 Hi, I'm Angela Brown. I'm the head of events at the Linux Foundation. And today I'm joined by Dr. Joel Salanikio, who is a physician, former CDC epidemiologist, emergency responder, and outbreak investigator. And he's here for a discussion on how we can safely return to events during the pandemic. Dr. Salanikio, thank you so much for joining us today. Pleasure. Thanks for having me. Yeah. Before we get into some of my questions, I'd like to share with the audience that you are working with us as a consultant as we get back to our in-person events this fall to make sure we can do so safely. Can you tell us a little bit more about your background? Sure. Well, I guess the simplest part of my background is that I'm a pediatrician by training. And often when I meet people and they want to know, if I don't think that I'll be speaking to them very long, I just stop with the pediatrician part because everybody gets that and everybody likes pediatricians. But actually, most of my professional career has been working as an epidemiologist, first for CDC and later for WHO and other organizations and also as a technologist. So I've been heavily involved in outbreak response and public health, but especially from the technological side. Very cool. Thank you so much. Well, let's go ahead and dive right in. So I guess the first question on everyone's mind is, is it safe to attend an event in person right now where vaccines and masks are required? Yeah, sure. I mean, I think it's important to think about the relative nature of the term safe. So if we say something safe, well, this is going to involve a risk evaluation. And the risk evaluation involves what's the probability that something is going to happen and what's the consequence if it does happen? So if we think that every time we leave the house, there's a 0.001% chance we're going to get it by a car. I mean, getting hit by a car is a big deal, but on the other hand, if we think it's not very likely to happen, we leave the house. And so we're always weighing these risks and trying to determine whether or not we should go outside or we should drive to the supermarket or take a vacation or whatever you might want to do. So in terms of attending events, I think it's important to recognize right now it's very clear that people who are vaccinated have very strong protection against serious COVID illness. So for example, there's been several studies, I was just hearing about one on NPR actually this morning I hadn't heard before that was done in the UK, but all the studies that have been done so far regarding the vaccination and especially regarding the vaccination and the Delta variant have shown that the vaccination is very, very effective against protecting against hospitalization and serious illness. And in most of those studies, they looked at what was the protection from even one shot. For example, if you got the Pfizer vaccine but you only got one dose, they also looked at two shots. They looked at the Johnson and Johnson and then in every single case they find similar results which is to say that the effectiveness in preventing any COVID infection and that could include asymptomatic infection. That effectiveness is reduced against the Delta variant but it is still extremely effective in protecting against any kind of severe infection or the need for hospitalization, et cetera. And all those studies took place just among the public in places. They didn't take place at events where everyone was masked and everyone was vaccinated. And so the point here is that unless you have particular conditions, unless you're immunosuppressed, unless you're over the age of 85, in which case those things by themselves give you a higher risk profile, then you have very, very little to fear for yourself I think from attending an event where everyone is vaccinated and everyone is wearing a mask. Now of course, the other last little bit is you may not be over the age of 85, you may not be immunosuppressed but if someone in your household or someone that you think you're gonna come into contact with routinely is in those categories, you'll wanna think about how you can mitigate the risk to them of you potentially getting, let's say an asymptomatic infection and transmitting it to them. So I'll give you an example. My mother is 80 years old. I do attend live events and when I attend those live events, if I'm gonna go see my mom, I wait for at least a week so that I can see if symptoms arise and I also get myself tested. Cause again, I don't feel myself to be at risk but I certainly don't wanna transmit it to others. What steps do, what could attendees do on site to help keep themselves as safe as possible aside from being vaccinated, which we're requiring and of course wearing masks? Yeah, well, I mean, vaccinated you're 99% of the way there, right? That is the single most important thing that we can do to protect ourselves against COVID and also to protect those other groups that I mentioned, our loved ones and associates and other family members who are in those high risk groups. So vaccinated, you're almost all the way there. I think when you add a mask to that equation, one more layer literally, in this case, one more layer of protection, you're making yourself even safer. So those things I think for attendees of the conference, if there's social distancing, mask wearing and people are vaccinated, I think they've done a great deal to keep themselves safe. Obviously, we would also, along the lines of keeping everyone else safe, we would also want people at an event to be immediately forthcoming if they started developing any kind of symptoms of illness. And that doesn't necessarily have to mean that you developed a cough, but certainly, you feel like you're starting to get a cold, you feel like you're getting a fever. Obviously, you need to let one of the event organizers know so that we can safeguard the other attendees at the event. Yeah. And that leads right into my next question, which is what shouldn't attendee do if they start to feel unwell while they're inside an event? I don't think that necessarily getting unwell or becoming unwell at an event is gonna be different from becoming unwell anywhere else. I mean, obviously, if you're at home, you have the option of staying at home. But if you're in an event, basically you'll just wanna seek care. And so I think the first thing is to contact event organizers to make sure that they're aware and that they can help you get the care that you need. But really what we're talking about is gonna be most likely a visit to urgent care, like everyone else who becomes sick and wants to make sure that they're gonna get the care they need and wants to make sure that they're not potentially COVID positive. I would emphasize that in a group of people who are entirely vaccinated and wearing masks, if someone gets sick at a conference, it's very, very unlikely to be COVID. It's likely to be all the other things that make people sick. And so again, you're gonna follow those standard protocols. Obviously, if you feel chest pain or you feel shortness of breath or someone around you says that they feel short of breath or they're feeling chest pain, what would you do? Well, you'd call 911 and then properly notify the event organizers. If you're talking about something that's less severe, again, you feel like you're a little warm. You're not sure if you have a fever, you started to develop a cough, et cetera. For those things, again, I think urgent care is gonna be sufficient to do whatever is needed. And if they feel that you should be tested for COVID, of course they can do that. Yeah, thank you. If we have participants that are watching or audience that are watching that are kind of on the fence on whether to go to events in person this fall. And I think this circles back to some of the things you've said, what advice would you give them in making that decision? For me personally, I think that the only real consideration for me, other than if the event is actually worth going to, is whether or not I'm gonna put someone else at risk. I understand that by being vaccinated and by wearing a mask and taking other precautions that I really am safeguarding myself. So for me, really, it's a question, if it's a worthwhile conference, I think it's important to think about whether or not I could potentially be putting someone else at risk. And if you're not, if that doesn't really apply to you, then my advice is to go. I think often when we evaluate these things, we think about, oh, well, out of an abundance of caution, we're just gonna stay home because that's something that reduces any possible bad outcome. And we forget that it sounds a little silly, but not attending conferences, not going out, not doing normal things, all of that, those are negative consequences. And certainly we've seen with kids and virtual schooling that some of the kids don't seem to learn very well with virtual schooling, right? There are consequences, negative consequences, to us choosing not to do these things. And so again, for me, I would say that, for me, the major concern really is whether or not you're gonna put someone else at risk and a high-risk individual. And if that's not the case, and you feel that this is going to be a great conference, my advice would be to go. We've discussed that if someone were to test positive on-site at the event for COVID, that we would not need to shut down the event. Of course, we would notify everyone. And this is, again, is where we're talking about where all participants are vaccinated, of course, which we are requiring in our events. So that we don't need to shut the event down and that participants don't need to quarantine. Can you provide a little more context there so the audience understands why that's the case? Right, so the protocol for folks who are vaccinated is quite different from folks who are not vaccinated. The presumption with folks who are vaccinated is that they do not have COVID, right? It's very unlikely that you're gonna develop COVID. And so they don't have to follow the same protocol. So CDC has been consistent with this throughout and now into this period of the Delta variant, saying that if you are vaccinated and you're wearing a mask and you know that someone has COVID at the event, then basically the people who are close contacts, right, not everybody at the event, but people who think that they have spent a substantial amount of time, essentially right next to that person, that they wear a mask, which of course everyone would be doing at the event already, that they get themselves tested three to five days after the potential contact with this person, right? And that three to five days is recognizing that having the vaccination may cause you to become symptomatic later than you might otherwise do, right, because the idea is that the vaccine, even when you, even if you were to contract COVID after being vaccinated, if you were so-called breakthrough case, that the vaccine would basically help your body to fight off that infection and it wouldn't be as severe or as apparent. So again, to wait for three to five days after the exposure and then you could stop wearing the mask if that test that you do at three to five days turns out to be negative, if it turns out to be positive, then you should wait for a full 14 days from the exposure, meaning if it's positive and you, in fact, did contract COVID, after 14 days you wouldn't be transmitting the virus to other folks, you'd probably be feeling much better and you could then stop taking the mask. I'm wondering, have you attended any in-person events or large gatherings recently and if you have what helped to make you comfortable in attending? Well, as you and I have talked about a little bit offline, I've actually been doing quite a bit of work with mass vaccination centers around the country. I normally, in a normal non-COVID year, attend many, many conferences. I haven't attended any conferences in about the last four or five months and or even large meetings. However, I've been traveling to many of the federally funded and federally operated mass vaccination centers, essentially trying to help them do a better job at that mass vaccination process. And in a funny way, the mass vaccination centers feel a lot like a conference. You're in a big room, there's people milling about, some people are waiting online, there's different booths offering different services or information, and of course there are people there who are in the case of the mass vaccination centers by definition, not vaccinated. Essentially, everybody who's waiting in that line is not vaccinated. Now, I am fully vaccinated and have been for months and months and I felt comfortable doing that work and being in those locations. One, because this is what I do, this is what I'm trained to do, but also because I'm a healthy person, I'm vaccinated, I do not live with high risk people that I could potentially transmit the virus to, and also that I was wearing a mask the whole time. So for me, again, there was sort of pseudo conferences, it sort of felt a lot by being at a conference. And I would have no problem attending a worthwhile conference now, again, given that I'm vaccinated, not at a high risk myself and would be wearing a mask. Yeah, and as you said, using your mom as an example, being sure to do the distancing and then getting a test afterwards before you saw her too, which is terrific. Right. Dr. Selenikio, thank you so much for joining us for the work that you're doing with us to help us get our community back, of course, to in-person events safely, also for your tireless efforts, along with all of our other first responders on those vaccination centers and all your work with FEMA. To our audience, we hope this helps you in making a decision on whether to join us or not this fall. If you decide to do so, we look forward to seeing you on site and in-person. Thank you.