You’re listening to a press conference from the Harvard School of Public Health with Michael Mina, assistant professor of epidemiology. This call was recorded at 12:00 p.m. Eastern Time on Friday, November 6th.
MODERATOR: Dr. Mina, do you have any opening remarks?
MICHAEL MINA: Well, I just wanted to say, well, that hopefully the election is now coming to a close. We’ll see. But I do think I’ve talked a lot over the months and some of you have been on this every week for months and some not. I hope that this can be an inflection point where we can actually start creating policy around how to actually tackle this virus in a truly meaningful way. I think that the election has probably distracted from it in a pretty serious way for months now. And, you know, this week, we passed one hundred thousand cases in a day that were detected. This virus is increasing at a pace of adding 50 percent new cases every two weeks right now. So it’s just accelerating, despite all of the research that has been done on it since March or February. We have yet to contain it. And really, we’re going the opposite direction. And I’m sure people will ask about it or I’ll talk about it a bit more in this hour. But we have options. And I think we’re getting to a point where the country believes that the only options are to close down, and that’s leading to incredible strife and fear and anxiety across the country. But the only reason why that is being discussed so broadly is because we continue to not put together a very clear strategy. And I think that there are simple strategies that could be explored that are much less economically devastating than shutdowns. I’ve talked a lot about rapid testing being one of those strategies. It’s a fairly straightforward strategy that needs some external parts like messaging and marketing and things like that, and public health buy in, and really putting the public back in public health. I hope that people are or are considering covering that there are other avenues to control the virus and to mitigate spread. And now that the election, I think with turnover in leadership or maybe the same leadership, whichever direction it goes, hopefully people can focus more and actually recognize that there are just so many options besides just total economic shutdown or herd immunity or natural derived herd immunity. There’s a lot of space in between to to keep people safe. And hopefully we’ll cover some of those in this. So I’ll just say that and I’m happy to take questions.
MODERATOR: Let’s get started. First question.
Q: All right, thanks very much for doing this. I think this is related a bit to what you were talking about earlier. One thing I’m trying to wrap my head around is governors or other leaders at this point. They’re stressing these personal choices, individual behavior, as a way to slow the spread and not really instituting any new policy or anything like that. And I guess one argument that they’re making is that a lot of the spread, apparently, that they’re seeing in their states is at family gatherings or sort of in private settings. So I guess arguably that’s something that a policy around business restrictions wouldn’t touch. But I guess I’m wondering how you kind of react to that argument and maybe by extension, why would policy changes or new strategies have an impact on wherever transmission is occurring, even if it’s in private?
MICHAEL MINA: Well, this is one of the hardest pieces of dealing with an acute virus like this that transmits through respiratory transmission. It can transmit in people’s homes; it can transmit very well when people get together with their loved ones. But we cannot shut down society and we can’t treat everyone like they’re positive every day and ask people just not to gather for the indefinite future. This virus, I think there’s a lot of people in the United States who are recognizing that the suggestions that they need to to just not gather, where’s the light at the end of that tunnel? We can’t just pause society, pause our lives, pause everything. As a result, we could for a little while. And that was the intention back in March and April to shut things down and to say, OK, this is going to be a short duration, complete shutdown in parts of the country to get things under control. And had we acted appropriately after that, as a country, to actually try to keep things under control? I think people would be more encouraged about what’s ahead. But I don’t think that many people in this country have any interest in saying, I’m blanket not going to get together with my family for Thanksgiving. Many people are not willing to do that. And that’s because there’s not a clear end in sight. Does that mean they’re not getting together for Christmas as well? And is it every moment that you can’t get together or is it just certain times? And this is one of the reasons. I think one of the best things we could possibly do is empower people to know if they are more or less likely at risk of transmitting this virus to their family members, so that they can make educated decisions. They can still go and do what it is that they’re going to do either way. But maybe they can be more discerning and choose not to, if in the end, the rarer event that they actually are positive, then they don’t go to Thanksgiving, for example. And that’s where getting people rapid tests that they can use in their home really is directly addressing this particular question.
I think it’s kind of naive. I mean, it’s beyond naive to say as public health people just don’t get together with people. You know, I have been myself very concerned to get together with my family. But I still have a family that I love, and I want to see and this has been a long year and so I have just spent a week with many of them. In our case, I had rapid tests to take every day. And that made me feel much better about being around older individuals in my family, for example, while still practicing other things like social distancing and wearing masks when needed. But it is empowering to people to actually know their status. And to not give them any information about their status, to not empower them to really know what their status is at any moment, then it’s an extremely difficult task to just ask people to not see their families, that is, for an invisible virus. It’s really naive of the public health community to just blanket ask that without trying to give something for people to hold on to, something for people to empower their choices with besides just taking our words for it. And I don’t know if that answers the question.
Q: That was helpful. You mentioned in your opening that there’s this sort of false binary between lockdown or not, and there are other avenues and you mentioned testing is one of those other avenues. But like what are some of those other avenues that exist before a lockdown type situation?
MICHAEL MINA: Well, I think we can strategize around how we use the resources we do have. We can strategize around how much we know about the virus we’ve been looking at. So much of this is sort of black and white, you’re in lockdown or you’re not. We’re either just letting the virus get completely out of control or we’re trying to let it get out of control and then suppress it. I actually don’t think we have a ton of choices, which is why for months I’ve been harping about rapid antigen tests and increasing testing, because at the end of the day, the way that you stop an outbreak like this is to know your status. It’s the same thing we did with HIV. If people know their status, then they can make more informed choices, even if they’re still going to go to Thanksgiving dinner, for example. I wouldn’t recommend it for somebody who is positive to go to Thanksgiving dinner. And I hope that people will not. But if they do, you know, maybe some of these very ardent, or people who think that this virus is a hoax, maybe if they are positive and they know that they’re going to dinner, or they know that they’re positive and they’re going to dinner, they will act a little bit different. They’ll behave a little bit different. Maybe they won’t give their grandma a hug or whatever it might be to stop spread. And I think it’s all about empowering people to know that they’re in a position where they could potentially give somebody else an infection that could kill them. That is an extremely powerful piece of information that should be a motivator for many, many people. But short of having a good understanding of what your exact sort of infectious status is at the moment, some of the other pieces also center a bit around more public health testing and surveillance. If you know that if you run a nursing home and you know that there’s not been any community prevalence of this virus for two months in your community, maybe you can become a little bit more relaxed about trying to figure out how to creatively get your your residents in the nursing home together with their loved ones. But if there’s massive outbreaks happening like we’re seeing right now, maybe then for shorter periods of time, you say, OK, you know, we adapt and we really change things, but we do it with strategy. We haven’t had a lot of strategy across the country to do that. And then finally, the other piece is essentially by just sort of not creating real centralized strategy. This is a virus that just truly does not care about borders. It doesn’t care about elections. It doesn’t care about politics. It’s not even alive. This virus is like a little robot that hijacks people’s cells. It doesn’t care about any of this stuff. It will just spread. And so the reason I say that is because any decisions that we’re making as policymakers or programs that we’re putting in front of policymakers, they need to be adopted or at least something that is adoptable by everyone. This virus will cross state lines. They’ll cross county lines. So if we’re doing things in a fragmented way, it’s just never going to work. And that’s what we’ve seen in the US thus far.
Q: Thanks very much, appreciate it.
MODERATOR: Next question.
Q: Hey, Michael, you know, everybody is going to ask the questions I want to ask, so I’m going to go somewhere a little different. So what’s up with the FDA? They’ve kind of gone wild. I wanted to know what you think is going on there and when they might get back to normal. I follow biotech quite a bit, and I’m not going to bore you with the details. But I could see many examples of companies that had a pathway worked out on drug approval. And then suddenly at the last moment, the FDA comes up with a completely different angle that derails the whole thing. And then if you, again, just look at the Biogen situation with as you can imagine, the FDA just came out with this statement that just goes against all statistical analysis. So they just seem to be kind of crazy. And I know you have interaction with them. So what’s going on there? And when might they get back to normal?
MICHAEL MINA: I mean, I can’t speak for them. I would say that I do talk to the in vitro diagnostics team at the FDA. I can’t really speak intelligently about your question too much, but I can say that they are under immense pressure at the moment and they are an agency that is like the CDC in the middle of enormous political strife. What is at stake is a difference between politics and anti-science decision making versus robust scientific decision making. And how do you start to reconcile that when the people above you I mean, the FDA essentially falls under the current White House, how do you push things and have any sort of reasonable sort of decision making process within the FDA when the person who can fire you is sitting there saying that this virus is a hoax and that we don’t need to act on it. In fact, we want to do the opposite and completely not act on it. And that’s his message. I mean, there’s no secret about that. I’m really glad I never decided to work at the CDC or the FDA because it just seems like a nightmare at the moment. So, of course, they can’t get anything done. And it seems to the general public that they’re not making reasoned decisions, because I think they’re getting pulled in completely opposing directions. One is, you know, to really work appropriately and do the job of the FDA, you need to be discerning, you need to be scientific, you need to be meticulous. And those words are nothing that anyone would apply to the current White House. And so I just think that that’s at the heart of it.
Q: OK, and just really quick, another one, then I’ll hop back into queue. So, again, maybe a little bit of an abstract question, but I think it’s really important. In the stock market, psychology is about 90 percent of the game. So I pay real close attention to it. And a big part of that is crowd psychology. So I’m just curious, obesity kills two point eight million people a year and COVID is at one point two in the U.S., the numbers are 360K versus 235K. So why do you think the group psychology has latched on to COVID when there’s a whole other epidemic that’s much more serious. Wouldn’t it have been better to latch on to the obesity epidemic? And by the way, Dunkin Donuts is up 35 percent this year versus about 2 percent for the S&P. So that’s kind of interesting and relevant. Anyway, what’s your take on the kind of the mass hysteria developing around one, but the other seems a little bit misplaced?
MICHAEL MINA: This is an issue that comes up again and again and again in public health. We say it a lot in public health. You know, we had Ebola, for example, which killed relatively very, very few people compared to this or compared to obesity. But it makes the headlines. Meanwhile, we have pneumococcal pneumonia, which is killing millions of children a year that nobody cares about. These things that become ubiquitous in life, we’re seeing it already with COVID. People cannot retain unless it’s something that you do as your profession or something that you are very, very passionate about. Anything that we deal with on a daily basis, you’re going to become desensitized to it. The complexities in obesity are far greater than the complexities of how to deal with an infectious disease like this. But it’s so intertwined with our lifestyle, with our culture, you know, with our socioeconomic status and our geography, how to deal with that. And frankly, global warming is no different than this, too. There are people who advocate and who do the science and tackle all of these issues. But at the end of the day, if it takes effort and it’s something that’s ubiquitous and would take real change at a social level, it is something that people generally lose interest in very, very quickly because people get busy. They have their lives to live. And COVID is no different in this case. Your using COVID versus obesity right now to say that people are really rallying around COVID and not obesity, as something that can be tackled. And I think the real difference here is that this is still an acute infection. There is still hope that we can figure this out. There is fear about it because it’s a new addition to the things that kill us. But let it go for another year and people are going to not care. We’re already seeing that happen, unfortunately. And, you know, I’m not a psychologist, but I do think that there are real intertwining things where you see a lot of overlap between the populations that have a lot of these other health problems, and populations that just don’t really care about this virus. You know, I’m sure that there are complexities that can be unraveled over years and in psychology, Ph.D.s. And trying to understand groupthink and things along those lines. I can’t say much more then. But this is an issue in public health that is sort of age old.
Q: OK, thank you.
MODERATOR: Dr. Mina, we have a lot of questions, so I’m going to ask you to maybe make your answers a little bit shorter so we can hopefully get through everybody.
Q: Hi, this is related to a recent study from the Medical School and Boston Children’s that found the case rate among detainees at ICE facilities was, on average, more than 13 times the rate of case rates among the US general population. So my question is, we do mass testing of asymptomatic individuals at places like universities and nursing homes. Should there be the same kind of testing and ICE detention facilities, even if there may not be the ability or resources to respond to those tests as per CDC guidance? Why or why not?
MICHAEL MINA: Absolutely. I mean, unless we’re wanting to give people who are detained by ice death sentences just because of being detained, we should absolutely be doing everything we can to protect them. We’ve seen this going on since the beginning of this pandemic where we haven’t been protecting prisons appropriately. We haven’t been protecting detainees appropriately. These people are in the custody of the federal government. And we absolutely should be doing everything we can to keep them safe there. Whatever crime people might have committed or, you know, just being in the US as undocumented, is not a reason to put them in physical harm’s way. And we need to be caring for people in all of these settings. Again, I mean, this virus doesn’t care. And it isn’t going to not infect people because they’re in an ICE detention facility and it’s going to, in fact, spread much more readily. These are places where people are probably close together, they’re at risk populations. And not providing a means to stop spread in those locations is a national travesty. It’s a stain on our country. I mean, it’s just astounding. This has come up before in the past with influenza vaccines, for example, should we be providing influenza vaccines to detainees in years past and in general in the previous years? We’ve decided as a nation not to. And it’s just terrible. I think we absolutely should be doing everything we can to stop spread and testing on a frequent basis is one of the best ways, especially in a place like that, to prevent spread and stop outbreaks. And dealing with stopping spread in those locations should be one of our top priorities.
Q: Thank you.
MODERATOR: Next question.
Q: Hi, thanks for doing this. You mentioned, you hope this is an inflection point in this election, sort of, get some policy processes moving. Is this something that the current administration can do in the next few months, or does leadership have to come from the states at this point? And then what are the consequences if nothing happens until mid-January?
MICHAEL MINA: So this is something that the current administration can absolutely do, and I know that there are people in the administration who want to do things, who want to actually create strategy. I have received calls in the last few days from people high up in the administration who are looking for advice on how best to use rapid testing, for example, to keep nursing homes safe. So I know that there are people in the administration who absolutely want to do good by the United States population and want to help combat this virus and with strategy and with science. I’m hoping that now that the election is over, that we can see that, you know, regardless of who wins, that people aren’t going to be trying to get votes and making decisions based purely on that. And so maybe there will be more willingness. But even beyond just the White House, we have a lot of options. We need to be putting funding into infrastructure and strategies to combat this. One of the most important things, in my opinion. Now we’ve put funding into vaccines and that’s that. There’s been a lot of funding going into that. We need to get funding into the Heroes Act to essentially build up our capacity to know who is infected and control the virus through in part with testing and ideally with frequent testing in order to get people to know when they’re infected. And so by appropriating the funds in things like the Heroes Act, we can start acting now. There’s no reason why the administration has to change to do that. And so much of this always comes down to funds. And this is just a small fraction of the cost that it would take to actually get the type of testing available in this country so that we could actually achieve herd effects and get outbreaks to become suppressed at a national level would take extremely small amounts of dollars compared to what this virus has cost us over the last six or seven months. And there’s just no reason why we are not aggressively doing this. If we had 10 billion dollars appropriated towards testing and towards the manufacturing and deployment of rapid tests, for example, that would be enough money, just 10 billion dollars, which maybe to the average person sounds like a lot, but it’s a drop in the bucket for federal response. I believe that we can actually get this virus and the outbreaks that are happening across the country under control. The science adds up, the math adds up. So we don’t have to wait until an administration either bans or changes. We can make changes that can be greatly effective tomorrow if we had the will.
Q: Now, what if this funding doesn’t come through immediately, right? You’re talking about 10 billion dollars, but if there’s no real legislative will to get this money through for another three, four months, is the virus just going to spread too much to be able to control it at that point?
MICHAEL MINA: At the moment, we have painted ourselves into a corner. I’m not going to lie. We have very, very few options at the moment. These tests aren’t going to become widely available tomorrow. They just can’t. I think they can be in a month from now. For example, if we were to start acting aggressively today, and does it have to be the federal government? I think it should be. But could it be a combination of Mark Zuckerberg, Tim Cook and Jeff Bezos? Sure. 10 billion dollars is not a lot. You could get 3 billion dollars now, get us three months’ worth of tests or four months’ worth of tests. So doesn’t need to be a lot. But, you know, at this very moment, we’re seeing exponential growth of this virus. This is expected. This was completely predictable. We have said it. I’ve been screaming it for months. My colleagues have been screaming it for months. And now we actually don’t have a lot of options. We could have a lot of options to control this and allow us to be safer when we go home for Christmas or go to our families for Christmas. But not for Thanksgiving. And this is the tragedy of this virus. And this is the tragedy of letting it get out of hand. If we let it get out of hand, our options dwindle and dwindle and dwindle every day. We are just going to have pretty soon, no options but to completely shut down or choose to just let the virus run unabated in the community and kill another two hundred or three hundred thousand people. You know, and this is why I’m saddened by this every day, because we have had tools at our disposal for months now and we just never have used them. But there’s no time like the present to start if we’re not going to have them tomorrow. But we could have them on December 10th. We don’t want to be looking back and saying I wish we started on November 6th to build these, because then we would have had them by now. I don’t want to see us in the middle of December having the same conversation about whether people can go home for Christmas. And it’s just becoming tragic and more tragic every day.
MODERATOR: Next question.
Q: Dr. Mina, thank you for doing this, first of all. This is a bit of a niche question, but on one of your calls a couple of months ago, you said that the idea of having fans, even partial crowds at sporting events outdoors would be potentially a disaster. And obviously, college football games have had crowds like that for months now. I’m curious, as we look forward to indoor sports, college basketball, the NBA potentially having limited capacity crowds, do you think that that’s something, at this point, that can be done safely with any sort of protocols? Or are we just at a point kind of with the spread of the virus in communities across the country, that that’s something that should not be happening?
MICHAEL MINA: Well, yes, a few months ago, when I said it could be disastrous, I think I was also saying that it’s a slippery slope. If you have people gathering, for example, in sports stadiums, even if they’re distance apart, it ends up becoming a slippery slope of saying, well, OK, we can start getting larger and larger crowds. And that’s exactly what we’ve seen, is that slippery slope happened. And now these are places where the virus can spread. Outdoors is definitely better than indoors. As we’re moving indoors, it’s the same story with sports as it is with work and everything else. It really depends on what precautions we’re able to take before people gather. We’ve seen pretty tremendous benefit from frequent testing on college campuses and universities across the country and at the White House. We’ve seen that it is possible to greatly reduce odds of major outbreaks happening at these types of events. And I think until we have really good ways to really reduce the odds of major outbreaks happening, we’re stuck at a fork in the road where we either say, it’s OK to have big outbreaks happen at sporting events and we’ve chosen the route of natural immunity to be developed and unfortunate deaths across the country, or we are trying to figure out how best to keep people safe when they go into these sporting events or when they go to work or go to a restaurant or whatever it might be. And that’s where I think really focusing on reducing spread as much as possible, masks and distancing and spacing things out, are crucial. But what is as crucial as those is trying to stop infected people from entering into those stadiums and into those indoor facilities. And that’s, again, it comes back to knowledge. This is a silent virus, that’s why I harp so much on testing. It is an invisible virus. It’s silent. It spreads asymptomatically, pre-asymptomatically. And if we’re not able to detect it, then we just don’t know who’s walking in there and what their status is. And that’s why I think, again, it always goes back to testing for me, along with these other public health mitigation strategies, because there’s just no other way to stop it from spreading with a virus that is circulating widely in a community.
MODERATOR: Next question.
Q: Perfect, thank you so much for doing this. You’ve touched on this, but I wanted to ask, looking at sort of what you know, of course, the presidential election is not a done deal by any means, but decided to look today at what a Biden response might look like and localizing as much as we can, what impact it might have here in Massachusetts. Just wondering, you know, he’s put out some pretty detailed plans on what a national response would look like under a Biden administration. If you might be able to weigh in on that and what you think, how things might change?
MICHAEL MINA: Well, I think things would change. There’s a lot of ways to potentially create policy around an infectious disease like this. There are so many different angles. I think the biggest thing that will change with a Biden administration is bringing scientific rigor and bringing strategy into the fight against this virus. And frankly, the fight to keep our economy alive and running. I do believe that a Biden administration will treat this in a wholly different way and with a very, very different approach and one that will focus on using the advice of experts bringing multiple parties to the table, whether that’s experts, economists, local health leaders, who understand the feelings of their constituents in their localities. I believe that we will see a rational response to the virus start to appear, and that’s the biggest thing for me, is that without going into the details of everything that he is wanting to put forward, I think the biggest thing is that administration, if it were to come about, would actually pay attention to the science and strategize around what are the best ways to utilize the resources we do have, what are the resources we need to build and what do we know about viruses like this? There’s a reason why the federal government and the NIH have funded infectious disease research for decades. And it’s not so that we could throw out all of that research when we actually need it. And I think that we will see something. I think that we’ll see strategy and science and rational behavior come back to the federal government.
MODERATOR: Next question.
Q: Yeah, hi, thanks for taking my question. Can you hear me?
MICHAEL MINA: Yep.
Q: Great. I’m wondering if you could focus on what we ideally want to see for nursing homes in terms of testing. I’ve been talking to a nursing home that’s frustrated because they just had the situation this week of several people tested negative on the rapid machines that they were issued by HHS and then testing positive with PCR. Now they’re just starting to receive the paper strip tests. I think they just got them this week. And so they’re hoping, oh, maybe those are more accurate than the machines we got from HHS. But I don’t know if that’s the right way to think about it or, you know, what else we expect to protect these nursing homes. They feel like they don’t have anything that’s good enough to protect their residents.
MICHAEL MINA: Sure. Well, let me answer that in one second, I was just thinking about the last question that was asked. I promise I’ll come right back to this. And I want to just say one other thing that I do believe is that I think that Biden, unlike Trump, really gets this idea that we can both control this virus and re-open the economy. And I think that that’s one of the major things, that these don’t have to be opposing forces. And the rhetoric that has come from the White House for all this time has made those appear to the public as opposing forces. They are not. And there are ways that we can control it, and re-open the economy simultaneously and focus on both of those, because that’s really what we need to do as a country. And I think that that’s one of the biggest pieces that Biden will bring to this. I don’t think that he’ll see things in this completely black and white way that the Trump administration has really dealt with almost everything. So I just wanted to say that.
On the nursing home front, I think it all kind of wraps up together. I think the nursing homes, they are medical types of facilities, but they generally have no expertise in infectious disease control. We saw that at the beginning of this pandemic, that truly there was almost no sense in infection control whatsoever in many nursing homes. They didn’t know what it was. But they reached out certainly to try to get help. And I think they’ve learned a lot. The reason I bring it up is because they are in a position of just trying to figure out what the heck is going on. And so far, tests have just kind of been thrown at them with almost no direction, no instruction, no policy, no strategy of how to use them appropriately. I keep using the word strategy because that’s what I keep thinking of this as a war. And whether it’s in a nursing home or the public at large, you can’t fight a war without strategy, and you will never win. You’ll go backwards. And we need to be providing nursing homes with policies. There’s lots of concern that arise with antigen tests versus PCR testing as an example. As one example, antigen testing by definition, will detect people when they actually have live virus in them. PCR, by definition, will detect the RNA of the virus, whether there’s a live virus or whether somebody is over the virus. So let’s say you have a patient in your nursing home who gets a rapid antigen test as part of a screening program, shows up negative, but the same day gets a PCR test and it shows a positive. If I didn’t know anything else, I would be extremely concerned about that issue and say this is terrible, the antigen test or the machine that HHS has provided us isn’t doing its job. But if I was given more instruction on how to use these tests appropriately and what questions to ask, I would actually ask the question. Well, is that person whose PCR positive actually a danger, or is these remnants of an old infection, for example? Because it turns out these rapid tests that the federal government has provided to many nursing homes are extremely good at detecting people when they are infectious and when they’re at risk of infecting others. But by definition, they won’t tell you if you were infected two weeks ago, or if you no longer have live virus in you. So I think it becomes a little bit nuanced. It’s really hard to answer your question without knowing more about it, because I would say that the nursing homes themselves don’t know how to interpret the results. And this is a disaster when you have tests that your just kind of throwing at some nursing homes and you don’t give them the agency to really understand how to interpret it. It leads to anxiety and fear and real concern. And that concern should be there, because if it truly is missing cases, we need to know that.
I don’t know which instruments it is that you’re referring to, whether they are the Abbott ID now molecular RNA tests or whether it’s BD Veritor or Sophia Quidel tests, those are some of the rapid sort of instrumented tests. But we’re starting to see things like the BinaxNOW come out and be distributed to nursing homes, and at least all of the research so far has shown that these tests really do a very good job at detecting people when they’re infectious, up to one hundred percent sensitivity when people are most infectious. And so that should give some level of comfort to individuals who run these nursing homes, but certainly not giving them that information and saying, hey, these turn positive when somebody is infectious, but people could then remain PCR positive for another two or three months. That means the ratio of time that you’re spent being PCR positive when you’re actually a risk to other people is just a small fraction of the whole time that somebody would turn PCR positive. And I don’t think that most nursing homes get that. And I think the reason that they don’t get that is because we have not, as a federal government, given them the resources to understand that. And I’m not even sure that the federal government fully understands that, to be honest.
Q: So in this case, it seems the employees were pre-symptomatic because they’ve since developed symptoms and now there are 10 people in the nursing home who are testing positive. But I wonder in terms of instruction to the nursing home from the feds, as you were talking about, that’s kind of lacking. I guess the instruction that they are receiving is that they have to test all of their employees every week based on their county positivity rate. So are you able to say something like that is not enough? Ideally, we want nursing homes to test everyone every two days or anything like that. Is there some sort of ideal guideline here?
MICHAEL MINA: Oh, absolutely. And in fact, I was just asked by the administration to provide this guideline, and we actually just put a new paper up online yesterday with those guidelines essentially or with suggesting how to best use rapid and frequent testing, regardless of the type of test, really, but frequent testing to keep nursing homes safe. And we found that if you’re just doing testing once a week, absolutely, you will miss people. You will have outbreaks. And this is a fast-moving virus. So that’s where this very frequent testing, if you’re testing every two days or every three days, you’ll probably be able to do a really good job at controlling outbreaks. If they enter, will you necessarily catch every single case? It’s extremely difficult to catch every single case. But when it comes to a virus like this, the goal is to stop every outbreak in a nursing home and not necessarily prevent every single case. The only way you can do that is to sort of never have anyone enter. And so if we can combat and stop every outbreak through every two day or every three day testing in these nursing homes, primarily of the staff, because they’re the ones going back out into the community, coming back, that can do a tremendous amount of good to keep these places safe. And even though every week sounds like it’s a lot, most people in this country are not getting tested every week. Unfortunately, this virus just moves too quick. It grows too rapidly that even testing once a week becomes for a place like a nursing home where things can sort of get out of control very quickly. Even weekly testing is too spaced out at a national level. Weekly testing would do an amazing job, but that’s where we’re just trying to sort of slowly bring the whole outbreak down at the country level. But you really don’t want to see 30 people get infected in a nursing home because you’re doing weekly testing. It needs to be more frequent if you want to sort of keep outbreaks at bay.
Q: Thank you.
MODERATOR: Next question.
Q: I’m sorry, can you hear me?
MICHAEL MINA: Yes.
Q: OK, great. I just wanted to go back to Biden for a minute. I want to get your comment specifically on what he’s called out in his COVID-19 testing plan. I mean, he said that he wants to ensure that all Americans have access to regular, reliable and free testing. And then more specifically, he wants to double the number of drive-thru testing sites. He wants to invest in next generation testing and scale up capacity by orders of magnitude. And then I think the other thing is that he’s he wants to set up a pandemic testing board, much like Roosevelt’s war production board, which he says could produce and distribute tens of millions of tests nationally. What is your view of those? Although there’s not a hell of a lot there in terms of specifics and he doesn’t give a dollar figure assigned to these tests. But what is your general view of that plan?
MICHAEL MINA: I think it’s absolutely what’s needed. I think that the most important thing that we could do right now if we want people to use test frequently, we have to make them convenient. Drive-thrus are never going to be convenient, for example. So it’s good to keep increasing those for surveillance testing just to keep building it up. But really, what we need is to increase the amount of testing if we want to use it as a strategy to combat the virus by orders of magnitude, like you said, and Biden’s team has said. And so this is one of the absolute most important things that we can do. If we can get 20 million tests or even 10 million tests per day in the United States, that is enough to create herd effects across the whole of the United States. Ten million is not out of reach, 20 million is not out of reach. To get most people in a community to use a test every three or four or five days doesn’t actually take a huge number of tests to be produced every day. 10 million or 20 million might sound like a whole lot, but these are small little pieces of paper. We make bags of Doritos at that amount every day, probably. And so we can absolutely create these little paper strips, get them out into the whole of the country so that people can wake up, they can brush their teeth and they can use their paper strep test. It’s as simple as putting in or taking out your contact lenses and they can know their status. That is how we combat this virus to give people knowledge of their status so that they know, do they do they go to work that day? The other piece is, we absolutely need to make it part of a comprehensive program. If we’re asking people to not go to work because they are positive, we need to ensure that they have a security net, that they’re getting paid, that they’re not going to be docked for not going to work. Whether the government has to pay, the employers to pay their employees or how that program works, it needs to be there. Otherwise, people will ignore their results and will continue spreading the virus. But I do think that the inclusion of rapid tests and the massive scale up is something that is well within. We should have done it months ago. This is a simple part of this problem. And it’s well within our grasp. And it can help to get outbreaks under control in weeks. And instead, we’ve just gone the opposite way. We’ve let the outbreaks get out of control. But even as out of control as they are at the moment, if we start having half of a community use these rapid tests just every four days, so if you’re a participant and you’re saying, yes, I volunteer to test myself in the morning on Mondays and Fridays and you can get 50 percent of your community to want to do that and to be willing to do it, you can start to get an outbreak like Ebola outbreaks we’re seeing now under control in a month. And this is through herd effects. It’s the same way that vaccines cause herd immunity, this is how it herd effects, by stopping on our transmission early in the course of people’s infections. And so I think part of this should be a cornerstone, a true cornerstone of the administration’s decision, if a new administration, how they choose to tackle this virus.
Q: Yeah, quick follow up, I mean, you alluded to this, but in terms of the Trump administration approach, it so far really has put states in charge of COVID testing. And Biden’s approach is more of a federally led approach to the problem.
MICHAEL MINA: Absolutely. I think from everything I know, and I’ve talked to people on their team, I think that they are extremely engaged. And, you know, this is priority number one, in my opinion, for them to get this under control and use their platform as a federal government and as a White House to encourage states to give states the tools that they need. We can’t have every state doing this on their own. Again, viruses don’t care about state borders. This needs to be coordinated. And the only way to coordinate a whole country is to do it at the national level. And I do believe that Biden’s team, from everything I can tell, and this really isn’t a political statement, I just think that Biden’s team is actually interested in tackling this through there, through what will become sort of a federal oversight in terms of the national response. And so I think that they will work with the states and I can’t imagine that they’re not going to work with the states. But the biggest thing for many of these states is they don’t have the expertise and they don’t have the funds, that we can’t have every state trying to create their own manufacturing plant for these tests. That just will take a long time. So the federal government, I think, needs to produce these tests or work much more deeply with other companies to produce them at scale, make 20 millions of them every single day, which is not very expensive. Again, sounds like a lot, but it’s really not very expensive. And the government needs to pay for it. They need to allocate the funds and they need to make sure that no state is having to decide between their purse and keeping their communities safe. We have the money as a government. We’re losing much more money. And the return on investment, on developing testing infrastructure, especially around these rapid tests, is enormous. And so I think that the federal government has to lead and I think that Biden’s team is likely going to do that.
Q: Thanks, Michael.
MODERATOR: Next question.
Q: Hey, Michael, just to circle back to your rapid test concept, which I think is really interesting and surprising nobody is doing it. So you’re saying they will cost about a dollar per test and if they’re not PCR, what are they? And if you test positive, you’re saying there’s a second test that you would need to do. What does that mean? Like a culture of the virus or like explain all that, please. And like, how many would people get? Like, would just everybody get like five for the month and then maybe not use them? Like, what’s your proposal here? Give me the detail there, please.
MICHAEL MINA: Yeah. So essentially, we need to make enough tests so that at the very least, we can get half of communities, 50 percent of people within a community to have access to a test that they could use every four days. And so we would produce these tests. What I would like to see is that the manufacturing capacity gets built by the federal government, maybe in conjunction with companies that already exist or just go and build it. This is simple. This is not complex procedure. These are essentially like small strips of paper with monoclonal antibodies printed on them and chopped up into little pieces. So the federal government could build the capacity, the manufacturing plants probably for 500 million dollars for a plant that can produce millions of these tests every single day. So 500 million to half a billion dollars, it’s almost nothing in reality. And so what would then happen, is these tests would get freely distributed to states to get distributed to individuals who sign up to participate. We get messaging on board. We get the best marketing teams in the country to want to join in this fight against the virus, to let people know what these tests are all about, how to best use them. We don’t just have the CDC’s a marketing team do this. We have Coca Cola’s marketing team do this to get the information out to people. We work with Google and Verizon and AT&T and Facebook and whoever else to make it known what these tests are doing and how to use them. It’s like putting in contact lenses. There is a step, but it’s really not very difficult at all. We need to have confirmation of rapid antigen test. One in every few hundred can turn positive for false reasons. So that means we need confirmation tests right now. The only way that the CDC is dealing with this is to say get a PCR test, but we don’t need to do that. You can’t have a five-minute test. Have to be confirmed with a four-day PCR. That’s insane. We need to build, but we have much better, simpler solution. You pair these tests together. You have two different tests and they look the exact same, more or less, maybe one size confirmation test on it. And if you turn positive on the screening one, the initial one, you immediately turn around and you pull out one of the few that came with your package. That is a confirmatory test and it’s very unlikely to turn false positive for the same reason. So right there, you have the whole procedure right in people’s hands.
You get a household, say, 30 tests or 20 tests that will work for that household for a few months. And they’re able to keep those tests. And with every 20 or 30 tests that they get, they have an extra three confirmatory tests that look similar but have different molecules on them. And that would work. We get 50 percent of communities to buy in. So 20 million tests. If we could get that out to communities across the United States and people have to use them just every four or five days, then 20 million test covers 100 million people. And because you only need 50 percent of a community to buy into doing this in order to get herd effects, then that 100 million people are actually covering 200 million Americans with herd effects. So only 20 million tests produced every day immediately gets us up to about 200 million covered. And beyond that, we could even have people within households have a parent and a kid pool their test together so we can really advance the use of these. They’re pooling where you each take your swab and you put it into the same little tube and put that onto the test, or stick the test into that tube. And so now we have the entirety of the country covered with herd effects with just 20 million tests a day. We can do that. That is so far within our grasp as a country. And the cost on that, we’re talking less than 10 billion dollars a year for that kind of project. And if that means we can save literally 10 trillion dollars a year if we continue to hemorrhage money like we have, because of this virus, then that is an enormous return on investment. 10 billion is practically nothing. So far, the government has put almost no money into testing as a federal government. We can do this. This needs to be coordinated. It needs to be driven by science. We need the manufacturing there. But it is not out of reach. There is caveats. People will say, well, you know, this would go wrong or some people won’t use it. That’s OK. Even if some people choose not to use the test, the benefit is we’re banking on herd effects. So if all of your neighbors or half of your neighbors are using the test and you want to go to work even if you’re infected, you know, it’s not a good choice for you to do that. But over the next few weeks, those outbreaks will subside around you and then, you know, and these outbreaks can come to a halt. And in a month, if we are to actually if we were to actually put this program into place, that’s finished.
Q: Just a couple of real quick follow ups, if I may. So these tests for antigens, right?
MICHAEL MINA: That’s right. And one of the benefits there, unlike PCR, these tests actually only turn positive if somebody is infectious. So they won’t turn positive if somebody was infected two months ago and still has lingering RNA in their nose.
Q: Yeah. And so you said that PCR has like a 30 day span, but you might be only infectious for 5of those days. So PCR is wildly un-useful? That’s part of this, right? Well, forget that. But I mean, the 30 and 5, that’s what I wanted to focus on, right? It can pick up when you’re not infectious is the point.
MICHAEL MINA: That’s exactly right.
Q: Would companies be involved in this or is it the government?
MICHAEL MINA: We need a fairly comprehensive plan to move forward. I think the federal government, if it wants to, it can work with the companies to do it and it can help fund them to, say, build up their capacity.
Q: OK, and just really quick, because of the limited time. You use the concept of herd immunity in here, doubling the effect from 100 to 200 million, I don’t get that at all because herd immunity means you’ve been infected and therefore, you know, so on and so forth. So could you just explain a little bit more like what that means, the concept of herd immunity expanding from 100, 200 million things?
MICHAEL MINA: So that’s what I said was herd effects. And so I’ll explain really quickly herd immunity, the reason it works. You’ve probably heard that vaccines, you only need to vaccinate, say, 50 percent of the community for this virus to get the outbreaks to completely subside in the whole of the community. And that’s because of herd immunity. If on average, everyone infects, say, 1.5 additional people and you get 50 percent of people to no longer be infecting other people than the average of the whole community level brings that R value below one. So these rapid tests, if you had 50 percent of people using them, then, you know, if I get infected and I’m not using a test, maybe I go out and infect, two additional people. But if I am using a rapid test, maybe I don’t go out and I don’t affect anyone, but maybe my neighbor isn’t using the rapid test and they do go and infect two. Then on average, we have infected one person. And if you do that across the whole of the community, you get that number below one on average, and that’s the death knell of an outbreak. That’s what causes outbreaks to fall. So herd immunity is the most famous form of a herd effect, but we can actually drive herd effects without having the immune response be the reason we don’t create onward transmission. We can have knowledge and a test, be the reason we don’t create onward transmission. And that’s exactly what we did with HIV.
Q: So basically, you’re saying you shut down enough people to create herd effects as we say, you close them down by keeping them in quarantine. So this is a really simple idea and it seems like it could be effective. Why aren’t we doing this? Like, well, other than being anti Trump, that’s fine. You know, I’m not disagreeing with that. But any of the reasons why we’re not doing this?
MICHAEL MINA: I mean, you know, I created this plan. Our research really led to this whole plan and that’s been in a pre-print since May or June or something. And now it’s getting published soon. And at the time, it got an amazing amount of traction and a lot of people were engaged. It was in the front of The New York Times, The Atlantic, everything. And senators and governors were very, very interested. I think what happened was it does cost maybe 5 billion dollars or 10 billion dollars, maybe could cost 3 billion just to get started. But no state is really in a position to appropriate those funds from their own purse. And I know that there were people in Congress and senators who are very interested and trying to push it, but it never made it to the top of the priority list and. And I think it just kind of just never really went anywhere, despite hundreds of hours of conversations. And what I’m trying to do now is reinvigorate the idea because we don’t have vaccines. There’s not another option, as far as I’m concerned, that really could be as powerful as these. And so that’s why I’m really trying to say that right now. I mean, right now is really when we need to act on this. There’s no time like the present and we can do this. We have new funding lines are coming about like we can push on it now that this election is over or soon to be over. We need to do this right now. There’s no excuse as it as a country not to. We saw, you know, those fears that vaccines could lose a small mutation in the virus could render the vaccines useless. I don’t subscribe to that. I think that we need a lot more research before. But certainly, any number of things could go wrong with vaccines. This is a known quantity that we know how these tests work. There is not a lot of risk. There’s not a lot of uncertainty. This is a tool we could do right now if we just start building these now. I don’t know why nobody has really taken the charge in Congress that I do believe that it is reflective of a haphazard and strategic less response so far for this virus.
Q: OK, great. I’m done.
MICHAEL MINA: Thank you.
MODERATOR: And it looks like that’s our last question for today, do you have anything you’d like to say before we head out?
MICHAEL MINA: I don’t think so. I think that’s it for right now.
This concludes the November 6th press conference.