You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Michael Mina, assistant professor of epidemiology and a faculty member in the Center for Communicable Disease Dynamics. This call was recorded at 11:30 am Eastern Time on Friday, June 5.
Previous press conferences are linked at the bottom of this transcript.
MODERATOR: Dr. Mina, do you have any comments for today before we get going?
MICHAEL MINA: No, I’ll just take questions.
MODERATOR: OK, we’ll jump right in then. First question.
Q: Hey, Michael, thanks for doing this.
MICHAEL MINA: Sure.
Q: So as my my media company may indicate I’m a sportswriter and I’m working on a story about the grosser aspects of sports, spitting, licking, all that stuff, sweating, all the fluids of sports and how they’ll be affected by a return to play within the global COVID-19 pandemic. And I was wondering if sports start to return. I suppose the question is, can they still spit? And and what are the other challenges as far as bodily fluids and the return to sports within a pandemic?
MICHAEL MINA: I think that the key thing with a particular sports teams and others, at least the professional sports teams, they will undoubtedly have the resources to allow them selves to get tested frequently. So I think the key thing there is not so much to worry about things like spitting and during games, it’s to make sure that upfront going into a game is not infected. And going into practice is not infected. And I think that these are groups of people who will undoubtedly sort of be interacting closely, whether that’s during the game or surrounding the game. And so I think that because of that, they are individuals who are – they’re teams and populations that are liable to have a lot of spread should a virus get introduced and somebody who is transmissible get into the population. And so I think that for these teams to really move forward and ensure that they’re all being safe, that they just need to make sure that they’re not infected going into their practices and games. And that probably should ameliorate the need for even asking the question anyways.
MODERATOR: Did you have a follow up?
Q: No, actually my only follow up would be I’ve I’ve talked to some other doctors who have have discussed. Whether there are things that can be done within the scope of play to further reduce the possibility of transmission, such as face shields in hockey and face shields in football and things like that, is that is that a step too far? Or is that something that you think that some leagues, particularly in contact sports, should investigate?
MICHAEL MINA: Oh, definitely. I think – I wouldn’t suggest that every soccer player goes and gets a helmet with a face shield. Certainly if the basic mechanism is already there to hold a face shield, that would absolutely reduce transmission. Remember that the whole purpose of the mask, for the most part, or one of the purposes is just to slow the spread of these droplets to block them from moving forward. And the vast majority of that dispersion comes in sort of a direct line out of the mouth or the nose. And so certainly having some sort of plexiglass face shield, I think is a good investment. I think a better investment is just to ensure that people going into the game are not shedding virus. Not a better investment, the face shield will be a cheap and very doable investment if people are already wearing helmets. But for for other sports where that’s not the case but there is potential contact, like soccer and I’m sure there are some others. I think, you know, then I think that you just need to be really careful to to ensure that the players are going into the game safe.
Q: Thank you very much.
MICHAEL MINA: Sure.
MODERATOR: Next question.
Q: Hi, guys, thanks again for doing this. So I cover the automotive industry and a lot of the automakers called back workers into their assembly plants last month. There’s a lot of safety measures in place like temperature scanners and PPE. But some of the leaders are calling for rapid mass testing for tens of thousands of auto workers to further ensure their safety. So my question to you is, where do we stand today in terms of developing and implementing such a system at that type of scale? And what are some of the challenges that it might take to get there?
MICHAEL MINA: Sure. So I think with things like the autoworkers and factory workers and other folks around the country, it’s a slightly more difficult task. These are these are huge numbers of people that do not necessarily have the kind of dollars per person that I was just discussing in terms of professional sports teams and things. And the way that these individuals are dispersed, it’s a little bit harder to envision them all getting extremely sort of routine testing daily or every three days or something along those lines. And I think that testing is coming along very quickly. We will see test that become cheaper. We’ll see more point of care tests that become available. And my hope is that in the near future, we’ll even see tests that are sort of very point of care antigen test that maybe somebody gets a result about a viral infection right there on the spot within minutes. And if those can come, if those can be produced in mass and they can get down to less than five dollars apiece, then I think that you get into a range that’s very reasonable to assume that most people can get tested twice a week, for example. But if all of the samples are having to get shipped out and it’s 50 dollars a test for PCR or something like that, I think that that it’s going to pose some huge logistical hurdles.
So there’s the testing, there’s a very routine testing that that you could envision doing. But then there’s also a different approach, which is to take a step back and take a view of it all more from a public health vantage point. And by that, I mean use tools of public health to try to monitor for outbreaks but at the population level. And in this case, the population level might be autoworkers and and other individuals like that. And you essentially can monitor people, potentially using some combination of antibody testing, which is which is very good for capturing, if you’re just monitoring on a rolling basis, for example, you can find when an epidemic is emerging or an outbreak is emerging. And then you can kind of go in with the artillery and, you know, really bombard with PCR testing and viral testing on a on a on a sort of very frequent basis. And that could some combination there can actually serve to be a very powerful tool to monitor epidemics when we look at really the long term.
So it might be that when we first get into the fall, we’ll be really focused on very intense sampling. But if this goes on for for two or three years, then we really have to start thinking what’s practical as a marathon. And so far, all of our thinking and our policies and our suggestions for the fall by policymakers and scientists has been assuming that this is a sprint. But the more we learn about this virus, the more we learn about just how few people have actually been infected overall as a fraction of the population, we have to look at this as a marathon. And in that regard, we have to start thinking about what are some smarter, more efficient ways. That won’t be perfect, but they’ll be good if your goal is to stop an outbreak, not to stop every last case, but to stop an outbreak, then we can really change our sampling scheme and have some combination of antibody testing, symptomatic surveillance, and then, of course, viral testing when an outbreak is detected. And I think that those are going to be the smart ways to go into the future.
Q: I appreciate that, just as a quick follow up. Is there any way to put a timetable on when we might be able to have that sort of almost instantaneous, you know, widespread testing? Are we talking months, weeks?
MICHAEL MINA: I think realistically, months, we’ll have some prototypes that become widely distributed. Technically speaking, these types of tests can be produced in the millions pretty easily and could be deployed. You know, I envision a world where everyone has a little carton of tests that they can go purchase or their employer gives them or their school gives them, whatever it might be. And every second or third day, you just test yourself and people around you have become infected, then you test yourself more frequently. So I hope that we will get there within the matter of of a couple of months, maybe maybe a little bit more than that by the time the FDA is done reviewing everything. But it’s not going to be a year from now. I think we’ll see it in months.
Q: Thank you.
MODERATOR: Next question.
Q: Thanks very much. Hopefully you can hear me. I was wondering, what do you make of the shape of infections across the country now? There isn’t the spikes that some people, some models were pointing to in early May with reopening, but we’re still having a lot of infections every day. You know, how do you see, like, what’s happening? And what does that say about the effectiveness of social distancing versus warm temperatures? You know, how do we unscramble the omelet here to tell people what’s working and what isn’t?
MICHAEL MINA: Yeah. Well, we don’t have the counterfactual in real life to look at. And so it’s very difficult to know what exactly is driving the patterns today. We have seen some small amounts of evidence in the US and others from elsewhere that reopening has been somewhat associated with increased cases. But we do have this competing model where on the one hand, we have reopening, and protests, and other areas where people are really coming into contact much more readily today than three weeks ago or four weeks ago.
And at the same time, we’re going into the summer. And if you look at the seasonality of this virus, the virus is usually from around January on down into June or July, it’s just the seasonal viruses, not this novel one, but seasonal coronavirus, which are very similar in genetic makeup to this one. And they tend to just decline, decline, decline more or less linearly with each passing week from around January through July or August. And so we might be getting a little bit of safety. And this has always been in the discussion. You know, for months now, we’ve been told that the weather going to improve the outcomes during the summer. And I think there’s good reason to believe that it will limit spread to some extent during the summer. And so it’s hard to know exactly why we’re not seeing big bumps.
Has something changed with the virus or the population that’s preventing it or is it just still a lagging indicator where we’re not actually seeing it yet, but we will in two weeks. Because a lot of cities are even the ones that are opening are just starting to really, like people are still being cautious. Is it weather that’s causing the decline or is it masks? A lot of places people are still wearing, even if they’re going out more, they’re wearing masks and we’re seeing that with the protests. A lot of protesters are wearing masks, and that’s good. I think that that alone, that one piece, mask wearing alone could have pretty profound effects on the transmissibility of the virus. But it’s not easy to tease these things apart, at least not within one year. If we had multiple years of time series data, then we could really probably do a lot more.
Right now, we’re just trying to aggregate the data at essentially cross sections of time and try to look at sort of what’s happening. My concern in this regard is if weather is playing a central role to sort of buffer the spikes that we might anticipate from reopening, I’m very concerned that come October or November, we usually see coronaviruses go from extraordinarily low levels in August to very high levels some years in throughout October, September and October, November. And so I do have a concern that- this isn’t quite the question you asked, but that the buffered sort of effects that we might be seeing because of weather and potentially because of mask wearing might get the community and the population to become much more laxed and assume that this virus is just kind of going away on its own. And then I think myself and many people are extremely concerned that come October, when we normally see coronaviruses sort of burst back into the population, that this could do the same and really hit us very hard. But unscrambling the omelet is a very difficult thing at this point.
Q: Just to follow up, though, it sounds like you’re saying that come September, October, we’ll still want to have answers to those questions. We’ll still be operating with a great deal of uncertainty.
MICHAEL MINA: Yeah, that unfortunately is what I think. Now, the southern hemisphere might be able to give us some of those answers as we’re watching what’s happening there. But, absolutely. I think this is our first year going through this, and so we don’t have a lot of the answers. We wish we did. And a lot of the effects are happening all simultaneously. And until we have longer durations of time over which we can explore these types of things, we end up a little bit in a position where it’s a little bit difficult to tease apart what exactly are the drivers of both blunting epidemics or causing epidemics and outbreaks to occur.
Q: Thank you very much.
MODERATOR: Next question.
Q: Hi. Thank you. Just one quick question. I’m working on a story right now about the availability of the tests as they exist now. Basically, the community hospitals in Massachusetts, some of the smaller hospitals are telling me that they’re having a hard time getting access to tests and they’re having to postpone surgeries. They’re having to hold patients in the E.R. who are psych patients for up to two days while they wait for test results to come from outside reference labs. At the same time, I could just drive up to a CVS clinic and get a test right now. And I’m just worrying about if you can speak at all about how the distribution, the allocations of these tests is being handled right now when some of the larger labs, the Quests of the world, the CVSs, have seemingly unlimited tests while these small community hospitals that are actually struggling to to get patients in and keep their businesses essentially open. I don’t have access to these tests. A number of them are saying that that’s a problem that they’re having. Can you address that at all? And basically, it seems like they’re saying they’re not being prioritized by the companies that are that are selling these tests.
MICHAEL MINA: Yeah, and that’s absolutely correct. Unfortunately, and it’s something I’ve been trying to stress here and there all along is that testing is still not widely available and distributed to everyone. It’s very bizarre. But the reason is these small hospitals, and a lot of them are coming to me personally and to some other colleagues asking for help with getting tests performed and just getting swabs and all this. The reason is we have a privatized health system, and that means that there are a lot of contracts involved. And so when these mega labs that can process millions of tests, you know, every night, not coronavirus tests overnight, but, you know, across the whole spectrum, when these massive labs have all the tests available and then CVS goes and asks to contract with them, that’s a big that’s a big win for both.
Those are two massive players and the contracts are nice between them. Versus if you have, you know, or even it goes even a step further to really the manufacturers of these tests, the Roches and Abbott and everyone else, Hologic and Cepheid. You know, they’re going to prioritize the bigger contracts that they view as priority over individual labs that might get less throughput, for example, on each test and so they’ll be smaller contracts overall. So this is – it’s kind of no different than how our health insurance works, where the bigger you are, the more leverage you have for the health insurance companies. It happens in this case to testing and and the bigger guys tend to win out.
And it’s a serious problem because we do as you say, we’ve now have made it accessible to get outpatient testing when it’s still not necessarily accessible in a lot of hospitals around the country, at least not in a timeframe that’s reasonable for the hospitals. And I would propose that, you know, somebody who needs a drive through test is getting a drive through test. And they’re probably not as high priority as somebody who needs to go in and get their gallbladder taken out or something like that and needs to be tested before they go into surgery. So I you know, I think that there’s a role to try to create a discussion where there is more load balancing in the way that the tests are being distributed. Or there could be a role for actually having increasing numbers of partnerships where smaller hospitals actually partner with the CVS down the road and say, hey, can you allocate 30 tests a day at your CVS for us to send our patients to before they arrive for their outpatient surgery?
And, you know, I think that that’s not an unreasonable thing. It’s just more contracts. And how does a small hospital, you know, build a contract with a behemoth like CVS in any sort of efficient way? How do those things get set up? They’re very, very difficult. And a lot of hospitals aren’t well connected to be able to do this. And I don’t think at the moment that there is a great solution, you know, short of people really paying attention to these small hospitals and prioritizing them.
MODERATOR: Did you have a follow up?
Q: Yes, I do. Thank you so much. Two, actually. Quickly, I think some might argue that there’s a place here for regulation as well. It doesn’t appear, though, that the state DPH or federal officials have any role really in the allocation of these tests and prioritizing them to to hospital patients that are undergoing surgeries over the the so-called worried well driving into to a CVS.
MICHAEL MINA: That’s been a hard discussion. I mean, there was some, initially at the federal level and probably still with some of the tests, the feds were certainly taking some control over where the initial rose Roche assays went and things like that. And so there was initially some effort to try to prioritize in some systematic way where the tests one. At the state levels within each state, I think that that is not being done, essentially. I can speak from our own experience, which is we we do all of our ordering of tests is directly with the vendors. And so it’s just not a discussion now.
Where the regulation could come in is that the – I think rather than going to each of the hospitals and the people requesting the tests or buying the tests to perform, it would be on the manufacturers. And you say that these tests need to be performed or you allocate actual resources that are needed for the testing. But then that leads to a whole other set of issues because there’s a lot of ways to do these tests. So there’s no central place to even do the allocation of resources in particular. So some labs have gone out of their way in order to get out of the normal supply chains early on so that they didn’t have to deal with sort of not getting the tests in time for their constituents.
And so I think it would be a very tricky thing given our framework and our health care system to actually try to regulate it. I don’t disagree, though. I think that there is a huge role for regulation here because, you know, testing, I don’t know if we want to call it a human right, but it certainly should be a right in the time of a public epidemic. Everyone should have equal access to tests or some well thought through, whether it’s equal or weighted based on some risk profile, for example. That would be, I think, something that would be useful. But so far, we don’t really see that. It’s sort of every man for himself.
MODERATOR: You said you had another follow up.
Q: Yes. Thank you very much. Just one quick follow up. Another thing that I’m looking at right now is also having to do with the availability of tests relates to the state order in Massachusetts requiring onsite testing at nursing homes. There are a number of people who live in independent living facilities in the state who are saying, hey, we need to be included in that order, essentially, that it’s an arbitrary distinction. There’s some facilities where one end of the hall is is sort of more of a nursing home or facility. And the other end is is more independent living. And the distinction is that the independent living just has a kitchenette. You know, I mean, but it’s the same building. And some of the patients or the people who live there are getting tests while others aren’t. And they’re asking the state to please expand this order to include the independent living as well. And I just wonder if that’s something you could reflect on that distinction and whether or not it’s important to extend the testing order with the National Guard showing up and doing tests to include independent living facilities.
MICHAEL MINA: Yeah, I mean, the tests are now that baseline testing is now complete in the state. So I guess the question is, should they kind of do another round of that, if you will, with senior living? And I certainly agree that to a large extent it is arbitrary. It’s one bucket to work on, one bucket that you can sort of focus on and make a policy around. And I think that baseline testing alone, really this has to be follow up testing.
This needs to be a series of testing programs that are utilized, again, both antibody testing as well as viral testing and on an ongoing basis. And senior living centers should absolutely be a part of that. There’s a lot of questions at the moment surrounding sort of who pays for it. Where it is, like who runs these programs. Our country isn’t usually set up to run programs like this. There’s very few examples where that’s happening. You know, maybe the V.A. and a few other hospital systems like that. But in general, we’re more private, you know, lab testing is usually done in some sort of private health care system. So I guess the point there is there’s just still a lot of questions that surround how to practically make this happen, who should be prioritized, who should be making decisions about who should be prioritized. There’s a lot of other groups that maybe should be. And will a single baseline test actually tell you much? I don’t really think a single baseline test tells much. It’s more a longitudinal sampling over time can be used for outbreak detection.
I think the whole system just needs to change. You know, we should have a lot more testing available. We should be increasing the way that testing can become performed. And that’s changing today. Not today, as in this Friday, June 5, but in general, we’re moving to self collected swabs are becoming more and more readily approved and available in terms of. So that alone will really help testing be rolled out. My hope is that we won’t need the National Guard to go in and do this testing if we can create programs, maybe utilizing pool testing. So you take 10 people living on the same hallway in a senior living facility, on the same set of condos or something. And you swab all of them or you ask all them to swab themselves, submit their swab in a capsule or a tube. And then all of those get pooled together and tested together as a pool, for example. And you kind of can go and do a long term monitoring of outbreaks that way.
I think that that would be a decent way to go. It’s just not tenable, though, to have nasopharyngeal swabs being performed in front on an ongoing basis with the National Guard. That was an extraordinarily difficult and expensive endeavor to get that done for the nursing homes alone and the senior living facilities, I believe, are a larger cohort of people. So hopefully it will move to self collection of swabs and testing. And my hope is that the finances will be figured out either through government funds or health insurance or CMS reimbursements. And we won’t have to have National Guard running these programs.
Q: Thank you very much, appreciate it.
MODERATOR: Next question. She e-mailed us into me now that it appears to be much easier to obtain a diagnostic test. What is your sense of the turnaround time for these tests and whether anything can be done to shorten the time between collection and a result?
MICHAEL MINA: Yeah, so I think, if you’re sending the samples to a laboratory, then there’s always going to be a delay built into that. And that’s just physically transport. These things can’t move through the telephone lines. So I think distributing the tests, having them being available, for example, at CBS is in Walgreens and Targets and Wal-Mart’s, you know. Anywhere where there’s pharmacies, for example, you could envision that testing could be available where people walk in. And that’s happening, of course, really rolling that out to more locations around the country, I think could improve turnaround time tremendously.
But the moment you have to put something into the mail or as a current service, then it then it becomes, there’s a built in delay immediately. The laboratories performing the tests have certainly gotten, as both a volume of tests being requested as sort of that the number available is going up, the number of requests is generally going down and the throughput is therefore increasing because the systems are now kind of getting ramped. They’ve been continuously getting ramped up and they’re sort of running at full, full speed and so there’s not a ton more that the labs will necessarily do to really reduce the duration of time. A lot of it is in this sort of transport. And so the closer you can get the test to the person, the better. And that’s why I’m a big advocate of things like the Abbott I.D. Now instrument and some of these other point of care instruments that are very good and can be placed in different locations and a point of care away. And hopefully the best thing will be that the pregnancy test models for the viral testing will become available.
MODERATOR: Great. Her next question is if a diagnostic test is taking up to 48 hours or 72 hours from collection to result reported, what effect does this have on containment and the efforts like contact tracing?
MICHAEL MINA: Massive, massive problems. So it’s we’ve been modeling we’ve been building a lot of mathematical models to explore this particular question. And what we find is that the longer the just having a 24 or 48 hour delay really undermines the whole program of testing. Even if you’re testing every two days, having that delay will really cause problems in containment and control, because most of this transmission happens when your titers are very high. And so usually that’s if somebody is going to be positive and is sort of on the way up with viral titers, that by the time they get the results back, they might have even had a full two days of peak viral transmission without knowing it, given how many asymptomatic there are. So, again, the closer you can get the test to the individual and temporally get the time down is much better.
MODERATOR: How close are we to having rapid testing be widely available and what are the current barriers to making this reality across the country?
MICHAEL MINA: Well, again, I think that we might start to see this point of care at this point of care tests that are kind of a pregnancy test model. My hope is in the next couple of months, we’ll start to see the first crop of them to become available. They won’t they probably won’t be widely, widely available. Then the question will be can these companies produce hundreds of millions of them in a very short amount of time? I think that will be difficult. But, you know, we’re seeing different instruments come out that are improving access. We’re seeing more little sites of collection sites and sampling sites being developed.
So I think that some combination of these pregnancy test models coming out in the next few months and and increased access to point of care testing and drive thrus and things like that, I hope will overall increase access. And then, of course, getting back to that first or second question, getting these point of care devices into smaller hospitals will be crucial. And, you know, one thing that the hospitals could leverage is maybe they could actually themselves host drive thru sites and things like that and and maybe gain more and more leverage because they can put in larger orders with the companies and things like that. So my hope is over the next few months, we’ll see it. And what I really hope is that by fall that we have testing just much more widely and readily available.
MODERATOR: Next question.
Q: Hello. Hi. I am back, Dr. Mina. Hi. So I have three questions based on the answer you gave to the previous questions. So I would like to know why public authorities are not changing the programs in order to implement the epidemiological surveillance tools that you and other researchers are proposing by combination of antibody and the PCR test. Why this is not happening in practice? Second question. Since some of those test like serological and PCR test sometimes proved to provide uncertain results in terms of exceeding positive to virus, I mean, mostly the test, I guess, they would have a lot lower sensibility to and a higher margin of error. So why governments should invest now in those tools, right, when in a few months, new tools might be available, so that would be a kind of a big waste of resources now? And the third, if you feel that all these kinds of test or test sampling or sampling test should be mandatory at which geographical resolution, at district level or blocks level, even the shop’s level, which one?
MICHAEL MINA: Yeah, well, I’ll start with talking about the technology. So the American or the global public really, most people before this pandemic were not familiar with testing and they weren’t familiar with the term PCR or antibody testing, serology. And now we’re finding that people are becoming increasingly familiar with it.
But what that means is that when people first, when this virus started to emerge, the test of choice and out of necessity was really viral testing. And so that was what most people sort of went with and started to understand that viral testing is absolutely essential. And it is. It is the crucial tool during the outbreak. And then serology came around and a lot of people said, well, why serology when you can test straight for the virus?
Well, the reason you do serology, which is antibody testing in this case, is because it gives you a whole history of somebody’s infection. And so the way that I think about this is imagine you have a hurricane and that hurricane is sitting at the tip of Florida hitting Miami.
Now, if you’re just if you’re only seeing the hurricane hitting Miami and you don’t know anything else about the trajectory that that hurricane has taken to get to Miami, you don’t know whether you need to start putting resources in Louisiana because the hurricane might keep going through the state or if you need to put resources in North Carolina. And the reason I’m saying that is virus testing is a lot like just seeing the hurricane and you’re sitting there in the middle of it and you’re seeing what’s happening right there on the ground. Antibody testing gives you the whole trajectory of the hurricane and it lets you know what the path is of that. And so you can start to allocate resources in more efficient and better ways if you can start to project where this virus is going next.
Then in the same way that weather systems can now project where storms are going. You can project where the virus is going in. Antibody testing helps you do that. It also helps you to monitor for new outbreaks because you don’t run the risk of missing somebody very much. If somebody becomes positive on the viral test, they might become negative six days later. And if you if you test them seven days later, you might have completely missed the fact that they were ever positive. But if you test them 10 days later, up through a year later, they’ll have always been they’ll stay positive. So it becomes a very powerful tool to be able to monitor for viruses because the signal stays with somebody over a long, long duration of time.
And so the point is, you can actually do a lot of public health and epidemic modeling to make projections of what populations are going to get hit the hardest. Where should you allocate resources? And part of that is where should you really ramp up PCR testing and maybe where do you not need so much PCR or viral testing? And that can help policymakers decide how to allocate those resources. So I think that antibody testing needs to be part of the discussion in front of the programs for a sustainable public health monitoring system. And we have a paper coming out next week that discusses this in the context of thinking about the viral testing with or antibody testing as sort of a weather system for viruses.
Going to the technology, there’s been a lot of discussion about these antibody tests not being accurate, but in general, that was a lot of these point of care instruments that came around first, those little plastic things. They generally are not as accurate and some of them are really quite off. I have a whole box of them sit in my house and they’re all just falsely negative, so the proteins on them must have unfolded. So they’re not good tests. But that’s not to say that there are no good tests. In fact, most of the laboratories that are running these antibody tests now are using very, very accurate tests. Ninety nine point five percent specificity, near 100 percent sensitivity after two weeks of infection. So these are very good tests. And and they can be very useful.
We have to remember that these are laboratory based assays and they should probably be used as such and have the samples sent to the lab. And in particular with the antibodies, it’s not usually, a day isn’t going to make a difference because the reason for doing antibody testing is is different than the reason for doing viral testing. So the nice thing is you have time on your side where you can send an antibody test out for testing and get it back a day later or two days later. And it’s not going to make a huge difference because it’s more used for forecasting and understanding the population sort of risk patterns rather than sort of keeping the outbreak right there at the source contained, which is really the role of viral testing.
Q: Right. So, if I could follow up on my first question. You think, I mean, you think that you believe this is very, very important way to do it in the outbreak surveillance. So what why government and public authorities are not, I mean, changing programs in the way that you wish. Why are they not doing that in practice?
MICHAEL MINA: Yeah, I, I think there’s a couple of reasons. If you had asked me five months ago or well, this virus is going on for five months. So if you asked me eight months ago, you know, do I think that if a new virus emerged, would sero-surveillance be an important piece of the efforts early on, I would have said absolutely. I think that we should be starting monitoring now and it should just be ongoing all the time in our communities. We should be offering antibody tests to anyone who wants to know and then using those same blood spots, for example, to be testing for other viruses in the background in an anonymous way, just to know sort of what the background load of viruses are in the population. The reason I think that it’s not being used right now is again because all of the discourse early on in this pandemic has been about testing for the virus. And that’s because we came into the virus in crisis mode.
The whole effort so far has just been to put out the fires, not to prevent the fires, and antibody testing helps you prevent and slow the fires and mitigate them over a surveillance program. But when you’re in the midst of a fire, you really need to be using viral testing. And I think that people are going to come around. I think in the next month or so, we will probably see a change in the national discussion about serology as people start to realize, OK, there are bad tests and there are good tests and there’s reasons to do serology and there’s reasons to do virology. I think that programs will come about where all of a sudden people start saying, oh yeah, there is actually a good use for it.
But there’s just been so much attention paid so far to the viral testing that that’s wherever one’s mind is. Most of the people making decisions haven’t ever had to really think about this in the United States anyway. We don’t normally have to do outbreak control and surveillance in the way that a lot of developing countries do. But sero-surveillance, serological surveillance has been a crucial part and a keystone of most epidemic control and surveillance programs around the world in developing countries and for decades. And that’s because it’s the right tool for ongoing surveillance. But that discussion hasn’t really made its way into the public discourse, nor the policy discourse here. Just because I think it’s just been such a, the discussion has been so overwhelmingly surrounding viral testing that there hasn’t really been a room for it.
I do think now that the summer is upon us and we might see fewer and fewer cases over time, it will give a little bit more room to breathe and think through long term solutions. And at the same time, we’re going to see antibody testing getting ramped up and becoming available where it wasn’t available early on either. And once that becomes more out there and some of us, I think, are really working hard to to try to make it known what the advantages are or where where serological tools can really be used for ongoing surveillance. I think that the tune will change and the discussion will move a little bit more towards it for the long term. And so we just have to get out of crisis mode first.
Q: I mean, the last question was, do you think that these test sampling should be mandatory at which geographical scale? Which is the geographical scale which is really the minimum required to monitor outbreaks beforehand?
MICHAEL MINA: Yeah, that’s a hard question, should mandatory testing be made available? I think the only way that mandatory testing could be made available, first and foremost, is you have to have it freely available and accessible. If you’re going to mandate it, then it has to be free and it has to be accessible. The next step is to decide should it be, is it right to do.
I think that there are other policies that can be made. You know, I feel very strongly that we should have different tiers of risk of population level viral activity and risk to individuals. And so what I think is we should have some monitoring systems set up, which are probably serologically-based, but maybe also viral testing as well. And these should be observing and looking and monitoring for any sense of outbreaks in communities.
If an outbreak is recognized to be beginning, then maybe mandatory testing or some frequent testing becomes readily available for everyone. And otherwise, you just sort of use your sentinel people to try to serve as some sort of outbreak monitoring system. And and we can kind of crowdsource the efforts once an outbreak starts, then maybe if you want to go to work, you have to get tested on it on a frequent basis. Or if you want to go to class, you have to be tested. And if you choose not to, then you have to work from home or you have to take class from from your dorm room or whatever might look like. So I think there’s some room for that. But in general, I’m not a proponent of mandatory testing of everyone because I don’t think it’s reasonable. I don’t know how it could really be rolled out, but I am a huge proponent of voluntary testing and crowdsourcing so that every person who wants to be can serve as sort of a sentinel for their community. And if you build up enough of those people, you can actually have a very good and robust surveillance program.
Q: OK. Thanks a lot.
MODERATOR: Thank you, Dr. Mina, for speaking today. Do you have any final thoughts before we go?
MICHAEL MINA: No. Thanks, everyone, for tuning in.
This concludes the June 5 press conference.
Barry Bloom, professor of immunology and infectious diseases and former dean of the school, and William Hanage, associate professor of epidemiology and faculty member in the Center for Communicable Disease Dynamics (June 3, 2020)
Michael Mina, assistant professor of epidemiology (June 1, 2020)