Coronavirus (COVID-19): Press Conference with Micheal Mina, 01/29/21

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, January 29th.


MODERATOR: Dr. Mina, do you have any opening remarks for us?

MICHAEL MINA: I don’t have any opening remarks right now, but I’m happy to take questions.

MODERATOR: Excellent. First question.

Q: Yeah, I have a question about the results from the J&J vaccine, which you probably saw, and wondered whether you can make a comparison between them and the RNA vaccines based on the results of the single dose regime that was tested in those nucleic acid vaccines, which I think I saw were something like fifty-eight and sixty- four percent effective, I could be wrong, after the first dose. And the point of my question obviously is since J&J is planning to test a second dose regime, I was trying to triangulate how effective this new vaccine really is.

MICHAEL MINA: So the reports have been unfortunately incorrect about the single dose of the mRNA vaccines, including their own publications, it’s not completely straightforward, but if you’re going to evaluate the effectiveness of a vaccine, you really have to evaluate it after you give the vaccine a chance to work. And so the single dose, because the spacing was so short, just to kind of accelerate the trials, which unfortunately is why we have these short spacing’s now potentially could have been longer, but the trials needed to get going and needed to finish quickly. So the spacing was made to only be three to four weeks rather than three months. Otherwise, we’d still be waiting for the results. In any case, what that meant was half of that time, almost a third to a half of the time before the second dose was provided, was spent in this sort of training phase of the immune system where it’s just getting a chance to take to the vaccine. But the moment you actually see the immune system kick in and say, OK, now the vaccine is working and I’m recognizing it, we immediately saw a massive plateau in terms of cases. So if you censor the data and get rid of that first 12 days while the immune system is really trying to recognize the vaccine in the first place, both of the mRNA vaccines actually rose to about 90 and 92 percent efficacy before dose two. And so there are a lot of unknowns along with it. How long would that persist? But actually, those two of the mRNA vaccines worked exceedingly well just with a single dose, whether that would persist out for a month more, six months more, we just don’t know because the people were given the second dose. I wrote an article in The New York Times a few weeks ago or a month ago or so now, suggesting that we start trials of single dose for the mRNA vaccines immediately because they were so successful at rising to such a high efficacy by the time the second dose was given. Going back to the J&J news, I would say that, you know, it’s concerning. J&J was trialed, the efficacy wasn’t as great as the mRNA, but it’s still decent efficacy for any given vaccine. If we go back in time, we remember that we weren’t really even knowing if any of these vaccines would reach 50 percent. The most concerning bit, though, about the J&J vaccine trial, and this is not specific to J&J, it’s just that when the vaccine was trialed for J&J, these new variants were out, whereas they weren’t out before. So all of the vaccines are probably susceptible, are probably going to lose some efficacy as a result of the new strains. As the strains evolve, they might lose more and more and more efficacy. These strains are showing that they have a very good predilection for evading our immune systems. And so the takeaway from the J&J news is really just how there is a pretty serious impact of the new strains. And I think that’s foreshadowing for all of these other vaccines as well, because they all essentially create the same spike protein. They all are introducing the human body to the same molecule. So if it’s losing efficacy against one, it’s probably lose efficacy against all of them.

MODERATOR: Next question.

Q: Thank you so much. Looking at the amount of vaccine that we’ve received in this state and there’s been consistently a pretty significant discrepancy between what the CDC has said has been sent to Massachusetts and what the state has reported. The state is reporting significantly less. Any sense of is that a source of concern or a question that you might have about just how much is being sent out and whether or not maybe there’s some unaccounted for?

MICHAEL MINA: I will be honest that I haven’t been following the states vaccine distribution and numbers sort of on any sort of daily basis recently, so I can’t speak directly to the state. But certainly, the new administration is just getting in place now. And I think that there were some serious discrepancies in terms of even just what was being said coming from the CDC versus what people were actually identifying as the reality. My hope is that we will start to see an equilibrium or a collaboration between the two, so they become similar numbers. Now that we have new people and a whole new government in there and leadership at the CDC. In the case of asking how many doses have actually been received within the state, I would suggest that the state’s numbers are probably the accurate ones. And the accounting for the vaccines are probably two different databases and logistical chains in terms of where they are, how they’re allocated on paper at the federal level versus what’s actually arriving. And so my hope is that over the coming weeks, we will see these two equilibrate a little bit more.

MODERATOR: Next question.

Q: Hi. I’m wondering if it’s necessary for vaccine makers to adjust their vaccines like Moderna is working on to work with these new variants. How will that change or complicate the rollout process in the United States? Will people potentially need to get a second vaccine? What might that look like?

MICHAEL MINA: This is an extremely challenging question, and it’s going to be a very formidable challenge ahead of us to do that well. A vaccine is something that you get once in and move and it works forward, so if you need to change the vaccine, you have to go back and re-vaccinate. You can’t just kind of change it on the fly. And so as we have this sort of priority list of people who need a vaccine, the question becomes, if we have to change the vaccine midway through getting through that priority list, what do we do? Do we start giving people who have already received two vaccines, a third and fourth vaccine, because their higher priority with the new version? Or do we keep going down the list and start giving the low priority, low risk people the more appropriate vaccine for today? Now, it’s a major challenge, I would say, for vaccine distribution to understand how to determine what is the best way to use any new vaccines that come about. We will also have to ask the question, what kind of due diligence has to be made as we start to adjust the vaccines to match new strains? Are we going to need to do any sort of trials? Is it going to be accelerated through without trials at all? Will there be immunological trials instead of full phase three type of efficacy trials? I think there’s going to be a lot of questions and it’s going to be a real challenge to do it well and equitable. We’re already seeing massive difficulties in getting equitability in the distribution of vaccine rollouts. I’ve certainly been fairly vocal about it in terms of who’s getting vaccinated in our state today and things like that. And so this is adding just one more level of complexity, and if we do end up with sort of one company making two distinct vaccines, it’s going to really lead to a lot of questions about how best to use those.

MODERATOR: Do you have a follow up?

Q: Yeah, so I’m wondering, do you feel confident that the vaccine makers will be able to make an effective vaccine for any imaginable mutation of this virus, or is there a possibility that that might not happen?

MICHAEL MINA: No, I don’t feel confident in that. The problem with the novel virus is it’s got so much room to grow and expand and shift and change to optimize itself. And we’re seeing, you know, we made all of our vaccines around versions of this virus, meaning we took the sequence that we first got from the virus back in January, February, and that’s what ended up in the vaccines. But just like software virus is just code, it really is just code. And at its core, it’s just RNA. And just like software evolves from version zero to version one and two and three and four, and we get updates, this virus is just updating itself. And so the question is how quickly is it going to keep updating itself? And it will keep updating itself, at least for a while. And it’s doing it at a much greater pace. It’s kind of like, it’s like a baby. A baby grows and changes and updates themselves so much in the beginning of life. But once you’re 40 years old, you’re not really changing that much from week to week. But when you’re six weeks old, you’re changing tremendously from week to week. This virus is the same. So for a while now, it’s going to continue having a lot of room to shift. And so the question is, at what point does a vaccine manufacturers say we have to change the vaccine composition today now versus at what point do we say that we need to do something different, that we really need to change course and make a whole different vaccine or kind of stay the course for a while until it gains enough mutations. And so we still haven’t gotten there. And I think that, you know, if we do make a change to the vaccine, by the time we get that rolled out. We might have a new virus on our hands again or a new version of this virus, and so it is for this reason why the best thing that we can possibly do to assist the vaccine is to ensure that vaccines are keeping. Are keeping their protective nature is to get cases as low as they can get through other means besides just immunological means, and that’s where rapid testing is one of the most powerful tools. Of course, we’ve tried, we have masks and distancing and everything else. But if we can use tests and other approaches to get cases as low as possible, that will give the vaccine the best shot it has to for the virus not to escape it.

MODERATOR: Next question.

Q: Yes, thanks. In Kentucky, we have quite a bit of vaccine hesitancy, and I guess what I’m wondering is what some good public health messages are to respond to concerns about things like long term consequences, since the vaccines have not been around very long, you know, things like autoimmune conditions that might pop up later, those kinds of things, as well as short term infertility and things like that that have been kind of going around. And I think it’s just for me is just trying to get a handle on what’s the best, most effective public messaging as opposed to just sort of dismissing those concerns.

MICHAEL MINA: Dismissing the concerns is one of the last things we should do. I deal with this a lot. Pre-COVID, I work on other vaccines and immunological consequences of vaccines. And for this type of issue has come up with measles vaccines and flu and all different things for many years. I think that it is, on the one hand, important to continue beating the drum that says these vaccines are protective. Even if they’re not 100 percent protective, if you can cut risk by 70 percent, that’s, of course, a major gain. A lot of what’s been in the media and what’s been sort of more in the rumor mill, I suppose, is just misinformation or just false information, infertility and things like that. These vaccines are very safe. One of the best messages, I think, is the vaccines have now been given to millions and millions of people with almost no serious side effects, you know, relatively speaking. Now, of course, something that makes it very difficult is this balance between media reports and reality, where media, of course, always puts a magnifying glass on small things that are interesting in the same way that physicians and scientists do. We see something really interesting and we write a paper in nature about it. And maybe it affects two people in the world, but it might be interesting. So we write about it and then the media covers it. And so this is a real challenge. How do we bring to light important things but place them in context to say this has happened, but it probably won’t happen to you? You know, the risk is exceedingly low, but do stay aware of it. And in medicine, we often are able to deal with that on a patient-by-patient basis. We give patients information about the risks versus the benefits, but we have the luxury of time and face to face contact to. To have that conversation and make sure that the patient is aware of sort of how it all fits together. With SARS-CoV-2 and COVID-19, this has been a real challenge because it’s just sort of every little thing gets magnified to literally billions of people. And I think that it’s really important for all of us to continue driving on this message that says, like, you know, look at all of your neighbors who have gotten this vaccine at this point and did so safely. You know, this is not causing massive disruptions to people’s lives. It might cause people to be out for a day because of fevers and things. But it is a safe and effective vaccine. And I think leveraging the community and the communal aspect of vaccination, look at the doctor who’s your neighbor down the road, go and ask your friends how many of them have gotten vaccinated. Of course, that’s hard when you find yourself in a friend group that’s kind of a tunnel bubble of type vaccine, hesitant people. It does make it more difficult. But I think we can keep pushing on that. I think some of the best evidence that comforts people is to know that their neighbors and their loved ones have gotten the vaccine successfully and are relieved by getting it feeling that they are in a better position should they come in contact with the virus. I think that pushing the positive nature of all of this is just so important. And the community nature of this is something that everyone in your community is going to be doing, this most people, and letting people know that they’re not alone when they go to get a vaccine.

Q: OK, thanks. I have a follow up, if somebody else wants to go, I can come back later.

MODERATOR: That’s fine. You can go on.

Q: OK, well, I guess it’s sort of related to the testing, the rapid testing that you’re really in favor of. And I was just doing a little reading earlier about, you know, it does seem like the PCR testing maybe hasn’t been the most effective. And I think that plays into some other kinds of virus deniers, ideas that, you know, this whole asymptomatic thing has been a fraud of some sort. And I guess again, back to the messaging, because I’m sort of stuck trying to figure out how to respond. But it seems like, is there a time when public health says, yeah, you know what, we were kind of wrong about this and now we’re going to get it right. And I guess that’s what I’m kind of wondering, is there a way to look back on what we’ve done and say, you know, OK, that took us as far as we can go, now we’re going further. Is that even part of the holdup in getting to the rapid test? Because they don’t want to admit that it wasn’t the best thing.

MICHAEL MINA: Well, I’ll be honest, I would say that scientists and physicians are not particularly good at admitting when they’re wrong. I don’t think that the PCR program has been wrong, but it has been in many ways misinterpreted. And unfortunately, or well, very fortunately, the public isn’t stupid. The public understands certain things. But they often let the average person often doesn’t understand all of the pieces of of this very complex puzzle that is COVID-19. And so PCR testing, for example, there’s been a lot of news around false positives on PCR. This is a misunderstanding in some ways, but it’s not a misunderstanding in others, technically, it’s a misunderstanding. The PCR tests are doing what they’re supposed to do, which is detect RNA. They generally turn positive if somebody actually had a SARS-CoV-2 RNA. Sure, there are false positives, but they’re very rare. But most people there’s this disconnect right now between why people are getting the test versus what the test is reporting to them, and so people are rightly recognizing that there are limitations to PCR. PCR is not a test that tells you if you’re infectious, it’s a test that tells you were you infectious potentially weeks ago or maybe yesterday or current. It doesn’t differentiate if you are currently infectious or if you are a few weeks ago. And so people are recognizing, hey, you know, I just have like remnants of RNA left in me. I think some people have misconstrued that argument or that notion to think that it’s actually a true false positive or that was a weird way to say that it’s a false positive, but it’s actually, it’s a true positive. But maybe they were infected weeks ago and their body is just kind of clearing the battlefield of their nose of the RNA that was left over. On the other hand, you know, so I think that that’s where all of this is coming from, it’s this disconnect between what the physicians and why these tests have been authorized and how the FDA is viewing the tests and how the medical professionals are viewing the test, which is like a detective finding DNA at a crime scene versus what the average person really wants to know, which is am I safe to go see my loved ones right now? Am I safe? Am I infected? Am I contagious? And that’s where that disconnect isn’t just affecting the average person. It’s affecting the regulation of these tests.

For example, this test continues to be compared against the PCR test, but this is a test of contagiousness. It will only tell you if you’re positive when you’re contagious. So this is the test that people want to know about. This is the test that gives the average person the information that they’re actually seeking. Am I infectious? But because it’s being compared to the PCR, there’s this disconnect where this appears as though it’s missing cases when it’s really not it’s missing, it’s missing RNA that is residual and kind of remaining at the battlefield after the war is done inside of your nose. But it’s not missing the positives who are actually infectious. And that’s a really complicated that requires pretty deep knowledge and understanding of this virus to make sense of that. And so I do think that we could do a better job at looking at trying to reconcile. Let’s stop being so strong headed about our position as scientists and physicians and recognize why the average public is getting a test and message them appropriately and get people to understand, you know, what the test actually means and let’s be transparent about it so that people are coming up with their own theories.

MODERATOR: Next question.

Q: Hi, Dr. Mina. I have kind of a two-part question. One is, since you were just talking about rapid testing, the first is, you know, we’re writing a story about a testing company. I just wonder if you can speak generally about this various saliva and oral fluid-based tests and how they compare to the rapid antigen tests. Also, I’m wondering if you could maybe give some thoughts on sort of how the apparent under funding of public health and public health labs sort of has created a space for a lot of these private testing companies which are providing the sort of tests of varying efficacy, some of it quite high cost and potentially quite profitably, you might think. And you know, what really would have been the proper role for public health labs versus private testing companies if these public health labs were properly funded? Long questions, two of them, sorry.

MICHAEL MINA: Yeah. So the first question you asked was about saliva in oral fluids versus nasal pharyngeal and nasal swabs and these different types of tests. Are you referring to curative or what’s one of them?

Q: Unsure.

MICHAEL MINA: OK, the only reason I ask is because they put out a preprint and I spoke with them and these tests, the PCR based tests are really working very, very well, regardless of whether it’s saliva or nose, and they’re working well, if you are interested again in the question, am I infectious? And so for anyone who is not aware, the FDA recently kind of made an announcement that says that the curative lab, which is performing a huge number of PCR based tests in this country for clinical testing, said that the test that people should be warned potentially not to use it because the test isn’t sensitive as well as other PCR tests. But this is really a mistake. What happens is when the virus is growing, the test is just fine, the saliva and oral fluid test, they’re working really well. The problem is once your body beats the virus, once the battle is done, this is the same story as the antigen tests. The RNA doesn’t last for very long inside of the mouth because you’re constantly swallowing your constant drinking water. Whatever might be the biological properties are simple that you’re the oral fluids in oral swabs. They get rid of the RNA quickly after the infection has finished in the same way that the proteins of the virus disappear quickly after the virus infection has finished.

And so by comparing that, I would say actually that test like the curative test that used an oral sample and run on PCR, that’s actually getting closer to what people actually want to know. People want to know, are they infected today? Are they infectious and infected today in at least a saliva based or an oral fluid-based PCR doesn’t stay positive for three or four or five or six weeks after infection? It will turn negative after like a week after infection. And so it’s actually working very, very well. The tests are working. They are as sensitive as PCR as a nasal pharyngeal swab with PCR when you need them to be, which is when you’re infectious. And all of the misunderstanding about the rapid tests and the saliva tests is completely after people are infected. We just finished a test, for example, of a study of the ANOVA test, it’s one of these tests here. And we found that this test is 100 percent sensitive when people are most infectious during these two, three, five or six, after they turn after the first term PCR positive. And so it’s 100 percent as sensitive as the PCR when you need it to be. And then it starts to trail off. Once you stop being infectious, they don’t work as well, which is what people want to know actually. And so I think that we have some work to do, I guess, to try to ensure that the way that we’re evaluating this test, whether it be the oral saliva test or the rapid antigen tests that we find that we start coming to terms with what is the right gold standard against which to measure and benchmark these tests?

Is it always the nasal pharyngeal PCR test that stays positive for six weeks? Maybe that’s actually bad for public health. Maybe that’s good for medicine, but bad for public health, because we don’t want to isolate people who are no longer infectious. That’s something we actively don’t want to be doing, but we are currently doing because the picture is positive for so long. So I think that there is a lot of miscommunication around this. The rapid antigen test, just like the saliva PCR tests, are working really, really well, really well. And I will on this note, I would caution that there are differences in rapid antigen tests. Some are better than others. I’m not going to make a comment on which ones are or are not as good. But I would say that these to this Abbott BinaxNOW test and this ANOVA test, we’ve trialed them both. They’re both working incredibly, incredibly well, you know, essentially equal to each other. And they are very powerful public health tools that are just being misunderstood, especially when it comes to asymptomatic people. There’s a lot of misunderstanding, thinking that they’re not working well, but it’s really not. The PCR is staying positive for too long. The other question that you asked me was, can you just repeat this?

Q: Basically, I mean, I think there’s been fairly well documented underinvestment in public health, public health labs in California, for example, many closed. And so, you know, that’s obviously provided a lot of opportunities for private companies to come in often, presumably making presumably fairly good profits. So, I mean, what would have been or what should have should be the proper role of public health labs and properly funded versus the private sector?

MICHAEL MINA: This is an extremely important question, and I think that it’s something we should be tackling over the next couple of years, especially with this new administration. We should have tackled it years ago. We need it. We need to invest in public health. If we learn just one thing from our experience with this virus, it’s the consequences of not valuing public health, of not investing and funding public health. What happened at the beginning, if we go all the way back to February, this was a real disaster where we didn’t have the public health facilities set up to really take part in helping keep the populations in this country safe. And so, as you said, this led to a huge decision to lean heavily on private industry and what we’re finding now is that the average PCR test is still over a hundred dollars. That’s criminal. I mean, the average PCR test, especially those that are using an open framework that your kind of just buying the primaries and doing all this on a regular sort of open platform. PCR, like the high throughput labs are doing now, cost six, eight dollars to run the test, maybe a few extra dollars for the overhead. But there’s a lot of these facilities are running hundreds of thousands of tests a week, some a day. And so, you know, it’s mostly automated. And I think that you’re absolutely right that we’re seeing predatory labs in some cases make huge amounts of money. We should be regulating the cost. People should not be profiting at the moment, or at least not excessively profiting off of this pandemic. Of course, profit and health care are a horrible problem in our country. And so I don’t know that this pandemic is the place in time to fix it all. But it’s a real problem.

I do hope that we will learn and that we will build up our public health capacity in a way that we haven’t done, at least, and that really, we haven’t done in forever in this country. The CDC was designed and developed in response to public health need and infectious diseases, in particular at the time malaria. And I think that, you know, that has in many ways been a shining example of what the benefits of investing in public health are. And now we just have to do it further. We have to ensure that we actually have the adequate facilities and laboratories so that when the next pandemic comes about or when the continued waves of this pandemic continue hitting, especially with immune escape variants, that we will be prepared. And we are not having sort of these expensive PCR labs skimming hundreds of millions or billions, frankly, of dollars from the American public just because they want to know they want to do a deed for their neighbor. And on that note, I think it’s extremely important. No person should have to pay for a COVID test. I’ve said this before, COVID testing is about protecting your community. It’s about participating in public health. It’s not, you know, short of being in the hospital, it’s not about affecting your own body. It’s knowing whether or not you’re safe to not infect other people is most of the reason people get tested. And so requiring individuals to pay for a service that they’re doing as a public good is really a travesty. I think we should really think hard about how we are funding the PCR testing that people are doing, and I think it’s also a reason why we need to get equitable. We have to make testing much more equitable as a public health service. And it’s not just the labs. And my hope is that we’ll start seeing these tests become much, much more prevalent because these are sort of the great equalizer in terms of people’s ability to test. They are much more effective as a public health tool than PCR ever could be because there’s no teleplay. And I think that these have huge places of public health good over the next year.

Q: Thank you.

MODERATOR: Next question.

Q: Thank you for taking my question. I wanted to get your thoughts on pool testing. The public-school districts are weighing that topic now. Districts are very concerned about monitoring infection rates in their buildings during hybrid learning, and now the state Education Department is offering six weeks of pool testing for districts. They’re weighing whether they should do this and how they’re going to pay for it going forward after that six-week period. So I just wanted to get your thoughts on that. And also, some districts are beginning to incorporate pool testing that is done at home so they can take a saliva sample. A child takes it at home, drops it off at school, and then it’s sent off to the lab so that the lab will have individual samples instead of having them all pulled together. And if there’s a positive, then they have to go back to the district and ask them to submit the samples again. So I just want to just get your thoughts on what school districts are facing right now in terms of having to decide whether testing is the way to go or not. And then secondly, the option of home-based pool testing on this. And thank you for taking my questions.

MICHAEL MINA: Yeah, it’s a great question. I think pool testing is fine, you know, it’s really, it’s a good approach, it increases efficiency. It is not where I would put all of my effort. But it is important, it’s better than single PCR for sure. I would say that it’s much better, you know, we may as well use the resources. PCR is so sensitive. We have a paper that we just put out. I think it’s coming out soon in a top journal. And it essentially shows that you could pool one hundred samples together and still get essentially as good sensitivity as you would otherwise get from single, I mean, obviously you’ll have some limits, but we have to remember that this virus and people are really infectious. The virus grows quite literally to a trillion viral particles per mill. And so there’s no good reason why we should be super focused on finding 100 RNA particles when it grows to a trillion. It’s like saying that the average poor person on the street is the same as Jeff Bezos. You could pull hundreds of people together and they won’t have near the money of just Jeff Bezos. And that’s so you can essentially use pool testing to really gain efficiencies. The problem with putting our eggs in the pool testing basket when we have rapid tests available is that the moment you have a delay, you’re doing yourself a disservice. Can I share a screen during this?

MODERATOR: You should be able to.

MICHAEL MINA: And I’m going to just show you an example of something. This is a little diagram that I drew to help people understand why rapid tests are so important and could serve to replace pool testing. And we could actually pool rapid tests, too. But this is just an example because there’s been so much confusion. You have a PCR test, you have five kids walk into a school who are infectious on day one, let’s just say you have a PCR test that’s going to give you results back in this case, two days, which is generally that’s fast for most of the country. Regardless of if you’re pooling or not pooling, that means that you at least going to have one hundred percent of the people who get PCR tested are going to have at least two days where they’re walking around, potentially infecting people. So it’s 10 person days’ worth of walking around infecting people until you get the results of your PCR test back two days later. And at that point, maybe already had those five people have gone on and infected nine others led to twenty-five others being quarantined. Yes, you find 100 percent of them. But if there’s a delay in the PCR results, that cannot be discounted. It’s 10 person days. Now, let’s take a rapid test. These are showing to be much more than 80 percent sensitive when people are actually contagious. But for conservative sake, let’s say that it’s 80 percent sensitive. You have a rapid antigen test on the same five people. You use it immediately before kids walking to school. You find four of them who are contagious out of the five, and you pull those 4 out. So 20 percent the one person gets through. That one person wasn’t particularly contagious that day. Otherwise, they would have been detected on this. The second day, OK, then they’re contagious. They infect two people, but then use a rapid test again the third day because they’re cheap and easy and inexpensive and there’s no delay and you find that person. So with a less sensitive test, you end up having two new infections versus nine. You end up having five people quarantined versus twenty-five. So this is one of the reasons I’ve been so vocal about the need to move away from PCR testing as our as our approach to tackle this, whether it’s pooled or not. The moment you have a delay, anyone who is infectious is going to walk around for days. And so we’ve been testing this on college campuses. They’re working extremely well. And so it’s not exactly the question you asked. I think if your baseline is PCR testing short, I think field testing is great. Even on a field testing, it’s fine. It’s surveillance. And then you get somebody an EUA test. But I really feel very strongly that we should be focusing on rapid testing. The speed is everything. And then that’s even given same frequency of testing. The speed of results is so important and on top of that that you can frequently test people twice a week and you immediately start finding pretty much everyone that’s infectious. So that’s what I think really, we should be focusing on for schools.

Q: Thank you.

MODERATOR: Next question.

Q: Yeah, hi. I was just wondering, you know, our state health department was talking about the Red Cross blood donation antibody studies again and saying that more recently it looks like maybe one in five donors in Kansas has the antibodies to COVID. And I’m wondering, you know, what the value of those studies is at this point? Like, is that helpful to know? And also, since there are different variations of COVID and because we still don’t know, like how long antibodies and immunity lasts, does it really tell us how far we’re getting towards, quote unquote, herd immunity?

MICHAEL MINA: It’s extremely important to do those. My laboratory here at Harvard, we are undertaking probably one of the largest of such studies in the world. We’re getting blood donor samples from all across the United States from plasma donors and running COVID antibody tests on them over every week for the whole year of 2020 now and into the future. So what these types of studies do is they give us an understanding of just how much the virus has spread. So in this case, my estimates have been that somewhere between 20 and 30 percent of the United States have been infected at this point with this virus. We generally only find a fraction of people who are infected with PCR. And so in general, we take the numbers and we assume that at this point we’ve been around three to five fold lower. So 20 to 30 percent of the US has been infected. Knowing that and then having data like you just described, suggesting that that is true is very powerful for planning for the future and for understanding what’s in store for us in the future. So let’s take what’s happening now in Brazil for a moment. This is a place where herd immunity was considered to have been achieved, but now there’s big outbreaks occurring there. So the question is, is this a problem that we should all be aware of? Is this because of the virus? Is escaping immunity or because of waning immunity? And so having this information is really very important. It tells us that we have a long way to go before we get to herd immunity. But it also tells us that we’re pretty far along that road as well. It will allow us to continue monitoring the situation and to be able to keep track of how the population immunity is working now that we’re vaccinating, people will probably have to start. Also, if we’re just using serological responses as our metric, we will probably want to start looking for different antibodies that would represent vaccination throughout community. But in general, I think that these are really important. The big unknown right now is certainly what the new mutations are going to do. And it’s not just the mutations that exist today. I look at these, we very well have new mutations in the US that we haven’t discovered. We have more cases than in any other country that we know about. And so that means that we’re probably breeding new strains right here, new variants and new mutations right here in the US. But we just haven’t discovered them yet because we have very poor surveillance and sequencing. And so other countries have described them on their soil, but that’s because they’re actually doing the needed surveillance to find them. So I worry that the big unknown for all of this is, will these viruses keep escaping immunity? And if so, will we attain herd immunity in a way that we are without? We’re hoping to and we very well might not. We might have to find other avenues and these tests again. We just don’t have a lot of tools at our disposal on these tests, getting these properties out can work to stop outbreaks and stop them from beginning. So if we start to see a new outbreak in a community with a new strain, we can just tell people, hey, use your rapid tests twice a week and keep it low so the outbreak never takes off. And we should be thinking about all the other tools we have besides just achieving herd immunity.

MODERATOR: We’ll just wait a moment, see if anybody has any questions.

Q: Hi, Michael, long time caller, first-time questioner. Thanks for today, and it’s just a little broad, so if you feel like it’s a little out of your specialty area, I totally understand. And I’m also a history geek and a little obsessed with the 1918-1919 pandemic. And I was struck when President Biden noted that our ultimate mortality in terms of absolute figures is coming pretty close to the estimated six hundred seventy-five thousand that died in that pandemic. And I mean, if there was a single cause of, I mean, compared to the improvements that the other countries have made and that hundred years, I mean, the population of America has tripled. So you could say, well, you know, we reduced mortality by two thirds. But, you know, given the advances one hundred years has seen has wrought in medicine and public health, etc., you would think that we would have performed far, far better. I’m just curious if you were to identify a couple reasons for that failure. If, say, you know, the failure to create positive surveillance testing would be chief among them or what you might ascribe.

MICHAEL MINA: Yeah, well, I mean, you point out an extremely important and good point, which is not a surprise, I think at this point that we have a lot of deaths on our hands. And I think that it’s extremely complex. I remember back at the beginning of this pandemic saying I think that the US will fare very poorly in terms of dealing with this and the reasons I said that at the time or because on the one hand, we’re fragmented. And we are incredibly fragmented socially and statewide at the moment, and so that makes a real formidable challenge for us to deal with a pandemic that just doesn’t care about our fragmentation. It can only use it to its advantage. And so one of the big problems that we had was we tried to invent the wheel in every state, in every county, in every lab. For testing, for example, at the beginning of this pandemic, we let it get out of control because we had no way to leverage the economy of scale. We are so incredibly fragmented and our regulations, which I am not against regulation at all, but we have to recognize what we’ve had a disconnect between the regulations and what’s needed, the why we’re regulating things versus what the regulations stand for. And the process was a great example where normally laboratories are able to scale up that are allowed to introduce their own tests without going through the FDA, like if I want to test for cholesterol, I can make my own new test for cholesterol and use it at Brigham and Women’s Hospital for my patients as a medical director, it’s part of the practice of medicine. What we saw with the idea was that the regulation landscape of the federal government provided me from creating a COVID test that I could use for my patients and that prevented me from creating activities that I could use for my patients. Instead, I had to go through this laborious application just to practice medicine for testing for COVID. We didn’t ask internal medicine physicians to get approval to put their stethoscope on people’s hearts, who had COVID. But this was a requirement of the labs. And this this was an example to me of how regulation has gotten so tied up.

It’s so complex and it’s so difficult to deregulate, to tangle when needed, that I think it left us in a pretty vulnerable position. And we generally have seen that kind of theme. We are not a country that’s able to act nimbly or quick. We don’t have experience having to deal with hardships on our soil, at least not. We have a lot of hardships there as well. But when it comes to population devastation, we haven’t had many opportunities in recent memory where many countries that are used to dealing with difficulties at a population level were able to go along with this. We’re able to adjust and be nimble and quick and deal with things as they came about, whereas we have really had a hard time shifting our mindset to say, hey, there’s something bad happening to us. We need to act differently than we did last year or two years ago now. And I think that that’s one of the biggest issues. We never treated this like it was like that, like it was something that’s actually bad. We know that it’s bad and we speak a lot about how it’s bad. But when it comes to actually acting, we didn’t ever act. And I’ve been saying for a long time that we needed to act more like this is a wartime effort. The type of organization and population commitment and public commitment towards a single cause was great during World War II, and that allowed what we defined as success to occur. And in this case, we haven’t taken that aggressive population level. We’re all in this together approach. And I think it has left us in a really, really, really bad position. And the other last thing I’ll say on this is that for so many years we have put all of our efforts towards medicine and medicine, medicine, medicine, the biomedical complex. We don’t have a bio public health complex, industrial complex we don’t have. We don’t even have the laws and regulations and legal words to talk about public health. Everything is centered around medicine. And so what we did was we just kind of took these medical principles and tried to apply them to a public health problem. And that was the wrong way. And I think that even going back to 1918, they recognized, hey, 1918 virus, that was a public health problem. First and foremost, let’s deal with the public health problem and then that resolves the medical problems. We’ve taken the backwards approach here. We’ve tried to treat this epidemic as though it’s a lot of medical problems that when we’re trying to claw our way back on each one. Meanwhile, the virus is growing quicker than we can possibly do that we need to take a big step back and say this is a public health problem. What are the public health tools we have at our disposal and kill the epidemic from that side and not try to claw back from the medical side? And I think that’s been a reflection of our economy and how reliant we are on medical regulation to drive everything that has to do with the human body.

Q: Thank you.

MODERATOR: Dr. Mina, do you have any final thoughts for us?

MICHAEL MINA: No, that’s good.

This concludes the January 29th press conference.

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