Coronavirus (COVID-19): Press Conference with Stephen Kissler, 03/12/21


You’re listening to a press conference from the Harvard School of Public Health with Stephen Kissler, research fellow in the Department of Immunology and Infectious Diseases. This call was recorded at 11 a.m. Eastern Time on Friday, March 12th.

Transcript

MODERATOR: Hello, Dr. Kissler. Are you all set?

STEPHEN KISSLER: Yes, I’m here, hello.

MODERATOR: Thank you very much. I’ve already gone through my introduction. Everybody knows who you are and how to do all this stuff, so I think I’m going to jump right into the questions. First question.

Q: Dr. Kissler, thank you for making time for us today. I’m going to ask you about the variants and spring break. So last year nationally, we saw a rise in coronavirus cases following spring break. Now it’s almost upon us again. So talk to me about what we saw last year and what we could expect to see this year, considering now vaccines and variants are also in the mix.

STEPHEN KISSLER: Yeah, so any time we see a surge in travel, we often see a surge in cases that follows, and I think that that’s in large part just because you’re interacting with many people who you wouldn’t normally otherwise on the way and potentially at your destination as well. So I think that we can expect that traveling for spring break might make it a little bit more difficult to manage cases in the immediately coming weeks. As you mentioned, we have the spread of the variants, in particular, the B.1.1.7 variant, which was first detected in the U.K., has been spreading quite a bit and is making up a large proportion of cases in a couple of states, including Florida and California. And so I think that’s something we’re going to have to be paying very close attention to. That variant is more infectious. And so I think that requires us to take elevated precautions, really making sure that our masks are fitting tightly, making sure that we’re trying to be a little bit more vigilant about distancing to reduce the spread. But as you said, vaccination rates are coming up as well. And it seems like the vaccines are effective, especially against severe disease, severe illness and death, which is a really good sign. So we’re sort of in this place where we’re on the one hand, we could see an increased amount of spread. But with the increase in vaccination, that will help sort of keep things at bay a little bit. I’m afraid that we may still see a bump in cases after the spring break holiday. I think that we haven’t quite reached enough vaccination to avoid that, especially given the variants. But I am also hopeful that with increasing rates of vaccination, that that bump won’t be too large.

Q: Thank you, and I’m in Florida, which is not only a spring break destination, but also considered one of those open states when it comes to our COVID policies. So do you have any recommendations or projections for Florida communities, hospitals or individuals as spring break approaches?

STEPHEN KISSLER: Yes, it’s always dangerous to make projections because there’s so much that goes into what actually leads to outbreaks in particular places at particular times. But that said, all right, with Florida being a destination, with many businesses being open at the moment, I think that there is what we would call an increased level of susceptibility in the population towards rising cases. So I think, you know, the most important thing for Florida residents to bear in mind is that there will be an influx of people from other states. And the bottom line, those is the same as it’s always been, the messaging and distancing work that when your name comes up to get the vaccine, get it when you’re able to. I think that we’re in an important time in terms of COVID control right now. With the spread of the variants, it could begin to go either way. So in terms of business owners, in terms of policy makers, I think that we need to be vigilant in terms of rising cases and be ready to pivot to reverse course if cases do start to rise again to maintain control. We don’t want to give up all the gains that we’ve made so far in terms of reducing COVID cases. But at the moment, the main thing to do is to just keep the same precautions in place and just recognize that with the increase in vaccinations, we have more work to do. But there’s hope in the not-too-distant future.

Q: Thank you very much.

STEPHEN KISSLER: Thanks.

MODERATOR: Next question.

Q: Thanks so much. I was going to just sort of follow up, I’m kind of curious how you’re viewing the B.1.1.7 right now? I mean, like I know it’s sort of still building up, whatever it is, doubling every roughly every whatever it is two weeks. And I know it depends and there’s geographic variability as well, but so far at least, it doesn’t seem to have led to any at least like even localized increases. Is that just like a matter of time or like between natural infections and vaccines and maybe like a seasonal boost? Like we’re just staying ahead of it for now? Can you just sort of walk me through your thinking on where things stand with B.1.1.7 in particular?

STEPHEN KISSLER: Yeah, well, you’ve largely named it all. So with B.1.1.7, we are, as far as we can tell from a lot of the genomic surveillance of the pathogen that we’ve been doing where we’re at least a few weeks behind the epidemic, B.1.1.7, that has been spreading, for example, in many countries in Europe. So part of it is just that we haven’t quite seen B.1.1.7 take hold enough to really begin bringing cases up in most places by and large. We really started to see noticeable increases in overall COVID cases once B.1.1.7 started making up over half, you know, up to two thirds of the total number of cases. And while that’s true in some areas, it’s definitely not true in a widespread fashion. So part of it is I think that we just haven’t quite seen what it can do yet. But we are helped a lot by, of course, the increase in vaccination rates. So I think that that’s really helping to keep you on one seven at bay as well as the changing seasonal effects. So I think one of the worst things about when B.1.1.7 emerged and caused major outbreaks in the UK was that that coincided with the holidays, with the wintertime when coronavirus transmission really peaks, whereas we’re seeing widespread transmission of B.1.17 during a time when the transmission of coronaviruses is expected to go down. So we’re in this sort of strange position where there are all of these different forces sort of pushing the COVID pandemic in different directions. And it’s still not totally clear which of those will win out in either the short term or the medium term. But I think that the fact that we have those counterbalancing forces, whereas in other countries that were all sort of helping B.1.1.7 to spread is part of what’s in our favor and what has been preventing us from seeing major surges of B.1.1.7 so far.

Q: Do you think like and again, you know, obviously like you were just saying, there’s a lot of factors at work here. But do you think B.1.1.7 could be partly responsible for the slowing of the decreases in the US?

STEPHEN KISSLER: Yeah, I do. I think that, you know, as you said, the cases in the U.S. decreased really quite quickly, especially over February, beginning of February. And so I think what we may be seeing is essentially the tide of the pandemic coming down, but sort of reaching this level where B.1.1.7 Is beginning to circulate. And I do think that that can be partly responsible for the slowdown.

Q: Thank you so much, appreciate it.

STEPHEN KISSLER: Thanks.

MODERATOR: Next question.

Q: All right, thank you for taking our questions. I’m curious what you think about the president’s announcement of May 1st, all eligible adults could start making appointments. I know there’s going to be more vaccine supply, but are there any concerns that there will be too many people fighting for vaccine appointments at that point or that there’ll be some equity issues? I’m curious what you think of that policy decision.

STEPHEN KISSLER: Yes. So first and foremost, I think that making vaccines as widely accessible as we can, given the supply, is a very good thing. Up until this point, of course, we haven’t had enough vaccine supply to allow everyone to get the vaccine immediately and so it’s made a lot of sense to prioritize people for vaccination who are at increased risk of severe disease, which is generally included to the elderly populations. But, of course, I think that accessibility certainly does not imply equity, and I think that there’s a lot of work to be done to make sure that in addition to making the vaccines accessible to American adults on May 1st, we still have a long way to go to make sure that they’re distributed to the communities who need the most. We know for certain I mean, the consistent story over the course of this entire pandemic is that people of color, communities of essential workers, have been at increased risk of infection and increased risk of severe illness and death. And now, you know, those disparities didn’t come from nowhere. And those disparities continue to exist and will probably continue to make those same communities have difficulty accessing the vaccines. For example, you take the case of essential workers, which is a really a wide net of individuals. But you can imagine that if vaccine clinics have restricted hours or if childcare isn’t made available so that people can go and get their vaccines, it’s going to be much harder for those populations who really need the vaccine to get it. So I was encouraged by the president’s speech the other evening that that it seems like these things are on their mind, that there’s a lot of emphasis on distribution of the vaccines, not just making them available at mass vaccination sites, but really trying to go into communities that need them most. But this is something we’re thinking a lot about right now because there’s a real danger towards persisting, allowing some of the inequities to persist if we just declare success by making the vaccine widely available. I think there’s a lot more work to be done to make sure that the communities who need the most get them. And I think that’s really our next major, major challenge.

Q: So a couple of follow ups. I’m wondering, there’s a few states, Maine, Connecticut, I think maybe Nebraska that have gone entirely age based. So will those states be more well positioned for the May 1st transition to opening the barn doors for everybody? Or the fact that we have done the more complicated if you have to qualify health conditions, you know, those kinds of things, it might be worse for equity. I realize that’s a broad question. I hope you understood it.

STEPHEN KISSLER: Yes. So there are a couple of things to bear in mind in terms of the intersection between age and comorbidities and equity and sort of how this rollout is working. So one thing that some people have pointed out is that by going strictly by age, simply because of differences in life expectancy between different demographic groups, you may disproportionally, vaccinate white individuals. And so that can sort of lead to some inequities in terms of the total vaccine uptake by demographic groups. But that, you know, the thing that makes this so complex is the intersectionality of all of these different factors. You know, person is, of course, has all of these different attributes. Age factors into it. Comorbidity factors into an occupation factor into it. Race and ethnicity factor into it to the extent that those reflect underlying disparities in access to care in these kinds of things. And so I think that I can’t necessarily say which states would be in a better position to address issues of vaccine equity, given what they’ve done so far. I could see an argument being made either way. I think the most important thing is just that we’ve had them in mind going forward and recognize that just making the vaccine available won’t be enough to address these issues properly.

Q: If I have time for just one last question, what about just simply the logistics of doing this, opening the doors wide for everybody on May 1st? I know there’ll be more supply and obviously they’re doing more with, you know, bringing federal resources to bear. But do you think this will go smoothly or do you think this is going to be a logistical problem?

STEPHEN KISSLER: So I’m cautiously hopeful. We’ve had a couple of months to think about how this distribution needs to happen, and this is also not the first time that we’ve done mass distribution of a vaccine. Just back in 2009, we had an influenza pandemic and we had to distribute that vaccine quickly to a large proportion of the population as well. So we have some experience doing this now. Will it go totally smoothly? No, certainly not. I think there will be lots of factors that will lead to frustration and difficulty in and potentially delays in accessing the vaccines. But I am also hopeful. I know that there have been a lot of really, really talented people working on this on every level to make sure that the logistics are smooth as they can be given the immensity of this operation. And so I think that, you know, well, I can’t guarantee that it will go perfectly smoothly, I am hopeful because this is not the first time that we’ve done something like this. And I’m confident that will be able to meet the challenge as it arises.

Q: Thank you.

STEPHEN KISSLER: Thanks.

MODERATOR: Next question.

Q: Hi, thanks for taking questions. So my question is, where would you say we are now regarding evidence on whether you could get COVID from a variant even after vaccination?

STEPHEN KISSLER: So we’re still learning a lot. I would say that it depends quite a bit on the variant as well. There are a couple of different variants that are spreading currently, some of which seem to have enhanced transmissibility where they spread more easily, but they don’t necessarily get around your immune response, whereas other variants do, in fact, have mutations that allow the virus to at least partially evade the immune response that you’ve built up, either from natural infection or from the vaccine. So I think the infections are absolutely possible after natural infection and after the vaccine and the particular variants that partially escape our immune response are more likely to do that. It seems like it’s possible to get infected with even a non-variant type of COVID after a natural infection. We haven’t seen that as much with vaccines, I believe. But certainly, the variants can cause infections after the vaccine. But I really want to emphasize that getting the vaccine is so incredibly important because reinfection does not necessarily mean that you’re at the same risk of severe outcomes from COVID. Getting the vaccine and getting infected with the variant will reduce your chances of ending up in the hospital or dying and will probably reduce your chances of spreading to others, although we’re still learning about that as well. So the vaccines, you know, despite the fact that they’re efficacy declines a little bit when they’re faced with some of these variants, their effectiveness against severe disease and mortality is still immensely high. And so they’re still important tools.

Q: Great, thanks. No follow ups.

STEPHEN KISSLER: Thanks.

MODERATOR: It looks like that was our last question. We can wait and see if anybody else who comes to mind.

Q: I have a quick one. Thanks for doing this. So obviously, you know, a few weeks ago, we were looking at a picture where cases were falling in the US. And we’re also following pretty much everywhere. I mean, Europe cases were falling as well. Latin America, they’re still falling, you know, in the United States. But that trend has reversed elsewhere. Europe is starting to see climbing cases. I guess I wonder whether we should take a warning from that. Is that something that could happen here? And also, is it just a case that we’re in different stages of the battle of vaccination against infection? I’m curious what your thoughts are on that?

STEPHEN KISSLER: Yeah, exactly. So, I mean, as I mentioned before, the way that I see our relationship with COVID and particularly the spread of the variants that were sort of lagged a couple of weeks behind many of the countries in Europe that are starting to see rises in cases right now. And so I think that we should take that as a very serious warning that that can and very well might happen here as well. That said, where we’re vaccinating people at a pretty high rate and by being delayed, we have the benefit of some of the seasonal factors working in our benefit as well. So clearly, it’s possible for these variants to cause surges in COVID during a time of year when you might not expect it to as much. And so, yeah, I think that we should take it as a very clear warning. I do think that there’s a decent possibility that that could happen here. But again, not a guarantee.

Q: Thank you.

STEPHEN KISSLER: Thanks.

MODERATOR: Do you have another question?

Q: Yeah, sure. Since this was going quickly, I’ll just ask one more quick question as long as everybody’s OK with that. Just switching gears, a little bit, I’m wondering what you’re thinking about schools reopening to more in-person learning. There’s a lot of discussion about the US CDC guidelines and that maybe they should be switched to deemphasize the three-foot, six-foot rules. And, you know, Massachusetts and other states, I think, are requiring full time in-person learning. There’s some movement towards that in Maine or at least some parents are really asking for that. So I’m wondering if you think it’s safe to open schools up full time.

STEPHEN KISSLER: So I think that we have ways to do it for sure. One of the most important things is to make sure that teachers, administrators and staff at schools are vaccinated. And so I think that making sure that they’re prioritized in terms of vaccination is incredibly important. Now, there are other things as well that help a lot. So we know for sure that increasing ventilation to the extent that it’s possible, installing air filters to the extent that it’s possible, masking and also frequent testing are all ways that we can really go a long way towards reducing the spread of COVID that can take place in schools. So I think that we have plenty of strategies at our disposal to open up schools. The crucial thing is to make sure that those resources are made readily available to those schools. It’s not enough to just say what needs to be done and then tell the schools to reopen. They need to be provided concretely with the tests and, you know, with resources to either inform the staff and administrators how to keep themselves safe and with physical resources, including air filters and whatever else might be needed to ensure that the schools are safe. We can do it for sure, but the resources need to be there. And so that’s my hope, is that the not only will the message go out that schools can reopen safely, but that we’ll be able to sort of put our money where our mouth is and provide them with the resources, they need to do that.

Q: I wonder if you could specifically address the need for that three-foot six-foot spacing rules, because I’m hearing from schools that that’s one of the biggest barriers to fully reopening, you know, five days in person with all the other measures, teacher vaccination, the other measures that you mentioned. Do you think reducing or eliminating that three-foot, six foot rule is wise and should be done or no?

STEPHEN KISSLER: So I think that there’s with all of these other measures, it could make sense to reduce that three foot, six foot rule. But there’s one important caveat with that, too, which is that we know for sure that one of the main ways that SARS-CoV-2 spreads is through super spreading events where a single person might infect many others. So while relaxing the three foot, six foot rule, I think that it does also still make sense to have some limitations on the total number of people who a person is interacting with. So maybe limitations on class sizes and trying to maybe keep people coldhearted to some extent. I think that those measures do still make some sense and form part of the overall strategy towards keeping schools safe. But the three-foot, six-foot rule in particular, I think that with these other measures in place, can probably be relaxed.

Q: Thank you very much.

STEPHEN KISSLER: Thanks.

MODERATOR: All right. Does anybody else have a question? If so, just raise your hand or you can get in touch via Zoom chat. I think that maybe it Dr. Kissler, do you have any comments you would like to make before you leave?

STEPHEN KISSLER: No, I think that’s all. Thanks very much for joining.

This concludes the March 12th press conference.