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This week Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said new data shows the Delta variant of the coronavirus, in rare breakthrough infections, is able to be transmitted from vaccinated individuals to others. The CDC revised its guidance and said everybody should wear a mask in areas with “substantial and high” levels of Delta transmission. With this revised guidance, how can people stay safe in social settings, and should fully vaccinated people be worried? Dr. Leana Wen, emergency physician and author of the new book, “Lifelines: A Doctor’s Journey in the Fight for Public Health” explains what Americans can do.
ROCHELLE WALENSKY: We have a country that is full of Delta. Delta is a more transmissible virus. And the new data that we have is that Delta is able, in those rare breakthrough infections, to be transmitted to others. The most important thing that we need to say right now is we have a lot of this country that has a lot of viral burden. That's driven a lot by people who-- mostly by people who are unvaccinated.
LEANA WEN: It is true, of course, that the majority of infections are from unvaccinated to unvaccinated. And yes, it is very true that the unvaccinated are the reason we're in the position that we're in now with massive surges around the country, with the Delta variant that's the most contagious variant yet, now dominant here. If you're vaccinated then, why should you care if others around you are also vaccinated?
But here's the thing-- spillover infection, these breakthrough infections do occur. 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 in 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. You could get infected. And that, then, could also be passed on to other people, including unvaccinated and immunocompromised family members. So I think we really need to change our attitude in this country and be honest about the likelihood of breakthrough infections.
We need to be honest also that it's not just a matter of individual choice. A person, sure, you could say, well, they could decide to become ill themselves. But in this case, we're talking about a highly contagious illness. I don't think that anyone should have the choice to infect others with a potentially deadly virus.
Now, we don't have the numbers for this. It's difficult for us to quantify and say, well, you have a 1 in 10 or 1 in 2 or 1 in 100 chance of this happening. We really don't know this information. 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, 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.
I do believe that come fall, nearly all schools will be open for 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 if mitigation, protection measures are put into place.
It's important to talk about this as layers of protection. And so if you have an area of the country with very high coronavirus transmission, you need more layers. On the other hand, if there is very high level of vaccination in the community, therefore very low level of coronavirus transmission, you need fewer layers. And this is the reason if you remove the level of physical distancing, you really need to have indoor mask mandates still in place and adding testing on top of that-- regular surveillance testing of unvaccinated people on top of that will be really helpful.
We know that vaccine mandates work. The 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. Legally, the mechanisms for imposing vaccine mandates, there are certain levers. So for example, employers, workplaces should certainly be doing this. City, county, state federal governments are also employers. They can also look at what could be done under their control.
Then, we also need to look at, again, the examples of other countries. France, for example, they're saying, you can choose to be unvaccinated, but if you want to enter restaurants, bars, concert venues, museums, you don't have a right to come infected and potentially give other people a deadly illness. And so be unvaccinated if you want to, but if you want to enter public spaces, there is a societal obligation.