Coronavirus (COVID-19): Press Conference with Sarah Fortune, 07/29/20

 

You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Sarah Fortune, the John LaPorte Given Professor of Immunology and Infectious Diseases and chair of the Department of Immunology and Infectious Diseases. This call was recorded at 10:30 a.m. Eastern Time on Wednesday, July 29th. 

Transcript

SARAH FORTUNE: I’m going to spend most of this time answering questions, but I wanted to begin by just giving you a sense of what I find interesting at this moment in time, and that really is how the curve, I think, has been flattening in the aggregate United States data. If you look at the incidence of new cases, you’ll see that while the incidence is rising, the rate of rise is really substantially better than it was 10 days ago. And what I find striking about this, and honestly surprising, is that has been achieved with a relatively light hand. So that really has been achieved by the implementation in sort of a, if we’re honest about it, haphazard way of basic infection control measures, masking, social distancing, and attention to density. I think that that should make us feel optimistic. I mean, those measures, while perceived of as onerous in some places, are really much less onerous than the total lockdowns we went through in the spring, and have had really, in my opinion, sort of remarkable success in stemming transmission in many places in the country. However, I think that we shouldn’t get too complacent in thinking about the effectiveness of those measures moving forward, because we are really looking at a significant challenge when we look at schools reopening in the fall.

The reopening of schools is incredibly important, societally, but that is going to be a major, major challenge for our system. I just wanted to highlight for you the discrepancy between what is happening at university levels as we think about reopening and the conversations we’re having and the measures we’re putting in place, and the measures that we’re talking about societally as we think about reopening K-12 schools. I think it’s important for people to understand what universities are talking about and what risk mitigation looks like at the level of the university and what I think serves as a bar that we should be striving for in our K-12 schools. So I think, as you know, the universities are really, really leaning into testing. So the testing strategies differ in different universities. At Harvard, we are designing a strategy where the undergrads are going to get tested, all of them, several times a week. My daughter is going to Tulane, and they’re doing spot testing of five percent of the total university population every day, so the design of those testing strategies differ. But what is clear is that these universities are really blanketing their communities with testing in order to open safely, and that gives those students a certain measure of freedom in thinking about their daily lives that I think we would like to have as we think about elementary schools and K-12 schools. So I have been looking for, and not seeing, a discussion of sort of increasing testing capacity, not just by a little bit, but by a couple of orders of magnitude, which is going to require not just more testing facilities, but engagement of different testing modalities. Testing modalities that may not be as sensitive, but actually will be cheap and allow for high volume, high throughput testing. But I think that that’s the conversation we really should be urgently having as we look forward to September in terms of thinking about how to open our schools safely. And that probably is enough intro. I’d be happy to answer any questions.

MODERATOR: All right. Looks like we’ve got quite a few already. First question.

Q: Doctor, thank you for doing this. Appreciate it as always.

SARAH FORTUNE: It’s a pleasure.

Q: Let’s talk about comfort level. We see the party boat going out of Boston Harbor, people not wearing masks, they have to shut that down. Major League Baseball starts up. All of a sudden the team has a big outbreak and they have to stop playing. Are we getting too comfortable too soon? And is part of the reason for that news from places like Moderna about getting closer to a vaccine?

SARAH FORTUNE: Well, OK. I don’t want to speculate as to why we might be getting too comfortable. But I do think that it’s hard to sustain sort of hyper vigilance all the time. And honestly, I think we, as the public health community need to realize that, and realize that we need to be sending messages to people that are easy and sustainable. So, making people focus on where the real risk is and allowing them a little bit more freedom in thinking about their daily life where the risk is lower. Things like the party boat in Boston or for example, a bar, where people are crowded into spaces, maybe without masks, but even with masks where they’re crowded into spaces with limited ventilation, and everybody is talking and aerosolizing viruses. People need to be aware that those are really risky situations, whereas going to the grocery store is probably just fine, anytime. And importantly, being outside, like if you’re on your party boat outside, you’re at substantially less risk than when you’re inside.

Q: Let me ask you to before I let someone else in. Concerning the Moderna efforts, I read early on an article in The New York Times that pointed out the fastest we’ve ever gotten a vaccine done is four years and it was the measles. We’ve been working on an HIV vaccine for 40 years and we’re not there yet. Because I think people, they’re thinking, OK, vaccine right around the corner. Is it right around the corner?

SARAH FORTUNE: Well, luckily, a vaccine for coronavirus is an easier challenge, biologically, than an HIV vaccine. So the biologic lift is lower and there’s a much higher probability of success. And then the other reality is that we are probably willing to tolerate less efficacious vaccine as long as it’s safe in this current moment than if we were talking about preventive vaccines in some different circumstance. So right now, a vaccine that was 70 percent efficacious would look pretty good to us. That would be an enormous step in terms of blocking transmission, where as five years ago, that would have killed that vaccine. So I think when we talk about previous timelines, it’s important to consider both the bar that we set in the past and the bar that we might want to achieve right now. Then, also recognize that the resources that are going into this vaccine effort are really, really unparalleled. So multiple strategies are being tried in parallel in a way that has never been undertaken before. And so I was honestly a vaccine skeptic two months ago, and I think that we will have some kind of vaccine, that we’ll have proof of concept for some kind of vaccine by the end of the year. That is different than having a vaccine that is ready to roll out into hundreds of millions of people. But it is a significant step forward.

Q: Thank you.

MODERATOR: Next question.

Q: Thanks very much. So in both Rhode Island and Massachusetts, we’re seeing these small upticks in cases and political leaders are attributing this to mostly private parties, family gatherings, that kind of thing. And that was given as a reason, when Governor Baker was asked whether he wanted to roll back any of the recent reopenings, he said, no, because it isn’t from people going to bars and things like that. It’s from these private parties. So my question for you is, what should public officials be doing? Do we need to roll back some of the reopening that has happened so far? Or should they be reacting aggressively to these parties and testing? What’s the right response?

SARAH FORTUNE: OK, I’m going to give you my opinion of the right response. And I just want to emphasize that it’s my opinion because there is a measure of judgment involved here. So I think that Governor Baker is correct in avoiding blanket increases and restriction in response to these small increases in case numbers, because those are very broad brushes and have huge impacts over many lives. And it is not clear that they are going to be that much more efficacious than just trying to convince people of the importance of masks, distancing, and limiting contacts. But the other thing we should recognize, and this is actually relevant to the question earlier, we need to understand that people are going to make mistakes. People are going to have parties. And we have to have a public health response that is flexible enough to accommodate that without the threat of blanket restrictions rolling back over communities. And I think the key to that is testing and contact tracing. So really aggressive, high capacity testing and tracing so that when these little outbreaks occur and they will occur and they clearly will occur when schools open, we have the ability to stamp them out without reimposing restrictions.

Q: So can you describe a little more what you mean by really aggressive? So there’s a party, a case shows up at a party. What does that mean? What should they be doing? Because I don’t even know if they are doing it.

SARAH FORTUNE: No, I think in Massachusetts, they are. So the case shows up. The person confesses they were a party four days ago, and then they go and they just, say, they call everybody who is at that party and say, you need to be tested. And that testing needs to happen quickly. So we need testing that with turnaround time is in hours rather than days, and cheap and accessible enough that you can test not only the people who are at the party, with the case, but the people in their household. You can test not only contacts, but sort of proximal contacts, that would be the ideal. I think we’re kind of halfway to the ideal, which is we have a good contact tracing system. We have testing. It probably should be faster. And we don’t have so much testing in Massachusetts that we can do sort of these iterative rings of contact testing.

Q: It’s taking a long time to get these results. So that seems like a major barrier.

SARAH FORTUNE: I know. I think it’s important to recognize the disconnect between the turnaround time and testing in different places in our community. So at Harvard, I told you we’re planning on testing our undergrads several times a week. We’re already testing everybody who’s back at work, for example, in the labs at least once a week. And the turnaround time on those tests is less than 24 hours. And so at the same time, if you go to your PCP and get tested, that turnaround time can be five to seven days. So there is an enormous discrepancy in the functional public health quality of that testing. We should be increasing our testing capacity as such that everybody in the state has access to that rapid, easy to access, testing.

Q: Yeah. So why do the universities have access to it and the public health officials don’t? I don’t get that. If it’s a possibility, why isn’t it possible for everyone?

SARAH FORTUNE: OK. The different institutions performing the testing have different turnaround times, and I don’t honestly understand why testing, for example, through Quest is taking so much longer than testing that’s going through the Broad, that is functionally the case. So, for example, the Broad is turning around tests in less than 24 hours and Quest is taking a long time. I suspect that’s because there’s a lot more volume going through Quest than through the Broad, so they just become backed up. And I should emphasize, the state of Massachusetts is doing relatively well compared to other states in terms of testing capacity. But I think what that means is we need to invest really substantially in testing capacity, in different testing modalities such that we have the testing we need, come September.

Q: OK, great. Thank you.

MODERATOR: Next question.

Q: Thank you so much, again, for doing these calls. Really appreciate it. I’m working on an article on a study that’s being published in JAMA today. I’m assuming you have not read the study yet, but it involves face touching habits as a result of a mask wearing. And again, I’m not sure if you’re familiar with the exact study, but could you give us an idea of really how important limiting face touching is in controlling the spread of the virus? And really what the implications are for mask wearing?

SARAH FORTUNE: OK. I’ll tell you what I know. What I know is that not just mask wearing, because mask actually has some very specific biomedical meaning, but protective face coverings, cloth protective face coverings actually have substantially impacted transmission. I think we can attribute a lot of the improvement in transmission epidemiologically to mask wearing. And there was a study in JAMA maybe about a week ago, Wang, from the Brigham, which is a very nice study that basically showed that in the Brigham at the beginning of the epidemic, the curve among individuals in the Brigham was just rising exponentially. And with the implementation of universal masking, that curve not only flattened, but began to decline. So I think that masking, writ large, is a very important part of control. Masking has a couple of roles. One, it’s going to block droplets. Two, for both production and inhalation, it’s going to provide some measure, depending on the quality of the mask, of protection against aerosols. And it may impact your face touching. It is also clear that to some extent, fomite transmission, so surfaces and then touching your face or your eyes, is an important measure of transmission. But honestly, I haven’t seen the study. I don’t want to say specifically how much face touching matters. And I kind of I’m suspicious of, given how blended those modes of transmission are, sort of isolating face touching.

Q: Right. Makes sense. I mean, everything I’ve read and heard from experts, such as yourself, is that really the contaminated surface issue is very minor compared to respiratory droplets, aerosol spread. Is that accurate or am I missing something?

SARAH FORTUNE: Yes. Minor, but not nothing. And so actually, there’s a study from Joe Allen who is trying to like think through this in terms of the Diamond Princess epidemic within a cruise ship. And he estimated that basically surfaces might contribute to about a quarter of transmission. So that’s whether you call that minor or medium scale, I don’t know. And then droplets was the sort of major chunk and then aerosols was another maybe quarter of transmission. I think it’s useful to think of all three of those as potential mechanisms.

Q: Makes sense. Thank you so much.

SARAH FORTUNE: Yeah.

MODERATOR: And I will say real quick, that paper by Joe Allen is a pre-print. I will put a link to that in that chat. I also put in a link to the press release about the JAMA network paper. The embargo for that one actually breaks in seven minutes. I can’t put a link to that one yet, but we’ll get there. Next question.

Q: Great. Thank you so much for being available. So my question is just sort of your view of the vaccine progress so far? You mentioned you could talk about Moderna’s results. But just looking at what we know about the variety of candidates. What is your feeling? And is there any way to compare them at this stage or do we have to wait for the phase three, just sort of your initial thoughts on that?

SARAH FORTUNE: OK, this is opinion. My initial thoughts are there are several modalities, really different platforms, that are showing reasonable immunogenicity. And I think there is reason to think that several of these platforms are going to generate candidates that are going to have some efficacy and sufficient efficacy to make a difference in terms of population level transmission, that once those efficacy data come in and the candidates might differ in terms of the speed with which they come in. But once those efficacy data come in, the real challenge, the next really significant challenge is going to be scale up manufacturing and delivery. And then it’s going to be important that we actually do have multiple candidates, and hopefully have multiple candidates clear an efficacy bar sufficient to get regulatory approval, because the idea that Moderna is going to be able to make enough vaccine to vaccinate vaccine in the world is, I think, wishful thinking. So we’re going to need multiple candidates, and multiple successful candidates, so that we can actually vaccinate enough people to curtail transmission.

Q: Do you think that issue of scaling up, is that a problem specific to Moderna or is that just for everyone?

SARAH FORTUNE: That is for everyone. In fact, I actually think there is reason to think that the nucleic acid based vaccines are going to be, in some ways easier to scale up because they don’t involve biologics that are as difficult to scale or as sensitive to environmental conditions as some of the other vaccine platforms. That said, for example, J&J, which has a recombinant viral vector delivered vaccine platform, which in some ways is actually, biologically more complicated to scale, but they have a lot of experience with the scaling of vaccines and the large scale manufacturing of vaccines. So sort of how those different factors are going to play out in real life, I think remains to be determined. And I think it will be important that we have multiple successful candidates.

Q: And are you worried about the MRNA vaccines being unstable?

SARAH FORTUNE: You know, every vaccine is to some extent unstable. A viral vector vaccine is unstable to some extent over component protein vaccine. I think every vaccine has stability and scale issues. So I don’t think that one vaccine platform is inherently riskier than the other. I think that the vaccine platforms that have already been scaled, the manufacturers have a better sense of what they’re scaling issues will be. That sort of preexisting knowledge about scaling is important and we don’t really have that for the Moderna vaccine. But I guess the thought is that we will rapidly acquire it.

Q: OK. Thank you very much.

MODERATOR: Next question.

Q: Hi. Thanks so much for doing this. I wanted to follow up on the point about the fall and schools, because from everything I’ve heard, all the public health experts were talking about a second wave in the fall. I just wanted to get some clarity. Are we going to be in a second wave in the fall or are we surging into the fall? And this is still the first wave? The second question is a question about sort of what is going to tax our system in the fall? Is it going to be schools or is flu season going to be a problem? Because I’ve seen some anecdotal reports that the flu is basically nonexistent in the southern hemisphere right now, which was really interesting.

SARAH FORTUNE: OK. I do not like this first wave, second wave language because I think it suggests to people a certain coordinated behavior of the epidemic, which implies that you can relax it sometimes. Oh, we’re through the first wave, we can relax and then, oh, my God, there’s a second wave coming. Whereas the way this epidemic is playing out across the United States is very, very local. So the progression through a community can have a big spike. In classic epidemiological terms, they might be at risk. Queens, which had a big spike, might be a risk of a second wave in the fall. But when we talk about second wave, it seems like we’re implying, oh, if the United States comes down now, we’ve been through our first wave, we’ve been the second wave, and we’re somehow home free.

So I think that we should consider ourselves always at risk until we either return immunity, which no community has, or we have a vaccine. And first or second wave isn’t super accurate in describing that. Then as to the fall, I think, anything that is going to accelerate transmission puts us at risk of increasing cases. And schools are clearly, clearly a problem. Influenza is not going to put us at risk of increasing COVID cases. So that’s sort of a confounder. What influence it does have, is it puts an additional strain on the health care system and our ability to deal with the COVID cases that we have in addition to the influenza cases, and then separate out what what is COVID transmission versus influenza transmission? And it’s important everybody can get a flu shot and help abrogate that problem. I don’t know, is that useful?

Q: Yes, that is useful. I guess I just wanted to clarify, is there evidence that if people staying home and wearing masks actually going to reduce flu? And actually, clearly the coronavirus will still be here, but that idea that the hospitals are going to be extra stress because of the flu, is that realistic?

SARAH FORTUNE: The sort of mitigation measures that we’re taking against COVID are going to help against flu. So we don’t know what flu will look like in the fall. And it is really possible that because everybody is observing all these precautions against respiratory viral viruses, that our flu season is not going to be as severe. I would hope that also contributing to that would be the fact that people understand the importance of protecting themselves against respiratory viruses and they would get a flu shot because any given individual, what you’d really hate to have happen is get the flu and then get COVID, because for a given individual that just, and this is in a data free zone here, but that feels like a lot of clinical risk. Is that helpful?

Q: Yes. Thank you.

SARAH FORTUNE: OK.

MODERATOR: OK, next question.

Q: Hi. Thanks very much. I appreciate your taking the question. I cover higher education in the Philadelphia region and some of our campuses are having different approaches to testing. Some are going to test all students when they return. Some are going to have to get tests before they come back. Some have random testing planned throughout the course this semester. I just wondered, what is the best approach on testing for it for a college campus?

SARAH FORTUNE: I don’t want to say there is one bets approach, because I don’t think we know. But I do think that there are some basic principles. And one of the basic principles is that some form of ongoing testing is going to be important. So many schools, like every school I know of, is doing an entry test to try to limit the import of new cases, seeding of new cases, into their returning classes. And that’s fantastic. That tells you where you are at a given point in time, but is not going to protect you as a community, you know, in two weeks time. Some form of high density ongoing testing is important. And whether that’s random sampling through the community and then cluster testing or blanketing the community, I think there’s a healthy debate about that and we’re going to learn a little bit about which of those practices is both more effective and cost effective as we move forward.

Q: Could you talk a little bit about what those kinds of testing are like? Cluster testing?

SARAH FORTUNE: Yeah. Some of it is based on like the test we have now, which you stick it up your nose and that test is individually run as a PCR test. And some some schools, like Harvard, we are going to test all of our undergraduates a couple times a week. So that’s sort of blanket testing. But other schools, I think, quite reasonably, are exploring strategies where you sample five percent of the community, not just undergrads, but five percent of the community every day. And then if you do find a case, then you immediately go within institution contact tracing and basically ring that case with testing. So any individual who has been in any kind of contact with that case, you ring with testing and then you use that strategy to ferret out micro outbreaks. And I think that those are honestly both reasonable strategies and it sort of depends a little bit on the institutional characteristics, which is most reasonable. But the other important thing, Michael Mina actually had an editorial in The New York Times maybe about a week ago, talking about the new testing technologies. So things like Sherlock tests, paper strip tests made by Sherlock or Mammoth Biotechnologies or E25Bio, that are maybe less sensitive, but actually really much cheaper and faster. So point of care turnaround, an hour kind of test, you know, for a dollar or two a test versus 10 times that. And if we had that kind of testing, you can imagine, the university strategies could be rolled out into K-12 schools sort of nationally.

Q: Otherwise, is testing pretty expensive?

SARAH FORTUNE: Well, I don’t know. It depends what you consider expensive. So I think the price point for testing, if you go to the urgent care clinic in Cambridge, obviously, I think you’re quoted a price of around one hundred and thirty dollars. Institutionally, institutions are looking at price points in the twenty five to thirty five dollar range. I think it is feasible to think about driving that price point down. Actually, the other way to drive the price point down is pooling testing. And there have been a couple of articles recently and pulled testing strategies where you basically take 10 people and put those shows together and all of a sudden that twenty five dollar test becomes a two dollar test. Then if you find a case, then you go back and test those individuals separately. I think we need to be aggressively using all of those strategies to increase testing done today in our communities.

Q: Thank you very much.

SARAH FORTUNE: Sure.

MODERATOR: Next question.

Q: I just wanted to ask, it looks like we’re approaching one hundred fifty thousand deaths in the U.S., obviously are way ahead of everyone else worldwide just in terms of death count. What are you expecting to see for that number going forward? Do you think that that the death toll is going to keep rising at the same rate as it has been in the U.S.? It looks like it’s been like twenty five thousand each month over the last couple of months. I just wanted to get your kind of forward-looking thoughts on that. Thank you.

SARAH FORTUNE: Yes. I think the death toll is going to track right behind the incidents. And so where cases increase, the death toll is going to increase right behind it. And I think it’s not unreasonable to think that probably the best case scenario is the mortality is point five percent of cases. And depending on where you are, who is being affected at any given point in time, meaning are your incidence numbers being driven by nursing homes or schools, where the the micro mortality is going to be different. That mortality might range from point five percent to two percent. And we have to do better in terms of limiting transmission, because the mortality is going to march in lockstep with our transmission, and so we have this terrible death toll because we’ve done a lousy job of limiting transmission. Is that helpful?

Q: Definitely. That was helpful. Do you think as we kind of take more steps for some areas of the country to be closed down again, like California took more statewide steps, that that’s going to be useful to lowering the death toll? I know you said it. It goes lockstep with cases.

SARAH FORTUNE: Lockstep with cases, so where you limit transmission, you’re going to limit the death toll. But I do think it’s. I personally find it more useful to keep my eyes focused on that transmission number rather than the death toll number because they are so linked, and the incidents numbers are more proximate measure of how we’re doing. The death toll, it’s going to march. Couple of weeks behind it. And I think we should just be prepared for that and really, really focus on limiting transmission. There have been medical advances in how people are cared for that will contribute to an improved mortality. But they’re really sort of around the edges compared to the impact of limiting transmission.

Q: Thank you very much, Sarah.

SARAH FORTUNE: Yeah, sure.

MODERATOR: Next question.

Q: Hello, Dr. Sarah Fortune, thank you very much for having us. We appreciate it very much that Harvard University has given us this opportunity so we can have an interview and ask you a few questions. Thank you very much.

SARAH FORTUNE: Sure. It’s a pleasure.

Q: Doctor, Sarah Fortune, we are an island. We go by the name of Curacao, and our economy is substantially based on the income of tourism, a big part of tourists are from the United States, also from Europe. But coming back on that, we need to receive tourists from the United States. For us right now, our borders are closed for the United States not only by flight, but also by cruise ships. We really do miss, actually, the tourists of the United States because we have had many years of a bond with the United States and also from a few countries in Europe. Now, coming back on that, there is no vaccine for COVID-19. We are still in a period of time where we cannot say when there will be a vaccine, is it going to be the end of this year? Some people say no, it won’t be till 2023. So there is actually not a stipulated time on when there will be a vaccine. Don’t you think, Dr. Fortune, that we would need to start adapting our whole system, not only for us here in Curacao, but for all the countries around the world adapting to the new normal?

SARAH FORTUNE: I do think we need to adapt to the new normal, but it is clearly true that some adaptations are easier than others in some communities are more directly impacted by the protective measures that are easy to take. And Curacao. As you point out, with an economy that depends so heavily on tourism, both because of flights and the cruise ship industry, is in a very difficult position because some of those, as we think about risk mitigation. There are some risk mitigation strategies that are very easy, wearing masks at the grocery store and some risk mitigation strategies that are much harder, or some places that are much harder to risk mitigate, like cruise ships and airplanes. And it’s a real problem. I think we should be thinking about sort of the economic supports needed for communities that are very hard hit where it is not obvious how to risk mitigate communities and businesses where we want them to be economically whole when we emerge from this. But it’s not so easy how to make that all safe with the current tools. But actually coming back to this emphasis on testing, again, we sort of transformed our ambitions for testing and if we had the ability to do paper strip test for everybody on a cruise ship every two days, that would really change the nature of the cruise ship industry and what is safe for people. So if we could think radically forward in terms of our testing capacity, then risk mitigation would look different and it would be easier to create a new normal, which would preserve the economies of places like Curacao.

Q: Dr., thank you very much for answering that question, coming to another question. I think the people here in Curacao would very much would like to know how far is Harvard University right now when we’re talking about research with COVID-19, what can you tell us?

SARAH FORTUNE: Well, Harvard is part of a global research community that is really working hard towards vaccines, testing and trying to develop strategies to use those tests well. And so we have important vaccine efforts. Actually, the J&J vaccine is being developed with a Harvard hospital. We have important testing efforts, one of these paper strict tests, a couple of these rapid tests are coming out of Harvard related institutions. And as you know, there are a lot of people at Harvard trying to think hard about how to use the tools we have wisely. But it’s not just Harvard. We are just part of a small cog in this giant wheel of research that is trying to rapidly come up with solutions to return us to a better normal.

Q: OK, Dr. Fortune, just for clarification. These strip tests, can we also buy them or order them? You cannot just use them at home?

SARAH FORTUNE: Well, they’re not available yet. So they’re sort of the next generation of tests coming out of this. Biotech companies like E25Bio, Sherlock, Mammoth. And they have not completed their regulatory approval yet. And honestly, I’m not exactly sure when they’re going to be available, but I want to highlight them because I do think that they will be a revolution in how we are able to control this virus.

Q: My last question. Schools. I’ve heard other reporters in United States have already asked you about schools that are reopening and they’re thinking about it. Some people in other countries think that homeschooling will be a preferably better. But coming back on reopening schools. Would it be a normal situation where you’d have to actually test children or teenagers once a week or twice a week? I don’t know what really the regulated stipulations are. Do you really need to test students often during a week when they will start going to school? Or is home school schooling way better?

SARAH FORTUNE: Well, you used two judgmental terms, need to and better. I think that if we had the capacity to test kids all the time, like we’re testing university students coming back all the time, that it would enabled schools to open in a much more normal way. And that has to be economically feasible and sort of programmatically feasible. But if we invest in that testing capacity, I think it will enable schools open in a more normal way. Different communities are different in terms of their ability to sort of implement a large scale home schooling. I know, here, from my friends and colleagues, a lot of parents depend on being able to send their kids to school. It’s how they’ve structured their lives, their kids like to see other kids. It’s an important part of their development. And so I think, I as a parent, my preference is to be able to send my kids to school as opposed to homeschooling them. But those decisions are gonna be really most appropriately made at a community level.

Q: Dr. Fortune, thank you very much.

MODERATOR: Next question, you talked about second waves. This question came in before you had referred to second waves. So what are the key indicators of a second wave? And where do you see those signs most prominently in the US? I guess, where do you see things, for lack of a better term, surging up?

SARAH FORTUNE: Well, OK, let me just like remind people where the terms first wave and second wave came from. So the idea in the first wave, second wave terms, strictly speaking, was you had a community. This community, like Queens goes through a first wave, then there is some sort of mitigation, or lock down or something. And then they go out and they’re exposed. And the people who are not yet immune in that community become exposed, sick, then there’s a second wave. So, that’s not what’s really happening in the United States writ large. So what happened was we had United States little first wave, but that was really a wave in New York, Massachusetts and, you know, New Jersey, California. And then we’re having this other wave, which is kind of through the American South. So that’s not exactly what people mean in terms of first wave. Second wave. In terms of the biology of it, because inherent in the biology of the original first wave and second wave term is the idea that like there’s a big swath of the population exposed and you the next swath is exposed, immune, and then you basically reach herd immunity. What we’re having our little waves everywhere that are communities going through truncated first wave and that’s looking like oscillating wave like behavior across the country.

I think you can see places across the country where you see increasing incidents. Tennessee, there’s still places in Mississippi and Alabama. Communities have to be aware that they’re going to need to always be vigilant.

MODERATOR: Thank you. And he said that was perfect. So thank you from him as well. Next question.

Q: Hi, can you hear me?

SARAH FORTUNE: Yeah.

Q: Thanks, Dr. Fortune. I wanted to talk a bit about states like Texas, where obviously we’re still in a big outbreak, but we’re doing much better. The positivity rate has been falling for about 10 days now. I’m just interested in what you think that tells us about the level of intervention that we will need going forward, because we’ve achieved this through closing bars again and statewide mask order. And just wondering, is that attributable specifically to those actions or just the larger awareness of our surge? And do you think it’s enough to get us down to below five percent by the time schools need to reopen in the fall?

SARAH FORTUNE: OK. So this actually brings us back to where I started, which is I’ve been very impressed with how effective the combination of closing bars, statewide mask orders, and whatever associated personnel changes in behavior go along with increased attention to COVID, how effectively they have brought down transmission in Texas, and in Arizona in particular. Now, whether they’re going to get you to less than five percent by the time schools open. I don’t know exactly, I don’t want to say cause I haven’t looked at that number or the curve closely enough with those numbers in mind to say. But I do think that it’s important to recognize that schools, schools are like little bars. Right? Schools are places where people are congregated. You know, even with the best of intentions, it’s hard to keep kids apart from one another, hard to keep them in their masks. And there is a lot of mixing of people who might be asymptomatic carriers. And so I don’t think that we can rely on those those risk mitigation strategies alone to protect us once schools open, I think we want schools to open. But that’s again why I am making a pitch for really thinking about testing capacity and getting testing into schools, because I think it’s going to be the equivalent of reopening bars. Or it could be the equivalent of reopening bars in communities, across communities.

MODERATOR: Do you have a follow up?

Q: No, that does help. I mean, it’s interesting because I don’t think we’re still at a point yet where we’re able to effectively do tracing, I mean, our testing is still coming back late.

SARAH FORTUNE: Yeah. And, you know, there are many things we should have done better during this whole epidemic, but one of the things we should do, we can learn from and should do better now is forsee what the needs will be as we move forward, and not be complacent with where we are. So continuing to invest in building, testing capacity and tracing capacity is important. And I don’t know if you know how like testing came to be in Boston or in Massachusetts. But, in March when it was clear that we did not have sufficient testing capacity, the academic labs and specifically the Broad institute was like, we have robots we will test. They are now the ones doing tens of thousands of rapid turnaround tests, and it was just because there was an investment from local institutions in building testing capacities. Actually, Houston has a fantastic biomedical research community and, you know, really leaning into testing capacity, I think will be very important for communities moving forward.

Q: Just one quick follow up on that. You had talked earlier about school testing and the coronavirus task force. And I’ve also heard other talk about other surveillance techniques like monitoring sewage and what not. How holistic are those? I mean, I haven’t heard state officials in Texas talk about implementing those tools at all. How likely are they to actually be deployed in a state like like Texas before the end of the year?

SARAH FORTUNE: So pool testing can happen now. There is no technical hurdle to pools testing. The problem in terms of the implementation of pool testing has been a little bit of contention about what the goal and quality of data return should be. There are sort of small scale pool testing strategies, you combine four tests into one, and that reduces cost and increases capacity, to some extent. And there are large scale pool testing strategies, like you combine 50 tests into one, which really, really dramatically increases your testing capacity. The regulators have not been enthusiastic about the very large scale pool testing strategies as public health tools because they don’t have the same sensitivity for a given individual. And so there’s a tension between what the performance of a test has to be for an individual to get regulatory approval versus how it could be used as a public health strategy. And I think that we need to be accepting of tests that have lower sensitivity, but still have sensitivity for the people who are at high risk of transmitting but may not catch you. You have six viruses in your nose. And get those rolled out in order to be able to much more effectively blanket communities with testing.

Q: All right. Thank you.

SARAH FORTUNE: Yeah.

MODERATOR: Dr. Fortune, I have one more question that came online, if you’d like to take it?

SARAH FORTUNE: Sure.

MODERATOR: She would like to know if vaccines are approved by early next year. What do you expect the pandemic will look like in a year? What safety measures will be long term, regardless of vaccine regarding return to normal?

SARAH FORTUNE: You know, that’s a really good question. I think a lot of it depends on not just having a vaccine, but how well we can roll out the vaccine, and then, how willing people are to be vaccinated. And those are real unknowns. So if we have a vaccine that we can rapidly and effectively roll out to many people, and especially the people at risk of serious complications, that’s going to much more rapidly return us to something that we feel looks like normal. And if that vaccine is, for whatever reason, less accessible so that it can only go out to people who are at risk, it’s expensive. There are some side effects, whatever. It’s less efficacious than the perfect vaccine. Then I think we’re looking at a situation in which life looks more normal, but we still have to take significant risk mitigation approaches.

Q: What type of mitigation approaches do you think that would be?

SARAH FORTUNE: Well, I could imagine those are, people continue to wear masks. That’s the obvious one. There are some limitations still on how people congregate and density. I think there are important questions about whether vaccines will be effective in the elderly, and the efficacy in the elderly is going to be important in terms of people in nursing homes, how much more normal their lives can be. Those are some of the considerations I would have in mind.

MODERATOR: Thank you. I think that’s our last question for today. Did you have any final thoughts?

SARAH FORTUNE: Oh no, it was a pleasure. Thank you very much.

This concludes the July 29th press conference.