You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Michael Mina, assistant professor of epidemiology. This call was recorded at 10:30 am Eastern Time on Friday, May 15.
Previous press conferences are linked at the bottom of this transcript.
Transcript
MICHAEL MINA: I’ll just take any questions.
MODERATOR: Alright. Looks like our first question.
Q: Thank you. So, I’m sorry, this is going to meander a tiny bit. I have a sort of an intertwined question. You might have seen The New York Times reports on PNAS study out today about how many viral particles come out when you talk even on certain consonants. And that connects to my main question. I’m baffled by why it seems like there are some really basic things about viral transmission that we didn’t know. And is it true? Like, why do we not know even some very basic things about how viruses are transmitted person to person and then the pragmatic side of the question is, as we head into reopening, I think, you know, a lot of concern has been focused on people who are kind of scofflaws about social distancing and so on.
But I think there’s a flipside, which is a lot of people are going to be so scared because of the flawed nature of our knowledge that they won’t reemerge very much and the economy won’t restart as much as it could purely because of this fear. So are there fears that you’ve seen that you think are really unreasonable and that you would want to reassure people about. Sorry. That’s a very double-headed. But you get where I’m going.
MICHAEL MINA: Yeah. I mean, I’ll tackle the second one first, which is I think it’s very reasonable that people are fearful. You know, in some ways I think we’re actually hoping that as things go back to normal, that people continue to be very cautious. You know, that is one approach to keeping the curve pretty flat as we open back up is if people remain cautious. And if that’s because they’re concerned about getting the virus, well, you know, as far as I’m concerned, that’s actually an appropriate reason to be extra cautious because it’s a real – people should have that concern. And so, I do think that might be okay.
I do understand from the other side of the coin, there are people just going to remain fearful because we just don’t, there’s so many open questions. And certainly, I mean, especially we live in a fear mongering social media world these days, and so I think there’s going to be unfortunate amounts of fear that’s not necessarily warranted. There’s going to be expectations that are, you know, confusing to the public.
For example, if we say that there’s a 1 percent mortality rate, you know, that sounds really, really scary. And it is. But that’s an average of our whole population. So, the you know, the 15-year-old probably doesn’t have to worry about having a 1 in 100 chance of dying if they get this virus. So, there’s a lot of not just unknowns, but misconceptions or a lack of communication from the scientific community to really convey what things mean. And a lot of times that’s because, as you all know, you’re journalists and media people, the way that you speak to the public has to be very simple in general and not in a bad way but it has to reach a wide audience and a lot of the nuances can’t be conveyed.
So I think even if we had a lot of the information, there would still be just as much, there’d still be as much missing or misconstrued anywhere. So, you know, that’s a bit of a pessimistic view of that I guess. But I do think that it’s very hard to really convey the nuances in the first place. That said, there are a tremendous number of things we don’t understand about the virus. We held an expert meeting in in the Netherlands maybe five years ago now. And it was all based on trying to bring a group of about 40 experts from around the world together to discuss what is known about pathogen transmission. And we split up into different groups. And there is a respiratory transmission group that I was in, it was a group of 10 of us and the fecal, oral route transmission, waterborne and all these things. And ultimately what we came up with, particularly in the respiratory group, was a whole series of questions with little data to really answer any of them. And it suggested to us and one of our major recommendations from that manuscript that came out of it was there are huge numbers of open questions.
We don’t actually know what the infectious dose of most pathogens are. We don’t know how long a pathogen really sits in the air before desiccating and dying off. Now, there’s a tremendous number of unknowns and these questions have been underfunded. They’re not the, you know – now everyone is interested in them because they see the relevance to their individual health.
But traditionally, public health studies like this that would really need to be occurring have been completely underfunded for decades. The public health infrastructure no less the science has lost funding on a continual basis. And trying to understand what should be basic questions that you would have thought were answered 60 years ago isn’t a sexy thing to do when you’re a funding agency and you’re trying to decide do you fund the next sequencing effort, you know, to understand some something that sounds very high tech or do you understand how many particles fly out of somebody’s mouth? You’re just not going to find the second one in the current climate. So, I hope that changes. But that’s kind of the reality of what happened with science over the last few decades.
Q: Thank you.
MODERATOR: Alright, next question.
Q: Thanks so much for doing this today. I’m the NFL writer at The Boston Globe and there’s been a lot of talk lately about sports like the NBA coming back. But I want to ask about what it would take for the NFL to be able to play this fall. There’s talk about not having fans in the stadium. But to me, that just seems like one of many steps the NFL would have to take. You have hundreds of people in players, coaches, trainers, et cetera, in close contact. There’s a lot of obviously in football, physical, close contact, players in meetings and classrooms together. It’s like I said, a couple hundred people in each club. What are some of the steps they’re going to have to take in order to try to play this fall?
MICHAEL MINA: Yeah, I think great question. The NFL has a lot of money, so that’s a good thing for them is that they’re not going to be restricted by funds. And so, they kind of have – they don’t they don’t run into the same resource limitations as nursing homes and in other places that we’re asking kind of similar questions, but for different reasons. I think that the thing that they can do, I do think that probably having fans out of the stadium is reasonable at this point, and I don’t anticipate that it would be appropriate to have fans in the stadium come fall. I see very little, very few avenues to responsibly do that. What I do see, though, are in terms of the hundreds of people that might have to exist for a game – coaches, trainers, everyone else, players – I think that there are going to be two changes that happen in the near future.
One is we’re going to see the accessibility of testing increase tremendously. And this is going to be from new types of tests. These might be a paper strip tests that look like pregnancy tests but actually for the pathogen itself, that might be a two- or five-dollar piece of paper that you can either spit on or you swab a Q-Tip into your nose and rub it on this thing or put some solution on it, whatever it might be. I think that will come up with very cheap, very accessible tests that are done at the point of care. And these are the types of things that I think, you know, looking not just at football, but the wider economy and getting people back to work, I can anticipate or I could see a day when people actually do test themselves every day.
And even if some of these tests aren’t quite as sensitive as you might hope, if you’re making this tradeoff and you’re saying, OK, I’m going to test myself every day, then if you’re just a little bit below the level of detection but you’re still technically positive, you’re not going to transmit that day anyway, but you’ll find it the next day when you go to test yourself. So, I think that we might see a moment in the not too distant future where that starts to become a reality and we aren’t running into the same limitations on testing that we’re seeing today. And essentially before a game, what I would suggest is that it’s not just once a day, but right before the players really go out, everyone essentially swabs themself. And if that swab is not coming up positive, then even if you have very low levels of virus in you, you’re probably not going to transmit to anyone in the next few hours if it’s a new, new acquisition of the virus, for example. So, I think there are safe ways that these things can be done and new technologies and new advancements will certainly play a big role in that.
Q: And so, you think just increased testing is all it will really need for sports to be backed by this fall? Not necessarily, you know, keeping players away from their families or moving to like a bubble scenario or a hub scenario or anything like that?
MICHAEL MINA: Well, I think that if we actually have that level of accessibility to daily testing, I mean, I’m envisioning a world where everyone, you know, you have a monthly shipment of 30 or 40 swabs that come in a little container – not swabs, little test strips that that come in a little container like toothpicks do. And you just use them every day.
And I think that if we do that, then it’s not just sports, but it’s you know, maybe then you can go visit grandma in the nursing home and you just have to make sure that you are negative right before walking in there. So, I think that these types of things can really change the whole way we’re thinking about a lot of these different questions. If everyone a daily basis can know with decent confidence that they are negative or at least that they’re not transmitting, then all of a sudden it makes things like going to a restaurant possible and playing football.
Q: But if you do test positive, will you still need to quarantine for two weeks and remove yourself from society and things of that nature?
MICHAEL MINA: Oh, yeah. I don’t think that’s going anywhere. I do think so. That’s not going anywhere until we have decent herd immunity anyway. But even that I think absolutely that would be the response. And that’s why you’d really want to have daily testing on a sports team because you – and you’d want it every day, not just for games. You’d want it every day they’re practicing because the last thing you want, if you’re a multi-billion-dollar organization like the NFL, you do not want teams having to all sit out for two weeks because, you know, there was a massive outbreak.
And so, I think you could start to make the case that if one person’s positive, you don’t take a whole team out, you just do much more heightened surveillance of everyone else, maybe three times a day. Whatever it might be if you’re completely not constrained by resources.
Q: Interesting. Thank you very much.
MODERATOR: Next question.
Q: Hi. Thank you for taking my question. And thank you for doing this call. There’s a study that’s coming out today that compares case rates in two states, Iowa and Illinois, one of which enacted stay at home measures, that being Illinois, while the other didn’t. Not asking you to comment specifically on this study, but I’m wondering if you can give us sort of a general comment about the effectiveness of state home measures in containing the outbreak.
MICHAEL MINA: When you say stay at home, you mean as opposed to more lax but still pretty strict social distancing measures?
Q: Yes.
MICHAEL MINA: I don’t know that the – I haven’t seen the study. I would like to. But that’s been an open question, how important – from what I know and maybe this new study is going to change, you know, what I know by the time I read it but from what I know now is that we don’t really know which component of our social distancing is really the most helpful. For example, could we have, pretty much could we have just said don’t go to work but still go about the rest of your days? Would we have actually come ninety five percent of the way as we did with full much more strict measures?
And so the question is how much are the diminishing returns once you get up to sort of very strict approaches, and I think that we don’t have a good answer for it at this point in terms of a real strict stay at home measure versus it’s OK to sort of meander out of your house for a walk, but don’t go to work, don’t get on public transit and, you know, wear a mask whenever you do all of that. I think, I don’t know that it’s really been pinned down that staying, that real strict stay at home measures are actually massively improving the situation over be vigilant when you go outside, wear a mask, don’t crowd around people outside, you know, go and walk around the park but that’s about it kind of thing.
Q: Right. To be fair, I don’t think the authors are saying that stay at home is an absolute case reducer. In fact, I think they said other factors may be involved as well, like increased testing and other things. So, I guess from your answer that it’s fair to say that the jury’s still out as to whether strict stayed home measures are necessary in this case.
MICHAEL MINA: Yeah, definitely. I think the jury is still out. Again, as far as I know, I don’t think anyone’s really shown any data that suggests otherwise. I would say that we just don’t know what the principal components are in terms of what’s been really the most successful. We kind of did everything at once.
Q: Right.
MICHAEL MINA: We stopped work. We stopped transit. We stopped. We stayed at home. So then now it’s going to be – what I would like to see given the heterogeneity that will occur over the next couple of months as different places open up differently, I would really like to see states and state departments of Health track these things very closely to understand what different communities or states are doing to try to understand which are the most important features because we can’t – I think everyone agrees that we don’t want to have to go into this level of social distancing again.
So, if we can find that, hey, you know, actually, if you just don’t do these two things, you can still practice the rest of your life per normal. That would be, you know, those it would be really great to find out what those two items are and parse them out from the rest. And so, I hope that as we open up the correct analysis and the correct data will be captured to really use the heterogeneity and use this natural experiment that we’re about to turn into to our advantage for the future. I don’t have a lot of hope. I don’t have a lot of – there’s not a lot of precedents to suggest that that will really happen in any very robust way. But I think we will be able to learn something.
Q: Great. Thank you.
MODERATOR: Next question.
Q: Hi. Thank you. I want to talk about antibody testing. I understand that there are maybe hundreds of them available, but none has been shown to be accurate. And meanwhile, they’re being offered at pop up sites all over the state. There was even somebody offering antibody testing in a bar in Cambridge before it got shut down. I’m just wondering what you think about that and whether, you know, what consumers should be thinking about when they decide what they want to take one of those tests.
MICHAEL MINA: Yeah, I think that antibody test should be – the market was flooded with them. There were a lot of various little kits that came out and were point of care. You know, you drop your blood onto one of these plastic things and it makes a a line light up if you’re positive. These are collateral flow assays or lateral flow tests and they are, they can be accurate, but because the market – there was a lot of business opportunities seen by investors, you know, investing in these manufactured products coming out of China and Korea initially. And a lot of those turned out to be really poor.
And this is not unexpected. It’s actually, antibodies are famous for their cross reactivity and they’re not playing nicely with what we want them to do. It’s part of their biology. It’s the way that antibodies work. So to make a very accurate test, you have to be very careful and you have to be very careful about not just the protein, but what you’re putting the protein onto, what kind of conditions that can withstand, and the protein itself, for example, is usually a piece of the virus that we produce and it can capture somebody as antibody if they have an antibody that binds to that piece of the virus. But antibody testing in general, though, can be extraordinarily powerful.
And I think what we’re seeing here is that there has been somewhat of a misconception about how, about what antibodies, what metrics we should assume exist and can exist from antibodies. I think that on the one hand there can be really there can be assays that are very poor performing assays and then there can be assays that are very good. But these are not nucleic acid tests. These are not PCR tests for the virus. And the reason I make this distinction is that, well, on the one hand, PCR tests the virus check for the virus and not a response. But in that sense, you’re looking for something that’s stable. You know that in general that the virus is going to have this one bit of nucleic acid and you can go and target it. Antibodies are totally different.
The thing that makes immunology and in particular antibodies so immensely incredible to me and why I love studying is because antibodies are different from one person to the next. There’s no two people that have the exact same repertoire of antibodies. And so that means you’re kind of having to find when you create an antibody test, you’re trying to find a target that is going to capture specifically all of the different antibodies that everyone formed. So the antibody, if I have an antibody test in my hand and I take a – and you all have had coronavirus and I collect each of your antibodies, you might each bind a little bit differently to this test. So. it’s an extraordinarily difficult thing to find that one protein I can put in this test that will really capture all of your antibodies and not capture antibodies that come from a different virus, immune response to different virus. So, it’s really a very difficult test.
And if you’re in the business of normally studying antibodies, which a lot of the people who are now working on these serological testing, especially, you know, the media isn’t used to talking about antibodies. I think there’s been a lot of confusion around what are the metrics that we should expect. We’re not going to get 100 percent accuracy with an antibody test. And for example, of what is a false negative. This has been talked about a lot. And, you know, a false negative if you have just gotten an infection, I wouldn’t call a test being negative when you’re five days into your infection a false negative. I would say that’s what you should expect.
We know that antibodies don’t come up within five days of infection usually. So that’s not a false negative. It’s just that you’re still under the limit of detection. It’s kind of like a pregnancy test. If you get pregnant today and you go and take a pregnancy test tonight, it’s going to be negative. But is it a false negative? No, it’s just you’re using it at the wrong time. You have to wait a little bit and then you can use it. And it’s still a good test, you just have to use it appropriately. So, I would say I want to differentiate because antibody testing has gotten a bad rap recently, and I think it’s because there’s a lot of confusion about what constitutes a false negative or false positive. And false positives are a little bit more clear cut. If you haven’t had the coronavirus and you get a positive, that’s a false positive. It’s not specific for that person.
But even that is assumed to happen every once in a while, because again, antibodies are sticky. They’re literally designed to cross react in some cases and evolutionarily. And so I think we have to be careful about calling them good or bad tests, but there are some that are bad. And so to get back to your question, I think we have to take all of this information. We have to really pay attention to what experts are saying about which ones are good and bad. And then we have to be really careful about how we’re using them for public health. And I say that because I think we see all these little point of care tests that don’t connect into the public health data system.
My real fear is that for ease of use, these point of care antibody tests are going to become widely available, even if they become very accurate, I’m fearful that they’d become very widely available because the real power of testing for antibodies is not so much personal health. It’s much more about public health in my viewpoint. And the moment we make everything sort of available at home, we lose the information that could come from that. That information doesn’t necessarily feed into the Department of Public Health data system to tell us where there are immunity gaps in the population or where there’s outbreaks happening or where we don’t need to allocate resources to because everyone’s immune already.
We need to have that information from a public health perspective. So people going out onto the sidewalk and testing people if they’re not capturing that information and sending it back to the Department of Public Health, that’s a real loss to public health and our ability to control this virus and understand where it’s where it’s moving.
I’m much more an advocate for antibody testing to be collected potentially at home, but ultimately sent to a laboratory to do a very high-quality quantitative test. And then those data can feed back both to the individual, but also to the Department of Public Health and used for understanding how to control and mitigate transmission in the future.
Q: In the current situation, though, do you have any concerns that people getting these tests will get a false sense of security? Take a test and say, OK, I got antibodies, I’m going to walk around without a mask, I’m going to go hug my grandma?
MICHAEL MINA: Oh, yeah, for sure, I think that’s why we’re pressing the narrative so much that we don’t know what having an immune response or what having antibody really means.
That’s a that’s a massive concern. You know, and it’s a little bit less about the individual’s health. I’m not too concerned that this virus – I do believe that this virus will lead to an immune response and probably a decent one for the individual. But I’m not sure if once when somebody has antibodies, if they can’t still be a transmitter of a virus if it lands in them again two months later, they might not get sick, but maybe they can still transmit it. So I am very nervous about that.
In addition, with elderly and with nursing home residents, I think we’re far off from understanding what their immune system is. You know, elderly are perpetually under studied in terms of their robustness of their immune responses. And we know that the immune response degrades over age. And so I’m particularly concerned about how we are – I think that using antibody testing in nursing homes is absolutely crucial and we need to be doing it any time we’re doing PCR testing. We should also be testing for antibodies. But we need to be very careful about how we’re interpreting what those mean. Then I don’t think we have a good understanding at this point about whether or not they will truly protect people, especially in older age categories.
Q: Thank you.
MODERATOR: Thank you. Next question.
Q: Hi, thank you for this. I have been focused on nursing homes and testing in nursing homes, and it seems to me that there are two giant obstacles and that is access to the supplies, the tests and resources in terms of financing. I’m wondering what does the supply chain look like to get to the point where we could test everyone in nursing homes? And what are your thoughts about the resources part of it? I know that’s not necessarily what you research, but could you give me your thoughts?
MICHAEL MINA: Well, it’s, you’re right. It’s not what I research, but it’s certainly what I do these days. So, I am often in the middle, I’m very much in the middle of a lot of the nursing home testing that’s happening in Massachusetts. There’s tens of thousands of nursing home residents and staff that need to be tested. And for various reasons, I’ve been thrown into this to help out. And you’re absolutely right, you hit the nail on the head. The resources aren’t apparent in terms of where they’re coming from, who is doing the testing, where is the money coming from to do the testing? These arrangements haven’t yet been really solidified.
And so, for example, in Massachusetts, Governor Baker, there’s a bulletin out now, and the the idea is that every nursing home resident, has to get what we call, what the governor and the state is calling baseline testing. And so, every nursing home resident and staff or at least 90 percent for each individual nursing home needs to be baseline tested by May 25. Otherwise, they risk not getting supplemental funds for COVID response. So, this is an effort to sort of twist their arms to make sure they’re getting tested.
The problem is, and this is why I’m getting involved, is that they have no idea how to get tested. There is not a good solid pipeline to get the supplies to test to figure out how to get in touch with people who can test. We have the National Guard going in and doing a lot of the testing. That has its own problems. We have E.M.S. services. So, we’re contracting a lot with various E.M.S. squads to go and do it. But this would only be possible for because we are working with a very sophisticated E.M.S. squad that can do all of their barcoding on the fly. And they’re very tech savvy.
So short of these things, I mean, nursing homes don’t have a lot of options if the state isn’t really laying out a foundation for this. And we have been writing a a couple of op-eds about it that should be coming out soon, I believe, you know, about this very issue and it’s very difficult to watch because the nursing homes are seeing the days tick forward. They essentially have 10 days now to ensure that their nursing home gets what is called the baseline tests, but they just don’t have access to the supplies or the connections to the laboratories to make it happen. And everyone around who can facilitate is stretched too thin, so there’s going to be nursing homes that fall through the cracks. And this isn’t just Massachusetts, of course. You’re in Miami, perhaps. And this is everywhere.
And it’s a real problem that isn’t being tackled in a coordinated fashion. And the other thing I would say, since we’re on the topic of nursing homes is that this idea of baseline testing is really, it’s just not – baseline testing for the virus alone is not an appropriate goal. And in particular, placing COVID response funds, supplemental funds, tying it to this is really, I think is not appropriate. And a reason for that is doing one cross-sectional sample, one sample time point of the nursing home, gives you very little information if you’re only testing for a virus.
If I go into a nursing home, I can give an example, I went into a nursing home – I didn’t personally but I helped direct it – on Monday, this past Monday. That nursing home was 13 percent positive across the nursing staff, across the residents and staff. So that sounds, okay, that nursing home has 13 percent positivity, but you have no idea if they’re on their upswing to create, to have a massive outbreak or if they’re finishing up with an outbreak. We do know, because we’ve actually longitudinally followed this particular nursing home over time, that three and four weeks ago they had 30 and 40 percent positivity. So we know then that this 13 percent means that they’re on the downslope.
So what I would suggest is anyone working to create policy surrounding testing nursing homes or any of these types of cross-sectional surveys, if you want to do a baseline testing or a one-time point, do virus, but then at the same time get a dried blood spot and do antibody testing, because that would show you that, yes, there’s 13 percent positivity right now in this nursing home for virus, but there is 62 percent seropositivity for antibodies, which lets you know that the epidemic is on its way down in that particular location. So, these are extremely important things to know. And only doing one test in a nursing home for a virus is really nonsensical.
Q: Is there a shortage of supplies for these tests? Is that – and how do we overcome that? Do we need like the Defense Production Act to be where we’re producing these domestically, vigorously, or do we have enough to go forward?
MICHAEL MINA: No, we do not have enough to go forward, despite what the president says. We are still – it’s one of the biggest struggles that we are going through. We’re still trying to order. We’re getting on the phone with manufacturers in China as independent people, myself and collaborators. We’re trying to just source fifty thousand swabs a time, get them on a plane and get them into Boston as soon as possible. But there’s very few people across the country who have those connections to really do that themselves. So I can’t, we can’t get the supplies we need here in Boston and here in Massachusetts and New England. And we’re Harvard and M.I.T. and Boston and, you know, we’re the biotech hub of the world in some ways and we can’t get these supplies.
So, the supplies for testing are still extraordinarily limited and very, very difficult to come by. And they might be heterogeneously spaced apart. There might be some people with a surplus and then others where there’s a complete void. And we know that these voids exist locally. Myself, I’m in the center of a lot of the testing. I can’t get all the supplies I need to do all the testing that I want to be doing for communities around Massachusetts, including for the nursing homes. So, this is one of the massive issues and I do think that anything the federal government can be doing to ramp up the development of the correct supplies to do testing is absolutely essential right now.
Q: Thank you.
MODERATOR: Next question.
Q: I want to ask, picking up on what you said earlier about confusing messages to the public. Do you think people will listen to the contact tracers programs that are being ramped up across the states and recommendations to stay inside, even as governors and the president are saying it’s safe to start going outside? Is that sort of mixed message concern you at all that, you know, on the one hand, contact tracers are saying stay away from everybody in the middle of the summer while you have even responsible governors saying nope, it’s time, you know, your patriotic duty is to restart the economy?
MICHAEL MINA: Yeah, I think that there’s mixed messages that are happening across all sectors of society at the moment, you know, from the White House on down. Even within the White House, probably there’s mixed messages. And within the federal government, there are clearly mixed messages coming out. And I think it leads to a tremendous amount of confusion. One of the worst things that you can do in any emergency and any crisis is to have poor communication. And at the very least, I think having communication within states be consistent is important. And communication within a country is important.
But these mixed messages that are coming out, whether it’s from contact tracers or just from academics in the media or from, you know, governors and mayors when that conflicts, then essentially what that leads to is it allows people to choose what person they want to listen to.
And so, some people will say, you know, this is the thing that I think makes most sense so I’m going to listen to what they’re doing in Georgia. And somebody else might say, well, I’m just going to listen to what’s happening in Massachusetts and what Governor Baker is saying. And so, I think that not having a very consistent message just leads people to throw up their hands. They start to lose trust in anything in terms of advice or suggestions or what’s the best approach and, you know, losing that trust, even if it’s just around this one item, like, should I go outside or not, really trickles down into the way that they listen to experts and advice later on about other things as well.
So, I think that the potential effects of the lack of, or the potential effects of discordant information that is coming out of all sectors of society right now may just further inflame the era of disinformation that we’re in and essentially an era where expert advice is not taken to mean much and people choose who they want to listen to, whether that’s a YouTube star or a professor. And I think it’s really detrimental.
Q: OK. The nuance of this. If you’re doing this responsibly, you are like even within Massachusetts, Governor Baker will start opening the economy, while at the same time certain hundreds of people every day will be getting a call telling them to stay home. It’s not necessarily conflicting messages because we want contact tracers, but there’s a nuance to it. Is that reasonable for people to understand?
MICHAEL MINA: Well, I think the contact tracing bid itself is a different story. I think people can – even if society was fully functioning, I think if a contact tracer calls you and explains to you what’s happening, that that is one area where there are discordance can be allowed. And that’s because contact tracing is a very important part of preventing outbreaks from spreading. So even if things were fully functioning, people were going to sports games, if I got a call from a contact tracer said, hey, you need to stay inside and this is why, I think that that is very important. And I don’t see that as conflicting of a message as the more broad strokes conflicting messages that are being that are being put out right now.
MODERATOR: OK. Next question, we just have a couple of minutes left.
Q: Just a quick question following up, Doctor, on some of the things you’ve already talked about, what are your predictions for the spread here in Massachusetts and what are your concerns?
MICHAEL MINA: So I think the question is, what are my predictions and what are my concerns?
And the prediction I would say, I would rather not make any real predictions because they’re always wrong. For all of us. But I would say that my concern is that we’re going to open up quickly, more quickly than we necessarily should, just like everywhere. And I think we have really allowed ourselves to be fooled as a society into thinking that the virus has gone away. The virus hasn’t gone away. It’s still very much present. And it’s only gone away because we’ve artificially beat it down intentionally through social distancing. So, I think it will return.
I do think we have more testing capacity and more ability to be able to track outbreaks and detect them when they come about now. So I hope that we will be able to monitor them more closely and find them. And people are more used to wearing masks when they go out. You know, when we went into social distancing, people weren’t wearing masks yet. So that alone might end up causing a tremendous benefit to reduce the risk of massive transmission events happening again. And so, I think that I do think we’ll see increases of cases as we move about.
And it might happen in the summer. It might not. But certainly, for moving about per usual in the fall, I think it will. But I’m hoping that we have changed our behaviors enough that maybe, just maybe, we can keep the case numbers down sufficiently so that at least we preserve the health care infrastructure, and we then deal with trying to also preserve and protect the most vulnerable and our populations. But I think that there’s little question in my mind that when we really open back up that we’ll see extra cases come back.
Q: Thank you.
MICHAEL MINA: Sure.
MODERATOR: Next question.
Q: Hi. Thank you so much for taking my question. I’m working on a story on sort of the dangers of asymptomatic cases, especially as more states move to reopen. And I was wondering if you could talk a little bit if there’s any idea of how many people are thought to be asymptomatic with the coronavirus and how this really might play into reopening plans, maybe things we need to consider going forward, things people should be on the lookout for.
MICHAEL MINA: Well, I think we should – I think asymptomatic or mildly symptomatic, I would say we can put them into the same bin because truly asymptomatic, as you know, it’s hard to measure that. But I think it’s probably a huge number of people who are mildly symptomatic or asymptomatic. It might be nine out of 10 infections are very mild or asymptomatic. And especially if you look across ages, the younger age groups will largely be very, very mild symptoms. And I think that that’s one of the reasons that transmission, that this infection and virus has been so hard to control and contain is because you have a lot of people who are either transmitting before they become symptomatic and in the incubation period, essentially, or they are just not particularly symptomatic so that they’re not changing their behavior in a way that’s commensurate with reducing transmission. And it will be and will continue to be a massive problem in terms of knowing, in terms of control measures.
And I think that that is why this virus will continue to transmit. I think it’s one of the major reasons and differentiators. For example, if you go to the other extreme, something like Ebola, where you have very clear symptoms, that virus doesn’t transmit or that it’s possible to stop it because it’s just so clear who’s infected. Whereas with coronavirus, there’s so many mild cases that it will perpetually cause a real challenge to us to be able to control and contain this.
Q: Is there anything places can do, I’m thinking, you know, in particular workplaces that may have announced, you know, precautions for opening up or doctor’s offices, a lot of it is, you know, screening for symptoms and doing temperature checks upon entry. Is there anything else that those places can be doing to really catch the asymptomatic or mildly symptomatic people?
MICHAEL MINA: I think that there are some ways to be able to use new technologies and apps, you know, where you can say, OK, you were exposed to somebody or you were in the vicinity of somebody who is symptomatic. And so, you can potentially use what’s happening in your environment or in people’s environments to help identify people and then do enhanced surveillance and testing of those individuals, for example.
So, I think there are creative things that can be done to help mitigate transmission despite a lot of people having mild symptoms. You know, we’re not going to do that tomorrow. But those types of technologies and sort of enhanced contact tracing, if you will, I think are coming down the pipeline pretty quickly. And that’s my hope, along with what I was talking about earlier, which is sort of daily testing, if the tests become simple and cheap enough and accessible enough.
Q: Excellent, thank you.
MICHAEL MINA: Sure.
MODERATOR: Next question.
Q: Thanks. Just real quick. It seems as though places are trying to make testing a little bit more convenient for people. Things like drive-thru retail locations, Rutgers has this thing you spit into a home and you can send it in. Just want to get your thoughts on that. Is that something that’s useful? Would you like to see more of that? Is that progress? What are your thoughts on those efforts?
MICHAEL MINA: Yeah, I think send home kits are terrific. I have one sitting right here that we’re developing ourselves for – we’re essentially going to be rolling out very wide scale surveillance shortly. Part of it’s going to be send a send out kits so that people can essentially sign up. And a lot of this will be truly public health efforts. It’s not going to be like Lab Corp’s for-profit approach. It’s going to be working with governors and Departments of Health to get the funding. And instead of having public health people go to apartment buildings, we’re going to be mailing them the supplies and we’ll receive those back and test.
So I think that this is a very good approach and it’s a way to reduce transmission. If you can partner, too, with some of these app companies, for example, that are really able to sort of identify through the syndromic surveillance where outbreaks might be occurring in the communities, then you can marry this sort of outbreak investigation type of approach with enhanced surveillance through send out kits. And you can you can maybe even have people call up, get lists, you know, work with departments of public health to get contact information and be able to call up and say, hey, this is going on in your community, would you be willing to receive a test? And then you just send it back to us and it will cost you nothing. You know, it’s a public health measure. So, I think that these are very, very important to start producing.
I think the era of requiring everyone to go to a doctor to get a test should be considered behind us. And that’s for everything from cholesterol and influenza tests and everything. I think that people should be allowed to have their results, at least to be able to get them and then have ready access to physicians and nurse practitioners and whatnot who can help explain the results to them and help them understand and interpret them. So, I think that these new approaches to make it accessible are terrific.
Q: Thank you.
MODERATOR: Next question.
Q: Hi. Thanks so much for doing this and staying longer. Your dream of daily testing, just wanted to add a few details to that. How soon or how close are we to that? How soon would that would that be possible? And then I know like my neighbors here in Cambridge just got tested this week, even though they don’t have any symptoms. But it’s going to take seven working days minimum to get the results. That seems kind of pointless to me.
MICHAEL MINA: Yeah. Exactly. And that’s – the country is still not testing appropriately. And that is exactly one of the examples. So, anyone who is saying that we have plenty of tests in this country is just wrong.
They’re not generally accessible in a timeframe that is useable or is useful. So, I think that these daily tests, you know, if we can really get these test strips, these paper throw away things available. There’s a lot of logistics. So, for example, we need to figure out if somebody gets one of these at home and finds out that they’re positive, what I was saying before, how do you how do you get that information to the Department of Public Health or, you know, is there some way to communicate that it’s a positive? Can you have these things have RFID chips in them or something to send out or Bluetooth? I don’t know what it would be. But it would be – I think we’re going to have to figure out how to balance the speed that individuals are getting their results with also ensuring that those results, because this is a public health issue, can get to the public health departments that need to be notified that there’s a positive result and they can have enhanced surveillance there.
But, you know, if we can figure out those logistics, I think the technology is coming upon us very quickly. I know just here in the Cambridge area, there’s quite a few companies who are really on the verge of antigen-based tests that can be done very quickly with just saliva or a nasal swab in a little paper strip. And we’ve been validating them in our hands for some of these companies. And I think that in the next couple of months, we might even see these things start to start to become available.
MODERATOR: Did you have anything else?
Q: I guess because it seems to me that’s what’s going to be needed to open say colleges back up would be daily testing, right?
MICHAEL MINA: Yeah. And certainly, some of the things that we’re talking about for various universities and colleges around New England that I’m talking to their various groups. It’s one of the things that comes up most frequently is will this type of frequent testing or accessibility to more complex testing, maybe with pooled sampling to cut down costs and increase speed, could become available. But absolutely, I think it’s going to be an essential part, both viral testing as well as antibody testing.
This concludes the May 15th press conference.
Barry Bloom, professor of immunology and infectious diseases and former dean of the School (May 13, 2020)
Shekhar Saxena, professor of the practice of global mental health in the Department of Global Health and Population (May 12, 2020)