Coronavirus (COVID-19): Press Conference with Joseph Allen, 12/14/21

You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Joseph Allen, associate professor of Exposure Assessment Science and director of the Healthy Buildings Program. This call was recorded at 11:30 a.m. Eastern Time on Tuesday, December 14th.


MODERATOR: Dr. Allen, do you have any opening remarks?

JOSEPH ALLEN: So first, thanks so much. And my only opening remarks, normally I’ve had something prepared, but I think I’ll just get to questions. So my only opening remark is a thank you to Nicole and everyone else at the Harvard comms team, they’ve been doing this for a long time and hosting these sessions. I know a lot of my faculty colleagues that participate. It’s a great way to get a lot of information out quickly. So special, thanks to the Harvard comms team, is my only opening comment.

MODERATOR: Well, thank you very much. And also a reminder, if anybody needs information from this call later on would try and post these all out on the website as well. So if you didn’t quite get your notes done, try and check on the website in the next couple of days and this should be posted there as well. So you can use this during the time out as well. All right. First question.

Q: My question is really about the current situation here in New England and I think across the Northeast that we seem to be in a really bad Delta surge right now. And I’m wondering, there seems to be sort of patchwork of restrictions going up here and there. What restrictions do you think should be imposed and what’s likely to do any good at this point?

JOSEPH ALLEN: This it’s a great question, I think what we’re experiencing is something that we all knew and predicted was coming right about now. Just like we saw last year was a rise in cases, and I don’t think anyone thought that the Northeast or anywhere in the north was going to be immune to the Delta surge that we saw there through the South. Key difference being at least in some regions like New England, we have a much higher rate of vaccination. I think some key things that have to take place, and I think there already are one. Well, first, let me take a step back and think about risk. I think too often we’ve been relying on one number to characterize what’s happening in the country or the region. The two most important determinants of risk are age and vaccination status. I am still seeing way too many pieces getting written and graphs being shared that show one number for the whole region or kind of conflating that issue. So risk is really different by age and vaccination status, and we’re really fortunate in the Northeast to have high vaccination rates, in particular high vaccination rates for the most vulnerable. So I don’t think this is going to be like what we saw in the South, even with a higher number of cases now, certainly the case numbers are increasing. But tracking the Boston wastewater data and tracking that for over a year and we’re above the peaks that we saw last winter, which is expected because Delta is much more transmissible, and the economy and society is a lot more open than it was last year at this time. A case in an 80-year-old ranging from a case in an 8-year-old and a case in someone’s vaccine is very different from someone who unvaccinated.

In terms of the strategies that we need to deploy, we need to double down on vaccinations and get vaccinations out to a wider group of people more quickly. I’m still hearing reports, even in Massachusetts, of friends and colleagues and acquaintances who were waiting days and days, sometimes weeks, to get their shots. That’s unacceptable at this point. So we need to push vaccinations. We also need to push boosters. It’s becoming clear the benefits to that third shot. The booster shot are really clear in terms of bringing up protection from any infection for Delta and certainly looks similar for Omicron. That’s going to be the case. So it looks like to me that this fully vaccinated, it’s going to mean three shots. If he said to me, shots are going to be a third shot are booster shots and that’s number one too. We should continue to push to get kids vaccinated. All my three kids are vaccinated. I think that’s critical. Particularly to help slow the spread in the region. Third thing is, and we’ve seen this at the Baker administration, but the nice job of increasing the availability of rapid tests, particularly in lower income communities. These tests, unbelievably, are still hard to find, and they’re expensive. I mean, it’s still twenty-five dollars for two tests. Their free in Europe. So we need to expand the use of these rapid tests quickly. And I like that move by the Baker administration, not just increasing the number of tests that are available, but also making sure that those most in need actually get the test. I think those two things will go a long way. Vaccination briefings, vaccinations, boosters and rapid tests.

Q: Thank you.

MODERATOR: Next question.

Q: Thanks. Can you hear me OK?

JOSEPH ALLEN: I can hear you.

Q: So you mentioned the three main things you mentioned did not include masking, and there’s a lot of public health people kind of shaking their fists, the governor baker saying we shouldn’t have a statewide mask mandate. Where do the masks fit in? Should there be a statewide mask mandate and would that save lives?

JOSEPH ALLEN: So let’s be clear, masks work. I’ve been a big proponent of universal masking for a long time. I think the vaccines change that. I don’t think the path out of this pandemic or even through the surge is masking the vaccinated. I think when they have places where everyone is vaccinated, then you don’t need to wear a mask. That’s the policy that was just put in place in New York, for example. So it’s either vax or test. And I think that’s right. So I mean, we should be crystal clear, if you’re unvaccinated, your risk is extraordinarily high right now if you’re an adult. Absolutely. You should be wearing a mask. I think the conundrum of the difficulty is from a policy standpoint. How do we convince people who won’t take a life saving vaccine that they should mask? That’s where the most benefit is going to come if that took place, but the people who are not vaccinated at this point, the adults who are not vaccinated at this point are also the people who are unlikely to wear a mask if you’re vaccinated and boosted, there’s little additional benefit to having that mask. So I don’t think that’s going to be the policy lever that’s most important at this point. I also want to say we have all the tools in place to meet everyone’s acceptable risk level if that feels unacceptable to you, you should be vaccinated, boosted and absolutely wear a High-Efficiency mask if you’re doing that. If you’re vaccinated, boosted and wearing a really good mask, that provides about as good as protection as anyone can get.

Q: So as a public policy matter, then you don’t think it would be basically worth the trouble to put in a mask mandate in Massachusetts as a handful of other states have done?

JOSEPH ALLEN: Well, I actually like what they did in New York City, which is mask mandates in public spaces. But if you’re fully vaccinated or you have people who are tested, but I don’t think it’s going to provide that much additional benefit.

MODERATOR: Are you all set?

Q: Yes.

MODERATOR: OK, next question.

Q: Hi Dr. Allen, thanks for doing this. You actually touched on two of my questions. And in this first two, but I was going to ask you, Boston is considering some sort of vaccination for entry policy for things like indoor dining. And I was curious, you mentioned you just like New York’s policy. So I guess my first question was just if you’d elaborate on that and why do you think? And in Boston outside the mask mandate, would you be advising some sort of like either masks or vaccination required policy for indoor public places in Boston?

JOSEPH ALLEN: Yeah, we should’ve been mandating vaccination for entry a long time ago. I’ve been to New York many times this fall. It’s terrific. I wrote about this in The Washington Post in August. The voluntary approach to vaccination hit its limit. We knew this in the summer. We knew we’d be in this spot in November, December, and the only way to push us past this plateau we were on and for vaccinations were for vaccine mandates, and they’ve been very effective. We saw a lot of companies do this on their own ahead of the formal move by the government that’s now held up by the federal government. And that’s been very effective. We’ve seen it in the U.S. military. That’s now, what, 96 97 percent vaccinated after the mandate went in. We’ve seen this in unionized workers look at New York City again for emergency medical workers police department fire department, where over the summer and August they were hovering at about 50 percent vaccinated, plus or minus maybe 10 percent, depending on the group. Now they’re all up in the 80s and 90 percent. So the vaccine mandates are something that we’ve been really far behind on. We should have been doing it several months ago. I absolutely think we should be doing it right now. And I think I mean, it’s clear that people who are vaccinated are much lower risk for severe disease impacts of this virus. People are vaccinated and boosted aren’t much lower risk of any infection. We have the tools at our disposal to really tamp down spread and also the worst impacts of this virus. And I don’t understand the reluctance for organizations to not mandate vaccines at this point.

Q: And then my other question that you also touched on earlier, I know you monitor the Boston area of wastewater data. And I feel like over the last week, we’ve seen it kind of peak to these all-time highs. But how should people be interpreting that data, especially given the vaccination rates here and what you were talking about earlier about how now we’re in a situation where there aren’t like as many restrictions as there were before?

JOSEPH ALLEN: Yeah, I’ve been tracking this data for a year. And the key difference is that, you know, December 2021 is very different from December 2020 in terms of the controls and the protections. And we’re a lot more open as a society than we were last year. And we see this these high number of cases, but we have very high vaccination rates for those most at risk, those who are older in particular. So I think what I’ve writing about this in March, looking at the wastewater data is that what we hope to see is a decoupling of cases where that wastewater is a great early indicator of cases. But at this point, it’s cases are not the. Are not the only metric we should be tracking as an indicator of community risk. In fact, I think an under discussed issue is the is the CDC’s use of two metrics that are quite honestly, really deeply flawed to set things like masking requirements or recommendations, right? They’re solely tracking cases and percent positivity. And I’ve written about this several times. And so of other infectious disease epidemiologists, how some of these metrics are just not appropriate for the moment. So I think the same thing about wastewater monitoring, I love it as an early indicator of spread. At the same time, I think it’s not just like cases, it’s not an indicator of community risk. It’s an indicator of community spread. Okay, thanks.

MODERATOR: And if you’re wondering what that case wastewater numbers are, there is a link to that in the chat. The Boston wastewater numbers. So there’s a chart can see there.

JOSEPH ALLEN: There’s a little lag in that reporting to, I think, the last data on there. I forget maybe two or three days ago and at least the peak, at least in one of the regions, looks like it’s well, but it didn’t continue up. It looked like continuing down whether that stays on a plateau at that peak or is actually the start of a turn. We don’t know what was interesting last year. If you remember this, the wastewater data actually predicted a turn in cases earlier than the case data and even before the vaccines hit, so we actually saw it. If you look, I can post the thread. I have a thread on Twitter going four since last year, but it was about mid-January. We saw that it starts to turn the wastewater data and then sure enough, we start to see case data hospitalization data. Follow that through the end of January and February. So it is a really nice early indicator of spread. I think the challenge, though, of course, is you just don’t know, is this spread in 20-year old’s who are who are at less risk than an older population and that the vaccination rates will determine the risk.

MODERATOR: Next question.

Q: OK. Well, I think a lot of people are wondering how to deal with the upcoming holidays and would seem like we did see a surge of cases in Rhode Island where I live after Thanksgiving. What do you recommend for the many of us who have either been vaccinated but not boosted or have our boosters, but haven’t waited a full two weeks for them to really take effect? Should we be skipping Christmas parties or if you’re just vaccinated but not boosted in your not elderly, is it OK to go ahead and celebrate the holidays?

JOSEPH ALLEN: Normally, I would say definitely. It’s OK to go ahead and celebrate the holidays. I think this is what the vaccines have afforded us. And so a couple of things. If you’re fully vaccinated under the current definition, you’ve got your two shots. You’re very well protected from severe disease, hospitalization and death from the Delta variant. And there’s a reduction in the protection against any infection from Delta and Omicron as well, but it’s more severe and Omicron. But that said you have that protection. I would gather with other people who are fully vaccinated. I think that makes a lot of sense. I would also get your booster, and I think there’s a slight misunderstanding out there on how quickly the vaccines and boosters take effect. If you look at even the vaccination data, it is true that we say, you know, two weeks pass. The second dose is when you’re fully vaccinated, but you get the vast, vast majority of protection after it within 10 to 12 days of that first shot. Same thing with the booster. If you got boosted today by Christmas, you will have excellent protection because think about it with the boosters doing it essentially, its reawakening your immune system to the virus. And just like if you were exposed in the community, you wouldn’t expect your immune system. You’re vaccinated, you’re exposed. You wouldn’t expect it to take two weeks for immune system to kick in and protect you. In fact, it kicks in immediately and you start to. Maybe you have mild symptoms a day or two and then your immune system starts winning the battle. So the same thing with the booster, right? So you actually see the effects within that first week of protection. It’s not, quote unquote full protection. More time, the better, but you actually get a benefit. So I no, we shouldn’t discourage anyone from getting a booster day thinking it’s too late for Christmas, and certainly it’s not too late for New Year and that whole the week between Christmas and New Year’s. So it’s important for people to even if you haven’t been vaccinated and you want to be protected by Christmas, get your first shot today and you’re right at the cusp there. You know you just you’ll just get it in time to have excellent protection, not full. But the vast majority of it kicks in after the first shot.

Q: That’s good to know. Can I ask a quick follow up on the rapid tests? I’ve taken a couple when I’ve gone to visit friends who are high risk immunocompromised people. I take it right before I see them, but I feel like there’s still a lack of understanding about when and why to take rapid tests.

JOSEPH ALLEN: Yeah, thanks for asking that. I should have brought it up my answer, but and I agree with you, and it’s a little surprising that there’s still so much confusion out there because this is a message that’s been many of us have been talking about for a long time now. But so I think it’s straightforward. What rapid antigen tests do is answer the question Am I infectious right now? You think about it? That’s the question we want answered when we visit. People like PCR will tell you, Is there any virus in your body, right? So it could be a little bit. It could be three weeks after infection and you’re no longer infectious. The rapid test answer Are you infectious in this moment? The perfect time to take them is day of. They are a day of tests. In other words, you should take them the morning before you see people, before you leave the house to go see high risk friends. It’ll tell you if you’re actively infectious and they’re highly sensitive and specific. Despite what people have been saying early on with these tests. If you’re vaccinated and boosted and you have a negative rapid test, you can feel quite confident that you’re not infected and also that you’re not a threat to somebody else. Even somebody else is very high risk. So again, this is a tool we should have been using 15 months ago, and I’m heartened to see that it seems like the federal government has bought into this literally and figuratively in the past couple of months, and so have regional leaders like Gov. Baker and several other states and cities are starting to do, including Boston, so. So this is an underutilized tool. They need to be a lot cheaper. It’s people are going to use these regularly. If they cost even $10 a pop or $5 a pop, they need to be a dollar or three. These things should be free and everywhere because then people will use them. It’s easier, you know? But if you think about some people getting together for the holidays, maybe with five people, 10 people, 15 people start multiply that by $10 a test and it’s no longer cheap. We’ve created a barrier to using one of the most effective public health tools we have. It’s been totally grossly underutilized throughout this whole pandemic.

Q: All right, thank you.

JOSEPH ALLEN: Thank you.

MODERATOR: Next question.

Q: I wanted to ask you kind of following up on question about the holidays. We talk again about travel. I’ve heard that planes are very safe because they change the air so often and everyone’s wearing masks. But as someone who just bought an Amtrak ticket, how about trains? How about busses? Do we need to worry about those ones with the ventilation?

JOSEPH ALLEN: Yes, I’m glad you brought up airplanes. It’s something and a little credentialing, in 2013 is one of the lead authors of a National Academies report on infectious disease transmission to airplanes and in airports, and I wrote a piece in The Washington Post early on in the pandemic, probably May 2020, pointing out that you don’t get sick on airplanes, really. And I think that surprised a lot of people. But that message has finally gotten through, I think, which is good. And yeah, it comes down to the basics. Look, one way to think about it before we get into the details of trains and busses. We see very little of any spread outdoors. But why is that? We have unlimited dilution, unlimited ventilation, so we need to make the indoors a lot more like the outdoors by either bringing more outdoor air, increased pollution or cleaning that air through filtration. So if you think about these fundamental principles and even more fundamental, how are we exposed? And this was missed for an entire year. Respiratory aerosols are generated just when we’re breathing or talking, constantly emitting these plumes that travel beyond six feet. We need to dilute them. And on an airplane, you can get 10 20 air changes per hour. And just a reminder and how that works. You get air from outside virus free and of course, led off the engine is called bleed air conditioned, brought into the cabin 50:50 mix of outdoor air plus recirculated air all recirculate air going through HEPA filters. And here’s something that most people miss or beyond this, unlike an office building or a school where air might come in from one corner of a room and leaves the other side. We have imperfect mixing or even dead zones. In an airplane, the air is delivered to each row and exhausted and your feet at each row, meaning you have very high ventilation effectiveness. So not only are you dumping a lot of air and all that air is getting filtered or clean, or the house that’s recirculated filtered through HEPA filters, which are captured just about everything, just about all airborne particles. You have high ventilation effectiveness. So this is why we don’t see spread on airplanes. Can it happen? Absolutely. There are no absolutes in a pandemic or anywhere, but if you look at the even over decades of research on transmission on airplanes. There are a handful of clusters related to air travel. Meanwhile, we have billions and billions of billions of passengers, just not the hotbed of transmission, people think. That said, I always caution and give the same warning we gave in 2013 that during boarding, well, the ventilation and filtration only work if they’re on filters are useless. If there’s no air passing through them.

When planes are at the gate, they’re not always running their ventilation systems. We warned about this in 2013. I was out at Boeing a couple of weeks ago talking about this again and confirmed that their policy is or their recommendation follows, what we said. They’re advising airlines to do this. I have been on many flights this fall and measured the carbon dioxide concentrations, and it is showing what we warned about and in our studies have shown high CO2 during boarding is telling you the ventilation system is not running. So despite our recommendations and the science showing higher risk or higher lower ventilation rates during boarding, at least from my anecdotes and traveling this fall, it’s not clear to me that airlines are running their ventilation system here at the gate. So that’s an area that I would pay most attention to. If you’re traveling, that’s the highest risk part of your travel related to the airplane is definitely during boarding and deplaning until that ventilation systems running in terms of trains, I’ve been traveling on train starts in New York City, back and forth. In fact, I go there Thursday again. I haven’t studied the air quality on trains, so I’m relying on what’s reported by Amtrak, and they’re reporting at fresh air exchange rate of every four to five minutes. So that’s a higher exchange rate. Right. So every for every four to five minutes, they’re reporting a turnover of air. And so what’s that air exchange rate? It’s 12 to 15 air changes per hour. So. Put that in perspective, so that’s similar to what was on an airplane, so I haven’t verified that I’ve done measurements in airplanes, so I could speak about it firsthand. I haven’t done measurements on trains. But to put it in perspective, and we wrote about this in a JAMA article on recommending a target of four to six air changes per hour. JAMA article came out in March, but a home gets about half an air change. Our schools get about three air changes. Hospitals recommend four to six air changes for patient rooms. So that should put these higher exchange rates in perspective in terms of what’s happening on trains and planes.

One area I know that I that I think about a lot, but I haven’t seen a lot reported on is what’s happening on busses. I think a lot of these busses that don’t have ventilation or operable windows, or when it’s cold, the windows aren’t open, you can have very, very little ventilation kind of like we have in cars. And so we’ve done some modeling on cars, which would apply the same way to busses of the recommendation. If you have windows, they should be open even an inch a little crack. If you have windows open and we’ve done this on school busses and cars, you will get very high air exchange rate and the risk of airborne transmission will drop significantly. Also, if you’re running your air conditioning or heat, it should not be on recirculated mode. You want to be bringing in fresh outdoor air. You just don’t want to be recirculating that air because that filters that are in a car or bus are not the kind that are going to capture a lot of these airborne particles. So busses cars should be having their air on off recirculated mode and windows open. Even an inch or two will help a lot.

Q: Thank you.

MODERATOR: I have a question, going along with this question. He’s looking for any travel advice specifically for parents with kids, too young for boosters or even a shot, and whether you might have any assessment of the claims that kids are seeing more serious cases with the new variant at this point?

JOSEPH ALLEN: Yes, I think there’s a couple of things wrapped up in that. The first is just to clarify the vaccines, not necessarily just boosters, right? The vaccines are not approved for those under five, even under emergency use authorization. So not about the booster question. And so if you’re talking about five to 18 year old’s, the boosters available for the oldest teenagers. But current recommendation is to have school age kids, five eight teens vaccinated and the older teens who have the booster available to get boosted. If you’re talking about younger kids under five, I think fortunately younger kids are at much lower risk than adults, right? Still, the hospitalization rate for the for the youngest is on the order of one in 100,000 and even can even be lower so their risk profile is really quite different. I think the best thing to do if you’re concerned is get everyone around them vaccinated. So if you think about your three kids, I know what they were like when they were younger, they’re going to be around you the most. You should be vaccinated and boosted. So should their siblings. If they have older siblings and then if they’re in a high-risk area, then masking is recommended. So I think that also gets to individual risk tolerance again, because again, the overall risk to kids is low. And the best way to protect them. And Tony Fauci has been saying this for a long time now. The best way to protect kids in general is to get everyone around them vaccinated. At this point, I would add. Get vaccinated and boosted. I think that was the entirety of the question.

MODERATOR: I think so. Are there are any other travel suggestions?

JOSEPH ALLEN: For what it’s worth. I’ve been traveling with my three kids. They are 15, 12 and 9. I was traveling with the 12 and the 9year old before they were able to be vaccinated. I feel very comfortable doing that again. I feel like their risk is low. People around them were vaccinated, but we were on planes and trains and I want to see shows and gone to sporting events taking vacations. I think this really maybe the only good thing about the only way we’ve been spared in this entire pandemic is that the risk to kids has stayed low. And the last part of the question was how does Omicron change this? I think it’s all really quite new. There’s another report that just came out today out of South Africa. I think some of the early reports on higher hospitalization rates for kids. A follow up report showed that some of that might be or have to do with whether you’re hospitalized with COVID or for COVID and disentangling that. And it looked like a very high percent of kids hospitalized from the early data were hospitalized with COVID, not for COVID. The new report today suggests a higher risk for kids, although it has to be taken in the context of the overall risk level and whether or not, you know, we’re still starting from a low risk standpoint. I think the data feels early. It’s something clearly that we’re watching. I mean, if that changes, that’s a game changer in terms of risk. But I don’t suspect based on what we’ve seen that it is going to be game changing in terms of dramatically changing the risk profile for kids who have fortunately fared well in the majority.

MODERATOR: Thank you. Next question.

Q: Just another one, I was curious, I don’t know if this is too early to ask, but based on what we know about the Omicron variant is, does that change? Does that change in any way? How you think about ventilation?

JOSEPH ALLEN: You know, it’s a really good question, and my answer is it doesn’t. And the reason it doesn’t change my recommendations on ventilation filtration is because we’ve got those recommendations right over a year ago. In fact, almost two years ago, first piece I wrote February 9, 2020 talks about ventilation, filtration, portable air cleaners with HEPA filters. As far as I know, I still think we’re one of the only groups to set a ventilation target. That should be stunning to people that none of the other standard no standard setting body has actually come out and gave targets to the public. It’s been a real miss in terms of our pandemic response. So the question is about how do we change anything? The answer is no, because I think we were correctly stringent right from the beginning, recognizing that airborne spread, airborne spread was dominant and we put in controls to protect against that. I think we’re Omicron changes. And in fact, what Delta changes is that if you didn’t do this. And you had someone infectious in your building and you didn’t have an outbreak or cases. Maybe you got lucky. I think the margin for luck shrinks with Delta and Omicron. So it’s imperative that people follow these recommendations on ventilation infiltration. I’m heartened to see that now when I see long lists of control measures recommended by CDC and others, ventilation is always in it. Every news story now has ventilation. That wasn’t the case for an entire year. And so I think I think people know it. I don’t know if everyone has done it and by it, I mean enhanced ventilation and filtration controls in the building. And so but I want to make clear that it’s not expensive and it’s not hard, right? And it’s not too late. You can make improvements today that would dramatically reduce the risk of airborne spread in any building. We’ve given tips on this. There’s a portable air cleaner, the HEPA filter size right for the room. You can get that four to six air changes per hour instantly, while you think about the longer term control strategy or how you can enhance or upgrade your ventilation system. But too many times I’ve heard it’s hard as expensive as long lead time. I can’t do it. I think that’s all nonsense. I think it’s excuse making. And quite honestly, I’m tired of hearing those excuses. We’re 20 months into this. The guidance has been out there. The tools are there, the money is there. There’s really no excuse for not pursuing these healthy building strategies at this point.

MODERATOR: Do you have a follow up?

Q: No, I think I think the answer. I’m just to go back to something you said earlier they were talking about how you didn’t understand the reluctance of organizations to require vaccinations or are there any organizations like here in Boston or Massachusetts that you think should be better right now?

JOSEPH ALLEN: I think every organization should be. I fully support the vaccine mandate to the federal government. I wrote about it before it happened. I think there were many companies that took action well ahead of any formal mandate. It’s good. So it’s good public health and it’s good business health. I mean, look around. Look what this pandemic has done to lives, livelihoods, the economy. Entire sectors have been absolutely devastated. We have been given a tool that can end this. With the vaccines, so it’s yeah, it’s surprising to me the reluctance here, and I think the early efforts were, I think the Biden administration’s does an excellent job of providing access to this vaccine, making it easy to get this. The doses are there, the sites are there where I think they and others failed is that it was clear this summer. That the voluntary approach wasn’t going to get us to population level immunity, 80, 90 percent or greater vaccination rates, fortunately in New England, we’ve hit that with our most vulnerable, the oldest, but it was clear we should have acted a lot earlier on these vaccine mandates. I mean, I also understand why we treat these vaccine mandates, as if it’s affront to our liberties. We do this routinely all of the time. So somehow that narrative has taken hold that this is something different. It’s really not. It’s something we’ve done all the time. All of our life and really effective. And so clearly, you can hear my voice. I’m quite frustrated by this. And I think the that I think the mandates are the way to move us off this plateau, especially as we have Delta surging Omicron on the horizon. And it’s clear that not only the vaccination, but boosters are going to become an important part of this story right now and in the coming weeks.

MODERATOR: Next question.

Q: Thanks for giving me another crack at this, I just want to make sure because for some reason, the question of the day is mask mandate, and I want to make sure that I understand what you said. You don’t think that a mask mandate is really going to have that much of an effect in Massachusetts and we should be focusing more on vaccine mandates. Is that fair to say?

JOSEPH ALLEN: Well, I think first and foremost, we should be focusing on vaccinations and boosters and rapid tests, definitely. I also think ventilation and engineering controls are important. In terms of masking, my position I’ve written about this in The Washington Post is that in a fully vaccinated environment, I don’t think people need to be wearing a mask. And that’s really consistent with New York’s policy that just came out. So that’s where I really stand on it. And you know, in theory, if everyone wore a mask all the time, I think they’d be great. I don’t know if people have been outside of some of these centers. You have to go very far outside of Boston? In fact, you can be in Boston and you see that the appetite for this is low. So I’m not even sure that’s going to have a major effect. Some people think, you know, maybe in an idealized sense. Quite honestly, I think we made a mistake for many, many months by requiring or having these strict mask mandates when risk was really low last spring, over the summer and even early this fall because fatigue has set in. And understandably, and I think we’ve taken the power of this tool out of our arsenal by failing to roll it back at the appropriate time so that we could put it back in place at an appropriate time. I think we’ve done ourselves a disservice there. And I think the public is largely frustrated by that messaging. I think when they knew it was low risk at certain times. Yet the public health messaging stayed on code red even when it wasn’t by region. I think that did us harm in terms of our ability to reinstitute some of these. So my position, you know, if you’re not vaccinated, you need to get vaccinated or you need to wear a mask for your risk is really quite high. And like I said earlier, I think the challenge is that. How do we expect people are not taking a lifesaving vaccine that they’re going to continue to wear a mask everywhere?

Q: So if you were an adviser to the governor, you would say this is not going to be effective and it’s not where you would focus.

JOSEPH ALLEN: Yeah. Right, I kind of laid out where I think the. What strategies would have the biggest benefit where we need to be spending our time and attention? I also think that people should be able to work. Anyone who wants to wear a mask should absolutely continue to wear a mask. The benefits of mask are not only when everyone’s wearing a mask. If you’re wearing a high efficiency mask, you’re very well protected. So I think we’ve reached that moment that might feel uncomfortable for a lot of people and that some of this individual decision making really is going to matter. And I understand people being reluctant at different points to pull back on controls. We have the tools to keep people safe. We do so in public settings where people are, where you’re mixing. You don’t really know the vaccination status of people. Yeah, I think masks make a lot of sense and I’ve been clear about that. I think if you’re unvaccinated, you should be wearing a mask. I’ve been very clear on that. I think New York has the right approach where those all those same rules apply. Except if you’re going into a venue and you’re either vaxxed or you test negative, then you don’t need to be wearing a mask. And I support that approach.

Q: Thank you, Dr. Allen.

MODERATOR: Before anybody else raises their hand, or if you have a question. Go ahead, please raise your hand. But while we’re waiting, you had mentioned in what I asked you what you could talk about today, what returning to the office would look like in the coming months and also setting goals and expectations that determine our response to the pandemic. Would you like to talk about those and how do you see returning to the office and schools in the next few months? Well, most schools are back, but returning to the office the next few months. And how think Omicron can affect that?

JOSEPH ALLEN: I think a lot of while schools are back thankfully. That was one of the biggest mistakes of the entire pandemic was closing schools. And offices or many offices are coming back, I think there’s still a high level, a level of anxiety, and I think Omicron is contributing to that and understandably so. I think what’s going to happen, I expect this conversation to be even more robust in the coming weeks is a little bit what I wrote about in the New York Times in August with my colleague Helen Jenkins at Boston University School of Public Health, which is at some point the country is going to have to have a conversation about what our goals are because it’s not clear now if the goal is zero COVID, that’s long gone, but it would lead to a certain prescription of policies. If you’re managing cases, it’s a certain set of policies if you’re managing towards hospitalization and severe disease and death. That’s a different set of policies. I don’t think the administration or even regional leaders have been clear about what we’re trying to manage. Some are talking about. If we’re managing, it’s no longer a crisis or there’s not a threat to the health care system, we’re going to manage it one way. I honestly think that’s where a lot of the disagreement is happening, even with the experts, is that we’ve actually failed to set or talk about what our goals are. And I think Omicron is going to change that, especially as you see that it’s leading to higher no breakthroughs, particularly for people who are not boosted. At least that’s what the early data suggests. We’re going to have a lot more cases that hopefully continue to be mild cases and people who are vaccinated the vast majority and boosted. So I think the country is going to have a lot more of this conversation in the coming weeks and months about what our goals are. I think the same applies to businesses as we think about what does that mean for return to business? What is your strategy and your company? If it’s absolute zero spread, you cannot ever have a case. Even if everyone’s vaccinated and it’s a mild case, then one set of policies would be put in place. I’ve done this forever. We can design buildings with zero spread. There’s no question. The problem is at some point there is an impact on how that space operates and functions. So I think businesses are going to be facing that going forward. I’m optimistic is that what I hear from the business community is not a oh, anything around once we’re done or out of that, the crisis phase, you know, we’re all done. Plexiglass goes away and it’s back to the old ways. I hear a fundamental shift in how they’re thinking about their buildings, specifically my domain, where healthy buildings is not a one off that we dealt with or needed for the COVID crisis. But it’s going to be part of an operational shift as the C-suite continues to pay attention to just how important buildings are for the health of their employees, but also the health of their business operations and the fact it’s existential for some of them. So I’m optimistic there that one of the key learnings coming out of this will be a continued emphasis on this healthy building strategies.

MODERATOR: Great, Dr. Allen. I was going to say too, we had a paper that came up fairly recently about that, about buildings and ventilation, poor ventilation actually making workers more tired, more sluggish and less productive because of the poor air quality.

JOSEPH ALLEN: Yeah, we’ve been writing about this in my Lancet. The task force that we put out a report on schools in particular and talking about all the benefits from these healthy building strategies in terms of COVID, but also the many multiple benefits that come with it. Better reading comprehension, better math test scores, fewer asthma attacks for students. Same thing applies for commercial office space. We just completed a global study of office workers and cognitive function and find that higher ventilation rates are associated with better cognitive function of workers. So that’s why these strategies are so important. They help against COVID, help against influenza, other respiratory diseases, but also help or provide these multiple positive benefits in our study showed better cognitive function and worker productivity. So it’s really a win situation. There’s really no reason why you shouldn’t adopt these strategies. It’s good for the moment, but it’s also good going forward. So like I said, I’m really kind of excited by the conversations I’m hearing, particularly in the business community, that this is not one and done in terms of improving your building. This is going to help. The building’s movement is going to sustain.

MODERATOR: Thank you, Dr. Allen. Do you have any final thoughts for us before we go?

JOSEPH ALLEN: Thanks to everyone who joined us. Appreciate all the good questions and thank you. Hope you all have a nice holiday!

This concludes the December 14th press conference.

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