Coronavirus (COVID-19): Press Conference with Michael Mina, 03/10/21


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 p.m. Eastern Time on Wednesday, March 10th.

Transcript

MODERATOR: All right, Dr. Mina, do you have any opening comments?

MICHAEL MINA: Yes, today. So I’ll take everyone’s questions just after. But we wanted to do this today instead of Friday, like usual, because we are announcing a new clinical trial that we’re starting today. And the trial is with Citigroup. And so I wanted to just let people know that those of you who normally join get sort of first steps to understand how this trial is working and hopefully work to sort of report on it, but also answer questions about that and then I’ll take whatever other questions you might have. So the trial that we’re starting with Citi today is what I think, at least for the US, it’s a it’s a fairly groundbreaking study. I’ve been working with Citigroup and my team at Harvard has been working with Citigroup for quite a number of months now to get this trial up and running. The goal is to evaluate for the American workplace how well does frequent rapid testing work in the home. Not surprising if you have gotten to know me at all over this year. But the goal here is to ask the question, what are companies doing and what is the workplace in the United States doing right now, the workforce and schools? And can we do better than that to help slow transmission? So we are enrolling people, specifically people who are who are part of Citibank and Citigroup and their employees to participate in this studywhen the participation essentially allows them to test themselves three times per week every Monday, Wednesday and Friday, as well as a test to any symptoms. Those people who aren’t participating essentially do what they would be doing otherwise, which is just to adjust to symptoms. And so the goal of evaluating this testing protocol over thousands and thousands of Citi employees is to see how many infections can we prevent relative to what otherwise would have happened? How well can we maintain COVID-free working environments and get our workforce back to work as quickly as possible. And so we’re doing this in a very regimented fashion. Every day people are attesting to whether or not they have any symptoms at all and are providing us with the results of their rapid tests. And this is giving us a very nice window to ask some very fundamental questions, like how many people are asymptomatic and potentially spreading this virus before they actually are detected as positive through symptoms. And that would be sort of the status quo at the moment. How many working days can we prevent people from having to stay at home because of quarantine or isolation by letting their colleagues know that they’re infected very rapidly before they go on and spread the virus in the workplace. And so the way that we’re doing the study is in collaboration both with Citi, but also there’s a different collaborationwhich is happening. And that’s between a rapid test company called ANOVA and an A.I. based company called Live Person. And this is where I think the real crux and where interest from me personally came from to actually study this is that Live Person it’s an A.I. based company that makes these chat bots for lots of companies around the world. And so as a result of COVID, they decided to start turning their technology, which is normally helping people navigate things like banking systems or websites. If you go to a website and you see a little chat that shows up that says, can I help you? That’s oftentimes powered by this company called Live Person. So Live Person and the test company called ANOVA got together and said, how can we actually think through allowing the average everyday user to be able to use a test in their own home? And what they came to is to develop a new tool called Bella Health, which I think is pretty cool anyway. And it’s essentially an app that allows people to, on the one hand, put in their symptoms if they’ve had any symptoms, but also when it comes to these tests, to see to see videos and see kind of instruction manuals in an extremely intuitive way to understand how to use these tests at home, how to read them. And ultimately, if you have any questions, they can then just start chatting into the app and somebody starts chatting back with them immediately, some of its A.I. based in some of its real person. And this is what this company Live Person is very, very good at doing.

I think that when I look at this and a lot of people have asked me over the year, how can we get Americans to actually understand how to do these simple tests? If the tests have any complication at all, Americans won’t do well with them. Well, on the one hand, I think Americans can do them just fine. They’re really, really simple tests. But the concerns warranted, warranted trying to come up with a solution. And so in this case, I think a very natural solution is to use the technology and tools we all have at our disposal every day, which many Americans have supercomputers in their pocket called a smartphone, and to essentially give them the power of being at a position of being at a professional testing location, but right there on their phone so that they can actually just start asking questions. So we’re measuring as part of the study anyway, where we’re measuring how well do people engage with this application? Are people actually able to use it? Are people enjoying it? Does it allow them to use their tests more appropriately and effectively? So we only recently started the study just a couple of weeks ago. We have enrolled around a thousand individuals and we’re going to be enrolling around six thousand individuals in this phase of the trial. And we’re going to be monitoring people’s test results and how well these tests are working to identify people early, how well people are using these application-based sort of approaches to help them be able to use this. And what I would like to see at the end of the study in a few months is a roadmap, a roadmap to give to Americans and to give to international businesses as well, and schools and colleges and everything else that says these are the types of approaches that are or are not working.

And ideally, when we start to see cases, resurge again in the fall, if not before, with variants, we’ll be in a better position to curb those outbreaks, in part through the use of tests like these rapid tests, but through a whole plethora of tools. And I want to see us in just a much better position overall to be able to use modern technology to help curb the spread of pandemic viruses today, in the future and in new outbreaks. So I’ll stop there and see if anyone has any questions specifically about this study to begin.

MODERATOR: First question.

Q: Hi. Thanks so much for doing this and thanks for discussing the study. I guess on the study specifically, could you talk a bit about there’s been rapid testing studies kind of looking at whether they can reopen theaters and reopening kind of public events with rapid testing. Could you talk about the difference between maybe rapid testing in a controlled setting and rapid testing at home and why you’re interested in that?

MICHAEL MINA: Sure. So I think to you know, I look at rapid tests, especially rapid antigen tests, specifically in this sort of red light, green light fashion. A test that is a red-light test is one that when it’s negative, you continue doing everything else you are doing, regardless of whether or not you were using the test. And that might be continuing to distance or mask, get a vaccine or whatever public health efforts you’re participating in. But if it’s positive, you pitstop, you don’t you don’t go to work. You get a confirmatory PCR, which, by the way, we are getting everyone because of the study, we are also getting confirmatory PCR tests on everyone when they turn positive. And that’s part of the evaluation process. But to use tests, if we start using these types of tests at a massive scale, we can actually find that we can curb epidemics, not just keep a specific location safe, but actually sort of bend the arc of an epidemic by getting that r value, the reproductive rate of the virus down below one so that viruses once said an epidemic, when it starts to arise, it actually just stays suppressed. And if we can do that, then we could have, for instance, prevented the false surges that just hit. If every American household had these tests in their homes back last summer, which was possible, we could have potentially prevented hundreds of thousands of deaths by preventing the epidemic from getting out of control in the fall and winter. But the only way we can really do that at scale, in my opinion, is to get these tests into the home for school-based testing. The best way to distribute the effort of doing massive testing is to do it inside the home, not put it on the workplace, not put it on the school. If additional layers of protection are desired by theaters, by schools, by other avenues, I think that that should be secondary in many ways relative to preventing the outbreaks from arising in the first place. So my first interest in sort of getting wide scale testing out is to just is to keep r below one and get the epidemic to not resurge in the fall. And if we can if we can keep r below one, what that means is that even if cases start to pop up in a community, if enough people are testing on a regular basis, the outbreak just won’t ever appear. It will be a blip and then it’ll be gone. So that’s the best way to keep our community safe.

Secondarily is to have what you’re describing, which is entrance screening. Entrance screening is exactly how it sounds, which is you want to have a proper set up of using the tests right before somebody walks into a theater or a building. And that can be extremely effective as well. It’s not going to bend the whole arc of an epidemic, but it’s going to allow certain facilities that want to put those in place to get back to get back to session. We saw great examples of entrance screening in all across New England colleges this whole year, where even in the midst of massive resurgence of cases, the one places that should have been considered the petri dishes to harbor massive amounts of infections turned out to be little protected oases because of frequent testing and those of our colleges and universities. So even when there are lots and lots of cases happening around those colleges and universities, they generally did an extremely good job at preventing cases on their campus from persisting and preventing large outbreaks because of frequent testing. So entrance screening can work extremely well. Just needs to be I think the two types of testing need to be performed in concert.

MODERATOR: Lauren, do you have a follow up question?

Q: I have a question on a bit of a different topic, if I may.

MICHAEL MINA: Sure.

Q: I was wondering, we’re now coming up on exactly tomorrow, a year since COVID-19 was declared a pandemic. And I guess when we’re thinking in retrospect to a year ago, it does seem a bit late. And I was wondering if you could talk a bit about that kind of time and maybe it was there. Do you think complacency on behalf of governments? Because this was maybe a coronavirus and there hadn’t been a pandemic from a coronavirus, what could we kind of learn now that it’s been a year from what happened? Thanks.

MICHAEL MINA: The short answer is, you know, people like me were extremely frustrated that it wasn’t being declared a pandemic yet. I mean, in early January, we knew that this was a pandemic and many of us were saying it publicly. I think that, you know, I’m I get frustrated even thinking about it, because I would like to say that we’ve learned that we need to take this virus seriously. And part of that was the moment we saw that the virus was spreading across all of East Asia and Southeast Asia and into the Middle East, all within weeks of it first being discovered. We should have declared it as a pandemic virus. We didn’t. The world didn’t. And that, to me, was the beginning of an in action as a response of tempering any sort of urgency in our response. And ultimately, it caused the world to end up where it did. And in the United States, we’re one of the worst perpetrators of this and I think, you know, the inaction that happened initially to not call it a pandemic to hedge and say that this isn’t going to be something we really need to prepare for caused massive issues. I remember early. Well, no, I think it was already March. I was speaking with some of the major test manufacturers, the ones that build the PCR laboratory tests, and they were still asking the question when I would call them up and say, hey, you know, we need tests. Where are you guys with your COVID tests? A number of the major ones in the world were still saying we’re not really sure if we’re going to be building a COVID test. And, you know, had to go back in January, said this is obviously a pandemic by definition already that would have given the companies a couple of months head start to start building their testing infrastructure, not even getting to these rapid tests or anything, just the PCR tests. And so there are major consequences to not looking at the writing on the wall, taking a very fact based approach and just saying, hey, this is a pandemic. Let’s let the world know. We’re seeing the remnants of that type of thinking continue today where we are hedging. Our FDA continues to hedge on whether these tests can be used in the United States at home by people without a medical prescription, which is why we’re doing this clinical trial. But a year into this pandemic, after everything we’ve seen, we’re still really talking about whether people need a prescription from a physician to get a COVID test. You know, it’s appalling to me at this point, and unfortunately, I think that your question just brings up the beginning of all of this, the beginning of our inability to really rise to the challenge as governing agencies and policymakers to really tackle this virus in a way that it needed.

Q: Great, thank you so much for your time.

MODERATOR: Next question.

Q: Hi, this is also a question that is not pertaining to the study, I hope that’s OK, but basically after the CDC guidelines were announced on Monday, I’ve been getting a lot of questions from readers and even colleagues alike, particularly with the part about the quarantining. So apparently vaccinated individuals don’t have to quarantine even if they have been exposed to a suspected or confirmed case of COVID if they’re not symptomatic. So a lot of people were asking me why. And so it is sort of a head scratcher, especially since we don’t have much data on asymptomatic transmission among immunize individuals. So I wanted to get your take on it.

MICHAEL MINA: Well, it does. I think the blanket recommendation is one that rightfully raises eyebrows. The CDC is genuinely in a tough position and trying to balance many priorities. The vast majority of the discussion during this pandemic has prioritized dealing with transmission of this virus and stopping the outbreaks with very, very good reason, obviously. But once we start to see vaccinated individuals and vulnerable people get vaccines and be protected, at least for the time being, while we believe that these vaccines are really working well, still at the strains that are circulating now, the CDC has to prioritize other pieces of public health, which include mental health and economic health. And so all of this, I would say, goes into their thinking around where does the balance exist? And this has been a discussion that should, I think, have been raised throughout the whole pandemic. It’s part of the reason why I started working with economists very early to understand, you know, what are some of the tradeoffs we’re making when we when we try to just focus on the virus whereas public health may be getting challenged in other places. And so I think the CDC is genuinely trying to come up with balance. They’re trying to come up with a policy that’s going to make sense. Should they say that everyone should just throw away the masks? I think keeping our masks on despite being vaccinated is just simple enough. If you’re already wearing a mask, just keep wearing a mask, you know, until we really see cases dwindle to very low. We still have almost a thousand deaths per day in this country. The virus, the epidemic isn’t done even if we want it to be. But trying to then balance quarantine is a different issue if we really have good evidence that people are not transmitting. That said, I would say that the evidence that people who are vaccinated don’t transmit is mediocre at best. They probably don’t transmit as much. But certainly, we know that people who are vaccinated can grow and harbor virus not as much, which makes sense. We don’t even need the data to tell us that we could have guessed that people who are vaccinated and protected from symptomatic disease are probably not going to have as much virus, if any. But we do know that they can still harbor a virus. And so one of the big questions that we don’t know is when vaccinated individuals or previous infected individuals harbor a virus, is it still as transmissible? Are they still likely to go and infect somebody who hasn’t been vaccinated? I would say we don’t have a good scientific answer for that, and so in some ways the decision I think was less about being sure about that data and more about prioritizing other components of public health. And those are some of the pieces that are really hard to quantify, especially after a year of just talking about the virus, to really try to quantify what are the competing interests of public health is a very difficult thing to do. So I don’t know that I’m in a position to advocate or not for that decision, but I think I can see where they’re coming from, even if the science doesn’t fully, fully align with it from a viral perspective, I think that the other pieces that they’re trying to protect are probably very valuable.

MODERATOR: Do you have a follow up?

Q: Yeah, I mean, I guess I understand where you’re coming from in terms of like balancing people and what they want, especially with the economy and what not. Quarantining is a temporary thing. Right? And especially I mean, does it have anything to do with testing as well? Because they’re not required to do testing? Are we limited in testing still? Is that a thing?

MICHAEL MINA: I mean, my very clear opinion on the matter is we could have probably greatly limited our need to quarantine a long time ago if everyone had tests in their home. If you if you knew that you were going to have to go into quarantine, maybe you could actually still continue to participate in society if you were testing daily. There is no reason to think that that couldn’t have been a much better approach. But to answer your question, I mean, the testing infrastructure still is not working in this country. Despite all of our efforts, the PCR infrastructure is just not equipped to stop transmission when in our in our public opinion poll of Americans that we released a couple of weeks ago, we found that two thirds of Americans have never received a single test. And one third, you know, the vast majority of people who have received a single test have received one that is not a way to test, trace and isolate. It never would have worked the PCR lab setups that we have. And I think that if we were to fix the testing problem, then all of a sudden, these issues would have so much more flexibility in terms of, you know, making these declarative statements. Should you quarantine, should you not quarantine? Maybe we could say you quarantine for five days and then you test yourself at home. And if you’re still negative, then you can leave because we know that most people who are going to become infected during quarantine will do so in the first five days. You know, there’s so much more option that we could have had if we actually had testing available. And it’s not just about the test. I mean, the point is that this is all about knowing that you’re infected. Quarantine is like taking a sledgehammer and saying whether you’re infected or not, we’re going to put you in jail for 14 days in your home just in case. And we know that most people who are in quarantine don’t become positive. And so it’s an inefficient public health tool. But because of its great inefficiency, it’s one of the first things to go once people start getting vaccinated. And I think if we could have made it much more efficient, for example, have instead of quarantine, you can have daily tests. I mean, heck, these things are so inexpensive, you can have twice a day testing, test yourself in the morning, test yourself in the evening. And, you know, that would be enough to catch essentially everyone that would have potentially gotten infected and found out that they were infected during quarantine. So I wish that that this wasn’t even a discussion that the CDC was having to make, that they could have said, just keep doing your testing. It’s 30 seconds a day. But instead, they’re balancing 14 days in in quarantine, which is a massive, massive economic loss to companies. It’s one school having to quarantine, for example, if a classroom has to quarantine because of one infection going into a classroom, that’s almost a year of person time spent away from school just because of one quarantine event in the classroom. And so, no, it is a massive issue that the CDC wanted to tackle. But I think we had better tools that we I wish we could have deployed.

Q: Great, thank you.

MICHAEL MINA: And I would say I think we can still deploy them if regulatory barriers would allow.

MODERATOR: Next question.

Q: Hi, Michael. I just want to backtrack to the trial for a minute. When do you expect results out from this? And I’m curious about that in relation to the comment you made about a Fall surge, I think a lot of people, even though there has been advice to the contrary, I think a lot of people are thinking, oh, we’re all going to get vaccinated and this is going to be over by the fall.  

MICHAEL MINA: People are thinking that you’re absolutely correct. Unfortunately, I don’t think that it’s going to be as peachy as we hope. But to answer your question, the trial right now is set to run for four months. We’re going to be doing an interim analysis, too, along the way. This isn’t it’s not like a vaccine trial where people are blinded. So we’re monitoring on a daily basis just as the study team. We’re not interacting directly with the participants, but we are monitoring the results as they come through. And already we’re seeing benefits. We’ve already had a number of participants who are completely asymptomatic and would have gone to work who found out that morning before work that they were infected. And again, because it’s a rapid antigen test, that means that they were infectious as well and or very likely to be. And so those events alone have showed us, look, this is working. These people were completely asymptomatic. I haven’t followed up yet to find out did they become symptomatic or were they pretty symptomatic and then gain symptoms. But either way, they would have gone to work on those days and without knowing that they were positive and transmitting. And so we’re already starting to see the benefits in terms of the other components of the study, which are trying to evaluate how well people can learn to use these tests at home through the use of the AI powered app. That’s been great. We recently did a feedback kind of survey to get information from people about how are they thinking about it? Was it helpful? And overwhelmingly the answer was yes. And in response to the overall program, the overwhelming comment is something akin to I don’t understand why everyone doesn’t just have these in their home already. They’re so simple to use. So we’re already getting the data and I think it’s already going to start informing much of the discussion in the near future. The full data set will be only occurred in four months’ time or three to three and a half now. But we’re monitoring closely.

Q: How important to your mind is this study in making an argument to the FDA that these kinds of tests you deployed as public health tools are important? I know you’ve commented in the past that the criteria are wrong for which these screening tools are being used.

MICHAEL MINA: Yeah, well, we’re submitting a paper today probably, which mathematically shows that the criteria is impossible in terms of what the FDA is asking for unless companies go and totally skew their representative, asymptomatic people. I don’t think that this study is, frankly, going to influence or not the FDA whatsoever. I think where it can be influential, assuming that the data continues to be positive about this as a tool to prevent transmission, is to go to HHS or CDC and say, look, there is a clear disconnect. These tools are public health tools, and somebody needs to just declare them as public health tools so the FDA can stop having to evaluate them as medical tools. This could be on the FDA. The FDA could come up with a new pathway to evaluate tools which have a primary purpose of public health. They have not done that yet, and I don’t anticipate that they will do that during this pandemic, unfortunately, and perhaps never do that, so the CDC and Health and Human Services, I think, can declare there are pathways that we that I could envision that a tool like this gets declared as a public health tool and not a medical device. And that would allow the tools to be maybe taken over in terms of in terms of certifying different public health tools for Americans to use. Maybe that challenge would go to the CDC or HHS in some other way or the NIH.

MICHAEL MINA: You know, what I would like to see as a presidential order from the president to look at the landscape of all of this and say, what the heck are we doing? What has happened, what has gone wrong? Why are we still declaring these tests as medical devices this long into a pandemic when there are clearly devices that are meant to just be used for people to just monitor themselves at home? The average American, it should be allowed to know if they’re harboring virus in their nose without having to go through an expensive doctor’s visit, even a virtual one which adds which adds cost. The fact that we’re preventing the American public from just allowing themselves to know if they’re infected, it is remarkable to me. And so I think the fastest pathway here would be if we if the data really shows, look, this has helped a major international organization get back to work safely and it worked well and thousands and thousands of people, then maybe this is a public health tool and maybe the president or HHS in conjunction with CDC could determine that in some more official way.

Q: Very good. Thank you.

MODERATOR: Just to let everybody know, Dr. Mina needs to go to another meeting at 10:45, so we have just a few minutes left.

MICHAEL MINA: I’ll speak quicker.

MODERATOR: OK. Next question.

Q: Hello, Doctor. Can you hear me?

MICHAEL MINA: Yeah.\

Q: OK, I want to ask you specifically about the tests that you’re calling for. We know that currently the FDA has given emergency use authorization to five at home tests and there are plenty more on the web that a person can get that haven’t received such authorization. So which test in particular would you like to see? And should they be mailed to all Americans or should Americans have availability?

MICHAEL MINA: Sure. Yeah. Just to be clear, the tests that don’t have EUA are currently illegal. Maybe people can buy them on the Web, but per US regulation, they are not legal. And so there’s a number of different tests that I would like to see. Laboratory tests are not one of them. Laboratory tests have a place in this pandemic as medical diagnostic lab developed tests and EUA authorized tests. But what I would really like to see is tests that are fast. A test that is fast starts to approach a public health test, a test that determines that somebody is infectious and not potentially has been infected weeks ago. Is a public health test a test that anyone can do simply on their own is a public health test? And a test that is equitably distributed and accessible is a public health test. The PCR laboratory tests fit essentially none of those categories, unfortunately. And so we’re going to see a rapid molecular tests can be the types of tests that I’m that I’m calling for. These are tests that anyone can use in the privacy of their own home, take a minute of hands-on time to actually use that could be done with or without reporting. And I think where the FDA is going is they’re going to continue demanding reporting because it’s going to detail that. But those are the types of tests. We do have some other tests. All of the ones that are at home currently still require a medical prescription, and that greatly drives up the cost a pack of five tests that should be five dollars or maybe twenty-five dollars total. But I would like to see a dollar per test is one hundred and twenty-five dollars. That means we have made these tests, the tests that are available to Americans at home or are available to rich Americans, that it is just completely backwards what we’re doing to charge for prescriptions for a test that most people are getting and Abbott BinaxNOW test, they get the box at home. They’ve paid for the prescription, and then they never even use the medical service. They open the box. It’s a simple, simple test and they just go and use it on their own. But yet they’ve had to pay the extra one hundred, one hundred and twenty dollars for the medical service that they’re not even utilizing. So I wish that our regulatory agencies would look at the reality of what people are doing and recognize that these prescriptions are costly and reduce equitable access to testing. There are some other tests which by themselves are expensive, you know, in order to get her on this reporting issue and to get to the tests like Ellume. Ellume is a rapid antigen test, just like any of the very, very simple paper strip tests don’t perform any better than those, but it has batteries and circuit boards and it’s expensive. And so that’s not a test that we can use as a public health tool. It’s going to be tens of dollars, maybe 30 or 40 dollars by the time it’s purchased and sold to a customer by Walgreens or CVS. So those are not the tests I want. I just want to see the simplest of tests like the Abbott BinaxNOW, like the ANOVA test, which we’ve evaluated and other studies, and it’s performing as well as the Abbott BinaxNOW, only it can scale to 10 times more. They can make right now; I think they make 15 million per day and export those around the world outside of the United States. It’s a US based company. I would like to see those types of tests start to be used in the future. I’d like to see the CRISPR based molecular tests that has come along. The other sort of very simple molecular assays like those. Those will be the next iteration of our home tests and they might be a little bit more sensitive, etc. But right now, what I really would like to see is these very, very dead simple antigen tests.

Q: Without a prescription. And doctor, currently, I know that Yale has something called saliva direct, which is similar to what you’re saying. Are those the types of tests that you are looking for? And finally, I would ask why you think Fall will not be, as you say, as peachy as we like to imagine?

MICHAEL MINA: And just to be very, very, very clear, saliva direct, a laboratory-based PCR test. It’s essentially the original CDC, PCR based test. It’s not a rapid test. It’s a small, complex, laboratory-based test that just uses saliva instead of a nasal swab. Everything else is essentially the same. So it still has to go get shipped to allowed. Everything is the same, it still takes days to return, etc. So that’s not the kind of test I’m really talking about, the simple little test that anyone can use at home with a simple nasal swab that they do themselves or even potentially saliva based at home tests as well. In terms of the fall, I think that we’re going to see a resurgence because this is a very seasonal virus. Every year we see surges of beta coronaviruses like Sars-CoV-2 come back and then we see them fall off very quickly towards the end of January and February, which is exactly what we saw with this virus. And I think that we’re going to see the vaccine derived immunity, particularly in the elderly, probably won’t last as long as we’re all hoping. The elderly are kind of famous for not being able to hold immunological memory very well. It’s part of the aging process. And so I think we will start to see breakthrough cases. We’ll see continued some level of transmission among vaccinated individuals, as I discussed earlier. And if that happens and we start to see a waning of protective immunity, which we don’t know will happen, but it very well could happen, then we might even see increased cases come with increased hospitalizations. And I think we have to just be very cognizant. We can hope let’s hope that that doesn’t happen. But I think it’s unlikely that we won’t have a surge. I think it’s very unlikely that we’ll have surges as big as what we have seen in the recent fall and winter. But we will probably have surges and society is going to have to make decisions. Do we continue counting cases and shut schools down or do we really count hospitalizations and deaths and allow society to keep running despite cases if people are protected? And there’s a lot of unknowns there, but I think we will see cases reemerge. I just wanted to take one more question.

Q: Yeah, you’ve been screaming the same argument into the wind for about a year now and you haven’t gotten much response. And my question even the tests that are on the market now and the one I believe that doesn’t require a prescription, you’re talking 40, 50, 60, 70 dollars. You really haven’t given up hope. But my question is, what gives you hope that we’re going to get a test that people can take at home every day and or twice a day, as you pointed out at one point, and make it an effect on this pandemic? Because of testing sure has not gotten a good reception, despite all your efforts to shout.

MICHAEL MINA: Well, am I going crazy and am I just crazy for trying to repeat the same thing over and over and over for a long time. And I think no, I think one regulatory change, just one just one regulatory change would allow Americans to have these tests in mass. And probably a lot of these companies if you get rid of the medical prescription. You’d see that these tests will start being sold for three bucks apiece, something like that, four dollars apiece. The reason that I keep going, frankly, is I mean, there’s the public health reason that I think that these are very powerful. But why do I keep going in here? The reason is, as I keep talking about it, I’m seeing more and more countries outside of the United States picking this up. So my advocacy in the US, I don’t think stops at the US. Just yesterday I was on the phone with a prime minister of one country and the leadership of another country. And so and it was all about them rolling out rapid tests. So and frankly, many of the countries that are doing it are pointing to a lot of what I’ve said over the year and the research that my team has put out over the year as evidence for why they’re thinking of doing this and why they’re acting on it today. So, you know, I’m American. I live in the United States, and I really want us to benefit as a country from smart public health and from following making science-based decisions on how to best combat the virus. But if the US can’t do that and can only think of medical interventions and biological interventions as the as a strategy, so be it. What I’m saying to the world, I think does truly get out globally. And so that’s why I keep doing it. I would like to see the United States get on board. But if we don’t, I feel. You know, I mean, from a very, very personal perspective, I think. I feel extremely strongly about this, that if this if all of my advocacy work to go and save, you know, prevent one additional life from getting lost, then that’s completely worth it. That’s why I went into public health. If somebody were said to me a year ago, hey, would you yell into the void about rapid tests for a year if it means my mom doesn’t die this year? You know, maybe I would have thought that’s a funny question, but I would have said yes if it was correct and of course I would say yes. And so this is an opportunity to have that magnified by tens or hundreds of thousands or more. And so it’s a small effort on my part relative to the toll that this virus has taken, in my opinion, whether it’s smart anymore, I can’t say. But I do think that as more and more countries are picking up this idea, I think that it does pay off. We’ve seen it really be beneficial. We’ve seen it prevent tens of thousands of cases across the globe already. We can look at the UK and how many cases have been identified before people have gone on to infect other folks has been really astounding. And that gives me hope that other countries can successfully do this as well.

Q: Thank you.

This concludes the March 10th press conference.