COVID-19: The Year Ahead

COVID-19: The Year Ahead

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ELANA GORDON: Hello and welcome. My name is Elana Gordon. I am a reporter at The World, covering global health. This is a live Q&A about COVID-19, the year ahead.

And joining me is Dr. Michael Mina, assistant professor of epidemiology at Harvard's TH Chan School of Public Health and a core member of the Center for Communicable Disease Dynamics. Michael, thank you for joining us. MICHAEL MINA: Happy to be here. ELANA GORDON: You can post your questions for us on Facebook @forumHSPH, or you can email them to

This Q&A is jointly presented by the Forum at Harvard's TH Chan School of Public Health and The World from PRX and GBH. Michael, to begin we are hitting some major milestones this month. It's been almost a full year since officials reported the first cluster of cases of what we now call COVID-19 and SARS-CoV-2.

The United States recently marked a new record for daily deaths from the virus, and projections suggest that the worst is yet to come. So that means right now, some 300,000 people have died nationwide. It's really hard to fathom right here in the United States. And at the same time, there is this seeming light at the end of the tunnel with vaccine rollouts and vaccinations, testing and treatments.

So today, we want to look at what's ahead in this coming year in taking on this pandemic. And so to begin, I wanted to ask you to give us an overview of where you see us right now in the US and globally in the progression of this pandemic. MICHAEL MINA: Well, we're in the thick of it at the moment.

Like you said, we are starting to see a light at the end of the tunnel. Unfortunately, I think human nature means that we're going to be blinded by that light in the middle of when we need to not be blind the most. We have immense numbers of deaths happening currently.

3,000 a day in the United States alone are being recorded as a result of COVID-19. And so while it's a time to-- we have come very far, we should be able to celebrate some achievements, and the most notable one at this point is that the vaccine has been developed. At least one of them has now gained authorization. We anticipate additional vaccines will follow very shortly, and these will allow us to start gaining some foothold over this virus. But until that happens and until we can roll these vaccines out soon enough, which we really-- it's going to be a challenge. There's still a bumpy road ahead of us for getting the vaccines out.

I think we're in this very difficult situation where all year we have seen, with the exception of what's been going on behind the scenes for vaccines, we've seen problem after problem after problem this entire year in terms of not successfully tackling this virus, at least in the United States and many other countries. We have been unprepared, underprepared, and in general, we have largely let politics get ahead of the science. So I don't feel great about where we are. I think a lot of people are congratulating the vaccine, which I fully, fully agree that that is warranted, but I can't get out of my head that we should be considering the current situation as though we have a bomb being dropped on the United States every single day, killing thousands of Americans, and we just don't seem to be able to act with any urgency, which is very sad and disappointing. ELANA GORDON: What are the biggest fumbles, and what are the biggest opportunities that you see could potentially respond to that? MICHAEL MINA: Well, I think the biggest fumble is we never really created a plan. To this day, the only plan, the only strategy we have had has been around the vaccine.

A vaccine is one way to tackle a virus, but we always knew that the vaccine wouldn't be around tomorrow. Months and months ago, back in March, we heard our president saying that the vaccine would be around in a month or something like that, and the vaccine was always a month away. Then today, the vaccine is, again, a month away. But it's not really. It's not actually a month away for most people.

And so I think that the greatest fumble we've made was to not have any strategy at all. We've seen just intermittent lockdowns, which truly, I think that the US has kind of taken all of the worst approaches and put them in together by not doing any of them well. We have criticized countries that have gone for herd immunity, like Sweden. Meanwhile, we essentially did the same thing, only we did it worse because we more or less didn't have a strategy to not go for herd immunity. But we also closed down our economy at the same time.

So we've gotten the worst of both worlds by not having any plan, and that's been hugely destructive. Testing has been botched. And I remember when you and I spoke in February or March maybe, I remember saying something along the lines of, now this would be a very difficult virus for us to test for and really get and really have some strategy because we have such a fragmented United States. We can call them a fragmented states, I suppose. And that's part of our individualism in America. That's part of states' rights versus federal rights and laws and such.

But what that means is it put us in a very, very difficult position to actually corral everyone, and for a pandemic that doesn't appreciate state borders, the way that we have the United States set up is just-- we were sort of at a disadvantage from the get go. And I think that as we look towards the future, what we really need to take very seriously is try to understand how do we have a country that does abide by some of these approaches, like state's rights over federal, and very individualistic society, while also having a capacity to deal with a pandemic that is able to spread very easily across the whole of the United States and requires truly that the whole of the United States act in concert if we're going to succeed in dealing with the next pandemic. And I think we have a lot of work to do to figure out how to reconcile these pieces and trying to set ourselves up for not having such a poor response in the future.

ELANA GORDON: Something that you have spoken a lot about and specialized in has to do with testing. How important is that right now? And while there is a fragmentation that you talked about in the US, there also are central regulatory agencies and ways that different treatments and products can become available. So is that technology available in a way that you've seen elsewhere? And what's the hold up? MICHAEL MINA: Yeah, so testing of course, since February, since the first blunders with the CDC test, testing has been sort of front page news on and off throughout the entirety of the pandemic.

We've seen that it's been one of the major limitations in our ability to control this virus because we haven't been able to get people tested, and we never actually designed a strategy that was-- our strategy was never really about testing people in an appropriate way to stop the spread of this virus. It was very haphazard. People could come and stand in lines for hours at a time and get a result five days later. That's kind of been so much of the strategy. There's been some laboratories, like the Broad Institute, like Curative that have done a better job at getting results very, very quickly. But in general, across the whole of the United States, most people don't get their results before they're done transmitting the virus.

And so one thing that I've been pushing is for these types of tests which are just little paper strip tests, and these are rapid antigen tests that give results in minutes and can be made in much, much greater numbers and deliver it to people's mailboxes, for example, or put at the front of restaurants to keep restaurants open or schools, businesses, doctors' offices. And we still don't test our health care workers on a routine basis, which I think is one of the greatest tragedies of this pandemic in the US. And so we do have these tests.

They exist. I have thousands of them sitting here in my house, but we have yet to really authorize them in the way that they need to be authorized. We do have some. This one here is a BinaxNOW card from Abbott.

This is the one that the US government bought 150 million of, but even these were not really deployed this strategy. ELANA GORDON: Wait, which kind? Is that an antigen test? MICHAEL MINA: Sorry, this is another antigen test. And if people want to see, there's another paper strip in there. So it's really just a paper strip test. And so these are all very similar in form. They can be made extremely cheaply.

This one was sold to the government for $5 apiece and distributed to the states for no cost, and that's really what we should be doing. We should be building these in the tens of millions a day, which we can, and we could get them out as public health tools, not as medical devices that require prescriptions, but purely as public health tools. And we haven't seen that, largely because of the FDA.

We have an FDA that is focused solely almost by definition on authorizing medical devices. And so they have required certain metrics to be kept up. Not seeing this as a public health tool but seeing it as a medical tool has bottlenecked it down certain paths and has slowed the introduction of them. But if we could get them out to tens of billions of people a day, we can actually achieve what I call herd effects that are due to the test, where we could actually slow the overall spread of this virus across the whole of the United States.

We can get that R value, which is the reproductive number of the virus, if it's above 1, it means you have exponential growth of the virus, and if it's below 1, it means you have exponential decay of the outbreaks. With these going out to tens of millions of people a day, we could get R below 1 and actually see a decline in cases throughout the pandemic instead of increasing cases. ELANA GORDON: I just want to make sure I'm understanding. So there are rapid tests available now, but what is the difference between the rapid test that you're holding, the ones that are available, and also the ones that take longer to process because there is a different kind of measure that regulators want to see and how, I guess, accurate the tests are as well? MICHAEL MINA: Sure. So these tests, this one here and this one here, these are two rapid tests.

They're both FDA approved or authorized. They're actually authorized by the FDA now for medical use. So they need to be prescribed by a physician technically. That is going to immediately limit how they can be utilized.

Also, by extruding them through a medical diagnostic pathway, they become more expensive. This doesn't have to cost $30 or $20. But these are liable to be sold for 20 or $30 once they get through this FDA process. That's just how our market works. If you get a device that can get reimbursed through insurance, of course, the companies will sell it for more money, because why not? And so that's a major setback. If we want to get these out to the whole of the population, we want to sell them-- we want the government to be able to purchase them say for $3 or $4 and not $20 or $30.

So those tests do exist. They are accurate. There is a big difference-- and this is part of the issue at the FDA. There's been a lot of confusion about whether these are accurate or not, and these actually are very accurate, but they're accurate to detect people with infectious virus, not remnant RNA. PCR can remain positive for, say, weeks after somebody has been infectious. People can remain positive, and that's why the CDC recommends not to get a second test after you have already been infected, not to get a second test for 90 days.

And so these tests, though, will only remain positive when somebody is infectious, and then they'll turn negative. So they're better referred to as contagiousness indicators, rather than medical diagnostic tools. ELANA GORDON: There's a lot of questions coming in from viewers. Thank you.

This one is from online. "Can I as a consumer get a rapid at home test right now? And if not, when do you think they might be commercially available?" MICHAEL MINA: Well, the first one was just authorized. It was just authorized today, but it's this test here, rather than this test. And so this, people will be able to buy now, and I don't know when exactly they'll come on the market. This is a test by a company called Ellume, but I'm just going to turn this around, and you can see what's inside of this test here.

It's got batteries and circuits and lights and gadgets and gizmos, and it connects to a phone via Bluetooth. And so people will be able to buy this test. It's very simple.

It's elegant. It will have-- it essentially runs on one of these inside of it, but it's going to be a little bit more expensive. It will probably be, again, something like $30. I don't actually know the price, though, so don't quote me on that to the world.

But it will be probably in the tens of dollars, I'm sure. It will probably work very well, but it requires a Bluetooth and a cell phone, and I worry that if that is the only type of test that the FDA is willing to make over the counter and accessible to the average person, then it won't really be accessible to the average person. It will be an expensive device that will have a limited audience in terms of who can use it, and frankly, how frequently they can use it. I wouldn't go out and buy 10 of those. That would be expensive.

I would buy 10 of these to use them twice a week, for example. And the only way we can stop the spread of this virus with testing is to test frequently, and that's one of the most important pieces here. So if we have a very expensive test, that would be a good diagnostic test if you're symptomatic. You can go to the CVS or Walgreens or something, pick it up.

But what I would really like to see as a means to control the outbreaks is to test frequently, have tests be fast, frequent, and accessible. And until we do that, we're just going to keep driving a wedge between the wealthy and the poor. ELANA GORDON: This question is from Chet. "Upon discovery that one is positive on one of those paper strips, is a confirmation test necessary? How long would it take to get from mass production of the paper strip tests?" So that was [INAUDIBLE]. MICHAEL MINA: We could have mass production.

We actually ship-- we're making millions and millions of these every day today, but we're shipping them overseas. So we have the ability to do it today if we wanted. We're not doing it for the United States, but the rest of the world has these. Many other countries have them available.

We don't need them all to be confirmed with a PCR test. I do suggest that rapid antigen test be confirmed, but not with a PCR. You can't have a rapid test be confirmed with a five-day test. It just can't be. That's wrong.

So what we can do is we can use a rapid test like this and then confirm with a different rapid test. That will get the false positive rate to say one in 2,000, which is very, very reasonable. The nice thing is then you can use it again the next day. And if you turn negative the next day and then the day after that, you can assume that you weren't actually positive, for example, but really just confirming with two different rapid tests is a great idea.

Sometimes, you'd want to have even more what I call orthogonal confirmation, meaning you want the test to be so incredibly different in biology that there's no way that a false positive on one would be related to a false positive on the other. So they're considered sort of orthogonal, and they're very good for confirming. So you could use one of these, and then you could confirm with one of these, which this is a PCR like test.

It's a rapid test, but it runs-- it's an RNA test instead of antigen, meaning while this looks for the protein of the virus, this looks for the RNA of the virus. And this, for example, I could see in nursing homes, where you don't want to-- you definitely don't want a false positive because you don't want to erroneously cohort a negative person of positive people. That could be a deadly false positive.

So in this case, have everyone use these. If you get a positive, confirm on a PCR like rapid test that would just-- this is going to be very cheap. It's got to actually a paper strip in here, but instead of detecting the protein, it detects the RNA of the virus after amplification. So it can be very, very accurate.

So we have the tools is the point. We just haven't really created the strategy around how to use them. ELANA GORDON: So this question comes from Denise. Regarding the vaccine, do we know if it will protect those vaccinated from being infectious to others? Which I suppose relates to the need for testing, too.

MICHAEL MINA: We don't know that, and that was in part-- unfortunately, that was not part of the phase three studies to identify infectiousness, a reduction in infectiousness as a result of being vaccinated. We do believe-- biologically, it makes sense that people will be less transmissible. But can people who get vaccinated go out into the world with no masks and be safe to themselves and be safe to others is a very, very different question, and I would say it's one that I would not recommend doing that. I think we have to learn a lot more about this. There are simple ways to do these transmission studies much more cheaply than we're planning on doing. I think we should be starting them now, for example, to send everyone who's been vaccinated or that was in the control arm of these studies.

We should be sending the bags of swabs to just use every day on their own, put them in their freezers, and then at the end of a month, collect all the swabs and run a PCR on them, for example, to see who actually became positive, even though they were vaccinated, and did the virus grow at all, or did it just kind of make a blip and then die out because of the immune response. We haven't done that, and so until we do those kinds of studies, it's going to be a very, very difficult to know whether people can potentially continue to be part of the transmission chain. And it's one of the most crucial questions to answer, though, if we want to rely on herd immunity to suppress the virus spread across the whole of the country. There's another very important piece of vaccines, which is we also don't know how well they're working after about two months, and there's a biological reason why we might be concerned about these 90-95% efficacy results that we've seen might not hold beyond a couple of months. And people, after they get vaccinated, the body has a very robust antibody response from cells that are temporary.

And so these cells are all spewing out huge numbers of antibodies, but after about two months, all of those cells, which are called plasmablasts, die off. And so we've only measured efficacy of this vaccine during the period when those temporary cells are alive. But all of them, the billions and billions of them die off after a couple of months, and we have to now really monitor longer term durability to know exactly how these vaccines should be used. ELANA GORDON: I would imagine that that monitoring is part of the process to see how well that is moving forward, but I'm surprised to hear you say that some of the studies that need to set this up to really know aren't happening yet. MICHAEL MINA: Well, that's true.

So now the phase three studies, for example, Pfizer, now that that has the books have closed a bit on that study, the question now becomes is it ethical to not give the control arms the vaccine. The moment we give the control arms the vaccine, we are in a position where we're no longer able to measure these effects and the benefits. And so there are some people saying, well, if these people-- and I I'll admit, I agree with this.

If there are people in the control arm who would not otherwise be in line already to get a vaccine early, I think that for a number of reasons, it's ethical and the right thing to do is to ask them to not get a vaccine. I mean, if they did participate in the study, and I think they deserve credit for that, but if they are not already in a position that they would otherwise be getting the vaccine based on their age or their work status, I would suggest that we try to keep that control arm preserved, so that we can continue to monitor the longer term benefits. But it is an ethical quandary. We like to normally reward people who dove in and decided to be part of the vaccine trial. But in this case, I think the benefits outweigh the ethical quandaries around not giving them vaccines, if they would otherwise not be in line anyway.

ELANA GORDON: This question is from Patricia. "How do we participants, for example, in the Pfizer BioNTech trial, it wasn't the behavior of the some 47,000 participants that reduced the risk of contracting COVID-19? How do we know it wasn't like the self-isolating most of the time, wearing masks that might have contributed to that difference?" MICHAEL MINA: It's a really great question. And it's why we do this as blinded studies. The participants don't know which vaccine they have received, and so we anticipate when we recruit people, we're either giving them the vaccine or placebo.

We kind of randomize it. And so over tens of thousands of people, we have these large numbers, A, to ensure that we get enough cases in one or the other arm that we can discern an effect, but also, any of those behavioral modifications that people might make as a result of being in the vaccine trial should ultimately average out to be evenly distributed across the two arms. And so that's why we always need the control arm, which gets a placebo or some other vaccine and the intervention arm, which actually gets the vaccine of interest. ELANA GORDON: There is two questions that came in, which have to do with COVID-19 itself, and I think speaking to the theme of this conversation of almost one year in. Is there any information on the length of time immunity lasts once you've had COVID-19? And also a question piggybacking off of that from Shaina is are people getting the virus more than once, and if so, what's happening? MICHAEL MINA: So the durability of the immunity after infection, we know that millions and millions of people on Earth have now gotten infected, maybe as many as 100 million just in the United States alone.

And what we don't see is we don't see many reinfections, or at least not symptomatic reinfections. And so we've now had an opportunity from January and February in China and other countries and then really in the US from March onwards to evaluate people who have been infected, and we have seen exceedingly low numbers of people getting severe reinfections of any sort over the subsequent six or seven or eight months. So we know that this virus is acting-- I like to say that this virus, in most ways, is acting like a textbook virus.

Our immune system is working just perfectly to deal with it. Reinfections are not always bad. This has been a big misconception. Symptomatic reinfections are not good, and especially severe symptomatic reinfections.

But just getting a reinfection alone is not a bad thing. It helps our immune system to learn. And so we actually, in many ways, if you have been infected, getting re-exposed is a boost to your immune system. It's almost like a vaccine boost, but it's just reeducating. It's reinforcing what your immune system has already learned. And so re-exposures might be very, very frequent, but as long as they're not causing disease, and hopefully not also really transmitting to other people, it shouldn't necessarily be seen as a terrible thing to turn up PCR positive again if you're asymptomatic, as long as the titers aren't getting really high or transmitting.

ELANA GORDON: That leads to another question from online. Should people who have been infected with COVID before get a vaccine? MICHAEL MINA: Well, this has been a big question. I think that-- my feeling is no, actually. I think we are in-- but this is not the-- the national decision is yes. But if we were to take a biological approach to this question and say how do we preserve all of the vaccines that exist to get them out to the most number of people, I mean, in the US, maybe as many as a third of the US has been infected at this point, which is a huge number. So if we're including that, and we were to vaccinate accordingly, we might be able to really stretch out the vaccine to many more people.

That being said, there is both a concern that maybe the vaccine would be better than an infection to derive a more durable immune response, so it wouldn't be ethical to withhold a vaccine from somebody who's been infected. And then just the logistical challenges of determining who gets a vaccine based on their previous infection history, for example, through serological assessment for antibodies would become a major hurdle and an expensive hurdle that I think, at this point, the government would prefer just to plow ahead and vaccinate cohorts without worrying about their infection history. But I would say that most people who have been infected probably are in a better position to deal with subsequent exposures than somebody who has never been infected. And so not getting a vaccine probably is not the end of the world for people who have been infected already. ELANA GORDON: This question is looking back a little bit.

I know we're looking ahead. But what is your opinion of the virological evidence suggesting that China was correct when it protested that it was not the source of COVID-19? And that question is from Paul. MICHAEL MINA: Well, I think the evidence is pretty good that the virus probably did evolve within China. Now, I think putting blame-- we've heard our president, for example, blame China.

That is absolutely not helpful. It's not useful, and it's just wrong. There are biological and sort of ecological differences that occur in all of our societies and in our landscapes.

And we can't place blame on a nation for a virus evolving. The next one could start in the US. We never know. And so I would say that the evidence is pretty good that the virus did begin its life cycle, or it evolved and became SARS-CoV-2 through mutations and other things in China, but I wouldn't go any further than that in terms of placing any blame. ELANA GORDON: Speaking of thinking about future instances, this question is from The World Facebook page. What do you believe is the larger long-term system solution for the US, and I would add, the world to ensure something like this doesn't happen again? MICHAEL MINA: Well, there's a lot of different opportunities that we have.

We have the tools and technologies to help prevent another pandemic like this. I don't really think the Earth, and I don't think our governments will get around to doing it because we're very short. Our memories are very short lived, it seems, as a society. But if I'm being less cynical, I think that one thing that I've been calling for is to create a global immunological observatory. This would be something that routinely is collecting specimens from people through convenient samples to people who just go to the hospital, go to the doctor's office, want to just participate and send in dried blood spots, whatever it might be, that we can actually start monitoring the global population for viruses, for viruses that are endemic and are constantly circulating, and also to look for novel viruses, and we can bank on the fact that all of us, every human being-- I look at our immune systems as little constantly recording hard drives. And we all have these little hard drives in us that are evolutionarily honed to do an extremely good job to record our exposure history to pathogens.

What that means is that if we can tap into those hard drives, then we can start extracting the information from them to know what people have been exposed to, then humans can all start acting like little weather buoys, and we can make a weather system for viruses. And this is what I call the global immunological observatory, where we can actually start to forecast pathogens, we can-- without having to go to the doctor, for example, say-- I mean, bring it very close to home. Let's say you have a child, and your child has a runny nose and you want to know, does my kid have COVID, does my kid have the flu, or does my kid have rhinovirus? Well, you can instead of opening up your iPhone and putting in your zip code and seeing the weather, you open up your iPhone, and you put in a zip code, and you see that there's a lot of rhinovirus circulating in your community today, and you expect that it will pass through over the next two weeks and don't be surprised if your kid comes home with a runny nose from school. We could do that on a global level and also use that as a very robust monitoring system for novel pathogens as well.

And I think that that would be one of the most important and crucial tools we could have as a globe to really have our governments work together to develop a framework for it in a very similar way as we've developed a framework for the weather system. ELANA GORDON: What about in the United States? MICHAEL MINA: Well, I think the US, we could also do something very, very similar. Certainly, I think for the future, I would like to see that system get started in the states, and in some ways, I'm doing a pilot of it now. I'm working with plasma donor companies that we're getting tens of thousands of samples, just convenient samples sent to the lab every week from all across the United States, and we're measuring antibodies to different pathogens in it, in all of those samples, as many as a million samples or so. But a different option I think to really prepare for another event like this, there's no reason why we shouldn't, A, be building up the capacity to build these rapid tests, so that if another virus comes around, we could just distribute these very quickly.

We could make a new test for that virus and start distributing them. But also, we should really be considering actually doing something useful with our public health infrastructure. We have this failing public health infrastructure in the US. We all talk about the CDC as though it's some glimmer shiny object in the world. But if the CDC isn't supported by a robust, national public health framework at the state laboratories and state public health departments, it becomes, as we've seen, almost a paperweight. We need to support something like the CDC with robust statewide departments of public health.

We need to invest in public health in so many ways, not just for pathogens. We have chronically underfunded public health in this country to the point where we don't even have regulation and language around public health. It's all around medicine. And if we can build up our public health infrastructure, both at the state level, state laboratories, actually pay good salaries to people who are working in public health. It shouldn't be an underpaid, underfunded position. We can start to actually get good advancement going.

And there's a very concrete thing I think we should also do. Along with getting these tests sped up or built up, we should also-- there's no reason we shouldn't have major sort of national laboratories scattered about-- regional laboratories scattered about the US, so that if-- where we ran into these PCR laboratory problems this pandemic, there's no reason we shouldn't have had the capacity and had bunkers, if you will, of PCR machines. The nice thing about pathogens is that they all run on genetic material, as all life does. And so PCR will always work for whatever pathogen might get thrown at us.

We should be building up bunkers of these so that if a new pandemic arises we don't have to bank on all of these different hospital laboratories scattered about to help. We can just really enlist the National Guard to essentially spin up millions and millions of PCR tests overnight, just like we would with the military. ELANA GORDON: So it sounds like infrastructure thinking ahead. I want to wrap up our conversation with something you mentioned in the beginning because we're in this moment of these sort of contradictions of this sort of light at the end of the tunnel but being blinded, you mentioned, by that light, you worry, because there's so many infections right now. And I wanted to kind of wrap up, if you can talk about the things you've learned this past year about this virus, and what are the main things in this moment to get through not being so blinded, so we can all make it through this? MICHAEL MINA: Well, I think one of the most important things to take away from this virus is how much we already knew about the virus before it was ever discovered. We all froze.

The world froze when a novel virus came on board that was infecting people, and we treated it as though we had to rewrite every textbook. We treated it as though we knew nothing about the growth parameters of the virus, the kinetics, the transmission. We went so far in the beginning as saying don't wear masks because they could backfire, or we said it's not aerosolized, or we're just not sure enough. Of course, this is a respiratory coronavirus.

We knew so much about it. And the next virus that comes around, we'll probably know so much about that, too, before it ever is even discovered. And there are some viruses that we don't know about, like HIV. HIV is a truly unique virus to humans for so many reasons, and that requires truly writing new textbooks. But I hope that one of the major takeaways that we can have as scientists, as policymakers is to not freeze up next time, not say, we know nothing about this, we need to do every study over and get all the empirical data before we can make policy. I mean, I'll go back and look at everything we have learned since February, and I would venture to say that we have been surprised for at least people who are normally in this world, we have been surprised by very little about this virus.

A different thing that I think we need to learn is while it is great to have so many people who got involved with trying to tackle the virus, I think when we look back, we'll see one of the biggest problems was having too many cooks in the kitchen. We had a lot of people who wanted to do the right thing but ultimately led to a dilution of voices, or the voices of the people who really needed to be heard got diluted out by a lot of physicians and scientists who are kind of normally tangentially involved in maybe infectious disease work or just medicine in general, making bold claims about saying things were surprising, like waning antibodies. That was headline news for a while. People are very scared about waning antibodies, but that's immunology 101.

We should never have let that be frontline news because that was fully expected 10 years ago. So I hope that one of the major takeaways is for us to figure out why we weren't able to learn, why we weren't able to use all of the knowledge we've gained over decades of studying viruses and apply them readily to this virus in a way that made a lot of sense. That's one thing I think we'll have to go and do a postmortem of and try to understand. Other areas where I think we have really learned is I think we've learned that dealing with the population is much more difficult than dealing with the virus itself, and we need very strong political leaders to wrangle a virus like this. If we have broken politics, and we have nations that within their borders are divided, just like war, we will never succeed if we're not working together. And I think that that has been a major travesty in our country anyway.

This was an event that had the potential to unite us. There's very few events in life that everyone can get behind and be united around. But this didn't do that. This only divided us further, I would say.

And there wasn't even another human faction that was against us. This was a virus. This should have been easy for all humans to unite around, but that didn't exactly happen.

And so I think it's, of course, the hardest thing always is dealing with fellow humans. But I think it's one of the most important things to take very, very seriously and try to understand exactly what went wrong and is there a way to write a playbook for this for the future, where somebody-- it doesn't matter who is in the presidency, who is in politics, that there is a playbook to open up, and say this is the scenario we're dealing with today, how can we quickly galvanize people, how can we quickly deal with this in a way that we haven't really done in this pandemic. ELANA GORDON: But in this moment, just one quick wrap-up message, as these vaccines are being rolled out, as one can think, wow, we might be getting towards the end of this thing, how soon can that come along? And at the same time, seeing that light, being blinded by it is something that you said. What are the main things in this moment for people to be mindful of how soon one can get to that light at the end? MICHAEL MINA: I think we should be very aware of just how many people are continuing to get sick with this virus today. The average person will not have access to a vaccine before April, maybe later.

I think there's a bumpy road potentially ahead of us with things as simple as cold chains, how do we get freezers to everywhere they need to be so that we can actually distribute the vaccine appropriately. Things are never as simple as they appear, and it's kind of like when Trump in February said that everyone was going to have a Roche test available to them any time, well, that absolutely never materialized, and I think we're seeing a very similar thing here. We're seeing everyone saying everyone's going to be vaccinated very soon. We need to be cognizant that that might be-- those expectations should be tempered. It is why I'm continuing to push for strategies to control the virus today. The average person will not have access to a vaccine soon.

The virus very well could mutate around immunity. We hope that it doesn't happen, but there's a lot of reasons that the vaccine could go awry, and I'm going to keep pushing, for example, for every American to have access to this. I would like to see these tests show up in everyone's mailbox essentially, and so they can know their status at any time and be informed, so when they go and see family, which they're going to do, that they can do it in the safest way possible because we still have a long road ahead. We still have almost 50% of the time that we've already spent with the pandemic now we still have ahead of us. And so I think we just have to remain cognizant of that, be excited that there is a light at the end of this tunnel, be excited that science is triumphant here, that it has worked to create a vaccine in record speed.

But let's not forget that every single day, we still have nearly a quarter of a million people getting infected with this virus. 3,000 people are currently dying with this virus daily in the US. Cases are continuing to increase, and we cannot lose track of time to make things better in the short term. ELANA GORDON: Thank you for fielding all of our questions and for your time and going over a little bit in this discussion.

But I think that's a good place to conclude it all. So thank you again for joining us. MICHAEL MINA: Absolutely. Thank you so much. ELANA GORDON: And this Q&A has been jointly presented by the Forum at Harvard's TH Chan School of Public Health and The World from PRX and GBH. You can view the full discussion on our Facebook pages and send feedback @forumHSPH and @PRITheWorld.

Join us again on January 12 at noon when we will talk about the impacts of the disrupted school year on kids. So I wanted to wish everyone a happy and healthy holiday season and join us again in 2021.

2020-12-25 16:22

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