Coronavirus (COVID-19): Press Conference with Stephen Kissler, 03/26/21

You’re listening to a press conference from the Harvard School of Public Health with Stephen Kissler, a research fellow in the Department of Immunology and Infectious Diseases. This call was recorded at 12:15 p.m. Eastern Time on Friday, March 26th.


MODERATOR: Dr. Kissler, do you have any opening remarks you’d like to say?

STEPHEN KISSLER: No, nothing to start off with. I think I’d just be happy to hear some questions and I’ll let you know to what extent I’m able to answer.

MODERATOR: All right. First question.

Q: Dr. Kissler, thank you so much for making yourself available today. I really appreciate it. There was national coverage of President Biden’s presser yesterday, but during it, no one asked him about the pandemic. So why do you think that is? And what would you have wanted to hear from the president?

STEPHEN KISSLER: While there are no questions asked, if I recall correctly, he did start off the press conference was with some remarks about the state of vaccination and announcing that they would, in fact, be ahead of his original goals to vaccinate 200 million people in the first 100 days. And I think that, you know, I certainly would have loved to hear more about the state of COVID, the state of some of the response that’s being done right now. I do think that vaccination is the main thing. So the thing that I would be most interested in hearing about that I know that both the administration and scientists all around the country are working on the spread of the novel variants. You know, we’ve started to see upticks in cases in a number of different places, maybe most alarmingly, probably Michigan at the moment. But I think we’re seeing them in many places. And I think it would be worth just addressing that, noting that there are rises in cases happening now. And one of the things that we really need to figure out is to what extent those are driven by novel variants of concern and to what extent they just reflect the natural epidemiology of the disease over the top of different policies and reopening and just the way that the disease itself spreads. So I would have loved to hear a little bit more about what’s being done to get a better handle on the variants, how they’re spreading. I know that much of that work is being done, but I think that definitely hearing it from the president would give it sort of wider knowledge, which would be very helpful. But again, I think that even with the spread of the variants with the increase in cases, the most important thing is that we’re continuing to vaccinate and that we’re increasing our vaccination rates. And so that’s the thing that I’m most encouraged by. And if there was one message that could get across, I think that it’s that we really just need to put most of our focus there.

Q: Thank you. And this is something I’ve been kind of thinking about is if we’re kind of falling into this complacency that we have the vaccine, so now we’re in a place where we don’t want to ask as many questions or they’re not coming to us, do you think that’s part of what’s happening?

STEPHEN KISSLER: I as much as anyone else would love to put this pandemic behind us, and I think that there’s some temptation to you know, there are many other issues that are facing our country and our world right now. And the pandemic is high among them, of course, not the only one. There might be some amount of pandemic fatigue here as well. I think there’s some danger in that, you know, we do have to recognize that we still have many cases and many deaths still every day from the pandemic. And there’s a danger in getting complacent and then just sort of implicitly accepting that bite by not continuing to talk about it. So I do fear entering into that and sort of thinking that now that we have the vaccine, that everything is over, that everything is fine. I think maintaining attention on it will be really important, as difficult as it is and as much as I and everyone else want to put it behind us.

Q: Thank you very much.

MODERATOR: Next question.

Q: Hey, Stephen, how are you? So just a couple of quick questions. How alarming are the variants? How much of the decline in case rates and hospitalizations is due to seasonality versus the vaccines? And how effective do you think vaccines are really? And this is all kind of the same question. I’m sorry. Sounds like a lot of different things, but Gates is saying we’re back to normal end of 2022. What’s your guess on that?

STEPHEN KISSLER: Yeah, so I’ll try to take them in order, and I’ll let you know if I need to be reminded on any of those particular.

Q: Sorry about that.

STEPHEN KISSLER: No, no, that’s fine. So with respect to the variants, there are things that we want to pay close attention to for sure, and they’re alarming in a way, in the sense that we have multiple variants circulating now and the different variants have different attributes. Some of them like the B.1.1.7 variant that was first detected in the U.K. is very clearly more infectious or transmissible and seems to potentially cause more severe illness as well. Other variants are able to get around immunity to some extent. And so each of them undermines our ability to control the pandemic in some way and many times in different ways. And so the part of what is concerning about the variants is just that they exist, and part of it is that there are different variants that are each sort of making our job more difficult in a different way. That said, the things that we’ve been doing so far are effective against the variants. And while it makes our job more difficult, really none of the fundamental messaging has changed. Physical distancing, masking is still important, are also crucial as our contact tracing, testing and vaccination as well. It seems to be the case, you know, and we’re still gathering a lot of data on this. I will also say that I’m not a vaccine expert in terms of how the vaccines themselves work. But so far, most of the evidence that we’ve seen is that the vaccines do provide decent protection against severe disease and illness, even against the variants that we’ve detected. So it’s very good news. It’s the severe disease and death that were that is most important to avoid. And it seems like both the current vaccines are holding up against that. And the vaccine companies are hard at work at developing variations on their vaccines that are more effective against these specific variants. So I think there’s a lot of hope.

You asked about the sort of the different forces driving the epidemic as well. To what extent the declines that we’ve seen are related to seasonality versus vaccination versus any number of other things. So I do it’s really hard to disentangle these things for so many different reasons, because we even when comparing two different geographic locations or one period of time against another, there’s just so much changing at once that I think the unsatisfying but truest answer is that we don’t fully know. I do anticipate that seasonality has played an important role in bringing cases down nationally up until this point. And part of that is because we saw that decline in such a uniform way that the decline was really shared many across many places across the United States and indeed many other parts at similar latitudes across the world. And some of that decline related to seasonality may well be due to the climate, the weather, but it may also be due to changes in behavior, things like that. Vaccination is absolutely played a role. So, we’ve at this point vaccinated in the United States, there are many, many people I haven’t updated myself on the most recent numbers, but on the order of 30 percent of people, I think as of last week, had at least gotten their first dose. And that’s very good. You know, that provides a quite a bit of underlying immunity. And even though it probably doesn’t get us to the herd immunity threshold, I mean, clearly, we’re seeing upticks in cases in various places. It does go a long way towards slowing down infection. And again, we’ve done a pretty good job of vaccinating those who are most at risk of severe disease and illness by vaccinating people, long term care homes, by vaccinating the elderly. And that’s going a long way towards making a dent in downstream hospitalizations and deaths, too. So I think that there’s a lot of success here to be celebrated. We’re just not out of the woods yet. And so it’s a complex story for sure. If there’s anything else that I haven’t addressed yet.

Q: Just a quick one, so Gates into 2022, what’s your guess for when this is kind of all over?

STEPHEN KISSLER: It depends on what it means.

Q: So I think that he’s saying back to normal. But yeah, we could discuss that. But I think you get the gist of what I mean.

STEPHEN KISSLER: Right. Yeah. Maybe I can address it this way is that we know from our experience with influenza pandemics that very frequently flu causes major pandemic spreads in multiple ways, but then that same strain enters into seasonal circulation thereafter for years potentially. I anticipate that something similar could happen with COVID-19. Now, that said, I think that we will likely return to something that resembles the life that we had prior to the pandemic. Even if SARS-CoV-2 does enter into seasonal circulation. I think that through vaccination, through natural exposure to the illness, we will hopefully build up some level of immunity to it that will prevent the most severe outcomes. So I think SARS-CoV-2 will likely continue to circulate. But I think that that’s a reasonable projection. Making these sorts of timeframe projections is just incredibly difficult, again, because we don’t know what the variants will do. We don’t know what new variants will emerge. And I think that that at the moment is probably the gravest threat towards extending that projection, but I think that it’s a reasonable one based on the information that we know.

Q: Meaning you agree with 2022, end of next year? That’s what you mean to say?

STEPHEN KISSLER: Yeah, I think so.

Q: Thank you so much.


MODERATOR: Next question.

Q: Hey, Dr. Kissler, thanks for taking questions. This is a question related to vaccines and testing, so I don’t know if you’ll be able to answer that, but I’ll take a shot.


Q: It’s sort of a situation that came up locally. If you were vaccinated, you’re now protected against the worst outcomes. But as I understand it, you know, if you’re exposed to the virus, you could still, you know, pick up low levels of the virus. You could still be shedding the virus. Now, you know, if we’re doing screening, frequent screening, testing at workplaces, schools, for instance, could that person still test positive? You know, someone who’s been vaccinated and doesn’t have a real case of COVID, but could they still test positive on one of these tests and have to kind of needlessly quarantine? Is that something that you’ve heard about that people are considering? Or is this kind of a rare or implausible situation?

STEPHEN KISSLER: Yes, so if a person is vaccinated, right, they can still become infected and if they do become infected, they could test positive on either a PCR or a rapid antigen test if a school or workplace is doing screening, that could cause that person to be quarantined. But I would say that that’s actually a very necessary quarantine. That’s a good thing, because you can still be infectious even if you’ve gotten vaccinated. And so especially if a rapid antigen test, which seems to be very good, especially at picking up people who are currently infectious, if that turns positive, then I think that it makes sense for a person, even if they’ve been vaccinated, to isolate so that they don’t go on to spread disease to others. Certainly, getting vaccinated reduces the probability both that you will become infected and spread the disease. It seems pretty clear that that the vaccines do reduce the amount of virus that your body produces if you do become infected. So that all reduces the probability of transmission. But there’s going to be a whole lot of variation between people and there will be some people who do get infected and who are able to infect others even after vaccination. So I think that actually what this points out is that these kinds of testing strategies, especially in workplaces and schools, can be absolutely crucial in tandem with the vaccines to help keep control of the spread of SARS-CoV-2.

Q: That’s super helpful. So I must confess, I haven’t looked at sort of like the latest CDC guidance on screening tests, but it sounds like you’re saying that even if you’re vaccinated, if you’re going into an environment where there’s screening, you still need to get tested.

STEPHEN KISSLER: Yeah, absolutely, especially while cases remain relatively high.

Q: Thank you.


MODERATOR: Next question.

Q: Hi, Dr. Kissler, thanks for making yourself available today. Just kind of wanted to go off of, I guess, what Mark was asking about. We haven’t heard a lot about a national testing strategy lately. And I just wanted to know your thoughts on whether we still need one. And if so, what sorts of components should be included in that? What sorts of situations and needs to address? Because certainly the pandemic looks very different now than what it did at the beginning, like the situation you raised with being vaccinated and still wanting to get tested and that sort of thing.

STEPHEN KISSLER: So, yes, I do still believe strongly that that testing remains key to our ability to control this pandemic. Again, the vaccines will help hugely. The important thing is to help the vaccines as much as we can too. So I think that’s what I would like to see in a national testing strategy is, you know, first just volume of testing, making testing as available as possible so that people who want to test are able to get a test and are able to do so. You know, not only are they available, but they’re available so that they’re affordable and quick. I think all of that is really important so that individuals can make decisions about how to go about their own lives. I do think that there’s a lot of room to expand rapid antigen testing. I think I’m pretty aligned here with Dr. Mina about the potential value of those in really giving us a much better sense of how much infection is circulating and empowering individuals to keep themselves and their communities safe. And part of the reason why I think some of this is so important is, again, because vaccines go a long way towards reducing the spread of disease. But the more disease we have, the more likely it is for variants to spread and just the more people will get infected and end up in the hospital while we’re still getting our vaccination ramped up. So I think both of these things, testing and vaccination together remain key. A couple of the reasons why high volumes of testing are really important. Part of it has to do with the variants as well. If we start seeing clusters of cases emerging in places where we wouldn’t expect them to. That gives us a lot of information that tells us that we might want to look there for a variant of concern. And the more testing we’re doing, the more quickly we’ll be able to pick those sorts of things up and to keep control of it before those variants spread elsewhere. On top of that, as we’re doing testing, so we have PCR testing, we have the rapid antigen testing, but meanwhile, I do think that there’s a lot of room to continue building up our genomic surveillance to make sure that we are sequencing enough of the samples that we were taking of the virus so that we can stay on top of the emergence and spread of variants that way, too. So I think that most importantly, I guess all three of these things are pretty important, making tests available, rapid turnaround, increasing the volume of rapid antigen tests that are available, and also increasing genetic surveillance. I don’t know if I could prioritize any one of those over the other. I think they’re all pretty important as we move forward.

Q: Thank you. And just a quick follow up. A lot of the antigen tests are not being reported. Do you have any recommendations on how to improve that system or what federal officials need to do to be able to track those results as they come in?

STEPHEN KISSLER: I don’t actually think I’m equipped to answer to sort of what logistically would need to be done to make that happen. I’m sorry.

Q: Okay. Thank you.


MODERATOR: Next question.

Q: Thanks for taking my question. I had a question, I guess, building on some of the testing that you were discussing specifically regarding positivity rates. And I’m wondering if you can maybe just talk a little bit about the reliability of this metric and if we should still be using it at this stage in the pandemic.

STEPHEN KISSLER: Yeah, so we sort of use multiple different metrics over the course of the pandemic to try to understand how much circulation is happening. I think that positivity rates remain valuable. But it’s important to be careful about how we’re interpreting them. I think the biggest difficulty about interpreting positivity rates and actually other metrics as well. But just they’re not especially consistent over time because they depend so much on how much testing is being done and who’s being tested and why they’re being tested. So if, you know, for example, we begin to implement testing strategies that are doing a lot of surveillance, testing of people who we don’t expect to necessarily be exposed to the virus in the workplace or even in the general community, naturally reduce our positivity rate just because we’ve got essentially a bigot and denominator. We’re dividing by more people who are getting tests who aren’t expected to be positive. And since that hasn’t been the case over the entire pandemic, you know, generally we’ve seen an overall trend of positivity rates falling, both in cases fall, but also just because more people who are unlikely to be infected are getting tested as well. So that makes it really difficult to compare positivity over time. But I think over short periods of time where you can be pretty confident that your testing strategy in a given community is fairly consistent and positivity is still immensely valuable because it does give us, I think, maybe one of the clearest insights into whether we are starting to see rises in infection when I’m looking at the surveillance data. I always try to triangulate between various inputs, including positivity and case counts, the amount of testing that’s being done, and then also with an eye to hospitalizations as well, even though those are a little bit further downstream and somewhat delayed. By combining all of those things, we can get a decent sense. And if all of them are trending upward, then we can be very confident that there’s a rise in cases. So I think that positivity still has an important role to play as testing is becoming more and more widespread. I think that we can rely more on just the raw case counts than we were able to earlier in the pandemic. So maybe its importance is declining somewhat, but I think that it’s still really valuable for it to be reported.

Q: On that, as more and more vaccines roll out, I mean, do you anticipate that having an impact on the ratios you’re describing? Because, you know, I’m thinking possibly fewer tests would be being conducted and maybe the pool of people getting tested would be likely unvaccinated people who might be more likely to have COVID or test positive?

STEPHEN KISSLER: Yeah, I can anticipate that vaccination could change this in a number of different ways. It’s a little bit hard to anticipate. Ideally by vaccinating those who are at most risk of severe disease and illness, what we may be doing is sort of skewing the overall, you know, we’re protecting the people who are most likely to feel symptoms, basically. And so that could just reduce the number of people who are getting tested. Yeah. So I think you’re exactly right that through vaccination we might we could see gosh, I can make an argument in both directions that we could see increases in positivity just based off of the scenario that you just outlined, but I could also see potentially decreases in positivity as we’re increasingly testing capacity in tandem with vaccination. So it’s not clear to me which direction that will head. And it’ll probably head different directions in different communities, depending on who’s been vaccinated and what their testing strategy is. So incredibly unsatisfying answer is that vaccination will affect this, but it’s not totally clear to me in what way.

Q: OK, thank you so much, appreciate it.


MODERATOR: Next question.

Q: Some countries like Denmark and Norway have suspended the AstraZeneca vaccine because of the adverse and very rare side effects, possible side effects with blood clotting. What kind of impact could this have, that one kind of vaccine, if not used, could that have on COVID-19 mortality? Do you have any kind of comment on that?

STEPHEN KISSLER: Yeah. I think the most important thing is that we’re in the fortunate situation where we do have multiple vaccines that are available. I think that the biggest issue in my mind about pulling authorization in particular for the AstraZeneca vaccine is just that it reduces the amount of supply that’s available, which in turn could reduce the rate at which people could get vaccinated. But it is a really important line to walk to ensure that the public has trust in the vaccines and trusts that, you know, the authorities are doing everything they can to closely review the safety and efficacy of the vaccines as we move along. So it can absolutely have an effect to the extent that it changes the overall rate of vaccination that’s happening. And so if it does lower the rate at which people are getting vaccinated, then I think that we might see less steep declines in mortality and hospitalizations, you know, this is a really crucial time to be vaccinating as much as we can, especially as many of these variants are starting to rise in prevalence. And we’re seeing surges in many, many countries around the world. So I think it’s a very difficult dance and sort of this this race between getting people vaccinated to try to prevent resistant infection. So it will likely have an effect. But I think the thing to underscore is that thankfully we do have multiple vaccine candidates and so hopefully people will still be able to get vaccinated and to use the other vaccines that we have at our disposal to keep vaccine rates high.

Q: Thank you very much. I have one follow up question also, how can different countries, health authorities have a different way of view as to how cautious you should be in this kind of situations?

STEPHEN KISSLER: Yeah, it’s very complex. And I think that I mean, in a way, I think that rightly, these decisions factor in so much, including the actual measured safety and efficacy of the vaccines, but also in any given country society. A tolerance for risk and tolerance for different types of risk of, you know, here people are voluntarily taking a vaccine and we want to make sure that it’s as safe as it can be. And I think that weighing the risks of that versus the risks of COVID, as is all, we can do that statistically and numerically. But it’s also kind of a delicate process that’s embedded in culture and politics as well. So I think it’s natural that different countries and different administrations will take different routes. I mean, I privately have my own opinions as to what ought to be done and what is safe and effective. But also, you know, I am not an elected official. And I think that that’s part of why we have these people in the roles that they’re in is to hopefully guide these decisions as best as they can. So I think it makes sense that there’s going to be variation. And I think that these decisions can be deeply informed by science but are not 100 percent scientific decisions. They also have to take into account risk tolerance and all sorts of different cultural and political things as well. I’m not sure if there’s any more I can say to it than that.

Q: Thank you very much.


MODERATOR: Next question.

Q: Thank you so much for being here. And you got a couple of questions on the rapid test. Do you know why we don’t have cheap, cheap, rapid one two antigen test available? And then do you think Biden’s team will be laying out a national strategy to use these? And then lastly, just I’ve never seen the specificity of these tests.

STEPHEN KISSLER: Right. Yeah, so I think that from everything that I have read, everything that I can tell, the barrier with having the cheap rapid tests available in the United States is essentially regulatory. So far, the rapid antigen tests that have been approved are almost entirely only available with a physician’s prescription. And just various regulatory barriers have made it really difficult to bring these cheap rapid tests to market in the United States. The technology exists. We’re producing them already. And many of the barriers are regulatory at this point, just ensuring essentially that the tests are effective at doing what they’re meant to do, which is in this case, to detect people who are likely to be infectious. So I’m hopeful that the current administration will put quite a bit of effort into making these sorts of tests more available. They have mentioned them by name in a number of documents and addresses to the American public, and so I think that it’s clearly something that they’re focusing on and thinking about. And so I’m glad to hear that these particular types of tests, their Abbott engine tests of have been highlighted at various points. So I think that there’s reason to think that there will be emphasis placed on this. But, of course, it requires, you know, not only the effort of the administration, but also of the FDA. And part of that includes increasing gathering more and more evidence among scientists and public health officials to demonstrate their efficacy, to the extent that it exists, which I’m pretty well convinced of, that I know that there are many others who are not. And I believe you asked about the specificity, is that right?

Q: Yes. Just you know, Dr. Mina is always talking about with great sensitivity and how is the specificity?

STEPHEN KISSLER: Yes, so the specificity similarly is actually even more so than the sensitivity is extremely high. As with any test, there’s risks of false positives. But from all of the evidence that I’ve seen, and this comes from some preliminary studies that I’ve seen both out of the UK and the US, the specificity is very good, upwards of 99 percent in most cases. Now that, of course, you know, takes into account different, you know, use cases, we have to be very clear about what exactly it is we’re measuring and that we’re trying to detect. And here the rapid antigen tests are trying to detect people who are producing antigens in their blood, which means that they’re likely to be infectious. But when we’re using that as the metric, both sensitivity and specificity are quite high.

Q: OK, thank you very much. I mean, it just seems like the FDA has approved expensive antigen tests. I don’t understand.

STEPHEN KISSLER: I wish I did. I’m not on any of the boards on the FDA, so I don’t know what those conversations are looking like right now or what evidence they’re looking at. But that I agree with you. I think that the evidence in my mind of their efficacy and the potential value of having these tests cheaply available is absolutely huge. And so I think that’s just the message I would most like to get across, is that I’m deeply convinced that would be a valuable tool in our fight against this pandemic.

Q: Thank you.


MODERATOR: And I will say too, if you would like Dr. Mina’s comment on why he thinks the FDA is not pushing these forwards. We have previous calls with him that are recorded. So I can send you one of those if you would like. Shoot me an e-mail so I don’t forget.

Q: Thank you.

MODERATOR: Next question.

Q: Hi, thanks for this conversation. I do have a follow up question to your comments on the FDA and its regulatory barriers. The FDA did issue a template, and some additional guidance was last week on rapid tests and requirements for these rapid at home tests. And I wanted to know if you think that helps alleviate the bottom vote to help alleviate the bottleneck. And they would say they didn’t get submissions for months on the rapid tests. So it took over the summer and the fall. They were waiting for more submissions and didn’t get them. Anyway, I wanted to know if the new recommendations, guidance, just whatever, from the FDA last week will help to alleviate the barriers that you see on the regulatory side.

STEPHEN KISSLER: Yeah, so I have to admit that I am not up to date on what exactly those new recommendations are, so I don’t know if I can speak to them directly. I think without reading them, I don’t know if I can give an informed answer to that, unfortunately.

MODERATOR: If you would like to send me your questions by email, I could see if Dr. Mina comment.

Q: I would appreciate that. Thank you.

MODERATOR: Looks like that may be the last question from folks on the call, but I still have a question that came in. You may have answered this already, but I’m just going to ask in case there’s anything else to fill in. He’s trying to understand some of the recent surges we are witnessing, even as weather warms and vaccines become more ubiquitous. One, the explanations, the UK variant, which seems more prolific in Michigan and Florida. But I’m kind of wondering why we are seeing such a steady increase in the Northeast, including Massachusetts. I have thought that between vaccines and the number of infected people from last spring, the new cases would at least plateau, if not steadily decline. So what do you think is going on here?

STEPHEN KISSLER: Yes, I think that we do have relatively high rates of different variants of concern, including the UK, B.1.1.7 variants here in the Northeast, too. So I’m certain that that’s part of the story apart, too. And I think that we need to do some more surveillance. And I actually need to get more up to date on the surveillance to know this for sure. But the other concern about, as I mentioned before, some of the other variants not only are more infectious but are able to escape some amount of our immune response. And so some of that may be partly why we are seeing increases in cases in places that have both have high vaccination rates and have had severe surges of infection before, similar to the way that we saw rises of infections in some of them were first detected in parts of Brazil that had had very severe first waves of the pandemic. But I think the last thing, too, is that even, you know, even in many of the hardest hit areas in the United States, there are still plenty of susceptible people remaining to be infected. One clear example of that, for example, is we know that in in New York City, certainly in parts of the city, many people left early in the pandemic. And so a lot of the transmission that we saw in New York City was among those who remained behind. And in it, meanwhile, there have been large shifts. You know, many, many people are moving back to these parts of the country. And if they hadn’t been previously infected and that that sort of increases the pool of susceptible people who are available to be infected from the disease as well. So I think that there’s a lot of complex things going on that, you know, include the variants, but also include sort of shifts in the population structure, who’s around to be infected. And all of that is likely playing into what we’re seeing now.

MODERATOR: Oh, great. Thank you. And then there was also going through my own two cents in there, do you think it’s going to be a big change when people start going back to the office as well? Right now, you and I are both working remotely. A lot of companies are still working remotely. And as people start heading back to the office, is that going to be an increase, that pool of people who are susceptible?

STEPHEN KISSLER: Yeah, so it’s it may well do that. The thing, though, that I’m optimistic about is that we’ve learned an awful lot about how to keep indoor environments relatively safe. And that includes really especially ventilation as well as masking, having air filtration. All of these things go a long way towards keeping places like offices relatively low risk for the spread of COVID. So I think that if we were to go back to offices just as if we were the pandemic era, they would absolutely contribute to spread because we would be causing people to interact who haven’t been interacting with each other or potentially even with the their broader communities up until now. But we’ve learned an awful lot. And I think that we know pretty clearly what it takes to keep indoor environments relatively safe. And as long as we’re prioritizing those things and making sure that we’re staying on top of them. I’m optimistic that people returning to work, especially office type work, won’t contribute hugely to new searches of an infection.

MODERATOR: Thank you. Anybody else have any other questions? So you can raise your hand using the blue hand icon or the reactions a hand icon you can get touch with by Simchat or anything like that? If not that’s great. Dr. Kissler, do you have any final thoughts for us before we go?

STEPHEN KISSLER: I don’t believe so. Thanks very much for being here today.

This concludes the March 26 press conference.

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