NYS Health Commissioner on Monkeypox, Polio and COVID

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Brian Lehrer: Brian there on WNYC. Well, it's a summer of 2022 and we still have COVID-19 to worry about, dozens of deaths a day in New York state attributed to COVID-19 for the last couple of months, plus monkeypox and now polio. With me to talk about all of this is the New York State Health Commissioner, Dr. Mary Bassett. Some of you may remember, she was New York City Health Commissioner under Mayor de Blasio early in his term as well. She's now graduated to be the health commissioner of the whole state. Dr. Bassett, welcome back to WNYC.

Dr. Mary Bassett: Thanks, Brian. Pleasure to be with you this morning.

Brian Lehrer: Let me start with something close to home for us here. One of our interns tried to sign up for a monkeypox vaccine through New York City's vaccine scheduler this morning, and it looks like there are no appointments currently available. Do you know what the situation is or when more appointment slots will open up?

Dr. Mary Bassett: Well, as you know that New York City is its own authority when it comes to monkeypox, it's getting an allocation of vaccination from the federal government. I can't really give you up-to-date information on the city, but we all know that there is more vaccine on the way. The federal government has indicated that 110,000 doses will be allocated to New York State, 80,000 of them to the city. The state has so far offered out of its first tranche 4,000 additional vaccines to the city in few of its hotspot, but there's just not enough vaccine more is coming, so tell your intern to keep trying.

Brian Lehrer: Because of a global shortage of the monkeypox vaccine, there's recently been talk that I saw of splitting one dose into five by adjusting the method of administration injecting the vaccine into people's skin instead of into the fat beneath the skin so basically giving people one-fifth of a dose in order to vaccinate more people. While Dr. Robert Califf, Head of the Food and Drug Administration, has been said to call this idea promising as reported by the New York Times.

The method hasn't been studied extensively when it comes to the monkeypox vaccine and some in the medical community call this approach to risky. I'm curious what you know about this method and if you have come to a conclusion of whether you support it, given the fact that we are in a monkeypox health emergency with over 7,500 cases in the US, 28,000 cases worldwide.

Dr. Mary Bassett: It would be a game changer if we could stretch our current vaccination doses. The data that we have on monkeypox on the JYNNEOS vaccine effectiveness against monkeypox is based not on human trials, remember, Africa was never offered this vaccine. Our data are all based on antibody levels, and that's what we're going with on this. It will be up to the FDA to make this decision but if it's promising, I would be very eager to see this change made.

The challenge is not just the data but also that this is a more difficult way of administering vaccine. Giving it sort of straight into the arm, or wherever is easier than applying the vaccine into a layer of skin. It would take more training. One of the things that our emergency declaration got us was expanding the people who could administer vaccination but this new strategy Inderal administration would take more training.

Brian Lehrer: You have deep experience, I know with HIV&AIDS. I wonder how you're drawing on that experience as you lead the state through the monkeypox crisis. One thing I'm wondering is how you are balancing your messaging so that you reach the people who are most affected by this outbreak, queer men and their sexual networks without stigmatizing queerness, queer sex, and potentially deepening distrust in the medical establishment.

Dr. Mary Bassett: Brian, you've hit directly on the tension that exists even within departments, even within my own department. We've had a lot of discussion about this and I've been heartened by the fact that we're hearing voices from the community itself giving more explicit advice about situations that are high-risk situations. By that, I mean settings where people have sex on site with multiple partners including anonymous partners, people who they don't know or don't know well. I think it's been helpful to have those voices join.

Additionally, I like anybody who lives with the aids epidemic cringe when things are said like the general population is not at risk or average people are not at risk because the word you used was the right word, sexual networks. This new virus it's spreading in new ways. It's not a new virus, but it's spreading in new ways has entered certain sexual networks. It's nothing special about skin-to-skin contact that protects so-called other people and that stigmatizing really worries me.

We have a balancing act here one, to be frank with people and not to give obscure messaging, and at the same time, to make it clear that there's no biological reason that protects anybody, man, woman, child from monkeypox if they have skin to skin contact with a lesion.

Brian Lehrer: Listeners, we will have time for a few phone calls for New York state health commissioner, Dr. Mary Bassett on the three viruses in our midst COVID, polio, monkeypox. 212-433-WNYC or if you have another relevant question for her, 212-433-9692, or you can tweet your question @BrianLehrer. Dr. Bassett, I do want to turn to polio, which was deemed eliminated in the United States in 1979. The last time it was seen in this country was almost a decade ago, 2013, when it was brought in by a traveler.

This summer, as most of our listeners probably know by now, one Rockland County resident was confirmed to have a case of polio and accompanying paralysis. They've now seen polio in the wastewater in Rockland and Orange counties, which I guess indicates that there may be more community spread that hasn't been diagnosed yet. I saw you said in a statement last week that despite they're being only one confirmed case, this is only "the tip of the iceberg" and that we probably have hundreds. What do you think is really out there?

Dr. Mary Bassett: Well, we have all the evidence points to a circulating revertant virus that originated from an oral polio vaccine. These vaccines haven't been used in the United States since 2000. The virus that originated from the oral polio vaccine was probably administered overseas where in some settings or OPV or poliovirus is still used. This person hadn't traveled in the index in the window of opportunity for infection. This person acquired this revertant virus here. It's now been identified in wastewater samples.

That's a polite word for sewage in both Rockland and Orange county in the time before, this individual was diagnosed and in the week subsequent. All of this is consistent with the circulating virus. Most polio infections don't result in any symptoms at all. The proportion of people who end up with paralysis is tiny often under 1%. That's why we consider and at this one case is the tip of the iceberg. We believe that the situation we should be responding to is of a circulating virus.

Brian Lehrer: Is it indicative of certain populations that are anti-vax, which, of course, expresses itself in COVID-19 and the ways we know, but that this maybe predates that, and there are certain parts of Orange and Rockland County that aren't vaccinated, and that's why this is happening there.

Dr. Mary Bassett: Well, we know that we're more likely to see this pattern in populations with low vaccination coverage. There are people who are resistant to vaccine who don't want to vaccinate their children as very young infants. There are people who got off track from vaccination during the COVID pandemic when kids weren't going to school and anybody who is not vaccinated or is not sure their vaccination status in these areas should get vaccinated. Anyone who's not vaccinated for polio should get vaccinated. The message is all the same in terms of what actions should be taken. The problem that we're seeing is related to under-vaccinated populations.

Brian Lehrer: Is this in the Orthodox Jewish community in particular? I've read that that's where this is taking place in Orange and Rockland County. Is that accurate?

Dr. Mary Bassett: We know that there was a community outbreak of measles. This corresponds to the same community. I just want to make it clear that it's vaccination or immunization that we want to talk about here. Any reason that a person is not immunized is a concern to me, as the State Health Commissioner. I don't want anybody to be a second case of polio.

Brian Lehrer: Will, in Hell's Kitchen, you're on WNYC with New York State Health Commissioner, Dr. Mary Bassett. Hi, Will.

Will: Hey, Brian, and hello, Commissioner. Thanks some for being here today, and I've appreciated your various messages over the past year that I've seen. I was fortunate enough to get my vaccination for monkeypox a week ago. The people with the city Health Department, I think that were administering it, who were really terrific where I went in Brooklyn at at this facility right near right near the bridge and near Dumbo.

Anyway, they said that they thought that we would be getting a second vaccination within a month or so. Of course, they weren't sure, but can we at any point after our first vaccination shot feel like we have a level of immunity that would make you feel less concerned about having contact? Just what you can tell us about their levels of protection after the first shot and when we could think about that happening?

Brian Lehrer: That's a great question, Will. Thank you very much. Very practical.

Dr. Mary Bassett: It is a great question.

Brian Lehrer: Doctor.

Dr. Mary Bassett: One dose helps and it does provide, as evidenced by antibody levels-- Remember, we don't have a real-world test of the JYNNEOS vaccine as protecting against monkeypox. It was developed to protect against smallpox, and the data that we have, 85% protection is from an older vaccine that was aimed at smallpox. In terms of antibody levels, one dose certainly is protective.

If you're asking whether you should feel free to engage in high-risk situations, I would advise against that, but there's certainly protection from a single dose, and on a population basis, it will be helpful. At the same time, the full protection from the vaccine is based on a two-dose regimen. I know that the city has decided to go all out and provide some coverage to the most people possible. I think in this situation that we have in New York City that that's a reasonable decision, but I don't think that I would consider myself fully protected. I would continue to take care and avoid exposure.

Brian Lehrer: Will, thank you for your question. I'm sure that served other people too to hear the answer to that. Be well. Diana in Manhattan, you're on WNYC with New York State Health Commissioner, Dr. Mary Bassett. Hi, Diana.

Diana: Hi. I'm 66 years old. I was born in New York, and I'm positive that I got the polio vaccine as a small child. Will that protecting me against the current epidemic?

Brian Lehrer: It's not an epidemic. We should say that, right?

Dr. Mary Bassett: Yes.

Brian Lehrer: Just to not overstate how much polio there is in the population right now. You tell me what word is accurate, but would somebody who was vaccinated as a young child and is now 66 be protected?

Dr. Mary Bassett: We're not advising revaccination at this time. My focus is on people who either are not vaccinated at all or people who are unsure of their vaccination status. For example, if you began your vaccine coverage in another country and you don't know whether you ever completed it, but we are not advising people who were fully vaccinated in childhood to seek revaccination.

Brian Lehrer: Diana, thank you. I hope that reassures you and a lot of other people who have had their polio vaccines already earlier in their lives. I'm going to take a call from Roy in Manhattan who's raising what might be a myth about monkeypox, or maybe is a warning. Dr. Bassett, maybe you can clear this up because I've seen this in a few places. Let's see if we can clear this particular thing up. Roy, you're on WNYC with Dr. Bassett. Hello.

Roy: Thanks, Brian. I ride Citi Bike all the time and I'm just curious as to whether there's a danger of residue from a disease being left on the handlebars of the Citi Bike when I get on and get off.

Brian Lehrer: This question has been circulating, Dr. Bassett. Can you put it to rest?

Dr. Mary Bassett: Sure. There's a lot of questions about what's called fomites spread of monkeypox, meaning--

Brian Lehrer: Meaning on surfaces, right?

Dr. Mary Bassett: On surfaces, exactly. The answer to that is, overwhelmingly, I'm talking 98% of cases have been related to sexual transmission. This is not something that we've documented, and it's not something that I worry about. I ride the subway, I touch the poles, I wear a mask, and that's for that other virus. This is not a source of concern, and if you are concerned, just use the sanitizer and wipe down the seat.

You might feel that way just in general, but this is not a way this virus is being transmitted. Overwhelmingly, not just most, but overwhelmingly, it's being spread through sexual networks of men who have sex with men. We know enough to know that it won't stay that way, but it's spreading through skin-to-skin contact. An exception to that would be people and households with somebody who has monkeypox, where we advise more careful management where there's a known person with monkeypox in the household.

Brian Lehrer: Roy, I hope that settles the question for you as you continue to ride Citi Bikes and for everybody else. Dr. Bassett, as for that other virus that you just referred to that way, that causes you not to touch the poles in the subway cars--

Dr. Mary Bassett: No, causes me to wear a mask. Sorry, Brian.

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Brian Lehrer: Okay, causes you to wear a mask in the subway. I apologize if I'm misheard that. We are experiencing dozens of deaths a day in New York State for months. The number for yesterday on the New York Times COVID Tracker was 31. I think that's the average of the last two weeks COVID deaths in New York State per day. It's been going on at that rate since June and yet, almost all policy except for masking on mass transit, which is questionably enforced, is coming off. For you as Health Commissioner, what should be the response policy-wise at this point to the pandemic which continues enough to be taking dozens of lives a day in New York State?

Dr. Mary Bassett: You're right, Brian. We're still seeing COVID, it's still costing lives. Nowhere near the number of lives that were lost during wave one which had such a devastating impact on people in New York City in particular, but we have higher infection rates now than we did last summer or the summer before. Probably because of vaccine coverage and the experience of infection, we're seeing much lower mortality rates, but we don't want to see anyone dying of COVID. The state continues to have masking mandates in place on public transport, and in hospitals, and nursing homes and, also in our prison system.

We still have those, and you're right, the the public seems to really be tired of wearing masks. I really would urge people to get vaccinated and boosted, for that's the best protection against severe disease and deaths. It's very clear that deaths are much more likely to occur among unvaccinated individuals. I urge people to wear masks when they're in settings that have high transmission. According to the CDC, community levels, those continue to be high transmission areas in downstate. I wish I could say that COVID is tired of us as we are of it but it's not. Viruses don't work that way.

Brian Lehrer: School is starting soon. Is the State Health Department going to be issuing any guidance for schools so they can minimize the spread of COVID? I know mask mandates in schools are very controversial maybe that's district by district now. For that matter, is there a risk of monkeypox spreading in schools this fall that requires any guidance from the state?

Dr. Mary Bassett: Well, you're right, I don't see in the offing another statewide school mask mandate, but as the governor continues to say, she reserves that authority, and I will retain that authority. We are issuing and then are in discussion now with the schools on back-to-school guidance which really tracks with the Centers for Disease Control virus. This is regarding COVID.

Regarding monkeypox, we are going to come up with guidance for families affected by monkeypox. I don't expect there to be a risk of transmission in schools, we've seen very, very few children with monkeypox and I don't think we'll be taking any special precautions beyond advice to families that have a person with monkeypox and in the household.

Brian Lehrer: Do you have any sense, by the way, before we go about where people are getting COVID these days, there are a lot of cases, even though the death rate, unacceptable at 2430 deaths a day is much lower than it was in the past but so many cases? Is it in indoor dining? Is it in schools? It's summer so there's limited schooling. I had a caller last week who said he got it on an Amtrak train. I don't know if that's true. Are people getting in the subways? Are people getting it in Citi Field and Yankee Stadium, which are packing them in 40,000 a game? Do you have any idea?

Dr. Mary Bassett: Well, we have increasingly contagious variants, the recent rise, which seems to be leveling off and going down in New York State, but affecting the rest of the country is this variant called the BA.5 variant, and there are waiting in the wings is 75, which is even more contagious than BA.5. I wish I could tell you where people are picking it up, it is not difficult to get infected with these new variants. That is just a fact. I wear a mask, I'm public transit, a transport I wear a mask on crowded downtown streets in New York City. I wear a mask indoors.

I have a 94-year-old mother who has given me permission to invoke her as the person who keeps me being very, very careful because she would not do well if she got infected for me. It's not just to protect ourselves. It's to protect our family group but you can pick up COVID anywhere and that's, right now wearing a mask, and being careful and for sure getting vaccinated and boosted is the best advice that I can continue to give people.

Brian Lehrer: Dr. Mary Bassett, the New York State Health Commissioner, thank you so much. Always good to have you on.

Dr. Mary Bassett: Thanks, Brian. It's pleasure to be on.

 

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