COVID: What comes next - With Dr. Ashish Jha

PROVIDENCE – The numbers indicate that the latest COVID surge has peaked, according to pandemic expert Dr. Ashish Jha, and while the next couple of weeks “are the critical time,” the nation as a whole can expect a better February than this January, when the Delta and omicron variants have combined to deal a coast-to-coast punishing blow.  Looking further ahead, Jha foresees the likely emergence of more variants but maintains that the country has the tools needed to protect health. And Jha, dean of Brown University's School of Public Health, said most experts believe COVID will become “a seasonal virus” enabling people to move mindsets away from the crisis mode of the last nearly two years and into a less stressful mentaility.  “So here we are on January 20th recording this and the good news is that the national surge has peaked,” Jha said Thursday during recording of the latest “COVID: What Comes Next” podcast. “I think the peak number was probably sometime in the last couple of days and we are going to see what I hope is a rapid decline down.”  Geographical differences remain, however, Jha said.  “Let me put some caveats on it,” he said. “Some places like Rhode Island probably peaked about a week ago. But lots of other places in America have not peaked yet… But nationally, I think we have peaked and we are starting our descent. To be clear, there are a lot of infections ahead. If you think about a peak, you're going to get as many people infected on the downturn as you did on the way up.    “So if you've not gotten infected yet, consider yourself lucky and be really careful for the next couple of weeks because I think the next couple of weeks are the critical time. My guess is after that it's going to really get down to pretty low numbers… the good news is we can see the end of this surge in front of us.”  Jha said now is the time to prepare for possible new variants.  “Once we get out of this surge and life begins to return more to a normal phase with low infection numbers and high vaccination rates, especially here in New England, we've got to start preparing like crazy for the next surge,” Jha said. “I don't know if it's going to come. I don't know when it's going to come. I don't know what the variant will be. I don't know where it'll begin, just like none of us predicted omicron specifically.”  But, the physician said, “we should assume that we're going to have more variants… so when it hits we're going to be ready to go. There's a whole series of things that need to be done: Plenty of testing, plenty of masks, making sure that we continue plugging away on vaccinations. All these things will help us be ready.”  Jha does not expect COVID to disappear, but with the passage of time, its presence will be experienced differently, he asserted.  “Most of us believe this will eventually become much more of a seasonal virus,” Jha said. “I don't know that we're ready to quite declare victory and call it a seasonal virus yet, and so for the next year or two I suspect we're going to have to continue managing this in a very aggressive way and knowing that we can get outbreaks at any time.  “That said, that shouldn't scare people. We have to do a mental shift away from thinking about this as an acute pandemic -- where ‘my God, it dominates our lives, my God we've got to think about COVID and talk about COVID all the time' -- toward a new mental model where, ‘yeah, it's around; yeah, it's going to be a problem; yeah, we need to deal with it, but we have all the tools and it's not going to disrupt our lives the same way.' ”      This is the 41st episode of the “COVID: What Comes Next” podcast, begun in October 2020 and available exclusively from The Providence Journal and the USA TODAY NETWORK. It is hosted by Providence Journal health reporter G. Wayne Miller, who has covered the pandemic since January 2020.

PROVIDENCE – As difficult as COVID-19 has made this December with omicron now the dominant variant, “we are looking toward a month of January when we're just going to see an extraordinary number of infections across all of the country,” Dr. Ashish Jha, dean of Brown University's School of Public Health, said on Tuesday.  “As it has been throughout, the pandemic is going to hit different parts of the country at different times,” jha said. “We're seeing pretty substantial increases in the Northeast. We're seeing Florida's numbers just skyrocket. We're seeing this really in Los Angeles. New York City has been one of the epicenters in the U.S. So we're really seeing this across the country.”  Jha said that while the number of reported new cases has hit record levels, the true numbers are likely even higher.  “I actually think we're way under-counting,” he said. “Because of the holidays, people are not testing. Lot of states are not reporting. So I would argue that right now, we have more people infected in America than at any moment during the entire pandemic, no question about it. In my mind, this is pretty staggering. And we are not anywhere near peak infection.”  According to The New York Times on Monday, 543,415 new cases were reported in the U.S. based on the latest data, with a daily average of 243,099. Rhode Island, according to The Times, had a daily average of 1,382 new cases with a positivity rate of 130 per 100,000, fifth highest in the nation, after Washington, D.C., New York, New Jersey and Puerto Rico.  https://www.nytimes.com/interactive/2021/us/covid-cases.html In Rhode Island, as elsewhere in the nation, the strain on hospitals concerns Jha, who spoke during recording of the latest “COVID: What Comes Next” podcast.  “All of our major hospitals are incredibly stressed largely because of staffing shortages, because of nursing shortages,” Jha said. “So I am very worried about both the cases we saw just before Christmas and what will happen over the Christmas and New Year's holidays in terms of the number of new infections. Even if it turns out that Omicron is milder, which it probably is, there will still be enough new infections to really cause a serious problem.”  https://www.providencejournal.com/story/news/coronavirus/2021/12/11/covid-fourth-wave-rhode-island-hospitals-short-staffed-omicron-ri/6461357001/    Jha and others on many occasions have urged people to get vaccinated and boosted when eligible. Experts also have repeatedly advised people to wear masks in many settings, particularly indoors; limit the size of gatherings; make provisions for proper ventilation, and continue hand-washing. These measures can also help prevent influenza and other diseases.  Isolation after testing positive has also been advised -- and on Monday, the Centers for Disease Control and Prevention issued new guidelines. Among them is shortening the time that infected patients should isolate from ten to five days after a positive result.   https://www.usatoday.com/story/news/health/2021/12/27/omicron-airlines-cancel-flights-covid-updates/9021308002/    Overall, Jha said he agrees with the new guidance.  “I'm in favor of the CDC changes, but I understand that not everybody loves them,” he said.   Looking deeper into 2022 and beyond, Jha said “there is no question in my mind that COVID-19 is going to be with us, probably forever but certainly for a very, very long time.”  The question then becomes, he said, “How do we manage our lives with the virus?”   Similar to “the way we manage our lives with lots of other respiratory viruses” such as flu, which has never disappeared, he said.  “We've got to figure out how to really lower the virulence, the way in which this virus gets people sick,” the scientist said.  Progress has already been made, according to Jha.  “Vaccines are going to be our primary tool,” Jha said. “We're also going to have therapies that will lower the severity of the disease, such as monoclonal [antibody therapy], oral pills like PAXLOVID from Pfizer. There will be hopefully others. It's going to become something that we manage and live with.”  https://www.providencejournal.com/story/news/coronavirus/2021/12/12/monoclonal-antibodies-hasbro-childrens-hospital-treat-covid-at-risk-kids/6478053001/   Jha foresees seasonality, just as with flu.  “We'll see surges maybe even in the summer in the south, in the winter in the north, and that will become a feature of this virus,” he said.  But the bottom line, according to the scientist, is that COVID-19 “It will not continue to torture us the way it has so far.”    This is the 40th episode of the “COVID: What Comes Next” podcast, begun in October 2020 and available exclusively from The Providence Journal and the USA TODAY NETWORK. It is hosted by G. Wayne Miller, health reporter for The Providence Journal. 

PROVIDENCE – The omicron variant has been detected in more than two dozen countries, including just this week in the U.S.   And this much is certain, says pandemic expert Dr. Ashish Jha: it will continue to spread.  Beyond that, Jha asserts, uncertainties at this early stage abound, just as they did when the last major variant, Delta, was first found in India about a year ago.  During recording of the latest “COVID: What Comes Next” podcast, Jha, dean of Brown University's School of Public Health, said he and other scientists are concerned with three major issues as they monitor developments.  -- Ease of transmissibility, which the Delta variant has abundantly demonstrated, is one.  “There's some data out of South Africa that suggests that it might be spreading very quickly in South Africa, but just because it does there does not mean it's going to spread more easily here,” Jha said. “The short answer is we don't know.”  But he added: “If Omicron is as contagious or more contagious than Delta, [most regions] will end up encountering this variant as well.”  -- A second issue is severity.  “Does it cause more severe disease?” Jha said. “We have no idea. You may have heard stories of somebody who had mild disease, but individual cases, anecdotes, don't tell you the story. We have to look at a lot more data. We don't know if it causes milder disease or more severe disease. Obviously, we all hope it causes more mild disease, but we don't know.”  -- A third is evasiveness, “the big issue,” as Jha described it.  “Does it break through our vaccines?” Jha said. “We don't have the data, but here's what concerns so many of us: the mutations we see with omicron are in parts of the virus where our vaccines usually work -- the parts of the spike protein where our vaccines work. That's where we're seeing the mutations and that's what's concerning many of us.”  Jha expects answers here relatively quickly.  “We will get more data in the next week to 10 days,” he said. “We don't have to wait months.”  Regarding the three current COVID vaccines – Pfizer, Moderna and Johnson & Johnson – and their potential defense against omicron, Jha was asked: “Is it better to be vaccinated than to be unvaccinated?”  “Oh my goodness, not even a close call,” Jha said. “Let's say our vaccines work a little less well. Is there any chance vaccine effectiveness goes to zero, meaning the vaccines atop working completely against omicron? There's essentially no chance in my mind that vaccines will stop working altogether.   “So if you've been vaccinated, you'll still have some degree of protection. And most of us believe, [given] our understanding of how boosters work, that if you are fully boosted, you actually will probably have a pretty high degree of protection against Omicron.”  Jha's advice? If you are not vaccinated, do so. And if you are eligible for a booster shot but not yet gotten it, do so.  During the podcast, Jha also explained why unvaccinated people who become infected with coronavirus are much more likely than vaccinated people to serve as a sort of haven in which mutations are more likely to occur. The reason, he said, is the more frequently a virus replicates, the greater the chance that one or more replications will carry a mutation.   “Vaccinated people most times won't even get infected, so the virus is not going to be multiplying,” Jha said. “Even if you get infected, [the virus] will be there for a much shorter period of time and you're not going to give the virus as much chance to mutate.  “No question there's a lot more replication happening among unvaccinated people and replication is the heart of mutations that lead us to” variants such as omnicon.  This is the 39th episode of the “COVID: What Comes Next” podcast, begun in October 2020 and available exclusively from The Providence Journal and the USA TODAY NETWORK. It is hosted by G. Wayne Miller, health reporter for The Providence Journal. 

PROVIDENCE – With the CDC expected this week to grant approval of the Pfizer vaccine for children age 5 to 11, polls show that some parents and guardians are hesitant about their youngsters getting the shots – and some have said they will refuse.  Dr. Ashish Jha's message to them?  “You can listen to what I have to say, but more importantly, look at what I'm doing.”  What he is doing, the Brown University School of Public Health dean revealed on Tuesday, is having his nine-year-old son get inoculated.  “The first possible day that the vaccine is available, he's getting the shot,” Jha said.   Needless to say, Jha and his wife are not subjecting their child to something untested. Science stands behind their decision.  “I have looked very, very carefully at the data and for my nine-year-old who's healthy, the benefits of the vaccines way outweigh any risks of the vaccines,” Jha said.  “The vaccine has been given to almost 4 billion people, including tens and tens of millions of kids around the world. The vaccines are exceedingly safe. And so between the global experience of vaccinations and the long-term effects of COVID, this is not a close call. This is a ‘gotta do this.' It's the right thing to do for your kids.”  Some 80,000 Rhode Island residents belong to this youngest group. The state Health Department has been preparing for weeks for the CDC's anticipated approval, which could come as soon as the end of the day Tuesday.  “We are working to ensure that vaccine is available to this population in Rhode Island very promptly after the CDC makes their announcement,” public information officer Joseph Wendelken told The Journal. After the CDC ruling, he said, “we will be making an announcement about when eligibility gets expanded in Rhode Island.”  https://www.providencejournal.com/story/news/local/2021/10/12/covid-2021-outlook-halloween-thanksgiving-according-dr-ashish-jha/6100647001    On another issue during Tuesday's taping of the “COVID: What Comes Next” podcast, Jha said that in Rhode Island and New England, “infection numbers are pretty stable, at a low-ish level -- not high, not tiny,” unlike last year at this time, when cooling autumn weather forced people indoors, where the coronavirus spreads easily, and the region experienced a surge.  The Health Department on Nov. 2, 2020, reported 214 Rhode Island residents hospitalized, with 26 in ICU; new cases totaled 429; and there were six deaths. Those numbers reported on this Tuesday, a year later, were 95, 11, 224, and two, respectively.  COVID-19 this year, Jha said, is “running up against a wall of vaccinated people, so we're not seeing those outbreaks… We're essentially at a stalemate, with the virus at a relatively low level.”  Still, he added, “I don't want to be too kind of ‘rosy-colored glasses' on this. Could I see outbreaks in New England over the next couple of months? Absolutely. Could we see hospitalizations rise? Yes, but I think we have so much vaccination here, so many people vaccinated, that I don't see large outbreaks in our future and I don't see anything like last winter.”  Not necessarily so for other parts of the U.S., however, Jha said.  “It's not just getting cold in New England, it's also getting cold in the Midwest and the Great Plains states, and those places I'm more worried about infection,” he said. “I some places like Montana, North Dakota, infection numbers are really quite high and that's because they just don't have the same level of vaccinations. And one has to be worried about those states for the next couple of months.”  During the taking, Jha also discussed the new Merck COVID medication, molnupiravir, saying “I am very optimistic this pill is going to end up becoming an important part of our tool set” in the fight against coronavirus disease. But he said it is no substitute for vaccination.  And Jha went into detail about the CDC's recent recommendation on booster shots.   On Oct. 21, the agency declared that “eligible individuals may choose which vaccine they receive as a booster dose. Some people may have a preference for the vaccine type that they originally received, and others may prefer to get a different booster. CDC's recommendations now allow for this type of mix and match dosing for booster shots.”   Three vaccines are available in the U.S.: the two-shot Pfizer and Moderna products, and the one-shot Johnson & Johnson, or J&J.   Said Jha: “If you got the J&J, you need a second shot no matter who you are… Whether you call it a booster or you just call it a second shot in the series is up to you but you need a second shot and it doesn't matter which second shot. If you got a J&J, you can get a Moderna, a Pfizer or another J&J, and I think you're fine.   “If you had a Moderna or Pfizer and you're in any kind of a high-risk group -- if you're older, chronically ill, high exposure -- you should get that booster. And here again, it doesn't matter which booster you get.”  Also Tuesday, Jha stressed the importance of providing vaccines to people on all parts of the planet, not just more privileged nations. Variants have arisen in parts of the world where vaccination rates were low, Jha said, and those have spread globally. New variants could arise in similar fashion.  This is the 38th episode of the “COVID: What Comes Next” podcast, available exclusively from The Providence Journal and the USA TODAY NETWORK. It is hosted by G. Wayne Miller, health reporter for The Providence Journal. 

PROVIDENCE – Do not expect a repeat of the grim fall and winter holidays of last year, when the pandemic raged. Instead, people in many parts of the U.S. can look forward to more traditional celebrations, now that “the delta surge of the summer has clearly turned a corner.”  Such was the assessment on Tuesday by Dr. Ashish Jha, dean of the Brown University School of Public Health, during taping of the 37th taping of the “COVID: What Comes Next” podcast.  “The horrible surge of the South, I think, is over,” Jha said. During the summer, he said, “Florida was among the worst in the world and now it's well below national average.”  Jha cited data confirming that nationally, infections, hospitalizations' and deaths are in decline. But, the physician and scientist warned, “I think there are pockets of concern. Certainly in the Upper Midwest and Great Plains… In North Dakota, Montana, large parts of Minnesota, Wisconsin and Michigan, you're seeing infection numbers still rising, and I'm worried.”  But for residents elsewhere, Jha said, the end of 2022 should be better than the last months of 2021, starting with Halloween.  “Is it safe to go trick-or-treating? Absolutely,” said Jha. “Halloween may not be 100% normal, but let's say, very, very, very close to normal.”  His one hesitation?  The fact that the federal government has yet to grant emergency use authorization of the Pfizer-BioNTech vaccine for children age five to 11. Approval is expected soon, but not in time for kids in that youngest age group to get the first and second shots required to reach full immunity.  And for that reason, Jha urged trick-or-treaters to wear masks if they enter a residence to get their candy. He also said “especially with young kids, I wouldn't do a house party.”  If all guests and members of a household – including the youngsters -- are fully vaccinated, Thanksgiving and the December holidays should be as they were in 2019 and previous years, Ashish said. Those willing to err on the side of caution, he added, should consider rapid testing, particularly if someone attending a gathering is not vaccinated.    “If you really want to be extra careful,” he said, “give everybody a rapid test before they come over for Thanksgiving dinner. It takes 15 minutes,” and the cost, now at about $10, is expected to drop, according to Jha said.  When everyone tests negative, Jha said, “I don't know what else you can do to make it safer. You're in an exquisitely safe situation.”  Jha said that once approval is given to the Pfizer vaccine for young children, he will arrange for his nine-year-old child to be inoculated as soon as possible.  And then he discussed an issue concerning many parents and guardians of children in the five-to-11 group: what factor does a child's weight play? Pfizer has recommended doses for the youngest children to be one-third of those now administered to people 12 and older – but some 11-year-olds weigh much more than their peers.   “I do wish that we could do this in more of a weight-based method,” Jha said.  Given that is not the case, he said, “this is a conversation with your pediatrician… It may be reasonable to go in a different direction, but really based on the guidance of your physician.”   Asked about recently enacted vaccine mandates for healthcare workers in Rhode Island and many parts of the country, Jha hailed them as a success, saying that nationally, only about one percent of such workers have declined.  “There is always going to be a small, noisy minority -- you know, the one nurse who so strongly refuses that he or she is willing to lose their job. Those are just extremely rare.”  Jha addressed the issue of flu season coinciding again with COVID.  “Last year, the flu basically didn't show up, he said. “And the reason is we did a lot of masking and hand-washing… and social-distancing. That made a big difference.  “What I suspect is going to happen this year with less masking, less social-distancing, is we're going to see a lot more flu. I'm hoping that some of the lessons of COVID will keep the flu level from getting horrible.” Hand-washing remains critical to prevent spread of influenza.  Jha urged all to get their flu shots if they haven't already.  The dean also answered an audience question from a man in New Jersey who wrote:   “We have a healthy 11-year-old son who turns 12 around Dec 1.  However, under the assumption that vaccines become eligible for kids 5-11 by the end of October, does Dr. Jha have any thoughts/data about kids that age getting the lower dose right away?  Or if there are any benefits/reasons to waiting the extra month to get the same dosage kids 12+ have been getting for a while?”  Here, too, Jha recommended a discussion with a pediatrician.    The “COVID: What Comes Next” podcast, available exclusively from The Providence Journal and the USA TODAY NETWORK, debuted in late October, 2020. Nearly nine hours have been recorded through this, the 37th episode. 

PROVIDENCE – The microbe that causes coronavirus disease may never disappear entirely, but there is an “end game” in sight for the pandemic, which means “we're going to get through this and we will get back to a normal that people will value and appreciate and love.”  And that could be as soon as the year 2022.  That was the prognosis Tuesday from Dr. Ashish Jha, dean of Brown University's School of Public Health, speaking during a recording of the “COVID: What Comes Next” podcast.  “We still have a lot of work to do, but the bottom line is if you think about the tools necessary to bring this pandemic to an end, we have them all,” starting with safe and effective vaccines, Jha said.  “Thinking about what the long-term looks like,” the scientist continued, “we are going to live with this virus. We're not going to eradicate it, but hopefully we can suppress it to very, very low levels. The 1918 flu pandemic was caused by this H1N1 influenza. That virus is still around, but it just doesn't cause much illness anymore.   “So I would not be a bit surprised if the SARS-CoV-2 virus that causes COVID-19 is around forever. My hope is at very, very low levels. My hope is that most of us have immunity either from vaccines or from infections and that the infection levels are very low and then we do some things for a while to keep infection levels low, like have regular widespread testing and improve indoor air quality and occasionally, if there's an outbreak, put on masks…  “The other thing that will help speed up this end game is if we get better treatments, which will also make it less serious.”  Bottom line?  “I think 2022 is going to be a much, much better year for all of this,” Jha said.  During taping of this 36th episode of the podcast, available exclusively from The Providence Journal and the USA TODAY NETWORK, Jha also said he suspects that the autumn months for the nation as a whole will be better than some who have been following the spread of the delta variant are predicting.  “There's an old line by Yogi Berra that predictions are hard, particularly about the future,” Jha joked, “but I'm going to make one which is: I think we as a country have peaked in our infection numbers. We had this very dramatic rise in cases all through the summer and I think in the last couple of weeks, it really looks like we've peaked.”  Regional differences remain.  “The infection numbers in the South really have started coming down,” Jha said. “When I look out to California, it's stabilized and coming down. New York is coming down. The Midwest and the Great Plains I still worry about; I can see infection numbers rising. Here in New England, infection numbers seem to have pretty much flattened over the last week to 10 days.”  Nonetheless, Jha said, nationally “we still have enormous numbers of people getting infected: 140,000 and 150,000 a day, down from 175,000, but still high.”   Deaths and hospitalizations remain unacceptable, the scientist said, “so I don't mean to paint a rosy picture of ‘sunny days are here again' and everything is great. We have lots of challenges especially as we look to the fall, but I think the peak of this wave has crested and now we've got to figure out how to get it down quickly.”  Jha responded to questions The Journal has received regarding the safety of large indoor gatherings, asserting that “we have the tools to do indoor concerts and conferences, but they're complicated… You've got to work harder to make those events safe.”  He gave the example of a two-day indoor academic conference, saying “the first thing I would do is do a vaccine mandate: ‘Sorry, you can't come and spend two days indoors with a lot of people if you're not vaccinated,' Second, I would add some rapid testing on top of antigen testing. They're cheap. They're relatively easy and I would get everybody tested upon arrival. I don't think once you've done that that you would need indoor masking.”  Proper ventilation also is key, Jha said.  The Brown dean said he approves of President Biden's decision last week to use the federal Labor Department's Occupational Safety and Health Administration to implement a vaccine mandate or require regular testing for companies that employ 100 or more people.  “I think that's a very reasonable set of regulations,” Jha said, “one certainly backed by the science. It makes sense to me that the federal government can require that as a safety measure.”  On the topic of booster shots, Jha said it is likely that an advisory panel to the FDA in the next week or so will recommend third shots of the Pfizer and Moderna products for “high-risk people -- people who are over 65, people who have chronic diseases, certainly frail elders. My guess is, they're not going to recommend boosters for young healthy people, largely because it's really not clear that they are needed at all.”  As for the one-shot Johnson & Johnson vaccine, Jha said he hopes the FDA will provide guidance on it, too, and not just “say ‘you're on your own' and not give any sense of a timeline for when they'll have answers… My hope is that when the FDA advisory committee meets in the next week, they address the J&J issue. If not, I'm happy to tell you what. I think the data [indicates] people are going to need an extra shot.” 

PROVIDENCE – As children including his own begin to return to the classroom, pandemic expert Dr. Ashish Jha expresses confidence that they and their teachers and support staff can be safe – provided school districts follow what he outlined Thursday as four requirements.   They are:   ◘ Vaccinations for all who are eligible   ◘ Proper ventilation and related mitigation measures in buildings   ◘ Regular testing   ◘ Mask-wearing   “For me this is personal,” said Jha, a resident of Newton, Mass., whose children attend public schools there. Jha, dean of Brown University's School of Public Health, serves on the Newton Public School District's Medical Advisory Group, whose recommendations have been adopted by the district.   “The bottom line here is we can get all kids back to school safely this fall,” Jha said, provided school districts anywhere in the U.S. embrace the four requirements, which are in line with guidance from many other public-health leaders and the CDC and FDA.   But the scientist cautioned: “If we ignore the science and the data and just say, ‘let's get them back,' it will go badly.”   During taping of this 35th episode of the “COVID: What Comes Next” podcast, available from The Providence Journal and the USA TODAY NETWORK, Jha elaborated on the four requirements.   “Kids 12 and over should be getting vaccinated and adults should have mandatory vaccinations,” Jha said. “To me, this is a no-brainer.” Currently, only individuals age 12 and older are eligible for coronavirus disease vaccinations.   Ventilation and related mitigation measures, Jha said, are also a “no brainer.” The federal government has allocated “billions and billions of dollars” for these, Jha said, based on the science of transmission, which is unambiguous.   “This is an airborne disease,” Jha said. “I think school leaders should be losing their jobs if they have not improved ventilation because it's unconscionable 15, 16 months into a pandemic, when you have the money and the science and the data's clear for you not to do that. So ventilation improvements are a no-brainer -- including just being able to open windows.”   Third, Jha said, “is testing. We have very good data that if you do weekly testing in schools of everybody, you pick up so many infections before they've had a chance to spread that you actually dramatically lower spread in schools.” Masking, Jha said, “is last but not least. Indoor masking especially right now where there's a surge of infections happening makes a lot of sense. Imagine we get to a point where infection numbers get really low -- I think masking could come off.   “So I really believe that masking is one part of a broader solution and [the fact that] we have somehow turned this into a political football makes no sense. We all agree: We've got to protect kids. No one says masking alone is going to do it, but it's part of a broader portfolio of activities that we absolutely need to have.” On this podcast episode, Jha also discusses the growing number of corporations including CVS Health, Walgreens, Bank of America, Delta and United Airlines, Facebook, Goldman Sachs, Microsoft, UPS, Walmart and Walt Disney that have instituted vaccine mandates for all or some of their employees.   He singled out Goldman Sachs, the investment bank and financial services firm that is headquartered in New York City.   “If you want to go visit them in their offices in New York, you have to show proof of vaccination,” Jha said. “Goldman Sachs is not your classic kind of ‘liberal public health entity…' They want to protect their employees. They really value their employees… Their employees are their business and they want to make sure their employees are not getting sick.''   Jha also discussed the rising numbers of teenagers becoming sick with coronavirus disease, saying “when you live in an unvaccinated community teens, definitely spread to each other and this is not just in schools. It's mostly out of schools, hanging out and having sleepovers…”   As for younger children, Jha said “the evidence is overwhelmingly clear that they get their infections from their parents, caregivers and older siblings.”   The dean also weighed on the Rhode Island Department of Health's COVID modeling that indicates hospitalizations in Rhode Island will peak in October. “In the next two months, we should expect hospitalization numbers to continue to climb and that worries me immensely for Rhode Island because when I look at what's happening in Rhode Island -- and in many other places [of the U.S.], even New England -- I worry about hospital capacity and hospitals really getting full.”   Jha also answered an audience question regarding a woman in California who contracted coronavirus disease and continues to experience pulmonary symptoms which her doctor could not explain. Jha does not give specific medical advice on the podcast, but in general, he recommends long-COVID patients reach out to leading universities with hospital affiliations.

PROVIDENCE – “I'm very worried.”  So declared Dr. Ashish Jha this week as the highly contagious Delta variant ravages many parts of the U.S. and some models suggest “as many as 35 million Americans may get infected over the next couple of months, the next few months,” according to the pandemic expert.  That, Jha said, “is an astronomically large number.”  And it is being driven in large part by the numbers of people who decline to be vaccinated -- although more people are getting shots recently than earlier in the summer, said Jha, dean of Brown University's School of Public Health.   “This variant is going to spare no one,” the scientist/physician said. “If you are unvaccinated, you are almost surely going to encounter this virus up close and personal. All of us will -- but for those of us who are vaccinated, we're going to encounter it as a vaccinated person and most likely will not get infected.”  As he and many other public-health expert have repeatedly now for months, Jha urged anyone who is unvaccinated to get inoculated. That will help in the long run, but not immediately, as weeks must pass after receiving the two-shot Pfizer and Moderna products and the one-shot Johnson & Johnson before full immunity is reached.  Speaking this week while recording the 34th episode of the “COVID: What Comes Next” podcast, available from The Providence Journal and the USA TODAY NETWORK, Jha also addressed the record numbers of coronavirus infections, hospitalizations, and deaths among children in some parts of America.  “We had a whole year of minimizing the infection of kids, saying ‘kids don't get sick, it's no big deal,' ” Jha said. “Kids thankfully don't get very sick, but some of them do and we want to be careful. The questions people are asking me right now are: ‘Is the Delta variant particularly bad for kids? Do kids get sicker with the Delta variant than they with Alpha, or the version from last year?'  “The short answer is, I don't know. We've been scouring the data but we don't have good data on this. So then people point to the fact that a lot of kids are getting hospitalized and are in ICUs and they say ‘how do you explain that?' The answer is a lot of places are having very large infection numbers and if you have a massive surge, kids are not immune. They're going to get infected. Most of them will do very well, but a small number will end up getting sick and hospitalized.”  On the topic of booster shots, Jha spoke about some fully vaccinated people who “are going surreptitiously into a [pharmacy] and acting like this is their first shot and then not showing up for their second shot. It's a mess because it totally ruins our record-keeping. Who then knows how many people have gotten vaccinated, who's gotten two shots, who's gotten three shots?”  Jha said “this is not based on science” but then expressed the hope that the CDC, which is studying the possible need for booster shots, “should make a determination… they should guide people and they've got to push this forward. Otherwise you're going to have, you know, hundreds of millions of Americans winging it on their own. And that never turns out well.”  During the taping, Jha also answered an audience question. A doctor in Pennsylvania wrote:  “In the July 1 episode, Dr. Jha said there was no evidence of asymptomatic immunized people spreading COVID. Is this there any further data on this? Can pre-symptomatic immunized people spread COVID?”  The pandemic expert's answer, in part:    “If the question is ‘can vaccinated people spread the virus?' the answer is yes. We've seen it, but all the cases that I'm aware of have happened while the vaccinated person was symptomatic. What does that mean? It means that they were coughing, they had a fever when they were spreading. That's important because if you have a fever and a cough, you can isolate yourself.   “The big question is: ‘What if you are vaccinated and you feel well, you're totally fine, can you be infected and spreading?' We just don't know. Most of the data suggests no, but I hope you hear enough uncertainty in my voice to be very clear that I honestly don't know.” 

PROVIDENCE – With the Delta variant now widespread, the World Health Organization recently repeated longstanding guidance that all people -- vaccinated or not – should wear masks. Some places in the U.S., including sprawling Los Angeles County, have advised mask-wearing for all indoors.   But the CDC differs.  Pandemic expert Dr. Ashish Jha on Thursday cut through the confusion, offering advice keyed to one's vaccine status and where one lives.  “I largely agree with the CDC,” Jha said during taping of the “COVID: What Comes Next” podcast. “What they're really trying to do is say these decisions should be made locally and that's my view as well.”  He gave the examples of Rhode Island and Massachusetts, which each have high vaccination rates and low numbers of new infections. Fully vaccinated people in the two states, he said, do not need to wear masks at indoor events with others who are fully vaccinated.  “If you're hanging around vaccinated people in a low-infection community, you're fine,” said Jha. But it's a different story in some other parts of the U.S., he said.  “Let's say you're in southwest Missouri right now. What you're seeing is a horrible outbreak and vaccination rates are low. Even if you're vaccinated, I'd wear a mask.”  Jha, dean of Brown University's School of Public Health, addressed the latest study, published in nature, that suggests immunity acquired through the Moderna and Pfizer vaccines may last years.    “It is more evidence, but not definitive evidence, that these vaccines are going to last a while,” Jha said. “We're going to have reasonably long-term immunity.” Further study will provide more definitive answers over time, he said.  The scientist also discussed the emergence of yet another COVID-19 variant -- a new version of the troublesome Delta variant that has been dubbed “Delta Plus.”    “I just had a long conversation about this with people in India, where it was first identified and is really spreading,” Jha said. “I'm not super worried about it. I don't think it'll become a major problem. Delta is a major problem. I don't think [Delta Plus] will be a problem even bigger than Delta. but we don't know for sure.” Like others, he awaits more data.  During recording of this 33rd episode of the podcast, Jha answered four audience questions.  ◘ A mother of three young boys living near Dusseldorf, Germany, asked Jha's opinion on her government's reluctance to recommend vaccinations for children aged 12 to 18. That group is eligible in the U.S.  “I think people should be getting vaccinated,” Jha said. “I think kids should be getting vaccinated.”  ◘ A psychotherapist living in Wisconsin had several questions regarding Long COVID. Jha spent two minutes answering.  ◘ A Boston resident asked about home tests. Jha endorsed them, but said he hopes the price will come down.  ◘ A Rhode Island woman asked about the need for a booster shot for people who have received the Johnson & Johnson one-shot vaccine. Jha devoted two minutes to this topic, too.    Available exclusively from The Providence Journal and the USA TODAY NETWORK, this podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. See omnystudio.com/listener for privacy information.

PROVIDENCE – The growing dominance of the deadly Delta variant will pose a grave risk this summer to people who are not fully vaccinated, pandemic expert Dr. Ashish Jha, dean of Brown University's School of Public Health, said during the latest recording of the “COVID: What Comes Next” podcast.  “If you have not gotten vaccinated, this is a potentially very dangerous time because the Delta variant is spreading,” Jha said. “It's about 6% of infections in the United States right now, doubling every two weeks. If you do the math, in about four to six weeks we'll start getting close to half… By mid-August, it'll be the dominant variant in the United States.”  Jha said that when he assesses risk posed by variants, he examines three factors: ease of contagion, potential for high mortality, and “does it evade immunity from vaccines or prior infections?”  The Delta variant, first detected in India, scores alarmingly on all three, Jha said.  “It is the most contagious variant we have ever seen in this pandemic and that's going to be a huge problem,” Jha said. “Second, it does look like it's a bit more deadly than other variants. And there is some evidence that it has more ‘immune escape' as well. So, it may be one of the first sort of true triple threats.”  Bottom line?  “If you have not started getting vaccinated, it's time to start,” Jha said.  “Now here's the good news on the Delta variant,” Jha added. “If you've gotten two shots of the mRNA vaccines -- Pfizer or Moderna -- you've got 90% protection against the Delta variant. That is amazing. Thank goodness.”  As for the single-shot vaccine available now across the U.S., Jha said “I think the Johnson & Johnson data will come in the same. We just don't have as much data. But if you got the J&J vaccine, don't freak out. You'll have almost certainly have very good protection.”  On another topic, Jha responded to recent reports in science publications Nature and BioRxiv that once acquired, immunity to COVID-10 is long-lasting – perhaps even as long as a lifetime.   “I don't think lifetime,” Jha said. “I'd love it if our vaccines lasted a lifetime and then we're just good to go forever. I'd be surprised. But it does really push back against this narrative that some people have been saying that we're going to need boosters in six months. I don't see us needing boosters in six months.   “And if immunity is long-lived from a previous infection or from two doses of an mRNA vaccine or a Johnson & Johnson vaccine, I can easily imagine going at least a year and maybe even a couple of years without needing a booster.”  Jha applauded recently reported results of clinical trials of the Novavax vaccine showing a 90.4% overall effectiveness, nearly as good as Pfizer's and Moderna's, and a 100% efficacy in preventing moderate or severe disease.  But with ample supplies of Pfizer, Moderna and J&J in the U.S., Jha envisions the vaccine playing a critical role elsewhere on the planet.  “I am thrilled beyond belief,” Jha said. “Because if things go well, they are on track to make as many as 1 billion doses by the end of the calendar year. That would be very helpful for the world. So as a global vaccination strategy, Novavax could end up being a really, really important player.”  Jha also answered two audience questions: “Would you take a baby or toddler under two, who cannot wear a mask, to a grocery store?” and “Would you take a baby or toddler under two, who cannot wear a mask, on a plane?”  Jha said in many instances, a two-year-old would be safe in a grocery store or on a plane. But his “caveat” was that geography must be considered, given the uneven status of the pandemic in different states and regions. And he said as the summer unfolds, the situation could change, especially in light of the Delta variant.    Recorded weekly since October, the “COVID: What Comes Next” podcast, available exclusively from The Providence Journal and the USA TODAY NETWORK, is now being produced less frequently. This is the 32nd episode.    This podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. See omnystudio.com/listener for privacy information.

PROVIDENCE – Children under 12 are not yet eligible for vaccination against coronavirus disease -- but despite lacking that protection, their fully vaccinated parents and guardians should not be overly anxious about their chances of becoming sick.   Rather, they should practice a degree of common sense – and, with a few exceptions, let their children be children.  That was the gist of a discussion on Tuesday by pandemic expert Dr. Ashish Jha, who also explored other subjects, including the “social science” aspects of mask-wearing now that fully vaccinated people need not wear face coverings in most settings.  “The single biggest way, the best method, for protecting kids under 12 from COVID is for adults to get vaccinated,” Jha said. “Because when adults get vaccinated, adults in general, they bring infection numbers down. And when the adults around the kid get vaccinated, they essentially create a ring of protection around the child.”  What about play dates with other children under 12 who also are not vaccinated?  Jha gave the example of his family. He and his wife have three children, one of them younger than 12.  “We tend to think about spending time with families whose parents are also vaccinated,” Jha said. “If the broad community around kids is vaccinated, then the chance that a kid will pick up the infection gets very, very, very low. That's sort of rule number one: Make sure that you're hanging out with vaccinated adults because their kids are also less likely to be infected.”  What about high-risk situations, such as long-lasting indoor gatherings with large numbers of people?  “Probably reasonable to keep your kid masked for a little bit longer,” Jha, dean of Brown University’s School of Public Health, said during taping of the 31st episode of the “COVID: What Comes Next” podcast.  And what about children under the age of two, who are unlikely to keep a mask on for long regardless of circumstances?  “No masks, but they're not at super high risk of getting infected,” Jha said.  In recent podcasts, Jha has repeatedly emphasized the importance of community. Transmission rates of COVID-19 vary by state, region and municipality and thus your local situation, the physician and scientist asserts, is key.  “If you're in a community with very, very low levels of transmission, your child is not going to get infected,” he said. “Even if you get super-duper unlucky and your child ends up getting infected, they will almost surely do very well.”  The disease “for kids in general is milder than the flu,” Jha said. “My general feeling on this is we can't stress excessively about kids. Use common sense, hang around vaccinated people, and we’ll be fine.”  During taping of the podcast, available exclusively from The Providence Journal and the USA TODAY NETWORK, Jha answered several audience questions, including from a pediatrician in Pennsylvania who asked about New York Yankees players testing positive for COVID.  Jha’s answer, in part: “The broad point is in a population of vaccinated people, you don't need to do ongoing asymptotic testing.”  The dean also responded to a mother of a seven-year-old girl in Illinois. Her questions: “Is it still recommended for kids to wear masks outside with their unvaccinated friends; there are times when they are not socially distant from each other. Also, if my daughter is the only unvaccinated person in a group of nine vaccinated people at a family home inside, should she wear a mask?”  Jha said: “She's the only unvaccinated person in a family home indoors with nine vaccinated people -- no mask, she doesn't need it. She's fine because she's surrounded by vaccinated people. She's not going to pick up the infection.”  Jha’s caveat was that risk, while negligible, is never zero for pretty much anything. Still, he said, “the risk is so incredibly low that I would not have my child wearing a mask if he or she were surrounded by vaccinated people.”  Outdoor play, he said, poses similarly low risk.   “No mask outdoors playing with other kids,” he said. Not necessary. I know they're not socially distanced, but it’s incredibly rare to pick up infections outdoors.”  He added: “If your child has some severe health problem, you have to take my advice with a bit more nuance. Talk to your doctor. But for healthy kids, their chances of getting infected in either of those scenarios is exceedingly low. And if you are that very unlikely person who gets infected, he'll do fine.”  This podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal See omnystudio.com/listener for privacy information.

PROVIDENCE – “A breakthrough” was Dr. Ashish Jha’s assessment Tuesday of the CDC guidance that fully vaccinated people need not wear masks in most situations.   “You basically can return to life as it was in 2019 and that’s pretty profound,” said the dean of Brown University’s School of Public Health.   But Jha acknowledged questions surrounding the ruling as states, municipalities, and businesses adopt policies while the COVID-19 pandemic continues to ease in much of the U.S. And he spent several minutes discussing the broad and fine points of mask-free living in an effort to cut through what he described as “confusion and complexities.”  “If you're fully vaccinated, you're good to go,” Jha said. “You don't need to be wearing a mask outdoors. You don't need to be wearing a mask indoors. You don't need to do to be socially distanced from vaccinated people. You don't need to be socially distant from unvaccinated people. If you're fully vaccinated, it doesn't matter what's happening around you, with a few exceptions.”  Jha listed three.  “A super-crowded stadium, a packed indoor concert, potentially a packed outdoor concert, someplace where you're essentially going to be breathing somebody's else's respirations for hours,” he said. “That's probably where maybe we should do something different,” such as wearing masks and practice distancing, or not attending at all.  Other exceptions where the CDC said masks and distancing are still required include health-care settings, facilities that serve people experiencing homelessness, and public transportation: buses, trains, airplanes and the airports and stations that serve them.  Jha acknowledged that in most settings currently an honor system, not actual proof of full vaccination, is the method of verification. Given the example of a health club or gym that might ask patrons if they are fully vaccinated, the scientist and physician said while recording the 30th episode of the “COVID: What Comes Next” podcast:  “If you're fully vaccinated, the CDC is saying, ‘why do you care?’ If someone is deceptive and lies and says they're vaccinated when they're not and they go in -- if you're fully vaccinated, it doesn't make any difference to you… You're not going to get infected or if you do, you're not going to get sick.”  The discussion turned to the eventual likelihood that reliable means will be developed allowing an individual to demonstrate full vaccination status beyond presentation of a paper card – vaccine passports, as they have been called.  “I don't think the government's going to be issuing vaccine passports, but let me assure you there are a whole bunch of private companies that are working on developing these things because businesses want them, gyms want them, restaurants want them,” Jha said.   “You can imagine that some restaurants know that some patrons are going to feel a lot more comfortable doing indoor dining if they know everyone is vaccinated. So as a restaurant, you could say ‘we have a vaccinated-only policy.’ And if you can verify who is vaccinated, that restaurant becomes exceedingly safe for everyone.”  And that would be a big selling point, Jha said.  “The basic point is that these vaccine passports are coming, but they’re going to be private-sector solutions,” he said.  During the recording, Jha also explored the possibility that come cold and flu season, people may choose to wear masks in certain situations to avoid becoming sick. Reflecting the experience of other countries where mask-wearing has been mandated until now, the just-ended annual flu season in America was comparatively mild.  “If everybody wears masks or some chunk of people wear masks, it’ll reduce the amount of flu,” said Jha. “And if we continue hand-washing and surface-cleaning, we will definitely make an impact on the flu as well. So I expect to have a milder flu season. Knock on wood, I haven't gotten a cold in a year.”  For the first time since the podcast, available exclusively from The Providence Journal and the USA TODAY NETWORK, debuted in October, the recording took place not by Zoom but in-person at Jha’s Providence office. Both Jha and Miller are fully vaccinated.  Jha also answered an audience question from a professor at a New England college who asked:  “Due to the potential lower efficacy of J&J in comparison to other vaccines, could (or should) one who is vaccinated with J&J consider doubling up with either the Pfizer or Moderna vaccine, especially if the current demand is lower than supply? Would there be a downside to doing that?”  Jha answered that he is impressed with the Johnson & Johnson one-shot vaccine and added: The CDC and a bunch of immunologists are working on guidelines on this. So, what I would say to this person is: ‘As a whole, infection numbers are down, They’re very, very well protected with a really terrific vaccine that will protect them from severe illness and death.’  “ ‘Let's see what the next few months bring in terms of science and data on mixing and matching of vaccines.’ ”    To hear Dr. Jha’s full answers to these questions and learn more details about other issues discussed in this 30th episode, please download the podcast. This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal.   See omnystudio.com/listener for privacy information.

PROVIDENCE – Dr. Ashish Jha on Tuesday welcomed the FDA’s Monday approval of the Pfizer vaccine for children 12 to 15 years old, declaring that it will keep those who receive it safe while moving the general population closer to population immunity.   The CDC’s COVID vaccine advisory committee is soon expected to follow suit, which means children in this age group should be able to get their first shots within days.   “This is about 16 million people kids,” Jha said while recording the 29th episode of the “COVID: What Comes Next” podcast. “My expectation is that about half to two-thirds will end up getting vaccinated in the first month or two and that will help with population immunity, which is going to be great. Of course, the most important thing is it'll protect them.”  Jha has two daughters in that age group and he said both are “excited” to soon be eligible.  Pediatricians will play a critical role in arranging for vaccinations, said Jha, dean of Brown University’s School of Public Health – and also in easing concerns that some parents and guardians may have.   “I'm very comfortable with the safety data, but not everybody's going to be, and [these parents and guardians] should absolutely talk to their pediatrician and have informed conversations from informed experts. I think that's going to make a big difference.”  Jha said that “one challenge” will be getting children to vaccination sites that have the means to store the Pfizer shots at the required frigid temperature. Most pediatricians and primary care providers do not have such refrigeration capabilities in their offices.  “That will present a bit of a barrier,” Jha said. Visiting a site equipped to administer the Pfizer product, he said, “may slow some people down,” but with the Pfizer vaccine in abundant supply and walk-in shots available, that shouldn’t discourage them.  Jha hailed a recent article in Science, the peer-reviewed journal of the American Association for the Advancement of Science, about scientists who are combing the Brazilian rain forest looking for animal disease that could cross over into humans, as COVID-19 did. One goal is to identify and contain such diseases before they reach people.  “It’s a really important effort” that will be useful in predicting potential outbreaks, Jha said. But as COVID has demonstrated so tragically, he added, “we also still need to be prepared for a virus that we weren't expecting.” That means a global public-health, he said.  Jha also discussed Japan’s planned summer Olympics, saying there is “a theoretical way” to make them safe that involves vaccinations for all participants, officials and others. He has not seen the latest plans, however, and thus could not properly assess them.  The scientist and physician also answered several audience questions during taping of the podcast, available exclusively from The Providence Journal and the USA TODAY NETWORK.  -- A 67-year-old woman with autoimmune disease who was vaccinated yet spent 12 days in the hospital after testing positive for coronavirus disease wrote the podcast stating that “my doctor says I have no vaccine antibodies.” Her question: “Where do I go from here?  Jha expressed his empathy and said “it's not like you have no protection. You have T-cell immunity that kicks in again. I don't know about the autoimmune condition specifically that the person has, but my point is that you still have some degree of protection.”  -- Another listener who is immunocompromised and has been vaccinated asked: “Is there a reliable test to check for vaccine response?  It would greatly relieve my anxiety to know I made antibodies.”  Such tests do exist but are experimental, Jha said, “but unless there's a compelling reason, I wouldn't worry about getting tested.”     -- Another listener who wrote that “Dr. Jha tells it like it is, but always injects a ray of hope, even on the darkest days” asked when someone should receive a third or “booster” shot. Some have suggested six months after the second shot of the Pfizer or Moderna products, which would be August for this listener.  Jha’s response: “This has gotten a lot of attention. So I will give you my personal feeling, which is stop thinking about boosters. I have no idea if or when we will need a booster, but I am quite confident that this person will not need one in August… vaccine-induced immunity is quite good.” Jha expects it to last “at least a year but probably longer.” Only time will tell, he said.  -- A fourth listener who tested positive for COVID in March but quickly recovered asked “when can I receive my second Covid vaccine? I have been advised of a timeline of 90 days after positive test results to any time after symptoms disappear.”  Jha said: “I think it's very reasonable to wait 90 days. That’s what I have been saying and what the CDC says as well, and that's where most of us in the public-health and medical communities are. If you want to get it sooner than that you can, but I don't think there's any major advantage.”    To hear Dr. Jha’s full answers to these questions and learn more details about other issues discussed in this 29th episode, please download the podcast at  This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal.   See omnystudio.com/listener for privacy information.

PROVIDENCE – The FDA is expected to soon authorize use of the Pfizer coronavirus vaccine for adolescents 12 to 15 years old, a development that pandemic expert Dr. Ashish Jha on Tuesday greeted with enthusiasm for its anticipated effect on the general population -- and prospects for fully reopening high schools in the fall.  “It’s really helpful,” Jha said. “It’s big.”  When adolescents in that age group begin getting shots, Jha said, “they add to population immunity. Right now, we have about 44 percent of Americans who have gotten at least one shot.  These twelve to fifteen-year-olds represent another about four or five percent of the population -- about 16 million. Let’s say half of them get vaccinated in the next month or so. That will cause another dampening effect on lowering infection rates across the country.”  During Tuesday’s taping of the 28th episode of the “COVID: What Comes Next” podcast, Jha, dean of Brown University’s School of Public Health, said “we had schools open this past year and it was always the high schools that were the hardest hit…”  Come summer’s end, Jha said “every high-schooler who wants a vaccine will be vaccinated. Every teacher in a high school and staff in a high school who wants to be vaccinated already is vaccinated. There just is no explanation anymore and no medical and public-health reason that high schools cannot be open 100%, full-time normal this fall.”  On another topic, Jha took a nuanced view of a recent report in The New York Times that cited experts who maintain reaching herd immunity is unlikely in the U.S.  “I think it's mostly right, but maybe I'm a little more optimistic,” Jha said. “This is not about the level of immunity in America. This is about level of immunity in your state or in your city… It's really about what's happening in your community.”  He added: “And I actually am more optimistic than the Times article about whether we'll get to 80% immunity. Because remember, there are a lot of people have been infected as well who have not gotten the vaccine. And so we've got to count their immunity.”  Regarding a recent study in the journal Nature that found that 73,000 people in America who were infected by COVID-19 but were not sick enough to be hospitalized had a 60% higher rate of death than non-infected people, Jha said:  “What it seems to me is something that I have been saying for a long time, which is we should not be cavalier with this virus. We should not kind of work with the assumption that ‘hey, if it doesn't kill you, it makes you stronger.’ In fact, not at all. We know there are long-term complications. We know a lot of people have long-term symptoms.”   Jha also addressed the prospect that the federal government in the next weeks will lift the emergency use authorization label from the Pfizer and Moderna vaccines. No longer “experimental,” as some who decline to be vaccinated have asserted, the vaccines could be become more appealing to people who hesitate to get the shots.  “I believe you're going to see both Moderna and Pfizer get what's called a full license probably sometime this summer,” Jha said. “It could be as early as next month, but certainly, before the end of the summer. In my mind, I already know that the evidence here has been so rigorous that they're well above the bar on full license.  “And if that helps some people feel better, that'll be great. But what I've been saying to people is, ‘don't worry about the designation. Look at the underlying evidence and data. We have so much safety data on so many people.’ ”  During taping of the podcast, available exclusively from The Providence Journal and the USA TODAY NETWORK, Jha answered an audience question from a woman in Raleigh, N.C., who asked: “Can you explain ‘asymptotic?’ I understand you don’t have symptoms, but how would you know when you are no longer contagious? Unless you are being tested regularly, you don’t know you could be infecting others. Are you asymptotic for a few days or weeks or longer?”  Jha’s answer: “We know that a lot of spread happens when people are asymptomatic, but the majority of that is for people who are really pre-symptomatic. So let me explain what I mean. Let's say I got infected today, which is unlikely since I've been vaccinated, but let's say I was unvaccinated and I got infected today.   “In about three, four days, I would potentially become contagious, but may not have symptoms. For a couple of days I'd been walking around, totally feeling fine like I'm normal -- but I could be spreading the virus. This is why the virus spreads so efficiently in pre-symptomatic people.”    This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. See omnystudio.com/listener for privacy information.

PROVIDENCE – Even though a single dose of the Pfizer-BioNTech COVID-19 vaccine provides a significant degree of immunity against coronavirus disease, it is imperative that those who have received one return for their second. The same holds true for those who have received only one shot of the Moderna product. So stated Dr. Ashish Jha on Tuesday during taping of the 27th episode of the “COVID: What Comes Next” podcast. His observation comes amidst reports that some five million Americans have missed their second dose as many experience pandemic exhaustion.  “One dose alone gives you a high degree of protection,” Jha said, “but here's the ‘but’: We don't think it lasts that long. Ten weeks, maybe 12 weeks, but I certainly have no idea that it will last much longer than that. There's an issue of that durability of protection. So everybody needs a second dose.”  Feeling that pandemic fatigue and been putting it off?   Jha, dean of Brown University’s School of Public Health, said no worries.    Just get the second dose.  “What I say to folks is, ‘You missed it, that’s not great, ideal to get [the second], but I wouldn't sweat it. Go get your second. You don't have to start all over again. No one's going to be mad at you that you miss the second dose. Just go get your second dose. Everybody needs their second dose of both Moderna and Pfizer.   “ ‘If you ended up missing at for a couple of weeks because life got busy, you ended up having some work thing or personal thing, don't sweat it. Go get the second dose. Better late than never. One dose does provide some protection but it won't last long enough and you need that second dose.’ ”  During taping of the podcast, available exclusively from The Providence Journal and the USA TODAY NETWORK, Jha gave the latest update on the pandemic around the U.S. and the planet. It remains a dramatically mixed picture, with some states and nations in relatively good shape while others suffer horrifically.   “These are some of the worst days globally for the pandemic,” Jha said. “We’re getting close to a million new cases a day happening around the world.”  The epicenter now is India, where Jha was born and spent his early childhood. That country has now recorded several straight days of some 350,000 or more new cases.   “Their hospitals are just completely overwhelmed,” Jha said. “People are dying on the streets because they can't get access to oxygen. It is really, really, really bad. And so this weekend, I was thrilled to see the Biden administration step in and say, they're going to help. A lot of other countries are also stepping in. This is a global pandemic. We’ve got to help each other out when other counties get into trouble.”  Jha also answered an audience question from a woman in Los Angeles who wanted him to address “the very real concerns of the immunocompromised and transplant patient populations with regards to COVID vax protection and risk mitigation. Many of these medically vulnerable adults, myself included, rushed to get the vaccine as soon as it was available to them.”  Her question: “What advice does Dr. Jha have for the immunocompromised regarding risk mitigation and what understanding does he have of how the vaccine may or may not protect us, i.e. T cells, antibodies, etc.?”  His answer, in part:  “There are a group of Americans who have immunocompromised states for a variety of different conditions for whom the vaccines may work less well. The antibody response may be lower. We don't know as much about the T-cell response and so it stands to reason until we have better evidence that these people will have some protection, but not the full degree of protection. It will probably vary by immunocompromised state: different ones will have different levels of response.”  What can be done?  “We’ve got to drive the infection numbers down, down, down. We have to get vaccinations numbers really, really high. Because the best way to protect that immunocompromise person with weak protection after vaccination is to make sure that they are exposed to the virus as infrequently as possible.   “And so, if we can drive infection numbers down to 5,000 or 10,000 infections a day in the United States, it will make it dramatically safer. The alternative is to keep public health restrictions in forever. That's not going to be possible. It's not advisable. I think people will not tolerate it.”      This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal.  See omnystudio.com/listener for privacy information.

PROVIDENCE – Pandemic authority Dr. Ashish Jha on Tuesday hailed this week’s opening of coronavirus vaccines to all U.S. residents age 16 and older – but strongly urged officials to simplify the process by which shots go into arms so all can take advantage.   The current patchwork of web sites and phone numbers used now in cities and states across America to schedule vaccinations, Jha said, is cumbersome and confusing and discourages many people who want protection quickly and easily.   “Nationally, we're at about 50 percent of adults who have been vaccinated,” Jha said. “We are now through the people who were ‘avid vaccine seekers’ -- the people who desperately, desperately wanted the vaccine, who were the equivalent of people who camp out all night for the new iPhone that's going to open up in the morning.”   People, he said, who have been willing to spend hours repeatedly refreshing their browsers until an appointment materialized and they could grab it.  But now, said the dean of Brown University’s School of Public Health, “there’s got to be an easier way. We shouldn’t make it hard for people.”  Jha said “the next ten to 20 percent” of people needed to help toward the goal of herd immunity are not anti-vaxxers, but rather individuals who do not fall in the “avid vaccine seeker” category.  How to reach them?  “Make it super-easy,” said Jha. “Things like no scheduled appointments -- just show up and you'll get a vaccine. Do outreach. Go to work sites. People have been talking about construction sites and construction workers, so send a vaccine van out to the construction site and vaccinate everybody who's willing to get vaccinated that day.  “There are all sorts of things we can do to get the next ten to twenty percent. If we just continue doing what we're doing, we're going to find that we're hitting a wall in terms of people getting vaccinated and that's going to be a huge problem because we're at 50 percent nationally now. We’ve got to get to 70, 80 % of adults before this disease really breaks and starts getting under full control.”  Regarding the federally recommended pause in administering the Johnson & Johnson vaccine last week following reports of a rare blood-clotting complication involving six women age 18 to 48 who received the company’s one-injection product, Jha repeated his assertion “that it was irresponsible.”  Jha said he expects the federal government will mostly lift the pause by the end of the week after a CDC scientific advisory board reports its findings. The CDC could, he said, “give an advisory for women [age 18 to 48] to get a little extra monitoring” after being inoculated.  “If they don't unpause it by Friday, I think that's a huge problem,” Jha said during Tuesday’s recording of the “COVID: What Comes Next” podcast, available exclusively from The Providence Journal and the USA TODAY NETWORK.  Jha also discusses COVID-19 mutations, saying “the reality of pandemics is that you're going to see new variants. We have seen new variants emerging out of India and one of them particularly has gotten a lot of attention. A lot of people are concerned about the implications and the bigger picture.  “The point is not to focus excessively on that variant per se but to really talk about the fact that variants are going to be coming for weeks and months and years and we need a strategy for how to identify them, how to track them, how to understand them, and whether they mean anything or not.”    The conversation turned to the safety of swimming pools, with Jha declaring that outdoor pools are safe and any risk associated with them would come after emerging, “when you're sitting with somebody for two hours and chatting and you're sitting right next to them. But passing by, you're not going to get it.”  Similarly, Jha said, transmission will not occur while swimming in an indoor pool, but if after “you sit with a friend for two hours right next to them and you’re not wearing a mask, that's a different thing.” In other words, risky.  Jha also answered two audience questions, one from a man in California who works for the Walt Disney Company who asked about the CDC’s V-SAFE monitoring program. Jha said it has value, but so do other programs that report adverse events.  Another woman asked about how best to discuss vaccinations with an adult daughter who is hesitant to be inoculated.   Jha said “lecturing and scare tactics almost never work” and he advised conversations about the benefits and safety of vaccines “and of course to listen to the questions that are driving the anxiety or the concerns” and respond with information and understanding.  This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. See omnystudio.com/listener for privacy information.

PROVIDENCE – The decision by the Centers for Disease Control and Prevention and the Food and Drug Administration to recommend an immediate pause in administration of the Johnson & Johnson vaccine demonstrates that “the system is working,” pandemic expert Dr. Ashish Jha said on Tuesday while recording the “COVID: What Comes Next” podcast.  The federal recommendation follows reports of six women, ages 18 to 48, who developed an unusual blood-clotting disorder after receiving the single-dose vaccine. One died and a second woman is hospitalized in critical condition.  “Obviously, none of us wish this had happened,” said Jha, a physician, scientist and dean of Brown University’s School of Public Health. But he added: “We have a system that always errors on the side of safety and I like that.”  Despite this setback to plans to get more people vaccinated in hopes of reaching herd immunity as soon as possible so that life can begin to return to a semblance of normalcy, Jha said “I remain very confident that the J&J vaccine is very safe.”  And he brought context to the situation, noting the importance of millions of people having received the protection of a Johnson & Johnson shot.  “We are aware of six cases out of seven million people vaccinated,” he said, “so these are exceedingly rare events… If you compare that to what would have happened for those seven million people -- if even a chunk of them had gotten COVID -- the complication numbers would have been dramatically higher.”  Scientists are now analyzing data “to make sure: Are there other cases out there that we're not aware of, that we haven’t caught,” Jha said, and also to determine why all six cases of the disorder were experienced by women and what implications that will have in deciding what recommendations come next.  “So then the question is: Should we make decisions like, say, let's unpause but let's not give women 18 to 48 this vaccine and let's have them get Moderna or Pfizer.”  As the news broke Tuesday morning, an audience member whose 18-year-old daughter received the Johnson & Johnson vaccine on Sunday was quick to ask: “What should we be watching for,” in terms of possible complications.  The rare disorder, Jha said, is known as “cerebral venous sinus thrombosis,” which he defined as “basically the veins in your in your brain, in your head, get clots. And so, as you might imagine, it's pretty serious -- but treatable if you catch it early. So what are the main symptoms? Pretty severe headaches, double vision, other neurologic symptoms.  “Typically, this has happened in this small number of cases [about] six to 14 days after and what I would say to folks is: Just keep an eye out for any untoward symptoms. Certainly, if you start developing severe headaches, if you start developing problems with your vision, things that would trigger alarm bells anyway,” don’t ignore what is happening.  “These are not subtle things like ‘oh, I woke up this morning and I feel a little bit off.’ If you feel any of these symptoms, take it seriously, go get it checked out and let's figure out if you're one of the very, very unlucky people who's had it.”  He concluded: “It's a very rare thing. If the numbers end up being six in seven million -- or about a one-in-a-million overall risk -- that's a lower risk than like your risk of getting hit by lightning in a given year. We have to keep things in perspective.”  Also during recording of this 25th episode of the weekly podcast, available exclusively from The Providence Journal and the USA TODAY NETWORK, Jha analyzed the crises in Michigan and India, where he was born and still has relatives and friends. Both the state and nation are suffering significantly now from COVID-19.  Jha also answered more audience questions sent to the podcast (they can be submitted by emailing gwmiller@providencejournal.com):  ◘ A man from southern New England asked about reactions to the second doses of the Pfizer and Moderna vaccines, which vary from none to mild to severe: “Is there any correlation between your immune system reacting and the expected effectiveness of the vaccine?”  Jha’s abbreviated answer: No, the vaccines are effective regardless of reaction. For those who have no reaction and wonder if they have been immunized, Jha gave assurance that they have. “What I say to people who don't have a reaction is ‘Mazel tov, you got lucky. Good for you!’ ”  ◘ Another person wanted to know if it is safe to sing in a community chorus again.  Jha answered: Not yet.  ◘ A listener in New York City asked about her children, who may want to visit Europe in the next few months after being vaccinated. Given the B117 variant and other factors, would that be safe?  “Most Western European countries will have a good chunk of people vaccinated and case numbers very low by late summer, but probably not early summer,” Jha said. “So I would be I would be hesitant about making plans right now because there's so much uncertainty across all these countries.”  This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. See omnystudio.com/listener for privacy information.

PROVIDENCE – The emergence of the B117 variant combined with the fact that a majority of Americans 65 and older have been vaccinated has resulted in larger numbers of young people, including children and adolescents, becoming infected with coronavirus disease.  That is the conclusion reached by Brown University School of Public Health dean Dr. Ashish Jha, the pandemic expert who elaborated on the topic during Tuesday's taping of the national “COVID: What Comes Next” podcast, available exclusively from The Providence Journal and the USA TODAY NETWORK.   “These more infectious variants, especially B117,” often called the British or UK variant, “are now widespread,” Jha said. “In many states, it is causing a surge in infections. In other states, it may not be surging but it's still at a high level. And this is in the context of the fact that a vast majority of people over 65 have gotten at least one shot and they're largely protected.  “And so what you're seeing is a shift in the demographics where, under this more contagious variant, it's young people who are getting primarily affected and in relatively large numbers,” Jha said.  Asked if a higher percentage of young people who are infected have a more severe course than they would have before the B117 variant became dominant, the scientist said: “Maybe. There is some evidence that B117 is more deadly as well and can get people sicker than the original version of this virus. But I think largely we're really seeing the effect on young people because of the dramatic effect of older people being protected and not being part of the pool.”  Jha said the reopening of schools to in-person learning can be a factor in higher infection rates of young people – depending on the system and school and the state of buildings, the protective resources available, and other factors.  “Some schools do better than others, and if you don't do a good job of mask-wearing and ventilation, you can see outbreaks,” Jha said.  Athletic events are also implicated in contagion in some instances, the Brown dean said.  “Let's say you’re playing soccer, playing football, or playing field hockey. Those aren't going to get you in trouble being outside. But what happens is then kids will go into a locker room afterwards -- or before -- and those basic things that we’ve got to make sure people do are not happening in many places,” things like distancing and wearing masks, Jha said.  “What I'm saying is if you want to have sports, you absolutely can,” he continued. “But keep it outside. Don't have locker rooms -- have people dress up before, and after, go home on their own. And really try to avoid the large social gatherings because that is starting to spread a lot of disease.”  Safe participation in indoor sports such as hockey, volleyball and basketball, Jha said, require even greater precautions.  During the taping, Jha also said that given the high numbers of people already vaccinated, he is optimistic that a fourth, post-Easter, surge some are predicting will not be as severe as the three that have already occurred.   He also discussed the possible need for booster shots and preparations researchers and manufacturers are already taking.   And he addressed the effect on the pandemic of the substantial number of people who do not intended to be vaccinated, some for religious reasons.  Jha answered two audience questions, which are put to the podcast by emailing gwmiller@providencejournal.com:  ◘ A woman who identified herself as “Grandma” wrote that “my daughter is refusing to get the vaccine as she insists her doctor has indicated that it might cause sterility. Is there any data to support that?”  The short answer?   “There is no data to support that,” Jha said.  ◘ The second question was from retired industrial hygienist Becky Randolph, who wanted to learn more about the extent and value of contact tracing. Jha discussed that, saying, among other things, that it “did generate quite a bit of good data.”             This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. See omnystudio.com/listener for privacy information.

PROVIDENCE – The second Easter of the COVID-19 pandemic is this weekend, and unlike last year, when many states were in lockdown and public-health officials urged people to stay home and not have guests, the guidance for this Sunday offers more freedom.  But not total freedom. Attention to the nuances of vaccination this year is critical.  So proclaimed Brown University School of Public Health dean Dr. Ashish Jha, a global pandemic expert, on Tuesday during the 23rd weekly taping of the national “COVID: What Comes Next” podcast.  “If you are with other vaccinated people, you are really quite safe and you can do whatever you want, meaning if you want to get together with four or five other vaccinated people and have a meal, fabulous,” Jha said. “The bigger problem is what about vaccinated people getting together with unvaccinated people -- or even more concerning, unvaccinated people in general getting together who are not part of the same household.”  What to do?  “With the variants circulating and infection numbers rising, it's not a good idea,” Jha said. “I know that Easter is incredibly meaningful for so many people and what I would say is: This is probably the last major holiday where people who want to be vaccinated have not been able to get a vaccine. By Memorial Day, anybody who wants a vaccine will have gotten one. So if [unvaccinated] people can hold off on gathering, that would be really important.”  On a related topic, Jha welcomed this week’s news of a CDC study showing that the Pfizer and Moderna vaccines are highly effective in what are called “real-life conditions” – namely, against today’s widely circulating variants. The same study also showed high rates of effectiveness after just one shot and found that vaccinated people seem unlikely to transmit the disease if they become asymptomatically infected.   “This is really good news and all consistent with a lot of other data we've had,” Jha said. “All of this is terrific and just a reminder of how great these vaccines are.”  Jha also reacted to cautionary statements Monday by CDC director Dr. Rochelle Walensky, someone he respects and has known for years. She warned of a possible fourth surge of COVID disease, which, she said, leaves her with a sense of “impending doom.” Walensky also spoke of America’s pandemic fatigue, declaring: “I know you all so badly want to be done. We are just almost there, but not quite.”  Said Jha: “She is very measured and forward in her words, so I take words like that seriously. This is not a person, a leader, who speaks glibly or quickly…   “Why did she say it? The concern is we are seeing an increase in cases in like 35 states, infection numbers are rising pretty quickly in a bunch of them, and given that we still have a good chunk of Americans who are vulnerable – who have not yet been vaccinated -- she's worried and I'm worried that we're going to see a spike in cases.”  Jha answered two audience questions while taping the podcast, available exclusively from The Providence Journal and the USA TODAY NETWORK:  ◘ Los Angeles resident Ryan Maldonado, a TV writer and father of a young child, asked about the UK variant, now the dominant strain of the coronavirus in the U.S.: “Are more kids being hospitalized? Are more kids dying?”  Jha answered, in part, that the variant in people of all ages “may cause slightly more severe disease but it's not a huge effect. I suspect that will show up in kids too, but do I expect kids in large numbers to start getting infected and really sick or even, God forbid, dying? No, I think that is highly unlikely.”  ◘ The second question was from a listener in New England who asked: “Could you please speak more about air travel for those who are already vaccinated? When is it safe/responsible enough for fully vaccinated people to travel by air within the US?”  Jha said: “I don't think people need to be avoiding travel at this moment for important things. I don't know that I would be doing a whole lot of unnecessary travel at this moment, but for things that feel important personally or professionally, if you're fully vaccinated, I think it's reasonable and safe to get on a plane.”    This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. See omnystudio.com/listener for privacy information.

PROVIDENCE – The breaking news overnight that the National Institutes of Health has concerns about the data used by AstraZeneca to prove the reported high effectiveness of its COVID-19 vaccine is not only troubling in its own right but may discourage more people who already were hesitant about getting a shot to get inoculated.  That was Brown University School of Public Health dean Dr. Ashish Jha’s reaction Tuesday morning after the NIH’s National Institute of Allergy and Infectious Diseases, which is headed by Dr. Anthony S. Fauci, issued a cautionary statement from an independent monitoring board that informs the NIH.  That board, Fauci’s division of the NIH wrote, “expressed concern that AstraZeneca may have included outdated information from that trial, which may have provided an incomplete view of the efficacy data. We urge the company to work with the DSMB to review the efficacy data and ensure the most accurate, up-to-date efficacy data be made public as quickly as possible.”  Jha said AstraZeneca “has managed to mess up communication both with the public and with regulatory agencies over and over again… You’ve got to get the facts and data right before you make it public. So it's been very frustrating because they're taking a good vaccine and they're tarnishing it not because the science is bad, but because the communication is so bad.”  Practically speaking, Jha said, the NIH caution will have no immediate impact on residents of the U.S., where the Pfizer, Moderna and Johnson & Johnson vaccines are going into millions of arms each week. AstraZeneca has not received U.S. emergency use authorization.  Nonetheless, Jha said, the latest news could prove further disincentive to Americans who already were reluctant to be vaccinated. And that could have ramifications in months to come.  “AstraZeneca messing things up in this way doesn't help,” Jha said on Tuesday during the 22nd taping of the weekly national “COVID: What Comes Next” podcast. “It doesn't help people feel confident about their vaccine and it doesn't help people feel confident about other vaccines.”  During the taping, Jha also delved into the profound short- and long-term impacts of the coronavirus pandemic on mental health. Substance and alcohol use, suicidal thoughts, depression and anxiety are among the manifestations of the so-called “Second Pandemic,” with roots in the isolation, stress, economic crises and other negative effects of COVID-19.  “A lot of us have been very worried about this,” Jha said. “We are seeing the tip of the iceberg now because people are still in kind of stress mode, ‘get-through-this-crisis’ mode. And we all know that we can get through a crisis by just kind of hunkering down, but when that crisis abates we are going to see this explosion of sentiment and also of effects on mood. I am very worried that we are going to be dealing with the mental health ramifications of this for years and years and years.”  Jha’s advice to people with mental-health challenges? Seek intervention through a primary-care practitioner, psychiatrist, therapist or other qualified healthcare professional.   And in an emergency, dial 911.  More broadly speaking, Jha said states need to prepare, along with physicians and nurses. “I've been talking to healthcare providers across the country and saying ‘you've got to develop a strategy now because you're going to be inundated in three to six months.’ ”   During taping of the podcast, available exclusively from The Providence Journal and the USA TODAY NETWORK, Jha answered three audience questions:  -- “I wonder what he thought of Emily Oster’s article in The Atlantic [last] week, titled “your unvaccinated kid is like a vaccinated grandma.”  Jha thought the substance of the piece with its advice on older peoples’ relationships with children and grandchildren was sound. Jha asserted, however, that the headline left much to be desired.  -- “What do we know about the vaccine and its protection from scenarios where mild or moderate COVID-19 leads to this ‘Long COVID’ phenomena where people are suffering from (sometimes debilitating) symptoms long-term? Will the vaccines protect us from ‘Long COVID’ as well?”  Jha answered in part by saying “We don't know a lot but I will say this: We have not seen much in the way of Long COVID symptoms in people who've gotten vaccinated so far.”  -- A third audience member wanted to know Jha’s guidance for “a vaccinated person with kids who wants to resume social activities with other kids” and for “a vaccinated person who lives with an unvaccinated person.”  The pandemic expert gave a detailed response, urging a degree of caution in various scenarios and concluding “in general, I wouldn’t worry excessively.”    This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. To get a deeper understanding of the issues and questions addressed during this 22nd episode, please download the podcast. See omnystudio.com/listener for privacy information.

PROVIDENCE – With polls showing that large numbers of Republicans -- males especially -- are not planning to be vaccinated against COVID-19, faith, political and other leaders must spread the message that inoculations are safe and effective.  So declared Brown University School of Public Health dean Dr. Ashish Jha on Tuesday during the 21st taping of the national “COVID: What Comes Next” podcast.   “I want to hear religious leaders, I want to hear political leaders talk about the importance of vaccinations,” Jha said, “that it's really for people, good for their communities and for their families. I think we can get there, but I'm worried about this demographic. I think we have not paid enough attention to them.”  Vaccine resistance, Jha said, is rooted in two main areas: misinformation over the last many months that has led some people to believe that COVID-19 is “not a big deal,” Jha said, and other misinformation about the nature of the three vaccines now available to Americans, the Pfizer, Moderna and Johnson & Johnson products.  Many people “who spent the last year saying that the fact that the disease was a hoax are now spending their time saying gibberish about the vaccine, that it's somehow going to control your body and do mind control and it's got nanoparticles and all sorts of stuff,” Jha said. “I feel really bad for folks who are kind of inundated with this kind of information and it's no surprise you see a lot of hesitancy in that group.”  Jha described as “unfortunate” former President Trump’s decision last year to “get his vaccine in secret” while he was at the White House.  “That should have been a public event,” Jha said during Tuesday’s taping of the podcast, available exclusively from The Providence Journal and the USA TODAY NETWORK. “He can still cut an ad now talking about getting vaccinated -- why it's important and why people should do it. He has a lot of credibility with a lot of Americans and I think that would be enormously important.”  Jha gave continuing high marks to the vaccine rollout in America, saying “things are cooking along pretty well. This weekend was a good weekend. We vaccinated six million people over the weekend: three million a day on Saturday and Sunday. Those are incredible numbers.”  Abroad, however, the pandemic picture differs dramatically, with Taiwan seeing fewer than 1,000 cases and only ten deaths -- and Italy reimposing a lockdown.   Jha explained some of the factors at work.  “One of the reasons why some countries have done so well is because they've just really adhered strongly to public health measures,” Jha said. “They've shut things down or put public health restrictions when things got bad, but mostly they've used testing and tracing and other public health tools and they've been able to manage their way through this pandemic.”  Italy, he said, “is in trouble and going into a lockdown” in large measure because with the exception of the United Kingdom, Jha asserted, not enough Europeans have been vaccinated. And that, he said, can be attributed to insufficient inoculations.   “They don't have the vaccines,” he said. “They didn't plan for this effectively and so they are in trouble.  As always, Jha answered questions from the national audience:  • “Should a recovered person seek the vaccine?”  Jha responded: “Absolutely. We’ve been largely recommending that people wait 90 days after recovery or after their symptom onset. So if you just had COVID last month and are now better, you probably don't need to go get vaccinated right now. You can wait 90 days.”   • “I donate blood every 8 weeks. Will getting the vaccine affect my donation? Also just curious if receiving blood with the vaccine/antibodies helps the recipients to become immune?”  Jha said: “If you've been vaccinated, you can absolutely give blood. I can't come up with any clinical reasons why you couldn't. And so then the question around it is: will it help the person receiving it? Probably not.”  • In response to an email from someone with an epidemiology background who had researched the term “COVID arm,” a term new to Jha when he heard it during last week’s podcast, the pandemic expert said he, too, after the taping had read a recent article in the New England Journal of Medicine that describes “COVID arm” as irritation around the injection site long after the Moderna vaccination.  This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. To hear more detail about the issues and questions addressed during this 21st episode, please download the podcast. See omnystudio.com/listener for privacy information.

PROVIDENCE – The CDC’s new guidelines regarding masking and socializing are “terrific,” Brown University School of Public Health dean Dr. Ashish Jha said Tuesday – “a taste of spring” during a week when temperatures across much of the Midwest and Northeast are forecast to be unseasonably warm.   The new guidelines, long anticipated and announced on Monday, permit people who have been fully vaccinated to get together without social-distancing or masking. Fully vaccinated people may also visit with family or friends from one household who have not been vaccinated and who are at low risk of a severe case of COVID-19.   “I thought it was terrific,” Jha said during the 20th taping of the national “COVID: What Comes Next” podcast. “I thought was really good. I think they got it right. Maybe a touch on the cautious side, but not unreasonably so, given the moment.”   The pandemic expert stressed the importance of what it means to be “fully vaccinated,” saying someone in that category has reached “two weeks after their second dose of Moderna or Pfizer, or two weeks after their only dose of Johnson & Johnson.”   Jha elaborated on the new guidelines, declaring that “anybody who's fully vaccinated can hang out with anybody else who's fully vaccinated in a small group setting… Fully vaccinated people can get together for drinks or dinner and no masks, no social-distancing. If you're fully vaccinated and you're with other fully vaccinated people, you're back to normal.”   A bit more tricky, as Jha put it, are circumstances involving fully vaccinated people socializing with unvaccinated people. He gave the example of fully vaccinated people visiting with relatives who are not vaccinated, but are not at high risk of severe disease.”   The CDC “said you can go you can do this without mask-wearing, you can do this without social distancing,” Jha said. “This is huge. This is grandparents can visit their kids and grandkids and socialize and hang out and give hugs and be normal and it's totally fine as long as the parents and the children are not high risk.”   During taping of the podcast, available exclusively from The Providence Journal and the USA TODAY NETWORK, Jha addressed an issue concerning many people, namely: Can someone who is fully vaccinated transmit COVID-19 to others?   “People who've been vaccinated are much, much less likely to transmit than people who have not been vaccinated,” Jha said. “Vaccination cuts down on transmission a lot. Are we 100% sure that's true? No, but there is a lot of very strong circumstantial evidence, [though] no one has done the definitive study to prove it.”   He added: “The CDC’s guidelines essentially assume that transmission is way down if you're vaccinated. And the last point I'll make is most vaccines -- not every, but most -- reduce transmission and we should assume that the COVID vaccines do, too. It won't be 100% but my best guess is it's probably in the 80 to 90% range. That's a lot of reduction of transmission.”   Jha also answered audience questions, including from a woman scheduled for surgery less than two weeks after her second dose of the Pfizer vaccine who wanted to know if it would be safe ("I won't give a clinical answer, but I'll give a public-health answer, which is it is safe,” the doctor said.)   Another audience member asked: “Is it safe, after having been vaccinated for COVID and having waited to reach full immunity, to begin using public transportation, specifically commuter rail and subways?”   Jha’s response: “The answer is yes, but you should continue wearing a mask, at least right now until a lot of other high-risk people are vaccinated.”   This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. See omnystudio.com/listener for privacy information.

PROVIDENCE – The just-authorized Johnson & Johnson coronavirus vaccine is “great news” for people in the U.S. and abroad, pandemic expert Dr. Ashish Jha declared on Tuesday – but not in that encouraging category, the Brown University School of Public Health dean said, is the recent plateauing of new COVID-19 cases in America.  The Johnson & Johnson product, now part of an inoculation arsenal that includes the Pfizer and Moderna vaccines, has several advantages, Jha said during the weekly taping of the national “COVID: What Comes Next” podcast.  “When you look at the data on J&J, it looks really good across the board,” Jha said. The vaccine has tested well against the South Africa and Brazil variants, the scientist said, and it requires only ordinary refrigeration, not extreme cold, which will be helpful in getting shots into arms of people living in remote areas.  Plus, Jha said, “it's one shot, so you can imagine all the advantages for people who don't want to have to come back for a second shot… It's great for the U.S., it's great for the globe, and we just have to make lots of it so that we can get it out to lots of people.”  Countering the new vaccine news, Jha said, is the fact that in the U.S., “this week, infections have really plateaued at a pretty high level around, 65,000 or 70,000 infections a day. Just to give people perspective, that's as bad as it got during the summer surge.”  Jha asserted: “This is worrisome because variants are still starting to crop up and get more and more common. You do not want to have variants becoming dominant with this level of infection… It's now making me concerned about what the next few weeks, next month or so, may bring.”  The factors at play?  “We don't know for sure,” Jha said. “Certainly I think one is that we saw such precipitous drops and my sense is people may have relaxed things a bit. You hear states starting to open up and saying ‘hey, we're opening up restaurants and bars.’ I think that's a terrible mistake right now. That is not by any stretch what any state should be doing.”  Jha also addressed reactions people have – or don’t have -- to the second dose of the Moderna and Pfizer vaccines, stating that side effects are common, but there is no reason for concern if someone does not experience any symptoms.  “On a personal level, I got my second shot of Moderna last week and I had what I would say is not a significant, not a horrible reaction by any stretch,” Jha said. “My arm was of course sore for a couple of days. I expected that but I was also super-tired for about 24 hours in a way that I'm not usually and I just felt a little bit off. By 24 hours, I was fully back to normal.”  Other people, Jha said, “have much more significant reactions,” but those are “a small minority. And then there are other people who barely feel it at all. The immune system is a very funny thing and we have seen no evidence that if you have a more strong reaction somehow you're better protected than if you have no reaction at all. So it's just about how your immune system reacts to the second dose.”  During taping of the podcast, available exclusively from The Providence Journal and the USA TODAY NETWORK, Jha answered an audience question about vaccines’ efficacy being described as preventing "moderate" symptoms, "severe" symptoms, and sometimes “moderate/severe" together.  “Moderate and severe are even used differently in different clinical trials, so that's a little frustrating,” Jha said before launching into a longer discussion.  Jha also answered a question from someone who wanted his assessment of three metrics that are used in calculating a “return to normality.” They are, the audience member stated, “daily new cases per 100,000”, “rate of transmission” and “percent positive from COVID testing.”  Those are good measures, Jha said, before discussing other metrics and factors as well.  To hear Jha’s full answers to these questions and to learn more about the Johnson & Johnson vaccine, the plateauing of new cases, reactions to second doses and other topics, please listen to the full podcast. New questions for Jha can be sent to gwmiller@providencejournal.com, with “question for Dr. Jha” in the subject field.      This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. See omnystudio.com/listener for privacy information.

PROVIDENCE – Pandemic expert Dr. Ashish Jha, dean of Brown University’s School of Public Health, on Tuesday expressed optimism about where the U.S. stands at this stage of the COVID-19 pandemic, which has now gripped the country for nearly a year.  “We have been seeing cases drop in the last six weeks and we've been waiting for the death numbers to start coming down -- and the numbers got below 2,000 daily deaths average over the weekend and they are dropping faster than I expected,” Jha said during the weekly taping of the national “COVID: What Comes Next” podcast.  Jha cited two driving factors.  “One is hospitals are no longer slammed and when hospitals are not slammed, what that means is that they have more time and they can focus more on patient care,” the pandemic expert said. “The flip side is when hospitals get really overwhelmed, you see death numbers pop… Part of the declining number of deaths is that hospitals are just able to do a better job.”  The second factor, Jha asserted, is the continuing rollout of vaccines.  “We have done a reasonably good job of vaccinating the highest risk people, in nursing homes,” with healthcare workers, first responders and others, Jha said.  As a result, Jha said, “I see a lot of optimism for the next two months, three months and and definitely longer, too.”  Jha said he supports the FDA’s decision Monday to not require vaccine manufacturers to run time-consuming clinical trials for new products that will be effective against the many coronavirus variants that have emerged in the U.S. and world. That means developers will in essence be able to more quickly tweak existing vaccines, much as they do yearly with flu vaccines.  “We don't need to run large 50,000, 100,000-person trials,” Jha said. We’ve [already] run them, and the vaccines are safe. If you make minor changes in the structure of the mRNA to deal with a variant, you want to do some safety checks to make sure that hasn't introduced any complications, and then you should be able to administer them. I would certainly feel comfortable getting them.”  Jha gave overall good marks to pandemic management by President Joe Biden’s administration, which has been in control for five weeks.   The country has gone from “one million doses a day being distributed to a million and a half to where we’re going to be over 2 million doses a day all through March,” Jha said. “It's a huge uptick. So on vaccinations, I feel like they've done a very good job.”  So, too, Jha said regarding communicating to the public.  Still, “if I had a critique,” he said, “I think they've been too negative about the long term. I hear ‘life will go back to normal by Christmas’ – but life will be way better well before.”  Jha praised the administration’s mask efforts. But he was not as complimentary about testing, saying “I think they have let testing slide a little bit. They've done a little bit… but I have been disappointed that they're not pushing testing harder.”  Also Tuesday during recording of the podcast, available from The Providence Journal and the USA TODAY NETWORK, Jha answered audience questions about the advisability of taking a cruise this summer (“It's still pretty risky and I personally would avoid it”);  the presence of polysorbate in vaccines (manufacturers are considering reformulations);  and “the appropriate freedoms and restrictions” starting two weeks after a second dose (they vary).    For the dean’s full answers  and more of what he said about variants, masks and other issues, please listen to the full podcast.   This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal.  See omnystudio.com/listener for privacy information.

PROVIDENCE – The seven new coronavirus variants that a team of researchers has recently discovered in the U.S. is reason for concern, pandemic expert Dr. Ashish Jha, Brown University School of Public Health dean, declared on Tuesday.  “The variants are out there, they're real, and they're scary, and the best way to deal with variants is to bring infection numbers way down,” Jha said during the weekly taping of the national “COVID: What Comes Next” podcast, available from The Providence Journal and the USA TODAY NETWORK.  Three questions are key, Jha said: “Are these variants more contagious? Are they more deadly? And are they any more resistant to our vaccines?”  Although these questions remain largely unanswered, Jha said “I would not be surprised if they're more contagious. I also am pretty firmly of the belief that our vaccines are going to work quite effectively against these variants.”  The new discoveries were reported Sunday on the preprint server medRxiv, where researchers often present work for later peer-reviewed publication. The team included scientists from New York City, Pittsburgh, Wyoming, New Mexico, Louisiana, and Switzerland.  Jha also addressed the issue of life after the COVID-19 pandemic. Many people wonder if it will ever be “normal” again – will existence return to how it was in 2019.  “The short answer is ‘yes,’ ” Jha said, “but it will look different because pandemics change societies. They have forever. And so there's no reason to think that this pandemic won't, too.”  Many people will continue to work remotely, for example, Jha said.   “But the things that were really important to us we'll be able to do again. So if the question is will we be able to see friends and family? Absolutely. Will we be able to hug each other? Absolutely. Will we be able to do indoor dining? Absolutely.”  Jha weighed in on the development of a so-called pancoronavirus vaccine – one effective against all types of coronaviruses. Some scientists are already at work on such a product.  “I think scientifically it's possible and from a social point of view and health point of view, it is certainly desirable,” Jha said. But he doesn’t see it immediately. “My guess is it’s probably a year or so away,” he said.  On Tuesday, Jha addressed several audience questions, including one from a woman in Massachusetts who asked: “How long after receiving the second dose of the Pfizer vaccine will I reach full protection?”  The Brown dean’s answer: “I think two weeks is probably the right time frame to think about. It may be sooner than that.” Clinical trials, he said, suggest it is as soon as ten days.  Jha also fielded a question from a woman in California regarding autoimmune disorders (consult your physician), and another from a person who had heard that vaccine protection wears off after three months (not true).  To hear Jha’s full answers to these questions and to hear more detail about variants, post-COVID life and development of a pancoronavirus vaccine please listen to the full podcast.   This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. See omnystudio.com/listener for privacy information.

PROVIDENCE – “Fit and filtration” are the two most significant factors people should consider when buying masks for use during the coronavirus pandemic, Brown University School of Public Health dean Dr. Ashish Jha said on Tuesday.   Speaking during the weekly taping of the national “COVID: What Comes Next” podcast, Jha also stressed the importance of America taking the lead role in the global fight against the disease, declaring that vaccinating residents of all countries is necessary to limit the emergence of new variants. The U.S. is the only country able to take that lead, Jha said.  In his discussion of masks, Jha addressed issues including the merits of fabric versus paper, double-masking, and how best to assess the quality of products that many companies are now manufacturing – and how to be wary of counterfeit offerings.   “Two features of a mask are important and they both start with ‘f,’ fit and filtration,” Jha said. “Filtration is how well does the mask filter out droplets, aerosols, the little things that are going to have the virus in it. And then the second is how good is the fit. You can have a terrific mask for filtration, but if the fit is not very good, then basically you're going to end up blowing out virus or breathing in virus.”   Regarding KN95 masks, Jha said “some of them are terrific and some of them are counterfeit or not very good at all and it's hard to tell exactly which brand. I have personally avoided [them] because I can't figure out for sure which ones are the best and which ones are reliable… so I go for kf94s, made in South Korea.”  Jha weighed in on Astra-Zeneca putting the rollout of its vaccine on hold in South Africa after a trial of 2,000 people found it offered “minimal protection” against mild and moderate cases of the South Africa variant: the small size of the trail, the dean said, leads him to conclude that “it may not work, but it may work, and this trial wasn't big enough [for a definitive] answer.”  The larger issue, Jha said, is the need for residents of every country to be inoculated with existing vaccines or ones, such as Johnson & Johnson’s, expected to be available soon. This is the only way to stay ahead of the variants that have merged or could in the foreseeable future, Jha asserted.  “Variants don't arise randomly,” he said. “They arise in context where you're having relatively large outbreaks. To the extent that we look at this global pandemic and think our job is to vaccinate Americans and that's it, we are asking for trouble.   “Imagine that everybody in the United States is vaccinated and let's say it's summer or fall of this year. And then there are large outbreaks happening in Brazil or India or elsewhere. Those outbreaks could lead to new variants that could then end up subjecting all of us and making us all vulnerable again.”  Even strict travel restrictions cannot contain spread of COVID-19, Jha said. Global travel and commerce continue in this inter-connected world.  “So the way to keep on top of it, the number one strategy,” Jha said, “is to help everybody bring their pandemic under control and that actually requires an all-out government response” by all nations – a response led by America, Jha said.  “If everybody can get their pandemic under control, it dramatically lowers the risk of new variants,” Jha asserted.  Also Tuesday during recording of the podcast, available from The Providence Journal and the USA TODAY NETWORK, Jha answered a question from a woman who experiences food, medicine and environmental allergies and wanted to know if she should be vaccinated. He said that severe allergic reactions to the Pfizer and Moderna have been exceedingly rare.    “If you've had severe allergic reactions to medicines, I would definitely bring an EpiPen” to the vaccination site, Jha said. He also advised individuals with such concerns to first consult their physician.  For the dean’s full answer about allergies and more of what he said about variants, masks and other issues, please listen to the full podcast.   This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. See omnystudio.com/listener for privacy information.

PROVIDENCE – Although some scientists early in the COVID-19 pandemic expressed concern that the disease could be spread on surfaces in addition to airborne transmission, the primary means, subsequent study has shown the risk is minimal, Dr. Ashish Jha said on Tuesday.  “We don't think surfaces are a major source of transmission and I'd be very surprised if there was much transmission happening from surfaces at all,” the dean of Brown University’s School of Public Health said during recording of the national “COVID: What Comes Next” podcast, available from The Providence Journal and the USA TODAY NETWORK.  Jha recounted the early history of concern about surface transmission, saying that with later research, “it turned out that much of the virus we were finding on surfaces were little fragments, not full viable virus.”   The pandemic expert said “imagine if I cough or sneeze and [the coronavirus] gets on a surface. You're going to have little bits of viral fragments sitting around for days but it's not going to affect anybody after a little bit.” An abundance of caution regarding that brief period, however, Jha said, leads to the conclusion that “we still think people should be washing their hands.”  Similarly, Jha said the risk of transmission by other means once thought to play a role in contagion is also low: takeout food and packaging, mail, and food from a store or home-delivery service, for example. “Things like wiping down groceries -- I used to worry about that last March or April,” Jha said. “I don't think I've worried about it since then.” Nonetheless, he does still wash his hands after putting food away.  As for postal deliveries, Jha injected an element of humor into the podcast, saying “don't lick your mail, but presumably you weren't doing that before the pandemic.” The doctor’s practice? He brings his mail in, puts it down, opens it and washes his hands afterwards.  On another topic, Jha discussed people who are living with long COVID-19 – the so-called long haulers, who have passed through the acute phase of coronavirus disease but continue to experience symptoms.  “There are a certain proportion of people who will continue to have symptoms for a very long period of time,” Jha said, for “many, many weeks and  often many, many months. The symptoms can vary from fevers and fatigue to almost autoimmune-like symptoms. There are some pretty good studies that suggest maybe it's as much as 25% of people who have ‘recovered’ still feel off.   “They could be having headaches. They could be having extra fatigue 90 days later. And so there is clearly a spectrum of people who recover and are totally back to baseline but a large minority of people who three months later, six months later, are not back to their baseline.”  Jha said that of these, “a small minority” are “really quite disabled and can't get back to work and function.” Research into the mechanisms involved continue, but Jha said this much seems clear: “We don't think it's the virus hanging around in their system anymore. It's the immune system’s response.”  Asked about reports that people who have become reinfected after recovering from an initial bout with coronavirus disease, Jha called that rare but “also not surprising. Almost no disease gives you lifelong what we call ‘sterilizing immunity,’ which is the kind of immunity when you can never get reinfected… But thank goodness it’s pretty uncommon.”  Jha also answered two audience questions.  -- The first concerned “the safety of the vaccine for the millions of people who have weakened immune systems,” as one listener wrote to the podcast.  Jha said the nature of the Pfizer and Moderna vaccines makes it “unlikely to generate any kind of negative effect,” but he did say that for those in this situation, “these are conversations you need to have with your physician about your specific type of immunodeficiency.”  -- The second question was actually two: “Should ibuprofen or Tylenol be avoided prior to receiving the COVID vaccination? What about afterwards?”  Jha said “there is a theoretical argument” that taking them before a shot “may somehow blunt the immune response. I'm pretty skeptical of that.” Nonetheless, he does not recommend using Tylenol or ibuprofen before a shot.  After?  “Once you've had the shot, if you feel lousy, taking Tylenol or Ibuprofen is perfectly reasonable,” Jha said. Some people do report feeling achy or fatigued for several hours after a second dose.  For the dean’s full answers on all of these topics, please listen to the full podcast.   This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. See omnystudio.com/listener for privacy information.

Speaking during the weekly taping of the national “COVID: What Comes Next” podcast, Jha said “I believe if things go well on production that we will be on track to be able to produce almost 2 million doses a day, and I want to make sure that there is a very short line between production of doses and vaccinations into people's arms.”  Vaccines from Moderna and Pfizer-BioNTech are currently being manufactured and distributed in the U.S., with new products from Johnson & Johnson and Astra-Zeneca heading toward likely emergency use authorization in the weeks to come. A fifth vaccine, from Novavax, is currently in clinical trials.   Jha said the emergence of COVID-19 variants warrants a more ambitious dosing plan. Several mutations of the virus have been identified, with the so-called British variant and one seen in South Africa of particular concern, given that both are more easily transmissible and the South Africa variant may be more resistant to vaccines – a possibility that has prompted Moderna to develop a booster shot. Variants have also been identified in California and Brazil.  For people who have been vaccinated, Jha said “all the evidence I see so far says you'll still have protection against the South Africa variant, but it may not be quite as strong a set of protection. So you may still get infected but you'll have milder disease and you probably will be less likely to be infected. We just don't know right now. There's a lot we're still sorting out but I guess my point is: it's not a moment of panic.”  The South Africa variant has not been discovered in the U.S., but Jha said it is inevitable that it will reach America, regardless of travel restrictions that have been enacted. The Brazil variant has just been detected in Minnesota and the British variant is spreading widely.  “There is zero chance in my mind that we will be able to keep any of these variants completely out,” Jha said. “The point of travel restrictions in my mind is not to keep these things completely out, that's not realistic. It's just to slow the spread. So instead of 1,000 people coming in with a variant and letting it take off, maybe only 20 will or 10 will and that means it'll spread much more slowly and you'll have more time to get it and catch up to it and identify it.”  Asked if more variants will emerge, Jha said “undoubtedly,” but the number and type “depends a little bit on what we do. Remember that these variants arise when we give the virus a chance to mutate -- and viruses mutate the more they replicate. So as long as these outbreaks remain very, very large, as long as we have large numbers of people infected, there will be more opportunities for variants.”  He added: “We can reduce the number of variants that arise by keeping the level of infections really low. There are many reasons to vaccinate lots of people quickly and one of them is ‘I want to bring this pandemic under control.’ By bringing it under control, we will actually reduce the risk of new variants arising.”      During the podcast, available from The Providence Journal and the USA TODAY NETWORK, Jha also answered two audience questions.  -- One person asked what to do if you receive a first dose of the Moderna or Pfizer vaccines but the recommended second dose is not available from the same manufacturer – should you take a second dose from the other manufacturer, a Pfizer shot after a first-dose Moderna, or vice versa?  “As a general rule, people should absolutely get the same one,” Jha said. “In extremely unusual circumstances, it may be fine to get another second one, but I do not think that should be the default. We should generally try our best to avoid mixing and matching.”  -- Another person asked: “Is there any data regarding the side effects of receiving the COVID vaccine along with the new shingles vaccine within the same timeframe or within a few months from each other?”  Jha said “the short answer here is we don't know we don't have enough clinical data.”  For the dean’s full answers and more about variants and vaccines, please listen to the full podcast.   This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. See omnystudio.com/listener for privacy information.

The two vaccines available now, from Moderna and Pfizer BioNTech, require two does for maximin effectiveness. A rollout of 100 million more doses would protect 50 million more people.  “It's going to take work. It's not going to be straightforward, but I think it's very doable,” Jha said during the weekly taping of the “COVID: What Comes Next” podcast, available from the Providence Journal and the USA TODAY NETWORK.  But Jha, one of the world’s leading pandemic experts, said he remains concerned about coronavirus variants that have emerged. He listed the four that have been identified so far.  “There's what's called B117 or the U.K. variant,” Jha said. “There's the South Africa variant. There's a new variant identified in Brazil. And then maybe there's a fourth variant identified in Los Angeles. The question is: do they all matter, are they all necessarily much more contagious? There's no doubt at this point that the U.K. variant is really bad. It's much more contagious and it's here in the United States. We don't know about the South Africa and Brazil variants and whether they're here in the United States. And then there’s the L.A. one.”  That mutation, he said, has only recently been discovered.  “We don't know enough about it” yet, Jha said. “We don't know if it's more contagious. We don't know if it's more dangerous. I think we're going to know more in the next week or two. So the one I'm most worried about is the U.K. variant because I know about it. It's in the United States and it is clearly much more contagious.”  Jha assessed the meaning of recent nationwide data that shows new reported cases, new reported deaths and hospitalizations recently have declined, saying “it really feels like a nationwide kind of slowing of the infection and I have to say I'm really pleased. It should mean that we should see a little bit of a relief on hospitals, a little bit of a relief on deaths.”  But Jha raised a note of caution.  “It's not to understate how bad things still are,” he said. “There are still a lot of infections and we're still on track to have 3,000-plus deaths a day for the next month if not more. So none of this is easy, but it is maybe starting to get a little bit better.”   Vaccines from Astra-Zeneca and Johnson & Johnson may be available in a few weeks, with one under development by Novavax now in clinical trials.  Looking beyond this pandemic, Jha repeated his warning – shared by many other public-health and medical experts – that there will be another pandemic at some point, the questions being not if, but when and how dangerous. Science does not have the ability to predict what deadly viruses or microbes may reach the human population.  Nonetheless, what steps can be taken?  “We need to first and foremost invest in public health,” Jha said.   He compared such investments to money and resources given the military so that the armed forces are able to quickly respond to threats. “The reason we invest in our military is because when we need it, we need it to be effective,” he said.  “We also need to invest in science, in much more broad-based science,” Jha said. “We need technologies that we can turn towards, whatever the new viruses. Look, we got lucky a little bit with this coronavirus because we had a lot of experience with a previous coronavirus, the SARS virus from 2003. And so we actually knew a lot about how to make a vaccine against this virus.   “I'm not convinced we're going to be so lucky next time. We might get a virus that we've never encountered or know very little about.”  Answering an audience question from a woman who lives with limited scleroderma, a rare auto-immune disorder, and is eager to be vaccinated, Jha said “”what I would do is try to figure out a mechanism by which we give some clinical judgment to physicians and nurses because there are some people who are really going to be at high risk with these auto-immune diseases.”  This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. See omnystudio.com/listener for privacy information.

“As I heard story after story after story, I realized we were going to see a ton of gaming, it’s going to be less efficient and inequitable, and I think a lot of us felt like this is too complicated,” Jha, , said Tuesday during taping of the 12th episode of “COVID: What Comes Next,” the weekly Providence Journal/USA TODAY NETWORK podcast.  Jha reaffirmed his advocacy for first vaccinating high-risk healthcare and other frontline workers, residents and staffs of nursing homes, and people living who live with underlying conditions. But even as states prioritize other groups, Jha said “the implementation is going to really just kill us, it's going to slow us way down and it's not going to be done well.”  The Brown dean first publicly proposed a lottery system in a Sunday New York Times op-ed essay cowritten with Dr. Robert M. Wachter, chairman of the University of California at San Francisco’s department of medicine. The two physicians have also called for single-dose use of the Pfizer and Moderna vaccines so that more people can quickly receive a degree of immunity, with the recommended second doses delayed.   Jha and Wachter recommended that after front-line workers, nursing home residents and staff, and people with co-morbidity have been vaccinated, likely by the end of this month, all people should be vaccinated “from oldest to youngest.” After that, they wrote, “to determine the order for the remaining 150 million or so American adults, use a lottery.”  On the “COVID: What Comes Next” podcast, Jha said “just make it something super simple like a lottery. It won't be perfect but it'll be much better than what is likely to be implemented.”  Also on the podcast, Jha discussed the likelihood that Wednesday’s riot at the Capitol will become a superspreader event. Already, two Congresswoman who were inside the building when the pro-Trump mob broke in have been infected with coronavirus disease, which they trace to the Wednesday riot.   Jha also assessed the merits of mass-vaccination sites. Stadiums, California’s Disneyland, and other venues have recently begun offering the two approved vaccines to large numbers of people. The Brown dean then discussed two vaccines in development but not yet approved for use in the U.S.: The Astra-Zeneca and Johnson & Johnson products.  And the pandemic expert also answered an audience question from a scientific researcher who wrote to the podcast “in frustration of those around me who refuse to or are hesitant to take the vaccine. I am hoping you can offer some advice on how to approach these individuals. I understand that this issue is more related to scientific communication and public health as a whole, but how can we work towards communicating to our loved ones about the safety and efficacy of this amazing research?”  If you have a COVID-related question, please send to gwmiller@providencejournal.com with “Question for Dr. Jha” in the subject field. Dr. Jha will get to as many questions as he can, but regrettably, given the volume, he cannot get to all. And please note Dr. Jha’s advice: Questions regarding one’s personal situation should be put to your healthcare provider.  This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. See omnystudio.com/listener for privacy information.

Welcome to Episode 11 of “COVID: What comes next,” an exclusive weekly Providence Journal/USA TODAY NETWORK podcast featuring Dr. Ashish Jha, dean of the Brown University School of Public Health and an internationally respected expert on pandemic response and preparedness.  Today, Dr. Jha reaffirms his recommendation that second doses of Pfizer- BioNTech and Moderna COVID-19 vaccinations be delayed so that more individuals can receive one dose and thereby acquire a degree of immunity to the disease, which is claiming record numbers of lives.  Jha first outlined his rationale in a co-written opinion piece in Sunday’s Washington Post. Today, he explains why he is adhering to a one-dose recommendation, despite the FDA’s restated guidance Monday night that people receive a second dose a few weeks after the first, as indicated by the pharmaceutical firms following clinical trials.  “By the end of December, we had more than 40 million doses of the two vaccines combined and we've given out about 5 million and that means about 35 million are sitting on shelves,” Jha says. “Part of that is we are saving more than 50%, more than 20 million doses -- holding back so we can make sure that we have a second dose for everybody. That's how the clinical trials were done, and it makes a lot of sense on some level to stick to the clinical trials.”  Two doses of the vaccines are required for maximum effectiveness, but a substantial degree of immunity is conferred with just one.  “Here's the problem,” Jha says. “We have virus raging across the country and I am deeply, deeply worried about this new variant that is now starting to pop up, this [British] variant  that we've talked about. It is going to put a massive strain on our hospitals and a lot more people are going to die.”  Also in this episode, Dr. Jha answers two audience questions sent to the podcast:  -- “Considering the data that shows the potential for long-term inflammation resulting from contracting Covid-19, is it possible that the vaccine could pose the same risk?”  -- “Can people test positive for weeks, even months, but are definitely NOT spreading the virus?”  If you have a COVID-related question, please send to gwmiller@providencejournal.com with “Question for Dr. Jha” in the subject field. Dr. Jha will get to as many questions as he can, but regrettably, given the volume, he cannot get to all. And please note Dr. Jha’s advice: Questions regarding one’s personal situation should be put to your healthcare provider.  This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. See omnystudio.com/listener for privacy information.

Today, Dr. Jha discusses the many problems surrounding the rollout of the Pfizer-BioNTech and Moderna vaccines. “It’s going way too slowly and the cost here is lives,” he says, and then gets into detail. Looking to the future, Dr. Jha says “we have to have a very serious conversation our country about how we structure public health.”  Dr. Jha also explains herd immunity – what it means, how it is achieved, and when we should know when we are there.  And, Dr. Jha breaks down the situation at many nursing homes across America, which have been especially hard hit by the pandemic, with residents and staff members infected and dying in large numbers.  Also today, Dr. Jha answers three of the audience questions sent to the podcast:  -- Is it true that people who sleep less than six hours a night get less benefit from a vaccine? (He says he has not seen evidence of that, and then he elaborates.)  -- What should people do if they will not be in their home state when the vaccines are rolled out there? People who are vacationing, for example, or have a winter residence in another state. (This remains to be determined.)  -- Why are older people not higher on some priority lists, which are set by the states? (“They should be,” Dr. Jha says before discussing the issue in greater depth.)  If you have a COVID-related question, please send to gwmiller@providencejournal.com with “Question for Dr. Jha” in the subject field. Dr. Jha will get to as many questions as he can, but regrettably, given the volume, he cannot get to all. And please note Dr. Jha’s advice: Questions regarding one’s personal situation should be put to your healthcare provider.  This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. It can be downloaded at  https://omny.fm/shows/covid-what-comes-next-with-dr-ashish-jha See omnystudio.com/listener for privacy information.

With reports from England and elsewhere about a variation of the coronavirus causing alarm, Dr. Jha today discusses what is known at this point about transmissibility and the effectiveness of existing vaccines, saying “we're still learning but I think it's exceedingly unlikely that the vaccine will not work against this strain.”  Dr. Jha in this podcast also gives a good tutorial in lay terms about how the Pfizer-BioNTech and Moderna vaccines work, and the years of research that that allowed for them to be created and manufactured in record time. He also debunks some of the misinformation that surrounds the vaccines – that the virus can somehow enter a person’s DNA (it cannot).  Also today, Dr. Jha answers four of the many audience questions sent to the podcast:  --  If someone has had COVID-19 and recovered should they get the vaccine?  -- Can the people who receive the vaccine still be carriers of the virus?  -- How long is the vaccination good for once you get the vaccine? Does each manufacturer have a different length?  -- The vaccines are 95% effective, which means, statistically, that for one of every 20 persons who gets the vaccine, the vaccine will not work. How do you, or that person, know that the vaccine will not protect him?  If you have a COVID-related question, please send to gwmiller@providencejournal.com with “Question for Dr. Jha” in the subject field. Dr. Jha will get to as many questions as he can, but regrettably, given the volume, he cannot get to all. And please note Dr. Jha’s advice: Questions regarding one’s personal situation should be put to your healthcare provider.  This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. It can be downloaded at  See omnystudio.com/listener for privacy information.

With the first doses of the Pfizer-BioNTech vaccine having reached the states on Monday, Dr. Jha breaks down the manufacturing, transportation and administration considerations of this largest-ever mass vaccination effort. As he explains, Operation Warp Speed was a partnership of the federal government and private companies, including Fedex and UPS; normally competitors, they joined forces to get the Pfizer vaccine to thousands of destinations. Two other competitors, the pharmacy giants Walgreens and CVS Health, are cooperating in providing the Pfizer vaccine to residents and staff of long-term-care facilities.    Also today, Dr. Jha looks ahead to later this week, when the Moderna vaccine is expected to received Emergency Use Authorization. And Dr. Jha today answered the first audience-submitted questions from what is now a weekly feature of the “COVID: What comes next” podcast.   The first question was: “Why is there not a standard mask now for the general population?” The second, from a parent in Missouri whose son will soon be attending Brown was: “What about students who have previously experienced anaphylactic reactions and are now being told not to take the Pfizer-BioNTech vaccine?” And the third question Dr. Jha answered was: “Should patients on biologics like Humira, who thus are immunosuppressed, receive COVID vaccine at the same time the elderly receive it! Or with the first responders?”  If you have a COVID-related question, please send to gwmiller@providencejournal.com with “Question for Dr. Jha” in the subject field. Depending on volume, Dr. Jha will get to as many questions as he can.  This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. It can be downloaded at  https://omny.fm/shows/covid-what-comes-next-with-dr-ashish-jha See omnystudio.com/listener for privacy information.

Today, Dr. Jha discusses the Pfizer vaccine, which is being rolled out in the United Kingdom this week. Also this week, on Thursday the federal Food and Drug Administration’s Vaccine Advisory Committee will hold a public hearing on Emergency Use Authorization for the vaccine, which the FDA is expected to grant. After authorization, Pfizer is expected to begin shipping the vaccine.  Dr. Jha explains why several weeks lapsed between Pfizer’s announcement of the results of clinical trials last month and the FDA’s action on approval for the vaccine, saying that intense study of the data contained in thousands of pages of documents took that long.   And the Brown dean on this week’s podcast examines the significant mental-health issues associated with the pandemic, both now and in years to come, and offers guidance on what people can do to stay mentally healthy.  Also, Dr. Jha today announced what will be a new weekly feature of the “COVID: What comes next” podcast: answering questions from the audience. If you have a COVID-related question, please send to gwmiller@providencejournal.com with “Question for Dr. Jha” in the subject field. Depending on volume, Dr. Jha will get to as many questions as he can.  This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. It can be downloaded at  https://omny.fm/shows/covid-what-comes-next-with-dr-ashish-jha See omnystudio.com/listener for privacy information.

Today, Jha discusses the continuing stresses on hospitals across America as doctors now are forced to make decisions on who will and will not be admitted when so few beds are available. Shortages affect both patients with coronavirus disease and those without – people living with heart disease, cancer, diabetes and other conditions who in ordinary times would receive hospital care.   Jha also debunks the theory that the COVID-19 virus was manufactured or emerged from a laboratory, declaring convincingly that science almost certainly will confirm that it crossed over from an animal, likely a bat, into the human population, as many other deadly viruses have. He discusses what science and medicine have learned about the virus since it was first reported late last year in China, and also the available treatments as the world awaits the first distribution of vaccines.  Finally, Jha walks us through how the virus functions: how it can replicate by the millions and even billions inside a person, overwhelming the body’s natural defenses and prompting an immune response that itself can be potentially deadly as the lungs become inflamed and begin to lose function. Such a situation, of course, urgently demands medical care.  This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. It can be downloaded at: https://omny.fm/shows/covid-what-comes-next-with-dr-ashish-jha See omnystudio.com/listener for privacy information.

In this installment, Jha discusses the continuing COVID surge, which is overwhelming hospitals across the U.S.; his Senate testimony last week in which he said there is no evidence demonstrating benefits from hydroxychloroquine, which the current presidential administration has trumpeted; and the welcome news Monday that the GSA is allowing President-elect Joe Biden and his team to begin the formal transition process, including plans to control the pandemic.  Jha also talks about the latest positive development to be reported: the Oxford/Astra Zeneca vaccine, which was announced as 70 percent effective, a somewhat misleading figure, as Jha explains. The actual effectiveness, Jha says, is almost certainly higher. And the vaccine has certain advantages over Pfizer’s and Moderna’s, which are headed toward mid-December emergency use authorization reviews by the FDA and CDC which, if approved, will open the door to vaccinations, as early as Dec. 11 for healthcare workers, first responders and others at high risk of coronavirus disease.   In closing, the dean discusses the Thanksgiving holiday and what the nation might expect during the following days, given the high numbers of people who are travelling, despite CDC guidance not to. Like others, however, Jha will be staying home and he offers advice for safe – and outside -- socializing.  This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. It can be downloaded at See omnystudio.com/listener for privacy information.

In this installment, Jha explains the significance of the just-announced Moderna COVID-19 vaccine, which follows last week’s welcome news about Pfizer’s vaccine; the still-rising toll of the pandemic as it ravages the U.S. and many foreign nations; and President Trump’s continuing refusal to give President-elect Joe Biden’s team the federal resources it needs to fully develop its pandemic plans.  Jha also talks about the example set in Michigan, where on Sunday Gov. Gretchen Whitmer announced new stay-at-home limitations starting Wednesday. And he breaks down the sacrifices people will have to make on Thanksgiving to avoid that holiday becoming a new source of widespread community transmission of coronavirus disease.  This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal.  https://omny.fm/shows/covid-what-comes-next-with-dr-ashish-jha   See omnystudio.com/listener for privacy information.

In this installment, Jha discusses the implications of the presidential election last week and what he anticipates from President-elect Joe Biden’s coronavirus task force, which is co-chaired by a former surgeon general, a former FDA commissioner, and an associate dean at the Yale School of Medicine.  Jha also talks about the Pfizer vaccine – the safety and efficacy issues, the logistics of manufacture and distribution, and who will get the vaccine first and who later if it receives emergency use authorization. He also gives an overview of what he foresees during the next seven days, until the next podcast, which will be recorded on Nov. 17.  This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal. It can be downloaded at   "Covid: What comes next full playlist"  Asset ID is: 6142725002  See omnystudio.com/listener for privacy information.

Welcome to Episode 2 of “COVID: What comes next,” a new weekly Providence Journal/USA TODAY NETWORK podcast featuring Dr. Ashish Jha, dean of the Brown University School of Public Health and an internationally respected expert on pandemic response and preparedness.  In this installment, Jha discusses the factors behind record numbers of coronavirus cases seen in the U.S. since last week’s episode 1, the implications for the country should President Trump be re-elected or if former vice president Joe Biden wins office, the likely “bleak” several weeks ahead regardless of who wins, and the roles of individual states as autumn advances.   He also gives an overview of what he foresees during the next seven days, until the next podcast, which will be recorded on Nov. 10.  This weekly podcast is hosted by G. Wayne Miller, health reporter for The Providence Journal.  See omnystudio.com/listener for privacy information.

In this first episode, Dr. Jha discusses the new surge in coronavirus cases and hospitalizations being seen now in most states, the situation at the White House including the infections of members of Vice President Mike Pence’s staff, the coming winter and steps that can be taken now to prevent an intensification of the pandemic, and his assessment of safety at the polls as Election Day, Nov. 3, approaches See omnystudio.com/listener for privacy information.