Coronavirus (COVID-19): Press Conference with Michael Mina, 10/02/20

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 12 p.m. Eastern Time on Friday, October 2nd.


MODERATOR: Do you have any opening remarks Dr. Mina?

MICHAEL MINA: No, happy to take questions.

MODERATOR: OK, let’s get started. First question.

Q: Hi. Thanks very much for doing this. I saw you tweeting about this in the past hour, could you just kind of expand on your thoughts on the president’s infection and because what the White House had said for a long time is that, oh, we do so much testing that that’s a way of protecting people. And so just kind of a little bit about your thoughts on what this show is about and I guess the benefits of testing, but what else might be required?

MICHAEL MINA: Yeah. So they do a lot of testing and it is a way of protecting people and stopping outbreaks. In this case, it’s a way of protecting people from Trump spreading to them, for example. So I think a lot of people from what I’ve seen in the media and stuff think that rapid tests aren’t working in the White House, but that’s completely false. If this was all of the people around Trump getting infected by getting tested positive and being held isolated from infecting Trump, people would say, oh, it’s succeeding. Trump’s just another person. And by isolating him, by detecting early in his infection, this program is working. It’s stopping him from further propagating the virus in the White House. How he got it, you know, one of the things that’s important here is that testing will never stop somebody from getting the virus. To stop yourself from getting the virus, you need to not come in contact with the virus or you need to protect yourself through wearing a mask. If you are in contact with the virus and obviously, I would say the president hasn’t been particularly good at doing that. So how exactly he got it is completely separate from whether or not the testing program is succeeding. And I would say, you know, there might be more people that will be detected early in the course of their infection, having been exposed, for example, and each infection stopped, each transmission chain severed, will potentially prevent 10 or hundreds of additional transmissions from occurring. And each of those could then spawn tens or hundreds. This is how exponential growth of an epidemic happens. And so each case we can stop is a benefit. In this case, through rapid and frequent testing, they found three individuals, at least that we know of. There are probably going to be more. And who knows how they got infected. But the point is that the rapid testing is apparently working.

Q: I don’t know if this is something you’ll necessarily have thoughts on, but do you have any guess at this point on how this might shape public opinion or people’s thoughts on the U.S. epidemic?

MICHAEL MINA: Well, I think there’s two ways that can go. If our president doesn’t do well in this infection, it might cause a lot of people who are thinking that it’s a hoax to think twice. If he sails through it, which is the most probabilistically likely scenario, then it could potentially create more fuel for somebody who has already disregarded this virus as not important to continue doing so and to have many people who listen quite dogmatically to him think the same. I just worry that essentially, assuming that he pulls through this just fine, my concern is that it will become more fuel to fan those flames up, saying that this isn’t an important virus. And we know that this is an exceptionally important virus to prevent it from spreading. And so I do worry that this is going to add sort of this unknown into the equation. And it could potentially advance our ability to control it in the country. But at the same time, depending on the outcome, it could cause more outbreaks.

Q: Thank you so much.

MODERATOR: Next question.

Q: Thank you, Nicole. Thank you, Michael. So just kind of the normal question in light of the new data from the last time we talked. Do you have any view on how severe the outbreak might be and the odds of a heightened lockdown? And in particular, I think the salient issue is the hospitalization rate, since capacity seems to be what triggers politicians to panic and close the economy. Thank you.

MICHAEL MINA: Yeah. I’ve been saying it for months. This is a seasonal virus. I don’t think that people are seeing the urgency. I don’t think the media has necessarily gotten the urgency right in this case and not that it’s the media’s fault. I just meant I don’t think scientists have been pushing hard enough and I don’t think policymakers and the media have really put out enough that this is a seasonal virus. We have been in July, August, September, in the absolute valley of what seasonal coronaviruses normally do. So any gains that we think that we have made on this virus might be a reflection much more of the natural state of this virus and the climate and the weather and other biological features that we don’t fully understand much more than any of our ability to actively control it. You know, we’ve seen that we can control it. We saw that in New York City. We saw that in Boston. Saw that many places in the spring. My concern is that we have now assumed that over the last few months that we’ve been continuing to control it and that we understand how transmissible it is. We understand these metrics. And so we can now kind of start reopening things without having what I think are the checks that need to be put in place, in place. And we have essentially done nothing in many ways since April to really actively as a country get a system in place to help it not spread this winter. And my concern is that we are going to hit maybe late October and maybe it will be late December. It’s difficult to say, the coronaviruses peak at different times. But I expect that we will see a sharp escalation in cases very soon, and it will cause us to once again have to shut things down. And if this is the dance, we want to continue dancing in this country. Sure. But it’s going to come at the expense of massive layoffs, massive closures of restaurants and businesses and economic downturn. You know, maybe the stock market will still continue looking good. But, you know, the average person on Main Street isn’t generally feeling that in their pocket. And I just worry that we haven’t done anything really significant since April and May to get us ready for the fall. Despite the clear predictions, there has been almost nothing about this virus that has really been super surprising and the seasonality of it is just another one of those. And if we think that we’re going to skirt through this winter without a seasonal upswing, probably a massive upswing in cases, we are mistaken.

Q: That’s a pretty amazing prediction. Thank you. And just also, if Spanish flu still circulates and it doesn’t shut down the world like it once did, why is that? And what will it take for Coronavirus to get to that status, too?

MICHAEL MINA: So that’s a great question. There’s actually some differences in between the true 1918 Spanish flu strain and the current H1N1. They’re both H1Ns, but they are different in the pathogenicity. There are some molecular changes or differences between them, some proteins like PB1-F2 and some other things that really distinguish the 1918 strain from the current H1N1 strain in terms of the pathogenicity and the way that infects people and hurts people. So that’s one piece of that. It’s just a different virus than when it emerged in 2009, it really has a different mortality rate. But to the question, though, I think it’s important to recognize that we will age out of the virus. We will become a population that has been exposed as younger people so that by the time the younger people become older people, they will have developed plenty of immunity over the years to this particular strain. And they develop that immunity at a time when they are not particularly susceptible to severe disease. So we will age out of it, but that’s obviously going to take years. So in the meantime, I think for the vulnerable populations, meaning in particular the elderly, we either figure out how to keep them alive and healthy if they do get sick. We figure out good treatments. We figure out vaccines, which I think anybody that thinks the vaccine is coming before 2021, it’s just not going to be available widely at all. And I don’t think there’s any way for that. But we do have to figure out some way to create either contrived immunity through vaccines or therapeutics or we have to stop the spread. And I think that rapid testing and masks and social distancing, those are three items that can really stop the spread of the virus.

Q: OK. Thanks. I’m done. Maybe one day, hold a Zoom call on what African salad is.

MICHAEL MINA: I used to live in South Africa, and when I was leaving this is a cookbook, which I actually didn’t know what African salad was until I had somebody write and say that it’s actually one of the recipes in the cookbook. Clearly, I haven’t looked at all the recipes.

Q: OK great, thank you.

MODERATOR: Next question.

Q: Hi. Thanks for taking questions. I’m going to take us all the way back to Monday, several lifetimes again, simply when the White House formally announced their plans for an additional 100 million antigen tests. I’d love to just quickly get your opinion on this. Obviously, it’s up to the states, but Trump is going to strongly suggest they use these to reopen schools, to test teachers, students. I’m just curious, you know, is that the best strategy? Is that the best use of these tests? And, you know, from a strictly logistical point of view, how far does 100 million rapid tests get us considering the numbers of students and teachers out there?

MICHAEL MINA: Wow that was just this week. Yeah. So, first of all, the president’s announcement, they had already announced it, you know, that was already known. And so I don’t know why they had a whole Rose Garden thing about it. But the point is, that announcement was full of hyperbole and half-truths. We’re not going to have one hundred and fifty million tests tomorrow. And even if we did, the way that they were suggesting that they’ll be used is just wrong. You know, one hundred and fifty million to the average person in the United States might sound like a big number, but we’re a country with 330 million people. So one hundred and fifty million tests isn’t even enough for each person to get one test once in the country. And he’s saying that this is going to be enough tests to really open up schools and make sure that schools are staying safe. And all of these things, what I would say is, I mean, in my framework and the calculations we’ve made, that hundred and fifty million, maybe it will last a week or two if we really want to be serious about using testing as a potential strategy to keep schools safe in the midst of ongoing outbreaks in the United States. Now, I wish that I could sit here and say that we don’t need testing, that we have gotten this virus under control and we can safely open schools because the absolute risk of a child walking into a school with the virus is sufficiently low. But it’s just not the case. We haven’t in our country to figure out how to get their cases under control. So that means that if we want to be serious about testing, we can’t just do a test on entrance. That doesn’t work. And that’s the whole idea of getting tens of millions of tests a day out to the country. If we had 20 million tests a day, what we need is for people to use them frequently. And just two days ago or maybe just four now, I can’t remember, we’ve published a paper in the New England Journal describing this a little bit more detail, but it’s essentially that we need frequent testing. We don’t have frequent testing. We’re not going to catch people at the beginning of their infection. And so what that means is that with only one hundred and fifty million tests and remember, they’re not yet available. So at the moment, maybe there’s 10 million tests and maybe each month Abbott will make 30 million. And so with that type of testing, essentially what the federal government is going to do is they’re going to try to distribute it equitably because that seems like the right thing to do. But if you’re trying to control outbreaks, we need more of a plan than just equitable distribution. That’s lazy. And that’s what we continue to see from this federal administration, is sheer laziness. These shouldn’t just get distributed to all the states to create something that looks like equitable distribution because this virus doesn’t distribute itself equitably. We need to be smarter than the virus. We don’t need to just keep chasing it. And so by that, I mean one thing that we could do is take the smaller amount of tests that we do have and figure out how to use them in a smart way. And that might look unfavorable to the public, but it might be smarter than just distributing them across the board. And so one thing that we could do is say choose places that are real hotspots and enroll people who live in those hotspots and ask them if they would be willing to participate in this public health testing program. And the best thing that you can do is ask people to take one of these tests, the same person multiple, maybe twice a week. And so you’d say, well, that’s not really fair. Then you have a pretty small number of people in a community getting a large number of the tests. But it’s a lot smarter a way to use these tests than just to dilute their use and put them out across the whole country and have them dissipate in a week. That’s a real waste. But I don’t think that the federal government has developed a plan for how to use these. They’re going to distribute them to the governors. And most states don’t have necessarily the expertise to figure out how to use these most appropriately.

I know that me personally, I get a lot of calls from governors and senators about these issues and how to use these tests. But, you know, that’s not always translating into public health action. And I just don’t think we can count on each individual state to come up with the most appropriate way. I think that there needs to be strong guidance from the CDC about how to do this. And that directive needs to come from the White House in my opinion, and I don’t think any of us have seen a plan of how these will be used. And I think they’ll just vanish.

Q: One quick follow up. You know, there are two ideas, I guess, they’re not mutually exclusive. But you know, that we need a central plan, that the federal government needs to map out a strategy. But on the other hand, as you said, the virus, it affects different parts of the country very differently. There’s no one size fits all plan. But, I mean, it sounds like you’re saying in spite of those disparities, the federal government just has to be the decider on how to use these limited resources we have and just sort of take it back from the states.

MICHAEL MINA: For something like this, I think that’s the only way to optimize it. If you have every state doing their own optimization, would we want to give for example, Montana, the same number of tests that we give to Florida per populous? Maybe not. Florida has huge outbreaks and Montana doesn’t. I just made those states up for that. And I think that only the federal government is in a position to really help develop this. Each individual state, sure, you take some of these states that have really strong public health departments. California, Massachusetts, New York. Some of these states that have a lot of deep expertise within their own, especially New York. They could potentially figure out really good ways to use these. But I think other departments of health are really strapped. They’re already extended. They don’t necessarily have the right approach. And maybe they don’t have enough cases to really warrant their use. Cases are still pretty low in Massachusetts, for example. So should Massachusetts be getting the same sort of allocation for populous as Georgia or something else knowing our cases are really still burning brightly? I don’t think that’s the most optimal use from a national perspective. I mean, the point is, if we can get the outbreak under control and in the states where they’re currently really burning, that makes all the other states safer. And so it’s in everyone’s best interest to get the operates under control, because as much as we would like to say we’re doing a good job here in the Northeast, for example, it just doesn’t really work that way because we can’t really take a breath. We can’t ever let our guard down as long as we know that there are lots of cases happening elsewhere. So from my personal perspective, I’d rather say, hey, you know, we have enough other testing. We have people who are wearing masks, who are adhering to social distancing in Massachusetts. So put all the tests where they can be optimally used. And I think that that does fall on the federal government. I think the federal government needs to not maybe they need to make guidance. They need to give the people the best approach. And I haven’t seen any guidance on the use of these besides very, very basic. We’re going to use this to open up schools and to keep nursing homes safe. And that has not generally been effective at really dictating how these are used.

Q: Right. Thank you.

MODERATOR: Next question.

Q: Hi. Thanks for taking my call. Contact tracing is underway, I believe, in multiple locations related to Trump and his wife testing positive. So contact tracers, if they reach people, can recommend to them that they get tested or quarantine. They can’t force it. Am I correct here? Can you talk about the limits here of contact tracing?

MICHAEL MINA: Yeah, absolutely. And that’s been one of the big criticisms that I’ve heard about the idea of rapid testing. I’ll get back to contact tracing as well. People don’t behave appropriately. Well, you know, nobody’s handcuffing people who get contact traced to their homes and nobody’s handcuffing people who get PCR positive results to their homes. And the same thing goes here where contact tracers, the whole goal is public health. With the expectation that people will do the right thing. Will people always do the right thing? Absolutely not. But the goal there is to let people know, hey, you have been exposed or potentially been exposed to this virus. You should look into getting a test. But beyond that, contact tracers don’t do much more. They maybe can give some information. Certainly, if somebody is in the White House, then maybe they can. Businesses maybe can demand it of their employees and the federal government maybe can demand it in some way. The Army can certainly demand it. But in general, know that the answer is there are not legal powers, at least not at this point in time.

Q: What have we seen with the success or a lack of success with contact tracing so far in the country? Are people even answering the phone or speaking with contact tracers? Do we have any sense of whether they are listening to their advice?

MICHAEL MINA: Well, you know, this is something I’m sure my colleagues will not like me for saying this, but I haven’t seen good evidence, in this country anyway, the way that we’re doing contact tracing, the way that we’re doing testing, it’s really making much of a dent. I would never say that we shouldn’t aspire to do it better and or just aspire to do it at all. But for example, still to this day, I get calls from contact tracers asking me for a patient contact information who have been diagnosed, you know, weeks ago. And, you know, that’s a failed attempt to contact tracing. I think we ran into this epidemic thinking that we knew how to deal with epidemics because and we followed the playbook that we have from Ebola, from HIV, from measles, in communities where measles immunity is very strong but there are small gaps. But there is nothing to say that those same methods of contact tracing should necessarily work with a fast-moving virus like this, especially when we have low frequency testing. And this has been the whole issue. This is why I brought this up to The New York Times a month ago, which was reported pretty widely after that about the CT value thing and with PCR testing that most people who are getting identified as positive through surveillance programs who are asymptomatic are probably much more likely to be getting tested after they’ve already passed their transmissible period of times, then contact tracers are potentially going down the wrong trails. And so my estimation is with all the surveillance and contact tracing we’re doing, we’re probably capturing fewer than five percent of people who are infected in time to actually act and stop them from transmitting to others. So that’s good. Five percent is better than zero. Maybe it’s seven percent, but it’s unlikely to be anything more than that. And so I would say in general, our surveillance systems are failing. And that’s just a fact. And that’s why we’re not able to keep this under control. It’s why we’re having to shut down economies in order to control it. So I would say that we haven’t really figured out how to do this. I think that there are things that could speed contact tracing up and that could really increase efficiency. One is we have to detect the index cases quicker. And the only way we can really do that is through more frequent testing. With that, we can also add things like G.P.S. locations. If people are willing to participate in some mobile phone sort of tracking through public health programs, then that could be a way that we can really accelerate contact tracing. And we’ve seen that work, contact tracing can work, but we have to maybe speed it up and adapt it to the speed that this virus transmits. This isn’t Ebola and it’s not HIV. Ebola, you know, many, many people who are infected because the symptoms are so strong and with HIV, it transmits much more slowly and through very fine contact networks. So we have a different situation on our hands. And I don’t know that we’ve risen to the occasion to really figure out how to deal with it appropriately.

Q: Has any country figured out how to successfully contact trace at a higher rate?

MICHAEL MINA: Well, it’s a good question. I would say that South Korea is a good example of one that used it as a central part of their control measures. The real question to me is, in South Korea, was it the contact tracing? Was it the strong adherence to masks and social distancing? So I think that it can work. And what they did with contact tracing, they actually did use mobile technologies to accelerate their tracing efforts. So I would say that there are some examples, but I think it has to be that all of these have to work together. Contact tracing, testing, detecting people early, using mobile phone, G.P.S. type of things. All that needs to work in concert to really defeat a virus like this. We just have too many susceptible people in the population for us to really let our guard down and not try to optimize each of the pieces individually. And only once we start optimizing each of them, can we get this under control without just strict closures of everything.

MODERATOR: OK, next question. Also, Dr. Mina, we have a lot of questions, so I’m going to try and limit folks to one follow up question.

MICHAEL MINA: And I’ll try to answer in shorter.

MODERATOR: Yeah, that, too. Thank you. All right. Next question.

Q: Hi, me again, sorry to bother you back to the White House question. Two things. One is what you were just talking about having to optimize everything. The White House obviously focused on testing, not on other measures. Do you think they should have done other things to protect the president? And two, do you have any sense of what their testing protocols are? We know they used a rapid test once. Would they have confirmed it with a PCR? Do you have any sense of what that process was?

MICHAEL MINA: Well, so the first question is, frankly, anyone in the White House who is not using a mask frequently is a fool. And this is a virus. You know, there are a lot of important people in the White House who have to run a country of 330 million and who have major influence on the whole of the human race. So now I’m doing everything in our power to keep those people healthy, no matter if we agree or disagree with their political decisions, to not keep themselves and to not do everything in their power to keep themselves healthy is just absolutely foolish. Testing alone can’t stop somebody from getting the infection. Testing alone can only stop the president from transmitting the infection to other people. Right? And so frankly, it angers me and really pisses me off that we have a president who has failed to do one of the most basic things that a president should do, which is keep himself safe. And so, no, I don’t think the protocols that have been adhered to in the White House have been nearly sufficient. Clearly, I’m upset about this. So I think that when it comes to the actual algorithm that they’re using to confirm, my guess is that because it’s the president, they probably did PCR confirm that with the Abbott test. I’m guessing that they’re still using an Abbott.  Now, I think it’s a great test. It works really well, it’s probably the best rapid test that we have available. And so they’re using it. And it’s a good call. But probably they want to get a just like anything, a second opinion, if you will. And so they probably did get a confirmation PCR as well.

MODERATOR: Next question.

Q: Just to piggyback on what Karen was asking about. We know that from President Trump’s travel and who picks his travel the last few days that they’ve been to several states. Could this be a super spreader event? And could you talk about how big of a task it would be to do contract tracing, not just in the White House, but also for those at the debate, at the rally, and then so that the events he held in New Jersey yesterday?

MICHAEL MINA: So they have to start a little bit, not slowly, but they have to investigate, and they have to figure out, you know, can they quickly find out where the virus entered into the three of them? Where did they get exposed? If they can figure that out, if they can trace it back, that will at least give them a defined place to say, OK, this is when they got exposed and these are all the people that they might have infected since that. Now, Trump, of course, he famously doesn’t wear masks and so, you know, he is a perfect individual because of the massive network of people he may come in contact with. Now I don’t know how close he gets to people on it on a regular basis. But certainly, people like Hope Hicks and Donald Trump are ripe for being the index cases that can lead to super spreading events because they have really large networks and they are often among large crowds. Now, the good thing I would say for people around the president is that he probably, by the fact that he is the president, he probably isn’t getting very close to them. So that alone could really stop the potential for him being a super spreader. But it’s unclear. It’s also unclear, you know, how aerosolized, you know, maybe he’d be. He could be aerosolizing virus. There is a lot on Twitter yesterday and today about, you know, let’s hope that Biden did not get this. And I completely agree. They were pretty far apart. But what did the ventilation look like? Is there possibility for aerosolized transmission? I think the risk if they stayed that far apart the whole time, there would have been scenes, for example. I know they kind of came out of the of this stage, you know, at a similar time. And I can’t recall if it was Biden walking in front of Trump or who walked in front of the other. But if it was Trump and then Biden, then he might have been walking through a cloud of virus. So the way that these spread, I think they might be able to quickly identify the source. But if they don’t, then I think that it might be a challenge to really try to figure out who might have been exposed and how much the federal government is necessarily going to put contact tracing into place to try to identify, you know, if people in the White House may spread it to others. You know, I don’t know that that would necessarily be the White House’s priority at the moment.

MODERATOR: Real quick, I’m going to interject. It’s like we have reporters on this call or something because a whole bunch of people have informed me that Joe Biden has tested negative. But the question with that is that given the incubation period, does that mean he did not contract the virus at the debate? Or is that still a possibility?

MICHAEL MINA: It’s certainly still a possibility. Let’s say that was Tuesday. So we’re still well in the incubation period, and I would say to really be out of the woods. I mean, technically speaking, by the CDC’s definition, you want to continue for 14 days to see negative. Realistically, the vast majority of positives, if somebody is going to turn positive, will turn positive within, say, five or six or seven days. So I would say he’s not completely out of the woods yet. But it’s good that he is remaining negative.

MODERATOR: Great. Do you have a follow up?

Q: I do, yeah. Given the president’s refusal to wear masks and to limit his rallies and the crowds he comes into contact with, was this inevitable? Is this their sort of bad habits coming home to roost, in your view?

MICHAEL MINA: Yeah, you know, it’s been hard for me to really be able to tell from the media clips and such how close he gets to people. But sure, this was not inevitable, this was the likely outcome. I’d be surprised if he kind of made it through all of these campaigns and everything. You know, if it’s not him getting it directly from a supporter, it’s somebody in the White House getting it and passing it to him or something along those lines. I think that I’m sure he’s as susceptible as anyone else in the country and in the world. And many of us are taking precautions that greatly exceed the precautions that he tends to take, at least from the perspective of this virus. And so this was likely.

Q: Thanks so much.

MODERATOR: Next question.

Q: Hi. Thank you. I’m sort of following up on that. I just wanted to ask about rallies and distancing from other people. How extensive do you think contact tracing would have to be, given that potential exposure to other people? And then also, I suppose what that means for the rest of the campaign trail, for both major candidates and what good protocols around rallies? Should they happen at all? 

MICHAEL MINA: Yeah. So, I mean, contact tracing, the reason we do it is to let people know that they might have been exposed and therefore ask them to get tested. And maybe if contact tracing happens to call up somebody and they say, oh, yeah, I got tested and was positive as well, then maybe they can follow up one more transmission and let those person’s contacts know that they might have been exposed. But the reason I say that is because we don’t necessarily have to individually contact trace every single person who is at a rally that might have been exposed, for example, just for the sake of sort of ticking boxes. So in this case, like this is the president, this is a very famous event. And so there’s a case to be made that we don’t even have to do the contact tracing if it gets on the headlines. If any of your stations or newspapers say, you know, if you were at these three events, get a test and found you can do sort of massive contact tracing at once and or simply if you’re at these three events, stay home for 14 days, you might have been exposed and quarantined yourself. I mean, that would be a lot of people, but maybe so. In some ways when it’s a famous person and it’s a famous event, the point of contact tracing is normally not famous. So you’re not going to put a plaster on the front of The New York Times that John Doe was exposed in this local restaurant and anyone who is in the restaurant should get tested. So you need individuals to call those people up. But this is almost a famous enough event. The contact tracing at the individual level almost isn’t needed in a way. So it could be done sort of in a in bulk.

Q: That’s a really helpful answer. I guess the one other thing I would just be looking for then, any protocols that should be followed if rallies are to continue? Should they continue? And if they do, what should be enforced there?

MICHAEL MINA: Well, I think that this should just drive home the message. The rallies should not be happening. There is no reason to have an in-person rally right now. You know, it’s just not needed. We have plenty. It’s just as far as I can tell, it’s just to stroke the president’s ego. We have TVs, we have lots of ways to get information to people. The president does not need to hold a rally. All he’s doing is putting his constituents in harm’s way. And we can’t expect the public to have enough appreciation and understanding of the gravity of this virus to really understand that going to a rally is putting them in harm’s way. They’re listening to Trump when he says it’s not dangerous. And by his rhetoric of saying it’s not dangerous and saying, come to my rally, he is effectively single handedly putting tens or hundreds of thousands of people at risk of getting this virus. And frankly, I think if people die because of COVID that they get at his rally, you know, to a certain extent that’s on them for showing up and going. But it’s also on him. He’s the president of our country. And people should be allowed to trust what he says. And so I think moving forward, this should be a reality check that these should not happen. They’re not necessary, and they put a lot of innocent people at risk.

MODERATOR: Next question.

Q: Thanks for taking my question. I came a little late to this call, so I apologize if this is redundant or has already been asked, but, you know, obviously, the president contracting this disease testing positive for it yesterday raises questions about transmission. And you’ve talked about contact tracing. And I apologize if this is kind of an obvious question, but kind of to give you a chance to expound upon it. We now know we actually published during the course of this call that Notre Dame president who attended the SCOTUS nomination event on Saturday has now tested positive for COVID-19 as well. He’s actually been in isolation since that event. So is there reason to suspect that there could have been transmission that occurred in these previous events, both in as far back as Saturday, but also these events that people have attended on Wednesday? There was a larger religious event the vice president attended indoors. Just curious if those are things that people should look at as potential points of transmission as well.

MICHAEL MINA: Absolutely. They all should be. I mean, a lot of the country doesn’t have restaurants open, why are we having SCOTUS nominations in person? This doesn’t need to happen. And, you know, until we can figure out how to get the virus under control, these in person, especially indoor events, but even outdoor events should not be taking place, especially not from our leaders who are trying to set good examples for this or who should be trying to set a good example. So all of those that you just mentioned are absolutely places where transmission can and likely would occur when infected people are there. And so, you know, as the president of Notre Dame was at that event, I don’t know if he was masked. But masked or unmasked, shaking hands during these things, you know, I think that, yeah, it’s unnecessary risks at this point. We’re literally in the middle of the greatest public health crisis that has happened to humans in a very long time. And, you know, this is just befuddling and dumbfounding. And you know how they are not taking this seriously and being the leaders, they should be and practicing what they preach. If they are presidents of universities, they’re probably telling people and students to social distance and not go to classes together and things like that. And, you know, there’s no excuse at this point.

Q: Just one quick follow up, one, for the record, the Notre Dame president was actually widely criticized for not wearing a mask and actually shaking hands, and so that’s why he’s so haunting. And I would bring that up just to say, just to put a finer point, my question, is it possible that the president could have contracted COVID-19 as far back as Saturday and it would not have shown up on a test and certainly would have shown up as symptoms until yesterday and this morning?

MICHAEL MINA: Sure, that would fit the epidemiology. That’s just fine. Yes.

MODERATOR: OK, next question.

Q: This may be a bit redundant, but this is to follow up on that. I was curious about why when you talk about former Vice President Biden not being out of the woods yet in this possibly going back as far as Saturday. We did hear from the White House at the debate that everyone had been tested before the debate. So what do we know roughly right now about I guess you might call it a false negative rate, right? If everyone was tested and then three days later, they test positive. What do we know about the initial testing rate that may come up negative and then may eventually turn out that someone was exposed?

MICHAEL MINA: Yeah. So the good thing, and I’ve talked pretty widely about this, is if somebody is testing negatives and they are infected. So we would call it a false negative if that happens. The good thing is that it is less likely that that person is transmitting at high levels at that point to transmit. You need the virus to expel from you. And if you’re expelling enough virus that it’s very likely that other people would get infected, then your nasal passage and your oral passage will be coated with virus and will likely get again detected on a test. And so if people are remaining negative on the test, then it’s very likely that they’re not high transmitters. What I say, and I’ve said this a lot, that it doesn’t mean you can’t transmit at all very close contacts you could potentially still transmit to. And that’s because the virus grows up. And so who knows what time they got tested before the event? Maybe it is in the morning and they had to know how they tested again in the evening or the next day. They would have detected it, for example. So I would say that it’s not impossible to have some transmission if somebody is testing negative. What I would say is that if people are testing positive, especially with different tests that look for viral protein, then they’re very likely to be people who could be transmitting very widely. But testing negative doesn’t mean you can’t transmit. That’s why we continue to say even if your negatives, you still have to wear a mask, you still have to social distance. Just testing negative does cut down on the risk that you are transmitting to other people relative to somebody who is testing positive, for example.

MODERATOR: Do you have a follow up?

Q: No, that’s good. Thank you.

MODERATOR: Great. Next question.

Q: Dr. Mina, could you give us a general overview, an update on the status of the development of rapid tests and what you’ve been doing to further their development at the national level?

MICHAEL MINA: Sure, so rapid tests are starting to become more and more discussed, or as with the announcement of the Abbott BinaxNOW, a little bit more widely available-ish. But there’s still niche. We’re still seeing the majority of them that are out there are these instrumented ones. So they’re not distributed widely. They’re still generally being used by health practitioners, although Brett Giroir and HHS has essentially said, look, even though this has claims for medical diagnostic use, congregate settings can go ahead and use them and still be covered by the prep act. And so that’s all-important pieces of information to keep in mind that these are becoming supported and they’re starting to become more available. But they’re still only, at the moment, one company that has approval in the US for an instrument free rapid test. That said, I’m personally trying to work with a number of the companies. Not for any pay, I’ve declined all pay. This has been a big thing for people accuse me of, and with regard to rapid tests and I’m trying to help them to get the data that they need. So we’re going to be setting up trials, for example, to try to help evaluate the use of these tests and the efficacy of these tests in asymptomatic and symptomatic people. And that’s really to give them some data, assuming their test works, to give them data to help them get through the FDA. But if it doesn’t work, I mean, either way, it’s to give a third-party sort of independent evaluations, so it will be sort of a multi-center, multi institutional trial at the federal level. I would say that we’ve had a lot of really productive discussions with the federal government and with the FDA in particular. The CDC has been very willing to hear those requests and these thoughts. And they’re on board, I would say, in general, about the use of rapid tests that the NIH has been quite responsive, and the FDA too, I give a lot of props to Tim Stenzel, who is one of the directors of in vitro diagnostics at the FDA just under Jeff Shyren. And Tim has been very, very willing to have continued discussions on this topic. And we’re seeing a lot of the language that we’ve been pushing to Tim and to the FDA and in the media is now showing up more and more in the FDA regulatory landscape. So I think that in many ways, the FDA is becoming less and less the barrier and now the barrier is becoming more and more, or not necessarily more, but just that the barrier now is really just the production and the development of these tests. And this is why I’ve sort of moved a little bit more towards really trying to push the federal government to take this on in the same way that they’d be taking on any sort of war against other people. They should be treating this the same way. It should not be an afterthought to put one hundred billion dollars into testing. It sounds like a lot, but if this was a battle against another foreign country, that would be nothing and a relatively economic losses of this virus, it’s just a small, small fraction. So I think that what I would like to see now is for the federal government to really be pushing the development of these tests, not sitting by and waiting for some company to come out with one hundred and fifty million of them that they can purchase. We saw this in March with Roche or maybe April when the government decided, OK, Roche is going to make two million, we’re just going to purchase them. We have yet to see the federal government actually actively support the development in a real meaningful way. They’re just saying, OK, well, we have money, we’ll buy what comes out. And that’s a wrong approach. I would like to see the federal government to be building million square foot manufacturing plants to produce these types of tests or to really be producing. You know, there’s all different rapid tests are going to come in all different shapes and sizes. And we have a lot of different options. But pick a few and really create guidelines of how to use them and make them not just buy them. But we haven’t seen that yet.

Q: Great. Thank you very much.

MODERATOR: Next question.

Q: Thank you. I just had a couple of quick questions. I’m not sure you can answer the first one but talking about the president’s risk factors for complications. The other one I wanted to ask you, in terms of isolation, what needs to be happening now with the Trumps?

MICHAEL MINA: So the risk factor is I mean, Trump is obviously I don’t know his exact BMI and weight and everything, but he’s obviously overweight and he is in his 70s. So that puts him in a pretty high-risk category. I don’t know if his exact comorbid status. I know there were early reports from his position that said he was in the best shape of any human that the doctor had ever seen. But I don’t think that that’s necessarily true. So though I would say that he probably he fits a pretty high risk category, not the highest, he’s not in his 80s or 90s. I don’t know that he has diabetes or cardiovascular risk factors at the moment. And so I would put him in a fairly high, high risk category relative to the overall public in terms of severe disease. Still, it’s not about 50 percent or something like that. It’s probably, I think, the mortality in his age classes around three and five or eight percent or so and putting it simply a little bit lower. And then in terms of isolation, he should be isolating now, for a at the very least, for the 10 days he’s recommended by the CDC. And he should not stop isolating at that point until he’s gone a few days without symptoms. And that’s really the recommendation of the CDC and that’s his agency. And he should probably follow it. I know he’s a VIP in the country, but nonetheless, he doesn’t know. He can do a lot of his work without being in direct contact with people.

MODERATOR: OK, next question.

Q: Hi, Dr. Mina, thank you so much for taking our time and your time to address all of this and for being willing to just adjust on the fly. Obviously, with news of the day, I didn’t want to let you know that our digital team is telling me that they so far have not postponed the Biden Grand Rapids campaign. That’s supposed to rally, that’s supposed to start any minute now. So I would assume, given what you said about Mr. Biden, that you would say that rally also should not be happening and that would either be a yes or no question. But I want to get to the Oklahoma stuff as well. Not to be outdone by the White House. Oklahoma is out doing the White House. We remain in a red zone. The White House task force has repeatedly said that we need a statewide mandate. Last week, they used their harshest language yet to say that we’re not doing everything we can to prevent unnecessary death. Our deaths are up. Hospitalizations are spiking. Obviously, our 5-17 age group is seeing the highest number of cases now, with many schools back in session, sports are happening as normal, all of those things. We have not had a statewide mask mandate to this point. Tulsa, Oklahoma City have. But the suburbs outside of Tulsa have refused to do so. And when I say suburbs, I mean, you know, across the street from each other. So not like you’re having to drive a long distance. But, you know, the mayors of both of Oklahoma City and Tulsa have been pleading with the suburbs to enact a statewide mandate and ask the governor to enact a statewide mask mandate or in the absence of that, the suburbs. But they just refused to do so. And so we’re not getting out of the red zone. And even with the statewide or the mask mandates, you know, in our communities, in the larger communities, Oklahoma City, Tulsa, which was, of course, on the map with the Trump rally. It’s just not happening. And so our cases are continuing to spike as we head right into the flu season. I asked the health commissioner for the state, so the head of our state health commission last week, why we are not having a mass mandate, and he just said that they review the White House recommendations, but that they basically see it as a copy paste sort of thing. And here we are.

MODERATOR: Do you have a quick question, because I know Dr. Mina has to go in one minute.

Q: Yes, so what would be your advice for us here? I mean, do you think that this is going to improve if they don’t do something different?

MICHAEL MINA: The advice? Make a mask mandate. I don’t have any other advice. Wear a damn mask. I think, you know, everyone in this country should. Everywhere we should have mask mandates. If you’re on public, wear a mask.

Q: Do you think it seems silly to think that things will change if we don’t?

MICHAEL MINA: No, I think things are going to get worse. Things will get worse; the winter is coming in and we know that this is a seasonal virus. And I think things can only get worse from here.

Q: What about the Biden rally? Do you think that needs to be canceled as well?

MICHAEL MINA: I think that yeah. I think that things like a rally should not happen. It’s just not worth it.

Q: Thanks, Dr. Mina.

MODERATOR: All right, Dr. Mina, do you have a couple of extra minutes or I think you’ve got a hard stop at 1:00 pm, correct?

MICHAEL MINA: Thank you. But I just let them know I’ll be five minutes late.

MODERATOR: OK, great. Thank you so much. Can you go ahead, please?

Q: Yeah. Hi. Bit of a change up question. I’ll make it quick. I cover the NFL, which is dealing with its first outbreak in Tennessee. Right now, they have eleven players and coaches who’ve tested positive in the last week and they canceled their game for Sunday. I think their hope right now is that they can use frequent testing to avoid having to shut everything down for two weeks. And I’m just wondering, is that reasonable? Is there a way to effectively use daily testing to cut short that maximum incubation period?

MICHAEL MINA: Do you mean among the individuals or the for the league?

Q: Among the team, so like they were last exposed to each other on Sunday. Is there a way that they can all, and obviously I’m not talking about people who have had positive tests who will, of course, recover before seeing each other again?

MICHAEL MINA: Are you asking can we can we test out of quarantine? Is that correct?

Q: Yeah.

MICHAEL MINA: So I’ve been actually talking to the CDC about this. Particularly because of colleges and universities where students are quarantining, for example, in dorm rooms. And so it’s leading to some mental health issues and things like that. And most of them never turn positive. I actually am advocating especially for when testing is available. I think that potentially being able to test, say, at day five and day seven into quarantine, if people are negative, to potentially release them with strict adherence to masks and social distancing. But then test them every single day. I think that alone could really do that. That can stop further spread for the most part. Well, is it perfect? Is it as good as telling people to completely quarantine for the full 14 days? No, but it really does cut risk down tremendously. And so it’s a cost benefit analysis in this case. I do think that there is a role for testing out of quarantine early. And if by seven days, most people, almost everyone who will be compositors has already become positive on a test. So you’re still testing negative. It’s probably very unlikely that you will become infected or that you will turn positive after that. But at the moment, that’s not the CDC guidance. Now, nobody has to for that. It’s just guidance. It’s not law. But I do think that there’s a role potentially for using tests to our advantage when they are available.

MODERATOR: Thank you. Next question.

Q: Hi, Michael. Just to backtrack a bit to the president. If we look at the week ahead and the progress of his disease, I mean, clearly this can go a number of ways. But what are sort of the milestones and the progression of the disease that we should be on the lookout for as indicators it’s getting particularly serious or not?

MICHAEL MINA: Well, so that the indicators are certainly, you know, we have already heard that he was lethargic, that he was not really up to his normal self yesterday, I believe. I mean, it’s not going to be a lot that we can necessarily see as a populace unless are giving us real detailed updates. But certainly, him coughing and things like that, those are normal symptoms for this. But what is most concerning is when somebody starts to have difficulty breathing, if it has a respiratory system, starts to be strained a bit, that starts to get increasingly concerning. And so they might be doing things like checking his pulse ox to see what his oxygen saturation is. And ultimately, I’m sure they’ll be doing, you know, whether it’ll be x-rays, or I don’t know what kind of care that they give a president. But there are a lot of symptoms. I think that the most concerning is if he has to be admitted to a hospital, then we know that things aren’t necessarily going in the right direction. And we will want to potentially know that ends up getting quite concerning. But other otherwise, it’s going to be hard for the for the public to really monitor exactly how he’s doing without kind of having access to his real time medical records.

Q: And is there a timeframe for that? If we don’t hear is that hospitalized in a week that we know it’s not severe or could that be two weeks from now?

MICHAEL MINA: Yeah, I would say in general it moves fairly quickly in a lot of people. But even two weeks from now, it’s not crazy to think that somebody can deteriorate slowly, especially if they’re if somebody is getting things like I’m sure that they know, they probably have him on Remdesivir almost as a prophylactic without being in the hospital. Things like those. So they might be able to slow the virus and hopefully that will give his immune system a chance to fight back. But if it doesn’t, it could be slowing it. So he might more than the average person might actually have a more delayed affected. His body doesn’t battle it off appropriately, but he is getting more supportive care and things like anti-virals.

Q: Thank you.

This concludes the October 2nd press conference.

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