Scientists and researchers responsible for the speedy creation of the Pfizer and Moderna vaccines are now seeing their work come out of the labs and injected into the arms of Americans who have dealt with the COVID-19 pandemic for over 10 months.
The vaccine from Pfizer labs was the first to be granted Emergency Use Authorization by the United States Food and Drug Administration and on December 14, the first Pfizer vaccines arrived in New York City for immediate use with frontline hospital workers and nursing home staff and residents. The vaccine from Moderna was also approved for emergency use by the FDA on Dec. 18.
Although 2020 may be ending, it is clear that the pandemic is not. The U.S. reached a grim milestone last week, with over 3,600 deaths reported on Dec. 16 and over 250,000 COVID-19 cases recorded on Dec. 18, according to data from The New York Times.
The New School Free Press spoke with Vincent Racaniello, a professor of virology at Columbia University, to discuss what to expect entering 2021. The Free Press spoke with Racaniello last spring, asking questions collected by students.
Racaniello teaches a virology course in the spring at Columbia and runs a lab where his team researches the coronavirus. This fall he has worked on a virology podcast, This Week in Virology, which discusses the COVID-19 pandemic with other scientists, epidemiologists and medical professionals.
This interview has been edited for length and clarity and was conducted on December 2, 2020.
At this point in time in viral research, aside from vaccine research, what has been one or a few of the most important discoveries about SARS-CoV-2?
I think there have been two big things that make a mark on me. First, once we got into this pandemic we realized that this virus doesn’t just cause serious respiratory infections in some people. About 20% of infections are very serious. But they also cause problems with all other organ systems weeks after the initial infection. The initial respiratory infection comes and goes and then many people have all sorts of issues with gastrointestinal, kidney, neurological, skin. It’s amazing and we don’t really understand what’s causing those.
Then, of course, there are a fraction of patients who have what we now call long-term COVID, [people] who clear the infection, yet have symptoms for months. We’re only less than a year into this, and it may go on for years. Things like fatigue, headaches, lethargy, muscle aches and loss of appetite. This has been very well documented. To me, this is all quite remarkable. What started out looking like a serious pneumonia now turned out to be a much broader disease.
Then the other thing is very important is that people have been studying immune responses to infection, because we’d like to know what kind of immune responses we make. Are they protective? How long do they last? Again, we’re only 10 or 11 months into this pandemic, but I think a number of studies have now suggested that we make a reasonably good immune response to infection. It has the potential to last for at least a number of years. That’s really good news. The last time I talked to you, we couldn’t have concluded that. I think those are the two things that stick out for me as being really interesting findings.
Now that we’re in the colder months, how does colder weather affect the virus?
The cold weather is a problem for respiratory viruses, because the infections seem to transmit better in cold weather, and there’s number of reasons for that. One is that the humidity drops and the temperature drops and that combination of things happening allows the virus to transmit better in droplets that we produce by breathing and coughing and sneezing and so forth.
In the summer months with all the humidity in the air, the droplets that you make absorb moisture, and they fall to the ground very quickly, and the heat inactivates the virus. But in the winter, the droplets remain dry and in the low humidity they can travel farther, plus the low temperatures help preserve infectivity, so the cold weather will increase transmission for sure. We’re already starting to see that now.
But also it forces people inside more than in the summer. More people congregating inside is a better way to transmit infection. The result is going to be for the next couple of months. A lot of new infections, unfortunately.
I have heard from some people that if they’ve already gotten infected, and they have the antibodies, that it’s kind of an excuse to either not get a vaccine, or not wear their mask or kind of just live life like it was before the pandemic. What’s your reaction to that?
Well, they don’t have any basis for saying that, right? Surely they have not read the literature on this. It’s just something they think happens when you get infected, you’re immune, and you can move on. But we don’t know if that happens in everyone for sure.
We don’t know if you can get reinfected. There have been some reinfections [asymptomatic but indicated through testing] and some cases with disease [symptoms of COVID-19]. One thing that is really a big question is whether when you recover from infection and you have some kind of immunity, will you still be infected and shed virus and transmit it to others? If that’s the case, these individuals shouldn’t just be going out and getting infected again, because they can infect more people.
For those reasons, a vaccine is in order for everyone. I mean, the plan right now is to immunize the whole world irrespective of whether you’ve had COVID or not, and scientifically, that makes perfect sense.
It’s pretty irresponsible, because you don’t actually know if you have antibodies, because not everybody makes a durable antibody response. I think you should be really thoughtful. If you’re young you may say, ‘Well, I’m not going to get very sick.’ On numbers, it’s true. But some people do get very sick at a young age and can die. More importantly, you can transmit it to other people. I think you have to be cognizant of that.
The last time we talked to each other, I think that was May and you expected that shutdowns would be lifted around June, and then there would be another wave in the fall. And we’ve kind of seen that. How much longer do you think this pandemic will continue?
Naturally, I would think it would continue to have a lot of cases. I would say through March or April, the winter months, however, we’re probably going to start immunizing in late December, January, and each month we’re going to have more and more people immunized.
It could be very well that by May, the whole U.S. is immunized. That should certainly stop the pandemic. I think for sure next summer, the pandemic will be stopped. In fall 2021, I think school can resume, most likely.
Right now, there’s two vaccines that have been in the news a lot, the Moderna and Pfizer vaccines. What are the differences between these two vaccines?
Pfizer and Moderna are very similar. They’re both mRNA vaccines. They’re just a piece of mRNA that’s made in the lab and it codes for the virus spike protein, and it’s wrapped in a lipid vesicle. Those are called liquid nanoparticles to protect the RNA. Then they are simply injected into your arm. What’s different about the two is the formulation of the lipid nanoparticle differs between Pfizer and Moderna.
Apparently, Moderna you can keep at not-so-low temperatures, even refrigeration for quite a while. Whereas Pfizer’s has to be extremely cold, minus-70 Celsius, otherwise it loses activity. So that’s unfortunate. The way they work is very similar. In fact, the results in their phase three trial, the efficacy were both in the 90 percent range. They both look really good.
They’re saying they can make 150 million doses a month starting in January. Within a month or two, we could immunize many people in the U.S. That would really make a big impact on the transmission, you’ll see the numbers start to go down.
Editor’s note: mRNA is messenger RNA, a single-stranded RNA molecule that is complementary to a DNA strand. Cells in the human body use the mRNA in the vaccine as instructions to make a specific protein, the “spike protein”, which is found on the surface of the coronavirus. Once the cells have made the spike protein, the body will begin to create an immune response, creating antibodies that will fight off any virus that has that spike protein. For more information about vaccines and how they work, stay up to date with the CDC.
A lot of people have doubts or distrust for the vaccine. One thing that I’ve seen is people critiquing how long it takes to create these vaccines. Especially because typically, it takes years to produce a vaccine, and at ‘warp speed’ it takes a few months.
It’s amazing. Most of the time, it takes years. But, we don’t have the luxury of taking years. We have had to accelerate the process, and I was initially very critical of that. But I’ve been watching it move through the different stages, and I have to say, it’s been done really well. I think the results look good in the sense that there have been no serious side effects. The immune responses look good, and now the efficacy looks very promising. In the end it’s going to be really a remarkable achievement to make a vaccine that’s safe and effective so quickly.
By the way, the vaccines have only been tested in people 18 years of age or older. Initially, that’s all who can get it. They’re going to have to start doing some tests in younger people, because eventually, we’ll want to immunize them as well.
It’s a problem for teachers too. We are more at risk for infection. That’s one of the reasons why we’re trying to be really careful. So if we could, at least we’ll be able to immunize the teachers. School teachers will have a high priority, which is good.
When you talk about the side effects from these vaccines, what does that like typically entail?
Typical side effects: pain at the site of injection, fever, sometimes you can have a high fever for a few days, headaches, general lethargy. Those are the most common ones and they are all related to the fact that when you get the vaccine injected, your body starts to make an immune response immediately. That’s associated with these kinds of side effects. This is something we’ve come to expect from vaccination.
But more serious ones would be obviously, death would be terrible, but paralysis of limbs, one or more limbs can happen with some vaccine side effects. You can have fever for many, many days. You can have vision impairment, and so forth. Neurological problems, cognitive issues, and I haven’t seen any of those so far that are caused by the COVID-19 vaccine.
You have to make a trade off, right? You have to balance risks and benefits. So far, the vaccines look really good, there’s very little risk. Yet the risk of getting infection could be severe. Everyone needs to make a decision. It seems to me it makes sense to get vaccinated, even if it’s been a vaccine that’s made quickly, it seems to be made properly.
What would you say to people who have distrust in the vaccine or are weary of taking it?
I would say that the risks of taking the vaccine appear to be very low or nonexistent. So far, in all the safety tests, which I think have been carried out very well and very thoroughly by all the companies, they have done three phases 1, 2, 3, since early this year. They have all looked good in terms of safety. I would say, take that into consideration [the vaccine] versus if you get infected with the virus, you’re going to get very sick, potentially and even die.
At this point, the risk-benefit in my view completely favors vaccination.
This is really a harmless vaccine, there’s no infectious virus in the vaccine. So it doesn’t even have a chance to infect you. I think there’s a very low chance of having any issues.
Do you foresee a high population of people refusing to take the vaccine at all?
Yeah, I think there’s a small percentage, fortunately, of the population. I think right now, surveys have said that half the population doesn’t want to take a vaccine, but I think as the vaccines are used and distributed, we see that people are okay, and that, in fact, disease goes down. I think more and more people will take it and realize, “I can go back to work, I can have my life now.”
About an hour or two hours ago Governor Cuomo announced that they could possibly get the Pfizer vaccine, like 170,000 doses in New York by December 15. What’s your reaction to this news?
The vaccines are going to be reviewed in the next week or two and I’m sure they’ll both get [Emergency Use Authorization] EUA’s just like in England. Then they’ll start immunizing. The first people to be immunized will be the high risk people in nursing homes and health care workers. I think that’s totally appropriate.
Pfizer and Moderna both need two doses. Most of them [vaccines] do need two. There’s one in development by Johnson & Johnson that’s a single dose. We don’t know how well that works yet. But all the others so far, are two [doses], which is too bad. It’s hard to get people to go back [for a second vaccine]. And I think a certain fraction of people probably won’t go back.
Editor’s Note: At the time of publication, both Pfizer and Moderna have been approved by the FDA for Emergency Use Authorization.
When do you expect normal people like me or you, or students to be able to get a vaccine?
You’re [young and relatively healthy people] in a very low-risk group. So you’ll be later. I am 65 and older so I think mine is the third wave, which will probably happen in February, March, April next year. You, probably, April, May, I would think. It’s not too far off. I’ve been being careful for a long time now. I can do it for a few more months. Realistically, I don’t expect to travel much in 2021, because I still think there’s going to be a lot of infections around. But in the U.S., by the summer, as I said, we can probably start doing a lot of normal things. I’m sure restaurants will open up in the summer and so forth.
Will there be only one vaccine in use or will there be multiple scattered around the U.S. and the world?
There will be multiple because we have 7 billion people in the world and if you want to get them immunized within the next six months, we’re going to have to depend on multiple vaccines because no one company can make enough vaccines for everyone. In the U.S., we’re gonna have probably four vaccines, as far as I could see.
Pfizer and Moderna are the most ahead. Then we have AstraZeneca, which is a little bit behind, but that’ll probably be approved. Then Johnson & Johnson, which is a little bit behind that, so four. If they can make 100 million doses each, we’ve got the U.S. covered. The timeline I gave you could be accelerated if more vaccines come online sooner.
Those are the ones that I think are the most advanced. The others, there are advanced ones, but they’re in China and other countries, so likely, we’re not going to see them here.
What is the impact of using multiple different vaccines? Like, is that a bad thing for people?
Well, they’re being tested on their own. You either get the Moderna vaccine or the Pfizer, and the efficacy numbers we get are just having one kind of vaccine. I think we will try and get people to have just one kind of vaccine. If you start with Pfizer, you stay with Pfizer. Because we don’t know what happens when you mix them. I mean, that is usually done in a trial, if you want to mix two drugs, for example, you have to try them mixed. We haven’t done that for the vaccine. I think as much as feasible, they will try to give people the same vaccine in multiple doses. That will simplify lots of aspects of immunization. I think scientifically, it makes more sense to.
What are your expectations about viral spread going into January and February next year?
December and January are going to be hard months, but depending on how we can deploy the vaccine, [cases] might start to come down in February.
Now I have a virology course to teach in January at Columbia that’s going to be all online. Columbia actually has some hybrid classes where you have some sessions in a class and some online and you make the classes small and spaced out, but my class is too big for that. Mine will be online for the whole semester.
I know that for students, it’s not great to sit in your room all day and watch Zoom classes. It’s probably crappy, but that’s what we have to do, unfortunately. But, I assume that in the fall that will go back to our regular classes because the vaccine will let us do that.
Some colleges, especially smaller ones like Sarah Lawrence, they’ve been able to like limit spread and kind of keep themselves in a bubble. Do you recommend New York City universities to do the same thing?
I don’t think they can because the space is too constrained. The small colleges can spread out students in classrooms, they can spread them in dorms. We [larger New York City universities] can’t do that. Columbia figured last month that there’s no way they can bring the students back for the spring semester and keep them spaced out. So that’s why they had to cancel.
I don’t think in a city, you can do that. You could certainly do it in rural areas where there are not a lot of people. As long as you do frequent testing, and keep people distant and in a bubble. The problem is, students on campus, you could keep in a bubble, but then they go off campus, and they encounter people outside the bubble and bring the virus in. That’s happened over and over on numerous campuses, as we have seen that’s really the problem.
Every college is in some kind of town of some size, so there’s always that danger. But I think if you’re testing frequently, and some colleges have done frequent testing it’s turned up to really help keep the number of infections down.
Do you think universities and schools should be in charge of providing vaccines for their students?
No. A vaccine should be paid for by the federal government. For everyone. Japan just announced that they’re going to pay for vaccines for everyone in their country. And I think it was announced some weeks ago already, that the federal government would pay to vaccinate everyone. I mean, they’re already paying for the development of many of these vaccines. It’s not a lot more to pay for immunizing people. I don’t think anyone should have to pay for this. Everyone should get it for free. Diagnostic tests are free. Also, if you got health insurance, you can get a free diagnostic test. And this should be the same for vaccines. I hope that stays that way.
I think that they should provide masks and they should provide testing regularly and pay for it. It costs money. I understand that. But it’s the safety of the students. If you don’t want to pay for it. That means you don’t care about their safety. And that’s just not right.
Editor’s Note: As of the date of publication, vaccine doses are purchased by the government using U.S. taxpayer dollars and are provided to the American public free of cost, according to the CDC.
Do you think there are still a possibility of some universities and colleges being able to still be in person in the spring semester? Or is that unethical?
Yeah, I think depending on the size, and the location, different parts of the country are having different infection rates. You could have classes, you have to space students out, you have to give them facemasks. You have to keep classes small. And you have to somehow limit them from interacting with other people who might be infected. But it’s not for every university.
I don’t think it’s unethical to have in-person classes in the spring at all. If you do it properly. We’ve always said if you do it right, with the right masking and distance sitting and so forth, you can do it. And this semester, some schools, as you said, have shown that it can be done.
In your opinion, how should colleges and universities be handling the upcoming semester?
First of all, they have to look at their size and whether it’s feasible to have classes with students distanced. We couldn’t do that at Columbia. But, some universities can do it. You have to see how many students you have, how many classrooms and their sizes, whether they’re big enough to accommodate that.
You also have to instill a testing program if you don’t already have one. At the Medical School of Columbia, we have the testing program where you can go and get tested free, anytime, as often as you want. I could go in every day if I wanted to and get a nasal swab, and I get the results in a day. Universities need to do something like that where they have to have rapid testing, and they should actually test every student, at least twice a week. Because then if someone’s infected, you can quarantine them, and the quarantine is going to be changed from 14 days to seven to 10 days now. So that’s good, because it will take people out of circulation for less time.
Distancing and testing, trafficking, making sure people avoid each other as much as possible. If you develop these plans, universities and colleges can open up again.
Would you advise for this upcoming holiday season people to be traveling?
No, I think people shouldn’t travel. Traveling is a very easy way to get infected.
Unless you’re going to get in a car, you know, trains and airplanes are full of people and that’s really an issue. I would not recommend it. If you were unfortunately away at school, you should probably stay there for your own safety and that of your family so you don’t bring any virus to them.
I don’t think people should go on vacations either. You really can do without it for another season, you’ll last. You can figure out ways to amuse yourself at home. I think traveling is a big problem, because we know now that when groups of people get together, that’s the best way to transmit this infection, and that’s what traveling does.
When President-elect Biden enters office in January, what do you hope he does in response to the pandemic?
Well, he’s already been formulating plans for vaccine distribution, so that when he’s inaugurated, he can immediately start making orders for where the vaccine is going and how, and to help out with federal money.
I think that’s really important, to show that the federal government has a plan, because right now, we haven’t had a plan. He should have plans for facemasks. Maybe he’ll do a mask mandate, depending on the numbers.
But maybe, even more importantly, which really, it’s not a science issue, he has to make a recovery package for people who are out of work, just to tide them over until they can get their jobs back. The republicans have blocked that so far, and that’s just inappropriate. If the Senate is Republican, he’s going to have a hard time getting such a bill passed. But, I think that he needs to inject money into the US to help people get through otherwise, it’s going to be a longer term tragedy than it is already.
He’s formulating plans for hospital capacity, face masking, vaccine distribution, and I think it is important that it’s actually not him that does all this, but the CDC should be the leader. So far, the CDC has not, and they need to be coordinating a lot of this vaccine distribution and approval and so forth.
What do you think local and state government should be doing right now, especially as positivity rates are rising?
I think we don’t have to have a shutdown if we can agree on behaving in the right way. New York City a week ago or so closed schools and now they’re opening them again, because they can do it in a responsible way, which involves masking and distancing, and testing. Testing, testing and testing.
Any state should mandate mask wearing. It’s crazy not to mandate mask wearing. I mean, that’s number one. You go outside, you wear a mask. They can leave restaurants and bars open, but you have to wear a mask, you have to be distant. If you’re going to eat in the restaurant, you have to take your mask off. You need to be distant from someone to do that.
I think if you do all these things, you can open responsibly, so we don’t destroy the economy, I don’t think we need to shut down, we just need to, first of all believe that this virus is an issue, and then act appropriately.
What do you want people to know about COVID-19 conspiracy theories?
Some states don’t have any regulations and they tend to be the red states, unfortunately. There’s so much scientific misinformation out there. It’s amazing. I mean, people are actively spreading it. I get emails routinely telling me that viruses don’t transmit, that COVID is a hoax, or it doesn’t exist. I mean, this is all crazy. I don’t know what people are thinking, and what they’re believing. But it’s a big problem. We have an information issue in this country, and this pandemic has really brought out the problems.
Is there anything that I didn’t ask that you would maybe like to say or to the readers? Let them know of anything or any myths you want to debunk?
Well, first of all, this virus exists, it’s transmitted from person to person. I’m basically saying these things because I get people telling me all these are not right. PCR is a good way to diagnose infection. We had an email today from someone who said PCR is useless. It’s crazy to say that I don’t know where that’s coming from.
The disease is real, it can kill you. It can kill even young people, not a lot compared to older people, but it can kill young people. I’ve seen many stories of young people dying of this, and it’s not going to go away. Even with a vaccine, the virus is going to be here, forever, essentially, we’re never going to be able to eradicate it. We’re going to have to vaccinate probably every year or every few years, I would guess. It [the virus] has gone into animals. It’s gone into minks, for example, on mink farms, and it can come back to people and who knows if it’s in rodents in the wild or not. This is a human virus now, and it’s here to stay and we have to deal with it. To politicize it is just wrong. Politics have their role in society. But when it comes to science, science is facts. They can’t be changed by politics, which is what politicians, of course, try to do all the time. Which is just crazy.
The other thing is that when this is over, and we slowly return to normal people will forget about it. I mean, this is a once in 100-year thing, right? The 1918 flu was the last one; it was probably as bad as this. But there will be another one. It’ll certainly be flu pandemics, not in 100 years, but maybe 10 years or five years from now. There’ll be other coronavirus pandemics and other viruses too. We have to be ready. We can’t forget the lessons that we’ve learned and we have to pass them on. We have to be ready and have plans. This administration of the past four years, had no plans, and they did nothing. And they do nothing to this day, which is not what the government is supposed to do. Government is supposed to take care of people.
We have to learn from this and elect people that are going to take care of us and listen to the scientists. We’re lucky we have that. But, there are a lot of people on the other side who want to come back and not believe science anymore. That’s just not the way to have a healthy country. I think we have to remember this. I hope it gets taught in classes for many years to come. Not just science classes, but economics classes, politics, government, sociology, all the things that were impacted by the pandemic, they can be reflected in classes of different kinds. Of course, there are going to be a lot of books written about it. I think it’s important to keep it going in people’s memories. It’s not just something that’s over and we can get back to life, it can happen again. We have to be ready.