Coronavirus (COVID-19): Press Conference with Michael Mina, 11/18/20


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 Wednesday, November 18th.

Transcript

MODERATOR: Dr. Mina, do you have any words that you would like to share with us before we get going to answer the questions?

MICHAEL MINA: No, I mean we did this last minute just to discuss, I think a lot of people are probably wondering both about the rapid test and some other things, but I’ll see where the questions go and then I’ll probably chime in about the rapid tests if the first question doesn’t hit on it.

MODERATOR: I find that unlikely. All right, great. Thank you, Dr. Mina. First question.

Q: Hey, Michael, congratulations, I know you have been tirelessly promoting this and finally, I guess a half a year later, we finally see some progress. How much are these tests going to cost? And is this the best one, do you think? Or was there a better one that they might have EUA’d.

MICHAEL MINA: Yeah, so I would save the congratulations at this point. This is a very, very small step. This is not really the kind of test that we need. This is a symptom of continuing to treat this like a bunch of medical issues. And so we keep wanting this sort of medical precision. I don’t want to use the word precision. Well, I’ll just explain the test. The test is a very expensive test. It’s an extremely manufactured test. It’s a test that simply cannot scale. It’s like taking an expensive medical product you might see in a hospital and putting it into somebody’s home. Like this is a symptom of having a medical system that is continuing to treat this public health crisis like it’s a bunch of medical crises that can get insurance reimbursements. So what I want to see as a test like this, this sort of little thing that I’m holding here that can be made at 20 million a day instead. The FDA wants to put out a lot of fanfare about their first approval of an at home test, which, while a fine test, is really not much better than a laboratory-based test. In fact, it’s going to be extremely limited. It’s so manufactured that it would be expensive, won’t be able to roll off the assembly line fast, and I don’t think it will actually be available widely in anyway until spring. And they’re going to be using it at a few places, it still requires a doctor’s note, a doctor’s prescription. Why in the middle of November, does anyone need a doctor’s prescription to get a COVID test? You know, we truly cannot seem, in this country, to get out of our way and recognize this as a public health problem, we still have yet to do it. And it’s astounding me. So what I would say to be fair to the test that just got approval, I’m glad that it is a very, very, very baby step for the FDA to accept that maybe somebody can swab their nose in their home and put that swab onto a device that can read out a positive negative. But, you know. This isn’t much harder, this is easier, I would say, than that test. And this is a small little paper strip that is now being used across the world.

And we still have yet to bring them here because we just continue to not have any strategy in the country. We continue to have objections based on reasons that I’ve laid out over and over and over, that should not be objections. And we continue to say we don’t have enough data yet. We don’t have enough data yet. But these things, A, we’re in the middle of a war. We really can’t get any worse than we are at the moment in terms of the case counts in the way that this virus is spreading. So when people say, what if somebody slips by who is using the test and doesn’t get detected? Well, eight percent of people getting infected today are slipping by. And so in any case, I think it’s a fine test and sure, it will work well, I think that LAMP assays have a lot of promise, but this particular one is really very, very highly manufactured. It’s got electronics in it and you throw those away every time. It’s just like such an overproduced sort of American version of what we really need, which is just a really simple test.

MODERATOR: Do you have a follow up?

Q: Yeah, I’d like to hear why you think the FDA and policymakers have gone so far-off track other than, you know, Trump’s terrible, which is sort of a recurring meme almost everywhere. But also just really quickly, on the case count. So I talked to a T. Rowe fund manager in health care who thinks it’s 5x, the occult, the hidden, and you’re at 10x. But in any case, just to cut to the chase, because I know we want to talk about rapid testing, but if there’s 11 million cases, does that mean 55 million? And if there’s 175K a month, does that mean 5x that? Or 10x that? And I’m just trying to get at the herd immunity issue, which I think is really fascinating. Nobody’s talking about that. Thank you.

MICHAEL MINA: Yes, certainly cases are building at this rate, we will potentially eventually get to herd immunity if we really keep increasing exponentially, of course, but it won’t be the way we want to, unless, I think I’ve said this before, unless as a society, we are OK right now today saying that we’re OK with another two or three hundred thousand people dying. Then, OK, you know, and a lot more, millions more, longer term effects potentially, then sure, let’s go that way if that’s a societal decision we want to make.

Q: Again, obviously, I’m not saying that. But just again, I want to get off so other people can ask questions. But if 11 million cases are now known, how many actual people have had COVID in the US right now? Then I’ll stop. Thank you.

MICHAEL MINA: Well, yeah. I mean, my guess is it’s probably somewhere around 50 million or more. I think that I’ve been saying 10 million. And, you know, I was rethinking that this past week. I think it’s somewhere between 5x and 10x versus what we’re at. So, we do have a lot of people who have been exposed and infected at this point. The FDA in some ways, they’re just doing their job and their job is to evaluate medical devices. Now, the question is, is that the FDA’s decision or is it the federal government’s decision or somebody else to say that a test is going to go out to people’s homes, not for sick people, not for medical use, but for public health use? It’s very unclear who needs to evaluate that test to authorize it. I think that there’s no better place than the FDA, which is why I’ve been saying the FDA just needs to make a new pathway, but they don’t seem to be imaginative enough to make a new pathway. And then we have leadership in the country that they don’t realize their leaders. I mean, the number of people I’ve talked to who say, well, why isn’t this happening? And my only answer is, because you’re not doing it. Because you the leadership of the country, whether it’s governors or federal government, is simply not acting. And I don’t think we have a government and the leadership in this country at this point who recognize how to be leaders. I think that people are just following at this point and not knowing what to do. And we really need to change that. We need to get our leadership to understand the power that they’re in and to understand that they can take that bold step to move forward.

MODERATOR: All right, thank you, Dr. Mina. Next question.

Q: Hi, thanks. I’m following up on the same issue with rapid tests, I guess I would ask one, is there another country in the world right now that is using the kind of rapid tests that you’re calling for on a widespread basis? Or have we seen that this can be done, or would the US be doing this for the first time? And two, just to specifically get at the FDA issue, is it that they have this 80 percent sensitivity threshold? I mean, is that the problem? And that so far, the test you’re talking about have not been able to clear that? I mean, I understand your logic for why maybe that’s not necessary. But I mean, is that kind of the specific hold up here?

MICHAEL MINA: There is now evidence for it. I would have liked the US to be the first evidence for it. There’s no reason why the US couldn’t have been. We’re living history now, so we can’t just ask who is doing it, but Slovakia is doing it. Slovakia is doing it on a massive scale. They’re trying to test around half of their population once a week, which is exactly what essentially, we have been calling for. And within a week, truly within a week, they stopped their virus from exponentially growing on a country level to dropping incidents by half. Two weeks later, it dropped more. They’re doing the third sort of infusion, if you will, of this test, the third mass testing period that’s coming this week. And so I think it’s the best proof that we have at the moment anyway, that this can work. I mean, this is just like so many other things, though. We know how it would work. There’s a reason we do the work that we do as researchers to build models that can accurately predict this. And right now, what’s happening in Slovakia fits exactly what we’ve seen, what we what we expected from a publication that we put out in June as a pre-print, which will be coming out in two days now, I’m sure many of you will get the press briefing, it’s under embargo now. And the other thing is that we’ve seen this work over and over and over again right here in the United States in the places that are the most fertile ground for transmission, which are college campuses, I’d say. College campuses, people are very close to each other. They do all this, whatever they do. But the point is, what the media is not reporting on a constant basis is how many outbreaks are being averted right now on America’s campuses. It’s so lovely for outbreaks to be discussed in the media.

You put it on the front page of newspapers when there’s a big outbreak at an institution or at the White House but fail every day to say how many outbreaks are being averted, whether it’s by the White House frequent testing program or by every academic institution in New England that continues to have small numbers of cases and stamps them out before any of them become outbreaks. So we have so much evidence for this at this point. You know, we just have to look for it. We have to say, well, what are we not noticing, because it’s not interesting? And that’s the hard part about public health. If public health works, it is completely boring. That’s like vaccines. And now that’s like these frequent testing programs. If you stop events from happening, it’s boring. And so there’s a lot of evidence for it.

Q: And is the issue the kind of 80 percent threshold that the FDA has? I mean, is that the main holdup or it’s really unclear what exactly the main holdup is now?

MICHAEL MINA: I think the Abbott BinaxNOW paved the pathway to show where we can get around that 80 percent threshold by just recruiting people who are in the peak of their infection or who are currently infectious, I shouldn’t even say the peak. So what Abbott did was they said, OK, we’ll look at the sensitivity of these tests just within the first seven days of symptom onset, which is the window of infectivity as well. So it made sense because, again, I’ve said a million times, these tests will only detect you if you’re infectious and not if you just have residual RNA like a crime scene. And so really what’s holding it up? One of the major things that the FDA can’t do is because they’re looking at this as a medical device and a medical problem, they make this distinction between symptomatic and asymptomatic use. But it’s really hard to do the trials needed for the companies to find an asymptomatic person who is in the midst of transmitting because you don’t have any basis to find them. And so almost all of the asymptomatic people we do find through our screening programs, PCR programs, things like that, are post transmissible. So then you have The New York Times report that these tests only have a 30 percent sensitivity and asymptomatic, but that was completely false. It’s because the denominator was a bunch of people, 70 percent of the people were post infectious, they only had RNA that the PCR could pick up. The point is, it’s very difficult for these companies making these tests to find asymptomatic people to recruit into their study, to get approval for asymptomatic use who are shedding virus at the time. It’s really hard to find those people. Ideally, they’re in their home. If they know that they’re infected, they’re in their home, but they probably don’t know they’re infected at all. And that’s the whole problem, is that they’re really hard people to find. And so that’s why I mean, if the FDA could take a step back and say, look, we’re not dealing with a medical problem, we’re dealing with a public health problem, they’d be able to look at these tests and they’d say the tests work exactly the same, regardless of whether you’re symptomatic or asymptomatic.

But this distinction they keep driving at is what’s preventing these tests from gaining traction and actually getting through the approval process because they say, sorry, you know, you don’t have an asymptomatic claim. And for example, the first Access Bio just got a test. BinaxNOW and Access Bio which are the two-instrument free paper strip tests that are available. The Access Bio test was approved with a nasal pharyngeal swab only for clinical medical use, just like the BinaxNOW. We have to stop how we’re authorizing this, right now, it’s just not working.

MODERATOR: OK, great. Thank you, Dr. Mina. Next question.

Q: Thanks very much, Dr. Mina, I wonder if you could say anything about your interaction with Elon Musk over Twitter this last week where he seemed to be calling for amplification counts, sort of being factored into treatment. Could you just elaborate, like, on you stepping in there and what do you think of that idea? Thank you.

MICHAEL MINA: Yeah, so just so you all know, I just had an op-ed in Time magazine where I kind of lay out the pros and cons and how this whole plan can work in Time. And the link is right there in the chat. So the conversation with Elon Musk, I think he got off on the wrong foot in terms of not understanding how to most appropriately use his antigen test. But, you know, he’s a very smart guy. I admire him a lot. Say what you will about his personality, I think is one of the most brilliant people in the world. And so I would love to continue conversing with him about this because it’s important stuff. And he’s in a position to really help shape policy, if he wanted. The question he brought up was, should hospitals and others and these labs, release CT values? That’s something I’ve been calling for, at least in the clinical domain, to use CT values to understand where patients are in terms of the course of their infection. And we should definitely be trying to use CT values to understand during surveillance because people are positive on a PCR for so much longer than they are infectious now, two, three, four, five times longer than they are infectious. We should be interpreting the PCR values if that’s what we’re using. If somebody has a very high PCR value, meaning a very low viral load, then we should ask them to get tested a second time, the next day. And if they remain at a very, very low viral load, a very high CT value, then ninety-nine percent of the time they’re beyond their period of transmissibility. So do they really need to be isolated and do we really need to be contact tracing the people who they were with yesterday? And this is where we’ve just completely failed. All of our public health programs have failed those we’re seeing. And this is one of the biggest failures. We have not been discerning at all in terms of how we use the tests that we do have. 

Q: Thank you very much.

MODERATOR: Next question.

Q: Hi, thanks for holding this, I found your comments on this new test clearance very helpful. I was hoping just to expand on a question asked earlier, what needs to happen to have a test like this that can be performed at home, available without a prescription, which I know a lot of folks have talked about having something like a pregnancy test. Could you talk a little bit about that and what kind of timeline you’re expecting here? I know it’s been quite a frustration for you.

MICHAEL MINA: Well, what needs to happen is somebody in the government needs to realize that enough is enough. I mean, we know how well these tests work. We know how they can work. I mean, I wrote the whole plan there. I’ve been talking about it for many months. Lots and lots of experts and people in positions of power are aware of it. We’re past the point of trying to do a statistical test and run another academic test to see if these tests can detect the virus, we know they can. We have to get these tests out of this medical regimen. We need the federal government, the administration. We need Congress, we need senators, we need state governors, if the federal government is not going to act, to just act, to act in the best interests of Americans. These tests could have allowed Thanksgiving to happen normally, had we started this in August. These tests can still, if we act appropriately starting today as a US government, could still get us to have a much better Christmas. But we have to start today, we can’t just keep asking when and hope that some company like Abbott or some small startup, why are we talking about a startup company creating a new test? Why are we even talking about it? This is the worst national catastrophe that has happened on our soil in decades. It is destroying lives, it’s destroying retirements, it’s destroying the economy. It’s closing down business after business after business. It’s stopping us from going to Thanksgiving. It’s stopping us from going to Christmas. It’s pausing our society. And yet we’re sitting here actually having a discussion, clapping about a very small startup company getting a new product on the market that will be available in April. Like I mean, just really why is it not on the front page of every single newspaper in America every day demanding action so that all of us can just go home for Thanksgiving? I feel like I’m one of the only people trying to actually act now instead of sitting on my ass and saying, I hope the vaccine comes out eventually. And I just can’t understand it, you know, and so there are so many things that I can discuss about what needs to happen, but it’s very simple. At the end of the day, what needs to happen, we just need to act like we actually are in a war and that we are actually having something bad happen to America. Remember, in April and May, when we are closing down, I said I don’t really think that people get it because nothing bad ever happens on our soil as a country. And it was it was in April, I think, I was talking to Helen Branswell. And I said, you know, this is going to be a catastrophe because humans because Americans don’t know how to deal with even recognizing that something bad is happening to us. We have just such cognitive dissidence as a country. And now it turns out our leaders do.

And so I could go into detail about what needs to happen, but what but really at the core of it is we need to have leadership at the state and federal level that are just willing to think about this as a war and put their resources in that it demands today. We have tools, these are our weapons right now that can be available. I know that everyone is aware of them already. And we just need to stop squabbling over ridiculous things and start acting. This is why we shouldn’t put academics, by the way, in charge of making decisions. This is a public health war, not a people war. We really need the military to be making these decisions. People who are decisive, who can say we have enough information, we need to act, because if we don’t act, we have many more people dying every day. But we haven’t done it yet, you know, and so every day, every week I’ve gotten up here and talked about this, it does nothing.

MODERATOR: Do you have a follow up?

Q: I did want to just quickly follow up and ask I know you’ve been following the Elon Musk back and forth about his test results for a couple of days now. What do you make of his situation and how generalizable is something like that? I’m just hoping you could clarify. He’s talked a little bit about, you know, do you think he basically kind of took a test early on and an infection? What’s your sense of what happened with him?

MICHAEL MINA: This is you know, I don’t even want to speculate exactly what happened, because I don’t know if he was at the beginning of this infection at the end, but he probably wasn’t in a position with a very high viral load. He may have been at the very beginning, and we know that these tests can waffle in and out, when you don’t have a lot of virus that’s the same as any test that’s ever been built in the world. If you’re out the limit of detection of the pathogen, then it goes in and out. So we just don’t know. But what he needed to do was not use the same test four times but use one test and then you confirm with another test, this is why we call them orthogonal testing. And it’s also why we need frequent testing. I don’t really care that Elon Musk got four results at one time. That’s not helping public health right now. What we need is frequent testing so that if he was negative on day one, when he maybe should have been positive, that he would have found himself the next day or two days later as positive when he was really positive and he would have been able to know that he was positive then. So this is why we can’t make inference based on single time points. That’s how we’ve been dealing with this whole thing. We keep trying to tell somebody, oh, you got your PCR test last week, you’re good now. No, this isn’t a PCR or an antigen test issue. This is why frequency of testing is the only thing that really can help people know if they’re positive when they’re infectious. This virus grows too quickly at the beginning to have to be able to figure that out unless you’re doing frequent testing. And these paper strip tests, again, as far as I’m concerned, are one of the only tools at the national level that we could use to get frequent testing possible. So I’ll just say that I don’t know enough about his clinical scenario to be able to say more.

Q: Thank you.

MODERATOR: Dr. Mina, it is 12:29. Do you have time for one more question?

MICHAEL MINA: I cancelled my 12:30, so it’s OK.

MODERATOR: OK, next question.

Q: Hey Michael, can you hear me?

MICHAEL MINA: Yeah.

Q: Thanks for hosting this call. It’s really helpful. I wanted to ask you about your comment that the military should be making decisions here. Admiral Giroir, the testing chief within HHS, he has a military background. I know that at one point you were in conversation with him. I was hoping you could kind of shed some light on how those conversations have gone, whether HHS has been receptive to your advice and your ideas here, and also whether you’ve been in touch with anyone either on the Biden COVID advisory team or anyone in the in the next administration team?

MICHAEL MINA: I don’t want to comment on any of the specifics. I would say that I think that you’re right, I mean, Admiral Giroir comes from a military background. I think, my expectation and assumption are that there are a lot of people in the current Trump administration who would want to be doing more and be acting in a way that’s very, very distinct from what from what President Trump is asking for and frankly, demanding. And so I don’t know why we haven’t seen more action by some people who probably in their prior careers as military people who had to act decisively to save Americans and to keep America safe. I can’t speak much towards how exactly the decisions are being made today, but my guess is I can’t imagine that many people who have had whole careers helping America are particularly happy to have a celebrity TV show host telling them what to do and allowing millions of Americans to get sick and hundreds of thousands to die. I can’t imagine it feels good, I suppose.

Q: And if I can follow up here, I know we’re running up to the deadline here, but you mentioned startups and kind of what the role of startups is here. I was looking, I guess it was about a month ago now that HHS announced almost, I think, a 400-million-dollar reward to QHealth. I don’t know if you’ve looked at their products, but I know they have aspirations to roll it out for at home use. Are there any specific products or any companies in particular that you’re excited about in terms of actualizing this?

MICHAEL MINA: Yeah, again, I think that we need the paper strips that come from Abbott, I think and SD Biosensor in Korea, Access bio potentially though I just got a package of them here, I haven’t looked at them yet. I mean, these are the ones that I want to see first. And then I’m very happy to see some of these other LAMP-based molecular approaches potentially serve as a different role, whether it’s confirming these, so maybe every household has 20 of these and a Q? Or maybe every corner store, something in America has a system that you can go and get tested with or every Walgreens and CVS, if you turn positive on one of these and you don’t want to confirm at home with a different one, then you can go get a molecular test. But really, I think one of the best places for those molecular tests, like Q, honestly, I’m not quite sure about this new one. It wasn’t even on my radar until last night. So I don’t have much information on the metrics.

I think that these tests are going to be really have a nice place, for example, with what I call entrance screening. This is a different type of screening than what I normally talk about. But this is to make sure that somebody entering into a location or a school or whatever it might be, is as safe as possible. Nothing’s perfect but is as safe as possible. And these sorts of molecular tests might be a good role, might play a good role in sort of getting people into nursing homes more safely. But that said, I mean, even these if you’re doing them every day, you could do these twice a day for people going in and out of nursing homes. And so I think that they’re not in odds with each other. They can really play off of each other well, and I would say that there’s three companies that I know of that I know about the metrics of; Q, Homodeus, and Pine Tree are all doing really good work.

Q: Thanks, Michael.

MODERATOR: Next question.

Q: Hi Dr. Mina, thank you for doing this. So as far as understood, all these rapid antigen tests need q tip swabs to get samples. So are there any saliva based antigen tests that work well and are available?

MICHAEL MINA: I mean, a lot of people wanted to use this like they got on the bandwagon of thinking that saliva is really the better approach. But taking a q tip in the front of your nose is really pretty simple and completely pain free. So I actually prefer those as public health tools I think they’re really, really easy, quick. But there will be potentially, I know Sona Nanotech in Canada is working on building a saliva-based version of one of their rapid antigen tests. You know, I don’t know what role they would necessarily have. I do think saliva is good. It’s a little bit harder to work with sometimes, especially for doing it at home. But that’s at least one company that I know of that’s trying to go that route.

Q: And second, quick question, you’ve been a vocal proponent of rapid tests, and many have wondered whether you have any conflict of interest, although I’m sure you have been asked this already. But would you please clarify whether you have any conflict of interest?

MICHAEL MINA: I have no conflict of interest in any of these companies, no investments. I just do science and try to help people.

Q: Thank you.

MODERATOR: Next question.

Q: Can you hear me?

MICHAEL MINA: Yes.

Q: I‘m sorry, I just didn’t perhaps understand totally what you said about the BinaxNOW test. The State Department of Public Health here, just as you were starting your event here today, announced that they’re going to start being used in schools and that they had done a test comparing them to PCR tests involving six hundred people at the Broad and Lawrence General. I’m still not understanding, you don’t think these are as good as rapid home tests? These are antigen rapid tests. I’m still trying to understand why you don’t think is are good and, you know, the fact that the state is now going to be using them for schools.

MICHAEL MINA: No, the Abbott, BinaxNOW is what I am referring to, same thing.

Q: OK, so you actually like these tests and think that’s a good move, one of these tests to be using?

MICHAEL MINA: Oh, absolutely. Yes. Underlying, what I don’t like about the BinaxNOW is that it is a little bit more manufactured. Abbott has essentially the exact same test. But one of these it just goes inside this. This is cheaper and easier to make. It could be scaled more widely and it’s a little bit more intuitive to use it. But they’re not selling this version of the test in the in the US, they’re only selling the BinaxNOW version, which if you’ve seen it, it looks like a little cardboard booklet. Both are very, very easy. So I think both I would be very happy if they’re used much more widely in this kind of screening that I’ve been referring to, whether it’s at school or at home, you know, there’s a role for both of those. And you get the same effect. The BinaxNOW though, I think it’s going to be more limited in terms of its production capacity versus this. And so I would like to see that they have their other version is called the Abbott Panbio instead of BinaxNOW. And the Panbio is working just as well as the BinaxNOW. But again, the BinaxNOW is designed specifically to be a medical device. And so it’s a little bit more complicated to use and things like that, whereas this is the same test, but this functions as a true public health test. So that’s the only difference. But to your question, no, the BinaxNOW is exactly the kind of test that I’m referring to. I would say I think that, you know, I’m really glad to see that Governor Baker is starting to lead the way in using these types of tests routinely in schools.

I think it’s a terrific decision. So finally, we have an n-of-1 leadership in the country who is really trying to push it forward. And I shouldn’t say n-of-1. I’ve talked to Mayor Garcetti of L.A., he has really been trying to push and think through how to do this. So there are some leaders in this country, and I’m very grateful and happy. And I think Americans should be grateful, really, that we are starting to see some people recognize the benefits that we’ve known for months. That’s why I’m so frustrated. We’ve known these same benefits exist for many months, but now we’re really starting to see some action, I suppose.

MODERATOR: Next question.

Q: Hi Doctor, nice to see you again. As you’ve probably seen, there are long lines for testing sites in Massachusetts and some of those lines are telling us that they are getting tested because they’re trying to clear themselves to go home and feel safe seeing family at Thanksgiving. You’ve kind of alluded to the erroneousness of this belief. And I do wonder, what would someone have to do to appropriately clear themselves to go visit family and at this point for Thanksgiving, is it too late to do that?

MICHAEL MINA: I don’t advocate for using these devices as clearance, per say. I think that they can be to decrease odds. So if you’re going to go home either way, which many, many, many people are, then having access to one of these tests is one of the best things you can do to make sure that you’re as safe as possible to do that. But getting a test on November 18th for Thanksgiving a week later is nonsense. I mean, even if you’re positive right now on a PCR test, I’m not making a recommendation here, but it would almost be the opposite. Let’s go back a little bit more time. If it was November 15th and I knew that I was positive on November 15th, I would actually use that as a positive confirmation that I’m actually particularly safe to go home for Thanksgiving because I’m very, very unlikely to be transmitting the virus. So we’re doing the testing too early. And the reason people are doing it really is because access isn’t there. So what I would like to see is these tests. But the benefit of these tests, again, is not to just say this is the most important piece of all of this, but I think people have really had a hard time getting this is not to make each individual event safe. If we use these with the right strategy at the national level or at the state level, we drop the prevalence of the virus that the entire community level. That is the best thing we can do to get people to be safe, to go see their family or go out to dinner is not to have a roaring epidemic going on and just take a test like this to gain entrance and the best thing is to get rid of the epidemic. That is the best thing.

And that’s what these tests can do. That’s why epidemiology and not medicine are so important here. If we don’t start thinking like public health epidemiologists to tackle this and we continue to treat it as individual events, we’re going to keep clawing one by one at an outbreak that’s going up exponentially. We need to focus on the outbreak, and we need to really focus on this as a true public health issue. And only once we tackle that and we use the right tools to tackle the outbreak, then all the individual cases begin to resolve. This is a public health event and not an individual health event that we’re dealing with. But we’re not there yet. So I’m going to answer your question. And the answer is getting a PCR test today does not make you any safer by Thanksgiving. It just doesn’t make you any safer. In fact, the only way it will change things is if it’s positive. Maybe it suggests that you might be safe on Thanksgiving if people had access to these. I would say one of the safest ways to use these or one of the most effective ways to use these, I would rather use one of these is the day of Thanksgiving, then get a PCR test the Tuesday before Thanksgiving, I’ll put it that way. It can be much more powerful to give you real time information when you need it.

MODERATOR: Next question.

Q: Hi again, I’m asking a question from a European perspective, I guess what you said about the US applies to a certain extent to Europe, and I was very interested in hearing that. So I can use this at-home test. I never heard of it. I also look for information on the website, but I couldn’t find any information. And I looked in Slovakia, and I want to know what kind of testing they use, which is the company?

MICHAEL MINA: I actually am not positive of the company they’re using, to be honest, I should figure that out. I’m trying to see if I can drop an image into the chat here. I guess I can. So I wanted to show you all a picture of what’s happening in Slovakia. I’ll try to find it’s on one of my tweets that I sent out last night. So I’m not positive what test they’re actually using to be honest.

Q: OK, but they allow people to do home testing?

MICHAEL MINA: So Slovakia is not doing home testing. They’re being a little bit more top down. I don’t think their version would work in America. They’re having people come to a site to get tested and they’re giving some incentive. To me, I think what would really work in the US is not to have a top-down sort of public health approach, it might work in Boston and L.A. and some places. But what we really need in the US, I think, is to make this immensely, immensely sort of accessible and easy to use and get it into people’s homes immediately. I think that that’s the best way that we can do it in the US, because a lot of people, they don’t want to go out of the way. We have long lines to do anything. And people don’t want the government in their business a lot of ways. And so if we can do this without that, that’s better. What I would like to see, really, I would like to see the US government either produce the tests on their own. They could start doing that tomorrow or really work with companies in the US and abroad to just produce 20 million of these a day, package them up into groups of 20 into little bags and ship one to every single or every other home in America would just get a little bag of these tests. That’s it. And they come with instructions. It’s very clear. They come with voluntary reporting. This can be done around the world, too, not just in the US. And so that’s, I think, a really good approach that we should be taking across the globe.

Q: OK, so if you get European governments to go the same way, I mean, as you see, Europe is facing a second wave, which is almost as crucial as the first wave. There is a lockdown again, Italy is having more deaths. So do you think that the European countries have used this kind of test they could have their contract tracing and avoid what is going on?

MICHAEL MINA: Yeah, I mean, one of the really nice things about this type of test, I think Nicole is about to put the link to my tweet about Slovakia in the chat here. The really nice thing about this plan where we have ready access to very frequent testing is we can actually get rid of contact tracing. In large part, we don’t even need it. This has been something that we have just assumed we need. But if everyone’s already testing themselves every three days anyway, then you’re going to get people tested even before they get a phone call from a contact tracer to go get tested. So this actually deals with so much of the overarching structure that we would need to have to tackle this virus in a traditional public health way, that we would normally tackle a virus like this. And to be very frank, we’ve never actually shown that contact tracing without really without very, very strong buy in to social distance and mask. We’ve never shown that contact tracing for a virus like this can actually be that useful. In fact, all of the evidence so far points to the fact that it’s not working. And I’ll give you one example, which is that Massachusetts probably has the best contact tracing in the country, has some of the best testing in the country, and has the best approach to where the citizens are actually following public health directives. If contact tracing and the tools that we had worked, it would have worked in Massachusetts more than any other place in the country. And we got cases, we said that we needed to get cases very, very low to make contact tracing work, we did that. But you know what? We still have exponential growth and massive numbers of cases now. So that’s why I just feel so strongly that we have to stop, across the world, we have to be realistic and reevaluate, learn from our mistakes or learn from what we know, which what we know is that in many countries of the world, the tools of the past aren’t working for an epidemic that spreads through the respiratory system. It is fast moving. It has a generation time of somewhere about five to six days, and everyone is more or less susceptible. We never really ask the question, does contact tracing actually work in this situation versus Ebola or TB and things like that.

Q: Your research, is it going to provide evidence that the home test can pick up your infection rates and contagion?

MICHAEL MINA: Well, it’s modeling work that we put together many months ago to form the foundation of a lot of what this plan calls for. And we’ve seen that now, we’re seeing in Slovakia, we’re seeing on lots of college campuses. Hopefully we’ll see in Massachusetts, although assuming doing the students may not, we’ll have to see what role it plays. But it was theoretical work that showed that this plan can work. There’s a preprint of it now, you can take a look at it. It’s called Test sensitivity is secondary to frequency and turnaround time. Nicole can probably put the link in.

Q: OK, thanks so much.

MODERATOR: Next question.

Q: Hi, Dr. Mina. Thank you again for doing this. I wanted to ask, so in Ohio and I think some other states are taking this line as well, Governors are applying curfews, except what’s unique about Ohio is it doesn’t apply to businesses. It applies to citizens. There’s a 10:00 p.m. to 5:00 a.m. curfew. The governor said it really won’t be enforced. I just wonder what you think about the strategy and whether it’s effective. I mean, it seems more like a messaging attempt than an actual curfew, although it is there.

MICHAEL MINA:  Yeah, I mean, I’m not convinced that curfews are doing much. It’s really based on this idea that people go out and drink and that’s when they spread the virus most, but, you know, I think that does happen. But people also go out to dinner and take off their mask and can spread the virus a lot. So you know what? Maybe it would be more important to limit the number of people that can go into a bar and not worry about the curfew, for example. But the idea is that if people are getting drunk, then they’re going to be acting disproportionately out of line with public health. And so, you know, if society is OK with it, I think it will probably help a little bit. But I don’t think that it’s a real game changer anywhere.

Q: Yes, I also wanted to ask if you have any thoughts on this. It seems like there’s a practice of just kind of using some of these unenforced orders more as messaging tactics than actual policy changes. And if that works or if that just contributes to the fatigue and burnout, that has been pretty well established.

MICHAEL MINA: Yes, the latter is what I think if we’re going to have messaging, we should have messaging around things that actually are really effective. And that’s where I think we keep messaging and keep doing things that aren’t effective, as we can see, and I get very frustrated with other people who are calling for things like, you know, just keep demanding the same thing over and over and over. At some point you have to say, OK, you know, we’re seeing that it’s not working. We’re not doing a root cause analysis to understand what’s really going on. But we just keep pushing the same thing over and over. And I just think it becomes numbing to people. And if we’re going to create policy and message, I think we should create policy and message things that work that people can actually do that aren’t going to put them completely out, having to go sit in a line for two hours or have to stay home for 14 days just because somebody they walk by in the street was infected. And we have to think about things, meeting people where they’re at. And that’s what the Time magazine piece that I wrote really goes into detail about that. We have to meet people where they’re at and start rethinking all of how we’re dealing with this, including the messaging. 

Q: OK, thank you.

MICHAEL MINA: Before we move on, I mean, I’m visibly very, very frustrated, but I want to thank everyone, all of you, like you’re obviously here trying to give good information. So I was saying about the media before, but, you know, I’m just frustrated about our country’s response. So I want to thank all of you for actually being here practically every week, a lot of you.

MODERATOR: OK, great.

Q: Hey, you mentioned at the state level, and I’m curious, I deal a lot with state government and when I bring this up to them, they kind of make it sound like their hands are tied by federal rules. What can they do and what should I be asking them about how to effectively get these tests out there and use them at the state or local level? If the federal level is kind of, from what you’re saying, kind of inhibiting it from the FDA?

MICHAEL MINA: Call a state of emergency, use these tests, these are not medical tests. I mean, this test that I’m holding here, you know, if it only gets FDA approval or authorization for being used in a doctor’s office, you know, a state can buy those and say, you know, we’re going to use it off label as surveillance, as screening tools. This is not a medical problem. And so this governor can call state of emergency and make these rules. At some point you have to just buck the system if the system is literally causing your constituents to die. And that’s what it is. And I don’t think the governors realize that or that maybe they do. But it’s not exactly leadership to me. If they say, well, you know, we realize Trump’s not great. We realize that our government is not acting, but our hands are tied. So we’re going to let our people continue to die. That’s what’s happening right now, but nobody’s going to sue this state if they start distributing these to their residents and message them appropriately, I promise nobody is going to sue a state for it. So we just have to start acting. Don’t call them a medical device. Buck the system, say this is not a medical device. Therefore, it’s not even clear a bill by FDA just change the language around it. There are so many ways to get around the system right now if it’s truly the FDA and the system that’s stopping it. But then the other thing that the states need to do, if they want to do this, they need to build the test. They need to work with companies that can build them. No, I don’t know why a state governor has not put five hundred million dollars into it, into building or not even. It wouldn’t be close to five hundred million to really build up a factory. That’s enough to just provide a test for that state. You could do it on practically a shoestring budget compared to what this is costing states. And so work with a smaller company if you want, and say, hey, we need two hundred thousand tests every single day for a state like Massachusetts, can you do that? And lots of companies can make two to five hundred thousand tests every day for a state like Mass. And so we could be doing this across the United States without the federal government.

Q: So then the simple answer is, this is absolutely available at the state level. States can absolutely do this if they wanted to?

MICHAEL MINA: If they wanted to. Exactly.

MODERATOR: Dr. Mina, that is our last question for today. Do you have any other thoughts you’d like to share with us before we go?

MICHAEL MINA: I think at this point, I just want to encourage anyone who has a voice that people are listening to, I really think that we are seeing a failure of leadership because leaders just aren’t realizing that they are actually in a place of power, and the more we can encourage them to recognize that they have tools at their disposal, that they have avenues. I’ll talk to any of them. I’ve talked to a lot of them, but it doesn’t really get the point across, I guess. But I’ll continue speaking with them about this to let them know what tools they have, what tools they can get and how they can bring this type of thing about so that a state like Massachusetts or a state like Ohio or any other state in this country can drop their incidents and stop having people die. The power is within them to decide to act without the federal government. And I don’t think the federal government’s going to be acting before the end of January. So we should probably have been trying this months ago. But there’s no time like the present to get them on board.

This concludes the November 18th press conference.