Coronavirus (COVID-19): Press Conference with Michael Mina, 02/12/21

You’re listening to a press conference from the Harvard School of Public Health with Michael Mina, assistant professor of epidemiology and a faculty member in the Center for Communicable Disease Dynamics. This call was recorded at 11 a.m. Eastern Time on Friday, February 12th.


MODERATOR: Dr. Mina, do you have any comments for today?

MICHAEL MINA: No, I’m happy to take your questions.

MODERATOR: Great. All right, first question.

Q: Hi, Dr. Mina, I know you’re traditionally a big advocate for testing, but if I can, I’d like to ask about masks for a second. So given the new guidance I wore to masks yesterday and it was uncomfortable and honestly kind of annoying and considering the difficulty we’re having, at least here in Florida, getting people to wear one mask, I don’t think we’re going to have a lot of uptake with two masks. So if you could, talk to me about what’s at stake if we don’t double mask and how we can gain more public acceptance of the practice, please.

MICHEAL MINA: Well, you’re hitting on something that on the one hand, I don’t evaluate human behavior, so it’s not exactly in my area of expertize. But it is something that many people like me have been thinking about a lot for the last year. So I can speak only from that perspective. And I think that, you know, getting people to change their daily behaviors to such an extent, like wearing a mask all day outside, I think there are some places and some personality types and whatnot that just won’t really gravitate towards that as a useful tool or as something that they necessarily want to buy into. I think the best thing that we can do is continue to push forward, to continue to remind people of just how important it is to do these these somewhat small things, even though I think wearing a mask is a is actually a fairly large thing for a lot of people. Wearing two masks, I do, I agree we have to be very careful when we start making recommendations about two masks or to really go down the road of recommending that everyone only wears an N95, for example. Nobody has made that recommendation. But as an extreme, we wouldn’t want to find ourselves in a position where we are so aggressive in terms of recommending something that people just so don’t want to do, that they end up throwing all of the, you know, the single mask away as well and say it’s not worth it. I don’t want to participate in this public health effort. And so it’s hard to quantify exactly what it will mean if everyone did wear two masks versus one mask. We know that even with two masks, people still won’t wear them correctly oftentimes. I mean, I think all of us have seen many, many, many examples of people without with their mask only half on and things along those lines. So, you know, I don’t think I think it’s a very, very difficult thing to actually quantify. I don’t want us to push so hard that people aboard all of the public health measures and just say this is getting too overwhelming, you know, probably what we should really be thinking hard about doing as a nation and as a globe is trying to find even better materials to create masks with rather than putting the onus entirely on the individual. Can we actually come up with new tools that are going to be even better, that are going to be much more comfortable, fit, much nicer than current day masks that break the mold of what is a mask that we recognize today, what could it be? Start reimagining it. There’s been some effort to sort of work on this at institutions like MIT and other places that have tried to create new materials. But that’s kind of where I think in the long run, we should really be looking rather than just trying to sort of double up on more and more uncomfortable things. But for the moment, for anyone who’s willing to, I would recommend filing guidance and trying as much as you can to wear your mask appropriately and double mask, if that is appropriate.

Q: You already answered my follow up, so thank you so much.

MODERATOR: Next question.

Q: Hi, Doctor. Thank you very much for talking to us today. I wanted to get your reaction to the Massachusetts decision this week to allow a plus one policy, allow people 75 and over to bring along a companion. There’s been some confusion about how it works and some concerns about whether or not it will be abused. Do you think it’s an efficient public health policy?

MICHAEL MINA: Yes, I haven’t read the details of it, but I think that it makes sense. Especially if somebody who is older, is bringing whoever that companion might be, that means that those two individuals likely have a certain amount of contact. Maybe it’s a child or whomever. And so keeping the companions safe, on the one hand is just adding to the overall reduction in susceptible individuals in the community at large. But also, that individual who’s showing up with a more vulnerable individual, with the older individual, is likely going to be somebody who otherwise could pose a risk if that person was going out into the world. And so it’s actually quite efficient if we focus our vaccination strategies. The moment we’re starting to go below the age category is the next best group to really focus on would be those people who have constant or at least high exposure to the individual who’s the primary person getting vaccinated. So I think it does make sense. I think the faster we can get people vaccinated and if it means that people come as a duo, then I think it’s absolutely appropriate to try to see if this can work. At this point, I think we’re still in a very hard place. We’re starting to ramp up. Vaccines are clearly becoming more and more available, which is great. And if this can help encourage individuals to get vaccinated, to get older individuals vaccinated, I think its all better public health.

Q: This does seem to fit into a pattern in Massachusetts, and I don’t know how widespread it is across the United States of seeming to focus on one group at a time. We try to get all the health care workers vaccinated before moving on to the next group. Then we try to get all the first responders. Now we’re trying to get all the seventy-five plus people vaccinated with this new policy of a companion before moving on to as many other states have already done, 65 and older, teachers, essential workers. Which strategy do you think is the best? Deliberately trying to get all the initial phase groups vaccinated or moving on to the next phase more rapidly to go to a wider net, if you will, of the population?

MICHAEL MINA: Well, I think the answer to that really lies in, are there places that are distributing vaccines right now to the most vulnerable age groups that are sitting there twiddling their thumbs, wondering why nobody is showing up? If that’s the case, then absolutely we should be we should be moving through and trying to say, you know, we we’ve gone through as many people in terms of the rate that we can vaccinate people. We should start moving on. But it’s every if there’s still a queue for more or less all of the locations that are providing vaccines, then it’s not necessarily wrong to do it in these bins. Every expert that you talk to will have a different view of who might be the most appropriate is the focus on on vaccinating the vulnerable person, is the focus on vaccinating the public servant and that there is no right answer here. I think that if we are trying to look for some sort of objective right answer, it would be watch which method overall over the next, you know, over the coming months is going to reduce the burden on the public the most. But how you define the burden has been a massive challenge throughout this entire pandemic. Is the burden one of mortality derived from the virus? Or is the burden one of being out of work or keeping or closing down your business or going broke? And I don’t know that there is. I think that, you know, I’m not personally equipped to really say what is the most important piece to society. And I don’t think any one person is. But I do think that the approach that’s being taken is at least one direction and one approach to actually break through some of the barriers that you just mentioned. The companion idea is actually a concession on that front to say it’s not only going to be this age category, but also to be somebody who interacts with this age category. And so that does start to increase the availability to other groups as well.

Q: Thank you very much.

MODERATOR: Next question.

Q: Hello and thank you for taking my questions, so I have a question on the parameters used by pharmaceutical company to basically run the clinical trial. So, as you know, there is a debate about whether or not vaccines can also prevent the transmission, so, blocking the infection and not only the disease. So I talked to the former director of the European Medicine Agency, which approved the vaccine in Europe, and he said that basically there was no consensus about the international regulators as to whether companies needed to show efficacy or effectiveness, both for the infection and the disease. So basically, the protocols were adopted at the national level. So I was wondering whether different countries where different companies perform their trials, so basically the regulator of all those countries adopted different protocols for companies which are selling the vaccines worldwide. And I really don’t understand how this could happen. And do you feel, is it is something normal, that the initial regulator basically told the companies to test just for the disease, not for an infection, which is something normally in vaccine approval.

MICHAEL MINA: Yeah. I had this conversation with Helen Branswell, a while ago. And it’s an interesting question because it really gets into into this discussion about, you know, what is the role of the regulatory agency versus the companies in particular in the midst of a pandemic. So normally regulatory agencies are regulating the products provided to them for the claims that the companies provide. Normally, we exist, at least in the United States, in a free market capitalistic society. We could have bad things happening to us. And the private sector may or may not come in and say, hey, we want to create a tool that is going to help deal with that problem. And so it’s very important to recognize where the regulatory agency, where their role starts and stops, and in this case, I think that there is a big question to be asked of. For example, we can take the FDA. There was guidance put out with regard to the vaccine trials and what would be an OK metric for an OK bar at minimum to pass for the FDA ultimately to provide an emergency use authorization for the vaccines, specifically for Pfizer and Moderna initially. And that was all based on symptoms. And so that was just the metric that they put out. My personal feeling is we should take a big step back before we leave those metrics up to the regulatory agencies, we should also ensure that the regulatory agencies are putting out metrics that are also needed for public health in this case. And so transmissibility and whether a vaccine is going to prevent transmission is a different metric. And could you actually have two vaccines, one that actually gets an authorization to be used with a claim that it will prevent symptomatic disease and a different vaccine or maybe the same one with a different claim that says that it will help prevent transmission or not? So I do think that it’s somewhere where we don’t have a terrific framework to really try to build to ensure that the way that they’re being regulated is entirely in lockstep with what they need. And I think this was the most basic need was can we get a vaccine which will reduce susceptibility to symptomatic disease. That is sort of the bread-and-butter way that you could view a vaccine. But that’s really still taking this very individualistic approach of what is the role of the vaccine. We usually consider vaccines to be they are regulated at the level of the individual who’s receiving the vaccine, and things don’t usually go beyond that. We could go to an extreme and say, should regulatory bodies actually be enabling a whole different approach? Could you actually have a vaccine that doesn’t prevent symptomatic disease? But that somehow it does prevent transmission. No, I don’t think that would be a biologically feasible vaccine to exist, but would that be acceptable? Because then then really what it’s doing, though, is it’s saying that it’s not actually helping the vaccinated individual. It’s helping the vaccinated individuals, colleagues or friends and family. And that’s not really how we regulate the safety and utility of the product that’s going to be injected into somebody, and so I do think that opens the door for a much broader discussion about what is the role of regulation. Is it always about the personal individual health or can we do a better job to ensure that that especially in the midst of a public health crisis, that the tools that we’re getting regulated are actually trying to tackle the problem at hand, which is the pandemic and not necessarily the individual symptoms? Both, of course, are important.

So I guess it’s a long-winded way of saying, I do think that we have work to do to try to improve the way that we’re really thinking about the regulations. And I do think that it’s an area where the regulators kind of drive the discussion in many ways because that’s how the for-profit companies want to know, what’s the minimum that they need to do and show to get over the line so they can start selling their vaccines regardless of how good or bad their intentions are. That’s essentially how it works out. So could we have a greater dialog between regulators and public health professionals to say to the regulators, you know, you have an immense amount of power to drive how these vaccines are evaluated and even how the vaccines are created because they’re going to create them with the regulation of mind. And we could leverage that to sort of now, if we could pull a lever on one area in this entire pandemic, I would say it’s at the level of the regulator. And if they say that a vaccine needs to block transmission, then all of a sudden, every vaccine company is going to really be focusing on the development of vaccines that would do that as well. So I do think that I would like to see in the future that that becomes a larger part of the overall picture of regulation for both vaccines and other products.

Q: Thanks a lot. I just have a very quick question. Many scientists say that we need to speed up our vaccination so we can prevent contagion, the transmission of variants. But consider the fact that, as we just said, the vaccine is not to prevent transmission. So if you actually vaccinate many people, it doesn’t prevent variants probably from make meeting since the vaccine don’t necessarily trannsmission. So I don’t understand this claim saying that this was impossible to block this variants.

MICHAEL MINA: Well, it really comes down to I think biologically we can look and ask the question reasonably well of a vaccine that is reducing symptoms sufficiently so that it actually has said it shows up in trials, would it be likely to decrease transmission? If it doesn’t do anything to transmission, then if the goal is to decrease variance spreading across the population to unvaccinated individuals, then you’re absolutely right. But biologically and just taking our common knowledge of what we know about vaccines and immunity and viruses, we do expect that we will see transmission reductions. Any time you have an immune response that’s able to really reduce your severity of infection, it should reduce the viral load to some degree. Maybe it doesn’t decrease the peak viral load per say, but maybe it increases and accelerates the clearance of the virus once somebody achieves that peak viral load. So the actual gains, I think we’ll have to wait and see and really do. We should have been doing this trial months ago, I think, to really understand if transmission is being blocked and to what degree. But so far, we’ve seen some limited evidence that suggests that when you couple that to our prior knowledge of immunity and viral clearance and there even some cat models that have shown reduced viral load in cats, monkeys that have been vaccinated, I think all of it adds up to suggest that vaccinated individuals on a whole will likely have a lower sort of a propensity to transmit the virus in large quantities to others. And so we can expect that it will have some gains, but we’re just not sure what the level of those gains will be.

Q: Thank you.

MODERATOR: Next question.

Q: Hi. Thank you for your time today. My question is actually a sort of a follow up to what you were saying, because I was wondering how these variants and their effect on their vaccine, how is all this affecting the goal of herd immiunity? If you could please elaborate, what are the latest estimates on the percentage of people that will need to be vaccinated to reach that immunity level and then how all these variants will factor in and also if we have the percentage of the population that have already been sick. And they are sort of immune to the virus, but they will still need to be vaccinated to count towards that immunity, or will they already have weakened immune?

MICHAEL MINA: So that’s a complicated set of questions. No problem at all. So the first question is. Well, the easiest one to tackle is this question of do people who have already been infected need to get vaccinated to count towards the number immune for achievement of herd immunity? First, herd immunity is on a very big continuum in the same way that our immune systems are on a continuum. So there’s a herd immunity threshold at which point the virus is generally unable to persist and transmit broadly through the population. But leading up to that threshold, as more and more and more people continue to get vaccinated, we continue to build up immunity. It’s sort of like training for a race. Every little bit counts. And so you’re building up herd immunity or decreasing transmission for every new person sort of that gets infected or gets immune. That’s one additional person that’s no longer ideally going to be spreading the virus. Now, of course, based on the last question, that’s not entirely true.

But first, we have to think that it’s all on a continuum and recognize that first and foremost. The next part is, do people who have been infected? Do they need to get vaccinated to count? No. We have seen quite a bit of data at this point that suggests that individuals who have been infected are actually doing quite well. And I have suggested quite loudly at different points that individuals that we should actually be doing serological analysis. And if somebody already has high titers of antibodies that demonstrate that they’ve been infected, maybe we don’t have to vaccinate those individuals who don’t take that vaccine dose and give it to an elderly person next door to that person. That would have been an efficient way. Or maybe a more palatable approach would be if you are already have been infected and you’ve been confirmed, and if you do or do not have detectable antibodies, maybe a different approach is just giving that person one dose of the vaccine and save the other dose for somebody else’s vaccine.

So essentially, people who have been infected, the infection can be considered as kind of driving a large immune response or at the very least driving the equivalent of your first dose of the vaccine. The trickier part of your question is what the role of the variants are. I think the the variants are certainly the ability of a virus to mutate as a vaccine’s Achilles heel, especially these vaccines that we’ve made. We’ve made multiple vaccines that are all almost identical. They all attack this. They all present the spike protein, not every single one, but all of the major contending vaccines present the spike. And that allows the virus a pretty narrow window or a pretty sort of simple path that if they can figure out a way to evade immunity against the spike alone, then they can evade immunity. And we’re already seeing evidence that that is occurring. It’s not one hundred percent. Ideally, people who get some of the variants that are evading immunity, ideally, they won’t get severely ill and die. So it’s still their immune systems are still supporting protection in some enough to a certain degree, not as much as we would have hoped. But if the vaccine, if the virus continues on this march to continue mutating and mutating, mutating, and especially as we start giving more and more people the vaccine, the vaccine won’t essentially elicit a strong immune response to the other parts of the virus because they’re just not in the vaccine at all. That means that the virus is going to have a more focused protein that it needs to evade, that it needs to change in order to evade immunity. And so as more people get vaccinated, are we going to see sort of a more robust set of mutations arise that really do allow this virus to work? More concerningly, evade the immune system? We haven’t seen it yet, but we’re certainly seeing the gradient of evasion. And I do think as that occurs, that has to put it, that should give us pause. That should have given us pause back in May probably or April. But at the moment, it should give us pause now and say, do we need to reconsider the vaccines that we’re pushing out? Should we be reevaluating how we develop and design these vaccines so that it fits more of a model of multidrug resistant tv and how we deal with that, we give multiple drugs at once so that if the bacterium even changes one piece of it, it still has a few other drugs that are tackling it from another side. We could do the same thing with the vaccine. We give multiple protein vaccines so that if the virus starts to mutate this way, there’s still an immune response tackling it from another side. We generally didn’t do that for the first crop of vaccines. But I think we’ll see vaccines 2.0 start being developed very, very soon. And these are going to try to tackle new proteins and deal with this a little bit more head on.

Q: Thank you.

MODERATOR: Next question.

Q: Hello, thanks for taking our questions today. I know that you continue to push vociferously for a national plan for rapid antigen testing. I was wondering, I know you talked about that on January 22nd during that call and said you were having some discussions with the administration. I wonder if that has progressed any further. And the second question I would have is why is it still important to have a rigorous testing regimen and possibly rapid antigen systems out widely in the populace, given that the focus now is on getting as many people vaccinated as possible?

MICHAEL MINA: So my discussions with the administration are generally a bit more one way I advise, and I don’t get much information back, which is totally fine. And so I do think, though, outside of those conversations, I think the administration has made it very clear through a number of signals now that they’re really thinking about testing as a major tool in this pandemic. They did describe a couple of announcements in the last couple of weeks of really trying to support rapid testing procedures so that rapid testing companies thought that we could see a greater distribution of rapid tests. I think that that is a terrific first step that they’re kind of putting their cards on the table and saying, we are going to be supporting this. We understand that these tests are useful.

And I think in the near future, we should anticipate seeing additional announcements to ideally for regarding sort of a more accelerated pathway to get more tests out, not by the summer, but by next month. That’s my hope. And I think that the potential is there. I’m trying to make it known as much as I can that there are tests out in the world right now that are able to scale to many millions and and are very effective tools. And so I think that the administration, I mean Biden in his plan, essentially said that rapid tests are going to be an investment to help reopen society. And I think it’s a smart idea, obviously. I think that I would continue pushing on that. Why are these continuing to be important in the context of vaccines? That question does get asked a lot. I find it perplexing. It’s like asking why do we need airbags now that we have seatbelts or vice versa? Do we really need seatbelts? Another way of airbags. We need all of the tools we can get right now. We still have businesses are still shutting down, we still have, you know, huge, enormous numbers of deaths in the United States and abroad. Most of the world is not going to have access to a vaccine anytime soon. But as we were just discussing, the variants create a whole new obstacle and a series of obstacles for us to contend with. We need backstops, if nothing else, but also, we need tools that are going to become available in the coming weeks for massive numbers of people versus tools that will be primarily distributed through the summer. Now, if the vaccine program works exceedingly well and COVID is no longer a major problem in our society, then I will absolutely stop it. The last thing I want to talk about these days, despite how much talk about it, is these rapid tests. I want this to be over. And so if the vaccine actually succeeds and stops transmission, allows us to very safely open schools and senior living centers and nursing homes. You know, that’s wonderful. That is the best news I think any of us could possibly ask for. But in the meantime, we need other approaches to add a level of security. My grandfather turned 94 yesterday, and he spent his birthday alone, essentially in quarantine in a senior living facility because somebody else had COVID in the facility. That is sad to me. You know, this may be his last year on Earth, and if we could make it safer for people to continue going about their business while the vaccines are getting authorized, I think we absolutely should, especially given the price tag of these is absolutely minimal.

The danger and risk are absolutely minimal. The potential benefits are vast. The return on investment alone is hundreds of billions of dollars on an investment that is much, much lower than that. These tests can help identify infected individuals before they walk into an event, before they walk into an office, before they walk into a school. So getting these tests to people ideally in their homes to be used on a regular basis will work to identify infected individuals and stop outbreaks. And the number of outbreaks prevented by these tests is going to be proportional to the number of tests that actually are available out in the population. And so I think we should continue pushing on all of the tools. It’s the same reason that we’re saying that we don’t say let’s stop wearing masks today because vaccines are being deployed. We all know inherently that that would be crazy. And so these tests, even though they don’t exist right now at the large scale that I want to see them, the investment is great to get them there. And so we should be thinking of them as another tool to help us all get to some sense of security and normalcy as soon as possible. I know me personally, I don’t want to go out and dine, dine out in a restaurant, even though I know that the restaurants around me are all closing down because of this. But it doesn’t feel safe. What I have a different sense of security. If I knew that every single person in a restaurant that was still keeping things based was tested within the 30 minutes before going into that restaurant, I think that would cut down on potential outbreaks by enormous numbers. And so I think that these tools are remain as as important today as they as they were a year ago.

MODERATOR: Next question.

Q: Hey, Dr. Mina, just really quick, over the last two weeks or so, we’ve seen at least in the reported HHS numbers, a drop in tests reported, I think somewhere between twenty, twenty-five percent. Different theories for what’s driving that. And some of it might be positive. One, more people masking, some of it negative, just sort of COVID fatigue. I would just be curious, do you have any thoughts on what’s behind that and whether it’s something we need to be concerned about or just cases go up, cases go down, testing goes up, testing goes down. Just be curious to get your thoughts here.

MICHAEL MINA: Just to just to be clear, you’re talking about the actual test numbers and not the case numbers, is that correct?

Q: I mean, yeah, clearly they’re related. And there’s been some debate about are we just seeing fewer cases because the test. But the testing numbers in particular, I think are down over 20 percent.

MICHAEL MINA: So I do think that it is in large part. It’s fatigue and it’s a reduced frenzy to get surrounding this this pandemic, people are starting to, on the one hand, see that there is some light, especially with regard to vaccines. On the other hand, this has been going on for over a full year, almost a full year in force in the United States. And I think what we are seeing is there COVID fatigue is absolutely real. And the burden and the hurdles that many people have to go through to get tested are quite high. Especially if you’re having to drive somewhere and the payoff is very low right now with tests that you have to make an appointment for, get a test maybe the next day after you’ve made the appointment and then get results two or three days later or more. It doesn’t exactly give you a lot of gratifying, immediate feedback. And so people’s willingness or interest in getting tested starts to go down. And actually, it underpins a lot of the reason why I’ve been trying to push for this really simple at home test is to make it so simple. The only way public health ever works is if you make tools that people can actually incorporate into their daily lives with minimal additional energy requirements to incorporate them. The current energy requirements to get a test of that are very high. And so there was no way that this mechanism was going to be sustained. If people just want to get back to their normal life in whatever way they can and not sitting on dragsters is one of those ways. So I think that that really does play a very important role in all of this. And, you know, having having test numbers go down isn’t the worst thing in the world by any means that I’ve said very vocally that that’s the way that we have been testing, testing people just here and there on random basis, having them just stop through a drive through every once in a while, on their way back from work. If it’s not frequent and if the results take a few days to return, then the effectiveness to prevent transmission plummets. My expectation is we probably have somewhere around a five percent sensitivity to actually detect people in time to help stop their onward transmission. So I don’t know that it’s, you know, in the current framework, I don’t know that it’s not necessarily surprising and it’s not necessarily the end of the world if test numbers are going down, particularly because I don’t think that testing strategy has been very effective so far. But I do think it continues to drive the discussion that suggests that people, you know, people do want these tests. We’ve done surveys which we will be presenting in the near future that have suggested there is an overwhelming desire among people to have the ability to test themselves at home. We can then incorporate voluntary, very simple one click reporting that people can do from their smartphone, for example. These are ways that we can really boost people’s ability to understand their transmission status. It’s not about the numbers overall. It’s about how many people actually know that they are infectious and can do something about it. And that’s sort of everything that I’ve been pushing for.

Q: Great, thank you. And, you know, assuming we can get to sixty, seventy, seventy five percent vaccination, herd immunity, what is the role of testing that? Is it just to track the variants in a clinical setting and just keep pace with the virus or assuming we can get to herd immunity, do we still need the test? What do you think is the role of testing then?

MICHAEL MINA: No, I mean, if we get to herd immunity and it actually works, you know, we actually see cases plummet and don’t come back in the fall, then these tests in the way that I have been describing them, can take a back seat. But one of the most important pieces, in my opinion, of these tests is they can be dynamic. We got into this thinking early on that that’s sort of what you decide to do now is sort of that’s your testing program. But that’s not a good way to it. That’s based on like having all the structures surrounding the PCR test. But when you have tests like these little paper strip tests that can be distributed and used, then what we can do is when I would like to see as we socialize people to just understand how these tests work, how simple they are to use at home to feel comfortable with it. And then if you have an outbreak that starts in your workplace or you have an outbreak that starts in your community in the future, herd immunity, it doesn’t mean that cases can’t happen. It means that on average cases won’t persist. But even if your community has herd immunity, if somebody from the outside walks in with the virus and goes into a school, they could still infect 20 people if there are super spreaders. So it’s not like herd immunity is actually like a human immunity word for protected. You’re protected at such and such a level. It’s really about stopping the onward transmission. And so these tests can be dynamically utilized if you have an outbreak.

I can envision a world where we have a text message that pops up and says, hey, you know, we have noticed that COVID cases have ticked up in your community. Start using your tests twice a week for the next two weeks and hopefully we’ll see cases disappear very, very rapidly. And once they do, then you can stop using the test again. So it can be a very dynamic picture and it can serve as an immediate tool for when these outbreaks do happen, even in the context of herd immunity. And froM a broader picture, I really look at these as part of a of a larger program of it’s now 2021, and we’re generally still using all of the same tools we’ve been using for half a century or more to track pathogens. You know, is there a better way to stop outbreaks, to preempt outbreaks, to not be not tie our hands behind our back and blindfold us every year when flu comes in and just say, I hope I don’t get flu, but can we actually tackle it? Can we have a surveillance system set up that, ah, that fits into this bigger idea that I have for an immunological observatory, a global weather system for pathogens, but then a way to act if we know that the pathogen is coming our way, very similar to how we act towards the weather or to our hurricane, let’s say flu comes in. Do we have to just say we’re OK because it’s influenza at some immutable thing and we can’t change it? Or can we say, actually, look, we all have flu tests in our home. We know that flu is sort of ticking up in our community. Let’s all use these rapid tests for flu and maybe their antigen, maybe their molecular PCR quality type tests like this one.

But in the future, we can envision that we actually give people the tools to help them not get infected and to help them participate in reducing overall burden of infectious diseases, especially respiratory diseases, in their community. I do think that this is a way that it’s time that we start actually recognizing that we can control viruses like influenza and SARS-CoV-2, RSV. We just have to think a little bit creatively about how to do it. I do think that right now is a good stepping point into that new era of being able to reduce the burden of these viruses to was taken on us.

Q: OK, thank you.

MODERATOR: Next question.

Q: Thanks for doing this, because I know you’re under a lot more stress in all of us that so I really appreciate that you make the time. And so I apologize. I missed the first 20 minutes and stocks are moving. I had to deal with that. But could you just reiterate, I’m sure you got to ask this. And then I have a quick follow up. What’s the glide path here for 2021? Are we kind of on an upward path here in terms of things getting better or what’s your take? How do things proceed from here?

MICHAEL MINA: Well, I certainly hope things continue to get better, I expect with a large caveat, I expect things to get better. We’ve seen cases start to really reduce at the community level. I do believe that this is part of a broader seasonal picture of this virus. It’s kind of fitting the expectation are a priority. Expectation for a virus like this was that it would increase in the late fall and decrease in in February or so. And that’s sort of exactly what we’re seeing. So my hope is that we will see this process, that we will see cases continue to drop and we’ll get some reprieve for months. But we also recognize that as we saw last year, seasonality isn’t everything. The source of infection, the sheer number of people who are still susceptible can still sort of take hold and allow large outbreaks to occur. But I do think that we have vaccines that are being distributed widely and accelerating. Ideally, we have cases that are naturally seeming to reduce, perhaps because of seasonal effects, not all of which we fully understand, but we know our real we have a large number of people who have already been infected. My estimate is probably something like 100 hundred million people in the United States have already been infected when you add all of that up. My hope is that for the coming months, we will see a continued decay of outbreaks and decline in cases. The biggest unknown or wildcard here is the variance. Of course, we’re starting to see a variance pop up that do appear to be evading the immune system with pretty decent ability to do so in a in a way that makes me very uncomfortable. And I think if we see variants that are both much more highly, much more transmissible and that can evade some level of immunity and continue transmitting even among people who have been vaccinated, that puts us in a much more difficult position than we were five months ago. Now, this is an outcome that I always expected would would happen. And unfortunately, now we’re seeing it happen. And it is one of the reasons why I think these tests remain. To get to the other question a moment ago, I think this is one of the questions or one of the reasons why these tests remain so important. So we have all these unknowns and it’s just good to have other tools to help us maintain this downward trajectory. And if we start to see if we get to low levels and we start to see an outbreak bounce back, whether it’s because of a variant or because people really just came together and started socializing much more because cases were low, that we start to see this sort of oscillating effect. We can take these tests and we can start using them and very rapidly suppress any of those outbreaks. Well, I’ll stop there for a moment and see if you have another question?

Q: OK, yeah. Just to clarify. And then I just want to do a quick follow up and hopefully lead time for other people on your rapid test. But you put the emphasis on seasonality and not the vaccines, did I hear you right? Is it more about seasonality and not so much the vaccines, the progress?

MICHAEL MINA: Well, we’ve seen massive declines in the recent weeks, and that is not because of the vaccine, but I do think I mean, my expectation is that the vaccine, as we get it more and more and more arms, it will start compounding and have compounding benefits to sort of even if these declines are temporary, for whatever reason, if we can ride the coattails of the current declines that have already existed and try to vaccinate and stop new cases, I think we we put ourselves in a pretty good position.

Q: OK, so on the rapid test here in New York, it’s incredibly easy. There are vans parked around you wait in line is four people. They’ve made it very easy. But the problem is that in my case, it took four days. So that was a four-day window where I really didn’t know how to behave in terms of interacting with other people. So my question to you, and that seems like to too long you and Bill Gates have been saying all along has got to be a 24 hour turnaround or it doesn’t really help. And that’s true. So to your rapid test. So could that be used as a passport, so to speak? Like suppose like a bunch of people wanted to get together and meet in an apartment and have dinner, like, OK, you take the test at the door you’re in. Is that like an appropriate use? Because I hear people challenging that as an appropriate use. What’s your take on that? It sounds like you’re saying it from before. You sound like you’re saying yes. But I just wanted to clarify.

MICHAEL MINA: Well, I think an appropriate use of these tests is I mean, what I’ve said all along since last April or May is that that these tests are add a layer of security and reduction in transmission in whatever capacity people are already, whatever people are already doing. So if you are going to a dinner, either way, having everyone test before that dinner is going to make it much safer to go to that dinner than if nobody was testing. So do I want this to be seen as a license to go out and party? I know I don’t. I’ve always said that I want to be seen as a public health, first and foremost, as a public health tool to suppress the outbreaks. And if we can do that, if we can use these tools to help us very quickly get our point size so that there is so that cases just don’t exist in the community anymore in any real number, then all of a sudden, regardless of whether you’re testing or not before party, everyone is safer. So so this you know, I think it’s very easy conceptually to think of these as entrance tests, the type of thing that you’re describing, where you use these right before you go, let them. The most important benefit to understand about how these tests work is this is the public health benefit to reduce and remove cases from the community at large and really help accelerate the effect of our on the asset. The impact and the ability to get to herd immunity or herd effects through testing is can be very, very rapid. And so if we can get cases to plummet to the point where just nobody is really infected anymore, then all of a sudden it does become much safer to go to dinner, to go to a party, because it’s just very unlikely that anyone walking into that party actually has COVID at that point. So that, I think, the most important feature of these tests that often gets overlooked because it’s a more conceptual idea versus this idea that everyone just tests before they walk into a doorway. That’s the whole idea of having everyone test. Having half of a community test twice a week would allow r to get below one very, very quickly and dramatically below one. And you could actually see the outbreaks teeter out entirely in communities. That would be the ideal outcome. And then everything else is just icing on the cake, whether it’s using these to help add one more level of security and and ease when you go out to dinner or to a restaurant or to a to a party or something. The other bit is if you and I don’t want people to take this the wrong way and think that I am advocating for this to be a license to party in the midst of a pandemic, but that said, I would rather if you had to make a decision between, OK, there’s going to be 10 parties happening with no testing done, but if we do that testing, those are going to be more parties. So people say that could backfire. But in reality, I would much prefer 100 parties to happen where everyone tests before those parties than 10 parties to happen where nobody tests the safety. In this situation of 100 parties with everyone, testing is much higher. And so so even these won’t backfire. It would be extremely difficult for them to backfire. So that I guess that’s a long-winded way of saying, you know what, I think these can be most used for.

Q: OK, I’m done. Thank you.

MODERATOR: Thank you. Because we have two questions left and two minutes left, so.

Q: Thanks, Nicole, and thanks again, Dr. Mina for always being available for these really quickly on the airport conversation and airlines conversation, I just wonder what you think sort of the best scenario is for any kind of domestic travel mandate considering A, international travel already requires tests, but that is a burden borne by the passenger. And B, the fact that many more people are likely to be vaccinated in the time that it takes for them to come out with any rule.

MICHAEL MINA: Yeah, well, I think that on the one hand, the way that we have set up the decision making of the task before flights with like three to five days before you fly, get a PCR test, it is not effective. It’s just not effective, period. In fact, if you get a test four days before you fly. So you get a test three days before you fly. Maybe you get the result the morning that you’re flying it. So it shows negative. But if you were in your incubation period and the test was still negative three days before you fly, you could be at your absolute peak viral titers while you’re on the flight and you’re still pretty symptomatic. So the way that we have been pushing for testing before flights and transit things is not is not particularly effective by any stretch. It’s window dressing. These tests are much more effective. Having a test that you use right before you fly, say, 20 minutes before you fly the gate even, is a much, much more effective approach, especially for something like a flight. If you’re flying to a country where the virus has been extremely well controlled, maybe instead of a rapid test, maybe days rapid molecular test, if you really want to decrease the likelihood that you have any virus in you. But the point is, we need the testing. If it’s going to be effective, we need it to be very, very close to the extent whether that event is flying or whether it’s going to be a sports game or something along those lines.

But right now, that’s difficult for policy to be made around these tests because they just don’t exist in huge numbers. But why don’t they exist? They don’t exist primarily because there hasn’t been the kind of investment that we need to make, which isn’t huge. But Biden, for example, announced 50 billion dollars is going towards testing. And we have been asking that 20 billion of that be specifically dedicated towards these types of tests because they’re the more effective public health test versus the medical tests. And if we were to do that, if we were to actually get 20 billion dollars to go towards these types of tests and the overall public health program surrounding them, we could have billions of tests per month essentially out in the in the world. They would be able then people could actually make plans. They can actually design programs to keep planes and flights safe, trains and busses safe. You would actually be giving policymakers the the tools that they need to essentially to essentially keep places safe using tests like these. And this is I think what it’s not difficult to understand this. And I believe that it’s one of the major reasons the president has made these types of rapid tests a real priority in the American rescue plan.

And so, you know, we’re hoping that Congress is going to authorize the 20 billion, especially given that it has the support of the president of the United States and the most important pieces that it will give tools to policymakers immediately. It will put something in their hands that they can use today to say, OK, how are we reopening schools? Are we reopening flights? How can we keep our borders safe when people come in from abroad? Let’s say that there are worse variants. So we’re just going to shut off our borders or can we actually create tools that are going to allow us to allow people to come into the country, even from a country where there might be a particularly bad variant and continue having society run? And so, you know, and we’ve actually been looking at a lot of these questions from a financial perspective, because at the end of the day, it’s dollars that move things, not lives saved for what unfortunately and we do have economic impact studies that are coming out soon that show just how large the return on investment from a societal and economic perspective is. And getting flights, making flights safe is part of that type of analysis. And the return on investment of these is just so great. And we need to start moving away from the clinical send out laboratory tests if we actually want to have effective testing.

Q: Thank you.

MODERATOR: Sorry, Dr. Mina, do you have a couple of minutes or do you have to go?

MICHAEL MINA: I do have time. I just want to before anyone mentions, if anybody’s interested, we have a memo for Congress that we can share, I don’t know if Nicole, you have that or I think Shauna’s on if she wants to share it in the chat and people want to take a look at that memo.

Q: Thanks very much for squeezing me and my questions also have to do with testing for air travel. Dr. Mina, in the hierarchy of places where you think rapid testing is needed most. Where would you place domestic air travel? That’s my first question. My second one is, have you been surprised at all by the airline industry and travel industry resistance to this idea of rapid testing? I mean, they are just it’s almost daily now that we hear them coming out against it for a variety of reasons. And I’m wondering if you think any of their concerns are valid. Thank you very much.

MICHAEL MINA: Sure. I think it’s certainly not the highest priority by any stretch. I think the highest priority for society right now is the type of broad public health testing that that I’ve been advocating for to get out below one. Because the whole notion there is it’s very much like you can either teach a manifesto or you can give them a fish. In this case, getting r below one at the population level. Ultimately will benefit every sector of society if you put all of your test just into schools or just into flights. You’re not going to stop transmission of the population level. You might make those individual locations safe. But then the restaurant down the road isn’t safe. And if we can use these sorts of get these into the homes of people in a broad enough way so that in the next, you know, it really could be in weeks, we could see cases just plummet. Then all of a sudden, the flights are much safer, regardless of if anyone’s using tests right before their flight, because just the fact that there’s fewer cases in the population. So that’s where I want to see these test bees first. And then after that, I think it really is it’s a societal decision. I think using them to help facilitate the reopening of schools is exceedingly important. The good thing about flights is it’s actually not a lot of people you could get you can one company, one company alone. In fact, one of these companies could make enough tests for every single passenger flying every day. That’s just one company. So it doesn’t have to be an and or thing it could or another thing it can really be. Hey, we have a public health test. This company is making X number of tests. You know, maybe it’s 20 million per day, but you can have a smaller company that just makes enough tests for everyone is flying on a given day. And actually, that’s the nice thing. They can be scaled to such a high number and you can make flights safe or safer. I think there’s been a lot of misinformation about these tests, especially coming out of Europe. We’ve been trying to I’ve been working with a lot of colleagues to write the record and try to explain where that misinformation is coming from. We have a new paper that’s coming on The Lancet, I think, next week to try to discuss some of this. But I think that flights and the big airlines and the airline industry at large, as these tests have been misunderstood, you know, people here, these are less sensitive tests, etc. And so they’d prefer to use a PCR test days earlier. That is, you know, it’s just a miscalculation. And it’s been made over and over by scientists, unfortunately. And we’ve been trying I’ve been personally, obviously very active in trying to cut through the misinformation because the real utility of these tests in the way that they are most valuable kind of goes against the normal grain of how we think about testing. And I do think that the resistance is stemming from the misinformation that’s out there and people’s confusion about are they sensitive or not. The point is they’re much more effective than PCR, given the restraints of PCR requiring days to return. As Michael Rush said a moment ago, a lot of people are still getting results back after three or four days. That makes the test essentially useless to stop transmission. The transmission window is only five days.

Q: So just a quick follow up on that, care to handicap the odds of passengers in the United States seeing Abbott testing required to board flights?

MICHAEL MINA: Is the question, do I think that that will happen?

Q: Yes.

MICHAEL MINA: I think it could. I don’t see why it shouldn’t. These tests are just so, so simple. They’re really very, very simple to use. And, you know, if it stops one person from getting on a flight while they’re particularly contagious, that could potentially stop 20 people from having to be quarantined for two weeks, quarantining 20 people as almost a year of person time spent in quarantine because they’re all 20 of those people out of the quarantine for two weeks, for example. So I do think that the payoff and the reward is really high for these. And I don’t see why they shouldn’t be used.

It’s really very, very simple. And again, I don’t want everything to happen in perpetuity. I want this to be useful as long as they’re needed. And if cases really decline and the risk of people walking onto a plane with COVID false or enough people are vaccinated, so COVID just really isn’t an urgent concern, then we can stop using them. And it’s not a huge cost to really get this set up and get enough tests out to the population. It’s a very minimal cost. So it’s not like we’re investing in something that’s going to take such a toll because of the investment. So I think we should plan to see that happen more. And again, I think as soon as we see the funds appropriated from Congress to really accelerate the development of these, all of a sudden people are going to see just how useful they can be. Right now, it’s still this enigmatic thing. Some people maybe have gotten a rapid test somewhere, but most people still wonder if they even exist. I have at least 10 companies worth of tests in my house right now, I think more than that. So they exist very in very high numbers if we want them to. And I think we just need to kind of build it and they will come. We have to get them out. And then all of a sudden, we’ll see executives and decision makers want to utilize them. I know that CEOs of many of the major companies have gotten in touch with me to ask, can they get these? Is there some way to use them to keep their offices and their stores safe? And so I think that the demand is very, very much there. It will only grow as we start to see the tools actually become useful and people can actually visualize what the program would look like.

Q: Thank you very much.

MODERATOR: Dr. Mina, do you have any final thoughts for us before we go?

MICHAEL MINA: No, I really hope we’re not having to meet and talk about COVID in a year from now, but otherwise, you know. Thanks, everyone.

This concludes the February 12th press conference.

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