Verily Head of Clinical Policy and former FDA Commissioner, Dr. Rob Califf, sat down with us to break down recent CDC guidance for vaccinated individuals. Learn more about the science behind the shift in guidelines.
Fully vaccinated people no longer need to wear a mask indoors or outdoors. This has been controversial, with some feeling it’s early to make that call. What have we learned about how the virus is transmitted that makes the CDC confident about this recommendation?
One of the most difficult things about public policy is that you need to make a strict yes-or-no, binary recommendation. Scientific evidence is not binary, it grows over time and speaks to probabilities and likelihood of risk. We now have many studies that show people who have received vaccines approved in the U.S. are at very low risk of becoming infected. If they do become infected, they are at very low risk of serious illness. Some vaccines approved globally are less effective than the ones available in the U.S.
From the original vaccine clinical trials, it was clear that the vaccines were very effective against serious illness or death, and now we know there’s a low risk of getting infected at all. If you’re vaccinated and in an environment with unvaccinated people or in a big crowd, or riding public transit — the guidance is still to wear a mask to protect the unvaccinated. I would do that as a courtesy to others.
Some states opted to leave mask mandates in place a while longer. What goes into the calculus of a locality or region when deciding its masking guidance?
The CDC actually doesn’t have authority over states or local public health agencies. We’re seeing that different localities have different risk tolerance. In California, for example, health authorities kept the mask mandate in place until mid-June, while many states with lower vaccination rates have decided to remove mask mandates and reopen.
One concern is people who don’t want to get vaccinated generally don’t want to mask. What risk do the unvaccinated pose to the vaccinated?
People who received an approved vaccine in the U.S., almost no matter what, have low risk of getting infected. Unvaccinated people with a high viral load pose some risk to the vaccinated, but not much. Currently, we’re thinking that being in an enclosed space and the viral load a person has are the biggest factors that go into being a risk to others.
Viral load refers to the amount of virus in the upper respiratory tract. The more virus you have in your system, the more of it you expel when you sneeze or speak. The vaccines create an immune response to suppress the virus, so even if you do happen to get it, you have a lower level of viral load. So we’re seeing asymptomatic infections or scenarios where you don’t get that sick.
Where does this leave parents of unvaccinated children or the immunocompromised? Are they at greater risk if adults stop wearing masks?
Children age 12 and older can now get vaccinated, so we strongly recommend parents of older children help them get vaccinated. For kids under age 12, it’s a dilemma. The recommendation for younger children is to continue to wear masks and social distance, but this can be a challenge with summer activities. I expect we’ll learn more over the summer about how to best manage risk for younger children, with more safety data.
Similarly, for the immunocompromised, the recommendation is to continue to mask and stay distanced. The best thing people can do to protect the immunocompromised is to get vaccinated.
As you mentioned previously, there is still some risk of “breakthrough” COVID infection when vaccinated. Doesn’t this run counter to the idea of removing masks before herd immunity?
Herd immunity is a concept — we don’t know exactly what level of vaccination is needed to achieve it and completely eliminate the virus. Most experts don’t think we can fully eliminate this virus and that it will be endemic, or present in the population at some basic level, similar to the flu and other viruses. Vaccines approved in the U.S. do work against the variants that are emerging. That said, they are less effective, which is why it’s important to vaccinate as many people as we can, as quickly as we can, to get the virus to a manageable level.
What’s the risk of someone who gets COVID-19 when vaccinated sustaining “long COVID”?
So far, it looks like the risk of long COVID in vaccinated individuals is very, very low based on the data we have from thousands to millions of people. It is still possible, and in the few people where that happens, it may be due to immune system differences that we’re still learning about.
For people who get COVID-19, develop long COVID, and then get vaccinated, we’re seeing some evidence that getting the vaccine can help. We’re not sure why that is yet, but one theory is that individuals with long COVID may continue to harbor the virus in the body after the initial infection, and the vaccine helps fight it.
Do we know any more about how long immunity lasts? Is it possible that we’ll need booster shots in a number of months?
We are collecting data that shows a strong immune system response that goes out pretty far from the original vaccination, but we’re only a year or so into this pandemic and can’t be sure of exactly how long immunity lasts yet. However, mRNA vaccine platforms lend well to making boosters, so we are set up to produce them.
Personally, when would you feel comfortable not wearing a mask in a crowded indoor function?
I’ll continue to wear a mask until we see the follow-up from summer holiday weekends, where people will likely wear fewer masks but many more will be vaccinated. In the fall, we should consider masking as it’s a good way to prevent the flu and other seasonal viruses. Our immune systems will be tested more during fall and winter by spending increased time indoors and coughing from other viruses. We’ve seen in Asia that masking has helped stop pandemics earlier, so I am hopeful that we may adapt to wearing masks during higher-risk time periods and situations.
Forty percent of adults in the United States struggled with a mental health disorder during COVID-19, according to the CDC. Along with this increase in need, utilization of mental healthcare like digital apps and telehealth for accessing talk therapy has risen tremendously. We sat down with Verily Mental Health Lead, Dr. Danielle Schlosser to understand how people are coping in the current phase of the pandemic, and tips for managing stress.
How has COVID-19 impacted mental health in the U.S.?
It’s important to note that the mental health impact of the pandemic has not been one-size-fits-all. On the one hand, we’ve seen huge increases in mental health needs as well as really high adoption of mental health services. Many people nationwide are dealing with grief from losing loved ones during the pandemic. There’s also evidence to suggest that many people who recover from COVID-19 have long-term struggles with mental health, with one study showing that one in five COVID survivors has a mental health disorder. We’re also seeing a lot more openness around talking candidly about mental health struggles.
Interestingly, on the flip side, we’re also seeing some people experience “post-traumatic growth.” Some are reporting positive experiences around feeling more connected to family and friends, or benefiting from reduced time spent commuting among those who are able to work from home. The mental health impact of the pandemic is nuanced, and we’ll continue to see this as we hopefully shift into a new normal.
Currently in the U.S., the approach to managing the pandemic and public health guidance is changing. As vaccinations increase and many communities loosen restrictions, what can happen with people’s mental health?
In the U.S., there is a sense of seeing a light at the end of the tunnel and many people are feeling excited about a return to normal in sight. By the same token, however, many people have also adapted to the pandemic over the course of the past year and we’ve settled into certain habits and routines. Some feel anxiety around socializing, even if they crave it. Humans are predisposed to feel stress around major life changes, and our brains like predictability. For example, getting married, having children, and graduating high school are all seen as positive events, but it takes time to adjust to the new normal.
The best way to manage this stress is to be gentle with yourself and validate your experience, realizing it’s one shared by many. One technique from talk therapy is identifying and naming an experience. When you’re in the midst of swirling thoughts that seem very chaotic, you may not recognize it as anxiety. In psychology, we refer to these thought patterns as “rumination.” Naming these experiences isn’t meant to stigmatize, but actually to gain a sense of control.
It can also be helpful to internalize that thought patterns are just thought patterns, not who you are. One technique of managing a detrimental thought pattern is to catch it, check it, and change it. This process involves being mindful and aware of when you start slipping into rumination, so you can challenge the unhelpful thought and replace it with an alternative thought.
On the preventative side, evidence shows us that physical activity, meditation and being in nature can help reduce stress. Socializing can also help, which can seem counterintuitive if you’re experiencing anxiety around socializing. But this can involve connecting with a partner or family member and just getting out of your own head.
How can people cope with information overload?
Greater exposure to news can induce stress, and digital hygiene can help. If you notice your heart rate goes up when you watch the news, for instance, notice and identify that. You can stop automatic notifications on your phone from news apps in order to create more control over when and how you consume information.
How can people navigate sensitive conversations around masking and vaccination with family and friends?
This is really hard, especially given how divisive the dialogue around public health has become in the U.S. When you’re having a difficult conversation about a really important public health guideline like vaccines, getting curious about the other person’s feelings and what is at the heart of their perspective is a good place to start.
When a decision gets into people’s value system and identity, it will not be productive and constructive to quickly criticize their point of view. One way to navigate these conversations is by sharing information so they can have the best data available to them to consider their choice. We can orient these conversations around helping people feel empowered to make these decisions, rather than controlled.
In one year, Baseline COVID-19 Research Project has made a significant impact on researchers’ understanding of the virus. Learn more about the community and their contributions to science:
One in five U.S. adults experiences mental illness. In honor of Mental Health Month, we sat down with data scientist Stefanie Nickels to learn about how digital tools can unlock better ways of managing mental health.
Why is it important to focus on mental health research, especially now with the impact of COVID-19?
Over the past 30 years, we’ve seen no improvement in mental health outcomes. Mental health disorders are the leading cause of disability in the United States, and anxiety and depression have only increased during the pandemic. Social isolation and worries around getting sick or losing loved ones can exacerbate existing mental health conditions. Not only is there a cost to the healthcare system, mental health issues have a profound impact on the sense of self, emotional and physical well-being, and the professional and personal relationships of the individual.
What are digital therapeutics and why are they interesting in the mental health space?
Digital therapeutics are technology tools used to prevent, treat, or manage a disease. We can deliver many types of therapies digitally. Telehealth allows you to speak to a mental healthcare provider via video chat, removing the barriers of needing to be in the same room if you’re physically distant or experience mobility challenges. There are also apps with built-in cognitive behavioral approaches — a common type of psychological treatment — that can teach valuable skills in a scalable way that’s accessible to many people. You can go at your own pace, using an app that’s always available and private.
What is a digital biomarker and what’s an example in mental health?
A digital biomarker is something you can measure digitally that indicates mental health status. A simple one is how long you sleep. Sleep disturbances are associated with depression so changes in sleep can indicate a shift in mental health.
Smartphones contain sensors that can capture data relevant to health, and figuring out how to translate this information into useful insights is still a young field. One of the data points mental health researchers are interested in is location, because it helps us infer how much time people spent at home. Increased homestay is associated with depression, as is increased social media app usage and decreased physical activity, which are other things we can infer from smartphone use.
Can you describe some notable aspects of mental health research that Baseline has conducted?
Most clinical studies are conducted at a study site like a hospital. For the Baseline Mood Study I and II, we set out to make them completely remote, easy to access, and fun. The studies were self-guided using an app, and one of the notable aspects was the use of an engaging chatbot that led participants through daily activities. We also used a mix of clinically validated electronic questionnaires that are approved by a body of experts to accurately measure something related to health, and more novel research approaches like audio diaries.
What is next with mental health research and care, and what do you hope we can achieve?
On the research side, we have a lot of work to do in finding digital biomarkers and provide evidence that they are valid mental health measurements that can tell healthcare providers something meaningful about mental health outside the clinic. This in turn can enable better care.
Measurement-based care is routine in other fields, but not in mental health. For example, with diabetes we continuously monitor A1C levels to understand if the disease is being controlled. What this might look like for psychology and psychiatry could be completing a questionnaire every one to two weeks in order to quickly identify whether a treatment is working. One reason this isn’t being done today is that it’s burdensome to providers, but through an app, this type of data can be collected very quickly.
As vaccines become widely available, we asked COVID-19 research Project members about their attitudes, questions and perceptions on vaccines. See infographics below:
Women hold less than 30% of jobs in science and technology fields. So what’s it like for women who are
in these roles today? Women leaders at Verily share their experiences and what they want others to
know about pursuing science careers.
What inspired you to pursue a STEM career?
“Curiosity was my biggest inspiration, but key mentors I met throughout my journey are the biggest reason
I got involved in STEM as a career.”
- Angela DiCiccio, Product Engineer
“Curiosity to solve the unsolved.”
- Dr. Meghna Beotra, Finance BI Analyst
“I love learning how things work! Biology gives me a deeper appreciation of my own precarious existence
and leaves me in continuous awe of the complexity and balance of the natural world.”
- Zoey Ferguson, Research Associate
“I had so many small nudges in that direction - a math award in second grade, a visit to my grandparents
in sixth grade during which my grandfather pulled out a binary logic workbook to entertain me,
a dad who was hopeless with anything mechanical and left me to install new light fixtures,
replace car radios, and repair broken door knobs. I also had fabulous math teachers in middle and high
school. Most importantly was probably all the history books my parents bought for me and the weeks
I spent at law camp. I was definitely not going to follow in my parents' footsteps and become an attorney.”
- Caitlin Donhowe, Software Engineer, Surgical Analytics
“My mom and my dad, who are both graduates in mathematics and successful in banking. I was very lucky
to have been born in an educational culture where I could not perceive any difference between genders or
being pushed to gender-based careers until I reached undergrad engineering school. My parents treated
my elder brother and I the exact same way in inspiring us both to study and take on STEM careers.”
- Nivi Arumugam, Head of Sensors Engineering
“I followed my insatiable curiosity down a STEM path so I could discover how things work and have fun
coming up with clever solutions to complicated problems.”
- Nursen Ogutveren-Armea, Software Engineer
“In high school I wanted to either become a doctor or journalist because I wanted to understand health and
share that information with the masses. I found public health in undergrad while volunteering as a sex
educator in Chicago Public Schools while witnessing stark health disparities; I knew I wanted to do
something about it. I worked in a variety of research roles both in academia and evaluating community
health programs with the goal of improving public health.”
- Jaclyn Shea, MPH User Experience Researcher
What do you want women and girls to know about STEM careers?
“It's okay to not have a plan and follow your passion - that's how you'll change the world the most. Highest
of all though, don't doubt your passion, continually work on communication, and have fun!”
“There is no such thing as a silly question. Ask to quench your thirst for knowledge.”
“It turns out that you don't have to choose between practicing science and creativity! Many of the best
scientific ideas and insights come from people who practice creativity in their personal and professional
life.”
They are so varied - I started in mechanical engineering because it seemed the most approachable for
someone who didn't have access to coding or robotics or AP physics classes in high school, and to be
honest, it wasn't a great fit. It's been a gradual migration ever since, figuring out which bits of each class/job
I like best and trying to get more of those bits in my next class/job. Nearly two decades later I'm deep in
algorithms and big data and there is no technical drawing in my life. I'm much happier for it!”
- Caitlin Donhowe - Software Engineer, Surgical Analytics
“STEM careers are very gratifying and shape the present and future of the world. Every day at work is fun,
provides ample opportunities for encountering new experiences and enjoying the best of life. There is never
a dull moment.”
“STEM isn't for one particular ‘type’ of girl. STEM is for everyone, so don't rule it out too quickly! Whether
you think you're ‘good at math’ or you think you're ‘more of an artsy type’ there's a fulfilling career for you in
a STEM field, because there are as many different ways to be creative and solve problems as there are
problems to solve!”
“STEM is diverse! I've conducted qualitative and quantitative research in public health and tech. There is no single path, but rather many ways to one's passion related to STEM to making the world a better place. I went from conducting research on taboo topics (sex, HIV, transgender healthcare) to researching how to design and improve healthcare products like patient apps and medical devices.”
Why is it important for women to be represented in STEM?
“STEM fields are magical forums for learning, collaboration, and exploration but will only thrive with
diversity!”
“Every mind counts when the world is working to answer questions. Women can contribute immensely by
bringing in their perspective and contributing to a pool of ideas.”
“Having badass STEM women around me reminds me that women can do incredible things because of their gender, not despite it. Any level of added diversity richens the wealth of perspectives, and the historical lack of a female presence in STEM makes it all the more meaningful.”
“Because they have so much to add! We can develop better products if we have diverse teams to develop them.
And the flip side of that, because there are women who are happiest in STEM jobs! My grandmother bemoaned the fact that my husband doesn't earn enough for me to stay home with our kids. I would be desperately unhappy at home with our kids!”
“Women make up more than half of the world and the world is shaped by STEM industries. It is imperative
for women's decisions, actions and perspectives to equally change how the world is and will be. The world
will be a better place with equal representation of all of its inhabitants in areas of influence and power.”
“People who work in STEM define the choices for everyone. What products are available at Target? What
medicine is available at the pharmacy? What apps are available on your phone? People in STEM create
these options. Women need to be in STEM roles to make sure there are options that work for us, and so
that there are solutions to problems women are uniquely positioned to see and understand.”
“We all see the world through our own experiences. When only men are in STEM they research and design
with themselves in mind as the default. The incredible book Invisible Women: Data Bias in a World
Designed For Men thoroughly details how our world is biased against women because men have
traditionally created products and services. The more diverse perspectives we have in STEM, the more
research and products will be inclusive to women and other oppressed communities.”
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