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Coronavirus Update With CDC Director Rochelle Walensky - February 17, 2021

Educational Objective
To identify the key insights or developments described in this video
0.5 Credit CME

CDC Director Rochelle P. Walensky, MD, MPH, returns to JAMA's Q&A series to discuss the agency's response to emerging SARS-CoV-2 variants, implications for the planned vaccine mobilization strategy, the upcoming Johnson & Johnson vaccine FDA advisory hearings, strategies for reopening K-12 schools, and other agency activities and priorities related to COVID-19 control. Recorded February 17, 2021.

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Transcript

This transcript is auto generated and unedited.

>> Howard Bauchner: Hello and welcome to conversations with Dr. Bauchner. Once again, it is Howard Bauchner, Editor-in-Chief of JAMA, and what a pleasure to joined by Rochelle Walensky. Now, Rochelle, the last time I introduced you, I introduced you as a Professor of Medicine, Director of the Division of Infectious Diseases at Mass General, but today I introduce you as the Director of the Centers for Disease Control and Prevention, one of the world's great public health institutions. What's it been like?

>> Rochelle Walensky: First of all, I'm always delighted to be back. I really enjoy spending a half an hour with you. Wow, it's just been a whirlwind. It's just been insane. It's been super humbling, the work of this agency, getting to know the people who have been doing the hard work for, you know, I would say for a year on COVID, that is for decades, right, has truly been extraordinary. The dedication, the tirelessness, the selflessness, really, for the public has really been inspiring to me.

>> Howard Bauchner: Well, I can only say on behalf of the medical community, the public, and the CDC, we're lucky that you became the director of the CDC.

>> Rochelle Walensky: Thank you. Thank you, so much.

>> Howard Bauchner: My Lord, so many questions, but we're here to discuss what has emerged as one of the most provocative and critical and challenging issues within just the last three or four weeks. I know it was there all the time. So, you, with Dr. Tony Fauci and Henry Walke have written a blueprint, a blueprint. It's being published as a Viewpoint in JAMA entitled "SARS CoV2 Variants of Concern in The United States, Challenges and Opportunities, and I know you wrote it with your two co-authors. You're Director of the Centers for Disease Control. Tony, obviously, is Director of the National Institute of Allergy and Infectious Diseases. How are the two of you and your two agencies thinking about the emergence of variance?

>> Rochelle Walensky: Yeah, it's great, and I would say it's not just our two agencies. It's really agencies across the federal government. So, when these issues of variance emerge, and you know, maybe we should consider ourselves lucky that it's just been the last month that they've been on our radar, right? We've known for really long time that viruses mutate. When they mutate, they mutate to some advantage of the virus. Whether that advantage we think about is increased transmissibility, which many of them have shown, whether it is increased morbidity and mortality, increased virulence, which we're starting to try and understand, or whether it's because they can evade our therapeutics or our vaccines, our community. So, you know, we are starting to see these, and I think what we all realized, you know, as they were starting to emerge is that we did not yet have the capacity to detect them, to understand their impact, and to understand what we were going to do with the information, how we were going to stop them from emerging moving forward. I maybe just want to set the foundation for the fact that we all know that the more viruses replicate they more they mutate. The more they mutate, the more we're likely to see dominant variants they could really emerge and become a problem for us. So, the best thing that we can do to prevent these, in general, to have less disease circulating, less virus circulating.

>> Howard Bauchner: In the Viewpoint, Rochelle, you lay out a blueprint for the US. A lot of changes that are being implemented, new resources dedicated, an ongoing surveillance system. Could you talk to the medical community and the public like you've developed a grand plan, and it's reassuring. We'll see if it works. But it's reassuring to know that you're putting in place a plan that, over the next few months to the next few years, should help us understand what it means, and it's not just in the United States. It's around the world. But could you talk about the elements that the CDC, the NIH, and some of the other governmental agencies are putting in place?

>> Rochelle Walensky: Yeah, it's a great question. So, the first thing is like let's diminish the amount of virus that's circulating and let's use all of our blunt public health mitigation strategies to try and do what we can to try to decrease the amount of virus that's out there, and we're doing all that, and in fact, the numbers, I'm encouraged, are coming down, although someone I keep worrying about the variants and what could happen in the future. So, one is the blunt mitigation strategies we been doing for the last year. The second is we need to have a public health surveillance system put in place where we can understand the variants that are out there, and you have to do that, both by having enough sequencing going on, and then you have to have that sequencing be representative of what happening across the country, right? So, we are partnering with state health labs. We're going to be getting about 750 samples a week from around the country every state lab, every country and tribe and locality. We are partnering with commercial labs so that we can get the volume, and we're partnering with academic universities, so that we can sort of get some volume there. Seven academic universities, numerous and expanding commercial labs, as well as enough from the states. So, we have both volume, as well as geographic diversity. And then, we're sequencing them. How many are we sequencing? Well, we need to make sure, you know, that number depends on how many do you want to be able to detect of an unknown strain, right? So, some people say it's 5%. Some people say it's 10%, but we need to have a really reasonable proportion of the virus that's out there, and in fact, how many you need to do is dynamic, because it really depends on how much disease is out there. So, we need to be able to sequence it, and see the distribution of what the sequences are that are coming in. Then we need to understand the basic science level, what they mean. What does this virus, you know, collaborating across agencies with DoD and BARDA and NIH, what does it mean when we have -- is this sequence of a meaningful impact? Is it going to change our monoclonal antibody viability, viability or usability of our monoclonal antibodies? What happens if you take convalescent plasma? Does it neutralize these variants? What happens if you take plasma from people who have been vaccinated and with which vaccine? And can we start to see the science behind what happens we've isolated these variants? And then, we also need to think about what happens over time with breakthrough from vaccine. As we start seeing these cases of and surveillance of vaccine breakthroughs, is it because it was one of the 5% that we expected would happen if we only have a 95% efficacy? Or is it because the breakthroughs that are happening are because of some more -- because of a variant that is out there, that has the capacity to evade the vaccine? So, all of that science, that whole package, really needs to happen, and then, I think we really need to understand that we could do this really well in the walls of the United States, from shore to shore, and if there's still virus circulating in huge volumes in other countries and in other parts of the world, that they continue to affect us, because, in fact, those variants are, you know, continue to threaten whether our vaccines will continue to work. So, this is a global problem.

>> Howard Bauchner: Yeah, it's interesting. I think, for the first time, you know, almost every country is prioritized around its citizens. We're not alone in doing that, but I think, for the first time with the emergence of the variance have been a renewed interest in saying we have to figure out a way to vaccinate 6.5 billion or 7 billion people. It can't just be people within the United States. I appreciate that that is the initial priority, but I think the emergence of the variance have, once again, renewed the discussion about how globally are we going to act as a community? The US lagged behind the UK, in terms of sequencing. There's been substantial data. Actually, the UK was very advanced and sequencing. Now geographically, it's a population of 60 million, Wales, Scotland, England. And so, it's a smaller country. As you and the other individuals in a leadership position have thought through what you just talked about, which is samples from around the country, a certain percent, testing against vaccines, convalescent plasma, are you comfortable we can get there in a reasonable amount of time?

>> Rochelle Walensky: Yeah, I mean, the scale up has really been a lot already. You know, I think, in early January, there was 250 samples a week that were being sequenced. We're now in the thousands.

>> Howard Bauchner: Okay.

>> Rochelle Walensky: We're not where we need to be. It's not, I think I said earlier, it's going to be a dial, not a switch. And we're going to need to dial it up. There's going to need to be resources. I mean, people have quoted $150 per samples a sequence. Now at higher volume, perhaps, we can do it for cheaper and faster, and then, you know, once you have 25,000 samples in a week and say we could get there, and I sure hope we can, and I anticipate we well. Who's going to analyze all that? Right? We need the computer analytics. We need the manpower. We need the workforce to take all of that data and look at it and sort of make sense of it understand what are the flags that we need to watch for? So, I think we have a lot of work that's ahead. What I will say is I really believe, based on what I've seen already, and realizing how much we've done just in instead of three and half weeks, since we started and where we can get to.

>> Howard Bauchner: It's comforting for me to hear plans are being put in place. I mean, obviously, it's the outcome, whether you can analyze to 25,000, but without the plans put in place, you can't even get to the 25,000. There's many questions that have come in, but I still want to keep it as a conversation between us. Then I trust -- I tell people we'll get to the questions.

>> Rochelle Walensky: But it's a privilege, right?

>> Howard Bauchner: Yes, it is. Rochelle, so, you know, I've spoken to a lot of people over the last couple of weeks, and most of us, until the variants emerged, were really optimistic about what March and April would bring. It's getting warmer. I mean, some people have estimated 50 or 75 million people have been infected and have some form of herd immunity. We vaccinated, at least initially, 45 million individuals. We're vaccinating at 1.5 to 2 million people a day. In 30 days, essentially, everyone older than 65, the highest risk group, should at least have the option of being vaccinated, even if they choose not to. The numbers of hospitalized patients have come down from 130,000 to about 70,000. So, I think many of us were feeling optimistic that March and April would really bring a change in the amount of disease in the United States. You mentioned that earlier. How are you thinking now about just in the short run, March and April, taking the variants out of the discussion?

>> Rochelle Walensky: You know, on the one hand, I'd like to share your enthusiasm and share your optimism, and I tend to be an optimistic person by nature. On the other hand, I've been flat wrong with this more times than I care to admit. And so, my job right now is to just make sure that I plan for the worst and hope for the best. And so, you know, let's say, 20% of the population is immune. Let's say from natural immunity. We're now at about -- we've delivered, I think, 54 million vaccines already. That's 5% of people who've been vaccinated twice. So, we're at 25% immunity, let's just say. You know, if these variants are, and it looks like they are, more transmissible, that means that we have a higher bar to get to, in terms of herd immunity, right? It's all about the transmissibility. What I really worry about is several things. One is the CDC models have projected that by March the B117 variant is likely to be the dominant strain.

>> Howard Bauchner: Okay.

>> Rochelle Walensky: It is likely to be -- and that's more transmissible. I worry that it will be spring, and we will all have had enough. Already some states have loosened their mask mandates. Already people are sort of, you know, resting on the fact that the numbers are starting to look better. And then, at around that time, I worry that, you know, life will feel and look a little bit better, and the motivation for those who might vaccine hesitant will be diminished. And just at the time where we really will have, you know, at some point, there's going to be an inflection point there will be more vaccine than we have people who want to take it, and at that point, we still need to be scaling up vaccination. And so, what I'd like to say is how it goes it going to depend on 330 million individuals. Are they going to continue to wear their masks through this this and are they go to, you know, roll up sleeves and get vaccinated through this, because while I really am hopeful for what could happen in March and April, I really do know this could go bad so fast, and we saw it in November. We saw it in December. We saw what could happen.

>> Howard Bauchner: The various variants that are circulating, and you know the numbers, as you've asked me not to identify them by the country. So, I'll just let you refer to them by the number. You mentioned one more transmissible and the dominant flavor in the United States. Is there any reason not to thank that the three major concerning variants will not make it to the United States?

>> Rochelle Walensky: They're all here. We know they're all here.

>> Howard Bauchner: Okay, and it is that likely that they'll simply emerge, because they found a preference and the way in which they're either transmissible or they're infections? That, you know, higher-quality viruses in those characteristics survive. Is it just likely that they'll continue to emerge as a greater and greater percent of the pathological component of disease?

>> Rochelle Walensky: Yeah, you know, some of this is we just turned the light on and started looking, right?

>> Howard Bauchner: Okay.

>> Rochelle Walensky: Right? And so, you know, we have two MMWRs out today actually. One of them was on the first time we detected these variants in Minnesota. So, there are three variants that we worry the most about. One that emanated from the UK. That's the B-117. That's the one that we believe to be the most likely to be the dominant strain in the United States. So, far, we've had over 1,200 cases in 41 states. So, we know it's pretty widely distributed. We know it likely to be about 50% more transmissible. Early data are now suggesting it's also 30-50% more virulent, meaning increased morbidity and mortality. Already, if you have more transmissible disease, you have more cases, right? So already, you have a problem there. So far, it looks like that strain is not -- doesn't have any real decreased susceptibility to our vaccine. So, that's good news. There's a second strain, the B-1351. That's the one that came from South Africa. And we have at least 19 cases here in the United States. Many of the cases that we're detecting here in the United States are related to contact tracing of some of the national cases, and when we do those contract tracing, we just like get so sad. It's, you know, they were not wearing masks. So, you just realize like our public health measures could and should work in these situations, and the third is the P1 variant. We have at least two of those in two different states. So, and the P1 is the one that people have been worried about from Brazil.

>> Howard Bauchner: Okay, I want to turn to a different subject, and then we'll come back, to variance and immunizations. Last week, the CDC released a blueprint for opening schools, and I know, in some quarters, it's been well received. In others, it's been a challenge. You've not had a week or 10 days to reflect. I know over the weekend, there was a lot of intense questioning on different shows. What do you think the strengths of that document are in the challenges at the local level?

>> Rochelle Walensky: Yeah, thank you for the questions. We released it on Friday. This has been months in the coming. You know, what you would've really liked early on is a blueprint for how and what to close when, and then, a blueprint for how it should open later, and what we found ourselves in is emerging data, actually, on what was possible in schools. So, we have the entire experience of the fall, both here in the United States where some schools had opted to be open, as well as in Europe, where other schools had opted to be opened, and what worked and what didn't. There were over 61 references in the scientific briefing associated with that. So, while we were later than I think the CDC should have been, in terms of providing guidance for schools, and there were lots of limitations in our ability to do so, we provided some really -- the science drove the entire thing. It really did. And so, you know, I know that not everybody was happy with how the school guidance read or the guidance that was said. I sleep at night because I know that it was science-based, and it was that children and teachers who go to school based on what we recommended could and should be safe, and that it was, you know, some people wanted more open. Some people wanted more closed, and sort of, we struck it in the middle, and I would even say we did the best we could. We did the best that science could inform.

>> Howard Bauchner: What's surprised you over the last few days about the conversation about the document and schools? What, you know, when you were in all the conversations, both at the CDC, and I'm sure you proofed the last pages of the document before it was posted. You were on a lot of TV shows over the weekend. What surprised you about the tenor of the conversation?

>> Rochelle Walensky: You know, I expected challenges related to vaccines. We had those conversations. I expected challenges related to ventilation. What really surprised me is that people didn't think it was clear, and we really did our best to make sure it was clear, and we're really talking now to key stakeholders to say what is in effect make it clearer for you? What are the things that need to be done to make it clearer for you? What I do want to convey is that it's hard. I mean, on the one hand, we were very clear that we said this is not a mandate to open, and this is not a mandate to close. On the other hand, if you are open, and you're not doing these things, and you happen to not have clusters, then you may want to consider yourself lucky and see if you can start implementing some more of these things. I did a huge amount of outreach to stakeholders. I listened to parents. I listened to teachers, and, you know, I did hear stories from across the country of like my school is open but, you know, our principal is doing contact tracing on the weekends. That's probably not how contact tracing should go, right? Or it takes us a week to get a diagnostic test after symptoms, and that's probably not how, you know, symptomatic testing should go. So, we really wanted to say like, you know, you can stay open, but we really would suggest that you have these key measures in place to avoid outbreaks.

>> Howard Bauchner: You know, it obviously happens at the journal. Sometimes, we're often criticized, and I feel like going, well, you know actually read the entire paper. So, if you had read the entire paper or the editorial, you would've seen the reaction address that issue. Did you feel like that came up a bit?

>> Rochelle Walensky: Yeah, I mean, it's dense. It's not easy reading. So, I wouldn't fault somebody for missing somebody in a footnote. The other thing that we are able to do there is to, you know, say this is about the education of our children, and there's a lot of discussion about school sports and about how we prioritize and how we stay open. One of the things that I said last week at the launch, will he launched it was, you know, it's a color-coded spectrum of, you know, how much disease you have, and therefore, what you can do in each level of disease, and at the time we released it, 90% of the districts were in the red zone, meaning, really, a lot of disease, and we know so much, most of the disease that comes to school is not transmitted in the school. It comes in from the outside, which why we're a lot more stringent in the red zone. Since we released it, and that was just last week, that number's come down to 75%. So, really, as the numbers in the community are coming down, so are the number of communities that are in the red zone, and therefore, you know, more opportunities to be a little bit more liberal in terms of what we're able to do to bring the kids back to school safely.

>> Howard Bauchner: I do have to say, you know, one of children is teaching in New York City, and you know, when I talk to people at JAMA on the editorial and publishing side who have children, everyone I know wants their children back in school. Live, not Zoom when I say, live school. And I think teachers want children back in school, and the question is how to get there. I do think that's a commitment, and you know, it's February, so, if you can begin to get children back into school in February and March, it's another three or four months of in-person learning, and that's why I was pleased that it came out. I didn't want it to wait until May or June, because then you really roll to next September. You know, there's three or four months left of the school year, and some schools may move into July. So, there's three or four live, in person months but are still available and if we can get there.

>> Rochelle Walensky: And what I would say is there is so much about this, and we, as the general public, are not good at evaluating risks. So, I've had so many people say to me, "Can you promise me that there will be COVID in the school?" And it's, you know, nothing is foolproof here, right? I can't make that promise, but, you know, what we're trying to do is evaluate the risk of COVID in the school, a potential outbreak, which we're doing our best to try to give guidance to mitigate, verses like, you know, the counterfactual, which is, you know, all the education loss, all of the food security loss, all the mental health, and so many things that we're missing out on and not really quantifying, or at least not yet. And I think, you know, a year from now, we'll start understanding all of those losses, and we'll really need to think about what the risk we were willing to take at the time.

>> Howard Bauchner: So, let's turn to some of the questions. How comparable is immunity acquired by natural COVID 19, I think you said 20% of 330 million, say, the 60-65 million, versus that conveyed by vaccines? And I haven't seen substantial data on this yet, but, oftentimes, the CDC has more information than has been released.

>> Rochelle Walensky: Yeah, I don't have any more information on that one. What I will say is, you know, we don't have a huge duration of experience with convalescent disease, never nines with vaccinated disease. So, you know, I've seen data in the absence of variance, somewhere between, and this is public data, 80-85% people, you know, are immune some period of time out after they've had disease. We don't know what that's going to be like. We are really anticipating that the immunity that's given by the two vaccines that we're using right now, the Moderna and the Pfizer vaccine, will be of same breath and depth as natural disease. And we'll just have to see. I don't know.

>> Howard Bauchner: You anticipate, in this, the ACIP, Advisory Committee on Immunization Practices will weigh in, but let's assume that the J&J vaccine is approved. Sometime in late February, I think, the FDA did an extraordinary job with maternal, and Pfizer, I think, the process they put in place his put to rest this concern about politicalizing the approval. I really want to congratulate Peter Mark [assumed spelling] and Steve Hahn [assumed spelling]. The system they put in place really has been wonderful, and I think that will exist with the J&J vaccine. So, say the J&J vaccine is approved, and its efficacy is lower than the 95% of Moderna and Pfizer, and you know, and I've talked to people who previously said part of the problem is that the bar was so high with Moderna and Pfizer, and you know, people have said, well, 70%, will people really care? I do think people will care. It's human nature. Can you imagine that there be a tiered recommendation, Moderna and Pfizer, for the highest-risk individuals, and then, J&J for those that are at less, or you don't want to venture a guess on what ASIP could do?

>> Rochelle Walensky: Yeah, it's a really great, great question, and one that's getting a lot of attention. Not just from the public but from people who are going to have to make these decisions, right? First of all, I don't want to get out ahead of it, because we don't know what the data show from J&J. It may very well be that the data point us to the best populations in which to use this vaccine. The other thing to comment on is the immunity. You know, you only need one dose, and I don't know how many of your listeners have gotten their first dose are there second dose of vaccine, but that second dose of Moderna and Pfizer, from what I hear, and really knock you out for a little while. Now, you know, I think it's well worth it, and, you know, fine, but what I would say is some people may prefer to have one dose, and then, the other thing I will say is you're right. Seventy percent vaccine efficacy is better than the flu vaccine. It's better than the vaccines that we have for many of the diseases we routinely vaccinate for. So, you know, we happen to have one that hit the 95%, but, and then, the final thing to comment on is there's efficacy against preventing disease, and then, there's efficacy against preventing severe illness and hospitalizations and death, and so, I think, we're going to be doing all of the benchmarks, because, you know, if you were to get this, the J&J, and know that you could have your hospitalizations and deaths prevented, even if you were unwell for a little while with mild disease, I think people, many people, would opt to get that one if they could get it sooner. So, I think we're really, the devil's going to be in the details with this one.

>> Howard Bauchner: Many people now know that they had COVID 19. They were ill. They were tested. Many were asymptomatic, and the issue has come up if they're in a high-risk category or they qualify state-by-state. It is being done state by state. Should they be vaccinated? And I believe I know what the CDC recommendation is about that, but could you just comment. It is a question, and we 50, 60, or 70 million people now having been infected, many of whom would be at a high-risk category, should they be vaccinated?

>> Rochelle Walensky: Yeah, there's no reason to say you shouldn't be vaccinated. I think we're recommending to wait 30 days. The real issue here is we think your immunity is probably reasonably good probably beyond those 30 days. And so, my -- if it were my family member I would say, you know, you're probably safe. How about while we're in this real crunch. I mean, we really are in -- if you looked at all the constrained resources in vaccine distribution right now, the most constrained one is we don't have enough vaccine. And so, if you think that you might be protected for a little longer, then maybe you pass up your point in line, and let somebody else take that space in the queue, and get yours, you know, in March or April when we have a little bit more.

>> Howard Bauchner: I don't know what floated up in the media, it's a question was testing prior to domestic flights, and I think that made the people who were still flying a little anxious, and you know, another bureaucracy. Something we haven't done very well, which is easy enough ability to be tested. Any further comments about what the CDC may say about testing in domestic flights?

>> Rochelle Walensky: Don't travel.

>> Howard Bauchner: Okay.

>> Rochelle Walensky: I mean, really, that's, you know, we learned one thing in this MMWR from Minnesota, the experience with the B-117 variant, several of them came from California. So, their only travel was from California. We really, really would advocate for not traveling right now. You know, once we have more widely available tests, I think people are not going to be worried about the bottleneck of tests and domestic flights. So, my first answer is, we don't have the tests now to make that really easy, and possible, and facile, for people who are trying to travel. Two, is you shouldn't be traveling anyway. Really, essential travel. It's spring break here in Boston, and I'm struck by how many people have traveled. And then, third, is there are arrival, you know, destination restrictions, in terms of quarantine and post-arrival tests. So, we're just really asking people to abide by that, especially as our numbers are coming down. We're worried about the variants, and we're scaling up the testing capacity.

>> Howard Bauchner: Going back to schools, can we decrease the 6-foot distance recommendations, big barrier to kids in classes five days a week?

>> Rochelle Walensky: Yeah, that's a really great question. In the guidance, and the sort of color-coded guidance, we say if you're in the blue and yellow areas, the low to moderate zones, that we can try and get back to everybody in school all the time, where we do our best to do the physical distancing. I think doing our best could go a really long way. There's a lot of sort of obstacles in the classroom. We're underutilizing our gyms and all-purpose rooms. We're underutilizing, you know, Lucite or Plexiglas. So, there are a lot of things that we could do to make it better, and certainly, as we have decreased community spread with masking, with masking, and I want to say the data from the schools really demonstrate that if there is, you know, really great masking, you're not going to have clusters. Where there is teacher-to-teacher transmission, staff to staff transmission, it's been in breakdowns of masking. And so, when you have limited community spread, when you have really good masking, we really think we could get, you know, back to five days a week.

>> Howard Bauchner: There's many more questions, and I'm going to stop because I'm concerned about your time, but I have two last questions. It's reassuring to know that you are laying out this plan. So, we've been discussing the viewpoint SARS CoV2 Variants of Concern in the United States, Challenges and Opportunities. And that that's the immediate now, what's happening now, and vaccination policies over the coming months, with more vaccines hopefully being approved, but people have begun to speculate what the summer, the late summer, and the fall, would look like if there's truly a virulent variant. And that is COVID 2, is it becoming the new flu, and do we need, really, to begin to think about a new science of vaccines? The broadly neutralizing CoV2 vaccine? And so, I'm sure there's people in the back room at the CDC that aren't focused on the here and now but are saying what does September and October and November look like, and Tony at the NIH is saying, what science do we need to look at, you know, a breakthrough variant that is just resistant to all of the current vaccines and therapeutic approaches? How do you think about that, Rochelle?

>> Rochelle Walensky: So, I think we need to plan ahead, right? We've been burned the entire year, right? Shame on us if we continue to be burned and we're not humbled about this. We don't know what the efficacy of this vaccine is going to be across these variants, but we are planning ahead, and one of the ways that we're doing that is to sort of work with the pharmaceutical companies that are making the vaccines now, and fortunately, the two mRNA vaccines that we have can be easily tweaked to these variants. So, they're already working to see if they can tweak to the variants, so that if, down the line, we need bivalent vaccine or we need a booster vaccine, we are ready to go. I think you're right. I think, for a while, we're going to not be talking about cold and flu season. We're going to be talking about cold, COVID, and flu season, because I think this is going to take a while to fully dampen down.

>> Howard Bauchner: And this is the last question. It's a pretty dramatic change to lead a division of infectious diseases in Boston to being the public face of the public health institutions in the United States, particularly the CDC. Putting you aside, what's it been like for your family, your kids and your family, your mother and your father? What's it been like for them?

>> Rochelle Walensky: You know, I have just gotten overwhelming amounts of love and support from so many places. I think it's a gift that my parents have been alive to see some of that support, especially in the public. I feel really grateful for that. Yeah, you know, it's interesting how each of my kids have decided to embrace, are not embrace this.

>> Howard Bauchner: They're not changing their last name, are they?

>> Rochelle Walensky: No, but some of their friends don't know, which is interesting. They're not only willing to admit it, which is fine. You know, but I really want from them is to live their own amazing lives. They're great kids. My husband's been unbelievable. As you can imagine, he's taken a big toll in this. So, I'm just getting as much as I'm working really hard and really doing my best for the agency and for the public, I have just an overwhelming amount of love and support coming in my direction, and I'm just feeling really blessed for that.

>> Howard Bauchner: This is Howard Bauchner, Editor-in-Chief of JAMA. This has been Conversations with Dr. Bauchner, and I've been joined by Rochelle Walensky, by the Director of The Centers for Disease Control and Prevention. Rochelle, thanks so much for joining me today.

>> Rochelle Walensky: Thank you so much, Howard. It's always a pleasure to be with you.

>> Howard Bauchner: Stay healthy.

>> Rochelle Walensky: You too. You too.

>> Howard Bauchner: Bye.

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