The following is a conversation with Michael Minna, his second time on the podcast.
He's a professor at Harvard doing research on infectious disease and immunology. In my view,
the most powerful, doable, and obvious solution to COVID-19 from the very beginning is rapid at
home testing. This is what Michael has been talking about and writing about since the
beginning of the pandemic. The accuracy of these tests is high for the task of detecting
contagiousness, which is what matters. Hundreds of millions can be manufactured quickly and
relatively cheaply. Privacy and individual freedoms are preserved. I believe that if you
give people the power of information, information about whether they are contagious or not,
they will do the right thing at scale, all while respecting their freedom and minimizing
the destructive effects of the pandemic on our health and our economy.
This solution was obvious in May of 2020. It was obvious when Michael and I spoke the first
time a year ago and it is obvious today. We talk about why it has not yet been done and how we can
still do it. This is the Lex Friedman podcast. To support it, please check out our sponsors
in the description. And now, here's my conversation with Michael Minna.
We spoke a year ago about rapid at home testing and I think you think it should have been,
still should be a big part of the solution to COVID. So, let's recap. Where do things stand
today in terms of rapid at home testing? Well, it's certainly something that you're
right. I do think we should have them today. We've now had almost 20 months of living in anxiety,
uncertainty, being afraid for our health, for our family's health, for our friends,
shutdowns, economic instability. Everything has been uncertain because of this virus.
And then there's this little test and it's the first time for many people that they're using it
and they're feeling empowered. They're feeling like they can control their little slice of this
pandemic. So, as these tests have come out and more and more and more Americans have had an
opportunity to go and buy them from CVS or Walgreens or wherever they're at,
I think that it's really shifting the tenor of the discussion. For a long time, all of 2020,
it was like, I often felt like it was me and a few other people against the world. These tests
should be public health tools. These tests are infectiousness indicators. They shouldn't be
compared to PCR. All of these different things, we could of course go through and recap what the
benefits and the metrics are that we should be looking at. But the point is, last year and most
of this year was about educating scientists, educating public health leaders, educating
physicians to get them to understand that there is a different reason to test in a pandemic than
purely diagnostics and transmission blockade and severing transmission chains is a big one.
So now, I think we're at a point where people are now understanding and they're understanding
because they are feeling it. They're holding it and they're doing it and they're seeing,
they're feeling the delight of seeing a negative and saying, I feel more comfortable. It's not
perfect, but it's pretty darn close to perfect to allowing me to go and see my mom without mistakenly
infecting her or whatever the story might be. And now that that's happening, I think
all of a sudden we're seeing a massive change politically for these tests. Biden just came
out the COVID-19 action plan the other day and one of the main pillars of it was testing and in
particular, bringing rapid tests, scaling them up. So on that front, I think finally there is
success. People are actually understanding and I haven't stopped beating this drum for far too
long and I hate rapid tests now. So maybe it's good to step back. Would you say most Americans
have not taken a rapid at home test? Absolutely. Most have definitely not taken a rapid test.
So like many of them probably don't know. They kind of probably say testing, they have like
memories of testing, like PCR testing, they have to go into somewhere and they have to like a swab
deep in their nose and that's the experience. Or maybe if you have to travel like Canada or
something like that, you have to get tested, that kind of stuff. So what are rapid at home tests?
Yeah. So the rapid at home tests are, I like to call them paper strip tests, simple. They're
simple tests that I wish I brought some today, but I didn't. They're simple tests that you swab at
the moment, most of them use a swab that you just swab the front of your nose. So it's not one of the
deep swabs that goes into your brain. And so it's not very uncomfortable. It's just like picking
your nose if you all, and you put that swab into a little tube and the tube has some liquid in it.
And then you put a few drops of that liquid onto a paper strip or you drop the paper strip
into the tube, just like one of those indicators for the pool. And if you just like a pregnancy
test, then if you get two lines, you're positive, one line, you're negative. It's super simple. It
takes 30 seconds once you know how to do it of hands-on time and you wait around 10 minutes
and then you read the result. They are extraordinarily effective to answer one question,
am I infectious? And that is the public health question that we need to answer and consistently
ask during this pandemic. Are you infectious? Am I infectious? Because it's only when we know
that we're infectious that we can be empowered to not mistakenly infect others.
The PCR test is a little different. And we can go into the pros and cons, but
one of the major differences is that a PCR test gets a lot of people talking about the
PCR test say it's much more sensitive. And at an analytical level, it is. It can detect one molecule
instead of 100,000. But for public health, we don't want a test that can detect one molecule.
In fact, that has created a net negative for public health. We just want to know,
am I infectious? And to know that question, to know if I'm infectious, I only need a test
that is going to be positive if I have a high viral load, like a million. And when you're and
the virus grows so fast, it will grow from zero to a billion in a day. So you don't really need,
even on the front end of an infection, you don't need better sensitivity. If the tradeoff is that
you don't get the result for one, two or three days, you absolutely want a rapid result that can
tell you, yes, you're infectious, you're transmitting to others right now. And I'm going to give you
the results right now. So it is a much more effective tool, because it's fast, because it's
accessible, we can use them in the home. And there's some issues with using them at home,
we can talk a little bit about what those issues are like reporting and how do you,
is everything on the honor system, if you have a test that you're taking at home and you use it
to go to work. But they can be, they can be accessible. PCR has to go into a lab. It takes a
lot of time for somebody to get a PCR test, they either have to go online and order it,
it takes the next day for it to come back. They swab themself, they ship it out the next day,
and then they get a result two days later. That's four days minimum for the most part. And
at that point, you're not even infectious, even if you did happen to be infectious when you first
ordered the test. So it's really of the speed of these tests and the accessibility and distribution
of them that makes them so immensely powerful. So you have this amazing graphic you tweeted.
It's exactly what you're saying, which is a rapid antigen test answers the question,
am I currently infectious? And you have, I think, a comparison of three different,
sorry, seven different tests based on the viral load. And based on the viral load across these
different tests, you look at the likelihood of infectiousness. So what is this graphic show?
We can overlay that for people. I think it's just really nice and really clear.
Yeah. So what that's showing is that we can never ask what's the sensitivity of a test
and just let that be the answer. That's what the FDA does currently. And that question doesn't mean
anything. We have to say, what is the sensitivity of the test to detect what? And so we can have
different viral loads. For example, you can have a viral load of one or you can have a viral load
of a trillion. And a PCR test will tell you that you are positive regardless of whether it's one
or a trillion. Now, so we can't ask the question, how sensitive is a rapid test compared to PCR?
Because that covers the whole gamut. What we really want to say is, how sensitive is the rapid test
to detect me if I am infectious? And that gets to about 97% or so sensitive.
If the question is, how likely is it to detect me if I'm a super spreader? That's a really important
one to be able to detect. They're all about 100% sensitive. So if you have extraordinarily high
viral loads to the point where you might be a super spreader, these simple rapid tests will
essentially always catch you and tell you you're positive. And then as you go down the line,
if you're no longer infectious at all, then these rapid tests might have a 0% sensitivity
compared to PCR. But that's actually a good thing. The FDA and others look at it as though
it's a bad thing because they average it all together and say, oh, this is only a 40% sensitive
test compared to PCR. But that's not the right way to look at it. You want to say, well, out of all
of the samples, how many of them were not transmissible? How many were mid, moderate, high,
extremely high super spreader? And you should at the very least create a weighted average based
on transmissibility potential. We don't do that. And that's why nobody in America has these tests
because that's why they're very rare because we have slowed down their authorization because of
that misunderstanding that they don't have to be 80 or 90% sensitive compared to any time PCR
positivity. They need to be 80 or 90% or more if you're infectious. And for that question,
they're like 95 up to 100% sensitive when you're most infectious. So you have a lot of
viral particles in you. So that's what it means when you say viral load. That means you're going
to be very infectious. The more you have, the more infectious you are. And this test is basically
very good at detecting when you're very infectious. Why don't we have a rapid at home test? So you
said there's a bit of confusion. FDA is involved. You've talked about, you continue to talk about
that these at home tests are classified as, I guess, medical devices.
That's right.
And so because of that FDA is looking at them differently, then they probably should be looked
at. So what's the problem here? Can you sort of explain what does it mean to be a medical device?
Why is that an issue? Where's the FDA messing up? When we declare something as a medical device
and we evaluate as a medical device, then it makes sense that the comparison, if you're trying to get
a new one onto the market, that the comparison would be against a gold standard medical device for
that purpose. So PCR is currently the gold standard, or at least in the eyes of the FDA,
the PCR test is the gold standard medical device. And that's because it's so sensitive.
As a physician, I have one patient in front of me at a time. And that patient comes to me,
and I don't have to care about the 99.999% of people in the world who are not in front of me.
I only care about that one patient. And so when I get a sample from that patient and that patient
saying, doc, you know, I don't feel well, I haven't been feeling well for the last few weeks. Do you
think this is COVID? Well, for that question, I want to have the absolute best sensitivity test,
regardless of what it means for transmissibility, because my patient isn't sitting in my office
saying, doc, do you think I'm infectious? They're saying, doc, do you think I have recently been
or am infected? And these are totally different things. One is medicine. And if the patient's
infected, you know, the time isn't of the essence because they're sitting there in my office. I
can say, look, I'm sorry, you're not feeling well. Let's get a PCR test on you. We'll be able to tell
you if you have any evidence that there has been recently an infection inside of you. And you'll
get the results in a couple of days. And it might be expensive. And so insurance is going to pay for
it. And you're just one person. And so I don't really care how many resources it takes to get
you this answer. On the other hand, there's rapid and there's public health testing and public
health testing is it has to account for all of the people you're not seeing as well as the person
you're testing at the moment. So accessibility becomes a central theme. Frequency of tests,
it has to account for all the days that you're not sitting there in front of your doctor's office
getting a test as well as the one you are. So it has to say how frequently, what if you're
infected tomorrow, but you're at the doctor's office today getting a negative COVID test,
that PCR test at the doctor's office today is going to do nothing to let you know that you get
exposed and infected tomorrow. The only way to know that is to be testing yourself frequently.
So, and the reason it matters is that these tests can be accessible if we are okay with saying
the real purpose of a public health test is to answer the question, am I infectious?
The reason we want to answer that is if you're infectious, that's when you isolate. We actually
don't want to isolate positive PCR, PCR positive individuals who are no longer infectious.
That's bad public health practice. Like, if I haven't been infectious for three weeks,
I don't want to have somebody tell me that I need to go and isolate for 10 days just because I
happened to use a PCR test today, three weeks after I was infectious. And furthermore, I definitely
don't want the public health agency to come and round up all the people I was with last night
and say, you guys have to quarantine for 14 days because you were with Michael who wasn't
infectious yesterday. It's nonsensical to do that. And it's a huge disincentive to actually get tested.
That's exactly right. Huge disincentive to get tested. People, if it's too sensitive,
especially with flights, things like that, we shouldn't be stopping people from taking a flight
if they haven't been infectious for 60 days. And to be clear, people are only infectious for,
I don't know, somewhere between three and seven days, but can be positive on a PCR test for 30 to
70 days. So I mean, it's potentially a tenfold difference in terms of how long your PCR positive
versus how long you're infectious. So we don't want to be taking people during those 30 to 70
days and saying you need to isolate just because you go and get a swab or you can't go
on your trip just because you had COVID last month. That's not good use of a test.
So the reason we don't have these tools right now is because
when we evaluate an antirapid test as a medical device, the FDA says, well, this has to achieve
the properties that we expect from a medical device, which again, doesn't have to take time into
account, doesn't really have to take cost or resources or scalability or access into account.
It only takes sensitivity and specificity to catch molecules. And so just by definition,
I mean, it is a mathematical fact that if you have a perfect public health test for COVID,
which means that it would be 100% sensitive and 100% specific for contagious people
or for the infectious stage of an infection, then it literally can't. It is an impossibility
for that test to achieve an 80% sensitivity at a population level against a medical device,
which is what the FDA asks for. And that's because you're only infectious for maybe 20%.
So theoretically, it should only have a 20% sensitivity against the PCR while still being
a perfect medical, a perfect public health test. And the test is answering the question,
am I infectious? That's what you're testing for, not for the exact counting of the
viron particles in your system. That's exactly right. Okay. So why are we still here?
So have you had conversations with folks? You said that there's a bunch of
leaders that are kind of starting to wake up to this idea. But why is this taking so long?
Why don't we still have hundreds of millions of at-home tests?
The reason it's taking long, I think, is because every agency and government
is generally deferential to the FDA. And in this context, I would argue that government hasn't
been particularly creative. So for example, last year, when Trump was still president,
I would, or in the transition, I recall talking to the White House a number of times and saying,
here's a plan to give us our lives back. I think that was actually the title of the Atlantic
article. And this plan can stop shutdowns. It can stop outbreaks. It can allow society to
keep running and could have prevented the outbreaks of last winter and fall and saved hundreds of
thousands of lives. So when I bring that to the White House or to the government, the federal
government, whoever it might be, and I say, here's a plan. This would work. They say, what I get back
is this sounds really interesting, Michael. It looks like it checks out, but there's one problem.
We don't have the test. There's no scale. And that's kind of where it all dropped. It's like this
defeatist attitude of like, oh, don't have the test. So we can't act on it. But now it's really
changing. Well, and so that's really where things have been. And so nobody's paid attention. It's
always been this like esoteric thing that, yeah, maybe one day we'll get around to it. But really,
it's not that important. And the pandemic's going away. But this was like 100% predictable,
everything that's happening today. We predicted it last year. It's not,
it's isn't like rocket science or anything. The variants and all those kinds of things.
So the FDA, we can start to understand why, but also one question I want to ask,
is it possible to go around the FDA? Yeah. So why has the FDA not changed?
And why has nobody tried to push the FDA to change? Like, I think what the real reason is the FDA
has one job around these tests. And it is to authorize them as medical devices. They haven't
been charged with doing anything else. So in their eyes, they're doing exactly what they're
supposed to do. They're evaluating these tests as medical devices and they're telling company
after company after company, sorry, you don't make the cut. And the only way to make the cut is really
to kind of skew your clinical trials to favor the rapid test being positive, which isn't really
good practice. We shouldn't be trying to skew clinical trials. But that's kind of what's happened.
It's been forced upon the companies to do that. And so I think the FDA truly believes from the
bottom of their heart that they are doing the right thing here. And I would argue that to an
extent they are. I've been pretty hard on the FDA, but maybe the issue is a higher level issue.
Like the Inveacher Diagnostics Division is they get applications and they evaluate them. And the
applications are for medical claims. That's, however, because there's been a misunderstanding
of these tests and the companies only know to apply for these as medical claims because there is no,
there's nothing else in this country to apply for except a medical claim. So we don't have a public
health pathway to evaluate a test and authorize a test. It doesn't exist. We have defunded and
devalued public health for so long that we literally don't have a language for it. We don't
have laws, a language, words. Is it called a public health test? Is it called something else?
I call it a public health test because I'm trying to create a new definition here.
But that's why nobody's acted because everyone says, well, there's no other pathway. So the FDA
Invitro Medical Diagnostics Division is the only pathway. So what I am trying to do
is to say, look, the FDA very clearly states that they do not authorize or review public health
tools and they don't authorize or review public health tests for COVID. So what I want the president
of the United States to do is to utilize executive powers and take an executive action that can
simply state one line. One line could potentially change all of this. And it's a pretty obvious
and simple line. And it is that any tools used for public health testing during this public
health emergency will be designated as public health tools. It's obvious. It's public health
emergency. It's a tool used for public health that should be designated as a public health tool.
If we can do that, if we can get that language out there so that that's the president's decision,
then all of a sudden the FDA is off the hook. They're not trying to cram a square peg through a
round hole. They can say, look, the antigen tests are not on us anymore, at least if they're going
to be used for public health, like when you test a thousand people at a time or test a school
classroom if they've been exposed, this is public health. And so then the CDC could take it over.
The CDC could say, okay, what are the metrics we are interested in? And they could say,
we're interested in a test that can catch you if you're infectious. So you want high viral
load detection. That's fast. That's scalable. And hey, if your test has been used in Europe for
months and has performed extremely well, then we'll give you a certificate by right immediately.
And that could actually get hundreds of millions of additional tests into the United States tomorrow.
So you need some kind of classification from an FDA or from somebody to call it a public
health tool in order for it to be manufactured? Is it possible to just go around all of this
and just for somebody to manufacture at scale tests? Well, if you did that and you just called
them, you put a claim on them that called them public health tools, the FDA has a very
weird view of this. And they will tell you that it's illegal, that it's a crime.
Is there a way to say like Elon Musk did with the flamethrower? It's not a flamethrower.
Believe me, I've tried to think of all the different approaches.
You know, there's weird, there's like, there's major inconsistencies here. So it's not like
we don't have a precedent for a public health test even during this pandemic.
There is a very strong precedent pooled testing. We have companies like Ginkgo,
right, based out here in Cambridge, that are, you know, working with 100 different labs around
the country. So that might mean like not a ton of quality control over those labs
doing. I mean, I don't want to say that they don't. I'm just saying the reality is if you're
working with that many labs, it's hard to say. They're running pooled testing of millions and
millions and millions of kids. So here you have a company that's testing in each pool five to
25 kids at a time, millions of kids in a pretty distributed way across the country in all these
different labs. And the FDA doesn't care at all. You don't need an EUA. It doesn't need a regulatory
authority. It's collection on site. It's getting shipped to a lab. There's no oversight of it.
So why does that have no oversight but a rapid test for the exact same purpose?
You're just giving people immediate results instead of two-day delayed pooled PCR results.
So it's a much more effective tool. Why is the rapid test used for the same purpose,
not designated as a public health tool, but requiring FDA authorization? It's a ridiculous
reason. And it's because the FDA says that if a test, and this is actually CMS that says this
in the FDA adopts it, if a test alters your behavior, if you get a single result and it's
going to alter your behavior, then that is a medical device. But the thing that I find
ridiculous is like, okay, but you can give a pooled test that alters 25 people's behavior at once.
And that's not falling like that's more risky. One person turns positive in the pool and 25
people have to be quarantined. And how do they evaluate the accuracy? So for people who don't
know a pooled test is you're testing a small fraction of the people. And if one of them is
positive, then you basically say, we have to retest everybody in the pool. Yeah. So you take,
let's say you have a school and each classroom, you might have 20 kids each swab their nose in a
classroom. And all those swabs go into a single tube. And then you rinse that tube out with some
saline and you run a PCR test on that tube of 25 samples or 20 samples. And so if that tube turns
positive in the PCR test, then all 20 or 25 of those students are now having to quarantine.
And if there's no positive, then all 20 or 25 students are interpreting that their result
is negative. So it really is ridiculous decision by the FDA to say that if the test itself only
tests one sample at a time, it's medicine because it will tell you one person at a time if you're
positive or if you're negative. But if you do it as a pool and you tell 25 people that your pool
was negative, then that's somehow different. That's public health, not medicine. It doesn't make,
there's no logic there. Was it just personalities and accidents of history or something like that?
For example, you talk about the public health tools and CDC, you look at masks. So masks were
decided to somehow be an effective tool to help with the pandemic. So I'm sure the evidence that
was used there was probably not as strong as the evidence supporting antigen rapid tests.
I was very much reading a lot of research on masks. It's tricky. It's really tricky to show how well
they stopped the transmission of a virus, especially when you don't fully understand how
the virus is transmitted or the viral load required, all that kind of stuff. But then the CDC pretty
quickly decided masks or whatever, there's some oscillations back and forth, but then they quickly
decided all everybody decided masks is a good tool. So masks being decided a good tool and then
rapid antigen tests, not a good tool. Is that just like certain personalities who didn't speak up in
a meeting or who did speak up in a meeting? Is it just like a weird roll of the dice or is there
better explanation? I think it's somewhat of a roll of the dice, but I also think it's that testing.
So doctors don't pretend to really understand much about fluid dynamics and how well masks
are working. That's way out of their realm. Doctors do believe that they understand all
aspects of the tests. And so the greatest barriers to rapid tests being brought to market or being
rolled out heavily and supported as public health tools, the greatest barriers came from physicians
saying, hell no, we can't use a test that's not as sensitive as a PCR. And look at what happens
if you use this antigen test and not a PCR test, you get people who are showing a positive on a
PCR negative on an antigen. And they just assume that that was a false negative on the antigen.
For public health, I would call it a false positive on the PCR test. But this type of thinking
literally does not exist in medicine. And I think the biggest problem here is that we
placed physicians in decision-making power. We have, when this pandemic hit, everyone called up
clinical laboratory folks and microbiologists and physicians to ask, well, what kind of test
should we use, that kind of thing. And there is no training in medical school for this kind of
public health work. You have to optimize on the right qualities of a test that have nothing to do
with medicine. And then sometimes, if not frequently, they're actually at odds. And I'll give an example
why the physicians, you could see why the physicians would have been against it from their
perspective. And they say, if a physician is a TSA agent at the airport, a TSA agent, their role
at any given time and the role they think that the instruments need to play is,
I want you to scan the bag as well as possible. This is the only bag that I'm interested in at
the moment. And this is my lane. This is my bag. I want to make sure that my instrument's doing.
I don't want the crappy instrument in my lane. I want to make sure that I'm doing everything I can.
But what those TSA agents don't have to worry about is, well, how many other instruments are
there in this airport? Is anyone getting through the lines here without going through security?
The average TSA agent doesn't have to worry about that. They literally have one job to do.
And it's pay attention to this lane. If there's a big gap in the security line and people are
flowing through without going through security, that's not on the TSA agent. That's on a big
systematic problem of the system. And we can't expect that TSA agent to have ever even thought
about that. That's not on them. They were trained to look at the bag. And that's like physicians.
And probably some physicians will hear this and feel like I'm insulting it. I don't mean to be
likening the two professions or anything like that. But the point is that a physician has one
duty, do no harm to this patient. Time isn't of the essence. Scale, how many tests can my hospital
perform in a day? How many tests can my county or country perform in a day? That's not a physician's
training to think like that at all. And so what has happened is doctors got on board early and said,
oh, hell no. We've seen these antigen tests before. They're not particularly sensitive compared to
PCR. And early in the pandemic, there was like pissing matches between labs who had the most
sensitive PCR. And it just distracted everything. I was trying to say pretty early, we don't need
sensitivity. We just need frequency. We just need scale. We need to think differently because our
only goal if we're doing frequent routine testing of asymptomatic people is not medicine. It's to
say, do you need to isolate now? And if you have a PCR test that's taking three days to return,
and you're like, if I was currently spreading virus before I walked in here and you handed me,
this actually happened to me today when I walked into Harvard. Today was my first day back into
Harvard since February of 2020. I go in, I scan my badge and they hand me a PCR tube and they say,
like, return this by noon or something before your workday is done. And I'm looking at it, I'm like,
what is this going to do? Like, what if I'm super spreader right now? You're giving me free reign
to walk around and infect everyone in the school. And you're going to give me my result to tell me
I did that in two days from now. It doesn't really make sense. So who is supposed to be... So it's
understandable that doctors kind of feel that way, just like you said, do no harm. Who is supposed to
care about public health? Is it the FDA? Is there some other organization yet to be created? Is it
like, just like with the military, the reason we have civilian leadership when you talk about war,
is it the president that's supposed to do like override FDA override doctors override
and basically politicians in representing the people in the state of emergency make big public
health decisions? Like, who is supposed to do it besides you on Twitter? It's like, most people
really thinking about solutions to COVID will mention you or will mention this idea of rapid
at home testing. And it's, it's, you watch that happening, this discussion that this is an obvious
part of the solution and the solution is not happening. So who is supposed to implement this
idea? I think the CDC that it should start there override the FDA. Well, I don't even think it needs
to override it. And that's why I think these should just be designated as a different tool.
So that the company is, it's not overriding. It's just saying, look, this isn't even,
this isn't in your jurisdiction to the FDA. This is just a public health tool. But the problem is
the Centers for Medicaid Medicare Services designates any tool just like FDA. They designate
these as medical devices purely because they could change somebody's behavior based on the
result of one test. So to change that at this point, unless you can get CMS buy-in, you know,
we don't have, there is no designation as a public health tool. But the president can just say,
these are public health tools. These are not to be regulated as medical devices if their goal is
not medicine but public health. And if he does it, he does have the authority to do that as president
and to say, I'm asking the CDC to certify these tests or authorize them for use in the United
States. And, you know, he has to say something like that. He can't come out and say, these are
public health tools have free reign. Just, you know, any companies start shipping them in the
US because that would create pandemonia and we'd have a lot of bad tests. But there's a lot of
really good tests out there. We just are taking like six to 12 months to run trials. They're
failing because they can't keep up with PCR. And if the president were to do this, then the CDC
could take it over and they could say, okay, it's on us. We're going to decide the UK actually did
this. Early on, they said, okay, they laid out a very clear regimen. They said, this is how we are
going to evaluate rapid antigen tests because they're public health tools. They did it in a domain
that was outside of their normal medical diagnostic regulatory agencies. And they literally just had
very fast screening to say, what are the best tests? They went through a huge number of different
tests and they said, okay, this is the rank order of which tests are good, which are bad, which are
scalable, which are not. And they were able to start deploying them in weeks, not years. So,
I think the CDC really needs to take charge. The problem is when it comes to like law,
if everyone currently perceives this as like fully within the domain of the FDA and they've never
heard of such a public health test idea enabling, but the FDA itself has created the idea by saying
we don't regulate public health tools. So, the word is out there. The FDA has said, we don't
regulate them. So, that gives the president an opportunity to say, okay, these are those. These
are public health tools by definition. And I do think that this is kind of a crisis and it's
a crisis of testing, but it's also a crisis of like, really, we're going to go through this whole
pandemic and never figure this thing out. That's just really sad. And if we get through this and
don't figure out how to evaluate a damn rapid test. So, how do vaccines play with this? So,
one of the things that when people discuss solutions to COVID, there's a sense that
once you have a vaccine, COVID is solved. So, how does that interplay? Why do we still need tests
if we have vaccines? Yeah, I actually wrote an op-ed in New York Times or Wall Street Journal
or something that was titled, Why We Still Need Rapid Test With Vaccines. And the real reason
is because we have evaluated our vaccines based on their ability to stop disease. In fact, most
of the trials didn't evaluate them based on their ability to stop transmission. They didn't even
evaluate that at all, no less put it as one of the metrics for authorization. And with a virus
like this, it would be a bit naive to think that it's really going to stop transmission well.
I think a lot of excitement happened right after the first clinical trials, and I'm sure we were
talking about it when I was last here, I would imagine, given the timing. But those first clinical
trials came out and everyone jumped for joy that these things were going to be the end to this
pandemic. But we had really short-sighted vision there by not recognizing two main features. One is
that they might not stop transmission. Another, I guess three, another is that new variants might
come around that will break through the vaccine protective immunity. And the third is that we
were measuring the efficacy of these vaccines during the peak of their performance in the first
few months after people got vaccinated. And that gives a skewed view of just how effective these
are going to be long-term. So what happened with the vaccines is that everyone got very comfortable
this including the CDC saying, if you've been vaccinated, this is the end of the pandemic for
you. And let's keep it up. But then Delta comes along and waning immunity comes along. And both
of these things compound exactly as anticipated to get breakthrough cases. And unfortunately,
what we're seeing now is the CDC and the administration went so all in on saying that
breakthrough cases are rare, that transmission doesn't really happen if you're vaccinated
without great data, especially with Delta, that once people started seeing breakthrough cases,
they started interpreting that as a failure of the vaccine. The vaccines are still working to
keep people out of the hospital for the most part. But they're not working to stop transmission. And
if our goal is to stop transmission, which until we decide as a society that we have different
goals, like we're okay with people getting ill and letting transmission go because we don't
want to worry about it anymore, we're not there yet. So until we decide we're not going to stop
transmission, we need other avenues besides the vaccine because it's not doing it. It also means
that herd immunity isn't going to happen. And unfortunately, as long as we keep letting spread
happen in the context of vaccinated people, we're kind of giving this virus a boot camp
of exactly what it needs to do and mutate to get around our vaccine-derived antibodies.
And that makes me very nervous. So the more we can do to stop spread in the unvaccinated,
in the elderly vaccinated, and in other people, the better. We just should be focusing on that.
So in your eyes, the solution would look like this. You would make enough tests where every
single person will get tested every single day? I think that that would be... I don't want to do
that, actually. I want to do a variation on that. I think what we should do is have a dynamical
testing program. It doesn't have to be complicated. Every household has a box of tests and they're
covered. And if you haven't seen any cases in your community for a long time, stop testing.
Do wastewater testing to see if there's any RNA coming back. If you start to see RNA in the
wastewater that represents the virus and you're still wanting to stop outbreaks, you say, hey,
you know those tests that are in your cupboards, households in this county,
what is in each household or each person in each household? Use one test per week.
And... Can you just pause on that idea? That's really cool, the wastewater testing. That's the
thing. So you can get a sense of how prevalent the virus is in a particular community by testing
the wastewater. That's exactly right. And so the viral load associated, the viral load that you
can find in the community represents the prevalence of the virus in the community, which is really
quite nice. That's a nice way to paint like a map of the intensity of the virus. Okay, so when it
when it goes above a certain level, you can start doing much higher frequency testing
per household in each household. That's right. So I don't want people to be in testing purgatory.
Like that's not what I want. I just want us to get through this pandemic. And so we can monitor
the wastewater or any other methods. We can monitor the hospitals and the clinics. And
if somebody does come in with COVID-like symptoms and then a few other people come in, you realize,
okay, we got spread happening in our community. Send out a text message, put it on the news,
put in the newspaper, whatever you need to do, tell people, tell families, use your test. And if
the cases get worse, because you're just doing it once a week, that's not going to stop transmission,
but it's going to enable you to identify where outbreaks are happening. If you start to find
outbreaks in pockets, then the rule is simply, okay, let's squash the outbreak real fast. So
everyone in that area and certain zip code or whatever it might be, test every two days,
you know, for seven days, or every day for seven days, and you'll get rid of the outbreak. We can
do that. And if you've now gone again, you know, a week or two with no cases identified, stopped
testing again. That's the nice thing that everything changes when people have the test in their home.
It becomes dynamic. It can become easy. You send a text message, take your test today.
If some people don't do it, that's fine. The only goal is to get R below one and you stop the outbreak.
People think it has to be near perfect. I always hear people say,
oh, what if somebody doesn't use it? Or what if somebody lies? Like, well, you have 98% of people
testing or even 50%, that's a whole lot better. And, you know, another big difference that people,
I think, oftentimes have a problem wrapping their head around, especially to an extent,
and physicians who are used to really, like who are used to different kinds of metrics is that
all we have to do to completely stop an outbreak from spreading in a community is to get, for every
hundred infected people, to get them to go on an infect 95. Most people would say, oh my God,
that's a horrible, you know, that's a horrible program. You're still letting 100 people go and
infect 95 people. But for a virus like this, that's a massive public health win. If you can get 100
people to infect 90, most people, doctors, I would say, like a lot of people would say that
sounds like a failure, to be honest. But if you do that for multiple days in a row, then in a
couple of weeks, you've gone from a big outbreak to a very, very small outbreak. And on the other
hand, if you don't do that, if you allow 100 people to just infect 140 people, because you're
not doing the testing, then instead of having 20 people at the end of those four weeks with the
testing, you literally would have 600. There's massive differences here. And all the only goal
then is to get R below one, have 100 people infect less than 100, and you stop the outbreaks and
everyone stays safe. From everything you've seen, how cheap can these things get from like in the
past year, in terms of the developments you've seen with the various test manufacturers, how
cheap can it be to make a test, to manufacture a test?
So there's the manufacturing process. That could be 50 cents, maybe less. It's hard to get,
it's hard to really have eyeballs inside these companies in terms of where they're producing
them in China and Taiwan, a number of other places. Some of them are produced here in the
United States too, but 50 cents, say, is a very, very reasonable, generous number for how much it
costs per test. You look at a place with high market competition that has actually authorized
a lot of these tests, like Germany. Germany has 60, 70, some different companies of high quality
rapid tests authorized. You can go there and buy it for 80 cents. That's, and they're still making
profit. So it's extremely cheap. Market competition can drive these tests way down in terms of cost.
I think one of the most important features of a rapid test program is what do you do with the
result? Is it going to be used for you to gain entry to school or work? Is it going to be reported
to the public health agencies? All of these, the primary mode should be just get people test,
but really if you're going to be using it for a workplace thing, like what Biden is now saying,
vaccinator test, which is going to lead to a crisis if we don't fix this soon because we're
going to massive demand for testing in the next couple of weeks. But when he says that, that's
essentially saying, okay, companies need to make sure that their people are testing. So are you
going to base it on the honor system? I would say you probably would not base testing on the honor
system if it's like to take somebody who would otherwise be quarantined from in school. And so
you can go to school as long as your test is negative. So test to stay program is a big thing
that I've been pushing for and others have. Business is bringing people into work who need
to test. They need to have verification, but they don't want to like set up nursing stations in their
lobbies or in the school parking lot or whatever. Like everyone's tired of that. We need to bring
the test into the home, but that means we need the technology to enable it. And so I was at a
conference recently, do you know Mike Milken? Milken Institute. He's a very wealthy,
very wealthy billionaire, but he's done a lot of philanthropy and he hosts a conference to raise
money for prostate cancer research. I was at this conference recently, Francis Collins and
a number of other people were there. And every morning, we all had to test in the morning,
which I thought was a great idea obviously before we walked into that conference. But you didn't
have to test there. And they didn't base it on the honor system. Every morning, I scanned a QR
code on the box and eMed, which is a service that provides test verification popped up with a proctor
right on my phone or on my computer and said, okay, let's go through your tests. And they watch you,
the videotape you're using the test. So it's all recorded. It's all a reportable type of test.
And at the end of it, just from your home, you don't actually see the proctor, but they're just
verifying that you actually do it. They verify the test, they verify the test result with you.
And at the end of it, you've then gotten from your couch or from your car, wherever you are,
an actual verified laboratory report that can be considered proof that you yourself use the test
and you yourself got a negative. So the tools are out here, if we want to use them at scale. And
in fact, the CDC uses eMed now to enable people to come back into the United States through an
antigen test. So before you get on your flight, you're sitting in the airport in Heathrow or
wherever you are, you can get on your computer, use your eMed test, and you get the negative and
that and CDC will accept that TSA will accept you to come back into the US with a rapid antigen
test that you did without anyone else watching, except for this proctor on your phone. Super simple.
Well, how much private information is being collected? So like this, you know, people have
in the United States, the American way they have a hesitancy on the overreach of government
in things like vaccine passports, like using any mechanism, any mechanism of verification
that's controlled by government can lead to overreach by said government. So there's a concern
of that. Do you see there a way of achieving testing that's verified but does not violate
people's privacy or sense of freedom? Absolutely. I think so. The way that right now in the United
States, they're requesting that these tests get that the results get delivered to public health
agencies. But I've long held that while that's ideal, it should never be the thing that holds up
somebody being allowed to know their own status. But if you are going to work and you have to let
your boss or your manager, whomever know that you were negative that day, or if you're going to
school, I think it's going to be hard to maintain complete privacy in that situation because they
need to know your name. But sure, I mean, could you cut off the public health reporting? Yes,
you could. But I worry, I mean, can you opt out? Maybe you could opt out. That should be a feature.
I want to opt out of the public health reporting because for whatever reason, otherwise, I'm not
going to do the test. But that means that, okay, then you're not going to go to work. So right now,
there's this serious tension. And I am very uncomfortable with the idea that we force anyone
to do anything. But there is a tension between these two things for sure. And how do you balance
that during a public health emergency? I think first and foremost, let people, everyone has
a right to know their status. The fact that we have made it hard for people to know their status
on their terms, I think is a travesty. I mean, it's just so terrible that we have
prioritized us knowing at the expense of you know, essentially what public health has long
said during this pandemic is if I'm public health, if I can't know, then you can't know your status.
Like that's not the right way to look at public health. We need to engage the public. And if
some of them don't want to participate in the public health part, but want to know their status,
by default, they are participating in public health, whether they know it or not, because
they're not going to go get their mom sick by mistake. At least most people wouldn't.
And then also you can create systems where you can individuals can form relationships
based on their status without ever reporting it to a centralized place. So you can go to,
I don't know, a local business owner might require that you show that you are negative,
but that doesn't require reporting it. You can, like there might be basically like an ID
that's only in possession. You are in the only person in possession of that. So you literally
show it. Here's a test I took, it's negative. And nobody else knows about that test.
So that could very well be done, even through a company like IMED. I think, and I might be wrong
here, I believe that they take the test result and because they are considered a CLIA-waved
laboratory, like a digital laboratory, they report their results by law out to the public
health agencies. But let's say there was something a little different. Let's say you were verifying
an over-the-counter test and it doesn't have to be a CLIA-waved because it's over-the-counter,
then you're not bound by CLIA rules and you could create the same service, but that just doesn't
report out to the public health agencies. It gives people the option to opt in or out of
public health reporting. And I know that public health people get a little queasy when I talk about
this, but as a public health person myself, like, yes, of course I would prefer that the data be
available to evaluate to know where the cases are. But first and foremost, I want to make sure that
the people using the test are going to use the test. And if that means that they're not reporting
and that's the only way that they will use it is if it's not reported, then that's better than no
test. Especially given that the central to the vaccine hesitancy is a distrust of authority
and the distrust of government. So you're asking people to get tested and report their
status to a centralized authority when they clearly do not trust that authority. It doesn't
make any sense. It seems like a perfect solution to let people who are hesitant on the vaccine
to get their own status and have full control of that information and opt in, provide that
information if they wish to, but they have the full control of it and have the freedom to do
that information what they want. I fully agree with that. I really do. I think we can have the
verified services and we could have the privacy if you want it. If you need to go into a restaurant
and there's a rule that you have to be a negative test, have it on your phone and only your phone.
And it's okay. Like email emails you the lab report. You have it. You can say, look, that's my name.
I use it this morning. Negative. And in that case, you'd want something that just is there and is not
going anywhere else. And I think that those services, I think they can exist. And it's a struggle
because for those companies, they don't want to fall out of favor with the CDC or with the FDA.
And so this is a big problem in our marketplace in general by having private companies who want to
be the public health agents of this pandemic. We lose a lot of control because the companies
ultimately have to do what's going to make them money so they survive and keep performing the
service. It's really just such a hard problem. And this is why last time I was here, I'm guessing
I was probably really pushing for the government to be producing these tests.
I think I would have still been pushing for that. You know, at this point, I've
decided, okay, the government's clearly not going to do that. I've been thinking I really
want Elon Musk to produce the tests. I really am sort of serious that these tests are simple to
make, but we've been using machines to make them that have been around for a long time.
Scale is an issue right now, kind of. Really, it's the EUA process and getting the companies to be
allowed to market in the US. That's the issue. But let's just say scale is the issue. And one
company wants to make 20 million tests a day. These aren't that hard. We should be able to do
that. We just need a faster machine, a better machine and a quicker one. And there's a few
folks, like you mentioned, know how to solve that problem. I've had a lot of discussion with Tesla
folks and know with people that used to work at Tesla, like Jim Keller, about how to make stuff
much cheaper, much better. That's basically what Tesla is world class at. And it's like, okay,
does this thing have to cost $1,000? No, it can cost $10. And let's figure out how to manufacture
it. Those folks are the best in the world at doing that. Okay, but what about this Biden action
plan? So it sounds like the guy agrees with you, vaccinate or test. So I think given that choice,
a lot of people go with test in America because there's like a division it seems like. So what is
this just politics? Is this just words or do you think this is actually going to lead to something?
And maybe can you explain what the action plan is? So there's a number of pillars to the action plan.
The two that I've been most focused on, I mean, some of them are, we want to get everyone vaccinated,
all these things. And one pillar is saying any company in the United States that has
more than 100 employees is now required to ensure that any unvaccinated individuals in their workforce
test weekly. Another pillar is that the president's going to reduce the cost of PCR tests
by 35%, which is pretty moderate reduction, and is going to reduce the cost of antigen tests
and scale them up and make 280 million tests and put $2 billion into it. So those are the two that I
found most intriguing for the kind of mission that I've been on, which is to just educate people
around, hey, we have really, really powerful public health tools we have yet to deploy.
The issue at hand, though, is that now that the president has said vaccinate or test,
there's a problem inherent in that. It's essentially to coerce people around vaccinated
to get vaccinated because vaccinator test doesn't make sense when the vaccinated people
can transmit the virus just fine. It should be vaccinate and test. Exactly. The problem that
I have with that vaccinate or test idea is it's great if you want to use it as a coercive effort
to get people vaccinated. I'm not going to wade into that argument. Do I agree with it or not?
I'm just not going to even put my words under. I disagree with it. Let me say,
that I disagree as opposed to doing great science communication, this weird people talking down
to the populace as if they're children trying to trick them. Here, have some candy. Everyone
with common sense. Somebody told me I was having a conversation. If the government is going to
give you money to take the vaccine, people that were already hesitant about the vaccine
are not going to trust whatever the heck you're doing. Don't trick people into taking the vaccine.
Be honest and communicate transparently everything that's known about the vaccine.
Communicate the data. Inspire people with transparency and real communication of
all the uncertainty around it and all the difficult decisions of risk and all those
kinds of things as opposed to trying to trick them like children into taking the vaccine anyway.
Yes. Okay. Well, I didn't have to say that. There we go.
But you're saying it should not be like vaccinate or test. That tradeoff doesn't make sense.
Exactly. By saying vaccinate or test is absolutely confusing because it implies,
for anyone who's thinking about it, it is implying. I've seen this because I have
business leaders call me Fortune 500 business leaders who call me and say,
what do I do? I have 8,000 employees. Where am I going to get my tests?
A lot of people are saying they're calling this a pandemic of the unvaccinated.
These types of divisive, this divisive language doesn't help. This isn't a pandemic of the
unvaccinated. This is a pandemic of a fucking virus. Don't ever put it on the unvaccinated
who frankly are just scared. They don't know who to trust. We haven't given them a lot of reason
to trust public health to be frank. I agree. Now that you've opened the door, I'll just say my
piece. Absolutely. We need to be the most honest we can with all of this. This is confusing language
to say vaccinate or test. We need to be very upfront and say, look, vaccines aren't stopping
transmission very well. Unfortunately, this is the world we have. We have Delta. We're going to
have new mutants. We have a vaccine that wanes somewhat over time. This is biology. I'm sorry.
This is just what it is. Then we say, but the vaccines are really protective for your personal
health. They're going to keep you out of the hospital. This is what you should care about
as an individual. As a population, we need to figure out, okay, we have to stop transmission
if that's our goal. We should use the tools that are going to stop transmission if that's our goal
and saying vaccinate or test. If our goal is to actually stop transmission, that's confusing because
vaccines are not stopping it. There may be mildly lowering the risk of transmission.
I'm just not a fan of that language. I think we should be being very, very clear, like you said,
and upfront about what are the limitations of the vaccine and of the test. We should
be very clear that it can only help. The American public in aggregate is extremely intelligent.
They will figure out when you say that vaccine breakthrough cases are rare, and then they start
seeing story after story of whole parties of people who are vaccinated have outbreaks and
everyone knows more people now who are having breakthrough cases than they knew who had
regular cases before the vaccine. People start to wonder, hmm, well, this is weird. They say that
the vaccines are working and breakthrough cases are rare. Maybe the whole vaccine program is
failing entirely, and so it ends up shooting ourselves in the foot if we try to create false
expectations because we think it's going to be beneficial for one thing when it's not for the
other. To get back to the action plan, vaccinate or test, I think, and the increase in rapid tests,
I do think it was a bold move. I would say that it was the most prominent display,
encouraging display of the fact that rapid tests are indeed effective public health tools.
My real concern now with is that 280 million tests, that's like less than one per person per
year in the United States. That's not the way that he said and delivered it. What most people
think of, when they hear the word 280 million, you don't usually put a lot of thought into what
does that number mean. It sounds a big number. Most people are now going to be expecting that
these tests are actually going to be staying in stock on the shelves at CVS and Walgreens and
Amazon or whatever. That's crisis number one. It's like, now the expectation is set for having
rapid tests, but they're not going to scale that well. We won't have them. Then there's vaccinate
or test. That's going to bring millions and millions of people who are not currently testing
to have to start testing. That's going to overwhelm our PCR labs. It's going to create
five-day delays again with PCR, if not longer, because we'll have backlogs. The only real solution
to this is to just scale up the tests that are actually scalable. That's the simple rapid test.
It's not even to scale them up through production and manufacturing here. It's to open the doors so
that the companies that already exist here and can scale are allowed to do it and to bring in
the international market. Some of the biggest diagnostic companies in the world are not selling
their millions and millions and billions of tests in the United States because they don't want to
play the game that the FDA is currently requiring of them. We have an opportunity. I am very
encouraged that the president actually did put these into the action plan. I do want to say for
the record that I'm supportive of it in principle, but I think now we actually are in a time where
has been set and we have to deal with the crisis before it happens. Otherwise, there could be some
real political points taken off. I do worry that the president, if he doesn't pull through with this
and really make the tests available and we end up getting into this other test crisis this fall,
there could be political consequences to that. The reason is these rapid tests are so personal.
They become emotional almost. They give people that empowerment that I was talking about earlier,
and when people can't get that because the shelves are out of stock, they actually feel
frustrated and then that converts into anger and blame. I do think that we have to be really smart
about making a policy like this and then ensuring that we can carry through with what the average
American is actually expecting. Speaking of politics, one of the great things about testing,
maybe you can correct me, but for my sense, it's one of the only solutions to COVID that has not
yet been politicized. Masks and vaccines, whether you like it or not, have been heavily politicized
where there's literally a red-blue split on the use of those or like proud use, effective use
of those tools. It seems like everybody I talked to about testing, everybody's on board, red or
blue. They are, which is why I am particularly concerned about the vaccinate or test policy
because all of a sudden, we just politicized it. We just brought it with this thing that was fully
bipartisan, really bipartisan. I've talked to the really right side of Congress and the
super liberal side of Congress, the Senate, the same politicians, governors everywhere in this
country have asked me for support around these rapid tests because you can have it reported
or not. You can have it in the home, in the privacy of your own home or not or you do it at
school. These tools are just so powerful to identify infectious people. They didn't have to be
politicized. They still don't. I don't think that the action plan went so far that it's going to
politicize them, but I do think already it's starting to conjure up emotion saying, well,
now I have to get tested. That is where we go wrong. I have to get tested or vaccinated, screw
that. I am independent, whatever. I do worry that this thing that was purely bipartisan,
that we could have just scaled up months ago, people would have, we could have delivered it
to every household, didn't even have to ask people to request it, just delivered packages
to every home in America by now easily. If we were smart about it, we could have done it.
The most unpleasant thing about COVID is the uncertainty and that's what leads to fear on
both the vaccine hesitant. It's the uncertainty about the vaccine and people who have taken
the vaccine, the uncertainty around like, am I in danger walking around? Can I go,
can I walk down the hall like this fear of the world around you? I think testing allows you
to remove a lot of that uncertainty. You gain back confidence that you can operate in this world
and not get infected. You become like a nicer person. I find myself every time I get tested,
I become a nicer person to others because I know I'm not putting people in danger.
It's a heavy burden to carry to worry. Am I infectious? I was out last night,
but I do want to go see my mom today. Am I infectious? I don't know. This has created
massive anxiety. I completely agree that it's a relieving feeling and it's an amazing feeling to
be in a room. I did this in the middle of the pandemic when everyone was supposed to be wearing
a mask indoors at everyone rapid test. I said, everyone should rapid test before you walk into
this room. It was a wonderful experiment because everyone was just so relaxed. The alternative
is nobody tests and everyone wears a mask. You have a mask that maybe gives you 20%
maybe protection if you're all in the same room together. Or you have a rapid test program
where everyone rapid tests before and that gives you 95% to 100% protection, not 100% but close.
All of a sudden, that allows everyone to take a big sigh and be like, wow, this is the first time
I've seen people without masks indoors in a long time and I feel pretty good. Restaurants are
scary right now because you just don't know who might be infectious and nobody's masked.
Wouldn't it be great to just go into a restaurant where you know that everyone just tested negative
that day? It just really reduces anxiety. It makes individuals feel empowered. At the end of the day,
COVID and our response to COVID is truly an information problem. Why do we quarantine anyone?
Why did we ever close anything down? We didn't close things down because everyone is positive.
We closed things down because we didn't know if anyone was positive. We quarantine a whole
classroom of kids not because they're all positive but because we don't know if one of them are
positive and so we just quarantine everyone when there's a positive in the case in the in the
classroom like one day. We'll then ask the whole classroom not to come to school for 10 days.
That's not a biological problem. That's an information problem and the crazy thing is we
have the tool to solve that information problem. It's literally our eyes on the virus. It's how
we see this virus and if everyone glowed green when they were infectious, we would have never
had to close down anyone, any society and we would have never had the outbreaks because
we would have been able to stay away from the green people. I like what you said,
the quarantine is an information problem. That's absolutely right. What is there something you
can say to what people can do like listening to this individuals? Do you just complain like loudly?
Like why can't we do this? Can you speak with your money somehow? What can people do to help?
God, it's amazing to think you're asking me this question and this video will go out to the
web and all the people that watch you. Last year in July, maybe something like that June,
I forget exactly when it was, I was on TWIV this week in virology.
Shout out to TWIV. Those guys are awesome. They are awesome. I love TWIV and they asked
me the exact same question towards the end. I said, this makes so much sense. Why wouldn't
we do this? What can people do? He said, just send me an email. Write to me. I'm sure you
could find my email somewhere online and get in touch and I will, and we can try to figure out how
to make something happen. Bad idea. Very smart. Way too many emails. I feel bad because I didn't
end up getting back to anyone because I just got inundated. But it did lead to the development
of rapidtest.org where we did automate the process of writing letters to congressional members and
elected representatives. That helps. Fast forward to today. What can people do?
I honestly don't know. What can the average person at this point do? We have tried everything.
The FDA is immutable on this. They will not change and we shouldn't ask them to change because they
have decided that this is how they regulate medical devices and they're going to stick to it.
But what we need to do, and maybe this is something to do, is get, if you know people
who have sway over politicians, lobbyists, whatever it might be, let people know to request
that the president, literally the president of the United States,
uses executive powers to just do something as simple as designating these powerful public
health tools as public health tools. Allow the CDC and the NIH or whomever it must be or academic
centers of excellence designated by the CDC to evaluate the tests in a very fast fashion
with the appropriate metrics that these tests need to achieve for public health.
And within two days, we can have 10 new tests authorized. This doesn't have to be a six to
12 month endeavor. This could be a two-day endeavor. We actually did it. I judged the rapid test X
price and it went great. We actually got incredible metrics about how well does each test work
and no clinical trials, just a couple days worth of work in the lab and boom. And if we
actually systematized it, it would be an hour or so in the lab. So simple. So I don't know. I mean,
I don't know how to really impact change. Thankfully, I have a platform and I've been able to start
talking with people who are very close to the president and the White House. And I do think
that some change is finally happening because the silver bullet of the vaccine has not panned out to
be the silver bullet. So now I think we're moving from a country that was a vaccine only approach
to finally recognizing at the highest levels that there's other tools. Do you think it's
possible to reopen fully without solving the testing problem completely? Like,
do you think this vaccine approach will get us to reopen fully? I do. Yeah. I think over time,
though. I mean, if we, a lot of people ask me like, what's, what's like happening? Like,
what's the end game here? Like, where does this end? And it's actually not a mystery. The end game
is we will grow out of this virus. And by that, I mean you and I and most people who are watching
this are adults, right? Adults don't like to get infected with a virus for the very first time as
adults. Babies are okay with it. And so what we have to do to understand how we're getting out of
this virus is to look at babies, like at newborns and say, okay, how does a baby get out of their
high risk time period? They get exposed. They get exposed multiple times or vaccinated, of course.
And eventually, they get exposed enough that they build up this nice cushion of immunity
that's sufficiently diverse that they can battle whatever gets thrown at them because they've seen
it already. But one exposure doesn't do it. I mean, over the course of the first few years of life,
kids get exposed to coronavirus tons of times, lots of different viruses they get. So unfortunately,
what's happening with us, why this is so bad for us is that as we're adults, we don't regenerate tissue
very well. We have like overabundant inflammatory response. We have all these problems that when
we get an infection for the first time, it sucks. It harms us. It causes us problems. But over time,
just like a baby, we're going to start building up our immunity through vaccines and exposures.
I hate to say it, but tons of people are getting exposed to Delta right now who don't know it,
tons. And if you're vaccinated, you don't know it is my point there. And at the end of the day,
this is actually, I do not want this to be misconstrued as like saying, go get infected.
But the fact that people are getting infected will add to our level of protection later on.
And so-
Yeah, but the question is how long that whole process takes.
I think my guess is probably by the end of next year, early 2023, we will probably start
looking at this as though it is not a particularly dangerous virus for most people.
The elderly though, it will still be, but that's because their immunity-
Variants and stuff.
Well, that's the- I've heard other people say this statement, you just said a year ago about this
spring, right?
Well, that probably was not wise.
Well, I mean, it's because the intuition is like, okay, now that there's a vaccine,
you're either going to take the vaccine or get infected, and then it'll be herd immunity over,
like it'll be very quick. So that's the intuition, but it seems like that's not happening.
It seems like work in this constant state of fear-mongering for different reasons.
It's almost like the virus got deeply integrated, not into just our biology, but
in the game of politics and in the fear-mongering around the news, because the virus now started
being together with the vaccine and the masks, and it started getting integrated into the division
that's so effective at monetizing social media, for example.
And so it's like, all right, so how do you get out of that?
Because you can always kind of present certain kinds of numbers about a number of cases or
how full hospitals are and start making claims about that we're still, this is as bad as it's
ever been, those kinds of statements. And so I'm not sure exactly what the way out is, except the
same way out as it was originally, which is testing, is information. It's information.
And I think we can do that. We can keep outbreaks suppressed with testing,
because it's information, like people keep thinking of tests as big medical things.
They're not. They're information. It can allow us to control things, just like we drive down a road
and we look at the cars and we don't hit other cars because we have the information that they're
in the lane next to us and they're moving over. That's just information.
Like you said, glow green. The problem, the virus, you don't see. You're walking around
and everybody is a potential infectious creature. And so if you see the world as a
potential for infection, you're going to be terrified of that.
That's exactly right. And that is what has happened. And that's why I've been pushing
so hard for these tests, because they can allow people, if you use them at a community level,
you can have enough people know that they're positive, enough people are good people that
they won't go out and infect others. And the other great thing about them is, again,
a 10-day isolation period, especially for a vaccinated person, but in either case,
this is also an information problem. We don't have to isolate for 10 days if we're infected.
What if we're only infectious for two, especially for vaccinated? Why are we telling people the
only reason the CDC ever and the WHO ever suggested a 10-day isolation or 14-day quarantine
is because we didn't know when people stopped being infectious. There's actually some people
stay infectious for 14 days. It's rare. But there's a lot of people who stay infectious for like
four. And that's a whole nother week that we're asking people to isolate. People would probably
be much more likely to comply if they only had to isolate as long as they wake up each morning
and see two lines. Because you're actually seeing it for your own two eyes. You're being empowered
to make your own decision. You're not being told you need to isolate for 10 days and you're sitting
there thinking, oh, I feel fine. I don't know why. There's a lot of asymptomatic spread. But if you
see the two lines every day, then you actually get to, you're doing a little experiment for yourself
to prove to yourself, today I'm still infectious. Let's hope it's tomorrow. Come on immune system.
You can do this. And then you get to day four and boom, you start being negative.
That's a much more tolerable thing because you are being able to make that decision based on
true data that is empowering you. And it really does change. It changes everything like because
it's all fear and empowerment and these are empowering devices.
Well, I wanted to have this conversation with you because obviously it's a great solution.
Let's keep talking about it. People who listen to this should, I guess, pressure local politicians,
federal, national politicians. Write articles with the title like Dear POTUS.
Please designate these as public health tools or just start talking about it in the media.
Talk about it on social media anywhere. Testing is a public health good.
Testing is a public health good. It should not be considered a medical device.
I shouldn't have to pay to keep you safe. Testing should generally be free for that matter.
Subsidized by the government. These tools exist. We should all, and I think the more people that
generate noise to just say a public health test is a public health tool. Period. You can't even
argue with it. Yeah, I think if you talk about it enough, then certain people that have even a
bigger platform like Elon Musk, Sundar Prachai, those folks that have power to really do large-scale
manufacture and also influence governments will pay attention. That's the hope. Enough people
talk about it. I think business leaders obviously have so much power here. They pay the lobbyists
who make things happen. Let's be honest. There's people who pull levers that are not the politicians
themselves. I do think business leaders have so much to gain from these tools to keep their
businesses safe, to not have to quarantine and lock down. I hope that all of them hear this
message to say, let's ask the president or the people around the president to designate these
as public health tools, change the system. If you can't change every aspect of the system,
then figure out how to change the system enough so that you're doing everything in a safe way
that is not endangering anyone, but it is only protective. Yeah.
You mentioned last time that you spent time as a Buddhist monk. We didn't spend much time
talking about it. I just would love to talk to you about it a little bit more. Maybe by way of
advice, how do you recommend people can integrate meditation into their lives? Or how does one
meditate? I think for me, meditation was really an active effort, which sounds weird because
most people think of meditation as the absence of activity. But just like anything, meditation is
it requires exercise. In this case, it requires exercise and quieting your mind.
And the whole, well, there's a lot of different reasons people meditate.
Most people watching this podcast or this show, what is this called? I don't know.
Is this an interview? I'm not even recording, this is just you and I talking.
It is, most people are meditating to bring some balance and bring some sanity to their life and
just be able to control their feelings and emotions a little bit more. And for that purpose,
I think the best way to, what meditation is, if you can call it what you will, it's just
getting some alone time, some time to think or not think. Whatever and it looks different for
each person. For me, it was a very active effort to try to quiet my mind with the explicit intent
to detach from things, from lots of things. And it's actually, it sounds weird in our culture
here to talk about detachment as a goal. Detachment from loved ones, detachment from objects is kind
of easy to reconcile. Like people understand that, yeah, I don't want to be too attached to my car
or whatever. But detachment from a loved one is like a very hard thing because we want to do the
opposite usually. We want to love a loved one. But in a lot of Buddhist thought, it is those
attachments that keep people in this cycle of rebirth. Now, I don't personally believe in
rebirth in the way that, in a Buddhist sense, in that you actually get born multiple times.
I think my personal feeling is we die and we're vanished. That's just me. But I still really
found meditation to be extraordinarily powerful to feel control over a whole different part of my
body that I never thought that it could be controlled, your mind. Like you close your eyes
and most of us immediately start seeing blotches and we start thinking about things. And it's
an amazing feeling to start getting to the point where you can actually actually quiet your mind
and close your mind down so that you can just have peace, like silence of your mind for a long
period of time. And I loved it. But it's kind of a dangerous slope because you can kind of get caught
up in it and really start going from, okay, I'm trying to quiet my mind to almost being
like addicted to quieting your mind. And it was a very active exercise every day, 15 hours a day
to just practice quieting my mind. And eventually I could. And in Buddhism, there's a whole lot
of stages that you go through to once you hit that point where you can quiet your mind, then
there's like other psychological things that happen. And eventually the end goal for a Buddhist monk
who's spending their life meditating in the forest is to achieve nirvana, is to have an absence of
any attachment to the point where you're not even attached to your own foot or your own leg,
you can cut it off. And so you don't even have an attachment to self, like to ego,
do you feel like a conscious being or no? Well, I never attained it. So the goal is
you have to first look at it through the eyes of samsara, which is the cycle of rebirth,
which is suffering. It's a cycle of suffering is how it's viewed. And the idea is like,
if I really love this hat, and then the hat gets lost, I'm sad. So that makes me suffer.
And if I hate this hat, and I see it, then it makes me sad or mad. And that, you know, it's an
emotion. But if I have, if I'm completely ambivalent about that hat, I'll get what's there, I don't
care if it gets lost, if it's shredded, then that invokes no emotional rise out of me, good or bad.
And so the idea is to find the balance there where you are so detached from everything that you're
not getting a rise negative or positive. And, you know, this is really, it's really such a distinct
thing in a relative to our normal lives here in America where we live for rises, you know,
you want happiness and joy. And then you also, you know, nobody wants sadness, but like, when
you come out of sadness, you feel happy. Either way, it averages out, right? And if it doesn't
average out, then you're, you know, you're in a bad spot. Like that would be things like major
depressive disorder where you're truly not averaging out. But if you're living a pretty
happy life, that's why there's no right or wrong. You can go up and down and you average out, or
you can just go that straight line. And this is not necessarily the Buddhist idea is somehow,
obviously, the ideal you should strive for. But the actual exercise of meditation that they,
the Buddhist monks use seems like a, seems like a great tool for becoming aware of your own mind.
And that seems to be important for appreciating life. There's some, some kind of experiencing life
on a deeper level. I, I think so. I mean, that's my, my personal opinion is yes. And that I think it,
I don't meditate anymore. Back in the capitalist western world where there's meetings and
that's right. I mean, I stopped after I was a monk and then the tsunami hit. And I lived in a refugee
camp and I was, that was the Indian Ocean tsunami in 2004. And it just really, it was really
interesting and surreal because they wanted me, I asked, well, what can I do to help? It was,
it was a horrible, horrible, you know, hell on earth experience in many ways. But when I said,
what can I do to help? The answer was, well, you could meditate. Like, that's how, you know,
be, keep, keep doing what you're doing. Like that's how you, that's how we can get good karma.
And to me, coming from like western roots, I just couldn't deal with that. I just said that,
doesn't make sense to me. Why would I just sit and meditate when there's so much devastation
happening here? And, and so I kind of stopped meditating then and then never really recovered
from that time in the refugee camp. But I do feel like I understand or like I am aware of,
of a part of me that most people never get the privilege to be aware of. And that is a pretty
profound and it's a, it's a profound feeling, I think, or just awareness to, to say, I do have
the capacity, if I ever need to go back to that, I have the capacity to do that. And I do use it.
I mean, I don't use it a lot, but I use it when I really need to, to try to like settle,
to settle myself to, to actually calm myself, whether it's pain, physical or emotional pain,
like it is possible to make those things go away. But it just like anything, it takes training.
Have you, if you take yourself back to that place you were, you know, Sam Harris talks about
that through his meditation practice, he's able to escape the sense of free will. And
the, the sense of agency, you can get away from that. Hey, do you ever think about consciousness
and free will when, when you were meditating? Like, did you get some deep insight about the nature
of consciousness that you were somehow able to escape it through meditation or no?
I looked at it in a much more utilitarian way, I think, and
in the sensation, like minimizing amount of thoughts in your mind, and then beginning to
really appreciate the sensation. Yeah. You weren't writing a book on the, on free will.
Right. And I mean, maybe if I kept at it, you know, there's a good chance that if the tsunami
didn't happen, I might still be sitting there on the top of that mountain.
Those anomalies, you see pain, you see, especially if you see cruelty, and you're supposed to
meditate through that, that doesn't, there's something in the human spirit that pushes us to
want to help. If you see somebody who's suffering to react to that seems like to help them as opposed
to care less through meditation, don't become attached to the suffering of others.
Exactly. I mean, that's, I do think that that's, you know, and they're two
totally valid ways to live life. Yeah. They are generally, I think, they're ingrained in us
pretty early in society. Right. And it's hard to escape. Yeah.
What about just in general, becoming detached from possessions, like minimalism,
and not having many things? So the capitalist world kind of pushes you towards having possessions
and deriving joy from more and more and better possessions. Have you returned back to the
joys of that world, or do you find yourself enjoying the minimalist life?
A little of both, I think. I really don't like, I find things to be a burden, to be a massive burden.
Yeah. And to me, when you have a burden like that, you know, even if it's just
knowing that there's like boxes in your basement of stuff, you know, whatever it might be,
it makes it hard to focus. And so I personally, like, I mean, my ideal, like if I had a,
my house, for example, would be to have like nothing on anything. And that to me is like
peaceful. Some people find that to be not peaceful. For me, it's like, I love the night to have the
night, the idea that if needed, I could like pack up and move and not worry about anything.
Do I actually have that in reality? No, we're about to have a baby. You know, there's, but it's
like, it's our, I already see it, it's like stressful. There's like boxes of stuff showing up at the
house, like bottles and clothes and all these little hats and whatnot. And I do, I do have to like,
sometimes go into my meditation to just, just say like, this is okay, you know, like, it's,
it's okay to have all of this stuff. It's not permanent, you know, and, but I do think that
it's easy to get lost in it all. And it's important to remember, given all that, like people who buy
houses, you know, buy a home and buy a house and make a home out of it. And you start a family,
it's easy to forget that even though you have all these responsibilities, you're still free.
And like freedom takes work and it takes remembering, it takes meditation on it, but
you're free. You're, you're born free, you live free. I mean, depends, of course, which country,
but in the United States, even with all the possessions, even with all the burdens of sort
of credit and owing money and all those kinds of things, you can scale everything down and you're
free. But ultimately, the people you love, you love each other, it doesn't take much money
to be happy together. And for me, I personally value that freedom of having the freedom to
always pursue your happiness as opposed to being burdened by material possessions that,
you know, yeah, that basically limit your ability to be happy. Because you're always paying off stuff,
you're always catching, you know, trying to match the neighbors that are always a little bit richer,
that kind of pursuit. I think that pursuit is wonderful for innovation and for building cooler,
better things. But on an individual level, I think you have to remember that, first of all,
life is finite. And second of all, like, your goal is not to get a bigger house,
your goal is to be just content and happy in the moment. I completely agree with that.
So in looking at our failure at scale to engineer, to manufacture, to deploy tests,
how do you feel about our prospect of human civilization? Are you optimistic? So this pandemic,
I think it is what it is. It hurt a lot of people, both it took lives, but it also hurt a lot of
businesses and a lot of people economically. But they're very likely to be a much worse pandemic
down the line. There might be other threats to human civilization. Are you nevertheless optimistic?
Oh, I don't think I'm optimistic about it all. What are you most worried about?
It's one of those things that's so existential that I don't worry about it.
But I do think, I mean, in the United States, for example, so you asked about the human civilization,
but let's talk about American society for a moment. I do think that we're probably seeing
like the end of a really interesting experiment, like the American experiment, and we're seeing
its limitations, we're probably going to become another blip, like another one, another power
that's in the history books that like rose and collapsed. Probably that's where we'll go.
In terms of civilization, I think we're demonstrating a pretty significant inability
to recognize the danger we're in, whether that's the pandemic or whether that's climate change.
I think it's extraordinary that we are not taking these things seriously,
and we're not acting with the urgency. And I mean, in some ways, climate change
truly makes like this pandemic look like child's play in terms of like the
destruction it has the potential to wreak. I tend to think if you just look at the progress of human
history, that the people who do good in the world outpower the people that do bad in the world.
So we kind of, there's something about our minds that likes to focus on the negative,
like on the destructive, because we're afraid of it. It's also, for some reason,
more fun to watch destruction. But it seems like the people who build,
who create solutions, who innovate, and who just put both on the emotional level,
so love out there, and on the actual engineering level, tools that make for higher quality of
life, I think those win out if you look at human history. But the question is whether the negative
stuff can sometimes peak to the level where everybody's just destroyed. But as long as
that doesn't happen, I tend to believe that there would be like a gradual, with some noise,
a gradual improvement of quality of life in human civilization.
I do think so to a certain extent, but it's that what you said, like,
unless there's like some significant peak of bad. And the problem with bad
is that it can happen like that. You know, good, you can't build a society overnight,
but you sure can kill one. Like, I just think about food crises and instability and just,
I don't know, but I do hope that, I mean, I completely agree. I think we can engineer
our way to a healthier, better world. Like, I truly do. My concern is that the people who are
doing that until very recently don't generally rule the world. Now, of course, we're seeing
non-elected leaders and, you know, people who run massive corporations essentially
having as much or really more power than elected leaders, or then kings and queens and such.
So how they choose to wield that power, you know, is an interesting choice. And I do hope
that you're right in that over time, fear will drive companies to produce a better product or
whatever, you know, something like over time, it's just like predator prey models. You get so
bad or so everything like it's so revved up that all of a sudden something cracks and they say,
okay, I do want an electric car or whatever. And that takes some combination of innovation,
and letting people know that these electric cars exist kind of rapid test to like,
you get to finally feel it and see it, have an electric car. And then all of a sudden things
change and everyone says, oh, this is so bad. And actually I'm doing good for the world relatively
speaking. And you know, I guess that's a paradigm shift. Yeah, it becomes a lack of a better word,
viral positivity does. And I mean, I believe that ultimately that that wins out.
Because I think there's much more power to be gained. So I think most people want to do good.
And if you want to wield power, you want to channel people's desire to do good. And I think
over time, that's exactly what people will do. But yeah, this, I mean, both on the natural side
of the pandemic, you know, there's still biology of play, there's still viruses out there. There's
accidents. There's nuclear weapons. There's unintended consequences of tools with this.
And then nanotechnology side or the artificial intelligence side, then there's the natural
things like meteors and all that that kind of stuff. And the climate change, all of that.
But I tend to think we humans are a clever bunch. And when there's a deadline, a real deadline,
or a real threat before us, we kind of step up. I don't know. But maybe you have to believe that
until the very end. That's right. I mean, we'll have to see, I guess, you know, neither. Well,
ideally, we won't be alive to see that. Well, no, I'm glad we talk again, because
this has been such a difficult time that feels like there's no solutions.
And it's so refreshing to hear that there's a solution to COVID. And there's an engineering
solution on the individual level, something people can do on the government level, something people
can do on the global level, something people can do, we should be doing rapid testing at scale.
It's obvious. It's amazing that you still are telling that story, pushing that message bravely,
boldly. I really, really appreciate the work you're doing. And I will do, in my small way,
the same to try to help out and everybody else should too, until we get hundreds of millions
of tests in people's hands. It's an obvious solution. We should have had a long time ago.
And I like solutions, not problems. And this is obviously a solution. So thank you for presenting
into the world and thank you for talking about it. It's something that I can't not do. If it
saves one person's life, then it was worth the two years of lobbying for this, you know. And so
let's hope we see a change. Thanks for talking to me. Absolutely. Thanks for listening to this
conversation with Michael Mina. To support this podcast, please check out our sponsors in the
description. And now, let me leave you with some words from Lord Byron. Always laugh when you can.
It is cheap medicine. Thank you for listening and hope to see you next time.