Coronavirus (COVID-19): Press Conference with Roger Shapiro, 06/17/20


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 am Eastern Time on Wednesday, June 17.

Transcript

MODERATOR: Dr. Shapiro, do you have any opening remarks?

ROGER SHAPIRO: Yes, hi. Good morning. I’ll make a few opening remarks and then open it for questions. So the good news this week has been the release of a statement from researchers in the UK for a trial called recovery. This study randomized patients to receive either placebo or dexamethasone, which is a common steroid that’s available at every hospital. The results show the first evidence for mortality reduction in the COVID epidemic, with about one third reduction in mortality among mechanically ventilated patients and about 20 percent reduction in other patients who required oxygen. There was no benefit seen for patients with milder disease who did not require oxygen.

So we are awaiting the full results of the study and it needs to be peer reviewed. But these are really encouraging results. In less good news, we are still seeing high numbers of cases across the United States in over 20 states. There are still about 25,000 cases per day. And overall, the curve is at best level possibly increasing with concerning upward trends across the Sunbelt. We’re also learning more and more about this virus. And it’s now clear that simple social distancing measures that include universal mask use can dramatically decrease transmission in our communities. And these measures will be needed to drive the number of cases downward. So I’m happy to answer any questions. Thanks.

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

Q: Hey, thanks for doing this. I want to get your opinion on schools. A lot of governors in the last couple of days have announced their intention on putting kids back in the classroom in August or September. What are your thoughts on that at the moment in terms of risks versus, I guess, risk versus reward?

ROGER SHAPIRO: Thanks. It’s an important question right now. It’s a hard one to answer because it’s all new and we took everyone out of schools in March and now the idea of bringing them back has a number of unknowns associated with it. So one of, you know, some of the unknowns include how much transmission is occurring in kids. So it may really vary between younger kids and older kids. So, you know, kindergarten is very different and senior in high school and the way we try to protect schools and mitigate risk is probably quite different across the board. And that’s not even to mention universities and how we deal with opening up places where there’s dormitories.

But I’m very optimistic that we can open schools in the fall safely. And I think it just needs to be done using the most proven strategies that we have. And I really say that word proven carefully because I don’t think we should be sort of making up rules that just seem good or sound good, I think we should be doing things that really are known to work. And right now we know that masks work and that staying socially distance with about six feet perimeter is probably probably our two best tools to keep things safe as we open up.

So I do think that if we were to try to enforce mask use universally for the older children who are able to wear masks, I think that would go a long way towards making schools safer. And I think that it’s important for us to really think hard about about trying to open up as much as we can. At the same time, we’re going to be watching things closely, testing and, you know, making sure that if things don’t go the right way, you know, we could readjust.

Q: Can I just follow up on that real quick? What about with the younger kids wear mask wearing and social distancing, you know, if you’re a first grader, second grader is a lot harder. What are some of your thoughts on those grades?

ROGER SHAPIRO: Well, I think it’s tricky because, you know, first of all, we think that transmission is less in that group of kids. And and we know that transmission is going to be a factor of how much COVID is in the community overall. So we have to play that, you know, the sort of risk, the overall risk into the model that you choose. But I think, you know, certainly making classrooms that are less dense, you know, so limiting the number, maybe going to alternate days, things like that – these are some of the plans that have been put on the table – makes sense for the younger kids.

And I hope that we don’t have to employ those kind of plans are quite as aggressively for the older kids who can wear masks and can control their distancing a bit. The other thing I want to say is that to the extent that school can be outside, that would be a fantastic idea because we think that everything we do outside is a lot safer than everything we do inside.

Q: OK. Thank you.

MODERATOR: Next question.

Q: Good morning. Thank you for doing this. I would like you to comment on contact tracing, which, if not all, most of the states are engaged in right now, and some of the issues that have come up or the the need to say that it’s voluntary when they’re calling people and asking them to get tested or quarantine. There’s been some pushback on that. So it kind of raises the issue of what, you know, should any of this be enforced or should it always just be voluntary?

ROGER SHAPIRO: Well, the voluntary versus enforced is it is a tricky question from a public health standpoint, and there are you know, there are situations in which public health officials can enforce actions. But I’d like to believe that a lot can be done in a voluntary manner because I believe that people want to do the right thing and will generally do the right thing. So if someone is called and said they have a close contact identified with COVID and they should self isolate, I think most people are going to do that.

And I think, you know, trying to enforce it is a matter of, to some degree, you know, how much transmission is occurring in the communities, how far ahead we are on getting to a containment stage or getting back to a containment stage where every single transmission we are now trying to isolate and lock down contacts. You know, as we can get back to that stage in the places where the curve has really come down, then I think it’s really even more important to try to make sure that those things happen, you know. But I do think it’s a decision that’s a political one and and a public health one to go to a mandatory enforcement of that. And so I’d really just leave it as I really hope that people will do it voluntarily. And I think most people will. And it should be and it should be something that, you know, contact tracing is something that is really important.

Q: I could ask a quick follow up to that. When it’s not clear to me if when the contact tracers are doing the nine, the circle of nine people that the infected person has come into contact with, are they then asking the nine people to get tested? Because it seems sort of a practical issue before you ask somebody to quarantine or self-isolate, you’d want to confirm that they actually have it.

ROGER SHAPIRO: Yes. And in the current situation where the testing has become much more available than earlier in the epidemic, I think it just makes sense to test close contacts, even those who are not showing symptoms. But that’s going to vary sort of by locality. And the most important thing is that they’re aware that they’re a contact and they’re isolating. But I think that testing and contact tracing go hand-in-hand.

Q: Thank you.

MODERATOR: Next question.

Q: So I have two questions are kind of unrelated. So I’ll just ask the first one. We in Miami have a lot of health care facilities. We’ve not heard a lot about outbreaks at these health care facilities among staff. The general feeling is that infection control is working pretty well despite us having a consistent volume of COVID patients in the 550 to 650 range really since the beginning of April. But there was an issue at the local V.A. recently where 20 employees tested positive after they tested about 200. And there’s some suspicion that there was transmission between staff and patients who were hospitalized not with COVID. So I guess I just was curious to get your general thoughts on how infection control has played out in U.S. hospitals? Because I know that was an issue in both China and Italy, and it doesn’t seem to have been as big of an issue here in the U.S. so far. But I guess I could be mistaken. So that’s the first question I have.

ROGER SHAPIRO: Sure. We had some warning in the United States after the outbreaks in China and Italy, and that helped us prepare our health care providers to a certain extent. It wasn’t perfect. And there were transmissions that were occurring early on in the epidemic, especially. What has happened more recently is transmission in most hospitals has really been driven down to nearly zero. And I think that’s because we’ve addressed this in a smart manner by enforcing universal mask use among staff at the hospitals and eye shields and masks and also precautions for virtually all patients that come into the hospital, not just those who are thought to have COVID.

I’ve seen in Boston a dramatic decrease in the number of employee related or health care related cases as soon as the universal mask use at the hospitals went into effect, I really believe that that’s what made the difference and ended transmission, both between employees and themselves, employees and other employees and also employee to patient transmission. So we really think we know what to do now with the right PPE and universal mask use. And I feel really confident that the hospitals can be made safe.

Q: Thank you. And my other question, which is unrelated to this is about treatments of patients who have COVID-19 but have mild symptoms. It’s just something that we haven’t heard a lot about. I spoke to a local physician here who is going to start enrolling people in a clinical trial next week. But he said, you know, he’s anticipating it’s going to be kind of challenging example from people who tested PCR positive within the last seven days. So I guess I just want to get your general thoughts on what you’re seeing in this area as far as clinical treatment for mild symptoms. I mean, this physician said right now there’s really nothing we can do for someone with mild symptoms, although there’s various anecdotal things floating around out there on vitamin D and other things. But I’m just curious to get your thoughts on where we are right now with treating mild cases of COVID, and if you expect that there will be more treatments available on it in the future for those mild cases.

ROGER SHAPIRO: Sure. I’ll start by saying that there are three categories of transmission that are really concerning, and those are the asymptomatic, the pre-symptomatic and the mild cases. And I think we’ve heard a lot about, you know, the likelihood of transmission in these three groups. But these are all groups that may be transmitting but don’t know they have it. So the mild cases are part of that and are of concern.

Now in terms of treating mild disease, there really has not been a lot out yet in the scientific literature because so much of the effort has appropriately gone towards the most severe cases first. I believe that, you know, if we were to try using antivirals like remdesivir, they would very likely have an impact in mild disease as well. And there are more data coming out from these early trials. But right now, we just know more about severe cases than mild cases. There are potentially other drugs that, you know, there’s an oral antiviral called favipiravir, which is going to be tested for mild disease. But we don’t have data for that yet. And so overall, I think it’s a bit of a waiting game to know how to whether we can shorten up the duration of illness from mild disease as we have proven we can do for severe disease.

Q: Thanks so much. I appreciate it.

MODERATOR: Next question.

Q: So I’m working on a recap piece on what we know we don’t know about the virus so far, especially looking at the last hundred days. So you’ve mentioned mask use earlier as one the best tools we have so far. But I’m curious what you think is the most important thing that we’ve learned so far about the virus or about mitigation.

ROGER SHAPIRO: This week the news is that steroids can help the most severe cases, and I think that’s important news. This is the first evidence we have that we can make a difference in mortality. And it really fits with what many of us have seen when treating patients with COVID. What we’ve seen is this very, very inflammatory state, more so than other viruses that we’ve encountered. And it makes a lot of intuitive sense that steroids are going to impact the course of disease. And we now have evidence that, in fact, that is the case.

So that’s really big news for this week in particular, but it’s big news in general for the whole epidemic right now. And I think that the fact that we’ve also identified remdesivir as an antiviral that has an impact is also really important because it shows that we can do something. It may not be the most perfect antiviral and it may not work perfectly, but when do we start to think about ways to combine the things that we now know work, so antivirals like remdesivir, with steroids for the more severe cases, et cetera, we will start to really make a difference in mortality. And that makes this disease a lot easier to manage. It makes our ICUs less overwhelmed. And most importantly, it reduces deaths. And when we have effective treatment, it also means we can think harder about how we can open up safely and get our economy going and get our world restarted. So these treatment modalities, I think, are really the most important thing so far.

At the same time, I am an epidemiologist and I’m a fan of the epidemiologic data that we are getting as well. And it’s harder to, it’s often harder to know what works in prevention because so many different things are going on. But as I’ve mentioned, the things that really work are social distancing and mask use. And I think mask use just can’t be stressed enough. If everyone wears masks, this epidemic will go down. And it’s very simple and not masks are not political, masks are public health. And we really need to approach masks with a scientific, in a scientific manner.

If you look at Japan, South Korea, China, which still has only 84,000 cases, even though they talk about an upsurge in Beijing, that’s a small number of cases, just over a hundred. And they’ve really gone into, you know, massive social distancing just for those hundred cases. If you look at – and they’re all wearing masks. If you look at how Japan has 17,000 cases. South Korea has 12 to 13,000 cases overall. Singapore, Taiwan. All of the countries that are wearing masks are not having the massive outbreaks that we’ve seen in the United States and Europe. And association is not causation, but these numbers are hard to ignore. And we really need to be looking to Asia for how to control this outbreak.

Q: And just to follow up on that, in terms of then what we don’t know about the virus yet, I guess, you know, you mentioned eye shields a little bit back talking about transmission. BDI has become a little more prominent lately. But I’m kind of curious what looks like the one thing that you kind of wish you knew at this point about the virus.

ROGER SHAPIRO: Well, there’s lots we still would like to know about the virus. We mainly want to know whether a vaccine is going to be effective and we’re making great progress towards that. So this summer they will have a phase three trial starting as early as July. And probably to other phase three trials in the following months. So we’re making progress on the vaccine front. But there’s no question that we need to understand and will understand whether we can achieve sterilizing immunity and that these vaccines will be effective.

I think we have more to learn on how to treat COVID, but as I mentioned before, we’ve made huge strides so far. So it is a lot better to be a hospitalized patient today than it was in March, because we do have some tools that we can apply and we’ve learned how to manage patients. We’ve learned now, as of this week, we learned we can give steroids. As of last month, we learned we could give remdesivir. We learned also last month that we should be proning patients and putting them in position and managing our ventilators in a way that works. So we’re in a much better position now, but we still have lots to learn.

And I’m sure that one day we will look back at June 2020 and say, oh, what were they doing back then? But as of now, I’m glad it’s June and not March for hospitalized patients and then, you know, finally, I think we really need to know whether or not herd immunity will ultimately play a part in this, you know, alongside the vaccine efforts, because those two things together are what will ultimately allow us to reopen.

Q: Thank you so much.

MODERATOR: Next question.

Q: So I actually cover sports and I’m working on a story about various college football programs trying to sort of dip their toes back in water here. One big issue is testing. Some experts I’ve talked to have said that they really advise testing every player, regardless of symptoms, at least once a week. Does that seem to make sense to you? Is it would that be a policy that you would advise?

ROGER SHAPIRO: Yeah, that makes sense to me. I think the more testing we do, the better. But we can’t test everybody every hour of the day, so we need to back away from, you know, the extreme version of testing to something that’s reasonable. But I do think that we have an obligation to protect our athletes. And, you know, the world wants sports and, you know, college sports, pro sports, we want all of it back. And I think frequent testing is a very small and easy thing that we can do to make it safer for the athletes.

Q: And then just what are your thoughts on the idea of allowing any fans to attend games, even distanced, reduced capacity, masks required?

ROGER SHAPIRO: I think outdoor games are safer than indoor arenas. So I would be very wary about indoor arenas, even with distanced seating. But I think it remains to be seen and it’s not an impossibility. For outdoor arenas with appropriate distancing and mask use, I can imagine a world where we have some limited fans in a stadium.

Q: That’s all I had. Thanks.

ROGER SHAPIRO: Sure.

MODERATOR: Next question.

Q: Hi. Thanks so much. I was so struck by your comments about hospitals. In Minnesota at least, and I think many other states, a lot of the problem has been in long term care. And I wonder if you had any thoughts about whether there are lessons from the hospitals that could apply to long term care, or is it just a different set of facts in long term care that that make the problem more difficult?

ROGER SHAPIRO: Thanks for the question. Over 40 percent of the deaths in this country have been at nursing homes or long-term care facilities, so there’s no question this is a massive problem. I do think they are different than hospitals in that long term care facilities are places more like an island and with less movement of people in and out. And we can do things to protect those long term care facilities by more tightly controlling who has access to coming in and out of the facilities. So clearly limiting guests and testing for testing at the door when it’s to the extent that that’s possible for but for those who have virus.

We know that, you know, looking for symptoms and fevers among workers is not enough because of the problem with those three groups that I mentioned, asymptomatic, pre symptomatic, so those are about to get sick, and mildly symptomatic who may not acknowledge that they have symptoms. And those three groups put long term care residents at risk if they’re in the facility and certainly if they’re caring for the residents.

So we need to be vigilant about the workers in those facilities and frequently test them, just like we’re talking about testing our athletes, frequently testing those high risk providers or those who are providing care to high risk patients and all visitors in those facilities. And we only do that and we can get facilities to be COVID free, we can keep them that way like like an island. And I think that is the strategy for managing those facilities and keeping people safe.

Q: A real quick follow up. I just don’t remember if there’s universal masking in long-term care in Minnesota and in other state. I don’t know if that’s something to explore.

ROGER SHAPIRO: I don’t know the answer to that. And it may vary from place to place. It makes a huge amount of sense to me that all staff in those facilities and all residents in those facilities should wear masks whenever they’re in any kind of common or public space. And certainly when they’re interacting with each other.

Q: OK. Thank you.

MODERATOR: Next question.

Q: Thank you. I wanted to ask I’m in terms of that optimism that you just spoke of, you know what we’ve learned, proning, remdesivir, other treatment conditions, are the numbers now reflecting any of that? Is there data to suggest that death rates are going down because of that care? That’s one question I had. And then I wanted to ask you about what we might be learning about the underlying genetics that impact the course of the disease, in particular terms in terms of the immune response. And, you know, possibly if we know anything about, you know, why some people get the very severe lung viral take over.

ROGER SHAPIRO: Sure. So for the first question, we are just starting to see an inkling of what you’re suggesting, which is that death rates are still go are actually going down in hospitals right now. And yet over the last 14 days, we’ve seen cases in the country either stable or slightly up ticking. So that is an association or those two facts suggests one of two things. Either we are getting better at keeping people alive. And that may be part of it.

The other possibility is that the people getting infected right now are less likely to die. So maybe younger people or healthier people are now representing the uptick that we’re seeing in the Sunbelt or and in over 20 states. And if that’s the case, then we may not see a mortality correlation to that. And also, finally, the mortality correlation follows several weeks from the risk of transmission. We know that most people who die die many weeks into their illness. And so we have to watch this closely. Right now, we’re still seeing a downward trend in mortality, and that’s fantastic. But we need to watch that closely.

Now, your second question about genetic factors or other comorbidities, these are associations that we’re learning more about all the time, and we just don’t know enough yet about how to use that data to manage cases or to improve outcomes. We know that people with diabetes and hypertension and heart disease are at much higher risk for severe COVID. We don’t entirely know why. We’re starting to get some inkling about that. But we’re learning more. Right now, we just know that they’re at high risk and we’re treating them accordingly and watching them closely because of that. Associations like the fact that people with certain blood types, type A blood, have a higher likelihood of severe disease, these are harder to understand right now, and I think it will take us years to fully unravel everything that’s going on with this really complicated illness.

Q: Thank you.

ROGER SHAPIRO: Sure.

MODERATOR: All right. Next question.

Q: Hi there. Thanks for taking the question. I just wanted to talk a little bit about protests and what impact, if any, they had had on spreading the virus. Are there meaningful data points that you’re monitoring in the major cities that we should keep an eye on now or in the coming weeks?

ROGER SHAPIRO: Thanks for the question, we are monitoring trends all the time and people are worried about whether there will be an uptick because of the protests. I think right now the answer is maybe. We are seeing some certainly a flattening across the country with about 25,000 cases per day. Some areas are going up. In over 20 states, it’s going up. It is hard to associate that right now with the protests.

But we’re just coming into the time where we would see an increase in, for example, hospitalizations or other sort of hard data where we could look to to see if specific areas where there were a lot of protests or whether we can have studies that ask whether people participated in a protest may have contributed to either new infections or hospitalizations. I was really encouraged to see that many protesters were wearing masks. And we know that virtually all the protests were outside and those two factors I really hope made a big difference to keeping people safe.

I support the protests. I think that they were critically important for our moment in this country right now. But as a public health person, I really was worried about people’s safety, and I am cautiously optimistic that we won’t see a huge increase. But certainly when you look at some of the protests and how close people were, there was concern for that.

MODERATOR: Do you have a follow up?

Q: Yeah, but I wondered what sort of time period was meaningful to really monitoring both the case uptick and hospitalizations. What’s the time period that we should consider relevant and important?

ROGER SHAPIRO: So it’s about five days on average for someone to develop COVID from the time that they are exposed. And what we see is symptoms remain relatively mild for most people. Mild is not a fair word. It’s actually a pretty tough illness for many people to get through. But one that they can manage at home, for example, for, say, 10 days. Where things really diverge is that at about 10 days, there are a subset of people that often get sicker.

And this is when we think about the cytokine storm and the overwhelming inflammatory response kicking in for those people who are not ahead of their virus. Their immune system is not controlling it. And this is often the time when hospitalizations occur. So we’re now at about two weeks after someone’s exposure. So I would expect hospitalizations to increase two weeks following someone’s exposure in general. It can vary tremendously. It can be later than that. And it can be certainly earlier than that. But I think that, you know, we’re just about at the two week mark from when protests really kicked up in the country but protests are continuing. And so I don’t think we can let our guard down in terms of watching the public health effect of this.

MODERATOR: We’ll go on to the next question.

Q: Oh, thanks. It was a follow up to a question earlier on genetics. Real quick, I wondered if if there is any evidence yet hat is a preponderance or a surprisingly large number of folks in the same family coming down with COVID to a degree that could be, you know, that folks are living near one another and so that enables spread. But I didn’t know just as a fact of the data right now whether we’re seeing lots of cases within families.

ROGER SHAPIRO: It’s a difficult question to answer because lots of cases in families can be because the exposure is so intense in families. The general prevalence of secondary infections among family numbers is a lot lower than you might expect. It can range from 10 to 16 percent in different studies. So family members are not generally at the level of risk that you’d often expect given the close contact. I’m not aware of any data that have shown particular hot spots related to family genetics, for example. And I believe those studies would be really hard to do. They may come in the future, but right now, I’m not aware of those kinds of studies.

Q: Thank you.

MODERATOR: Next question.

Q: Thanks again. On a different topic, I’m interested in your take on public health communication efforts. As you might imagine, since the pandemic started, the messaging has changed around masks as supplies have become more, and tests and some other things as supplies, for example, have become more available. But I just you know, if you had to assign a grade to public health communication efforts, you know, what would you what would you say about how they’re doing and whether they’ve improved? Do you think in their messaging or not?

ROGER SHAPIRO: Can you let me know which public health agency you’re asking about?

Q: Well, it runs from the gamut from the you could argue even their national level, the WHO had to walk back its statement about asymptomatic people. So I think there are two challenges. One is the ever fluid state of – well, they’re both fluid – one is the state of supplies as supplies become more available. The messaging, for example, around testing has changed. It was reserved for priority groups, now it’s more accessible. Same thing maybe with masks. And then the science, of course, is evolving, too. So in that context.

ROGER SHAPIRO: Sure. I think we need to be careful about messaging around science and messaging about shortages or limitations that are separate from science. And so I believe that the messaging early in the epidemic about testing was influenced by the fact that there wasn’t a lot of testing available. And likewise, I think messaging about masks may have been influenced early in the epidemic by two things. One, this fear that hospitals wouldn’t have enough masks. And secondly, that early in the epidemic, I don’t think it was as clear that mask use would be as effective as we now think it is.

And so those together combined to perhaps make a public health message that was a bit off target early on in the epidemic. It’s a challenging situation to get everything right and to do this in real time when the epidemic is unfolding before our eyes. And I’m very sympathetic to CDC and WHO, you know, and the need to get it right all the time. Having said that, I’m sure there are many, many instances where we will look back in history and say maybe these statements shouldn’t have had been made. I’m most concerned about the lack of appropriate pushing for masks.

Now, WHO has now finally supported mask use as of early June and and and CDC sort of slowly stepped into it in the past several weeks, maybe a little longer back than that. I believe we should have been looking to Asia and looking to what mask use was accomplishing there in making our policies. And I do think that there were some missteps in communication around universal mask use. A lot was confused. It was confusing because people are early on in the epidemic said that, well, a mask, a surgical mask or a cloth mask won’t protect you. But what we weren’t thinking at the time was if we all wear them, then masks can protect everybody. And I wish that public health message had been clearer from the start. And I wish a few other messages had been clearer from the start. But at the same time, I’m sympathetic to how difficult a job it is for public health officials.

Q: If I could ask one quick follow up, because I’ve noticed this myself, not all masks are created equal, right? So I even had a friend of mine it kept slipping off her nose and I kept watching keep adjusting at like 20 times just while we were talking. So it just seems fairly like, you know, it kind of raised the question in my mind, should there be some universal standard for masks if they’re, you know, just to prevent these kinds of do it yourself, perhaps a bit sloppy efforts?

ROGER SHAPIRO: Yeah, well, I mean, the mask only works if it’s in front of your nose and mouth. There’s no question about that. But I think one thing that we learned over the course of time is that any mask is better than no mask. And so, you know, our early questions about, oh, does it have to be an end five research mess and do cloth masks make any difference? Yes, there’s a gradation in the quality. But really, when we’re trying to prevent someone’s cough and sneeze from being sprayed across a grocery store, that’s when masks really, really play a role.

Q: Right. So you’re saying too they know more about the preventive, the dynamics of this, you know, how far it travels and those kinds of specifics that they may not have known early on?

ROGER SHAPIRO: Right. Because we know that there’s been a lot of talk about whether the virus is aerosolized in some settings, whether it’s droplets spread, etc. But most of the time, you know, the virus does travel with larger droplets and even cloth masks will be effective in blocking a large percentage of those infectious particles from escaping from the mask wearer and getting out into the environment. So wearing a cloth mask is a lot better than not wearing any mask at all. Whether it’s a surgical mask that has properties that kick up small particles because of electrostatic charge and can have an impact in some ways that is greater than a cloth mask. But really, we shouldn’t obsess over that because what we should do is everyone should be wearing some type of mask and that should be the main public health message.

Q: Thank you.

MODERATOR: Next question.

Q: Hi. Thanks. I just wanted to turn to a little bit of a policy question. The UK has that recovery trial, which is sort of a national trial that’s managed on one front and looking at a number of different drugs, whereas in the US we have sort of all these other trials. Does that end up being competition, being a sort of free for all with our inability, you know, and then you have to find patients for each of these. So what do you think the US could learn from the UK in terms of that? And is that the sort of leadership we should have had or should contemplate going forward?

ROGER SHAPIRO: I am not concerned about competition between different trials. I believe that the more trials we do, the better, as long as they’re high quality trials. And as long as we have standards in place for what trials are done and each, you know, place, each hospital or each locality has a method for making sure that maybe the trials that make most sense to that particular hospital or area are getting a fair chance to enroll their participants, then I think that it’s fine to have lots of different trials out there.

But it can be a little tricky to to manage, you know, how participants are approached when there are lots of different trials in one hospital, for example. And my experience is that that gets worked out between the investigators and and when needed, you know, people can step in and help kind of organize that. But I’m not concerned about too many trials. We need more data and we just need high quality good trials that are testing, you know, the right kinds of drugs or approaches that make sense to each epidemic, you know, each hospital and each locality.

MODERATOR: Do you have a follow up?

Q: No, thanks very much. That’s good. Thanks.

MODERATOR: Next question.

Q: Hi, thanks for taking my call. I’m a little, I came in a little late, so I apologize if you already talked about this. I have questions about protests. So I’m in Minneapolis and we’re one of the cities that has put out a bunch of community testing sites and open up testing criteria for people who’ve been at large mass gatherings. And we’re starting to see some data coming out of that. I know Minneapolis as well as in Seattle, the positive rates are around one percent across thousands of people who’ve been tested. And I am wondering and kind of a two part question. Do you think it’s – is it too early to start seeing some significant signal in that data and 2) kind of how would you interpret these initial results, as far as what they can tell us about transmission dynamics among large groups outdoors?

ROGER SHAPIRO: Thanks. As I said earlier, I support the protests and I really want to make sure that we do everything we can to keep protesters safe. So I am encouraged by the data that you’re mentioning. One percent positivity is a pretty good number to have. I think in places where the epidemic is really on the uptick, we are seeing more like three or four percent or even higher in the positivity rate.

So when I hear one percent, then it is encouraging to me that that’s not representing sort of a new hotspot. Having said that, I think we need to keep vigilant and keep testing people. So I’m really glad to hear that there’s free testing going on in Seattle and Minneapolis. And I think it’s the right time to be testing right now, because if you think about the incubation period being around five days for an average, but it can be as low as two, it can be as long as 14 or so, but five to seven is typical. And so now is certainly a very good time to be testing people.

MODERATOR: Did you have a follow up?

Q: Yes. Sorry. Just to the second part of my question, is there anything that you think can be said right now based on this data about transmission dynamics out of doors in large groups?

ROGER SHAPIRO: Right now, I’m cautiously optimistic that the fact that the protests were outdoors and that most people were wearing masks did in fact protect the vast majority of people. I think we would have seen a very different situation with fewer masks and with indoor events. So I’m really hopeful that these two factors played a role in protection. And right now, I’m cautiously optimistic that we are not going to see a large uptick among protesters.

Q: Thank you.

MODERATOR: OK, great.

ROGER SHAPIRO: I wish I could – we just don’t know yet. And I still think it’s too early to say one way or the other. So that’s all I can give you right now.

Q: Yeah. No, I appreciate it. Thank you.

MODERATOR: Dr. Shapiro, I have a quick question of my own, and I think this is going to be the last one. And I think everybody also has gotten their questions answered anyway. What have you seen for the long term effects in people who have recovered from COVID? Are there any – is there residual lung damage or is there anything like that?

ROGER SHAPIRO: There’s a lot of concern about long term recovery, and I think that it really has a range because this virus has such a range. You know, this virus ranges from completely asymptomatic, so of course there would be no issues for recovery in that situation, to, you know, about the sickest that a human can be in terms of, you know, what we’ve seen in the hospitals and people with every organ system down on ventilators.

Now for those patients, when they recover, any person who suffers, you know, multi-system organ damage and a long period of of mechanical ventilation is going to require a really long recovery time. So we’ll only know how this differs from other long-term illnesses, you know, over the course of time. I’m hopeful that most people can, you know, recover fully. But, you know, the inflammatory state that has occurred and in some patients we’re seeing people who have had strokes and other more permanent sequelae from this virus, those may not lead to full recovery. So it depends on how severe the illness is and what the sequelae are during the acute process, you know, in terms of how we think about what the recovery is going to look like.

MODERATOR: OK. Thank you. And I said, I think that’s the last question for today. Do you have any final thoughts you would like to share before we go?

ROGER SHAPIRO: No, I think we’ve covered everything.

This concludes the June 17 press conference.