Coronavirus (COVID-19): Press Conference with Rachael Piltch-Loeb, 12/13/21

You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Rachael Piltch-Loeb, Globe Preparedness Fellow in the Division of Policy Translation and Leadership Development and a research associate in the Department of Biostatistics. This call was recorded at 1:00 p.m. Eastern Time on Monday, December 13th.

Moderator: Dr. Piltch-Loeb, do you have any opening comments?

Rachel Piltch-Loeb: Hi, everyone. Happy almost holiday season. Hopefully, everyone can find some way to enjoy the holidays. Whatever you feel comfortable with. And I think that that’s kind of one of the biggest points to start with and to hit home is at the moment, we are just in such a climate of uncertainty and with Omicron and the state of the pandemic. I think that depending on if you are local to Massachusetts or the northeast region, other parts of the United States or even abroad, the context is very, very different in terms of what’s going on in the pandemic. And by that, I specifically mean, what’s the state of vaccine uptake? What’s the state of folks getting their boosters? And what’s the state of kind of the health care system where you are? And all three of those factors kind of what the health care capacity is, what the vaccine rates are, how many people are boosted are kind of contributing to this question mark of how what’s the case burden going to look like in a given location? Now that being said, I think it’s important to recognize that these were issues or questions prior to the concerns related to this particular variant. These are issues that have continued to come up in the context of the Delta variant. We know that parts of the United States, for example, are hospital capacity is completely overwhelmed. That means that sometimes there won’t be ability to treat other health related issues, like you get in a car accident, where can you go if your hospital systems are overwhelmed, for example, and that largely is still attributable to folks who are completely unvaccinated. What we are seeing in the context of this new variant is an additional level of unknown. And, you know, in South Africa has become the dominant variant. There’s, you know, we haven’t had much time yet, but so far there have hospitalizations are cases are up exponentially. Hospitalizations are also up. It’s been taking some time to see what happens and in terms of death rates. But the reality is, and so there have been sort of some rumors that are out there that Omicron is a more mild variant compared to some others that we’ve seen. From my perspective, regardless of whether or not that may or may be may not be true, it’s still kind of hard to tell because we don’t have this slightly longer term data on the horizon. It does appear to be incredibly transmissible and perhaps kind of be able to avoid have some kind of avoid or reinfect those who have been infected in the past and the vaccines to be seem to be at least slightly less effective in terms of preventing infection. What all of that means is even if the vaccine is, or excuse me, even if the variant is potentially more mild, if enough people get infected, it’s still going to be a large burden on our health care system. So, you know, there’s still a lot we’re still trying to figure out about the variant, but it’s going to pose a concern to the to the population, especially in the short term. The kind of key points to hammer home are if you’re not vaccinated, you really need to be vaccinated. You know, vaccine vaccination does appear to still be preventive from severe infection, meaning hospitalization and death, which is ultimately the entire intent of vaccines in the first place. And booster seemed to be effective at reducing infection in the first place. So before I go on too much further, it just hits home a little bit. There’s still much to be discovered in terms of the impact of this variant. Vaccination and boosters, if you are vaccinated, are critical, but we also are in the state we were in before where even with Delta, we were still kind of in the midst of this pandemic. And that hasn’t changed anything. We we’re kind of just continuing to respond while having to counter all of the unknowns with the new variant. So, I’ll take questions, and I’m happy to answer more specific questions about travel or what we do and don’t know or anything of that nature.

Moderator: Thank you, Dr. Piltch-Loeb. All right. First question.

Q: Hi, Dr. Piltch-Loeb, a question for you on kind of last winter versus this winter. And, you know, Delta seems to have been here forever, but when you think about last winter was actually Alpha, that was the dominant strain here last winter and probably what we should be comparing this to as we come into this winter surge. Can you talk a little bit about Omicron compared to Alpha?

Moderator: Sure, I mean, from a variant specific perspective in terms of what are the actual kind of mutations on the virus? I don’t have a perfect answer for you, but I think a better answer from my perspective is where do we stand in terms of the ability to respond to the pandemic at this point in time, whether it be with Delta and Omicron or with Alpha? And I think the reality is at this point in time last year, going into the winter surge, the vaccines were just beginning to roll out and we were certainly very specific about who was eligible for a vaccine at the point in time in December. I think it was just this past week that we commemorated or will be commemorating the kind of first FedEx trucks leaving the plant to bring the vaccine to folks to be able to be distributed. So we are not in the same place we were last winter in terms of our ability to respond to the pandemic. We have a greater sense of treatment abilities. We have various kind of therapeutics that we know are available and may be able to cut the impact of the virus once somebody is in a hospitalized setting. And of course, we have vaccines that have become widely available throughout the country. So from that perspective, where we are in terms of responding to these variants, where during this current winter, 2021 is in a better place than we were in winter 2020. What will determine kind of the impact of the winter surge has a lot to do with people’s willingness to maintain pandemic mitigation measures. So that includes, of course, you know, getting your vaccine if you haven’t or getting boosted, if you have the ability to. And that also includes being willing to wear masks in indoor spaces or reduce kind of crowded or crowded gatherings and to get tested if you were potentially exposed, take at home rapid test prior to participating in a variety of different events. And if you actually test positive, then stay home and isolate yourself, that is the critical piece after testing is acting upon the results of those tests. So to kind of summarize a response to your question, we’re not in the same place we were a year ago. We think that the more recent variants are certainly more transmissible than what we were seeing with Alpha. We know that that was the case with Delta and Omicron seems to be even more transmissible than Delta at this point in time. Plus, able to avoid prior have some immune escape from prior infections. But we’re in a better place in terms of what we know about the virus overall and mitigation measures to respond to it.

Q: So are we are we essentially getting better at this pandemic business?

Moderator: I think that nobody wants to be in the pandemic business, but I think the answer to your question is actually kind of twofold. We are getting better at understanding what we can do to prevent spread and to protect individuals. I think we haven’t necessarily gotten much better at an overall response strategy that makes people want to participate. Meaning we still see a lot of vaccine hesitancy is super high. People are at a population level, want to go see their family. They’re fatigued by public health mitigation measures. So I think we’re we’ve gotten better at understanding certain aspects of the virus. I think we’ve gotten a little bit better at understanding that there’s stuff we don’t know. And I think they’re still kind of a lot of questions about COVID patterns and infection patterns. We’ve gotten better at knowing that COVID is airborne, but I think we still haven’t done great or are a work in progress in terms of our ability to kind of bring the public along and in being a part of this response.

Q: Very good, thank you.

Moderator: Next question.

Q: Hi, can you hear me.

Rachel Piltch-Loeb: Yes.

Q: Thank you. So this kind of follows nice to what you were talking about, is that a big public response was announced this morning. The governor of the state has purchased, they purchased all these rapid tests.

Rachel Piltch-Loeb: Yes, two million tests to be distributed to the hundred hardest hit communities is my understanding at the moment.

Q: Will that have an effect?

Rachel Piltch-Loeb: So I think it’s a great question. And I think first of all, it’s a positive move in the sense that one of the biggest challenges and something that got, I think, a variety of decently negative attention last week was kind of the notion that there wasn’t support for free rapid testing or there’s been limited support for free rapid testing tests to as much of the population as possible. And the reality is that, you know, it’s a burden to access a test. Then, you know, oftentimes people are not going to take the time to do it, whether that’s because of expense or that’s because of a physical barrier, meaning you don’t have two hours to wait in line to get it at a store. There’s a variety of kind of structural limitations there. So I think that the notion that we bring tests to you, meaning two people could be really effective. However, it’s really critical that there’s been a plan in place for how informing people what to do with the test. With these most of these rapid kits and I didn’t see which ones they’re distributing, but you need to take two tests at a time to feel and they often come two in a pack, the notion is that if you then test positive, you should stay home and isolate if you are, you know, if for a certain number of days, certainly until you then test negative after x period of time. And I think that what those some of those timeframes should be is kind of hasn’t been updated, but perhaps will be depending on your vaccination status. But lo and behold, either way, the point is if we’re going to give out rapid tests, we also need to be really clear about what the protocol is. Should you test positive and expectations for individuals and for employers in terms of what it means for folks to be able to feel comfortable using these tests? The impact certainly could be that we have reduced a huge access barrier that people get in the habit of using rapid testing to determine whether or not they should participate in an activity and if more people recognize their COVID status and end up staying home. We did reduce the potential for spread at some of these family or community or employment-based settings.

Q: So part of the issue is what people should do when they test positive, but the other question is when do you test and you think that is widely understood and what advice would you give about that?

Rachel Piltch-Loeb: That’s a great point. So there are, you know, depending on how, in the UK, for example, you have folks who take rapid tests every day so that when they notice a change right in their antigen levels or whatnot, they have the ability to very rapidly kind of determine that they’re in a different spots than they were a few days before and stay home and isolate. Now my guess is we will all depend on capacity, but should we not be able to make the recommendation that this is something that folks can be doing every day? A lot of recommendations are to use rapid testing prior to parked in the same day or prior to participation in a given event. For folks who are in-person every day going to an office place, the main recommendation perhaps should be you should be testing every day to kind of reduce spread if you are in any kind of public or human facing job. And the other kind of the next level to that could be prior to attending an event, especially with high-risk individuals or those who, for whatever reason, are immunocompromised or can’t be vaccinated because of because of some other health related factor. So the rapid test? Yes, it’s not just a question of what to do with the results, but also a question of when to use them. The two components would be, you know, in theory as often as possible would be the best to basically be able to determine on an on a day-to-day basis, a change in your antigen status. However, the alternative to that, which is probably more realistic, is prior to participation in a given type of event, whether that be a family gathering or a community gathering where there will potentially be exposure to other individuals who may be immunocompromised or who just in general. The idea is you don’t want to be bringing the virus to one of those settings.

Q: The tests like this, making them available is, millions of dollars, does that really have the potential to significantly reduce? It leaves a lot in the hands of individuals.

Rachel Piltch-Loeb: I’m not sure I’m fully following your question, but I think you’re asking whether or not we can, there would be an impact from this sort of an impact on the spread of the virus. Is that the question, really?

Q: Yeah. But I mean, how much of a difference can this sort of thing makes when it depends on people knowing to go and get the test even if it’s available at town hall or however they’re going to do it? It still puts a lot of in the hands of individuals making the right decisions.

Rachel Piltch-Loeb: I think there’s a few different ways to think about it. One is a lot of, you know, there’s different approaches to pandemic kind of mitigation. Some of that is what policymakers can do, and that’s where we see things like vaccine mandates or indoor mask requirements. But it’s a lot of requirements that we see put in place. That’s a policy lever. There are also individual levers, meaning we can reduce barriers to make it the default for people to do certain types of activities that are likely to reduce the ability of the virus to spread. Some of those activities are to get vaccinated, right? If you’re vaccinated, you’re more likely to get infected, you’re less likely, excuse me, to get infected and you’re less likely to spread the virus. Another is to make it easy to know if you may be maybe someone who is spreading the virus because you test positive on a test, so you get tested. Another is, of course, to wear a mask. So the first comment is there’s different levels that can be used. Some at the policy level, some at the individual level. And at the end of the day, we need to be using both of those. I think, you know, the reality is that if you look kind of around the states and you look around the world, a lot of kind of the response to the pandemic and to vaccines is a little bit of a social construct. So like what’s normative where you where you are and what do other people around you do? If it becomes commonplace or it can be commonplace to test prior to going to a gathering in addition to be vaccinated, et cetera? We are just basically giving the virus less opportunity to transmit. We’re giving ourselves as much information as possible, both on our status and whether or not we’re COVID positive, so we’re giving ourselves kind of information to make more informed decisions. To your concern, I think about whether or not this can actually make a difference. I think the reality is that if you look around the world, testing is far more widespread and available in pretty much every country that had that’s on kind of economically on par with the United States. And the reality is that tests are used so that kids can stay in school more often so that folks can feel comfortable going to work or participating in a variety of events. It’s become a normative practice, and I think that one of the goal should be to make rapid testing part of a broader strategy to encourage individuals to kind of make it as least risky as possible to participate in events. And so yes, it places burden or I don’t want to use that word. Yes, it places the onus on an individual. But the reality is that there’s been a lot of pushback for the kind of policy levers that are being pushed. So let’s why not empower people with a lever that can be in their own hands?

Q: So speaking of policy levers, the governor at the same press conferences has absolutely no plans to impose a mass statewide mask mandate. So do you think that’s good policy or would it be more effective to have less?

Rachel Piltch-Loeb: So we do. We have seen that masks reduce transmission. So the question is, what’s the what’s the balance between a variety of different activities? And so the policy levers are a kind of a time and a place. And so my guess is the governor’s calculus has a lot to do with balancing what is the government’s role and what is individual’s role within kind of the reduction of transmission of the virus. You know, individuals should still be encouraged to wear masks in indoor spaces. There’s no two ways around that to reduce transmission. Whether or not the state wants to make that a statewide requirement is clearly not where they stand at this point in time. My guess is there will be a variety of local jurisdictions, perhaps Cambridge or Somerville or wherever. I know Cambridge had been, had done it in the past where mask mandates will be used, and that’s similar to what we see in a variety of different places. I think the governor of Colorado just came out with a similar message. So the from my perspective, this is a balance between use of different types of policies. Yes, mask mandates can be incredibly helpful, and when we’re seeing widespread community transmission should be a policy lever that is considered. But from where the governor stands, that may not be the point at the point that the state is at this point in time.

Q: What do you think a mask mandate, are you saying that a mask mandate might not be effective because there is the recent public buy in for it statewide? Or are you saying, I mean, this is a political decision by the governor or?

Rachel Piltch-Loeb: I did not say that, no.

Q: Do you think it was a good decision from a public health standpoint?

Rachel Piltch-Loeb: I think it depends. You know, I think that the reality is that the question is, what are you trying to achieve and what is the level of community transmission at this point in time? If the state, you know, I think that masks mandates in a similar perspective to vaccine mandates are all forms of mandates are a lever that is intended to be used to to change behavior. But similar to your initial point, there’s levers that both the state or the government and individuals for individuals to enact. So my guess is in local areas or in certain context, mask mandates will be used. Mask mandates can certainly reduce transmission. And the reality is there may come a point in time in the state where community transmission reaches a point that the state does feel changes their mind. And I think that’s the thing to keep in mind of. Where we are at this point in time is that everybody has to reserve the right that we can change our mind because the public health situation has changed now without looking at the specific community transmission data in the state at the moment in time. My guess is that’s what they’re considering and whether or not to use that policy lever. And my guess is this is also a little bit about public buy in because there has been significant pushback to a variety of different mandates. And my guess is that is part of the decision-making process being used at the state level.

Q: Thanks very much.

Moderator: I’m just going to interject really quickly. One of the questions I’ve heard in regard to rapid at home tests and distributing rapid at home tests is that there’s a concern that these tests don’t come with a requirement or an ability to report back to the state so that information about the positive positivity rate isn’t getting into the system. Do you see that as being a significant concern or outweighing the potential benefits of having readily available tests?

Rachel Piltch-Loeb: So it’s a great point. And I think from a public health surveillance standpoint, it does create a challenging challenge to understand kind of where we stand in the context of transmission, community transmission. That being said, this kind of goes to what, from my perspective, the perfect, the perfect shouldn’t be the enemy of the good, meaning we shouldn’t prevent people from using or not make it easy for people to use at home test because we are concerned that we will not then get the surveillance data because the reality is that if you have to wait two hours in line to get a test from a clinic that will then report to the state, you may never take that test and we’ll just go about your merry way. But if it’s at home and you take the test and you test positive and you are able to then self-isolate, while we’ve prevented kind of a potential transmission event because of access. And so, from my perspective, yes, it’s a concern for the state. It’s a potential concern, but it’s also the kind of benefit outweighs the concern. And this is all about kind of figuring out calculated risks and calculated benefits.

Moderator: Thank you. Next question.

Q: Hi, thanks for doing this. I’m working on a story looking at how 2022 will be different than 2021 when it comes to COVID, and I know you touched on a few things earlier about how things have changed where we stand now, but I’d love to pick your brain on variance. Can you talk about the role Omicron may play in the course of the pandemic as we enter 2022? And I mean, it really just seemed like 2021 was the year of the variance. We saw several pop up, even as more people got vaccinated. Can we expect the same or expect to see even more in 2022?

Rachel Piltch-Loeb: So, yeah, to answer your first question. I think we should definitely expect to see more variants. One, primarily because the majority of the world is not vaccinated. And the reality is that, you know, variants continue to emerge as the virus continues to spread and coronaviruses in general mutate. So it’s not uncommon for variants to exist. I think that the the question that we will probably be paying the closest attention to is whether or not the variants the variants vary, but whether or not the variants are different enough that they evade their complete immune escape from prior infection or certainly from our vaccines. To this point in time, that doesn’t seem to be the case with the Omicron, certainly in comparison to the Delta, to the prior variants that we’ve seen. But we may get to a point where, again, COVID 19 is a virus that is circulating, it becomes endemic, and either the vaccines need to be kind of updated in the form of an annual booster. Again, this is hypothetical, we can’t know for certain, or the virus kind of continues to circulate at levels where or as mild enough because enough of the population has either been previously infected or is vaccinated. That is less of a concern to us. So yes, we should expect to see additional variants. I think that the reason that we are spending so much time on this particular variant one is because it was rapidly named a variant of concern, certainly faster than then some of the prior variants that we saw. The detection and pivot to that being a variant of concern was relatively rapid, all things considered. But I think otherwise, in terms of other viruses, we’re likely familiar with it that circulating, we don’t necessarily focus so much on what variant is in the population because we’re not, it doesn’t have an impact or a change on any form of protocol. And I think eventually with COVID 19, when it does kind of shift to this more endemic nature, we may not be having these conversations about variant types nearly as much, but we should recognize that there will continue to be variants and mutations in the virus.

Q: Thank you.

Moderator: Great. Any of the questions out there?

Q: Just to follow up on that question. Are there evolutionary pressures that indicate that future variants are likely to be more transmissible?

Rachel Piltch-Loeb: Yeah, so that’s a good question, and I think that there is different, my understanding is there’s different kind of schools of thought about this at the moment. One is that as kind of that there are, yes, that the goal for the variant to be kind of more competitive. The idea is that it would be more transmissible. The question is, you know, nothing is kind of perfect. And so as something becomes more transmissible, it’s also possible that due to other mutations that have evolved, it may become more unstable, meaning it is not able to outcompete whatever the other dominant variant is. So there’s a balance kind of in different types of mutations whereby, yes, a future variant may be more transmissible, but it also may not be able to be sustained and become the dominant variant. And so I think that that is really the question at the moment. It seems like Omicron, you know, if we look at South Africa or we look at the UK is able to outcompete Delta, but if that was not the case, then well, it may be more transmissible, it wouldn’t necessarily have the ability to outcompete whatever the prior dominant variant is. So that, I think, will be an open question. Yes, we should expect higher transmissibility, potentially, but we may not see the sustainability from a new variant.

Q: So it’s a case of wait and see which is what we have been doing?

Rachel Piltch-Loeb: That’s exactly right. And I think that that unfortunately, with the pandemic, you know, one of the greatest challenges has been kind of the coping with the uncertainty that comes from tracking an evolving virus. And I think that are probably one of our greatest mistakes is placing too much certainty on what we think we know about, about what’s going to change or what the various patterns are going to be. As I was saying before, I think that it’s really critical that individuals and government entities kind of reserve the right to make changes because at the end of the day, you know we’ve been flying the plane as it was built. I mean, this has been an ongoing response to an evolving scientific situation, and we’ll continue to be that a little bit for some time to come.

Q: Great, thank you.

Moderator: Any other questions out there? All right. Dr. Piltch-Loeb, any final thoughts for us?

Rachel Piltch-Loeb: No, I’m wishing everyone happy holidays, and please let me know if there’s any follow up questions from this conversation.

This concludes the December 13th press conference.

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