Coronavirus (COVID-19): Press Conference with Stephen Kissler, 09/29/21


You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Stephen Kissler, research fellow in the Department of Immunology and Infectious Diseases. This call was recorded at 11:30 a.m. Eastern Time on Thursday, September 29th.

MODERATOR: Dr. Kissler, do you have any opening remarks for today?

STEPHEN KISSLER: Yeah, I mean, one other thing that I’ve had on my mind that I would be happy to talk about today and answer some questions about is just sort of what the outlook looks like. How are we transitioning into a world of living with COVID? And sort of what does that look like, especially in the context of other respiratory viruses that we’ve had spread in the past, so also happy to take questions about that if that’s of interest.

MODERATOR: Great, thank you. First question.

Q: Hi, Dr. Kissler. Can you hear me okay?

STEPHEN KISSLER: Yup.

Q: I wanted to ask you exactly about what you started to talk about with what do you see coming over the winter months? You’ve done some of the best modeling that I remember on the pandemic. And so I’m wondering if you’ve updated that or what tealeaves are you reading to give us your prediction?

STEPHEN KISSLER: Yeah. So I appreciate that kind remark. The landscape has gotten a lot more complex. And so my job has gotten a lot harder. And so also my projections are a lot less certain, unfortunately, but I can walk through sort of how I’m thinking about the coming months. So I think the first and most important change has been the emergence of the Delta variant and especially how much more infectious it is. That’s going to make these the coming winter months more difficult than they would have been otherwise. But I think that there are a lot of other things going in our favor, including especially here in the U.S., quite a bit of underlying immunity, both from previous infection and from vaccination. And so what I expect is that especially in places that were largely spared from a major summer surge, so especially parts of the then more northern parts of the country, we’re almost certainly going to see another significant winter wave. I think that it’s worth saying that I expect us to start seeing recurring winter waves of COVID-19 in the coming years more or less permanently. And fortunately, as we move forward, as more and more people get vaccinated and as we keep getting exposed to the virus, I do think that the severity on a per case basis will continue to decline. But I do still think that this winter, we’ll probably see in some parts of the country similar scenarios to what we saw especially parts of the southeastern U.S. over the summer, where in some regions, hospitals will be very full. We’ll have to put elective surgeries on hold. And so I think those surges again will be probably geographically more isolated since they’re different degrees of immunity across the country. But they’re still going to be some communities that are going to be hit pretty hard this winter. So I think that’s something we have to be really clear eyed about as we move forward. But my hope is that beginning with this, you know, once we get through this winter wave will start to enter into a phase of the pandemic where it actually becomes that SARS-CoV-2 is more of a seasonal respiratory virus than this incredibly disruptive pandemic virus that we’ve been dealing with. So we’ve still got a little work left to do. But my hope is that we’re approaching something that is ever closer to normalcy.

Q: Can I ask a follow up question? And that has to do with the flu. I’ve seen a lot of concerns that we might be facing a resurgence of the flu after not seeing at all last year. Do you have any thoughts about what the flu might do this year?

STEPHEN KISSLER: I appreciate you bringing that up. I think it’s really important that people get their flu vaccine this year, ideally soon by the end of October. And that’s especially true for people in older age groups who are also vulnerable to COVID-19. Since we didn’t have much circulation of the flu last year, I do expect there to be quite a bit of spread this year, especially because I don’t expect that we’ll have nearly the same amount of masking and physical distancing that we had last year, which is really what seemed to suppress flu spread. So because of that and because we don’t really have much immunity to carry over from last year’s flu epidemic, it’s possible that this year’s outbreak will be especially bad. And what we really don’t want to see is this joint epidemic of flu and COVID-19 at the same time. That’s bad for individuals and also especially bad for our health care settings. So getting vaccinated and staying mindful of, you know, all of these same precautions. I think that you’re masking in indoor spaces makes a lot of sense, both for flu and for COVID. So, yeah, I do worry a little bit about the coming flu season. And so definitely getting vaccinated is something I would highly recommend for everyone.

MODERATOR: Thank you.

STEPHEN KISSLER: Thanks.

MODERATOR: Quickly, Dr. Kissler, going back to your first question. It sounds like then what you’re saying is that COVID is probably going to be more of a seasonal virus. Is that correct?

STEPHEN KISSLER: That’s what I anticipate based off of some of our modeling in the modeling of some colleagues as well. And based off experience with previous flu pandemics, that seems to be the pattern that a lot of these respiratory diseases follow. They’ll cause a major pandemic that’s really disruptive for a couple of years and then after that settles into this seasonal wintertime circulation pattern. So that’s really what I expect for COVID-19. I don’t think it’s a guarantee, it could behave differently than previous viruses that we’ve seen. But based off of our models based off of previous experience, I think that’s the most likely scenario.

MODERATOR: Thank you. Next question.

Q: Hi, thank you for doing this. I have heard a lot of concern from college professors, including some there in Cambridge and other places, about having to come back and teach in person. Some of them are elderly, some of them are cancer survivors. And you know, as we’ve heard, the masking has a modest effect on spread, maybe a 10 percent improvement. I don’t think that’s very reassuring for people, given how many breakthrough cases there have been. And I wondered what would you say to a professor who was maybe 75 or had had cancer, who’s being asked to teach in-person this year?

STEPHEN KISSLER: Boy, that’s very difficult. You know, I think that this is, you know, stepping aside from the epidemiology a little bit, but I think that institutions really do have a responsibility to be mindful of both of their mission and the principles of the health and safety of their employees. I think it’s difficult because in-person education really does add a lot of value to education, we see that through K-12 education, but also, I think in university education. So there’s always this this balance of risks and benefits that is not really totally an epidemiological question. I think it has to do with much broader values as well. We are in a setting where, you know, for many people, including, you know, the 75-year-old professor who you mentioned, the vaccine protection does seem to be pretty good and there are breakthrough infections, but in the majority of cases, even if they do cause symptoms, those people are not ending up in the hospital or dying at nearly the same rate. I don’t like to see breakthrough infections. I don’t want to see people getting sick from COVID-19. But I think that we are going to be living in a world where COVID-19 infections are going to continue to occur. So I think that you know this, this really needs to be answered on a on a case by case basis. It’s true that people who are cancer survivors who might be immunosuppressed may not have had the same response to the vaccine, and they’ll have to behave differently. And my hope is that we would find ways to compromise for that at an institutional level that there would still be the opportunity to provide virtual education for those who need to do so. And that that would be the case both for professors but also, you know, there are plenty of students who are also immunocompromised who might need those sorts of accommodations as well. I think we have a lot of work to do there to make that a reality, and I don’t know what the best answer is in the short term, but I do think that we need to be working on that very hard, especially because this, you know, this isn’t going to be the last issue that we face where we have an epidemic spreading and we need to keep people safe from it. So whatever we do now will pay dividends in the future as well. I imagine that might be a bit of an unsatisfying answer, but I think that’s the best I can give.

Q: Well, it certainly would more a broader follow up to, it seems like if we are and going into an endemic situation and everything about the science has been telling us that some people are vastly more risk than others, that people like me are not at much risk at all because I’m young and I have had the vaccine. Do we need to get away from a one size fits all policy and just and start really giving people more options, depending on their situations and their own individual risk tolerance?

STEPHEN KISSLER: Yeah, I think that that would be beneficial, and to some extent, we’re making moves in that direction. I think some movements in that direction have included the recent approval of third doses of the vaccine for certain groups, even though they’re not broadly approved yet anticipate that they might be broadly approved. And so that may be getting back towards that one size fits all approach. But it’s common for a lot of medical interventions to be targeted towards the individuals who need the most, and I think that we’ll start to see that more and more with COVID-19 as well. One of the things that has blocked that so far is that we’re still learning about the virus a lot. We haven’t had the vaccines for all that long. And so we’re still in the beginning of learning about how our immunity works and how that immunity looks in people of different ages and with different medical backgrounds. As we learn more, I think that these recommendations are going to get more and more personalized. And my hope is that it won’t be just up to individuals to shoulder that burden of figuring out what they need to do and how they need to do it. That there will also be a lot of this institutional support from universities, from places of employment and so on that lay the groundwork for people to still, you know, fulfill their jobs while keeping themselves safe. And I think we have a lot of the technology we need to do that. We can develop a lot of the infrastructure to make our workplaces safer, and I think we just need to do that to share the burden between institutions and individuals.

Q: Thank you.

MODERATOR: Next question.

Q: Hi. You were talking a little bit about what might be to come a little bit further down the road, but I guess I’m just curious how you view what’s happening now. Obviously, things are so really high and a lot of places they are on the decline, seemingly in places in the south and such had summertime surges just like it’s almost reminiscent of last summer in a way. Or is it just sort of the sort of, you know, when you look at like local geographies, that wave pattern that has kind of defined everything like how do you assess what’s happening now?

STEPHEN KISSLER: I mean, in some ways, it does seem to me like almost a repeat of what we saw last year, and we did see a lot of major summertime spread in the southeastern U.S. and that wave sort of transitioned into the autumn and winter waves that spread sort of in this wave up towards the northeastern U.S. And that’s a pattern as a geographic pattern of respiratory virus spreads that we actually frequently see that it’s very similar actually to what happened in 2009 with H1N1 swine flu pandemic as well and where we saw a lot of spreads starting in the southeastern U.S. and then sort of spread like a wave northward in the fall, in winter. And there are a lot of different factors that contribute to that, including, you know, indoor crowding, which tends to be more common in the summertime months in the south versus is more common in the wintertime, once in the north and probably some element of the weather meteorological factors that contribute to spread as well. We’re still sort of trying to disentangle. But again, I think that part of the reason that we’re seeing such a pronounced wave that seems to recapitulate what we saw last year is in large part due to the delta. I think that in the absence of this new variant, that wave might not have been as pronounced. I think that it might have a lot more resistance from the underlying immunity that we have in the population. The Delta is just so much more infectious that it’s sort of behaving almost like we would expect a new respiratory pandemic virus to behave. The underlying immunity helps a lot and really reduces the severity of infection and deaths. But in terms of transmission, we’re seeing something that looks, you know, it looks a lot like previous waves of COVID-19 and even previous waves of flu pandemics.

Q: Thanks very much, appreciate it.

STEPHEN KISSLER: Thanks.

MODERATOR: Next question.

Q: Hi, yeah, this picks up just a bit more on the outlook, because I’ve seen some modelers talk about how we’ve gotten our surge out of the way ahead of the winter, you know, and this idea that would and then there’s some estimates that between vaccination and prior infection, we’re like, there’s some 90 percent of the population, have some level of, you know, some degree of immunity. So I’m just curious, can you just kind of address those? Let’s get your thoughts on that.

 STEPHEN KISSLER: Yeah, it’s I think that’s a possibility. You know, a lot of the places where we saw surges this summer are also places with relatively lower vaccination rates. And so I think that there’s reason to believe that maybe, you know, we’ve seen a surge in many of those places. Now we’re coming up on the wintertime months where we would expect to see a surge in other parts of the country, but maybe those places are more highly protected from vaccination. Also, many parts of the Northeast are really strong transmission waves very early in the pandemic, so there’s quite a bit of underlying immunity from natural infection as well. So I think that’s possible. I base off of my own experience with past epidemics and some of our modeling. The seasonal effect, I often wait that a little bit more strongly than some other epidemiologists and modelers. From the models that I’ve worked on, the models I’ve built and some of the experience with past epidemics really seems like the increase in transmissibility in the wintertime really can play a very strong role. And so I still expect to see some surges, and I think that we’re not based off the evidence that I’ve seen my understanding of underlying immunity. I don’t think we’re totally out of the woods yet, and I don’t think that the summer surges will have totally gotten us out of a situation where we’ll have continued surges this winter as well. I really hope I’m wrong, though. But I do think that there’s still enough people who have been infected or vaccinated long enough ago that their immunity will have waned to a point where they can be reinfected. And I think that that will allow transmission to continue. And when you layer the wintertime transmission over the top, it’s hard for me to believe that we have really completely gotten this major surge behind us.

Q: Great, thank you.

MODERATOR: Next question.

Q: Hi Stephen, I’d like you to continue to elaborate a bit on this. You mentioned the expectation of a surge shifting from south to north, but here, you differentiate between vaccinated northern parts of the country and unvaccinated northern parts of the country, which in places like Idaho and Wyoming, they’re clearly in a surge now. How much protection will the vaccine provide in northern regions that have high vaccination rates? And do you expect the proportion of the population that is unvaccinated in those areas to get hit pretty hard?

STEPHEN KISSLER: Yeah, I do. I mean, I’ll try to be very careful with my terms here because I think there are a lot of different layers of things going on. So I do think that we will still see a lot of cases, especially among the unvaccinated members of other parts of the country that haven’t yet seen their major Delta surge. I think it will hit the both the individuals in the communities that are more unvaccinated hardest. But the thing that I’m most closely watching and that seems to be the strongest correlate of how hard these new waves of COVID-19 are hitting in the sense of causing severe illness and death is really the proportion of the oldest age groups who are vaccinated. The number of observed cases of severe cases of hospitalizations and deaths is extremely tightly connected to how many in those older age groups are vaccinated. So even if we have lower vaccination rates among younger age groups, you know, ideally, we would have high vaccination across all age groups. But as long as the oldest members are vaccinated, then I think that that will go a really, really long way towards protecting our hospitals and health care systems from seeing the sorts of surges that we’ve seen. We’ll still see a lot of spread of COVID-19, but my hope is that it won’t be as disruptive to our health care system and won’t cause as much severe illness and death because those most vulnerable age groups will hopefully be protected. Now, of course, that’s not true across the board. There are still plenty of people in those older age groups who have not been vaccinated and are still vulnerable. And I think those communities, they’re the ones that I’m the most concerned about as we enter into these winter months and we start to see further surges of Delta going forward. So, I think hopefully that that elaborates a little bit on some of these things that we’ve been talking about previously.

Q: Yeah, that helps with the nuance. I wanted to follow up with your comment early on that you expect it to be seasonal. Did I hear you say right after this winter? So you know, well, are you expecting these winter surges to be bad enough, essentially to get us to a point where you know it will become seasonal, say next winter, we won’t expect surges this summer.

STEPHEN KISSLER: Yeah, I think that is my guess. But, you know, I think that if I had to put probabilities to that, I’d say maybe 70, 30, 70 percent is that we won’t see as much of a surge this next summer and it’ll start to be wintertime. It could be that we still have sort of one more year left or something on that order, assuming that this virus behaves as I imagine it should. And that’s based off of the fact that between vaccination and natural immunity, by the time we get through this coming winter surge, really, most people probably will have been either infected or vaccinated at that point. Certainly not everyone, but a pretty high proportion. And once we reach that point, then we’ll have underlying immunity carrying forward and hopefully providing enough protection during the summer months to keep transmission low during that time. Again, it might take a little bit longer than just this winter, but based off of my estimates of how long immunity lasts, how many people will have been infected or given the vaccine? That’s my best guess is that this coming summer won’t ideally resemble the two summers previous.

Q: Thank you.

MODERATOR: Next question.

Q: I wanted to follow up on what you said about the thing you’re watching most carefully is the older percentage of older people who are unvaccinated in a given area. What age cut off are you giving them to define what an older person is and when you see a percentage, do you look at it and go, Wow, they’re in trouble?

STEPHEN KISSLER: Yeah, so generally, I mean, and apologies to anyone who might be already in this age group, but you know, I’ve been thinking about 65 and up as the category that I’m really paying attention to. But that’s partly because a lot of our data are reported with that cutoff. So vaccination rates in people who are 65 and older is a something that a lot of public health agencies are measuring. So I want to talk a little bit about the experience in Florida over the summer. Now Florida is interesting because especially relative to their neighboring states in the southeastern United States had pretty high vaccination rates. And one of the things that surprised me about the Florida surge is that they still saw a lot of hospitalizations and deaths relative to the initial delta surge in the UK. And as far as I can tell, one of the key differences between those two places is that in the UK, the vaccination rates among the very oldest people were extremely high. And in Florida, they were they were high, but not as high. And we’re in a scenario where the people in those older age groups are so much more vulnerable to severe disease and to death that even, you know, five percent shy of 100. If 95 percent of those age groups are unvaccinated, that remaining five percent can still really contribute a lot to severe disease and death. So I mean, to prevent a lot of these hospitalizations and deaths in those age groups, we really need near 100 percent vaccination rates in those older age groups. And we definitely want to see high vaccination rates in the younger age groups as well. We are seeing young people being hospitalized with COVID-19, too, and I think that’s really important. But it remains true that the older age groups are the ones who remain the most vulnerable, and we need vaccination rates there to be as high as absolutely possible.

Q: Thank you.

MODERATOR: Next question.

Q: I’m sorry, I forgot to ask earlier you were saying model like right now sort of modeling and predicting is more difficult because the landscape is more complex. And I guess I just wanted to ask why that is? Is it just because the varying levels of population immunity in different places are like, what else is making it more difficult at this point?

STEPHEN KISSLER: Yeah, so exactly, it’s varying levels of population immunity. Different ways in which that immunity was acquired, whether it was through natural infection or all of the different vaccines that we have available. Also, behavior is changing a lot in ways that it’s hard to know how to how to incorporate into our models. It’s changing differently in different places. Some parts of the country are still frequently wearing masks indoors. Others have really given that up a long time ago, and it’s hard to weigh these things together, in part because we don’t really even know how to measure them in the first place. So the main things are immunity and behavior, but both of those things have become a lot more heterogeneous across the country and more complex, and that’s made the modeling a lot more difficult.

Q: Great, thank you.

MODERATOR: Next question.

Q: I wonder, you know, your comments on the your projections for the pandemic. You know, as it becomes seasonal, does it track the 1918 flu pandemic?

STEPHEN KISSLER: Yeah. And in fact, that pandemic and the 2009 flu pandemic are sort of two of the places where I’m drawing some of these projections from. In 1918, we saw a couple of waves of that H1N1 flu. And they those waves. There was one major early autumn wave, but there were also waves in the summer, sort of similar to what we’ve been seeing with COVID 19. But then as we moved forward, by the time we got to 19, 20, 21, that very same virus became a seasonal flu virus and continued circulating as a seasonal flu virus for years afterward continued to mutate and change. But it was it was derived from that original virus. A very similar thing happened in 2009, even though in 2009 that virus was much less deadly than in 1918. But the transmission patterns are quite similar. And so my guess is that a similar pattern is what we can expect with SARS-CoV-2 too.

Q: Thank you.

MODERATOR: Next question.

Q: Yes, when you mentioned Florida, it reminded me that it’s been a little bit challenging this summer to get good data on who these people are who are being hospitalized in this most recent wave, whether it’s that small percentage of old people who aren’t vaccinated, whether it’s breakthrough cases among the old and vulnerable, whether it’s young, unvaccinated, who these people are. It seems like we need that data. Are there places that that data can now be obtained? Is it a state-by-state thing? What do we know about it?

STEPHEN KISSLER: Less than I would like to, it’s data that we would love to have, and it would be really helpful for developing policies for the coming months. But you’re right, it’s more on a state by state and even hospital system by hospital system scenario. And that makes it really difficult, and it is very frustrating, and one might be tempted to say, you know, why don’t we centralize everything and make everything standard and uniform? And I’m very sympathetic to that. That said, I think that early in the pandemic, the ability for different geographic locations to adjust sort of how they responded to the pandemic, myths made some sense, and I think that, you know, there is a balance between sort of allowing different communities to decide what’s best for them for response and then also collecting data that’s useful on a national level. I think that we should be edging towards more of the centralized data collection. I think that we should have more standard ways of collecting these data because they’re so immensely valuable. But I also understand why we may not have gotten to that point. So it’s a big lack that we have right now and it’s something that we should be working on. And I think people are, but it’s a big gap in our knowledge right now. And in this case, in terms of knowing who’s been hospitalized, how old they are, what their vaccination status is, what their previous infection statuses. We don’t have very good information on that at all, and that’s something that I do think we do need to change.

Q: Do you learn much from looking at Israel and the UK and other places where there is a little bit more standardized data collecting? Are there lessons that we can draw from those countries?

STEPHEN KISSLER: Definitely. And those two countries, where a lot of our information is coming from right now precisely because they do have that kind of centralized data collection. It is still difficult because behaviors differ. Seasonality of the virus differs. Age distribution and comorbidity distribution differs between the countries, so it’s hard to make a one-to-one comparison, but they are very helpful. And so we’ve been relying on the data that they’ve been collecting quite a bit.

Q: Thank you.

STEPHEN KISSLER: Thanks.

MODERATOR: Looks like nobody else, I should say right now, but I do. So I’ll go ahead and ask some while people raise their hands. So October starts on Friday. Do you have any suggestions for how people should act during Halloween?

STEPHEN KISSLER: Oh yeah. A lot of the same principles hold that we’ve been talking about all along, but that we can make some Halloween centric. I mean, what better opportunity to wear a mask than Halloween and try to incorporate it into your costume in any way that you can? But the principles that you know that we’ve been bearing in mind throughout the pandemic really do still hold, which are that outdoor gathering is better than indoor and that ventilation is important. Masking remains helpful. And so I think that, you know, there are ways to socialize during Halloween, that there are ways to do it safely. And it’s the same things that we’ve been sort of talking about all along. I do think we need to be mindful of the fact that Halloween coincides with when we, you know, if this seasonal element of transmission really does end up playing an important role in the winter surge, Halloween is when we’re probably going to start to see that surge coming on and potentially circulation of the flu as well. One thing you might consider doing is getting your flu vaccine in the next week or two so that you have immunity to the flu by the time Halloween comes around. That, I think, would be a very good idea. And so, yeah, I think otherwise. Same principles hold. We can socialize. But I think doing it safely makes a lot of sense.

Q: And we don’t have to worry about transmission of the virus by handing out candy or anything like that, physically touching the candy that somebody else’s hand.

STEPHEN KISSLER: Exactly. I mean, a surface transmission really seems to be not particularly important. So in terms of handing out candy, I would be much more mindful of the face to face interaction you’re having with people from door to door than I am of the candy itself. So that’s the opportunity for transmission there. And so wear your mask, maybe stay a few steps back and but enjoy your candy.

MODERATOR: No bobbing for apples, although there’s many reasons not to do that. So I have been seeing a bit more in the last couple of days, but the R.1 mutation, the R1 variant, is that something to be concerned about at this point? Or is it more an unknown because we just don’t know that much about it?

STEPHEN KISSLER: Yeah. So with that variant, we’re still in the early stage where we’ve seen ourselves repeatedly as these new variants emerge. It’s something worth paying attention to for sure. But when I say worth paying attention to at this point, I’m mean, mainly epidemiologists. I don’t think that it’s something that that we really need to be concerned about on a large scale. So far, it’s been a long time since we’ve seen any new variant emerge that has been able to stand up against the delta. There have been a couple of situations in which a variant has emerged and caused a localized outbreak, but by the time Delta comes in, it really seems to outcompete and out spread whatever variant is there previously. This R1 variant could be, you know, it’s something that we’ll have to watch and see how it plays out against the Delta in various settings. But to my knowledge, right now, we don’t have good evidence that it will be able to outcompete Delta on a large scale. So it’s something we’ll be watching very closely, but I don’t think it’s something that I would worry about on a large scale at the moment.

MODERATOR: Yeah. Next question.

Q: Yeah, I just I was looking at the recent CDC study about, where they looked at hospitalizations among vaccinated and unvaccinated people, and they were finding that about 14, you know, in June and August, about 14 percent of hospitalizations were among vaccinated people. So I’m just curious how people should make sense of this number and is this does this is this what you would expect or as people are trying to understand the risk with breakthroughs?

STEPHEN KISSLER: Yeah, so this statistic is a really difficult one to interpret, what I mean by that is specifically the number of the number of hospitalized people who are vaccinated. And that’s because as vaccination rates increase, we expect more of the people who are hospitalized to be vaccinated because, you know, the thought experiment is that if you have a population where ninety nine point nine nine percent of the population is vaccinated, and then you say that while half of people who are hospitalized are vaccinated, well, that’s actually still very good evidence of the vaccine being very effective because it can do two people at random, you’d be almost certain that those two people would be vaccinated. And so really, when we’re thinking about the number of hospitalized people who are vaccinated, we need to compare that to vaccination rates in the overall community. So the higher vaccination rates are in the community, the more people we expect to be vaccinated in the hospital just by chance. And so as vaccination rates increase, I do expect a greater share of people in the hospital to be vaccinated as well. But I also expect the proportion of people in the hospital who are vaccinated to be much lower than the proportion of people in the population who are vaccinated, and that’s the indication of vaccine success and vaccine protection. So it’s really difficult because it’s that number is a sort of a moving target and can actually lead to some pretty alarming and in fact, misleading headlines when you start to say that even sometimes even a majority of people who are hospitalized are vaccinated. But really, what matters is not that round number, but the relative proportion of people to the people in the population who are vaccinated.

Q: Thank you.

STEPHEN KISSLER: Thank you.

MODERATOR: I had a request for a fact check, so nobody else has any questions right now, I’ll go through this, but if somebody else has a question, just pop up your hand. They’re looking into misinformation stemming from social media users who misinterpret the Vaers, vaers data to mean verified and causal events regarding the COVID-19 vaccine. Could you answer these questions, and if not, I can talk to you about these. Any thoughts on the misinformation stemming from the database, even though there are many disclaimers about that?

STEPHEN KISSLER: First thing here, I mean, it’s really difficult. It’s like I and many of my colleagues really think that it’s important to make these data available to the research community, available to the public. But you’re right that misinterpreting a relationship where these data frequently report somebody receiving a vaccine and then some kind of health effect. But it’s unclear whether or not that health effect came from the vaccine. For someone who’s just looking at the data who may not be aware of these caveats about using the data that they may not represent a causal link between vaccination and health effect, it can be very alarming, and it can seem like the vaccine is causing all of these different kinds of health effects. A knee-jerk reaction might be to say that, well, maybe we shouldn’t be making these data as publicly available as they are, or maybe they shouldn’t be as detailed. But I really hesitate to go that direction because I really do think that empowering people to make database decisions about their health and about community health making data accessible is really important. One thing that may help with the sort of thing is having in the CDC at certain points has done this fairly well, is making data available, but also having sort of the first interface with that data would be a couple of brief high-level visualizations and summaries of that data that put it into context. So currently, it’s possible to download that data from the reviewers and look at adverse reactions that followed vaccination. But that doesn’t put it into the context of how frequent those adverse reactions are in the general population. And so that sort of thing is what I would like to see read on the first page. So coming up with those data and saying these are the most common medical events that follow vaccination, here’s the prevalence of these things in the population as it is. And maybe even here’s the prevalence of these things in response to the infection that the vaccine prevents in the first case.

So one of the examples that that falls under this is the reports of myocarditis colitis post COVID-19 vaccination. There actually does seem like there’s probably a link. We’re getting vaccinated does slightly increase the risk of myocarditis in young people, but it doesn’t increase that nearly to the same degree that having COVID-19 does, and it actually doesn’t increase it that much more over the rates of myocarditis in the general population. So putting things into that context and having that be the first thing that a person sees when they come to approach those data, I think might go some way towards preventing that misinformation, preventing disinformation, which is the, you know, the the intentional use of those data to push an agenda forward is much more difficult. But I think that that’s an entirely different can of worms for misinformation where it’s just a misinterpretation of those data. I think that having these high-level visualizations and summaries can be really helpful.

MODERATOR: Thank you. There are a couple other questions you may have answered these already. How beneficial do you think the database is to the public and to the medical community?

STEPHEN KISSLER: So for the medical community, I think it’s extremely helpful. I think that there are issues with the data for sure in that it is generally self-reported. And so it doesn’t meet the standards of a super, well, well-conducted study that we would want to base a lot of these decisions on. But it is a large database that does give us a sense for what sorts of symptoms can follow vaccination. So from that standpoint, I think it’s extremely beneficial for the medical community, if only to prompt further research into some of these links that are hinted at by the database. I think that it can be helpful for the public as well. But again, these data can be difficult to interpret, for sure. It really does require looking at them fairly skeptically and recognizing all of the biases that can creep their way into the data. The database itself does a very good job of explaining what these things are, and because of that, I do think that it is a good resource for the public. All of that information is there. It has a very good guide for how to use the data. So as long as those things are heated, I think that a person in the general public can actually derive a lot of value from these data as well. And so I’m really glad that it exists. And but I think that, you know, as with anything using it wisely, it is critically important.

MODERATOR: Last question and this again, I think you kind of covered what precautions can be taken to reduce the possible misinformation or improve the database since its creation in the 1990s?

STEPHEN KISSLER: Yeah. So I think that, you know, I’d mentioned some of these high level summaries, but we can also think a little bit about there should be. Should we be changing the way that these data are collected in the first place? I think that building off of some of the surveys that are done by the CDC, for example, they have some databases where they where they have actually proactive surveys that ask people about their health care encounters and ask people about their vaccination status and actually run lab tests. I think that supplementing these data with more proactive sampling could be really helpful, and it could help us understand to what degree the data is biased and how we should be interpreting it in the context of the overall population. Since the 1990s, you know, one of the big advances that we’ve had is with the digital data collection, so it’s much easier to reach people through computers, through cellular phones. And because of that, I think that we have new opportunities for gathering these kinds of data on a larger scale in a more unbiased manner than through some of the self-reporting that that there’s really still a reliance largely on. So that’s what I would like to see is both the high-level summaries and sort of revision of how the data is collected in the first place.

STEPHEN KISSLER: Thank you.

MODERATOR: All right, looks like that might be it. Dr. Kissler, do have anything else you’d like to say before we go?

STEPHEN KISSLER: I think that’s all. Thank you.

This concludes the September 29th press conference.