am wearing a mask in those cities. And so I think certainly individuals that are at higher risk of severe disease should absolutely be wearing a mask in those areas, doing what they can to remain as up to date as possible on their vaccines. That includes a fourth shot for those over the age of 50. We have, you know, about 25 percent of people over the age of 50 who have gotten that fourth booster dose or that fourth shot, their second booster dose. And so really what we're working to do is give jurisdictions the information that they need so that they can work to make policies according to our recommendations, and then also individuals the information that they need so that they can protect themselves.

MR. DIAMOND: I have been covering this pandemic from the beginning. You've been part of responding to this pandemic from the beginning in a couple of different roles. Throughout the pandemic, the view of public health agencies has weakened if you're looking at polling. Public trust has fallen at agencies like CDC and others. What is your message to Americans who feel frustrated with how the public health apparatus or public health system has responded to the pandemic?

DR. WALENSKY: This has been challenging times. There is no question about it. As you said, I've worked in this in different roles. For the first year of the pandemic, I was running a clinical division at the hospital level in the very beginning when we had our first cases in Boston at the patient bedside. It has been challenging for the entire two and a half years. When I came into the administration, I said that we were going to be making decisions based on science. That remains true.

What I didn't say, which was implied, but I think we should articulate, is that that science moves, that science changes. And sometimes we have to make decisions in the absence of all the data and all the science that we would like to have before all of that information is available. That is very hard in a pandemic. People want to understand a decision and have it not move. But my responsibility to the American people and to populations and to individual patients is to deliver the best information that I have at the time, and sometimes that has changed.

I will tell you that since the beginning, since that first case that we had in early March 2020 in Boston that that we saw, you know, we have had a Wuhan--a Wuhan variant, we have had alpha, we have had delta, and now we've had four or five different omicron variants. Not all of them behave exactly the same, and it is my responsibility and the responsibility of this agency to move as that virus moves.

MR. DIAMOND: I'd like to take another audience question, and this one is going to come from Agnes from Virginia. She asks, "As an immunocompromised and immunosuppressed person, I am terrified of going out with all the unmasked people and new variants. Is there any positive news for me?" Doctor.

DR. WALENSKY: So we do have data that demonstrates that Evusheld, the monoclonal antibody for protection, is still working against these variants. That is good news. We have data that demonstrate that if you are responding to the vaccines, that you are up to date on your covid-19 vaccines, we have really good protection from our higher-level masks, our KN95s and our N95s. And all of those layers, I think, are good news, because it does mean that if you merit Evusheld and you get it, if you get your three or four doses of vaccine, if you have people who are coming to visit you or who gather with who are all taking a test at the same time so that before they gather they--their latest test demonstrates that they're negative, I think all of those things, in addition to wearing an N95 or a KN95 means that you can gather safely.

MR. DIAMOND: I just wanted to ask a question or two on vaccines. What is the CDC’s plan to reach the tens of millions of adults who still haven't gotten a single dose of vaccine, let alone the additional Americans who haven't gotten booster shots? What is your plan?

DR. WALENSKY: We continue to do that work one day at a time and one vaccine at a time. We are still seeing about a million people getting a vaccine dose every single day. Every single one of those is a win. I've talked to many people in communities, many people in public health who continue to do that outreach. We knew early on that people were going to flock who were interested in getting that vaccine early, and that we knew that we were going to have a lot of hard work on the tail end. That's the hard work we’re doing now. I've been to vaccine sites where people have said to me, I came--I visited a store and talk to a worker in that store every single day, asked him if today is the day to get the vaccine. It may very well be that there are numerous conversations that need to be had. One of the things I always encourage physicians and clinicians to do is to listen. It's very easy for us to say you should get vaccinated. But what we really need to do is take the time to listen and say why haven't you been already and to give information, to provide information that addresses their specific concerns. Not everybody's concern is the same. And we as clinicians can't guess what the--what somebody's concern is. So, we need to do a lot of time--spend a lot of time listening as well.

MR. DIAMOND: A quick follow-up. My colleagues and I have reported that you and other Biden administration officials are discussing a plan to make second booster shots available for younger adults. Can you provide an update on that?

DR. WALENSKY: Yeah, we've started to look at some data--well, we have been looking at the data all throughout. What I can tell you right now is that since April of 2022, so really just in these last several months, we have seen that about 94 percent of the deaths are happening in people over the age of 50. Now, there's a small portion that are happening under 50, and we need to get those people up to date and understand where those fatalities are happening as well. But we do know that we can make a huge stride in those over the age of 50 if we can get those folks vaccinated and double boosted. We have had discussions with the FDA. They are continuing to look at those data, as are we. But the first action there would have to be an action from the FDA to authorize a fourth dose in the meantime, one of--for people under 50.

In the meantime, another thing that we are doing is planning for the fall and understanding what the implications are and where we are going for the fall, which is just about six weeks away.

MR. DIAMOND: I do have questions beyond covid. Maybe we can start turning to those. The consequences of vaccine resistance appear to be on the rise. Just yesterday a case of polio was reported in New York, an unvaccinated man. Doctor, how do you shore up trust in vaccines at this moment?

DR. WALENSKY: Yeah, we've had a very divisive country where it comes to vaccines, and that has only grown over the covid pandemic. And I think one of the things that you're seeing is a challenge related to that. Another challenge that we have, data put out from the CDC just a few months ago demonstrated that incoming kindergarteners were less vaccinated than they had been in the year prior. So, if you look at 2019 to 2020, we have less vaccination 95 percent compared to 94 percent. It's just a 1 percent drop. But it represents about 35,000 incoming kindergarteners who are under vaccinated. So, it does speak to the fact that we need growing trust in vaccines. And this case of polio, detrimental to the patient himself, but importantly demonstrating that we really do need--we are at a real public health crossroads if we can't protect communities against preventable diseases. One thing we certainly learned the hard way with polio and that this case reiterates, this tragic case reiterates and demonstrates is that we--sometimes we can't do anything about the infection after it's happened. And really the most important tools that we have are in prevention and how important it is to get young people and our older populations vaccinated.

MR. DIAMOND: There is another virus that is concerning public health experts. It is monkeypox. It was not historically found in the United States. CDC has reported more than 2,500 cases in the past two months. Former FDA commissioner Scott Gottlieb criticized the federal response earlier this week. You said his comments were, quote, "misinformed and off base." To outside experts and some administration officials I’ve spoken with, it does look like the CDC is repeating some of the same mistakes from earlier in the covid pandemic. Can you say categorically that the CDC has a better handle on this virus than it did on covid in the earlier days of that pandemic?

DR. WALENSKY: Let me say a few things about those comments and your question. First, we're in a very different situation with monkeypox. It's a very different disease, a very different virus than SARS-CoV-2. With monkeypox, we are standing on the shoulders of decades of research that has happened here at the CDC. We had a test for it that was already approved, and we launched that test. We were able to do immediately 6,000 tests throughout the country per week, scale that up to 10,000 tests per--in the country per week. And now we're up to about 70,000 tests that we're able to do in the country per week. And just to give you a sense of where we are, we get right now about 3,000 samples a week to test. So one of the things that we've really had to do, in addition to our ability to scale up, is to do some teaching around the country to tell patients how monkey pox will present so that they can go present for care and to teach providers and clinicians what to look for and how to do the test for monkey pox.

But I do want to articulate that we have never seen the demand for testing that has taken over our possibility of testing, our supply of testing. In fact, we have more and more testing that we should be doing, and we are doing a lot of clinical outreach in order to do so. But there's one key important similarity with covid and with monkey pox, and that is CDC’s inability to see the data in real time. And I think that this is really important. I have been struck as we at CDC are now conquering another public health challenge--monkey pox--as to how little authority we at CDC have to receive the data. So, I can tell you that while we have been working with our ASPR colleagues to get vaccine out to jurisdictions, we at CDC currently have no data on who's been vaccinated. So, when people are asking has this distribution, allocation, administration, where has it gone to people and how will that vaccine be working, we at CDC have no authority to receive those data, and we haven't received any of it. Data like case, data. Case data are coming in, and as you noted, about 2,500 cases around the country. We have about 50 percent rate on our data on race and ethnicity of those cases. About 80 percent rate in our data on age of those cases. So, we very much want to get as much information as informed decisions out to the American public as possible. And yet again, like we were for covid, we are again really challenged by the fact that we at the agency have no authority to receive those data. We're working on that right now.

MR. DIAMOND: But what's stopping CDC from just putting a couple of people in a room and calling local state health departments and compiling data that way? Are they saying no to CDC when CDC calls?

DR. WALENSKY: Well, of course--of course, we do that. We have been speaking to our state and local partners probably at least three times a week, all of them. And I myself made phone calls to at least five jurisdictions in the last 48 hours. That is not how you synthesize data. We need--we need standardization of those data, and we need to have those data come to us in a standardized fashion so that they can be connected, we can compile them and rapidly report them out. We cannot at CDC collect the data and make informed decisions by calling 64 jurisdictions and honestly 3,000 counties.

MR. DIAMOND: You've warned that monkey pox cases could rise into August. Do you have projections on what those total cases would be, and how many would be in children?

DR. WALENSKY: You know, I don't have projections as of yet. I have seen projections that are depending on estimates that are--go from very high to very low. So, I don't think that we have a stable estimate now to see what those projections will be. What I can tell you is, with the scale up of testing, with the scale up of information that we are getting out to providers, we anticipate that there will be more cases before they are less cases. We do--have seen now two cases that have occurred in children. Both of those children are traced back to individuals who come from the men who have sex with men community, the gay men community. And so when we have seen those cases in children, they have generally been what I call adjacent to the community most at risk. I should also mention, importantly, those children are doing well.

MR. DIAMOND: Thank you for that update. One more monkey pox question. When do we know that monkey pox has become permanently entrenched in the United States? Is there a threshold of cases? Is there something else that you're looking at?

DR. WALENSKY: You know, your question implies that that's going to be our steady state, and I would like to push back on that being our steady state. What I'd like--what I would envision is--

MR. DIAMOND: I’m not suggesting it's going to be the steady state. It's just a possibility that some experts have said could happen, especially if monkey pox gets into the animal reservoirs, or if it circulates that way. So as the head of the CDC, is there something you're looking at as the red flag, the warning light?

DR. WALENSKY: Certainly--well, certainly, one of the things that we have said is it would be--we really want to try and work to prevent a reverse zoonosis or it getting back--getting into the animal community. What I will--or the animal population. What I will say is we're working really hard now on containment, on testing, on isolation of cases, on vaccination of those who might either be at highest risk or potentially exposed. And I do think over time, when we have ample vaccines available, as people are understanding the things that they can do to protect themselves, how and when they should present to care, how clinicians can identify this disease and provide information and treat it, that we will get to a place where we are able to contain this in this community, but importantly, our outside--we will be able to contain this from this community.

Importantly, though, I think we also have to recognize that this outbreak is now not just in the United States, and not just in areas endemic in Africa. It's in 70 countries. And so unless we have trust in our vaccines, scale up of our vaccine so that people at risk choose to get vaccinated, and we do so around the world, we will continue to be at risk of somebody traveling to a place where monkey pox may have not been contained, and bringing it back here to this country. So, the hard work ahead of us is working within some constraints of vaccine availability right now. And the U.S. government is actually working to procure more vaccine. But working within those constraints right now, ultimately, we need to get to a place where we have more and more vaccine available. We are offering that vaccine and people are taking us up on that vaccine, especially those in the highest risk communities.

MR. DIAMOND: You know, something I've been curious about, as CDC director, you're being probed by Republicans in Congress. You get second guessed by experts like Dr. Gottlieb. Your comments can be distorted, taken out of context. You have to deal with questions from reporters like me. Is this job fun for you?

DR. WALENSKY: I have this incredible agency that is working 24/7 to work towards public health around this country and around the world. And that is truly a gift and truly an honor. I will say maybe in the context of your question, I came from the bedside. When you go see a patient at the bedside, especially when you go in the wee hours early in the morning or later in the evening, the patients generally know that you're there. And the only reason that you're there is because you care. And when you--when you take care of that patient, they don't really challenge you. They don't challenge your intentions or think that you're there for some malintent. That has been challenging for me, to go from that position to one where my intentions are frequently challenged. But in general, I will say I have the great gift of leading an agency of people, individuals who work 24/7, whose names public will never know, you will never know, but who work to benefit public health. They are working not just on covid and not just on monkey pox, but they are working to, you know, deliver antiretroviral therapy to 12 million people around the world with HIV. They are working to avert 63 foodborne outbreaks that we had last year that most people never heard about. This is the work of CDC. And it's truly a gift and an honor for me to be in this position.

MR. DIAMOND: Quick last question. We understand that CDC has been conducting an internal review and those findings may be public soon. When do you expect your review to be public? What can you tell us about that?

DR. WALENSKY: Yeah, this has been an important thing for us to be able to do. And even as we did this with covid, you know, we had some time to do some introspection, to understand where we were both internally and actually to speak with our key stakeholders, not just with covid, but with our systems and processes throughout CDC and to learn some of the lessons that we learned in covid and actually apply them now--I didn't think we'd be applying them so quickly--but apply them now to a new outbreak, the timeliness of our science, how quickly we need to deliver, how well we need to communicate, how well we work with our public health partners. And so we've been learning those lessons and applying them in real time. And I'm really anticipating that the work that we've done as part of this review will be available soon.

MR. DIAMOND: Well, Dr. Walensky, unfortunately, we're out of time, so we will leave it there. Dr. Rochelle Walensky, head of the CDC, thank you for joining Washington Post Live.

DR. WALENSKY: Glad to be here. Thank you.

MR. DIAMOND: And thanks to all of you for watching. To check out interviews that we have coming up, please head to WashingtonPostLive.com to register and find more information about our upcoming programs. Again, I’m Dan Diamond, a health reporter at The Washington Post. Thanks for joining us.

[End recorded session]

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