Coronavirus (COVID-19): Press Conference with Roger Shapiro, 05/06/20

You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Roger Shapiro, associate professor of immunology and infectious diseases. This call was recorded at 11:30 a.m. Eastern Time on Wednesday, May 6.

Previous press conferences are linked at the bottom of this transcript.


ROGER SHAPIRO: Hi, everyone. My name’s Roger Shapiro and I’m trained as an infectious disease physician, and I’ve also worked as an epidemiologist at CDC. My main research is in international HIV. But I teach a course on outbreak investigation and control at HSPH. And especially these days, I’ve been working clinically as an infectious disease physician at Beth Israel Deaconess Medical Center and I’m currently on the COVID-19 service. And I’m also helping with treatment guidelines for hospitalized patients and with the remdesivir treatment study. So I’m happy to talk about that or any aspect of this and including treatment and management.

MODERATOR:  Thank you, Dr. Shapiro. First question.

Q: Hi, Dr. Shapiro. Thanks for doing this call. I wonder, you mentioned the remdesivir trial. I wonder if you could give us your take on this drug. You know, there’s a lot of hope tied to it. And I’m wondering if you feel strongly that it’s, you know, that hope is warranted.

ROGER SHAPIRO: Sure, I’m happy to answer that. I do believe the hope is warranted. I think that remdesivir has really been our first proof of concept that we can do something about this virus. And I think that’s an important first step. We don’t know all the data yet. We haven’t seen the full extent of the data that was discussed from the NIH trial. But we do know that a DSM V for that trial reviewed the data and you know, released the fact that it has a 30 percent improvement in length of hospital stay from 15 days to 11 days. And that was highly significant. So that’s really good evidence that this antiviral can make a difference. We don’t know how much of a difference it will make for every patient, but I do believe that that has moved the standard of care forward for treating this disease.

Q: Can you share any personal observations during during your part of the trial?

ROGER SHAPIRO: Sure. I’ve been working to help consent patients today to the part of the trial that’s now open, open label so that all patients are getting active drug. And we’re still doing that. It’s right now the only way we’re getting remdesivir to patients until the U.S. government supplies arrive at hospitals, which we hope will be soon. So right now, we’re still giving the drugs, but all but all patients get active drug. And, you know, we don’t want to give anecdotes in medicine, but, you know, every time I give the drug, I am really hopeful that this will help make a difference.

And I do believe that we’ve seen some instances where it seems to be working. I mean, all of that is in line with what’s been released from the trial, which is that there was evidence that that it made a difference and significantly so. So I think some of our early anecdotes are now being proven out by the data, but we are still waiting for more data to see exactly who is the right population for this drug and when the right time to give the drug may be.

Q: And do you have any sense, just ask one more, as to whether this drug is sort of showing the path ahead to attack this thing? Is it possible that other drugs with similar molecular composition could also prove promising?

ROGER SHAPIRO: Yes. As I said, I think it’s a proof of concept and a first step. And and this is an I.V. drug. We really would love a by mouth drug, if we had pills. You know, there are drugs that can be or formulated oraly that are in the works, in the pipeline, that are either in development or early trials. So we’re hoping that similar drugs will eventually be available that are orals so that we can get those out to the community. And, you know, with the idea of preventing people from needing to be hospitalized. Right now, remdesivir is largely being used in hospitalized, pretty severely sick patients. And so we hope that we’ll be moving that, you know, to getting drugs to people earlier in the disease. So I do think it’s a first step. And I and I I’m hopeful that, you know, we will continue to get better and better drugs for this virus.

Q: Great. Thank you very much.

MODERATOR: Next question.

Q:  Hi. Hi, doctor. So I have two questions. The first one is since the end of April, so nearly half of the states have relaxed their restrictions and partly reopened like some essential industries. But after 10 days or so, this reopening, the data is not so optimistic. And the pandemic of the whole country seems still not past. So how did you evaluate the reopening, which is perhaps – or do you think for some states they should stop and turn back or maybe in some days later?

ROGER SHAPIRO: Yes, I think I think reopening is very tricky, and I think that it really depends on having adequate testing and adequate trace backs and the ability to control any uptick that occurs from reopening. So until we have the adequate tests out and available and traceback capacity, you know, I think reopening is a bit of a risky business. And I think each state we’re seeing, you know, epidemics that are staggered across different states. Some states are coming down, but others are plateaued and others are going up.

And I really do think that it’s difficult because, you know, these just because we have lines drawn on a map for states doesn’t necessarily mean that the virus respects those lines. And so we are at risk for having or changing our epidemic as different states have different policies. So an element of coordination would certainly be welcome. And and also, you know, having adequacy of testing and traceback and making sure that hospitals are ahead of the curve and and are not overwhelmed is a critical piece of the reopening decision.

Q: OK, so the second question is about two models recently published. So why is the Johns Hopkins University models showing that the deaths could reach 3000 per day by June 1, and the other is the University of Washington analysis showing that the U.S. death toll could reach 135,000 by the beginning of August. So, President Trump has said these two models were wrong. So how do you come out on this?

ROGER SHAPIRO: Well, it’s hard to comment on models, but we do know that we have 71,000 deaths in the United States right now and that is too many. And it is a huge number. And a month ago, I think we would have had difficulty even imagining that number. So I don’t think it’s easy to predict right now when we will get a flattening. One one thing that is true is that in Massachusetts, we are starting to see a decline in the number of deaths per day. And that’s really encouraging.

That’s not true in every state, of course, because every epidemic is different as we were talking about before. But right now, the number of deaths per day is declining in Massachusetts. And that’s encouraging. But, you know, but that doesn’t mean they’ve gone to zero by any means. And the plateau of this epidemic has been very frustrating. It has not, you know, kind of turned off like a spigot. It has really continued to stay pretty active. There’ve been active cases. And I think it’s really hard to predict where deaths are going to go until we can get to the point where we can really see no more cases and no more deaths everywhere.

Q: Thank you.

MODERATOR: Next question came to my email. Contact tracing apps don’t take into account several factors that are vital to understanding how coronavirus spreads and who also profit positively diagnosed person may have infected. Yet a lot of governments and tech companies are actively pouring resources into them. How big of a role do you believe contact tracing apps play in our fight against this pandemic?

ROGER SHAPIRO: Thanks. I think that contact using apps may complement human contact tracing and in many ways, you know, add to efficiency of human contact tracing, but they don’t replace all the things that you can do with just people calling contacts and reaching out. Because there are so many things that go into a call like that and to helping someone understand the nature of the contact and what they should do about it and what they should do if they become ill, that, you know, these contact tracing calls actually are not, you know, just a minute or two. They can actually be sort of complicated calls that health departments are doing. And, you know, and I think what we need to do is train an army of volunteer contact tracers that are willing to make those calls and put in the time to do it well. I do believe that technology can augment that and that the two can work in parallel and hopefully in a way that is a symbiotic and additive manner.

MODERATOR: One more question. Contact tracing itself is a complicated, long process that demands a lot of on the ground manual investigation like you just indicated. Do you find contact tracing apps to be misleading terms since they are largely just proximity notifiers?

ROGER SHAPIRO: Sure. I think I think it’s important to distinguish a single technological app from a human contact tracing event because because they are different but I think they can complement each other and be part of the same process. And so they can all fall under the same overall heading with the distinction being a subdivision.

MODERATOR: Great. Thank you. Next question.

Q: Hi, thanks for taking the call. I’m working on a story about influenza and COVID readiness in the fall. And I was wondering if you might have some insight into the flu vaccine production of that, when it should be administered, how it can be distributed in the of COVID also being ongoing at the same time. And if you have any thoughts on kind of the health systems readiness for a dual pandemic.

ROGER SHAPIRO: Sure, I know there’s been a lot of concern about the fall, and I think appropriately so because, you know, just having two diseases to deal with rather than one is going to be a challenge. Having worked in the hospital recently, I can tell you the two diseases are very different and they’re easy to distinguish in the hospitalized patients because flu does not behave like COVID for the very sick hospitalized patients. We’re seeing a very different pattern. And so that’s one aspect.

In terms of the overall epidemiology, my understanding – and I don’t have any actual insider knowledge on this, but I would expect that we would have flu vaccine for the fall just like every year, and that we would want to get that out there to make sure we minimize the impact of flu, you know, next next fall and winter to the extent possible. We want that every year. But this coming year may be particularly important. How much that impacts hospital beds and an overall ability to handle things? It’s hard to say. What we’re seeing is a very, very high number of ventilated ICU patients with COVID. And fortunately, we don’t see that in flu, you know, to any degree like we’re seeing with COVID. So my hope is that hospitals will be able to manage both diseases.

Q: Could you talk a little bit about the importance of diagnostics in hospital settings since that’s kind of what you’re discussing? Let’s say you have a patient coming in with a fever and you don’t know if they’re presenting with flu or COVID. What what resources are going to be needed in terms of PPE? And then also rapid diagnostic tests for both flu and COVID?

ROGER SHAPIRO: Sure, right now, we’re not worried about flu because it’s no longer flu season and we’re basically just testing for COVID. When flu season reoccurs, we will almost certainly test for both I would imagine. And in terms of COVID, it will overwhelming and it will kind of trump the flu in terms of needing PPE and needing the appropriate – if you suspect COVID, you’re going to do full PPE. And so that would take care of whatever you needed to protect yourself from flu, you know, because it’s more it’s more than what we normally would do with flu. So I think I think that when the fall comes, we will probably add back that the flu to the diagnostic algorithm, although it’s currently not in there. Some schools may still be testing for flu, but we are not because we’re not seeing it here in Massachusetts.

Q: Yeah, I was more speaking of in the fall when it comes back, but thank you.

MODERATOR: Alright, next question.

Q: I wanted to ask about. Seems like there’s been some more studies showing that coronavirus spreads less outside. You’re less likely to get it if you’re outside as opposed to indoors. I’m wondering if you think that’s right. And does that have implications for – does that mean it’s relatively low risk for the average person to go to the park or go to the beach? I mean, should those places be open? Is it better to be encouraging people to be outside in those places as opposed to indoors?

ROGER SHAPIRO: Difficult question to answer, but the first part is easier. Yes, it definitely spreads more indoors than outdoors and outdoors. The virus droplets dispersed so rapidly and in the wind that they become a non-factor. If you’re not really very close to someone outdoors, you know, let’s say within 6 feet. People have said, you know, if you’re running, you know, in maybe a bigger distance that we want to keep between each other. But indoors, I think everyone is seeing those sneeze videos by now and the circulating virus that you can see that just continues to circulate in an indoor air space.

So I do believe that there’s a difference in risk between indoor and outdoor settings. But I think when you think about re-opening outdoor settings, we all want that and we are tempted to want to push for that. We have to also remember that to get to those outdoor settings you’re driving and you may fill up with gas and you may be outdoors interacting, you may be interacting in other ways besides just being, you know, all of a sudden magically on a beach that’s isolated. And I think that some of the factors that go into opening places also have to do with the workers that have to be available to keep those places open and keeping everybody safe. So I think there is a balance between trying to open public spaces, but keeping everyone safe when we do so.

Q: Thanks.

MODERATOR: Next question.

Q: Hi. Thank you for doing this. I’m looking for some clarification on the antibody tests. It seems at first that id’ing people who had the virus, was going to be real key to reopening plans. And now we’re hearing that maybe having had an infection doesn’t necessarily grant immunity going forward. Can you sort of bring us up to speed on what we know about immunity with COVID-19?

ROGER SHAPIRO: Sure. Thanks. That’s a great question. I think the problem is that we’re still waiting for some of the studies to come out that really tell us for sure that when you’ve had the virus and mounted an antibody to it, that you are protected. And we can only do that when we get the data from actual studies that show that. And so that hesitation people have had or the qualification people have made has been we don’t know yet whether having the virus will protect us and for how long. And the general feeling is that there’s a lot of optimism that it will be the case.

We know that with SARS and MERS, there was sterilizing immunity for years, months to years. And so we are hopeful that COVID-19 will be the same and that the SARS-2 virus will also behave in a similar manner. And that would be you know, that would be what we would expect for most viruses like this. Now, we also know that this virus’ cousin, the common cold. Is is a little more tricky because we do get the common cold over and over again, although not in the same season. So immunity can be shorter for some viruses that are able to vary there immunogenicity and infect us, you know, from one season to the next now.

So we hope that that’s where some of the hesitation comes. You know, where will COVID-19 fit in that spectrum? And we hope it’ll be more like the viruses that give years of immunity and less like the viruses that give maybe months of immunity. But we certainly do expect that some period of immunity will occur because that occurs for virtually all viruses that we know of. And I think we will know more as we get serology results that are linked to actual clinical results and any evidence of true well-conducted studies of patients who have recovered and how they have fared after they recovered.

Q: OK. Wonderful.

Q: I have a second question. I was hoping you could also sort of clear up maybe a little bit of exercise etiquette outside with running and biking and walking. Do you need a facemask, do you not need a facemask? You mentioned maybe giving a little more space than six feet if you’re outside. Can you sort of clarify that? I know it’s a big topic of concern.

ROGER SHAPIRO: Well, remember, the first point, which I think most people have now come to understand, is that face masks are not about protecting you. They are about protecting the people around you. When we’re talking about surgical face masks or coverings and not N-95 respirators, which hospital personnel use to protect themselves. So an outdoor face mask is used to protect your community. And so, you know, a lesson I’m trying to tell my teenagers is it’s about, you know, trying to do the right thing, set the right example and, you know, make a statement that you’re trying to do your part to protect others just in case you may have the virus.

I think, you know, we’ve heard a lot about the six feet distancing and then we’ve heard that it may be more than six feet if you’re running. And all of that may be true. It’s very hard to do proper epidemiologic studies that prove that. But my overall take would be that it’s a good idea to kind of do your part and try to wear the face mask even when you’re running and when it’s uncomfortable. When I run, I started to wear face mask. And, you know, and therefore, I least won’t get dirty looks from my neighbors.

Q: Thank you.

MODERATOR: Next question.

Q: And my question is regarding contact tracing, I understand like you said, it’s gonna be necessary to hire an army of these people. And I’m wondering, how many contact tracers do you think we’ll need to hire nationwide to actually effectively slow the spread of the virus? And my second question is, are these suitable positions for those workers who have recently joined the ranks of the unemployed? Could this help offset some of the job losses we’re seeing or are these really, are these positions that are really only suitable for those folks with public health backgrounds?

ROGER SHAPIRO: I’ll take the second part first, because I really don’t think I can answer the first question in terms of an absolute number, except to say a lot for the first part. The second, I do think that it’s a fantastic job for people who’ve been furloughed. And it’s something that people can be trained to do. And I don’t think – it takes some training but it’s not impossible to train almost anybody who has reasonable social skills and can work off a script and then, you know, begin a conversation with people, you know, and convey a few key minute messages and maybe collect a little bit of data. So I’m really proud of my colleagues at Partners in Health who in Massachusetts have really spearheaded this effort and are hiring people to people to do this. And it’s wonderful to have a growth industry right now, given the state of our economy.

Q: That’s great.

MODERATOR: Do you have any other questions?

Q: So are these efforts almost all led by local health department, city and state health departments, or is there a more broad effort or even private efforts to to hire contact tracing armies?

ROGER SHAPIRO: Well, any private effort would have to be done in coordination with city and state health authorities. For example, Partners in Health is partnering with the state of Massachusetts because it’s critical to get any numbers, you know, back to the proper agencies so that cases can be tracked and tallied and we can track, you know, follow the epidemic in that manner. So it definitely has to be done in a coordinated manner.

Q: Thank you.

MODERATOR: Next question.

Q: Hi. Thanks. I wanted to ask about nursing homes and a lot of these plans to open up states. They talk about, you know, we need to continue to protect and maybe continue to isolate the elderly until even the later stages or later phases of the opening plans. But how do you protect these, you know, elderly people, nursing homes, which are known as particular hotspots?

ROGER SHAPIRO:  Nursing homes are a real challenge and they are clearly a place where we get places that are driving the mortality in this country. I think that testing is the critical piece for nursing homes, testing all residents and then testing all staff. And we’ve got two types of testing now as we’ve now got serology. We can bring that into the mix going forward. So we know that the PCR tests that we’ve had can tell us if someone’s immediately infectious. But it doesn’t work great for asymptomatic individuals, although we are starting to use it now more on asymptomatic individuals as we ramped up that testing.

So you can tell, you know, if somebody may be immediately infectious with a PCR test and testing workers in the nursing homes is critical for that because this disease is going to get into nursing homes from visitors and from staff. And, you know, we need to limit visitors, unfortunately, and then we need to test staff. And so obviously, part of the testing is symptomatic screening, testing for fevers and asking about symptoms. The other part is going to be regular PCR testing. And then eventually we may be able to bring some serologic testing into the mix. If somebody is proven to be seropositive for COVID, has already had it and recovered, the hope is that we again, as we talked about earlier, the hope is that this will provide immunity to that worker, and that would be an ideal worker to be working with patients because they should not be able to spread COVID to patients.

Again still some unknowns there. But that is the hope that we can use this combination of testing between PCR and serology to keep the staff, make sure that the staff are safe. And, of course, you know, once there is a, you know – we have to get past this initial wave of infected patients and spread and contain the spread that we’re seeing in this first wave.

Q: So it sounds like so, you know, as you just said, we’re going to have to get past this initial wave. So it sort of sounds like this is not going to be something that happens anytime soon. Is that is that true?

ROGER SHAPIRO: It’s not you know – we have to get past the first wave because right now transmission can occur from patient to patient to patient. And so once we get past that and we get all the patients, you know, negative and we have you know, we get to a point where we can take a breath and say there are no active cases in this nursing home, that’s when we can really effectively try to control the the situation going forward. But until we get past that first wave of cases, it’s really difficult.

Q: I mean, how do we get past that first wave then? I mean, are we – is there enough testing going on? Is there enough prevention to to get to this point where we can take a breath?

ROGER SHAPIRO: I think we protect the patients who are negative and any patient, you know, who was negative, you know, needs to be really strictly isolated. And we need to protect those patients until until the sick patients can be quarantined, you know, hospitalized and taken care of. You know, and and appropriately quarantine. It’s a challenge.

MODERATOR: OK. Next question.

Q: Thank you. Thank you for being here. I just had a quick question about here in Boston. The city has yet to cancel the Fourth of July fireworks, although a decision on that may be coming at some point the coming days. Could you just speak to the risks associated with fireworks displays in general and big, especially big popular ones like the one that’s coming up in Boston in particular?

ROGER SHAPIRO: I think there are risks for any large gathering at this point. It really you know – I’m not saying there might not be a way to make it happen safely, you know, and manage the social distancing. But if you think about the way to fireworks event has occurred in Boston in years past, that certainly can’t occur this year. I don’t think anyone expects that to occur by July 4th. So whatever fireworks display happens in Boston will certainly have to be socially distanced and managed in the way we’re managing all of our public events. And that may include, you know, no crowds at all, but just fireworks and watching them from a distance.

Q: So this this idea, though, of having something spectacular up in the sky seems like it might necessarily bring people out, even if you were to close the Esplanade or some other area that people tend to congregate for the fireworks. You can still only see them from so many areas. That must be part of the calculation as well.

ROGER SHAPIRO:  I’m sure the city will be making those calculations and determining whether it’s too tempting and whether it will create excess risk. I don’t feel like I’m in a position to comment on that.

MODERATOR: Next question.

Q: A question which is a bit far away from the topic we are discussing now. It’s a question about the controversial debate on the decision making timeline of the World Health Organization. As you know, there was an international debate whether or not the W.H.O. took a decision fast enough to help the international community to counter the spread of the virus. So you said, as far as I understood, you said that these coronaviruses are basically following the same transmission or contagion paths than the previous SARS epidemics. So your opinion why since the genome, the genetic sequence of the novel coronavirus was available by January 15, so it was quite intriguing that the transmission would be at least as high or close to the first SARS epidemic. So why then did the World Health Organization take at least a couple of weeks to decide that the virus was actually transmitted between humans? Is it really lack of information, scientific information? Or was it insufficient due to some political issues?

ROGER SHAPIRO: You’ve packed a lot into that question and you’re digging into it feels like ancient history, even though I know it was just a few months ago. The genetic code was published on January 8th, around January 8th by China. And that was remarkably fast. And really China gets a lot of credit for making that sequence available so quickly. And I think that – I couldn’t quite follow your statement about that this was like SARS because this virus is not behaving like SARS epidemiologically. And I don’t think we knew that originally.

I think we didn’t know how this virus would behave until the genie was out of the bottle and you know, this virus has found a sweet spot. If you’re a virus, it’s a sweet spot. If you’re a human, it’s a very bad spot because it’s found this niche that’s more severe than the common cold and can lead to fatality especially in elderly and patients with co-morbidities, yet it’s very transmissible. And we know that the R0 of this virus, the transmissibility of this virus, has been very high, over 2 in many circumstances, perhaps up to 3. And you know that’s been impacted by our efforts to seek to isolate and and lock down cities.

But we know that this virus has the potential to spread very rapidly, and that it can spread prior to causing symptoms in a substantial number of people. Maybe up to 40 percent of the transmission may occur when people are not aware that they have the virus. And so that’s different than what SARS and MERS – than the behavior of SARS and MERS and has made it really difficult to stop the spread of this globally. So it’s you know, it’s something we’ve learned over the fallout over a few months as this has, you know, traveled around the world. I really can’t comment on the timing of the W.H.O.’s activities. I think at this point, I think every everyone was doing their best at the time to to address this as information became known. And it’s really hard for me to think back two months ago about what, you know, what was happening day to day on this, because I feel like we’ve really moved past this at this point and are  really you know, we’re facing a world with, you know, three million plus COVID-19 cases.

Q: Well, you said you cannot comment. As you said, these viruses are highly transmissible. So since the genetic code was available by January 8 and they found out the genetic code is very, very close with the first SARS virus. So at least they could have guessed that the novel coronavirus should be highly transmissible. But it just declared that by the end of January that there was a sustained human to human transmission. So I don’t understand this gap.

ROGER SHAPIRO: Well, I don’t think you can look at a genetic code and guess how a virus is going to behave. I wish we could, but we can’t. And again, I really don’t feel like it’s appropriate to go back to January and I can’t remember every aspect of, you know, of  what the W.H.O., of how the W.H.O. responded on a day to day basis in January. But clearly by February, everyone was in, you know, complete, you know, in a mode where we were, you know, doing everything we possibly could. So I think that it would it would be wonderful if we could look at a genetic code and know what the epidemic potential of the virus is. But we just can’t.

Q: OK. Thanks.

MODERATOR: Really quickly, I have an e-mail question, and you got into this a little bit earlier. Does a dominant role of close contact droplets and infection argue for moving business contact outside and reopening? For example, like if Georgia reopens, should people get a haircut on the sidewalk rather than inside? Should they start allowing sidewalk kiosks for restaurant takeout and pickup rather than walking into a building to pick it up? Should we allow drive in theaters rather than multiplexes?

ROGER SHAPIRO:  I think all of those ideas may help. I think that being outside is safer than being in a closed space indoors. So I would certainly support any kind of outdoor movement to outdoor activities to lessen the risk of transmission.

MODERATOR: And what scientific questions do we need answered to give this kind of advice, perhaps some sort of viral particle threshold for infection or more aerodynamics of dispersion studies? Is there anything that you think people should know before they have things inside or outside?

ROGER SHAPIRO: Well, you know, viral studies are hard to do because we can’t do human experiments where we give certain amounts of virus and expose them and see if they become sick because this is too severe a disease to come to contemplate doing that. So we’re left with having to do epidemiologic studies and and trying to understand as people become infected who have only very limited risk factors, for example, and they say they’ve been totally isolated but the only thing they did was, you know, receive their groceries on their doorstep.

And if we start to piece together, you know where risk may or may not occur, then I think we’ll learn more. So if we find that, you know, all the people who are worried that that their groceries are bringing the COVID in but in fact, if we find no cases from that, once we can isolate enough patients or people that had very few risk factors, for example, then perhaps we can start to get an estimate of how risky our daily activities may be. But it’s such early days now that I don’t think we have a sense of where all the transmission is occurring in the community.

MODERATOR: OK, great. Thank you. Another question.

Q: So I have two more questions as there is still time left. So some experts said if they can’t get access to a vaccine for one or two years, you have to accept the actual new normal. And so your opinion, how do you describe the new normal in that situation? How can we channel our limited resources into some essential places or areas?

ROGER SHAPIRO: I think there’s a lot of people who have tried to describe the new normal. It’s certainly not going to be the old normal. It will still require social distancing and the highest risk activities are probably not going to come back for a while. So large crowds at sporting events and similar situations are unlikely to return until we can make those safer. You know, everybody hopes that we can find novel ways to do as much as we can to return to normal behavior. And I think the last question about, you know, moving things outdoors and trying to trying to find novel ways to open businesses will be really welcome as we bit by bit try to safely open up economies.

Q: OK, so next question, because in terms of reopening the economy, many people are talking about gating criteria to loosen the restrictions. What is the trigger of restricting again after reopening? Because I think we should come to a consensus on this issue, too. It’s very important.

ROGER SHAPIRO: Well, part of the trigger will be looking at hospitalizations and our capacity to keep up in the hospitals. Another part will be and hopefully before that, we will have test results and our ability to trace those test results. And if we start to see that we are not staying on top of the new cases and aren’t able to do contact tracing for those new cases and kind of keep a lid on things and that we’re seeing sort of unfettered community spread once again, then I think that’s when those decisions will have to be made.

Q: Thank you.

MODERATOR: Next question.

Q: Hey, thanks. This is sort of a very state specific question, but I’m wondering if you can speak to how Florida has dodged a bullet here and that, you know, that they’re the third most populated state, but they were really slow to institute, you know, social distancing requirements and business closures. So how did they end up with such a lower number of cases compared with New York and California?

ROGER SHAPIRO: It’s a great question. Hard to answer. Maybe the way to answer this question is to make make it a little more general, which is that why do we see different epidemic patterns in different parts of the world?

And, you know, I think part of that has to do with testing and tracing and getting an early start and a head start on that and making sure it’s not in the community and running amuck, you know, without any control on it. So as you’re suggesting, maybe Florida didn’t do that, but maybe it had some other advantages in other ways that we’re still learning about. We have talked a lot about geography and weather and whether or not warmer weather may impact this epidemic. You’ve probably all heard that most experts think it may affect it a little bit, but it’s not likely to really end this because we are clearly seeing epidemics in warm places.

The virus does like cold, dry climates. It certainly does well in those climates and survives better. But that’s not to say that when we get to warm weather or looking at Florida, which is already warm, that they’re entirely safe. But there there could be some advantage in some areas because of geography and weather. Demographics is another part. But in that case, I would think Florida would be of concern. You know, we know that the older population is so much more affected in terms of severe disease and needing hospitalization. That, you know, places with younger populations may be having you know – maybe we’re seeing subclinical, mild, asymptomatic disease in those places that it’s going under the radar and that’s in part accounting for low numbers in some areas with very young populations.

And I think about Africa in that regard where we have not seen a huge epidemic yet. Hopefully it will remain that way. But also it’s the youngest continent as well. So that may play a role, but hard to – certainly head scratching when you think about Florida in that respect. And then, you know, other aspects are just luck. It hasn’t gotten to some places yet, but may still be on its way there. And so, you know, as this makes its way to different parts of the world, you know, places that have so far dodged a bullet may not be that lucky going forward.

Q: So we shouldn’t necessarily say that Florida has been a success story yet. You just sort of wait and see, I guess?


Q: And is this going to be – would you still say this is part of the the first wave or, you know, can we say at this point we should look for Florida on the second wave come the fall?

ROGER SHAPIRO: I don’t think we know but I think that the virus is still on the move and it can still travel to new places in the world, and it may still be finding inroads into some of the states and some of the countries that are so far less affected. And that’s why we need to test massively and do tracebacks because without testing, we’re flying blind and we need to – if we are testing, testing, testing, then we can see where it’s emerging and where this virus is headed and without testing it’s like driving a car blind.

Q: Great. Thanks.

MODERATOR: I think we may have had our last question. OK. Thank you, Dr. Shapiro.

ROGER SHAPIRO: Nicole, I want to make one comment also. I want to just say that the attitudes in the hospital right now, everyone is working together. They’re working incredibly hard. And there is a real shared sense of mission and incredibly positive attitudes despite very difficult circumstances among the staff. So really, the stories you’re hearing about, you know, nurses being our heroes really ring true to me.

This concludes the May 6 press conference.

Phyllis Kanki, the Mary Woodward Lasker Professor of Health Sciences in the Department of Immunology and Infectious Diseases (May 5, 2020)

Michael Mina, assistant professor of epidemiology (May 4, 2020)

Aaron Bernstein, interim director of the Center for Climate, Health, and the Global Environment (Harvard C-CHANGE), a pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School (May 1, 2020)