( Tsafrir Abayov / AP Photo )
Michael Mina, MD, PhD, assistant professor of epidemiology at Harvard T. H. Chan School of Public Health, talks about how schools are preparing to test students, the science on boosters and who gets them, and more of the latest COVID-19 news.
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Brian Lehrer: It's the Brian Lehrer Show on WNYC. Good morning, everyone. Have you heard this phrase that many people seem to be using these days in the health professions and in politics, "We may be done with COVID, but COVID's not done with us." Some version of that seems to be popping up in lots of places, and obviously, it's true.
Here we are in September now, the month that back to office was really supposed to take off in business districts, but has now been widely delayed, the month at back to school was supposed to happen in lots of places, leaving mask mandates, remote learning, and frequent quarantining in the dustbin of history, good riddance, not, the month by which so much of the country would be vaccinated and the vaccines would prevent not only individuals from getting seriously ill, but also stop the spread. Delta's transmissibility and spotty vaccination rates are delaying that too.
Here we are with the first September COVID headlines being the political bore over masks and schools, US hospitals with no beds left, more than at any time in the pandemic, there have been some individual really tragic stories that we don't have to repeat here, and confusion over when vaccinated people should get or can get booster shots. You've probably heard that the government was considering an eight-month timeline after your previous dose. Then it was maybe going to be six months. President Biden even said this on Friday to Naftali Bennett, prime minister of Israel, where boosters are available after five months.
President Biden: The question raised is, should it be shorter than eight months, should it be [unintelligible 00:01:54] five months? That's being discussed.
Brian: Should it be five months? That's being discussed. Well, that was Friday, but slow down Mr. President, here's his chief medical advisor, Dr. Fauci on Sunday on Meet the Press.
Dr. Fauci: We're still planning on eight months. That was the calculation we made. This rollout will start on the week of September the 20th, but as we've said all along, Chuck, in the original statement, that's the plan that we have, but we are open to data as they come in.
Brian: We'll try to clear up some of this booster confusion now as Dr. Fauci waits for more data to come in, and also hear a proposal for using the rapid COVID tests to minimize the amount that kids have to stay home from school after being exposed to classmates with the virus. Our guest is Dr. Michael Mina, epidemiologist at Harvard Chan School of Public Health and a leading voice on testing and many other things COVID throughout the pandemic. Dr. Mina, thanks for coming on again. Welcome to WNYC.
Dr. Michael Mina: Well, thanks so much for having me.
Brian: Can we start with your idea for minimizing the number of kids who have to quarantine from school? I'm sure lots of parents would like to hear that.
Dr. Mina: Absolutely. COVID and quarantining is really an information problem. We quarantine a child and we say, "You can't go to school for 10 days because you've been exposed," because we don't know whether or not they've been infected, so we say, "Go home and quarantine." We actually have the tools now to know if they are infected and infectious and [unintelligible 00:03:35] a simple rapid test that a lot of people have now been finally hearing about.
Instead of quarantining the child or a whole classroom of children because somebody else turns up positive in the class, we can do what I call test to [unintelligible 00:03:53]. That's instead of having everyone quarantine, you just have them use a simple rapid test at home before school and you do that each day that they would otherwise be quarantining. You say, "You've been exposed potentially. We don't know if you're infected," so on Monday, use a rapid test in the morning, and if negative, go to school. Tuesday, use rapid test in the morning, and do that for the week. Most people don't actually turn positive who ended up being quarantine.
This is in a critical tool that we haven't really utilized very well at all in this pandemic to keep society running. This works for businesses, for schools. It's an information problem and we know how to solve that problem.
Brian: We always hear that the rapid tests aren't as accurate as the so-called PCR tests, the full nose swab. Are the rapid tests accurate enough for use like that and still protect the other kids in the class?
Dr. Mina: Absolutely. The rapid tests that have been authorized thus far in the United States are very accurate to answer the question, am I infectious? This is a very different question than have I been infected in the last few weeks? The question is, and why we quarantine people is we are worried about whether or not they are spreading the virus today. These rapid tests do exactly that, they detect infectiousness. I actually like to call them-- These are public health tools that I think should actually be called contagiousness indicators or something along those lines, because that's really what they excel at. They are very, very good to answer that question.
Brian: I see you have this Twitter thread going that's partly aimed at the Los Angeles public schools in particular. Is LA and outlier for some reason or typical of this issue?
Dr. Mina: This is happening all over the place. That was just one of the first big news reports to break. That was that day one, day two of school there were a huge number of quarantines and now we're seeing people and the teachers unions and such pushing for more extreme quarantines, that when one child becomes positive in a class, to quarantine the whole classroom. This is not the way to go. It wasn't last year and it still is not.
Kids have been out of school enough. The last thing we want to do in a pandemic is to have the societal ramifications be worse than the virus itself. We need to figure out and utilize the tools that we have available to us to ensure that children remain in school, to ensure that businesses keep running and we don't just keep using these brute force methods of closing things down and make major quarantines to solve a public health problem. Those solutions should be considered public health failures, and we have ways not to have to utilize those.
Brian: Yes. I'm sure a teachers and parents and kids are all listening with great interest right now. I was talking to one New Jersey teacher the other day, who told me that they quarantined five times last school year, five times without ever getting COVID, because of kids in the class.
Dr. Mina: That has happened to so many people. Millions and millions of people have been quarantined who ultimately never became positive, and we need to use the tools like rapid tests. We have companies out there like eMed that can verify that little Johnny is in fact the one who used his test this morning, and then he gets to school and he just shows the results of that rapid test and it's been verified through a service like that. We have these tools and these technologies now, we just need to really deploy them in much more efficient and logical ways.
Brian: I should note that you also say, lobby our states and schools to pay. That means so each family won't have to buy these rapid tests themselves?
Dr. Mina: That's exactly right. One of the biggest issues happening in the United States right now is that these tests are still expensive. That's for a number of reasons. What is very, very critical to understand here is that the Biden administration and Congress have appropriated billions of dollars for the American public to have these types of tests to keep schools and businesses open.
These costs should not be incurred by the individual, this is public health. It should not be on the individual to ensure public health, we should be lobbying our congressional leaders, we should really be asking the hard questions, "Where is that money that Congress appropriated?" because schools themselves generally don't have the money, families certainly don't. We need to make sure that the money is getting to where it needs to go to keep schools open.
Brian: We can take some calls, listeners, for Harvard epidemiologist Dr. Michael Mina on rapid testing to minimize quarantining from schools, rapid tests. Generally, we're going to talk about rapid tests in another way here in just a second. Rapid tests on quarantining or to minimize quarantining in the school year, rapid test for admission to things, which we'll get to. Also, the debate about how long to wait for a booster shot, and I hope to touch on masks in schools, or it can be on anything else if it's really relevant to Dr. Michael Mina. 646-435-7280 or a tweet @brianlehrer. By the way, your last name is spelled M-I-N-A but pronounced Mina, right?
Dr. Mina: That's correct, yes.
Brian: Just making sure that I was getting it right. There was a time earlier in the pandemic, as you well know, when people were saying rapid tests would be the key to reopening lots of things, it would be the way to get theaters and concert halls and sports arenas open again, for example. I was looking back at some old news clips on rapid tests to get ready to talk to you, and here's the Gothamist headline from February, "Cuomo wants rapid testing to reopen sporting events. Should he consider COVID sniffing dogs?" [chuckles] That was the headline.
Most of the article about dog's ability to be trained to literally smell COVID, like, I guess, they can smell some other diseases, but the premise was rapid tests at the gate, and the dogs were just one potential version of that. Did vaccines and vaccine mandates for things like Broadway and US Open tennis tournament, which has a vaccine mandate in Queens now, replace what was starting to become a rapid test protocol?
Dr. Mina: Generally, in the United States, yes. I was actually pushing for these programs to make sure that we never had to close anything down all the way back in April of 2020. These tools we've been aware of them. They could have been mass-produced by the US government. We could have prevented hundreds of thousands of deaths in the United States and likely curbed the major outbreaks that we saw in the fall and winter and that we're seeing now had we really rolled these types of tests out in strategic ways.
The US has, unfortunately, taken a vaccine-only approach, in my opinion. Of course, there's been a lot of discussion around masks and distancing and lockdowns, but ultimately, we put all of our eggs in the vaccine basket. This, in my opinion, was always a bad idea. I was writing about this a year ago, saying, "If we put all of our eggs in this vaccine basket, then we are really playing with fire because the moment the vaccine don't turn out to work as well as the initial trials suggested," and there's reasons for us to have believed that they would not have and all of what's happening now is predictable, that we would really be stuck, and that's exactly where we are now.
We were hoping that the vaccines would be the silver bullet. It was apparent that that was a very risky hope, and now vaccines do not stop transmission of Delta. We have to be very clear and honest about that fact. The idea of a vaccine passport to stop spread in a place like a theater, it will help decrease risk of spread, but it is not going to be a tool that should be assumed to stop the spread inside a theater or sporting event. We need to layer these strategies together, and rapid tests are generally one of the best approaches to do that because they tell you if you're infectious within minutes of walking through that gate, and it's a very, very powerful tool.
Brian: This is really interesting and so different from where the political sector is headed, which is toward vaccine mandates with no negative test option to get out of the vaccine mandate. Yet from what you're saying, it sounds like you might think that for a Broadway Show, let's say, it would be more accurate information about the audience if everybody had to either take a rapid test at the door or show proof of a negative PCR test from the last few days, that the testing requirement would be more accurate and more protective than the vaccine requirement. Is that your position?
Dr. Mina: It is, and I want to comment on two parts of that, one on what you mentioned about the PCR tests as an option and one on the vaccine. We really have to be very clear with the American public, and the CDC has to do a much better job of this as do state governments, about what it is that we should expect from the vaccine. When we are talking about vaccination and why there's such a massive push for vaccination, it is to reduce severe disease, and the vaccines continue to be doing a pretty darn good job at that.
The much older individuals in our society are becoming more susceptible, again, predictably, but the vaccines are not going to stop transmission of this virus at this point. Those shouldn't be considered-- When we have a breakthrough case and an outbreak amongst the vaccinated, we should not consider that a failure of the vaccine program. The vaccines are going to do a very good job of keeping people from dying from some very severe disease, but we need to really be honest with Americans and with the world that the vaccines at the moment are, unfortunately, not going to stop the outbreak, so we need to use the other tools at our disposal if our goal is stopping outbreaks.
Brian: Just to be very, very clear, you are not against vaccination or mass vaccination as a primary tool for individuals and for society, right?
Dr. Mina: Oh, absolutely. That is 100% correct. I'm very, very pro getting everyone vaccinated because that is the best thing as individuals for individual health. We can do it to keep ourselves out of the hospital, keep the hospitals unclogged, and keep the healthcare system running okay. These are different issues. One is personal health and keeping yourself safe and one is transmission, and those have to be separated when we start talking about what is the role of a vaccine in society.
Brian: All right. We have so much more to do with Harvard epidemiologist, Dr. Michael Mina. We're going to continue after a short break. I'm going to take a few phone calls pushing back, looks like one is from the doctor, one is from somebody who got a false negative on a rapid test, on your theory of the case here, we'll also get into mask mandates in schools, we'll also get more into the booster shots and whether it should be five months, six months, eight months since the previous dose, so stay with us, Brian Lehrer on WNYC.
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Brian: Brian Lehrer on WNYC with Harvard epidemiologist Dr. Michael Mina proposing among other things daily rapid tests for students who've been exposed to somebody with COVID in schools as an alternative to mass quarantining. Robert in Morningside Heights, you're on WNYC. Hi, Robert.
Robert: Hi, good morning, Brian. Great to be on the air with you. I want to preface what I'm saying by mentioning that I appreciate what the guest is trying to do in terms of finding a way forward. I'm not in favor of living in lockdowns and living in fear, but after hearing a segment this morning, I want to relay what happened to me in March of this year. I had a bachelor party that was going to take place in New Jersey. I live in Manhattan. Was going to take place on Saturday in one of the first weekends of March of 2021. I started feeling not well on Thursday of that week, so I figured I'd better get a rapid test on Friday before I go down to New Jersey and see my friends and family.
Basically, I went and got a negative test. "I guess, I'm going to go even though I don't feel too great." Obviously, you know what happened. By Sunday, I got my PCR result, I was positive. I had gone to the bachelor party, I saw my family in New Jersey, and I ended up infecting, I think, six or seven, maybe eight people and plus their girlfriends. I was a super spreader, basically. At the end of the day, I was the one that made the choice to go down. I could have not gone, but certainly, if that result had been positive, I would never have gone. It was negative and it made me feel like it was okay to go.
Brian: Based on a false-negative rapid test. Dr. Mina, are you cringing?
Dr. Mina: Well, I'm cringing because it describes so well how poorly we've been utilizing these tests and how poorly we've been conveying how they should be used. If somebody is not feeling well and they're going to a multi-day event like this or a party over a weekend, any test, whether it's PCR or a rapid test will be negative until the viral load gets above a certain level.
The virus load for COVID and for SARS-CoV-2, it grows exponentially over the course of a day or two. One day or even in the morning, you could be undetectable by any of these tests, and 24 hours later, you could literally be a super spreader with billions or trillions of viral particles. That's why when somebody is quarantining and using a test instead of quarantine, for example, or to go to an event, it needs to be right there just before that event. If I'm going to go to a dinner party and I'm worried that I might be transmitting, I want to use the test as soon before the event as possible. If it's negative, it's very unlikely that I'll transmit.
Brian: On the way into school that day is okay the day before to say, "Okay, I'm good for tomorrow"? Is not okay.
Dr. Mina: That's exactly right. For society, we have to balance these if we're doing it at mass numbers. There needs to be some balance, but this is also why I have never been supportive of this idea of PCR testing two or three days before an event. That is nonsensical because you could have a negative result in your hand, meanwhile, you can be super spreading if you get the test too early, because the virus grows very fast.
Brian: Even with a PCR test. Robert, that's such a horrible experience that you had to go through, and innocently on your part. Are your friends from the bachelor party still talking to you?
Robert: [laughs] They did forgive me. I ended up being hospitalized, and so everybody felt bad for me-
Brian: Oh, geez.
Robert: -but I'm okay now and I'm vaccinated. One thing I would like to add really quickly is that the rapid test and the PCR tests were taken at the same time that Friday, and the PCR test came back positive at the end of that weekend, on like Sunday night, whereas the rapid test was negative. Just to the doctor's earlier point, I think that is relevant.
Brian: Robert, thank you and good luck to you. I'm glad it seems like you better now. Thank you for sharing your story. Duke in Jersey city, you're on WNYC. Hi Duke?
Duke: Hey, Brian, can you hear me?
Brian: I can hear you.
Duke: First, I want to say, Dr. Mina, thank you so much for what you're saying. I've been saying the same thing for a year now. This whole ideal that this vaccine-only approach is going to solve this problem was ridiculous on its face. Everybody knows the vaccines are important and everybody should get a vaccine if they want to save their life. In terms of public health and trying to prevent the spread of infection, it was ridiculous just to focus on this one bullet.
Brian, I hate to say this. I love you, Brian. You're a treasure to New York, but you've been pushing this vaccine-only thing for a year also. I've never heard-- In the year and a half I've been listening every day, you have not had one expert on to talk about any other approach, anything. I'm not even going to go into the conspiracy realm of ideals that are out there, but there are simple things, there are tests. Don't let people call in and say what they've heard. Why don't you do the research and get the scientists and the clinicians who are doing these things on your program.
Brian: In fairness to us, that is what we do almost every day. We have scientists and clinicians, and Dr. Mina and I would not say that this show has had a stance of vaccine only. We certainly try to burst any false vaccine, anti-vaxxer conspiracy theories. I think complexity is a hallmark of what we try to do here, but Duke, keep calling us, and I take your point. He was joking to our screener, so I'll pass this along to you that he was afraid that you're going to get "canceled" Dr. Mina, for the heresy of what you're saying here today and what you've been writing similarly, that vaccines can't be the only solution and might even be less accurate than tests for admission to public spaces. Are you getting that kind of backlash?
Dr. Mina: I certainly have, and to Duke's point, I would say that most epidemiologists and scientists have focused almost exclusively on the vaccine for a year now. That's because that's normally how we would deal with an infectious disease outbreak. Vaccines have traditionally been considered the number one thing to do, and in this pandemic, they are still the number one thing to do.
My take has always been, "Look, there's a lot of people talking about the vaccines. There's very few people talking about other strategies like rapid tests. There's a few other things, ventilation, rapid testing, these are extraordinarily powerful, but there's not a lot of people talking about them." In fairness to your show, you could have a huge number of varied scientists, but ultimately, the scientific discussion has all been focused on the vaccines.
That's why I think I've, in some ways, built a social media following and that's why I'm on the news quite a bit, is because I am trying to think of, okay, what are the other things? Five steps ahead, what might go wrong? Do we have the tools to solve that problem before it happens? Or all of last year before we even had a vaccine that was available, we just chose lockdowns and very brute-force measures instead of these simple, elegant tools that could have really done a lot more.
I do get backlash because I oftentimes go against the grain, but me talking about testing does not mean I don't want vaccinations amongst people. Actually, my real work pre-COVID is all about vaccines. That's really what I do, I do vaccine immunology.
Brian: I would say that just last week, as far as the show goes, we had Ed Yong from The Atlantic who was also saying we've relied on vaccines too much, especially with how the Delta variant has proven to act even in the face of vaccines in certain respects and we need to re-institute or re-emphasize testing and masking and other tools as well.
Duke: Brian, can I just add one point?
Brian: Yes, you can.
Duke: I love you, Brian Lehrer. You are a treasure to New York and to this country-
Brian: Get to the buts, okay.
Duke: -but in a year and a half, you have had the same doctors on over and over and they've been pushing-- I'm not saying you and I'm not saying WNYC, I'm just saying the doctors that you have had on have been pushing the same narratives. You haven't had Dr. Pierre Kory on to talk about ivermectin. That can't even be spoken about in public. If you even say the word, you're a conspiracy theorist.
There are many things that are saving people's lives and we're moving a big ship in the ocean. We're waiting and waiting and waiting on testing and data and these doctors and clinicians are out there doing the work. Why don't you talk to these people, give them a voice and give them a chance to say what they're doing.
Brian: Duke, I appreciate it. We do give lots of people voices, but I love you too, Duke, and keep calling us and keep critiquing if you want to critique. What do you think about ivermectin, Dr. Mina?
Dr. Mina: I have generally stayed far away from that discussion. A lot of people ask me about it on on social media and such. It's not my area of expertise and I try to stay very much in my area, which is immunology and testing and all things having to do with that and the therapeutic side of it. While I have read different reports on the data, I'll choose not to weigh it in at the moment.
Brian: All right, which means it's an open question for you, I guess. Related to what we've been talking about, what's your position on mandatory masking in schools?
Dr. Mina: I think masks are going to limit spreads. There's no doubt about that. The question is, especially with younger kids, what are the costs and benefits of it? Especially with kids, you just see the masks are on them and off them, or throughout the course of the day, they're off half the time. When you're sitting in a school, if you don't have good ventilation and you're just certain that you're breathing in the same air in the same classroom all day long, it does make one wonder how much is a mask going to work in that setting where kids are really close together and breathing the same air all day along.
That said, I think it's a pretty practical and simple layer of all of this. I'm personally in favor. of masking because I think the more we can do to keep schools from having to shut down because of massive outbreaks, the better. What masks will do is they'll ideally stop big super spreading kind of transmission. It might not stop Johnny from infecting his neighbor at the desk next to him, but it should do a good job of really preventing a super spreader from just spewing out tons of virus in the hallways and things along those lines.
Brian: It seems to me that if I'm any human being right now spending hours in a small room indoors with 20 or 30 other people, I'm going to wear a mask, vaccinated or not, open windows and good air purifiers or not. Is that too conservative or is that more or less what you recommend for anybody right now who's spending hours at a time in a relatively small room with 20 or 30 other people?
Dr. Mina: I think it's the conservative approach. It's a smart approach, but what I would say is if we had to choose one or the other, and that is, would I prefer to be in a room all day long where everyone was wearing a mask but not tested that morning or would I prefer to be in a room where nobody was wearing a mask but everyone tested negative that morning? I would choose the latter where everyone tested negative that morning in a heartbeat. That to me is a much safer approach to it, but that's not necessarily the decision most are making right now. Usually, it's- [crosstalk]
Brian: You're saying, though, that if schools were to implement your rapid test strategy, where if anybody in the classroom were to be COVID positive and everybody else would be taking rapid tests just before school for the next week, and assuming they tested negative, they could go to school. That in that environment, masks wouldn't be necessary?
Dr. Mina: Well, they would still be a layer of protection, but if it was one or the other, especially in these schools where people are really, really actively against a mask-- I actually think that if the US would get its act together and really create a program around rapid testing and say, "Look, if every student in your class tests Monday morning before they get to school with these simple 30-second paper strip tests and they're all negative," that to me creates a much safer environment in that school, in that classroom than if nobody's testing and everyone's just wearing a mask. The safest, of course, is to do both.
We have to really utilize the tools that we actually have available to us. I think, and there's good data to suggest that as a nation, we have the resources to really scale up these tests and make them a major component to this pandemic so that we don't have to lock things down, especially as we move into the fall in the Northeast. These outbreaks that we're seeing in the south are going to move north. We need to be thinking of the real solutions here to, for the time being, stop the spread in places like schools. These tests are just extraordinarily powerful approaches to that.
Brian: A few more minutes with Harvard epidemiologist Dr. Michael Mina. I want to get to the one more topic that I was trying to make sure to get to. We've spent so much time on the rapid test in the conversations that you have started with your positions on that. I'm glad you did, but I do want to get to boosters. I played the clips of President Biden and Dr. Fauci on the boosters way back at the beginning of the segment. Maybe it'll be eight months after your last shot. In Israel, it's five months. Biden said he'd consider that. Do you have an opinion?
Dr. Mina: I do. That is that there is no magic number to all of this. The immune system is extremely variable across people and especially across ages. This is something I was talking about all of last year when people had asked me what I thought about what would happen with the vaccines. Even if the vaccines were 95% effective, we had to be very aware that especially the older individuals in our community, people in nursing homes, senior living facilities, people over the age of 65, 75, the architecture to actually store immunological memory that is to really retain the protective benefits of the vaccine start to erode and degrade as we age.
For the oldest individuals in our communities, they might not really be able to retain much long-term memory at all from a vaccine, and so they might need a booster earlier as long as there's a lot of spread of this virus and you'd have to just keep re-upping it. For a 30-year-old with a very healthy immune system, some of them might lose their immunity after six months, some might retain it for six years. Unfortunately, there's another tool that we're also not using in this pandemic to help answer these questions. One of the things I've advocated for is to check our antibody titers.
Even though we don't have a perfect line in the sand where we say, "If you're above or below this antibody level, you're protected," what we could look at is measure somebody right before they get vaccinated, three months after they've been vaccinated, and six months after, and ask the question, "Are you declining quickly or slowly in terms of your antibody levels?" We could have come up with new metrics so that we didn't have to try to figure out is it five months or eight months?
We could do more personalized approaches and somebody could say, "Hey, my antibodies have dropped 90% or 99% since I first got my vaccine." Then we draw a threshold and we say, "Okay, if this is how much you've dropped, you get a prescription for a booster." We didn't utilize those tools, unfortunately, and now we're stuck in this impossible position of trying to come up with a number that's going to be based on just finding some average.
Brian: Yes, average of time.
Dr. Mina: One person versus the next might not need it.
Brian: You're saying we missed an opportunity at the beginning to measure people's antibody levels just before their first vaccines so they could then be measured over time. What about, assuming that we didn't have those earlier tests, if people as individuals should get antibody tests now, and is there a number below which you would recommend a booster?
Dr. Mina: Well, unfortunately, the antibody tests that are available for the most part now are just plus-minus just like the way we report out PCR values. I've been very critical of that as well, that we should have been reporting out viral loads. We should have been storing all these antibody levels, even if we're giving people plus or minus, so that we can then do the research to say what is the level that somebody should get a booster. Unfortunately, we just don't have the data.
Brian: Oh, I thought we have those tests. I'll tell a personal story. A friend of mine was telling me just the other day about, for whatever reason, he got an antibody test and he told me the number that he tested at. He was six months past his last vaccine dose. The number that he gave me was very low and he told me what the doctor told him is the typical number for somebody his age, somebody that many months after vaccine. He was recommended to get a booster based on a specific number. Those tests aren't widely available for people in that format?
Dr. Mina: They're not widely used. Quest Diagnostics, for example, does have a semi-quantitative on and it gives you a number between 1 and 20. If it's above 20, it just kind of-- but it's very difficult to interpret what that number is. Truly, nobody can interpret it at the moment because we just haven't done a thorough research with the right tests, but it's still possible. I think what we should be doing right now, we should come up with some standardized tests for antibodies. If somebody's questioning, "Do I need a booster?" Then we should just say, "Look, if you're in the upper 80th percentile of your antibody titers, you probably don't need a booster."
We could come up with very rudimentary guidance and say, "If you're in the lower 20th percentile, yes, get a booster, especially if you're older." We could do that and we could actually take a more informed approach to all of this. Unfortunately, we've been really not using any of these types of information throughout this entire pandemic.
Brian: In the meantime, in the absence of that information, what do you recommend for, let's say, a 45-year-old versus a 65-year-old versus an 85-year-old?
Dr. Mina: Well, at the moment, I would recommend-- because Delta, and this is- [crosstalk]
Brian: This is assuming not seriously immunocompromised, but otherwise relatively healthy individuals.
Dr. Mina: I also want, for my own sake because I'm in public health and I feel strongly about this, I want to say that my answer is going to be with the expectation that the vaccines do not have a better place to go. I feel very strongly about the ethics of how we're distributing vaccines.
Brian: Globally.
Dr. Mina: One extra dose in a 70-year-old in India or in Sub-Saharan Africa might be worth 10,000 doses in the United States. We really have to-- There are ethics, but if we relax the ethical question and the ethical dilemma of vaccine distribution, I would say that an individual, when they come up for a booster, get it at this point, because Delta is infecting people, it is still causing disease in vaccinated people, and if you're eligible for a booster, my suggestion, because we have a general void of the data we really needed to take a better approach to this, is when you're up for it, go get it. I don't believe that there's going to be harm in getting it and probably only benefit for individuals.
Brian: Dr. Michael Mina, epidemiologist at Harvard Chan School of Public Health. Thank you so much for this today. Really, really, really informative and interesting. Thank you.
Dr. Mina: My pleasure. Thanks.
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