Coronavirus (COVID-19): Press Conference with Thomas Tsai, 08/19/20

You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Thomas Tsai, assistant professor in the Department of Health Policy and Management and an affiliated faculty member of the Harvard Global Health Institute. This call was recorded at 11:30 a.m. Eastern Time on Wednesday, August 19th. 


THOMAS TSAI: Thank you, everyone. Still waiting for Nicole to show that picture of the puppy to start things off in a good mood for everyone. But I’m thinking since our last one of these, we’ve actually made a lot of progress along the way. When I, a few weeks ago, did one of these press calls, there were over 11 states that were in our red risk level. That’s over twenty five per hundred thousand new cases off of a seven day moving average. And now, according to our current dashboard at the Harvard Global Health Institute, three current states, Georgia, Florida, Texas, that have over twenty five new cases per hundred thousand. So those are the three states are still in the tipping point hot spot category. So I think we’ve made a lot of progress along the way. But I think it’s also important to consider the guidance that we had back in April in terms of reopening across the states. And we’ve seen the consequences of states that have opened too soon, as well as the courses of those states have had taken a more measured approach reopening. It’s important to have that consistent 14 day, two week decline of new cases decline of test positive rate to be really sure that the coming level of transmission is going down. 

The last comment I’ll make is that over the last several weeks, there’s been new technologies have come online in terms of testing, both saliva testing for PCR purposes, newer antigen based tests are on the scene. I think it’s now important you to think about testing in two broad categories, testing that’s more reactive and based on diagnosing cases with symptoms where you need to be sure that it’s a true positive, and these are settings, for example, in hospitals where you have to be sure that somebody has COVID and you’re worried about a false negative. But then there’s also the more proactive way to thinking about testing, which is the context around surveillance testing or assurance testing, which is the term that’s often been used as well, where antigen tests are used at a higher frequency, for example, can come into play. So I think it’s a good moment that we now can come up for air as a country and start rethinking again about having a strategy around testing and then also to realize that testing is only part of the part of the puzzle. The other pieces of the puzzle still remain, so masking and physical distancing. And I think these things become incredibly important as schools start to reopen, as we head into the fall. 

MODERATOR: Great. Thank you, Dr. Tsai. All right. Looks like our first question. 

Q: Hi. Thanks for doing this. Some schools have already opened with in-person instruction for the school year. I was wondering if you could talk about what schools should look at when they’re making decisions about whether to pull back as they start seeing cases within their classrooms, particularly in hotspots where we are already seeing students and teachers need to quarantine after coming into contact with a confirmed case in the school building. 

THOMAS TSAI: Thank you. I think that’s an incredibly important question and a question a lot of schools are currently facing. So I think there’s two parts to it. The first part you alluded to, which is the community level transmission. And I think schools may have reopened despite high levels of transmission, and those are the situations where I’m deeply worried, as I think you’re familiar with. But the Global Health Institute, we have our risk level dashboard, community level of transmission where we have green, yellow, orange and red counties. That links to not just a set of testing metrics, as well as non pharmacologic interventions, such as distancing and masking metrics, but also a set of corresponding priorities for reopening and guidelines for what categories of students should be able to have or in-person education. So, you know, within the schools, I think in order to stay open, it’s important to think about the contact tracing that happens within schools and then the clusters that can happen. 

So I know some schools have had isolation of cases around the whole classrooms, so the whole classroom is a cluster. There has been football teams and sports teams have had to isolate because of individual students along that way. So I think it’s important that schools need to have plans. We’re not just thinking about the school as a binary open or shut down, but thinking about it in terms of the classrooms themselves, which means that if you want to have that sort of more targeted response, you also have to make the plans ahead of time to make sure that you’re limiting the physical distancing across classrooms or from teacher to teacher across classrooms, students to students across classrooms. Otherwise, the number of contacts per case can rapidly grow if there is non strict adherence to physical distancing guidelines and exposure guidelines within the school. So I think the schools need to have detailed plans ahead of time for this exact scenario. I think trying to respond on the fly becomes very challenging and disorienting to both the students, the teachers and families in terms of how to plan for that. So I think ahead of time, school districts in the country need to have A priority thresholds that are transparent of what their localized response is. Is it shutting down certain classrooms or does it mean at a certain point, a school needs to move to virtual again, if there’s multiple classrooms across the schools that are having exposed cases. 

Q: Just kind of going off your final statement about, you know, what happens when you have multiple classrooms that need to shut down. I know there is at least one school district in Georgia where they have two thousand students and teachers in quarantine right now. Is that a good thing? Because that means that you’re stopping chains of transmission, or is that kind of just like once you get to that point, you really need to reevaluate what’s going on? 

THOMAS TSAI: Yeah, I think it’s the latter because there’s the epidemiology and the public health strategy, but there’s also the education goals. And at a certain point, I think one can be disruptive of the other. If you have two thousand students and teachers that are under quarantine, you know, I’m not an education specialist, but I can imagine that’s very hard to plan for a cohesive teaching plan where you have this uncertainty. So I think that goes back to my original comment about, you know, it’s important to prioritize elementary age children over that of the middle school age, children over that of the high school students because the high school students are more able to do virtual or a remote learning. I think the other piece of this is that this is going to be dynamic. The transmissions are going to change, and school districts have an opportunity to do this right, once. Otherwise, these cases like this district in Georgia are likely going to continue to grow. And I think the districts need to think beyond the districts and really need to think about, again, within the district, how do they prioritize elementary age children versus middle school age children versus high school students? So I think in some districts it has been very binary, either the school district stays open or a school district postpones and moves to virtual or the whole district moves to a hybrid, but really needs, I think, to be targeted and tailored off of the individual schools within a district. 

Q: Thank you. 

MODERATOR: Next question. 

Q: Hi, Thomas. I wanted to ask, about the K-12 schools. We’ve seen a bunch of examples now of colleges and universities really struggling to reopen like Notre Dame and Michigan State. Can that be a lesson or a teaching moment for any of the K-12 school that haven’t opened like New York City? 

THOMAS TSAI: I think that’s absolutely right. And, you know, there’s one opportunity to do this well, because once you open, you want the schools to stay open as much as possible, given how disruptive, isolating students and teachers can be. So this goes back to sort of phased reopening of society at large. And in some ways, we need to think about sort of phase reopening for schools as well, where you really prioritize in the elementary phase first, over the middle school phase, over the high school phase. We’re not sort of putting all our eggs into one basket all at once. And what I have seen less of is sort of a phased approach as opposed to really just postponing school and moving everything to virtual, or doing hybrid, which is not really a phase. That’s sort of a compromise across the way. So I think a phased approach is really important for K-12 schools. 

The other sort of lesson there is, a lot of the college campuses have been planning and thinking about testing. And I haven’t seen that level of conversation nationally for school districts. I know Los Angeles has announced very ambitious plans to test teachers and students. I think that’s a very important model for other school districts to follow. And we’ve been providing some technical assistance before Congress recessed to develop proposals to fund surveillance testing for teachers and students, including options to test students and teachers twice a week versus if there was a capacity issue, you know, prioritizing, testing teachers given a higher age and possibly higher risk for transmission. I think that’s the level conversation that I think we need to be having. And I haven’t seen as much detail sort of generally, across school districts about testing in the K-12 level. We get a lot of e-mails and even conversations with teacher groups and there’s a lot of concerns. And, you know, my worry and fear is that the teachers of today are the essential health workers of a few months ago. You know, it’s very similar conversations about a tension between responsibility to fulfill their duties as teachers and to educate students, but also very legitimate concerns about their own personal health and safety. So its very similar conversations frontline health care workers were having back in March. But it’s not a shortage PPE we’re talking about. It’s sort of lack of clarity about what the testing strategy is going forward. 

So, you know, again, it goes back to, I think, the same discussions we were having, you know, on a national level, on a state level and the county level about phased reopening and what that means in terms of the metrics for it, for testing the transparency of those metrics. Accountability for those metrics. I think that’s where the rubber meets the road part for school reopening that all of these school districts and the parents and teachers need to see is, yes, the school districts may have decided to postpone or move to no in-person teaching. But what’s the trigger? You know, on the national level, if it has not been a two week decline in cases, it’s clear what that guideline is. So what’s a similar guideline for schools to stay open once they open in terms of what’s the critical mass and threshold, when you really worry about, in some ways, a test positivity of your student and teacher population, where the considerations about shutting down, they have to occur. The ideal situation is we don’t open too soon. And think about how far the southern states have come now versus a few weeks ago. A few weeks ago, our dashboard was essentially red across the board and now we’re seeing yellow and orange and red. I think that’s important progress. But I think erring on the side of caution for reopening, we’ll let these schools have the option to stay open. And it goes back to the same conversation around testing, all this is, is buying time. We were buying time to flatten the curve. So what are the school districts doing in terms of all this time that’s being bought by moving to virtual learning? It’s not just about holding your breath and waiting and seeing is, you know, schools need to be using this time to come up with contingency plans. So if they do move back to the Green Zone, can they actually reconsider opening if they happen virtual. 

Q: So when you say phased approach for K-12 schools, you’re talking about having those thresholds to know when to scale back or to move forward or it would it be like you have certain students come, then, after a few weeks, you have more students come? 

THOMAS TSAI: I think both. I’ll be honest, I don’t have the answers and I wish I did. But I think we need to engage on the same national conversation that we did in April and May around all the different roadmaps to reopening. All these state governors have put up these roadmaps about what phase one reopening would look like, what industries would open, what size of the gathering bans and what metrics we’d be looking at to see if we should move to phase two. So it’s both the plan and the metrics, as well as the volume of students potentially. I think that the second part is part of the first plan. I know a lot of schools have had to submit plans to the school districts. What I haven’t seen is sort of the same level of transparency and clarity of communication around those reopening plans that we saw for the states at large in May. So I think that’s a national conversation we should be having. Obviously, we’ll be local with each local school district and the coming level risk at each county. But I think the school districts need to convey to the students and teachers and the families, you know, what are the metrics that the schools are measuring? Is it the overall community level transmission rate, the test positive rate? Is it the number of cases within their own schools? What are the triggers for moving forward or moving backwards in terms of schools staying open? 

Q: Thank you so much. 

THOMAS TSAI: Of course. 

MODERATOR: Next question. 

Q: Hi. Thank you. I was wondering what you could tell us about testing in general. How have the states, for example, New York State that has a super low positivity rate and just a ton of tests? How have they been so successful at getting people tested? Are they just letting people come to them? Are they going out and testing others? I know you’re not in New York, but I thought you might have some insights into how these states are able to get so many people tested. 

THOMAS TSAI: So I think it’s really about moving the testing out of the hospitals and into the community. And this is, when I was opening a few minutes ago, moving from reactive testing to proactive testing, and we’ve seen that strategy play out in New York and Massachusetts, for example. So the test positive rate is less than one percent now in New York. In Massachusetts, it’s around two percent. So these are huge improvements from what we’re seeing in April and May. And what’s been remarkable, and I think part of the success for New York and Massachusetts, is that the testing has stayed high and consistently high despite a low number of cases. So this is sort of what we were talking about, what South Korea was doing several months ago and in some ways, New York is like the South Korea of our country, where the test positive rates are low. Number of cases have been low enough where, you know, you can snuff out the embers before they turn into wildfires. And you know, the example of Massachusetts, as you know, despite the improvements over the last several months, the state is actually embarking on even more. Community based testing initially was eight cities, and I think it’s up to seventeen different cities now, where the state is really trying to ramp up testing efforts. And it has to be both accessible and affordable, really, meaning free. So I think that’s the key part. It’s not enough just to have the capacity. We have to get sort of the swabs to the noses and noses to the swabs. I think that’s where the successful lesson from New York and some of these other states. 

The states like Texas, they’re at this tipping point where it’s almost like it’s Memorial Day again. Do we reopen because the data are showing some signs of improvement, or do we double down on keeping our testing going, continuing our efforts to reduce coming level transmission and having several weeks of declining data to be really sure that things are heading the right direction. So I think that’s the position that some of the southern states are in. So Texas, unfortunately, I think, still has very high levels of coming level transmission. And the testing numbers have gone down quite significantly in Texas and the positive rate has stayed very high. Not all the metrics are aligned yet. And I think what New York has done well, is making sure that all the metrics have been aligned and state aligned before progressing with reopening. 

MODERATOR: Are you all set?

Q: If I could just ask one follow up. 


Q: Do you know what the the method has been? To just encourage so much testing? Or are there are there sweeps of testing done in neighborhoods, like how do you get people to actually agree to that and go out and find the people and actually swab them for free? Or in Massachusetts, for example, are people just coming just at the service or just they’re curious? How is it that they’re actually getting done? 

THOMAS TSAI: Yeah. So part of it is, for example, Somerville and Cambridge are two cities in Massachusetts where testing has been free and demand for testing has stayed very high. So I think part of it is, we’ve been focusing a lot about the supply side of the equation, capacity and swabs and which types of tests and turnaround time like all that is incredibly important. But in some states, you know, we’re a situation where there are enough tests. And how do we continue to shore up demand for testing? Part of it is consistent messaging. And in the Northeast, I think the pandemic was a very real and visceral thing for New York and Boston. And many of us have had friends or family members, with COVID-19. I think this was a very much a lived experience. And the policymakers and public health community have been very consistent about the need to stay vigilant around testing. So supply has stayed up and demand has stayed up. So I think in the states in the South, we need to make sure that demand stays high. 

The other day, I did a sort of unscientific analysis looking at Google trend, just search terms for COVID testing sites near me. And what has been concerning is that the prevalence of the search terms for COVID testing sites has decreased over the last several weeks in Texas and in lots of other states. And I think there’s a couple explanations for that. One is, you know, people may just know where the testing sites are and testing sites are easier to get to. So they’re not relying on search to find the testing sites. My worry, though, is that I think the demand for testing is decreasing. And I think that that’s where consistent public health messaging, going back to that framework of reactive versus proactive testing, going back to proactive testing is really important. We’ve come to a point where we can have a conversation about proactive testing as newer technology and the lag times are slowly starting to improve. So let’s take advantage of that. This should have happened months ago, but we’re finally getting to a moment where we can start thinking about a strategy again. So let’s double down on that strategy. And that’s not just a supply side. That’s on the on the demand side. So we have to make tests accessible and free. And, you know, and there have been a lot of conversations before Congress went into recess on how to make that possible is not just funding for the public health infrastructure, but it’s, you know, sort of funding for the proactive testing infrastructure and not just relying on insurance reimbursements and CLIA certified diagnostic labs. 

And that’s where the strategy around high frequency antigen based tests to the point of care, you know, big strides could be made there. And I think as Congress returns from their recess in September, this is the moment to really support with adequate funding. The terminology that we’ve been discussing with economists, is you need an advanced market commitment? If the demand is lagging, it’s hard for the testing companies to ramp up their manufacturing lines to produce more tests for the fall. So we need to be consistent about the demand for tests and this is where states can work together either for more, and for more interstate compacts to pre purchase a lot of these tests to signal that there is an existing demand for tests out there. 

Q: Thank you. 

MODERATOR: Next question. 

Q: Thanks for doing the call. I noticed that Pennsylvania said today they’re launching one of the Apple and Google Apps for COVID tracking as a voluntary thing. It helps you know if maybe through Bluetooth technology, you’ve been exposed to someone that has tested positive. They follow Virginia and I believe Alabama in launching this. Just want to get your thoughts on whether these apps seem to be useful. What are the benefits or drawbacks? And do those benefits outweigh any privacy concerns people might have? Thank you. 

THOMAS TSAI: Yeah. So they definitely can be useful. And they’ve been used especially in the global context in other countries. I don’t think it replaces the really hard work of contract tracing. So part of the contact tracing, and the terminology we’ve been using is test trace and supported isolation, it’s a second part of the equation. It’s one thing to be able to get the number of contacts or notify those individuals. But convincing somebody to go get tested because they’ve been exposed or to go into voluntary supported isolation is challenging. Right? If I got a text message that told me to do that, I’m not sure I would. And this is a very personal, very human conversation that needs to happen. I think the hard work of the in-person contact users is incredibly important because it links a test result to a set of actions and a set of services to support those actions. The people who get notified, need to know where to go to get tested. Does it cost them anything? If they needed to to self isolate, how do they do that? So I think the technology has a very important role to play. But it’s that first step, it’s the notification step, getting people to follow through. And that takes real person to person contact. And that’s where the role of the actual individual contextual tracers can be important. So I don’t think it’s a substitute for good old public health contact tracing and linking those individuals to social services. But it is, I think, a helpful way to make the process potentially more efficient. My one worry, though, is as we get more technological solutions, the data infrastructure is already very complicated. And we’re constantly hearing about software bugs, reporting glitches from the county to the state level, and I just think we need to be thoughtful that these other approaches are still feeding into the same data pipelines, and getting that right is just as important as getting the patient facing side of it worked out. 

Q: Thank you. Just for a quick follow up, if someone does get one of these notifications on their phones as they were potentially exposed, what do you think they should do? Should they seek out a test or just kind of retrace in their mind some of situations there in which they do? 

THOMAS TSAI: Yeah. I think they should seek out a test. Part of the testing strategy that we’ve been developing at the Harvard Global Health Institute is that the TTSI part, is to trace individuals, test them in support isolation. So you want this to be a positive feedback. If you have one positive case, their contacts want to get tested as well, and know that if there are also potential asymptomatic carriers and the goal is to basically break the chain of transmission, and if we disrupt information, stop there, then it’s not serving its full public health purpose. So, yes, absolutely. I think if these individuals have been notified, they should go get tested. And the whole point of all this massive effort on the public health side was to make it easy for these individuals to go get tested and not just wait for them to be tested if they’re symptomatic. 

Q: Thank you. 

MODERATOR: Next question. 

Q: Hi, Thomas. Thanks for doing this. My question is about colleges and universities in particular. A lot of them, especially here in Massachusetts, are bringing students back to campus right now. Just yesterday, I talked to a BU student who was moving in this week, and their universities are implementing things like a universal COVID testing schedule and other measures. I just wanted to ask, how effective do you think that will be in preventing outbreaks? And what measures do you think are going to make the biggest difference for helping universities stay open this semester? 

THOMAS TSAI: Yeah, I think that’s a great question. That goes back to my earlier comment where we want to do assurance testing, but I find the term assurance testing a little potentially misleading because the test itself is not a preventive strategy. The test gives you the information and it’s everything else that breaks the chain of transmission. So it’s still following through with universal masking and physical distancing. So the tests don’t replace that strategy. And my worry is that students may feel that the test itself is somehow sort of protective or therapeutic. The test is just information, and it’s what you do with that information that really matters. So I think it’s a point to not let that piece of the message get lost as a college campuses reopen around the country. So the testing has important role to play because you don’t want to introduce sort of new cases, new clusters into college campuses, such as people traveling from communities that may have varying risk levels of transmission. We’ve seen that happen at UNC with an explosion of cases in it’s very first few weeks. So the testing is is important, but really even more important is what you do with that information. I think that’s the important message for our students on college campuses across the country. 

Q: Following up with that, we’re talking about students who may not always follow rules like anyone who works in a university like yourself or those in a college town knows that university students, they don’t always listen to what administrators tell them to do. And during the school week, you’re showing up twice a week for testing or wearing a mask all the time, and it can be difficult. I think even for adults, it would be difficult. How competent do you feel that universities are going to be able to stay open and university students are going to maintain good behavior for, you know, the rest of the year.  

THOMAS TSAI: It’s a challenge. And I think that’s why the schools have to be very clear about what their metrics are for staying open. That’s why this school conversation on college campuses and even K-12 can’t be divorced from the overlying community level risk of transmission. Because, you know, the schools aren’t closed bubbles. They’re still part of the overall community. And so I think it’s just as important for the schools to make sure that their strategy is in line with the overlying community. At BU, in Boston, our positive rates have decreased and they could go lower. And the number of cases have remained low. But they have been in a blips where the case counts have risen. So I think it’s important to really stay vigilant, on the side of the whole community, but especially for the school as well. So I think that’s a very real concern. I think it’s a false sense of security too, for the schools to only look to their their internal testing data of their students and their teachers because, again, they’re part of the overall community. What’s happening in terms of the positivity rate, the number of cases in the surrounding community is, I think, just as important as the test results that’s happening on campus. And really reinforcing all the best practices on campuses is important. It’s hard, you know, this goes back to the K through 12 discussion a bit earlier,  I think that’s why it’s one thing to have really good, transparent metrics for this part and a good testing plan. But just as importantly, there needs to be plans for when do you dial things back? And so, again, around reopening on the state level, I know it’s important to think about states reopening as not a one direction course. Same thing comes for schools and college campuses is that, you know, bringing students on campus is not a binary event. This is a dial that may need to be dialed up or down, depending on campus testing, and on campus compliance to the guidelines and the overlying communities. 

Q: Thanks so much, Thomas. I guess, I don’t know if you could adjust this, but do you feel like compliance is going to be good among university students? 

THOMAS TSAI: I don’t have a crystal ball, but my fear is that it’s not. But what I’m encouraged by is there’s now a lot of evidence from hospital and health care settings where when hospitals switched to universal masking and universal precautions, the transmissions within hospitals went down dramatically. And for the most part, the hospitals have continued their policy. And we have, for example, at my hospital, at Brigham Women’s Hospital. So I think, you know, I’m encouraged that this is a behavior change and people have been able to sustain that, at least on the professional side, for higher risk occupations. So I think the same messaging needs to happen for our students on campus as well. But I think that’s where the schools have a role to play with the policies. But I think that’s where the state does and the cities do as well, because, again, the campuses don’t live in a bubble. There has to be alignment of the reopening plans and the public health guidelines for the entire state, for the municipality, as well as it is for the school campuses themselves. So you can sort of have restrictive policies that only exist on campus. Restrictive is not the right word, but universal masking, for example, on campus, but not when they cross the threshold. Off campus and in the community, all those things have to be realigned, one, that makes it consistent, but two, also makes it easy to follow through with the guidelines. So I am worried that the consistency may not be there for college students and college campuses. But I’m also hopeful that if we can make sure that the campus policies are aligned with the surrounding city and state policies, then there’s a chance that people understand how serious this is. And I think it’s just important to keep that message and reinforce that. 

Q: Okay, great. Thanks so much, Thomas, I appreciate it a lot. 

MODERATOR: Next question. 

Q: Thanks so much for doing this. I was wondering if you could talk a little bit about disparities of testing. We’re seeing some people say that testing is not equally distributed among communities. I’m wondering if you could look at that and your assessment on that. 

THOMAS TSAI: Yes, I think that’s a very real concern. We’re seeing large disparities in the the cases themselves. Black and Latino populations have about two to fourfold higher copied incidence rates than what would have been suggested by their population demographics alone. So that’s a very large concern. And there’s also concern that, you know, the accessibility of testing may really vary across different demographic groups. So I think that’s something that states have made improvements on. And nationally, there’ve been improvements on terms of reporting the cases and the demographics of those data. We also see that in more granular forms, the test positive rate, which is, I guess, a sense of of how wide a net you’re casting and in some ways, how accessible the testing is and potentially more medically underserved or vulnerable populations. So we can improve, but we don’t measure so that, you know, there’s been there’s been small steps along the way. But there needs to be much more uniform reporting of socioeconomic factors associated with our testing results on state dashboards and national. So I think that those are incredibly important. 

Our work at the Global Health Institute, for example, we have partnered with Google Cloud to publish a COVID-19 public forecast model, which was released about a week ago, which gives to predictions off of a machine learning and artificial intelligence informed model that projects the number of cases and hospitalizations and deaths across counties. And well, I bring this up because it’s relevant. But we were worried about, and this is part of the preprint paper where we actually had a very deep dive into an equity analysis, is that for a lot of our projection models, if the underlying data are biased by under testing, then there’s a potential from the models to perpetuate those biases by under projecting cases. Now, if those data are being used to inform decisions, then maybe fewer testing resources are distributed to those areas. So that’s a concern that on the science side, we’re very aware of and want to make sure we keep our eyes open to the quality and the disparities that the underlying data that are being used to form projections which are then informing decisions and policy. So I think that’s a hugely important issue that I know I think about every day on the research side. I think that’s why we need to increase our testing in some of these areas. In Massachusetts, there’s a lot of focus testing in the communities where there’s not just high prevalence rates, but there is also areas where we know there are some disparities in access to testing sites and availability of testing and cost of testing. That’s why the states made an effort to push testing out into the community. Now, we’d love to see that across the board. In some ways, testing students in K-12 and testing teachers is one way to get the equity piece, you know, because that is a common denominator of access to the community. One strategy to improve the equity of testing is, is by, doing that in a fair and equitable way across populations. And I think the schools and especially K-12 can represent that. 

Q: Thanks so much. 

THOMAS TSAI: Thank you. 

MODERATOR: Next question. 

Q: I wanted to ask about that test and trace strategies. And, you know, since that sort of becomes moot with widespread transmission, is there kind of a positivity rate or a case number at which contact tracing once again becomes feasible? You know, if you didn’t catch it on the front end, can you catch it on the way back down? And then what are the weak points in that in terms of the number of tracers needed? Is there sort of a model for how many contact tracers per hundred thousand? And what kind of support? You talked about support. Could you talk a little bit about what you mean by the support? Thank you. 

THOMAS TSAI: So those are all important questions and as part of our COVID-19 dashboard, we did put corresponding metrics of the number of contact tracers and the number of contacts per case. The challenging part is the number of contacts per case varies a lot across jurisdictions, and it also varies a lot across time. So the initial predictions were that there would be about 10 contacts per case for COVID-19. And because many states had stayed, as part of the shut down in April, May, the number was actually a lot lower. Massachusetts was closer to about two or three contacts per case because people would mostly stay at home. So their contacts were fewer. But as states have reopened again, that number has crept back up to over five to six contacts per case. That implies varying levels of resources that are needed. And in some modeling efforts in collaboration with Harvard Safra Center for Ethics and team of volunteer scientists from Microsoft Research, we estimated about 10 person hours to trace a contact. Which if it takes one whole day, that may be really hard. So the rough estimate was that it would be about five contacts tracers per case, which ends up becoming a very, very high number when, as you mentioned, you have a very, very high number of new cases. 

So I think contact tracing is really helpful as part of the strategy on the upswing and on the downswing, as you’re saying. But again, it’s not the only piece of the puzzle. The other pieces include the masking and physical distancing and all those other things. If you look at what’s happened across the South, testing increased, but the number of cases reduced largely because I think individuals have taken it more seriously, there’s better masking, there’s been restaurant and bar bans. In states, for example, in Florida, some bars were losing licenses because if they were not following through the public health guidelines and I think there was more consistent messaging around the public health interventions. So all those things play a role in line with contact tracing. 

What I would love to see is that as sort of better clarity and more and more dashboards around the state, contact tracing efforts. So there’s been a push towards that across several groups. New York health and hospitals for example, they do have a waterfall, the contacts tracing efforts. But you know what’s concerning is that it’s the number of individuals that are giving and providing information or contacts and making its way all the way through the process has still remained relatively low. Is it worthwhile? I think it’s still a worthwhile effort because it’s still getting important information on where the super spending and where the clusters are. So I think that from an information standpoint, it’s still very important. The support the isolation piece, I think is important as well. And I know my worry is that for the voluntary sort of quarantines that individuals, at least anecdotally across municipalities and I work with mayors and governors, is that individuals aren’t taking advantage of some of these options as much as possible in terms of subsidized isolation and hotel rooms. And I think that effort can be improved as part of the stimulus package proposals that were being considered in Congress prior to the recess. There was funding that was allocated, for example, in Senator Cassidy’s suppress COVID-19 2020, specifically around the TTSI, the trace test supported isolation approach. And now in Partners in Health in Massachusetts, for example, has also been really pioneering and making sure that social services are being connected to individuals who may be under isolation’s. If you don’t have family members to help you with grocery deliveries, for example, if you tested positive, are there any resources that could be brought to bear? So it’s a complex human problem that goes back to the earlier question about can technology be part of the solution? The answer is yes from the information side. But there’s this whole other dimension where you have to get individuals to follow through with, getting tested themselves if they’re a contact, following through with staying at home if they had been exposed. And I think that part just takes a human to human conversation. 

MODERATOR: Do you have a follow up question? 

Q: I wanted to also ask you about, just moving to that participation in trials. And do you know anything about sort of outreach efforts to increase the minority participation in those vaccine and also treatment trials? 

THOMAS TSAI: I don’t have an answer for that. I don’t know any specific, at least I’m not aware of any specific efforts. I think it’s incredibly important for trials of any sort to make sure that the trial population, and this is true even before the pandemic, are generalizable to the population of the US. Whatever the target population for that, pharmaceutical or without intervention is. And that’s especially true for COVID-19. We know there are high risk individuals and it’s important to make sure that some of the vaccine trials results can be generalized to a representative sample of the population. So I think outreach is an incredibly important part of that. You know, that’s a good question. I’ve not heard of any specific outreach to minority groups, but I think that’s important to do so. 

MODERATOR: Are you all set or you have any other questions? 

Q: All set. Thank you so much. 

MODERATOR: Great. OK. Next question. 

Q: So here in Boston, all things considered, over the last couple of weeks, we’ve been able to enjoy some level of comfort. I mean, things have been going fairly well here comparatively. And in part because we’ve been able to move so many of our activities outdoors into the safety of outdoors for the summer. But the summer is not going to last forever, as I am sure you know, things are going to get cold and uncomfortable here fairly soon. And so I just wanted to get your sense of how much things are going to change when the colder months arrive and these outdoor activities are no longer available and how we ought to prepare for the new realities that are coming our way. 

THOMAS TSAI: I think that’s a really important question. And I think states like Massachusetts have to prepare for what physical distancing looks like when the outdoor options become very different. A lot of restaurants have been able to have outdoor dining options, for example, in Boston and Massachusetts. And that may be less feasible as we move into the fall, but especially the winter. So I think that’s an incredibly important point. And I think that’s why, just as you know, it’s important. Even though Massachusetts made it a lot of progress, we can’t rest on our laurels. And that’s where reinforcing that messaging is really important as we enter the fall, it’s easy to do this in the summer. It’s going to be hard in the fall. And there’s growing pandemic fatigue that’s built up over the last several months. I think we’ve been fortunate to have a little bit of release, not a reprieve from that Massachusetts with our lower level of cases and sort of generally nicer weather. You know, during the summer, I think that’s a very real concern. And I think people need to kind of anticipate that and plan for that. And I think the most important part is that there’s a lot of hope based on vaccines. But even when the vaccines do come, they’re not going to be 100 percent effective. They’re still going to be a ramp up in terms of getting the vaccines manufactured and distributed equitably across populations. And the vaccines, even when they do come, are not a silver bullet. They are still part of the overall strategy. They’ll be a very big part of the strategy. But I think even when the vaccine arrives, masking and physical distancing will still play in a very important part of that moving forward. So I think that’s a very important message to consider and get out there. 

Q: Quick follow up to that. What do we already know about the way the flu and cold spreads and has for years here, what can we learn from that from years past? And how similar will that be this year? I mean, flu season is coming. And I wonder how similar it is now, given the new concerns that we have about about this particular virus. 

THOMAS TSAI: Yeah. The concern that all the public health side and that’s been expressed through Dr. Redfield from CDC and it expresses a few months ago and it’s been sort of a growing concern, is that, you know, part of the silver lining was that the flu peak and the COVID peak in early 2020, they weren’t quite completely overlapped. But the concern is that as you move to the fall and winter is that not only are we dealing with COVID, as you mentioned, we’re also be dealing with flu as well. And again, I think the flu is a good example. The vaccine plays a very important part of our annual strategy for flu, especially for vulnerable populations such as the elderly. But part of our everyday sort of tool kit to fight flu is to make sure that we have good hand hygiene. And I think that’s really important for flu especially. But for the coronavirus, fortunately, a lot of the interventions that help to mitigate the transmission of COVID also worked for flu and vice versa. So I think there’s a lot of good synergy there. But I think the cautionary tale is, one, we had a flu vaccine for years and every year, the number of people who could be vaccinated is a lot lower than where it needs to be. And I think that’s a cautionary tale for COVID as well. So, you know, we need to make sure that we don’t put all our eggs in the vaccine basket, that we still follow through with basket and physical distancing. I don’t see that going away over the next several months. 

Q: OK, thank you. 

MODERATOR: I think that’s our last question, and also we’re at 12:29 pm. Do you have any final thoughts you’d like to share with us? 

THOMAS TSAI: No, I think we covered a great breadth of topics today. And one important message is, again, this is a moment where we can start thinking about having a, not just testing strategy again, but having a comprehensive public health strategy of which testing plays a critically important part. Vaccines will play an important part, but all the other components are important. And we’re at another stage where transparency of metrics are important for schools to reopen. But just as important as the decision making and the decision points about when we dial back up the response or dial back down. I think that’s important over the next few weeks. There is some time now to develop this strategy. I think schools, businesses really need to sort of focus on that before we head to fall. 

This concludes the August 19th press conference. 

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