This Infectious Disease Specialist Is Answering Your COVID-19 Questions On Instagram

IRA FLATOW: This is Science Friday. I’m Ira Flatow. Remember when no one had ever heard of the term “flatten the curve”? Last week marked one year since the World Health Organization declared the coronavirus outbreak a global pandemic, and since then, we’ve been asking scientists to answer your questions about the pandemic.

My next guest has been answering countless numbers of questions, explaining terms like “flatten the curve” to her family and friends, and now to her many, many followers on Instagram. Joining us to answer even more questions is Laurel Bristow, an infectious disease specialist and science communicator. For the last year, she’s been sharing COVID-19 information on her Instagram, kinggutterbaby. Welcome to Science Friday.

LAUREL BRISTOW: Thank you so much for having me.

IRA FLATOW: I’ve got to ask you first about the handle you use, kinggutterbaby.

LAUREL BRISTOW: That handle has become very popular with my followers. It’s just a really good example of how I did not anticipate being in the position that I have put myself in with this pandemic and being a source of information, because it’s just my personal Instagram. The name is based off of a joke from a Bob’s Burgers episode, and I didn’t think too much of it until it started becoming my de facto professional account.

IRA FLATOW: I love the Bob’s Burgers show, so it’s OK with me. Let’s get right to the first question. First up is James from Denver.

JAMES: Hey, Sci Fri. I look forward to getting my first vaccine, but I wanted to know if taking more than one type of vaccine would improve my immunity even more than just taking one vaccine.

IRA FLATOW: All right, Laurel, how do you answer that?

LAUREL BRISTOW: That’s a really good question. It’s a common question. So right now, in terms of the mRNA vaccines, their efficacy is extremely high. You would not get any benefit from taking an additional vaccine. For things like Johnson & Johnson, which also has a high efficacy, we don’t really have reason to believe that taking anything would be more beneficial because it’s just about how it elicits your immune response.

There are studies happening right now looking at a potential mix-and-match protocol to stretch vaccines or allow people to get booster doses with something that they didn’t get the prime dose with. But I would not recommend taking any vaccine that’s not recommended in your schedule until we have more information about that.

IRA FLATOW: Let’s go next to Tom from California.

TOM: Our county is distributing second doses of COVID vaccine quite late. What are the implications of receiving a COVID vaccine second dose two or three weeks beyond the recommended date?

IRA FLATOW: Laurel, I think a lot of people are wondering that.

LAUREL BRISTOW: Yeah, I think that that’s a pretty common question as well. There is certainly a window period for second doses. It doesn’t have to be exactly on the date that they tell you. Most places tested using a one-week window on either side. I’d say don’t worry too much if your second dose is delayed.

We’re actually getting increasing evidence, especially in terms of things like the Oxford AstraZeneca vaccine, that it is OK to delay those doses for quite a while, that you still have strong protective immunity. If we’re talking about the mRNA vaccines, you get really strong protective immunity from just one dose as well, so I really wouldn’t panic if your second dose is delayed by a couple of weeks. Beyond that, we really want to test to make sure what the best efficacy would be for how long you can stretch those doses before we make that a recommendation.

IRA FLATOW: Yeah, we really don’t know how long the immunity lasts either, do we? We’re sort of in an experiment on that.

LAUREL BRISTOW: Yeah, so people get really scared or confused when we say three months because they think that that’s as far as it goes. That’s kind of the minimum. We’re sure that there are three months of protective immunity. There are a lot of parts of your immune system that we actually can’t measure easily or test for easily, like your T-cell immunity.

So we do believe that there is going to be long-lasting immunity beyond three months. But right now, as we’re gathering more data and more information, we’re kind of existing in this abundance of caution realm, which is why we say three months. But I do anticipate it being longer than that.

IRA FLATOW: And speaking of second doses, David from Anchorage, Alaska wants to know why we need a second shot of the Moderna and Pfizer vaccine. Why are these vaccines designed that way, Laurel?

LAUREL BRISTOW: Yeah, so most vaccines that we have in our regular vaccine schedule are a prime and a boost vaccine. Some have multiple boosters over years. It’s just based off of what we know about how our immune system works and the most effective way to distribute vaccines or the most effective way to elicit an immune response.

So with a lot of vaccines in the clinical trials, because we were working under pressure, decisions were made based off of best estimates, based off of what we historically know about vaccines. So for example, the mRNA vaccines were tested with a two-shot schedule, but Johnson & Johnson was tested as a single dose. Now, Johnson & Johnson is being tested to see what happens if we do give a booster dose a few weeks later, and there has been a push to look into the efficacy of mRNA vaccines if we only give one dose.

So as time goes on, we’re going to really refine those things. But for right now, the FDA has given emergency use authorization for these vaccines based on the way the large phase III clinical trials were performed. So we really just stick to those schedules until we know more about how we can kind of tweak the vaccine dosing schedule.

IRA FLATOW: We have people asking about whether the vaccine could potentially mutate in a person who is not fully vaccinated. Here’s that question from Shalom in Santa Cruz, California.

SHALOM: If we have vaccines which require two doses and some weeks after the second dose to achieve maximum effectiveness, won’t we have a pool of tens of millions of people who’ve received their first dose and will be partially protected, and might the vaccine mutate in that population to be more resistant to the vaccine?

IRA FLATOW: Good question. Laurel, how would you answer that?

LAUREL BRISTOW: I would say the first dose of the vaccine gives very high levels of protection. So the goal really is to vaccinate as many people as we can to limit the bodies that the virus is able to inhabit. Currently, none of the COVID vaccines are 100% efficacious at preventing disease, at preventing infection. So we don’t worry about that with other vaccines that we have that also don’t prevent infection 100%.

I would say it’s important for people to keep in mind that the variants that we talk about all the time now arose before vaccines were available because the virus was so widespread with circulating so much. And so if we don’t get the virus under control, we are absolutely in a position to see more variance. Whereas with the vaccines, it’s a theoretical risk that’s probably not that large, but we’re not going to get the virus under control currently without vaccines. So really, the benefits of vaccines at this point far, far outweigh any theoretical risk, and we also know that variants happen when you don’t vaccinate a population.

IRA FLATOW: And now that the first group of eligible people have received their second shot, people are asking us, what are they allowed to do now that they’re fully vaccinated? Michael from El Cerrito, California has something to ask about that.

MICHAEL: I have received my second Moderna vaccination and soon will be the required 14 days beyond that. At that time, how can I change my activities safely? Can I have another person inside my house without increased risk? Can I dine inside without increased risk? I know when I am away from my home I should still wear a mask at least for modeling proper behavior. Are there other reasons as well?

LAUREL BRISTOW: Yes. So this is a really good question. It’s one that comes up a lot as well. The current CDC recommendations for people who have been vaccinated is that two weeks after your last shot of whatever vaccine you get– so in the case of the mRNA vaccines, that’s two weeks after your second dose. In the case of the Johnson & Johnson vaccine, that’s two weeks after your single dose of that vaccine– you’re considered fully vaccinated.

And in these situations, they’re making realistic recommendations for how people can relax their mitigation strategies while also trying to limit the amount of spread that’s happening. So for people who are considered fully vaccinated, they are allowed to have small gatherings indoors with, ideally, other people who are fully vaccinated. Or they can also have small indoor gatherings with people from a single household who might be unvaccinated but are low risk. And in this case, low risk means under 65 and without comorbidities.

And the reason that they want to do this and limit this to a single household rather than multiple low-risk households is just about limiting the risk and the spread and slowing it. If you are with a group of people, and someone from one unvaccinated household is a carrier, you would be at lower risk because you’re fully vaccinated, but someone from a different household who is also unvaccinated would be at greater risk of bringing that back to their home. So that’s why we’re trying to keep groups small.

IRA FLATOW: All right, let’s go back to our questions. Claudia from [? Catamount, ?] Massachusetts.

CLAUDIA: I’m wondering about why public health experts are saying that you could potentially carry the coronavirus in your nose after you’re vaccinated and then give it to unvaccinated people. Why do they think that, and what will they need to find out in order to verify if that’s true or not?

IRA FLATOW: Good question.

LAUREL BRISTOW: That is a good question. So I think the idea or the question of asymptomatic carriership or transmission when you’re fully vaccinated is one that is really interesting because it was born out of the fact that these clinical trials, the large phase III clinical trials, their primary endpoints were looking at things like severe disease, hospitalization, and death. We have a priority of the things that we need to make sure the vaccines do, which is reduce morbidity and mortality.

So from that we said, we don’t know about its impact on transmission for people who may not have any symptoms, so we need to still be cautious. And people interpreted that as there’s no impact on transmission, when really, it was we’re not willing to say what it is yet. More and more studies are coming out now that we are learning more about.

Johnson & Johnson had antibody testing in blood worked in in their regular follow-ups, and we’re finding that that vaccine absolutely reduces the prevalence of asymptomatic or undetected cases. There has been evidence from hospital systems in Israel that the Pfizer mRNA vaccine absolutely impacts transmission and people’s chances of being an asymptomatic carrier. There’s also information on this on Oxford AstraZeneca.

So we do know that they have an impact. We just don’t know the exact extent of it because it wasn’t worked into those initial trials. But again, falling under that umbrella of an abundance of caution, we said, we’re not sure yet, so treat yourself as if you’re still a risk to others until we get a better idea.

IRA FLATOW: OK, let’s move on to Mira from Boston. Let’s hear what her question is.

MIRA: What I don’t understand is how the COVID-19 vaccines could ever get us herd immunity if we don’t know that they prevent the spreading of the virus. My understanding is that herd immunity develops when enough of a population is immune, usually through vaccination, so that a sick person can’t transmit the virus to anybody who’s going to be a host where the virus would multiply. But if they’re going to continue to multiply and spread, how do we get to herd immunity?

LAUREL BRISTOW: I think there’s two important takeaways from her question. First, she said that herd immunity is mostly achieved through vaccination. It’s only ever been achieved through vaccination. I think that’s a really important thing to keep in mind. There’s never been an infectious disease for which natural immunity in a population has led to herd immunity.

And the other thing is she asked how can we get to herd immunity if we don’t know the impact on transmission. But the more people who are vaccinated, the fewer bodies that this has available to infect. It starts to run into walls when it’s trying to find new people to infect.

And so I tell people there’s a lot of infectious diseases out there that are endemic, that still exist, that still pop up, but we don’t spend all of our time thinking about them the way we think about COVID. And that’s the goal. That’s what we want to get to.

And even if we had a vaccine that maybe, say, was not capable of achieving herd immunity– and this is completely theoretical– if we had one that you still transmitted, keeping people out of the hospital and keeping people alive, if we can reduce it to a point where it’s like a common cold, that’s so much better than what we’re dealing with right now.

IRA FLATOW: Just a quick reminder, this is Science Friday from WNYC Studios. You know President Biden has come out and said everyone will be eligible to be vaccinated by May 1st, and that’s going to require a lot of vaccine to be produced. And Rebecca from Portland, Oregon is wondering if other drug companies can help out with that.

REBECCA: I’m curious why if so many companies have tried and somewhat failed to create their own COVID vaccines, why Pfizer and Moderna can’t contract those companies under NDA to mass produce the successful vaccines to help get vaccines out to the public faster.

LAUREL BRISTOW: Yeah, so they are. Sanofi has had a couple of delays in their vaccine clinical trial schedules due to a few errors on their part. And in the meantime, they have contracted to help produce Pfizer-BioNTech’s mRNA vaccine. They’re also now helping to produce the Johnson & Johnson vaccine.

Merck just gave up their vaccine bid, decided to focus on treatments instead, and they are now going to help produce the Johnson & Johnson vaccine. So there are companies that are stepping up to the plate for cooperation so that we can make sure that we get enough vaccines not only locally but also globally. Because really, this pandemic is not something that’s going to end until we take care of lower resource countries as well who also need access to these vaccines.

IRA FLATOW: We’ve covered the so-called long-hauler group on this show before, people who have COVID-related symptoms for months after they’re technically virus-free. Amanda from Missouri wants to know if the vaccines will work any differently for these people.

AMANDA: I started the Facebook group COVID-19 Long-Haulers Discussion Group. Our 11,000 members want to know how the vaccines might affect long-haulers. Will it help us? Will it hurt us?

LAUREL BRISTOW: Yeah, so this is a very interesting topic and something that is going to be looked at really closely in the future. Long-haul COVID has just been given the acronym of PASC. I think it’s Post-Acute Sequelae of COVID Infections. And the anecdotal data that we’ve seen so far is that for a portion of long-haul sufferers, about maybe 30% to 40%, that the vaccine, just by their own accounts, has improved their symptoms to a degree.

There’s a couple of theories that have been proposed for why a vaccine might help improve people’s symptoms, and it’s certainly something that’s going to be looked into. But there has not been any data so far or recorded evidence that it exacerbates long-COVID symptoms, only that it could potentially be helpful for some people.

IRA FLATOW: I suspect that many families are wondering about when they will ever get to return to, quote, “normal life” if their children remain unvaccinated. Will they still be at risk if their kids return to school, or go to the playground, or have friends come over? Annie from Madison, Wisconsin wants to know about a potential clinical trial for kids.

ANNIE: I’m wondering what makes vaccines potentially behave differently in children, and why are they not included in the initial trials that are done?

LAUREL BRISTOW: Yeah, I would say that in a pandemic, in an emergency situation, a lot of it has to do with dealing with prioritization of needs. Data around children is very hotly debated right now. But so far, it is pretty clear that kids who are without underlying medical conditions are at fairly low risk for severe COVID, and their role in transmission is not as clear. But obviously, the priority was adults, people with comorbidities, and the elderly, in terms of protecting them from severe disease.

So that’s why kids weren’t initially included in any clinical trials. And of course, you want to try stuff on adults before you move on to children. There are multiple studies that are happening right now for children for vaccinations. I know Moderna has just started enrolling for theirs. I think Johnson & Johnson might be enrolling for theirs currently.

So we will get answers to vaccinations for children fairly quickly. But I do think there is a possibility that we could still get back to normal without mass vaccination in children if we can have at-risk adults be vaccinated as well.

IRA FLATOW: This is Science Friday. I’m Ira Flatow. In case you’re just joining us this hour, we’re answering your COVID-19 questions with help from our guest, Laurel Bristow, an infectious disease specialist and science communicator. You may be familiar with her via her popular Instagram account, kinggutterbaby. Let’s talk a little bit about your career on Instagram, and what turned you to making videos about COVID, and then everyone following you. Why did you make your first Instagram video about this?

LAUREL BRISTOW: Back in March of 2020, I was working on respiratory research before in hospitalized populations. All those studies got paused when we realized that COVID was in the hospitals, and we needed to make a new plan for how we were going to approach things. And there was about a four-day period between those studies getting paused and us starting up full force, hit the ground running, doing COVID treatment research that I didn’t have a lot to do.

And so I offered to my private friends and family, only 600 Instagram followers, if anyone wanted me to make a video explaining what “flatten the curve” meant, explaining what COVID was, why it wasn’t just the bad flu. And a few people said yes, that they would like that. So I made my first informational video, giving a broad overview of what we knew.

And people started asking if I could make my private profile public so that they could tell people to watch the story or share it. And I did that, and then by the end of the weekend, I got 2,000 followers. And it just never stopped. People started sending me their questions. They started sending me news stories that they had seen that had scared them.

And so it’s really just grown from there into this wonderful community of people who really want to learn. They want to do their part to help out with others, and they just want to feel really informed and empowered to make choices in their life, and also talk to their family members who might be more hesitant or confused to try to get the pandemic under control while looking out for each other.

IRA FLATOW: And right now, you have, what, hundreds of thousands of followers.

LAUREL BRISTOW: Yeah, I think we’re somewhere in the 360,000 range in about a year.

IRA FLATOW: Now, do you consider that great success the topic, or your really good skill at being a communicator?

LAUREL BRISTOW: I think it’s both. I think my proximity to the information is obviously helpful and draws people to me. But also, I do enjoy teaching people. I think it’s really fun to come up with creative ways to make sure that people understand really complex topics so that they can feel really empowered in their life.

I am so close to this pandemic. The only people in the hospital who I see are very sick with COVID, and so I interact with them. And even that proximity, I am not afraid of the pandemic the way I think a lot of people who only get exposed to it through headlines are.

And so I want people to feel the way that I feel, and feel like they can make good choices that might not be the most fun. And it’s obviously not enjoyable, the last year of this social distancing and isolation, but that they can feel confident that they are doing what’s best for them, and also what’s best to minimize their impact on others.

IRA FLATOW: You ended up working on the Moderna clinical trial and ended up having a very close connection to some of the COVID information people had questions about. Did you find you needed to filter the information you were sharing because of this?

LAUREL BRISTOW: No, not particularly. I think I’d been lucky in a couple regards. One in that mostly people are asking me to explain stuff that’s public information. It’s headlines based off of papers or conspiracy theories that are out there. And so there’s never been a conflict about what I can share.

And also the fact in this pandemic, preprint servers that host papers that have not yet been reviewed have been really overwhelmed with an immediate access to data. So there’s not really a lot of stuff that stays under lock and key. I actually can’t really think of anything that I’ve worked on where I have learned any data that hasn’t been published within the next few days. And then once it’s out there, I feel completely confident sharing it with other people. So I think the free sharing of information in this pandemic has made it super easy to not even have to worry about giving away any information that was under lock and key for whatever reason.

IRA FLATOW: And of course, you’ve got a very positive take on the news, whereas the media elsewhere, people might say not so cheerful. Was that something you intentionally put into your messages?

LAUREL BRISTOW: I don’t know about intentionally. I mean, I think getting people hooked on fear is a very powerful way to keep them coming back. And so I like to be the balance to that just by default, and there is a lot of positive news that comes out of this.

And also, just my natural disposition has been that this is going to end. It’s going to end one way or another. I would just prefer it end in the way that doesn’t involve mass casualties. So here’s what we can do to prevent that, and here’s the things to look forward to, and here’s the evidence that we might be coming out of the tunnel.

So I think it’s been pretty easy and also important for me to be a guiding light to hold people together and have people hold on. Because it is exhausting, and it’s draining, and I do take time to acknowledge that. But I think that people are capable of really incredible things, and so they just need someone to remind them of that.

IRA FLATOW: OK, I have to ask you the question that everybody asks a very successful person, and that is, would you do anything differently?

LAUREL BRISTOW: If I had to do it all over again, I definitely would. I think I might respond to the difficult aspects of it a little bit differently. It was such a quick change, and of course, with this kind of notoriety comes people from the conspiracy side of the spectrum who post my information, and then my DMs are full of their trolls. And I think if I would do it again, I would know better than to give my time and my energy to those people because it’s just not worth it. I think in the beginning, it was a lot easier to pick a fight with me than it would be now.

IRA FLATOW: Let’s talk about post-pandemic, and we all hope there’s going to be a post-pandemic. Do you plan to continue being a science communicator on what you do on another topic?

LAUREL BRISTOW: Yeah, I think I would definitely like to continue in some capacity. I think this year has certainly shown me that I really do enjoy teaching.

IRA FLATOW: Well, we have to leave it there, Laurel. This has been very educational and certainly helpful to all our listeners.

LAUREL BRISTOW: Thank you so much. I’m so happy that I could be here.

IRA FLATOW: Laurel Bristow is an infectious disease specialist and science communicator, and you can find her sharing important science information, answering questions about COVID-19 on her Instagram account, kinggutterbaby.

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