Coronavirus (COVID-19): Press Conference with Michael Mina, 02/24/21


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 10 a.m. Eastern Time on Wednesday, February 24th.

Transcript

MICHAEL MINA: Thanks for you who are here. Anyone who’s watched me over the last year talk about the epidemic, it’s been peppered or sometimes fully in the form of discussing rapid tests and at home tests. One of the big mysteries, or frankly, not really a mystery, but one of the big questions that comes up often with regard to testing and really changing the landscape of testing, in particular over the foreseeable future as vaccines get rolled out, has been do people care? Will this actually be something that the American public will pick up? And so with COVID Collaborative, which is a collaborative that I will introduce in just a moment. We took it upon ourselves to essentially do a survey of the American public and try to understand what are the feelings and the uses, how would people actually feel about having rapid tests in their homes? This is important for so many reasons for this pandemic int the future. And would people actually be willing to use these? Is it something that would actually be useful if the American government expanded the access to these tests, which is crucial because the president has made it clear that it’s one of his objectives is to increase access to testing, importantly, increase equitable access to testing and make it available to anyone who wants it, not just the wealthy, and make it fast in a timeframe that’s actually actionable by people. And so I want to introduce Shawna Marino right now who is going to provide some of the details and the results of this survey, which we haven’t released yet in any large way to tell anyone. So for those of you who have made it onto the call, you’ll get a peek at all of this. And we’re hoping that you will find it sufficiently compelling to consider it in your reporting. But, Shawna?

SHAWNA MARINO: Thank you, Dr. Mina. Nicole, can you give me screen sharing?

MICHAEL MINA: Sorry, let me just cut in for one second. Shawna has been helping in a in a very serious way, me over the last six or maybe more months now I suppose on policy and all things regarding policy. And as I think many of you know that we’ve talked a lot with Congress and senators and the White House and many other folks, governors and Shawna has been behind the scenes helping just an academic like me navigate all of that stuff. So, Shawna?

SHAWNA MARINO: Thank you. We recently partnered with the COVID Collaborative, which, as Dr. Mina said, is a national organization of health policy and economic experts focused on a united action and the pandemic. And we asked COVID Collaborative and their research arm Heart Research to conduct a first of its kind national public opinion survey on at home testing and venue-based rapid testing because, as you know, we’ve been speculating that this is of high consumer demand for a long time. But we thought it was time to inform policymakers on that consumer demand, especially as we’re currently speaking. Congress is contemplating a sizable 46-billion-dollar investment in testing. And the Biden administration has identified at home rapid testing as a priority. And although we’re still waiting on a national rapid testing strategy to be announced and to be put forward, we think that this is an important step in informing the Biden administration about consumer demand. What we learned, first and foremost, and this is not a surprise, but that Americans are still recognizing the continued threat of COVID-19. But testing, however, testing is viewed just as importantly as masks, distancing and vaccines. However, the current testing infrastructure is clearly not working. We were pretty surprised to see that 64 percent of Americans have never been tested for COVID-19, and a sizable amount would have trouble getting tested. But once they are informed that there is a convenient way to test themselves at home, eighty-six percent of Americans are willing and eager to use rapid at home tests. And another interesting fact here, though, is that only 36 percent of Americans had ever heard of a rapid antigen test. So even though we’re talking about this issue every day, this is still a fringe issue. Education is important, but once they are informed, there is clear support for a national testing program. But the support does not come at any price. The willingness for people to test at home decreases as the price of the test increases. And this is really important because even though a majority of people support the idea of testing regularly, if the test cost twenty-five dollars or more, which is in fact the price of the only EUA authorized at home tests, only 33 percent of Americans would test themselves regularly. Whereas if these tests were between one in five dollars, which we know they can be produced for and distributed for, we have a much higher rate of adoption. And as we know, the more people use these tests, the more effective they will be.

Entrance screening is a concept that Dr. Mina has been discussing for a while as a really effective tool to complement the at home testing. And while we know there may be some logistical hurdles, at first, a strong majority of Americans approve of the use of rapid antigen tests to reopen schools, travel, sports venues, offices, public transit, retail, restaurants. These tests, people understand, will make venues safer and that will lead to greater economic activity. And I want to mention, in case folks didn’t hear about this yet, but the state of New York just a few days ago announced a new rapid testing initiative called New York Forward that is aimed to build consumer confidence with rapid testing centers all across the state and using rapid testing to get into certain venues. We also see very strong bipartisan support, and this is something we’ve known for a while because of all the congressional outreach we’ve done, but the American public across the board of all political ideologies are also demonstrating their support. And we are currently calling on Congress to allocate at least 20 billion of the 46 billion in testing dollars to a national rapid testing program. And like we saw with the price slide; 85 percent of Americans want the government to fund these tests and distribute them. So there is a huge opportunity here for the government to lead and people will be willing and grateful to receive less expensive tests, whether it’s at their home or in a venue, and they want the government to be funding those tests. Lastly, one of the biggest hurdles in our efforts in all the work we’ve been doing with the White House and with various public agencies, one of the biggest hurdles is around reporting. And many of you ask about reporting a lot. Public health authorities, understandably, are worried that they’ll lose track of case counts, they won’t be able to sufficiently contact trace if everyone is just using these tests in their homes. However, a large majority of Americans say that they will report their positive result. And as you can see here, privacy matters. Reporting directly to the doctor is their preference. But there’s a lot of options that based on probably their comfort level with technology and how they communicate, there’s a lot of different options for them to report. So these were just a few slides that we thought captured the most interesting findings and the most relevant findings, especially as Congress decides on funding for testing and the White House continues to develop a national strategy. The full report is linked in the chat, and it is our hope that this is something you will continue to cover. We think that this is a really important part of the story because it now demonstrates that even though these tests are not available to the general public, we can talk a little bit more about some of those hurdles today, but that people really want them, and people understand how they can play a role in their lives.

MICHAEL MINA: So that’s just some of the survey data about what Americans are thinking right now about these, and so a lot of people will ask, well, vaccines are on the way. Why do we need these tests? And that’s a slightly longer answer that I’m going to give at the moment, but essentially these tests will support the vaccines. The last thing that we want to do is sort of what we’re doing, which is rolling out a vaccine when cases were sky high. Thankfully, seasonality and probably some herd effects from immunity from preexisting infections are really bringing cases down rapidly. But we know that the economy is going to continue being held up as a result of this pandemic. We’re not going to go back to normal tomorrow. We’re not going to go back to normal this summer. And we will see blips and outbreaks continue to occur. We’ll see if schools continue to be nervous about opening up and any number of other things, environments where individuals will congregate, airports, just all sorts of things, will not go back to normal any time soon. And these tests are a way to accelerate all of that. It’s a way to accelerate re-opening the economy in a much, much more substantial way. So they are still needed now. And they’re probably going to be needed when cases reemerge and we have another surge in the fall despite vaccine, and we will likely have another surge in the fall. And so it’s important to note the tests do exist today. They’re not authorized. The FDA is holding many applications up. Millions and millions, millions of tests per day could be available today, except that the FDA is sitting on the applications, many of which I’ve looked at. And the applications are stellar. There’s absolutely no reason for an inexpensive three- or four-dollar test to be being outright rejected by the FDA right now or just sitting in a queue for many months. It’s no longer a normal time at the FDA, they’re being held up there for unknown reasons. And I think that it’s incredibly important to recognize this, that these applications by these companies have been in since the fall. Had we had these tests out towards the end of last summer, we could have potentially mitigated much of the devastation that we have seen over the fall and winter. And had they actually been available, we could have potentially prevented huge numbers of outbreaks and hundreds of thousands of deaths. So it’s very, very unfortunate when our regulatory agency, which is meant to help protect Americans, is really at the center of preventing Americans from getting tools that will help limit the spread of an infection like SARS-CoV-2 and COVID-19. So I want to also mention that Steven Phillips is on and he is one of the scientific leaders at the COVID Collaborative, which again has been a mainstay of scientists and policymakers and other influential thinkers surrounding this pandemic for a long time. And it’s actually headed up in part by the dean of the Harvard School of Public Health, as well as many other individuals. And so if there’s questions about the COVID Collaborative and the survey otherwise, I’m also happy to take any routine questions you might have.

MODERATOR: Thank you. I’m going to ask you first, if you have a question about the COVID collaborative, if you do fantastic. If not, we’ll come back to you in a couple of minutes. First question.

Q: Hi, thanks so much. Can you hear me?

MODERATOR: Yes.

Q: Dr. Mina, I wanted to ask you specifically about the rapid testing, I saw your tweets about this yesterday and just wanted to follow up what you said there and just what you said now about the FDA. Does the FDA have a reason that they’re holding this up, that we just don’t know what are their concerns about test accuracy or is there something else going on?

MICHAEL MINA: I have to be careful what I say right now. I honestly can’t answer that question without starting to fume. So they’re simply not authorizing certain tests. They have authorized some, and that was months ago. And they’re just not moving on others. They don’t give a good reason. I can say there’s one company that can produce quite literally millions per day, an American company. They can make them in the United States. And this is a company that’s producing the majority of tests for the UK. And we have evaluated the test ourselves, and it is looking the metrics are excellent, as good as the BinaxNOW and better than most all of the other rapid tests that we have evaluated. And this particular test was just outright rejected by the FDA and said that it was not a priority type of test and that was months ago. So how when testing has been continued to be front page news in terms of the limitation and the long delays of testing that have especially happened throughout the winter, the FDA took a stance and said that the test that can produce tens of millions per week and many millions per day is just not of interest in this pandemic. It just doesn’t smell right, as far as I’m concerned. There is no good reason at the moment for why they are not authorizing them. But they’re not. It’s been months since any of them were authorized. The only one authorized that’s really scalable is the BinaxNOW, and we know that that’s been authorized for many months. There are numerous companies just trying to get an idea for symptomatic use, no less, over the counter asymptomatic use and to be honest, I cannot understand their thinking, I’ve looked at the data, the data meets every criterion that they’ve laid out. So why they’re picking some companies and not others, and in particular, they’re picking a couple of companies and really leaving all the other side there in the queue for months and months now, or just rejecting the application outright in the case of the test that can scale by far, the most frankly, is disappointing to say it in the mildest way.

Q: Just a couple of quick follow ups, if I could, two companies that you mentioned in your tweets yesterday were E25Bio and Thermo Fisher, both of which are local to us here. And I’m just wondering if you could speak to where they’re at with these rapid tests and how effective you’ve seen their tests to be and what their status as well.

MICHAEL MINA: All of these tests are very, very similar to each other is the thing. Some of them change, they’ll change a little bit. For example, access bio versus BinaxNOW versus Quidel, those are the three that have been authorized. BinaxNOW is the only one that’s really scaling in a real way, but even that is limited. But E25Bio and Thermo, you know, Thermo is one of the biggest bio life sciences companies in the world. It seems to me that if the FDA were to get an application, now I do have to be clear, I’m almost certain that they have an application and, but I’ll put that at ninety nine percent. I’ve spoken with them a while ago about it. But if that application is in and I do believe it is, to not bring that to the top of the pile and go through that application in a day essentially would be crazy. These tests are not complicated. The information around them is not complicated. They all they all look like this. They all look the same and they have similar metrics. So you should be able to scan through the list and be able to say, yep, no, this isn’t meeting whatever criteria and reevaluate and get it out in a week and not be delaying and holding up the authorizations with unnecessary questions and then months delay and then another round of unnecessary questions and months delay. They seem to be running the companies in circles. From what I hear from many of these companies, I want to be clear that Thermo is one company who has not necessarily complained to me. But there are much more professional companies than some of the smaller companies that are trying to just get their products out to the American public. But nevertheless, all of these are sort of in the same boat right now. They’re sitting in a queue waiting for symptomatic claim going nowhere.

Q: Lastly, really quickly, just needed to confirm. I see your involvement in rapidtests.org, and this is something you’ve been pushing for, just need to confirm you don’t have any disclosures related to rapid tests that we should know.

MICHAEL MINA: No, not about rapid antigen tests, the ones that I’m really pushing for. I did just start as an adviser for the company to Detect, which is molecular RNA test, which is in a whole different boat. And I just started advising for them last week.

Q: Thank you.

MODERATOR: Next question.

Q: Hello, good morning. I have two questions for you, the first about what’s happening in New York State and second about deaths. So if you want to hold the second one until more general questions, that’s fine. New York State started rolling out rapid antigen testing sites throughout the state partnership with Bio-Reference. And they’re using the Binax test. The overall plan is to open two hundred across the state, I was told. You know, the point of these sites is to enable folks to test before eating dinner, going to the office or going to the movies or whatever. And the cost is thirty dollars. What do you think of that? And is this application the right one for using antigen tests? And are we capturing the right folks with that?

MICHAEL MINA: Well, the application is correct, I mean, if I had my druthers, it would be at home, and it would be very, very inexpensive for individuals and it would be frequent period. This is a really great step in the right direction coming from New York, in my opinion. The problem is that New York, like everywhere is under the grip of the FDA and how the FDA is authorizing these tests and the policies of the United States at the moment. For example, the FDA is requiring a test like the BinaxNOW to be a prescription test. Nobody should need a prescription at this point in this pandemic, the prescription is making this test go from five dollars to twenty-five dollars for the for the physician fee. So that means you have a company like Emed, which is the prescription provider for these, making ungodly amounts of dollars for taking care of a fake prescription. The FDA is now in the business of eroding medicine. The FDA’s formal stance, which they have published and discussed, Tim Stenzel discussed it, is that people that one doctor can write a prescription for tens of thousands or hundreds of thousands or millions of people at once. That’s not the appropriate use of a prescription. So by the FDA requiring that these tests be given prescription use and then having our own FDA suggesting that doctors write prescriptions for tens of thousands of people at once is absurd, and it is not in the practice of public health, it’s in the practice of eroding a medical process that is in place for a reason. And so in this case, all it’s doing at this point in time in this pandemic is raising the cost of tests to the point where they are not accessible to most people. And frankly, eroding what it means to have a physician written prescription. And, you know, it’s absurd at this point, I don’t know, are there financial ties to Emed? I have no idea. But these tests should be three or four dollars, max. I think they should be one dollar, but they should not be a prescription at this point. That is absurd. I think we all know that, you know, there is no useful use of the prescription at this point if you’re going through one of these sites. So what we need to do and what I think New York State should push is to get these tests, at the very least in New York as true public health tests. Anyone should be able to walk up and screen themselves at this point. This should not be a medical an expensive medical process. And then the other piece is, I know that New York wants to scale to much higher numbers. They actually want to make this even more accessible, but they don’t have access to the type of numbers of tests they need. Why? Because the FDA is not authorizing more of these tests. The only one that’s available is the BinaxNOW, we know that a company like Anova knows where others can scale to millions a day, whereas BinaxNOW for the whole country is making around a million and a half.

So this all falls on the FDA at this point, in my opinion, and I’ve gotten more vocal about it because the more I look at the pieces, the only bottleneck in all of this is the FDA. And I think it needs deep investigation of what’s going wrong there and why. The real question of why? But I anyways, to go back to New York State, I think that they are doing the right thing. I think they are trying as hard as they can to do exactly what Shawna and myself and others have been talking about for months, which is that these tests can reinvigorate they can accelerate the reopening of America. New York State is recognizing that and trying as hard as they can to put the pieces in place with this very limited materials and tools that are available to them today. I would love to see these tools become much more available to any governor. We have spoken with governor after governor after governor, some who have already put aside hundreds of millions or billions of dollars to purchase these tests and cannot purchase them and use them and get them out to for free to their communities in their states because the FDA will not authorize them. And so the states all want to do the right thing. For months now, I’ve been talking to governors since last summer who have been asking how do we can get these rapid tests? How do we get them out? And we’re still back exactly where we were in July and August. Governors do not have the tools. The White House does not have the tools. And all of it has to get bottlenecked through the FDA before these policy leaders can get the tools and actually plan around them. So New York is making great strides toward doing what they can with the tests available at the price point available. But it’s very, very difficult for them to really create a public health program when they have to be paying prescription fees and they can only get access to thousands per day for a state like New York.

Q: Thank you for the thorough answer, do you want to take the death question now or should we circle back?

MICHAEL MINA: I want to say one other thing, just as a point of reference for New York and what’s happening there. Liverpool in the UK, they started in a similar way to what New York is doing and now it wasn’t the UK at large, it was just the pilot was in Liverpool. They started in a very similar way with smaller sort of scale. And they are now scaling up. Boris Johnson is really pushing the test into people’s homes and is trying to do that for the whole of the UK and actually using the tests that the FDA is just outright rejecting and failing to authorize. But the UK is actually moving forward with that. So I hope that this is just the first step in a in sort of an accelerated pathway to open the economy.

Q: Thank you so much. We see that the age distribution of COVID deaths has been pretty well cemented in place throughout the pandemic. This seems something of an obvious question, but do you think vaccines will change this? Why or why not? And if you do think it will drive up deaths in the older populations, do you think we should be seeing evidence of that yet or will it take a while still?

MICHAEL MINA: Yes, I do, of course, think that it will drive down deaths in the older populations for sure, we will start seeing reductions in deaths in the United States pretty soon. We have had a gradual and slow rollout. But, you know, at this point, it’s accelerated pretty well. And so we have large fractions of the over seventy five population who have now been vaccinated. I do think we should anticipate seeing changing distribution of death rates across ages. We’ll start seeing that certainly in the next month. It should become quite striking. That said, we will have to look at rates against each other. The cases are falling quickly, which I would attribute in large part to probably quite a significant amount of herd immunity that’s already occurred and seasonal forces that are in our favor quite considerably. So cases are really coming down. But certainly, I think we should anticipate that the overall rate of mortality is going to plummet. We know that children don’t get severe disease, not in any frequent way anyway. Of course, there’s always the headlines of the small number of children who do. But for the most part, the mortality rate and the severe disease rate is extremely low in little kids. And it scales, of course, from there. And as we march down that age order, we’re going to see the skew start to normalize and even out across everyone. It still might be a little bit higher of course, in older individuals, vaccines also don’t really work long term, especially in the most in the oldest age categories. So we’ll have to monitor that closely and understand better. Are these vaccines continuing to work after four or five, six months in the older age brackets? We just don’t really know how they’re going to how they’re going to work long term; all of the studies so far have just been in the very short term over a number of months when sort of all of the energy of the vaccine is still persisting. So I’m not sure if that answered the question.

Q: Thank you very much.

MODERATOR: Next question.

Q: I keep hearing reporting concerns or that people would mess up the tests and get bad results. How much of a role is that playing in not getting the green light from the FDA for these tests?

MICHAEL MINA: Well, there’s a couple of answers. They say that they do not require reporting as part of their metrics. They don’t ask about it as part of their formal template. So it shouldn’t be being a part of it. And for example, the BinaxNOW doesn’t have it. Access Bio doesn’t have reporting built in. And so I don’t see this as the reason. Of course, I think some people then use these tests, the companies can’t even get physician use case authorization at this point. The FDA is just stalling all of it. So I don’t think it’s a use thing either. If this was an at home, if they were going immediately for at home, then use case has to be looked at a little bit more or how easy it is to use or not has to be looked at a little bit more with a little bit stronger eye towards that. But in general, in this case, I don’t think it’s playing a massive part. I know that people say it a lot and there’s a lot of people who think that that’s the reason why they’re not getting authorized. It is part of, I would say, the policy surrounding it. Policy leaders are struggling to understand if these tests become widely available, how to ensure that they’re getting enough data for public health in general. It’s actually sort of a moot point in some ways. We can make reporting voluntary. We can do that with third party apps. There are so many ways to make that to actually get much more public health data than we’re currently getting. It’s not hard to get more public health data. We’ve run around three hundred and fifty million tests in this country. That’s enough tests for every person in the country to have one test once, essentially. So we have done very, very little testing if our goal was really public health reporting in a real way. So I think it’s part of the policy decisions and what policymakers are struggling with. But from an FDA perspective, I don’t believe that that is playing a major role.

Q: I was going to follow up on that, but it sounds like it’s moot, so we’ll come back at a later press conference when we’re over this FDA hurdle, maybe.

MICHAEL MINA: I mean, you can ask if you have another question about it. It’s fine.

Q: No, I’ll let you move along.

MODERATOR: Next question.

Q: So this is kind of on topic with what we have been asking you, but I know you were consulting with the White House and you had the ear of policymakers. Did you have the opportunity to address your concerns with those leaders about the FDA and rapid tests? And if so, what kind of response did you get?

MICHAEL MINA: Yeah, I want to be clear, not consulting I’ve been more like informally advising, I’ll call it. But yes, we have discussed at length these issues. I think rightly, the White House is in a position where they want to make policy and of course, Biden in day one said that he wanted to make policy surrounding rapid tests. Congress has put aside 50 billion for it and the White House has been on board with that. But the White House is in a pretty tough position, it does not want to appear to be interfering with the FDA. A lot of people in the White House now spent the last few years trying to shield the FDA from the Trump administration. And so they don’t want to there. Isn’t there a little bit stock? I would say that they don’t want to have some appearance of trying to go around the FDA or question that this is just my view on this. And I think that that is appropriate. Is it the desired outcome during a pandemic? No. But is it a slippery slope if you have an executive branch that really starts interfering significantly with the FDA? You never know who the next president’s going to be. Do I think something should happen? I think so, but I also understand if the White House is feeling like its hands are tied on this front. The sad part of it, though, is that it’s very clear that the White House wants to do something with these tests, but similar to New York, the White House doesn’t have a lot to go with. They can only look around and say what tests are actually available and they look around and they say, well, very few. And so they can’t make policy on how to use these tests. The CDC can make policy because everyone is deferential to the FDA. And so until the test gets any way at this point, the White House just can’t act and they don’t. And my feeling is that they don’t want to intervene in any significant way. That would appear that they’re undermining the FDA’s stance on these.

Q: Thank you.

MODERATOR: Next question.

Q: Thank you for doing this call, I am writing for clinicians specifically about what the role of testing is now as we move into the vaccine era. I know that you’ve been an outspoken supporter of the rapid tests, obviously, but what do you think that means that the future of testing is outside of the clinical arena? What role do you think clinicians will be playing going forward? Thanks.

MICHAEL MINA: I think we’re in a new era. We’re still playing by so many of the same rules that existed 70 years ago, a hundred years ago. Everything in the United States is still kept behind the barricade of the doctor, but if I’m a parent, why am I not allowed to know that my kid has COVID? Why am I not allowed to know that my kid has adenovirus? Why can’t I know for myself that my blood sugar is at a certain level without a prescription? You know, all of these things I think we’re entering into a new phase where this paternalism of medicine, at one point it had to exist. There wasn’t enough information out in the world to the average person to be able to know what to do with this information. But now we have every single person, especially software, has gotten better. Every person has much more knowledge in their phone than any physician has in their head. Sifting through that is difficult, not the way that people are using. Technology today is so different, the way that these tests know this is the test, this test called Detect, this is just to be clear, this is the company that I’m advising for now. But the reason that I’m advising for this company when I’ve said no to every other test company in the world is because this thing is so simple and scalable. And it is this little device has the power to tell some person in the future if their kid has flu or whatever, it can look for all sorts of things. And I really do want to see a world where people have access to testing. They don’t have to go through hundreds of dollars of physician bills and hassle with scheduling everything just to know, you know, as my kids have the flu can attend school, it also doesn’t even work. If our goal is public health with infectious diseases, it should be having to go to the doctor’s office and bring your kid there when they’re sick is insane. And we have the tools now that could allow us to not have to do that. So I really do hope that one of the lasting effects of this pandemic is that we will see a democratization of testing, that people should be allowed to know what’s happening with their body. I’m allowed to feel my pulse. I’m allowed to check my temperature. I should be allowed to know what virus is causing my nose to be running and if it’s rhinovirus or if it’s SARS-CoV-2 in the future and I really do hope that we start to see a change in this way and we move away from this paternalistic medical approach and we somehow figure out a better medium. But there is a massive amount of money in medicine and the regulators generally are doctors. And control is a major thing and money is a major thing. And so I just I would like to see all this stuff be free, frankly. But short of that, I hope that we can at least remove people like me from the equation so that we’re not marking up the bills in hospitals and laboratories as something like 40-fold, not 40 percent. The average markup is 40-fold of a test. That’s criminal. It’s bankrupting us as an economy. And so I would like to see that change.

Q: Quick follow up. These are amazing visions for the future. But as things stand now, testing still hasn’t really ramped up to where it needs to be. So I’m curious what your feeling is about how the rollout of vaccines might be impacting capacity for actual testing until these self-test get out there in a more broad way.

MICHAEL MINA: So as vaccines are rolling out, testing will still be needed to know for a long time now, people are going to be wondering what’s causing my illness and my safe to go see Grandma and my safe. Even if grandma has been vaccinated, there is going to be a lot of fear. There’s going to be new mutants that come about. So there’s a few different roles for testing, for clinical diagnostic testing, meaning the type of testing that is through a physician that’s not going away, that won’t go away. That’s at least like I just said, I want it to go away. But in any time soon, when people are sick, they’re going to need to go get a COVID test and flu tests are going to still be asked to stay home from work even when a lot of people are vaccinated. So medical testing isn’t going away. The public health testing is, I think, still needed even upon even as vaccines are being rolled out. Schools are needed to get going again. Businesses need to open. And with vaccines, I think we’re still going to see a very long delay before businesses can reopen fully and then come fall. I think we’re going to see a resurgence of cases again, even with the vaccine. I think we will probably see that spread continues. Ideally in the fall, we’ll have enough people immunized. And with some, even if they’re there in immunological response, has waned by then. My concern is that the older people got vaccinated first. They have the lowest retention of immunological memory. And so when we get to the fall and seasonality causes cases to go up again, we might end up seeing, again, large increases in transmission and some people will be vulnerable once again to disease. I hope that it doesn’t cause an economic shutdown. Again, that would be terrible, but I think we’re going to be on edge as a society for quite some time. And in that sense, I think that these tests can just make everything safer. You can have them as a backstop as we see blips on, as we see new outbreaks start to emerge in a community, even a community that’s been largely vaccinated. We can have this. What I would like to see is for these types of simple, simple tests just be in people’s homes. They don’t have to be using them twice a week when there’s very few cases. But then maybe cases start to emerge again, even in the vaccine era. And people can get a text message that says, hey, this case is in your community, start testing your kid or yourself twice a week for the next three weeks and we’ll keep our way below one and stop that outbreak from even emerging. This becomes even more important as we see new variants that we’re still not sure what exact role they’re going to play. My personal feeling is that most of the variants, you’ll still be protected through the vaccine derived immunity or preexisting infection derived immunity. But we just we don’t actually know how long that will last as we start vaccinating millions, millions of people. We run the risk of a viral mutant strain, just really being able to become invisible to the immune system. We all hope that that doesn’t happen. But should it happen, we want backstops. We need backstops. Really, we can’t go through another year of this. And cases are still going to be transmitting wildly throughout the world, even if they’re not in the United States. And so this this is a backstop if a strain comes out, that is going to evade the immune system in any significant way. This is an inexpensive tool that the US government could scale up and just have out for the American public so that if a new outbreak starts to emerge or if a new epidemic starts to emerge on US soil, we can have this and be able to pick them up quickly. Even in the vaccine era, if new mutant strains come around or people’s immune systems just start to wane.

Q: Thank you so much.

MODERATOR: Next question.

Q: Hi, thanks so much for taking my question. We have a local study out by a hospital group that is forecasting that Dallas County is going to reach herd immunity by late June. And I was wondering if you could comment on whether it’s meaningful at all. How meaningful is it to project herd immunity for a county and then what questions I should be asking them about their methodology? The methodology, it’s based on a model of how many people have recovered from COVID-19, as well as how rapidly vaccinations are scaling up.

MICHAEL MINA: Yeah, well, I mean, herd immunity, it’s a fluid state, I would say. Herd immunity is just like our own immunity. It comes and then it can go if people are no longer immunity wanes, for example, and it’s not it’s not just reaching herd immunity. Every new infection that happens in every new immune person adds and builds up to the amount of population level immunity that exists. Eventually, you get to a threshold at which the r value of the virus goes below one and you start to see reduced in cases. If seasonality means that cases are already below one, then it’s a different kind of then you’re already kind of herd immunity between the combination of already infected people and seasonality, for example. And so in many ways, we’re already seeing in the United States the drop in cases. The precipitous drop probably to me reflects that we have for the season, given the data, given the source of infection right now and the seasonal source of infection at the moment, I believe that the US has effectively achieved some level of herd immunity. Is it the complete threshold? No, but I do think that some are probably over one hundred and fifty million people have likely been infected. And I put that as a low estimate. You know, that sounds like a crazy high estimate, one hundred and fifty million, but we have 30 million people who have been diagnosed as having COVID and I do not believe for a moment that we have caught one in five infections. That would be pretty extraordinary given the testing was and given that we’ve only had enough tests for every American to have one throughout the year is how many tests we perform. So, you know, when we assume that we’ve probably had less than one in five cases detected and we already have 30 million people who are known to have been infected, that already puts us up at almost 50 percent as almost a low bar for how many people in America have been infected. And we’ve barely tested the kids in adolescence. So that’s like not even counting this full part of the population. So that’s just to say that I think we are probably achieving herd effects already, but does it necessarily change how we’re viewing all of this? I would say no, because, again, herd effects and the herd immunity threshold is a feature of your environment, of the of the seasonal patterns and where you are in the seasonality. And, for example, even if we were a very high herd of herd immunity right now, come fall, I worry that we won’t be again comfortable. We’ll end up seeing surges in cases because of seasonal forces not being in our favor, waning immunity. And then we are really going to want the people who are getting vaccinated to get vaccinated now. But at the moment, I think I’m hoping that we will largely see a reprieve from this virus from now that will hopefully last through the summer. I don’t think cases are going away. Cases are going to unfortunately stay stable, probably tens of thousands a day. But mortality will hopefully decline. Cases will stay stable before they rise again in the fall. But I do think we should use this as an opportunity to get as many people vaccinated as possible.

Q: Just one quick follow up. I mean, is it meaningful at all for readers to understand when their local county will return immunity, given people’s mobility? Does it make sense to track it at the county level as this group is doing?

MICHAEL MINA: I mean, people live locally, and if you’re in an area where if you’re a county is at such a high threshold for community that that the virus is unlikely to persist in your county, I think that’s important. But it’s really, really important for people to understand what herd immunity is. It doesn’t mean that you can’t get infected anymore. If your neighbors are all immune and it doesn’t mean somebody who is infected can’t come and infect you. And so I think it matters only to the extent that I think policy leaders and policymakers should be able to look at that data and say, OK, you know, if we’re truly at a herd immune threshold and we are seeing large reductions in cases and to the point where cases in terms of outbreaks are really going to zero. Then that is meaningful in that it really does change the balance of what does it mean to stay open if you can stay open and maybe every time you have a blip of cases. But they never turn into large outbreaks because you have so many people who are already immune that they just can’t sustain itself because you’re on herd immunity, then that it is important, I think. But we have to remember that if it’s just sort of county wide and I don’t know exactly why this would happen, but let’s see if one county that is up 70 percent have already been infected and another county has 30 percent. And you have a lot of cases happening over here still in those transit between them, the 30 percent who haven’t been immune or are not immune yet over here can still certainly get sick when coming in contact. So we just have to keep in mind that herd immunity isn’t like our own immunity and that it can really protect those who are not it can’t do anything to really protect those who are not immune already individually when they come in touch with somebody who is infected.

Q: Thank you.

MODERATOR: My connection, just slowed down for a second. I think that’s the last question we have. Dr. Mina, do you have any final thoughts you want to share with us before we go?

MICHAEL MINA: Not at the moment. I’m excited to see the vaccines being rolled out. I would really like to see the economy opened up more rapidly. I want people to feel safer, and I do hope that we get the delays for now and for our future worked out from the FDA perspective for these tests. But certainly, if you have questions about the survey or any of the things we covered, you can email us directly if you’d like. And Shawna, I don’t know if you or Steven want to put your four emails. And Steven, you have something you want to say.

STEVEN: Yeah, if I could just add a couple of things, Dr. Mina, on the behalf of the COVID Collaborative, I think we are looking for very leverage able interventions that could end the pandemic sooner and also reopen the economy and our dynamic culture. And we had the good fortune of discovering Dr. Mina about eight months ago. And our sense is that there are two approaches to deriving the benefits of rapid tests. I think as a product profile, doctors have demonstrated, I think repeatedly in a variety of forums and a variety of scientific journals that this is a better mousetrap, the rabbits as a product profile, that if it wasn’t invented, should be, and I think there are there are two ways of massively scaling rapid tests nationally to the level that is required for the public good effects, the contributions to herd immunity effects that Dr. Mina was just discussing. One is what I would call a product push, which is keep beating on the qualities of the rapid tests that are so desirable, so unique and so complementary to both the PCR medical diagnostic testing and also to a massively scaled up vaccine rollout. So that’s the product push at the collaborative. We kind of imagine what the market would look like. And we really believe that the business sector is going to be incentivized and see value in this on their own, whether or not these various technical and regulatory obstacles are overcome. And the other is that this is tailor made for a federal program. It has almost all the characteristics of the vaccine program in terms of end-to-end management of the supply chain. So that’s where we’re placing our emphasis. And just so happy to be part of this session now. And we are going to continue to work with Dr. Mina and support his activities to bring it to scale if possible.

This concludes the February 24th press conference.